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Institute
The development of non-precious metal-based electrodes that actively and stably support the oxygen evolution reaction (OER) in water electrolysis systems remains a challenge, especially at low pH levels. The recently published study has conclusively shown that the addition of haematite to H2 SO4 is a highly effective method of significantly reducing oxygen evolution overpotential and extending anode life. The far superior result is achieved by concentrating oxygen evolution centres on the oxide particles rather than on the electrode. However, unsatisfactory Faradaic efficiencies of the OER and hydrogen evolution reaction (HER) parts as well as the required high haematite load impede applicability and upscaling of this process. Here it is shown that the same performance is achieved with three times less metal oxide powder if NiO/H2 SO4 suspensions are used along with stainless steel anodes. The reason for the enormous improvement in OER performance by adding NiO to the electrolyte is the weakening of the intramolecular O─H bond in the water molecules, which is under the direct influence of the nickel oxide suspended in the electrolyte. The manipulation of bonds in water molecules to increase the tendency of the water to split is a ground-breaking development, as shown in this first example.
Purpose
This study operationalizes risks in stakeholder dialog (SD). It conceptualizes SD as co-produced organizational discourse and examines the capacities of organizers' and stakeholders' practices to create a shared understanding of an organization’s risks to their mutual benefit. The meetings and online forum of a German public service media (PSM) organization were used as a case study.
Design/methodology/approach
The authors applied corpus-driven linguistic discourse analysis (topic modeling) to analyze citizens' (n = 2,452) forum posts (n = 14,744). Conversation analysis was used to examine video-recorded online meetings.
Findings
Organizers suspended actors' reciprocity in meetings. In the forums, topics emerged autonomously. Citizens' articulation of their identities was more diverse than the categories the organizer provided, and organizers did not respond to the autonomous emergence of contextualizations of citizens' perceptions of PSM performance in relation to their identities. The results suggest that risks arise from interactionally achieved occasions that prevent reasoned agreement and from actors' practices, which constituted autonomous discursive formations of topics and identities in the forums.
Originality/value
This study disentangles actors' practices, mutuality orientation and risk enactment during SD. It advances the methodological knowledge of strategic communication research on SD, utilizing social constructivist research methods to examine the contingencies of organization-stakeholder interaction in SD.
Introduction: Patients undergoing revision total hip surgery (RTHS) have a high prevalence of mild and moderate preoperative anemia, associated with adverse outcomes. The aim of this study was to investigate the association of perioperative allogeneic blood transfusions (ABT) and postoperative complications in preoperatively mild compared to moderate anemic patients undergoing RTHS who did not receive a diagnostic anemia workup and treatment before surgery. Methods: We included 1,765 patients between 2007 and 2019 at a university hospital. Patients were categorized according to their severity of anemia using the WHO criteria of mild, moderate, and severe anemia in the first Hb level of the case. Patients were grouped as having received no ABT, 1–2 units of ABT, or more than 2 units of ABT. Need for intraoperative ABT was assessed in accordance with institutional standards. Primary endpoint was the compound incidence of postoperative complications. Secondary outcomes included major/minor complications and length of hospital and ICU stay. Results: Of the 1,765 patients, 31.0% were anemic of any cause before surgery. Transfusion rates were 81% in anemic patients and 41.2% in nonanemic patients. The adjusted risks for compound postoperative complication were significantly higher in patients with moderate anemia (OR 4.88, 95% CI: 1.54–13.15, p = 0.003) but not for patients with mild anemia (OR 1.93, 95% CI: 0.85–3.94, p < 0.090). Perioperative ABT was associated with significantly higher risks for complications in nonanemic patients and showed an increased risk for complications in all anemic patients. In RTHS, perioperative ABT as a treatment for moderate preoperative anemia of any cause was associated with a negative compound effect on postoperative complications, compared to anemia or ABT alone. Discussion: ABT is associated with adverse outcomes of patients with moderate preoperative anemia before RTHS. For this reason, medical treatment of moderate preoperative anemia may be considered.
Background
Beta-blocker (BB) therapy plays a central role in the treatment of cardiovascular diseases. An increasing number of patients with cardiovascular diseases undergoe noncardiac surgery, where opioids are an integral part of the anesthesiological management. There is evidence to suggest that short-term intravenous BB therapy may influence perioperative opioid requirements due to an assumed cross-talk between G-protein coupled beta-adrenergic and opioid receptors. Whether chronic BB therapy could also have an influence on perioperative opioid requirements is unclear.
Methods
A post hoc analysis of prospectively collected data from a multicenter observational (BioCog) study was performed. Inclusion criteria consisted of elderly patients (≥ 65 years) undergoing elective noncardiac surgery as well as total intravenous general anesthesia without the use of regional anesthesia and duration of anesthesia ≥ 60 min. Two groups were defined: patients with and without BB in their regular preopreative medication. The administered opioids were converted to their respective morphine equivalent doses. Multiple regression analysis was performed using the morphine-index to identify independent predictors.
Results
A total of 747 patients were included in the BioCog study in the study center Berlin. 106 patients fulfilled the inclusion criteria. Of these, 37 were on chronic BB. The latter were preoperatively significantly more likely to have arterial hypertension (94.6%), chronic renal failure (27%) and hyperlipoproteinemia (51.4%) compared to patients without BB. Both groups did not differ in terms of cumulative perioperative morphine equivalent dose (230.9 (BB group) vs. 214.8 mg (Non-BB group)). Predictive factors for increased morphine-index were older age, male sex, longer duration of anesthesia and surgery of the trunk. In a model with logarithmised morphine index, only gender (female) and duration of anesthesia remained predictive factors.
Conclusions
Chronic BB therapy was not associated with a reduced perioperative opioid consumption.
In modern times, closed-loop control systems (CLCSs) play a prominent role in a wide application range, from production machinery via automated vehicles to robots. CLCSs actively manipulate the actual values of a process to match predetermined setpoints, typically in real time and with remarkable precision. However, the development, modeling, tuning, and optimization of CLCSs barely exploit the potential of artificial intelligence (AI). This paper explores novel opportunities and research directions in CLCS engineering, presenting potential designs and methodologies incorporating AI. Combining these opportunities and directions makes it evident that employing AI in developing and implementing CLCSs is indeed feasible. Integrating AI into CLCS development or AI directly within CLCSs can lead to a significant improvement in stakeholder confidence. Integrating AI in CLCSs raises the question: How can AI in CLCSs be trusted so that its promising capabilities can be used safely? One does not trust AI in CLCSs due to its unknowable nature caused by its extensive set of parameters that defy complete testing. Consequently, developers working on AI-based CLCSs must be able to rate the impact of the trainable parameters on the system accurately. By following this path, this paper highlights two key aspects as essential research directions towards safe AI-based CLCSs: (I) the identification and elimination of unproductive layers in artificial neural networks (ANNs) for reducing the number of trainable parameters without influencing the overall outcome, and (II) the utilization of the solution space of an ANN to define the safety-critical scenarios of an AI-based CLCS.
Dairy farming has been the subject of public debate on animal welfare for a number of years now. Animal welfare discussions on dairy farming often include the demand for more nature connectedness in this area. This study focuses on the divergent perspectives of consumers and scientists on the importance of more nature connectedness for animal welfare strategies in German dairy farming. Within Europe, Germany is the main producer of cow’s milk and an important industry in many rural areas in Germany is dairy farming. The insights presented are based on qualitative interviews with dairy farming and livestock researchers from Germany and Austria. A key finding of this study is that we need to look more closely at the actual content of nature claims in animal welfare debates. The scientists interviewed tend to see idealized conditions in animal welfare discussions with images of nature which in fact seldom lead to improved conditions in dairy farming and, even then, only to a limited extent. The scientists interviewed rate calls for more nature connectedness in dairy farming from the nonagricultural public as anti-modern, complexity-reducing, and normative. Nevertheless, some of the scientists interviewed did have valuable insights into the nonagricultural public’s criticism of dairy farming practices. These scientists argued, however, that animal welfare needs to differentiate between nature connectedness and the innate needs of cattle when it comes to animal welfare strategies. An important conclusion of the study is that more discussion formats are needed to promote the exchange of ideas between different social groups attempting to understand animal welfare in dairy farming.
Primary Liver Cancers : Connecting the Dots of Cellular Studies and Epidemiology with Metabolomics
(2023)
Liver cancers are rising worldwide. Between molecular and epidemiological studies, a research gap has emerged which might be amenable to the technique of metabolomics. This review investigates the current understanding of liver cancer’s trends, etiology and its correlates with existing literature for hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA) and hepatoblastoma (HB). Among additional factors, the literature reports dysfunction in the tricarboxylic acid metabolism, primarily for HB and HCC, and point mutations and signaling for CCA. All cases require further investigation of upstream and downstream events. All liver cancers reported dysfunction in the WNT/β-catenin and P13K/AKT/mTOR pathways as well as changes in FGFR. Metabolites of IHD1, IDH2, miRNA, purine, Q10, lipids, phosphatidylcholine, phosphatidylethanolamine, acylcarnitine, 2-HG and propionyl-CoA emerged as crucial and there was an attempt to elucidate the WNT/β-catenin and P13K/AKT/mTOR pathways metabolomically.
Aims and Objectives:
Preventive home visits are a low-threshold counselling and support approach. They have been reported to achieve heterogeneous effects. However, preventive home visits have the potential to reduce the risk of becoming dependent on long-term care. The aim of this study is to investigate the effect of preventive home visits as a nursing intervention on health-related quality of life of older people in a longitudinal survey and to develop recommendations for which target groups preventive home visits have the highest benefit. The sample consisted of 75 people, aged between 65 and 85, who were able to understand and speak German, had not yet been eligible for benefits from the long-term care insurance and lived in the municipality under study.
Methodological Design and Justification:
A quantitative longitudinal study in order to investigate the effects of preventive home visits.
Ethical Issues and Approval:
There were no ethical concerns. Accordingly, ethical approval was granted.
Research Methods, Results and Conclusions:
The health-related quality of life was recorded four times between 01/2017 and 08/2020 with the Short-Form- Health- Survey- 12 and analysed using descriptive statistics. Results reveal that the physical health status cannot be easily influenced over a short period of time. The main effect, however, is that preventive home visits have a significant positive effect on the mental health status. The main topics during the home visits were mobility, nutrition and social participation. Increased knowledge and motivation for preventive behaviour extended the autonomy of older people. Accordingly, preventive home visits can support a self-determined life in a familiar environment. The results of the present study show that preventive home visits as a nursing intervention in rural areas are successful. In Germany, preventive home visits have not yet been implemented on a regular basis. In order to do so, a general definition of the concept is needed. Preventive home visits should be officially included in the regular health care services in Germany.
While developing traffic-based cognitive enhancement technology (CET), such as bike accident prevention systems, it can be challenging to test and evaluate them properly. After all, the real-world scenario could endanger the subjects’ health and safety. Therefore, a simulator is needed, preferably one that is realistic yet low cost. This paper introduces a way to use the video game Grand Theft Auto V (GTA V) and its sophisticated traffic system as a base to create such a simulator, allowing for the safe and realistic testing of dangerous traffic situations involving cyclists, cars, and trucks. The open world of GTA V, which can be explored on foot and via various vehicles, serves as an immersive stand-in for the real world. Custom modification scripts of the game give the researchers control over the experiment scenario and the output data to be evaluated. An off-the-shelf bicycle equipped with three sensors serves as a realistic input device for the subject’s movement direction and speed. The simulator was used to test two early-stage CET concepts enabling cyclists to sense dangerous traffic situations, such as trucks approaching from behind the cyclist. Thus, this paper also presents the user evaluation of the cycling simulator and the CET used by the subjects to sense dangerous traffic situations. With the knowledge of the first iteration of the user-centered design (UCD) process, this paper concludes by naming improvements for the cycling simulator and discussing further research directions for CET that enable users to sense dangerous situations better.
Grasslands are ubiquitous globally, and their conservation and restoration are critical to combat both the biodiversity and climate crises. There is increasing interest in implementing effective multifunctional grassland restoration to restore biodiversity concomitant with above- and belowground carbon sequestration, delivery of carbon credits and/or integration with land dedicated to solar panels. Other common multifunctional restoration considerations include improved forage value, erosion control, water management, pollinator services, and wildlife habitat provisioning. In addition, many grasslands are global biodiversity hotspots. Nonetheless, relative to their impact, and as compared to forests, the importance of preservation, conservation, and restoration of grasslands has been widely overlooked due to their subtle physiognomy and underappreciated contributions to human and planetary well-being. Ultimately, the global success of carbon sequestration will depend on more complete and effective grassland ecosystem restoration. In this review, supported by examples from across the Western world, we call for more strenuous and unified development of best practices for grassland restoration in three areas of concern: initial site conditions and site preparation; implementation of restoration measures and management; and social context and sustainability. For each area, we identify the primary challenges to grassland restoration and highlight case studies with proven results to derive successful and generalizable solutions.
Advances in high-throughput DNA sequencing have propelled research into the human microbiome and its link to metabolic health. We explore microbiome analysis methods, specifically emphasizing metabolomics, how dietary choices impact the production of microbial metabolites, providing an overview of studies examining the connection between enterotypes and diet, and thus, improvement of personalized dietary recommendations. Acetate, propionate, and butyrate constitute more than 95% of the collective pool of short-chain fatty acids. Conflicting data on acetate’s effects may result from its dynamic signaling, which can vary depending on physiological conditions and metabolic phenotypes. Human studies suggest that propionate has overall anti-obesity effects due to its well-documented chemistry, cellular signaling mechanisms, and various clinical benefits. Butyrate, similar to propionate, has the ability to reduce obesity by stimulating the release of appetite-suppressing hormones and promoting the synthesis of leptin. Tryptophan affects systemic hormone secretion, with indole stimulating the release of GLP-1, which impacts insulin secretion, appetite suppression, and gastric emptying. Bile acids, synthesized from cholesterol in the liver and subsequently modified by gut bacteria, play an essential role in the digestion and absorption of dietary fats and fat-soluble vitamins, but they also interact directly with intestinal microbiota and their metabolites. One study using statistical methods identified primarily two groupings of enterotypes Bacteroides and Ruminococcus. The Prevotella-dominated enterotype, P-type, in humans correlates with vegetarians, high-fiber and carbohydrate-rich diets, and traditional diets. Conversely, individuals who consume diets rich in animal fats and proteins, typical in Western-style diets, often exhibit the Bacteroides-dominated, B-type, enterotype. The P-type showcases efficient hydrolytic enzymes for plant fiber degradation but has limited lipid and protein fermentation capacity. Conversely, the B-type features specialized enzymes tailored for the degradation of animal-derived carbohydrates and proteins, showcasing an enhanced saccharolytic and proteolytic potential. Generally, models excel at predictions but often struggle to fully elucidate why certain substances yield varied responses. These studies provide valuable insights into the potential for personalized dietary recommendations based on enterotypes
Hintergrund
Demografisch bedingt wird sich die Anzahl pflegebedürftiger Menschen weiter erhöhen. Tragende Säule der pflegerischen Versorgung sind ihre Angehörigen, die den Großteil der Pflegeaufgaben übernehmen. Dies hat jedoch oftmals Auswirkungen auf ihre eigene Gesundheit und ihr Wohlbefinden.
Methodisches Vorgehen
Mit dem Fragebogen zur Angehörigenresilienz und -belastung (FARBE) liegt ein Instrument vor, um sowohl die Resilienz als auch Belastung pflegender Angehöriger zu ermitteln. Der Fragebogen wurde im Rahmen der Pflegestudie des VdK-Sozialverbands genutzt und von 12.475 Angehörigen komplett ausgefüllt. Durch eine multiple lineare Regression wurden Einflüsse und ihre Wirkstärke auf die Resilienz und Belastung analysiert.
Ergebnisse
Angehörige von Menschen mit Demenz, Depression oder hohem Pflegegrad weisen eine stärkere Belastung auf. Demenz und Depression mindern zudem die Resilienz. Positiv wirkt sich die soziale Unterstützung aus. Ebenso bedingt ein höheres Alter eine stärkere Resilienz.
Schlussfolgerungen
Im Ergebnis dieser Arbeit gelang eine Identifikation von relevanten Einflussfaktoren. Dies ermöglicht, Unterstützungs- und Entlastungsangebote auf ihre Anwendung und Wirksamkeit zu überprüfen. Besondere Bedeutung haben Unterstützungsangebote für Angehörige von Menschen mit Demenz, Depression und/oder höheren Pflegegraden. Stressreduzierende Maßnahmen und das Bilden sozialer Netzwerke für Angehörige können weitere Maßnahmen zur Stärkung der Resilienz und Abschwächung von Belastung sein.
HRM processes are increasingly AI-driven, and HRM supports the general digital transformation of companies’ viable competitiveness. This paper points out possible positive and negative effects on HRM, workplaces, and workersorganizations along the HR processes and its potential for competitive advantage in regard to managerial decisions on AI implementation regarding augmentation and automation of work.
A systematic literature review that includes 62 international journals across different disciplines and contains top-tier academic and German practitioner journals was conducted. The literature analysis applies the resource-based view (RBV) as a lens through which to explore AI-driven HRM as a potential source of organizational capabilities.
The analysis shows four ambiguities for AI-driven HRM that might support sustainable company development or might prevent AI application: job design, transparency, performance and data ambiguity. A limited scholarly discussion with very few empirical studies can be stated. To date, research has mainly focused on HRM in general, recruiting, and HR analytics in particular.
The four ambiguities’ context-specific potential for capability building in firms is indicated, and research avenues are developed.
This paper critically explores AI-driven HRM and structures context-specific potential for capability building along four ambiguities that must be addressed by HRM to strategically contribute to an organization’s competitive advantage.
In a protein reduction feeding trial (Study 1) on a commercial broiler farm in northern Germany, it was attempted to be shown that research results from station tests on protein reduction can be transferred to agricultural practice. In a second study, the limits of the N reduction were tested in a research facility. In Study 1, commercial standard feeds were fed to the control group (variant 1:210,000 animals; n = 5 barns). In the test group (variant 2:210,000 animals; n = 5 barns), the weighted mean crude protein (CP) content was moderately reduced by 0.3%. The nitrogen reduction in the feed did not affect performance (feed intake (FA), daily gain (DG), feed conversion (FCR)), but nitrogen conversion rate increased from approx. 61% to approx. 63%. The solid litter weight was reduced by 12% and nitrogen excretion by 9% (p < 0.05). Significantly healthier footpads were due to lower water intake (−4%; p < 0.05) and a numerically drier bedding. In Study 2, responses of treatments (1250 broiler per variant; n = 5) showed that sharper N-lowering (−1.5% CP; weighted average) did not impair performance either, but N-conversion improved and N-excretions decreased significantly. Converted to a protein reduction of one percentage point, the N excretions were able to be reduced by 22% in Study 1 and 18% in Study 2. Feeding trials in the commercial sector, such as the present Study 1, should convince feed mills and farmers to allow the latest scientific results to be used directly and comprehensively in commercial ration design.
Duckweed is gaining attention in animal nutrition and is considered as a potential alternative protein source for broiler chickens. In order to evaluate the nutritional value of duckweed, three individual batches were investigated. They consisted of a mixture of Lemna minuta and Lemna minor (A, 17.5% crude protein), Spirodela polyrhiza (B, 24.6% crude protein) and Lemna obscura (C, 37.0% crude protein). Treatment diets contained 50% batch A, 50% batch B, and 25, 50 and 75% of batch C. All diets were fed to broiler chickens (Ross 308) from an age of 21 to 27 days. Diets with a share of 50 and 75% of batch C led to decreased feed intake (109.3 and 74.9 g/day, respectively) compared to the control. Standardized ileal digestibility of crude protein and amino acids differed significantly between duckweed batches, at values for methionine between 49.9 and 90.4%. For all amino acids, batch A consistently had the lowest and batch C the highest digestibility. Batches had different tannin contents of 2943, 2890 and 303 mg/kg for batches A, B and C, respectively. The apparent ileal digestibility of phosphorus differed significantly between all batches (50.8–78.9%). Duckweed can be used as a protein feed for broiler chickens. However, a defined and stable biomass composition optimized for the requirements of broiler chickens is needed.
Iron deficiency is still widespread as a major health problem even in countries with adequate food supply. It mainly affects women but also vegans, vegetarians, and athletes and can lead to various clinical pictures. Biofortification of vitamin C-rich vegetables with iron may be one new approach to face this nutritional challenge. However, so far, little is known about the consumer acceptance of iron-biofortified vegetables, particularly in developed countries. To address this issue, a quantitative survey of 1000 consumers in Germany was conducted. The results showed that depending on the type of vegetable, between 54% and 79% of the respondents were interested in iron-biofortified vegetables. Regression analysis showed a relationship between product acceptance, gender, and area of residence. In addition, relationships were found between consumer preferences for enjoyment, sustainability, and naturalness. Compared to functional food and dietary supplements, 77% of respondents would prefer fresh iron-rich vegetables to improve their iron intake. For a market launch, those iron-rich vegetables appear especially promising, which can additionally be advertised with claims for being rich in vitamin C and cultivated in an environmentally friendly way. Consumers were willing to pay EUR 0.10 to EUR 0.20 more for the iron-biofortified vegetables.
Introduction Postoperative delirium (POD) is seen in approximately 15% of elderly patients and is related to poorer outcomes. In 2017, the Federal Joint Committee (Gemeinsamer Bundesausschuss) introduced a ‘quality contract’ (QC) as a new instrument to improve healthcare in Germany. One of the four areas for improvement of in-patient care is the ‘Prevention of POD in the care of elderly patients’ (QC-POD), as a means to reduce the risk of developing POD and its complications.
The Institute for Quality Assurance and Transparency in Health Care identified gaps in the in-patient care of elderly patients related to the prevention, screening and treatment of POD, as required by consensus-based and evidence-based delirium guidelines. This paper introduces the QC-POD protocol, which aims to implement these guidelines into the clinical routine. There is an urgent need for well-structured, standardised and interdisciplinary pathways that enable the reliable screening and treatment of POD. Along with effective preventive measures, these concepts have a considerable potential to improve the care of elderly patients.
Methods and analysis The QC-POD study is a non-randomised, pre–post, monocentric, prospective trial with an interventional concept following a baseline control period. The QC-POD trial was initiated on 1 April 2020 between Charité-Universitätsmedizin Berlin and the German health insurance company BARMER and will end on 30 June 2023. Inclusion criteria: patients 70 years of age or older that are scheduled for a surgical procedure requiring anaesthesia and insurance with the QC partner (BARMER). Exclusion criteria included patients with a language barrier, moribund patients and those unwilling or unable to provide informed consent. The QC-POD protocol provides perioperative intervention at least two times per day, with delirium screening and non-pharmacological preventive measures.
Ethics and dissemination This protocol was approved by the ethics committee of the Charité-Universitätsmedizin, Berlin, Germany (EA1/054/20). The results will be published in a peer-reviewed scientific journal and presented at national and international conferences.
Hintergrund
Die Anämie hat eine hohe Prävalenz bei Patienten vor Hüftgelenkrevisionsoperation und ist mit einer erhöhten Komplikationsrate assoziiert. Die vorliegende Arbeit untersucht erstmals den Zusammenhang von Kosten, realen DRG-Erlösen und Falldeckung der präoperativen Anämie bei elektiven Hüftgelenkrevisionsoperationen.
Methoden
Für alle Patienten, die sich von 2010 bis 2017 an 2 Campi der Charité – Universitätsmedizin Berlin einer Hüftgelenkrevisionsoperation unterzogen, wurden Daten zu Patienten sowie Transfusionen, Kosten und Erlösen gesammelt. Subgruppen- und lineare Regressionsanalysen untersuchten die Falldeckung anämischer und nichtanämischer Patienten.
Ergebnisse
Von 1187 eingeschlossenen Patienten waren 354 (29,8 %) präoperativ anämisch. Insgesamt wurden 565 (47,6 %) Patienten, mit einem deutlichen Überwiegen anämischer Patienten (72,6 % vs. 37,0 %, p < 0,001), transfundiert. Kosten (12.318 € [9027;20.044 €] vs. 8948 € [7501;11.339 €], p < 0,001) und Erlöse (11.788 € [8992;16.298 €] vs. 9611 € [8332;10.719 €], p < 0,001) waren für anämische Patienten höher, die Fallkostendeckung defizitär (−1170 € [−4467;1238 €] vs. 591 € [−1441;2103 €] €, p < 0,001). Bei anämischen Patienten nahm die Falldeckung mit zunehmender Transfusionsrate ab (p ≤ 0,001). Komorbiditäten hatten keinen signifikanten ökonomischen Einfluss.
Schlussfolgerung
Die präoperative Anämie und perioperative Transfusionen bei Hüftgelenkrevisionsoperationen sind mit erhöhten Behandlungskosten und einer finanziellen Unterdeckung für Kostenträger im Gesundheitswesen verbunden. Konzepte zur Behandlung der präoperativen Anämie (z. B. Patient Blood Management) könnten mittelfristig Behandlungskosten senken.
A brief questionnaire for measuring alarm fatigue in nurses and physicians in intensive care units
(2023)
When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop “alarm fatigue” (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the “alarm stress scale” and the “alarm coping scale”). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.
Easy and inexpensive methods for measuring ammonia emissions in multi-plot field trials allow the comparison of several treatments with liquid manure application. One approach that might be suitable under these conditions is the dynamic tube method (DTM). Applying the DTM, a mobile chamber system is placed on the soil surface, and the air volume within is exchanged at a constant rate for approx. 90 s. with an automated pump. This procedure is assumed to achieve an equilibrium ammonia concentration within the system. Subsequently, a measurement is performed using an ammonia-sensitive detector tube. Ammonia fluxes are calculated based on an empirical model that also takes into account the background ammonia concentration measured on unfertilized control plots. Between measurements on different plots, the chamber system is flushed with ambient air and cleaned with paper towels to minimize contamination with ammonia. The aim of this study was to determine important prerequisites and boundary conditions for the application of the DTM.
We conducted a laboratory experiment to test if the ammonia concentration remains stable while performing a measurement. Furthermore, we investigated the cleaning procedure and the effect of potential ammonia carryover on cumulated emissions under field conditions following liquid manure application. The laboratory experiment indicated that the premeasurement phase to ensure a constant ammonia concentration is not sufficient. The concentration only stabilized after performing more than 100 pump strokes, with 20 pump strokes (lasting approximately 90 s) being the recommendation.
However, the duration of performing a measurement can vary substantially, and linear conversion accounts for those differences, so a stable concentration is mandatory. Further experiments showed that the cleaning procedure is not sufficient under field conditions. Thirty minutes after performing measurements on high emitting plots, which resulted in an ammonia concentration of approx.
10 ppm in the chamber, we detected a residual concentration of 2 ppm. This contamination may affect measurements on plots with liquid manure application as well as on untreated control plots. In a field experiment with trailing hose application of liquid manure, we subsequently demonstrated that the calculation of cumulative ammonia emissions can vary by a factor of three, depending on the degree of chamber system contamination when measuring control plots. When the ammoni background values were determined by an uncontaminated chamber system that was used to measure only control plots, cumulative ammonia emissions were approximately 9 kg NH3-N ha1.
However, when ammonia background values were determined using the contaminated chamber system that was also used to measure on plots with liquid manure application, the calculation of cumulative ammonia losses indicated approximately 3 kg NH3-N ha1. Based on these results, it can be concluded that a new empirical DTM calibration is needed for multi-plot field experiments with high-emitting treatments.