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Institute
Aim: The aim of this study was to give an overview of family caregiver satisfaction within the home palliative care situation in North Rhine-Westphalia, Germany.
Design: A cross-sectional study.
Methods: An anonymous questionnaire, with seven validated scales, and comprising of 71 items, was used. The items investigated perceived needs and burdens of families within a home-based palliative care situation.
The satisfaction of the family caregivers with the services delivered by palliative care teams was measured by the FAMCARE-2 Scale. Descriptive statistics and analysis of covariance (ANCOVA) were performed.
Results: A convenience sample of 106 family members agreed to participate in the study. Overall, we found high satisfaction within our sample. There was high satisfaction with how the services respected the dignity of families, and how they provided comfort to patients. Satisfaction was lower with regard to information about patients.
Conclusion: High or low satisfaction with palliative care, tells us little about the quality of services. The high satisfaction within this study could be interpreted as a sign that palliative care was important to families at the time of availability. Regular and continuous assessment can serve to inform the continuous quality of care provision for patients and their families.
The break-up of the Soviet Union in 1991 triggered cropland abandonment on a continental scale, which in turn ledto carbon accumulation on abandoned land across Eurasia. Previous studies have estimated carbon accumulationrates across Russia based on large-scale modelling. Studies that assess carbon sequestration on abandoned land basedon robust field sampling are rare. We investigated soil organic carbon (SOC) stocks using a randomized samplingdesign along a climatic gradient from forest steppe to Sub-Taiga in Western Siberia (Tyumen Province). In total, SOCcontents were sampled on 470 plots across different soil and land-use types. The effect of land use on changes in SOCstock was evaluated, and carbon sequestration rates were calculated for different age stages of abandoned cropland.While land-use type had an effect on carbon accumulation in the topsoil (0–5 cm), no independent land-use effectswere found for deeper SOC stocks. Topsoil carbon stocks of grasslands and forests were significantly higher thanthose of soils managed for crops and under abandoned cropland. SOC increased significantly with time sinceabandonment. The average carbon sequestration rate for soils of abandoned cropland was 0.66 Mg C ha1yr1(1–20 years old, 0–5 cm soil depth), which is at the lower end of published estimates for Russia and Siberia. Therewas a tendency towards SOC saturation on abandoned land as sequestration rates were much higher for recentlyabandoned (1–10 years old, 1.04 Mg C ha1yr1) compared to earlier abandoned crop fields (11–20 years old,0.26 Mg C ha1yr1). Our study confirms the global significance of abandoned cropland in Russia for carbonsequestration. Our findings also suggest that robust regional surveys based on a large number of samples advancemodel-based continent-wide SOC prediction.
Health IT adoption research is rooted in Rogers' Diffusion of Innovation theory, which is based on longitudinal analyses. However, many studies in this field use cross-sectional designs. The aim of this study therefore was to design and implement a system to (i) consolidate survey data sets originating from different years (ii) integrate additional secondary data and (iii) query and statistically analyse these longitudinal data. Our system design comprises a 5-tier-architecture that embraces tiers for data capture, data representation, logics, presentation and integration. In order to historicize data properly and to separate data storage from data analytics a data vault schema was implemented. This approach allows the flexible integration of heterogeneous data sets and the selection of comparable items. Data analysis is prepared by compiling data in data marts and performed by R and related tools. IT Report Healthcare data from 2011, 2013 and 2017 could be loaded, analysed and combined with secondary longitudinal data.
The primary objective of this study was to determine the structural and known-group validity as well as the inter-rater reliability of a test battery to evaluate the motor control of the craniofacial region. Seventy volunteers without TMD and 25 subjects with TMD (Axes I) per the DC/TMD were asked to execute a test battery consisting of eight tests. The tests were video-taped in the same sequence in a standardised manner. Two experienced physical therapists participated in this study as blinded assessors. We used exploratory factor analysis to identify the underlying component structure of the eight tests. Internal consistency (Cronbach's α), inter-rater reliability (intra-class correlation coefficient) and construct validity (ie, hypothesis testing-known-group validity) (receiver operating curves) were also explored for the test battery. The structural validity showed the presence of one factor underlying the construct of the test battery. The internal consistency was excellent (0.90) as well as the inter-rater reliability. All values of reliability were close to 0.9 or above indicating very high inter-rater reliability. The area under the curve (AUC) was 0.93 for rater 1 and 0.94 for rater two, respectively, indicating excellent discrimination between subjects with TMD and healthy controls. The results of the present study support the psychometric properties of test battery to measure motor control of the craniofacial region when evaluated through videotaping. This test battery could be used to differentiate between healthy subjects and subjects with musculoskeletal impairments in the cervical and oro-facial regions. In addition, this test battery could be used to assess the effectiveness of management strategies in the craniofacial region.
Health IT and communication systems are indispensable in German hospitals for clinical as well as administrative process support. However, IT is often regarded as a “black box” for hospital CEOs. Thus, the question arises how can CEOs decide if they do not know what is in the box? In order to answer this question, half-structured interviews with 14 German hospital CEOs were conducted. They revealed three principle decision processes: the supported decision, the joint decision and the corporate level decision. In all cases, the hospital CEO and the CIO interacted to reach the final decision, most strongly in the joint decision mode and least strongly in the corporate decision mode. Only the joint decision mode definitely forced the CEO to open the “black box” of IT. In the era of digitalisation, however, CEOs must develop better competencies to decide over complex matters.
Recent theoretical models suggest that repetitive negative thinking might be a key mechanism explaining the negative effects of maternal psychopathology on mother–infant relations. While an emerging body of research largely supports this idea, the relative importance of differences in the trajectory of repetitive negative thinking during and after pregnancy for mother–infant bonding as well as maternal depressive symptoms is currently unknown. Therefore, we investigated associations between the course of maternal repetitive negative thinking during pregnancy and after birth and mother–infant-bonding and maternal depressive symptoms in a longitudinal study. The overall level of repetitive negative thinking was a significant predictor of mother–infant bonding, maternal anxiety and rejection in dealing with her infant four months after birth. Furthermore, differences in the trajectory of repetitive negative thinking predicted bonding, but not anxiety or rejection. The overall levels of repetitive negative thinking as well as the differences in the trajectory of repetitive negative thinking were significant predictors of maternal depressive symptoms. These findings indicate that changes of repetitive negative thinking during and after pregnancy can increase the risk of postpartum depressive symptoms.
Objective:
To compare the short- and long-term effects of a structural-oriented (convential) with an activity-oriented physiotherapeutic treatment in patients with frozen shoulder.
Design:
Double-blinded, randomized, experimental study.
Setting:
Outpatient clinic.
Subjects:
We included patients diagnosed with a limited range of motion and pain in the shoulder region, who had received a prescription for physiotherapy treatment, without additional symptoms of dizziness, a case history of headaches, pain and/or limited range of motion in the cervical spine and/or temporomandibular joint.
Interventions:
The study group received treatment during the performance of activities. The comparison group was treated with manual therapy and proprioceptive neuromuscular facilitation (conventional therapy). Both groups received 10 days of therapy, 30 minutes each day.
Main measures:
Range of motion, muscle function tests, McGill pain questionnaire and modified Upper Extremity Motor Activity Log were measured at baseline, after two weeks of intervention and after a three-month follow-up period without therapy.
Results:
A total of 66 patients were randomized into two groups: The activity-oriented group (n = 33, mean = 44 years, SD = 16 years) including 20 male (61%) and the structural-oriented group (n = 33, mean = 47 years, SD = 17 years) including 21 male (64%). The activity-oriented group revealed significantly greater improvements in the performance of daily life activities and functional and structural tests compared with the group treated with conventional therapy after 10 days of therapy and at the three-month follow-up (p < 0.05).
Conclusions:
Therapy based on performing activities seems to be more effective for pain reduction and the ability to perform daily life activities than conventional treatment methods.
This article proposes the concept of a simulation framework for environmental sensors with multilevel abstraction in agricultural scenarios. The implementation case study is a simulation of a grain-harvesting scenario enabled by LiDAR sensors. Environmental sensor models as well as kinematics and dynamic behavior of machines are based on the robotics simulator Gazebo. Models for powertrain, machine process aggregates and peripheral simulation components are implemented with the help of MATLAB/ Simulink and with the robotics middleware Robot Operating System (ROS). This article deals with the general concept of a multilevel simulation framework and in particular with sensor and environmental modeling.
Patient handovers are cognitively demanding, crucial for information continuity and patient safety, but error prone. This study investigated the effect of an electronic handover tool, i.e. the handoverEHR, on the memory and care planning performance of nurse students (n=32) in a randomised, controlled cross-over design with the factors handover task and handover role. On a descriptive level, handover recipients could improve their memory performance with electronic support, handover givers their performance of writing care plans. Statistically meaningful differences occurred, however, only when the participants were givers. Without handover experience and with low fluency to word problems, givers performed badly in the most demanding of the handover tasks. Final recommendations, however, can only be made after replicating this study in a clinical setting with mixed groups.
What Leads to Lunch-How Social Practices Impact (Non-)Sustainable Food Consumption/Eating Habits
(2017)
Der Bereich der Ernährung wird in den kommenden Jahrzehnten mit zahlreichen Herausforderungen konfrontiert sein, die sich aus den globalen Konsummustern ergeben und zu einem hohen Ressourcenverbrauch führen. Die Akteure des Gaststättengewerbes sehen sich bei der Förderung ihrer Lösungen für eine nachhaltigere Situation in ihrem Bereich mit Schwierigkeiten konfrontiert, unter anderem mit der mangelnden Akzeptanz der Verbraucher. Wir müssen uns die Frage stellen, wie wir das Verbraucherverhalten beeinflussen und einen Übergang zu einem nachhaltigeren Lebensmittelkonsum herbeiführen können. In diesem Beitrag werden die Ergebnisse einer qualitativen Bewertung von Ernährungsgewohnheiten vorgestellt. Eine Gruppe von zehn Verbrauchern nahm an problemzentrierten Interviews teil und machte Angaben zu ihrem Essverhalten im Laufe von zwei Wochen. Mit Hilfe des theoretischen Ansatzes der Praxistheorie wurden die in dieser Studie gesammelten Daten verwendet, um ein Verständnis der Praxis des Auswärtsessens zu entwickeln, wobei der Schwerpunkt auf den täglichen Routinen lag, die die Wahl der Verbraucher beeinflussen.
Die Ergebnisse zeigen, dass die Praxis des Auswärtsessens in hohem Maße von externen Faktoren abhängt. Vielbeschäftigte Lebensstile, Mobilitätsroutinen und ein wahrgenommener Zeitmangel führen zu der Entscheidung, auswärts zu essen. Die Verbraucher tun dies bewusst, um Zeit und Mühe zu sparen und ihren Zeitplan zu straffen. Mobilität scheint ein wichtiger Grund für das Auswärtsessen zu sein. Die Teilnehmer versuchen, die Möglichkeiten, auswärts zu essen, einzuschränken, kehren aber häufig spontan zwischen zwei Terminen zum Essen ein. Die Ergebnisse deuten darauf hin, dass Ernährungswissen und eine nachhaltige Denkweise wenig Einfluss auf die Essensentscheidungen außerhalb des Hauses haben: Die Teilnehmer zeigen ein hohes Maß an Misstrauen gegenüber Qualitätsansprüchen und stellen ihre gesundheitlichen Bedenken beim Essen außer Haus zurück. Daraus lässt sich schließen, dass das Auswärtsessen stark von den täglichen Routinen und den Praktiken, die ihm vorausgehen oder folgen, beeinflusst wird. Veränderungen der Arbeits- und Mobilitätsmuster werden sich höchstwahrscheinlich auf die Art und Weise auswirken, wie die Verbraucher außer Haus essen.
Introduction
Socioeconomic deprivation in high‐income industrialized countries is a key factor in poor perinatal outcomes. Limited access, utilization, and quality of antenatal care seem to play an important role in poor perinatal outcomes.
Methods
This integrative review aimed to explore experiences of antenatal care among women who are socioeconomically deprived in high‐income industrialized countries. A search was conducted using 5 databases for articles published from 2004 to 2014. Six qualitative and 3 quantitative articles were selected. These were systematically appraised for quality independently by 3 researchers. Relevant themes were identified and organized into categories.
Results
The disadvantages experienced in antenatal care by women who are socioeconomically deprived start before the first contact with health care services and are notable throughout the entire pregnancy. There is disparity in choice of medical or midwifery service provision models. Six categories emerged during review: choice of service provision model, feeling valued, various types of discrimination, structural and interpersonal accessibility, comprehensibility and trustworthiness of information, and engagement and sense of responsibility. Categories underscored the importance of the woman's relationship with the antenatal care provider.
Discussion
Antenatal care models with women‐centered approaches and continuity of care, such as midwifery models, have potential to increase the satisfaction of women with low socioeconomic status with care; this may increase antenatal care utilization and improve perinatal outcomes.
Information Technology (IT) continues to evolve and develop with electronic devices and systems becoming integral to healthcare in every country. This has led to an urgent need for all professions working in healthcare to be knowledgeable and skilled in informatics. The Technology Informatics Guiding Education Reform (TIGER) Initiative was established in 2006 in the United States to develop key areas of informatics in nursing. One of these was to integrate informatics competencies into nursing curricula and life-long learning. In 2009, TIGER developed an informatics competency framework which outlines numerous IT competencies required for professional practice and this work helped increase the emphasis of informatics in nursing education standards in the United States. In 2012, TIGER expanded to the international community to help synthesise informatics competencies for nurses and pool educational resources in health IT. This transition led to a new interprofessional, interdisciplinary approach, as health informatics education needs to expand to other clinical fields and beyond.
In tandem, a European Union (EU) - United States (US) Collaboration on eHealth began a strand of work which focuses on developing the IT skills of the health workforce to ensure technology can be adopted and applied in healthcare. One initiative within this is the EU*US eHealth Work Project, which started in 2016 and is mapping the current structure and gaps in health IT skills and training needs globally. It aims to increase educational opportunities by developing a model for open and scalable access to eHealth training programmes. With this renewed initiative to incorporate informatics into the education and training of nurses and other health professionals globally, it is time for educators, researchers, practitioners and policy makers to join in and ROAR with TIGER.
Climate change is expected to exacerbate the current threats to freshwater ecosystems, yet multifaceted studies on the
potential impacts of climate change on freshwater biodiversity at scales that inform management planning are lacking. The aim of this study was to fill this void through the development of a novel framework for assessing climate
change vulnerability tailored to freshwater ecosystems. The three dimensions of climate change vulnerability are as
follows: (i) exposure to climate change, (ii) sensitivity to altered environmental conditions and (iii) resilience potential.
Our vulnerability framework includes 1685 freshwater species of plants, fishes, molluscs, odonates, amphibians, crayfish and turtles alongside key features within and between catchments, such as topography and connectivity. Several
methodologies were used to combine these dimensions across a variety of future climate change models and scenarios. The resulting indices were overlaid to assess the vulnerability of European freshwater ecosystems at the catchment scale (18 783 catchments). The Balkan Lakes Ohrid and Prespa and Mediterranean islands emerge as most
vulnerable to climate change. For the 2030s, we showed a consensus among the applied methods whereby up to 573
lake and river catchments are highly vulnerable to climate change. The anthropogenic disruption of hydrological
habitat connectivity by dams is the major factor reducing climate change resilience. A gap analysis demonstrated that
the current European protected area network covers <25% of the most vulnerable catchments. Practical steps need to
be taken to ensure the persistence of freshwater biodiversity under climate change. Priority should be placed on
enhancing stakeholder cooperation at the major basin scale towards preventing further degradation of freshwater
ecosystems and maintaining connectivity among catchments. The catchments identified as most vulnerable to climate
change provide preliminary targets for development of climate change conservation management and mitigation
strategies.
Vor dem Hintergrund der Umweltprobleme, die sich aus dem zunehmenden Abbau natürlicher Ressourcen und der Erschöpfung der Ressourcen ergeben, ist die Verwirklichung einer nachhaltigen Entwicklung eine unverzichtbare Herausforderung des 21. Jahrhunderts.
In diesem Artikel wollen wir zeigen, wie soziotechnische und produktbezogene Dienstleistungsinnovationen soziale Praktiken - das routinemäßige Tun im Alltag - verändern und damit den Wandel soziotechnischer Systeme unterstützen können. Wir stellen theoretische Überlegungen dazu vor, wie Theorien sozialer Praktiken und der Rahmen der Mehrebenenperspektive in der Transformationsforschung miteinander verbunden werden können, um Transformationsprozesse aus einer Mikro-Makro-Verbindungsperspektive besser zu verstehen. Anhand von Fallbeispielen aus dem Bereich der Bade-, Heiz- und Ernährungspraktiken wird aufgezeigt, wie sich diese in den letzten Jahrzehnten verändert haben. Darauf aufbauend werden Beispiele für Konzepte zur nachhaltigen Produkt-Dienstleistungs-Gestaltung in diesen Bereichen als Hebel zur Veränderung sozialer Praktiken im Alltag vorgestellt. Diese wurden in Forschungsprojekten bzw. in Seminararbeiten von Designstudenten entwickelt. Wir argumentieren, dass dies bedeutet, dass nachhaltige Produkt-Service-Systeme in einem nutzer- und akteursintegrierten Rahmen entwickelt werden sollten, wie z.B. in Sustainable LivingLabs. Die Einbindung von Nutzern und anderen Akteuren in partizipative Co-Creation-Prozesse ermöglicht maßgeschneiderte Lösungen, die tatsächliche Routinen und Abhängigkeiten ernsthaft berücksichtigen.
CIOs' innovation capability is regarded as a precondition of successful HIT adoption in hospitals. Based on the data of 142 CIOs, this study aimed at identifying antecedents of perceived innovation capability. Eight features describing the status quo of the hospital IT management (e.g. use of IT governance frameworks), four features of the hospital structure (e.g. functional diversification) and four CIO characteristics (e.g. duration of employment) were tested as potential antecedents in an exploratory stepwise regression approach. Perceived innovation capability in its entirety and its three sub-dimensions served as criterion. The results show that CIOs' perceived innovation capability could be explained significantly (R2=0.34) and exclusively by facts that described the degree of formalism and structure of IT management in a hospital, e.g. intensive and formalised strategic communication, the existence of an IT strategy and the use of IT governance frameworks. Breaking down innovation capability into its constituents revealed that “innovative organisational culture” contributed to a large extent (R2=0.26) to the overall result sharing several predictors. In contrast, “intrapreneurial personality” (R2=0.11) and “openness towards users” (R2=0.18) could be predicted less well. These results hint at the relationship between working in a well-structured, formalised and strategy oriented environment and the overall feeling of being capable to promote IT innovation.
Interpolation of data in smart city architectures is an eminent task for the provision of reliable services. Furthermore, it is a key functionality for information validation between spatiotemporally related sensors. Nevertheless, many existing projects use a simplified geospatial model that does not take the infrastructure, which affects events and effects in the real world, into account. There are various available algorithms for interpolation and the calculation of routes on infrastructure based graphs and distances on geospatial data. This work proposes a combined approach by interconnecting detailed geospatial data whilst regarding the underlying infrastructure model.