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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.
Background
Lay family caregivers of patients receiving palliative care often confront stressful situations in the care of their loved ones. This is particularly true for families in the home-based palliative care settings, where the family caregivers are responsible for a substantial amount of the patient’s care. Yet, to our knowledge, no study to date has examined the family caregivers’ exposure to critical events and distress with home-based palliative care has been reported from Germany. Therefore, we attempt to assess family caregiver exposure to the dying patient’s critical health events and relate that to the caregiver’s own psychological distress to examine associations with general health within a home-based palliative care situation in Germany.
Methods
A cross-sectional study was conducted among 106 family caregivers with home-based palliative care in the Federal State of North Rhine Westphalia, Germany. We administered the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) Scale. Descriptive statistics and linear regression models relating general health (SF-36) were used to analyze the data.
Results
The frequency of the caregiver’s exposure, or witness of, critical health events of the patient ranged from 95.2% “pain/discomfort” to 20.8% “family caregiver thought patient was dead”. The highest distress scores assessing fear and helpfulness were associated with “family caregiver felt patient had enough’” and “family caregiver thought patient was dead”. Linear regression analyses revealed significant inverse associations between SCARED critical health event exposure frequency (beta = .408, p = .025) and total score (beta = .377, p = .007) with general health in family caregivers.
Conclusions
Family caregivers with home-based palliative care in Germany frequently experience exposure to a large number of critical health events in caring for their family members who are terminally ill. These exposures are associated with the family caregiver’s degree of fear and helplessness and are associated with their worse general health. Thus the SCARED Scale, which is brief and easy to administer, appears able to identify these potentially upsetting critical health events among family caregivers of palliative care patients receiving care at home. Because it identified commonly encountered critical events in these patients and related them to adverse general health of family caregivers, the SCARED may add to clinically useful screens to identify family caregivers who may be struggling.
Aim: The aim of this study was to give an overview of family caregiver satisfaction within the home palliative care situation in North Rhine-Westphalia, Germany.
Design: A cross-sectional study.
Methods: An anonymous questionnaire, with seven validated scales, and comprising of 71 items, was used. The items investigated perceived needs and burdens of families within a home-based palliative care situation.
The satisfaction of the family caregivers with the services delivered by palliative care teams was measured by the FAMCARE-2 Scale. Descriptive statistics and analysis of covariance (ANCOVA) were performed.
Results: A convenience sample of 106 family members agreed to participate in the study. Overall, we found high satisfaction within our sample. There was high satisfaction with how the services respected the dignity of families, and how they provided comfort to patients. Satisfaction was lower with regard to information about patients.
Conclusion: High or low satisfaction with palliative care, tells us little about the quality of services. The high satisfaction within this study could be interpreted as a sign that palliative care was important to families at the time of availability. Regular and continuous assessment can serve to inform the continuous quality of care provision for patients and their families.
Background
Forced migration significantly endangers health. Women face numerous health risks, including sexual violence, lack of contraception, sexually transmitted disease, and adverse perinatal outcomes. Therefore, sexual and reproductive healthcare is a significant aspect of women asylum seekers’ health.
Even when healthcare costs of asylum seekers are covered by the government, there may be strong barriers to healthcare access and specific needs may be addressed inadequately. The study’s objectives were a) to assess the accommodation and healthcare services provided to women asylum seekers in standard and specialised health care, b) to assess the organisation of healthcare provision and how it addresses the sexual and reproductive healthcare needs of women asylum seekers.
Methods
The study utilised a multi-method approach, comprising a less-dominant quantitative component and dominant qualitative component. The quantitative component assessed accommodation conditions for women in eight asylum centres using a survey. The qualitative component assessed healthcare provision on-site, using semi-structured interviews with health and social care professionals (n = 9). Asylum centres were selected to cover a wide range of characteristics. Interview analysis was guided by thematic analysis.
Results
The accommodation in the asylum centres provided gender-separate rooms and sanitary infrastructure. Two models of healthcare were identified, which differed in the services they provided and in their organisation: 1) a standard healthcare model characterised by a lack of coordination between healthcare providers, unavailability of essential services such as interpreters, and fragmented healthcare, and 2) a specialised healthcare model specifically tailored to the needs of asylum-seekers. Its organisation is characterised by a network of closely collaborating health professionals. It provided essential services not present in the standard model. We recommend the specialised healthcare model as a guideline for best practise.
Conclusions
The standard, non-specialised healthcare model used in some regions in Switzerland does not fully meet the healthcare needs of women asylum seekers. Specialised healthcare services used in other regions, which include translation services as well as gender and culturally sensitive care, are better suited to address these needs. More widespread use of this model would contribute significantly toward protecting the sexual and reproductive integrity and health of women asylum seekers.
In this paper, we evaluate the application of Bayesian Optimization (BO) to discrete event simulation (DES) models. In a first step, we create a simple model, for which we know the optimal set of parameter values in advance. We implement the model in SimPy, a framework for DES written in Python. We then interpret the simulation model as a black box function subject to optimization. We show that it is possible to find the optimal set of parameter values using the open source library GPyOpt. To enhance our evaluation, we create a second and more complex model. To better handle the complexity of the model, and to add a visual component, we build the second model in Simio, a commercial off-the-shelf simulation modeling tool. To apply BO to a model in Simio, we use the Simio API to write an extension for optimization plug-ins. This extension encapsulates the logic of the BO algorithm, which we deployed as a web service in the cloud.
The fact that simulation models are black box functions with regard to their behavior and the influence of their input parameters makes them an apparent candidate for Bayesian Optimization (BO). Simulation models are multivariable and stochastic, and their behavior is to a large extent unpredictable. In particular, we do not know for sure which input parameters to adjust to maximize (or minimize) the model’s outcome. In addition, the complex models can take a substantial amount of time to run.
Bayesian Optimization is a sequential and self-learning algorithm to optimize black box functions similar to as we find them in simulation models: they contain a set of parameters for which we want to identify the optimal set, they are expensive to evaluate, and they exhibit stochastic noise. BO has proven to efficiently optimize black box functions from varius disciplines. Among those, and most notably, it is successfully applied in machine learning algorithms to optimize hyperparameters.
SimBO is a flexible framework for optimizing discrete event-driven simulations (DES) using sequential optimization algorithms. While specifically designed for Bayesian Optimization (BO) in the context of DES, SimBO can be applied to any black-box problem with other optimization algorithms. The framework consists of four encapsulated components - the black-box problem, the sequential optimization algorithm, a database for experiment configuration and results, and a web-based graphical user interface - that communicate via well-defined interfaces. Each component can be run in different environments, allowing for cooperation between different hardware- and software configurations. In our research context, SimBO’s architecture enabled BO algorithms to be run on a high-performance cluster with GPU support, while the simulation is executed on a local Windows machine using the Simio simulation software. The framework’s flexibility also makes it suitable for evolving from a research-focused tool to a production-ready, cloud-based optimization tool for modern algorithms.
Background:
The evaluation of somatosensory dysfunction is important for diagnostics and may also have implications for prognosis and management. The current standard to evaluate somatosensory dysfunction is quantitative sensory testing (QST), which is expensive and time consuming. This study describes a low-cost and time-efficient clinical sensory test battery (CST), and evaluates its concurrent validity compared to QST.
Method: Three patient cohorts with carpal tunnel syndrome (CTS, n=86), non-specific neck and arm pain (NSNAP, n=40) and lumbar radicular pain/radiculopathy (LR n=26) were included. The CST consisted of 13 tests, each corresponding to a QST parameter and evaluating a broad spectrum of sensory functions using mechanical and thermal detection and pain thresholds and testing both loss and gain of function. Agreement rate, significance and strength of correlation between CST and QST were calculated.
Results: Several CST parameters (cold and warm detection, cold pain, mechanical detection, mechanical pain for loss of function, pressure pain) were significantly correlated with QST, with a majority demonstrating >60% agreement rates and weak to relatively strong correlations. However, agreement varied among cohorts. Gain of function parameters showed stronger correlation in the CTS and NSNAP cohort, whereas loss of function parameters performed better in the LR cohort. Other CST parameters (vibration detection, heat pain, mechanical pain for gain of function, windup ratio) did not significantly correlate with QST.
Conclusion: Some, but not all tests in the CST battery can detect somatosensory dysfunction as determined with QST. The CST battery may perform better when the somatosensory phenotype is more pronounced.
This review aimed to synthesize the current evidence on the effectiveness of invasive treatments for complex regional pain syndrome in children and adolescents. Studies on children and adolescents with complex regional pain syndrome that evaluated the effects of invasive treatment were identified in PubMed (search March 2013). Thirty-six studies met the inclusion criteria. Articles reported on a total of 173 children and adolescents with complex regional pain syndrome. Generally, many studies lack methodological quality. The invasive treatments applied most often were singular sympathetic blocks, followed by epidural catheters and continuous sympathetic blocks. Rarely, spinal cord stimulation and pain-directed surgeries were reported. An individual patient frequently received more than one invasive procedure. Concerning outcome, for approximately all patients, an improvement in pain and functional disability was reported. However, these outcomes were seldom assessed with validated tools. In conclusion, the evidence level for invasive therapies in the treatment of complex regional pain syndrome in children and adolescents is weak.
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.
Introduction Postoperative delirium (POD) is seen in approximately 15% of elderly patients and is related to poorer outcomes. In 2017, the Federal Joint Committee (Gemeinsamer Bundesausschuss) introduced a ‘quality contract’ (QC) as a new instrument to improve healthcare in Germany. One of the four areas for improvement of in-patient care is the ‘Prevention of POD in the care of elderly patients’ (QC-POD), as a means to reduce the risk of developing POD and its complications.
The Institute for Quality Assurance and Transparency in Health Care identified gaps in the in-patient care of elderly patients related to the prevention, screening and treatment of POD, as required by consensus-based and evidence-based delirium guidelines. This paper introduces the QC-POD protocol, which aims to implement these guidelines into the clinical routine. There is an urgent need for well-structured, standardised and interdisciplinary pathways that enable the reliable screening and treatment of POD. Along with effective preventive measures, these concepts have a considerable potential to improve the care of elderly patients.
Methods and analysis The QC-POD study is a non-randomised, pre–post, monocentric, prospective trial with an interventional concept following a baseline control period. The QC-POD trial was initiated on 1 April 2020 between Charité-Universitätsmedizin Berlin and the German health insurance company BARMER and will end on 30 June 2023. Inclusion criteria: patients 70 years of age or older that are scheduled for a surgical procedure requiring anaesthesia and insurance with the QC partner (BARMER). Exclusion criteria included patients with a language barrier, moribund patients and those unwilling or unable to provide informed consent. The QC-POD protocol provides perioperative intervention at least two times per day, with delirium screening and non-pharmacological preventive measures.
Ethics and dissemination This protocol was approved by the ethics committee of the Charité-Universitätsmedizin, Berlin, Germany (EA1/054/20). The results will be published in a peer-reviewed scientific journal and presented at national and international conferences.
A brief questionnaire for measuring alarm fatigue in nurses and physicians in intensive care units
(2023)
When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop “alarm fatigue” (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the “alarm stress scale” and the “alarm coping scale”). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.
The present study investigates consumers’ acceptance of Se-biofortified apples, as well as Se health and nutrition claims that have been approved by the European Commission. Despite indications that such statements are more likely to be accepted if the carrier product itself has a healthy image, unprocessed fruits biofortified with Se have not been investigated in this context yet. Apples as the most frequently-consumed type of fresh fruit in Germany may offer the potential to improve the Se status of consumers when the produce is enriched with Se. Therefore, an online survey of 356 German adults was conducted to analyze different aspects that could affect the perception of and preference for the proposed product concept by consumers. The findings indicate a moderate acceptance of Se-biofortified apples, as well as of Se health and nutrition claims among the participants. Additional information about beneficial health effects of Se had a significant impact on consumer acceptance. People who regularly eat convenience food and prefer to buy apples at supermarkets were particularly attracted by the product idea. In conclusion, the results of the study indicate good prospects for a successful introduction of Se-rich apples in the German food market, if the produce is advertised with approved health and nutrition claims.
Rationale: Three-dimensional (3D) motion analysis has proved helpful in the diagnosis of different musculoskeletal syndromes and identifying injurious movement patterns in high string players. Furthermore, an optoelectronic 3D motion capture system allows an accurate and objective assessment of upper body posture and motion during violin and viola performance. However, no reference upper body model of high string players has been proposed as yet. Moreover, a more physiological shoulder model that separates the joints of the shoulder complex has not been reported. Especially in view of given the role of the scapula in the normal movement of the humerus, it cannot be disregarded when evaluating musculoskeletal strain in the shoulder.
The International Society of Biomechanics recommends definitions of joint coordinate systems for the report of upper body joint motion using anatomical landmarks as reference for the placement of surface markers. Using markers on the skin for some of the proposed locations is, however, inappropriate when an instrument is being played. There are skin movement artifacts, e. g. caused by the movement of the scapula underneath the skin, whereas some markers interfere with the instrument on the shoulder or might be occluded by the bowing arm in motion.
Purpose: The aim of this study was to develop a marker-based method for quantifying 3D upper body kinematics of high string players and to demonstrate its clinical feasibility in violin and viola performance. The method is intended to provide an objective evaluation of high string players’ motor strategies, especially in the shoulder complex, while minimizing skin movement artifacts, marker occlusions and limitations in instrument placement.
Methods: A custom marker set was developed consisting of thirty-one single markers to define the anatomical coordinate systems of sixteen upper body segments including the pelvis, thorax, spine and head, as well as both scapulae, upper arms, forearms and hands. Twenty-one of these markers as well as two pre-built and four custom-made rigid marker clusters were used for tracking the segment motions.
Twelve professional violinists without history of musculoskeletal or neurological problems were recruited for assessing the clinical feasibility of the method. They were asked to perform a single sequence of two consecutive musical notes on each of two adjacent strings (G- and D-string) in real time, played at 50 bpm with tempo audibly regulated by a metronome, and using a standardized violin and bow. The participants played up- and down-bow alternately using the whole length of the bow.
A custom biomechanical model was applied to the motion capture data and the rotation angles of fifteen joints were calculated. The location of each glenohumeral joint rotation center was computed by upper arm movements with respect to the scapula based on a functional method. For a description of the motion patterns, minimum, maximum and range of angular motion were averaged across participants for each string and rotation. Inter-subject variability was assessed by calculating the standard deviation (SD) at each sample of the angle-time series between participants for each rotation and for both strings. Then SD was averaged over sequences for each rotation and string. For comparing mean rotation angles between strings over time, random effect models were used.
Results: The highest range of motion was observed in the right elbow flexion and right wrist flexion/extension. Also, high ranges of motion (> 10°) were found in all right glenohumeral rotations and right wrist deviation and pronation/supination. In conclusion, lumbar and thoracic spine, thorax, neck, and left upper limb were quite static, while large motion occurred in the right upper limb during up and down bowing.
Most rotation angles showed a reasonable inter-subject variability except for left and right glenohumeral plane of elevation as well as left glenohumeral internal/external rotation, and left and right wrist pronation/supination (> 10°).
Significant differences in the rotation angles between G- and D-string bowing were detected especially in the left wrist and right shoulder joints.
Conclusions: This is the first study that used quantitative 3D analysis to explore the upper body kinematics of high string players during performance, providing a detailed view of the motor control in the shoulder as well as in the lumbar and thoracic spine. The biggest advantage over previously published methods is the more physiological shoulder and spine models while providing a simple application.
The method was found to give consistent motion patterns across participants and to be sensitive to differences between adjacent strings. Although the method appears to be valid, more rigorous validation is necessary. Since there is no gold standard with which we could compare results, we were only able to assess the clinical feasibility. We believe that our method represents a good compromise between accuracy and practicability for clinical application.
Due to the inclusion of multi-segmented shoulder and spine models, it will improve understanding of the motor strategies adopted by high string players and may contribute to injury prevention, diagnosis and treatment.
Rationale:
Instrumentalists often suffer from playing-related (neuro-)musculoskeletal disorders (PRMDs). Most common PRMDs in string players are related to upper-body regions. Motion analysis has proven to be helpful in the evaluation of functional disorders. It was already shown that it is a valid and clinically feasible tool for accurate, repeatable, and objective assessments of functional movement in string players. Thus, it may guide clinicians to improvements in injury prevention, diagnosis, and treatment. Nevertheless, its application in clinical consultation is still very uncommon. For this reason, there is a lack of well-established motion analysis protocols for the examination of PRMDs in string players using advanced biomechanical instruments in clinical settings.
Purpose:
To demonstrate the development and application of a motion analysis protocol for the evaluation of functional upper-body movements in violinists, violists, and cellists in a clinical setting for the investigation of PRMDs.
Approach:
The protocol was to be integrated into a clinical reasoning process for testing clinical hypotheses and evaluating treatment outcomes in physiotherapy. As a starting point, a primary clinical question was defined, and then, specific upper-body symptom regions as well as measurement parameters (relative rotation angles and muscle activities over time) were identified. Subsequently, involved segments, joints, and muscles were assorted. For quantification of upper-body kinematics a novel, marker-based method was used which provides multi-segmented shoulder and spine models while providing simple application. Based on that, a comprehensive mechanical model of the upper body as well as the associated coordinate systems and rotation sequences were specified. This further guided both, the definition of a custom-made marker set as well as the selection and placement of surface electrodes. Furthermore, required static and functional calibration trials as well as movement tasks for functional assessment were specified. Finally, advanced approaches, such as a comprehensive kinematic model and functional determination of joint centers and axes were established for extraction. Then, outcome parameters and their form of representation were determined for further analysis and interpretation.
The application of the method first includes the selection of segments, joints, and muscles to examine – originating from one or more clinical (working) hypotheses or symptom regions. This drives the configuration and placement of required surface markers and electrodes. Then, the required calibration and functional movement trials are executed. After measurement, the outcome parameters get extracted and analyzed. Based on the results the hypothesis is discarded or verified.
Content:
The method was applied to a violinist (female; 18 years old; 13 years of experience; practicing 2 to 3 hours per day, 7 days per week) with playing-related demands in the left cervical-shoulder-arm region.
Subjective findings indicated that the pain regularly occurred after 30 minutes of playing fast or difficult musical pieces. Physical examination showed that strength testing of left serratus anterior muscle caused pain, lower trapezius muscles seemed weak, forearm muscles were sensitive to pressure, movement of the cervical spine to the left was reduced, and upper limb neural tension test was noticeable.
This led to the following working hypothesis: Neck-related arm pain with neurodynamic component and motor control problem in the scapulothoracic region. Thus, left-sided cervical-shoulder-arm region was selected for functional examination.
Optoelectronic motion capture system and surface electromyography were used for data collection. Static and function calibration trials as well as functional assessment trials (chromatic scale with different tempi) were conducted. Afterwards, data was further processed, and outcome parameters were extracted.
Results showed that greater tempo and pain had an impact on the rotation angles and muscle activities. They led to less overall joint movement and range of motion, to less muscle activity in the forearm muscles, and to greater activity inputs in the scapulothoracic muscles. Overall, greater tempo and pain led to a different motor program which verified the working hypothesis.
The procedure was repeated after treatment (four appointments over one week) with manual therapy, training, and education. The pre-/post-interventional comparison showed changes in the motor program. There was noticeable higher mean activity in upper trapezius and deltoid muscles and simultaneously less in the remaining ones. In addition, only marginal differences in ranges of motion and muscle activity inputs were found between tempi. The playing style appeared to be more stable now. Overall, it appeared that nearly the same motor program was used for each tempo.
Clinical Implications:
Potential applications are intraindividual evaluations of simultaneously joint and muscular function in string players during clinical consultation. It is intended to contribute to the diagnosis of PRMDs in terms of an objective, comprehensive and yet clinically feasible diagnostic assessment as well as pre-post-intervention outcome evaluation.
Nonetheless, motion analysis must be used with care in clinical decision making. Motion data is subject to both, intraindividual variations, and measurement errors. In addition, the smallest clinically relevant changes are not clear yet. Therefore, results should only be interpreted together with other clinical findings.
This study reported the impact of electron beam (e-beam) treatment on microbiota and mycotoxins naturally present in red pepper powder and physicochemical quality changes. Treatment at 6 kGy indicated significant (p < 0.05) decontamination of yeasts and molds by 3.0 and 4.4 log CFU/g, respectively. A reduction of 4.5 log CFU/g of total plate counts (TPC) was observed at 10 kGy for 23 s. Fungal inactivation followed first-order kinetics while TPC better fitted with Gompertz function (R2 = 0.9912). E-beam treatment was not efficient for the degradation of aflatoxins but indirectly controlled their production by inactivation of mycotoxigenic molds. Indeed, reduction of 25% ochratoxin A was recorded at 30 kGy retaining >85% of total phenols, carotenoids and antioxidants activity. Moreover, treatment impact on total color difference (ΔE*) indicated ‘slight differences’. Overall, e-beam treatments up to 10 kGy were efficient in decontaminating the natural microbiota without detrimental effects on the physicochemical qualities of red pepper powder.
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.
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.
Red pepper (Capsicum annuum L.) is one of the major spices consumed globally, recognized for its aroma and nutrient properties, and it has a major economic value for high producing countries. However, characterization of its techno-functional properties and in-depth understanding of oxidative stability is needed to produce food of high quality and stability. Thus, this work focused on the chemical, functional, thermal, oxidative stability and rheological properties of red pepper powder and paste. Experiment was designed in a Completely Randomized Design (CRD) fashion. The red pepper powder contained 14.50 g/100 g, 44.00 g/100 g and 7.57 g/100 g of crude fat, crude fiber and ash, respectively. The concentration of total phenols, carotenoids and antioxidants activity of the powder were 1.04 g GAE/100 g, 374 mg βc/100 g and 38.61 μmol TE/g, respectively. Functional properties showed lower bulk density (395.1 kg/m3) and higher tapped density (583.4 kg/m3) indicating the higher compressibility of the powder. In contrast, Hausner ratio (1.48), Carr’s index (32%) and angle of repose (45°) indicated poor flowability of the powder. Particle size distribution also indicated that the volume weighted mean values D[4,3] of the powder and paste were 262.20 and 201.46, respectively. Emulsifying capacity of the powder was 47.5%. Oil and water absorption capacities varied from 1.41 to 1.73 and 0.86 to 2.29 g/g of initial weight, respectively. Higher glass transition temperature was observed for the powder (62.54°C) than the paste (45.64°C). The induction period indicated that red pepper was more stable against oxidation in powder (5.2 h) than in the paste form (3.2 h). Rheological analysis revealed that the paste exhibited shear-thinning behavior. Overall, understanding of the properties of red pepper could contribute to enhance quality.
Sustainable market economy
(2015)
The Lingen equilibrium model
(2021)
Equilibria protect against crisis. All disciplines of sciences have the objective to create equilibria. But economics are not successful in this point. Here a simple equilibrium model based on a wage-price-rule is demonstrated. Economics are able to create economic equilibria by using this rule. But in economic systems there are a lot of rules, especially in accounting, which make economic equilibria impossible. These rules must be changed. If it is possible to create economic equilibria, the side-effect is the realization of economic sustainability.
PEF is an innovative technology to extend the shelf life of fresh liquid food products, mainly juices, with minor impact on the quality. Many lab scale studies have been published, indicating the great potential of PEF for the juice industry. For industrial realization, the PEF systems have been adapted to the industrial requirements, establishing HACCP and hygienic design concept. Important process parameters have been identified from research and integrated in industrial PEF processes. Juice producers are now able to use PEF for their production lines.
This paper investigates four different mobile robots with respect to their drivingcharacteristics and soil preservation properties in an agricultural environment.Thereby, robots of classical design from agriculture as well as systems from spacerobotics with advanced locomotion concepts are considered to determine theindividual advantages of each rover concept with respect to the application domain.Locomotion experiments were conducted to analyze the general driving behavior,tensile force, and obstacle‐surmounting capability and ground interaction of eachrobot. Various soil conditions typical for the area of application are taken intoaccount, which are varied in terms of moisture and density. The presented workcovers the specification of the conducted experiments, documentation of theimplementation as well as analysis and evaluation of the collected data. In theevaluation, particular attention is paid to the change in driving characteristics underdifferent soil conditions, as well as to the soil stress caused by driving, since soilquality is of critical importance for agricultural applications. The analysis shows thatthe advanced locomotion concepts, as used in space robotics, also have positiveimplications for certain requirements in agricultural applications, such as maneuver-ability in wet conditions and soil conservation. The results show potential for designinnovations in agricultural robotics that can be used, to open up new fields ofapplication for instance in the context of precision farming.
The study aimed for the analysis of the impact of pulsed electric field (PEF) pre-treatment on convection (CD) and microwave (MW-CD) assisted air drying. Drying kinetics acceleration and retention of bioactive compounds of PEF pre-treated carrots and apples has been demonstrated. Moreover, the direct and indirect environmental energy impacts of CD and MW-CD technologies with consideration of bioactive compounds preservation has been evaluated. PEF assisted CD and MW-CD demonstrated lower energy use, especially for indirect energy consumption, in the case of carotenoids preservation in dried carrots.
Health-related quality of life (HRQOL) in parents of children suffering from renal disease is often diminished by the illness burden experienced in daily life and by unfavorable ways of coping. Our aim was to examine the relationship between psychosocial strains perceived by parents, their ways of coping, and HRQOL. In an anonymous cross-sectional study, parents completed a questionnaire concerning psychosocial strains, coping strategies, and HRQOL, as well as sociodemographic and illness parameters. Study participants were recruited in two outpatient dialysis centers. Participating in the study were 195 parents (105 mothers, 90 fathers; age 43 ± 8 years; representing 108 families) of children suffering from renal disease (age 12 ± 5 years). Parents of children with chronic renal failure reported moderate HRQOL with parents of children undergoing dialysis experiencing more limitations in quality of life than parents of children living with a kidney graft and parents of children undergoing conservative treatment. Mothers experienced lower HRQOL and higher psychosocial strains than fathers. HRQOL was predicted by the coping strategies “focusing on child” (β = –0.25), “improving marital relationship” (β = 0.24), “seeking social support” (β = –0.22) and “self-acceptation and growth” (β =0 .19) as well as parents′ perceived limitation by illness in daily life (β = –0.15; explained variance 57%). In the comprehensive care for families with a child suffering from a renal disease, screening for psychosocial strains and ways of coping, along with applying interventions to strengthen adaptive coping strategies, may be a preventative means of improving parents′ quality of life.
Climate change is the biggest social challenge facing the globalised world. The aim of this paper is to investigate the requirements for governance structures in regional sustainability programmes against climate change.
The study is an explorative case study. It is based on a literature review and expert interviews. It also involves the participatory observation of working groups meetings, and a design thinking workshop.
In spite of their enormous importance, little is known about the institutional conditions of the regional governance of climate change projects in Germany.
For this reason, the research project focuses on the important aspect of networking and governance structures. Consequently, the investigation will contribute to answering the question of which institutional framework conditions can raise the likelihood of climate change projects having a sustainable effect.
The outcomes of the application
This research has not only practical implications for the single case. The exploration of the critical factors of success also offers other regions important food for thought in shaping their governance structures. In particular, the design thinking process and the business network in the District of Steinfurt offer valuable points of reference.
Purpose
Attracting skilled students is an important aim of many cities in a knowledge-based society. This paper focuses on urban factors of attractiveness from a student's perspective and analyses their influence on locational choices of students. The criteria found were also used to evaluate how the City of Osnabrück, Germany, is rated in terms of these criteria and to reveal the greatest discrepancies.
Design / Methodology / Approach
The paper is based on a multi-level empirical research concept, including qualitative and quantitative approaches. A survey of 2,300 students was conducted in Osnabrück on the basis of focus group discussions with students and interviews with various experts such as a neighbourhood manager, an urban planner, a district mayor, a college president, a real estate manager.
Originality/value
To date, little research has been undertaken to empirically examine the specific requirements that German students look for in a place to live and study. According to the author’s present state of knowledge (January 2018), a comparable study has not been done.
The main contribution of this paper is the empirical analysis of what makes cities attractive to students. In contrast to the findings of Richard Florida about the Creative Class, the cleanliness of a city, beautiful city scenery, and attractive apartments are more important to students than cultural offers, interesting job opportunities, or a multicultural population.
Practical Implications
Insights from the empirical survey can both help to analyse important factors in students' decision-making process and provide possible measures that the city stakeholders can take.
Keywords
1. Knowledge-based urban development
2. Mobility decisions by students and skilled professionals
3. Location factors
4. Place branding
Proposed paper: Academic Research Paper
Purpose
In a knowledge-based society, one of the main driving forces of prosperity at city and regional levels is the ability to attract students and recently qualified graduates. The purpose of this paper is to identify the urban factors that contribute to “attractiveness” from a student perspective and to subsequently analyse the influence of these factors on students’ location choices. In the corresponding case study, the criteria identified were used to evaluate student satisfaction with the German city of Osnabrück.
Design/methodology/approach
A multi-level empirical research concept was used to analyse the relevant criteria. Focus group discussions served as the basis to design and conduct a survey of almost 2,300 students in the university city of Osnabrück at the end of 2016. A follow-up study in November 2017 at two universities in Berlin provided data for comparison.
Findings
Accessible – safe – clean and with affordable housing: these terms sum up the core expectations that students have of an attractive city. In contrast to the findings of Richard Florida regarding the creative class, cultural opportunities, exciting nightlife and a multicultural population were not important factors among the survey participants.
Research limitations/implications
As the study was conducted in two cities only, the findings cannot be generalised. It should be replicated in at least five other cities to validate and compare the research findings presented here. Furthermore, this study focused on the factors influencing the attractiveness of the city as a whole. However, the attractiveness of a specific neighbourhood may be of greater relevance to the decision-making process. As housing plays a major role, students’ particular needs with regard to accommodation should also be examined at greater depth.
Practical implications
Insights generated by the empirical study provide relevant information that may assist city stakeholders in taking effective measures regarding place management to attract and retain students.
Originality/value
To date, little research has been undertaken to empirically examine the specific factors that German students look for when deciding where to study and live. The goal of this paper is to present new empirical insights concerning the quality-of-life factors that influence students’ decision-making processes.
The break-up of the Soviet Union in 1991 triggered cropland abandonment on a continental scale, which in turn ledto carbon accumulation on abandoned land across Eurasia. Previous studies have estimated carbon accumulationrates across Russia based on large-scale modelling. Studies that assess carbon sequestration on abandoned land basedon robust field sampling are rare. We investigated soil organic carbon (SOC) stocks using a randomized samplingdesign along a climatic gradient from forest steppe to Sub-Taiga in Western Siberia (Tyumen Province). In total, SOCcontents were sampled on 470 plots across different soil and land-use types. The effect of land use on changes in SOCstock was evaluated, and carbon sequestration rates were calculated for different age stages of abandoned cropland.While land-use type had an effect on carbon accumulation in the topsoil (0–5 cm), no independent land-use effectswere found for deeper SOC stocks. Topsoil carbon stocks of grasslands and forests were significantly higher thanthose of soils managed for crops and under abandoned cropland. SOC increased significantly with time sinceabandonment. The average carbon sequestration rate for soils of abandoned cropland was 0.66 Mg C ha1yr1(1–20 years old, 0–5 cm soil depth), which is at the lower end of published estimates for Russia and Siberia. Therewas a tendency towards SOC saturation on abandoned land as sequestration rates were much higher for recentlyabandoned (1–10 years old, 1.04 Mg C ha1yr1) compared to earlier abandoned crop fields (11–20 years old,0.26 Mg C ha1yr1). Our study confirms the global significance of abandoned cropland in Russia for carbonsequestration. Our findings also suggest that robust regional surveys based on a large number of samples advancemodel-based continent-wide SOC prediction.
While recent studies have demonstrated that events are fundamentally climate sensitive, this seems to not be fully considered in event research or corporate event practice. Thus, this study aims to identify the influencing factors that affect the acceptance of climate adaptation measures among decision-makers in the event industry. The analysis was divided into three main parts. First, the existing literature related to climate change in an events context was reviewed. Using 15 semi structured interviews, the findings from this review were then critically discussed with stakeholders in Germany involved in event planning. Finally, explicit climate adaptation measures were proposed and discussed. Based on all findings, there appears to be a low level of awareness of and interest in climate adaptation amongst German event industry players. There is an imminent need for further research on climate adaptation and for decision-makers to better prepare for climate change in order to counteract resulting negative impacts.
Events are intangible services and services marketing thus plays a considerable role within event management education. The marketing mix with its “4 Ps” (product, price, promotion, place) is an essential element of many event management curricula. Most educational institutions also reflect the development (and related discussions) towards the existence of “7 Ps” – adding personnel, physical facilities and process management (Meffert/ Bruhn 2009) – or even “8 Ps” – adding physical environment, purchasing process, packaging and participation(Burke/ Resnick 2000) – within the service marketing domain.
Artificial intelligence will change our lives permanently - both at work and in our private lives. But how does machine learning actually work? The authors explore this question in their English-language textbook. They teach the necessary basics for the use of support vector machines, for example, through linear programming, the Lagrange multiplier, kernels and the SMO algorithm. They also cover neural networks, evolutionary algorithms, and Bayesian networks. Definitions are highlighted in the book and assignments invite readers to think along. The textbook is aimed at students of computer science, engineering and natural sciences, especially in the fields of robotics, artificial intelligence, and mathematics.
Iron deficiency is a global issue and can lead to a variety of clinical pictures. The biofor-tification of vegetables with iron could complement the existing portfolio of iron-rich products, thus improving iron supply in the long term. In order to determine whether the iron-biofortified vegetables could meet this demand and would address appropriate target groups, a quantitative online survey was conducted in Germany. Based on 1000 consumer responses, a cluster analysis was performed. The results showed a four-cluster solution. The first cluster was holistically engaged, the second was fitness-affine but health unconcerned, the third cluster consists frugal eaters with a focus on medical prevention, and the fourth cluster are hedonists. No cluster focused its consumption on iron-enriched products, but instead all developed an individual mix of the three product groups.
Iron deficiency is still widespread as a major health problem even in countries with adequate food supply. It mainly affects women but also vegans, vegetarians, and athletes and can lead to various clinical pictures. Biofortification of vitamin C-rich vegetables with iron may be one new approach to face this nutritional challenge. However, so far, little is known about the consumer acceptance of iron-biofortified vegetables, particularly in developed countries. To address this issue, a quantitative survey of 1000 consumers in Germany was conducted. The results showed that depending on the type of vegetable, between 54% and 79% of the respondents were interested in iron-biofortified vegetables. Regression analysis showed a relationship between product acceptance, gender, and area of residence. In addition, relationships were found between consumer preferences for enjoyment, sustainability, and naturalness. Compared to functional food and dietary supplements, 77% of respondents would prefer fresh iron-rich vegetables to improve their iron intake. For a market launch, those iron-rich vegetables appear especially promising, which can additionally be advertised with claims for being rich in vitamin C and cultivated in an environmentally friendly way. Consumers were willing to pay EUR 0.10 to EUR 0.20 more for the iron-biofortified vegetables.
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.
Perceptions of German consumers regarding methods for fortifying foods with iodine (Abstract)
(2022)
Health IT adoption research is rooted in Rogers' Diffusion of Innovation theory, which is based on longitudinal analyses. However, many studies in this field use cross-sectional designs. The aim of this study therefore was to design and implement a system to (i) consolidate survey data sets originating from different years (ii) integrate additional secondary data and (iii) query and statistically analyse these longitudinal data. Our system design comprises a 5-tier-architecture that embraces tiers for data capture, data representation, logics, presentation and integration. In order to historicize data properly and to separate data storage from data analytics a data vault schema was implemented. This approach allows the flexible integration of heterogeneous data sets and the selection of comparable items. Data analysis is prepared by compiling data in data marts and performed by R and related tools. IT Report Healthcare data from 2011, 2013 and 2017 could be loaded, analysed and combined with secondary longitudinal data.
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:
Etomidate is typically used as an induction agent in cardiac surgery because it has little impact on hemodynamics. It is a known suppressor of adrenocortical function and may increase the risk for post-operative infections, sepsis, and mortality. The aim of this study was to evaluate whether etomidate increases the risk of postoperative sepsis (primary outcome) and infections (secondary outcome) compared to propofol.
Methods:
This was a retrospective before–after trial (IRB EA1/143/20) performed at a tertiary medical center in Berlin, Germany, between 10/2012 and 01/2015. Patients undergoing cardiac surgery were investigated within two observation intervals, during which etomidate and propofol were the sole induction agents.
Results:
One-thousand, four-hundred, and sixty-two patients, and 622 matched pairs, after caliper propensity-score matching, were included in the final analysis. Sepsis rates did not differ in the matched cohort (etomidate: 11.5% vs. propofol: 8.2%, p = 0.052). Patients in the etomidate interval were more likely to develop hospital-acquired pneumonia (etomidate: 18.6% vs. propofol: 14.0%, p = 0.031).
Conclusion:
Our study showed that a single-dose of etomidate is not statistically associated with higher postoperative sepsis rates after cardiac surgery, but is associated with a higher incidence of hospital-acquired pneumonia. However, there is a notable trend towards a higher sepsis rate.
The benzodiazepine, midazolam, is one of the most frequently used sedatives in intensive care medicine, but it has an unfavorable pharmacokinetic profile when continuously applied. As a consequence, patients are frequently prolonged and more deeply sedated than intended. Due to its distinct pharmacological features, including a cytochrome P450-independent metabolization, intravenous lormetazepam might be clinically advantageous compared to midazolam. In this retrospective cohort study, we compared patients who received either intravenous lormetazepam or midazolam with respect to their survival and sedation characteristics. The cohort included 3314 mechanically ventilated, critically ill patients that received one of the two drugs in a tertiary medical center in Germany between 2006 and 2018. A Cox proportional hazards model with mortality as outcome and APACHE II, age, gender, and admission mode as covariates revealed a hazard ratio of 1.75 [95% CI 1.46–2.09; p < 0.001] for in-hospital mortality associated with the use of midazolam. After additionally adjusting for sedation intensity, the HR became 1.04 [95% CI 0.83–1.31; p = 0.97]. Thus, we concluded that excessive sedation occurs more frequently in critically ill patients treated with midazolam than in patients treated with lormetazepam. These findings require further investigation in prospective trials to assess if lormetazepam, due to its ability to maintain light sedation, might be favorable over other benzodiazepines for sedation in the ICU.
The usage of high-level synthesis (HLS) tools for FPGAs has increased significantly over the last years since they matured and allow software programmers to take advantage of reconfigurable hardware technology.
Most HLS tools employ methods to optimize for loops, e. g. by unrolling or pipelining them. But there is hardly any work on the optimization of while loops. This comes at no surprise since most while loops have loop-carried dependences involving the loop condition which result in large recurrence cycles in the dataflow graphs. Therefore typical while loops cannot be parallelized or pipelined.
We propose a novel transformation which allows to optimize while loops nested within a for loop. By interchanging the two loops, it is possible to pipeline (and thereby parallelize) the inner loop, resulting in a reduced execution time. We present two case studies on different hardware platforms and show the speedup factors - compared to a host processor and to an unoptimized hardware implementation - achieved by our while loop optimization method.
Acute post-operative delirium (POD) and long-term post-operative cognitive dysfunction (POCD) are frequent and associated with increased mortality, dependency on care giving and institutionalization rates. The POCD-related cost burden on the German long-term care insurance provides an indication for the savings potential from risk-adapted treatment schemes. Comprehensive estimates have not been assessed or published so far.
A model-based cost-analysis was designed to estimate POCD-related costs in the long-term care insurance. Comprehensive analysis of inpatient operations and procedures (OPS-codes) served as the base for case number calculations, which were then used as input to the actual cost model. POCD-incidence rates were obtained from the BioCog study. Various sensitivity analyses were performed to assess uncertainty of the model results.
Total POCD related annual costs in the German long-term care insurance account for approximately 1.6 billion EUR according to the base case of our analysis. Total annual costs for all POCD cases depend on surgery numbers, incidence rates, other assumptions, and uncertain input parameters.
The financial burden to the long-term care insurance is substantial, even in a conservative scenario of the cost model. Variability of results stems from uncertain assumptions, POCD-incidence rates and from uncertain patient numbers who are undergoing surgery and are therefore at risk to develop POCD.
After foundation of the Wadden Sea National Park, grazing and artificial drainage was ceased or reduced on large areas of the salt marshes at the Schleswig-Holstein mainland coast (Northern Germany). The effect of grazing cessation versus intensive and moderate grazing on vegetation diversity was studied on small (plant species richness on plots between 0.01 and 100 m2) and large scale (vegetation type richness per hectare) over 18 to 20 years by analysing data from long-term monitoring programs. Plant species richness and vegetation type richness increased strongly over time in all management regimes, because grazing-sensitive species increased first in ungrazed marshes and later dispersed to and established in intensively grazed marshes. Dominance of the tall, late-successional grass Elymus athericus on 7% to 52% of all moderately and ungrazed (primarily high marsh) plots led to a decrease in species richness. After 18 to 20 years, species richness was highest in moderately and intensively grazed high marshes. Differences were significant only on small plots of up to 4 m2. On the large scale, vegetation type richness in the low marsh was higher without grazing, while no differences were found in the high marsh. Our results indicate that grazing effects differ between spatial scales and that different spatial scales have to be considered for monitoring and evaluation of vegetation diversity in salt marshes. To conserve vegetation diversity on all scales, a large-scale mosaic of different management regimes should be maintained.
BACKGROUND:
There is little knowledge regarding the association between psychological factors and complex regional pain syndrome (CRPS) in children. Specifically, it is not known which factors precipitate CRPS and which result from the ongoing painful disease.
OBJECTIVES:
To examine symptoms of depression and anxiety as well as the experience of stressful life events in children with CRPS compared with children with chronic primary headaches and functional abdominal pain.METHODS: A retrospective chart study examined children with CRPS (n=37) who received intensive inpatient pain treatment between 2004 and 2010. They were compared with two control groups (chronic primary headaches and functional abdominal pain; each n=37), who also received intensive inpatient pain treatment. Control groups were matched with the CRPS group with regard to admission date, age and sex. Groups were compared on symptoms of depression and anxiety as well as stressful life events.
RESULTS:
Children with CRPS reported lower anxiety and depression scores compared with children with abdominal pain. A higher number of stressful life events before and after the onset of the pain condition was observed for children with CRPS.
CONCLUSIONS:
Children with CRPS are not particularly prone to symptoms of anxiety or depression. Importantly, children with CRPS experienced more stressful life events than children with chronic headaches or abdominal pain. Prospective long-term studies are needed to further explore the potential role of stressful life events in the etiology of CRPS.
Artificial intelligence (AI) promises transformative impacts on society, industry, and agriculture, while being heavily reliant on diverse, quality data. The resource-intensive "data
problem" has initialized a shift to synthetic data. One downside of synthetic data is known as the "reality gap", a lack of realism. Hybrid data, combining synthetic and real data, addresses this. The paper examines terminological inconsistencies and proposes a unified taxonomy for real, synthetic, augmented, and hybrid data. It aims to enhance AI training datasets in smart agriculture, addressing the challenges in the agricultural data landscape. Utilizing hybrid data in AI models offers improved prediction performance and adaptability.
Chitin is an abundant waste product from shrimp and mushroom industries and as such, an appropriate secondary feedstock for biotechnological processes. However, chitin is a crystalline substrate embedded in complex biological matrices, and, therefore, difficult to utilize, requiring an equally complex chitinolytic machinery. Following a bottom-up approach, we here describe the step-wise development of a mutualistic, non-competitive consortium in which a lysine-auxotrophic Escherichia coli substrate converter cleaves the chitin monomer N-acetylglucosamine (GlcNAc) into glucosamine (GlcN) and acetate, but uses only acetate while leaving GlcN for growth of the lysine-secreting Corynebacterium glutamicum producer strain. We first engineered the substrate converter strain for growth on acetate but not GlcN, and the producer strain for growth on GlcN but not acetate. Growth of the two strains in co-culture in the presence of a mixture of GlcN and acetate was stabilized through lysine cross-feeding. Addition of recombinant chitinase to cleave chitin into GlcNAc2, chitin deacetylase to convert GlcNAc2 into GlcN2 and acetate, and glucosaminidase to cleave GlcN2 into GlcN supported growth of the two strains in co-culture in the presence of colloidal chitin as sole carbon source. Substrate converter strains secreting a chitinase or a β-1,4-glucosaminidase degraded chitin to GlcNAc2 or GlcN2 to GlcN, respectively, but required glucose for growth. In contrast, by cleaving GlcNAc into GlcN and acetate, a chitin deacetylase-expressing substrate converter enabled growth of the producer strain in co-culture with GlcNAc as sole carbon source, providing proof-of-principle for a fully integrated co-culture for the biotechnological utilization of chitin.
Alexithymia, or a lack of emotional awareness, is prevalent in some chronic pain conditions and has been linked to poor recognition of others' emotions. Recognising others' emotions from their facial expression involves both emotional and motor processing, but the possible contribution of motor disruption has not been considered. It is possible that poor performance on emotional recognition tasks could reflect problems with emotional processing, motor processing or both. We hypothesised that people with chronic facial pain would be less accurate in recognising others' emotions from facial expressions, would be less accurate in a motor imagery task involving the face, and that performance on both tasks would be positively related. A convenience sample of 19 people (15 females) with chronic facial pain and 19 gender-matched controls participated. They undertook two tasks; in the first task, they identified the facial emotion presented in a photograph. In the second, they identified whether the person in the image had a facial feature pointed towards their left or right side, a well-recognised paradigm to induce implicit motor imagery. People with chronic facial pain performed worse than controls at both tasks (Facially Expressed Emotion Labelling (FEEL) task P < 0·001; left/right judgment task P < 0·001). Participants who were more accurate at one task were also more accurate at the other, regardless of group (P < 0·001, r2 = 0·523). Participants with chronic facial pain were worse than controls at both the FEEL emotion recognition task and the left/right facial expression task and performance covaried within participants. We propose that disrupted motor processing may underpin or at least contribute to the difficulty that facial pain patients have in emotion recognition and that further research that tests this proposal is warranted.
The primary objective of this study was to determine the structural and known-group validity as well as the inter-rater reliability of a test battery to evaluate the motor control of the craniofacial region. Seventy volunteers without TMD and 25 subjects with TMD (Axes I) per the DC/TMD were asked to execute a test battery consisting of eight tests. The tests were video-taped in the same sequence in a standardised manner. Two experienced physical therapists participated in this study as blinded assessors. We used exploratory factor analysis to identify the underlying component structure of the eight tests. Internal consistency (Cronbach's α), inter-rater reliability (intra-class correlation coefficient) and construct validity (ie, hypothesis testing-known-group validity) (receiver operating curves) were also explored for the test battery. The structural validity showed the presence of one factor underlying the construct of the test battery. The internal consistency was excellent (0.90) as well as the inter-rater reliability. All values of reliability were close to 0.9 or above indicating very high inter-rater reliability. The area under the curve (AUC) was 0.93 for rater 1 and 0.94 for rater two, respectively, indicating excellent discrimination between subjects with TMD and healthy controls. The results of the present study support the psychometric properties of test battery to measure motor control of the craniofacial region when evaluated through videotaping. This test battery could be used to differentiate between healthy subjects and subjects with musculoskeletal impairments in the cervical and oro-facial regions. In addition, this test battery could be used to assess the effectiveness of management strategies in the craniofacial region.