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Every culture has its paradise vision: desirable and external conditions which, inside the concerned culture, are infrequently observed or difficult to realize and are linked to one another. This cross-cultural study compares well-being inChina,Bulgaria,FranceandGermany. The cultural patterns of the culture are differently, but well-being is easier to achieve if people adapt to their cultural patterns. The adjustment (positive subjective culture) is formed by culture-specific content and needs different in regards to different cultures.
Work–life balance is one of the challenges of a globalized world. The study described in this chapter aimed to identify the factors influencing the work–life balance of working mothers. Additionally, we will describe differences and similarities between the well-being and working styles of German and US-American working mothers. It is particularly difficult for mothers to be successful, because to do so, they must master the double burden of work and family. In this study, 320 working mothers were surveyed, 142 in Germany and 178 in the USA. It was found that the cultural concepts of work–life balance of these working mothers are comparable. Furthermore, differences in working styles were identified: US-Americans valued both well-being and work–life balance more strongly than Germans. In both cultures, younger mothers felt more burdened by work than older mothers. This may indicate that competences are learned with an increasing age, enabling a more successful mastery of challenges, even though an increasing age usually has a negative effect on health. The number of children, family status and education did not influence work–life balance. These findings are further discussed in this chapter.
Building on Hofstede's finding that individualism and social hierarchy are incompatible at the societal level, the authors examined the relationship between individualism-collectivism and orientations toward authority at the individual level. In Study 1, authoritarianism was related to three measures of collectivism but unrelated to three measures of individualism in a U.S. sample (N = 382). Study 2 used Triandis's horizontal-vertical individualism-collectivism framework in samples from Bulgaria, Japan, New Zealand, Germany, Poland, Canada, and the United States (total N = 1,018). Both at the individual level and the societal level of analysis, authoritarianism was correlated with vertical individualism and vertical collectivism but unrelated to horizontal collectivism. Horizontal individualism was unrelated to authoritarianism except in post-Communist societies whose recent history presumably made salient the incompatibility between state authority and self-determination.
Aims: Intercultural competence has become a key-competence, since the world has become more and more volatile, uncertain, complex and ambiguous. Therefore, insights in the development of intercultural competence and its´ links to individual traits are crucial for companies and researchers to face the requirements in a VUCA world. This study examines the relationship between the time, students spent abroad, personality traits and circumstances during this time with the student’s intercultural competence and integration performance in the target culture. The study had a correlative cross-sectional design. Design and sample: A total of 202 academic subjects were surveyed. The average age was 22 years. There was one measuring time, to which 58 % of the participants stated that they have had a stay abroad. Measurements: Metacognitive, cognitive, motivational and behavioural intercultural competence were measured with the Cultural Intelligence Scale. The personality traits involvement, discipline, social competence, cooperation, dominance and stability were captured with the "Bochum inventory for job-related personality description-6F". Work-related attitudes as patterns of behaviour and experience were measured using the "Work-related Behaviour and Experiencing Pattern 44" (German: Arbeitsbezogene Verhaltens- und Erlebensmuster, AVEM). This scale captures the way participants relate to work in general based on the measurement of personality traits and their fit to specific clusters, which describe, whether individuals have healthy or risky patterns. In addition, the demographic factors and characteristics of stays abroad as well as the integration into the target culture based on the Sociocultural Adaption Scale were examined. The data was tested for relationships and differences by tests for mean differences, variance and regression analyses. Results: There was a positive correlation between duration and cognitive, motivational and behavioural intercultural competence. The motivational competence is higher in subjects who have no risk pattern in the AVEM. The different types of competence influence each other at diverse times. Moreover, the suggested structural equation model could be confirmed. This showed the effect of the AVEM pattern on intercultural competence, moderated by the stay abroad and the social competence. Thus, the study contributes to the understanding of both the measurement of intercultural competence and the development process of intercultural competence in a globalized world.
Do multipliers have to be more sensitized for the issue diversity? Do they have to develop specific competences? Which do they already have? These questions were analysed by a qualitative investigation. Ca. 70 interviews with managers of the large DAX companies and employees were conducted. The results show a field of tension between self-perception and perception of others and the assessment of the relevance of diversity attitudes and measures, competences and their actual implementation. The results indicate the need of promotion of competences, especially regarding the intercultural competence. We position ourselves in a functionalist perspective, in line with the work on paradigms of Burell and Morgan (2017) and Deetz (1996) in social sciences and Cross-Cultural Management. We present these results from a functionalist perspective in order to ensure the greatest possible "objectivity".
The central aim of the investigation at hand is to deal with the problem areas of Human Resource Management, which arise by demographic changes and migration. The paper focuses on mutual relationships. Managers and human resource managers are considered as multipliers. Older employees, migrants and women are important potential. Therefore, following research questions have been investigated: Which competences are necessary to promote to recognise the potential of migrants correctly and to promote them? Do the multipliers have to be more sensitized for the issue diversity? Do they have to develop specific competences to make the system more permeable and to make the entry and promotion of migrants possible? Which competences should be promoted to increase the sensitivity for diversity? The questions were examined by a qualitative investigation to develop hypotheses for a quantitative study. Overall, 30 interviews with managers, human resource managers and diversity representatives of the large DAX companies were conducted. Furthermore, 17 employees with immigration background and 15 employees without an immigration background were interviewed. The data was transcribed and analysed by the qualitative content analysis according to Mayring (2010). Comparative analyses were made with single items with Likert Scales. The investigation of managers and employees is a highly diversified issue. Therefore, the main focus of the project lays on the problem areas, conflicts and competences of human resources managers in demographic-sensitive personnel management. In comparison, employees with and without an immigration background were asked. The results show an interesting field of tension between self-perception and perception of others and the assessment of the relevance of diversity attitudes and measures, competences and their implementation. Furthermore, a contrary perception regarding strains and stresses of person with and without immigration background is determined, which is developed in the consequences of migrations stress and experiences of discrimination. The results indicate the need of promotion of competences, especially regarding intercultural competence. A critical analysis of the results will be presented.
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.
Possessing skills in social and intercultural interaction is vitally important for employees who work in globalized environments, especially as people's working lives tend to involve an increasingly large amount of service-related activities. As a consequence, universities offer cultural studies courses and strive to enable their students to study abroad for a period of time. However, there is still no widely shared agreement on how intercultural experiences and cultural preparation courses predict the perception, thinking and acting of individuals. Therefore, the study at hand uses a cross-sectional design with N = 430 participants in order to investigate whether students of cultural studies gain more intercultural competencies during the time spent studying abroad, compared to studies of other subjects. The results reveal that students of cultural subjects show significantly higher levels of cultural empathy and openness in the post hoc measurement, even though there was no interaction effect with the amount of time spent studying abroad. Length of stay abroad had a significant indirect effect on social competence via all the dimensions of the Multicultural Personality Questionnaire. Moreover, results indicate that flexibility to adapt one's behaviour to cultural norms may predict problems when returning to one's home country.
Adaptivity is prevalent in today’s software. Mobile devices
self-adapt to available network connections, washing machines
adapt to the amount of laundry, etc. Current approaches for engineering such systems facilitate the specification of adaptivity in the analysis and the technical design. However, the modeling of platform independent models for adaptivity in the logical design phase remains rather neglected causing a gap between the analysis and the technical design phase.
To overcome this situation, we propose an approach called Adapt Cases. Adapt Cases allow the explicit modeling of adaptivity with domain-specific means, enabling adaptivity to gather attention early in the software engineering process.
Since our approach is based on the concept of use cases it
is easy adoptable in new and even running projects that
use the UML as a specification language, and additionally,
can be easily incorporated into model-based development
environments.
Business-driven development favors the construction of process models
at different abstraction levels and by different people. As a consequence, there is a demand for consolidating different versions of process models by merging them. In this paper, we study a basic scenario, derive requirements and present a prototype for detecting and resolving changes between process models.
Detection and resolution of conflicting change operations in version management of process models
(2013)
Version management of process models requires that different versions of process models are integrated by applying change operations. Conflict detection between individually applied change operations and conflict resolution support are integral parts of version management. For conflict detection it is utterly important to compute a precise set of conflicts, since the minimization of the number of detected conflicts also reduces the overhead for merging different process model versions. As not every syntactic conflict leads to a conflict when taking into account model semantics, a computation of conflicts solely on the syntax leads to an unnecessary high number of conflicts. Moreover, even the set of precisely computed conflicts can be extensive and their resolution means a significant workload for a user. As a consequence, adequate support is required that guides a user through the resolution process and suggests possible resolution strategies for individual conflicts. In this paper, we introduce the notion of syntactic and semantic conflicts for change operations of process models. We provide a method how to efficiently compute conflicts precisely, using a term formalization of process models and consider the subsequent resolution of the detected conflicts based on different strategies. Using this approach, we can significantly reduce the number of overall conflicts and reduce the amount of work for the user when resolving conflicts.
Introduction
Observations show that foam rolling improves joint movements. Likewise, it can be stated that a vibration stimulation of the tissue leads to improved joint mobility.
Method
This study investigates whether the combination of foam rolling and vibrations (31 Hz) can influence the sliding of the thoracolumbar fascia more effectively than normal foam rolling. 45 subjects participated in the study and were divided into a foam roll with additional vibration group (FRV), a foam roll group (FR) and a control group (CG). The intervention groups rolled out the gluteal muscles, the lateral trunk and the upper and lower back. Mobility measures were taken pre and post the respective intervention. Subsequent cross correlation software analysis quantified the sliding of the fascia and calculated its shear strain mobility (SSM).
Results
The sliding of the thoracolumbar fascia improved significantly within the FRV by 2.83 mm (SD ± 1.08/p < .001), in the FR by 0.96 mm (SD ± 0.43/p < .001) and in the CG decreased the sliding by 0.1401 mm (SD ± 0.28/p = .076). The fascia/fascia SSM increased in the FRV by 22.61% (SD ± 15.64/p < .001), in the FR by 11.41% (SD ± 20.38/p = .056) and in the CG decreased the SSM by 0.9473% (SD ± 11.35/p < .751). The lumbar movement increased in both intervention groups, but showed no significant result.
Conclusion
The use of a foam roll with additional vibration and standard intervention have increased thoracolumbar fascia sliding and lumbar movements. The improved shear strain mobility can be attributed to the multi-activity of mechanoreceptors, such as Pacini- and Ruffini-Bodies.
Due to new research results in the past few years, interest in the fascia of the human body has increased. Dysfunctions of the fascia are indicated by various symptoms, amongst others, musculoskeletal pain. As a result stronger focus has been put on researching therapeutic approaches in this area. The main aim of this study was to investigate the effect of Foam Roll exercises on the mobility of the thoracolumbar fascia (TLF). Study has been conducted in a randomized and controlled trial which sampled 38 healthy athletic active men and women.
The subjects were randomly assigned to a Foam Roll Group (FMG), a Placebo Group (PG) and a Control Group (CG). Depending on the assigned group the volunteers were either instructed to do exercises with the Foam Roll, received a pseudo treatment with the Foam Roll or received no treatment.
A total of three measurements were carried out. The most important field of research was the mobility of the TLF, which was determined using a sonographic assessment. In addition the lumbar flexion and the mechanosensivity of relevant muscles were determined.
After the intervention, the FMG showed an average increase of 1.7915 mm for the mobility of the TLF (p < 0.001/d = 0.756). In contrast, only an average improvement of 0.1681 mm (p = 0.397) was shown in the PG, while the CG showed a slight improvement of 0.0139 mm (p = 0.861). However, no significant changes were observed with regard to the lumbar flexion and mechanosensivity of the treated muscles.
Thus, evidence is that the use of Foam Roll exercises significantly improves the mobility of the thoracolumbar fascia in a healthy young population.
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.
The global climate system is currently warming due to the increase in CO2 emissions caused by humans. Technically oriented efficiency strategies are seen more frequently as solutions to reach the European Union’s maximum two degrees Celsius target. Companies play an important role in limiting climate change and must either prepare for such consequences or adopt new strategies such as the sufficiency strategy.
This article will discuss how the sufficiency strategy and the promotion of sufficient living in the context of the tourism industry can contribute to reducing CO2 emissions. Most common approaches toward sufficient living found in literature will be identified, analysed and discussed. Based on chosen keywords, the most common approaches were identified through a literature review of relevant journals from 1989 to 2014. Four main research fields that can promote sufficient living and reduce CO2 emissions were identified. Based on the prospects of the companies, it is apparent that sufficient strategies are not only able to support a market-orientated corporate management but also promote sufficient living and thus reduce CO2 emissions.
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.
Objective
Gross mandibular position and masticatory muscle activity have been shown to influence cervical muscles electromyographic activity. The purpose of this study was to investigate the influence of three different mandible positions including conscious occlusion, tongue tip against the anterior hard palate (Palate tongue position) and natural resting position (Rest), on sagittal plane cervical spine range of motion (ROM) as well as the flexion-rotation test (FRT) in asymptomatic subjects.
Materials and methods
An experienced single blinded examiner evaluated ROM using an Iphone in 22 subjects (7 females; mean age of 29.91years, SD 5.44).
Results
Intra-rater reliability for range recorded was good for the FRT with ICC (intraclass correlation) 0.95 (95% CI: 0.88–0.98) and good for sagittal plane cervical ROM with ICC 0.90 (95% CI: 0.77–0.96). A repeated measures ANOVA determined that mean ROM recorded during the FRT differed significantly between assessment points (F(1.99, 41.83) = 19.88, P < 0.001). Bonferroni Post hoc tests revealed that both conscious Occlusion and Palate tongue position elicited a significant large reduction in ROM recorded during the FRT from baseline (p < 0.01). Despite this, one activation strategy did not influence ROM more than the other. An additional repeated measures ANOVA determined that mean sagittal cervical ROM did not significantly vary between assessment points (F(2, 42) = 8.18, P = 0.08).
Conclusion
This current study provided further evidence for the influence of the temporomandibular region on upper cervical ROM. Results suggest that clinicians should focus on the natural mandible rest position when evaluating upper cervical mobility.
The study addresses staffing and workforce issues for home‐ and community‐based long‐term care in Germany. It is based on a study aimed at developing staffing recommendations for home‐care provider organisations. The study was commissioned within the regulation of the German long‐term care act. Following an exploratory literature search on staffing issues in home‐ and community‐based care qualitative interviews with 30 experts in home care were conducted. In addition, time needed for different interventions in homes of people in need of care (n = 129) was measured. Ethical approval for the study was obtained. The literature on the topic is limited. In Germany, no fixed staff‐to‐client ratio exists, but staffing is determined primarily by reimbursement policies, not by care recipients’ needs. The results of the interviews indicated that staffing ratios are not the main concern of home‐care providers. Experts stressed that general availability of staff with different qualification levels and the problems of existing regulation on services and their reimbursement are of higher concern. The measurement of time needed for selected interventions reveals the huge heterogeneity of home‐care service delivery and the difficulty of using a task‐based approach to determine staffing levels. Overall, the study shows that currently demand for home‐care exceeds supply. Staff shortage puts a risk to home care in Germany. Existing approaches of reimbursement‐driven determination of staffing levels have not been sufficient. A new balance between staffing, needs and reimbursement policies needs to be developed.
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.
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.
Aim
Manual cranial bone tissue techniques (CBTT) are used by physiotherapists as a tool for assessment and treatment of complaints in the craniocervical, face, and head regions. The goal of this study was to determine whether CBTT were able to discriminate between subjects with cervical and/or temporomandibular disorders (TMD) and a healthy group. In addition, the inter-rater reliability when applying CBTT was also investigated.
Methods
A cross-sectional study was conducted and included 60 participants. Six standardized passive techniques were applied and judged for resistance, compliance, and sensory answer. In order to evaluate the inter-rater reliability of these techniques a cohort of participants was measured twice (by two evaluators) prospectively. A logistic regression model and Receiver Operating Curve (ROC) analyses were used to determining the discriminative validity of these techniques.
Results
Logistic regression identified a significant difference for five techniques for resistance and/or compliance and/or the sensory answer between the groups. Based on the Area Under the Curve (AUC) analysis, the discriminative ability of the temporal rotation to distinguish between the groups was fair to good (for resistance AUC = 0.7775 and for compliance AUC = 0.8065). The highest agreement between the two assessors was for the resistance with occipital compression (73%) technique.
Conclusion
This study highlights that some of the CBTT could be potentially useful in distinguishing subjects with cervical and/or TMD from healthy subjects. Inter-rater reliability was moderate. CBTT could be potentially integrated in the examination of participants with complaints in the craniofacial region.
Comparison of quantitative sensory testing profles between people living in Germany and Australia
(2021)
In Germany, a lot of young children at risk of language difficulties still go undetected or are not assessed before preschool-age. For children where parents may suspect a disorder, this practice causes a lot of emotional distress alongside lost time for intervention. Thus, what contribution can parents and nursery staff make for the earlier detection of language difficulties? 34 children from four German kindergartens were tested with a standardized preschool screening for language problems by an SLT. Parents and nursery staff completed a questionnaire (FEE 3-4) that was designed to collect potential risk-factors and included the rating of children’s abilities across the main language domains. Outcomes from the FEE 3-4 were compared between parents and nursery staff as well as triangulated with results from the standardized screening. Agreement between parents and nursery staff re. individual children’s potential language difficulties was moderate (Kappa = 0.44, p = .050). Overall, nursery staff rated children’s language abilities more strictly and precisely than parents. Especially their rating of ‘word order’ (p = .022) and ‘verb endings’ contributed significantly to the identification of potential language difficulties similar to the standardized screening. The screening identified two children at risk without caregiver's concern, but not two others who were at risk of language disorder and for whom caregivers expressed concern. Caregiver’s awareness of early language difficulties appears to be rather intuitive. Young children at risk are most reliably detected if standardized instruments are used in combination with caregiver questionnaires. Ideally, this process includes data from parents and nursery staff to be interpreted by an experienced SLT, as the use of a standardized screening alone may lead to missed or mistaken identification where essential information about the child’s environment (e.g. risk factors) is not provided. If parents are concerned about children’s language, full assessment is clearly justified.
The increasing complexity of caseloads in SLT practice, e.g. due to higher comorbidity, lacking information or experience in the
treatment of complicated cases, calls for support from experienced as well as specialist practitioners from within the field - especially
for novice therapists. One way to tackle these challenges may be peer coaching and how it can be employed within the educational
and professional SLT setting.
Peer coaching was implemented across five semesters of a successive SLT study programme at a University of Applied Sciences in
Germany. The approach was embedded in a clinical reasoning seminar with 25 SLT students who each presented a challenging case
study from their current workload. All participants completed a short online survey to evaluate the feasibility of the team approach
within this setting as well as their personal benefit and development re. the discussed case studies.
Students felt encouraged by being able to share their experience and tackle actual challenges. They particularly valued receiving
answers from a broad range of other SLTs but also contributing to other students’ queries and providing practical solutions for
them. All participants felt that peer coaching was an appropriate approach for clinical reasoning to support their professional as well
as personal development. Other outcomes were a perceived increased ability to employ metacognitive reflection to be used with
their whole caseload but also a prospective need for further training. Some students suggested the employment of peer coaching
within their work setting.
In the educational as well as professional SLT setting, peer coaching can be successfully employed, triggering metacognitive
reflection re. practitioner’s thinking and acting, resulting in an increased awareness of needs and skills as part of the clinical
reasoning process.
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.
The purpose of this study was to evaluate which mode of birth first-time mothers in Germany and in the USA prefer and how this desire is related to maternal well-being and sense of coherence. The paper describes emotional well-being postpartum in relationship to mode of birth. For data collection a prospective cohort study was conducted in both countries. A self-administered questionnaire including validated instruments (WHO-5 Well-Being Index, Sense of Coherence Scale and Edinburgh Postnatal Depression Scale) was used. Results showed that only a few of the pregnant women in Germany and the USA preferred to deliver by caesarean section. There was a relationship between women's well-being, women's sense of coherence and the preferred mode of birth. The majority of women who wanted a caesarean section delivered in this way. No relationship was found between women's well-being and the type of birth experienced. Well-being in both samples generally decreased after giving birth, but there was a difference between German and American first-time mothers on the postpartum well-being and depression scores. German mothers had a higher postnatal quality of life and lower postnatal depression scores. To give families the opportunity for a healthy start, midwives and obstetricians should try to enhance women's well-being and they should give some thought to health professionals' decision-making processes. Expanded postpartum care might have an impact on women's depression scores..
Objective. To examine the association between region of origin and severe illness bringing a mother close to death (near‐miss). Design. Retrospective cohort study. Setting. Maternity units in Lower Saxony, Germany. Population. 441 199 mothers of singleton newborns in 2001–2007. Methods. Using chi‐squared tests, bivariate and multivariable logistic regression we examined the association between maternal region of origin and near‐miss outcomes with prospectively collected perinatal data up to seven days postpartum. Main outcome measures. Hysterectomy, hemorrhage, eclampsia and sepsis rates. Results. Eclampsia was not associated with region of origin. Compared to women from Germany, women from the Middle East (OR 2.24; 95%CI 1.60–3.12) and Africa/Latin America/other countries (OR 2.17; 95%CI 1.15–4.07) had higher risks of sepsis. Women from Asia (OR 3.37; 95%CI 1.66–6.83) and from Africa/Latin America/other countries had higher risks of hysterectomy (OR 2.65; 95%CI 1.36–5.17). Compared to German women, the risk of hemorrhage was higher among women from Asia (OR 1.55; 95%CI 1.19–2.01) and lower among women from the Middle East (OR 0.66, 95%CI 0.55–0.78). Adjusting for maternal age, parity, occupation, partner status, smoking, obesity, prenatal care, chronic conditions and infertility showed no association between country of origin and risk of sepsis. Conclusion. Region of origin was a strong predictor for near‐miss among women from the Middle East, Asia and Africa/Latin America/other countries. Confounders mostly did not explain the higher risks for maternal near‐miss in these groups of origin. Clinical studies and audits are required to examine the underlying causes for these risks.
This review gives an overview about the existing research concerning siblings' perspective within the familial experiences of childhood chronic illness. Besides attaining a conception of their world, it was intended to identify the unacknowledged issues concerning siblings' experience. Four databases were systematically searched. The analysis was concentrated on nine literature reviews. As a result, we identified a map of dimensions of experiences—well-elaborated as well as fragmentary. Many of the studies were conducted by a proxy and not from the sole siblings' perspective. Further research should concentrate on the sole siblings' perspective, in order to make siblings' voices audible.
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).
Objective
Brass players are exposed to high musculoskeletal strains during their instrumental play. Various assessments can be used to measure these strains, whereby a targeted therapy can also be supported. The aim of this study was to review literature concerning assessments used in quantitatively based studies about the analysis of musculoskeletal loads of brass players.
Data sources
The Cochrane Library, PubMed, CINAHL, PEDro as well as the journal “Medical Problems of Performing Artists” were searched for relevant studies.
Study selection
Two reviewers independently applied the inclusion and exclusion criteria to select potential studies. A third reviewer was involved in the case of discrepancies.
Data extraction
Two reviewers independently extracted the data.
Data synthesis
A total of 73 studies conducted between 2004 and 2019 were included. Within a total of 30 studies, 18 assessments could be found that collect 2-dimensional or 3-dimensional kinematic data using video- or image-based analysis of posture, sonographic, optoelectronic and various electromagnetic systems. In 7 studies kinetic data were measured by force-transducers, pressure platforms, stabilizer and dynamometer. Fifteen studies used clinical examinations and additional assessments to screen individual body regions and 9 studies derived electromyography measurements from a total of 25 muscles. Thirty-one partially validated questionnaires were used to record musculoskeletal pain of brass players.
Conclusions
A variety of assessments can be used to optimize analysis and treatment procedures in research and clinical work. Future studies should both examine quality criteria of the various assessment methods and validate clinical examinations and questionnaires.
Thirty years ago, the Fourth King of Bhutan famously proclaimed that ―Gross National Happiness is more important than Gross National Product, thereby setting Bhutan on a holistic development path. Following this historic declaration, Bhutan developed a Gross National Happiness (GNH) Index and screening tool to evaluate all new policies, proclaiming that:
―Gross National Happiness measures the quality of a country in more holistic way [than GNP] and believes that the beneficial development of human society takes place when material and spiritual development occur side by side to complement and reinforce each other.
In July 2011, 68 nations joined Bhutan in co-sponsoring its UN General Assembly resolution on ―Happiness: Towards a Holistic Approach to Development.
Keynes’ Grandchildren and Easterlin’s Paradox. What Is Keeping Us from Reducing Our Working Hours?
(2019)
In 1930 Keynes famously predicted that 100 years later-i.e. in 2030-the “economic problem” would be solved and we would be living in an “age of leisure and of abundance” working only 3 h a day. In the same text, Keynes stated that there are absolute and relative needs (“in the sense that we feel them only if their satisfaction lifts us above, makes us feel superior to, our fellows”), but he thought that relative needs are of minor importance. Richard Easterlin’s work, on the other hand, suggests that relative needs are pervasive and that wellbeing depends much more on one’s relative income than Keynes once thought.
It will be argued in this text that Richard Easterlin’s findings, in spite of proving Keynes off the mark in his understatement of relative needs, strengthens the case for working time reductions: the larger the proportion of goods subject to the relative-income effect, the greater are the benefits of working fewer hours. Perhaps the main explanation for why we are still sticking to the 40-h work-week is that the Easterlin paradox has not been widely understood yet.
Hedonism
(2009)
Despite decades of empirical happiness research, there is still little evidence for the positive effect of economic growth on life satisfaction. This poses a major challenge to welfare economic theory and to normative conceptions of socio-economic development. This book endeavours to explain these findings and to make sense of their ethical implications.
While most of the existing literature on empirical happiness research is ultimately interested in understanding how to improve human lives and societal development, the ethical backdrop against which these findings are evaluated is rarely made explicit. In contrast to this, Professor Hirata focuses on the role happiness should play in an ethically founded conception of good development. Taking a development ethics perspective, this book proposes a nuanced conception of happiness that includes both its affective and its normative dimensions and embeds this in a comprehensive conception of good development.
The argument is that happiness should not be regarded as the only thing that determines a good life and that good development cannot sensibly be thought of as a matter of maximizing happiness. Happiness should rather be seen as an important indicator for the presence or absence of those concerns that really matter to people: the reasons that give rise to happiness. This book should be of interest to students and researchers of economics, psychology and development studies.
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.
The assessment of somatosensory function is a cornerstone of research and clinical practice in neurology. Recent initiatives have developed novel protocols for quantitative sensory testing (QST). Application of these methods led to intriguing findings, such as the presence lower pain-thresholds in healthy children compared to healthy adolescents. In this article, we (re-) introduce the basic concepts of signal detection theory (SDT) as a method to investigate such differences in somatosensory function in detail. SDT describes participants’ responses according to two parameters, sensitivity and response-bias. Sensitivity refers to individuals’ ability to discriminate between painful and non-painful stimulations. Response-bias refers to individuals’ criterion for giving a “painful” response. We describe how multilevel models can be used to estimate these parameters and to overcome central critiques of these methods. To provide an example we apply these methods to data from the mechanical pain sensitivity test of the QST protocol. The results show that adolescents are more sensitive to mechanical pain and contradict the idea that younger children simply use more lenient criteria to report pain. Overall, we hope that the wider use of multilevel modeling to describe somatosensory functioning may advance neurology research and practice.
Multiple-group confirmatory factor analysis (MG-CFA) is among the most productive extensions of.structural equation modeling. Many researchers conducting cross-cultural or longitudinal studies are interested in testing for measurement and structural invariance. The aim of the present paper is to provide a tutorial in MG-CFA using the freely available R-packages lavaan, semTools, and semPlot. The combination of these packages enable a highly efficient analysis of the measurement models both for normally distributed as well as ordinal data. Data from two freely available datasets – the first with continuous the second with ordered indicators - will be used to provide a walk-through the individual steps.
Selecting items for Big Five questionnaires : At what sample size do factorloadings stabilize?
(2014)
Researchers often use exploratory factor analysis (EFA) to develop and refine questionnaires assessing theBig Five personality traits. We use sequential sampling and bootstrapping to determine the number ofparticipants needed to yield stable loading patterns for the Big Five Inventory (BFI) and the InternationalPersonality Item Pool Big Five measure (IPIP). Overall 21,350 participants (BFI = 10,285; IPIP = 11,065)participated. In two studies primary factor loadings are highly variable in smaller samples (n< 500)and some primary loadings are not stable with 10,000 participants. Most studies will not have adequatesample size to yield stable loading patterns for Big Five measures such as the BFI and IPIP. Researchersshould assess and report the variability of loading patterns.
Aims:
To assess the diagnostic utility of a novel abbreviated monofilament test in comparison with the tuning fork test to detect diabetic peripheral neuropathy in children.
Methods:
A total of 88 children with Type 1 diabetes mellitus were screened for diabetic peripheral neuropathy using the monofilament test and the tuning fork. Nerve conduction studies were performed according to the ‘gold standard’ for neuropathy. We assessed the diagnostic utility and inter-rater agreement of the two screening methods.
Results:
A total of 43 (49%) children (aged 6–18 years) had at least one abnormal nerve conduction study result. Diagnostic utility and inter-rater agreement were very low for both screening methods. The monofilament test yielded a sensitivity of 18% and a specificity of 80%. The tuning fork yielded a sensitivity of 0% and a specificity of 98%.
Conclusion:
The present study found that an abbreviated monofilament test has low diagnostic utility for the detection of early diabetic peripheral neuropathy because of its low reliability. The problem of reliability needs to be more thoroughly addressed in order to improve the screening procedures in diabetes management in childhood and adolescence.
Background:
Recurrent pain is a common experience in childhood, but only few children with recurrent pain attend a physician. Previous studies yielded conflicting findings with regard to predictors of health care utilization in children with recurrent pain.
Methods:
The present study analyzes data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) study comprising n = 2,149 children (3–10 years old) with recurrent pain to find robust predictors.We used multiple logistic regressions to investigate age, gender, socio-economic status(SES), migration background, pain intensity, pain frequency, pain-related disability, mental health problems, and health-related quality of life (HRQL) as predictors for visiting a doctor due to pain.
Results:
Overall, young girls with high pain-related disability, intensity, frequency, and migration background were more likely to attend a physician. Pain-related disability had the largest impact. Socioeconomic status, health-related quality of life anmental health problems were not systematically related to health care utilization. An analysis of the variability of these results indicated that several hundred participants
are needed until the results stabilize.
Conclusions:
Our findings highlight the importance of pain-related disability and frequency in assessing the severity of recurrent pain. Generic predictors and demographic variables are of lesser relevance to children with recurrent pain. On a methodological level, our results show that large-scale studies are need to reliably
identify predictors of health care utilization.
Co-financing arrangements in which investors from outside the motion picture industry become co-owners of the completed films are a common phenomenon in Hollywood. Kay H. Hofmann analyzes the conflicts of interest and the organizational problems that may arise between the experienced major studios and investors with comparably low industry expertise. Guided by principal agent theory, the empirical analysis provides evidence for adverse selection and moral hazard. Based on his findings, the author develops solutions that are not only relevant for investors but also for film producers who rely on the long-term availability of external funds.
Guided by cultural labor economics, the paper analyzes the career paths of former actors from popular television soap operas, and addresses in particular, if and under which conditions such serial engagements may function as a stepping stone for a subsequent professional acting career. A novel database of 396 German artists with detailed and long-term biographical information is used for the quantitative empirical analyses. The results indicate that soaps, contrary to popular opinion, function as a stepping stone, especially for younger actors. However, soap engagements should be rather short but long enough to allow artists to play multiple roles in other shows or films besides being in the cast of a soap. While formal acting education does not influence soap actors’ future filmographies, there is evidence that it helps artists to find jobs in arts-related occupations such as voice acting. Finally, publicity and media presence foster a later acting career. Practical implications for artists and their managers are outlined, along with a discussion on the meaning of serials for the creation and commercialization of stars.
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.
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.
By drawing on the two prevailing economic stardom theories, the paper investigates the sources of superstardom in the US movie industry. For the econometric analysis, we use income and popularity data of screen actresses and actors from the annual Celebrity 100 lists as published by Forbes Magazine. The empirical findings indicate that Hollywood, in contrast to other professional settings, supports two different types of stars. While 'talent stars' exploit acting merit, it is media exposure that drives the income of 'publicity stars'. Apparently, in the motion picture industry both underlying resources are equally important and equally valued. Based on these insights we develop concrete recommendations for the career management of artists and the management of film projects.
In this article, we build on Stigler and Becker’s (1977) “consumption capitaltheory” and propose a novel conceptualization of film quality for the analysisof motion picture franchises. Generally, this theorypredicts that the utilityconsumers derive from a particular goodor service increases with prior con-sumption. We test our theoretical conjectures by drawing on the population ofsequels that were running in the US between 1992 and 2011. The empiricalresults point to the explanatory power of the proposed framework. Filmexecutives may use our findings to improve the profitability of their sequelproductions. From a theoretical point of view, consumption capital theoryallows for a more refined analysis of sequel performance along differentdimensions. Moreover, it may provide a fruitful basis for the analysis of otherserial media content, including books, TV, music, and games.
The location of manufacturing is operationally and strategically important for multinational companies. The spatial dispersion of manufacturing is determined by firm-specific as well as external factors, both of which are subject to constant change. After decades of offshoring production, the paper uses interview data from UK high value manufacturing companies to explore the recent phenomenon of reshoring and the strategic and operational effects of manufacturing location. The analyses show that concentrating manufacturing in home countries enables firms to increase organizational agility and stimulate innovation. However, under certain conditions, firms also continue benefiting from the known advantages of offshoring. This underlines that there is no universal recommendation for improving competitiveness by a certain spatial configuration of manufacturing. Instead, firms need to consider their specific markets, competitive context, and capabilities when strategizing manufacturing location."
Stakeholder relations and sustainability practices of US small and medium-sized manufacturers
(2012)
Purpose: The purpose of this paper is to investigate the adoption of sustainability practices by small and medium-sized manufacturing (SMM) firms, the ways these firms work with their stakeholders for social and environmental purposes, and the relationships between the adoption of sustainability practices, stakeholder interaction, and product and process innovation.
Design/methodology/approach: This paper uses data from telephone interviews with 296 companies, a sustainability typology, and descriptive and statistical regression analysis.
Findings: The majority of the firms are adopting sustainability practices at least to some degree,stakeholders such as community advocacy groups, employees, suppliers, customers, and the localmedia are influencing the adoption of sustainability practices, and firms with high adoption rates of environmental practices are more successful in product and process innovation.Practical implications– The results of this research can help firms and stakeholder groups with their joint efforts to develop sustainability strategies. Community advocacy groups, employees,suppliers, customers, and the local media are capable of motivating firms to give something back tothe communities in which they conduct their business.
Originality/value: This paper contributes new understanding of the adoption of sustainabilitypractices by SMM firms, the ways these firms work with their stakeholders for social and environmental purposes, and the relationships between the adoption of sustainability practices,stakeholder interaction, and product and process innovation.
How do companies decide where to locate their manufacturing? This study uses insights from manufacturing company executives collected by means of in-depth interviews with 50 manufacturers in the United Kingdom to develop an understanding of manufacturing location decision making. The findings indicate that companies derive competitive advantage from organizing manufacturing in different ways. Retaining or reshoring manufacturing to a company’s home country can enhance new product development, control of quality, product customization, delivery performance, and cost leadership. On the other hand, companies can enhance new product development, customization, and delivery performance for new markets, if production facilities are offshored to or in proximity to these locations. In addition, some companies use a hybrid approach of offshoring the production of some components or products for cost arbitrage while retaining or reshoring other components or products for advantages from value chain integration. Based on the findings of this study, a set of key manufacturing location questions are developed that should be considered by firms pondering onshore, offshore, reshore, or hybrid manufacturing location decisions.
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.
Background: For more than 30 years, there has been close cooperation between Japanese and German scientists with regard to information systems in health care. Collaboration has been formalized by an agreement between the respective scientific associations. Following this agreement, two joint workshops took place to explore the similarities and differences of electronic health record systems (EHRS) against the background of the two national healthcare systems that share many commonalities.
Objectives: To establish a framework and requirements for the quality of EHRS that may also serve as a basis for comparing different EHRS.
Methods: Donabedian's three dimensions of quality of medical care were adapted to the outcome, process, and structural quality of EHRS and their management. These quality dimensions were proposed before the first workshop of EHRS experts and enriched during the discussions.
Results: The Quality Requirements Framework of EHRS (QRF-EHRS) was defined and complemented by requirements for high quality EHRS. The framework integrates three quality dimensions (outcome, process, and structural quality), three layers of information systems (processes and data, applications, and physical tools) and three dimensions of information management (strategic, tactical, and operational information management).
Conclusions: Describing and comparing the quality of EHRS is in fact a multidimensional problem as given by the QRF-EHRS framework. This framework will be utilized to compare Japanese and German EHRS, notably those that were presented at the second workshop.
Objective: To pilot benchmark measures of health information and communication technology (ICT) availability and use to facilitate cross-country learning.
Materials and Methods: A prior Organization for Economic Cooperation and Development–led effort involving 30 countries selected and defined functionality-based measures for availability and use of electronic health records, health information exchange, personal health records, and telehealth. In this pilot, an Organization for Economic Cooperation and Development Working Group compiled results for 38 countries for a subset of measures with broad coverage using new and/or adapted country-specific or multinational surveys and other sources from 2012 to 2015. We also synthesized country learnings to inform future benchmarking.
Results: While electronic records are widely used to store and manage patient information at the point of care—all but 2 pilot countries reported use by at least half of primary care physicians; many had rates above 75%—patient information exchange across organizations/settings is less common. Large variations in the availability and use of telehealth and personal health records also exist.
Discussion: Pilot participation demonstrated interest in cross-national benchmarking. Using the most comparable measures available to date, it showed substantial diversity in health ICT availability and use in all domains. The project also identified methodological considerations (e.g., structural and health systems issues that can affect measurement) important for future comparisons.
Conclusion: While health policies and priorities differ, many nations aim to increase access, quality, and/or efficiency of care through effective ICT use. By identifying variations and describing key contextual factors, benchmarking offers the potential to facilitate cross-national learning and accelerate the progress of individual countries.
The demand for evidence-based health informatics and benchmarking of 'good' information systems in health care gives an opportunity to continue reporting on recent papers in the German journal GMS Medical Informatics, Biometry and Epidemiology (MIBE) here. The publications in focus deal with a comparison of benchmarking initiatives in German-speaking countries, use of communication standards in telemonitoring scenarios, the estimation of national cancer incidence rates and modifications of parametric tests. Furthermore papers in this issue of MIM are introduced which originally have been presented at the Annual Conference of the German Society of Medical Informatics, Biometry and Epidemiology. They deal as well with evidence and evaluation of 'good' information systems but also with data harmonization, surveillance in obstetrics, adaptive designs and parametrical testing in statistical analysis, patient registries and signal processing.
Objectives: eHealth and innovation are often regarded as synonyms - not least because eHealth technologies and applications are new to their users. This position paper challenges this view and aims at exploring the nature of eHealth innovation against the background of common definitions of innovation and facts from the biomedical and health informatics literature. A good understanding of what constitutes innovative eHealth developments allows the degree of innovation to be measured and interpreted.
Methods: To this end, relevant biomedical and health informatics literature was searched mainly in Medline and ACM digital library. This paper presents seven facts about implementing and applying new eHealth developments hereby drawing on the experience published in the literature.
Results: The facts are: 1. eHealth innovation is relative. 2. Advanced clinical practice is the yardstick. 3. Only used and usable eHealth technology can give birth to eHealth innovatio. 4. One new single eHealth function does not make a complex eHealth innovation. 5. eHealth innovation is more evolution than revolution. 6. eHealth innovation is often triggered behind the scenes; and 7. There is no eHealth innovation without sociocultural change.
Conclusions: The main conclusion of the seven facts is that eHealth innovations have many ingredients: newness, availability, advanced clinical practice with proven outcomes, use and usability, the supporting environment, other context factors and the stakeholder perspectives. Measuring eHealth innovation is thus a complex matter. To this end we propose the development of a composite score that expresses comprehensively the nature of eHealth innovation and that breaks down its complexity into the three dimensions: i) eHealth adoption, ii) partnership with advanced clinical practice, and iii) use and usability of eHealth. In order to better understand the momentum and mechanisms behind eHealth innovation the fourth dimension, iv) eHealth supporting services and means, needs to be studied. Conceptualising appropriate measurement instruments also requires eHealth innovation to be distinguished from eHealth sophistication, performance and quality, although innovation is intertwined with these concepts. The demanding effort for defining eHealth innovation and measuring it properly seem worthwhile and promise advances in creating better systems. This paper thus intends to stimulate the necessary discussion.
When speaking about eBusiness as applied to the healthcare market two questions arise immediately. Firstly, what is eBusiness? Secondly, why is eBusiness in healthcare different from eBusiness in other sectors?
Within the arena of eBusiness in healthcare, the focus is on purchasing and selling online as the most advanced application. In this book, the Authors consider both the perspective of the healthcare providers and that of the suppliers, showing the interdependencies between the two and developing concepts for a new synergistic cooperation.
eBusiness in Healthcare raises awareness of and interest in electronically mediated business processes in healthcare to a large audience including healthcare informaticians, medical business managers, clinicians, pharmacists and scientists. By taking an international approach to the topic the authors demonstrate the many similarities of eBusiness problems and their solutions among different countries which permits analysis of the differences that are often defined by the national healthcare systems and their rules. Case studies from healthcare institutions and from suppliers in the US, the UK and Germany will illustrate the achievements, barriers and future plans, thus enabling newcomers to learn from previous experience.
Clinicians will gain significant insight by this book which demonstrates the interconnection between patient care processes and management issues at the level of medical supplies. The book also makes a plea for a multidisciplinary effort, to enable the right product to be procured for the right patient. As a rather new discipline, eBusiness in healthcare needs further scientific backing. Against this background, this book will not only provide answers but will also raise questions for future research. Managing change and innovation and establishing the critical mass for eBusiness in healthcare is a major undertaking. The aim of this book is to support this process.
Health Telematics Europe
(2011)
The adoption and use of information technology (IT) in health care is influenced by many factors and depends on legal and cultural constraints prevailing in a country. While Europe is constantly coalescing on a political basis, health care is a sector still dominated by national legislation. Consequently, different types of national health care systems have existed throughout Europe for decades which now build the framework for the use of information and communication technology (ICT) by health care provider organizations. The following paragraphs will, therefore, provide a concise overview of the different types of national health care systems in Europe and will characterize the countries with regard to key indicators.
This workshop will review the history of the TIGER initiative in order to set the framework for an understanding of international informatics competencies. We will include a description of clinical nursing informatics programs in 37 countries as well as the results of a recent survey of nursing competencies in order to further discussions of internationally agreed-upon competency definitions. These two surveys will provide the basis for developing a consensus regarding the integration of core competencies into informatics curriculum developments. Expected outcomes include building consensus on core competencies and developing plans toward implementing intra- and inter-professional informatics competencies across disciplines globally.
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.
Objective: The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately.
Methods: A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education.
Results: By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders’ attitudes, but not to evaluate specific implementations.
Conclusion: Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.
Background: IT adoption is a process that is influenced by different external and internal factors. This study aimed
1. to identify similarities and differences in the prevalence of medical and nursing IT systems in Austrian and German hospitals, and
2. to match these findings with characteristics of the two countries, in particular their healthcare system, and with features of the hospitals.
Methods: In 2007, all acute care hospitals in both countries received questionnaires with identical questions. 12.4% in Germany and 34.6% in Austria responded.
Results: The surveys revealed a consistent higher usage of nearly all clinical IT systems, especially nursing systems, but also PACS and electronic archiving systems, in Austrian than in German hospitals. These findings correspond with a significantly wider use of standardised nursing terminologies and a higher number of PC workstations on the wards (average 2.1 PCs in Germany, 3.2 PCs in Austria). Despite these differences, Austrian and German hospitals both reported a similar IT budget of 2.6% in Austria and 2.0% in Germany (median).
Conclusions: Despite the many similarities of the Austrian and German healthcare system there are distinct differences which may have led to a wider use of IT systems in Austrian hospitals. In nursing, the specific legal requirement to document nursing diagnoses in Austria may have stimulated the use of standardised terminologies for nursing diagnoses and the implementation of electronic nursing documentation systems. Other factors which correspond with the wider use of clinical IT systems in Austria are: good infrastructure of medical-technical devices, rigorous organisational changes which had led to leaner processes and to a lower length of stay, and finally a more IT friendly climate. As country size is the most pronounced difference between Germany and Austria it could be that smaller countries, such as Austria, are more ready to translate innovation into practice.
Teachers in health informatics have a broad variety of international and national educational recommendations to rely on when designing programmes, curricula, courses and educational material. However, in addition they often need very specific information for their setting, blue-prints, hands-on experience and encouragement to try something new. This workshop presents three case studies from European universities who have implemented inter-professional, technology enabled health informatics courses in undergraduate, postgraduate and open university settings. These approaches will be put into the context of the TIGER recommendation framework that includes priority ratings of health informatics competencies and case studies to illustrate them. The workshop attendees will have ample opportunity to exchange ideas with the presenters and start a mutual learning process for health informatics teachers.
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.
The TIGER Initiative
(2016)
Background: While health informatics recommendations on competencies and education serve as highly desirable corridors for designing curricula and courses, they cannot show how the content should be situated in a specific and local context. Therefore, global and local perspectives need to be reconciled in a common framework.
Objectives: The primary aim of this study is therefore to empirically define and validate a framework of globally accepted core competency areas in health informatics and to enrich this framework with exemplar information derived from local educational settings.
Methods: To this end, (i) a survey was deployed and yielded insights from 43 nursing experts from 21 countries worldwide to measure the relevance of the core competency areas, (ii) a workshop at the International Nursing Informatics Conference (NI2016) held in June 2016 to provide information about the validation and clustering of these areas and (iii) exemplar case studies were compiled to match these findings with the practice. The survey was designed based on a comprehensive compilation of competencies from the international literature in medical and health informatics.
Results: The resulting recommendation framework consists of 24 core competency areas in health informatics defined for five major nursing roles. These areas were clustered in the domains “data, information, knowledge”, “information exchange and information sharing”, “ethical and legal issues”, “systems life cycle management”, “management” and “biostatistics and medical technology”, all of which showed high reliability values. The core competency areas were ranked by relevance and validated by a different group of experts. Exemplar case studies from Brazil, Germany, New Zealand, Taiwan/China, United Kingdom (Scotland) and the United States of America expanded on the competencies described in the core competency areas.
Conclusions: This international recommendation framework for competencies in health informatics directed at nurses provides a grid of knowledge for teachers and learner alike that is instantiated with knowledge about informatics competencies, professional roles, priorities and practical, local experience. It also provides a methodology for developing frameworks for other professions/disciplines. Finally, this framework lays the foundation of cross-country learning in health informatics education for nurses and other health professionals.
This paper describes the methodology and developments towards the TIGER International Recommendation Framework of Core Competencies in Health Informatics 2.0. This Framework is meant to augment the scope from nursing towards a series of six other professional roles, i.e. direct patient care, health information management, executives, chief information officers, engineers and health IT specialists and researchers and educators. Health informatics core competency areas were compiled from various sources that had integrated the literature and were grouped into consistent clusters. The relevance of these core competency areas was rated in a survey by 718 professional experts from 51 countries. Furthermore, 22 local case studies illustrated the competencies and gave insight into examples of local educational practice. The Framework contributes to the overall discourse on how to shape health informatics education to improve quality and safety of care by enabling useful and successful health information systems.
Background: Clinical information logistics is the backbone of care workflows inside and outside of hospitals. Due to the great potential of health IT to support clinical processes its contribution needs to be regularly monitored and governed. IT benchmarks are a well-known instrument to optimise the availability and use of IT by guiding the decision making process. The aim of this study was to translate IT benchmarking results that were grounded on a hierarchical workflow scoring system into an appropriate visualisation concept.
Methods: To this end, a three-dimensional multi-level model was developed, which allowed the decomposition of the highly aggregated workflow composite score into score views for the individual clinical workflows concerned and for the descriptors of these workflows. Furthermore this multi-level model helped to break down the score views into single and multiple indicator views.
Results: The results could be visualised per hospital in comparison to the results of organisations of similar size and ownership (peer reference groups) and in comparison to different types of innovation adopters. The multi-level model was implemented in a benchmark of 199 hospitals and evaluated by the chief information officers. The evaluation resulted in high ratings for the comprehensibility of the different types of views of the scores and indicators.
Conclusions: The implementation of the multi-level model in a large benchmark of hospitals proved to be feasible and useful in terms of the overall structure and the different indicator views. There seems to be a preference for less complex and familiar views.
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.
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.
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.
Radiology has a reputation for having a high affinity to innovation – particularly with regard to information technologies. Designed for supporting the peculiarities of radiological diagnostic workflows, Radiology Information Systems (RIS) and Picture Archiving and Communication Systems (PACS) developed into widely used information systems in hospitals and form the basis for advancing the field towards automated image diagnostics. RIS and PACS can thus serve as meaningful indicators of how quickly IT innovations diffuse in secondary care settings – an issue that requires increased attention in research and health policy in the light of increasingly fast innovation cycles. We therefore conducted a retrospective longitudinal observational study to research the diffusion dynamics of RIS and PACS in German hospitals between 2005 and 2017. Based upon data points collected within the “IT Report Healthcare” and building on Rogers’ Diffusion of Innovation (DOI) theory, we applied a novel methodological technique by fitting Bayesian Bass Diffusion Models on past adoption rates. The Bass models showed acceptable goodness of fit to the data and the results indicated similar growth rates of RIS and PACS implementations and suggest that market saturation is almost reached. Adoption rates of PACS showed a slightly higher coefficient of imitation (q = 0.25) compared to RIS (q = 0.11). However, the diffusion process expands over approximately two decades for both systems which points at the need for further research into how innovation diffusion can be accelerated effectively. Furthermore, the Bayesian approach to Bass modelling showed to have several advantages over the classical frequentists approaches and should encourage adoption and diffusion research to adapt similar techniques.
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.
Background
Diabetes mellitus is a major global health issue with a growing prevalence. In this context, the number of diabetic complications is also on the rise, such as diabetic foot ulcers (DFU), which are closely linked to the risk of lower extremity amputation (LEA). Statistical prediction tools may support clinicians to initiate early tertiary LEA prevention for DFU patients. Thus, we designed Bayesian prediction models, as they produce transparent decision rules, quantify uncertainty intuitively and acknowledge prior available scientific knowledge.
Method
A logistic regression using observational collected according to the standardised PEDIS classification was utilised to compute the six-month amputation risk of DFU patients for two types of LEA: 1.) any-amputation and 2.) major-amputation. Being able to incorporate information which is available before the analysis, the Bayesian models were fitted following a twofold strategy. First, the designed prediction models waive the available information and, second, we incorporated the a priori available scientific knowledge into our models. Then, we evaluated each model with respect to the effect of the predictors and validity of the models. Next, we compared the performance of both models with respect to the incorporation of prior knowledge.
Results
This study included 237 patients. The mean age was 65.9 (SD 12.3), and 83.5% were male. Concerning the outcome, 31.6% underwent any- and 12.2% underwent a major-amputation procedure. The risk factors of perfusion, ulcer extent and depth revealed an impact on the outcomes, whereas the infection status and sensation did not. The major-amputation model using prior information outperformed the uninformed counterpart (AUC 0.765 vs AUC 0.790, Cohen’s d 2.21). In contrast, the models predicting any-amputation performed similarly (0.793 vs 0.790, Cohen’s d 0.22).
Conclusions
Both of the Bayesian amputation risk models showed acceptable prognostic values, and the major-amputation model benefitted from incorporating a priori information from a previous study. Thus, PEDIS serves as a valid foundation for a clinical decision support tool for the prediction of the amputation risk in DFU patients. Furthermore, we demonstrated the use of the available prior scientific information within a Bayesian framework to establish chains of knowledge.
Multinational health IT benchmarks foster cross-country learning and have been employed at various levels, e.g. OECD and Nordic countries. A bi-national benchmark study conducted in 2007 revealed a significantly higher adoption of health IT in Austria compared to Germany, two countries with comparable healthcare systems. We now investigated whether these differences still persisted. We further studied whether these differences were associated with hospital intrinsic factors, i.e. the innovative power of the organisation and hospital demographics. We thus performed a survey to measure the “perceived IT availability” and the “innovative power of the hospital” of 464 German and 70 Austrian hospitals. The survey was based on a questionnaire with 52 items and was given to the directors of nursing in 2013/2014. Our findings confirmed a significantly greater IT availability in Austria than in Germany. This was visible in the aggregated IT adoption composite score “IT function” as well as in the IT adoption for the individual functions “nursing documentation” (OR = 5.98), “intensive care unit (ICU) documentation” (OR = 2.49), “medication administration documentation” (OR = 2.48), “electronic archive” (OR = 2.27) and “medication” (OR = 2.16). “Innovative power” was the strongest factor to explain the variance of the composite score “IT function”. It was effective in hospitals of both countries but significantly more effective in Austria than in Germany. “Hospital size” and “hospital system affiliation” were also significantly associated with the composite score “IT function”, but they did not differ between the countries. These findings can be partly associated with the national characteristics. Indicators point to a more favourable financial situation in Austrian hospitals; we thus argue that Austrian hospitals may possess a larger degree of financial freedom to be innovative and to act accordingly. This study is the first to empirically demonstrate the effect of “innovative power” in hospitals on health IT adoption in a bi-national health IT benchmark. We recommend directly including the financial situation into future regression models. On a political level, measures to stimulate the “innovative power” of hospitals should be considered to increase the digitalisation of healthcare.
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.
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.
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.
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.
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 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.
Social networking technologies such as social media, crowd concepts, or gamification represent key resources for the integration of customers, value network partners, and the community into sustainable business models. However, there is a lack of understanding of how sustainable enterprises apply such technologies. To close this gap, we propose a taxonomy of design options for social networking technologies in sustainable business models. Our taxonomy comprises eight dimensions that deal with relevant questions of the design of social networking technologies. When creating our taxonomy, we built on existing literature and use cases and involved experienced practitioners in the field of sustainable business models for the validation of our taxonomy. In this way, our study contributes to knowledge on the use of social networking technologies in sustainable business models and how such technologies influence the boundaries of sustainable business models. Likewise, we provide practical insights into the use of social networking technologies in sustainable business models.
This study investigates how microenterprises in Ethical Fashion (EF) retail adopt and make use of social media. Drawing on an explorative case study, supplemented by an action research approach, we first examine the antecedents of a successful Adoption based on the Technology-Organization-Environment (TOE) framework. Subsequently, we shed light on the benefits and drawbacks of social media adoption for the three microenterprises of our case study on the operational and the strategical level. More particularly, we present how they improve value creation through the employment of social media in their value networks and how they overcome the lack of a sophisticated IT infrastructure. Finally, we investigate the reluctance of the three microenterprises to adopt inter-organizational information systems. The findings of our study also reveal a halo effect in the adoption process that may mislead the adopting organization.
The political geography of central government debt has hardly been investigated. We propose a method for calculating implicit interregional transfers stemming from central government debt.
We apply this method to Belgium over the 1970-2016 period. The share of poorer Francophone Belgium in debt-financed central government spending was persistently larger than its share in central government revenue used to pay the resulting interest bills. The opposite holds for richer Flanders. Also, a primary deficit in one particular year leads to an interest bill in each of the following years as long as debt caused by that primary deficit is not repaid. All the above caused debt-related transfers from Flanders to Francophone Belgium of over 7% of Flemish GDP during many years.
Interregional interest transfers may also be large in the many other democracies suffering from both high central government debt and considerable geographic income disparities.
The size of these transfers may in turn explain the size and persistence of central government deficits. This is also because poorer, less densely populated regions such as Francophone Belgium tend to be overrepresented within central governments. This strengthens their ability to cause deficits.
We recommend more fiscal decentralisation or at least smaller central government deficits.
Since teachers spend several hours a day in interactions with other people, it seems plausible to assume that their social competencies are a vital foundation for their professional success. Thus, it makes sense to put special emphasis on such competencies in the context of career counseling/occupational orientation, teachers’ training and education as well as personnel selection procedures at schools. Hence instruments are required to measure job-relevant social competencies. Subsequently, we will describe the development and validation of a self-perception questionnaire to measure social competencies of teachers. It was designed as a self-assessment procedure and it informs on 10 job-relevant competencies. The main application areas lie in occupational orientation as well as in self-refl ection during university studies. Further application areas will be discussed.
Wir berichten von einer Studie, in der das englischsprachige Original einer Skala zur Messung des organisationsbezogenen Selbstwertes in fünf weitere Sprachen (deutsch, polnisch, ungarisch, spanisch, malaiisch) übersetzt und validiert wurde. Befragt wurden die Mitarbeiter eines internationalen Konzerns in sieben Ländern (USA, Kanada, Deutschland, Polen, Spanien, Ungarn und Malaysia). Zur Validierung werden die Arbeitszufriedenheit, die selbst eingeschätzte Arbeitsleistung sowie die Unterstützung der Mitarbeiter bei der Umsetzung der Unternehmenswerte (Commitment) herangezogen. Die Ergebnisse belegen, dass die Übersetzungen erfolgreich verlaufen sind. In allen Fällen ergibt sich eine reliable Skala, die positiv mit den Validititätskriterien korreliert.
International research on a construct presupposes that the same measurement instruments are implemented in different countries. Only then can the results of the studies be directly compared to one another. We report on a study in which the English-language original of the Organizational Commitment Questionnaire (OCQ) as well as a German-language version of the OCQ was adapted into four further languages (Polish, Hungarian, Spanish, Malay) and validated. The employees of an international company were surveyed in seven countries (USA, Canada, Germany, Poland, Spain, Hungary and Malaysia). For purposes of validation, the job satisfaction, the self-rated job performance and the support of the employees in implementing the company values were used. The results show that the translations proceeded successfully. In all cases, a reliable scale emerges, which correlates positively with the validity criteria.
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.
Abstract
Background
The clinical presentation of neck-arm pain is heterogeneous with varying underlying pain types (nociceptive/neuropathic/mixed) and pain mechanisms (peripheral/central sensitization). A mechanism-based clinical framework for spinally referred pain has been proposed, which classifies into (1) somatic pain, (2) neural mechanosensitivity, (3) radicular pain, (4) radiculopathy and mixed pain presentations. This study aims to (i) investigate the application of the clinical framework in patients with neck-arm pain, (ii) determine their somatosensory, clinical and psychosocial profile and (iii) observe their clinical course over time.
Method
We describe a study protocol. Patients with unilateral neck-arm pain (n = 180) will undergo a clinical examination, after which they will be classified into subgroups according to the proposed clinical framework. Standardized quantitative sensory testing (QST) measurements will be taken in their main pain area and contralateral side. Participants will have to complete questionnaires to assess function (Neck Disability Index), psychosocial factors (Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Depression, anxiety and stress scale), neuropathic pain (Douleur Neuropathique 4 Questions, PainDETECT Questionnaire) and central sensitization features (Central Sensitization Inventory). Follow-ups at three, six and 12 months include the baseline questionnaires. The differences of QST data and questionnaire outcomes between and within groups will be analyzed using (M)AN(C)OVA and/or regression models. Repeated measurement analysis of variance or a linear mixed model will be used to calculate the differences between three, six, and 12 months outcomes. Multiple regression models will be used to analyze potential predictors for the clinical course.
Conclusion
The rationale for this study is to assess the usability and utility of the proposed clinical framework as well as to identify possible differing somatosensory and psychosocial phenotypes between the subgroups. This could increase our knowledge of the underlying pain mechanisms. The longitudinal analysis may help to assess possible predictors for pain persistency.
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.
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.
The demographic shift in the age structure has the effects that many ageing employees work in organisations. Migration can slow down the ageing of population but could not stop it. More and more people with immigration background work in organisations. Therefore, the question is, whether diversity sensitive attitudes count for all diversity aspects. The central aim of the study is to deal with the problem fields of multicultural teamwork. Thereby, the focus is on the collaboration of employees with and without immigration background. The interviews with employees with and without an immigra-tion background of various company branches were conducted. The results show that employees with an immigration background have more contact and feel comfortable with persons from different cultures than employees without an immigration back-ground. The qualitative analysis indicates that there is a high need of competence devel-opment, especially intercultural and social competences in organisations. The results of the study reveal that personality traits and characteristics of employees play a role to what extent they accept diversity and are willing to work with persons from another culture. Age is not important regarding intercultural competence development.
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.
Background
The continuous rise in caesarean rates across most European countries raises multiple concerns. One factor in this development might be the type of care women receive during childbirth. ‘Supportive care during labour’ by midwives could be an important factor for reducing fear, tension and pain and decreasing caesarean rates. The presence and availability of midwives to support a woman in line with her needs are central aspects for ‘supportive care during labour’.
To date, there is no existing research on the influence of effective ‘supportive care’ by German midwives on the mode of birth. This study examines the association between the attendance and workload of midwives with the mode of birth outcomes in a population of low-risk women in a German multicentre sample.
Methods
The data are based on a prospective controlled multicentre trial (n = 1,238) in which the intervention ‘midwife-led care’ was introduced. Four German hospitals participated between 2007 and 2009.
Secondary analyses included a convenience sample of 999 low-risk women from the primary analyses who met the selection criterion ‘low-risk status’. Participation was voluntary. The association between the mode of birth and the key variables ‘attendance of midwives’ and ‘workload of midwives’ was assessed using backward logistic regression models.
Results
The overall rate of spontaneous delivery was 80.7% (n = 763). The ‘attendance of midwives’ and the ‘workload of midwives’ did not exhibit a significant association with the mode of birth. However, women who were not satisfied with the presence of midwives (OR: 2.45, 95% CI 1.54-3.95) or who did not receive supportive procedures by midwives (OR: 3.01, 95% CI 1.50-6.05) were significantly more likely to experience operative delivery or a caesarean. Further explanatory variables include the type of hospital, participation in childbirth preparation class, length of stay from admission to birth, oxytocin usage and parity.
Conclusion
Satisfaction with the presence of and supportive procedures by midwives are associated with the mode of birth. The presence and behaviour of midwives should suit the woman’s expectations and fulfil her needs. For reasons of causality, we would recommend experimental or quasi-experimental research that would exceed the explorative character of this study.
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.