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The ability of film stars to attract viewers is a widely accepted rationale for hiring expensive actors. However, the precise mechanisms behind this ‘drawing power’ remain unclear. By reviewing the existing literature, six possible antecedents of drawing power are identified. Artists with high acting abilities (i) increase a film’s artistic appeal, (ii) function as markers of quality and (iii) facilitate the matching process with the right audiences. Widely popular, commonly perceived as beautiful/handsome but often less talented actors, on the other hand, rather (iv) facilitate the marketing campaigns of films, (v) offer entertaining interactions with famous personalities and (vi) provide manifold opportunities for gossiping. Based on a discussion of the implications for theory and a preliminary analysis of a sample of Hollywood actors, managerial recommendations for those who have and those who depend on star drawing power are developed.
Purpose
This paper aims to investigate the strategic consequences of manufacturing location decisions, with a focus on understanding the link between collocating manufacturing with other value chain activities, via reshoring or retaining and organizational agility.
Design/methodology/approach
The paper uses qualitative data from 115 interviews with executives from UK high value manufacturing companies to explore the recent phenomenon of reshoring and the strategic effects of manufacturing location.
Findings
The location of manufacturing is operationally and strategically important for multinational companies. The spatial dispersion of manufacturing is determined by firm-specific and external factors, both of which are subject to constant change. The analysis shows that concentrating on manufacturing in their home countries enables firms to increase organizational agility and stimulate innovation. Better integration with and more extensive collaboration between related value chain activities, such as research and development, sales and marketing, leads to higher flexibility, speed and responsiveness to customer requirements. However, under certain conditions, firms also continue to benefit from the known advantages of offshoring.
Originality/value
This research sheds light on possible strategic downsides of global value chains, characterized by dispersed activities and intermitted processes. The results provide evidence that retaining manufacturing or bringing back manufacturing operations to a company’s home country can increase organizational flexibility, speed, adaptability, innovativeness and responsiveness to customer requirements. As these capabilities are critical for long-term survival, especially in dynamic environments, firms need to review their global factory configurations and determine whether the short-term advantages of foreign locations continue to justify offshoring practices.
Over the past decade, the proliferation of entrepreneurial ventures and small firms with sustainable business models have pushed the sustainability agenda in the fashion industry. Despite prominent success stories, these companies often encounter significant operative challenges that hinder growth or even cause business failure. This paper adopts a qualitative research design and uses data gathered during 18 expert interviews with entrepreneurs and executive managers of 18 firms from 13 countries to identify and explore the dominant challenges that micro- and small-sized sustainable fashion companies struggle with. The results indicate that communicating with consumers is perceived as surprisingly difficult, especially because sustainable brands need to justify higher prices and explain the added benefits of their products. Second, resource constraints lead to operative friction and overburdening of the decision makers and their small management teams. Third, sustainable sourcing and production processes are economically difficult in an industry that continues to occupy a mass and low-cost logic. Against the background of these insights, a range of managerial recommendations are developed and contextualized in the framework of the Business Model Canvas. This novel approach makes the suggestions which are rooted in the resource-based view actionable and supports sustainable businesses to better manage their operations and achieve growth. For example, collaborative approaches with different stakeholders may mitigate constraints across all three identified problem areas.
Conceptualising event value co-destruction and developing a future agenda for events research
(2021)
Purpose
Value co-destruction has received little attention in an event-related context. This appears surprising, given that the interactions among actors at an event may also reduce the value for other participants, stakeholders and that of the entire event or the event's service ecosystem. This paper first aims to conceptualise value co-destruction and to provide an overview of related research in an event context. Second, a future research agenda for value co-destruction processes in an event context is developed.
Design/methodology/approach
Journals of the “Scimago Journal and Country Rank” were systematically reviewed for the keywords “value co-destruction”, “value destruction” and “negative value co-creation”. A second literature review specifically aimed at the events context extended the search scope to non-Scimago journals, Google Scholar and Google Web using the same keywords. All identified articles were qualitatively analysed concerning (1) the conceptualisation of value co-destruction and (2) reasons for value co-destruction.
Findings
The review of previous research highlights a limited scope of analysis, a focus on value co-destruction as an outcome and on interactions at the meso-level. Based on these findings, a holistic definition of value co-destruction is proposed. The paper identifies two major directions for future studies on value co-destruction at events and suggests specific examples.
Originality/value
The paper contributes to a more holistic understanding of value co-creation and co-destruction in an event setting. For example, a clearer understanding of the interactions that reduce the overall value of an event may assist to better design valuable events in the future.
Transport operations are climate sensitive. Despite this, scientific literature and corporate practice present little evidence on how corporate actors use climate adaptation measures to prepare their transport operations for climate change. This paper explores two research questions: How can the acceptance among corporate decision-makers towards climate adaptation measures for their transport operations be explained? Based on the Theory of Planned Behavior and the Diffusion of Innovations we develop a theoretical framework for dealing with climate adaptation measures for transport operations (step 1). We support the use of this framework through a literature review (1989–2020) (step 2) and semi-structured interviews with German companies that have implemented best practice measures (step 3). The results show that the handling of climate adaptation measures for transport operations can be described in three acceptance phases: acceptance of attitude, action, and use. We conclude that these phases determine the approaches required for promoting climate change adaptation.
Sustainable Digital Entrepreneurship : Examining IT4Sustainability as Business Development Path
(2022)
There is an increasing interest within the field of Information Systems as well as political agendas to identify the potential of digital technologies to promote sustainable development. Nonetheless, sustainable entrepreneurship and digital entrepreneurship are widely treated separately within the literature, suggesting that there is little understanding of how entrepreneurs could employ digital technologies to promote sustainable development. Based on an empirical, qualitative research approach, relying on Grounded Theory methodology, this paper identifies characteristics of sustainable digital entrepreneurs. An investigation of the manifestations of the sustainable digital orientation reveals a rather diffuse understanding of the relation and potential synergy effects. In response to this gap, the paper presents examples on how sustainable digital entrepreneurs employ digital and disruptive technologies to tackle sustainability challenges (IT4Sustainability development path), including information and communication technology, such as digital platforms, artificial intelligence, or drone technology. The presented approaches range from second-mover approaches associated with low digital maturity limited to the business level to the development of new business models facilitating the sustainable transition of whole sectors. These insights are summarized in an IT4Sustainability maturity model, which presents different starting points for entrepreneurs. Relevant theoretical, practical, and policy implications are discussed, especially concerning the education on IT4Sustainability, including Corporate Digital Responsibility.
In recent years, various studies have highlighted the opportunities of artificial intelligence (AI) for our society. For example, AI solutions can help reduce pollution, waste, or carbon footprints. On the other hand, there are also risks associated with the use of AI, such as increasing inequality in society or high resource consumption for computing power. This paper explores the question how corporate culture influences the use of artificial intelligence in terms of sustainable development. This type of use includes a normative element and is referred to in the paper as sustainable artificial intelligence (SAI). Based on a bibliometric literature analysis, we identify features of a sustainability-oriented corporate culture. We offer six propositions examining the influence of specific manifestations on the handling of AI in the sense of SAI. Thus, if companies want to ensure that SAI is realized, corporate culture appears as an important indicator and influencing factor at the same time.
Purpose
The purpose of this paper is to distinguish different types of sustainable digital entrepreneurs (SDEs) and explore their approaches toward enhancing organizational resilience.
Design/methodology/approach
Investigation of entrepreneur characteristics using Grounded Theory methodology; 12 semi-structured telephone interviews with (owner-)managers of digital-resilient small and medium-sized enterprises (SMEs) and start-ups in Germany; adaptation of a sustainability-digitalization-matrix for initial clustering; investigation of reoccurring patterns (within and between clusters) through variable-oriented content analysis; application of the capability-based conceptualization of organizational resilience for synthesis and extension.
Findings
First, the authors present a new typology of SDEs, including descriptions of the four main types (Process-Oriented System Thinker, Unconventional Strategist, Dynamic Visionary and Success-Oriented Opportunist). Second, the authors propose a conceptual framework with six success factors of organizational resilience. The framework accentuates the influence of SDEs on organizational culture and the macro-environment.
Practical implications
Digital sustainability and resilience are emerging management principles. The insights gained will allow (future) entrepreneurs to perform a self-assessment and replicate approaches toward enhancing SME resilience; for example, governing the co-creation of an organizational culture with a strong integrative view on sustainability and digitalization.
Originality/value
SMEs are characterized by high vulnerability and a reactive response to the disruptions caused by sustainability crises and digitalization. Blending sustainable and digital entrepreneurship at a micro-level, the authors identified the success factors underpinning organizational resilience that are associated with the characteristics of four types of SDEs.
Information systems (IS) play a central role in promoting corporate sustainability and pro-environmental behavior. This study explores the use of mobile apps for fostering sustainability-oriented corporate culture. It accentuates issues relating to sustainability-oriented corporate culture (RQ1), app meta-requirements as a strategic approach to addressing these issues (RQ2), as well as design and implementation principles (RQ3). Referring to the literature on sustainability apps, gamification, and nudging, our qualitative research design combines an analysis of four corporate apps intending to promote sustainable behavior and expert interviews (Grounded Theory). The proposed framework supports the planning, realization, and monitoring of this targeted app use. Single cultural dimensions inform seven issues in culture development. Five meta-requirements address this multi-dimensionality, challenges provided by new digital working environments, and principles of Green IT. Four design principles support, extend, and integrate current knowledge on app features, nudging, and gamification. Five variables determine the app intervention and maturity level. We conclude that this targeted app use should intend to foster the sustainability orientation within all dimensions of corporate culture instead of being limited to promoting sustainable behavior.
Background
Citizen energy cooperatives (CECOs) are an important element for realising the transformation of the European energy system from a central system, dominated by a few market players to a decentralized system with the participation of many citizens, in which energy supply is largely based on renewable energy sources. This article identifies success factors that ensure a working organization that is capable of implementing projects to support the energy transition and improving the well-being of citizens.
Methods
The aim of this study is to identify success factors using the example of CECOs in north western Germany through a two-step process. The first step is a literature review to identify success factors of CECOs. Second, 12 semi-structured expert interviews with managers of CECOs are conducted and evaluated by means of a qualitative content analysis. The interviews identified the success factors and barriers of CECOs. The interviews were recorded and transcribed verbatim. The coding process was carried out using a qualitative data analysis software (ATLAS.ti 8.4.5,).
Results
The results show that three factors particular should be present, but can influence each other, to lead to successful CECOs: (1) the CECOs require business models with low complexity, as business models that span different stages of the value chain can overwhelm organizational managers. (2) Committed key individuals must be found and promoted. They need the support of the members. (3) Social and ecological principles are the core values of CECOs. The maintenance and strengthening of social–ecological credibility must be promoted in the public perception.
Conclusions
The results show that CECOs emerge from a strong social cohesion in a society. In addition, local "key individuals" need to be identified and supported. To this end, the framework conditions (e.g., policy, legislation, municipal support, etc.) must be adapted in such a way that these "key individuals" in CECOs are not overburdened. The analysis of the interviews also revealed that political or regulatory barriers are often cited as obstacles to the implementation of community energy projects.
In the race against climate change, small and medium-sized enterprises (SMEs) play a fundamental role. To clarify the contribution of corporate culture to SMEs' emission reduction, three perspectives can be useful: corporate culture as driver and barrier, current and planned corporate culture development actions, and the corporate culture profile as an outcome. As the first application of the extended Belief-Action-Outcome framework, this single case study exemplifies the role of corporate culture in an SME from the steel construction and manufacturing sector in Germany. The investigated SME has achieved emission reduction while increasing its revenue and is an early adopter of sustainable and digital development. The rich insights from an employee survey, semi-structured interviews, observation, and document analysis allowed us to outline an informed approach toward corporate culture development that emphasizes vision development of the desired corporate culture and the role of information systems for promoting emission reduction.
In recent years, the issue of land consumption or land use has become increasingly important in many areas of our society. Logistics processes in particular take up a lot of space and have a significant impact on the environment. The question is how this use of land can be optimised. Based on a systematic literature review and interviews with experts in the period between May 2021 and July 2021, this paper presents indicators that constitute or influence space-efficient logistics in the context of cooperation. The results show that in addition to the established cooperation characteristics, there are other indicators that are directly related to land use. In the logistics sector, there is strong competitive pressure and, as a result, little trust between companies. It has been shown that with the help of a neutral moderator, the gap between trusting, land-efficient cooperation and one’s own entrepreneurial interests can be narrowed, and cooperation can be profitable for all participants. In addition, digitisation actually does not seem to be sufficient to meet the information needs of a cooperation. The exchange of information not only serves to automate processes, but also makes cooperation more transparent. It shows that legal and municipal requirements need to be developed. It also becomes clear that the indicators have a mutual influence on each other and cannot be considered in isolation when it comes to the actual implementation of a cooperation. By increasing the efficiency of cooperative processes and value creation, it offers the opportunity to make land use more sustainable.
In view of the rapid depletion of natural resources and the associated overloading of the biological ecosystem, the concept of circular business models (CBMs) is increasingly discussed in the literature as well as in business practice. CBMs have the potential to significantly reduce the demand for natural resources. Despite their increasing relevance, the diffusion of CBMs in business practice is largely unexplored. Consequently, this article investigates the extent to which CBMs have already been adopted by large German companies. To answer this question, the annual and sustainability reports of the members of the DAX40 are analyzed for the presence of five specific types of CBMs. Data was gathered for the years 2015 and 2020 in order to describe the development over time. The results show an increasing prevalence of CBMs in the DAX companies. In addition, it is noticeable that CBM types that serve to close material cycles are implemented more frequently than those that decelerate material cycles. In particular Sharing Platforms and Product as a Service stand out due to comparatively low adoption. Potential reasons for these findings are discussed and managerial as well as policy implications suggested.
While recent studies have demonstrated that events are fundamentally climate sensitive, this seems to not be fully considered in event research or corporate event practice. Thus, this study aims to identify the influencing factors that affect the acceptance of climate adaptation measures among decision-makers in the event industry. The analysis was divided into three main parts. First, the existing literature related to climate change in an events context was reviewed. Using 15 semi structured interviews, the findings from this review were then critically discussed with stakeholders in Germany involved in event planning. Finally, explicit climate adaptation measures were proposed and discussed. Based on all findings, there appears to be a low level of awareness of and interest in climate adaptation amongst German event industry players. There is an imminent need for further research on climate adaptation and for decision-makers to better prepare for climate change in order to counteract resulting negative impacts.
While the topic of artificial intelligence (AI) in multinational enterprises has been receiving attention for some time, small and medium enterprises (SMEs) have recently begun to recognize the potential of this new technology. However, the focus of previous research and AI applications has therefore mostly been on large enterprises. This poses a particular issue, as the vastly different starting conditions of various company sizes, such as data availability, play a central role in the context of AI. For this reason, our systematic literature review, based on the PRISMA protocol, consolidates the state of the art of AI with an explicit focus on SMEs and highlights the perceived challenges regarding implementation in this company size. This allowed us to identify various business activities that have been scarcely considered. Simultaneously, it led to the discovery of a total of 27 different challenges perceived by SMEs in the adoption of AI. This enables SMEs to apply the identified challenges to their own AI projects in advance, preventing the oversight of any potential obstacles or risks. The lack of knowledge, costs, and inadequate infrastructure are perceived as the most common barriers to implementation, addressing social, economic, and technological aspects in particular. This illustrates the need for a wide range of support for SMEs regarding an AI introduction, which covers various subject areas, like funding and advice, and differentiates between company sizes.
This chapter examines the integration of Sustainable Development Goal 5 (SDG 5) into identity-based brand management by focusing on Dove’s brand management as a case study. The Dove “Real Beauty” campaign highlights the potential for brands to address gender equality and female empowerment by aligning with pro-female and feminist principles. A narrative literature review shows how the components of identity-based brand management have been observed in scholarly discussions. Despite mixed responses and criticisms, Dove initiated important conversations around beauty standards and gender equality. The chapter emphasizes the need for authenticity, sensitivity, and continuous improvement in integrating SDG 5 into brand management while acknowledging the potential risks and limitations of consumerist therapy and false hopes. Future research could therefore explore diverse brands, industries, and cultural contexts, as well as the role of intersectionality in identity-based brand management.
The excitement sparked by the emergence of AI open platforms has encountered significant scrutiny from educators and educational planners, who have raised valid concerns about issues such as plagiarism, testing protocols, and the authenticity of content submitted by students. While these concerns are timely and crucial, it's essential not to overlook other pressing issues that often go unnoticed in the lived educational experience of learners, particularly within the field of social sciences. This paper aims to advocate for a humanistic approach with a focus on education in the generative AI Era.
Methods: Systematic review of randomized controlled trials (RCT). Searches were conducted in five electronic databases. Studies were selected if they included patients with NP over 18 years old treated with aerobic exercise (AE) (e.g., cycling, running, hiking, and walking). The main outcome of interest was pain intensity. Qualitative and quantitative data were extracted. The risk of bias (RoB) was determined using the Cochrane RoB Tool-2 and the overall certainty of the evidence with the GRADE recommendations.
Results: Out of 21,585 initial records screened, a total of six individual studies published in ten manuscripts were included. There was a great heterogeneity between protocols, comparisons, and studies’ results (different magnitudes and directions). When looking at the effect of aerobic exercise versus control groups or other interventions on pain intensity measured with the VAS, not statistically (nor clinical) significant differences between aerobic exercise and control groups (MD [95%CI] 5.16 mm [-6.38, 16.70]) were identified. The combined effect of AE plus other interventions seems to be effective. Strength exercise obtained better effects than aerobic exercises (MD [95%CI]: -11.34 mm [-21.6, -1.09]).
Conclusions: Aerobic exercise presented positive results to reduce pain intensity, and improving disability, and physical and emotional functioning. However, the evidence is restricted, low quality, and heterogeneous.
Methods: The searches were conducted on five electronic databases. RCTs or CTs with patients over 18 years old of both sexes with OFP diagnoses were targeted. The intervention of interest was AE (i.e., walking, cycling, and running), compared to any other conservative and non-conservative therapy. The primary outcome was pain intensity. Risk of bias (RoB) was done with the Cochrane RoB tool (RoB 2). The overall certainty of the evidence was evaluated with GRADE.
Results: Out of 21,585 initial records found in the initial database search, only one study (reported on three manuscripts) was included. The diagnosis of interest was headache plus temporomandibular disorders (TMD). Three treatment groups (strengthening (Str) exercise + manual therapy (MT) (G1); AE + MT + Str exercises (G2); AE (G3)) were compared. The main outcome was pain; the secondary outcomes included disability, strength, anxiety, and quality of life. The combined treatment (AE+MT+Str exercises) had the strongest effect to decrease pain and headache intensity in patients with OFP (SMD: 9.99 [95%CI: 7.19, 12.80].
Conclusions: a multimodal treatment strategy achieved the greatest positive effects on pain and other outcomes in the short/medium term. AE seems to be an important component of this strategy. However, the scientific evidence supporting AE’s isolated effect is limited, indicating a research gap in this scientific field.
Background: Singers belong to the group of professional voice users with the highest demands regarding voice quality and vocal load. Thus, they also have a high risk of developing a voice disorder, which in return has major impact on their ability to work. Besides voice disorders caused by organic changes, there are functional voice disorders caused by, e.g., a hypertonia of the larynx, shoulder and neck muscles or insufficient breathing patterns. In these cases, physiotherapy can be one component of a multidisciplinary approach to treatment.
The purpose of this presentation is, based on anatomical considerations and current evidence, to inform about and demonstrate physiotherapy techniques for treating singers with functional voice disorders.
Approach of Presentation: A case from a special physiotherapy outpatient clinic for vocalists will be described. Based on this example, information on the evidence of physiotherapy approaches for functional voice disorders will be provided. Afterwards, some practical hands-on techniques will be demonstrated for participants to try.
Content of Presentation: This workshop will focus on the physiotherapy treatment for a vocalist with functional voice disorders. The vocalist experienced changed pitch and hypertonia in both the muscles of the shoulder-neck region and the extrinsic laryngeal muscles. Paralaryngeal manual techniques, in addition to posture and breathing exercises, will be demonstrated with the purpose of mobilizing the larynx and relaxing the hypertonic muscles.
Conclusions and Practical Relevance: This workshop highlights the special potential of physical therapy in the treatment of functional voice disorders in singers.
Objectives:
The purpose of this study was to determine the motor function of the abdominal muscles in singers with and without functional voice disorders and to examine them for possible differences. Additionally, the breathing behaviour and posture control was investigated.
Study Design
Observational study.
Methods:
Female subjects (n = 20) with differing levels of professional competence were used to provide the data for analysis. By using the Singing Voice Handicap Index (SVHI) the grade of dysphonia could be measured, and the subjects were organized in groups. The change of muscle thickness of the M. transversus abdominis (TVA) and the M. obliquus internus abdominis (OIA) during different singing tasks was measured by using ultrasound. The subjects were then asked to perform the Abdominal Hollowing Test (AHT) with the STABILIZER. Finally, the subjects were all filmed while singing. The videos recordings of the singing sessions were analysed by an independent clinical expert regarding breathing and secondary motor activities (SMA). For the statistical analysis, the Mann-Whitney-U Test and the Chi-Square-Test was mainly used.
Results:
The results showed a significantly thinner TVA in the group with dysphonia in comparison to the group without dysphonia. Ultrasound measurements showed significantly higher changes of muscle thickness of the TVA during singing tasks in the group with dysphonia. Regarding the AHT there was a significant difference between the two groups. The group with dysphonia was not able to increase the pressure by 15mmHg. Furthermore, the healthy subjects demonstrated abdominal breathing, while the group with dysphonia present with thoracic breathing. Additionally, it was noted that the subjects with dysphonia showed a higher level of associated movements especially at and/or on the lumbar spine, cervical spine and the left arm and shoulder.
Conclusion:
Differences in TVA-recruitment, breathing behaviour and secondary motor activities while singing were found. This study sparks new ideas for neuromusculoskeletal assessments and therapy.
Key Words
Transversus abdominis, Abdominal muscles, Dysphonia, Ultrasound, Singing voice, Singers
rationale: Musculoskeletal problems are widespread in performing artists and are due to the special demands of instrument playing, singing or dancing. Additionally, various other factors might contribute to performance-related musculoskeletal problems. In order to provide a specific physiotherapeutic management for performing artists, it is important to gain information about the performing art, the individual (biomechanical) demands and contributing factors. The subjective examination is the basis of the clinical reasoning process and the hypothesis forming, which is important for goal setting in further clinical examination and biomechanical analysis. In the present protocol, the subjective examination consists of a questionnaire based section and an interview based section and is part of the evaluation process of the neuromusculoskeletal examination of a performing artist specific reference laboratory.
purpose: The aim of this study was to develop a standardized protocol for an interview based subjective examination of performing artists with musculoskeletal problems. The results of this section of the subjective examination will be combined with the results of the questionnaire based subjective examination , in order to gather as much relevant information as possible to specifically address the individual’s musculoskeletal health status.
methods: A common physiotherapeutic recording of findings which addresses the relevant questions of the subjective examination of musculoskeletal problems was used. In order to adapt the anamnesis to performing-related musculoskeletal problems, questions specific to instrument playing, singing and dancing were selected on the basis of a literature search and the expertise of the research group.
results: The protocol is based on the five aspects of clinical practice described by Maitland and the Musculoskeletal Clinical Translation Framework by Mitchell et al. (2017) .The performing art specific questions especially address (1) performing art specific considerations including style, genre, education and professional level, practice habits, repertoire, and external factors, e.g. concert conditions, (2) performing art specific physical and psychosocial contributing factors, and (3) performing art specific activities which trigger the musculoskeletal problems and help to form hypotheses for the following clinical examination. Individual tracks lead through the subjective examination so that irrelevant questions are skipped depending on the kind of musculoskeletal problem and the performing art practiced by the individual client.
conclusions: A pretest of this standardized anamnesis protocol is ongoing in a special physiotherapy clinic for performing artists since spring 2022. In an iterative approach, the protocol will be continuously improved based on patient feedback and clinical considerations.
The aim of this European interprofessional Health Informatics (HI) Summer School was (i) to make advanced healthcare students familiar with what HI can offer in terms of knowledge development for patient care and (ii) to give them an idea about the underlying technical and legal mechanisms. According to the students’ evaluation, interprofessional education was very well received, problem-based learning focussing on cases was rated positively and the learning goals were met. However, it was criticised that the online material provided was rather detailed and comprehensive and could have been a bit overcharging for beginners. These drawbacks were obviously compensated by the positive experience of working in international and interprofessional groups and a generally welcoming environment.
Background and Aims
Early identification of nerve lesions and associated neuropathic pain in spine-related pain disorders is important for tailored treatment. Management may consist of surgical intervention for compressive neural lesions.
With a growing waitlist for public surgical outpatient clinics in Western Australia and wait times exceeding the recommended wait time for initial assessment (Category 1 – assessment within 1 months, Category 2 within 3 months, category 3 within 12 months), a call to support new models of care has been made1, including the evaluation and expansion of workforce models supporting advanced skills in allied health.1
An Advanced Scope Physiotherapy (ASP) led Neurosurgery Spinal Clinic operates at Sir Charles Gairdner Hospital in Western Australia. The ASPs (2FTE) examine patients from the neurosurgery waitlist for their suitability for spinal surgery. Recommendation of either further investigation and possible assessment by a neurosurgeon or appropriate non-surgical management of the patients’ pain condition is suggested. Patient assessment is conducted either ‘in person’ at the hospital or via telehealth due to the remoteness of some rural patients. Patient cases are discussed with a neurosurgery consultant on a weekly basis. The aim of this project is to evaluate the ASP service in the year 2022.
Method
A retrospective descriptive analysis of patient data captured in 2022 was performed.
Results
In 2022, 1337 new patient referrals were managed plus 267 follow-ups from the previous year. Category 1 patients (n=81) waited on average 31 days for their first appointment, Category 2 patients (n=394) waited 76 days and Category 3 patients (n=854) waited 376 days.
287 (18%) referrals were discharged without physical assessment of the patient (DNA, cancellations, declined). Of the 1317 patients physically assessed by the ASPs (57%) were discharged directly after assessment, for 290 patients (22%) their outcome was still pending at time of analysis (March 2023) and 281 (22%) patients were referred for review with a neurosurgeon. Of the 229 patients assessed by a neurosurgeon (including patients from 2022), 103 patients (45%) were offered surgery, 52 (23%) were not offered surgery, 46 ( 20%) patients had to be reviewed, and for the remaining (n=18) their outcome was unknown.
Conclusion
Of the 1604 patients managed in the Neurosurgery Spinal Clinic, only 17% needed to see a neurosurgeon. The conversion rate to surgery of 45% is higher compared to an estimated 5%-10% in a non-triaged clinic.
The ASP model of care has proved invaluable to (i) provide access of patient care within the recommended wait times (ii) optimize neurosurgeons’ time, (iii) educate patients and, in case of non-suitability for surgery, advise and refer them for alternative appropriate management.
Relevance for Patient Care
The Advanced Scope Physiotherapy model of care at the Neurosurgery Spinal Clinic allows timely assessment of patients with spine-related disorders and supports targeted management of their condition.
Ethical Permissions
This project is registered as a Quality Improvement Project at Sir Charles Gairdner Hospital (QI35728) and as per the National Statement on Ethical Conduct in Human Research was exempt from review by the Sir Charles Gairdner Hospital Human Research and Ethics Committee
References
1Sustainable Health Review (2019). Sustainable Health Review: Final report to the Western Australian Government of Health, Western Australia
Workshop: “‘Sciatica’: neuropathic or not and does it matter? Outcomes from a NeuPSIG working group”
(2023)
The identification of neuropathic pain in persons with spine-related leg pain is important as this information guides treatment and management, including self-management. The NeuPSIG neuropathic pain grading system was developed to assist clinicians and researchers in determining whether patients have neuropathic pain and the level of confidence associated with that decision. Based on clinical and laboratory examination findings, patients are classified as having no neuropathic pain, possible, probable or definite neuropathic pain. Whereas this grading system works nicely in people with systemic neuropathies where sensory findings and diagnostic tests are mostly present, its application in patients with spine-related leg pain, particular in radicular pain, can be challenging. For example, in the absence of sensory changes and MRI findings, patients with radicular pain would at best reach a classification of possible neuropathic pain according to the current neuropathic pain grading system.
In this presentation I will explain the adaptations to the neuropathic pain grading system for spine-related leg pain recommended by the NeuPSIG working group. I will demonstrate its application in clinical practice using case studies and provide clarity for how the system can be incorporated in clinical trials. This will be an interactive session with audience participation.
Purpose
Sedentary behaviour (SED) and low level of physical activity (PA) might be associated with the development or worsening of pain. Still, studies assessing physical behaviours by accelerometry in individuals with orofacial pain are limited. This study aims to assess whether women with temporomandibular disorders (TMD) present different patterns of physical behaviours in days with (DWP) or without pain (DWoP).
Methods
Twenty-nine out of forty-four women (mean age 29.21 sd 7.96) were diagnosed with TMD and monitored over seven days using a thigh-worn accelerometer. DWP was determined when subjects presented pain in one of the craniocervical regions (head, jaw and neck) with intensity of at least 3 in the numerical rating scale. To be considered a DWoP, the individual presented less than 3 points in the three regions. Daily time-use compositions were described in terms of SED in short (<30 min) and long (≥30 min) bouts, light PA (LPA), moderate-to-vigorous PA (MVPA), and time-in-bed. Isometric log-ratios (ilr) were calculated to express the ratio of time-in-bed to time spent awake, SED relative to LPA and MVPA, SED in short relative to long bouts, and LPA relative to MVPA. Differences between DWP and DWoP were examined using MANOVA, followed by univariate post-hoc tests of pairwise differences.
Results
During DWP, women with TMD spent more time in SED in short (239 min) and long bouts (419 min), less time in LPA (245 min), MVPA (68 min), and in bed (468 min) compared with DWoP (235, 378, 263, 70 and 493 min, respectively). The MANOVA showed that all sets of ilrs did not differ statistically (ηp2 = 0.19, p = 0.25). Still, the post-hoc tests showed a trend that time spent SED relative to LPA and MVPA was larger in DWP than in DWoP (Cohen’s d = 0.36, p = 0.05).
Conclusions
Women with TMD did not show different patterns of physical behaviours in DWP or DWoP. However, there is a trend of more sedentary behaviour and less physical activity in DWP compared to DWoP. Future studies should consider other pain intensity cut-offs, isolated pain locations, and larger sample sizes to confirm these results.
Nostalgia is a construct that, even when rooted in lived experiences, serves the ultimate purpose of creating a desired sense of world. Fundamental cognitive competencies, including memory and imagination, are utilized by the nostalgic subject to fulfill a need for narrative coherence. A temporal or spatial distance is necessary for the occurrence of a nostalgic episode, which can be conceptualized as a “had been” state of being, as direct access to the experience is often impossible. Nostalgia may thus be viewed as a tool for sense-making rather than solely as a yearning for the past. The nostalgic narrative form is a construct that permits human subjects to comprehend their existence in the world while drawing upon their roots. These tools for sense-making serve as bridges between past experiences and current conditions. Ultimately, nostalgic identity is not just about longing for the past but also about utilizing the past as a resource for navigating the labyrinths of the present. Analyses are conducted to examine the medium of music video at three levels - auditory, visual, and linguistic - in order to investigate the strategies and techniques employed by the Iranian diaspora to create nostalgic narratives. Samples of original pieces and renditions are contrasted in order to identify elements of nostalgic narrativity. Drawing on empirical research, it is argued that the unity of a music video arises from the integration of separate layers of sensory and conceptual inputs that have been composed towards an affective resonance and narrative coherence.
Background: Multilingual children with suspected SLCN are often overlooked or their needs not accurately differentiated regarding the necessity of language support or therapy. The purpose of the study was to conceptualize, carry out and evaluate a local language support (LS) project within linguistically and culturally diverse (LCD) families and its effects on all collaborating participants.
Methods: Eight SLT students and one lecturer took part in the LS-project, alongside equivalent numbers of family liaison personnel. Students visited more than 10 young children aged between 2-6 years, and for each child 10 weekly home visits were carried out. Language enhancement was documented, several case studies with children and interviews with five liaison personnel conducted.
Results: All SLT students perceived changes in the behaviour and communication of participating children. Children in the case studies developed from pre-verbal to verbal means of communication and family liaison personnel reported positive changes alongside parental wishes to continue the support.
Conclusion: Local language support projects with LCD families can lead to positive differences regarding their children's communication development and better inclusion in mainstream society. SLT students benefit from working with LCD families and their collaborative support together with family liaison personnel, and vice versa.
Learning Outcomes: To differentiate the influence of language enhancement vs. formalized SLT therapy. To enhance the relationship with LCD clientele and collaboration with liaison personnel in SLCN settings. To incorporate life-long learning and intercultural sensitization.
Biomechanical analyses are capable of capturing and evaluating human motions. In addition to the major biomechanical fields of kinetics and kinematics, electromyography (EMG) provides a reliable way to analyse neuromuscular activities, e.g. inter- and intramuscular coordination or fatigue behavior. Based on these parameters it is possible to conclude to clinically relevant parameters such as motor control, muscular coordination or compensation strategies with different loads. In addition to this, EMG can be used in treatment itself, e.g. biofeedback-training with an EMG is an effective and evidenced based tool to improve neuromuscular control. The purpose of this workshop is to show the advantages of implementing EMG in performing artists´ health and to demonstrate additional therapy and diagnostic options.
This workshop briefly introduces the theoretical principles of EMG and the clinical applications in the context of performing artists´ health. It explains why EMG provides an additional value in the clinical reasoning process and supports the therapist, but decision making in the clinical reasoning process should never be based on EMG solely.
In the further course of the workshop the use of EMG in diagnostics and therapy (biofeedback) with performing artists is practically demonstrated and discussed with the participants.
Approach of Presentation:
1. Short presentation: introduction and understanding of EMG (educational objective 1)
2. Short case presentation of a performing artist to introduce EMG in the field of performing artists´ health and clinical reasoning (educational objective 2)
3. Interactive practical demonstration (diagnosis and biofeedback-training) as the central part of the workshop. Questions and comments will be discussed directly throughout the group (educational objective 3)
Clinical Significance:
EMG based functional neuromuscular diagnostics and biofeedback-training provides both the therapist as well as the performing artist with additional value in their clinical work.
Educational Objectives:
At the end of the workshop, the participants will be able to…
1. understand and describe the basic principles of EMG
2. understand and describe the importance of EMG in the context of performing artists´ health, physical therapy and clinical reasoning
3. use EMG on performing artists in the performance process
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.
Aims and Objectives:
Preventive home visits are a low-threshold counselling and support approach. They have been reported to achieve heterogeneous effects. However, preventive home visits have the potential to reduce the risk of becoming dependent on long-term care. The aim of this study is to investigate the effect of preventive home visits as a nursing intervention on health-related quality of life of older people in a longitudinal survey and to develop recommendations for which target groups preventive home visits have the highest benefit. The sample consisted of 75 people, aged between 65 and 85, who were able to understand and speak German, had not yet been eligible for benefits from the long-term care insurance and lived in the municipality under study.
Methodological Design and Justification:
A quantitative longitudinal study in order to investigate the effects of preventive home visits.
Ethical Issues and Approval:
There were no ethical concerns. Accordingly, ethical approval was granted.
Research Methods, Results and Conclusions:
The health-related quality of life was recorded four times between 01/2017 and 08/2020 with the Short-Form- Health- Survey- 12 and analysed using descriptive statistics. Results reveal that the physical health status cannot be easily influenced over a short period of time. The main effect, however, is that preventive home visits have a significant positive effect on the mental health status. The main topics during the home visits were mobility, nutrition and social participation. Increased knowledge and motivation for preventive behaviour extended the autonomy of older people. Accordingly, preventive home visits can support a self-determined life in a familiar environment. The results of the present study show that preventive home visits as a nursing intervention in rural areas are successful. In Germany, preventive home visits have not yet been implemented on a regular basis. In order to do so, a general definition of the concept is needed. Preventive home visits should be officially included in the regular health care services in Germany.
This report summarizes and discusses the development, main achievements and overall progress of The Interprofessional European eHealth Programme in Higher Education (eHealth4all@EU) project. The project evolved through a strong partnership between members of the consortium, grounding its activities on previous initiatives like TIGER and taking them one step further while looking into the digital health competencies required by graduate students working in health and care and providing teaching approaches and other initiatives to extend further a set of core competencies: Health Information Systems Interoperability, Data Security and Privacy and Data Analytics. Although the project activities underwent during the pandemic period, a condition that forced reorganization and adaptation of the workplan, the main initiatives like the identification of significant areas of interest for digital health competencies and related relevant teaching methods that foster active learning paved the way for the construction of learning content structured around a syllabus aimed at distance learning and faceto- face learning moments developed with the intent for reuse and fostering the development of these set of competences in future Health Professionals. To this purpose, we are convinced that grounding steps have been taken with these eHealth4All@EU activities and initiatives.
IO6 is a report of the evaluation of the online courses and Summer School. The project plan of eHealth4all@EU guides the evaluation. The aim of the evaluation is to present the strengths and developing parts of the project. The main evaluation themes are eHealth, inter-professional education, and problem-based learning. For the funder’s perspective, evaluation focusing themes of digital support, lifelong learning, an active citizen, and the future. Evaluation of the project assign around all these themes and will find out students’ and teachers’ feelings of satisfaction, efficiency, and quality of the learning experience.
In September 2022, the interprofessional European Summer School on the topic “Information in Healthcare – From Data to Knowledge” was held at the University of Porto. This Summer School included the topics Interoperability, Data Protection and Security and Data Analytics and consisted of an online preparation phase and an attendance phase in Porto. The didactic concept involved problem-based learning using a case study. A variety of course materials were developed and used to achieve the learning objectives. There are plans to continue the Summer School concept at participating institutions in the future, starting with a Spring School 2023 in Osnabrück.
Interoperability, Data Protection and Security and Data Analytics are of high relevance for the future of eHealth and interprofessional care. Three online courses were therefore designed and delivered for these topics, all of which followed the same structure. A variety of materials were developed and different tools for knowledge transfer, communication and collaboration were used.
Problem-based learning (PBL) has become established as a successful didactic approach far beyond the field of medicine. Although there is no single concept of PBL, there is agreement on its objectives and implementation. Of central importance is the case that supports autonomous and reflective learning. Even before COVID-19, digital methods were used in traditional PBL. These served to support, for example, the provision of learning materials. As a result of university closures during the COVID-19 pandemic, technical solutions were made available at an unprecedented speed, which made it possible to implement the different requirements of traditional PBL in a digital PBL (DPBL). The present study results based on two scoping reviews demonstrated that PBL can be implemented digitally and that different digital methods, both asynchronous and synchronous, are available for the different steps. They show that DPBL not only leads to comparable student performance, but can also develop further competences, e.g. digital communication. With the findings, a concept for the implementation of DPBL as well as recommendations for the further development of DPBL are available.
The University of Eastern Finland was the responsible partner of IO1: European eHealth Education: Policy and Practice Review. The aim of this intellectual output was to customize and validate the already existing international health informatics recom-mendations. Based on that the aim was also to describe the priorities of core compe-tencies and learning outcomes particularly in the fields addressed by this project. The methods used were a scoping review and focus group interviews. The aim of the scoping review was to explore how education in health informatics (HI) has been taught by evaluating the existing international frameworks and reported ed-ucations in HI. The scoping review was conducted based on the instructions of Joanna Briggs Institute to find English language publications published between 2016 and 2020. All publications found in the bibliographical database MEDLINE via PubMed, Scopus and Web of Sciences were included. The results indicated that education in HI is essential to everyone, and everyone needs skills and knowledge in both technical and non-technical skills in HI. Education in HI should be introduced already in the first year of the education and with time increase the knowledge to a more advanced level. The teaching methods can vary between lectures in class to a more hybrid method. The aim of the online focus group interview was to investigate the needs of HI compe-tencies in health care. To achieve the answers, two main questions were used as a base of the interview. The first question focused on how knowledge and competencies in health informatics could contribute to improving health care. The second question focused on which HI competencies are seen as important to learn and how to achieve them. Online focus group interviews were conducted in each of the three countries. The interviews were done the own languages (German, Portuguese, and Finnish) and later summarized and translated to English. The focus group interviews concluded that there are challenges and possibilities in health informatics. It also highlighted the com-petencies seen as important to have in daily working life. For example, skills in appli-cations in patient care, knowledge in IT-background and IT related management are considered important.
Europe's freshwater biodiversity under climate change: distribution shifts and conservation needs
(2014)
Aim
To assess the future climatic suitability of European catchments for freshwater species and the future utility of the current network of protected areas.
Location
Europe.
Methods
Using recently updated catchment-scale species data and climate projections from multiple climate models, we assessed the climate change threat by the 2050s for 1648 European freshwater plants, fishes, molluscs, odonates, amphibians, crayfish and turtles for two dispersal scenarios and identified hotspots of change at three spatial scales: major river basins, countries and freshwater ecoregions. We considered both common species and the often overlooked rare species. To set our findings within the context of current and future conservation networks, we evaluated the coverage of freshwater biodiversity by Europe's protected area network.
Results
Six per cent of common and 77% of rare species are predicted to lose more than 90% of their current range. Eight fish species and nine mollusc species are predicted to experience 100% range loss under climate change. As the most species-rich group, molluscs are particularly vulnerable due to the high proportion of rare species and their relatively limited ability to disperse. Furthermore, around 50% of molluscs and fish species will have no protected area coverage given their projected distributions.
Main conclusions
We identified the species most at threat due to projected changes in both catchment suitability and representation within the European protected area network. Our findings suggest an urgent need for freshwater management plans to facilitate adaptation to climate change.
The conservation of freshwater ecosystems has lagged behind that of marine and terrestrial ecosystems and often requires the integration of large-scale approaches and transboundary considerations. This study aims to set the foundations of a spatial conservation strategy by identifying the most important catchments for the conservation of freshwater biodiversity in Europe.
Using data on 1296 species of fish, mollusc, odonate and aquatic plant, and the key biodiversity area criteria (species Red List status, range restriction and uniqueness of species assemblages), we identified a network of Critical Catchments for the conservation of freshwater biodiversity. Applying spatial prioritisation, we show how the prioritised network differs from the ideal case of protecting all Critical Catchments and how it changes when protected areas are included, and we also identify gaps between the prioritised network and existing protected areas.
Critical Catchments (n = 8423) covered 45% of the area of Europe, with 766 qualifying (‘trigger’) species located primarily in southern Europe. The prioritised network, limited to 17% of the area of Europe, comprised 3492 catchments mostly in southern and eastern Europe and species targets were met for at least 96% of the trigger species.
We found the majority of Critical Catchments to be inadequately covered by protected areas. However, our prioritised network presents a possible solution to augment protected areas to meet policy targets while also achieving good species coverage.
Policy implications. While Critical Catchments cover almost half of Europe, priority catchments are mostly in southern and eastern Europe where the current level of protection is not sufficient. This study presents a foundation for a Europe-wide systematic conservation plan to ensure the persistence of freshwater biodiversity. Our study provides a powerful new tool for optimising investment on the conservation of freshwater biodiversity and for meeting targets set forth in international biodiversity policies, conventions and strategies.
Climate change is expected to exacerbate the current threats to freshwater ecosystems, yet multifaceted studies on the
potential impacts of climate change on freshwater biodiversity at scales that inform management planning are lacking. The aim of this study was to fill this void through the development of a novel framework for assessing climate
change vulnerability tailored to freshwater ecosystems. The three dimensions of climate change vulnerability are as
follows: (i) exposure to climate change, (ii) sensitivity to altered environmental conditions and (iii) resilience potential.
Our vulnerability framework includes 1685 freshwater species of plants, fishes, molluscs, odonates, amphibians, crayfish and turtles alongside key features within and between catchments, such as topography and connectivity. Several
methodologies were used to combine these dimensions across a variety of future climate change models and scenarios. The resulting indices were overlaid to assess the vulnerability of European freshwater ecosystems at the catchment scale (18 783 catchments). The Balkan Lakes Ohrid and Prespa and Mediterranean islands emerge as most
vulnerable to climate change. For the 2030s, we showed a consensus among the applied methods whereby up to 573
lake and river catchments are highly vulnerable to climate change. The anthropogenic disruption of hydrological
habitat connectivity by dams is the major factor reducing climate change resilience. A gap analysis demonstrated that
the current European protected area network covers <25% of the most vulnerable catchments. Practical steps need to
be taken to ensure the persistence of freshwater biodiversity under climate change. Priority should be placed on
enhancing stakeholder cooperation at the major basin scale towards preventing further degradation of freshwater
ecosystems and maintaining connectivity among catchments. The catchments identified as most vulnerable to climate
change provide preliminary targets for development of climate change conservation management and mitigation
strategies.
The distribution of a species along a thermal gradient is commonly approximated by a unimodal response curve, with a characteristic single optimum near the tempera‐ture where a species is most likely to be found, and a decreasing probability of occur‐rence away from the optimum. We aimed at identifying thermal response curves (TRCs) of European freshwater species and evaluating the potential impact of climate warming across species, taxonomic groups, and latitude. We first applied generalized additive models using catchment‐scale global data on distribution ranges of 577 freshwater species native to Europe and four different temperature variables (the current annual mean air/water temperature and the maximum air/water temperature of the warmest month) to describe species TRCs. We then classified TRCs into one of eight curve types and identified spatial patterns in thermal responses. Finally, we in‐tegrated empirical TRCs and the projected geographic distribution of climate warm‐ing to evaluate the effect of rising temperatures on species’ distributions. For the different temperature variables, 390–463 of 577 species (67.6%–80.2%) were char‐acterized by a unimodal TRC. The number of species with a unimodal TRC decreased from central toward northern and southern Europe. Warming tolerance (WT = maxi‐mum temperature of occurrence—preferred temperature) was higher at higher lati‐tudes. Preferred temperature of many species is already exceeded. Rising temperatures will affect most Mediterranean species. We demonstrated that fresh‐water species’ occurrence probabilities are most frequently unimodal. The impact of the global climate warming on species distributions is species and latitude depend‐ent. Among the studied taxonomic groups, rising temperatures will be most detri‐mental to fish. Our findings support the efforts of catchment‐based freshwater management and conservation in the face of global warming.
Niche-based species distribution models (SDMs) have become an essential tool in conservation and restoration planning. Given the current threats to freshwater biodiversity, it is of fundamental importance to address scale effects on the performance of niche-based SDMs of freshwater species’ distributions. The scale effects are addressed here in the context of hierarchical catchment ordering, considered as counterpart to coarsening grain-size by increasing grid-cell size. We combine fish occurrence data from the Danube River Basin, the hierarchical catchment ordering and multiple environmental factors representing topographic, climatic and anthropogenic effects to model fish occurrence probability across multiple scales. We focus on 1st to 5th order catchments. The spatial scale (hierarchical catchment order) only marginally influences the mean performance of SDMs, however the uncertainty of the estimates increases with scale. Key predictors and their relative importance are scale and species dependent. Our findings have useful implications for choosing proper species dependent spatial scales for river rehabilitation measures, and for conservation planning in areas where fine grain species data are unavailable.
Model-derived relationships between chlorophyll a (Chl-a) and nutrients and temperature have fundamental implications for understanding complex interactions among water quality measures used for lake classification, yet accuracy comparisons of different approaches are scarce. Here, we (1) compared Chl-a model performances across linear and nonlinear statistical approaches; (2) evaluated single and combined effects of nutrients, depth, and temperature as lake surface water temperature (LSWT) or altitude on Chl-a; and (3) investigated the reliability of the best water quality model across 13 lakes from perialpine and central Balkan mountain regions. Chl-a was modelled using in situ water quality data from 157 European lakes; elevation data and LSWT in situ data were complemented by remote sensing measurements. Nonlinear approaches performed better, implying complex relationships between Chl-a and the explanatory variables. Boosted regression trees, as the best performing approach, accommodated interactions among predictor variables. Chl-a–nutrient relationships were characterized by sigmoidal curves, with total phosphorus having the largest explanatory power for our study region. In comparison with LSWT, utilization of altitude, the often-used temperature surrogate, led to different influence directions but similar predictive performances. These results support utilizing altitude in models for Chl-a predictions. Compared to Chl-a observations, Chl-a predictions of the best performing approach for mountain lakes (oligotrophic–eutrophic) led to minor differences in trophic state categorizations. Our findings suggest that both models with LSWT and altitude are appropriate for water quality predictions of lakes in mountain regions and emphasize the importance of incorporating interactions among variables when facing lake management challenges.
Land cover change is a dynamic phenomenon driven by synergetic biophysical and socioeconomic effects. It involves massive transitions from natural to less natural habitats and thereby threatens ecosystems and the services they provide. To retain intact ecosystems and reduce land cover change to a minimum of natural transition processes, a dense network of protected areas has been established across Europe. However, even protected areas and in particular the zones around protected areas have been shown to undergo land cover changes. The aim of our study was to compare land cover changes in protected areas, non-protected areas, and 1 km buffer zones around protected areas and analyse their relationship to climatic and socioeconomic factors across Europe between 2000 and 2012 based on earth observation data. We investigated land cover flows describing major change processes: urbanisation, afforestation, deforestation, intensification of agriculture, extensification of agriculture, and formation of water bodies. Based on boosted regression trees, we modelled correlations between land cover flows and climatic and socioeconomic factors. The results show that land cover changes were most frequent in 1 km buffer zones around protected areas (3.0% of all buffer areas affected). Overall, land cover changes within protected areas were less frequent than outside, although they still amounted to 18,800 km2 (1.5% of all protected areas) from 2000 to 2012. In some parts of Europe, urbanisation and intensification of agriculture still accounted for up to 25% of land cover changes within protected areas. Modelling revealed meaningful relationships between land cover changes and a combination of influencing factors. Demographic factors (accessibility to cities and population density) were most important for coarse-scale patterns of land cover changes, whereas fine-scale patterns were most related to longitude (representing the general east/west economic gradient) and latitude (representing the north/south climatic gradient).
Thermal response curves that depict the probability of occurrence along a thermal gradient are used to derive various species’ thermal properties and abilities to cope with warming. However, different thermal responses can be expected for different portions of a species range. We focus on differences in thermal response curves (TRCs) and thermal niche requirements for four freshwater fishes (Coregonus sardinella, Pungitius pungitius, Rutilus rutilus, Salvelinus alpinus) native to Europe at (1) the global and (2) European continental scale. European ranges captured only a portion of the global thermal range with major differences in the minimum (Tmin), maximum (Tmax) and average temperature (Tav) of the respective distributions. Further investigations of the model-derived preferred temperature (Tpref), warming tolerance (WT = Tmax − Tpref), safety margin (SM = Tpref − Tav) and the future climatic impact showed substantially differing results. All considered thermal properties either were under- or overestimated at the European level. Our results highlight that, although continental analyses have an impressive spatial extent, they might deliver misleading estimates of species thermal niches and future climate change impacts, if they do not cover the full species ranges. Studies and management actions should therefore favor whole global range distribution data for analyzing species responses to environmental gradients.
Freshwater ecosystems host disproportionately high numbers of species relative to their surface area yet are poorly protected globally. We used data on the distribution of 1631 species of aquatic plant, mollusc, odonate and fish in 18,816 river and lake catchments in Europe to establish spatial conservation priorities based on the occurrence of threatened, rangerestricted and endemic species using the Marxan systematic conservation planning tool. We found that priorities were highest for rivers and ancient lakes in S Europe, large rivers and lakes in E and N Europe, smaller lakes in NW Europe and karst/limestone areas in the Balkans, S France and central Europe. The a priori inclusion of well-protected catchments resulted in geographically more balanced priorities and better coverage of threatened (critically endangered, endangered and vulnerable) species. The a priori exclusion of well-protected catchments showed that priority areas that need further conservation interventions are in S and E Europe. We developed three ways to evaluate the correspondence between conservation priority and current protection by assessing whether a cathment has more (or less) priority given its protection level relative to all other catchments. Each method found that priority relative to protection was high in S and E Europe and generally low in NW Europe. The inclusion of hydrological connectivity had little influence on these patterns but decreased the coverage of threatened species, indicating a trade-off between connectivity and conservation of threatened species. Our results suggest that catchments in S and E Europe need urgent conservation attention (protected areas, restoration, management, species protection) in the face of imminent threats such as river regulation, dam construction, hydropower development and climate change. Our study presents continental-scale conservation priorities for freshwater ecosystems in ecologically meaningful planning units and will thus be important in freshwater biodiversity conservation policy and practice, and water management in Europe.
This textbook introduces you to international bookkeeping and accounting. It is designed as self study materials and covers the syllabus of an introductory class in accounting. After studying the Basics, you are well prepared to keep bookkeeping records and prepare financial statements like the balance sheet, the income statement, the cash flow statement and the statement of changes in equity.
All chapters outline the learning objectives, provide an overview, include case studies and how-it-is-done-paragraphs. They end with a summary, the explanation of new technical terms and a question bank with solutions for checking your learning progress. On the internet, you can find more than 350 exam tasks including solutions as well as youtube-videos from the author.
The textbook prepares you to study accounting and assists you with the transition from German bookkeeping to international accounting when qualifying for IFRSs.
Background:
Neck pain is one of the most common musculoskeletal pains and among the fourth leading causes of years of life lost due to disability, following back pain, depression, and arthralgia. (1)
In the course of their lives, about 70% of all people will experience a clinically relevant episode of neck pain, (2) so finding a good therapy to treat it is of high interest. Aerobic exercise is associated with pain reduction in patients with different types of MSK pain. Recent studies have shown a positive impact of aerobic exercises on brain function, memory processing, cognition, and motor function. (3, 4)
Therefore, the influence of aerobic exercise on pain modulation seems to be of particular interest for individuals with chronic MSK pain, since brain imaging studies have shown that these patients have structural and functional changes, as well as abnormal brain features in various areas of the brain. The evidence regarding the effectiveness of aerobic exercise for neck pain seems limited and outdated.
Thus, a systematic review evaluating the effects of aerobic exercise in patients with neck pain is needed. Therefore, this review aims to investigate the effectiveness of aerobic exercise interventions when compared to other conservative and non-conservative interventions (e.g., localized exercises, medication, acupuncture, physical agents, manual therapy) to decrease pain intensity in people with neck pain.
Materials and methods:
Electronic literature searches were conducted in a total of six databases such as Medline, Embase, CINAHL, Cochrane Library, Web of Science, and Scopus. The review considered randomised controlled trials (RCTs) including patients over 18 years having musculoskeletal pain in the neck area. The Neck Pain Task Force's classification of pain severity describes four levels of neck pain, with the first three levels considered in this review. (5)These must be clinically diagnosed by a health care provider according to signs and symptoms or based on standardized criteria specific for each disease. Studies involving subjects with any pre-existing conditions, previous surgery, or pain not clearly related to the musculoskeletal system were excluded. No limits were applied in terms of sex, ethnicity, and living country. Data were extracted using a standardized data extraction form.
Methodological quality was determined using the Cochrane Collaboration Risk of Bias Tool (CCRBT) and the strength of the evidence with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were extracted and evaluated by two independent reviewers.
Results:
A total of 21585 records were identified and screened independently for eligibility by two reviewers. A total of six unique studies, reported on ten manuscripts met the specified inclusion criteria. Different types of aerobic exercise were used in the studies. Studies included isolated and combined aerobic exercise using interventions such as cycling on an ergometer or walking outdoors at a moderate intensity. Comparison groups were for example strength training or education. The most common outcome was pain assessed with the Visual Analogue Scale (VAS) or the Nordic questionnaire.
The included studies had a high risk of bias and the overall quality of the evidence for this systematic review was considered low. There was high heterogeneity in the included studies regarding interventions applied and study results.
When looking at the effect of aerobic exercise versus control group or other intervention groups measured with VAS, it can be observed, that there was a great heterogeneity between studies results (different magnitudes and directions). Although none of the comparisons showed a statistically significant difference between aerobic exercise and control (MD 6.24 mm, 95% CI [-11.21; 23.96]) or active intervention groups (MD -9.52 mm, 95% CI [-18.48; -0.56]) on pain intensity; it seems that aerobic exercise is slightly better than a control group, and equally effective as other active treatments such as strength exercise or education.
In addition, when combined with other therapeutic modalities, aerobic exercise, could potentially help to reduce pain intensity (MD 7.71 mm, 95% CI [1.07; 14.35]). Especially in the long term, the combination of strength and aerobic exercise showed promising results. Statistically significant differences in favour of aerobic exercise for pre vs. three months follow up (MD 11.20 mm, 95% CI [2.85;19.55]) and pre vs. six moths follow up (MD 15.10 mm, 95% CI [6.99; 23.21]) were found.
Conclusions:
Although there is currently limited evidence on the effectiveness of aerobic exercise in individuals with chronic neck pain, aerobic exercise was found to not only reduce pain intensity, but also to improve disability as well as physical and emotional functioning. However, as the evidence is limited, low quality, and heterogeneous, further research is needed in this area to obtain more accurate results.
This new edition of the classic textbook on health informatics provides readers in healthcare practice and educational settings with an unparalleled depth of information on using informatics methods and tools. However, this new text speaks to nurses and -- in a departure from earlier editions of this title -- to all health professionals in direct patient care, regardless of their specialty, extending its usefulness as a textbook. This includes physicians, therapists, pharmacists, dieticians and many others. In recognition of the evolving digital environments in all healthcare settings and of interprofessional teams, the book is designed for a wide spectrum of healthcare professions including quality officers, health information managers, administrators and executives, as well as health information technology professionals such as engineers and computer scientists in health care. The book is of special interest to those who bridge the technical and caring domain, particularly nurse and medical informaticians and other informaticians working in the health sciences. Nursing Informatics: An Interprofessional and Global Perspective contains real-life case studies and other didactic features to illustrate the theories and principles discussed, making it an ideal resource for use within health and nursing informatics curricula at both undergraduate and graduate level, as well as for workforce development. It honors the format established by the previous editions by including a content array and questions to guide the reader. Readers are invited to look out of the box through a dedicated global perspective covering health informatics applications in different regions, countries and continents.
Management accounting
(2020)
Management Accounting is written for students in international Business Management study programs. It covers the widely applied syllabus of Cost Accounting and Management Accounting at universities on bachelor’s and master’s level. The book is based on more than 20 years’ academic teaching experience in Germany and at international universities in South Africa, Malaysia, China, the Netherlands and South Korea.
In this text book, the application of methods and instruments comes first. Management Accounting follows a case study based approach. All cases are taken from previous exam papers and explained in detail.
The text book starts with a case study of a manufacturing company and compares Financial Accounting to Management Accounting. It covers two point of views: (1) a General Management view, with aspects of business planning, cost-volume-profit analysis, degree of operating leverage, mergers and cross-border acquisitions and risk valuation. (2) a Cost Accounting view with Management Accounting systems, flexible budgeting, cost allocations, performance measurement and monitoring, reporting, calculation, manufacturing accounting (job order and process costing), activity based costing and multi-level contribution margin Accounting.
On the UVK website, numerous exam tasks and complete solutions thereto are available in English.
Managerial accounting
(2018)
Basics of Accounting targets students in international business study programs. It covers the widely applied syllabus of Accounting at universities on bachelor’s and master’s level. In this book, the application of the methods comes first. The Basics teach how to do Accounting by a case study based approach. All cases were taken from former exam papers at international universities and calculated completely and illustrated understandably.
Managerial Accounting is about Accounting for managers. It is linked to General Management where companies are seen as a whole as well as to Cost Accounting which comprises all methods/instruments applicable for calculations, budgeting and cost monitoring in business.
Basics of Accounting targets students in international business study programs. It covers the widely applied syllabus of Accounting at universities on bachelor’s and master’s level. In this book, the application of the methods comes first. The Basics teach how to do Accounting by a case study based approach. All cases were taken from former exam papers at international universities and calculated completely and illustrated understandably.
Bookkeeping and Financial Accounting covers the preparation of financial statements based on IFRS. Bookkeeping is taught as far as it is required for the understanding by managers – more formal aspects about how to keep financial records are cut short to the minimum.
This textbook covers the IAS/IFRS-syllabus of financial accounting on bachelor's and master's level. It covers how to prepare financial statements and tackles special problems in IFRSs-accounting, like asset revaluations, manufacturing accounting, share issues, financial instruments, group statements etc. The content is explained by more than 60 case studies completely illustrated with bookkeeping entries and financial statements.
All chapters outline the learning objectives, provide an overview, cover the contents of relevant IAS/IFRS-standards, include case studies and how-it-is-done-paragraphs. They end with a summary, the explanation of new technical terms and a question bank with solutions for checking your learning progress. On the internet, you can find further cases linked to the textbook by QR-codes and more than 350 exam tasks including solutions as well as youtube-videos from the author.
The textbook helps you to learn IFRSs and to familiarise yourself with international accounting in English. It is an accurate translation of the textbook Bilanzen from the same author.
This textbook covers the syllabus of Financial Accounting following IFRSs. The teaching approach is to explain financial statements and their items by more than 60 international case studies which include all relevant Bookkeeping entries and accounts. Furthermore, you can download more than 300 exam tasks and solutions online, accessable through QR codes in the text. The books help you to prepare for your Accounting exam at the university.
All chapters outline their learning objectives, provide an overview, explain the contents with referring to relevant IAS/IFRS-standards and their paragraphs, introduce case studies by a data sheet box and explain the Accounting work completely by Bookkeeping entries and accounts.
The text contains How-it-is-Done sections to give you short and precise guidance for your own calculations. Every chapter ends with a sumary, working definitions for newly introduced technical Accounting terms and test-questions with solutions for checking your comprehension
background: Musculoskeletal problems (MP) are widespread in performing artists and are due to the special demands of instrument playing, singing or dancing. Additionally, various other factors might contribute to performance-related MP. To provide a specific physiotherapeutic management for performing artists it is important to gain information about the performing art, the individual demands and contributing factors. The subjective examination (SE) is the basis of the clinical reasoning process and the hypothesis forming for further clinical examination and biomechanical analysis. In the present protocol, the SE consists of a questionnaire-based section and an interview-based section and is part of the evaluation process of the neuromusculoskeletal examination of a performing artist specific reference laboratory.
purpose: To develop a standardized SE protocol divided into a questionnaire-based section (Part 1) via web application and an interview-based SE (Part 2) to address MP of performing artists.
methods: The questionnaires for part 1 were selected based on the expertise of the research group and the psychometric properties of each possible questionnaire. A common physiotherapeutic recording of findings which addresses the relevant questions of the SE of MP was used. To adapt the anamnesis to performing-associated MP questions specific to instrument playing, singing and dancing were selected on the basis of a literature search and the expertise of the research group.
summary of content/results: Part 1 consists of three topics. (1) information about the performing art, professional level and sociodemographic data, (2) information about pain and pain processing, and (3) the anatomical location of the main MP including a body region-specific questionnaire. Part 2 is based on the five aspects of clinical practice described by Maitland and the Musculoskeletal Clinical Translation Framework by Mitchell et al. The performing arts specific part is particularly focused on performing art specific considerations, physical and psychosocial contributing factors and art-specific activities.
significance: This standardized SE protocol should help clinicians evaluating the musculoskeletal health of performing artists in a standardized and specific way.
Background: Musculoskeletal problems (MP) are widespread in performing artists and are due to the special demands of instrument playing, singing or dancing. In order to specifically evaluate these problems, a reference laboratory is under development. The evaluation covers 4 steps: a subjective examination (SE) including (1) a questionnaire-based online survey and (2) an interview-based anamnesis. On the basis of the results of the SE, hypotheses are formed for (3) an individual musculoskeletal clinical examination and a (4) biomechanical analysis. Here, the focus is on the clinical examination.
Purpose: to develop a standardized protocol for a clinical examination addressing especially musculoskeletal problems in performing artists.
Methods: A common physiotherapeutic clinical examination should be supplemented with techniques, which are specific to performance-related musculoskeletal problems and/or their risk factors. The development was based on a literature search and the clinical expertise of the physiotherapeutic research group.
Summary of content/Results: The performing arts specific clinical examination includes the common analysis of posture as well as passive/active movement capacities and specific differentiating tests in relation to the signs and symptoms of the individual artist. The examination is supplemented by a functional demonstration focusing on the special demands of playing the respective instrument, while singing or dancing. Common overuse risk factors like hypermobility, special anthropometric data or an examination of the motor control of different body regions are addressed. Optional, the various parts of the examination process could be skipped, if not relevant for the individual artist.
Significance: This clinical examination protocol should help clinicians evaluating the musculoskeletal health of performing artists in a standardized and specific way.
The increasing diversity of cultural backgrounds offers potential for a more elaborated information processing, yet has been shown to be challenging for individuals, due to intergroup hostility, prejudices, and difficulties of intercultural communication. Current research thus focusses on the interaction of employees with different cultural heritages, as well as on their intergroup attitudes and competences. Thereby, leaders have been shown to shape the way diversity is considered in their teams in a top-down process. However, their perception of diversity as well as related challenges and chances are poorly investigated. The current paper thus aims to contribute to the understanding of leader’s perspective on and role in diversity-management by building on a comparative qualitative study with sixteen employees and twenty-two leaders. Research questions are how employees and leaders perceive cultural diversity from their specific point of view, which experiences are likely to contribute to their opinion on and perception of diversity and in how far do employees and leaders differ in these aspects. The results show that employees are aware of the topic of diversity in general but have poor competences in dealing with diversity in their daily working life. This seems to be associated with lack of experience with intercultural interaction and a lack of support from the respective organizations/leaders. Leaders are rarely aware of this lack of support. The results indicate that leaders’ experiences with cultural and age diversity, their identification with the company and previous diversity measures in the context of the companies’ policy towards diversity seem to be relevant for the formation of leaders’ attitudes. As a consequence, most participants focus on the question whether they do or do not want diversity within their teams and companies, while they actually fail to perceive the diversity that is already there.
The Corona pandemic confronted societies with several unexpected constraints that had the effect of making certain goods much scarcer than before. Withdrawal from Russian oil and gas supplies has a similar effect. Carbon abatement can also be seen as a deliberate choice to make certain goods scarc-er than they actually are. These parallels suggests that it may be worthwhile to take a close look at societies’ responses to all three challenges. This paper makes an attempt to synthetize empirical and theoretical insights regarding these scarcity shocks from a well-being perspective, i.e. replacing the prevalent welfare economic focus on production and consumption with a focus on sustainable well-being.
Taking the case of Germany, it will be argued that the observed responses to all three challenges reflect a focus on maintaining incomes and production and that therefore these responses risk being detrimental to sustainable wellbeing and even to economic stability. This is particularly relevant if carbon abatement requires not only transient material sacrifices but lasting and significant reduc-tions of consumption.
It will be argued that the impact of these new scarcities will be much less problematic in a society that acknowledges the priority of sustainable wellbeing over production and consumption measures. Such a society would still need to incur material sacrifices, but these need not translate into a loss of wellbeing if economic conditions and social norms adapt. This will also be more sustainable not only in terms of ecological impact, but also in terms of debt, inflation and inequality.
Germany is Europe’s most populated country and it is actual locomotive for growth. The Germans have a positive image in China. However, this appreciation is not mutual. Various polls indicate that Germans are reserved concerning China’s rise; some even dislike outward foreign direct investment (OFDI) from Chinese Companies flowing to Germany. Nevertheless, Chinese investments in Germany will accelerate in the near future; already it increased from 600 million € 2 years ago to more than 800 million €. Experts predict a further massive increase. Asian OFDIs in Europe will be an integral part of the Asian Century, transforming the host countries, just as western OFDIs changed Asia during the last decades. This article analyses the German “China readiness” in the field of public economic policy at a local level.
This qualitative study focuses on assessing the “future readiness” capacity of three Peruvian Higher Education Institutions under the HEInnovate framework. The main question guiding this research is: To what extent can Peruvian universities be considered entrepreneurial and ready
for tackling the Challenges of the Future? The Challenges of the Future are understood as the challenges generated by concepts such as The Future of Work, The Global Skills Gap, Employability and unexpected and destabilizing risks of the environment, such as COVID-19.
Universities were studied based on 4 research sub-questions: 1) How do Peruvian HEIs rate in Entrepreneurial Capacity according to the HEInnovate framework? 2) What are the factors supporting or preventing Peruvian HEIs to accomplish their entrepreneurial potential? 3) What efforts are Peruvian HEIs making for developing 21st century skills, accomplishing Digital Transformation, and enhancing their students Employability? and 4) What measures could Peruvian HEIs take in order to maximize their entrepreneurial and future-proof potential? The research methodology used was mixed, applying first a quantitative assessment, and then
complementing the results with in-depth interviews. After presenting the conclusions, recommendations for policy action and for university management are given.
Purpose
In a knowledge-based society, one of the main driving forces of prosperity at city and regional levels is the ability to attract students and recently qualified graduates. The purpose of this paper is to identify the urban factors that contribute to “attractiveness” from a student perspective and to subsequently analyse the influence of these factors on students’ location choices. In the corresponding case study, the criteria identified were used to evaluate student satisfaction with the German city of Osnabrück.
Design/methodology/approach
A multi-level empirical research concept was used to analyse the relevant criteria. Focus group discussions served as the basis to design and conduct a survey of almost 2,300 students in the university city of Osnabrück at the end of 2016. A follow-up study in November 2017 at two universities in Berlin provided data for comparison.
Findings
Accessible – safe – clean and with affordable housing: these terms sum up the core expectations that students have of an attractive city. In contrast to the findings of Richard Florida regarding the creative class, cultural opportunities, exciting nightlife and a multicultural population were not important factors among the survey participants.
Research limitations/implications
As the study was conducted in two cities only, the findings cannot be generalised. It should be replicated in at least five other cities to validate and compare the research findings presented here. Furthermore, this study focused on the factors influencing the attractiveness of the city as a whole. However, the attractiveness of a specific neighbourhood may be of greater relevance to the decision-making process. As housing plays a major role, students’ particular needs with regard to accommodation should also be examined at greater depth.
Practical implications
Insights generated by the empirical study provide relevant information that may assist city stakeholders in taking effective measures regarding place management to attract and retain students.
Originality/value
To date, little research has been undertaken to empirically examine the specific factors that German students look for when deciding where to study and live. The goal of this paper is to present new empirical insights concerning the quality-of-life factors that influence students’ decision-making processes.
Greenwashing, defined by the Oxford Dictionary as “disinformation disseminated by an organization so as to present an environmentally responsible public image” can cause multifarious problems for companies. The phenomenon of greenwashing has, however, not attracted much attention in the event marketing literature to date. The purpose of this paper is twofold. It first describes and analyses the specific characteristics and features of greenwashing in event marketing. It then seeks to identify the current fundamental approaches of how to avoid greenwashing in event marketing and to assess their potential. A two-step literature analysis with complementary search approaches served as a methodical framework. First, journals related to event marketing were screened for the keywords “greenwashing” and “greenwash”. Next, the general literature was consulted for the same keywords. The results clearly demonstrate that the subject of greenwashing has been widely neglected in the event literature. There appears to be no overall concept or approach that allows event actors to avoid greenwashing, albeit various individual initiatives exist. However, it also became clear that initiatives against greenwashing in event marketing can be developed and implemented in the short and long term, for example by integrating different stakeholders. Additional political and juridical efforts based on specific guidelines are also necessary to prevent greenwashing in the future. The study is the first one to provide a systematic approach to the topic of greenwashing in the context of event marketing, including relevant approaches for its avoidance. It can thus help practitioners to better detect and avoid greenwashing in the event industry and to guide similar research in the future.
Events are intangible services and services marketing thus plays a considerable role within event management education. The marketing mix with its “4 Ps” (product, price, promotion, place) is an essential element of many event management curricula. Most educational institutions also reflect the development (and related discussions) towards the existence of “7 Ps” – adding personnel, physical facilities and process management (Meffert/ Bruhn 2009) – or even “8 Ps” – adding physical environment, purchasing process, packaging and participation(Burke/ Resnick 2000) – within the service marketing domain.
Access to digital technologies depends on the availability of technical infrastructure, but this access is unequally distributed among social groups and newly summarized under the term digital divide. The aim is to analyze the perception of a tracing app to contain Covid-19 in Germany. The results showed that participants with the highest level of formal education rate the app as beneficial and were the most likely to use the app.
Artificial intelligence will change our lives permanently - both at work and in our private lives. But how does machine learning actually work? The authors explore this question in their English-language textbook. They teach the necessary basics for the use of support vector machines, for example, through linear programming, the Lagrange multiplier, kernels and the SMO algorithm. They also cover neural networks, evolutionary algorithms, and Bayesian networks. Definitions are highlighted in the book and assignments invite readers to think along. The textbook is aimed at students of computer science, engineering and natural sciences, especially in the fields of robotics, artificial intelligence, and mathematics.
The PosiThera project focuses on the management of chronic wounds, which is multi-professional and multi-disciplinary. For this context, a software prototype was developed in the project, which is intended to support medical and nursing staff with the assistance of artificial intelligence. In accordance with the user-centred design, national workshops were held at the beginning of the project with the involvement of domain experts in wound care in order to identify requirements and use cases of IT systems in wound care, with a focus on AI. In this study, the focus was on involving nursing and nursing science staff in testing the software prototype to gain insights into its functionality and usability. The overarching goal of the iterative testing and adaptation process is to further develop the prototype in a way that is close to care.
Building on Rogers’ Diffusion of Innovation Theory, Bass models describe the diffusion processes distinguishing between innovation (p) and imitation (q). This study aimed at modelling the uptake of RIS, PACS and EHR systems in Germany and Finland. The Bass models revealed a quick and almost identical uptake process across all three systems for Finland. In contrast, the Bass models mirrored a slower uptake in Germany. Consequently, the Finnish “imitation” coefficients were larger than the German ones. While in Germany almost free market forces were driving the adoption through imitation but without tail wind from policy, the adoption process in Finland was centrally governed. This suggests that the diffusion process in Finland reflected a well-managed roll-out of the systems rather than imitation behaviour. Thus, in order for Bass model coefficients to be understood properly, additional contextual information is required.
Rationale:
Biomechanical analyses are capable of capturing and evaluating human motions. In addition to the major biomechanical fields of kinetics and kinematics, electromyography (EMG) provides a reliable way to analyse neuromuscular activities, e.g. inter- and intramuscular coordination or fatigue behavior. Based on these parameters it is possible to conclude to clinically relevant parameters such as motor control, muscular coordination or compensation strategies with different loads. In addition to this, EMG can be used in treatment itself, e.g. biofeedback-training with an EMG is an effective and evidenced based tool to improve neuromuscular control.
Purpose:
To show the advantages of implementing EMG in performing artists´ health and to demonstrate additional therapy and diagnostic options.
Educational Objectives:
At the end of the workshop, the participants will be able to…
1.understand and describe the basic principles of EMG
2.understand and describe the importance of EMG in the context of performing artists´ health, physical therapy and clinical reasoning
3.use EMG on performing artists in the performance process
Content of Presentation:
This workshop briefly introduces the theoretical principles of EMG and the clinical applications in the context of performing artists´ health. It explains why EMG provides an additional value in the clinical reasoning process and supports the therapist, but decision making in the clinical reasoning process should never be based on EMG solely.
In the further course of the workshop the use of EMG in diagnostics and therapy (biofeedback) with performing artists is practically demonstrated and discussed with the participants.
Approach of Presentation:
1.Short presentation: introduction and understanding of EMG (educational objective 1)
2.Short case presentation of a performing artist to introduce EMG in the field of performing artists´ health and clinical reasoning (educational objective 2)
3.Interactive practical demonstration (diagnosis and biofeedback-training) as the central part of the workshop. Questions and comments will be discussed directly throughout the group (educational objective 3)
Clinical Significance:
EMG based functional neuromuscular diagnostics and biofeedback-training provides both the therapist as well as the performing artist with additional value in their clinical work.
Introduction: Hamstring injuries are among the most common injuries in soccer players. Especially the danger of hamstring injuries increases in the final third of each half, with the biceps femoris muscle being highly susceptible, but currently there is no supporting evidence in soccer players. It is important to investigate to provide a basis for further clinical investigations in order to reduce the risk of hamstring injuries.
Objective: To investigate a soccer-specific muscle fatigue protocol has an effect on the activation patterns of the biceps and semitendinosus muscles and correlates with the subjectively perceived exertion of the soccer players.
Methods: 19 healthy soccer players aged 19 - 35 years were included and underwent a standardized procedure that included: (1) performance of the nordic hamstring curls (NHC) and a 10m sprint (pre-test), (2) a soccer-specific muscle fatigue loading protocol for 30 minutes with subsequent rating of perceived exertion (RPE), (3) re-assessed like pre-assessment (post- test). Electromyography (EMG) data were recorded the biceps and
semitendinosus muscles of both legs. Two parameters were analyzed: the peak amplitude during the NHC and the mean amplitude during the 10m sprint.
Results: The RPE score (9.5, p<0.001) and 10m sprint shows significant differences between pre- and post- test for the biceps (standing leg: -82.45, kicking leg: -81.77; p<0.01) and semitendinosus muscle (standing leg: -60.08, p=0.001); kicking leg: -65.30, p=0.03). Significant correlation exists between RPE score and biceps muscles at posttest (standing leg: r=-0.54, kicking leg: r=-0.51; p<0.05).
Conclusion: Muscle fatigue leads to significant changes in the activation behavior of the hamstring muscles. In particular, the biceps muscle shows a correlation with perceived exertion, the higher the exertion, the lower the muscle activity. This may help explain the higher prevalence of the biceps muscle in hamstring injuries and offers a basis for further clinical investigations
This paper provides a discourse based upon the key development of nursing in response to the emerging 4Ds of health technology re-design. Building informatics capability among health professionals is a workforce issue necessitated through the increasing prevalence of information technology and digitization of healthcare affecting the entire health workforce, specifically front-line nurses. The key concepts will be explored of Digitization, Distribution, Disruption and Diversity, a framework recognising the tsunami of technology such as Big Data analytics, comprehensive decision support systems for nursing, nanobots, robotics, and pharmacogenomics and the impact these have upon the nursing workforce.
Rationale
Playing the trombone can lead to playing-related musculoskeletal disorders (PRMD). Previous research suggests that professional trombonists predominantly struggle with PRMD on the left body side. An increasing volume leads to an increasing contact pressure on the mouthpiece of the trombone, but it is still unclear how the muscle activity relates to this and whether it differs in musicians with PRMD from those without PRMD.
Purpose
The purpose of this study was to investigate the relationship between the activity of different muscles of the left body side, the contact pressure on the mouthpiece and the volume level in healthy trombonists.
Methods
Six male healthy tenor trombonists were included in this study and run through a standardized protocol which consisted of playing a b-flat major scale with three different volume levels (pianissimo, mezzoforte, fortissimo). Analyzed parameters were (1) the activity of several muscles of the left body side (measured with surface electromyography), (2) the contact pressure on the mouthpiece (measured with a force sensor) and (3) the different volume levels.
Results
Analysis of variance reveals significant differences of the muscle activity for the three volume levels. Depending on the volume level and the selected muscle, results show very weak to moderate correlations between contact pressure on the mouthpiece and muscle activity (Spearman´s rho between .11 and .58). The strongest correlation across all muscles occurs during fortissimo playing.
Conclusions
These results show a relationship in healthy trombonists between volume level, contact pressure on the mouthpiece and muscle activity when playing a b-flat major scale. Future research should include trombonists with PRMD to enable comparison between PRMD and non-PRMD musicians.
Educational Objectives:
At the end of the presentation, the participants will be able to…
1. understand the relationship between muscle activity, contact pressure on the mouthpiece and volume when playing the trombone
2. recognize that there are different muscle activity patterns on the left body side when playing the trombone
3. understand that a comprehensive functional diagnosis is important in the management of musicians
Differentiating nociceptive and neuropathic components of clinical pain presentations matters!
(2016)
Hypothesis/Aims of study
Many results related to the effectiveness of surgical and non-surgical proce- dures for treating urinary incontinence (UI) are reported in the literature. Following the principles of evidence based-practice, besides the interpreta- tion of study results based on statistical significance, authors should consid- er evaluating the clinical relevance of treatment effects in this field.
The minimal important difference (MID) of clinical outcomes could be used to assess the clinical relevance of interventions. MID is defined as “the small- est difference in score in the domain of interest that patients perceive as important, either beneficial or harmful, and which would lead the clinician to consider a change in the patient’s management’’[1]. One common way to obtain MID for outcomes of interest is by using anchor-based methods. These methods apply one anchor that analyzes the change in the patient's health status according to the patient’s perception.
However, MIDs should be provided according to appropriate calculations and methods and based on the definition of a MID. However, there are a lot of misconceptions and misunderstandings related to the MID. These mis- understandings have led to incorrect reports of these values. Moreover, it is still not known which criteria the authors considered during the analysis of the MID in the Women’s Health area. Therefore, with this preliminary re- port, we aimed to identify and report all anchor-based methods to estimate MIDs for outcomes measures related to UI available in the literature; and analyze which concepts and levels of improvement in the health status of the patient have been considered by the authors to calculate the MID.
Study design, materials and methods
This systematic review was conducted according to PRISMA guide- lines. The study protocol was registered in the PROSPERO database (CRD42022299686). A systematic search was performed using Ovid Med- line, Embase, Web of Science, and Scopus from May to June 2021. Any study generating MIDs for UI that included women with more than 18 years, stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and/ or miXed urinary incontinence (MUI) was included. The primary outcome was the MID for outcomes related to UI. No limits were applied on the data- bases for the date, language or publication range.
Studies were classified into three categories according to the level of im- provement in health status assessed by the anchor and considered by the authors during the MID calculation: 1) slight improvement: if authors in- cluded participants that evaluated their health status as “a little better” in their analysis; 2) moderate improvement: if authors considered women that reported a “better” or a “much better” status of the condition; or 3) strong imporvement: if all patients that improved (“very much better” or if authors grouped all the patients that improved in one single category) were consid- ered in one group against other group that did not report any improvement. After classifying the papers, we counted and reported how many studies were considering only the minimal level of improvement to reported the MID, according to previous definition and recommendation.
The initial electronic search resulted in a total of 1,662. After removing du- plicates (n=719), 943 were screened, and at the end of the selection stages, nine papers that reported anchor-analysis were included in this preliminary report. Seven studies included women with SUI (total sample size= 2,436), while one study included only women with UUI (n=307), and the other one evaluated women with SUI and MUI (n=288). SiX studies analyzed data and provided the MID after a non-surgical treatment of UI, while three analyzed the results after surgery to correct UI. Eleven different questionnaires to measure the patient-related outcomes related to UI with their MIDs were identified. All the tools were related to measuring the impact, distress, or quality of life of women with UI.
Different anchors were used to analyze MID, including scales that evaluated the improvement and satisfaction of the patient, and the visual analogue scale, measures of urinary leakage and questionnaires that measure the se- verity and impact of UI. The MID of siX tools was determined according to the smallest difference detected by the patients, using the Patient Global Im- pression of Improvement questionnaire and the self-reported satisfaction to assess the change of the condition. Most of the MIDs (n=28, 80%) were mis- calculated considering a moderate or a strong improvement of the patients, and not a minimal improvement as suggested by the literature (Table 1).
Interpretation of results
Although previous systematic reviews have reported the psychometric prop- erties of different questionnaires to measure UI outcomes, this is the first study to analyze methods of obtaining MIDs for UI outcomes from the pa- tients perspective (anchor based methods). All the tools with their respec- tives MIDs were related to the impact, distress, and/or quality of life of women with UI. The use of these outcomes measures is in line with the as- sociated impairments of social, psychological, financial, and sexual aspects of a women’s life produced by UI.
Most of the authors in this field did not consider the smallest difference identified by the participants to calculate the MID, which does not follow the original definition of MID proposed by Jaeschke et al.,1 This could gen- erate underestimation or over-estimation of MID, which may directly im- pact the interpretation of the findings from the clinical trials[2] and biased interpretation of the results of the clinical significance from the interven- tions used to manage female UI. Therefore, the interpretation of the clinical significance related to UI outcomes should be done with caution.
Concluding message
Few studies that aimed to calculate the MID using anchor-based methods for outcomes related to female UI were found in the literature. Eleven different questionnaires to measure the outcomes related to UI with their MIDs were identified. However, most studies had not considered the smallest change of improvement (as perceived by the patients) in their analysis, which does not follow the definition of the MID. This could impact decision making. Future research should provide clear guidelines on how to calculate, report, and interpret MIDs in this field.
Diabetic foot ulcer (DFU) is a chronic wound and a common diabetic complication as 2% – 6% of diabetic patients witness the onset thereof. The DFU can lead to severe health threats such as infection and lower leg amputations, Coordination of interdisciplinary wound care requires well-written but time-consuming wound documentation. Artificial intelligence (AI) systems lend themselves to be tested to extract information from wound images, e.g. maceration, to fill the wound documentation. A convolutional neural network was therefore trained on 326 augmented DFU images to distinguish macerated from unmacerated wounds. The system was validated on 108 unaugmented images. The classification system achieved a recall of 0.69 and a precision of 0.67. The overall accuracy was 0.69. The results show that AI systems can classify DFU images for macerations and that those systems could support clinicians with data entry. However, the validation statistics should be further improved for use in real clinical settings. In summary, this paper can contribute to the development of methods to automatic wound documentation.
Communication deficits belong to the most frequent errors in patient handovers calling upon specialized training approaches to be implemented. This study aims to harness problem-based learning (PBL) methods in handover education and evaluated the learning process. A digitally enabled PBL course was developed and implemented at Klinikum Osnabrück from which eight nurses participated in the course. They agreed on the stimulating effect of the setting regarding self-directed learning and on the potential to translate the new knowledge and skills into the daily clinical practice. In conclusion, the findings are promising that a digitally enabled PBL course is a suitable learning format for handover education.
Comparison of quantitative sensory testing profles between people living in Germany and Australia
(2021)
Venous leg ulcers and diabetic foot ulcers are the most common chronic wounds. Their prevalence has been increasing significantly over the last years, consuming scarce care resources. This study aimed to explore the performance of detection and classification algorithms for these types of wounds in images. To this end, algorithms of the YoloV5 family of pre-trained models were applied to 885 images containing at least one of the two wound types. The YoloV5m6 model provided the highest precision (0.942) and a high recall value (0.837). Its mAP_0.5:0.95 was 0.642. While the latter value is comparable to the ones reported in the literature, precision and recall were considerably higher. In conclusion, our results on good wound detection and classification may reveal a path towards (semi-) automated entry of wound information in patient records. To strengthen the trust of clinicians, we are currently incorporating a dashboard where clinicians can check the validity of the predictions against their expertise.
With the start of the 21st century, patient safety as a topic of special interest has attracted increasing attention in both academia and clinical practice. As technology has continued to develop since then, questions and focal points surrounding the topic have also shifted. In particular, questions regarding the impact of digitalization on patient safety and its measurement are now of high interest. This work aims to develop a maturity assessment instrument in the form of a criteria set for measuring structural requirements for digital patient safety in hospitals. Based on the results of a literature review and a derivation of maturity objects (MO) from known maturity models, 64 criteria across 11 categories were developed. Written comments of two digital patient safety experts as well as subsequent interviews were used to evaluate and refine the criteria catalog. The resulting catalog offers hospitals guidance for detecting possible areas of structural improvements in their information systems with regard to patient safety and represents a unique instrument for assessing digital maturity in this particular area.
This study describes the eHealth4all@eu course development pipeline that builds upon the TIGER educational recommendations and allows a systematic development grounded on scientific and field requirements of competencies, a case/problem-based pedagogical approach and finally results in the syllabus and the course content. The pipeline is exemplified by the course Learning Healthcare in Action: Clinical Data Analytics.
Apps have been attested to empower patients regarding disease self-management through numerous studies. However, it is still unclear what factors determine the perception of patients whether an app is a useful tool for this purpose. A multiple regression model that was informed by the Technology Acceptance Model (TAM 2) was tested based on the answers of 235 app users with Diabetes type 1 or 2. The model accounted for 59.2% of the variance of the perceived degree of self-management. Factors belonging to the relevance-usefulness-quality complex as well as factors reflecting the patient’s self-control were found to be significant in the model. Patient demographics, i.e. age, gender, app experience and type of Diabetes did not play any significant role. In conclusion, this study raises the question whether apps should be designed to strengthen self-management in the sense of self-control (e.g. own measurements, diary) as opposed to guiding and advice giving.
Background
Digital health technologies enable patients to make a personal contribution to the improvement of their health by enabling them to manage their health. In order to exploit the potential of digital health technologies, Internet-based networking between patients and health care providers is required. However, this networking and access to digital health technologies are less prevalent in sociodemographically deprived cohorts. The paper explores how the use of digital health technologies, which connect patients with health care providers and health insurers has changed during the COVID-19 pandemic.
Methods
The data from a German-based cross-sectional online study conducted between April 29 and May 8, 2020, were used for this purpose. A total of 1.570 participants were included in the study. Accordingly, the influence of sociodemographic determinants, subjective perceptions, and personal competencies will affect the use of online booking of medical appointments and medications, video consultations with providers, and the data transmission to health insurers via an app.
Results
The highest level of education (OR 1.806) and the presence of a chronic illness (OR 1.706) particularly increased the likelihood of using online booking. With regard to data transmission via an app to a health insurance company, the strongest increase in the probability of use was shown by belonging to the highest subjective social status (OR 1.757) and generation Y (OR 2.303). Furthermore, the results show that the higher the subjectively perceived restriction of the subjects' life situation was due to the COVID-19 pandemic, the higher the relative probability of using online booking (OR 1.103) as well as data transmission via an app to a health insurance company (OR 1.113). In addition, higher digital literacy contributes to the use of online booking (OR 1.033) and data transmission via an app to the health insurer (OR 1.034).
Conclusions
Socially determined differences can be identified for the likelihood of using digital technologies in health care, which persist even under restrictive conditions during the COVID-19 pandemic. Thus, the results indicate a digital divide with regard to the technologies investigated in this study.
In the context of the ongoing digitization of interdisciplinary subjects, the need for digital literacy is increasing in all areas of everyday life. Furthermore, communication between science and society is facing new challenges, not least since the COVID-19 pandemic. In order to deal with these challenges and to provide target-oriented online teaching, new educational concepts for the transfer of knowledge to society are necessary. In the transfer project “Zukunftslabor Gesundheit” (ZLG), a didactic concept for the creation of E-Learning classes was developed. A key factor for the didactic concept is addressing heterogeneous target groups to reach the broadest possible spectrum of participants. The concept has already been used for the creation of the first ZLG E-Learning courses. This article outlines the central elements of the developed didactic concept and addresses the creation of the ZLG courses. The courses created so far appeal to different target groups and convey diverse types of knowledge at different levels of difficulty.
Identification of differences in clinical presentation and underlying pain mechanisms may assist the classification of patients with neck–arm pain which is important for the provision of targeted best evidence based management. The aim of this study was to: (i) assess the inter-examiner agreement in using specific systems to classify patients with cervical radiculopathy and patients with non-specific neck–arm pain associated with heightened nerve mechanosensitivity (NSNAP); (ii) assess the agreement between two clinical examiners and two clinical experts in classifying these patients, and (iii) assess the diagnostic accuracy of the two clinical examiners. Forty patients with unilateral neck–arm pain were examined by two clinicians and classified into (i) cervical radiculopathy, (ii) NSNAP, (iii) other. The classifications were compared to those made independently by two experts, based on a review of patients' clinical assessment notes. The experts' opinion was used as the reference criterion to assess the diagnostic accuracy of the clinical examiners in classifying each patient group. There was an 80% agreement between clinical examiners, and between experts and 70%–80% between clinical examiners and experts in classifying patients with cervical radiculopathy (kappa between 0.41 and 0.61). Agreement was 72.5%–80% in classifying patients with NSNAP (kappa between 0.43 and 0.52). Clinical examiners' diagnostic accuracy was high (radiculopathy: sensitivity 79%–84%; specificity 76%–81%; NSNAP: sensitivity 78%–100%; specificity 71%–81%). Compared to expert opinion, clinicians were able to identify patients with cervical radiculopathy and patients with NSNAP in 80% of cases, our data supporting the reliability of these classification systems.
Background: The painDETECT questionnaire (PD-Q) has been used as a tool to characterize sensory abnormalities in patients with persistent pain. This study investigated whether the self-reported sensory descriptors of patients with painful cervical radiculopathy (CxRAD) and patients with fibromyalgia (FM), as characterized by responses to verbal sensory descriptors from PD-Q (sensitivity to light touch, cold, heat, slight pressure, feeling of numbness in the main area of pain), were associated with the corresponding sensory parameters as demonstrated by quantitative sensory testing (QST).
Methods: Twenty-three patients with CxRAD (eight women, 46.3 ± 9.6 years) and 22 patients with FM (20 women, 46.1 ± 11.5 years) completed the PD-Q. Standardized QST of dynamic mechanical allodynia, cold and heat pain thresholds, pressure pain thresholds, mechanical and vibration detection thresholds, was recorded from the maximal pain area. Comparative QST data from 31 age-matched healthy controls (HCs; 15 women) were obtained.
Results: Patients with CxRAD demonstrated a match between their self-reported descriptors and QST parameters for all sensory parameters except for sensitivity to light touch, and these matches were statistically significant compared with HC data (p ≤ 0.006). The FM group demonstrated discrepancies between the PD-Q and QST sensory phenotypes for all sensory descriptors, indicating that the self-reported sensory descriptors did not consistently match the QST parameters (p = ≤0.017).
Conclusion: Clinicians and researchers should be cautious about relying on PD-Q as a stand-alone screening tool to determine sensory abnormalities in patients with FM.
Rationale:
Instrumentalists often suffer from playing-related (neuro-)musculoskeletal disorders (PRMDs). Most common PRMDs in string players are related to upper-body regions. Motion analysis has proven to be helpful in the evaluation of functional disorders. It was already shown that it is a valid and clinically feasible tool for accurate, repeatable, and objective assessments of functional movement in string players. Thus, it may guide clinicians to improvements in injury prevention, diagnosis, and treatment. Nevertheless, its application in clinical consultation is still very uncommon. For this reason, there is a lack of well-established motion analysis protocols for the examination of PRMDs in string players using advanced biomechanical instruments in clinical settings.
Purpose:
To demonstrate the development and application of a motion analysis protocol for the evaluation of functional upper-body movements in violinists, violists, and cellists in a clinical setting for the investigation of PRMDs.
Approach:
The protocol was to be integrated into a clinical reasoning process for testing clinical hypotheses and evaluating treatment outcomes in physiotherapy. As a starting point, a primary clinical question was defined, and then, specific upper-body symptom regions as well as measurement parameters (relative rotation angles and muscle activities over time) were identified. Subsequently, involved segments, joints, and muscles were assorted. For quantification of upper-body kinematics a novel, marker-based method was used which provides multi-segmented shoulder and spine models while providing simple application. Based on that, a comprehensive mechanical model of the upper body as well as the associated coordinate systems and rotation sequences were specified. This further guided both, the definition of a custom-made marker set as well as the selection and placement of surface electrodes. Furthermore, required static and functional calibration trials as well as movement tasks for functional assessment were specified. Finally, advanced approaches, such as a comprehensive kinematic model and functional determination of joint centers and axes were established for extraction. Then, outcome parameters and their form of representation were determined for further analysis and interpretation.
The application of the method first includes the selection of segments, joints, and muscles to examine – originating from one or more clinical (working) hypotheses or symptom regions. This drives the configuration and placement of required surface markers and electrodes. Then, the required calibration and functional movement trials are executed. After measurement, the outcome parameters get extracted and analyzed. Based on the results the hypothesis is discarded or verified.
Content:
The method was applied to a violinist (female; 18 years old; 13 years of experience; practicing 2 to 3 hours per day, 7 days per week) with playing-related demands in the left cervical-shoulder-arm region.
Subjective findings indicated that the pain regularly occurred after 30 minutes of playing fast or difficult musical pieces. Physical examination showed that strength testing of left serratus anterior muscle caused pain, lower trapezius muscles seemed weak, forearm muscles were sensitive to pressure, movement of the cervical spine to the left was reduced, and upper limb neural tension test was noticeable.
This led to the following working hypothesis: Neck-related arm pain with neurodynamic component and motor control problem in the scapulothoracic region. Thus, left-sided cervical-shoulder-arm region was selected for functional examination.
Optoelectronic motion capture system and surface electromyography were used for data collection. Static and function calibration trials as well as functional assessment trials (chromatic scale with different tempi) were conducted. Afterwards, data was further processed, and outcome parameters were extracted.
Results showed that greater tempo and pain had an impact on the rotation angles and muscle activities. They led to less overall joint movement and range of motion, to less muscle activity in the forearm muscles, and to greater activity inputs in the scapulothoracic muscles. Overall, greater tempo and pain led to a different motor program which verified the working hypothesis.
The procedure was repeated after treatment (four appointments over one week) with manual therapy, training, and education. The pre-/post-interventional comparison showed changes in the motor program. There was noticeable higher mean activity in upper trapezius and deltoid muscles and simultaneously less in the remaining ones. In addition, only marginal differences in ranges of motion and muscle activity inputs were found between tempi. The playing style appeared to be more stable now. Overall, it appeared that nearly the same motor program was used for each tempo.
Clinical Implications:
Potential applications are intraindividual evaluations of simultaneously joint and muscular function in string players during clinical consultation. It is intended to contribute to the diagnosis of PRMDs in terms of an objective, comprehensive and yet clinically feasible diagnostic assessment as well as pre-post-intervention outcome evaluation.
Nonetheless, motion analysis must be used with care in clinical decision making. Motion data is subject to both, intraindividual variations, and measurement errors. In addition, the smallest clinically relevant changes are not clear yet. Therefore, results should only be interpreted together with other clinical findings.
Rationale:
Neck pain is a large health problem worldwide and often seen in musicians [1, 2]. Neck pain can radiate into the arm due to various underlying pain types and pain mechanisms making it heterogeneous in clinical signs and symptoms [3-5]. On the one hand, patients may present with dominant nociceptive neck-arm pain caused by activation of the nociceptors in muscles, joints, ligaments, fascia, tendons and the connective tissues of a nerve [6, 7]. Activation of nociceptors in nerve connective tissues may cause clinical signs of heightened nerve mechanosensitivity what is per definition categorized as nociceptive pain [6, 8, 9]. On the other hand, patients may present with dominant neuropathic pain, defined as pain as a direct consequence of a lesion or disease affecting the somatosensory system [10, 11]. The clinical profile of these different pain types is sometimes difficult to disentangle based on the localization and pain character [12]. Moreover, non-specific neck-arm pain patients shown a neuropathic pain component based on somatosensory changes detected via Quantitative Sensory Testing (QST) [3, 13]. Classifications with a defined physical examination pathway can be helpful to define subgroups to guide the clinical decision making [14]. This workshop updates the background about the pathophysiology of neck-arm pain and mediates an evidence-based examination to classify patients.
Purpose:
The aim of this workshop is to give a current insight into the background and evidence of neck-arm pain and to plan and practice a physical examination.
Content of Presentation:
This workshop will summarize evidence of neck-arm pain. Thereupon, current evidencebased diagnostic options will be presented and practiced together. Finally, a short insight in the management of neck-arm pain will be given.
Approach of Presentation:
QST testing and current cost-effective evidence-based methods will be presented to identify neuropathic components in neck-arm pain. Selected methods will be performed practically together, e.g. bedside sensory testing and neurodynamic tests.
Clinical Significance:
After the workshop, participants will have improved skills to diagnose in the spectrum of neck-arm pain for musicians with neck-arm pain.
At the end of the presentation, the participants will be able to:
- understand the heterogeneity of neck-arm pain,
- plan an appropriate diagnostic physical examination,
- have an insight in possible management strategies.