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Die Beschaffung von Leistungen zur medizinischen Rehabilitation wurde durch den neuen § 15 SGB VI zum 1. Juli 2023 grundlegend reformiert. Seither gilt ein mehrstufiges System aus Zulassung der Rehabilitationskliniken, Belegungsvertrag, Belegungsentscheidung und Vergütung. Sämtliche Beschaffungsstufen werden von der DRV Bund durch verbindliche Entscheidungen gesteuert.
Dieses neue Beschaffungssystem verstößt gegen das Wettbewerbsrecht der Europäischen Union und ist deshalb unwirksam. Das Unionsrecht (Art. 106 Abs. 1 AEUV), aber auch das nationale Kartellrecht (§ 19 Abs. 2 Nr. 1 GWB) und das Verfassungsrecht (Art. 12 Abs. 1 GG) verlangen eine Trennung von hoheitlichen Befugnissen und unternehmerischen Funktionen der Rentenversicherungsträger. Anderenfalls ist die gebotene Gleichbehandlung (Nichtdiskriminierung) der Rehabilitationskliniken freigemeinnütziger und privater Träger mit den Rehabilitationskliniken der Rentenversicherungsträger bei der Erbringung von Leistungen zur medizinischen Rehabilitation nicht gewährleistet.
Dieses Trennungsprinzip ist verletzt. Denn die Rentenversicherungsträger nehmen hoheitliche Zulassungs-, Belegungs- und Vergütungsaufgaben wahr und sind gleichzeitig unternehmerisch mit eigenen Rehabilitationseinrichtungen auf dem Markt der Erbringung von Leistungen zur medizinischen Rehabilitation tätig. Freigemeinnützige und private Rehabilitationskliniken werden auf allen Stufen der Beschaffung gegenüber den Kliniken der Rentenversicherungsträger diskriminiert. Das gilt insbesondere für die Belegungsentscheidungen der Rentenversicherungsträger, weil hierdurch systematisch eigene Kliniken gegenüber freigemeinnützigen und privaten Kliniken begünstigt werden.
Invisible iterations: how formal and informal organization shape knowledge networks for coordination
(2024)
This study takes a network approach to investigate coordination among knowledge workers as grounded in both formal and informal organization. We first derive hypotheses regarding patterns of knowledge-sharing relationships by which workers pass on and exchange tacit and codified knowledge within and across organizational hierarchies to address the challenges that underpin contemporary knowledge work. We use survey data and apply exponential random graph models to test our hypotheses. We then extend the quantitative network analysis with insights from qualitative interviews and demonstrate that the identified knowledge-sharing patterns are the micro-foundational traces of collective coordination resulting from two underlying coordination mechanisms which we label ‘invisible iterations’ and ‘bringing in the big guns’. These mechanisms and, by extension, the associated knowledge-sharing patterns enable knowledge workers to perform in a setting that is characterized by complexity, uncertainty and ambiguity. Our research contributes to theory on the interplay between formal and informal organization for coordination by showing how self-directed, informal action is supported by the formal organizational hierarchy. In doing so, it also extends understanding of the role that hierarchy plays for knowledge-intensive work. Finally, it establishes the collective need to coordinate work as a previously overlooked driver of knowledge network relationships and network patterns. © 2024 The Authors. Journal of Management Studies published by Society for the Advancement of Management Studies and John Wiley & Sons Ltd.
We use worldwide gridded satellite data to analyse how population size and density affect urban PM 2.5 pollution. We find that more populated and denser grid cells are more exposed to pollution. However, across urban areas, exposure increases with cities’ population size but decreases with density. Moreover, the population effect is driven mostly by population commuting to core cities rather than the core city population itself. We analyse heterogeneity by geography and income levels. A counterfactual simulation shows that exposure could fall by up to 40% if population size were equalized across all cities within countries, but the relocation of population from large to small cities that maximizes welfare would be small.
We study the effect of energy and transport policies on pollution in two developing country cities. We use a quantitative equilibrium model with choice of housing, energy use, residential location, transport mode, and energy technology. Pollution comes from commuting and residential energy use. The model parameters are calibrated to replicate key variables for two developing country cities, Maputo, Mozambique, and Yogyakarta, Indonesia. In the counterfactual simulations, we study how various transport and energy policies affect equilibrium pollution. Policies may be induce rebound effects from increasing residential energy use or switching to high emission modes or locations. In general, these rebound effects tend to be largest for subsidies to public transport or modern residential energy technology.
It is a common finding that preschoolers have difficulties in identifying who is doing what to whom in non-canonical sentences, such as (object-verb-subject) OVS and passive sentences in German. This dissertation investigates how German monolingual and German-Italian simultaneous bilingual children process German OVS sentences in Study 1 and German passives in Study 2. Offline data (i.e., accuracy data) and online data (i.e., eye-gaze and pupillometry data) were analyzed to explore whether children can assign thematic roles during sentence comprehension and processing. Executive functions, language-internal and -external factors were investigated as potential predictors for children’s sentence comprehension and processing.
Throughout the literature, there are contradicting findings on the relation between language and executive functions. While some results show a bilingual cognitive advantage over monolingual speakers, others suggest there is no relationship between bilingualism and executive functions. If bilingual children possess more advanced executive function abilities than monolingual children, then this might also be reflected in a better performance on linguistic tasks. In the current studies monolingual and bilingual children were tested by means of two executive function tasks: the Flanker task and the task-switching paradigm. However, these findings showed no bilingual cognitive advantages and no better performance by bilingual children in the linguistic tasks. The performance was rather comparable between bilingual and monolingual children, or even better for the monolingual group. This may be due to cross-linguistic influences and language experience (i.e., language input and output). Italian was used because it does not syntactically overlap with the structure of German OVS sentences, and it only overlapped with one of the two types of sentence condition used for the passive study - considering the subject-(finite)verb alignment. The findings showed a better performance of bilingual children in the passive sentence structure that syntactically overlapped in the two languages, providing evidence for cross-linguistic influences.
Further factors for children’s sentence comprehension were considered. The parents’ education, the number of older siblings and language experience variables were derived from a language background questionnaire completed by parents. Scores of receptive vocabulary and grammar, visual and short-term memory and reasoning ability were measured by means of standardized tests. It was shown that higher German language experience by bilinguals correlates with better accuracy in German OVS sentences but not in passive sentences. Memory capacity had a positive effect on the comprehension of OVS and passive sentences in the bilingual group. Additionally, a role was played by executive function abilities in the comprehension of OVS sentences and not of passive sentences. It is suggested that executive function abilities might help children in the sentence comprehension task when the linguistic structures are not yet fully mastered.
Altogether, these findings show that bilinguals’ poorer performance in the comprehension and processing of German OVS is mainly due to reduced language experience in German, and that the different performance of bilingual children with the two types of passives is mainly due to cross-linguistic influences.
In Immobilienkaufverträgen finden sich nicht selten Vertragsklauseln, welche die Maklerprovision auf den anderen Beteiligten abwälzen sollen. Die rechtliche Ausgangssituation hat sich für diese sog. Maklerprovisionsklauseln durch die Novellierung des Maklerrechts (§§ 656a–656d BGB) im Zuge des Gesetzes über die Verteilung der Maklerkosten bei der Vermittlung von Kaufverträgen über Wohnungen und Einfamilienhäuser (BGBl. 2020 I 1245) grundlegend verändert. An diese Entwicklung knüpft die vorliegende Klausur an. Sie behandelt Grundfragen des Textformerfordernisses bei Abschluss eines Maklervertrags (§ 656a, § 126b BGB) sowie die Möglichkeiten und Grenzen der Provisionsabwälzung auf einen Verbraucher. Im Mittelpunkt des Falls steht eine Maklerprovisionsklausel aus der Kautelarpraxis. Damit dient der nachfolgende Beitrag nicht nur der Vermittlung des examensrelevanten neuen Maklerrechts, sondern auch der Förderung vertragsgestalterischer Fähigkeiten.
The experience of premenstrual syndrome (PMS) affects up to 90% of individuals with an active menstrual cycle and involves a spectrum of aversive physiological and psychological symptoms in the days leading up to menstruation (Tschudin et al., 2010). Despite its high prevalence, the precise origins of PMS remain elusive, with influences ranging from hormonal fluctuations to cognitive, social, and cultural factors (Hunter, 2007; Matsumoto et al., 2013).
Biologically, hormonal fluctuations, particularly in gonadal steroids, are commonly believed to be implicated in PMS, with the central factor being varying susceptibilities to the fluctuations between individuals and cycles (Rapkin & Akopians, 2012). Allopregnanolone (ALLO), a neuroactive steroid and progesterone metabolite, has emerged as a potential link to PMS symptoms (Hantsoo & Epperson, 2020). ALLO is a positive allosteric modulator of the GABAA receptor, influencing inhibitory communication (Rupprecht, 2003; Andréen et al., 2006). Different susceptibility to ALLO fluctuations throughout the cycle may lead to reduced GABAergic signal transmission during the luteal phase of the menstrual cycle.
The GABAergic system's broad influence leads to a number of affected physiological systems, including a consistent reduction in vagally mediated heart rate variability (vmHRV) during the luteal phase (Schmalenberger et al., 2019). This reduction in vmHRV is more pronounced in individuals with high PMS symptoms (Baker et al., 2008; Matsumoto et al., 2007). Fear conditioning studies have shown inconsistent associations with cycle phases, suggesting a complex interplay between physiological parameters and PMS-related symptoms (Carpenter et al., 2022; Epperson et al., 2007; Milad et al., 2006).
The neurovisceral integration model posits that vmHRV reflects the capacity of the central autonomous network (CAN), which is responsible for regulatory processes on behavioral, cognitive, and autonomous levels (Thayer & Lane, 2000, 2009). Fear learning, mediated within the CAN, is suggested to be indicative of vmHRV's capacity for successful
VI
regulation (Battaglia & Thayer, 2022). Given the GABAergic mediation of central inhibitory functional connectivity in the CAN, which may be affected by ALLO fluctuations, this thesis proposes that fluctuating CAN activity in the luteal phase contributes to diverse aversive symptoms in PMS.
A research program was designed to empirically test these propositions. Study 1 investigated fear discrimination during different menstrual cycle phases and its interaction with vmHRV, revealing nuanced effects on acoustic startle response and skin conductance response. While there was heightened fear discrimination in acoustic startle responses in participants in the luteal phase, there was an interaction between menstrual cycle phase and vmHRV in skin conductance responses. In this measure, heightened fear discrimination during the luteal phase was only visible in individuals with high resting vmHRV; those with low vmHRV showed reduced fear discrimination and higher overall responses.
Despite affecting the vast majority of menstruating people, there are very limited tools available to reliably assess these symptoms in the German speaking area. Study 2 aimed at closing this gap, by translating and validating a German version of the short version of the Premenstrual Assessment Form (Allen et al., 1991), providing a reliable tool for future investigations, which closes the gap in PMS questionnaires in the German-speaking research area.
Study 3 employed a diary study paradigm to explore daily associations between vmHRV and PMS symptoms. The results showed clear simultaneous fluctuations between the two constructs with a peak in PMS and a low point in vmHRV a few days before menstruation onset. The association between vmHRV and PMS was driven by psychological PMS symptoms.
Based on the theoretical considerations regarding the neurovisceral perspective on PMS, another interesting construct to consider is attentional control, as it is closely related to functions of the CAN. Study 4 delved into attentional control and vmHRV differences between menstrual cycle phases, demonstrating an interaction between cycle phase and PMS symptoms. In a pilot, we found reduced vmHRV and attentional control during the luteal phase only in participants who reported strong PMS.
While Studies 1-4 provided evidence for the mechanisms underlying PMS, Studies 5 and 6 investigated short- and long-term intervention protocols to ameliorate PMS symptomatology. Study 5 explored the potential of heart rate variability biofeedback (HRVB) in alleviating PMS symptoms and a number of other outcome measures. In a waitlist-control design, participants underwent a 4-week smartphone-based HRVB intervention. The results revealed positive effects on PMS, with larger effect sizes on psychological symptoms, as well as on depressive symptoms, anxiety/stress and attentional control.
Finally, Study 6 examined the acute effects of HRVB on attentional control. The study found positive impact but only in highly stressed individuals.
The thesis, based on this comprehensive research program, expands our understanding of PMS as an outcome of CAN fluctuations mediated by GABAA receptor reactivity. The results largely support the model. These findings not only deepen our understanding of PMS but also offer potential avenues for therapeutic interventions. The promising results of smartphone-based HRVB training suggest a non-pharmacological approach to managing PMS symptoms, although further research is needed to confirm its efficacy.
In conclusion, this thesis illuminates the complex web of factors contributing to PMS, providing valuable insights into its etiological underpinnings and potential interventions. By elucidating the relationships between hormonal fluctuations, CAN activity, and psychological responses, this research contributes to more effective treatments for individuals grappling with the challenges of PMS. The findings hold promise for improving the quality of life for those affected by this prevalent and often debilitating condition.
Examining the dissemination of evidence on social media, we analyzed the discourse around eight visible scientists in the context of COVID-19. Using manual (N = 1,406) and automated coding (N = 42,640) on an account-based tracked Twitter/X dataset capturing scientists’ activities and eliciting reactions over six 2-week periods, we found that visible scientists’ tweets included more scientific evidence. However, public reactions contained more anecdotal evidence. Findings indicate that evidence can be a message characteristic leading to greater tweet dissemination. Implications for scientists, including explicitly incorporating scientific evidence in their communication and examining evidence in science communication research, are discussed.
In der DDR sollte die Rechtsprechung den Zielen der Politik und dem Aufbau sowie der Sicherung des Sozialismus dienen. Zur Verwirklichung dieser Ziele unternahm das SED-Regime insbesondere den Versuch, auf die Ausbildung des juristischen Nachwuchses Einfluss zu nehmen. Die Arbeit untersucht anhand der im Bundesarchiv verwahrten Originalquellen die Anforderungen, die an das juristische Studium in der DDR gestellt wurden, und die Umstände, unter denen die juristische Ausbildung erfolgte. Unter besonderer Berücksichtigung der Auswahl, Aus- und Weiterbildung der Staatsanwälte beleuchtet die Arbeit die sog. »Kaderarbeit« der DDR-Justiz sowie die wesentlichen Zulassungs-, Prüfungs-, Studien- und Weiterbildungsbedingungen. Die Auswertung des überlieferten Archivmaterials führt zu der Erkenntnis, dass die Aus- und Weiterbildung der DDR-Juristen zur Sicherstellung der Ziele der sozialistischen Partei durch eine planmäßige und systematische politisch-ideologische Erziehung und Kontrolle bestimmt war.
Economic crises as critical junctures for policy and structural changes towards decarbonization
(2024)
Crises may act as tipping points for decarbonization pathways by triggering structural economic change or offering windows of opportunity for policy change. We investigate both types of effects of the global financial and COVID-19 crises on decarbonization in Spain and Germany through a quantitative Kaya-decomposition analysis of CO2 emissions and through a qualitative review of climate and energy policy changes. We show that the global financial crisis resulted in a critical juncture for Spanish CO2 emissions due to the combined effects of the deep economic recession and crisis-induced structural change, resulting in reductions in carbon and energy intensities and shifts in the economic structure. However, the crisis also resulted in a rollback of renewable energy policy, halting progress in the transition to green electricity. The impacts were less pronounced in Germany, where pre-existing decarbonization and policy trends continued after the crisis. Recovery packages had modest effects, primarily due to their temporary nature and the limited share of climate-related spending. The direct short-term impacts of the COVID-19 crisis on CO2 emissions were more substantial in Spain than in Germany. The policy responses in both countries sought to align short-term economic recovery with the long-term climate change goals of decarbonization, but it is too soon to observe their lasting effects. Our findings show that crises can affect structural change and support decarbonization but suggest that such effects depend on pre-existing trends, the severity of the crisis and political manoeuvring during the crisis.
How do the rights of same-sex couples have to be ensured by states, and which kind of environmental obligations are induced by the right to life and to personal integrity? Questions as diverse and far-reaching as these are regularly dealt with by the Inter-American Court of Human Rights in its advisory function. This book is the first comprehensive, non-Spanish-written treatise on the advisory function of this Court. It analyzes the scope of the Court's advisory jurisdiction and its procedural practice in comparison with that of other international courts. Moreover, the legal effects of the Court’s advisory opinions and the question when the Court should better reject a request for an advisory opinion are examined.
Efficiently managing large state is a key challenge for data management systems. Traditionally, state is split into fast but volatile state in memory for processing and persistent but slow state on secondary storage for durability. Persistent memory (PMem), as a new technology in the storage hierarchy, blurs the lines between these states by offering both byte-addressability and low latency like DRAM as well persistence like secondary storage. These characteristics have the potential to cause a major performance shift in database systems.
Driven by the potential impact that PMem has on data management systems, in this thesis we explore their use of PMem. We first evaluate the performance of real PMem hardware in the form of Intel Optane in a wide range of setups. To this end, we propose PerMA-Bench, a configurable benchmark framework that allows users to evaluate the performance of customizable database-related PMem access. Based on experimental results obtained with PerMA-Bench, we discuss findings and identify general and implementation-specific aspects that influence PMem performance and should be considered in future work to improve PMem-aware designs. We then propose Viper, a hybrid PMem-DRAM key-value store. Based on PMem-aware access patterns, we show how to leverage PMem and DRAM efficiently to design a key database component. Our evaluation shows that Viper outperforms existing key-value stores by 4–18x for inserts while offering full data persistence and achieving similar or better lookup performance. Next, we show which changes must be made to integrate PMem components into larger systems. By the example of stream processing engines, we highlight limitations of current designs and propose a prototype engine that overcomes these limitations. This allows our prototype to fully leverage PMem's performance for its internal state management. Finally, in light of Optane's discontinuation, we discuss how insights from PMem research can be transferred to future multi-tier memory setups by the example of Compute Express Link (CXL).
Overall, we show that PMem offers high performance for state management, bridging the gap between fast but volatile DRAM and persistent but slow secondary storage. Although Optane was discontinued, new memory technologies are continuously emerging in various forms and we outline how novel designs for them can build on insights from existing PMem research.
While Information Systems Research exists at the individual and workgroup levels, research on IS at the enterprise level is less common. The potential synergies between the study of enterprise systems (ES) and related fields have been underexplored and often treated as separate entities. The ongoing challenge is to seamlessly integrate technological advances and align business processes across organizations. While systems integration within an organization is common, changes occur when industry and ecosystem perspectives come into play. The four selected papers address different facets of the future role of enterprise ecosystems, including implementation challenges, ecosystem boundaries, and B2B platform specifics.
Digital Fashion
(2024)
Das virtuelle Kleid als mediale und soziokulturelle Alltagserscheinung der Gegenwart bildet den Gegenstand der vorliegenden interdisziplinären Unter-suchung. An der Schnittstelle zwischen Menschen, Medien und Mode ist das virtuelle Kleid an unrealen Orten und in synthetischen Situationen ausschließlich auf einem Screen erfahrbar. In diesem Dispositiv lassen sich Körperkonzepte, Darstellungskonventionen, soziale Handlungsmuster und Kommunikations-strategien ausmachen, die zwar auf einer radikalen Ablösung vom textilen Material beruhen, aber dennoch nicht ohne sehr konkrete Verweise auf das textile Material auskommen. Dies führt zu neuen Ansätzen der Auseinandersetzung mit Kleidern, die nun als Visualisierung gebündelter Datenpakete zu betrachten sind. Die dynamische Entwicklung neuer Erscheinungsformen und deren nahtlose Einbindung in traditionelle Geschäftsmodelle und bestehende Modekonzepte macht eine Positionsbestimmung notwendig, insbesondere im Hinblick auf gegenwärtige Nachhaltigkeitsdiskurse um immaterielle Produkte. Für diese Studie liefern die hinter den Bildern liegenden Prozesse der ökonomischen Ausrichtung, der Herstellung, der Verwendung und der Rezeption den methodologischen Zugang für die Analyse. Mithilfe eines typologisierenden Instrumentariums wird aus der Vielzahl und Vielfalt der Darstellungen ein Set an forschungsleitenden Beispielen zusammengestellt, welche dann in einer mehrstufigen Kontextanalyse zu einer begrifflichen Fassung des virtuellen Kleides sowie zu fünf Kontexteinheiten führen. Am Beispiel des virtuellen Kleides zeichnet diese Untersuchung den technischen, gesellschaftlichen und sozialen Wandel nach und arbeitet seine Bedeutung für zukünftige Modeentwicklungen heraus. Damit leistet die Untersuchung einen Beitrag zur medien- und sozialwissenschaftlichen Modeforschung der Gegenwart.
In this paper, we study how the European Financial Reporting Advisory Group (EFRAG) used different legitimacy strategies between 2004 and 2021 to secure its organisational survival. Although EFRAG is now an established player within the regulatory space of corporate reporting, the organisation’s path towards this position was not straightforward. Based on 20 interviews with current and former members of EFRAG and archival documents, we investigate how EFRAG initially gained and maintained its legitimacy and how it responded to a legitimacy crisis arising in the aftermath of the 2008–2009 financial crisis. Based on prior research on organisational strategies for legitimising actions, we derive a framework for our analysis and show how EFRAG has adapted various legitimacy strategies over time. We further find that the use of legitimacy strategies is constrained by various systemic factors and show how EFRAG’s adaptations to its legitimacy strategies led to new tensions. Our findings contribute to the literature on private regulatory organisations’ legitimacy and the political economy of standard setting.
Ausgehend von der Beobachtung, dass die aktuelle Digitalisierungsforschung die Ambivalenz der Digitalisierung zwar erkennt, aber nicht zum Gegenstand ihrer Analysen macht, fokussiert die vorliegende kumulative Dissertation auf die ambivalente Dichotomie aus Potenzialen und Problemen, die mit digitalen Transformationen von Organisationen einhergeht. Entlang von sechs Publikationen wird mit einem systemtheoretischen Blick auf Organisationen die spannungsvolle Dichotomie hinsichtlich dreier ambivalenter Verhältnisse aufgezeigt: Erstens wird in Bezug auf das Verhältnis von Digitalisierung und Postbürokratie deutlich, dass digitale Transformationen das Potenzial aufweisen, postbürokratische Arbeitsweisen zu erleichtern. Parallel ergibt sich das Problem, dass auf Konsens basierende postbürokratische Strukturen Digitalisierungsinitiativen erschweren, da diese auf eine Vielzahl von Entscheidungen angewiesen sind. Zweitens zeigt sich mit Blick auf das ambivalente Verhältnis von Digitalisierung und Vernetzung, dass einerseits organisationsweite Kooperation ermöglicht wird, während sich andererseits die Gefahr digitaler Widerspruchskommunikation auftut. Beim dritten Verhältnis zwischen Digitalisierung und Gender deutet sich das mit neuen digitalen Technologien einhergehende Potenzial für Gender Inklusion an, während zugleich das Problem einprogrammierter Gender Biases auftritt, die Diskriminierungen oftmals verschärfen. Durch die Gegenüberstellung der Potenziale und Probleme wird nicht nur die Ambivalenz organisationaler Digitalisierung analysierbar und verständlich, es stellt sich auch heraus, dass mit digitalen Transformationen einen doppelte Formalisierung einhergeht: Organisationen werden nicht nur mit den für Reformen üblichen Anpassungen der formalen Strukturen konfrontiert, sondern müssen zusätzlich formale Entscheidungen zu Technikeinführung und -beibehaltung treffen sowie formale Lösungen etablieren, um auf unvorhergesehene Potenziale und Probleme reagieren. Das Ziel der Dissertation ist es, eine analytisch generalisierte Heuristik an die Hand zu geben, mit deren Hilfe die Errungenschaften und Chancen digitaler Transformationen identifiziert werden können, während sich parallel ihr Verhältnis zu den gleichzeitig entstehenden Herausforderungen und Folgeproblemen erklären lässt.
Lust auf Verzicht
(2024)
Der globale Klimawandel nimmt weiter bedrohlich zu. Hitzewellen, Flutkatastrophen und Waldbrände gehören fast schon zum Alltag. Trotzdem ist die Bereitschaft in der deutschen Bevölkerung gering, selbst einen Beitrag zum Klimaschutz zu leisten. Das überrascht, denn in Umfragen bekennt sich immer eine große Mehrheit zum Klimaschutz. Allerdings haben wohl viele einen Klimaschutz im Kopf, der persönlich nichts kosten und nichts verändern darf.
Ingo Balderjahn setzt sich mit diesem Widerspruch aus verhaltenswissenschaftlicher Sicht auseinander und legt offen, warum viele weiterhin ungebremst verschwenderisch und klimaschädlich konsumieren. Andererseits gibt es durchaus Menschen, die deutlich weniger konsumieren, als sie sich finanziell leisten könnten. Diese Minderheit in Deutschland verzichtet freiwillig auf eher unnötige und kurzlebige Güter - ohne irgendetwas dabei zu entbehren. Im Gegenteil: Genügsame Konsumgewohnheiten stärken die persönliche Selbstbestimmung, Unabhängigkeit und Zufriedenheit.