German Institute Research Articles

Optimal test design for binary response data: the example of the fish embryo toxicity test

The fish embryo toxicity test (FET) is an established method in toxicology research for quantifying the risk potential of environmental contaminations and other substances. The typical results of the method are the half maximal effective concentration (EC50) or the no observed effect concentration (NOEC). However, from an environmental perspective, it is most important to safely identify the concentration of the substance effect which lies above the effect under control condition (spontaneous effect). The common FET is not optimal to detect ECs for small target effects. This paper shows how to optimize the efficiency and consequently the benefit of the FET for small effects using an adequate experimental design. The approach presented here can be carried over to all test systems generating binary (yes/no) outcomes. The experimental design has three components in this context: determination of spontaneous response, sample size calculation, and dose allocation. A strategy for all three components is proposed from which a design is given including precision requirements and makes the most effective use of the experimental effort. This strategy amounts to expanding the usual FET guidelines of Organisation for Economic Co-operation and Development, German Institute for Standardization, or American Society for Testing and Materials by adding a planning step that adapts the test to the specific user’s need. For the practical calculation of an adapted design, a newly developed software is presented as R package toxtestD. It provides a user-friendly way of developing an optimal experimental design for the FET without in-depth statistical knowledge. The programme is suited for all experimental problems involving a binary outcome and a continuous concentration.

The German Primate Center – planning and realization of the institute

Abstract. It took almost 20 years from the first proposal for the foundation of a German primate centre to the final establishment of an institute for research on primates. Since 1964, the German science community had considered the idea of founding a national primate centre in the Federal Republic of Germany (West Germany) following existing models in the USA. In 1967, the project received a significant boost from the outbreak of the lethal Marburg virus infections, which was transmitted from African green monkeys to humans. However, a memorandum from Hans-Jürg Kuhn, at that time at the University of Frankfurt, facilitated a breakthrough in 1970. He conceived an interdisciplinary institute that would both conduct its own scientific research and be a service institute for other German institutions. After highly charged debates on a suitable location, the federal government decided on Göttingen, and in 1972 the University of Göttingen provided the necessary ground. With the certificate of incorporation in 1977, the federal government and the German state Lower Saxony appointed Professor Kuhn as the first scientific director. Based on his memorandum, a research and service institute was developed with several scientific departments associated with primate husbandry, and full operation began in 1984.

Review: Theories of Sustainable Development

Book Review Copyright Information: All rights reserved unless otherwise indicated. Contact the author or original publisher for any necessary permissions. eScholarship is not the copyright owner for deposited works. Learn more at http://www.escholarship.org/help_copyright.html#reuse Review: Theories of Sustainable Development Edited By Judith C. Enders and Moritz Remig Reviewed by: Yves Laberge Centr'ERE, Quebec. G1V 0A6, Enders, Judith C. and Remig, Moritz (eds.), Theories of Sustainable Development. Abingdon: Routledge, 2015, x+201 pp. ISBN: 9781138796362, hardcover, US $140.00. This book is part of the Routledge Studies in Sustainable Development. Theories of Sustainable Development does not pretend to present all the existing theories of Sustainable Development, but these thirteen essays undoubtedly induce a fundamental theoretical discussion, not aiming for “the drafting of a comprehensive theory of sustainability, but rather the creation of a fruitful relationship between practice and theory,” as claimed by Armin Grunwald in the second chapter (titled “What kind of theory do we need for Sustainable Development?”) (p. 25). Most contributors to this collective effort are working in German institutions; here, they present their research in English but often rely on German authors and German theoretical frameworks which are probably unknown to most Anglophone researchers in our field, and that is what makes this book relevant. Incidentally, many bibliographical references at the end of chapters are in German, but English-speaking readers can now benefit from these lesser-known perspectives and thoughts with these essays. For example, discussions and references based on the writings of thinkers such as Lothar Kuhne and Martin Warnke about landscapes conceived as “always historical places” can be seen as an interesting renewal for non-German scholars in domains like the philosophy of the environment (p. 158). As an elusive concept, “Sustainable Development” is defined in many interesting ways by various contributors in about every chapter; many experts reaffirm the importance for sustainability to always be critical and aware of the social dimensions of the environment. For example, Armin Grunwald conceives Sustainable Development firstly “as a process” (Armin Grunwald, p. 27). Elsewhere, in his excellent essay on “Transdisciplinary humanistic sustainability theory” (Chapter 6), Felix Ekardt gives a rich and detailed definition of Sustainable Development, covering almost two pages, “as the establishment of a permanent, globally practicable and future-capable mode of life and economics” (Felix Ekardt, pp. 65-66), but also as “a complex array of problems, involving a wide range of social-scientific and humanistic disciplines” (Felix Ekardt, pp. 65-66). On a related topic, Thomas Jahn sees sustainability as “a relational, not a substantive concept” (p. 33) as he provides a detailed and nuanced articulation of this core concept that can be characterized “as a normative category,” that “triggers a specific complex of integration problems” (p. 33). At the center of every chapter, theory itself seems to be the neglected dimension of most studies in sustainability, although its real importance remains debatable for some experts like Armin Grunwald: “...the fact that virtually no theoretical debate on sustainable development has been carried out during the past ten years is not necessarily a problem” (p. 17). Laberge: Review: Theories of Sustainable Development

In the Warming Arctic Seas

In the Warming Arctic Seas

GIP increases adipose tissue expression and blood levels of MCP-1 in humans and links high energy diets to inflammation: a randomised trial.

Obesity is associated with elevated monocyte chemoattractant protein-1 (MCP-1), a proinflammatory chemokine related to diabetes and cardiovascular disease. Since obesity is triggered by energy dense diets, we hypothesised that nutrient induced intestinal hormones such as glucose-dependent insulinotropic peptide (GIP) may directly stimulate the release of chemokines from adipose tissue and induce low-grade inflammation. GIP effects on gene expression and secretion of inflammatory markers were studied by microarray analysis and PCR from human subcutaneous fat biopsies of slightly obese but healthy volunteers in the metabolic ward of German Institute of Human Nutrition, Department of Clinical Nutrition, Potsdam-Rehbrücke. To allocate the participants to the study arms they were numbered in order of their recruitment and then assigned to the groups by a random number generator. In a randomised, single-blind (participants) crossover design, the participants received GIP infusions in postprandial concentrations (2 pmol kg(-1) min(-1)) or saline (154 mmol/l NaCl) infusions for 240 min either alone, in combination with hyperinsulinaemic-euglycaemic (EU) or hyperinsulinaemic-hyperglycaemic (HC) clamps. Possible mechanisms of GIP effects were investigated in single and co-cultures of macrophage and adipocyte cell lines and in primary human monocytes, macrophages and adipocytes. A total of 17 participants were randomised to the following groups: EU with GIP infusion (n = 9); EU with NaCl infusion (n = 9); HC with GIP infusion (n = 8); HC with NaCl infusion (n = 8); sole GIP infusion (n = 11) and sole placebo infusion (n = 11). All 17 individuals were analysed. The study is completed. In human subcutaneous adipose tissue (hSCAT), infusions of GIP significantly increased inflammatory chemokine and cytokine gene networks in transcriptomic microarray analyses. Particularly MCP-1 (180 ± 26%), MCP-2 (246 ± 58%) and IL-6 (234 ± 40%) mRNA levels in adipose tissue as well as circulating plasma concentrations of MCP-1 (165 ± 12 vs 135 ± 13 pg/ml; GIP vs saline after 240 min; p < 0.05 for all variables) in humans increased independently of circulating insulin or glucose plasma concentrations. GIP stimulation increased Mcp-1 mRNA-expression in co-cultures of differentiated 3T3L1-adipocytes and RAW 264.7 macrophages but not in the isolated cell lines. Similarly, GIP increased MCP-1 transcripts in co-cultures of primary human macrophages with human adipocytes. GIP receptor (GIPR) transcripts were present in primary monocytes and the different cell lines and induced activation of extracellular related kinase (ERK) as well as increases in cAMP, indicating functional receptors. Our findings suggest that the nutrient induced gut hormone GIP may initiate adipose tissue inflammation by triggering a crosstalk of adipocytes and macrophages involving MCP-1. ClinicalTrials.gov NCT00774488. This work was supported by the German Research Foundation (DFG): grant No. Pf164/021002.

State of Digital Education Options in the areas of Medical Terminology and the History, Theory and Ethics of Medicine.

Background: Institutes of the history of medicine, the theory of medicine, and medical ethics at German institutions of higher learning have created various e-learning options that are based on different learning platforms and tailored to the specific curricular needs of individual teaching. Up to now no valid data has been available about the types of such e-learning options as well as possibilities of future developments thanks to coordinated cooperation among the different institutes.Methods: Of 31 German institutes of the history and theory of medicine and medical ethics that were asked to fill out a questionnaire, 30 answered, which equals a return rate of 97 per cent. The questionnaire was completed between July and August 2012 using a telephone survey.Results: Available to students online, digitally interactive teaching tools have boomed in the course of the last few years at German institutes of the history of medicine, the theory of medicine, and medical ethics. This trend is also reflected in a willingness of more than half of the respective departments (67 per cent) to expand their e-learning options on the basis of previous experience. The offered e-learning systems are accepted very well by the students. 57 per cent of the institutes stated, that 90-100 per cent of the students use the offered systems regularly. E-learning courses for terminology are offered particularly often, this is also reflected in the intended extension of these courses by the majority of institutes which plan to expand their e-learning systems.Conclusions: This article discusses the results of a comprehensive empirical survey about e-learning. It illustrates ways in which individual German institutes plan to expand their e-learning options in the future. Finally, specific proposals for cooperation among institutions (not just online) are introduced, the purpose of which is to produce synergy in e-learning.

Tai Chi as an Intervention on Health Promotion for Older Adults: A Systematic Review

Purpose: In June 2002 the authorization of medicinal drugs with kava extracts (Piper methysticum), which was used for the treatment of stress-related anxiety disorders, was withdrawn by the German Institute of Drugs and Medicinal Products (BfArM) because of an unfavorable risk-benefit ratio. The decision, which initially was based on several case reports on liver toxicity in 1999 and 2000, found a worldwide resonance. Methods: Literature on efficacy and safety of kava extracts was searched and related to the still ongoing legal dispute. Results: Between 1990 and 2000 several randomized controlled clinical studies have been published, which were the basis for the authorization of kava products in Germany for stress-related anxiety disorders in the past. However, in the course of time since 2002, the BfArM did not any longer accept these studies as proof of efficacy because of several deficits in the study protocols. In 2002, no study was left. The case reports were re-analyzed by a specialized hepatologist, who found that the risk of hepatotoxicitywas “rare” or “very rare” at its best and could not identify a specific pattern. However, the resulting publication was ignored completely by the BfArM. In fact, BfArMnowconsidered kava extracts being a ,,newentity“, because of their alleged unproven efficacy. That means that based on the most recent ICH-guidelines now the complete spectrum of preclinical studies has to be performed before undertaking a clinical trial. However, the administrative court of Cologne, Germany, underlined in its decision from 10. June 2014, that current rules of the proof of efficacy of a drug should not be applied retrospectively. Conclusion:Thedecision is importantnot only for kava, but for all drugs on the German market, e.g. for benzodiazepines, which were tested in the 1960s for efficacy. By the way, BfArM applied for revision. Contact: Karin Kraft, karin.kraft@med.uni-rostock.de

Kava reloaded? The tip of a regulatory iceberg

Purpose: In June 2002 the authorization of medicinal drugs with kava extracts (Piper methysticum), which was used for the treatment of stress-related anxiety disorders, was withdrawn by the German Institute of Drugs and Medicinal Products (BfArM) because of an unfavorable risk-benefit ratio. The decision, which initially was based on several case reports on liver toxicity in 1999 and 2000, found a worldwide resonance. Methods: Literature on efficacy and safety of kava extracts was searched and related to the still ongoing legal dispute. Results: Between 1990 and 2000 several randomized controlled clinical studies have been published, which were the basis for the authorization of kava products in Germany for stress-related anxiety disorders in the past. However, in the course of time since 2002, the BfArM did not any longer accept these studies as proof of efficacy because of several deficits in the study protocols. In 2002, no study was left. The case reports were re-analyzed by a specialized hepatologist, who found that the risk of hepatotoxicitywas “rare” or “very rare” at its best and could not identify a specific pattern. However, the resulting publication was ignored completely by the BfArM. In fact, BfArMnowconsidered kava extracts being a ,,newentity“, because of their alleged unproven efficacy. That means that based on the most recent ICH-guidelines now the complete spectrum of preclinical studies has to be performed before undertaking a clinical trial. However, the administrative court of Cologne, Germany, underlined in its decision from 10. June 2014, that current rules of the proof of efficacy of a drug should not be applied retrospectively. Conclusion:Thedecision is importantnot only for kava, but for all drugs on the German market, e.g. for benzodiazepines, which were tested in the 1960s for efficacy. By the way, BfArM applied for revision. Contact: Karin Kraft, karin.kraft@med.uni-rostock.de

PGI24 - Cost-effectiveness of interferon-free Therapy for Hepatitis C in Germany - an application of the efficiency frontier approach

The approval of direct-acting antivirals for Interferon-free treatment revolutionized the therapy of chronic Hepatitis C infection. As of August 2014, two treatment regimens for genotype 1 infection received conditional approval in the European Union: Sofosbuvir and Ribavirin for 24 weeks and Sofosbuvir and Simeprevir with or without Ribavirin for 12 weeks. We aim to analyze the cost-effectiveness of both regimens in Germany. We set up a Markov model with a lifetime horizon to simulate immediate treatment success and long-term disease progression for treatment-naive patients. The model analyzes both short-term and long-term costs and benefits from the perspective of the German Statutory Health Insurance. We apply the efficiency frontier method, which was suggested by German Institute for Quality and Efficiency in Health Care for cost-effectiveness analysis in Germany. The efficiency frontier is defined by dual therapy and first generation direct-acting antiviral Boceprevir, yielding a maximum of € 1,447.69 per additional percentage point of sustained virologic response gained. Even without rebates, Sofosbuvir/Simeprevir is very close with € 1,560.13 per additional percentage point. It is both more effective and less expensive than Sofosbuvir/Ribavirin. In addition to higher sustained virologic response rates, new direct-acting antivirals save long-term costs by preventing complications such as liver cirrhosis, hepatocellular carcinoma and ultimately liver transplants, thereby offsetting part of higher drug costs. Our findings are in line with the guidance published by German Society for Gastroenterology, Digestive and Metabolic Diseases, which recommends Sofosbuvir/Simeprevir for Interferon ineligible or intolerant patients.

Hospital Costs of Ambulatory Care-Sensitive Conditions in Germany

Ambulatory care-sensitive conditions (ACSC) are defined as conditions that lead to a hospital admission of which the onset could have been prevented through a more easily accessible ambulatory sector or one that provides better quality care. They are used by health-care systems as a quality indicator for the ambulatory sector. The definition for ACSC varies internationally. Sets of conditions have been defined and evaluated already in various countries, e. g., USA, England, New Zealand and Canada, but not yet for Germany. Therefore this study aims to evaluate the hospital costs of ACSC in Germany using the National Health Service's set of ACSC. In order to calculate these costs a model has been set up for the time period between 2003 and 2010. It is based on G-DRG browsers issued by the German Institute for the Hospital Remuneration System as required by German law. Within these browsers all relevant DRG-ICD combinations have been extracted. The number of cases per combination was then multiplied by their corresponding cost weights and the average effective base rates. The results were then aggregated into their corresponding ICD groups and then into their respective conditions which lead to the costs per condition and the total costs. The total number of cases and total costs were then compared to another second source. These calculations resulted in 11.7 million cases, of which 10.7% were defined as ambulatory care-sensitive. Within the analysed time period the number of ambulatory care-sensitive cases increased by 6% in total and had a 0.9% CAGR. The corresponding costs amounted to a total of EUR 37.6B and to EUR 3.3B for ACSC. 60% of the costs were caused by three of the 19 ACSC. These results validate that it is worthwhile to further investigate this quality indicator for the ambulatory sector.

‘Caught’ between foreign cultural and development policies: perspectives of German Studies and German as a foreign language in Africa

The promotion of the German language abroad and of German Studies plays a central role in German Foreign Cultural Policy. With regard to Sub-Saharan Africa, otherwise a peripheral region for foreign policy, German as foreign language is firmly established as second language after English. Learners especially in Francophone West and Central Africa have increased over the past decade. Numerous funding programmes and actions are supported by German nongovernmental organizations at college/university levels. But bilateral cooperation between German and African academic institutions are challenged both by negative perceptions of the ‘Global South’ among Western colleagues and by an infrastructure adverse to research and to career development in most African countries. Additionally, North/South relations are traditionally seen in terms of (under-)development by German institutions, effecting cooperation. The paper develops a differentiated picture of African Studies in Africa, and outlines benefits that can be attained through collaboration ‘at eye-level’.

Le programme de traductions de l’Institut allemand de Paris (1940-1944). Un aspect peu connu de la politique culturelle national-socialiste en France

As early as December 1940, The German Institute in Paris launched an ambitious programme to translate German books into French so as to supposedly end the lack of knowledge about German literature by the French elite. In reality, it was one of the chapters of a vast enterprise of cultural penetration which was to support “collaboration”, but also complete the military and political hegemony of the Third Reich on the Continent through its supremacy in the cultural domain. The French publishing companies, which depended entirely on the German authorities for their paper supplies, obediently bowed to their request. Even if propaganda work was included in the list of books to be translated which were submitted to the publishers, books by German classic authors – headed by Goethe – were strongly represented as this was more about influencing and seducing rather than offering the French the nazi political model which was, in any case, not destined to be exported.

The Role of decision-analytic modelling in German health technology assessments.

BackgroundDecision-analytic modelling (DAM) has become a widespread method in health technology assessments (HTA), but the extent to which modelling is used differs among international HTA institutions. In Germany, the use of DAM is optional within HTAs of the German Institute of Medical Documentation and Information (DIMDI). Our study examines the use of DAM in DIMDI HTA reports and its effect on the quality of information provided for health policies.MethodsA review of all DIMDI HTA reports (from 1998 to September 2012) incorporating an economic assessment was performed. All included reports were divided into two groups: HTAs with DAM and HTAs without DAM. In both groups, reports were categorized according to the quality of information provided for healthcare decision making.ResultsOf the sample of 107 DIMDI HTA reports, 17 (15.9%) used DAM for economic assessment. In the group without DAM, conclusions were limited by the quality of economic information in 51.1% of the reports, whereas we did not find limited conclusions in the group with DAM. Furthermore, 24 reports without DAM (26.7%) stated that using DAM would likely improve the quality of information of the economic assessment.ConclusionThe use of DAM techniques can improve the quality of HTAs in Germany. When, after a systematic review of existing literature within a HTA, it is clear that DAM is likely to positively affect the quality of the economic assessment DAM should be used.Electronic supplementary materialThe online version of this article (doi:10.1186/s13561-014-0039-x) contains supplementary material, which is available to authorized users.

Metric-based data quality assessment — Developing and evaluating a probability-based currency metric

Data quality assessment has been discussed intensively in the literature and is critical in business. The importance of using up-to-date data in business, innovation, and decision-making processes has revealed the need for adequate metrics to assess the currency of data in information systems. In this paper, we propose a data quality metric for currency that is based on probability theory. Our metric allows for a reproducible configuration and a high level of automation when assessing the currency of attribute values. The metric values represent probabilities and can be integrated into a decision calculus (e.g., based on decision theory) to support decision-making. The evaluation of our metric consists of two main steps: (1) we define an instantiation of the metric for a real-use situation of a German mobile services provider to demonstrate both the applicability and the practical benefit of the approach; (2) we use publicly available real world data provided by the Federal Statistical Office of Germany and the German Institute of Economic Research to demonstrate its feasibility by defining an instantiation of the metric and to evaluate its strength (compared to existing approaches).

Health-related quality of life: a pivotal endpoint in benefit assessment of medical procedures

According to German law, health-related quality of life is a relevant criterion in the early assessment of the benefits of drug treatment. In spite of its regulatory importance, the role of quality of life assessment in quantifying the additional benefits of novel vs standard treatments is not yet clear. The paper is aimed at analyzing the theoretical foundation, the methodological foundation, and the empirical evaluation of the criterion "quality of life" in recent benefit dossiers, as published by the Federal Joint Committee (G-BA) and the German Institute for Quality and Efficiency in Health Care (IQWiG). Benefit dossiers assessed by the end of 2013 were quantitatively analyzed regarding the choice, frequency of use, and consequences of quality of life assessment. In 59 of the 66 dossiers quality of life assessment was performed, frequently using the EQ-5D (n = 16 procedures) and the SF-36 (n = 8 procedures). Of the 107 evaluations of the subpopulation within these 59 dossiers, in only 2 cases was an additional benefit due to the quality of life declared by the IQWiG and G-BA. In spite of the acceptance of quality of life measures and their inclusion in the dossiers, they have rarely been the basis for the declaration of additional benefits. This reluctance does not stem from the availability of instruments, but results from problems in their selection, the design and conduct of the study, data interpretation, together with shortcomings regarding the statistical and clinical significance of quality of life data.

Belgian guidelines for budget impact analyses

Objectives:To develop methodological guidelines for budget impact analysis submitted to the Belgian health authorities as part of a reimbursement request.Methods:A review of the literature was performed and provided the basis for preliminary budget impact guidelines. These guidelines were improved after discussion with health economists from the Belgian Health Care Knowledge Centre (KCE) and different Belgian stakeholders from both government and industry. Preliminary guidelines were also discussed in a workshop with health economists from The German Institute for Quality and Efficiency in Healthcare. Finally, the guidelines were also externally validated by three external experts.Results:The guidelines give explicit guidance for the following components of a budget impact analysis: perspective of the evaluation, target population, comparator, costs, time horizon, modeling, handling uncertainty and discount rate. Special attention is given to handling varying target population sizes over time, applying a time horizon up to the steady state instead of short-term predictions, and similarities and differences between budget impact analysis and economic evaluations.Conclusion:The guidelines provide a framework for both researchers and assessors to set up budget impact analyses that are transparent, relevant, of high quality and apply a consistent methodology. This might improve the extent to which such evaluations can reliably and consistently be used in the reimbursement decision making process.

Г. ГЕЛЬМГОЛЬЦ И ИСТОРИЯ ОСНОВАНИЯ ГЕРМАНСКОГО ФИЗИКО-ТЕХНИЧЕСКОГО ИНСТИТУТА

Г. ГЕЛЬМГОЛЬЦ И ИСТОРИЯ ОСНОВАНИЯ ГЕРМАНСКОГО ФИЗИКО-ТЕХНИЧЕСКОГО ИНСТИТУТА

Vergleichende Evaluierung von Informationsprodukten zu Krebsscreening der deutschsprachigen Krebs-Organisationen

Evidence-based information materials about the pros and cons of cancer screening are important sources for men and women to decide for or against cancer screening. The aim of this paper was to compare recommendations from different cancer institutions in German-speaking countries (Austria, Germany, and Switzerland) regarding screening for breast, cervix, colon, and prostate cancer and to assess the quality and development process of patient information materials. Relevant information material was identified through web searches and personal contact with cancer institutions. To achieve our objective, we employed a qualitative approach. The quality of 22 patient information materials was analysed based on established guidance by Bunge et al. In addition, we conducted guided interviews about the process of developing information materials with decision-makers of cancer institutes. Overall, major discrepancies in cancer screening recommendations exist among the Austrian, German, and Swiss cancer institutes. Process evaluation revealed that crucial steps of quality assurance, such as assembling a multi-disciplinary panel, assessing conflicts of interest, or transparency regarding funding sources, have frequently not been undertaken. All information materials had substantial quality deficits in multiple areas. Three out of four institutes issued information materials that met fewer than half of the quality criteria. Most patient information materials of cancer institutes in German-speaking countries are fraught with substantial deficits and do not provide an objective source for patients to be able to make an informed decision for or against cancer screening.

Магистерская диссертация: исследовательский проект нового поколения

The article deals with the specific features of the graduation thesis within the framework of the degree program in linguistics (translation skills profile) alongside the implementation of the competency based approach at the institutions of higher education. An attempt is undertaken to analyze the basic requirements for Master’s and Bachelor’s theses at Volgograd State University and some German and Austrian translation institutions of higher education.

From Small Auditor Dissatisfaction to Active Resistance: A Practice Theoretical Perspective on the 'Palace Revolt' in the German Auditing Profession

For decades the German auditing profession was governed under the relatively sedate supervision of two professional bodies the German Institute of Public Auditors (IDW) and the German Chamber of Public Auditors (WPK), both of whom worked in cooperation with the Federal Ministry responsible for these matters. This state of affairs was transformed, however, after wp.net, a third professional body, was set up in 2005 for small auditors and after it subsequently staged a takeover of the WPK, an event since termed a palace revolt by the media that reported on it. Based on a practice theoretical perspective, we trace the process that led up to these events. We show how the events are related to the context of practices pursued in the working environments of the audit industry where practices of smaller auditors and larger audit firms were ever more drifting apart, and how they are related to the profession as a whole. We highlight also the role played by the successful implementation of the peer review in the German audit profession for the course of the events. Finally, we discuss some important implications that might follow from these unique events for current developments in accounting/professions worldwide.