TY - JOUR A1 - Stangl, Stephanie A1 - Rauch, Sebastian A1 - Rauh, Jürgen A1 - Meyer, Martin A1 - Müller‐Nordhorn, Jacqueline A1 - Wildner, Manfred A1 - Wöckel, Achim A1 - Heuschmann, Peter U. T1 - Disparities in Accessibility to Evidence-Based Breast Cancer Care Facilities by Rural and Urban Areas in Bavaria, Germany JF - Cancer N2 - Background Breast cancer (BC), which is most common in elderly women, requires a multidisciplinary and continuous approach to care. With demographic changes, the number of patients with chronic diseases such as BC will increase. This trend will especially hit rural areas, where the majority of the elderly live, in terms of comprehensive health care. Methods Accessibility to several cancer facilities in Bavaria, Germany, was analyzed with a geographic information system. Facilities were identified from the national BC guideline and from 31 participants in a proof‐of‐concept study from the Breast Cancer Care for Patients With Metastatic Disease registry. The timeframe for accessibility was defined as 30 or 60 minutes for all population points. The collection of address information was performed with different sources (eg, a physician registry). Routine data from the German Census 2011 and the population‐based Cancer Registry of Bavaria were linked at the district level. Results Females from urban areas (n = 2,938,991 [ie, total of females living in urban areas]) had a higher chance for predefined accessibility to the majority of analyzed facilities in comparison with females from rural areas (n = 3,385,813 [ie, total number of females living in rural areas]) with an odds ratio (OR) of 9.0 for cancer information counselling, an OR of 17.2 for a university hospital, and an OR of 7.2 for a psycho‐oncologist. For (inpatient) rehabilitation centers (OR, 0.2) and genetic counselling (OR, 0.3), women from urban areas had lower odds of accessibility within 30 or 60 minutes. Conclusions Disparities in accessibility between rural and urban areas exist in Bavaria. The identification of underserved areas can help to inform policymakers about disparities in comprehensive health care. Future strategies are needed to deliver high‐quality health care to all inhabitants, regardless of residence. KW - accessibility KW - breast cancer KW - evidence‐based medicine KW - geographic information science KW - health care service research Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239854 VL - 127 IS - 13 SP - 2319 EP - 2332 ER - TY - THES A1 - Rüppel, Frederike T1 - Accessibility of Bilinear Interconnected Systems T1 - Akzessibilität von bilinear vernetzten Systemen N2 - The subject of this thesis is the controllability of interconnected linear systems, where the interconnection parameter are the control variables. The study of accessibility and controllability of bilinear systems is closely related to their system Lie algebra. In 1976, Brockett classified all possible system Lie algebras of linear single-input, single-output (SISO) systems under time-varying output feedback. Here, Brockett's results are generalized to networks of linear systems, where time-varying output feedback is applied according to the interconnection structure of the network. First, networks of linear SISO systems are studied and it is assumed that all interconnections are independently controllable. By calculating the system Lie algebra it is shown that accessibility of the controlled network is equivalent to the strong connectedness of the underlying interconnection graph in case the network has at least three subsystems. Networks with two subsystems are not captured by these proofs. Thus, we give results for this particular case under additional assumption either on the graph structure or on the dynamics of the node systems, which are both not necessary. Additionally, the system Lie algebra is studied in case the interconnection graph is not strongly connected. Then, we show how to adapt the ideas of proof to networks of multi-input, multi-output (MIMO) systems. We generalize results for the system Lie algebra on networks of MIMO systems both under output feedback and under restricted output feedback. Moreover, the case with generalized interconnections is studied, i.e. parallel edges and linear dependencies in the interconnection controls are allowed. The new setting demands to distinguish between homogeneous and heterogeneous networks. With this new setting only sufficient conditions can be found to guarantee accessibility of the controlled network. As an example, networks with Toeplitz interconnection structure are studied. N2 - Gegenstand der Doktorarbeit ist die Steuerbarkeit vernetzter linearer Systeme, in denen Kopplungsparamter die Kontrollvariablen bilden. In 1976 hat Brockett alle möglichen System Lie Algebren klassifiziert, die bei einem single-input, single-output (SISO) System unter zeitvarianter Ausgangsrückführung auftreten können. Dieses Ergebnis wird auf Netzwerke von linearen Systemen, die durch zeitvariante Ausgangsrückführung miteinander gekoppelt sind, verallgemeinert. Als erstes werden hierfür Netzwerke von SISO Systemen unter der Annahme betrachtet, dass alle Kopplungen unabhängig voneinander kontrollierbar sind. Indem man die Lie Algebra berechnet, wird gezeigt, dass Akzessibilität des kontrollierten Netzwerkes äquivalent ist zum starken Zusammenhang des zugrundeliegenden Kopplungsgraphen falls das Netzwerk aus mindestens drei Subsystemen besteht. Der Beweis kann nicht auf Netzwerke mit zwei Subsystemen übertragen werden. Daher werden Resultate für diesen Fall unter Zusatzannahmen angegeben, einmal an die Graphstruktur und einmal an die Dynamik der Subsysteme, wobei beide Annahmen nicht notwendig sind. Zudem wird die Struktur der System Lie Algebra untersucht falls der zugrundeliegende Kopplungsgraph nicht stark zusammenhängend ist. Es werden dieselben Ergebnisse für Netzwerke von multi-input, multi-output (MIMO) Systemen verallgemeinert. Außerdem werden verallgemeinerte Kopplungen betrachtet, d.h. lineare Abhängigkeiten zwischen den Kopplungen und parallele Kopplungen können auftreten. Hierbei muss nun zwischen homogenen und heterogenen Netzwerken unterschieden werden. Die Ergebnisse liefern hinreichende Bedingungen für Akzessibilität. Als Beispiel werden Netzwerke, deren Kopplungsstruktur Toeplitz ist, betrachtet. KW - Steuerbarkeit KW - vernetze lineare Systeme KW - Steuerbarkeit von Netzwerken KW - Akzessibilität KW - interconnected systems KW - accessibility KW - Netzwerk KW - Lineares System Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-99250 ER -