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1
Geyer, Martin H. « “Gaps” and the (Re-)Invention of the FutureSocial and Demographic Policy in Germany during the 1970s and 1980s ». Social Science History 39, no 1 (2015) : 39–61. http://dx.doi.org/10.1017/ssh.2015.41.
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To argue that the future was (re-)invented in the 1970s and the 1980s might seem especially puzzling in light of arguments that the optimism associated with utilitarian, modernization, and socialist theories withered at the time amidst widespread debate over a variety of “crises.” Nonetheless, it was in this peculiar constellation that ideas of the future became fundamentally renegotiated. “New risks” were juxtaposed with prevailing older ideas of social security that were predicated on individual and collective risk management. Focusing on West Germany, this article examines the various technical and political debates over “gaps” in terms of the finances, demographics, and trust in the system of social policy, which helped to put technical and political diagnoses of “new risks” squarely on the political agenda. This demographic argument is of particular interest, as it dramatized the unintended side effects of older social policy and created new, dystopian future scenarios of total systemic breakdown. At times, however, these discussions about managing the risks associated with Germany's demographic future verged on the utopian. New concepts of governmentality and biopolitics prevailed in this context. Moreover, pragmatic and sometimes technocratic concepts of new “governance” (and thus risk management) were proposed by social scientists and politicians as a means to address anxieties about the demographic future, and new models of risk-taking and risk-managing individuals also flourished at the time. With their descriptive but also prescriptive features, these theories contributed to ongoing academic efforts to explain the present and the future in terms of risk.
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Schlich, Thomas. « Farmer to industrialist : Lister's antisepsis and the making of modern surgery in Germany ». Notes and Records of the Royal Society 67, no 3 (29 mai 2013) : 245–60. http://dx.doi.org/10.1098/rsnr.2013.0032.
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This paper analyses what is possibly the most important long-term impact of Joseph Lister's method of antisepsis on surgery, namely its role in replacing surgery's traditional regime of the management of chance by what can be called a regime of modern risk management. It was a crucial step for the expansion of surgery and thus the formation of modern surgery, as we know it today. It put surgery on a par with contemporary trends in industry, transport technologies and science, and made it a component factor in the formation of a modern technology-oriented society. The paper uses the example of the German-speaking countries, which, because of the rapid and emphatic acceptance of Lister's antisepsis there, is particularly well suited for such an analysis. It shows how, in this context, risk management, as a way of dealing with uncertainty, was an integral part of the new techniques of antisepsis and asepsis.
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Pohle, Monika, et Iain L. Fraser. « Risk, information and noise : risk perception and risk management of French and German banks during the nineteenth century ». Financial History Review 2, no 1 (avril 1995) : 25–39. http://dx.doi.org/10.1017/s0968565000001244.
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Kleinschmidt, Christian. « Comparative Consumer Product Testing in Germany ». Business History Review 84, no 1 (2010) : 105–24. http://dx.doi.org/10.1017/s0007680500001264.
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The introduction of comparative product testing in Germany reflected the rise of a mass consumer society within a rapidly changing market economy. The first proposal to establish a federally supported institute for product testing was made in 1957. Proponents wished to reduce the asymmetries of power and information between producers and consumers. Producers' initial opposition was overcome once federal legislation was passed and they recognized that the institute's work gave them an opportunity to use the test results in their corporate marketing and advertising strategies. By integrating state-regulated consumer protection into the social-market economy, the Stiftung Warentest, Germany's independent product-testing foundation, became an expression of both the emerging modern consumer society and the German corporatist model.
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Berghoff, Hartmut. « Varieties of Financialization ? Evidence from German Industry in the 1990s ». Business History Review 90, no 1 (2016) : 81–108. http://dx.doi.org/10.1017/s0007680516000039.
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Following some general remarks on the impact of financialization on nonfinancial sectors of the economy, this article identifies common misconceptions about the German and American varieties of capitalism. It then outlines the post-1960 U.S. experience with financialization, including the reasons for the rise of financialization and its main consequences. The article will then look at Germany, a country with a very different entry point into the world of financialization, and ask when and to what degree the concept was adopted. Finally, a detailed case study of Siemens—one of Germany's largest industrial concerns—will explore how this icon of Germany Inc. adapted to the demands of financialization and coped with the external changes caused by globalization, deregulation, and digitalization.
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Eberl, W., R. Knöfler, M. Olivieri, K. Kurnik et C. Bidlingmaier. « Haemostatic testing prior to elective surgery in children ? Not always ! » Hämostaseologie 29, no 01 (2009) : 64–67. http://dx.doi.org/10.1055/s-0037-1616942.
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SummaryIn Germany, preoperative coagulation tests are commonly used, based on the belief that these tests should identify patients with an increased bleeding risk. However, published evidence does not longer support this approach for both traditional screening tests and novel techniques of global assessment of haemostasis. Unselected screening yields many false positive results and detects irrelevant disorders. It leads to postponement of surgery, anxiety in parents and patients, and is not cost effective. Even worse, it does not reliably detect relevant bleeding disorders such as the most common coagulopathy, von Willebrand disease. The bleeding history of patients and their relatives is a more effective tool to detect patients at risk. According to international guidelines and a joint statement of different German medical societies, a standardized questionnaire should be mandatory in preoperative screening. A diagnostic pathway should be employed to identify patients in whom specific tests are helpful. Because neither laboratory tests nor questionnaires can infallibly predict or exclude perioperative bleeding, guidelines for the management of these unexpected situations have to be established.
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Painter, James. « Disaster, uncertainty, opportunity or risk ? Key messages from the television coverage of the IPCC’s 2013/2014 reports ». Mètode Revista de difusió de la investigació, no 6 (15 avril 2016) : 81. http://dx.doi.org/10.7203/metode.6.4179.
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This article examines the television coverage of the three 2013 and 2014 reports by the Working Groups of the IPCC in five European countries: Germany, Norway, Poland, Spain and the United Kingdom. The presence, salience and dominance of four frames (disaster, uncertainty, explicit risk and opportunity) were examined in each of the bulletins monitored. The «disaster» frame was the strongest of all the frames, measured by all three metrics. «Opportunity» was the next most present, followed by «uncertainty». Although the IPCC put considerable emphasis on a risk management approach to tackling climate change in its communication of the WG2 report, the «explicit risk» frame was hardly present. The UK stood out for including some coverage of sceptical viewpoints.
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Schmidt, M. E., J. Chang-Claude, T. Slanger, N. Obi, D. Flesch-Janys et K. Steindorf. « Physical Activity and Postmenopausal Breast Cancer ». Methods of Information in Medicine 48, no 05 (2009) : 444–50. http://dx.doi.org/10.3414/me9239.
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Summary Objectives: Epidemiological evidence suggests an inverse association between physical activity (PA) and postmenopausal breast cancer risk. Breast cancer is a heterogeneous disease, influenced by reproductive factors, lifestyle pattern, and predispositions. We investigated whether these risk factors modify the effect of PA on breast cancer risk. Methods: We analyzed data from 2004 hormone-receptor-positive postmenopausal breast cancer cases and 6569 controls from the population-based MARIE study conducted 2002–2005 in Germany. Interaction was statistically tested using adjusted unconditional logistic regression models. Results: The inverse association between leisure-time PA and risk of postmenopausal hormone-receptor-positive breast cancer was not heterogeneous by family history of breast cancer or by hormone therapy. PA showed a significant interaction with benign breast diseases (p = 0.023) and with breastfeeding (p = 0.045) but not with parity (p = 0.94), with clear risk reductions only for women who ever had breastfed or who ever had a benign breast disease (among ever breastfed: odds ratio = 0.63; 95% confidence interval = (0.52, 0.77), highest vs. lowest PA quartile). Interaction with BMI was weak (p = 0.053). Conclusions: Breastfeeding and benign breast diseases modified the effect of PA on postmenopausal breast cancer risk. If other studies find similar modifications, increasing knowledge about these risk factors may contribute to a better understanding of the mode of action of PA on breast cancer risk. For women who are at higher risk for breast cancer due to family history or due to hormone therapy use, it is encouraging that they might lower their risk by being physically active.
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Burhop, Carsten. « Pharmaceutical Research in Wilhelmine Germany : The Case of E. Merck ». Business History Review 83, no 3 (2009) : 475–503. http://dx.doi.org/10.1017/s000768050000297x.
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This paper offers a detailed case study of the emergence, organization, and development of research and development at E. Merck. During the 1890s, revolutionary changes in the scientific knowledge base, especially the rise of bacteriological research and the entry of dyestuff producers into the pharmaceuticals market, combined with the financial distress Merck was undergoing to force the firm to reorganize pharmaceutical research as a corporate strategy. Consequently, between 1895 and 1898, Merck restructured its in-house research, forming closer ties with universities and other outside inven- tors. Merck depended on these sources to generate new products, while relying on in-house scientists to improve productive efficiency. A spate of new products was launched between the late 1890s and 1905, but, in the following years, resource constraints restricted Merck's innovative capacity.
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Vos, Cora, Angélica Jaconi, Anna Jacobs et Axel Don. « Hot regions of labile and stable soil organic carbon in Germany – Spatial variability and driving factors ». SOIL 4, no 2 (6 juin 2018) : 153–67. http://dx.doi.org/10.5194/soil-4-153-2018.
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Abstract. Atmospheric carbon dioxide levels can be mitigated by sequestering carbon in the soil. Sequestration can be facilitated by agricultural management, but its influence is not the same on all soil carbon pools, as labile pools with a high turnover may be accumulated much faster but are also more vulnerable to losses. The aims of this study were to (1) assess how soil organic carbon (SOC) is distributed among SOC fractions on a national scale in Germany, (2) identify factors influencing this distribution and (3) identify regions with high vulnerability to SOC losses. The SOC content and proportion of two different SOC fractions were estimated for more than 2500 mineral topsoils (< 87 g kg−1 SOC) covering Germany, using near-infrared reflectance spectroscopy. Drivers of the spatial variability in SOC fractions were determined using the machine learning algorithm cforest. The SOC content and proportions of fractions were predicted with good accuracy (SOC content: R2 = 0.87–0.90; SOC proportions: R2 = 0.83; ratio of performance to deviation (RPD): 2.4–3.2). The main explanatory variables for the distribution of SOC among the fractions were soil texture, bulk soil C ∕ N ratio, total SOC content and pH. For some regions, the drivers were linked to the land-use history of the sites. Arable topsoils in central and southern Germany were found to contain the highest proportions and contents of stable SOC fractions, and therefore have the lowest vulnerability to SOC losses. North-western Germany contains an area of sandy soils with unusually high SOC contents and high proportions of light SOC fractions, which are commonly regarded as representing a labile carbon pool. This is true for the former peat soils in this area, which have already lost and are at high risk of losing high proportions of their SOC stocks. Those “black sands” can, however, also contain high amounts of stable SOC due to former heathland vegetation and need to be treated and discussed separately from non-black sand agricultural soils. Overall, it was estimated that, in large areas all over Germany, over 30 % of SOC is stored in easily mineralisable forms. Thus, SOC-conserving management of arable soils in these regions is of great importance.
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Himmelreich, Jörg. « Nord Stream 2 : A Political Economic Crime Novel and Its EU Legal Consequences ». European Energy and Environmental Law Review 29, Issue 5 (1 octobre 2020) : 206–15. http://dx.doi.org/10.54648/eelr2020045.
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Hardly any other energy infrastructure project is as politically and legally controversial in the EU as Nord Stream 2, with the project company’s headquarters in Zug, to export gas from Russia through the Baltic Sea to Germany. This European infrastructure project is an excellent example of the intertwined economic, political and legal implications inherent in any such energy project in the EU single market. Just like an exemplary model case of a European law textbook, the following article aims to give an insight into the constantly developing new architecture of European energy law in the internal gas market, together with its European policy background, by means of concrete individual questions raised by this case. To this end, it proposes to take the concrete legal questions of this case and selectively illustrate the detailed and complex nesting of European law competences of the EU with the national competences of an EU Member State, here the Federal Republic of Germany, that regulates the EU internal gas market. This article focuses on the legal regime of exemptions from the legally required competitive conditions for the EU internal gas market, which is established by the relevant EU Gas Directive 2009/73EG in its Article 36 and Article 41a and its German implementation under Article 28a and 28b EnWG (Energiewirtschaftsgesetz, i.e. Energy Industry Act). This also includes a detailed presentation of the history of amendments to these standards. Finally, it should be made clear which legal, political and ultimately also economic risks await any investor in infrastructure projects with a construction period of several years on the EU internal market should they try to push through their large-scale project unchanged during the amendment of decisive relevant legal regulations by standard-setting EU authorities and against expanding political resistance in the EU and in EU Member States. These risks affect every investor who is involved in the EU internal market. Nord Stream 2, EU gas market, competition requirements, Russia, Gazprom, European energy security, Energy Charter Treaty, US sanctions, German Federal Network Agency, German Energy Industry Act (EnWG=Energiewirtschaftsgesetz)
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Bösmeier, Annette Sophie, Iso Himmelsbach et Stefan Seeger. « Reliability of flood marks and practical relevance for flood hazard assessment in southwestern Germany ». Natural Hazards and Earth System Sciences 22, no 9 (8 septembre 2022) : 2963–79. http://dx.doi.org/10.5194/nhess-22-2963-2022.
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Abstract. Flood marks are rarely utilized in hazard assessment, mainly because of a lack of data availability and accessibility and mistrust in their reliability. Challenging these common assumptions, we present an approach for evaluation and practical utilization of flood marks by the example of the Kinzig River, a Rhine tributary from the Black Forest with a history of severe floods. We combined written documents describing flood marks with field mapping at three study sites and collected information relating to 89 marks – about 50 % of them still preserved – which refer to ≥15 large floods between 1824 and 1991. The inclusion of a detailed historical-mark survey enabled an assessment of changes through time for each flood mark: they extend from small (±15 cm) imprecisions in mark heights to considerable uncertainties in position, height, and displayed date for some modified marks. Plausibility checks with further data nevertheless demonstrated good overall consistency. We then juxtaposed these marks with the current, modeled flood hazard maps. A wide agreement is apparent, in that the large majority of marks are situated at probable heights and within the modeled flooding area associated with extreme floods. For the few exceptions, we see plausible and historically sound reasons in changed local hydraulic conditions by flood protection walls, exceptional processes during a massive ice jam, and possibly also a local underestimation of hazard along Kinzig River tributaries. Overall, this study highlights (1) the broad availability of flood mark data, both on a larger spatial scale and with regard to already vanished marks, and (2) the significance of the marks, verified by further data, and also demonstrates (3) the possibility of a straightforward inclusion in hazard assessment. We thus encourage the systematic collection, maintenance, and integration of flood marks as responsible risk management, not least regarding their value in the wider context of risk awareness and memory.
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YACOB, SHAKILA. « Rising of the Phoenix : Mitigating Political Risk through Knowledge Management—Behn, Meyer & ; Co., 1840–1959 ». Enterprise & ; Society 19, no 4 (7 août 2018) : 946–78. http://dx.doi.org/10.1017/eso.2017.72.
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This article examines how a German firm in the Malay Peninsula—Behn, Meyer & Co.—capitalized on its knowledge management to overcome political risks during the period from 1840 until 1959. During the two world wars, all assets and properties of the Behn Meyer firm were systematically expropriated because of the introduction of the Alien Enemies (Winding Up) Act of 1914 and the subsequent imposition of a ten-year ban by the British colonial administration in the Malay Peninsula. However, Behn Meyer’s resilience and flexible outlook, as demonstrated by its management of political risks during these tumultuous periods, enabled it to rebuild its business interests and reestablish a foothold in postcolonial Malaysia and the region. This article argues that Behn Meyer displayed an exemplary business strategy, utilized its understanding of the geopolitics of the area, and leveraged its local and international networks to ensure its survival and longevity in the most tumultuous period in the history of the world.
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Kersting, Mathilde, Hermann Kalhoff, Michael Melter et Thomas Lücke. « Vegetarische Kostformen in der Kinderernährung ? » DMW - Deutsche Medizinische Wochenschrift 143, no 04 (février 2018) : 279–86. http://dx.doi.org/10.1055/s-0043-119864.
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AbstractIn Germany, the “Dietary Schedule for the 1st year of life” and the “Optimised Mixed Diet” for children and adolescents serve as scientifically based and generally applicable dietary concepts throughout the period of growth and development. Vegetarian diets as the lacto-ovo-vegetarian diet (exclusion of meat, fish) and the vegan diet (exclusion of all food groups of animal origin) need to be evaluated for their potential to safely meet the high and specific requirements for growth and development. In this regard, high-quality studies are needed. In individuals on lacto-ovo-vegetarian diets, the safe supply with critical nutrients should be checked by thorough dietary history, possibly additional laboratory tests in risk situations like pregnancy, infancy and toddlerhood. Children on pure vegan diet need ongoing elaborate dietary strategies and continuous supplementation at any age, similar to nutritional management in children with metabolic disorders. A vegan diet is disadvised during all periods with intense growth and development.
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Erler, T. « Pediatric resuscitation, emergencies in pediatrics. Various infusion methods for children ». Infusion & ; Chemotherapy, no 3.2 (15 décembre 2020) : 97–99. http://dx.doi.org/10.32902/2663-0338-2020-3.2-97-99.
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Background. Medical care for premature babies in Germany is divided into two levels. Perinatal centers of the first level provide care for infants with body weight at birth <1500 g. Perinatal centers of the second level provide care for children whose body weight exceeds 1500 g. In order to be included in the list of first level institutions, the hospital must, among other, be able to pick up children from other institutions in the surrounding region. Mobile incubators are used for this purpose. Such an incubator is a kind of a mobile intensive care unit. In some cases, the incubator is delivered to the desired location by helicopter, but in most cases, specialized road transport is used.
Objective. To describe neonatological medical care in Germany.
Materials and methods. Analysis of own experience and available literature data on this issue.
Results and discussion. In recent years, Germany experiences a decrease in the number of births, which causes the problem of professional training of doctors. Hospitals with the fewest births are closed due to lack of efficiency. Although there are some fluctuations from year to year, in general, the number of premature babies with extremely low birth weight remains approximately constant. Prematurity remains one of the most important problems of modern medicine, as it is accompanied by high mortality rates. The earlier the premature birth is and the lower the body weight is, the higher these rates are. Prematurity is caused by numerous risk factors. Multiple pregnancies are accompanied by the highest risk of premature birth. The presence of twins or triples increases this risk by 7.7 times. Other risk factors include vaginal bleeding in late pregnancy, preeclampsia, and a history of preterm birth. Over the past 20 years, the survival of children born before 32 weeks of pregnancy or weighing <1500 g has increased by almost 20 %. The smallest premature baby born in our clinic is a baby born at 24 weeks of gestation with a body weight of 350 g. Nowadays in Germany, the survival rate of infants born after 24 weeks of gestation is almost 80 %, and after 29 weeks – almost 100 %. It should be noted that maintaining the life of a premature baby from birth to discharge costs 250-300 thousand euros. Bronchopulmonary dysplasia is an important problem of premature infants, especially in case of mechanical lung ventilation (MLV) or joining infections. Up to 40 % of children who die from complications of bronchopulmonary dysplasia can be saved. If possible, MLV and infections should be avoided, premature births should be prevented, so-called neuroprotective ventilation and nasal or mask devices that do not require intubation should be used. Surfactants have made great progress in the management of premature infants. The modern LISA (less invasive surfactant administration) method allows to inject a surfactant into a child’s lungs without intubation. In the early 20th century, 100 % oxygen was used in the resuscitation of newborns, but now we use air (21 % oxygen) or a mixture containing up to 30 % oxygen. To prevent necrotizing enterocolitis, premature infants are prescribed probiotics based on lyophilized lactic acid bacteria and bifidobacteria. Breast milk is an another way to prevent this complication of prematurity. There is a breast milk bank in Potsdam.
Conclusions. 1. Prematurity remains one of the most important problems of modern medicine, as it is accompanied by high mortality rates. 2. Multiple pregnancies are accompanied by the highest risk of premature birth. 3. Nowadays in Germany, the survival rate of children born after 24 weeks of gestation is almost 80 %, and after 29 weeks – almost 100 %. 4. Surfactants and the LISA method have made great progress in the management of premature infants. 5. Probiotics and breast milk are prescribed to premature babies to prevent necrotizing enterocolitis.
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Kobe, C., M. Schmidt, H. Schicha et M. Dietlein. « The incidentaloma of the thyroid ». Nuklearmedizin 44, no 05 (2005) : 213–24. http://dx.doi.org/10.1055/s-0038-1625208.
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Summary:The incidentally detected thyroid nodule using sonography is described as incidentaloma; the most nodules have a diameter up to 1.5 cm. Sonography will detect thyroid nodules in more than 20% of the population in Germany. Epidemiological studies investigating the prevalence of malignancy in such incidentalomas are missing. The incidence of differentiated thyroid cancer is about 3 per 100,000 people and year. However, several monocentric studies have shown a prevalence of malignancy of up to 10% of the thyroid nodules in selected patients’ group. The histology did not found microcarcinomas only, but also small cancer with infiltration of the thyroid capsule, lymph node metastasis or multifocal spread. The studies were not designed for outcome measurement after early and incidental detection of small thyroid cancers. Hypoechogenity, ill defined borders, central hypervascularization or microcalcifications were used as combined criteria for risk stratification. The second method for risk stratification is scintigraphy and further tests are warranted for hypofunctioning nodule ≥1 cm. Additionally, the family history, patient’s age <20 years, former radiation of the neck, and measurement of calcitonin should be regarded. Without such a risk stratification selection for fine needle aspiration is impossible. Fine needle aspiration of non-palpable incidentalomas led to non-representative or unequivocal cytological findings in up to 40%. Because better outcome of incidentally detected small thyroid carcinomas is not proved and because sonography, scintigraphy and fine needle aspiration remain imprecise regarding dignity of incidentalomas, fine needle aspiration is not the standard for small, non-palpable thyroid nodules. Conclusion: For management of incidentaloma, sonographically unsuspicious, scintigraphically indifferent (nodules ≥1 cm) and without any risk factors in patients’ history, wait and see is justified when patient is informed about the problem.
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Kulikov, Volodymyr. « The Hundred Largest Employers in the Russian Empire, circa 1913 ». Business History Review 91, no 4 (2017) : 735–65. http://dx.doi.org/10.1017/s0007680517001362.
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The article analyzes a list of the hundred largest private and state-owned employers in the Russian Empire in 1913. It explains the validity of sources underlying the data and contributes to the methodological debates concerning the interpretation of such lists. It examines the geographical and sectoral distribution as well as the ownership structure of the largest Russian employers in a comparative context, using lists from Germany and the United Kingdom. The annexed list contributes to a more representative dataset of large firms beyond western Europe and therefore adds to the discussion on the rise of big business.
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Lubinski, Christina, Valeria Giacomin et Klara Schnitzer. « Internment as a business challenge : Political risk management and German multinationals in Colonial India (1914–1947) ». Business History 63, no 1 (13 avril 2018) : 72–97. http://dx.doi.org/10.1080/00076791.2018.1448383.
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Kühn, Charlotte Marie, Hans Strasser, Alexander Romming, Bernd Wullich et Peter J. Goebell. « Testosterone Replacement Therapy in Hypogonadal Men Following Prostate Cancer Treatment : A Questionnaire-Based Retrospective Study among Urologists in Bavaria, Germany ». Urologia Internationalis 95, no 2 (2015) : 153–59. http://dx.doi.org/10.1159/000371725.
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Background: Several reports suggest testosterone replacement therapy (TRT) may be an option in selected hypogonadal patients with a history of prostate cancer (PCa) and no evidence of disease after curative treatment. Our aim was to assess TRT experience and patient management among urologists in Bavaria. Materials and Methods: Questionnaires were developed and mailed to all registered urologists in Bavaria (n = 420) regarding their experience with TRT in patients with treated PCa. Results: One hundred and ninety-three (46%) urologists returned the questionnaire and reported their experience with TRT in hypogonadal patients after curative treatment for PCa. Complete data was available for 32 men. Twenty-six patients (81%) received TRT after prostatectomy, 1 patient after external beam radiation, 3 patients after high-dose brachytherapy and 2 patients after high-intensity focused ultrasound. Of the PCa cases, 88.5% (23/26) were organ confined (pT2a-c), and 3 were pT3 tumors. All patients were pN0/cN0, and only 1 patient (pT3a) had a positive surgical margin status postoperatively. After a mean follow-up of 39.8 months, no biochemical relapse was observed. Conclusion: To date, there is no clear evidence to withhold TRT from hypogonadal men after curative PCa treatment. Our findings, although with limitations, fit in with the available data showing that TRT does not put patients at an increased risk after curative treatment of PCa.
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Gattermann, Norbert, Andrea Kuendgen, Lenka Kellermann, Matti Zeffel, Hans-Juergen Berger et Ulrich Germing. « Results of a Multicenter Treatment Survey Yielding Insights Into Diagnosis and Management of MDS Patients In Daily Clinical Practice In Germany ». Blood 116, no 21 (19 novembre 2010) : 4959. http://dx.doi.org/10.1182/blood.v116.21.4959.4959.
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Abstract Abstract 4959 During the last few years (yrs) remarkable improvements have been made in the treatment of patients (pts) with myelodysplastic syndromes (MDS). However, there are only few analyses available on daily clinical practice, in particular on how pts are managed in the era of hypomethylating agents. For the first time, this analysis offers a comprehensive insight into diagnosis and management of MDS in Germany. Prior to patient documentation, 117 of 886 centers contacted provided information on patient load in a structural evaluation; the data collection period was scheduled accordingly. The data for this retrospective, non-interventional analysis were gathered during the 3rd and 4th quarter of 2009. 57 representative institutions documented 303 pts (41% from private-based offices [PBO], 59% from hospitals), 269 of which met the inclusion criteria (treatment decision, i.e. start, change or discontinuation, during data collection period; pts fully documented; positive plausibility check of data) of this analysis. Median age at the time of first diagnosis was 70 yrs. 78% had a Karnofsky Index (KI) ≥ 80%. The most common symptoms leading to diagnosis included cytopenia (e.g. anemia 79%), fatigue (38%), and deteriorating performance (36%). Distribution among MDS types according to the FAB classification at the time of first diagnosis was: 32% RA, 16% RARS, 20% RAEB, 4% RAEB-T, 7% CMML (21% “not documented”). According to WHO classification (2008), the distribution was: 17% RCUD, 12% RARS, 23% RCMD, 13% RAEB-I, 15% RAEB-II, 1% MDS-U, 5% MDS with del5q, 14% unknown/not classified as MDS. Cytogenetic analysis was performed in 67% of pts at initial diagnosis, but much less frequently (44%) in pts > 75 yrs (p<0.001; see table). The proportion of pts karyotyped was higher in university hospitals (83%) than non-university hospitals (63%) and PBOs (58%). Accordingly, more pts had their prognosis assessed by IPSS in university hospitals (75%) than non-university hospitals (61%) and PBOs (48%) (p=0.01). Red blood cell transfusions (RBCT) were given more often in non-university hospitals (30%) than university hospitals (10%) or PBOs (23%) prior to first diagnosis. The percentage of pts receiving RBCT was lower among older pts (> 70 yrs). However, length of transfusion history and frequency of RBCT were higher in older pts. The IPSS score was calculated in 61% of all pts at diagnosis. IPSS score calculation depended on several factors, e.g. RBCT dependence prior to diagnosis, age, and WHO MDS type. On bivariate analysis, IPSS scoring at first diagnosis was done significantly less frequently in pts > 75yrs (p=0.014; see table) and significantly more frequently in pts belonging to WHO types RCUD, MDS del(5q) and RAEB I-II (p<0.001). The IPSS score was more regularly used in university hospitals than other institutions (p=0.001). On multivariate analysis, the WHO type of MDS was confirmed to be the most relevant predictor of physicians using the IPSS (p<0.001). When trying to identify factors driving active treatment (defined as chemotherapy, stem cell transplantation (SCT), immunosuppressants, hypomethylating or other novel agents) in this survey, bivariate analysis showed a significant correlation with age ≤ 75 yrs (p=0.007) and the WHO types of RCUD, MDS del(5q), and RAEB I-II (p=0.0019); multivariate analysis revealed age as the most important factor (p=0.006; see table). MDS initial treatment was as follows: Supportive care only (34%), G-CSF/ESA only (16%), azacitidine (19%), any other active treatment (27%), and allogeneic SCT (5%). Azacitidine was the active treatment most frequently used (44 % overall) in MDS pts.Table:Impact of age on MDS diagnosis and treatmentPts ≤ 75yrsPts >75yrsSignificance% of pts with cytogenetic analysis performed at first diagnosis72.9%43.7%p<0.001% of pts with assessment of IPSS score65.4%51.0%p=0.014% of pts receiving active treatment39.7%22.2%p=0.006 Conclusion: While distribution among prognostic groups in this survey was consistent with previous findings from the Duesseldorf MDS Registry, it became clear that many patients, particularly the older ones, did not receive a comprehensive risk assessment including cytogenetics/IPSS. Proper risk assessment, however, is important for correct and consistent therapeutic decision-making, particularly with the availability of treatment options that offer a significant survival benefit to defined groups of patients. Disclosures: Gattermann: Novartis, Celgene: Honoraria, Research Funding. Kuendgen: Celgene: Honoraria. Zeffel: Celgene: Employment. Berger: Celgene: Employment. Germing: Celgene, Chugai, Novartis, Amgen: Honoraria; Celgene, Novartis, Amgen, GSK: Research Funding.
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Hielscher, Stefan, et Bryan W. Husted. « Proto-CSR Before the Industrial Revolution : Institutional Experimentation by Medieval Miners’ Guilds ». Journal of Business Ethics 166, no 2 (7 novembre 2019) : 253–69. http://dx.doi.org/10.1007/s10551-019-04322-5.
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Abstract In this paper, we argue that antecedents of modern corporate social responsibility (CSR) prior to the Industrial Revolution can be referred to as “proto-CSR” to describe a practice that influenced modern CSR, but which is different from its modern counterparts in form and structure. We develop our argument with the history of miners’ guilds in medieval Germany—religious fraternities and secular mutual aid societies. Based on historical data collected by historians and archeologists, we reconstruct a long-term process of pragmatic experimentation with institutions of mutual aid that address social problems in the early mining industry, and thus before the rise of the modern state and the capitalist firm. Co-shaped by economic and political actors, these institutions of mutual aid have influenced the social responsibility programs of early industrialists, modern social welfare legislation, and contemporary CSR. We conjecture that other elements of proto-CSR might have evolved according to similar trajectories.
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López, Santiago M., et Mar Cebrián. « The Development of Wind Farm Businesses and the Central Control of the Smart Grid in Spain : Making a Virtue of Necessity ». Energies 14, no 20 (13 octobre 2021) : 6582. http://dx.doi.org/10.3390/en14206582.
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This paper lays out the role of the first centre in the world for the integration into the electrical grid of electricity coming from renewable energy (the Spanish acronym for which is CECRE (Centro de Control de Energías Renovables; Control Centre for Renewable Energies)) and the industrial development of large energy suppliers and wind turbine manufacturers in Spain. These two initiatives enabled the development of one of the first integrated markets for this type of energy source. The key contributions were the development of two software programs (wind management and management of solar light incidence), their visual implementation, and centralized digital control. An economic and business history approach is used to show the rise and relative failure of the Spanish wind industry during the period 2004–2015, when Spain became the fourth country after China, the US, and Germany in terms of installed capacity of renewable energy and, in relative terms, the second country after Denmark. This study is unique in that it provides an integrated vision of the reasons for the relative fall of Spain in the world ranking of wind energy producers. The methodology of the economic analysis of industrial policies makes it possible to explain the fall in the relative importance of Spain in the international panorama of wind farms.
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Müller, Jonas, Stephan Nowak, Antje Vogelgesang, Bettina von Sarnowski, Eiko Rathmann, Sein Schmidt, Sebastian Rehberg et al. « Evaluating Mechanisms of Postoperative Delirium and Cognitive Dysfunction Following Elective Spine Surgery in Elderly Patients (CONFESS) : Protocol for a Prospective Observational Trial ». JMIR Research Protocols 9, no 2 (13 février 2020) : e15488. http://dx.doi.org/10.2196/15488.
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Background Elderly people are at particular high risk for postoperative delirium (POD) following spine surgery, which is associated with longer hospital stays, higher costs, risk for delayed complications, long-term care dependency, and cognitive dysfunction (POCD). It is insufficiently understood which mechanisms and risk factors contribute to the development of POD and POCD following these major but plannable surgeries. Objective This study aims to identify modifiable risk factors in spine surgery. A better understanding thereof would help adapt medical management and surgical strategies to individual risk profiles. Methods This is a single-center observational study jointly conducted by the departments of neurosurgery, neurology, and anesthesiology at a tertiary care hospital in Germany. All patients aged 60 years and older presenting to the neurosurgery outpatient clinic or ward for elective spine surgery are screened for eligibility. Exclusion criteria include presence of neurodegenerative or history of psychiatric disease and medication with significant central nervous system activity (eg, antidepressants, antipsychotics, sedatives). Surgical and anesthetic procedures including duration of surgery as primary end point of this study are thoroughly documented. All patients are furthermore evaluated for their preoperative cognitive abilities by a number of tests, including the Consortium to Establish a Registry for Alzheimer's Disease Plus test battery. Physical, mental, and social health and well-being are assessed using the Patient-Reported Outcome Measurement Information System Profile 29 and Hospital Anxiety and Depression Scale. Patients additionally receive preoperative cerebrovascular ultrasound and structural and functional brain imaging. The immediate postoperative period includes screening for POD using the Nursing Delirium Screening Scale and validation through Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, criteria. We furthermore investigate markers of (neuro)inflammation (eg, interleukins, C-reactive protein, tumor necrosis factor alpha). Preoperative examinations are repeated 3 months postoperatively to investigate the presence of POCD and its mechanisms. Statistical analyses will compare delirious and nondelirious patients for predictors of immediate (POD) and delayed (POCD) cognitive dysfunction. Results This is the first study to prospectively evaluate risk factors for POD and POCD in spine surgery. Recruitment is ongoing, and data collection is estimated to be finished with the inclusion of 200 patients by mid-2020. Conclusions The identification of mechanisms, possibly common, underlying POD and POCD would be a major step toward defining effective interventional strategies early in or even before the postoperative period, including the adaptation of surgical strategies to individual risk profiles. Trial Registration ClinicalTrials.gov NCT03486288; https://clinicaltrials.gov/ct2/show/NCT03486288
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Zeynalova, Samira, Katja Rillich, Eike Linnebank, Tina Stegmann, Michael Brosig, Matthias Reusche et Markus Loeffler. « Event dependent overall survival in the population-based LIFE-Adult-Study ». PLOS ONE 17, no 12 (1 décembre 2022) : e0278069. http://dx.doi.org/10.1371/journal.pone.0278069.
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Backround Information about the direct comparability of big data of epidemiological cohort studies and the general population still is lacking, especially regarding all-cause mortality rates. The aim of this study was to investigate the overall survival and the influence of several diagnoses in the medical history on survival time, adjusted to common risk factors in a populations-based cohort. Methods From 10,000 subjects of the population-based cohort LIFE-Adult-Study (Leipzig Research Centre for Civilization Diseases), the medical history and typical risk factors such as age, smoking status and body-mass-index (BMI) were assessed. The survival status was identified from the saxonian population register. Univariate and multivariate analyses were used to determine the influence of the medical history and risk factors on overall survival. To develope an optimal model, the method by Collet [1] was used. Results The mortality rate of the participants is approximately half the mortality rate expected for the german population. The selection bias in epidemiological studies needs to be considered whenever interpreting results of epidemiological cohort studies. Nevertheless we have shown that several diagnoses proved to have a negative influence on overall survival time even in this relatively healthy cohort. This study showed the significantly increased mortality risk if the following diseases are reported in medical history of the participants in a large population-based cohort study including adults aged 18 and over: diabetes mellitus (HR 1.533, p = 0.002), hypertension (HR 1.447, p = 0.005), liver cirrhosis (HR 4.251, p < 0.001), osteoporosis (HR 2.165, p = 0.011), chronic bronchitis (HR 2.179, p < 0.001), peptic ulcer disease (HR 1.531, p = 0.024) and cancer (HR 1.797, p < 0.001). Surprisingly, asthma has the opposite effect on survival time (HR 0.574, p = 0.024), but we believe this may be due to an overrepresentation of mild to moderate asthma and its management, which includes educating patients about a healthy lifestyle. Conclusion In the LIFE-Adult-Study, common risk factors and several diseases had relevant effect on overall survival. However, selection bias in epidemiological studies needs to be considered whenever interpreting results of epidemiological cohort studies. Nevertheless it was shown that the general cause-and-effect principles also apply in this relatively healthy cohort.
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Valenzuela Fernandez, Leslier Maureen, Carolina Nicolas, José M. Merigó et Francisco-Javier Arroyo-Cañada. « Industrial marketing research : a bibliometric analysis (1990-2015) ». Journal of Business & ; Industrial Marketing 34, no 3 (1 avril 2019) : 550–60. http://dx.doi.org/10.1108/jbim-07-2017-0167.
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PurposeThe purpose of this paper is to determine the most influential countries and universities that have contributed to science in the field of industrial marketing research during the period from 1990 to 2015.Design/methodology/approachBibliometric methodology is adopted, focusing on the most productive and influential countries and universities within this discipline, for the scientific community analyzing journals listed in the Web of Science (WoS) database from 1990 to 2015 and is supplemented by using VOS viewer to graph the existing bibliometric networks for each and every variable.FindingsEvidence that the USA and UK remain leaders in the investigation of industrial marketing research. Finland stands at the third place, leaving Australia and Germany behind. In reference to the universities, Michigan State University ranks as the leader.Research limitations/implicationsThe process of data classification originates from WoS. Moreover, to provide a comprehensive analytical scenario, other factors could have potentially been considered such as the editor’s commitment to leading journals, to partnerships and conferences, as well as other databases.Originality/valueThis paper takes into account alternative variables that have not been previously considered in previous studies, such as universities and countries in which the transcendental contributions to this field have taken place, providing a closer look, which gives rise to further discussions and studies with more detail to the history of this science in the future.
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Stroh, Christine, Daniel Luderer et Frank Meyer. « Transition of care in a case of obesity with metabolic surgery ». Zeitschrift für Gastroenterologie 59, no 03 (mars 2021) : 250–54. http://dx.doi.org/10.1055/a-1348-2378.
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The World Health Summit 2011 confirmed the epidemic-like occurrence of diabetes mellitus and obesity. In Germany, 62.7 % and 21.9 % of the population have a BMI of more than 25 kg/m² and more than 30 kg/m2, respectively. Currently, 10.5 obese people per 100 000 German inhabitants undergo bariatric surgery, while 86 and 114.8 per 100 000 in France and in Sweden, respectively, favor bariatric surgical interventions. Aim By means of a scientific case report, the instructive case of a young patient with morbid obesity is illustrated based on 1) selective references from the medical literature and 2) insights from the daily clinical practice in the case-specific medical and perioperative management after successful surgery for malformation in his childhood and, thus, the limited therapeutic options of metabolic surgery. Case report (case-, diagnostic-, and treatment-specific aspects) 35-year-old patient with morbid obesity. Medical history: Status after surgical intervention for gastroschisis as a newborn (surgery report not available). Clinical findings: Super obesity characterized by 234 kg and 174 cm (→ BMI: 77.3 kg/m²), hypogonadotrophic hypogonadism. Approach & course: Outcome (early postoperative and mid- to long-term): The patient tolerated the intervention well. Postoperative course was uneventful with regard to mobilization, beginning of oral nutrition, and wound healing; there was a subsequent weight reduction due to a “common channel” of 250 cm. Conclusion While the increase of obesity prevalence in adults has currently stopped, incidence in children and teenagers is rapidly rising. The consequence might be that children and young adults who have undergone bariatric surgery in childhood and adolescence can develop complications from these former interventions as adults. Therefore, it is reasonable to recommend follow-up investigations within specialized centers according to well-established standards. On the other hand, the increasing prevalence of obesity in childhood leads to the possibility that adults who underwent pediatric surgery because of embryonal malformations may require an appointment with a bariatric surgeon at some point. For these patients (as a representative example of the transition of care phenomenon), the risk of metabolic surgical intervention is increased; such operations require the appropriate knowledge and expertise of the bariatric surgeon on embryonal malformations and their approach by pediatric surgery.
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Kobrak, Christopher, et Jana Wüstenhagen. « The Politics of Globalization : Deutsche Bank, German Property and Political Risk in the United States After World War II ». Entreprises et histoire 49, no 4 (2007) : 53. http://dx.doi.org/10.3917/eh.049.0053.
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Matzdorff, Axel, et Florian Langer. « Factors Influencing the Choice between DOACs and LMWHs : A Survey of German Physicians on the Treatment of Cancer-Associated Venous Thromboembolism ». Hämostaseologie 40, no 05 (30 avril 2020) : 655–61. http://dx.doi.org/10.1055/a-1129-2573.
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AbstractRecently direct-acting oral anticoagulants (DOACs) have become a new therapeutic option besides parenteral anticoagulants to treat cancer-associated venous thromboembolism (VTE). With this survey we wanted to identify factors influencing the choice between low-molecular-weight heparin and DOACs among physicians treating cancer patients. A questionnaire was presented at several medical educational activities on cancer care and VTE management between August 2018 and January 2019. One hundred fifteen physicians returned their surveys. The two most compelling arguments pro DOAC were when the patient had no chemotherapy and when he expressed unwillingness to apply injections. The two most important arguments against DOACs were if the patient had problems with taking oral medications or when he had a history of severe bleeding. This survey shows that future studies need to consider many more factors, particularly patient preferences and physician concerns on bleeding risk, to improve their applicability in daily practice.
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op den Buijs, Jorn, Marten Pijl et Andreas Landgraf. « Predictive Modeling of 30-Day Emergency Hospital Transport of German Patients Using a Personal Emergency Response : Retrospective Study and Comparison with the United States ». JMIR Medical Informatics 9, no 3 (8 mars 2021) : e25121. http://dx.doi.org/10.2196/25121.
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Background Predictive analytics based on data from remote monitoring of elderly via a personal emergency response system (PERS) in the United States can identify subscribers at high risk for emergency hospital transport. These risk predictions can subsequently be used to proactively target interventions and prevent avoidable, costly health care use. It is, however, unknown if PERS-based risk prediction with targeted interventions could also be applied in the German health care setting. Objective The objectives were to develop and validate a predictive model of 30-day emergency hospital transport based on data from a German PERS provider and compare the model with our previously published predictive model developed on data from a US PERS provider. Methods Retrospective data of 5805 subscribers to a German PERS service were used to develop and validate an extreme gradient boosting predictive model of 30-day hospital transport, including predictors derived from subscriber demographics, self-reported medical conditions, and a 2-year history of case data. Models were trained on 80% (4644/5805) of the data, and performance was evaluated on an independent test set of 20% (1161/5805). Results were compared with our previously published prediction model developed on a data set of PERS users in the United States. Results German PERS subscribers were on average aged 83.6 years, with 64.0% (743/1161) females, with 65.4% (759/1161) reported 3 or more chronic conditions. A total of 1.4% (350/24,847) of subscribers had one or more emergency transports in 30 days in the test set, which was significantly lower compared with the US data set (2455/109,966, 2.2%). Performance of the predictive model of emergency hospital transport, as evaluated by area under the receiver operator characteristic curve (AUC), was 0.749 (95% CI 0.721-0.777), which was similar to the US prediction model (AUC=0.778 [95% CI 0.769-0.788]). The top 1% (12/1161) of predicted high-risk patients were 10.7 times more likely to experience an emergency hospital transport in 30 days than the overall German PERS population. This lift was comparable to a model lift of 11.9 obtained by the US predictive model. Conclusions Despite differences in emergency care use, PERS-based collected subscriber data can be used to predict use outcomes in different international settings. These predictive analytic tools can be used by health care organizations to extend population health management into the home by identifying and delivering timelier targeted interventions to high-risk patients. This could lead to overall improved patient experience, higher quality of care, and more efficient resource use.
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Thibeault, Charlotte, Barbara Mühlemann, Elisa T. Helbig, Mirja Mittermaier, Tilman Lingscheid, Pinkus Tober-Lau, Lil A. Meyer-Arndt et al. « Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic : a prospective observational study ». Infection 49, no 4 (22 avril 2021) : 703–14. http://dx.doi.org/10.1007/s15010-021-01594-w.
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Abstract Purpose Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10–1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00–16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26–46.75, vs 18 days, IQR 16–46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6–15.5) for non-IMV and 49.5 days (IQR 36.8–82.5) for IMV patients. Conclusions Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19.
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Titor, S. E. « Education management in Germany ». E-Management 5, no 1 (1 mai 2022) : 69–79. http://dx.doi.org/10.26425/2658-3445-2022-5-1-69-79.
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Russia is actively reforming the state control and supervisory functions in the various spheres of activity. In education, the reform has launched in 2020. The purpose of risk-oriented model of the organisation of control and supervisory activities is to reduce the number of inspections and administrative pressure on business, increasing the legally protected values protection level. Since the risk-oriented model is being introduced again for Russia, it is relevant, in this regard, to analyse the control (supervision) experience in education abroad. The main purpose of the study is to identify positive or negative experience in the management of the education sector in Germany that can be applied in legislative and applied practice in Russia. By comparative and analytical methods, the study reveals common and special features of education management in Germany compared to Russia. The scientific research novelty is the Germany’s education management experience study in comparison with Russia in the perspective of control and supervisory functions.
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Thanarajasingam, Gita, Matthew J. Maurer, Umar Farooq, Patrick B. Johnston, Carrie Thompson, Stephen Ansell, Luis Porrata et al. « Natural History of Central Nervous System Relapse in Diffuse Large B Cell Lymphoma in the Immunochemotherapy Era ». Blood 126, no 23 (3 décembre 2015) : 1456. http://dx.doi.org/10.1182/blood.v126.23.1456.1456.
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Abstract Introduction Relapse in the central nervous system is an uncommon complication of diffuse large B cell lymphoma (DLBCL) associated with a poor prognosis. The addition of rituximab to chemotherapy has improved outcomes in patients with DLBCL but its effect on the outcome of patients with CNS relapse is not well characterized. Here we present the natural history of patients with CNS relapse in a large cohort of patients with DLBCL who were treated in the immunochemotherapy (IC) era. Methods Newly diagnosed patients with DLBCL or primary mediastinal B-cell lymphoma (PMBCL) and treated with primary anthracycline based IC were prospectively enrolled on the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource (MER) within 9 months of diagnosis and followed for relapse, retreatment, and death. Clinical management at diagnosis and subsequent therapies were per treating physician. Patients with documented CNS involvement at diagnosis, primary CNS lymphoma, or post-transplant lymphoproliferative disorder at diagnosis were excluded. All CNS relapse and retreatment details were verified by medical record review. Results 1017 patients with newly diagnosed DLBCL or PMBCL, no documented CNS disease at diagnosis, and treated with IC were enrolled in the MER between 2002 and 2012. At a median follow-up of 59 months (range 1-148), 36 patients had CNS relapse. The cumulative incidence of CNS relapse was 3.1% (95% CI: 2.2%-4.4%) at 2 years and 3.7% (95% CI: 2.7%-5.0%) at 5 years after diagnosis. CNS involvement was identified after first line IC in 25 patients, and after salvage therapy in 11 patients. 22 patients had an isolated CNS relapse, while 14 had both systemic and CNS disease at relapse. The incidence of isolated CNS relapse at two years from diagnosis was 1.9% (95% CI: 1.2%-3.0%, figure 1). CNS involvement was parenchymal in 22 patients, leptomeningeal in 11, and parenchymal and leptomeningeal in 3 patients. At diagnosis, this subset of 36 patients had a median age of 61 years (range 20-86); 25 (69%) were male. IPI was 0-1 in 6 patients, 2 in 13 patients, 3 in 11 patients and 4-5 in 6 patients. Cell of origin per Hans algorithm was available in 17 patients, 8 were GCB and 9 were non-GCB. Extranodal sites of disease at diagnosis included testicular (2), renal (5), bone (10) and bone marrow (6). 7 patients had no sites of extranodal disease. LDH was elevated in 71%. The German High-Grade Non-Hodgkin Lymphoma Study Group CNS risk score was low risk in 6 patients, intermediate risk in 22 patients, and high risk in 8 patients. 6 patients received CNS prophylaxis with their initial immunochemotherapy, including 3 of the 21 patients who subsequently developed isolated CNS disease. First line therapy after CNS relapse included high dose methotrexate based chemotherapy in 22 patients and other systemic regimens in 6, with intrathecal (IT) chemotherapy in 5. Overall survival in patients after CNS relapse was poor with a median survival of 6.3 months (95% CI: 2.9-15.5) and 12-month survival rate of 29% (95% CI: 17%-49%). Patients who had CNS relapse following initial IC had better subsequent survival (median OS = 7.6 months) compared to patients with first presentation of CNS relapse following salvage therapy (OS = 2.1 months, p=0.005, see figure 2). 10 patients (28%) proceeded to SCT after CNS relapse, of which 6 remain alive at a median follow-up of 39 months. There were no differences in post-CNS relapse survival by age, sex, CNS risk score, cell of origin, extranodal site involvement at diagnosis, or site of CNS relapse (all p>0.10), though power was limited due to small numbers. Conclusions The incidence of CNS relapse in DLBCL is approximately 4% in the immunochemotherapy era. The vast majority of CNS relapses occur within 2 years of diagnosis. Isolated relapse in patients without CNS involvement at diagnosis is a relatively rare event with an incidence of approximately 2% at 2 years of diagnosis. Outcomes remain poor, and standard clinical variables do not predict survival after CNS relapse. Novel therapeutic approaches are needed in this population, with consideration to autologous SCT, which produces durable remission in a subset of patients. Disclosures Maurer: Kite Pharma: Research Funding. Farooq:Kite Pharma: Research Funding. Thompson:Kite Pharma: Research Funding. Ansell:Bristol-Myers Squibb: Research Funding; Celldex: Research Funding. Cerhan:Kite Pharma: Research Funding. Link:Genentech: Consultancy, Research Funding; Kite Pharma: Research Funding.
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Uth, Hans-Joachim. « Risk management in the Federal Republic of Germany ». Environmental Management 13, no 3 (mai 1989) : 317–23. http://dx.doi.org/10.1007/bf01874910.
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Gorgoń, Monika, Konrad Raczkowski et Felix Kraft. « Compliance Risk Management in Polish and German Companies ». Journal of Intercultural Management 11, no 4 (1 décembre 2019) : 115–45. http://dx.doi.org/10.2478/joim-2019-0026.
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Abstract Objective: This article focuses on the analysis of cultural similarities and differences important in terms of the compliance risk management in Polish and German enterprises, with the deliberate omission of Hofstede’s four cultural dimensions, in favour of the modified E. Schein’s model. This article explains the basic concept of risk management culture, the compliance risk and the essence of the compliance management system in Poland and Germany as well as the impact of cultural factors of each of the analysed countries on the development of compliance. The research objective of this paper is to present a comparative analysis of the examined countries, through the analysis of compliance management systems, as an indispensable element of risk management in an organisation, both in practical and formal terms. Methodology: This research is based on a critical review of the source literature and inference with assigned classical and fuzzy logic values as part of the culture description and risk management. Findings: The initial hypothesis is that the compliance risk management in companies in Poland and Germany has common and standardised features of the Community legal standards, which can be differently displayed from the declarative and actual point of view in Germany, due to an increase in internationalisation and intercultural relations. Value Added: This article presents the theoretical significance and functions of compliance risk management based on an analysis of applicable compliance systems and cultural systems in Poland and in Germany. Recommendations: The compliance risk management system is an essential risk management mechanism in organisations, both in formal and practical terms. It should take into account both the cultural diversity of the regions in Germany and the high cultural and ethnic homogeneity of enterprises in Poland – open, however, to cultural diversity.
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Hartwich, A., M. Gandorfer et V. Bitsch. « Risk management in fruit and vegetable production in Germany ». Acta Horticulturae, no 1103 (octobre 2015) : 151–58. http://dx.doi.org/10.17660/actahortic.2015.1103.23.
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Dhar, Ashim, Jobaida Naznin, Muhammad Abdul Halim Khan, Devjani Banik, Mohammad Fariduddin, Muhammad Abul Hasanat et Shahjada Selim. « Comparison of Thyroid Functional Status among Different Levels of Glycaemic Status ». Scholars Journal of Applied Medical Sciences 10, no 8 (19 août 2022) : 1289–93. http://dx.doi.org/10.36347/sjams.2022.v10i08.021.
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Background: Diabetes mellitus (DM) is a leading cause of death and disability worldwide. Its global prevalence was about 8% in 2011 and is predicted to rise to 10% by 2030. Nearly 80% of people with diabetes live in low- and middle-income countries. Asia and the eastern Pacific region are particularly affected. In Bangladesh, which had a population of 149.8 million in 2011, a recent meta-analysis showed that the prevalence of diabetes among adults had increased substantially, from 4% in 1995 to 2000 and 5% in 2001 to 2005 to 9% in 2006 to 2010. According to the International Diabetes Federation (IDF), the prevalence will be 13% by 2030. Methods: This cross-sectional study was carried out on newly detected type-2 DM patients [n=200, m/f: 81/119; age: 41.1±8.3; BMI (kg/m2): 26.0±4.2; mean±SD] recruited consecutively from the department of Endocrinology, BSMMU. History and relevant clinical examination were recorded. Free thyroxine (FT4), thyroid stimulating hormone (TSH), anti-TPO and anti-TG antibody were tested Chemiluminescence Immunoassay System (Germany). Results: Highest frequency for positive anti-thyroid antibody (87.5%) was observed in group having TSH ≥10 m IU/L followed by 66.7% in the group having TSH (5-10) m IU/L, while only 2.8% in the group having TSH <5 m IU/L (p<0.001). There was no significant difference either for level of FT4 (14.0±4.5 vs 14.1±2.2 vs 13.9±1.5; p= 0.925) or for TSH (3.4±5.0 vs 3.7±9.7 vs 2.3±1.6; p= 0.691) or for the antibody status (p= 0.721) among different levels of HbA1c. No significant correlations of FPG, 2Hr75gPPG and HbA1c was found with any of FT4, TSH, anti-TPO and anti-TG antibodies (p= NS for all). Logistic regression revealed anti-TPO antibody as independent predictor for thyroid dysfunction in subjects with diabetes mellitus (p<0.001). Conclusion: A comparative study of thyroid hormone levels in diabetic and non-diabetic patients revealed that patients with type-2 DM had significantly lower serum FT3 levels ..........
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Younggren, Jeffrey N., et Michael C. Gottlieb. « Termination and abandonment : History, risk, and risk management. » Professional Psychology : Research and Practice 39, no 5 (2008) : 498–504. http://dx.doi.org/10.1037/0735-7028.39.5.498.
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Ziemińska, Renata. « Intersex newborns and people with nonbinary gender identity : The beginning of legal recognition ». Studia Iuridica, no 90 (27 juin 2022) : 236–50. http://dx.doi.org/10.31338/2544-3135.si.2022-90.14.
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Intersex newborns cannot be qualified as male or female at the level of their biological traits. People with nonbinary gender identity are those who do not identify as a man or a woman (at the level of gender identity). In most countries both groups, intersex people and nonbinary people, are in legal limbo. The existence of congenital eunuchs/ hermaphrodites is confirmed in the Bible. Recently, a process has begun to introduce third sex/gender options in documents. I discuss the legal recognition in Germany, where since 2019 there have been used three sex/gender categories: male, female, and diverse (divers). Finally, I present a nonbinary and multilayered conceptualization of sex/gender that goes beyond the system of male/female categorization. It includes a third category in addition to male/female and allows us to describe the clash of layers.
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Dreyer, Marion, et Bernhard Gill. « RISK MANAGEMENT AND EXPERTISE : Germany : “Elite precaution” alongside continued public opposition ». Oléagineux, Corps gras, Lipides 7, no 4 (juillet 2000) : 366–69. http://dx.doi.org/10.1051/ocl.2000.0366.
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Lechner, Philipp, et Nadine Gatzert. « Determinants and value of enterprise risk management : empirical evidence from Germany ». European Journal of Finance 24, no 10 (10 juillet 2017) : 867–87. http://dx.doi.org/10.1080/1351847x.2017.1347100.
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Hiebl, Martin R. W., Christine Duller et Herbert Neubauer. « Enterprise risk management in family firms : evidence from Austria and Germany ». Journal of Risk Finance 20, no 1 (21 janvier 2019) : 39–58. http://dx.doi.org/10.1108/jrf-01-2018-0003.
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Purpose Family firms are the most prevalent type of firm worldwide. Nevertheless, the existent enterprise risk management (ERM) literature is silent on the adoption of ERM in family firms. Family firms exhibit specifics likely to influence the adoption of ERM. Most importantly, they often feature lower levels of agency conflicts, which should make them less prone to invest in mechanisms to control such problems. Consequently, it is expected that family firms are less prone to invest in ERM. This paper aims to explore this basic expectation. Design/methodology/approach This study is based on a survey of 430 firms from Austria and Germany. Findings It is observed that family firms show a lower adoption of ERM, especially in family firms where there is a family CEO. Research limitations/implications The results suggest that future empirical ERM research should more closely analyze or at least control for family influence. Originality/value This study is among the first to analyze ERM adoption in family firms.
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Lane, Bradley W., Natalie Messer–Betts, Devin Hartmann, Sanya Carley, Rachel M. Krause et John D. Graham. « Government Promotion of the Electric Car : Risk Management or Industrial Policy ? » European Journal of Risk Regulation 4, no 2 (juin 2013) : 227–45. http://dx.doi.org/10.1017/s1867299x00003366.
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There are two prominent motivations for why governments seek to promote the electric car: risk management and industrial policy. This article provides operational definitions of these two motivations and uses them to characterize the public policies of six political jurisdictions: California, China, the European Union, France, Germany, and the United States. The article finds that while the European Union is focused primarily on risk management, China, Germany and the United States are primarily engaged in industrial policy. California and France are intermediate cases with a substantial blend of industrial policy and risk management. Future research into the ramifications of industrial policy for liberalized international trade is recommended.
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Dionne, Georges. « Risk Management : History, Definition, and Critique ». Risk Management and Insurance Review 16, no 2 (septembre 2013) : 147–66. http://dx.doi.org/10.1111/rmir.12016.
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Gitt, AK, W. Smolka et K. Bestehorn. « PCV121 LIPID MANAGEMENT OF HIGH RISK PATIENTS IN THE OUTPATIENT SETTING IN GERMANY : RESULTS OF DYSIS-GERMANY ». Value in Health 11, no 6 (novembre 2008) : A419. http://dx.doi.org/10.1016/s1098-3015(10)66419-4.
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Voges, Wolfgang, et Götz Rohwer. « Receiving Social Assistance in Germany : Risk and Duration ». Journal of European Social Policy 2, no 3 (août 1992) : 175–91. http://dx.doi.org/10.1177/095892879200200302.
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Wendling, Cécile. « Incorporating Social Sciences in Public Risk Assessment and Risk Management Organisations ». European Journal of Risk Regulation 5, no 1 (mars 2014) : 7–13. http://dx.doi.org/10.1017/s1867299x00002907.
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The objective of the article is to analyse the use of Humanities and Social Sciences (HSS) in public risk assessment and risk management organisations in France, Germany, the UK, the Netherlands, Canada and the United States based on more than a hundred interviews conducted with social sciences experts employed by or working for these organisations. If the added value brought by the integration of social scientists is recognised, the use of social sciences differs from one organisation to another. The article compares the different positions given to social scientists inside and outside the organisation, the various methods used and the different contents produced. The survey highlights a set of initiatives that are scattered, differentiated and ultimately have little in common – except that they often play a marginal role in the main activities of the agencies concerned.
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Kumar, Ramesh, Frederic W. B. Deleyiannis, Corbett Wilkinson et Brent R. O'Neill. « Neurosurgical sequelae of domestic dog attacks in children ». Journal of Neurosurgery : Pediatrics 19, no 1 (janvier 2017) : 24–31. http://dx.doi.org/10.3171/2016.7.peds1646.
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OBJECTIVE The authors' goals in this study were to describe a series of dog attacks on children that required neurosurgical consultation and to better understand the pattern of injuries inflicted, the circumstances that place children at risk for attack, and the dog breeds involved. In addition, the authors review the surgical and medical management of these patients. METHODS The authors performed a retrospective review of all children requiring neurosurgical consultation for dog bite at a regional Level 1 pediatric trauma center over a 15-year period. RESULTS A total of 124 children with dog bites to the head, face, and neck were evaluated in the emergency department. Of these, 17 children (13.7%) incurred injuries requiring neurosurgical consultation. Fifty-three percent of victims were female. The mean age at the time of attack was 30 months. Twelve (71%) of the attacks were perpetrated by the family pet, and 13 (76%) occurred at the patient's home. Breeds involved in the attacks included German Shepherd, Pit Bull, American Bulldog, large mixed breed, Labrador Retriever, and Akita, with German Shepherds and Akitas being the most frequently involved. Neurosurgical injuries included nondepressed skull fracture in 5, depressed skull fracture in 10, intracranial hemorrhage in 5, cerebral contusions in 4, dural laceration in 4, pneumocephalus in 5, clinically evident CSF leak in 3, spinal fracture with complete spinal cord injury in 1, stroke in 2, vascular injury in 2, and cranial nerve injury (hypoglossal and facial nerve) in 1. Prophylactic antibiotics were administered in 16 patients (94%). Only 1 patient had a confirmed infection involving the site of injury. Neurosurgical intervention was required in 10 patients (59%) and ranged in severity from debridement and closure of a complex scalp wound to decompressive craniectomy. Neurological deficits, all of which were considered catastrophic, developed in 3 patients (18%). CONCLUSIONS Dog attacks on children requiring neurosurgical consultation commonly involve the family pet, which is usually a large-breed dog with no history of prior aggression. Neurosurgical injuries often involve the cranial vault, with depressed skull fractures being the most common injury pattern. Most patients do not suffer a neurological deficit, although catastrophic neurological injury may occur. Prophylactic antibiotics are commonly used and surgical intervention is required in the majority of cases.
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Steinisch, Irmgard. « Studies of American labor history in West Germany ». Labor History 29, no 4 (octobre 1988) : 531–41. http://dx.doi.org/10.1080/00236568800890341.
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Niens, Christine, Micha Strack et Rainer Marggraf. « Parental risk perception of mycotoxins and risk reduction behaviour ». British Food Journal 116, no 6 (27 mai 2014) : 1014–30. http://dx.doi.org/10.1108/bfj-10-2012-0260.
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Purpose – The purpose of this paper is to analyse the parental risk perception of mycotoxins (mould toxins) related to child health in Germany. It ascertains the parental risk reduction behaviour operationalised as parental additional willingness to pay (aWTP) for special child products. It investigates the interrelationships between parental risk perceptions and risk reduction behaviour. Design/methodology/approach – Altogether, 771 questionnaires were sent to 17 day-care centres in Lower Saxony, Germany. A total of 238 questionnaires were completed. The Perceived Food Risk Index was used to identify the main dimensions of parental risk perception of mycotoxins. Open and closed questions measured aWTP for risk reduction and parental risk estimates. Findings – The respondents believed that mycotoxins posed a moderate health risk for children in Germany. However, parental risk assessment was found to be subjected to an optimistic bias. Nevertheless, the parents were willing to pay a premium to protect their children's health against mycotoxins. Parental risk perception of mycotoxins could be described by two dimensions named “Dread” and “Control”. “Dread” and “Control” predicted aWTP for risk reduction as well as being involved in the genesis of optimistic bias. Research limitations/implications – Information regarding mycotoxins provided in the questionnaire probably influenced parental responses. This limits the generalisation of the findings. Originality/value – This research provides initial findings regarding parental risk perceptions of mycotoxins and its impact on risk reduction behaviour. The results are useful for the development of effective risk management and thus for the protection of child health.
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Wulff, Antje, Marcel Mast, Marcus Hassler, Sara Montag, Michael Marschollek et Thomas Jack. « Designing an openEHR-Based Pipeline for Extracting and Standardizing Unstructured Clinical Data Using Natural Language Processing ». Methods of Information in Medicine 59, S 02 (14 octobre 2020) : e64-e78. http://dx.doi.org/10.1055/s-0040-1716403.
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Abstract Background Merging disparate and heterogeneous datasets from clinical routine in a standardized and semantically enriched format to enable a multiple use of data also means incorporating unstructured data such as medical free texts. Although the extraction of structured data from texts, known as natural language processing (NLP), has been researched at least for the English language extensively, it is not enough to get a structured output in any format. NLP techniques need to be used together with clinical information standards such as openEHR to be able to reuse and exchange still unstructured data sensibly. Objectives The aim of the study is to automatically extract crucial information from medical free texts and to transform this unstructured clinical data into a standardized and structured representation by designing and implementing an exemplary pipeline for the processing of pediatric medical histories. Methods We constructed a pipeline that allows reusing medical free texts such as pediatric medical histories in a structured and standardized way by (1) selecting and modeling appropriate openEHR archetypes as standard clinical information models, (2) defining a German dictionary with crucial text markers serving as expert knowledge base for a NLP pipeline, and (3) creating mapping rules between the NLP output and the archetypes. The approach was evaluated in a first pilot study by using 50 manually annotated medical histories from the pediatric intensive care unit of the Hannover Medical School. Results We successfully reused 24 existing international archetypes to represent the most crucial elements of unstructured pediatric medical histories in a standardized form. The self-developed NLP pipeline was constructed by defining 3.055 text marker entries, 132 text events, 66 regular expressions, and a text corpus consisting of 776 entries for automatic correction of spelling mistakes. A total of 123 mapping rules were implemented to transform the extracted snippets to an openEHR-based representation to be able to store them together with other structured data in an existing openEHR-based data repository. In the first evaluation, the NLP pipeline yielded 97% precision and 94% recall. Conclusion The use of NLP and openEHR archetypes was demonstrated as a viable approach for extracting and representing important information from pediatric medical histories in a structured and semantically enriched format. We designed a promising approach with potential to be generalized, and implemented a prototype that is extensible and reusable for other use cases concerning German medical free texts. In a long term, this will harness unstructured clinical data for further research purposes such as the design of clinical decision support systems. Together with structured data already integrated in openEHR-based representations, we aim at developing an interoperable openEHR-based application that is capable of automatically assessing a patient's risk status based on the patient's medical history at time of admission.