Das Treatment Exit Options for Uveitis (TOFU) Register: Einbindung von Patienten in die Evidenzgenerierung

ZusammenfassungUveitis ist eine seltenere entzündliche Augenerkrankung, die zu schwerer Sehbehinderung und Blindheit führen kann und besonders Menschen im berufstätigen Alter betrifft. Besonders schwere Verläufe, die meist einer immunmodulierenden Therapie (IMT) bedürfen, treten bei einer Uveitis auf, die die hinteren Teile des Auges oder das ganze Auge betreffen und nicht infektiöser Ursache sind. Für diese Formen der Erkrankung gibt es nur wenig gute Evidenz zum langfristigen Management der Erkrankung und insbesondere zur Beendigung oder Reduktion einer IMT. Das Treatment exit Options For non-infectious Uveitis (TOFU) Register der Sektion Uveitis der Deutschen Ophthalmologischen Gesellschaft (DOG) hat das Ziel, Krankheitsverläufe von Patienten mit nicht-infektiöser nicht-anteriorer Uveitis zu dokumentieren und Empfehlungen zur Beendigung einer IMT zu erarbeiten. Ein wesentlicher Aspekt des TOFU-Registers ist die aktive Einbeziehung von Patienten in die Erfassung Patienten-berichteter Endpunkte über ein Patientenmodul (Patient Reported Outcomes, PROs). Neben seh- und gesundheitsbezogener Lebensqualität werden auch Fragebögen zur Therapieadhärenz, Produktivität und Auswirkungen der Therapien eingesetzt. Die eingesetzten Fragebögen wurden in dieser Kombination in einer Pilotstudie mit Patienten getestet und es hat sich gezeigt, dass die wesentlichen Patienten-relevanten Aspekte der Erkrankung und deren Auswirkungen auf den Alltag erfasst werden. Das Patientenmodul, wie das Register selbst, nutzt zur Dokumentation die electronic data capture (EDC)-Software REDCap (Version 9, Vanderbilt University, USA). Durch die Einbindung von Patienten in sowohl die Konzeption des Registers als auch die fortlaufende Datensammlung wird sichergestellt, dass Patienten-relevante Evidenz für z. B. die Erstellung von Leitlinien und Behandlungsempfehlungen generiert wird.

Resource Redeployment and Divestiture as Strategic Alternatives

What should the managers of a multibusiness firm do when their company’s resources are not used profitably? Research on redeployment proposes that managers should withdraw those resources from the business where they are underutilized and switch them to a business where they can be used more profitably, whereas the literature on divestiture advocates that managers should divest the business containing those resources. In this study, we investigate the factors that lead managers to choose resource redeployment over divestiture as a mode of exit and vice versa. Using a formal model, we establish that the two exit modes act as intertemporal substitutes, whereby redeployment dominates for earlier exits but divestiture dominates for later exits. Although both redeployment and divestiture are inversely related to their implementation costs, redeployment costs amplify the effect of divestiture costs on the likelihood of exit, and divestiture costs amplify the effect of redeployment costs on the likelihood of exit. Finally, we derive a series of results that show that disregarding one of these two exit options as a strategic alternative to the other may lead to misspecifications of empirical models that seek to predict the likelihood of redeployment, divestiture, or exit. Overall, our work contributes to the corporate strategy literature by uniting two streams of research that have largely remained disparate, yet whose insights have significant implications for each other.

Using Markov Models to Characterize and Predict Process Target Compliance

Processes are everywhere, covering disparate fields such as business, industry, telecommunications, and healthcare. They have previously been analyzed and modelled with the aim of improving understanding and efficiency as well as predicting future events and outcomes. In recent years, process mining has appeared with the aim of uncovering, observing, and improving processes, often based on data obtained from logs. This typically requires task identification, predicting future pathways, or identifying anomalies. We here concentrate on using Markov processes to assess compliance with completion targets or, inversely, we can determine appropriate targets for satisfactory performance. Previous work is extended to processes where there are a number of possible exit options, with potentially different target completion times. In particular, we look at distributions of the number of patients failing to meet targets, through time. The formulae are illustrated using data from a stroke patient unit, where there are multiple discharge destinations for patients, namely death, private nursing home, or the patient’s own home, where different discharge destinations may require disparate targets. Key performance indicators (KPIs) of this sort are commonplace in healthcare, business, and industrial processes. Markov models, or their extensions, have an important role to play in this work where the approach can be extended to include more expressive assumptions, with the aim of assessing compliance in complex scenarios.

Self-Organized Crowd Dynamics: Research on Earthquake Emergency Response Patterns of Drill-Trained Individuals Based on GIS and Multi-Agent Systems Methodology

Predicting evacuation patterns is useful in emergency management situations such as an earthquake. To find out how pre-trained individuals interact with one another to achieve their own goal to reach the exit as fast as possible firstly, we investigated urban people’s evacuation behavior under earthquake disaster coditions, established crowd response rules in emergencies, and described the drill strategy and exit familiarity quantitatively through a cellular automata model. By setting different exit familiarity ratios, simulation experiments under different strategies were conducted to predict people’s reactions before an emergency. The corresponding simulation results indicated that the evacuees’ training level could affect a multi-exit zone’s evacuation pattern and clearance time. Their exit choice preferences may disrupt the exit options’ balance, leading to congestion in some of the exits. Secondly, due to people’s rejection of long distances, congestion, and unfamiliar exits, some people would hesitant about the evacuation direction during the evacuation process. This hesitation would also significantly reduce the overall evacuation efficiency. Finally, taking a community in Zhuhai City, China, as an example, put forward the best urban evacuation drill strategy. The quantitative relation between exit familiar level and evacuation efficiency was obtained. The final results showed that the optimized evacuation plan could improve evacuation’s overall efficiency through the self-organization effect. These studies may have some impact on predicting crowd behavior during evacuation and designing the evacuation plan.

How Do Divided Societies Come About? Persistent Inequalities, Pervasive Asymmetrical Dependencies, and Sociocultural Polarization as Divisive Forces in Contemporary Society

The article looks at divisive forces in contemporary societies and links them to the unfulfilled hopes of the revolutions at the beginning of modernity: the hopes for equality, freedom, and fraternity/solidarity. There are, first, in the twenty-first century situation, persistent inequalities that emerge in all the function systems of society and that become divisive as soon as a discontinuous split arises in the distribution of rewards, a split that makes it improbable that someone might switch from one to the other side of a distribution. There are, second, strong asymmetrical dependencies that are connected to an escalation of controls by which persons and groups control resources wanted by others and furthermore build up controls regarding the actions, communications, exit options, and ways of perceiving the world available to these other ones. The more control dimensions are implied in a specific social relation, the stronger and more pervasive asymmetrical dependencies become and then definitely separate in society those who exercise controls from those who are objects of control. There is, third, as a structure of division, the rise of sociocultural polarization that creates a split between significant subcommunities of a society, on the basis of which communities perceive the members of other communities as strangers and as dangerous for the values and ways of life one regards as essential for one’s own community. The article finally explains these societal divisions by studying them as forms of inclusion and exclusion. Inequalities come from cumulations in the inclusion dynamics of function systems; asymmetrical dependencies emerge in institutions and groups that absorb persons that are being excluded from relevant participations; polarizations are based on reciprocal and totalizing exclusions by which communities define the members of other communities as radical “others.”

Jemaah Islamiyah and the Ambiguities of Disengagement from Violence

This chapter traces Jemaah Islamiyah’s complicated relationship with violence in Indonesia to explain why the group has temporarily disengaged from violence without permanently renouncing armed struggle. The organization first engaged in violence in the context of communal clashes. Members subsequently organized large-scale terrorist attacks, but these were largely the acts of factions, whose relationship to the group’s leadership remains contested. More recently, the organization has prioritized social activities over armed struggle. Yet despite internal debates and defections around the use of violence, the leadership has not officially abandoned armed struggle. The chapter reveals that despite political openings and widespread opposition to terrorism, public attitudes toward the group are more ambivalent than they were toward the Egyptian al-Gama’a. Combined with the availability of exit options, this social milieu enables the group to continue its activity without feeling the pressure to undergo a more drastic transformation.