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Institute
Pregnancy loss is the most common complication in pregnancy. Yet those who experience it can find it challenging to disclose this loss and feelings associated
with it, and to seek support for psychological and physical recovery. We describe our process for
interleaving interviews, theoretical development, speculative design, and prototyping Not Alone to
explore the design space for online disclosures and
support seeking in the pregnancy loss context.
Interviews with 27 women who had experienced pregnancy loss resulted in theoretical concepts such as
“network-level reciprocal disclosure” (NLRD). We discuss how interview findings informed the design of
the Not Alone prototype, a mobile application aimed at enabling disclosure and social support exchange among those with pregnancy loss experience. The Not Alone prototype embodies concepts that facilitate NLRD: perceptions of homophily, anonymity levels, and selfdisclosure by talking about one’s experience and engaging with others’ disclosures. In future work, we will use Not Alone as a technology probe for exploring
NLRD as a design principle.
background: Musculoskeletal problems (MP) are widespread in performing artists and are due to the special demands of instrument playing, singing or dancing. Additionally, various other factors might contribute to performance-related MP. To provide a specific physiotherapeutic management for performing artists it is important to gain information about the performing art, the individual demands and contributing factors. The subjective examination (SE) is the basis of the clinical reasoning process and the hypothesis forming for further clinical examination and biomechanical analysis. In the present protocol, the SE consists of a questionnaire-based section and an interview-based section and is part of the evaluation process of the neuromusculoskeletal examination of a performing artist specific reference laboratory.
purpose: To develop a standardized SE protocol divided into a questionnaire-based section (Part 1) via web application and an interview-based SE (Part 2) to address MP of performing artists.
methods: The questionnaires for part 1 were selected based on the expertise of the research group and the psychometric properties of each possible questionnaire. A common physiotherapeutic recording of findings which addresses the relevant questions of the SE of MP was used. To adapt the anamnesis to performing-associated MP questions specific to instrument playing, singing and dancing were selected on the basis of a literature search and the expertise of the research group.
summary of content/results: Part 1 consists of three topics. (1) information about the performing art, professional level and sociodemographic data, (2) information about pain and pain processing, and (3) the anatomical location of the main MP including a body region-specific questionnaire. Part 2 is based on the five aspects of clinical practice described by Maitland and the Musculoskeletal Clinical Translation Framework by Mitchell et al. The performing arts specific part is particularly focused on performing art specific considerations, physical and psychosocial contributing factors and art-specific activities.
significance: This standardized SE protocol should help clinicians evaluating the musculoskeletal health of performing artists in a standardized and specific way.
Background: Musculoskeletal problems (MP) are widespread in performing artists and are due to the special demands of instrument playing, singing or dancing. In order to specifically evaluate these problems, a reference laboratory is under development. The evaluation covers 4 steps: a subjective examination (SE) including (1) a questionnaire-based online survey and (2) an interview-based anamnesis. On the basis of the results of the SE, hypotheses are formed for (3) an individual musculoskeletal clinical examination and a (4) biomechanical analysis. Here, the focus is on the clinical examination.
Purpose: to develop a standardized protocol for a clinical examination addressing especially musculoskeletal problems in performing artists.
Methods: A common physiotherapeutic clinical examination should be supplemented with techniques, which are specific to performance-related musculoskeletal problems and/or their risk factors. The development was based on a literature search and the clinical expertise of the physiotherapeutic research group.
Summary of content/Results: The performing arts specific clinical examination includes the common analysis of posture as well as passive/active movement capacities and specific differentiating tests in relation to the signs and symptoms of the individual artist. The examination is supplemented by a functional demonstration focusing on the special demands of playing the respective instrument, while singing or dancing. Common overuse risk factors like hypermobility, special anthropometric data or an examination of the motor control of different body regions are addressed. Optional, the various parts of the examination process could be skipped, if not relevant for the individual artist.
Significance: This clinical examination protocol should help clinicians evaluating the musculoskeletal health of performing artists in a standardized and specific way.
Problem-based learning (PBL) has become established as a successful didactic approach far beyond the field of medicine. Although there is no single concept of PBL, there is agreement on its objectives and implementation. Of central importance is the case that supports autonomous and reflective learning. Even before COVID-19, digital methods were used in traditional PBL. These served to support, for example, the provision of learning materials. As a result of university closures during the COVID-19 pandemic, technical solutions were made available at an unprecedented speed, which made it possible to implement the different requirements of traditional PBL in a digital PBL (DPBL). The present study results based on two scoping reviews demonstrated that PBL can be implemented digitally and that different digital methods, both asynchronous and synchronous, are available for the different steps. They show that DPBL not only leads to comparable student performance, but can also develop further competences, e.g. digital communication. With the findings, a concept for the implementation of DPBL as well as recommendations for the further development of DPBL are available.
Hypothesis/Aims of study
Many results related to the effectiveness of surgical and non-surgical proce- dures for treating urinary incontinence (UI) are reported in the literature. Following the principles of evidence based-practice, besides the interpreta- tion of study results based on statistical significance, authors should consid- er evaluating the clinical relevance of treatment effects in this field.
The minimal important difference (MID) of clinical outcomes could be used to assess the clinical relevance of interventions. MID is defined as “the small- est difference in score in the domain of interest that patients perceive as important, either beneficial or harmful, and which would lead the clinician to consider a change in the patient’s management’’[1]. One common way to obtain MID for outcomes of interest is by using anchor-based methods. These methods apply one anchor that analyzes the change in the patient's health status according to the patient’s perception.
However, MIDs should be provided according to appropriate calculations and methods and based on the definition of a MID. However, there are a lot of misconceptions and misunderstandings related to the MID. These mis- understandings have led to incorrect reports of these values. Moreover, it is still not known which criteria the authors considered during the analysis of the MID in the Women’s Health area. Therefore, with this preliminary re- port, we aimed to identify and report all anchor-based methods to estimate MIDs for outcomes measures related to UI available in the literature; and analyze which concepts and levels of improvement in the health status of the patient have been considered by the authors to calculate the MID.
Study design, materials and methods
This systematic review was conducted according to PRISMA guide- lines. The study protocol was registered in the PROSPERO database (CRD42022299686). A systematic search was performed using Ovid Med- line, Embase, Web of Science, and Scopus from May to June 2021. Any study generating MIDs for UI that included women with more than 18 years, stress urinary incontinence (SUI), urgency urinary incontinence (UUI) and/ or miXed urinary incontinence (MUI) was included. The primary outcome was the MID for outcomes related to UI. No limits were applied on the data- bases for the date, language or publication range.
Studies were classified into three categories according to the level of im- provement in health status assessed by the anchor and considered by the authors during the MID calculation: 1) slight improvement: if authors in- cluded participants that evaluated their health status as “a little better” in their analysis; 2) moderate improvement: if authors considered women that reported a “better” or a “much better” status of the condition; or 3) strong imporvement: if all patients that improved (“very much better” or if authors grouped all the patients that improved in one single category) were consid- ered in one group against other group that did not report any improvement. After classifying the papers, we counted and reported how many studies were considering only the minimal level of improvement to reported the MID, according to previous definition and recommendation.
The initial electronic search resulted in a total of 1,662. After removing du- plicates (n=719), 943 were screened, and at the end of the selection stages, nine papers that reported anchor-analysis were included in this preliminary report. Seven studies included women with SUI (total sample size= 2,436), while one study included only women with UUI (n=307), and the other one evaluated women with SUI and MUI (n=288). SiX studies analyzed data and provided the MID after a non-surgical treatment of UI, while three analyzed the results after surgery to correct UI. Eleven different questionnaires to measure the patient-related outcomes related to UI with their MIDs were identified. All the tools were related to measuring the impact, distress, or quality of life of women with UI.
Different anchors were used to analyze MID, including scales that evaluated the improvement and satisfaction of the patient, and the visual analogue scale, measures of urinary leakage and questionnaires that measure the se- verity and impact of UI. The MID of siX tools was determined according to the smallest difference detected by the patients, using the Patient Global Im- pression of Improvement questionnaire and the self-reported satisfaction to assess the change of the condition. Most of the MIDs (n=28, 80%) were mis- calculated considering a moderate or a strong improvement of the patients, and not a minimal improvement as suggested by the literature (Table 1).
Interpretation of results
Although previous systematic reviews have reported the psychometric prop- erties of different questionnaires to measure UI outcomes, this is the first study to analyze methods of obtaining MIDs for UI outcomes from the pa- tients perspective (anchor based methods). All the tools with their respec- tives MIDs were related to the impact, distress, and/or quality of life of women with UI. The use of these outcomes measures is in line with the as- sociated impairments of social, psychological, financial, and sexual aspects of a women’s life produced by UI.
Most of the authors in this field did not consider the smallest difference identified by the participants to calculate the MID, which does not follow the original definition of MID proposed by Jaeschke et al.,1 This could gen- erate underestimation or over-estimation of MID, which may directly im- pact the interpretation of the findings from the clinical trials[2] and biased interpretation of the results of the clinical significance from the interven- tions used to manage female UI. Therefore, the interpretation of the clinical significance related to UI outcomes should be done with caution.
Concluding message
Few studies that aimed to calculate the MID using anchor-based methods for outcomes related to female UI were found in the literature. Eleven different questionnaires to measure the outcomes related to UI with their MIDs were identified. However, most studies had not considered the smallest change of improvement (as perceived by the patients) in their analysis, which does not follow the definition of the MID. This could impact decision making. Future research should provide clear guidelines on how to calculate, report, and interpret MIDs in this field.
Advances in high-throughput DNA sequencing have propelled research into the human microbiome and its link to metabolic health. We explore microbiome analysis methods, specifically emphasizing metabolomics, how dietary choices impact the production of microbial metabolites, providing an overview of studies examining the connection between enterotypes and diet, and thus, improvement of personalized dietary recommendations. Acetate, propionate, and butyrate constitute more than 95% of the collective pool of short-chain fatty acids. Conflicting data on acetate’s effects may result from its dynamic signaling, which can vary depending on physiological conditions and metabolic phenotypes. Human studies suggest that propionate has overall anti-obesity effects due to its well-documented chemistry, cellular signaling mechanisms, and various clinical benefits. Butyrate, similar to propionate, has the ability to reduce obesity by stimulating the release of appetite-suppressing hormones and promoting the synthesis of leptin. Tryptophan affects systemic hormone secretion, with indole stimulating the release of GLP-1, which impacts insulin secretion, appetite suppression, and gastric emptying. Bile acids, synthesized from cholesterol in the liver and subsequently modified by gut bacteria, play an essential role in the digestion and absorption of dietary fats and fat-soluble vitamins, but they also interact directly with intestinal microbiota and their metabolites. One study using statistical methods identified primarily two groupings of enterotypes Bacteroides and Ruminococcus. The Prevotella-dominated enterotype, P-type, in humans correlates with vegetarians, high-fiber and carbohydrate-rich diets, and traditional diets. Conversely, individuals who consume diets rich in animal fats and proteins, typical in Western-style diets, often exhibit the Bacteroides-dominated, B-type, enterotype. The P-type showcases efficient hydrolytic enzymes for plant fiber degradation but has limited lipid and protein fermentation capacity. Conversely, the B-type features specialized enzymes tailored for the degradation of animal-derived carbohydrates and proteins, showcasing an enhanced saccharolytic and proteolytic potential. Generally, models excel at predictions but often struggle to fully elucidate why certain substances yield varied responses. These studies provide valuable insights into the potential for personalized dietary recommendations based on enterotypes
Diet can influence healthy aging through anti- or proinflammatory effects, partly by modulating the gut microbiome composition. This study investigated the relationships between the Dietary Inflammatory Index (DII), the gut microbiome, and nutritional status in elderly individuals. Methods: This cross-sectional analysis included 114 home-dwelling individuals aged over 70 years. The Energy-adjusted DII (E-DII) was calculated from 3-day food diaries, and blood samples were taken to measure micronutrient status, glucose, and lipid metabolism. Body composition was assessed using bioimpedance, and fecal gut microbiome composition was analyzed through 16S rRNA gene sequencing. The participants were categorized into maintaining an anti-inflammatory diet (AD) and a pro-inflammatory diet (PD) based on the median E-DII score. The associations of E-DII groups with blood markers and microbial diversity and composition were examined using the analysis of covariance, permutational analysis of variance, and multivariate linear models. Results: The AD (n = 57, 76 ± 3.83 years) and PD (n = 57, 75 ± 5.21 years) groups were similar in age but differed in sex distribution, with a higher proportion of females in the AD group (p = 0.02). When compared to the PD group and adjusted for sex, the AD group had a lower body mass index, fat mass, fasting insulin level, HOMA-IR (Homeostasis Model Assessment of Insulin Resistance), fasting triglycerides, and serum uric acid concentration (all p < 0.05), with higher concentrations of high-density lipoprotein, red-blood-cell folate (RBC), and Omega-3 index (all p < 0.05). While the microbial diversity and composition did not differ between the DII groups, folate concentrations were negatively associated with Agathobacter and positively associated with Bacteroides abundance (both q = 0.23). Lower uric acid concentrations were associated with a higher abundance of Bifidobacterium (q = 0.09) and lower abundance of Phocaeicola (q = 0.11). Discussion: The study suggests that following an anti-inflammatory diet is associated with improved nutritional status in the elderly. Dietary blood markers, rather than E-DII, were found to be associated with the gut microbiome, suggesting a potential link between the microbiome and changes in nutritional markers independent of diet. Further studies are needed to explore the causal relationship between dietary inflammatory potential, gut microbiome, and healthy aging.
Nitrogen (N) pollution of groundwater bodies is often a result of high livestock densities combined with use of mineral N fertilisers in Northwest Germany, specifically in combination with sandy soils and high amounts of precipitation. Organic agriculture is discussed as an alternative management practice reducing nitrogen losses due to area-based livestock densities and waiving of mineral N fertilisers. A field trial with integrated ceramic suction cups over three years showed potential for reduced N loads under conventional management specifically with organic fertilisation. Now, the field trial is under transition into organic farming with promising additional benefits for drinking water quality and the great potential to develop optimised N management strategies.
Oleamide is used as a lubricant in the manufacturing and application of polypropylene (PP) medical devices. Samples of PP were prepared with 0, 1500, and 15 000 ppm oleamide content as lubricant. The samples were either left non-sterile, sterilized with ethylene oxide (ETO), γ-radiation (γ) or autoclaved (A) and stored for up to 4 weeks. To determine the oleamide bulk-to-surface distribution depending on sterilization method and storage time an extraction method and a washing technique were applied. The oleamide content was determined by gas chromatography (GC-FID) and compared with the coefficient of friction (COF). The COF dependent on the measured lubricant content at the surface. The content of lubricant on the surface depends on the type of sterilization: ETO increased the lubricant content to some extent, γ-sterilization and autoclaving reduced it. After storage, no migration of the lubricant to the surface could be detected.
Primary Liver Cancers : Connecting the Dots of Cellular Studies and Epidemiology with Metabolomics
(2023)
Liver cancers are rising worldwide. Between molecular and epidemiological studies, a research gap has emerged which might be amenable to the technique of metabolomics. This review investigates the current understanding of liver cancer’s trends, etiology and its correlates with existing literature for hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA) and hepatoblastoma (HB). Among additional factors, the literature reports dysfunction in the tricarboxylic acid metabolism, primarily for HB and HCC, and point mutations and signaling for CCA. All cases require further investigation of upstream and downstream events. All liver cancers reported dysfunction in the WNT/β-catenin and P13K/AKT/mTOR pathways as well as changes in FGFR. Metabolites of IHD1, IDH2, miRNA, purine, Q10, lipids, phosphatidylcholine, phosphatidylethanolamine, acylcarnitine, 2-HG and propionyl-CoA emerged as crucial and there was an attempt to elucidate the WNT/β-catenin and P13K/AKT/mTOR pathways metabolomically.
Objectives: Among varied challenges of COVID-19, challenges in food and nutrition security world-over are critical. We compared the nutritional policy responses in India and Germany since both countries differ on the Human Development Index, yet both have committed to the G20 common policy response to COVID-19, besides the comparability of two large and heterogeneously populated countries, both having democratic governments.
Methods: Policy research publications were reviewed using qualitative meta-policy approach. We used comparative case-study. Recent food and nutrition policies of G20 nations of India and Germany were evaluated.
Results: India has primarily targeted her public distribution system and Germany has primarily targeted her food markets in order to manage the food and nutrition security in response to COVID-19. Both countries are coordinating additional associated nutritional policies, policies and strategies to effect an integrated sectoral approach to COVID-19 management. Both are using corrective measures of the process management strategies as well. However, the Indian management of micronutrient security for her population has over COVID-19 times acerbated and the German loan management to nutrition and agricultural small-scale industry appears to be functioning sub-optimally.
Conclusions: Our analysis indicates both India and Germany have responded to COVID-19 in a timely and appropriate manner regarding the food and nutrition security measures. Even so not all measures employed to tackle COVID-19 food and nutrition security have been effectively implemented, It appears, that both countries are using integrated policy in their nutrition and food security response to COVID-19.
Longitudinal analysis investigates period (P), often as years. Additional scales of time are age (A) and birth cohort (C) Aim of our study was to use ecological APC analysis for women breast cancer incidence and mortality in Germany. Nation-wide new cases and deaths were obtained from Robert Koch Institute and female population from federal statistics, 1999–2008. Data was stratified into ten 5-years age-groups starting 20–24 years, ten birth cohorts starting 1939–43, and two calendar periods 1999–2003 and 2004–2008. Annual incidence and mortality were calculated: cases to 100,000 women per year. Data was analyzed using glm and apc packages of R. Breast cancer incidence and mortality increased with age. Secular rise in breast cancer incidence and decline in mortality was observed for period1999-2008. Breast cancer incidence and mortality declined with cohorts; cohorts 1950s showed highest incidence and mortality. Age-cohort best explained incidence and mortality followed by age-period-cohort with overall declining trends. Declining age-cohort mortality could be probable. Declining age-cohort incidence would require future biological explanations or rendered statistical artefact. Cohorts 1949–1958 could be unique in having highest incidence and mortality in recent time or future period associations could emerge relatively stronger to cohort to provide additional explanation of temporal change over cohorts.
Background
We explore the association between bone T-scores, used in osteoporosis diagnosis, and functional status since we hypothesized that bone health can impact elderly functional status and indirectly independence.
Methods
In a cross-sectional study (2005–2006) on community dwelling elderly (> = 75 years) from Herne, Germany we measured bone T-scores with Dual-energy X-ray Absorptiometry, and functional status indexed by five geriatric tests: activities of daily living, instrumental activities of daily living, test of dementia, geriatric depression score and the timed-up-and-go test, and two pooled indexes: raw and standardized. Generalized linear regression was used to determine the relationship between T-scores and functional status.
Results
From 3243 addresses, only 632 (19%) completed a clinical visit, of which only 440 (male∶female, 243∶197) could be included in analysis. T-scores (−0.99, 95% confidence interval [CI], −1.1–0.9) predicted activities of daily living (95.3 CI, 94.5–96.2), instrumental activities of daily living (7.3 CI, 94.5–96.2), and timed-up-and-go test (10.7 CI, 10.0–11.3) (P< = 0.05). Pooled data showed that a unit improvement in T-score improved standardized pooled functional status (15 CI, 14.7–15.3) by 0.41 and the raw (99.4 CI, 97.8–101.0) by 2.27 units. These results were limited due to pooling of different scoring directions, selection bias, and a need to follow-up with evidence testing.
Conclusions
T-scores associated with lower functional status in community-dwelling elderly. Regular screening of osteoporosis as a preventive strategy might help maintain life quality with aging.
Studies on nutrition have historically concentrated on food-shortages and over-nutrition. The physiological states of feeling hungry or being satiated and its dynamics in food choices, dietary patterns, and nutritional behavior, have not been the focus of many studies. Currently, visual analytic using easy-to-use tooling offers applicability in a wide-range of disciplines. In this interdisciplinary pilot-study we tested a novel visual analytic software to assess dietary patterns and food choices for greater understanding of nutritional behavior when hungry and when satiated. We developed software toolchain and tested the hypotheses that there is no difference between visual search patterns of dishes 1) when hungry and when satiated and 2) in being vegetarian and non-vegetarian. Results indicate that food choices can be deviant from dietary patterns but correlate slightly with dish-gazing. Further, scene perception probably could vary between being hungry and satiated. Understanding t he complicated relationship between scene perception and nutritional behavioral patterns and scaling up this pilot-study to a full-study using our introduced software approaches is indispensable.
Background
The aim of this qualitative study was to identify a practice level model that could explain a sustained change in nutritional behavior.
Methods
The study used three data inputs from four interviewees, one merged input from a married couple, as narrative interviews. The interviews were analyzed using grounded theory.
Results
Coexistence of a certain suffering and a triggering episode lead to the decision to change nutritional life-style by all interviewed. Maintenance of the self-determined newly learned nutritional behavior was supported by subject-related intrinsic motivation, the ability to reflect, and a low expectation of success from the behavioral change. Environment-related factors were identified as support from life-partner and peers. Subjects reported that the sustained nutritional behavior change impacted their holistic health through subject-perceived improved life quality, increase in the number of social contacts, and a change in personal attitudes and perception. The analysis remains limited, and at best hypothesis generating, in that only three data inputs from four interviewees were used.
Conclusion
In this hypothesis-generating narrative interview study of four study subjects, volition, personal decision making, and long-term motivation (though not external determination) seemed to sustain a change in newly learned nutritional behavior.
Objectives
To develop a time-efficient motor control (MC) test battery while maximising diagnostic accuracy of both a two-level and three-level classification system for patients with non-specific low back pain (LBP).
Design
Case–control study.
Setting
Four private physiotherapy practices in northern Germany.
Participants
Consecutive males and females presenting to a physiotherapy clinic with non-specific LBP (n=65) were compared with 66 healthy-matched controls.
Primary outcome measures
Accuracy (sensitivity, specificity, Youden index, positive/negative likelihood ratio, area under the curve (AUC)) of a clinically driven consensus-based test battery including the ideal number of test items as well as threshold values and most accurate items.
Results
For both the two and three-level categorisation system, the ideal number of test items was 10. With increasing number of failed tests, the probability of having LBP increases. The overall discrimination potential for the two-level categorisation system of the test is good (AUC=0.85) with an optimal cut-off of three failed tests. The overall discrimination potential of the three-level categorisation system is fair (volume under the surface=0.52). The optimal cut-off for the 10-item test battery for categorisation into none, mild/moderate and severe MC impairment is three and six failed tests, respectively.
Conclusion
A 10-item test battery is recommended for both the two-level (impairment or not) and three-level (none, mild, moderate/severe) categorisation of patients with non-specific LBP.
Introduction:
Due to demographic change and lack of health care personnel new solutions like preventive home visits (PHV) are necessary. PHV reduces the risk of long-term care and therefore, enables older people to live in their home as long as possible.
Aim of the study:
The aim of this study is to analyse the acceptance of PHV and the effect of PHV on health status of the older people.
Methods:
In this mixed method study PHV as a nursing intervention will be offered to people older than 65 years, not yet eligible for benefits from the long-term care insurance and living in Emlichheim, a region in the northwestern part of Lower Saxony. A sample of 75 people is determined. The health status will be recorded with the Short Form 12 questionnaire. Fifteen semi-structured interviews will be performed to investigate acceptance of the PHV intervention. Quantitative data will be analysed using inferential statistics, qualitative data will be analysed using content analysis. Ethical approval has been obtained.
Results:
It is expected that the findings of this study complete current knowledge about the concept of PHV.
Practical relevance:
This study is of high practical relevance, because additional insights of acceptance might enable the adaption of the PHV concept. Furthermore, increased knowledge and motivation for preventive behaviour of the older people is anticipated in order to extend their autonomy. The results of this study could contribute to the implementation of PHV in Germany, especially in rural areas. It tends to allow a self-determined life in their familiar environment for the older people, as the biggest need of this group.
Aims and Objectives:
Preventive home visits are a low-threshold counselling and support approach. They have been reported to achieve heterogeneous effects. However, preventive home visits have the potential to reduce the risk of becoming dependent on long-term care. The aim of this study is to investigate the effect of preventive home visits as a nursing intervention on health-related quality of life of older people in a longitudinal survey and to develop recommendations for which target groups preventive home visits have the highest benefit. The sample consisted of 75 people, aged between 65 and 85, who were able to understand and speak German, had not yet been eligible for benefits from the long-term care insurance and lived in the municipality under study.
Methodological Design and Justification:
A quantitative longitudinal study in order to investigate the effects of preventive home visits.
Ethical Issues and Approval:
There were no ethical concerns. Accordingly, ethical approval was granted.
Research Methods, Results and Conclusions:
The health-related quality of life was recorded four times between 01/2017 and 08/2020 with the Short-Form- Health- Survey- 12 and analysed using descriptive statistics. Results reveal that the physical health status cannot be easily influenced over a short period of time. The main effect, however, is that preventive home visits have a significant positive effect on the mental health status. The main topics during the home visits were mobility, nutrition and social participation. Increased knowledge and motivation for preventive behaviour extended the autonomy of older people. Accordingly, preventive home visits can support a self-determined life in a familiar environment. The results of the present study show that preventive home visits as a nursing intervention in rural areas are successful. In Germany, preventive home visits have not yet been implemented on a regular basis. In order to do so, a general definition of the concept is needed. Preventive home visits should be officially included in the regular health care services in Germany.
The development of non-precious metal-based electrodes that actively and stably support the oxygen evolution reaction (OER) in water electrolysis systems remains a challenge, especially at low pH levels. The recently published study has conclusively shown that the addition of haematite to H2 SO4 is a highly effective method of significantly reducing oxygen evolution overpotential and extending anode life. The far superior result is achieved by concentrating oxygen evolution centres on the oxide particles rather than on the electrode. However, unsatisfactory Faradaic efficiencies of the OER and hydrogen evolution reaction (HER) parts as well as the required high haematite load impede applicability and upscaling of this process. Here it is shown that the same performance is achieved with three times less metal oxide powder if NiO/H2 SO4 suspensions are used along with stainless steel anodes. The reason for the enormous improvement in OER performance by adding NiO to the electrolyte is the weakening of the intramolecular O─H bond in the water molecules, which is under the direct influence of the nickel oxide suspended in the electrolyte. The manipulation of bonds in water molecules to increase the tendency of the water to split is a ground-breaking development, as shown in this first example.
The relevance of cross-industry innovation has increased in recent decades with a growing number of inter-industry fields emerging on the borderline between formerly distinct industries. The aim of this paper is to analyse industry convergence in four probiotics innovation value chains based on the following indicators: cross-industry relationships along the innovation value chain as well as knowledge, technological, regulatory and competence convergence. In so doing, the study delivers a framework of indicators for scrutinising industry convergence processes. In order to identify industry convergence, we analyse companies in the converging area of foods and drugs based on products containing the four bacteria strains: Lactobacillus caseii DN 114001, Bifidobacterium lactis Bb12, Lactobacillus acidophilus LA5 and Lactobacillus rhamnosus. Hence, the commercial availability of the strains on the market serves as a selection criterion. Altogether 12 companies stemming from four industrial backgrounds, food and agriculture (5), pharmaceutics (5), chemistry (1) and personal care (1), as well as one research organisation are identified. Cross-industry relationships occur along the innovation value chains of the four strains. Clear signs of knowledge and technological convergence are found as companies are not only publishing and patenting in the usual area of their own industrial field but also in the area of other industrial fields. Companies with different industrial backgrounds show activities in obtaining health claims indicating regulatory convergence. Companies' competence bases seem to converge as companies with different industrial backgrounds are involved in acquisitions, licencing agreements and strategic alliances (competence convergence). We contribute to the existing body of literature by assessing industry convergence from an innovation value chain perspective with a set of indicators reflecting the intensity of industry convergence. This framework of indicators stemming from literature has not yet been used in a combined comprehensive analysis. Furthermore, we tried to show the characteristics of strategic types driving industry convergence in probiotics.
Current discussions about the concept of nutritional sustainability show a high complexity of this topic leading to many different definitions. Regarding communication issues of nutritional sustainability between actors of food chains this complexity should be reduced. One opportunity to tackle these challenges of reducing complexity might be the concept of ingredient branding. Therefore, the aim of this mini-review is the identification of conditions for ingredient branding application as a communication strategy for nutritional sustainability which might overcome challenges in communicating the complexity between the different stakeholders of supply chains. In doing so, the specific case of agrifood chains is discussed based on the selected characteristics of globalization, increasing consumer demands, foods incorporating credence attributes and price. Along the agrifood chain, a sourcing strategy reflecting nutritional and sustainable aspects might lead to an ingredient branding strategy implying a brand policy for a special ingredient within the final product which is an important component but cannot be clearly recognized by the user. A “nutritional sustainability inside” strategy should reflect the multifaceted information along the agrifood chain and should be based on standardized criteria for nutritional sustainability.
Duckweed is a promising resource for future feed and food production as well as wastewater treatment. However, diseases and pests can critically limit the performance of the production systems. Patches of discolored and bleached duckweed (Lemna minor L.) appeared in hydroponic systems and spread rapidly through the crop. Pythium myriotylum was confirmed as the causing pathogen by microbiological and molecular biological analysis. This is the first report of P. myriotylum on duckweed in Germany. The result and possible countermeasures are discussed.
High Performance and Privacy for Distributed Energy Management: Introducing PrivADE+ and PPPM
(2018)
Distributed Energy Management (DEM) will play a vital role in future smart grids. An important and often
overlooked factor in this concept is privacy. This paper presents two privacy-preserving DEM algorithms
called PrivADE+ and PPPM. PrivADE+ uses a round-based energy management procedure for switchable and
dynamically adaptable loads. PPPM utilises on the market-based PowerMatcher approach. Both algorithms
apply homomorphic encryption to privately gather aggregated data and exchange commands. Simulations
show that PrivADE+ and PPPM achieve good energy management quality with low communication requirements
and without negative influences on robustness.
Introduction Development and implementation of appropriate health policy is essential to address the rising global burden of non-communicable diseases (NCDs). The aim of this study was to evaluate existing health policies for integrated prevention/management of NCDs among Member States of the Organisation for Economic Co-operation and Development (OECD). We sought to describe policies’ aims and strategies to achieve those aims, and evaluate extent of integration of musculoskeletal conditions as a leading cause of global morbidity.
Methods Policies submitted by OECD Member States in response to a World Health Organization (WHO) NCD Capacity Survey were extracted from the WHO document clearing-house and analysed following a standard protocol. Policies were eligible for inclusion when they described an integrated approach to prevention/management of NCDs. Internal validity was evaluated using a standard instrument (sum score: 0–14; higher scores indicate better quality). Quantitative data were expressed as frequencies, while text data were content-analysed and meta-synthesised using standardised methods.
Results After removal of duplicates and screening, 44 policies from 30 OECD Member States were included. Three key themes emerged to describe the general aims of included policies: system strengthening approaches; improved service delivery; and better population health. Whereas the policies of most countries covered cancer (83.3%), cardiovascular disease (76.6%), diabetes/endocrine disorders (76.6%), respiratory conditions (63.3%) and mental health conditions (63.3%), only half the countries included musculoskeletal health and pain (50.0%) as explicit foci. General strategies were outlined in 42 (95.5%) policies—all were relevant to musculoskeletal health in 12 policies, some relevant in 27 policies and none relevant in three policies. Three key themes described the strategies: general principles for people-centred NCD prevention/management; enhanced service delivery; and system strengthening approaches. Internal validity sum scores ranged from 0 to 13; mean: 7.6 (95% CI 6.5 to 8.7).
Conclusion Relative to other NCDs, musculoskeletal health did not feature as prominently, although many general prevention/management strategies were relevant to musculoskeletal health improvement.
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The last two decades have been characterized by a fundamental change in the approaches, tools and instruments in the quality management at Higher Education Institutions. Comparison of two Higher Education Institutions in the Slovak Republic and Germany highlights similarities and trends in quality assurance. Both case studies show how multifaceted the quality management is, and the needs to be approached if a meaningful progress is to be made. Complexity has to be explicitly recognized and built into the approach chosen. Higher Education Institutions have to develop internal quality assurance processes. Quality culture is key for addressing the challenges.
Talent scarcity in emerging economies such as India poses challenges for companies. Limited labour market participation among well-educated women has been observed. The reasons that professionals decide not to pursue a further corporate career remain unclear. By investigating their career decision making, this handout summerizes research results from a study that aims to highlight the contextual factors that impact those decisions.
Following a qualitative research design interviews with internationally experienced Indian business professionals show that rebellion against Indian societal and family expectations is essential to following a career path, especially for women. The current institutional framework of society and organizations serves as a legitimizing façade veiling traditional practices that hinder females’ careers.
This paper introduces ideas to reduce talent scarcity by binding female talent in India. As a theoretical lens Neo-Institutionalism in the Indian context is combined with the family-relatedness of work decision model. The qualitative research design and first results as well as propositions for companies are included.
Career Decisions of Indian Female Talent: Implications for Gender-sensitive Talent Management
(2020)
Purpose: Talent scarcity in emerging economies such as India poses challenges for companies,and limited labour market participation among well-educated women has been observed. The reasons that professionals decide not to pursue a further corporate career remain unclear. By investigating career decision making, this article aims to highlight (1) the contextual factors that impact those decisions, (2) individuals’ agency to handle them, and (3) the implications for talent management (TM).
Design/methodology/approach: Following a qualitative research design, computer-aided analysis was conducted on interviews with 24 internationally experienced Indian business professionals. A novel application of neo-institutionalism in the Indian context was combined with the family-relatedness of work decisions (FRWD) model.
Findings: Career decisions indicate that rebellion against Indian societal and family expectations is essential to following a career path, especially for women. TM as part of the current institutional framework serves as a legitimising façade veiling traditional practices that hinder females’ careers.
Research limitations: Interviewees adopted a retrospective perspective when describing their career decisions; therefore, different views might have existed at the moment of decision making.
Practical implications: Design and implementation of gender-sensitive TM adjusted to fit the specific Indian context can contribute to retaining female talent in companies and the labour market.
Originality/value: The importance of gender-sensitive TM can be concluded from an empirical study of the context-based career decision making of experienced business professionals from India. The synthesis of neo-institutionalism, the FRWD model and the research results provides assistance in mapping talent experiences and implications for overcoming the challenges of talent scarcity in India.
Talent scarcity in many parts of the world leads to the necessity to enlarge talent pools in order to provide enough future holders of key positions. Taking the scholarly discussion at the overlap of talent management and current careers literature as a starting point our qualitative empirical research provides insights in talent’s career decisions in an eastern emerging market, India, and a western developed country, Germany. 49 interviews with internationally experienced knowledge-workers were held to find out how to they come to career decisions throughout their career. Special focus was the balancing act of professional and private life sphere. An inductive-deductive approach was used to develop categories in MaxQda. Results show the impact of institutional frame, cultural context, and gender differences. Consequently, a stronger focus on talent’s different life phases with context specific deviations when configuring Talent Management in Multinational Enterprises can be advised.
HRM processes are increasingly AI-driven, and HRM supports the general digital transformation of companies’ viable competitiveness. This paper points out possible positive and negative effects on HRM, workplaces, and workersorganizations along the HR processes and its potential for competitive advantage in regard to managerial decisions on AI implementation regarding augmentation and automation of work.
A systematic literature review that includes 62 international journals across different disciplines and contains top-tier academic and German practitioner journals was conducted. The literature analysis applies the resource-based view (RBV) as a lens through which to explore AI-driven HRM as a potential source of organizational capabilities.
The analysis shows four ambiguities for AI-driven HRM that might support sustainable company development or might prevent AI application: job design, transparency, performance and data ambiguity. A limited scholarly discussion with very few empirical studies can be stated. To date, research has mainly focused on HRM in general, recruiting, and HR analytics in particular.
The four ambiguities’ context-specific potential for capability building in firms is indicated, and research avenues are developed.
This paper critically explores AI-driven HRM and structures context-specific potential for capability building along four ambiguities that must be addressed by HRM to strategically contribute to an organization’s competitive advantage.
We investigated whether design experts or laypersons evaluate webpages differently. Twenty participants, 10 experts and 10 laypersons, judged the aesthetic value of a webpage in an EEG-experiment. Screenshots of 150 webpages, judged as aesthetic or as unaesthetic by another 136 participants, served as stimulus material. Behaviorally, experts and laypersons evaluated unaesthetic webpages similarly, but they differed in their evaluation of aesthetic ones: experts evaluated aesthetic webpages as unaesthetic more often than laypersons did. The ERP-data show main effects of level of expertise and of aesthetic value only. There was no interaction of expertise and aesthetics. In a time-window of 110–130 ms after stimulus onset, aesthetic webpages elicited a more negative EEG-amplitude than unaesthetic webpages. In the same time window, experts had more negative EEG-amplitudes than laypersons. This patterning of results continued until a time window of 600–800 ms in which group and aesthetic differences diminished. An interaction of perceiver characteristics and object properties that several interactionist theories postulate was absent in the EEG-data. Experts seem to process the stimuli in a more thorough manner than laypersons. The early activation differences between aesthetic and unaesthetic webpages is in contrast with some theories of aesthetic processing and has not been reported before.
Despite normal neurological bedside and electrodiagnostic, some patients with non-specific neck arm pain (NSNAP) have heightened nerve mechanosensitivity upon neurodynamic testing [1, 2]. It remains however unclear whether this is associated with a minor nerve injury. The aim of this study was to evaluate potential differences in somatosensory function among patients with unilateral NSNAP with and without positive neurodynamic tests and healthy controls.
Quantitative sensory testing was performed in 40 patients with unilateral NSNAP; 23 with positive upper limb neurodynamic tests (ULNTPOS) and 17 with negative neurodynamic tests (ULNTNEG). The protocol comprised thermal and mechanical detection and pain thresholds as well as mechanical pain sensitivity, wind-up ratio and dynamic mechanical allodynia. All parameters were measured in the maximal pain area on the affected side as well as over the corresponding area on the unaffected side. Symptom severity, functional deficits, psychological parameters, quality of life and sleep disturbance were also recorded.
Fifty-seven percent of patients with NSNAP had positive neurodynamic tests despite normal bedside neurological integrity tests and nerve conduction parameters. Clinical profiles did not differ between patient groups. Somatosensory profiling revealed a more pronounced loss of function phenotype in ULNTPOS patients compared to healthy controls. Hyperalgesia (cold, heat and pressure pain) was present bilaterally in both NSNAP group. The ULNTNEG subgroup represented an intermediate phenotype between ULNTPOS patients and healthy controls in both thermal and pressure pain thresholds as well as mechanical detection thresholds.
In conclusion, heightened nerve mechanosensitivity was present in over half of patients with NSNAP. Our data suggest that NSNAP presents as a spectrum with some patients showing signs suggestive of a minor nerve dysfunction.
[1] Elvey RL. Physical evaluation of the peripheral nervous system in disorders of pain and dysfunction. J Hand Ther 1997;10:122-129.
[2] van der Heide B, Bourgoin C, Eils G, Garnevall B, Blackmore M. Test-retest reliability and face validity of a modified neural tissue provocation test in patients with cervicobrachial pain syndrome. J Man Manip Ther 2006;14:30-36.
The aim of the study was to examine different pH parameters, such as variations throughout the day, depending on differing concentrate feed proportions. Moreover, special attention was payed to individual variation in microbial efficiencies (microbial crude protein/fermented organic matter) and their relation to ruminal pH, nutrient flows and digestibilities. For this, cows were grouped according to microbial efficiency (more, n = 5, vs. less efficient cows, n = 4). After calving, thirteen ruminally cannulated pluriparous cows, including nine duodenally cannulated animals, were divided into groups offered rations with a lower (35% on dry matter basis, n = 7) or a higher (60% on dry matter basis, n = 6) concentrate feed proportion. Ruminal pH parameters were assessed continuously by using intraruminal probes. Nutrient flows, nutrient digestibility and microbial efficiency were determined for duodenally cannulated cows. For most ruminal pH parameters it seemed that individual variability was higher than the treatment effect. However, a positive relationship between actual concentrate intake and diurnal pH fluctuations was found. Besides, the effect of individually different microbial efficiencies was assessed. Again, there were no group differences for pH parameters. However, nutrient flows were significantly higher in more efficient cows, whereas digestibilities were lower in in more efficient cows.
Background: Pancreatic cancer is one of the malignant diseases with the highest cancer-specific mortality. At the time of diagnosis, life expectancy is often already very limited, as it is usually discovered late and in an advanced stage. Coping with cancer is a complex process. Coping strategies of patients with pancreatic cancer probably differ from those of other malignancies. Yet to date, there exists no pancreatic cancer-specific coping model.
Objective: The objective of this scoping review is to explore and characterize the academic literature related to coping processes in patients with pancreatic cancer.
Methods/Design: The JBI's three-step search strategy, combined with the Arksey and O'Malley framework, will be used to identify articles via PubMed/MEDLINE, CINAHL, Cochrane Library, Google Scholar, CAMbase, CareLit, CC Med, Scopus, and PsycARTICLES (Arksey & O'Malley, 2005; Peters et al., 2017). It follows the PRISMA guidelines for scoping reviews (Tricco et al., 2018). Primary and secondary studies and reviews which report on coping with pancreatic cancer (adenocarcinoma) in adults in English or German language will be included in this scoping review, regardless of publication date or study design.
Discussion: This scoping review will add new insights on coping with pancreatic cancer by summarizing current knowledge, and identifying research
Objectives: This paper addresses recent steps for reforming the eligibility criteria of the German long-term care insurance that have been initiated to overcome shortcomings in the current system.
Methods: Based on findings of a survey of international long-term care systems, assessment tools and the relevant literature on care needs a new tool for determining eligibility in the German long-term care insurance was developed.
Results: The new tool for determining long-term care eligibility broadens the understanding of what ‚dependency on nursing care' implies for the person affected. The assessment results in a degree of dependency from personal help provided by formal or informal caregivers. This degree of dependency can be used for determining eligibility for and the amount of long-term care benefits.
Discussion: The broader understanding of "dependency on nursing care' and the new tool are important steps to adapt the German long-term care insurance to the challenges of the demographic and societal changes in the future
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.
The interdisciplinary research project TiP.De - Theatre in Dementia Health Care aims at identifying the effects of theatre pedagogy on quality of life of people with dementia in two German nursing homes.
The mixed-methods intervention study measures cognitive impairment, quality of life in daily living and agitation in a pre-post-comparison, as well as emotional reactions during the theatre pedagogical interventions of the participants.
The intervention is expected to have a positive impact on cognitive impairment, quality of life, agitation and relationship between the participants and the assisting nursing home staff. Further data analysis will show correlations between specific items.
The results and the theatre pedagogy concept for people with dementia will be published, so that theatre pedagogues are able to implement the concept in other nursing homes. The nursing situation, communication and work experience of nurses, as well as quality of life of people with dementia are going to be positively affected.
Dairy farming has been the subject of public debate on animal welfare for a number of years now. Animal welfare discussions on dairy farming often include the demand for more nature connectedness in this area. This study focuses on the divergent perspectives of consumers and scientists on the importance of more nature connectedness for animal welfare strategies in German dairy farming. Within Europe, Germany is the main producer of cow’s milk and an important industry in many rural areas in Germany is dairy farming. The insights presented are based on qualitative interviews with dairy farming and livestock researchers from Germany and Austria. A key finding of this study is that we need to look more closely at the actual content of nature claims in animal welfare debates. The scientists interviewed tend to see idealized conditions in animal welfare discussions with images of nature which in fact seldom lead to improved conditions in dairy farming and, even then, only to a limited extent. The scientists interviewed rate calls for more nature connectedness in dairy farming from the nonagricultural public as anti-modern, complexity-reducing, and normative. Nevertheless, some of the scientists interviewed did have valuable insights into the nonagricultural public’s criticism of dairy farming practices. These scientists argued, however, that animal welfare needs to differentiate between nature connectedness and the innate needs of cattle when it comes to animal welfare strategies. An important conclusion of the study is that more discussion formats are needed to promote the exchange of ideas between different social groups attempting to understand animal welfare in dairy farming.
Duckweed is gaining attention in animal nutrition and is considered as a potential alternative protein source for broiler chickens. In order to evaluate the nutritional value of duckweed, three individual batches were investigated. They consisted of a mixture of Lemna minuta and Lemna minor (A, 17.5% crude protein), Spirodela polyrhiza (B, 24.6% crude protein) and Lemna obscura (C, 37.0% crude protein). Treatment diets contained 50% batch A, 50% batch B, and 25, 50 and 75% of batch C. All diets were fed to broiler chickens (Ross 308) from an age of 21 to 27 days. Diets with a share of 50 and 75% of batch C led to decreased feed intake (109.3 and 74.9 g/day, respectively) compared to the control. Standardized ileal digestibility of crude protein and amino acids differed significantly between duckweed batches, at values for methionine between 49.9 and 90.4%. For all amino acids, batch A consistently had the lowest and batch C the highest digestibility. Batches had different tannin contents of 2943, 2890 and 303 mg/kg for batches A, B and C, respectively. The apparent ileal digestibility of phosphorus differed significantly between all batches (50.8–78.9%). Duckweed can be used as a protein feed for broiler chickens. However, a defined and stable biomass composition optimized for the requirements of broiler chickens is needed.
Technological support options for the usage of Brazilian Açaí berries in the European Food Market
(2022)
The highly perishable fruit açaí grows on palm trees in northern Brazil and is colloquially known as a berry with high nutritional value. The seed of the drupe makes up around 85 percent of the fruits weight and only the pulp around the seed is used for human consumption. The manufacturing step after harvest includes the pulping and the preservation of the fruit. The preservation step is necessary, because the açaí pulp contains a high microbial load. There are several preservation processes including the use of chlorinated or ozonated water, alcoholic fermentation, pasteurization, freezing or dehydration. Those techniques are overall not very gentle and have the potential to leave residues in the final product, which can change its typical sensorial characteristics. Therefore, an experiment was conducted, to see if a relatively new gentle preservation method called PEF can reduce the microbial load in an açaí- smoothie.
For this purpose, a PEF-machine was built and verified based on the paper from HEINZ ET AL. [2003]. The self-built machine works efficiently, when there is a reduction of microorganisms like Escherichia coli in apple juice due to the induced Pulsed Electric Fields. If this is the case, the described experiment with açaí-smoothie can be carried out with the self-built PEF- machine. In this experiment the results of the validation of this PEF-machine were not comparable to those from the paper from HEINZ ET AL. [2003]. So, the self-built PEF-machine in Brazil did not work sufficiently. Hence, the experiment which should show that a reduction of microorganisms, such as Escherichia coli, in açaí-smoothie with PEF is possible, was performed in Germany. It was accrued out at ELEA with using the PEFPilotTM Dual. This experiment confirmed the assumption, that microorganisms can be reduced in açaí-smoothie with PEF. Escherichia coli was reduced by 2 logs, Saccharomyces cerevisiae by 3 logs and Lactobacillus plantarum by 6 logs. And a comparison between PEF and the known preservation methods for açaí showed that it can be a compatible alternative.
Moreover, the topic, how açaí fits into the European Food Market is answered within this paper. When offering açaí food products to the European population, ideas can be originated from the well-working Brazilian market. It can be helpful to mix açaí with known European fruits for a better acceptance by the people. Then açaí can help to meet the Europeans needs of the current time for fresh and healthy food, especially when preserved with PEF. Furthermore, it is important to work towards a sustainable supply chain system from the cultivation until the unloading at the destination in Europe. Sustainability is important for the integration in the European market, not only for environmental protection, but also in terms of social stability and marketing purposes. In addition, access requirements, further food-related regulations, and the seasonality of açaí present a major hurdle.
Building on this thesis, further papers shall be written, not only in the field of the preservation of the açaí pulp with PEF, but also in the direction of combined preservation methods for açaí, the sustainable usage of the açaí seeds, product innovations containing the Brazilian fruit or various market research.
Who is more eager to use Gamification in Economic Disciplines? Comparison of Students and Educators
(2022)
Background: In this paper, the focus is on the application of digital and mobile technologies as supporting tools for the implementation of gamification in the field of education of future economists. Objectives: The paper's main objective is to explore whether educators and students are motivated and willing to apply additional technologies as main gamification components in their work and education. Moreover, the paper aims to assess how their more comprehensive application affects the quality of teaching, work flexibility, new learning opportunities, and outcomes. Methods/Approach: The survey method was used to collect answers from educators and students primarily interested in accounting, finance, trade and tourism from higher and secondary education institutions in Croatia, Poland, Serbia and Germany. Afterwards, the responses were compared using statistical methods. Results: Research results confirm that educators and students are willing to use gamification in teaching. Still, they also expressed the need for better administrative support in using particular e-learning tools. Surprisingly, educators are more eager to use gamification in their work than students. Conclusions: The study's general conclusion is that educators and students are both aware of the advantages of using e-learning tools provided through digital and mobile technologies and are eager to implement more gamification in the teaching process. However, continuous education in applying new digital technologies is needed on both sides.
Communication deficits belong to the most frequent errors in patient handovers calling upon specialized training approaches to be implemented. This study aims to harness problem-based learning (PBL) methods in handover education and evaluated the learning process. A digitally enabled PBL course was developed and implemented at Klinikum Osnabrück from which eight nurses participated in the course. They agreed on the stimulating effect of the setting regarding self-directed learning and on the potential to translate the new knowledge and skills into the daily clinical practice. In conclusion, the findings are promising that a digitally enabled PBL course is a suitable learning format for handover education.
Introduction: Handovers are a central process for ensuring information continuity in patient care and, therefore, possess a major influence on patient safety as errors due to poor handovers can lead to life-threatening events. Education to improve handovers and ensure safe patient care can be supported by using critical incident reporting systems (CIRS). The aim of the study is to perform a content analysis of a national CIRS-database with regard to identifying adverse events in handovers situations and to derive competencies for the development of continuing education from these findings.
Methods: A meta model served as a research framework to merge the empirical findings with the London protocol of analysing critical events and the Canadian framework of safety competencies. Relevant cases to be investigated were searched in a freely accessible German CIRS database.
Results: A total of 253 case descriptions were found and analysed. Team factors emerged as the most frequently reported influencing factors following the analysis of the London protocol. Communication errors and missing information as well as a lack of appropriate standards and processes appeared to be the main reasons for critical events to occur. Most of the events happened in units involving surgery and intensive care. A mapping of patient safety competences with the reasons for critical events was conducted in order to determine the practical, concrete and handover related competencies.
Conclusion: Data from a CIRS database and theoretical frameworks can be combined to extract meaningful information about patient safety risks in handover situations. The results are useful for developing curricula to improve handovers based on patient safety competencies.
The article describes an analysis of the use of e-learning to improve the learning transfer to practice in continuing education. Therefore an e-learning offer has been developed as a part between two attendance periods of a training course in the field of Ambient Assisted Living (AAL). All participants of the course were free to use the e-learning offer. After the end of the e-learning part we compared the e-learning users to the other participants. Using an online questionnaire we explored if there are differences in the activities in the field AAL after the training course. The results show that e-learning is beneficial especially for communication processes. Due to the fact that the possibility to talk about the learning content is an essential factor for the learning transfer, e-learning can improve the learning success.
An Iterative Methodology for Developing National Recommendations for Nursing Informatics Curricula
(2016)
The increasing importance of IT in nursing requires educational measures to support its meaningful application. However, many countries do not yet have national recommendations for nursing informatics competencies. We thus developed an iterative triple methodology to yield validated and country specific recommendations for informatics core competencies in nursing. We identified relevant competencies from national sources (step 1), matched and enriched these with input from the international literature (step 2) and fed the resulting 24 core competencies into a survey (120 invited experts from which 87 responded) and two focus group sessions with a total of 48 experts (steps 3a/3b). The subsequent focus group sessions confirmed and expanded the findings. As a result, we were able to define role specific informatics core competencies for three countries.
We describe an automated approach, to easily track patients regaining their walking ability while recovering from neurological diseases like e.g. stroke. Based on captured gait data and objective measures derived out of it the rehabilitation process can be optimized and thus steered. In order to apply such system in clinical practice two key requirements have to be fulfilled: (i) the system needs to be applicable in terms of ease of use and performance; (ii) the derived measures need to be accurate.
Current challenges are a result of complex and multi-layered factors. They require systemic solutions: problems must be solved holistically by identifying interconnections between the different problems which are results of the same root cause. Social entrepreneurs are agents of change, their mission is to generate societal impact. I investigated how a social entrepreneurship think tank can be conceptualized to support systems change. Think tanks can conduct in-depth research to inform about the systems and share knowledge. Entrepreneurs can make strategic interventions based on the research findings. To create a framework of how social entrepreneurship think tanks can promote systems change I conducted 14 case studies. The framework is created based on the method of Theory of Change, it displays how different activities can contribute to succeeding in systems change. I outline eleven activities which include strategies in capacity building, research and collaboration with the other actors in the field. In the end, the framework is applied to the evolving case of a think tank founded in 2018.
Die Ernährung ist für etwa 30 % des weltweiten Verbrauchs an natürlichen Ressourcen verantwortlich. Um die negativen Auswirkungen des Ernährungssektors auf die Umwelt und die Gesellschaft zu begrenzen, ist der Verbrauch und die Verarbeitung von Lebensmitteln mit vermeintlich geringen negativen Auswirkungen ein wichtiges Thema bei den Bemühungen um eine nachhaltige Entwicklung. In den Großküchen sind klar definierte Indikatoren zur Bewertung der Auswirkungen von Geschäftsaktivitäten erforderlich, um dieses Ziel zu erreichen. Die Forschungs- und Entwicklungsarbeiten im Rahmen des NAHGAST-Projekts liefern Grundlagen, die bei diesen Bemühungen eine wichtige Hilfe sein können. Es wurden zwei Versionen eines Bewertungsinstruments mit Indikatoren unterschiedlicher Komplexität (NAHGAST Meal-Basic und NAHGAST Meal-Pro) entwickelt, die von Küchenfachleuten verwendet werden können, um die Nachhaltigkeitsleistung ihrer Produkte - der angebotenen Mahlzeit - zu bestimmen. Eine sachkundige Auswahl von Indikatoren und eine Diskussion darüber, auf welche Prozesse und Auswirkungen sich dieser Indikator im weiteren Kontext bezieht, sind von wesentlicher Bedeutung und werden in diesem Papier erörtert. Darüber hinaus wurden bei der Auswahl der Indikatoren für den Zweck unserer Forschung bestimmte Kriterien gleichzeitig berücksichtigt: (1) Kommunizierbarkeit - Welche Informationen ein Indikator vermitteln kann und wie verständlich diese Informationen für verschiedene Akteure sind; (2) Machbarkeit und Datenverfügbarkeit: Gibt es genügend Daten für einen Indikator und ist es für die Unternehmen realistisch, diesen Indikator in ihre tägliche Arbeitspraxis zu integrieren? (3) Wissenschaftliche Relevanz: Ist der Indikator für die Nachhaltigkeitsbemühungen in größerem Maßstab und für entsprechende Diskussionen in der wissenschaftlichen Gemeinschaft relevant? Die Erkenntnisse aus diesen Überlegungen sind wertvoll für zukünftige Entwicklungen in der Nachhaltigkeitsbewertung in der Außer-Haus-Gastronomie. Das Instrument wurde zur Bewertung einer Reihe von Gerichten verwendet und die Ergebnisse werden als aussagekräftig erachtet. Allerdings dürfen Bewertungen jedoch nicht als genaue Messung, sondern nur als Annäherung an die Nachhaltigkeit von Speisen verstanden werden. Auf der Ebene der einzelnen Indikatoren ermöglichen sie eine detaillierte Analyse und gezielte Optimierung von Rezepten, während die aggregierten Ergebnisse in Form von Etiketten gut an die Kunden kommuniziert werden können. Defizite und Herausforderungen, wie sie in der Anwendungsphase des Projekts festgestellt wurden, zeigen jedoch Forschungslücken im weiteren Kontext auf. Abschließend werden weitere Schritte für eine Integration des Tools in Unternehmensprozesse und verbleibende Anpassungsmöglichkeiten für Unternehmen diskutiert.
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.
Going Mobile : An Empirical Model for Explaining Successful Information Logistics in Ward Rounds
(2018)
Background: Medical ward rounds are critical focal points of inpatient care that call for uniquely flexible solutions to provide clinical information at the bedside. While this fact is undoubted, adoption rates of mobile IT solutions remain rather low.
Objectives: Our goal was to investigate if and how mobile IT solutions influence successful information provision at the bedside, i.e. clinical information logistics, as well as to shed light at socio-organizational factors that facilitate adoption rates from a user-centered perspective.
Methods: Survey data were collected from 373 medical and nursing directors of German, Austrian and Swiss hospitals and analyzed using variance-based Structural Equation Modelling (SEM).
Results: The adoption of mobile IT solutions explains large portions of clinical information logistics and is in itself associated with an organizational culture of innovation and end user participation.
Conclusion: Results should encourage decision makers to understand mobility as a core constituent of information logistics and thus to promote close end-user participation as well as to work towards building a culture of innovation.