Society needs information and communication technology (ICT) hardware to produce, process and store highly valuable information. This hardware, of course, affects the environment throughout its whole life cycle, starting with manufacturing, where the necessary scarce and precious resources (e.g. rare earth metals) are often mined under miserable environmental conditions. This leads to pollution of soil, water and air in the present as well as for the future. During the use phase of ICT hardware, energy consumption impacts the environment. At the end of life of ICT hardware, recycling, disposing as e-waste in landfills or disassembling are additional impacts that affect the environment. More and more producers and users, especially companies, want to measure these impacts, which is a complex task. However, approaches to measure the impacts are at hand, either as single indicators, measuring one specific impact, or as composed indicators, combining different single indicators into one "summarizing" indicator. However, collection of data, measurement, assessment and interpretation are challenging. Unfortunately, guidelines for those who want to measure the impact of ICT hardware are rare. With our research, we aim to shed light on the various approaches to measure impacts of ICT hardware as well as their application in practice. Based on a literature review, we identified different indicators and them to the attention of experts from companies to assess these approaches in terms of practicability, significance and value for practice. The results show that research investigates and proposes a variety of different more or less complex indicators. However, business prefers single indicators, which are easy to measure and understand.

When only whole years of age are recorded in survey data, children who experienced a birthday since the beginning of the school year may appear to be of school-age when they are not, or vice-versa. This creates an error in estimates of school participation indicators based on such data. This issue is well-known in education statistics, and several procedures attempting to correct for this error have been proposed. The present study critiques current practice and demonstrates that its limitations continue to confound educational research and high-stakes policy conclusions: speculative explanations have been proposed for what is actually a measurement artefact. An alternative adjustment strategy is proposed that coherently exploits all available information and explicitly indicates the remaining uncertainty. The application of the method is illustrated by a number of empirical case studies using recent household survey data. These examples demonstrate that the method is feasible, accurate, and that taking survey timing into account can significantly alter how these data are interpreted.

O objetivo deste estudo foi avaliar a prevalência de cárie dentária e sua associação com índice de massa corpórea (IMC), bem como seus fatores de risco demográficos (sexo e idade), socioeconômicos, familiares (escolaridade dos pais, número de filhos) e comportamentais (dieta e práticas de higiene bucal) de crianças e adolescentes. Duzentos e trinta e sete crianças e adolescentes foram inseridos neste estudo. Após a autorização de participação, aplicou-se um questionário, realizou-se exame clínico intrabucal das crianças e a coleta dos dados antropométricos. Os parâmetros analisados neste estudo foram peso, altura, IMC-para-idade e número de dentes cariados, extraídos e obturados para posterior cálculo do ceo-d ou CPO-D para dentes decíduos e permanentes, respectivamente. Teste do Qui-quadrado e o teste T foram usados para analisar a associação entre as variáveis (idade, etnia, gênero, hábitos de higiene bucal e alimentar) e alterações do IMC. A média e desvio padrão do índice ceo-d nos grupos de baixo peso, peso normal, grupos de sobrepeso e obesidade, foram de 9.5 (± 0.70), 5.06 (± 4.54), 7.66 (± 4.41), e 6 (± 5.19), respectivamente (p>0,05). A porcentagem de indivíduos que estavam com a dentição hígida foi de 13,5%. Houve uma associação entre prevalência de cárie e etnia (p<0,05), indivíduos de cor branca e parda apresentaram maiores índices de cárie do que os indivíduos pretos. Características sociodemográficas como escolaridade materna e paterna não influenciaram na experiência de cárie das crianças e adolescentes (p>0,05). Em relação aos hábitos alimentares na primeira infância, o tempo de aleitamento materno não influenciou na experiência de cárie (p>0,05), por outro lado, o açúcar acrescido na mamadeira esteve associado à doença cáries (p<0,05). A escovação diária realizada somente pela criança, sem supervisão dos pais ou responsáveis, foi significativamente associada com a cárie. Não houve associação entre cárie dentária e IMC. / The aim of this study was to evaluate the prevalence of dental caries and its association with body mass index (BMI), as well as their demographic risk factors (gender and age), socioeconomic, family (parents\' education, number of children) and behavioral (diet and oral hygiene practices) of children and adolescents. Two hundred and thirty-seven children and adolescents 3-15 years treated were entered into this study at the Ribeirão Preto Dental School - USP. After the authorization of participation, we applied a questionnaire and an intraoral clinical examination of children was held and the collection of anthropometric data. The parameters analyzed in this study were weight, height, BMI-for-age and number of decayed teeth extracted and sealed for subsequent calculation of the dmft and DMFT for deciduous and permanent teeth, respectively. It was used the Chi-square test and T test to analyze the association between variables (age, ethnicity, gender, oral hygiene and dietary habits) and changes in BMI. The mean and standard deviation of the DMFT in groups of underweight, normal weight, overweight and obese groups were 9.5 (± 0.70), 5:06 (± 4:54), 7.66 (± 4:41), and six (± 5.19), respectively (p> 0.05). The percentage of subjects who were healthy female with the teeth was 13.5%. There was an association between caries prevalence and ethnicity (p <0.05), white and brown colored individuals had higher caries rates than black individuals. Sociodemographic characteristics such as maternal and paternal schooling did not influence the caries experience of children and adolescents (p> 0.05). With regard to eating habits in early childhood, the duration of breastfeeding did not affect the caries experience (p> 0.05), on the other hand, sugar plus the bottle was associated with caries disease (p <0.05). Daily brushing performed only by the child without supervision of parents or guardians, was significantly associated with caries. There was no association between dental caries and BMI.

O presente estudo foi dividido em dois experimentos, tendo como objetivo determinar a curva de excreção do cortisol fecal e sua estabilidade nas fezes perante exposição à diferentes períodos de tempo e temperatura entre as colheitas e análises, correlacionando os níveis de cortisol fecal com o pico de cortisol sanguíneo. No experimento 1, seis fêmeas mestiças (Dorper x Santa Inês) tiveram suas fezes totais colhidas durante 24 horas após a aplicação do hormônio adrenocorticotrófico (ACTH), além de colheitas de sangue realizadas antes da aplicação do ACTH, 60, 120 e 300 minutos depois; durante as quais foram atribuídos escores de reatividade para cada animal. Logo após as análises foi iniciado o experimento 2, no qual 9 cordeiros mestiços (Dorper x Santa Inês) foram submetidos a uma situação de estresse térmico durante os horários das 11 às 15 horas da tarde, tendo suas fezes colhidas às 23 horas do mesmo dia. Após a colheita, as fezes foram agrupadas e homogeneizadas em três grupos distintos, de onde retiraram-se alíquotas referentes aos tratamentos propostos: três temperaturas (15°, 25° e 35°) e quatro tempos (1, 3, 6 e 12 horas). Os dados da curva de excreção foram analisados por ANOVA, bem como pela correlação entre os valores de cortisol sanguíneo, fecal e reatividade. Para análise da estabilidade foi utilizada ANOVA multifatorial com dois fatores (temperatura e intervalo de tempo). Para avaliação das variáveis comportamentais foi realizada a transformação de escala dos dados para \"arco-seno raiz de porcentagem\", procedendo-se à análise de variância. O modelo estatístico contemplou os efeitos de dia (1, 2 e 3) com análise individual por animal. Os parâmetros de cortisol sanguíneo, frequência respiratória e temperatura retal foram analisados pelo teste t e correlação de Pearson. Todas as comparações de médias foram realizadas por teste F e teste t (PDIFF). A reatividade durante a colheita não exerceu efeito significativo sobre os valores de cortisol sanguíneo, os quais demonstraram médias maiores 60 minutos após a aplicação do ACTH e, após 300 minutos as ovelhas apresentaram níveis de cortisol considerados normais para ovinos sem estresse. Por outro lado, o pico de cortisol nas fezes foi verificado aproximadamente 10 a 12 horas após o pico de cortisol no sangue, não sendo verificadas diminuições significativas nas concentrações que indicassem o retorno aos níveis basais durante o período de 24 horas (P&gt;0,05). Não foram observadas diferenças significativas entre os tempos e temperaturas aos quais as amostras de fezes foram submetidas (P&gt;0,05), verificando-se uma tendência a manutenção da concentração do cortisol fecal em ovinos durante o período de 12 horas após a colheita. / This present study was divided into two experiments, aiming to determine the excretion curve of faecal cortisol and its stability over different periods of time and temperature between harvest and analyzes, correlating the fecal cortisol levels with peak blood cortisol. The project was developed in Biometeorology and Ethology Lab, Faculty of Animal Science and Food Engineering, University of São Paulo, Pirassununga - SP. In the first experiment, six crossbred (Dorper x Santa Inês) females sheep had their total feces collected during 24 hours after the application of adrenocorticotropic hormone (ACTH), beyond the blood samples taken before the application of ACTH, and one, two and five hours after application; in which was attributed reactivity scores to each animal. Soon after the analysis was started the second experiment, in which nine crossbred lambs (Dorper x Santa Inês) underwent a situation of thermal stress from 11 to 15 pm, and their feces were collected at 23 hours the same day. After harveting, the feces were pooled and homogenized in three different groups, where aliquots were withdrawn relating to the treatments proposed: three temperatures (15, 25 and 35°C) and four times (1, 3, 6 and 12 hours). The excretion curve data were analyzed by ANOVA, as well as the correlation between blood cortisol levels, faecal and reactivity. For stability analysis were used multifactor ANOVA with two factors (temperature and time range). To evaluate the behavioral variables was performed the transformation of the data range for \"arc sine percentage root\", proceeding to the analysis of variance. The statistical model included effects of day (1, 2 and 3) with individual analysis by animal. The blood cortisol parameters, respiratory rate and rectal temperature were analyzed by t test Pearson correlation. All comparisons of means were performed by F and t test (pdiff). The reactivity during harvest did not exert significant effect on blood cortisol levels, which showed higher averages 60 minutes after the application of ACTH, and after 300 minutes, the sheep showed cortisol levels considered normal to them, without stress. On the other hand, the peak of cortisol in the feces was observed approximately 10-12 hours after the peak of cortisol in the blood, not being observed significant decreases that indicate the return to the basal levels during the 24 hour period (P&gt;0, 05). Were not observed no significant differences between the time and temperature in which the faecal samples were subjected (P&gt;0.05), verifying a tendency on the maintenance of the concentration of faecal cortisol in sheep during the 12 hour period after harvest.

For over one hundred years, indicator organisms such as coliforms have been measured as an index of public health risk from transmission of waterborne diseases. Even so, waterborne disease outbreaks have occurred in systems with negative coliform results, many traced to viral or protozoan etiologies. Conversely, no discernible public health outcomes have occurred in systems with positive coliform results. These inconsistencies arise because coliforms, as bacteria, respond differently to environmental stressors and engineered treatment processes than protozoan and viral pathogens. Recent reviews of four decades of indicator and pathogen monitoring indicated that coliphages are more highly correlated to pathogen presence in a variety of waters than coliforms. Therefore, the goal of this research was to re-examine a variety of traditional and novel indicator systems to determine their value as indicators, either singly or as a toolbox. We collected samples of animal feces, wastewaters, source waters and treated drinking waters. Samples were collected from four geographical regions of the United States (Northeast, South, Midwest and West) to assess spatial variability and in all four seasons to assess temporal variability. Samples were monitored for total coliforms, E. coli, male-specific and somatic coliphages, and other physical and chemical water quality parameters including organic carbon, pH and turbidity. The detection of coliforms and E. coli in this study's drinking waters suggests fecal contamination and supports the need for indicator monitoring in drinking water systems. The strength of bacterial indicators (coliforms and E. coli) was supported in this study by the fact that there was no seasonal variance in wastewaters or drinking waters. In addition, coliforms and E. coli did not vary by region in drinking waters. Male-specific and somatic coliphages proved to be promising indicators. In this study, male-specific coliphages correlated to bacterial indicators in animal feces. Both coliphages were able to survive various environmental conditions, wastewater treatment, and drinking water treatment processes. Neither of the coliphages varied by season in untreated drinking waters. An area of concern for both male-specific and somatic coliphages was the high level of non-detects. The thermotolerance of male-specific coliphages is also an area of concern for its use as a good universal indicator.

O estudo tem a finalidade de avaliar e comparar a configuração espacial dos indicadores que caracterizam as carências socioespaciais em duas grandes cidades brasileiras: Belém e Rio de Janeiro. Para a construção dos indicadores socioespaciais do habitat foram utilizados os resultados da principal pesquisa domiciliar da Fundação Instituto Brasileiro de Geografia e Estatística (IBGE): o Censo Demográfico. O ano de referência é o de 2000. A elaboração de um índice sintético constituiu outra etapa da pesquisa, a partir do qual foram identificadas e mapeadas as áreas de carências socioespaciais. Os resultados da pesquisa mostram que há semelhanças e diferenças quanto à configuração espacial das áreas de maiores carências socioespaciais nas duas cidades analisadas. Algumas das diferenças, entretanto, estão mais associadas à intensidade do que à configuração em si, denotando estágios diferenciados da evolução urbana e das carências socioespaciais das cidades. Quanto aos indicadores utilizados e analisados individualmente, foi possível constatar que se torna a cada dia mais difícil a obtenção de parâmetros universais para avaliar e medir as carências socioespaciais; contudo, alguns deles ainda se destacam neste sentido. Embora os resultados não tenham sido conclusivos, sugerem a necessidade e possibilidade de estabelecimentos de parâmetros regionais, metropolitanos e intraurbanos, no processo que envolve a seleção e elaboração de indicadores para a avaliação da localização das áreas de maiores carências socioespaciais, assim como as diversas formas de assentamentos informais. / This study has the purpose of evaluating and comparing the spatial configuration of the indicators characterizing the socio-spatial needs in two large Brazilian cities: Belém and Rio de Janeiro. For constructing the socio-spatial habitat indicators were used the results from the main household survey of the Brazilian Institute of Geography (IBGE): the Demographic Census. The reference year is 2000.The development of a synthetic index was another step in the research, from which have been identified and mapped the areas of socio-spatial deficiencies in the two cities.The survey results show that there are similarities and differences between such areas. Some of the differences, however, are more associated with the intensity of processes than the setting itself, showing different stages of urban development and socio-spatial deficiencies. As for the indicators used and analyzed individually, it was established that it becomes increasingly more difficult to obtain universal parameters to evaluate and measure the socio-spatial deficiencies, however some of them still stand out in this regard. Although the results were not conclusive, they suggest the need and possibility of using regional, metropolitan and intra-urban parameters, in processes involving selection and development of indicators for selection of socio-spatial areas with major needs, as well as the various forms of informal settlements.

O estudo tem a finalidade de avaliar e comparar a configuração espacial dos indicadores que caracterizam as carências socioespaciais em duas grandes cidades brasileiras: Belém e Rio de Janeiro. Para a construção dos indicadores socioespaciais do habitat foram utilizados os resultados da principal pesquisa domiciliar da Fundação Instituto Brasileiro de Geografia e Estatística (IBGE): o Censo Demográfico. O ano de referência é o de 2000. A elaboração de um índice sintético constituiu outra etapa da pesquisa, a partir do qual foram identificadas e mapeadas as áreas de carências socioespaciais. Os resultados da pesquisa mostram que há semelhanças e diferenças quanto à configuração espacial das áreas de maiores carências socioespaciais nas duas cidades analisadas. Algumas das diferenças, entretanto, estão mais associadas à intensidade do que à configuração em si, denotando estágios diferenciados da evolução urbana e das carências socioespaciais das cidades. Quanto aos indicadores utilizados e analisados individualmente, foi possível constatar que se torna a cada dia mais difícil a obtenção de parâmetros universais para avaliar e medir as carências socioespaciais; contudo, alguns deles ainda se destacam neste sentido. Embora os resultados não tenham sido conclusivos, sugerem a necessidade e possibilidade de estabelecimentos de parâmetros regionais, metropolitanos e intraurbanos, no processo que envolve a seleção e elaboração de indicadores para a avaliação da localização das áreas de maiores carências socioespaciais, assim como as diversas formas de assentamentos informais. / This study has the purpose of evaluating and comparing the spatial configuration of the indicators characterizing the socio-spatial needs in two large Brazilian cities: Belém and Rio de Janeiro. For constructing the socio-spatial habitat indicators were used the results from the main household survey of the Brazilian Institute of Geography (IBGE): the Demographic Census. The reference year is 2000.The development of a synthetic index was another step in the research, from which have been identified and mapped the areas of socio-spatial deficiencies in the two cities.The survey results show that there are similarities and differences between such areas. Some of the differences, however, are more associated with the intensity of processes than the setting itself, showing different stages of urban development and socio-spatial deficiencies. As for the indicators used and analyzed individually, it was established that it becomes increasingly more difficult to obtain universal parameters to evaluate and measure the socio-spatial deficiencies, however some of them still stand out in this regard. Although the results were not conclusive, they suggest the need and possibility of using regional, metropolitan and intra-urban parameters, in processes involving selection and development of indicators for selection of socio-spatial areas with major needs, as well as the various forms of informal settlements.

The beauty of mathematics can arguably be found in the way in which all concepts are interrelated and interwoven to create a massive web of knowledge and in the ways this can be applied to all aspects of life and technology. Given this inextricable interrelationship amongst several mathematical topics, many students encounter issues in learning mathematics due to gaps in their understanding of previously taught material. As a result, mathematics education in the K-12 setting has emphasized the need for interventions in order to help students grasp the progressively complex concepts that are required by our current society and education system as they advance throughout their academic career. This literature review researches effective and non-effective indicators of future mathematics proficiency as an initial step towards identifying the most beneficial cognitive and non-cognitive areas of focus, and consequently early interventions, in order to support student learning especially for underperforming students. Specifically, this research synthesizes research about three essential questions: (1) What skills, conceptual understandings, or student traits can serve as possible predictors of future mathematics proficiency? (2) Which of these identified skills, conceptual understandings, or student traits are stronger predictors of future mathematics proficiency? and (3) What is the degree of accuracy of these predictors? The research was conducted through the review of articles retrieved from diverse research studies. The literature revealed that the single most effective indicator of future mathematical proficiency is knowledge of fractions, specifically, conceptual understanding of and operations with fractions as well as fluidity with rational operations. Other less effective indicators included early knowledge of whole number division, functional numeracy, students’ attitudes and dispositions towards mathematics, gender, early mathematics achievement/ability, and literacy/linguistic ability. Other skills, conceptual understandings and student traits investigated in the relevant research included whole number arithmetic knowledge, number system knowledge, verbal & non-verbal IQ, working memory, and family education & income. These indicators did not exhibit a significant correlation to future mathematics performance and thus were classified as non-effective.

This paper investigates the relationship between tourism and well being, or quality-of-life, within eighteen counties in Utah. To evaluate the relationship, comparisons of the counties' differing l evel s of tourism versus their levels of welfare are necessary. To make these comparisons, three basic steps were followed. First, a social ordering model was derived. The proposed social ordering model was based upon Maslow's theory of the hierarchy of human needs. By utilizing his theory, both economic and noneconomic indicators were identified, and a basis was provided upon which to judge the differing positions of well-being. Factor analysis was applied to this model in order to aggregate the indicators and derive a single quality-of-life index. Second, measurement of tourism was developed. A direct measurement of the level of tourist activity was not available. An indirect indicator of tourism was estimated by taking the proportion of total gross taxable revenue earned by eating and drinking establishments and taxable room sales. The derived indirect variable was more reflective of comparative tourism dependency levels than of the actual level of tourism. Therefore, the variable was renamed touri sm dependency. Third, the correlation between quality-of-life and tourism dependency was calculated. A Pearson correlation coefficient test was performed from which initial results sugge sted a potentially strong negative relationship between the particular qualifiers of well-being used here and tourism. It was apparent that thE two variables that could be defined by certain available indicators were not perfect measurements of the proposed variables, but aspects or components of the desired variables . Each reflected certain attributes of the proposed variables, but not the total concept. A possible explanation for the strong inverse relationship between the qualifiers of quality of life and tourism in this study may be each county's potential for economic diversification. Other studies have shown that areas that are dependent upon a single resource may experience higher levels of economic, demographic, and social instability as compared to those areas with a more diverse economic base. These factors, which in this model would lead to lower values for the calculated quality -of- life indicator in those counties, were estimated to be more tourist dependent .

The benefits of an early integration of palliative care in patients with cancer were already shown in various studies. Regarding the increase of palliative care it is important to ensure an adequate end of life care (EoL Care). One possibility is the use of clinical quality indicators (cQIs). Therefore the present study sought to explore the applicability of cQIs in the German health care system and in certification programs of the German Cancer Society. Retrospective clinical routine data from patients with recurrent or newly diagnosed lung cancer, gastrointestinal cancer, melanoma or brain tumor treated at the University Hospital Würzburg were used. 331 patients were included in the analysis. 18,1% underwent a tumorspecific therapy in the last 14 days of life and 21.8% had a new tumorspecific therapy in the last 30 days of life. This was most common in patients with lung cancer and newly diagnosed cancer. 56.2% had contact with palliative care services. 17.2% were admitted to an intensive care unit and 3.7% had more than one emergency admission during the last 30 days of life. This was most common in patients with gastrointestinal or lung cancer and in patients with newly diagnosed cancer or tumorspecific therapy. Only 22.4% had a documented formal living will. Due to the variant results shown between the different cancer diagnoses we concluded that it is possible to compare the quality of EoL Care in different samples using cQIs. As shown in various studies the benchmarks defined by C. Earle could not be achieved in all cQIs. Therefore we conclude that the use of cQIs comparing the quality of EoL Care in an international approach is limited. On the other hand it could be stated, that cQIs are valuable tools to assess the quality of EoL Care in individual hospitals to detect gaps in the quality of care and to provide the basis for a quality improvement. Therefore it could be advisable to implement cQIs in certification programs of the German Cancer Society. / Zahlreiche Studien haben in den vergangenen Jahren den Vorteil einer frühen Einbeziehung der Palliativmedizin in die Versorgung von Tumorpatienten nachgewiesen. Aufgrund der Zunahme an palliativmedizinischen Einrichtungen besteht Bedarf, die Qualität der Patientenversorgung zu evaluieren. Hierfür können klinische QI zum Einsatz kommen, anhand derer auch andere Aspekte der Versorgung am Lebensende (z.B. Zeitpunkt der letzten tumorspezifischen Therapie) evaluiert werden können. In der vorliegenden Arbeit sollte geklärt werden, inwieweit sich klinische QI auf das deutsche Gesundheitssystem übertragen lassen und in Kennziffern für Zertifizierungsprogramme der Deutschen Krebsgesellschaft überführbar sind. Hierfür wurden mithilfe des SAP retrospektiv die Daten von Tumorpatienten der Entitäten Lunge, ZNS, Darm und Haut erhoben, die im Jahr 2011 aufgrund der Diagnose einer primären Metastasierung oder aufgrund eines Rezidivs und/oder Metastasen in einer Tumorkonferenz an der Universitätsklinik Würzburg vorgestellt wurden. Von den insgesamt 631 Patienten war eine Auswertung bei 331 möglich. 263 wurden ausgeschlossen – größtenteils, weil sie noch nicht verstorben waren – und bei weiteren 37 Patienten war die Datenlage nicht ausreichend. Im Folgenden sind die wichtigsten Ergebnisse dieser Studie nochmal kurz zusammengefasst. In den letzten 14 Lebenstagen hatten 18,1% eine tumorspezifische Therapie und 8,4% eine Chemotherapie, wobei die Lungenkrebspatienten am häufigsten betroffen waren. Es ergaben sich signifikante Unterschiede zwischen den einzelnen Tumorentitäten. Für die Umstellung bzw. den Start einer neuen tumorspezifischen Therapie in den letzten 30 Lebenstagen ergab sich ein Anteil von 21,8%, wobei 8,4% aller Patienten eine Chemotherapie erhielten und auch hier die Lungenkrebspatienten den größten Anteil ausmachten. Ebenfalls zeigten sich Unterschiede zwischen den Entitäten und zudem zwischen Primär- und Rezidivfällen. Kontakt zur Palliativmedizin bestand bei 56,2% aller Patienten und dies am häufigsten bei den Hirntumorpatienten und Rezidivfällen. Mit 12,9% hatten nur wenige Patienten einen Erstkontakt kürzer 3 Tage vor Tod, was bei Patienten mit tumorspezifischer Therapie signifikant häufiger war. Eine medizinische Akutversorgung hatten 19,9%, wobei 17,2% intensivmedizinisch behandelt wurden und nur 3,7% mehr als eine Notaufnahme hatten. Am häufigsten betroffen waren die Lungen- und Darmkrebspatienten. Ein höheres Risiko bestand zudem für Patienten mit Primärfall und tumorspezifischer Therapie am Lebensende. Eine Patientenverfügung war bei 22,4% dokumentiert, wobei für 12,4% eine Datenerhebung nicht möglich war. Aufgrund der dargelegten Unterschiede zwischen den einzelnen Tumorentitäten und zwischen den Primär- und Rezidivfällen lässt sich festhalten, dass anhand der QI vergleichende Aussagen zur Versorgungsqualität am Lebensende möglich sind. Wie bereits in verschiedenen internationalen Studien gezeigt, ließen sich auch in dieser Arbeit die Sollvorgaben von C. Earle nur für die QI „Therapie in den letzten 14 Lebenstagen“ und „Palliativkontakt“ einhalten. Ein Vergleich der Versorgungsqualität in verschiedenen Krankenhäusern ist daher vermutlich nur bedingt möglich. Die QI sind dagegen gut dafür geeignet, die Versorgungssituation an einzelnen Kliniken darzustellen, um Lücken der Versorgungsqualität aufzudecken und so die Grundlage für eine Qualitätsverbesserung zu schaffen. Daher ist es durchaus empfehlenswert, die QI im Rahmen von Zertifizierungsprogrammen der Deutschen Krebsgesellschaft zu testen. Um eine vollständige und zeitsparende Datenerhebung zu ermöglichen, sollte allerdings die Dokumentation von Patientendaten verbessert werden, so dass auch eine effiziente Umsetzung im klinischen Alltag möglich ist.