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Das Chronic Care Model (CCM) stellt eine Zusammenfassung evidenzbasierter Erkenntnisse dar, um die Versorgung chronisch Erkrankter zu optimieren. Diverse Messinstrumente sind in den letzten Jahren zur Erfassung des Implementierungserfolges des CCM aus Sicht der Leistungserbringer und der Patienten entwickelt worden. Einen Ansatz zur Erfassung, inwiefern die im CCM beinhalteten Dimensionen angewendet werden, stellt das Patient Assessment of Chronic Illness Care (PACIC- 5A) dar. Dieses Instrument wurde im englischsprachigen Raum entwickelt und primär im amerikanischen Gesundheitssystem eingesetzt. Es besteht in der ursprünglichen Fassung aus 20 Items und erfragt in fünf Subskalen CCM-konkordante Aspekte: Patientenaktivierung, Leistungserbringerstruktur / Entscheidungshilfen, Zielsetzung, Problemlösung / Beratung, Follow-up / Koordination. Die erweiterte Version aus 26 Items erlaubt zusätzlich zur Beurteilung der Erfüllung des CCM die Analyse der Umsetzung im Sinne des 5A-Modells, eines behaviouristischen Ansatzes zur Verhaltensänderung. Ziel dieser Arbeit war es, den Fragebogen in die deutsche Sprache ohne Verlust des semantischen Inhaltes zu übersetzen und an einer primärmedizinischen Population im deutschen Gesundheitssystem zu evaluieren. Eine weitere Zielsetzung war, den Implementierungsgrad des CCM-Konstruktes im spezifischen Fall der Major Depression zu erkunden. Hierzu wurde das übersetzte PACIC-5A im Rahmen der im Institut für Allgemeinmedizin der Universitätsklinik Frankfurt durchgeführten ProMPT-Studie zur Betreuung von Patienten mit Major Depression an insgesamt 509 Patienten erprobt. Hiervon wurden 436 Patienten in die Studie eingeschlossen. Hierauf erfolgte die Überprüfung der psychometrischen Eigenschaften. Die statistischen Messergebnisse, hinsichtlich innerer Konsistenz (Cronbach´s α) und Trennschärfe (korrigierte Item-Skala-Korrelation), ergaben gute und mit der aktuellen Literatur übereinstimmende Resultate. Die konvergente Validität des PACIC-5A wurde anhand des primärmedizinisch validen Fragebogens EUROPEP (European Project on Patient Evaluation of General Practice Care) geprüft. Das Ergebnis zeigte hohe Korrelationen vor allem in den inhaltlich vergleichbaren Skalen, wie z.B. Skala „Patientenaktivierung“ aus dem PACIC-5A und Skala „Information und Unterstützung“ des EUROPEP. Die diskriminierenden Fähigkeiten des Fragebogens wurden durch die geringen korrelativen Eigenschaften mit Skalen des EUROPEP, welche andere Dimensionen erörtern, nachgewiesen. Zusätzlich ermöglichte der Vergleich der Mittelwerte der einzelnen Skalen des PACIC-5A zwischen dem Kontroll- und Interventionsarm eine zusätzliche Beurteilung der diskriminierenden Potenz. Das PACIC-5A ist bis jetzt vorrangig an Patienten mit chronischen Erkrankungen aus dem organischen Formenkreis (z.B. Osteoarthritis, Diabetes Mellitus) angewendet und validiert worden. Die kongruente Anwendung des PACIC-5A auf Erkrankte mit Major Depression ist ein limitierender Aspekt. Hier besteht weiterer Forschungsbedarf. Für eine optimale Patientenversorgung in der Primärmedizin ist es essentiell, primärmedizinisch valide Instrumente den Hausärzten zur Verfügung zu stellen.
The mTOR kinase inhibitor rapamycin (sirolimus) is a drug with potent immunosuppressive and antiproliferative properties. We found that rapamycin induces the TGF/Smad signaling cascade in rat mesangial cells (MC) as depicted by the nuclear translocation of phospho-Smads 2, -3 and Smad-4, respectively. Concomitantly rapamycin increases the nuclear DNA binding of receptor (R)- and co-Smad proteins to a cognate Smad-binding element (SBE) which in turn causes an increase in profibrotic gene expression as exemplified by the connective tissue growth factor (CTGF) and plasminogen activator inhibitor 1 (PAI-1). Using small interfering (si)RNA we demonstrate that Smad 2/3 activation by rapamycin depends on its endogenous receptor FK-binding protein 12 (FKBP12). Mechanistically, Smad induction by rapamycin is initiated by an increase in active TGF1 as shown by ELISA and by the inhibitory effects of a neutralizing TGF antibody. Using an activin receptor-like kinase (ALK)-5 inhibitor and by siRNA against the TGF type II receptor TGF-RII) we furthermore demonstrate a functional involvement of both types of TGF receptors. However, rapamycin did not compete with TGFfor TGF-receptor binding as found in radioligand-binding assay. Besides SB203580, a specific inhibitor of the p38 MAPK, the reactive oxygen species (ROS) scavenger N-acetyl-cysteine (NAC) and a cell-permeable superoxide dismutase (SOD) mimetic strongly abrogated the stimulatory effects of rapamycin on Smad 2 and 3 phosphorylation. Furthermore, the rapid increase in Dichlorofluorescein (DCF) formation implies that rapamycin mainly acts through ROS. In conclusion, activation of the profibrotic TGFSmad signaling cascade accompanies the immunosuppressive and antiproliferative actions of rapamycin. Keywords: FK506 binding protein; p38 MAP kinase; rapamycin; renal fibrosis; Smads; TGFβ
Das vorliegende Arbeitspapier analysiert die sich in Westmittelfranken konzentrierende Kunststoff verarbeitende Industrie. Im Mittelpunkt der Analyse stehen die Wertschöpfungsprozesse der Unternehmen und damit verbunden unterschiedliche Interaktionsformen und Vertragsbeziehungen innerhalb der Branche. Die Arbeit diskutiert, ob es sich bei der regionalen Konzentration der Branche um ein sogenanntes Cluster handelt, aus dem Unternehmen Synergien bei der Wertschöpfung und unternehmerische Wettbewerbsvorteile gewinnen können. Die Analyse ist Teil eines Forschungsprojektes zum Thema „Innovationsfinanzierung im Mittelstand“ am Institut für Humangeographie (Abteilung Wirtschaftsgeographie) der Johann Wolfgang Goethe-Universität Frankfurt.
Römische Bildnisse : Bibliographie, ungekürzt, mit den zu ergänzenden Literaturverweisen des Autors
(2010)
Originalfassung der in der Verlagspublikation um zahlreiche Literaturverweise gekürzten Bibliographie des Werkes: Götz Lahusen: Römische Bildnisse : Auftraggeber, Funktionen, Standorte. - Mainz : von Zabern, 2010. - Lizenz der WBG (Wiss. Buchges.) Darmstadt. - ISBN: 978-3-8053-3738-0. Pp. : EUR 49.90
Ernst Bloch pointed out in a particularly emphatic way that the concept of human dignity featured centrally in historical struggles against different forms of unjustified rule, i.e. domination – to which one must add that it continues to do so to the present day. The “upright gait,” putting an end to humiliation and insult: this is the most powerful demand, in both political and rhetorical terms, that a “human rights-based” claim expresses. It marks the emergence of a radical, context-transcending reference point immanent to social conflicts which raises fundamental questions concerning the customary opposition between immanent and transcendent criticism. For within the idiom of demanding respect for human dignity, a right is invoked “here and now,” in a particular, context-specific form, which at its core is owed to every human being as a person. Thus Bloch is in one respect correct when he asserts that human rights are not a natural “birthright” but must be achieved through struggle; but in another respect this struggle can develop its social power only if it has a firm and in a certain sense “absolute” normative anchor. Properly understood, it becomes apparent that these social conflicts always affect “two worlds”: the social reality, on the one hand, which is criticized in part or radically in the light of an ideal normative dimension, on the other. For those who engage in this criticism there is no doubt that the normative dimension is no less real than the reality to which they refuse to resign themselves. Those who critically transcend reality always also live elsewhere.
The overvaluation hypothesis (Miller 1977) predicts that a) stocks are overvalued in the presence of short selling restrictions and that b) the overvaluation increases in the degree of divergence of opinion. We design an experiment that allows us to test these predictions in the laboratory. The results indicate that prices are higher with short selling constraints, but the overvaluation does not increase in the degree of divergence of opinion. We further find that trading volume is lower and bid-ask spreads are higher when short sale restrictions are imposed. JEL Classification: C92, G14 Keywords: Overvaluation Hypothesis , Short Selling Constraints , Divergence of Opinion
Regulations in the pre-Sarbanes–Oxley era allowed corporate insiders considerable flexibility in strategically timing their trades and SEC filings, for example, by executing several trades and reporting them jointly after the last trade. We document that even these lax reporting requirements were frequently violated and that the strategic timing of trades and reports was common. Event study abnormal re-turns are larger after reports of strategic insider trades than after reports of otherwise similar nonstrategic trades. Our results also imply that delayed reporting is detrimental to market efficiency and lend strong support to the more stringent trade reporting requirements established by the Sarbanes–Oxley Act. JEL Classification: G14, G30, G32 Keywords: Insider Trading , Directors' Dealings , Corporate Governance , Market Efficiency
This paper studies the market quality of an internalization system which is designed as part of an open limit order book (the Xetra system operated by Deutsche Börse AG). The internalization sys-tem (Xetra BEST) guarantees a price improvement over the inside spread in the Xetra order book. We develop a structural model of this unique dual market environment and show that, while adverse selection costs of internalized trades are significantly lower than those of regular order book trades, the realized spreads (the revenue earned by the suppliers of liquidity) is significantly larger. The cost savings of the internalizer are larger than the mandatory price improvement. This suggests that internalization can be profitable both for the customer and the internalizer. JEL Classification: G10
This paper reconsiders the effect of investor sentiment on stock prices. Using survey-based sentiment indicators from Germany and the US we confirm previous findings of predictability at intermediate time horizons. The main contribution of our paper is that we also analyze the immediate price reaction to the publication of sentiment indicators. We find that the sign of the immediate price reaction is the same as that of the predictability at intermediate time horizons. This is consistent with sentiment being related to mispricing but is inconsistent with the alternative explanation that sentiment indicators provide information about future expected returns. JEL Classification: G12, G14 Keywords: Investor Sentiment , Event Study , Return Predictability
This paper examines to what extent the build-up of "global imbalances" since the mid-1990s can be explained in a purely real open-economy DSGE model in which agents’ perceptions of long-run growth are based on filtering observed changes in productivity. We show that long-run growth estimates based on filtering U.S. productivity data comove strongly with long-horizon survey expectations. By simulating the model in which agents filter data on U.S. productivity growth, we closely match the U.S. current account evolution. Moreover, with household preferences that control the wealth effect on labor supply, we can generate output movements in line with the data. JEL Classification: E13, E32, D83, O40