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Oleamide is used as a lubricant in the manufacturing and application of polypropylene (PP) medical devices. Samples of PP were prepared with 0, 1500, and 15 000 ppm oleamide content as lubricant. The samples were either left non-sterile, sterilized with ethylene oxide (ETO), γ-radiation (γ) or autoclaved (A) and stored for up to 4 weeks. To determine the oleamide bulk-to-surface distribution depending on sterilization method and storage time an extraction method and a washing technique were applied. The oleamide content was determined by gas chromatography (GC-FID) and compared with the coefficient of friction (COF). The COF dependent on the measured lubricant content at the surface. The content of lubricant on the surface depends on the type of sterilization: ETO increased the lubricant content to some extent, γ-sterilization and autoclaving reduced it. After storage, no migration of the lubricant to the surface could be detected.
Objectives: This paper addresses recent steps for reforming the eligibility criteria of the German long-term care insurance that have been initiated to overcome shortcomings in the current system.
Methods: Based on findings of a survey of international long-term care systems, assessment tools and the relevant literature on care needs a new tool for determining eligibility in the German long-term care insurance was developed.
Results: The new tool for determining long-term care eligibility broadens the understanding of what ‚dependency on nursing care' implies for the person affected. The assessment results in a degree of dependency from personal help provided by formal or informal caregivers. This degree of dependency can be used for determining eligibility for and the amount of long-term care benefits.
Discussion: The broader understanding of "dependency on nursing care' and the new tool are important steps to adapt the German long-term care insurance to the challenges of the demographic and societal changes in the future
Background: Availability and usage of individual IT applications have been studied intensively in the past years. Recently, IT support of clinical processes is attaining increasing attention. The underlying construct that describes the IT support of clinical workflows is clinical information logistics. This construct needs to be better understood, operationalised and measured.
Objectives: It is therefore the aim of this study to propose and develop a workflow composite score (WCS) for measuring clinical information logistics and to examine its quality based on reliability and validity analyses.
Methods: We largely followed the procedural model of MacKenzie and colleagues (2011) for defining and conceptualising the construct domain, for developing the measurement instrument, assessing the content validity, pretesting the instrument, specifying the model, capturing the data and computing the WCS and testing the reliability and validity.
Results: Clinical information logistics was decomposed into the descriptors data and information, function, integration and distribution, which embraced the framework validated by an analysis of the international literature. This framework was refined selecting representative clinical processes. We chose ward rounds, pre- and post-surgery processes and discharge as sample processes that served as concrete instances for the measurements. They are sufficiently complex, represent core clinical processes and involve different professions, departments and settings. The score was computed on the basis of data from 183 hospitals of different size, ownership, location and teaching status. Testing the reliability and validity yielded encouraging results: the reliability was high with r(split-half) = 0.89, the WCS discriminated between groups; the WCS correlated significantly and moderately with two EHR models and the WCS received good evaluation results by a sample of chief information officers (n = 67). These findings suggest the further utilisation of the WCS.
Conclusion: As the WCS does not assume ideal workflows as a gold standard but measures IT support of clinical workflows according to validated descriptors a high portability of the WCS to other hospitals in other countries is very likely. The WCS will contribute to a better understanding of the construct clinical information logistics.
Background: Continuous improvements of IT-performance in healthcare organisations require actionable performance indicators, regularly conducted, independent measurements and meaningful and scalable reference groups. Existing IT-benchmarking initiatives have focussed on the development of reliable and valid indicators, but less on the questions about how to implement an environment for conducting easily repeatable and scalable IT-benchmarks.
Objectives: This study aims at developing and trialling a procedure that meets the afore-mentioned requirements.
Methods: We chose a well established, regularly conducted (inter-) national IT-survey of healthcare organisations (IT-Report Healthcare) as the environment and offered the participants of the 2011 survey (CIOs of hospitals) to enter a benchmark. The 61 structural and functional performance indicators covered among others the implementation status and integration of IT-systems and functions, global user satisfaction and the resources of the IT-department. Healthcare organisations were grouped by size and ownership. The benchmark results were made available electronically and feedback on the use of these results was requested after several months.
Results: Fifty-ninehospitals participated in the benchmarking. Reference groups consisted of up to 141 members depending on the number of beds (size) and the ownership (public vs. private). A total of 122 charts showing single indicator frequency views were sent to each participant. The evaluation showed that 94.1% of the CIOs who participated in the evaluation considered this benchmarking beneficial and reported that they would enter again. Based on the feedback of the participants we developed two additional views that provide a more consolidated picture.
Conclusion: The results demonstrate that establishing an independent, easily repeatable and scalable IT-benchmarking procedure is possible and was deemed desirable. Based on these encouraging results a new benchmarking round which includes process indicators is currently conducted.
Developing organizations
(2021)
This chapter reviews organizational development (OD) as networked man-agerial practices and investigates the role these practices play in contemporary strategic management and in management communication. Our analytical overview of studies finds that the literature lacks empirical evidence on the linguistic properties of OD’s practices as these properties have not been researched in OD but in settings where change is solely approached as a planned process. To fill this gap, we propose a research framework to inquire into OD’s verbal, paraverbal, and nonverbal practices. After a tour d’horizon of OD’s and change management’s ontological and epistemological paradigms, we outline the implications of the practice perspective of OD for strategic management, then narrow our focus to empirical studies’ prominent out-comes on discursive practices in change processes, and conclude with a framework for future research
Every modern institution involved in higher education needs a Learning Management System (LMS) to handle learning and teaching processes. It is necessary to offer e.g. electronic lecture materials to the students for download via the internet. In some educational contexts, it is also necessary to offer internet tutorials to be able to give the students more personal support and accompany them through the whole lecture period. Many organisations have introduced commercial LMS and gained the experience that monolithic solutions do not fulfil the dynamic requirements of complex educational institutions and are very cost-intensive. Therefore, many universities face the decision to stick to their commercial LMS or to switch to a potentially more cost-effective and flexible solution, for instance by adopting available Open Source LMS. Since we have made profound experience in developing and operating an Open Source LMS, this contribution enlightens the main characteristics of this alternative. This paper describes a use case dealing with a full product lifecycle (development, deployment, use and evaluation) of an Open Source LMS at the University of Muenster (Germany). It identifies relevant instruments and aspects of system design which software architects in practical application domains should pay attention to.
Background: Clinical information logistics is the backbone of care workflows inside and outside of hospitals. Due to the great potential of health IT to support clinical processes its contribution needs to be regularly monitored and governed. IT benchmarks are a well-known instrument to optimise the availability and use of IT by guiding the decision making process. The aim of this study was to translate IT benchmarking results that were grounded on a hierarchical workflow scoring system into an appropriate visualisation concept.
Methods: To this end, a three-dimensional multi-level model was developed, which allowed the decomposition of the highly aggregated workflow composite score into score views for the individual clinical workflows concerned and for the descriptors of these workflows. Furthermore this multi-level model helped to break down the score views into single and multiple indicator views.
Results: The results could be visualised per hospital in comparison to the results of organisations of similar size and ownership (peer reference groups) and in comparison to different types of innovation adopters. The multi-level model was implemented in a benchmark of 199 hospitals and evaluated by the chief information officers. The evaluation resulted in high ratings for the comprehensibility of the different types of views of the scores and indicators.
Conclusions: The implementation of the multi-level model in a large benchmark of hospitals proved to be feasible and useful in terms of the overall structure and the different indicator views. There seems to be a preference for less complex and familiar views.
A systematic study was performed to understand the effects of the devulcanizing agent dibenzamido diphenyl disulfide (DBD) on the vulcanization and devulcanization process of a sulfur-cured ethylene-propylene-diene monomer (EPDM) rubber. The influence of DBD on vulcanization was investigated by mixing DBD with virgin rubber and curative system. The devulcanization of rubber waste was achieved with varying amounts of DBD ranging from 0.4 to 13.8 wt% and temperatures from 150 to 200°C. The quality of vulcanizates and devulcanizates was evaluated by rheometer tests, temperature scanning stress relaxation measurements, and analysis of mechanical properties. During vulcanization, DBD acts as an accelerator in the presence of sulfur. When accelerators are added, the scorch time increases, and the cure rate decreases. Thus, DBD acts as a retarder. In the presence of activators, DBD leads to a significant reduction of crosslink density. This results in composites with high elongation at break and poor compression set values. The efficiency of the devulcanization of rubber waste depends strongly on DBD concentration and temperature. The monosulfidic crosslinks are cleaved by low concentrations of DBD, while polysulfidic crosslinks require higher concentrations. These results show that DBD is effective as a devulcanizing agent and degrades the network below 200°C.
Introduction
Tests to evaluate the integrity of the alar ligaments are important clinical tools for manual therapists, but there is limited research regarding their validity.
Method
A single blinded examiner assessed alar ligament integrity using the lateral shear test (LST), rotation stress test (RST) and side-bending stress test (SBST) on a sample of convenience comprising 7 subjects with MRI confirmed alar ligament lesions and 11 healthy people. Alar ligament lesions were identified using both supine and high-field strength upright MRI.
Results
The RST had a sensitivity of 80% and a specificity of 69.2%. The SBST and the LST both showed a sensitivity of 80% and a specificity of 76.9%. In cases where all three tests were positive, the specificity increased to 84.6%.
Discussion
Tests of manual examination of alar ligament integrity have some diagnostic utility; however, these findings require further corroboration in a larger sample.