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Reduzierung im Außer-Haus-Verzehr zu erleichtern, analysiert unsere Studie die Auswirkungen von zwei gängigen Interventionsstrategien zur Reduzierung von Speiseresten in einem ganzheitlichen Verhaltensmodell. Auf der Grundlage eines quasi-experimentellen Baseline-Interventions-Designs haben wir in einem Strukturgleichungsmodell untersucht, wie sich das Aushängen von Informationspostern und die Reduzierung von Portionsgrößen auf persönliche, soziale und umweltbezogene Faktoren auswirken. Anhand von Daten aus Online-Befragungen und Beobachtungen von 880 Gästen (503 Baseline, 377 Intervention) während zwei Wochen in einer Universitätsmensa erlaubt das vorgeschlagene Modell, die Effekte der beiden Interventionen auf die Tellerreste spezifischen Veränderungen von Verhaltensdeterminanten zuzuordnen. Es hat sich gezeigt, dass die Verringerung der Portionsgröße bei den Zielgerichten mit einer geringeren Menge an Tellerabfällen zusammenhängt, die auf bewusster Wahrnehmung, die sich in einer geringeren Bewertung der Portionsgröße ausdrückt. Die Auswirkungen des Sehens von Informationsplakaten auf veränderten persönlichen Einstellungen, subjektiven Normen und wahrgenommener Verhaltenskontrolle beruhen. Je nachdem, wie eine Person auf die Information reagiert (indem sie sich nur bemüht, alle Speisen aufzuessen, oder indem sie sich bemüht und zusätzlich ein anderes Gericht in der Kantine wählt), ergeben sich jedoch entgegengesetzte Auswirkungen auf diese Determinanten und folglich auch auf die Tellerreste. Insgesamt sprechen die differenzierten Ergebnisse zu den Interventionseffekten dafür, dass ganzheitlichere und tiefer gehende Analysen von Interventionen zur Reduktion von Essensresten und damit zu einem nachhaltigeren Lebensmittelkonsum in der Außer-Haus-Verpflegung beitragen können.
Standard extensive green roofs (EGRs) with their shallow substrate layers represent extreme sites for plant growth and therefore are planted mostly with drought-resistant species, including non-native plant species. As standard EGR substrates often lack potentially mutualistic soil microorganisms, it has been stated that inoculation with arbuscular mycorrhizal fungi (AMF) might increase plant performance and drought resistance. Aiming to support native biodiversity on EGRs, we tested whether AMF inoculation into standard green roof substrate can enhance plant performance and drought resistance of regionally occurring native dry grassland species.
The results of a pot experiment with 11 native plant species growing with and without AMF inoculation showed considerable differences in fitness-relevant plant traits. Over 88 days of moderate drought conditions, inoculated plants produced 2.5 times more above-ground biomass than control plants. In addition, the number of inflorescences on inoculated plants was significantly higher in 5 out of 7 flowering species. Under severe drought stress created by stopping the water supply, however, inoculated plants wilted on average 2.38 days earlier than control plants.
Although the underlying mechanisms of the observed results remain unresolved, AMF inoculation might help to enhance an earlier and higher seed set, facilitating the establishment of a soil seed bank, which is necessary for a self-sustaining plant population in drought-governed habitats such as EGRs.
German farmers are required by law to regularly self-assess the welfare of their animals. The project Q Check is aiming at developing a system that will assist farmers to objectively assess animal health and welfare in dairy cows. For this reason, a quarterly report will be compiled from animal-based key indicators to give an overview of the on-farm situation. The anonymised and aggregated reports can also be used for national animal welfare monitoring: Continuous collection of these key indicators enables the summary and publication of figures reflecting the current animal health and welfare status and progressions at federal state and at national level. Q Check is based on four data recording and analysis systems, which are already established in Germany and implemented on a national level. Out of these systems, the most suitable indicators to describe herd health have been selected by 215 experts within a twostage Delphi study. In addition, over 50 face-to-face interviews with stakeholders related to the German dairy sector have been performed in order to take into account the socio-scientific point of view. To complete the process, the selected indicators are currently being checked against mass data and hence tested for suitability regarding monitoring purposes. An automatic farm-specific evaluation of animal health, based on verified indicators, will provide support to farmers in fulfilling their legal requirements and in identifying weak points on the individual farms. A benchmarking system will be set up which will allow tracking the individual herd health indicators in the same farm in their course over time and compared with similar farms. These routinely provided horizontal and vertical statistics will facilitate targeted intervention and support objectified management decisions, implying that dairy farmers can benefit in several respects. In the course of the project, new tools for determining the risk of ketosis in the scope of milk recording will also be validated and implemented at national level to enhance monitoring of this major disease complex. The results of these nationwide, systematic investigations will contribute substantially to objectifying the discussion about the health and welfare situation of dairy cows.
This study identifies and evaluates factors for success in innovation work in the Bavarian dairy farming industry. The research is based on an analysis of innovation system theories and a comparison with innovation work in the Dutch dairy sector. Dutch dairy farming is characterized by high productivity and technical efficiency at the farm level. Moreover, important developments in dairy farming have originated in the Netherlands. Therefore, this study delves into the systemic background of the successful innovation work in the Netherlands and makes a comparison with Bavaria. The main result of this study is that innovation work in the Bavarian dairy farming sector is lacking in two respects: end-user (farmer) integration and within-sector cooperation.
Auch um die Milchviehhaltung gibt es seit einigen Jahren eine öffentlich geführte Tierwohldiskussion. Zwei Aspekte sind dabei immer wieder Gegenstand der Kommunikation: Die Anbindehaltung und der Weidegang. Auf Basis von qualitativen Interviews mit zivilgesellschaftlichen Verbänden und landwirtschaftlichen Verbänden wurden die Einstellungen und die Argumentationsmuster beider Verbandsgruppen zu den Haltungsformen Weidegang und Anbindehaltung ergründet. Von Interesse ist dieser Vergleich, da im Rahmen öffentlich-medialer Kommunikation die Diskussionsfronten zwischen beiden Verbandsgruppen verhärtet erscheinen. Die Analyse der Aussagen, die im Rahmen der qualitativen Interviewreihe dieser Studie getätigt wurden, erlaubt die begründete Annahme, dass beide Verbandsgruppen mit den Themenkomplexen Anbindehaltung und Weidehaltung in einem wissenschaftliche orientierten Kommunikationskontext differenziert umgehen. Eine klare Polarisierung der Einstellungen zwischen beiden Verbandsgruppen ist in einem solchen Umfeld nicht mehr wahrnehmbar gewesen.
Gebäude beanspruchen Ressourcen und verändern die Umwelt. Die Landwirtschaft benötigt oftmals großvolumige Gebäude. Eine nachhaltigere landwirtschaftliche Baukultur wäre damit begrüßenswert. Für das agrarische Bauen könnte eine verstärkte Verwendung des Rohstoffs Holz eine Perspektive darstellen. Holz überzeugt durch zahlreiche ökologische Vorteile wie die langfristige Kohlenstoffbindung oder eine einfache Recycelbarkeit. In Deutschland spielt Holz allerdings beim landwirtschaftlichen Bauen eine immer geringere Rolle. Diese Studie stellt Meinungsbilder deutscher LandwirtInnen zusammen zum Holzeinsatz beim Stallbau. Es wurden zehn Gruppendiskussionen gestaltet zum Themenfeld landwirtschaftliche Baukultur in verschiedenen deutschen Schwerpunktregionen der Rinderhaltung. Die Auswertungen zeigen, dass die LandwirtInnen weitestgehend die optische Wirkung von Holz schätzen, aber häufig an der Dauerhaftigkeit von Holzställen zweifeln.
In the organic production of pot grown basil, yield depressions and quality impairments are often observed. During the early development stage, cotyledons become chlorotic and necrotic. Subsequently, fungal diseases such as botrytis occur. One possible reason for this problem could be the high concentration of ammonium in the growing media released by the mineralization of organic fertilizers. Therefore, a fertilization trial was carried out to investigate the effect of ammonium (NH4+) on basil in comparison to nitrate (NO3-). The experiment included different NH4+-N/NO3--N ratios (100/0, 50/50 and 0/100) and nitrogen (N) concentrations in the nutrient solution (8, 12 and 16 mmol N L‑1). Plants were cultivated in a peat substrate and fertilized with a nutrient solution which, in addition to the different N sources, contained equal concentrations of a base fertilizer as well as the nitrification inhibitor DMPP. Furthermore, an organic fertilization treatment was realized. Basil fertilized solely with NH4+ showed a diminished growth in comparison to well-developed plants receiving NO3- as N source. Germination rate, plant height and fresh matter yield were significantly reduced by NH4+ nutrition. Similar results occur in the organic treatment where the NH4+ concentration rose up to 350 mg NH4+-N L‑1 substrate at the beginning of the cultivation period. Along with a reduction in biomass production, chlorotic cotyledons were observed. These effects might have been caused by NH4+. When N mineralization declined and NH4+ was largely converted to NO3-, plants exhibited improved growth. Within the mineral N treatments, rising NO3- concentration and NO3--N/NH4+-N ratio promoted plant height and reduced plant compactness due to an increased internode elongation. At the end of the experiment, the NO3- content in basil shoots was highest in the organic treatment and lowest with NH4+ as the sole N source. The best herb quality in terms of plant compactness, turgidity and healthiness of cotyledons was observed when basil was fertilized with ammonium nitrate.
Design knowledge on smart glasses-based systems is scarce. Utilizing literature analysis on software development publications, insights from the design and implementation of four smart glasses-based systems and expert interviews, we elicited 16 design principles to provide guidance in the development of future service support systems. Heuristic Theorizing is an abductive Design Science Research method, hitherto far too little known or little noticed, which was applied to conduct the research. We contribute to theory and practice with applicable design principles to support the development of smart glasses-based systems. Phenomena known to have an impact on the adoption of smart glasses are addressed by these design principles.
Current discussions about the concept of nutritional sustainability show a high complexity of this topic leading to many different definitions. Regarding communication issues of nutritional sustainability between actors of food chains this complexity should be reduced. One opportunity to tackle these challenges of reducing complexity might be the concept of ingredient branding. Therefore, the aim of this mini-review is the identification of conditions for ingredient branding application as a communication strategy for nutritional sustainability which might overcome challenges in communicating the complexity between the different stakeholders of supply chains. In doing so, the specific case of agrifood chains is discussed based on the selected characteristics of globalization, increasing consumer demands, foods incorporating credence attributes and price. Along the agrifood chain, a sourcing strategy reflecting nutritional and sustainable aspects might lead to an ingredient branding strategy implying a brand policy for a special ingredient within the final product which is an important component but cannot be clearly recognized by the user. A “nutritional sustainability inside” strategy should reflect the multifaceted information along the agrifood chain and should be based on standardized criteria for nutritional sustainability.
Integration of nutritional and sustainable aspects is a complex task tackled by a few scientific concepts. They include multiple dimensions and functions of food systems trying to provide solutions for harmonic co-evolution of humanity and planet Earth. “Nutritional Sustainability” is differentiated from other concepts which combine nutrition and sustainability as it not only sets environmental sustaining capacity as a baseline level for balanced nutrition, but also aims for the search of food system driving nodes. It does not aim for the support of solutions of producing enough or more food for increasing population (sustainable nutrition), neither does it contradict other similar concepts [sustainable nutrition security, nutritional life cycle assessment (LCA)]. However, it calls for more definite estimation of the carrying capacity of the environment on personal, local, and national levels for the development of more efficient solutions of nutrition balanced in the limits of environmental carrying capacity. The review is providing a few examples of advances in nutritional science (personalized nutrition, nutrigenetics), food technology (personalized food processing, food ecodesign), and food complex systems (artificial intelligence and gut microbiome), which have a great potential to progress sustainable food systems with Nutritional Sustainability set as a guiding concept.
Für viele Fragstellungen, z. B. Unternehmensbewertung, Rating, strategische Entscheidungen etc., ist die Prognose der zukünftigen Erfolge von Unternehmen von entscheidender Bedeutung.
Das Buch stellt alle wichtigen Analysemöglichkeiten mit ihren Vor- und Nachteilen dar. Zahlreiche Fallbeispiele, Übersichten und Tabellen legen die Erfolgsquellen vieler Unternehmen offen. Besonders hilfreich ist die Auswertung einer umfassenden Datenbank mit den Jahresabschlüssen von ca. 2000 Unternehmen weltweit. Die Auswertungen liefern für viele Fragestellungen passende Betriebs- und Branchenvergleiche.
Wer einen Großteil seiner Arbeitszeit in die Analyse von Unternehmen steckt, sollte auf diese solide Arbeitsgrundlage nicht verzichten. Aber auch als Einstieg für Studierende ist das kompakte Buch bestens geeignet.
Insbesondere in wissensintensiven Unternehmen wie dem Krankenhaus birgt die Umstellung auf digitale Prozesse ein großes Innovations- und Produktivitätspotenzial. Der Beitrag erörtert und bewertet die Digitalisierungsfrage aus der betrieblichen Sicht des Krankenhausmanagements hinsichtlich der Voraussetzungen und der aktuell als realistisch einzuschätzenden Potenziale für das Unternehmen. Ausgehend von einer Begriffsklärung der Digitalisierung wird der Zusammenhang zwischen Digitalisierung und Krankenhausorganisation betrachtet. Daran knüpfen Ausführungen zu organisatorischen, personellen und finanziellen Voraussetzungen eines digitalen Krankenhauses an. Bei der Darstellung der Potenziale wird zwischen innerbetrieblichen und unternehmens- bzw. institutionenübergreifenden Aspekten eines digitalen Krankenhauses unterschieden. Ein besonderes Augenmerk wird auf die Elektronische Patientenakte (EPA) gelegt, da sie für den medizinisch-pflegerischen Kernprozess im Krankenhaus besonders wertvoll ist. Am Beispiel der Materialwirtschaft/Logistik werden die digitalen Anwendungsmöglichkeiten in den Unterstützungsprozessen des Krankenhauses erläutert.
A structured hospital discharge management process can lead to a smoother transition to aftercare. In practice, providing continuity of nursing care after a stationary hospital stay is accompanied by numerous challenges. The presented study aims to point out the use cases and requirements for an IT system supporting the diverse tasks of the participating actors. Within the scope of a multi-method research design, the authors conducted and analysed stakeholder interviews, a shadowing, a systematic literature search and statutes in order to gain the presented results. This publication presents 37 requirements, grouped to 14 use cases. A process model in BPMN visualises the discharge management process. Further, the authors derived implications for practice and research. These can be used for the development, classification and assessment of IT systems. Therefore, this publication provides a significant contribution to the development of socio-technical systems within the health care domain.
In this paper, we introduce a framework to identify domain specific use cases for smart glasses in the domain of logistics services. We further present and evaluate our framework through its application in a single case study in a wholesale warehouse. We contribute to theory and practice by presenting an approach to identify, define and describe application scenarios for the adoption of smart glasses in the logistics domain, and by enriching the current body of knowledge on digitalization, service support systems and wearables. Therefore, our research falls into line with the second topic. We directly address current challenges in logistics, one of Germany’s major economic sectors, regarding the implementation of new or advanced services with smart glasses. The presented case study is embedded in the digitalization project Glasshouse. The processes of two logistics services providers are the main research subjects in this project. In contrast to this, we focus on a third logistic service provider in this paper, to evaluate the transferability of our findings.
The development of augmented reality glasses is still ongoing and faces barriers in diffusion and concerns about their impact on users, organizations and society. The study aims to find sufficient solutions for this struggling digital innovation and to provide guidance for the implementation of augmented reality glasses in design-oriented projects. During a 3-year consortium research, acceptance and privacy have been identified as major phenomena that influence the adoption of augmented reality glasses in the logistics domain. To forge ahead digital innovation research, the focus of the presented research lies on the diffusion of this technology with design knowledge for the development of augmented reality glasses-based systems. Evidence and artifacts contribute to the still limited knowledge of system design based on augmented reality glasses from a domain-specific instantiation and an implementation framework.
Smart Glasses haben das Potenzial, die Einarbeitungsphase von Mitarbeitern durch eine kontextsensitive Informationsversorgung und Kommunikation direkt im Blickfeld des Nutzers zu erweitern und zu verbessern. Im Rahmen eines gestaltungsorientierten Ansatzes wird das Einsatzszenario mit Hilfe von Experteninterviews analysiert und durch fachbezogene Literatur strukturiert. Als Resultat liefert dieser Beitrag spezifische Anforderungen an Smart-Glasses-basierte Assistenzsysteme in der Einarbeitungsphase von Mitarbeitern am Beispiel der Logistik-Branche aus Sicht der Praxis. Zusätzlich werden eine entsprechende Konzeption mit anschließender Evaluation eines korrespondierenden Systems sowie die dafür spezifizierten Kollaborationsfunktionen vorgestellt. Die Meta-Anforderungen, die Evaluation des vorgeschlagenen Konzeptes und die identifizierten Kollaborationsfunktionen erweitern die Wissensbasis der Wirtschaftsinformatik hinsichtlich des wenig erforschten Gestaltungswissens für Smart-Glasses-basierte Applikationen. Der Einsatz von Smart Glasses in der Einarbeitung stellt einen nutzenstiftenden Anwendungsfall für diese aktuell noch wenig verbreitete Technologie, sowie eine neue Interaktionsebene und zugehörige Kollaborationsfunktionen in der Einarbeitungsphase von Mitarbeitern dar und ist somit von hoher Relevanz sowohl für die Praxis als auch Wissenschaft.
Niche-based species distribution models (SDMs) have become an essential tool in conservation and restoration planning. Given the current threats to freshwater biodiversity, it is of fundamental importance to address scale effects on the performance of niche-based SDMs of freshwater species’ distributions. The scale effects are addressed here in the context of hierarchical catchment ordering, considered as counterpart to coarsening grain-size by increasing grid-cell size. We combine fish occurrence data from the Danube River Basin, the hierarchical catchment ordering and multiple environmental factors representing topographic, climatic and anthropogenic effects to model fish occurrence probability across multiple scales. We focus on 1st to 5th order catchments. The spatial scale (hierarchical catchment order) only marginally influences the mean performance of SDMs, however the uncertainty of the estimates increases with scale. Key predictors and their relative importance are scale and species dependent. Our findings have useful implications for choosing proper species dependent spatial scales for river rehabilitation measures, and for conservation planning in areas where fine grain species data are unavailable.
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).
Lean Management in der Lebensmittelindustrie - Zukünftige Perspektiven für effizientere Prozesse
(2019)
Der Beitrag beschreibt die Entwicklung eines Inverted Classroom Konzeptes für ein Informatik-Grundlagenfach an einer Hochschule. Basierend auf Vorlesungsaufzeichnungen und Vorlesungsskript wurde hierbei besonderes Augenmerk auf die Gestaltung der gemeinsamen Präsenzzeit zwischen Studierenden und Lehrenden gelegt. Durch zahlreiche aktivierende Elemente sind die Studierenden hierbei gefordert, ihren Lernprozess selbst zu gestalten, um somit über die fachlichen Kompetenzen des Faches hinaus auch überfachliche Kompetenzen, wie beispielsweise Kommunikations- und Kooperationskompetenz, Selbstlernkompetenz und Eigenverantwortung zu trainieren.
Das asiatische Jahrhundert - dreht sich die Welt falsch? : eine Antwort auf Kishore Mahbubani
(2019)
Asiatische Intellektuelle kritisieren zunehmend scharf strategische Fehler westlicher Globalpolitik. Kishore Mahbubani (Singapur) etwa wirft dem Westen falschen Umgang mit dem Islam, Demokratisierungseifer, die Erniedrigung Russlands und die Nichtbeachtung Chinas vor. Rainer Lisowski versucht in seinem Essay, auf die Thesen Mahbubanis zu antworten und zu verdeutlichen, dass dessen Analyse oberflächlich zwar an manchen Punkten zutrifft, aber in der Tiefe zwei entscheidende Treiber westlicher Entwicklung unterschätzt werden: eine immer weiter zunehmende Verrechtlichung der Welt und eine Wohlstandsverwahrlosung durch überzogenen Konsum. Sie sind der tiefere Grund, wieso realpolitische Außenpolitik im Westen zunehmend erschwert wird. Und Asien folgt dem westlichen Vorbild zeitverzögert - insgesamt keine guten Aussichten.
Die Akzente im Stadtmarketing haben sich in den letzten Jahren in vielen Städten verschoben: Stand früher die Ausrichtung auf externe Stakeholder wie Touristen, Unternehmen oder potenzielle Arbeitskräfte im Zentrum, so richtet sich die Aufmerksamkeit heute in zunehmendem Maße auf interne Stakeholder, insbesondere auf die Bürgerinnen und Bürger. Diese werden nicht nur auf ihre Rolle als Kunden reduziert, sondern sie werden als Mitgestalter in Beteiligungsprozesse integriert. Der Beitrag beschreibt die Entwicklung einer Dachmarke in einem beteiligungsorientierten Stadtmarketing-Prozess unter besonderer Berücksichtigung der Methode Design Thinking.
Purpose
In a knowledge-based society, one of the main driving forces of prosperity at city and regional levels is the ability to attract students and recently qualified graduates. The purpose of this paper is to identify the urban factors that contribute to “attractiveness” from a student perspective and to subsequently analyse the influence of these factors on students’ location choices. In the corresponding case study, the criteria identified were used to evaluate student satisfaction with the German city of Osnabrück.
Design/methodology/approach
A multi-level empirical research concept was used to analyse the relevant criteria. Focus group discussions served as the basis to design and conduct a survey of almost 2,300 students in the university city of Osnabrück at the end of 2016. A follow-up study in November 2017 at two universities in Berlin provided data for comparison.
Findings
Accessible – safe – clean and with affordable housing: these terms sum up the core expectations that students have of an attractive city. In contrast to the findings of Richard Florida regarding the creative class, cultural opportunities, exciting nightlife and a multicultural population were not important factors among the survey participants.
Research limitations/implications
As the study was conducted in two cities only, the findings cannot be generalised. It should be replicated in at least five other cities to validate and compare the research findings presented here. Furthermore, this study focused on the factors influencing the attractiveness of the city as a whole. However, the attractiveness of a specific neighbourhood may be of greater relevance to the decision-making process. As housing plays a major role, students’ particular needs with regard to accommodation should also be examined at greater depth.
Practical implications
Insights generated by the empirical study provide relevant information that may assist city stakeholders in taking effective measures regarding place management to attract and retain students.
Originality/value
To date, little research has been undertaken to empirically examine the specific factors that German students look for when deciding where to study and live. The goal of this paper is to present new empirical insights concerning the quality-of-life factors that influence students’ decision-making processes.
Background and aims
In 2008, the International Association for the Study of Pain Special Interest Group on Neuropathic Pain (NeuPSIG) proposed a clinical grading system to help identify patients with neuropathic pain (NeP). We previously applied this classification system, along with two NeP screening tools, the painDETECT (PD-Q) and Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS), to identify NeP in patients with neck/upper limb pain. Both screening tools failed to identify a large proportion of patients with clinically classified NeP, however a limitation of our study was the use of a single clinician performing the NeP classification. In 2016, the NeuPSIG grading system was updated with the aim of improving its clinical utility. We were interested in field testing of the revised grading system, in particular in the application of the grading system and the agreement of interpretation of clinical findings. The primary aim of the current study was to explore the application of the NeuPSIG revised grading system based on patient records and to establish the inter-rater agreement of detecting NeP. A secondary aim was to investigate the level of agreement in detecting NeP between the revised NeuPSIG grading system and the LANSS and PD-Q.
Methods
In this retrospective study, two expert clinicians (Specialist Pain Medicine Physician and Advanced Scope Physiotherapist) independently reviewed 152 patient case notes and classified them according to the revised grading system. The consensus of the expert clinicians’ clinical classification was used as “gold standard” to determine the diagnostic accuracy of the two NeP screening tools.
Results
The two clinicians agreed in classifying 117 out of 152 patients (ICC 0.794, 95% CI 0.716–850; κ 0.62, 95% CI 0.50–0.73), yielding a 77% agreement. Compared to the clinicians’ consensus, both LANSS and PD-Q demonstrated limited diagnostic accuracy in detecting NeP (LANSS sensitivity 24%, specificity 97%; PD-Q sensitivity 53%, specificity 67%).
Conclusions
The application of the revised NeP grading system was feasible in our retrospective analysis of patients with neck/upper limb pain. High inter-rater percentage agreement was demonstrated. The hierarchical order of classification may lead to false negative classification. We propose that in the absence of sensory changes or diagnostic tests in patients with neck/upper limb pain, classification of NeP may be further improved using a cluster of clinical findings that confirm a relevant nerve lesion/disease, such as reflex and motor changes. The diagnostic accuracy of LANSS and PD-Q in identifying NeP in patients with neck/upper limb pain remains limited. Clinical judgment remains crucial to diagnosing NeP in the clinical practice.
Implications
Our observations suggest that in view of the heterogeneity in patients with neck/upper limb pain, a considerable amount of expertise is required to interpret the revised grading system. While the application was feasible in our clinical setting, it is unclear if this will be feasible to apply in primary health care settings where early recognition and timely intervention is often most needed. The use of LANSS and PD-Q in the identification of NeP in patients with neck/upper limb pain remains questionable.
Introduction Development and implementation of appropriate health policy is essential to address the rising global burden of non-communicable diseases (NCDs). The aim of this study was to evaluate existing health policies for integrated prevention/management of NCDs among Member States of the Organisation for Economic Co-operation and Development (OECD). We sought to describe policies’ aims and strategies to achieve those aims, and evaluate extent of integration of musculoskeletal conditions as a leading cause of global morbidity.
Methods Policies submitted by OECD Member States in response to a World Health Organization (WHO) NCD Capacity Survey were extracted from the WHO document clearing-house and analysed following a standard protocol. Policies were eligible for inclusion when they described an integrated approach to prevention/management of NCDs. Internal validity was evaluated using a standard instrument (sum score: 0–14; higher scores indicate better quality). Quantitative data were expressed as frequencies, while text data were content-analysed and meta-synthesised using standardised methods.
Results After removal of duplicates and screening, 44 policies from 30 OECD Member States were included. Three key themes emerged to describe the general aims of included policies: system strengthening approaches; improved service delivery; and better population health. Whereas the policies of most countries covered cancer (83.3%), cardiovascular disease (76.6%), diabetes/endocrine disorders (76.6%), respiratory conditions (63.3%) and mental health conditions (63.3%), only half the countries included musculoskeletal health and pain (50.0%) as explicit foci. General strategies were outlined in 42 (95.5%) policies—all were relevant to musculoskeletal health in 12 policies, some relevant in 27 policies and none relevant in three policies. Three key themes described the strategies: general principles for people-centred NCD prevention/management; enhanced service delivery; and system strengthening approaches. Internal validity sum scores ranged from 0 to 13; mean: 7.6 (95% CI 6.5 to 8.7).
Conclusion Relative to other NCDs, musculoskeletal health did not feature as prominently, although many general prevention/management strategies were relevant to musculoskeletal health improvement.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.
Background
This study describes a low-cost and time-efficient clinical sensory test (CST) battery and evaluates its concurrent validity as a screening tool to detect somatosensory dysfunction as determined using quantitative sensory testing (QST).
Method
Three patient cohorts with carpal tunnel syndrome (CTS, n = 76), non-specific neck and arm pain (NSNAP, n = 40) and lumbar radicular pain/radiculopathy (LR, n = 26) were included. The CST consisted of 13 tests, each corresponding to a QST parameter and evaluating a broad spectrum of sensory functions using thermal (coins, ice cube, hot test tube) and mechanical (cotton wool, von Frey hairs, tuning fork, toothpicks, thumb and eraser pressure) detection and pain thresholds testing both loss and gain of function. Agreement rate, statistical significance and strength of correlation (phi coefficient) between CST and QST parameters were calculated.
Results
Several CST parameters (cold, warm and mechanical detection thresholds as well as cold and pressure pain thresholds) were significantly correlated with QST, with a majority demonstrating >60% agreement rates and moderate to relatively strong correlations. However, agreement varied among cohorts. Gain of function parameters showed stronger agreement in the CTS and LR cohorts, whereas loss of function parameters had better agreement in the NSNAP cohort. Other CST parameters (16 mN von Frey tests, vibration detection, heat and mechanical pain thresholds, wind-up ratio) did not significantly correlate with QST.
Conclusion
Some of the tests in the CST could help detect somatosensory dysfunction as determined with QST. Parts of the CST could therefore be used as a low-cost screening tool in a clinical setting.
Significance
Quantitative sensory testing, albeit considered the gold standard to evaluate somatosensory dysfunction, requires expensive equipment, specialized examiner training and substantial time commitment which challenges its use in a clinical setting. Our study describes a CST as a low-cost and time-efficient alternative. Some of the CST tools (cold, warm, mechanical detection thresholds; pressure pain thresholds) significantly correlated with the respective QST parameters, suggesting that they may be useful in a clinical setting to detect sensory dysfunction.
Prof. Dr. Ingmar Ickerott - "Mit 32 berufen zu werden, war eigentlich nicht mein Lebensziel."
(2019)
Er liebt die Veränderung und das Neue: Prof. Dr. Ingmar Ickerott ist seit Frühjahr 2019 Vizepräsident für Digitalisierung an der Hochschule Osnabrück. Die Studierenden fit für eine digitalisierte Arbeitswelt zu machen, ist sein großes Anliegen – gleichzeitig ist er überzeugt, dass man nicht alle Trends mitgehen sollte. Wieso er über netzfreie Zonen sinniert, was er über autonome Systeme denkt, warum er mit Anfang 30 eigentlich noch kein Professor werden wollte und wie sein Doktorvater ihn beeindruckt hat, erzählt der Professor für Betriebswirtschaftslehre uns in der heutigen Folge von Hochschulstimmen.