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Recording of Low-Oxygen Stress Response Using Chlorophyll Fluorescence Kinetics in Apple Fruit
(2023)
Long-term storage of apples (Malus x domestica, Borkh.) is increasingly taking place under Dynamic Controlled Atmosphere (DCA). The oxygen level is lowered to ≤ 1 kPa O2 and the apples are stored just above the Lower Oxygen Limit (LOL). Low oxygen stress during controlled atmosphere storage can lead to fermentation in apples if oxygen levels are too low. Chlorophyll fluorescence can be used to detect low-oxygen stress at an early stage during storage. The currently available non-imaging fluorescence systems often use the minimal fluorescence (Fo) parameter. In contrast, the use of chlorophyll fluorescence kinetics is insufficiently described. Therefore, this study aimed to gain more knowledge about the response of chlorophyll fluorescence kinetics to low oxygen stress in apples using a fluorescence imaging system. The results show that the kinetic fluorescence curves differ under aerobic and fermentation conditions. The fermentative conditions initiated a decrease in fluorescence intensity upon application of the saturation pulses during exposure to actinic light. This result was made at 18 °C and 2 °C ambient temperatures. Interestingly, the kinetic curve changed at 2 °C before fermentation products accumulated in the apples. Non-photochemical quenching (NPQ) decreased under fermentation conditions in the dark phase after relaxation. Upon entering the dark relaxation phase after Kautsky induction, ɸPSII began to increase. Under atmospheric oxygen conditions, ɸPSII reached values of 0.81 to 0.76, while under fermentation, ɸPSII values ranged from 0.57 to 0.44.
Recognition of Emotional Facial Expressions and Alexithymia in Patients with Chronic Facial Pain
(2018)
Objectives
Alexithymia, conceived as difficulties to identify emotions, is said to be related with several pain syndromes. This study examined the recognition of facially expressed emotions and its relation to alexithymia in subjects with chronic facial pain.
Methods
A total of 62 subjects were recruited, with n=20 patients with chronic facial pain and n=42 healthy controls. All subjects were tested for the recognition of facially expressed emotions (Facially Expressed Emotion Labelling Test (FEEL test). The Toronto Alexithymia Scale (TAS-26) was used for the diagnosis of alexithymia.
Results
Patients with chronic facial pain performed worse than controls at the FEEL task (p<.001) and showed higher total TAS scores (p<.001). This indicates the presence of alexithymia and facial emotion recognition deficits in the facial pain group.
Discussion
It was concluded from the results that both the recognition of facially expressed emotions, and the ability to identify and describe one’s own feelings (TAS), are restricted in chronic orofacial pain patients. This relationship is particularly important in the treatment of chronic facial pain, indicating that it should become part of the treatment in addition to the therapeutic key issues, to influence the quality of life of the affected patients positively.
The effects of reaction parameters on Hurn:xwiley:23670932:media:cptc202000216:cptc202000216-math-0001 production from ethanol photocatalysis in the gas phase have been investigated. The photocatalytic activity evolves from an early mass‐transfer limited regime to an independent one at later irradiation times, which is interpreted in terms of a photocatalytic site activity distribution. Ethanol molar fraction exhibits two different domains, with Hurn:xwiley:23670932:media:cptc202000216:cptc202000216-math-0002 production increasing up to a molar fraction of 0.12, beyond which it plateaus. Hurn:xwiley:23670932:media:cptc202000216:cptc202000216-math-0003 :AcH ratios are very sensitive to reaction conditions, reaching 1.8 at low reactant flows. UV light is converted to Hurn:x-wiley:23670932:media:cptc202000216:cptc202000216-math-0004 with an efficiency of nearly 3 %.
Duckweeds are fast-growing and nutritious plants, which are gaining increased attention in different fields of application. Especially for animal nutrition, alternative protein sources are needed to substitute soybean meal. The current bottleneck is the standardized production of biomass, which yields stable quantities of a defined product quality. To solve this problem, an indoor vertical farm (IVF) for duckweed biomass production was developed. It consists of nine vertically stacked basins with a total production area of 25.5 m2. The nutrient solution, a modified N-medium, re-circulated within the IVF with a maximum flow rate of 10 L min−1. Nutrients were automatically added based on electrical conductivity. In contrast, ammonium was continuously supplied. A water temperature of 23 °C and a light intensity of 105 μmol m−2 s−1 with a photoperiod of 12:12 h were applied. During a 40-day production phase, a total of 35.6 kg of fresh duckweed biomass (equals 2.1 kg of dried product) was harvested from the IVF. On average, 0.9 kg day−1 of fresh biomass was produced. The dried product contained 32% crude protein (CP) and high levels of proteinogenic amino acids (e.g. lysine: 5.42 g, threonine: 3.85 g and leucine: 7.59 g/100 g CP). Biomass of this quality could be used as a protein feed alternative to soybean meal. The described IVF represents a modular model system for duckweed biomass production in a controlled environment and further innovations and upscaling processes.
Landwirtschaftliche Wertschöpfungsprozesse werden häufig nur isoliert betrachtet. Eine ganzheitliche Betrachtung der vorhandenen Wertschöpfungskette mit ihren Material-, Informationsund Finanzflu?ssen findet jedoch selten statt. Dies hat zur Folge, dass singuläre Optima erzeugt werden, die in ihrer Summe geringer ausfallen als eine globale Optimierung der gesamten Wertschöpfungskette. Aus diesem Grund muss eine effiziente essourcenallokation entlang der gesamten Wertschöpfungskette angestrebt werden. Die hier vorgestellte „MaisApp“ kann als herstellerunabhängiges Instrument eingesetzt werden, um die Einsatzsteuerung moderner, kapitalintensiver Arbeitsmaschinen zu verbessern.
Background
A pre-existing neurocognitive disorder (NCD) is a relevant factor for the outcome of surgical patients. To improve understanding of these conditions, we investigated the association between parameters of the cholinergic system and NCD.
Method
This investigation is part of the BioCog project (www.biocog.eu), which is a prospective multicenter observational study including patients aged 65 years and older scheduled for elective surgery. Patients with a Mini-Mental State Examination (MMSE) score ≤23 points were excluded. Neurocognitive disorder was assessed according to the fifth Diagnostic and Statistical Manual of Mental Disorders criteria. The basal forebrain cholinergic system volume (BFCSV) was assessed with magnetic resonance imaging, the peripheral cholinesterase (ChE) activities with point-of-care measurements, and anticholinergic load by analyzing the long-term medication with anticholinergic scales (Anticholinergic Drug Scale [ADS], Anticholinergic Risk Scale [ARS], Anticholinergic Cognitive Burden Scale [ACBS]). The associations of BFCSV, ChE activities, and anticholinergic scales with NCD were studied with logistic regression analysis, adjusting for confounding factors.
Results
A total of 797 participants (mean age 72 years, 42% females) were included. One hundred and eleven patients (13.9%) fulfilled criteria for mild NCD and 82 patients (10.3%) for major NCD criteria. We found that AcetylChE activity was associated with major NCD (odds ratio [95% confidence interval]: [U/gHB] 1.061 [1.010, 1.115]), as well as ADS score ([points] 1.353 [1.063, 1.723]) or ARS score, respectively ([points] 1.623 [1.100, 2.397]) with major NCD. However, we found no association between BFCSV or ButyrylChE activity with mild or major NCD.
Conclusions
AcetylChE activity and anticholinergic load were associated with major NCD. Future research should focus on the association of the cholinergic system and the development of postoperative delirium and postoperative NCD.
Quo vadis Oecotrophologie?
(2021)
In this experimental work, the quasi static and fatigue properties of a 40 wt.% long carbon fiber reinforced partially aromatic polyamide (Grivory GCL-4H) were investigated. For this purpose, microstructural parameter variations in the form of different thicknesses and different removal directions from injectionmolded plates were evaluated. Mechanical properties decreased by increasing misalignment away from the melt flow direction. By changing the specimen thickness, no change in the general fiber distribution pattern transversal and normal to the axis of melt flow was observed. It has shown that with increasing specimen thickness the quasi static properties along the melt flow direction decreased and vice versa resulting in superior properties normal to the melt flow axis. At around 5 mm, an intersection suggests quasi-isotropic behavior. In addition, the fatigue strength of the material was significantly higher in the flow direction than normal to the flow direction. No change in fatigue life was observed while changing specimen thickness. The Basquin equation seems to describe the effect of stress amplitude on the fatigue strength of this composite. Scanning electron microscopy was used to investigate fracture surfaces of tested specimens. Results show that mechanical properties and morphological structures depend highly on fiber orientation.
Introduction:
Many patients with cerebral palsy (CP) suffer chronic pain as one of the most limiting factors in their quality of life. In CP patients, pain mechanisms are not well understood, and pain therapy remains a challenge. Quantitative sensory testing (QST) might provide unique information about the functional status of the somatosensory system and therefore better guide pain treatment.
Objectives:
To understand better the underlying pain mechanisms in pediatric CP patients, we aimed to assess clinical and pain parameters, as well as QST profiles, which were matched to the patients' cerebral imaging pathology.
Patients and methods:
Thirty CP patients aged 6–20 years old (mean age 12 years) without intellectual impairment underwent standardized assessments of QST. Cerebral imaging was reassessed. QST results were compared to age- and sex-matched controls (multiple linear regression; Fisher's exact test; linear correlation analysis).
Results:
CP patients were less sensitive to all mechanical and thermal stimuli than healthy controls but more sensitive to all mechanical pain stimuli (each p < 0.001). Fifty percent of CP patients showed a combination of mechanical hypoesthesia, thermal hypoesthesia and mechanical hyperalgesia; 67% of CP patients had periventricular leukomalacia (PVL), which was correlated with mechanic (r = 0.661; p < 0.001) and thermal (r = 0.624; p = 0.001) hypoesthesia.
Conclusion:
The combination of mechanical hypoesthesia, thermal hypoesthesia and mechanical hyperalgesia in our CP patients implicates lemniscal and extralemniscal neuron dysfunction in the thalamus region, likely due to PVL. We suspect that extralemniscal tracts are involved in the original of pain in our CP patients, as in adults.
Qualität in der häuslichen Pflege : Ansätze zu einer lebensweltorientierten Weiterentwicklung
(2014)
Background: For more than 30 years, there has been close cooperation between Japanese and German scientists with regard to information systems in health care. Collaboration has been formalized by an agreement between the respective scientific associations. Following this agreement, two joint workshops took place to explore the similarities and differences of electronic health record systems (EHRS) against the background of the two national healthcare systems that share many commonalities.
Objectives: To establish a framework and requirements for the quality of EHRS that may also serve as a basis for comparing different EHRS.
Methods: Donabedian's three dimensions of quality of medical care were adapted to the outcome, process, and structural quality of EHRS and their management. These quality dimensions were proposed before the first workshop of EHRS experts and enriched during the discussions.
Results: The Quality Requirements Framework of EHRS (QRF-EHRS) was defined and complemented by requirements for high quality EHRS. The framework integrates three quality dimensions (outcome, process, and structural quality), three layers of information systems (processes and data, applications, and physical tools) and three dimensions of information management (strategic, tactical, and operational information management).
Conclusions: Describing and comparing the quality of EHRS is in fact a multidimensional problem as given by the QRF-EHRS framework. This framework will be utilized to compare Japanese and German EHRS, notably those that were presented at the second workshop.
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.
Im Mittelpunkt des vorliegenden Beitrags stehen thematische Schwerpunkte, methodische Zugänge und Entwicklungspotentiale
qualitativer Wirkungsforschung, die sich im Kontext einer experimentell-naturwissenschaftlich dominierten Interventionsforschung
entwickelt. Eine Analyse ausgewählter aktueller Studien zur Wirkung physio-, ergo- und sprachtherapeutischer sowie
pflegerischer Interventionen der Schlaganfallrehabilitation verdeutlicht die Dominanz des Studienformats einer auflistenden
qualitativen Inhaltszusammenfassung. Qualitative Interventionsstudien dieses Formats werden weitgehend ohne Bezugnahme
auf etablierte qualitative Forschungstraditionen realisiert. Sie sind durch eine fallübergreifende Auflistung von Interviewaussagen
zu ausgewählten Themenbereichen gekennzeichnet. Basierend auf in den Pflegewissenschaften entstandenen Typologien der
Ergebnisse qualitativer Studien, werden Potentiale zur Weiterentwicklung der Komplexität und interpretativen Erklärungskraft
qualitativer Interventionsforschung vorgestellt. Ihre methodologische Fundierung und Qualitätssicherung werden als zentrale
Entwicklungsaufgaben diskutiert.
Qualitative Ansätze in der teilhabeorientierten Aphasie-Diagnostik: Kennzeichen und Anwendungen
(2015)
Um eine an Teilhabe und Selbstbestimmung orientierte Sprachtherapie planen, gestalten
und bewerten zu können, sind vielfältige und detaillierte Informationen über die
Teilhabesituation, die Teilhabeziele und das individuelle Erleben eines Menschen mit
Aphasie grundlegend. Eine therapierelevante und veränderungsorientierte Diagnostik
braucht methodische Zugänge, die der Individualität, Kontextbezogenheit und Subjektivität
menschlicher Teilhabe gerecht werden können. Nach Auffassung der Autorinnen
bietet die qualitative Sozialforschung der Sprachtherapie hierfür ein viel versprechendes
methodisches Repertoire. Der vorliegende Beitrag skizziert grundlegende Kennzeichen
dieses Forschungsstils, der Sprachtherapeutinnen und -therapeuten oftmals
wenig vertraut ist. Ausgewählte Ansätze einer qualitativen teilhabeorientierten Aphasie-
Diagnostik werden beispielhaft vorgestellt.
Schlüsselwörter: Aphasie, Teilhabe, Diagnostik, Evaluation, qualitative Methoden,
Interview, Ethnografie, Konversationsanalyse
Qualitative Ansätze in der teilhabeorientierten Aphasie-Diagnostik: Kennzeichen und Anwendungen
(2015)
Um eine an Teilhabe und Selbstbestimmung orientierte Sprachtherapie planen, gestalten und bewerten zu können, sind vielfältige und detaillierte Informationen über die
Teilhabesituation, die Teilhabeziele und das individuelle Erleben eines Menschen mit
Aphasie grundlegend. Eine therapierelevante und veränderungsorientierte Diagnostik
braucht methodische Zugänge, die der Individualität, Kontextbezogenheit und Subjektivität menschlicher Teilhabe gerecht werden können. Nach Auffassung der Autorinnen
bietet die qualitative Sozialforschung der Sprachtherapie hierfür ein viel versprechendes methodisches Repertoire. Der vorliegende Beitrag skizziert grundlegende Kennzeichen dieses Forschungsstils, der Sprachtherapeutinnen und -therapeuten oftmals
wenig vertraut ist. Ausgewählte Ansätze einer qualitativen teilhabeorientierten Aphasie-Diagnostik werden beispielhaft vorgestellt.
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 kiwifruit processing industry is focused on product yield maximization and keeping energy costs and waste effluents to a minimum while maintaining high product quality. In our study, pulsed electric field (PEF) pretreatment enhanced kiwifruit processing to facilitate peelability and specific peeling process and enhanced valorization of kiwifruit waste. PEF optimization was applied to obtain the best treatment parameters. A 32 factorial design of response surface methodology was applied to find the effect of time elapsed after PEF treatment and the PEF-specific energy input on specific peeling force and kiwifruit firmness as response criteria. Under the optimized condition, the specific peeling force decreased by 100, and peelability increased by 2 times. The phenolic content and antioxidant capacity of PEF-treated kiwifruit bagasse were 5.1% and 260% richer than the control sample. Overall, the optimized PEF pretreatments incorporated into kiwifruit processing led to decreased energy demand and increased productivity.
In this study the effect of PEF pre-treatment on the microstructure of freeze-dried strawberry dices was investigated. The PEF treatment has been performed at an electric field intensity of 1.07 kV/cm and a specific energy input of 1 kJ/kg. The samples were freeze-dried at a temperature of 45 °C and a pressure of 1 mbar. The microstructure of dried material was evaluated by different physical and optical methods, such as SEM, μ-CT and thermogravimetry. Moreover, mechanical and acoustic properties as well as the colour of processed material have been analyzed. PEF pre-treated strawberry dices showed a more uniform shape, a better retention of volume and a visual better quality compared to untreated ones. Moreover, PEF pre-treatment led to a more homogeneous distribution and a greater thickness of pores. In accordance, analysis of textural properties evidenced that PEF treated freeze-dried strawberry dices were crispier than untreated ones. Measurement of L*a*b*-values showed that PEF treated material was characterized by a more preserved colour after freeze-drying than untreated ones.
Plant-based proteins are rapidly emerging, while novel technologies are explored to offer more efficient extraction processes. The current study aimed to evaluate the effects of pulsed electric fields (PEFs) and temperature on the extraction of soluble proteins from nettle leaves (Urtica dioica L.) and identify an optimal operational range for the highest yield of soluble proteins. Extractions and kinetic modeling were conducted with whole and ground dried leaves at different temperatures (30–70 °C) and specific energy of PEF (0–30 kJ kg−1) with extraction times of up to 60 min. The influence of temperature and specific energy on the soluble protein extraction yields was investigated and modeled using composite central design and response surface methodology. The experimental results were fitted to Peleg's kinetic model, which satisfactorily described the extraction process (R2 > 0.902), and PEF treated samples resulted in a higher soluble protein yield and shortened processing time. Response surface methodology showed that the linear effect of temperature and quadratic effect of PEF (p < 0.01) were highly significant for protein yield. In the optimized PEF-extraction region (specific energy between 10 and 24 kJ kg−1, and 70–78 °C), soluble protein yield was higher than 60% after 5 minutes of extraction. The achieved results are relevant for developing processes for PEF assisted extraction of soluble proteins from leaves. Understanding the effects of PEFs and process parameters is crucial to obtain high protein yields, while requiring low energy and short processing time.
To ensure the quality of long-term care services has been one of the key elements of German long-term care insurance since its implementation in 1995. A joint agreement between insurers and service providers served as the baseline for quality assurance. Monitoring and control of quality in institutional and home based long-term care was performed by the insurers’ Medical Board. As a result of problems in some long-term care facilities reported in the media the Long-term Care System Reform Act of 2008 contained several provisions to ensure and improve the quality of services. The obligatory use of expert standards for the performance of particular nursing interventions and the establishment of a system of public reporting were the first measures implemented. The development of quality indicators has also been initiated. These routes to quality, their anticipated effects and remaining challenges will be addressed in this article.
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.
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.
Hintergrund
International stellen präventive Hausbesuche (PHB) ein implementiertes Konzept dar. Aufgrund des demografischen Wandels und andauernden Fachkräftemangels werden alternative Versorgungsformen wie PHB benötigt. Ziel der PHB ist, älteren Menschen den Verbleib in ihrem Zuhause und somit ihre präferierte Lebensform möglichst lange zu ermöglichen.
Methodik
Im Rahmen des vorliegenden Scoping-Reviews wurde eine datenbankgestützte, systematische Literaturreche durchgeführt, um einen Überblick der Literatur über PHB darzustellen. Der Fokus der Literaturanalyse lag auf den Effekten PHB, die aus internationalen und nationalen Reviews abgeleitet werden konnten, nationale Studien dienten der Analyse des Konzepts PHB. Es wurden 9 internationale und ein nationales Review sowie 7 nationale Studien eingeschlossen.
Ergebnisse
Die PHB erzielen heterogene Effekte auf die Mortalität, den stationären Krankenhausaufenthalt, die Pflegeheimaufnahme, das Sturzereignis, den funktionellen Status und die Lebensqualität. Die Ergebnisse sprechen tendenziell dafür, dass durch die PHB Pflegebedürftigkeit hinausgezögert oder gar vermieden werden kann.
Schlussfolgerungen
Weitere Forschungsarbeiten zu PHB sind notwendig, um das bisherige Wissen zu ergänzen und mögliche Konzeptanpassungen für eine größere Akzeptanz der Zielgruppe sowie die deutschlandweite Implementierung zu erreichen. Zudem ist die Politik gefordert, die Finanzierung innerhalb Deutschlands sicherzustellen. In Deutschland sind PHB noch nicht flächendeckend implementiert, obwohl verschiedene Projekte in unterschiedlichen Kontexten auf einen anhaltenden gesellschaftlichen Bedarf für und Interesse an PHB hindeuten.
The global climate system is currently warming due to the increase in CO2 emissions caused by humans. Technically oriented efficiency strategies are seen more frequently as solutions to reach the European Union’s maximum two degrees Celsius target. Companies play an important role in limiting climate change and must either prepare for such consequences or adopt new strategies such as the sufficiency strategy.
This article will discuss how the sufficiency strategy and the promotion of sufficient living in the context of the tourism industry can contribute to reducing CO2 emissions. Most common approaches toward sufficient living found in literature will be identified, analysed and discussed. Based on chosen keywords, the most common approaches were identified through a literature review of relevant journals from 1989 to 2014. Four main research fields that can promote sufficient living and reduce CO2 emissions were identified. Based on the prospects of the companies, it is apparent that sufficient strategies are not only able to support a market-orientated corporate management but also promote sufficient living and thus reduce CO2 emissions.
Quantitative Umweltbewertungen sind von entscheidender Bedeutung, wenn es darum geht, effektiv auf nachhaltige Produktions- und Verbrauchsmuster hinzuarbeiten. In den letzten Jahrzehnten haben sich Lebenszyklusanalysen (LCA) als praktikables Mittel zur Messung der Umweltauswirkungen von Produkten entlang der Lieferkette etabliert. In Bezug auf Nutzer- und Konsummuster wurden jedoch methodische Schwächen festgestellt, und es wurden mehrere Versuche unternommen, Ökobilanzen entsprechend zu verbessern, beispielsweise durch Einbeziehung von Effekten höherer Ordnung und verhaltenswissenschaftlicher Unterstützung. In einer Diskussion solcher Ansätze zeigen wir, dass den Konzepten des Verbrauchs keine explizite Aufmerksamkeit geschenkt wurde, was häufig zu produktzentrierten Bewertungen führt. Wir führen Theorien sozialer Praktiken ein, um Konsummuster für LCA zugänglich zu machen. Soziale Praktiken sind routinierte Handlungen, die aus miteinander verbundenen Elementen (Materialien, Kompetenzen und Bedeutungen) bestehen, die sie als eine Einheit denkbar machen (z. B. Kochen). Da die meisten sozialen Praktiken eine Art von Verbrauch (Material, Energie, Luft) beinhalten, konnten wir einen Rahmen entwickeln, der soziale Praktiken mit der Ökobilanz verbindet. Der vorgeschlagene Rahmen bietet eine neue Perspektive für quantitative Umweltbewertungen, indem er den Schwerpunkt von Produkten oder Nutzern auf soziale Praktiken verlagert. Dementsprechend sehen wir die Chance darin, die reduktionistische Sichtweise zu überwinden, dass Menschen nur Nutzer von Produkten sind, und sie stattdessen als Praktiker in sozialen Praktiken zu sehen. Dieser Wandel könnte neue Methoden der interdisziplinären Konsumforschung ermöglichen, die beabsichtigte Sozialwissenschaften und wirkungsorientierte Bewertungen einbeziehen. Allerdings bedarf der Rahmen einer weiteren Überarbeitung und vor allem einer empirischen Validierung.
Professionalization in low-threshold drug aid : between managerialism and practitioner knowledge
(2021)
Background
Against the background of a steadily increasing degree of digitalization in health care, a professional information management (IM) is required to successfully plan, implement, and evaluate information technology (IT). At its core, IM has to ensure a high quality of health data and health information systems to support patient care.
Objectives
The goal of the present study was to define what constitutes professional IM as a construct as well as to propose a reliable and valid measurement instrument.
Methods
To develop and validate the construct of professionalism of information management (PIM) and itsmeasurement, a stepwise approach followed an established procedure from information systems and behavioral research. The procedure included an analysis of the pertaining literature and expert rounds on the construct and the
instrument, two consecutive and comprehensive surveys at the national and international level, exploratory and confirmatory factor analyses as well as reliability and validity testing.
Results
Professionalism of information management was developed as a construct consisting of the three dimensions of strategic, tactical, and operational IMas well as of the regularity and cyclical phases of IM procedures as the two elements of professionalism.
The PIM instrument operationalized the construct providing items that incorporated IM procedures along the three dimensions and cyclical phases. These procedures had to be evaluated against their degree of regularity in the instrument. The instrument proved to be reliable and valid in two consecutive measurement phases
and across three countries.
Conclusion
It can be concluded that professionalism of information management is a meaningful construct that can be operationalized in a scientifically rigorous manner. Both science and practice can benefit from these developments in terms of improved self-assessment, benchmarking capabilities, and eventually, obtaining a better understanding of health IT maturity.
„Wissen ist Macht“. Diese Redewendung ist sicherlich keine Neuheit. Im Rahmen des Knowledge Managements wird die aktuelle Gültigkeit dieses geflügelten Wortes jedoch mehr denn je unterstrichen. Das Wissen über den Kunden gilt als zentraler Erfolgsfaktor, wodurch den Methoden zur Generierung dieses Wissens eine signifikante Bedeutung zukommt. Immer mehr Unternehmen beschäftigen sich mit dem Thema Kundentracking im stationären Handel und das Angebot von Dienstleistungen in diesem Bereich steigt folglich stetig. Durch die gewonnen Daten können Vertriebs- und Marketingaktivitäten zielgerichtet durchgeführt werden, wodurch das Einkaufserlebnis der Kunden und die Verkaufszahlen von Einzelhändlern nachhaltig gesteigert werden können. Die beidseitigen Vorteile des Kundentrackings hat auch das Modehaus Lengermann und Trieschmann GmbH & Co. KG aus Osnabrück erkannt. Hierbei handelt es sich um das größte inhabergeführte Modehaus Norddeutschlands.
The purpose of this study was to evaluate which mode of birth first-time mothers in Germany and in the USA prefer and how this desire is related to maternal well-being and sense of coherence. The paper describes emotional well-being postpartum in relationship to mode of birth. For data collection a prospective cohort study was conducted in both countries. A self-administered questionnaire including validated instruments (WHO-5 Well-Being Index, Sense of Coherence Scale and Edinburgh Postnatal Depression Scale) was used. Results showed that only a few of the pregnant women in Germany and the USA preferred to deliver by caesarean section. There was a relationship between women's well-being, women's sense of coherence and the preferred mode of birth. The majority of women who wanted a caesarean section delivered in this way. No relationship was found between women's well-being and the type of birth experienced. Well-being in both samples generally decreased after giving birth, but there was a difference between German and American first-time mothers on the postpartum well-being and depression scores. German mothers had a higher postnatal quality of life and lower postnatal depression scores. To give families the opportunity for a healthy start, midwives and obstetricians should try to enhance women's well-being and they should give some thought to health professionals' decision-making processes. Expanded postpartum care might have an impact on women's depression scores..
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.
The paradox of Indian women’s declining presence in the labor market despite their
advancements in higher education leads to questions regarding how this “leaky pipeline” can be
patched and (partly) prevented. At the same time, female educational advancement in Western
countries, such as Germany, does not equate to significantly more females in leadership positions
or changes in gender role expectations. In both the Indian and German contextual setting, women
face hurdles in developing their career and the risk of lifelong dependency or poverty.
This paper clarifies the perspectives of young females on leadership careers and success
before they enter the labor market and uses the results from career research to show “blind spots”
that might lead to hurdles for their future careers. The second contribution of the paper is
envisioning future teaching that (1) prevents females from making decisions that might lead to
dependency and poverty while fulfilling organizational and societal gender role expectations and
(2) fosters organizational changes that facilitates female careers. The Paper also reflects on the
learning stages necessary for transforming theoretical knowledge into practical solutions and
promoting more equal opportunities in the labor market.
Die demokratische Gesellschaft ist als eine Kommunikationsgemeinschaft gleichberechtigter und mündiger Menschen angelegt. Das spiegelt sich gleichermaßen in der Verfassung wie in den Institutionen unseres Staates wider. Der Ausgleich der Interessen soll als offener und fairer Streit erfolgen. Das notwendige Wissen und damit die Urteilskraft, um die Argumente in diesem Streit bewerten zu können, beziehen wir vor allem aus den Massenmedien. Sie haben die Aufgabe, eine öffentlich zugängliche Sprache für eine hochkomplexe Welt und die darin auftretenden Probleme und Konflikte zu finden. Zugleich dienen sie den politisch Herrschenden als Plattform ihrer Legitimation und damit zur Loyalitätsbeschaffung.
Preoperative medication use and development of postoperative delirium and cognitive dysfunction
(2021)
Postoperative delirium (POD) and postoperative (neuro-)cognitive disorder (POCD) are frequent and serious complications after operations. We aim to investigate the association between pre-operative polypharmacy and potentially inappropriate medications and the development of POD/POCD in elderly patients. This investigation is part of the European BioCog project (www.biocog.eu), a prospective multicenter observational study with elderly surgical patients. Patients with a Mini-Mental State Examination score less than or equal to 23 points were excluded. POD was assessed up to 7 days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method (for the intensive care unit [ICU]), and a patient chart review. POCD was assessed 3 months after surgery with a neuropsychological test battery. Pre-operative long-term medication was evaluated in terms of polypharmacy (≥5 agents) and potentially inappropriate medication (defined by the PRISCUS and European list of potentially inappropriate medications [EU(7)-PIM] lists), and associations with POD and POCD were analyzed using logistic regression analysis. Eight hundred thirty-seven participants were included for analysis of POD and 562 participants for POCD. Of these, 165 patients (19.7%) fulfilled the criteria of POD and 60 (10.7%) for POCD. After adjusting for confounders, pre-operative polypharmacy and intake of potentially inappropriate medications could not be shown to be associated with the development of POD nor POCD. We found no associations between pre-operative polypharmacy and potentially inappropriate medications and development of POD and POCD. Future studies should focus on the evaluation of drug interactions to determine whether patients benefit from a pre-operative adjustment.
Background
Postoperative delirium (POD) is a frequent and serious complication after surgery. Evidence of a relationship between anticholinergic medication and the development of delirium is inconclusive, but studies on POD are rare.
Objectives
The objective of this study was to evaluate the anticholinergic load of preoperative medication in older adult patients and its association with the development of POD.
Methods
This investigation was part of the European BioCog project (http://www.biocog.eu), a prospective multicenter observational study in older adult surgical patients (ClinicalTrials.gov identifier: NCT02265263, 15 October 2014). Patients with a Mini–Mental State Examination score ≤ 23 points were excluded. POD was assessed up to 7 days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method and a patient chart review. The preoperative anticholinergic load was calculated using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS) and the Anticholinergic Cognitive Burden Scale (ACBS), and associations with POD were analyzed using logistic regression analysis adjusting for age, comorbidities, duration of anesthesia and number of drugs used.
Results
In total, 837 participants were included for analysis, and 165 patients (19.7%) fulfilled the criteria of POD. After adjusting for confounders, we found no association between preoperative anticholinergic load and the development of POD (ADS [points] odds ratio [OR] 0.928; 95% confidence interval [CI] 0.749–1.150; ARS [points] OR 0.832; 95% CI 0.564–1.227; ACBS [points] OR 1.045; 95% CI 0.842–1.296).
Conclusion
This study found no association between the anticholinergic load of drugs used preoperatively and the development of POD in older adult patients without severe preexisting cognitive impairment. Future analyses should examine the influence of intra- and postoperative administration of anticholinergic drugs as well as dosages of and interactions between medications.