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Objectives
Germany has one of the highest numbers of coronary angiography worldwide. Nevertheless, we find a great variation between German regions for both, diagnostic coronary angiographies and percutaneous coronary interventions (PCI). We assume that this variation is not only due to variation in morbidity but also reflects factors such as guideline adherence, physician-patient communication and access to care.
In this mixed method project, we aim to first describe the variation of coronary angiographies and PCIs in different German regions. Secondly, we explore current practices and motives for (non-)adherences to guidelines in the diagnostic process of patients with suspected CHD. Based on these results, we consequently plan to develop a complex intervention (treatment pathway) to improve guideline adherence and thus appropriateness of coronary angiography.
Method
The projects will be organized according to the recommendation of the Medical Research Council for the development and evaluation of complex interventions. The first study will use descriptive methods based on routine data of three German Health Care Insurances and registry data to describe status quo and associated factors of coronary angiography. The second study will use qualitative methods to understand barriers and facilitators of guideline adherence and medical decision making. Furthermore, we will discuss variations in care and thereby identify implementation targets for the planned treatment pathway. Based on this information, we will develop local treatment pathways in four selected regions. Relevant peers will develop the local pathway in group discussions. Using this bottom-up approach, we directly address implementation challenges.
Wie groß ist der Speicherbedarf in Deutschland in der weiteren Umsetzung der Energiewende? Welche Rolle spielen Batteriespeicher, Pumpspeicher, Power-to-Gas etc. im Kontext anderer Flexibilitätsoptionen auf den verschiedenen Netzebenen? Wie entwickelt sich der Markt für Batterien und Wasserstoff? In unserer Agora-Speicherstudie haben wir auch erstmalig den Begriff Power-to-X definiert und damit die bis dato entstandenen Begriffe Power-to-Gas, Power-to-Liquids, Power-to-Products, Power-to-Chemicals etc. zusammengefasst.
Plastic design allows the exploitation of the full resistance of steel structures by taking advantage of stress–redistributions due to plastic strains exceeding the yield strain. Especially in seismic design the utilization of material reserves and the formation of plastic hinges play an important role. In devastating earthquakes in Northridge (USA) and Kobe (Japan) brittle fracture of welded connections in steel moment frames occurred prior to formation of plastic hinges and utilization of plastic material reserves. The subsequent research works resulted in improved design rules and recommendations for these kinds of failure. But to guarantee sufficient ductile performance of these connections also in the upper shelf region, plastic and earthquake resistant design rules should take into account degradation of strain capacity and toughness properties due to quasi static and especially seismic loading.
In the scope of the current European project “Plastotough”, the main objective is to derive quantified toughness design rules in the upper shelf based on the strain requirements opposed to strain capacities. This paper gives an overview over the research work in performance and shows recent results from experimental and numerical analyses performed within this project for monotonic and cyclic loading.