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Patient-reported outcomes are an important tool in clinical research. In the setting of cancer treatments, benefit of therapy is essentially characterised by improvement of survival as well as quality of life ( QoL). A standardised instrument to assess QoL is the standardised QoL questionnaire of the European Organisation for Research and Treatment ( EORTC QLQ- C30 questionnaire). QoL instruments provide data on different aspects (domains) of the framework of QoL. Using these questionnaires in studies provides data on how a treatment affects QoL in a group of patients. The goal of our concept is to individualise QoL and to use validated instruments in order to integrate patients' perspectives and aims into treatment assessment, planning and control. We propose to use the domains of the EORTC QLQ- C30 and to ask the patient to determine which objectives besides survival are relevant for him and should be achieved by treatment. These individual goals can be used in a process of shared decision-making to choose and monitor treatment. In clinical studies, this approach would allow to recruit more patients who would most probably benefit from the therapy. In addition, supportive data could be gathered in correlation to treatment goals and actual benefits. [ABSTRACT FROM AUTHOR]

Aims: To investigate factors that influence the willingness of inactive nurses to return to nursing in a crisis situation and to identify aspects that need to be considered with regard to a possible deployment. Design: A deductive and inductive qualitative content analysis of semi-structured focus group interviews. Methods: Semi-structured focus group interviews with inactive or marginally employed nurses, nurses who have been inactive for some time and nursing home managers in October and November 2021. The participating inactive nurses had declared their willingness for a deployment during the COVID-19 pandemic or not. Data were analysed using qualitative content analysis. Results: Communication was seen as essential by the participants for an informed decision for or against a temporary return to nursing and to potential or actual deployments. To make them feel safe, inactive nurses need to know what to expect and what is expected of them, for example, regarding required training and responsibilities. Considering their current employment status, some flexibility in terms of deployment conditions is needed. A remaining attachment to care can trigger a sense of duty. Knowledge of (regular) working conditions in nursing can lead to both a desire to support former colleagues and a refusal to be exposed to these conditions again. Conclusion: Past working experiences and the current employment situation play a major role in the willingness of inactive nurses to return to nursing in a crisis situation. Unbureaucratic arrangements must be provided for those who are willing to return. Summary Statement: • What already is known - In crisis situations, not every inactive nurse is willing or able to return to nursing and therefore, the 'silent reserve' may not be as large as suspected. • What this paper adds - Inactive nurses need to know what to expect and what is expected of them for their decision regarding a return to active patient care during a crisis situation. • Implications for practice/policy -- Inactive nurses need to be informed and should be offered free training and refresher courses to ensure patient safety. Impact: This research shows that the group of inactive nurses are not a silent workforce which can be activated anytime. Those who are able and willing to return to direct patient care in crisis situations need the best possible support -- during and between crises. Reporting Method: This study adhered to COREQ guidelines. No Patient or Public Contribution: The involvement of patients or members of the public did not apply for the study, as the aim was to gain insight into the motivations and attitudes of the group of inactive nurses. [ABSTRACT FROM AUTHOR]

During the COVID‐19 pandemic, national triage guidelines were developed to address the anticipated shortage of life‐saving resources, should ICU capacities be overloaded. Rationing and triage imply that in addition to individual patient interests, interests of population health have to be integrated. The transfer of theoretical and empirical knowledge into feasible and useful practice models and their implementation in clinical settings need to be improved. This paper analyzes how triage protocols could translate abstract theories of distributive justice into concrete material and procedural criteria for rationing intensive care resources during a pandemic. We reconstruct the development and implementation of a rationing protocol at a German university hospital: describing the ethical challenge of triage, clarifying the aspirational norms, and summarizing specific norms of fair triage and allocation for developing an institutional policy and practice model and implementing it. We reflect on how critical topics are seen by clinicians and what helped manage the perceived burdens of the triage dilemma. We analyze what can be learned from this debate regarding the difficult issues around triage protocols and their potential implementation into clinical settings. Analyzing the ought‐to‐is gap of triage, integrating abstract ethical principles into practical concepts, and evaluating those should clarify the benefits and risks of different allocation options. We seek to inform debates on triage concepts and policies to ensure the best possible treatment and fair allocation of resources as well as to help protect patients and professionals in worst‐case scenarios. [ABSTRACT FROM AUTHOR]

The recent migration waves from countries ruled by leaders with autocratic tendencies or under war regimes included also the forced migration of academics who have become targets of widening severe attacks against academic-scientific values, institutions, and students/scholars (GCP EA). Based on empirical research, this paper studies the forced migration of scholars from such countries to Germany after 2015. While putting theoretical concepts deriving from distinct study fields (such as forced migration and exile studies) into a dialog, the paper perceives the migration of these scholars as forced due to risks they encountered in their home countries. It also addresses the complexity of their forced migration as a multidimensional and relational process involving various structural and subjective push-pull drives. In line with the empirical data and post-structuralist theories on migration and forced migration, the paper pursues the following theses: Risks and responses against risks are varied and involve the agency of migrants. Although forced migration is a regulated process concerning migration regimes and laws, it calls for the performance/agency of exiled scholars and other actors' governing activities. As a complex and transformative process, forced migration results in different exilic positions. It is not a predetermined linear process in time and space, but a process with unexpected outcomes, since it entails the ongoing struggle of exiled scholars over/through their academic and social networks and capitals, which function as mediating-pulling drivers. [ABSTRACT FROM AUTHOR]

The intensifying regional competition in the past decades has a serious impact on the work of decision makers, as well as on science. The presence of the concept of regional competitiveness in the documents of the European Union dates back to a considerable period. One needs only think of the development of the union's regional (cohesion) policy. On the other hand, the revaluation of the topic is shown by the number of related scientific papers, including, of course, the investigation of the causes leading to the process. In my paper, I examine the factors defining and influencing regional competitiveness. The regional framework of the analysis is provided by two major economies of the European Union, Germany and France, and their NUTS2 regions. In the analytical part, using the method of PLS-Path Analysis (PLS, partial least squares), a model explaining competitiveness is developed, which includes the latent variables representing the elements of the examined concept. Analysing the effect mechanisms between these latent variables help explore which capital factors can be considered important or less significant in terms of competitiveness in the studied regions. [ABSTRACT FROM AUTHOR]

Purpose: Enhancing the resilience of cities and strengthening risk-informed decision-making are defined as key within the Global Agenda 2030. Implementing risk-informed decision-making also requires the consideration of scenarios of exposure and vulnerability. Therefore, the paper presents selected scenario approaches and illustrates how such vulnerability scenarios can look like for specific indicators and how they can inform decision-making, particularly in the context of urban planning. Design/methodology/approach: The research study uses the example of heat stress in Ludwigsburg, Germany, and adopts participatory and quantitative forecasting methods to develop scenarios for human vulnerability and exposure to heat stress. Findings: The paper indicates that considering changes in future vulnerability of people is important to provide an appropriate information base for enhancing urban resilience through risk-informed urban planning. This can help cities to define priority areas for future urban development and to consider the socio-economic and demographic composition in their strategies. Originality/value: The value of the research study lies in implementing new qualitative and quantitative scenario approaches for human exposure and vulnerability to strengthen risk-informed decision-making. [ABSTRACT FROM AUTHOR]

Governments around the globe use non-pharmaceutical interventions (NPIs) to curb the spread of coronavirus disease 2019 (COVID-19) cases. Making decisions under uncertainty, they all face the same temporal paradox: estimating the impact of NPIs before they have been implemented. Due to the limited variance of empirical cases, researchers could so far not disentangle effects of individual NPIs or their impact on different demographic groups. In this paper, we utilize large-scale agent-based simulations in combination with Susceptible-Exposed-Infectious-Recovered (SEIR) models to investigate the spread of COVID-19 for some of the most affected federal states in Germany. In contrast to other studies, we sample agents from a representative survey. Including more realistic demographic attributes that influence agents' behavior yields accurate predictions of COVID-19 transmissions and allows us to investigate counterfactual what-if scenarios. Results show that quarantining infected people and exploiting industry-specific home office capacities are the most effective NPIs. Disentangling education-related NPIs reveals that each considered institution (kindergarten, school, university) has rather small effects on its own, yet, that combined openings would result in large increases in COVID-19 cases. Representative survey-characteristics of agents also allow us to estimate NPIs' effects on different age groups. For instance, re-opening schools would cause comparatively few infections among the risk-group of people older than 60 years. [ABSTRACT FROM AUTHOR]

This paper examines women's experiences with decision-making about non-invasive prenatal testing (NIPT). Such tests offer knowledge about chromosomal disorders early in pregnancy, without the risk of miscarriage associated with invasive procedures such as amniocentesis. Based on qualitative interviews with women in Germany who used, or declined, NIPT, we show how some women, who would not consider amniocentesis due to the risk of miscarriage, welcome the knowledge provided by, and the additional agency resulting from, NIPT. For others, declining the offer to "know more" becomes increasingly difficult to articulate. The absence of risk strips women of a "good reason" to justify their decision not to test, thus implicitly challenging their "right not to know." Moreover, NIPT heightens moral dilemmas within relationships with partners, existing children, and sometimes other close relatives. While clinically "non-invasive," we argue that NIPT changes decision-making in an ethically and socially highly significant way. [ABSTRACT FROM AUTHOR]

This paper examines the discretionary reasoning of the judiciary in three jurisdictions, England, Germany and Norway, in cases deciding whether a newborn child is safe with her parents or intervention is necessary. Our analysis focuses on one specific dimension of decision makers' exercise of discretion, namely, if and how the strengths and weaknesses of the mother are considered. The data material consists of all decisions concerning care orders of newborns from one large city in Germany from 2015 to 2017 (n = 27) and 2016 in Norway (n = 76) and all publicly available newborn removal decisions in England for 2015–2017 (n = 14). The findings reveal a high number of risk factors in the cases and less focus on risk‐reducing factors. The situation of the newborn is considered to be harmful, as most cases result in a care order. Judicial discretion differs by how much information, and what types of factors, are included in the justification for the decision. A learning point for decision makers and policymakers would be to actively undertake a balancing act between risk‐increasing and risk‐reducing factors. [ABSTRACT FROM AUTHOR]

Background: The topic of this paper is related to equity in health within a country. In public health care sectors of many countries decisions on priority setting with respect to treatment of different types of diseases or patient groups are implicitly or explicitly made. Priorities are realized by allocation decisions for medical resources where moral judgments play an important role with respect to goals and measures that should be applied. The aim of this study is to explore the moral intuitions held in the German society related to priorities in medical treatment. Methods: We use an experimental questionnaire method established in the Empirical Social Choice literature. Participants are asked to make decisions in a sequence of distributive problems where a limited amount of treatment time has to be allocated to hypothetically described patients. The decision problems serve as an intuition pump. Situations are systematically varied with respect to patients' initial health levels, their ability to benefit from treatment time, and the amount of treatment time available. Subjects are also asked to describe their deliberations. We focus on the acceptance of different allocation principles including equity concepts and utilitarian properties. We investigate rule characteristics like order preservation or monotonicity with respect to resources, severity, or effectiveness. We check the consistency of individual choices with stated reasoning. Results: The goals and allocation principles revealed show that the moral intuitions held by our experimental subjects are much more complex than the principles commonly applied in health economic theory. Especially, cost-utility principles are rarely applied, whereas the goal of equality of health gain is observed more often. The principle not to leave any patient untreated is very dominant. We also observe the degrees to which extent certain monotonicity principles, known from welfare economics, are followed. Subjects were able to describe their moral judgments in written statements. We also find evidence that they followed their respective intuitions very consistently in their decisions. Conclusions: Findings of the kind presented in this paper may serve as an important input for the public and political discussion when decisions on priorities in the public health care sector are formed. [ABSTRACT FROM AUTHOR]

The paper aims at explaining why large-scale energy-intensive industries-here the German iron and steel industry-had a period of slow uptake of major energy-efficient technologies from the mid 1990s to mid 2000s (Arens and Worrell, 2014) and why from the mid 2000s onwards these technologies are increasingly implemented again. We analyze the underlying factors and investment/innovation behavior of individual firms in the German iron and steel industry to better understand barriers and drivers for technological change. The paper gives insights on the decision-making process on energy efficiency in firms and helps to understand how policy affects decision-making. We use a mixed method approach. First, we analyze the diffusion of three energy-efficient technologies (EET) for primary steelmaking from their introduction until today (top-pressure recovery turbine (TRT), basic oxygen furnace gas recovery (BOFGR), and pulverized coal injection (PCI)). We derive the uptake of these technologies both at the national level and at the level of the individual firm. Second, we analyze the impact of drivers and barriers on the decision-making process of individual firms whether or not they want to implement these technologies. Economics and access to capital are the foremost barriers to the uptake of an EET. If the expected payback period exceeds a certain value or if the company lacks capital, investments in EET seem not to happen. But even if an EET is economically viable and the company has access to capital, investments in EET might not be realized. Policy-induced prices might have strengthened the recent diffusion of TRT. We found indications that in a limited number of cases, policy intervention was a driving factor. Technical risks and imperfect information are only marginal factors in our cases. Site-specific factors seem to be important, as site-specific factors shape the economics of the selected EET. [ABSTRACT FROM AUTHOR]

For most of her political career Angela Merkel has been perceived as a pragmatic political leader, avoiding tough and divisive decisions wherever possible, and joining decision-making coalitions on contested issues when they emerged. To some extent, this remarkable ability appears to explain her extended hold on the German chancellorship. In the midst of her third term, however, her behaviour changed suddenly and unexpectedly, or so it seemed. When in July 2015 the euro crisis flared up again due to the standoff between Greece and its EU partners on the second bail-out, Merkel let her European convictions prevail and backed another support package against the wishes of many in her party. Moreover, when Germany was hit by a wave of refugees only a few months later, Merkel became the torch-bearer of a 'culture of welcome' and defended her 'open-door' policies with a measure of conviction that few observers would have considered possible. This paper looks at Merkel's leadership performance during her third term through the lens of the concept of 'conviction leadership', and inquires if, or to what extent, Merkel can be meaningfully considered a 'conviction leader'. [ABSTRACT FROM AUTHOR]

This paper explores how the Protestant territorial churches in Germany deal with the so-called "visitation" - an instrument aimed at developing and inspecting the church and its local parish. We analyze (1) how and to what extent the visitation is used for program development and improving the church, (2) how church officials (ministry) and volunteers (lay ministry) are involved in the visitation process, and (3) how these people communicate with each other. After presenting an organization theory perspective on churches and church communities, we illustrate our arguments using case studies in four selected territorial churches - "Landeskirchen" - in Germany. The findings reveal that the visitation serves as a multifunctional instrument for both the church as an organization as well as the church community as an interaction system. The dual nature of the visitation as a tool for inspection and organizational development produces "useful insecurities", which can create room for informal, trusting exchange among church members. Some unintended side effects also occur, including "window dressing" and a sense of "artificial naturalness" during the visitation. Our findings suggest that the different functions of the visitation are the result of shifting expectations as the visitation is imbued with new functions. While this increases organizational opportunities, it also leads to a further increase in expectations. The findings are potentially of interest to other organizations rooted in a community and personal beliefs. [ABSTRACT FROM AUTHOR]

Abstract: This paper explores practical and ethical dilemmas for professionals when securing the protection of children in the complex non‐clinical setting of individual families. It is based on a cross‐country study on cultural encounters in interventions against child physical abuse and neglect in four countries (England/Wales, Germany, Portugal, and Slovenia). Drawing on national reports of legal‐organizational frameworks and socio‐cultural backgrounds of European child protection systems, it also presents the results of a series of focus groups with professionals. Data were analysed to identify implicit and explicit discursive constructions as well as normative representations and from this deriving the key ethical issues and dilemmas. Despite a shared normative framework across Europe, intervention cultures vary across the four countries and between the different stakeholder groups. Although each child protection system faced widespread mistrust, policy approaches differ, some relying on strong and detailed guidance whereas others stress professional skill and judgement. We conclude that despite a shared commitment to the protection of children, deliberations and perceived ethical dilemmas suggest interdependency between differences in system cultures and policy approaches that inform the character of professional interventions in the four countries. [ABSTRACT FROM AUTHOR]

To equalize differences in health plan premiums due to differences in risk pools, the German legislature introduced a simple Risk Adjustment Scheme (RAS) based on age, gender and disability status in 1994. In addition, effective 1996, consumers gained the freedom to choose among hundreds of existing health plans, across employers and state-borders. This paper (a) estimates RAS pass-through rates on premiums, financial reserves, and expenditures and assesses the overall RAS impact on market price dispersion. Moreover, it (b) characterizes health plan switchers and investigates their annual and cumulative switching rates over time. Our main findings are based on representative enrollee panel data linked to administrative RAS and health plan data. We show that sickness funds with bad risk pools and high pre-RAS premiums lowered their total premiums by 42 cents per additional euro allocated by the RAS. Consequently, post-RAS, health plan prices converged but not fully. Because switchers are more likely to be white collar, young and healthy, the new consumer choice resulted in more risk segregation and the amount of money redistributed by the RAS increased over time. [ABSTRACT FROM AUTHOR]

Behavioural models of migration emphasize the importance of migration decision-making for the explanation of subsequent behaviour But empirical migration research regularly finds considerable gaps between those who intend to migrate and those who actually realize their intention. This paper applies the Theory of Planned Behaviour, enriched by the Rubicon model, to test specific hypotheses about distinct effects of facilitators and constraints on specific stages of migration decision-making and behaviour The data come from a tailor-made panel survey based on random samples of people drawn from two German cities in 2006-07. The results show that in conventional models the effects of facilitators and constraints on migration decision-making are likely to be underestimated. Splitting the process of migration decision-making into a pre-decisional and a pre-actional phase helps to avoid bias in the estimated effects of facilitators and constraints on both migration decision-making and migration behaviour [ABSTRACT FROM AUTHOR]

The article examines the impact of organised interests on the passage of legislation in the German Bundestag through an empirical analysis of the position papers presented in the public hearings of its standing committees in 2011. These committees are the most important forums to revise legislative proposals. Drawing on resource dependency theory, we employ GLM regression analyses to study if interest groups act as change agents that bring legislation closer to their own policy preferences. Controlling for institutional and bill characteristics, we discuss two major findings that shed light on the role of interest groups in legislation. First, business groups' opposition to government bills triggers legislative changes because their members control the means of production and make investment decisions. In contrast, fundamental opposition of non-business groups has no impact. Second, bills debated and opposed by a greater number of interest groups undergo more changes pointing to the importance of the density of interest groups and balance of opinions on a proposal. [ABSTRACT FROM AUTHOR]

This paper analyzes the impact of hydrogen as energy storage on production and investment decisions in an electricity market when individual participants behave strategically. We develop a game-theoretic model on investment and generation game à la Cournot under the open-loop information structure. This framework is implemented as a mixed complementarity problem and applied to the German case assuming the phase-out of the German nuclear power plants, rising renewable energy supply and increasing energy demand for electric vehicles. The numerical results of our analysis indicate that utilization of energy storage has a positive effect on energy systems with large amount of intermittent electricity and inelastic demand. We find that additional hydrogen storage capacities improve system reliability, increase overall welfare and decrease GHG emissions. Adding demand for hydrogen as a fuel for FCEVs allows for a synergetic use of the technology and changes the investment incentives for energy storage. Although the power-to-gas technology has a price-smoothing effect the overall generation capacity is higher with energy storage providing additional supply security in markets with a large amount of intermittent energy production. [ABSTRACT FROM AUTHOR]

Background: Limiting treatment forms part of practice in many fields of medicine. There is a scarcity of robust data from Germany. Therefore, in this paper, we report results of a survey among German physicians with a focus on frequencies, aspects of decision making and determinants of limiting treatment with expected or intended shortening of life. Methods: Postal survey among a random sample of physicians working in the area of five German state chambers of physicians using a modified version of the questionnaire of the EURELD Consortium. Information requested referred to the patients who died most recently within the last 12 months. Logistic regression was performed to analyse associations between characteristics of physicians and patients regarding limitation of treatment with expected or intended shortening of life. Results: As reported elsewhere, 734 physicians responded (response rate 36.9%) and of these, 174 (43.2%) reported a withholding and 144 (35.7%) a withdrawal of treatment. Eighty one physicians estimated that there was at least some shortening of life as a consequence. In 25.9% of these cases hastening death had been discussed with the patient at the time or immediately prior to this action. Types of treatment most frequently limited was artificial nutrition (n = 35). Bivariate analysis indicates that limitation of treatment with possible or intended shortening of life for patients aged > 75 years is performed significantly more often (p = 0.007, OR 1.848). There was significantly less limitation of treatment in patients who died from cancer compared to patients with other causes of death (p = 0.01, OR 0.486). There was no significant statistical association with physicians' religion, palliative care qualification or frequencies of limiting treatment. Conclusions: In comparison to recent research from other European countries, limitation of treatment with expected or intended shortening of life is frequently performed amongst the investigated sample. The role of clinical and non-medical aspects possibly relevant for physicians' decision about withholding or withdrawal of treatment with possible or intended shortening of life and reasons for non-involvement of patients should be explored in more detail by means of mixed method and interdisciplinary empirical-ethical analysis. [ABSTRACT FROM AUTHOR]

Looking back on the many prophets who tried to predict the future as if it were predetermined, at first sight any forward-looking activity is reminiscent of making predictions with a crystal ball. In contrast to fortune tellers, today's exercises do not predict, but try to show different paths that an open future could take. A key motivation to undertake forward-looking activities is broadening the information basis for decision-makers to help them actively shape the future in a desired way. Experts, laypeople, or stakeholders may have different sets of values and priorities with regard to pending decisions on any issue related to the future. Therefore, considering and incorporating their views can, in the best case scenario, lead to more robust decisions and strategies. However, transferring this plurality into a form that decision-makers can consider is a challenge in terms of both design and facilitation of participatory processes. In this paper, we will introduce and critically assess a new qualitative method for forward-looking activities, namely CIVISTI (Citizen Visions on Science, Technology and Innovation; ), which was developed during an EU project of the same name. Focussing strongly on participation, with clear roles for citizens and experts, the method combines expert, stakeholder and lay knowledge to elaborate recommendations for decision-making in issues related to today's and tomorrow's science, technology and innovation. Consisting of three steps, the process starts with citizens' visions of a future 30-40 years from now. Experts then translate these visions into practical recommendations which the same citizens then validate and prioritise to produce a final product. The following paper will highlight the added value as well as limits of the CIVISTI method and will illustrate potential for the improvement of future processes. [ABSTRACT FROM AUTHOR]

This paper examines consumers' knowledge and lifestyle profiles and preferences regarding two environmentally labeled food staples, potatoes and ground beef. Data from online choice experiments conducted in Canada and Germany are analyzed through latent class choice modeling to identify the influence of consumer knowledge (subjective and objective knowledge as well as usage experience) on environmentally sustainable choices. We find that irrespective of product or country under investigation, high subjective and objective knowledge levels drive environmentally sustainable food choices. Subjective knowledge was found to be more important in this context. Usage experience had relatively little impact on environmentally sustainable choices. Our results suggest that about 20% of consumers in both countries are ready to adopt footprint labels in their food choices. Another 10-20% could be targeted by enhancing subjective knowledge, for example through targeted marketing campaigns. [ABSTRACT FROM AUTHOR]

New modes of scientific knowledge production and decision-making have been gaining societal importance. This is because science and politics became more open towards external expectations in the last decades. Features of this development are reflected by the way society is handling nanotechnology. In Germany, many stakeholder dialogues took place. According to social science concepts, they might influence relevant processes in economy or science. This assumption will be dealt with by the present paper, with the German NanoKommission being used as an example. By means of a sociology-ofknowledge approach, the conditions which gave the commission its influential position and the significance of its decisions will be analysed. The argumentation relies on documents from the German debate on nanotechnology and interviews conducted with important speakers. It becomes clear that the society refers to previous experience to give stakeholder dialogues their meaning. The paper will outline the normative and functional implications of these kinds of participatory settings. [ABSTRACT FROM AUTHOR]

This paper addresses the role of ticket-splitting in decreasing the accuracy of recalled previous voting. It suggests that ticket-splitting makes recalling vote choice a more difficult task and thus increases recall error. Using data from three German panel surveys conducted from 1998 to 2008, the paper demonstrates that ticket-splitting increases recall error by a considerable margin, even after controlling for behavioral and attitudinal predictors. This finding suggests that recall accuracy is not a stable voter characteristic. It also lends credence to the notion that the increase in ticket-splitting in recent German elections decreased the accuracy of recalled previous voting. Finally, the evidence suggests that electoral systems affect the validity of survey answers concerning previous vote choice. [Copyright &y& Elsevier]

Purpose – Often farmers do not switch to a new bank even if it offers better interest rates than the house bank. This can be attributed partly to transaction costs, and partly to bounded rationality. The purpose of this paper is to better understand farm borrowers by analyzing the role of incomplete information and limited cognitive abilities in their finance decisions. Design/methodology/approach – The data for the analysis were retrieved from a written survey conducted among German farmers who were "experimentally" confronted with a funding problem and who had to make a choice between two loan offers: one from the housebank, and one from a competing bank. Using contingent valuation, each farmer's willingness to pay (WTP) for continuing business with his house bank was assessed. Findings – Approximately 90 per cent of the farmers misjudged the absolute losses caused by higher interest rates. In the frame "accepted interest rate surcharge" the WTP for staying with the house bank was, on average, ten times higher than in the frame "accepted surcharge in Euro". The misjudgment was found to differ depending on education, the duration of the business relationship, etc. The findings indicate that bounded rationality is a relevant determinant of the "reluctance to switch". Originality/value – Complementing research on the decision making of lenders, this paper studies the demand side of the agricultural credit market. Two research questions are examined which, to the authors' knowledge, have not previously been investigated through empirical surveys: first, to what extent do farmers make bounded-rational financing decisions? Second, which factors explain bounded rationality? [ABSTRACT FROM AUTHOR]

The Bureaucratic Politics Model (BPM) is usually employed to explain crisis decision-making in US foreign policy. Proponents of the model argue, however, that its explanatory scope also encompasses non-crisis decision-making in domestic political issues in parliamentary systems. This paper takes up this claim and applies the BPM to the reform of the German Federal Criminal Police Office. In line with the BPM's predictions, the paper finds that the policy preferences of the key actors were indeed strongly influenced by their bureaucratic position and the outcome of the decision-making process was a compromise solution. However, the model cannot account for the impact of two non-executive institutions, that is, the Federal Constitutional Court and the Bundesrat, on the executive bargaining process. This finding suggests that the BPM could be an even better analytical tool if it were expanded to systematically incorporate the influence of non-bureaucratic actors into its framework. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to study the perceptions of the advisors and valuers of German associations regarding the relevance of intangible assets in general, and for the purpose of company succession in particular. Design/methodology/approach - To perform this study German associations were examined, which play an essential role in company succession in Germany, from both sides of the process. Conducting a web-survey, 51 answers were received (response-rate?=?42.5 per cent) which could be used for the analyses. Findings - Amongst others, the study showed that intangible assets are of a moderate relevance. However, a large proportion of respondents expect intangible assets to be of greater relevance in the future. The study highlighted that intangibles do have a great impact on the decision-making process of an investor. Research limitations/implications - The total population of German Association is 135. The author received answers from 51 associations, which did not fulfil the statistical size to conduct advanced statistical methods. The specific relationship of German associations with small- to medium-sized enterprises (SMEs) is rather unique compared to similar institutions around the world, therefore, the results may not be replicable in other countries. Practical implications - The results of this study will help practitioners as well as academics to better understand the relevance of intangible assets in SMEs. Originality/value - This paper is pioneering in the analysis of the influence of intangible assets in German SMEs for the purpose of company succession. [ABSTRACT FROM AUTHOR]

This paper investigates the theoretical concept that a city is always influenced by the relations it has to its hinterland and to other cities. Taylor and colleagues point out that city-city relations and city-hinterland relations can be understood as two sides of a coin. Using this conception the polycentric structure and dynamics of the German urban system can be described through: (i) metropolitan functions representing city-hinterland relations (cosmopolitanity) and (ii) a network of cities representing city-city relations (connectivity). Measuring separately the degrees of cosmopolitanity and connectivity, we look at whether the German urban system after reunification has grown together, becoming one balanced urban system, and what role Berlin - as the new capital in the overall system - now has. The results of the two perspectives are compared and analysed. [ABSTRACT FROM AUTHOR]

Deliberative monetary valuation has emerged as a promising alternative to conventional stated preference studies of ecosystem services. It promises to give respondents a better basis for decision-making by exposing them to a more diverse set of knowledge, arguments and opinions through group discussion. However, under certain conditions, small groups may fail to effectively pool the individual knowledge of their members. This paper examines the impact of the initial distribution of individual preferences in discussion groups on the outcome of deliberative choice experiments. Drawing on a deliberative monetary valuation study of forest ecosystem services in West Saxony, Germany, it is shown that the initial preference distribution in groups influences both the diversity of arguments exchanged during group discussions and respondents' consideration of the costs of environmental policies. Furthermore, results indicate that respondents' post-discussion willingness-to-pay is affected by the initial preference distribution in groups, though these changes were not statistically significant. The choice certainty of respondents was found to remain largely unaffected. Overall, the empirical findings of this study provide preliminary evidence about the need to conduct future deliberative monetary valuation studies with groups with heterogeneous initial preferences as this may provide respondents with a more complete set of decision-relevant information. [ABSTRACT FROM AUTHOR]

Applying ecosystem services (ES) concepts and indicators in landscape planning requires them to be linked with models for decision-making by practitioners. The objective of this paper is to introduce an ES-in-Planning framework, which combines ES assessment and valuation indicators with the widely used Driving Forces, Pressures, State, Impacts and Responses (DPSIR) model. Within this framework, ES indicators become part of landscape planning as a means of assessing the current state of the environment and for determining how it might change in the future. The implementation and added value of the framework is illustrated in a case study of planning issues in the Mardorf community bordering the Steinhuder Meer Lake, Northern Germany. Two scenarios of potential landscape changes and possible response measures are considered in terms of alterations in a set of ES indicators. The ES examined are food production (a provisioning ES), climate mitigation (a regulation ES), landscape esthetics (as the basis for many cultural ES), and biodiversity. The ES indicators employed distinguish between services valued by humans and those which are actually utilized. Valuation of changes in ES has shown to reflect societal objectives (as institutionalized in legal requirements) and expert-based estimates. However, these valuations could be further validated by including economic and social valuation of impacts. The added value of applying ES in the planning process lies in improved opportunities for developing targeted response measures, for communicating trade-offs between planning options, and for facilitating joint implementation by partners. [ABSTRACT FROM AUTHOR]

This paper investigates the average effects of firm-provided workplace health promotion measures on labour market outcomes of the firms' employees. Exploiting linked employer-employee panel data that consist of rich survey-based and administrative information on firms, workers and regions, we apply a flexible propensity score matching approach that controls for selection on observables and time-constant unobserved factors. While the effects of analysing sickness absenteeism appear to be rather limited, our results suggest that health circles/courses increase tenure and job stability across various age groups. A key finding is that health circles/courses strengthen the labour force attachment of elderly employees (51-60), implying potential cost savings for public transfer schemes such as unemployment insurance or early retirement schemes. [ABSTRACT FROM AUTHOR]

German electricity giants have recently taken high-level decisions to remove selected fossil fuel operations from their company portfolio. This new corporate strategy could be seen as a direct response to the growing global influence of the fossil fuel divestment campaign. In this paper we ask whether the divestment movement currently exerts significant influence on decision-making at the top four German energy giants--E.On, RWE, Vattenfall and EnBW. We find that this is not yet the case. After describing the trajectory of the global fossil fuel divestment campaign, we outline four alternative influences on corporate strategy that, currently, are having a greater impact than the divestment movement on Germany's power sector. In time, however, clear political decisions and strong civil support may increase the significance of climate change concerns in the strategic management of the German electricity giants. [ABSTRACT FROM AUTHOR]

Background The provision of tobacco dependence treatment in health care settings, particularly in countries lacking a history of strong tobacco control policy implementation, is limited by continued misconceptions on the part of health professionals and decision-makers regarding its worth and efficacy. In this paper, we rebut 9 arguments against the provision of tobacco dependence treatment that we have encountered in our experiences implementing and maintaining a dedicated smoking cessation service at a large university hospital in southern Germany. Discussion Broadly, the arguments relate to the nature of addiction, the efficacy and safety of stop- smoking medication and behavioural support, and the benefits and challenges of quitting. They include: (a) If smokers really want to quit, they will be able to do it alone (without help); (b) You can't forbid patients from doing what they want; (c) Patients will be upset if you talk to them about their smoking; (d) Stop-smoking medication has side effects that are more dangerous than smoking; (e) You have to be well trained to help smokers to quit (otherwise you can do more harm than good); (f) If you smoke yourself, you lack credibility; (g) If you have cancer, it is too late to quit; (h) Nicotine withdrawal is dangerous for heavy smokers; and (i) Smokers die earlier, thus reducing costs to the health system. Summary It is hoped that the counter-arguments presented here arm tobacco control advocates and practitioners working in health care settings, particularly in countries which have not prioritised tobacco control, to respond appropriately and convincingly to those opposed to the provision of tobacco dependence treatment. [ABSTRACT FROM AUTHOR]

In this article, we explore the risks associated with direct payments to users enabling them to purchase social care. These payments are intended to enable people with disabilities to make choices and increase their autonomy. However, there is little evidence in the existing literature about the risks involved in direct payments as seen by service users. In this paper, we draw on data from a qualitative study of direct payments for people with disabilities in a federal state of Germany. We interviewed 37 individuals involved in direct payment schemes including individuals receiving payments, care assistants, members of organisations providing care and the administrative officers of the local authorities between December 2011 and January 2014. In this article, we use a governmentality perspective to explore how individuals who received the payments saw and sought to manage the risks associated with the scheme. We found that while users reported that direct payments reduced the risk associated with being directly dependent on the care providers and hence increased their desired self-determination, they identified new risks linked to their liability for the transferred money, problems associated with their liquidity and cash flow, challenges presented by budget cuts, and sanctions resulting from violation of norms of ‘appropriate use’ and the difficulties of negotiating with the funders. To manage these perceived risks users indicated that they had subjected themselves to a new way of active self-control and self-management, normalising their behaviour. We note that risk to service users has been neglected in policy design and should be acknowledged more explicitly. [ABSTRACT FROM AUTHOR]

The paper seeks to describe whether reflections about the legitimacy metropolitan governance arrangements found consideration in metropolitan reforms in five German metropolitan regions. Metropolitan regions are an increasingly relevant scale for political decision-making but mechanism for legitimacy and accountability did not keep pace. Given the fact that in most metropolitan institutions only indirect mechanisms of legitimacy such as regional assemblies with representatives from municipal councils or public–private governing boards are at work, one may expect that output legitimacy or legitimacy by performance is the dominant source for legitimacy in metropolitan governance. In fact, citizens care much about the quality and the prize of services such as waste management or public transport but less about the transparency of decision-making procedures behind these services – at least on the scale of the region. The results show a mixed picture. In two out of five regions, directly elected regional assembly have been established and now constitute genuine tiers of metropolitan politics where input and output legitimacy are combined. In other regions, the turn to flexible forms of governance opened up decision-making arenas for societal actors, but it seems that this opening of the policy process is very selective and comes at the expense of citizen participation. [ABSTRACT FROM AUTHOR]

A decision conflict is present when a person wants and, simultaneously, not wants to follow an action course. This paper describes firstly the double decision conflict on the physicist Werner Heisenberg: Conflict regarding decisions of going into exile or to remain in the Nazi Germany, and with regard to the degree of scientific collaboration with the Nazi regime to create an atomic bomb. Secondly, discusses the fact that on the summer of 1945 while Oppenheimer was celebrated by his success in coordinating the Manhattan project, which made possible the atomic destruction of Hiroshima and Nagasaki, Heisenberg was in detention for his scientific collaboration with the Nazi regime even when the collaboration was parsimonious and limited. Finally, the Author discusses the ethical and practical problem of the relation between science and power: when scientists forced to serve power are judged lately according to victories and defeats of such power that personally are not imputed to them. [ABSTRACT FROM AUTHOR]

Modeling and forecasting international migration are significant research areas since migration forecasts are vital in decision making and policy design regarding economy, security, society, and resource allocation. The methods for modeling and forecasting migration rely on strict subjective or statistical assumptions which may not always be met. In addition, lack of a universally accepted definition of the term "migrant" and the ambiguities in data due to recording and collection systems result in inconsistencies and vagueness in migration modeling. Considering these, in this paper, a fuzzy bi-level age-specific migration modeling method is proposed. The bi-level structure embedded in the model makes use of the well-known Lee-Carter method as well as fuzzy regression, singular value decomposition technique, and hierarchical clustering to reflect the general characteristics of the country of concern together with the distinct emigration and immigration behaviors of the age groups. Bayesian time series models are fitted to the time-variant fuzzy parameters obtained through the proposed method to forecast future migration values. The proposed method is applied on female and male age-specific emigration and immigration counts of Finland for 1990–2010 period and Germany for 1995–2012 period, and the future values are forecasted for 2011–2025 and 2013–2025 respectively. The method is compared with an existing Bayesian approach and the numerical findings display that the proposed fuzzy method is superior to the existing one in modeling and forecasting age-specific migration values within significantly narrower prediction intervals. • A fuzzy migration modeling method is proposed to eliminate the restrictive assumptions of the existing methods • The bi-level structure of the model reflects general country characteristics and distinct age group behaviors. • The proposed method is applied on migration data of Finland and Germany; and compared with an existing Bayesian approach. • The proposed method is superior to the existing one in forecasting migration values within narrower prediction intervals. • This paper shows the applicability of fuzzy approach in modeling and forecasting the inherent uncertainty for migration. [ABSTRACT FROM AUTHOR]

Circumcision of a male child was recently ruled illegal by a court in Germany on the grounds that it violates the child's rights to bodily integrity and self-determination. This paper begins by challenging the applicability of these rights to the circumcision debate. It argues that, rather than a sweeping appeal to rights, a moral analysis of the practice of circumcision will require a careful examination of the interests of the child. I consider three of these interests in some detail. The first is the interest in avoiding a moderate decrease in expected future sexual pleasure. I argue that even if such a decrease were to occur, it is not wholly unreasonable to think that this might actually be a good thing for the child. Second, I consider the interest in self-determination. I argue that this interest is not as strong as it might appear because the adult's circumcision decision is subject to a variety of biases and a significant lack of information. Finally, I consider the child's interest in avoiding the future costs of adult circumcision. I argue that this interest becomes much stronger in the religious case because the child is quite likely to choose to become circumcised as an adult. The likelihood of the child choosing circumcision in the religious case also reduces the extent to which infant circumcision violates his interest in self-determination. I conclude that male infant circumcision falls within the prerogative of parental decision-making in the secular case and even more clearly so in the religious case. Finally, I distinguish male circumcision from female genital cutting in several important respects and argue that we can coherently hold that male circumcision is permissible without also endorsing all forms of female genital cutting. [ABSTRACT FROM AUTHOR]

Recognizing the ageing of populations and expected increase in prevalence of dementia, the necessity of research involving persons with dementia is widely agreed upon. Autonomy is key to nursing home residents' well-being and quality of life, but this phenomenon has not been thoroughly assessed from the residents' perspective. The aim of this cross-sectional study was to investigate perceived autonomy of nursing home residents. Data on 560 randomly selected residents in 40 nursing homes in two German federal states were generated by face-to-face interviews, psychological and physical assessments, analysis of nursing records, and acquisition of institutional parameters. This paper reports on a subsample ( n = 179) that met screening requirements, including subjects with and without mild cognitive impairment ( Mini Mental Status Examination score 30-18), who completed the Hertz Perceived Enactment of Autonomy Scale ( HPEAS). The mean score of HPEAS was 101.1 ± 14.5 (range 54-122). In our population, Cronbach's alpha was 0.89. Scores in HPEAS were not related to demographical factors but positively associated with increasing self-efficacy and absence of pain. The novel findings contribute to an understanding of autonomy from the residents' perspective. [ABSTRACT FROM AUTHOR]

Economic theory suggests that incentives matter for people's decisions. This paper investigates whether this also holds for less self-evident areas of life such as the timing of births. We use a natural experiment when the German government changed its parental benefit system on January 1, 2007. The policy change strongly increased economic incentives for women to postpone delivery provided that they were employed. Applying a difference-in-difference-in-difference approach, we find very strong evidence that women with an employment history near to the end of their term indeed succeeded to shift births to the New Year and, therefore, could benefit from the new and more generous parental benefit system. Suggesting a model of chain reactions, we also report evidence that some women with due dates earlier in December tried but did not succeed to shift births to the New Year. [ABSTRACT FROM AUTHOR]

Abstract: This paper uses the introduction of tuition fees in seven of the sixteen German states in 2007 as a natural experiment to identify the effects of tuition prices on enrollment probabilities. Based on information on enrollment decisions of the entire population of high-school graduates between 2002 and 2008, I find a negative effect of tuition fees on enrollment behavior. The effect is larger than in existing studies for European countries, but of a similar magnitude as effects identified with U.S. data. A potential spill-over effect of the policy intervention to the comparison group is accounted for by using the estimation results to calibrate a structural model of the enrollment decision. [Copyright &y& Elsevier]

Abstract: Quantitative and qualitative approaches to assessing and valuing ecosystem services have been compared using case studies from Italy and Germany. This paper describes and analyzes two different methods of applying an ecosystem service approach and discusses their relative strengths, shortcomings and peculiarities. This allows the conditions to be identified that best support the application of one or other of these methods. Suggestions are offered on how to integrate both methodologies in order to improve the implementation of an ecosystem service approach in decision-making processes. [Copyright &y& Elsevier]

Student recruitment is an increasingly important topic for universities worldwide. But in order to develop sophisticated recraitment strategies, recruitment officers need to have a clear understanding of how and why students choose colleges. This review compares the German and US research concerning university choice models, choice criteria and information sources prospective students use when exploring their options after school. The paper emphasizes the complexity of the decision-making processes of freshmen and reveals three gaps in the German student recruitment research literature. The development of a German university choice model, an increased application of explorative research methodologies, and the consideration of additional aspects possibly impacting the college choice could help to refine German research approaches. [ABSTRACT FROM AUTHOR]

Abstract: In many cases decision-makers apparently do not adapt as fast as expected to changing economic conditions. This is also the case for the conversion of farm land to short rotation coppice. From an economic point of view, short rotation coppice has become more interesting in the last few years. Nevertheless, farm land still is rarely used to grow this quite unknown crop. Several explanatory approaches (e.g., traditionalistic behavior and risk aversion) are currently discussed in order to explain this behavior. A relatively new explanatory approach is the Real Options Approach. The Real Options Approach uses a comprehensive dynamic-stochastic model that combines the uncertainty of investment returns, the sunk costs, and the temporal flexibility of the investment implementation. The quintessence of the Real Options Approach is that—compared to the Classical Investment Theory—the investment triggers will be shifted upwards if investments involve intertemporal opportunity costs. This paper develops a real options model which allows the determination of triggers on the basis of realistic assumptions. We examined when farmers, who only dispose of sandy soils with little water-storing capacity, should convert set-aside land to short rotation coppice. The results show that farmers should not convert until the present value of the investment returns exceeds the investment costs considerably. Thus, they confirm the empirically observed reluctance in conversion. Furthermore, it turned out that the magnitude of the difference between the Classical Investment Theory and the Real Options Approach depends heavily on the type of stochastic process that underlies the investment returns. [Copyright &y& Elsevier]

Background: Little is known about the practice of palliative sedation (PS) in Germany. This paper presents an analysis of sedation-related data obtained from the German standardized core documentation system (HOPE) for palliative care patients. Methods: HOPE was complemented by an optional module on ethical decision making (EDM) which was pretested in 2004, data was collected in 2005-6 during the annual 3-month census. Data was analyzed descriptively from palliative care units (PCU - representative) and inpatient hospice (H - non-representative control group). Chi2 test was used to test for differences between the reported data per item and year within one kind of setting (significance level p ≤ 0.05). Free-text entries were categorized inductively. Results: Datasets were obtained for 1,944 patients (P) with EDM. PS was performed in 13.0/11.8% (2005/2006) P in palliative care units (PCU) and 25.5/22.9% in hospices (H). Main reasons for PS in PCU were dyspnea, pain, fear or anxiety, in H reasons were inconsistent, high prevalence of psychosocial reasons. Most PS in PCU and about half of the PS in H were intermittent. Sedated P were younger than non-sedated. Only 7 P received PS after asking for euthanasia. The most used medication was midazolam. Conclusions: This study reveals a first insight into the use and practice of PS in German PCU and H. For a more detailed systematic survey into the course of decision-making and procedures, a new complementary optional module on PS is being developed by the HOPE group. [ABSTRACT FROM AUTHOR]

Abstract: The location of first generation processing plants for biogas using bulky inputs is a prominent example of locational decisions of plants that face high per unit transport costs of feedstock and simultaneously depend to a large extent on feedstock availability. Modelling the resulting regional feedstock markets then requires a spatially explicit representation of demand. With production capacities of plants small in comparison to market size, large numbers of possible type-location combinations need to be considered, requiring considerable computation time under existing integer programming-based approaches. Therefore, in this paper we aim to present an alternative, faster and more flexible iterative solution approach to simulate location decisions for processing plants. And with greater flexibility, this approach is able to take into account spatially heterogeneous transport costs depending on total demand. The approach is implemented in a modelling framework for biogas production from green maize in Germany, which currently accounts for ca. five per cent of Germany’s agricultural area. By modifying green maize prices, demand functions are derived and intersected with regional supply functions from an agricultural model to simulate market clearing prices and quantities. The application illustrates that our approach efficiently simulates markets characterised by small-scale demand units and high, spatially heterogeneous transport costs. [Copyright &y& Elsevier]

Abstract: The analysis of the environmental situation in urban areas is of higher importance than ever because of the altered urban ecosystem itself and its impacts on ecosystem services for the rapidly growing urban population. A major challenge remains in developing methods to assess and value ecosystem services and integrate them in urban decision-making processes. In this paper, the urban environmental indicator “Biotope Area Ratio” (BAR) is studied. We aim to analyse the benefits and limits of the BAR to assess and manage the urban ecosystem services using high resolution remote-sensing. We choose two urban environmental settings in Berlin and Seoul where the BAR has been already successfully applied. Results show that the BAR as is represents a valuable instrument and augments existing indicators but that there are modifications advisable to address recent challenges of ecosystem services in urban areas. For the successful implementation as a planning instrument we identify the legally required regulation in the planning process and the existence of reliable data as major challenges. The investigated high resolution remote-sensing based approach provides some advantages to map surface types of the urban environment for a first screening, monitoring and evaluation of implemented measures of the BAR and can therefore support existing field mappings. Insights from our study may stimulate developments of explicitly assessing and managing urban ecosystem services using aggregated indicators such as the BAR and may highlight the importance of a more adequate representation of the urban environment in decision-making processes in other cities in the future. [Copyright &y& Elsevier]