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Freshwater ecosystems host disproportionately high numbers of species relative to their surface area yet are poorly protected globally. We used data on the distribution of 1631 species of aquatic plant, mollusc, odonate and fish in 18,816 river and lake catchments in Europe to establish spatial conservation priorities based on the occurrence of threatened, rangerestricted and endemic species using the Marxan systematic conservation planning tool. We found that priorities were highest for rivers and ancient lakes in S Europe, large rivers and lakes in E and N Europe, smaller lakes in NW Europe and karst/limestone areas in the Balkans, S France and central Europe. The a priori inclusion of well-protected catchments resulted in geographically more balanced priorities and better coverage of threatened (critically endangered, endangered and vulnerable) species. The a priori exclusion of well-protected catchments showed that priority areas that need further conservation interventions are in S and E Europe. We developed three ways to evaluate the correspondence between conservation priority and current protection by assessing whether a cathment has more (or less) priority given its protection level relative to all other catchments. Each method found that priority relative to protection was high in S and E Europe and generally low in NW Europe. The inclusion of hydrological connectivity had little influence on these patterns but decreased the coverage of threatened species, indicating a trade-off between connectivity and conservation of threatened species. Our results suggest that catchments in S and E Europe need urgent conservation attention (protected areas, restoration, management, species protection) in the face of imminent threats such as river regulation, dam construction, hydropower development and climate change. Our study presents continental-scale conservation priorities for freshwater ecosystems in ecologically meaningful planning units and will thus be important in freshwater biodiversity conservation policy and practice, and water management in Europe.
The energy transition can be mapped on four levels. While industry and the state should act on the national and international level, most of the energy transition is taking place at the regional and municipal levels. Here the small-scale and decentralized nature of the new energy world is reflected, where customized individual solutions are created.
Information systems (IS) play a central role in promoting corporate sustainability and pro-environmental behavior. This study explores the use of mobile apps for fostering sustainability-oriented corporate culture. It accentuates issues relating to sustainability-oriented corporate culture (RQ1), app meta-requirements as a strategic approach to addressing these issues (RQ2), as well as design and implementation principles (RQ3). Referring to the literature on sustainability apps, gamification, and nudging, our qualitative research design combines an analysis of four corporate apps intending to promote sustainable behavior and expert interviews (Grounded Theory). The proposed framework supports the planning, realization, and monitoring of this targeted app use. Single cultural dimensions inform seven issues in culture development. Five meta-requirements address this multi-dimensionality, challenges provided by new digital working environments, and principles of Green IT. Four design principles support, extend, and integrate current knowledge on app features, nudging, and gamification. Five variables determine the app intervention and maturity level. We conclude that this targeted app use should intend to foster the sustainability orientation within all dimensions of corporate culture instead of being limited to promoting sustainable behavior.
Duckweeds are fast-growing and nutritious plants, which are gaining increased attention in different fields of application. Especially for animal nutrition, alternative protein sources are needed to substitute soybean meal. The current bottleneck is the standardized production of biomass, which yields stable quantities of a defined product quality. To solve this problem, an indoor vertical farm (IVF) for duckweed biomass production was developed. It consists of nine vertically stacked basins with a total production area of 25.5 m2. The nutrient solution, a modified N-medium, re-circulated within the IVF with a maximum flow rate of 10 L min−1. Nutrients were automatically added based on electrical conductivity. In contrast, ammonium was continuously supplied. A water temperature of 23 °C and a light intensity of 105 μmol m−2 s−1 with a photoperiod of 12:12 h were applied. During a 40-day production phase, a total of 35.6 kg of fresh duckweed biomass (equals 2.1 kg of dried product) was harvested from the IVF. On average, 0.9 kg day−1 of fresh biomass was produced. The dried product contained 32% crude protein (CP) and high levels of proteinogenic amino acids (e.g. lysine: 5.42 g, threonine: 3.85 g and leucine: 7.59 g/100 g CP). Biomass of this quality could be used as a protein feed alternative to soybean meal. The described IVF represents a modular model system for duckweed biomass production in a controlled environment and further innovations and upscaling processes.
25-hydroxycholecalciferol (25-OHD3) formed via hepatic hydroxylation from vitamin D, cholecalciferol, represents the precursor of the biologically active vitamin D hormone, 1,25-dihydroxyvitamin D. Due to a higher absorption rate and the omission of one hydroxylation, dietary supplementation of 25-OHD3 instead of vitamin D3 is considered to be more efficient as plasma concentrations of 25-OHD3 are increased more pronounced. The present review summarises studies investigating potential beneficial effects on mineral homeostasis, bone metabolism, health status and performance in sows, piglets and fattening pigs. Results are inconsistent. While most studies could not demonstrate any or only a slight impact of partial or total replacement of vitamin D3 by 25-OHD3, some experiments indicated that 25-OHD3 might alter physiological processes when animals are challenged, for example, by a restricted mineral supply.
To investigate the influence of two dietary sources of vitamin D on the vitamin D status, bone metabolism, welfare and birth progress of gestating and lactating sows, forty-nine multiparous sows were randomly assigned to one of two diets: “CON” (n = 25; 50 μg vitamin D3/kg feed) and “HYD” (n = 24; 50 μg 25-hydroxycholecalciferol/kg feed). The basal diets were protein- and phosphorus-reduced. The trial started on day 3 ante insemination of the sows and ended with weaning of the piglets on day 28 postpartum. Dietary supplementation of 25-hydroxycholecalciferol resulted in improved maternal vitamin D status (p < 0.001), fewer gait changes (p < 0.01) and longer standing time after feeding (day 5 ante partum; p < 0.05) compared to vitamin D3. However, the bone markers CrossLaps and osteocalcin were not affected. Overall, the present results suggest that sows fed 25-hydroxycholecalciferol instead of vitamin D3 showed improved locomotion and stance strength. However, this outcome is probably not related to altered bone metabolism. The underlying mechanisms must be investigated in further studies.
Duckweeds can be potentially used in human and animal nutrition, biotechnology or wastewater treatment. To cultivate large quantities of a defined product quality, a standardized production process is needed. A small-scale, re-circulating indoor vertical farm (IVF) with artificial lighting and a nutrient control and dosing system was used for this purpose. The influence of different light intensities (50, 100 and 150 µmol m−2 s−1) and spectral distributions (red/blue ratios: 70/30, 50/50 and 30/70%) on relative growth rate (RGR), crude protein content (CPC), relative protein yield (RPY) and chlorophyll a of the duckweed species Lemna minor and Wolffiella hyalina were investigated. Increasing light intensity increased RGR (by 67% and 76%) and RPY (by 50% and 89%) and decreased chlorophyll a (by 27% and 32%) for L. minor and W. hyalina, respectively. The spectral distributions had no significant impact on any investigated parameter. Wolffiella hyalina achieved higher values in all investigated parameters compared to L. minor. This investigation proved the successful cultivation of duckweed in a small-scale, re-circulating IVF with artificial lighting.
Complete diets for laying hens are usually offered in meal form. This form initially promotes the laying hens’ natural feed intake behavior and allows them to satisfy their pecking behavior. At the same time, it can also cause difficulties, because it consists of different particles and is not a homogeneous unit. A homogeneous mixture is essential to ensure that each laying hen in the flock can meet its nutritional needs. If feed exhibits a wide particle size distribution, this can promote feed segregation during transport and selective feed intake behavior of laying hens. These two processes sometimes lead to significant differences between the composition of the feed produced and the composition of the feed that is finally ingested by the laying hens. Multi-stage sampling can be used to investigate progressing differences in feed composition. In this study, samples of different complete diets for laying hens (n = 76) were collected from ten organic farms in Germany to examine their particle size distributions (dry sieve analysis). Samples were taken at four different locations (V1 = loading, V2 = silo, V3 = at the beginning of the feed chain, V4 = at the end of the feed chain) in each farm. There was a tendency for V1 and V2 to be characterized by high proportions of particles between 1400 and 3150 µm (V1 = 61.2%, V2 = 43.5%). V3 and V4 consisted mainly of particles of size 500–800 µm and 200–400 µm, respectively. The lowest proportions across all variants were in the range above 3150 µm (V1 = 2.20%, V2 = 1.30%, V3 = 1.00%, V4 = 0.400%) and between 400 and 500 µm (V1 = 2.50%, V2 = 4.50%, V3 = 5.70%, V4 = 6.60%). The mean value comparison of the proportions of sieve mesh sizes from 200 to 1000 µm resulted in: V1 < V2 < V3 < V4; and of sieve mesh sizes between 1400 and 2000 µm in: V1 > V2 > V3 > V4. This observation can be explained by segregation of the feed during transport and a selective feeding behavior of the laying hens. However, trends were discontinuous and varied between the farms. Deviations from the guideline values were found in particular for particle sizes in the range of 1000 to 1400 µm.
A project was initiated to apply dietary CP reduction under commercial conditions. The main objective was to demonstrate and validate that dietary CP can be reduced without compromising broiler performance in a production system which is already rather efficient. In addition, we wanted to demonstrate the potential of dietary CP reduction on reducing N-excretions especially in the context of German revised regulations and monitoring attempts. Finally, as previous research suggested, few further aspects such as impact of dietary CP reduction on litter quality and quantity, footpad health, change of ingredient inclusion levels and related impact on sustainability impact factors were evaluated.
Background
Citizen energy cooperatives (CECOs) are an important element for realising the transformation of the European energy system from a central system, dominated by a few market players to a decentralized system with the participation of many citizens, in which energy supply is largely based on renewable energy sources. This article identifies success factors that ensure a working organization that is capable of implementing projects to support the energy transition and improving the well-being of citizens.
Methods
The aim of this study is to identify success factors using the example of CECOs in north western Germany through a two-step process. The first step is a literature review to identify success factors of CECOs. Second, 12 semi-structured expert interviews with managers of CECOs are conducted and evaluated by means of a qualitative content analysis. The interviews identified the success factors and barriers of CECOs. The interviews were recorded and transcribed verbatim. The coding process was carried out using a qualitative data analysis software (ATLAS.ti 8.4.5,).
Results
The results show that three factors particular should be present, but can influence each other, to lead to successful CECOs: (1) the CECOs require business models with low complexity, as business models that span different stages of the value chain can overwhelm organizational managers. (2) Committed key individuals must be found and promoted. They need the support of the members. (3) Social and ecological principles are the core values of CECOs. The maintenance and strengthening of social–ecological credibility must be promoted in the public perception.
Conclusions
The results show that CECOs emerge from a strong social cohesion in a society. In addition, local "key individuals" need to be identified and supported. To this end, the framework conditions (e.g., policy, legislation, municipal support, etc.) must be adapted in such a way that these "key individuals" in CECOs are not overburdened. The analysis of the interviews also revealed that political or regulatory barriers are often cited as obstacles to the implementation of community energy projects.
Over the past decade, the proliferation of entrepreneurial ventures and small firms with sustainable business models have pushed the sustainability agenda in the fashion industry. Despite prominent success stories, these companies often encounter significant operative challenges that hinder growth or even cause business failure. This paper adopts a qualitative research design and uses data gathered during 18 expert interviews with entrepreneurs and executive managers of 18 firms from 13 countries to identify and explore the dominant challenges that micro- and small-sized sustainable fashion companies struggle with. The results indicate that communicating with consumers is perceived as surprisingly difficult, especially because sustainable brands need to justify higher prices and explain the added benefits of their products. Second, resource constraints lead to operative friction and overburdening of the decision makers and their small management teams. Third, sustainable sourcing and production processes are economically difficult in an industry that continues to occupy a mass and low-cost logic. Against the background of these insights, a range of managerial recommendations are developed and contextualized in the framework of the Business Model Canvas. This novel approach makes the suggestions which are rooted in the resource-based view actionable and supports sustainable businesses to better manage their operations and achieve growth. For example, collaborative approaches with different stakeholders may mitigate constraints across all three identified problem areas.
Applications of pulsed electric fields for processing potatoes: Examples and equipment design
(2022)
In the last two decades, pulsed electric fields (PEF) have successfully been introduced into the food industry, as one of the most promising and "game changing" technologies. This review is devoted to the recent applications of pulsed electric fields used in processing potatoes. The potato processing market size was estimated to be ca. USD 24.83 billion (2018) and with an annual growth rate of 5.2%. The physicochemical characteristics of potatoes and the specificity of potato processing lines makes a pulsed electric field very versatile and flexible allowing one to achieve different technological aims by its implementation into technological lines. In this paper, a short analysis of the potato structure and its nutritional properties, applications of moderate electric fields, ohmic heating, and pulsed electric fields are presented. Moreover, the basic electroporation effects, metabolic responses, texture modification and different PEF assisted processes applied to the potato are discussed. Finally, some examples of commercial applications and a brief description of the available equipment for the PEF processing of potatoes are presented.
The impact of Pulsed Electric Field (PEF) processing pre-treatment on the texture and kinetics of in vitro starch digestibility of French fries made from two potato cultivars (Solanum tuberosum L.) containing dry matter content ranging from 19 to 22% was investigated. Whole and steam-peeled potato tubers were treated with a pilot scale PEF unit (electric field strength of 1.1 and 1.9 kV/cm with energy input <10 kJ/kg or ∼50 kJ/kg). This trial was carried out in a commercial French-fry plant using an industrial scale cutter, blancher, fryer and blast-freezer to prepare the frozen par-fried French fry samples. After subsequent final batch frying of the frozen fries, at 180 °C for 3 min to mimic the typical preparation practice at restaurant, retail and household, the outer crust of the fries produced from PEF-treated potatoes was significantly harder (9.4–16.3 N) than crust produced from untreated potatoes (6.9–8.5 N). High intensity (1.9 kV/cm with energy input ∼50 kJ/kg) PEF processing was found to cause defects (i.e. hollowness in the internal core) in the fries. A fractional conversion model was a good fit for the starch digestion kinetics of all French fry samples during the small intestinal phase (based on standardised INFOGEST static in vitro digestion assay). A lower % of total starch hydrolysis was predicted for French fries produced from high dry matter (>21%) tubers pretreated with PEF at electric field strength of 1.9 kV/cm. The findings generated in this study demonstrate PEF pretreatment may influence the texture of French fries and the extent of starch digestion that occurs.
The impact of pulsed light (PL) treatment on naturally occurring microorganisms, mycotoxins, and on physicochemical properties in red pepper powder was investigated. Powder samples were exposed to different PL treatments up to 61 pulses, with fluence ranging from 1.0 to 9.1 J/cm2. The highest fluence applied (9.1 J/cm2, 61 pulses, 20 s) resulted in 2.7, 3.1, and 4.1 log CFU/g reduction of yeasts, molds, and total plate counts (TPC), where initial microbial loads were 4.6, 5.5, and 6.5 log CFU/g, respectively. At the same fluence intensity, a maximum reduction of 67.2, 50.9, and 36.9% of aflatoxin B1 (AFB1), total aflatoxins (AF), and ochratoxin A (OTA) were detected, respectively. Proportional increase in temperature of the samples was observed from the absorbed PL energy, reaching maximum of 59.8°C. The inactivation of investigated microorganisms and mycotoxins followed first-order kinetics (R2 > 0.95). The fluence intensity at 6.9 and 9.1 J/cm2 did not cause degradation, but rather a significant (p < .05) and apparent increase of total phenols. Total color difference (ΔE*) revealed only “slight differences,” compared to the untreated sample. In conclusion, higher reduction of microbial load and mycotoxins in red pepper powder could be achieved, when higher treatment intensity was applied. This suggests the PL as a potential technology for decontamination of red pepper powder and other spice powders.
Dieser Artikel befasst sich mit dem bundesweiten Niveau der Treibhausgas (THG)-Emissionen und des Ressourcenverbrauchs in der deutschen Gemeinschaftsverpflegung im Segment "Business" und deren Einsparpotenziale durch verschiedene Szenarien der ungestützten und gestützten Rezeptüberarbeitung. Unter "ungestützt" verstehen wir in dieser Arbeit die intuitive Optimierung von Rezepten durch die Mitarbeiter von Betrieben der Gemeinschaftsverpflegung. Die "unterstützten" Ansätze mussten dagegen bestimmte Zielvorgaben erfüllen, zum Beispiel der Deutschen Gesellschaft für Ernährung; engl. Deutschen Gesellschaft für Ernährung oder das nachhaltige Niveau. Konkret Konkret wird getestet, wie sich (A) eine ungestützte Rezeptüberarbeitung, (B) eine Rezeptüberarbeitung auf Basis von Ernährungsempfehlungen und (C) eine Rezeptüberarbeitung mit wissenschaftlicher Begleitung die Umweltauswirkungen eines Gerichtes beeinflussen. Als methodischer Rahmen diente eine Online-Befragung von Unternehmen der Gemeinschaftsverpflegung sowie eine Szenarioanalyse auf Menüebene und auf nationaler Ebene durchgeführt. Die Ergebnisse basieren zum einen auf empirischen Daten und zum anderen auf Hochrechnungen. Die Ergebnisse zeigen, dass die die bundesweite Umsetzung der Rezepturüberarbeitung nach wissenschaftlichen Vorgaben - wie konkrete Zielvorgaben für die THG Emissionen pro Portion - bis zu 44% des Ressourcenverbrauchs in der deutschen Betriebsgastronomie einsparen kann (das entspricht 3,4 Millionen Tonnen Ressourcen pro Jahr) und bis zu 40 % der THG-Emissionen (0,6 Millionen Tonnen THG-Emissionen pro Jahr) einsparen.
The study aimed to investigate inactivation of naturally occurring microorganisms and quality of red pepper paste treated by high pressure processing (HPP). Central composite rotatable design was employed to determine the impacts of pressure (100–600 MPa) and holding time (30–600 s). HPP at 527 MPa for 517 s reduced aerobic mesophilic bacteria count by 4.5 log CFU/g. Yeasts and molds counts were reduced to 1 log CFU/g at 600 MPa for 315 s. Total phenols, carotenoids and antioxidants activity ranged from 0.28 to 0.33 g GAE/100 g, 96.0–98.4 mg βc/100 g and 8.70–8.95 μmol TE/g, respectively. Increase (2.5–6.7%) in these variables was observed with increasing pressure and holding time. Total color difference (ΔE∗) values (0.2–2.8) were within the ranges of ‘imperceptible’ to ‘noticeable’. Experimental results were fitted satisfactorily into quadratic model with higher R2 values (0.8619–0.9863). Optimization process suggested treatment of red pepper paste at 536 MPa for 125 s for maximum desirability (0.622). Validation experiments confirmed comparable percentage of relative errors. Overall, this technique could be considered as an efficient treatment for the inactivation of microorganisms that naturally occur in red pepper paste with minimal changes in its characteristics.
Der Schwerpunkt des vorliegenden Papiers liegt auf der Nachfrageseite. In realen Labors verwenden wir einen standardisierten empirischen Ansatz, um verschiedene Nudging-Maßnahmen aus dem Bereich der physischen Umwelt und des Entscheidungsprozesses der Verbraucher zu vergleichen. Wir vergleichen die Auswirkungen ein und derselben Maßnahme in verschiedenen Umgebungen und die Auswirkungen verschiedener, aufeinander folgender Nudging-Maßnahmen in derselben Umgebung. Die Daten wurden in acht Betriebs- und Schulkantinen in Deutschland in zwei Projektdurchläufen (2016/2017; 2019/2020) erhoben. Es wurde ein ähnliches Interventionskonzept angewandt. Die Vergleichbarkeit wurde durch eine harmonisierte Speisekarte gewährleistet. Die erste Iteration des Projekts ergab, dass nur ein Nudge (oberste Menüposition, +22,5 %) zu einem signifikanten Anstieg der Wahl nachhaltiger Lebensmittel führte, während die Ergebnisse der zweiten Iteration zeigten, dass alle Nudge-Interventionen (beste Thekenposition, +11,6 %; oberste Menüposition, +6,9 %; Etikett plus Informationen, +15,9 %) die Wahl der Verbraucher positiv beeinflussten. Mögliche Erklärungen wie die striktere Einhaltung des Versuchsplans in den Cafeterien, aber auch gesellschaftliche Entwicklungen wie das Aufkommen der Fridays for Future-Bewegung werden diskutiert. Da die Ergebnisse je nach Standort und Umfeld variieren, legen unsere Ergebnisse nahe, dass Nudges situativen Bedingungen angepasst werden müssen, um die höchste Wirksamkeit zu erzielen.
The present study investigates properties of heat-induced, self-standing gels of globular proteins. Native egg white protein (EWP) with 9,8 wt% protein and 0,395 wt% NaCl content was adjusted to pH = 7,0 and heated from 25 to 85 °C via Ohmic heating (OH) and conventional heating (COV) with respective come-up times (CUT, 240 and 1200 s) and holding times (HOLD, 30 and 900 s). Gels heated under OH showed lower denaturation levels and less water holding capacity. When HOLD was short, the firmness of OH gels exceeded COV gel firmness but deceeded at long HOLD. Similarly, at short HOLD OH samples presented higher hydrophobic interactions whereas at long HOLD COV gels showed more hydrophobic interactions. This correlated with changes of intermolecular beta-sheet structures which increased with HOLD at COV but decreased or remained unchanged during OH. Furthermore, as an SDS-PAGE revealed the main EWP, ovalbumin, did not fully denature when heated via OH, this lead to the assumption that the oscillatory electric field partially interferes the complete denaturation and development of intermolecular beta-sheet structures and hydrophobic interactions during thermal gelation of this protein. Scanning electron microscopy also showed deviances in network structures between OH and COV as COV gels exhibited a denser and OH gels a more open and porous network structure.
Currently, the modelling of drying processes of plant tissues pre-treated by pulsed electric field (PEF) is following experimentally identified curves or separate heat and mass transfer and diffusion models with different levels of accuracy. This research had two major objectives: mathematical modeling and control of drying process of different vegetables pretreated by PEF during convective drying. The mathematical modeling was based on Luikov's heat and mass transfer model along with properties of different vegetables. Computer modelling was done using the difference method for predicting moisture and the temperature potentials of untreated and PEF-treated vegetables. The formulation and the solution procedures were applied to simulate the simultaneous heat and mass transfer in selected vegetables subjected to the convective drying. Suggested model had a good correlation with experimental results. Moreover, cell disintegration index can be used as a controllable parameter in heat and mass transfer models to predict drying behavior of potato, onion, and carrot tissues. Obtained drying models can be used as a mathematical tool to predict drying behavior for various types of agricultural products pre-treated by pulsed electric field.
The impact of Pulsed Electric Fields (PEF) on the peeling ability of different fruits and vegetables in particular tomatoes, peaches, peppers, and oranges were investigated. Samples were exposed to a fixed electric field strength of 2.15 kV/cm. The specific energy ranged from 0.6 kJ/kg to 50.3 kJ/kg. The treated raw materials were analysed regarding to the peeling ability, skin size and weight and firmness. The best result for tomatoes at a specific energy of 1.2 kJ/kg induced a high score of peeling ability that led to less product loss and could therefore increase the yield by 33.84%–41.53% compared to untreated samples. Moreover, an increased skin size by a factor of 3.7 was observed. However, PEF had no significant impact on peeling ability of oranges, peppers, and peaches. Although oranges showed an improvement in peeling ability by up to 32%, this cannot be traced back to the PEF treatment. The different properties and structures of the raw materials were discussed and provided indications about the limitation of PEF.
Background
Spinach is a nitrogen (N) demanding crop with a weekly N uptake of up to 60 kg ha–1. Consequently, a high N supply is required, which can temporarily lead to high quantities of nitrate (NO3–) being at risk of leaching.
Aims
The objective of this study was to develop a N fertilization approach to reduce the risk of NO3– leaching in field-grown spinach production without adversely affecting crop yield and quality at an early and late harvest stage.
Methods
Ten fertilization trials were conducted to compare different base fertilization rates and splits of top dressings. For top dressings, granulated fertilizers or foliar sprays were used. In a further treatment, N supply was reduced by withholding the second top dressing of 50–70 kg ha−1.
Results
Nitrate concentration at risk of leaching was considerably reduced by decreasing the base fertilizer rate as well as by splitting the top dressing. However, at an early harvest stage, total aboveground dry mass was reduced by, on average, 6% by these measures across all seasons. In contrast, at a later harvest stage, spinach was less affected by the fertilizer schedule. Urea foliar sprays proved to be insufficient in promoting plant growth and caused leaf necrosis. A reduced N supply led to impaired plant growth and yellowish leaves in both spring and winter.
Conclusions
Base N fertilization of spinach is only required in spring, but not in other seasons. Despite slight yield reduction, the top dressing should be split to reduce the risk of NO3− leaching after an early harvest.
Intensive care units (ICU) are often overflooded with alarms from monitoring devices which constitutes a hazard to both staff and patients. To date, the suggested solutions to excessive monitoring alarms have remained on a research level. We aimed to identify patient characteristics that affect the ICU alarm rate with the goal of proposing a straightforward solution that can easily be implemented in ICUs. Alarm logs from eight adult ICUs of a tertiary care university-hospital in Berlin, Germany were retrospectively collected between September 2019 and March 2021. Adult patients admitted to the ICU with at least 24 h of continuous alarm logs were included in the study. The sum of alarms per patient per day was calculated. The median was 119. A total of 26,890 observations from 3205 patients were included. 23 variables were extracted from patients' electronic health records (EHR) and a multivariable logistic regression was performed to evaluate the association of patient characteristics and alarm rates. Invasive blood pressure monitoring (adjusted odds ratio (aOR) 4.68, 95%CI 4.15–5.29, p < 0.001), invasive mechanical ventilation (aOR 1.24, 95%CI 1.16–1.32, p < 0.001), heart failure (aOR 1.26, 95%CI 1.19–1.35, p < 0.001), chronic renal failure (aOR 1.18, 95%CI 1.10–1.27, p < 0.001), hypertension (aOR 1.19, 95%CI 1.13–1.26, p < 0.001), high RASS (aOR 1.22, 95%CI 1.18–1.25, p < 0.001) and scheduled surgical admission (aOR 1.22, 95%CI 1.13–1.32, p < 0.001) were significantly associated with a high alarm rate. Our study suggests that patient-specific alarm management should be integrated in the clinical routine of ICUs. To reduce the overall alarm load, particular attention regarding alarm management should be paid to patients with invasive blood pressure monitoring, invasive mechanical ventilation, heart failure, chronic renal failure, hypertension, high RASS or scheduled surgical admission since they are more likely to have a high contribution to noise pollution, alarm fatigue and hence compromised patient safety in ICUs.
Background
To detect changes in biological processes, samples are often studied at several time points. We examined expression data measured at different developmental stages, or more broadly, historical data. Hence, the main assumption of our proposed methodology was the independence between the examined samples over time. In addition, however, the examinations were clustered at each time point by measuring littermates from relatively few mother mice at each developmental stage. As each examination was lethal, we had an independent data structure over the entire history, but a dependent data structure at a particular time point. Over the course of these historical data, we wanted to identify abrupt changes in the parameter of interest - change points.
Results
In this study, we demonstrated the application of generalized hypothesis testing using a linear mixed effects model as a possible method to detect change points. The coefficients from the linear mixed model were used in multiple contrast tests and the effect estimates were visualized with their respective simultaneous confidence intervals. The latter were used to determine the change point(s). In small simulation studies, we modelled different courses with abrupt changes and compared the influence of different contrast matrices. We found two contrasts, both capable of answering different research questions in change point detection: The Sequen contrast to detect individual change points and the McDermott contrast to find change points due to overall progression. We provide the R code for direct use with provided examples. The applicability of those tests for real experimental data was shown with in-vivo data from a preclinical study.
Conclusion
Simultaneous confidence intervals estimated by multiple contrast tests using the model fit from a linear mixed model were capable to determine change points in clustered expression data. The confidence intervals directly delivered interpretable effect estimates representing the strength of the potential change point. Hence, scientists can define biologically relevant threshold of effect strength depending on their research question. We found two rarely used contrasts best fitted for detection of a possible change point: the Sequen and McDermott contrasts.
Background
A peripheral venous catheter (PVC) is the most widely used device for obtaining vascular access, allowing the administration of fluids and medication. Up to 25% of adult patients, and 50% of pediatric patients experience a first-attempt cannulation failure. In addition to patient and clinician characteristics, device features might affect the handling and success rates. The objective of the study was to compare the first-attempt cannulation success rate between PVCs with wings and a port access (Vasofix® Safety, B. Braun, abbreviated hereon in as VS) with those without (Introcan® Safety, B. Braun, abbreviated hereon in as IS) in an anesthesiological cohort.
Methods
An open label, multi-center, randomized trial was performed. First-attempt cannulation success rates were examined, along with relevant patient, clinician, and device characteristics with univariate and multivariate analyses. Information on handling and adherence to use instructions was gathered, and available catheters were assessed for damage.
Results
Two thousand three hundred four patients were included in the intention to treat analysis. First-attempt success rate was significantly higher with winged and ported catheters (VS) than with the non-winged, non-ported design (IS) (87.5% with VS vs. 78.2% with IS; PChi < .001). Operators rated the handling of VS as superior (rating of “good” or “very good: 86.1% VS vs. 20.8% IS, PChi < .001). Reinsertion of the needle into the catheter after partial withdrawal—prior or during the catheterization attempt—was associated with an increased risk of cannulation failure (7.909, CI 5.989–10.443, P < .001 and 23.023, CI 10.372–51.105, P < .001, respectively) and a twofold risk of catheter damage (OR 1.999, CI 1.347–2.967, P = .001).
Conclusions
First-attempt cannulation success of peripheral, ported, winged catheters was higher compared to non-ported, non-winged devices. The handling of the winged and ported design was better rated by the clinicians. Needle reinsertions are related to an increase in rates of catheter damage and cannulation failure.
Background: New ischaemic brain lesions on magnetic resonance imaging (MRI) are reported in up to 86% of patients after transcatheter edge-to-edge repair of the mitral valve (TEER-MV). Knowledge of the exact procedural step(s) that carry the highest risk for cerebral embolisation may help to further improve the procedure.
Aims: The aim of this study was to identify the procedural step(s) that are associated with an increased risk of cerebral embolisation during TEER-MV with the MitraClip system. Furthermore, the risk of overt stroke and silent brain ischaemia after TEER-MV was assessed.
Methods: In this prospective, pre-specified observational study, all patients underwent continuous transcranial Doppler examination during TEER-MV to detect microembolic signals (MES). MES were assigned to specific procedural steps: (1) transseptal puncture and placement of the guide, (2) advancing and adjustment of the clip in the left atrium, (3) device interaction with the MV, and (4) removal of the clip delivery system and the guide. Neurological examination using the National Institutes of Health Stroke Scale (NIHSS) and cerebral MRI were performed before and after TEER-MV.
Results: Fifty-four patients were included. The number of MES differed significantly between the procedural steps with the highest numbers observed during device interaction with the MV. Mild neurological deterioration (NIHSS ≤3) occurred in 9/54 patients. New ischaemic lesions were detected in 21/24 patients who underwent MRI. Larger infarct volume was significantly associated with neurological deterioration.
Conclusions: Cerebral embolisation is immanent to TEER-MV and predominantly occurs during device interaction with the MV. Improvements to the procedure may focus on this procedural step.
During gestation, the most drastic change in oxygen supply occurs with the onset of ventilation after birth. As the too early exposure of premature infants to high arterial oxygen pressure leads to characteristic diseases, we studied the adaptation of the oxygen sensing system and its targets, the hypoxia-inducible factor- (HIF-) regulated genes (HRGs) in the developing lung. We draw a detailed picture of the oxygen sensing system by integrating information from qPCR, immunoblotting, in situ hybridization, and single-cell RNA sequencing data in ex vivo and in vivo models. HIF1α protein was completely destabilized with the onset of pulmonary ventilation, but did not coincide with expression changes in bona fide HRGs. We observed a modified composition of the HIF-PHD system from intrauterine to neonatal phases: Phd3 was significantly decreased, while Hif2a showed a strong increase and the Hif3a isoform Ipas exclusively peaked at P0. Colocalization studies point to the Hif1a-Phd1 axis as the main regulator of the HIF-PHD system in mouse lung development, complemented by the Hif3a-Phd3 axis during gestation. Hif3a isoform expression showed a stepwise adaptation during the periods of saccular and alveolar differentiation. With a strong hypoxic stimulus, lung ex vivo organ cultures displayed a functioning HIF system at every developmental stage. Approaches with systemic hypoxia or roxadustat treatment revealed only a limited in vivo response of HRGs. Understanding the interplay of the oxygen sensing system components during the transition from saccular to alveolar phases of lung development might help to counteract prematurity-associated diseases like bronchopulmonary dysplasia.
Objectives: To measure and assess the economic impact of adherence to a single quality indicator (QI) regarding weaning from invasive ventilation.
Design: Retrospective observational single-centre study, based on electronic medical and administrative records.
Setting: Intensive care unit (ICU) of a German university hospital, reference centre for acute respiratory distress syndrome.
Participants: Records of 3063 consecutive mechanically ventilated patients admitted to the ICU between 2012 and 2017 were extracted, of whom 583 were eligible adults for further analysis. Patients’ weaning protocols were evaluated for daily adherence to quality standards until ICU discharge. Patients with <65% compliance were assigned to the low adherence group (LAG), patients with ≥65% to the high adherence group (HAG).
Primary and secondary outcome measures: Economic healthcare costs, clinical outcomes and patients’ characteristics.
Results: The LAG consisted of 378 patients with a median negative economic results of −€3969, HAG of 205 (−€1030), respectively (p<0.001). Median duration of ventilation was 476 (248; 769) hours in the LAG and 389 (247; 608) hours in the HAG (p<0.001). Length of stay (LOS) in the LAG on ICU was 21 (12; 35) days and 16 (11; 25) days in the HAG (p<0.001). LOS in the hospital was 36 (22; 61) days in the LAG, and within the HAG, respectively, 26 (18; 48) days (p=0.001).
Conclusions: High adherence to this single QI is associated with better clinical outcome and improved economic returns. Therefore, the results support the adherence to QI. However, the examined QI does not influence economic outcome as the decisive factor.
The apple fruit (Malus domestica L. Borkh) is one of the most popular fruits worldwide. Beyond their beneficial properties, apples contain proteins that trigger allergic reactions in susceptible consumers. Mal d1 to d4 are allergens present in a variety of different isoforms in apples. In this study, we used proteomics to quantify all four Mal d proteins in 52 apple genotypes with varying allergenic potentials. A total of 195, 17, 14, and 18 peptides were found to be related to Mal d1, d2, d3, and d4 proteins, respectively of which 25 different Mal d proteins could be unambiguously identified. The allergenic potential of the Mal d isoforms was characterized by comparing the isoform abundance with the allergenic score of genotypes from oral challenge tests. The detected Mal d peptides presumably have different IgE binding properties and could be used as potential molecular markers to discriminate between hypoallergenic and hyperallergenic cultivars.
Currently, only non-imaging chlorophyll fluorescence measurements are used to identify the Lower Oxygen Limit (LOL) in Dynamic Controlled Atmosphere - Chlorophyll Fluorescence (DCA-CF) storage. The disadvantage of non-imaging fluorescence is that no statement can be made about the spatial heterogeneity of the sample. In contrast, chlorophyll fluorescence imaging can detect spatial heterogeneity of photosynthetic activity and has been established in research for some decades because the information benefit is higher. In this study, the chlorophyll fluorescence (Fo, Fm, Fv, Fv/Fm) of apples (Malus x domestica, BORKH.) was measured with a fluorescence imaging system in situ during storage. Intact apples of ‘Braeburn’ and ‘Golden Delicious’ were stored under low-oxygen stress conditions (< 1 kPa). The metabolic shift from aerobic to fermentative metabolism was made visible with the chlorophyll fluorescence imaging and was spatially localized on the sample. Furthermore, a method was developed to identify the LOL based on the chlorophyll fluorescence imaging combined with the histogram division method. This method considers the heterogeneity of the fluorescence and bundles the measured Fo data as histograms. Our results showed that the fluorescence imaging combined with the histogram division method can be a powerful tool for identifying the LOL.
Background:
Contact tracing apps are potentially useful tools for supporting national COVID-19 containment strategies. Various national apps with different technical design features have been commissioned and issued by governments worldwide.
Objective:
Our goal was to develop and propose an item set that was suitable for describing and monitoring nationally issued COVID-19 contact tracing apps. This item set could provide a framework for describing the key technical features of such apps and monitoring their use based on widely available information.
Methods:
We used an open-source intelligence approach (OSINT) to access a multitude of publicly available sources and collect data and information regarding the development and use of contact tracing apps in different countries over several months (from June 2020 to January 2021). The collected documents were then iteratively analyzed via content analysis methods. During this process, an initial set of subject areas were refined into categories for evaluation (ie, coherent topics), which were then examined for individual features. These features were paraphrased as items in the form of questions and applied to information materials from a sample of countries (ie, Brazil, China, Finland, France, Germany, Italy, Singapore, South Korea, Spain, and the United Kingdom [England and Wales]). This sample was purposefully selected; our intention was to include the apps of different countries from around the world and to propose a valid item set that can be relatively easily applied by using an OSINT approach.
Results:
Our OSINT approach and subsequent analysis of the collected documents resulted in the definition of the following five main categories and associated subcategories: (1) background information (open-source code, public information, and collaborators); (2) purpose and workflow (secondary data use and warning process design); (3) technical information (protocol, tracing technology, exposure notification system, and interoperability); (4) privacy protection (the entity of trust and anonymity); and (5) availability and use (release date and the number of downloads). Based on this structure, a set of items that constituted the evaluation framework were specified. The application of these items to the 10 selected countries revealed differences, especially with regard to the centralization of the entity of trust and the overall transparency of the apps’ technical makeup.
Conclusions:
We provide a set of criteria for monitoring and evaluating COVID-19 tracing apps that can be easily applied to publicly issued information. The application of these criteria might help governments to identify design features that promote the successful, widespread adoption of COVID-19 tracing apps among target populations and across national boundaries.
Background:
Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes.
Objective:
The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved.
Methods:
We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects.
Results:
The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities.
Conclusions:
The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.
The effects of reaction parameters on Hurn:xwiley:23670932:media:cptc202000216:cptc202000216-math-0001 production from ethanol photocatalysis in the gas phase have been investigated. The photocatalytic activity evolves from an early mass‐transfer limited regime to an independent one at later irradiation times, which is interpreted in terms of a photocatalytic site activity distribution. Ethanol molar fraction exhibits two different domains, with Hurn:xwiley:23670932:media:cptc202000216:cptc202000216-math-0002 production increasing up to a molar fraction of 0.12, beyond which it plateaus. Hurn:xwiley:23670932:media:cptc202000216:cptc202000216-math-0003 :AcH ratios are very sensitive to reaction conditions, reaching 1.8 at low reactant flows. UV light is converted to Hurn:x-wiley:23670932:media:cptc202000216:cptc202000216-math-0004 with an efficiency of nearly 3 %.
The study addresses staffing and workforce issues for home‐ and community‐based long‐term care in Germany. It is based on a study aimed at developing staffing recommendations for home‐care provider organisations. The study was commissioned within the regulation of the German long‐term care act. Following an exploratory literature search on staffing issues in home‐ and community‐based care qualitative interviews with 30 experts in home care were conducted. In addition, time needed for different interventions in homes of people in need of care (n = 129) was measured. Ethical approval for the study was obtained. The literature on the topic is limited. In Germany, no fixed staff‐to‐client ratio exists, but staffing is determined primarily by reimbursement policies, not by care recipients’ needs. The results of the interviews indicated that staffing ratios are not the main concern of home‐care providers. Experts stressed that general availability of staff with different qualification levels and the problems of existing regulation on services and their reimbursement are of higher concern. The measurement of time needed for selected interventions reveals the huge heterogeneity of home‐care service delivery and the difficulty of using a task‐based approach to determine staffing levels. Overall, the study shows that currently demand for home‐care exceeds supply. Staff shortage puts a risk to home care in Germany. Existing approaches of reimbursement‐driven determination of staffing levels have not been sufficient. A new balance between staffing, needs and reimbursement policies needs to be developed.
Possessing skills in social and intercultural interaction is vitally important for employees who work in globalized environments, especially as people's working lives tend to involve an increasingly large amount of service-related activities. As a consequence, universities offer cultural studies courses and strive to enable their students to study abroad for a period of time. However, there is still no widely shared agreement on how intercultural experiences and cultural preparation courses predict the perception, thinking and acting of individuals. Therefore, the study at hand uses a cross-sectional design with N = 430 participants in order to investigate whether students of cultural studies gain more intercultural competencies during the time spent studying abroad, compared to studies of other subjects. The results reveal that students of cultural subjects show significantly higher levels of cultural empathy and openness in the post hoc measurement, even though there was no interaction effect with the amount of time spent studying abroad. Length of stay abroad had a significant indirect effect on social competence via all the dimensions of the Multicultural Personality Questionnaire. Moreover, results indicate that flexibility to adapt one's behaviour to cultural norms may predict problems when returning to one's home country.
The political geography of central government debt has hardly been investigated. We propose a method for calculating implicit interregional transfers stemming from central government debt.
We apply this method to Belgium over the 1970-2016 period. The share of poorer Francophone Belgium in debt-financed central government spending was persistently larger than its share in central government revenue used to pay the resulting interest bills. The opposite holds for richer Flanders. Also, a primary deficit in one particular year leads to an interest bill in each of the following years as long as debt caused by that primary deficit is not repaid. All the above caused debt-related transfers from Flanders to Francophone Belgium of over 7% of Flemish GDP during many years.
Interregional interest transfers may also be large in the many other democracies suffering from both high central government debt and considerable geographic income disparities.
The size of these transfers may in turn explain the size and persistence of central government deficits. This is also because poorer, less densely populated regions such as Francophone Belgium tend to be overrepresented within central governments. This strengthens their ability to cause deficits.
We recommend more fiscal decentralisation or at least smaller central government deficits.
Objectives: This study aimed at the construction of what the core of eHealth policy making is, offering new perspectives about high priority procedures along the policy making process
Methods: Following Grounded Theory methodology, 59 qualitative telephone interviews with a broad variety of stakeholders from Austria, Switzerland and Germany were conducted
Results: The findings hinted at five priorities of eHealth policy making: strategy, consensus-building, decision-making, implementation and evaluation that emerged from the stakeholders’ perception of the eHealth policy. Hereby strategy, consensus-building and implementation gained the highest attention
Conclusions: These findings suggest three high priorities in eHealth policy: 1) developing and pursuing a consistent eHealth strategy, 2) investing time and resources into consensus-building to clear up difficulties early on in the process, 3) governing implementation towards serving patient care through systems fit for practice.
Public Interest Summary: Digitalisation is playing an increasingly crucial role in providing high quality health care. However, different countries have pursued different political paths. In this study, we wanted to know how the stakeholders perceived the political process in their country to identify strengths and weaknesses. We, therefore, conducted interviews about digital health policy with experts from Austria, Switzerland and Germany covering the full spectrum of stakeholders. The findings suggest three political musts: 1) a convincing and coherent strategy followed throughout the entire process, 2) consensus- building among the stakeholders, 3) using “fit for practice” as the yardstick to measure political success.
Professionalization in low-threshold drug aid : between managerialism and practitioner knowledge
(2021)
Background
Digital health technologies enable patients to make a personal contribution to the improvement of their health by enabling them to manage their health. In order to exploit the potential of digital health technologies, Internet-based networking between patients and health care providers is required. However, this networking and access to digital health technologies are less prevalent in sociodemographically deprived cohorts. The paper explores how the use of digital health technologies, which connect patients with health care providers and health insurers has changed during the COVID-19 pandemic.
Methods
The data from a German-based cross-sectional online study conducted between April 29 and May 8, 2020, were used for this purpose. A total of 1.570 participants were included in the study. Accordingly, the influence of sociodemographic determinants, subjective perceptions, and personal competencies will affect the use of online booking of medical appointments and medications, video consultations with providers, and the data transmission to health insurers via an app.
Results
The highest level of education (OR 1.806) and the presence of a chronic illness (OR 1.706) particularly increased the likelihood of using online booking. With regard to data transmission via an app to a health insurance company, the strongest increase in the probability of use was shown by belonging to the highest subjective social status (OR 1.757) and generation Y (OR 2.303). Furthermore, the results show that the higher the subjectively perceived restriction of the subjects' life situation was due to the COVID-19 pandemic, the higher the relative probability of using online booking (OR 1.103) as well as data transmission via an app to a health insurance company (OR 1.113). In addition, higher digital literacy contributes to the use of online booking (OR 1.033) and data transmission via an app to the health insurer (OR 1.034).
Conclusions
Socially determined differences can be identified for the likelihood of using digital technologies in health care, which persist even under restrictive conditions during the COVID-19 pandemic. Thus, the results indicate a digital divide with regard to the technologies investigated in this study.
Currently, the treatment of musicians is an interprofessional approach. Playing-related health complaints may impact the performance of a musician. In Germany, a medical consulting hour for musicians exists, but those for athletes in sports medicine are not so common. The diagnosing and treatment procedure within the physiotherapy consultation for musicians follows a specific concept-b and requires knowledge of instruments and musician-specific complaints. Based on the consulting hour in a clinic in Osnabrueck, 614 case reports were part of this sample, of which 558 data sets were complete. The focus of the analysis is the instrument and the primary complaint. Also, the type of therapy is characterized, and the amount is calculated. Primary complaints of musicians, in general, are found most frequently in the spine and upper extremity. Musician complaints are different between instruments. Instrumentalists have a significantly higher chance to suffer from a primary complaint in the area of the upper extremity. Furthermore, the groups without an instrument (e.g., singing or dancing) are developing complaints in the anatomical area which they primarily use. Therefore, these types of therapy were used: physiotherapy, manual therapy, and osteopathy with an average of 5.9 treatment units. This study underpinned the importance of musician-specific physiotherapy as a profession to treat musicians. Also, an interdisciplinary approach is necessary to treat all aspects of complaints.
The current study presents a new class of functional derivatives (1–3) consisting of a dicationic viologen (4,4’-bipyridinium unit) (V21) capped by nucleobases thymine (NB1), adenine (NB2), thymine/adenine (NB1, NB2), and ion-paired with amphiphilic anion 3,4,5-tris(dodecyloxy)benzene sulfonate (DOBS-). The target of our work focuses on the design and synthesis of molecular building blocks in which three different functionalities are combined: chromophore (V21 unit), molecular recognition (NB unit), and thermotropic liquid crystal (DOBS unit). The resulted materials exhibit liquid crystalline properties at ambient temperature with significant particularities-induced by nucleobases in the mesogen structure. Structure–properties relationship study focuses on providing knowledge about (1) how the thermotropic, redox properties, thermochromism, or ionic conductive properties are influenced by the presence of purinic or pyrimidinic nucleobases, and (2) how effective is their ability to selfassembly by hydrogen bonding in nonpolar solvents. The presence of nucleobases has been proved to have a substantial impact on electron transfer rate during the reduction of viologen moieties by intermolecular aggregation. Ionic conductivity and thermochromic properties of derivatives 1–3 were investigated and compared to a non-containing nucleobase analog methyl viologen with 3,4,5 tris(dodecyloxy)benzene sulfonate anion (MV) as reference.
Introduction
Observations show that foam rolling improves joint movements. Likewise, it can be stated that a vibration stimulation of the tissue leads to improved joint mobility.
Method
This study investigates whether the combination of foam rolling and vibrations (31 Hz) can influence the sliding of the thoracolumbar fascia more effectively than normal foam rolling. 45 subjects participated in the study and were divided into a foam roll with additional vibration group (FRV), a foam roll group (FR) and a control group (CG). The intervention groups rolled out the gluteal muscles, the lateral trunk and the upper and lower back. Mobility measures were taken pre and post the respective intervention. Subsequent cross correlation software analysis quantified the sliding of the fascia and calculated its shear strain mobility (SSM).
Results
The sliding of the thoracolumbar fascia improved significantly within the FRV by 2.83 mm (SD ± 1.08/p < .001), in the FR by 0.96 mm (SD ± 0.43/p < .001) and in the CG decreased the sliding by 0.1401 mm (SD ± 0.28/p = .076). The fascia/fascia SSM increased in the FRV by 22.61% (SD ± 15.64/p < .001), in the FR by 11.41% (SD ± 20.38/p = .056) and in the CG decreased the SSM by 0.9473% (SD ± 11.35/p < .751). The lumbar movement increased in both intervention groups, but showed no significant result.
Conclusion
The use of a foam roll with additional vibration and standard intervention have increased thoracolumbar fascia sliding and lumbar movements. The improved shear strain mobility can be attributed to the multi-activity of mechanoreceptors, such as Pacini- and Ruffini-Bodies.
The management of patients experiencing chronic orofacial pain is a great challenge, due to the complexity of chronic pain itself, combined with an increased peripheral sensitization in the craniofacial itself. Therefore, patients with orofacial pain may present a clear distortion of the somatorepresentation after some time. In this review, the authors develop a neurophysiological explanation of orofacial distortion, as well as propose assessment and treatment options, based on scarcely available scientific evidence and their own clinical experience. The assessments of facial somatosensory, cognitive-affective and motor dysfunctions are crucial to establish the most accurate treatment; the assessment tools are described in the article. Two-point discrimination, laterality recognition and emotion recognition are altered in patients with orofacial pain. Other sensorimotor assessment tools, such as motor acuity and auditory acuity, are also explained. Finally, the authors review their treatment proposals, based on the integration of brain training techniques and biobehavioral interventions. Somatosensory reintegration (tactile acuity training), facial emotion recognition, movement representation techniques, orofacial motor training and therapeutic patient education are explained in detail, and this may challenge new directions in rehabilitation and research.
BACKGROUND: The Craniofacial Pain and Disability Inventory (CF-PDI) is a cross-culturally adapted instrument designed from a biopsychosocial perspective to measure pain, disability, and function in orofacial head and neck pain with shown psychometric properties; however, the German cross-cultural adaption is lacking.
OBJECTIVES: To carry out a transcultural translation of CF-PDI into German and assess its psychometric properties in patients with painful temporomandibular disorders (TMD) with respect to construct and clinical validity, internal consistency and reproducibility.
STUDY DESIGN: Multicenter, prospective, cross-sectional design.
SETTING: Patients (n = 398) were recruited from dental and physical therapy clinics in middle and south Germany.
METHODS: Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We investigated know-group validity by means of the scale’s potential to discriminate between affected and unaffected subjects. Multiple linear regression analysis was used to estimate convergent validity. We tested test-retest reliability by the intraclass correlation coefficient and the Internal consistency by Cronbach’s alpha, or each dimension separately, and the total score. Multiple linear regression analysis was used to estimate convergent validity.
RESULTS: Two hundred forty-six heterogeneous chronic craniofacial pain patients and 152 patients without complaints were recruited from the middle and south of Germany. The German version CF-PDI-G presents 21 items, 4 factors, and adequate psychometric properties. The test-retest reliability and internal consistency of the CF-PDI-G were both excellent for the entire instrument and also for all sub-scales (intraclass correlation coefficient [ICC] > 0.90) except for the comorbidities and interference with work which was acceptable (ICC = 0.69). Standard error of the measurement (SEM) and minimal detectable change values are sufficiently low. Assessment of clinical validity shows good potential of discrimination and classification into categories “no,” “mild,” “moderate,” and “severe.” The multiple linear regression model showed a strong association between neck disability index, Visual Analog Scale, and anamnestic questionnaire (supporting the scale’s convergent validity).
LIMITATIONS: Our sample has a higher prevalence of women and the sample was not recruited consecutively, which may lead to a biased estimation of psychometric properties.
CONCLUSIONS: The CF-PDI-G represents valid and reliable instrument to assess pain and disability in patients with orofacial pain and headache suitable for research and clinical practice.
Chronic illness can have a profound impact on couples’ relationships. In dealing with relational changes, new constructions and forms of relationships may arise. In the context of a larger grounded theory study on relational processes and practices in couples faced with chronic illness, this article focuses on concurrent relationships as an alternative form of relationship construction which embodies an additional relationship existing parallel to that of the couple confronted with chronic illness. Based on qualitative interviews with a subsample of five persons within the larger study, conditions for the development and characteristics of concurrent relationships are presented. From an individual and shared life questioned by chronic illness, concurrent relationships are formed in the attempt to be able to live on together in a new partner relationship and a continued care relationship. This can lead to new constructions of relationships, family life, and social relations in everyday life.
Objective: To understand the meaning of the Learning Incubator as a teaching and learning technology in the nursing area.
Method: Qualitative research, supported by grounded theory. Data was collected from March to November 2019, through interviews with guiding questions and hypotheses directed at two different groups. The analysis was done by comparative data analysis and included open, axial and integrated coding, as proposed by the method. The theoretical sample included 23 participants, which were nurses, technicians, and nursing students.
Results: The delimitation of the categories converged in the phenomenon (Re)signifying knowledge and practices in the Learning Incubator. Guided by the paradigmatic model, the categories were named according to the three following components: Condition: Recognizing that the being and the professional practice are inextricable; Action/interaction: Revisiting professional practices that are repetitive and mechanic; Consequence: Referring to the reflections and knowledge constructed in the Learning Incubator.
Conclusion: The Learning Incubator, as seen by the study participants, is not limited to the Incubator meetings or the themes addressed in it. Beyond a welcoming physical space, the Incubator expands itself and becomes a tool that promotes self-reflection and self-assessment of professional behaviors and attitudes.
Consumer Acceptance and Market Potential of Iodine-Biofortified Fruit and Vegetables in Germany
(2021)
Biofortification of food crops with iodine is a novel approach to preventing iodine deficiency in humans. The present study analyses the consumer target groups and the market potential of iodine-biofortified fruit and vegetables in Germany. For this purpose, an online survey of 1016 German fruit and vegetable consumers was conducted to investigate the acceptance of different product categories as well as relevant criteria for the market launch. The results show that io-dine-biofortified fruit and vegetables are particularly attractive to consumers who purchase at farmers’ markets, organic food shops, and farm stores. Out of this group, 39% of consumers rate such iodine-rich foods as very appealing. They attach importance to food that naturally contains iodine and prefer produce from integrated domestic cultivation. With their focus on sustainability and naturalness, this group of consumers clearly differs from typical users of dietary supplements, who are primarily concerned with health benefits. However, overall about 85% of respondents would prefer biofortified fruits and vegetables to supplements to improve their iodine supply. The greatest market potential for iodine-biofortified fruit and vegetables is to be expected in super-markets, as this is the preferred food shopping location for most consumers. A total of 28% of those who buy here rate the biofortified foods presented as very appealing. Nevertheless, a successful market launch requires that the benefits of the new products are communicated according to the potential consumer group needs.
Objective
Brass players are exposed to high musculoskeletal strains during their instrumental play. Various assessments can be used to measure these strains, whereby a targeted therapy can also be supported. The aim of this study was to review literature concerning assessments used in quantitatively based studies about the analysis of musculoskeletal loads of brass players.
Data sources
The Cochrane Library, PubMed, CINAHL, PEDro as well as the journal “Medical Problems of Performing Artists” were searched for relevant studies.
Study selection
Two reviewers independently applied the inclusion and exclusion criteria to select potential studies. A third reviewer was involved in the case of discrepancies.
Data extraction
Two reviewers independently extracted the data.
Data synthesis
A total of 73 studies conducted between 2004 and 2019 were included. Within a total of 30 studies, 18 assessments could be found that collect 2-dimensional or 3-dimensional kinematic data using video- or image-based analysis of posture, sonographic, optoelectronic and various electromagnetic systems. In 7 studies kinetic data were measured by force-transducers, pressure platforms, stabilizer and dynamometer. Fifteen studies used clinical examinations and additional assessments to screen individual body regions and 9 studies derived electromyography measurements from a total of 25 muscles. Thirty-one partially validated questionnaires were used to record musculoskeletal pain of brass players.
Conclusions
A variety of assessments can be used to optimize analysis and treatment procedures in research and clinical work. Future studies should both examine quality criteria of the various assessment methods and validate clinical examinations and questionnaires.
In this experimental work, the quasi static and fatigue properties of a 40 wt.% long carbon fiber reinforced partially aromatic polyamide (Grivory GCL-4H) were investigated. For this purpose, microstructural parameter variations in the form of different thicknesses and different removal directions from injectionmolded plates were evaluated. Mechanical properties decreased by increasing misalignment away from the melt flow direction. By changing the specimen thickness, no change in the general fiber distribution pattern transversal and normal to the axis of melt flow was observed. It has shown that with increasing specimen thickness the quasi static properties along the melt flow direction decreased and vice versa resulting in superior properties normal to the melt flow axis. At around 5 mm, an intersection suggests quasi-isotropic behavior. In addition, the fatigue strength of the material was significantly higher in the flow direction than normal to the flow direction. No change in fatigue life was observed while changing specimen thickness. The Basquin equation seems to describe the effect of stress amplitude on the fatigue strength of this composite. Scanning electron microscopy was used to investigate fracture surfaces of tested specimens. Results show that mechanical properties and morphological structures depend highly on fiber orientation.
Objective:
to carry out a theoretical reflection on the Nursing Now Campaign and the experience of the unexpected irruptions facing the pandemic period.
Method:
a theoretical-reflective study, supported by the theoretical framework of complexity thinking. It aims at understanding the dialogic between the notions of order, disorder and organization, which translate the transition from simplification to complexity of the pandemic phenomenon and its relation to the theme of Nursing Now and Nursing in the future.
Results:
the universe of phenomena is simultaneously composed of order, disorder and organization. Reasserting the central role of Nursing in the health team, facing the irruptions and uncertainties caused by the current pandemic, implies the ability to dialog with disorder and raise a new and more complex global (re)organization of the being and doing Nursing.
Conclusion:
in addition to answers, theoretical reflection raises new questions and irruptions. The inseparability between the notions of order and disorder in the evolutionary dynamics of the Nursing system is conceived and the promotion of even more complex levels of organization, management and Nursing assistance to achieve universal access to health is advocated.