Was ist Qualit?t im Gesundheitswesen?

Definition of the problem With the introduction of diagnosis-related groups, German hospitals were obliged to develop quality assurance schemes. This article analyses (1) commonly used definitions for quality in health care and (2) their implementation in terms of interventions for improving quality in hospitals.Arguments Consequences of current quality assurance practices include advances in objective quality, but also a shift within the culture of medicine towards dividing the treatment of patients into measurable and standardized steps. In contrast to this objective meaning of quality, there is a demand for more patient orientation and for more attention to the subjective quality of treatment which refers to a therapeutic interaction-based notion of quality standards. Besides technical quality standards, there are important quality standards that are being defined in and through interpersonal therapeutic interaction.Conclusion Good hospital management should, therefore, protect the cultivation of therapeutic interaction in its essentially interpersonal qualities.     

Synthesis,characterization and in situ monitoring of the mechanochemical reaction process of two manganese(II)-phosphonates with N-containing ligands

Two divalent manganese aminophosphonates, manganese mono(nitrilotrimethylphosphonate) (MnNP₃) and manganese bis(N-(carboxymethyl)iminodi(methylphosphonate)) (Mn(NP₂AH)₂), have been prepared by mechanochemical synthesis and characterized by powder X-ray diffraction (PXRD). The structure of the novel compound Mn(NP₂AH)₂ was determined from PXRD data. MnNP₃ as well as Mn(NP₂AH)₂ exhibits a chain-like structure. In both cases, the manganese atom is coordinated by six oxygen atoms in a distorted octahedron. The local coordination around Mn was further characterized by extended X-ray absorption fine structure. The synthesis process was followed in situ by synchrotron X-ray diffraction revealing a three-step reaction mechanism. The as-prepared manganese(II) phosphonates were calcined on air. All samples were successfully tested for their suitability as catalyst material in the oxygen evolution reaction.     

Crystallization and microstructure of a glass seal for rapid laser sealing in the system CaO/Al<Subscript>2</Subscript>O<Subscript>3</Subscript>/SiO<Subscript>2</Subscript>

A glass with the composition 61 CaO·30 Al₂O₃·9 SiO₂ was studied with respect to its crystallization behavior and its suitability as a rapidly crystallizing material for laser sealing. The glass was studied by differential scanning calorimetry; from the profiles recorded, Avrami activation energies and Avrami coefficients were calculated. The latter are in the range between 0.99 and 1.55 which is supposedly attributed to sole surface crystallization. During thermal treatment as well as during laser sealing, Ca₁₂Al₁₄O₃₃, CaAl₂O₄ and Ca₃Al₂O₆ are formed. These phases were also observed in SEM micrographs as evidenced by electron backscatter diffraction from the attributed Kikuchi patterns. Transmission electron microscopy showed a crystallized CaO- and SiO₂-enriched interface which strongly adhered to the Al₂O₃ ceramic. The porosity of the crystallized seal was in the order of few percent. The studied glass proved suitable as crystallizing seal for rapid laser sealing.     

Driving comfort,enjoyment and acceptance of automated driving – effects of drivers’ age and driving style familiarity

Automated driving has the potential to improve the safety and efficiency of future traffic and to extend elderly peoples’ driving life, provided it is perceived as comfortable and joyful and is accepted by drivers. Driving comfort could be enhanced by familiar automated driving styles based on drivers’ manual driving styles. In a two-stage driving simulator study, effects of driving automation and driving style familiarity on driving comfort, enjoyment and system acceptance were examined. Twenty younger and 20 older drivers performed a manual and four automated drives of different driving style familiarity. Acceptance, comfort and enjoyment were assessed after driving with standardised questionnaires, discomfort during driving via handset control. Automation increased both age groups’ comfort, but decreased younger drivers’ enjoyment. Younger drivers showed higher comfort, enjoyment and acceptance with familiar automated driving styles, whereas older drivers preferred unfamiliar, automated driving styles tending to be faster than their age-affected manual driving styles.

Practitioner Summary: Automated driving needs to be comfortable and enjoyable to be accepted by drivers, which could be enhanced by driving style individualisation. This approach was evaluated in a two-stage driving simulator study for different age groups. Younger drivers preferred familiar driving styles, whereas older drivers preferred driving styles unaffected by age.     

Moving Fourier Analysis for Locally Stationary Processes with the Bootstrap in View

We introduce a moving Fourier transformation for locally stationary time series, which captures the time‐varying spectral density in a similar manner as the classical Fourier transform does for stationary time series. In particular, the resulting Fourier coefficients as well as moving local periodograms are shown to be (almost all) asymptotically uncorrelated. The moving local periodogram is obtained by thinning the local periodogram to avoid multiple information present at different but close points in time. We obtain consistent estimators for the local spectral density at each point in time by smoothing the moving local periodogram. Furthermore, the moving Fourier coefficients, respectively periodograms, are well suited to adapt stationary frequency domain bootstrap methods to the locally stationary case. For the wild time frequency toggle bootstrap, it is shown that the corresponding bootstrap covariance of a global locally stationary bootstrap samples captures the time‐varying covariance structure of the underlying locally stationary time series correctly. Furthermore, this bootstrap in addition to adaptations of other frequency domain bootstrap methods is used in a simulation study to obtain uniform confidence bands for the time‐varying autocorrelation at lag 1. Finally, this methodology is applied to a wind data set.     

Data processing and law enforcement access to information systems at EU level

EU Agencies and Information Systems collect and exchange personal data with Member States but also between each other. In this context, law enforcement agencies such as Europol increasingly get access to data originally serving other purposes. Europol already has access to the Visa-Information System; plans to allow the access to Eurodac also exist. The rules regulating this exchange are so far not harmonised. The article illustrates the existing exchange and access possibilities in light of the EU data protection reform.     

Nanostructural insights into the dissolution behavior of Sr-doped hydroxyapatite

In this study, high-resolution transmission electron microscopy (HRTEM) was employed to characterize the nanostructure of strontium-substituted hydroxyapatite (Sr-HA) and its evolution following in vitro immersion in physiological solutions. HRTEM images showed that the substitution of Sr induced local distortions in the hydroxyapatite (HA) lattice: minor levels of edge dislocations were detected at low doping contents of Sr ions (1 at%); when the Sr content exceeded 10 at%, the density of grain boundaries increased notably and triple junctions were clearly observed. The dissolution of undoped HA was initiated at crystallite surfaces, whereas the dissolution of Sr-HA started around grain boundaries. Acicular nanocrystal reprecipitation was observed on grain surfaces immersed in simulated body fluid (SBF), while not in dilute hydrochloric acid (HCl). These ?ndings suggest appropriate levels of Sr incorporation can introduce imperfections in the crystal structure of apatite and thus enhance its dissolution rate towards enhanced physicochemical performance in biomedical applications.     

Migration and the Multi-Dimensional Well-Being of Elderly Persons in Georgia

High rates of migration coupled with low formal social protection provisions may place many members of the elderly Georgian population in precarious living conditions that promote vulnerability and limit well-being achievement. This potential connection has been poorly explored in past literature, however, suggesting a need to better assess how the migration of an adult child may influence the multidimensional well-being of the elderly in Georgia. Using a novel dataset comprising 2202 elderly individuals across all regions of Georgia (excepting the territories of Abkhazia and South Ossetia), this paper proposes a multidimensional well-being index that has been specifically designed to encompass the unique resources and constraints faced by elderly individuals in different age cohorts. Following the construction of a multidimensional well-being index—comprised of domains including physical health and independence, housing well-being, social well-being, and emotional well-being—the outcomes of elderly individuals are compared by age and the presence/absence of adult children due to migration. Findings suggest that the migration status of an elderly person’s adult children is related to the attainment of well-being. Elderly individuals with a migrant child are more likely to attain well-being in physical health as well as in the overall multidimensional well-being index.