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Institute
Advances in high-throughput DNA sequencing have propelled research into the human microbiome and its link to metabolic health. We explore microbiome analysis methods, specifically emphasizing metabolomics, how dietary choices impact the production of microbial metabolites, providing an overview of studies examining the connection between enterotypes and diet, and thus, improvement of personalized dietary recommendations. Acetate, propionate, and butyrate constitute more than 95% of the collective pool of short-chain fatty acids. Conflicting data on acetate’s effects may result from its dynamic signaling, which can vary depending on physiological conditions and metabolic phenotypes. Human studies suggest that propionate has overall anti-obesity effects due to its well-documented chemistry, cellular signaling mechanisms, and various clinical benefits. Butyrate, similar to propionate, has the ability to reduce obesity by stimulating the release of appetite-suppressing hormones and promoting the synthesis of leptin. Tryptophan affects systemic hormone secretion, with indole stimulating the release of GLP-1, which impacts insulin secretion, appetite suppression, and gastric emptying. Bile acids, synthesized from cholesterol in the liver and subsequently modified by gut bacteria, play an essential role in the digestion and absorption of dietary fats and fat-soluble vitamins, but they also interact directly with intestinal microbiota and their metabolites. One study using statistical methods identified primarily two groupings of enterotypes Bacteroides and Ruminococcus. The Prevotella-dominated enterotype, P-type, in humans correlates with vegetarians, high-fiber and carbohydrate-rich diets, and traditional diets. Conversely, individuals who consume diets rich in animal fats and proteins, typical in Western-style diets, often exhibit the Bacteroides-dominated, B-type, enterotype. The P-type showcases efficient hydrolytic enzymes for plant fiber degradation but has limited lipid and protein fermentation capacity. Conversely, the B-type features specialized enzymes tailored for the degradation of animal-derived carbohydrates and proteins, showcasing an enhanced saccharolytic and proteolytic potential. Generally, models excel at predictions but often struggle to fully elucidate why certain substances yield varied responses. These studies provide valuable insights into the potential for personalized dietary recommendations based on enterotypes
Hintergrund
Demografisch bedingt wird sich die Anzahl pflegebedürftiger Menschen weiter erhöhen. Tragende Säule der pflegerischen Versorgung sind ihre Angehörigen, die den Großteil der Pflegeaufgaben übernehmen. Dies hat jedoch oftmals Auswirkungen auf ihre eigene Gesundheit und ihr Wohlbefinden.
Methodisches Vorgehen
Mit dem Fragebogen zur Angehörigenresilienz und -belastung (FARBE) liegt ein Instrument vor, um sowohl die Resilienz als auch Belastung pflegender Angehöriger zu ermitteln. Der Fragebogen wurde im Rahmen der Pflegestudie des VdK-Sozialverbands genutzt und von 12.475 Angehörigen komplett ausgefüllt. Durch eine multiple lineare Regression wurden Einflüsse und ihre Wirkstärke auf die Resilienz und Belastung analysiert.
Ergebnisse
Angehörige von Menschen mit Demenz, Depression oder hohem Pflegegrad weisen eine stärkere Belastung auf. Demenz und Depression mindern zudem die Resilienz. Positiv wirkt sich die soziale Unterstützung aus. Ebenso bedingt ein höheres Alter eine stärkere Resilienz.
Schlussfolgerungen
Im Ergebnis dieser Arbeit gelang eine Identifikation von relevanten Einflussfaktoren. Dies ermöglicht, Unterstützungs- und Entlastungsangebote auf ihre Anwendung und Wirksamkeit zu überprüfen. Besondere Bedeutung haben Unterstützungsangebote für Angehörige von Menschen mit Demenz, Depression und/oder höheren Pflegegraden. Stressreduzierende Maßnahmen und das Bilden sozialer Netzwerke für Angehörige können weitere Maßnahmen zur Stärkung der Resilienz und Abschwächung von Belastung sein.
HRM processes are increasingly AI-driven, and HRM supports the general digital transformation of companies’ viable competitiveness. This paper points out possible positive and negative effects on HRM, workplaces, and workersorganizations along the HR processes and its potential for competitive advantage in regard to managerial decisions on AI implementation regarding augmentation and automation of work.
A systematic literature review that includes 62 international journals across different disciplines and contains top-tier academic and German practitioner journals was conducted. The literature analysis applies the resource-based view (RBV) as a lens through which to explore AI-driven HRM as a potential source of organizational capabilities.
The analysis shows four ambiguities for AI-driven HRM that might support sustainable company development or might prevent AI application: job design, transparency, performance and data ambiguity. A limited scholarly discussion with very few empirical studies can be stated. To date, research has mainly focused on HRM in general, recruiting, and HR analytics in particular.
The four ambiguities’ context-specific potential for capability building in firms is indicated, and research avenues are developed.
This paper critically explores AI-driven HRM and structures context-specific potential for capability building along four ambiguities that must be addressed by HRM to strategically contribute to an organization’s competitive advantage.
In a protein reduction feeding trial (Study 1) on a commercial broiler farm in northern Germany, it was attempted to be shown that research results from station tests on protein reduction can be transferred to agricultural practice. In a second study, the limits of the N reduction were tested in a research facility. In Study 1, commercial standard feeds were fed to the control group (variant 1:210,000 animals; n = 5 barns). In the test group (variant 2:210,000 animals; n = 5 barns), the weighted mean crude protein (CP) content was moderately reduced by 0.3%. The nitrogen reduction in the feed did not affect performance (feed intake (FA), daily gain (DG), feed conversion (FCR)), but nitrogen conversion rate increased from approx. 61% to approx. 63%. The solid litter weight was reduced by 12% and nitrogen excretion by 9% (p < 0.05). Significantly healthier footpads were due to lower water intake (−4%; p < 0.05) and a numerically drier bedding. In Study 2, responses of treatments (1250 broiler per variant; n = 5) showed that sharper N-lowering (−1.5% CP; weighted average) did not impair performance either, but N-conversion improved and N-excretions decreased significantly. Converted to a protein reduction of one percentage point, the N excretions were able to be reduced by 22% in Study 1 and 18% in Study 2. Feeding trials in the commercial sector, such as the present Study 1, should convince feed mills and farmers to allow the latest scientific results to be used directly and comprehensively in commercial ration design.
Duckweed is gaining attention in animal nutrition and is considered as a potential alternative protein source for broiler chickens. In order to evaluate the nutritional value of duckweed, three individual batches were investigated. They consisted of a mixture of Lemna minuta and Lemna minor (A, 17.5% crude protein), Spirodela polyrhiza (B, 24.6% crude protein) and Lemna obscura (C, 37.0% crude protein). Treatment diets contained 50% batch A, 50% batch B, and 25, 50 and 75% of batch C. All diets were fed to broiler chickens (Ross 308) from an age of 21 to 27 days. Diets with a share of 50 and 75% of batch C led to decreased feed intake (109.3 and 74.9 g/day, respectively) compared to the control. Standardized ileal digestibility of crude protein and amino acids differed significantly between duckweed batches, at values for methionine between 49.9 and 90.4%. For all amino acids, batch A consistently had the lowest and batch C the highest digestibility. Batches had different tannin contents of 2943, 2890 and 303 mg/kg for batches A, B and C, respectively. The apparent ileal digestibility of phosphorus differed significantly between all batches (50.8–78.9%). Duckweed can be used as a protein feed for broiler chickens. However, a defined and stable biomass composition optimized for the requirements of broiler chickens is needed.
Iron deficiency is still widespread as a major health problem even in countries with adequate food supply. It mainly affects women but also vegans, vegetarians, and athletes and can lead to various clinical pictures. Biofortification of vitamin C-rich vegetables with iron may be one new approach to face this nutritional challenge. However, so far, little is known about the consumer acceptance of iron-biofortified vegetables, particularly in developed countries. To address this issue, a quantitative survey of 1000 consumers in Germany was conducted. The results showed that depending on the type of vegetable, between 54% and 79% of the respondents were interested in iron-biofortified vegetables. Regression analysis showed a relationship between product acceptance, gender, and area of residence. In addition, relationships were found between consumer preferences for enjoyment, sustainability, and naturalness. Compared to functional food and dietary supplements, 77% of respondents would prefer fresh iron-rich vegetables to improve their iron intake. For a market launch, those iron-rich vegetables appear especially promising, which can additionally be advertised with claims for being rich in vitamin C and cultivated in an environmentally friendly way. Consumers were willing to pay EUR 0.10 to EUR 0.20 more for the iron-biofortified vegetables.
Introduction Postoperative delirium (POD) is seen in approximately 15% of elderly patients and is related to poorer outcomes. In 2017, the Federal Joint Committee (Gemeinsamer Bundesausschuss) introduced a ‘quality contract’ (QC) as a new instrument to improve healthcare in Germany. One of the four areas for improvement of in-patient care is the ‘Prevention of POD in the care of elderly patients’ (QC-POD), as a means to reduce the risk of developing POD and its complications.
The Institute for Quality Assurance and Transparency in Health Care identified gaps in the in-patient care of elderly patients related to the prevention, screening and treatment of POD, as required by consensus-based and evidence-based delirium guidelines. This paper introduces the QC-POD protocol, which aims to implement these guidelines into the clinical routine. There is an urgent need for well-structured, standardised and interdisciplinary pathways that enable the reliable screening and treatment of POD. Along with effective preventive measures, these concepts have a considerable potential to improve the care of elderly patients.
Methods and analysis The QC-POD study is a non-randomised, pre–post, monocentric, prospective trial with an interventional concept following a baseline control period. The QC-POD trial was initiated on 1 April 2020 between Charité-Universitätsmedizin Berlin and the German health insurance company BARMER and will end on 30 June 2023. Inclusion criteria: patients 70 years of age or older that are scheduled for a surgical procedure requiring anaesthesia and insurance with the QC partner (BARMER). Exclusion criteria included patients with a language barrier, moribund patients and those unwilling or unable to provide informed consent. The QC-POD protocol provides perioperative intervention at least two times per day, with delirium screening and non-pharmacological preventive measures.
Ethics and dissemination This protocol was approved by the ethics committee of the Charité-Universitätsmedizin, Berlin, Germany (EA1/054/20). The results will be published in a peer-reviewed scientific journal and presented at national and international conferences.
Hintergrund
Die Anämie hat eine hohe Prävalenz bei Patienten vor Hüftgelenkrevisionsoperation und ist mit einer erhöhten Komplikationsrate assoziiert. Die vorliegende Arbeit untersucht erstmals den Zusammenhang von Kosten, realen DRG-Erlösen und Falldeckung der präoperativen Anämie bei elektiven Hüftgelenkrevisionsoperationen.
Methoden
Für alle Patienten, die sich von 2010 bis 2017 an 2 Campi der Charité – Universitätsmedizin Berlin einer Hüftgelenkrevisionsoperation unterzogen, wurden Daten zu Patienten sowie Transfusionen, Kosten und Erlösen gesammelt. Subgruppen- und lineare Regressionsanalysen untersuchten die Falldeckung anämischer und nichtanämischer Patienten.
Ergebnisse
Von 1187 eingeschlossenen Patienten waren 354 (29,8 %) präoperativ anämisch. Insgesamt wurden 565 (47,6 %) Patienten, mit einem deutlichen Überwiegen anämischer Patienten (72,6 % vs. 37,0 %, p < 0,001), transfundiert. Kosten (12.318 € [9027;20.044 €] vs. 8948 € [7501;11.339 €], p < 0,001) und Erlöse (11.788 € [8992;16.298 €] vs. 9611 € [8332;10.719 €], p < 0,001) waren für anämische Patienten höher, die Fallkostendeckung defizitär (−1170 € [−4467;1238 €] vs. 591 € [−1441;2103 €] €, p < 0,001). Bei anämischen Patienten nahm die Falldeckung mit zunehmender Transfusionsrate ab (p ≤ 0,001). Komorbiditäten hatten keinen signifikanten ökonomischen Einfluss.
Schlussfolgerung
Die präoperative Anämie und perioperative Transfusionen bei Hüftgelenkrevisionsoperationen sind mit erhöhten Behandlungskosten und einer finanziellen Unterdeckung für Kostenträger im Gesundheitswesen verbunden. Konzepte zur Behandlung der präoperativen Anämie (z. B. Patient Blood Management) könnten mittelfristig Behandlungskosten senken.
A brief questionnaire for measuring alarm fatigue in nurses and physicians in intensive care units
(2023)
When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop “alarm fatigue” (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the “alarm stress scale” and the “alarm coping scale”). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.
Easy and inexpensive methods for measuring ammonia emissions in multi-plot field trials allow the comparison of several treatments with liquid manure application. One approach that might be suitable under these conditions is the dynamic tube method (DTM). Applying the DTM, a mobile chamber system is placed on the soil surface, and the air volume within is exchanged at a constant rate for approx. 90 s. with an automated pump. This procedure is assumed to achieve an equilibrium ammonia concentration within the system. Subsequently, a measurement is performed using an ammonia-sensitive detector tube. Ammonia fluxes are calculated based on an empirical model that also takes into account the background ammonia concentration measured on unfertilized control plots. Between measurements on different plots, the chamber system is flushed with ambient air and cleaned with paper towels to minimize contamination with ammonia. The aim of this study was to determine important prerequisites and boundary conditions for the application of the DTM.
We conducted a laboratory experiment to test if the ammonia concentration remains stable while performing a measurement. Furthermore, we investigated the cleaning procedure and the effect of potential ammonia carryover on cumulated emissions under field conditions following liquid manure application. The laboratory experiment indicated that the premeasurement phase to ensure a constant ammonia concentration is not sufficient. The concentration only stabilized after performing more than 100 pump strokes, with 20 pump strokes (lasting approximately 90 s) being the recommendation.
However, the duration of performing a measurement can vary substantially, and linear conversion accounts for those differences, so a stable concentration is mandatory. Further experiments showed that the cleaning procedure is not sufficient under field conditions. Thirty minutes after performing measurements on high emitting plots, which resulted in an ammonia concentration of approx.
10 ppm in the chamber, we detected a residual concentration of 2 ppm. This contamination may affect measurements on plots with liquid manure application as well as on untreated control plots. In a field experiment with trailing hose application of liquid manure, we subsequently demonstrated that the calculation of cumulative ammonia emissions can vary by a factor of three, depending on the degree of chamber system contamination when measuring control plots. When the ammoni background values were determined by an uncontaminated chamber system that was used to measure only control plots, cumulative ammonia emissions were approximately 9 kg NH3-N ha1.
However, when ammonia background values were determined using the contaminated chamber system that was also used to measure on plots with liquid manure application, the calculation of cumulative ammonia losses indicated approximately 3 kg NH3-N ha1. Based on these results, it can be concluded that a new empirical DTM calibration is needed for multi-plot field experiments with high-emitting treatments.