Steinau an der Strasse, Germany

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Muhlbacher A.C.,University of Applied Sciences Neubrandenburg | Sadler A.,University of Applied Sciences Neubrandenburg
Value in Health | Year: 2017

Background The German Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) adapted the efficiency frontier (EF) approach to conform to statutory provisions on cost-effectiveness analysis of health technologies. EF serves as a framework for evaluating cost-effectiveness and indirectly for pricing and reimbursement decisions. Objectives To calculate an EF on the basis of single multidimensional benefit by taking patient preferences and uncertainty into account; to evaluate whether EF is useful to inform decision makers about cost-effectiveness of new therapies; and to find whether a treatment is efficient at given prices demonstrated through a case study on chronic hepatitis C. Methods A single multidimensional benefit was calculated by linear additive aggregation of multiple patient-relevant end points. End points were identified and weighted by patients in a previous discrete-choice experiment (DCE). Aggregation of overall benefit was ascertained using preferences and clinical data. Monte-Carlo simulation was applied. Uncertainty was addressed by price acceptability curve (PAC) and net monetary benefit (NMB). Results The case study illustrates that progress in benefit and efficiency of hepatitis C virus treatments could be depicted very well with the EF. On the basis of cost, effect, and preference data, the latest generations of interferon-free treatments are shown to yield a positive NMB and be efficient at current prices. Conclusions EF was implemented taking uncertainty into account. For the first time, a DCE was used with the EF. The study shows how DCEs in combination with EF, PAC, and NMB can contribute important information in the course of reimbursement and pricing decisions. © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR)


Kohler M.,University of Applied Sciences Neubrandenburg | Poll P.H.,Atmosfair gGmbH
Ecological Engineering | Year: 2010

In Germany, the construction of extensive greenroofs has been a tradition for over 100 years. This study picked up older Berlin research conducted in 1960, 1982, 1986, 1987, 1990, 1995 and compared it with current findings (Poll, 2008). The older research was made either on the old "Tar-Paper-Greenroofs" (TPG-roofs), established between 1880 and 1930, or on the first systematically vegetated Modern Extensive Greenroofs (MEG-roofs), established in the 1980s. This survey compares both roof types and supplements the chronology of analysis. The research showed that MEG and especially TPG are resilient roof types and can last up to 100 years. About 70 vascular plant species were found on the surveyed roofs (> 10 % resp. consistency). Regarding the growing media, we could show that total porosity rises over a period of 10 years from 50 to 60%. In the meantime C/N-ratio falls from initially 25 down to 13. While the pH of the slightly acidic TPG-media rose to neutral, the slightly alkaline MEG-media sank down to neutral. With the help of a specially developed vegetation quality index, which incorporates both relative plant coverage and species quantity, we could show that media depth and the grade of sunlight exposition influence floral quality of greenroofs as well as how. According to the specified criteria, the quality of the modern extensive greenroofs is significantly higher than the quality of the 100-year-old ones. Nevertheless, a significant correlation between water holding capacity and vegetation coverage was shown for both roof types. © 2010 Elsevier B.V. All rights reserved.


Muhlbacher A.C.,University of Applied Sciences Neubrandenburg | Muhlbacher A.C.,Gesellschaft fur Empirische Beratung GmbH GEB | Bethge S.,University of Applied Sciences Neubrandenburg
European Journal of Health Economics | Year: 2015

Objective: Lung cancer is a major cause of cancer-related deaths and thus represents a global health problem. According to World Health Organization (WHO) estimates, approximately 1.37 million people die each year from lung cancer. Different therapeutic approaches as well as several treatment options exist. To date decisions on which therapies to use have largely been made by clinical experts. Comparative preference studies show that underlying weighting of treatment goals by experts is not necessarily congruent with the preferences of affected patients. Aim and methods: The aim of this empirical study was to ascertain patient preferences in relation to treatment of non-small-cell lung cancer (NSCLC). After identification of patient-relevant treatment attributes via literature review and qualitative interviews(ten) a discrete-choice experiment including seven patient-relevant attributes was conducted using a fractional factorial NGene-design. Statistical data analysis was performed using latent class models. Results: The qualitative part of this study identified outcome measures related to efficacy, side effects and mode of administration. A total of 211 NSCLC patients (N = 211) participated in the computer-assisted personal interview. A clear preference for an increase in “progression-free survival” (coef.: 1.087) and a reduction of “tumor-associated symptoms”(cough, shortness of breath and pain); coef.: 1.090) was demonstrated, followed by the reduction of side effects: “nausea and vomiting” (coef.: 0.605); “rash” (coef.: 0.432); “diarrhea” (coef.: 0.427); and, “tiredness and fatigue” (coef.: 0.423). The “mode of administration” was less important for participants (coef.: 0.141). Conclusion: Preference measurement showed “progression-free survival” and “tumor-associated symptoms” had a significant influence on the treatment decision. Subgroup analysis revealed that the importance of “progression-free survival” increases with increased therapy experience. Based on the presented results therapies can be designed, assessed and chosen on the basis of patient-oriented findings. As such, more effective and efficient care of patients can be achieved and benefits increased. © 2014, The Author(s).


Muhlbacher A.C.,University of Applied Sciences Neubrandenburg | Nubling M.,GEB MbH
European Journal of Health Economics | Year: 2011

Background: Against the background of patient involvement, understanding patients' preferences for treatments is crucial: Do physicians have the same or a different perception of the patients' preferences? As there is currently no cure for patients with multiple myeloma, primary objectives of treatment are to extend survival at the best possible quality of life. In this study, physicians' beliefs about patients' preferences regarding the treatment of multiple myeloma (MM) were explored in a direct assessment and a discrete choice experiment (DCE), and were compared to the previously explored patients' views. How much do physicians know about their patients' preferences? Methods: In a preceding study with German multiple myeloma patients, relevant attributes of an ideal multiple myeloma treatment were collected by reviewing the literature and by conducting a qualitative study with focus groups. The attributes were analyzed using both a direct measurement (16 items on a five-point Likert scale) and a DCE (eight pairs with eight characteristics). For the present study, 30 German physicians reviewed the treatment attributes from the previous study for completeness. A total of 243 physicians participated in the study (including the 30 participants in the pre-test). The direct assessment and the DCE covered four major preference dimensions that both the literature review and the focus groups revealed: Aspects of medical effectiveness (including prolonged life expectancy, effectiveness and long duration of effect), side effects, quality of life (including social, physical and emotional quality of life) and flexibility (breaks in therapy and further treatment options). Results: In the direct measurement of patients' preferences, physicians rated physical quality of life (specified as "reduced mobility or good mobility"), rare side effects and effectiveness aspects (duration of effect, maximal prolonged life expectancy and effectiveness) as the most important attributes from the patients' perspective, followed by emotional quality of life (specified as "Not always think of the disease") and therapy-free intervals. Especially further treatment options and dosage were more important to patients than physicians believed. In this case, the physicians had quite obviously underestimated the importance of these attributes from the perspective of those affected. Physicians ranked prolonged life expectancy as relatively the most important and significantly more important than all other treatment attributes. Further treatment options were the second most important attribute and significant compared to the attributes breaks in therapy and physical quality of life, whereas the patients ordered these two attributes in reverse order. Similarly, the patients gave the opposite relative importance to the next two priorities: self-application of treatment and emotional quality of life. Conclusions: Asking patients or physicians about the multiple myeloma patients' treatment preferences, the combination of direct assessment and DCE proves to be a valid survey technique. Over a broad range of treatment attributes, the physicians' perceptions of preferences were very close to those of multiple myeloma patients. Both the direct assessment of importance in order to rank the patient perceptions and the DCE provide important insights into the preference structure of patients with multiple myeloma. The findings can subsequently be used as a basis for tailoring health care services for multiple myeloma patients in reference to their preferences. © 2010 Springer-Verlag.


Kraft V.,University of Applied Sciences Neubrandenburg
Zeitschrift fur Padagogik | Year: 2012

On the basis of recent empirical findings, the theory-related problems of general pedagogy are examined from a disciplinary perspective. In this, the common distinction between profession and discipline is differentiated in more detail by showing that modern educational science - in contrast to theology, law, or medicine - is to be considered a secondary discipline the development of which is directly related to processes of secondary professionalization. Against this background, the author substantiates his proposal to determine a dual function of general pedagogy: on the one hand, it serves as delimitation against other disciplines (interdisciplinary aspect), and on the other hand, it serves the intra-disciplinary integration with regard to differential pedagogies. Both functions converge in an operative understanding of education in which the identity of educational science is reflected.


Teschke G.,University of Applied Sciences Neubrandenburg | Borries C.,University of Applied Sciences Neubrandenburg
Inverse Problems | Year: 2010

This paper is concerned with the construction of an iterative algorithm to solve nonlinear inverse problems with an ℓ1 constraint on x. One extensively studied method to obtain a solution of such an ℓ1 penalized problem is iterative soft-thresholding. Regrettably, such iteration schemes are computationally very intensive. A subtle alternative to iterative soft-thresholding is the projected gradient method that was quite recently proposed by Daubechies et al (2008 J. Fourier Anal. Appl. 14 764-92). The authors have shown that the proposed scheme is indeed numerically much thriftier. However, its current applicability is limited to linear inverse problems. In this paper we provide an extension of this approach to nonlinear problems. Adequately adapting the conditions on the (variable) thresholding parameter to the nonlinear nature, we can prove convergence in norm for this projected gradient method, with and without acceleration. A numerical verification is given in the context of nonlinear and non-ideal sensing. For this particular recovery problem we can achieve an impressive numerical performance (when comparing it to non-accelerated procedures). © 2010 IOP Publishing Ltd.


Muhlbacher A.C.,University of Applied Sciences Neubrandenburg | Juhnke C.,University of Applied Sciences Neubrandenburg
Applied Health Economics and Health Policy | Year: 2013

Clinicians and public health experts make evidence-based decisions for individual patients, patient groups and even whole populations. In addition to the principles of internal and external validity (evidence), patient preferences must also influence decision making. Great Britain, Australia and Germany are currently discussing methods and procedures for valuing patient preferences in regulatory (authorization and pricing) and in health policy decision making. However, many questions remain on how to best balance patient and public preferences with physicians' judgement in healthcare and health policy decision making. For example, how to define evaluation criteria regarding the perceived value from a patient's perspective? How do physicians' fact-based opinions also reflect patients' preferences based on personal values? Can empirically grounded theories explain differences between patients and experts - and, if so, how? This article aims to identify and compare studies that used different preference elicitation methods and to highlight differences between patient and physician preferences. Therefore, studies comparing patient preferences and physician judgements were analysed in a review. This review shows a limited amount of literature analysing and comparing patient and physician preferences for healthcare interventions and outcomes. Moreover, it shows that methodology used to compare preferences is diverse. A total of 46 studies used the following methods - discrete-choice experiments, conjoint analyses, standard gamble, time trade-offs and paired comparisons - to compare patient preferences with doctor judgements. All studies were published between 1985 and 2011. Most studies reveal a disparity between the preferences of actual patients and those of physicians. For most conditions, physicians underestimated the impact of intervention characteristics on patients' decision making. Differentiated perceptions may reflect ineffective communication between the provider and the patient. This in turn may keep physicians from fully appreciating the impact of certain medical conditions on patient preferences. Because differences exist between physicians' judgement and patient preferences, it is important to incorporate the needs and wants of the patient into treatment decisions. © 2013 Springer International Publishing Switzerland.


Engel P.,University of Applied Sciences Neubrandenburg | Schweimler B.,University of Applied Sciences Neubrandenburg
Journal of Applied Geodesy | Year: 2016

The deformation monitoring of structures and buildings is an important task field of modern engineering surveying, ensuring the standing and reliability of supervised objects over a long period. Several commercial hardware and software solutions for the realization of such monitoring measurements are available on the market. In addition to them, a research team at the University of Applied Sciences in Neubrandenburg (NUAS) is actively developing a software package for monitoring purposes in geodesy and geotechnics, which is distributed under an open source licence and free of charge. The task of managing an open source project is well-known in computer science, but it is fairly new in a geodetic context. This paper contributes to that issue by detailing applications, frameworks, and interfaces for the design and implementation of open hardware and software solutions for sensor control, sensor networks, and data management in automatic deformation monitoring. It will be discussed how the development effort of networked applications can be reduced by using free programming tools, cloud computing technologies, and rapid prototyping methods. © 2016 Walter de Gruyter GmbH, Berlin/Munich/Boston.


Muhlbacher A.,University of Applied Sciences Neubrandenburg | Bethge S.,University of Applied Sciences Neubrandenburg
Value in Health | Year: 2016

Background There has been tremendous progress regarding treatment options for hepatitis C virus (HCV) infection. Several interferon-free regimens are awaiting regulatory approval. These innovations promise substantial reductions in the burden of disease and side effects as well as a decrease in treatment duration. Objectives The aim of this quantitaitive study was to elicit patient preferences for attributes of innovative antiviral therapies for hepatitis C. Methods A systematic literature search and 14 semi-structured interviews were performed, resulting in eight patient-relevant characteristics. For the discrete choice experiment, an experimental design (3×3 + 5×6) was generated using Ngene software. The survey was conducted in August 2014 through computer-assisted personal interviews. The data were effects-coded in a random parameter logit estimation. Results Participants were patients with HCV (N = 561; 58.1% men) in different treatment states. The analysis revealed a predominance of the attribute “reaching sustained virological response.” When considering confidence intervals, the results showed three different preference ranks. At first place was “sustained virological response” (level difference [LD] 3.98), second was “anemia” (LD 1.10), followed by “number of interferon injections” (LD 0.92), “rash” (LD 0.82), “nausea and/or diarrhea” (LD 0.79), and “duration of antiviral therapy” (LD 0.78). The last position was occupied by both “tiredness/fatigue” (LD 0.31) and “headache” (LD 0.34). Conclusions From the patients’ point of view, sustained virological response is the most essential criterion for choosing an HCV therapy. It was ranked at the highest, dominating all side effects and modes of administration. Furthermore, this study proved that patients consider both the probability of occurrence and the severity of treatment-induced side effects. Results clearly point to valuation of probabilities that is separate from that of severity. © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR)


Bolenz S.,University of Applied Sciences Neubrandenburg | Manske A.,University of Applied Sciences Neubrandenburg
European Food Research and Technology | Year: 2013

Consumer acceptance depends on taste and mouth feeling. Processing can generate varying particle size distributions (PSD), which again influence flow parameters. Chocolate can be produced by roller refining and conching or alternatively by ball milling. Fat content during milling is an important parameter of both processes. The aim of this project was to elucidate relationship between this processing parameter, PSD and flow properties, so they can be controlled. Milk chocolate samples were produced in pilot scale and measured. The results showed that varying fat contents influences PSD for both processing types. Higher fat contents resulted in bimodal distributions for roller refining. Small particles fill voids between big ones, improve packing density and liberate fat for flowing. Nevertheless, fat content during refining should not be too high either, as downstream conching requires low initial content. Pre-dried raw materials were used for ball milling, since this process offers few possibilities to evaporate water and undesired volatiles, unlike conventional conching. Samples showed narrower, multi-modal PSDs. The lack of fine particles decreases packing density and results in higher viscosity at medium and high shear rates. Viscosity at low shear can be less than for roller refined products, which is a consequence of reduced specific surface. Unlike roller refiners, the PSDs became broader at lower fat contents. Almost bimodal PSDs were achieved in lab scale at very low fat contents. Under industrial conditions, the mass must be pumpable for milling. This is a restriction for influencing properties via PSD and needs further optimization. © 2013 Springer-Verlag Berlin Heidelberg.

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