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Institute
- Fakultät WiSo (367)
- Fakultät AuL (259)
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- Institut für Management und Technik (30)
- Institut für Duale Studiengänge (23)
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- Präsidium Hochschule Osnabrück (1)
Semi-solid metal alloys, as used in thixoforming, have a special microstructure of globular grains suspended in a liquid metal matrix. The complex rheological properties are strongly influenced by the local solid fraction, particle shape, particle size and state of agglomeration. There is a high demand for models and software tools allowing the simulation of semi-solid casting processes. The material under investigation is a tin-lead alloy (Sn-15%Pb) which exhibits a similar microstructure to aluminium alloys. The experiments were performed with a concentric cylinder rheometer of the Searle type. Initially, the liquid alloy is cooled down to the semi-solid range under constant shearing and then kept under isothermal conditions for further experimentation. Based on the experimental data, a single-phase model has been derived where the semi-solid alloy is regarded as a homogeneous material with thixotropic properties and the microstructure is characterised by a structural parameter. The model consists of two parts: the equation of state, including a finite yield stress, and a rate equation for the structural parameter. The model equations are employed in numerical software and used for the simulation of characteristic filling cases and the comparison with the conventional filling.
Information Technology (IT) continues to evolve and develop with electronic devices and systems becoming integral to healthcare in every country. This has led to an urgent need for all professions working in healthcare to be knowledgeable and skilled in informatics. The Technology Informatics Guiding Education Reform (TIGER) Initiative was established in 2006 in the United States to develop key areas of informatics in nursing. One of these was to integrate informatics competencies into nursing curricula and life-long learning. In 2009, TIGER developed an informatics competency framework which outlines numerous IT competencies required for professional practice and this work helped increase the emphasis of informatics in nursing education standards in the United States. In 2012, TIGER expanded to the international community to help synthesise informatics competencies for nurses and pool educational resources in health IT. This transition led to a new interprofessional, interdisciplinary approach, as health informatics education needs to expand to other clinical fields and beyond.
In tandem, a European Union (EU) - United States (US) Collaboration on eHealth began a strand of work which focuses on developing the IT skills of the health workforce to ensure technology can be adopted and applied in healthcare. One initiative within this is the EU*US eHealth Work Project, which started in 2016 and is mapping the current structure and gaps in health IT skills and training needs globally. It aims to increase educational opportunities by developing a model for open and scalable access to eHealth training programmes. With this renewed initiative to incorporate informatics into the education and training of nurses and other health professionals globally, it is time for educators, researchers, practitioners and policy makers to join in and ROAR with TIGER.
Teachers in health informatics have a broad variety of international and national educational recommendations to rely on when designing programmes, curricula, courses and educational material. However, in addition they often need very specific information for their setting, blue-prints, hands-on experience and encouragement to try something new. This workshop presents three case studies from European universities who have implemented inter-professional, technology enabled health informatics courses in undergraduate, postgraduate and open university settings. These approaches will be put into the context of the TIGER recommendation framework that includes priority ratings of health informatics competencies and case studies to illustrate them. The workshop attendees will have ample opportunity to exchange ideas with the presenters and start a mutual learning process for health informatics teachers.
The TIGER Initiative
(2016)
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.
Background: Lumbar discectomy is considered a safe, efficacious and cost-effective treatment for selected cases of patients with leg pain associated with the presence of a disc protrusion. But despite technically successful surgery, 30 % of patients complain of persistent pain on long-term follow up. Identification of possible predictors for a negative outcome is important, in the search for appropriate pre- and/or post-operative care and prevention of persistent disability. There is some evidence in the literature that quantitative sensory testing (QST) measures may play a role in prediction of patients’ pain persistency, however, this has never been investigated in patients undergoing lumbar discectomy.
Objective: The aim of this study is to determine the predictive value of QST parameters, in combination with previously documented predictor variables such as medical/psychological/cognitive behavioural factors, in patients with lumbar radiculopathy and/or radicular pain, for predicting patients’ clinical outcome after lumbar discectomy.
Method: Participants with radiculopathy and/or radicular pain and confirmed imaging diagnosis of nerve root compression will be recruited from the elective surgery waitlist at one hospital. All participants will undergo lumbar discectomy performed by one neurosurgeon. A standardized QST protocol comprising all of the somatosensory sub-modalities that are mediated by different primary afferents (C-, Aδ-, Aβ-) will be performed prior to surgery. QST will be conducted in the patients’ main pain area and contralateral side, in the affected dermatome and at a remote control site. The presence of other predictor variables will be captured by questionnaires. Follow-up at 3 months will include QST and measurements of pain intensity, pain descriptors, functional status, health related quality of life, return to work and health care utilisation. A further 1-year follow-up will include the same measurements except QST.
Results/Conclusions: Identification of new predictor variables may assist in the development of pre-surgical screening methods and in targeted pre- and/or post-operative patient care, with the potential to improve patients’ functional status, quality of life, work capacity whilst also reducing health care costs associated with persistent disability
Objectives: Evaluation of multislice-CT (MSCT) during diagnosis and therapeutic decision-making in patients with suspected non-occlusive mesenteric ischemia (NOMI).
Methods: Retrospective, institutional review board-approved study of 30 patients (20 men, 10 women, mean age 64.6±14.2 years, range 24-87 years) undergoing biphasic abdominal MSCT followed by digital subtraction angiography (DSA) due to suspected NOMI. MSCT and DSA were qualitatively and quantitatively evaluated independently by two radiologists with respect to the possible diagnosis of NOMI. MSCT analysis included quantitative measurements, qualitative evaluation of contrast enhancement and assessment of secondary findings (bowel wall thickening, hypo-enhancement, intestinal pneumatosis). MSCT diagnosis and secondary findings were compared against DSA diagnosis.
Results: NOMI was diagnosed in a total of n = 28 patients. No differences were found when comparing the R1-rated MSCT diagnosis (p = 0.09) to the "gold standard", while MSCT diagnosis was slightly inferior with R2 (p = 0.02). With R1, vessel-associated parameters revealed the best correlation, i.e. qualitative vessel width (r = -0.39;p = 0.03) and vessel contrast (r = 0.45;p = 0.01). Moderate correlations were found for quantitative vessel diameters in the middle segments (r = -0.48,p = 0.01), increasing to almost high correlations in the distal (r = -0.66;p<0.00001) superior mesenteric artery (SMA) segments. No significant correlation was apparent from secondary findings.
Conclusions: MSCT is an appropriate non-invasive method for diagnosing NOMI and leads to adequate and immediate therapeutic stratificatio
Rationale
Playing the trombone can lead to playing-related musculoskeletal disorders (PRMD). Previous research suggests that professional trombonists predominantly struggle with PRMD on the left body side. An increasing volume leads to an increasing contact pressure on the mouthpiece of the trombone, but it is still unclear how the muscle activity relates to this and whether it differs in musicians with PRMD from those without PRMD.
Purpose
The purpose of this study was to investigate the relationship between the activity of different muscles of the left body side, the contact pressure on the mouthpiece and the volume level in healthy trombonists.
Methods
Six male healthy tenor trombonists were included in this study and run through a standardized protocol which consisted of playing a b-flat major scale with three different volume levels (pianissimo, mezzoforte, fortissimo). Analyzed parameters were (1) the activity of several muscles of the left body side (measured with surface electromyography), (2) the contact pressure on the mouthpiece (measured with a force sensor) and (3) the different volume levels.
Results
Analysis of variance reveals significant differences of the muscle activity for the three volume levels. Depending on the volume level and the selected muscle, results show very weak to moderate correlations between contact pressure on the mouthpiece and muscle activity (Spearman´s rho between .11 and .58). The strongest correlation across all muscles occurs during fortissimo playing.
Conclusions
These results show a relationship in healthy trombonists between volume level, contact pressure on the mouthpiece and muscle activity when playing a b-flat major scale. Future research should include trombonists with PRMD to enable comparison between PRMD and non-PRMD musicians.
Educational Objectives:
At the end of the presentation, the participants will be able to…
1. understand the relationship between muscle activity, contact pressure on the mouthpiece and volume when playing the trombone
2. recognize that there are different muscle activity patterns on the left body side when playing the trombone
3. understand that a comprehensive functional diagnosis is important in the management of musicians
Objectives
The aims of the present study were to provide back pain (BP) point prevalence data from inpatients at an Australian tertiary hospital on one day, and compare this with Australian non-hospitalized population prevalence data; to collect data around the development of BP throughout hospital admission; and to analyse the association between BP and past history of BP, gender, age, admission specialty and hospital length of stay (LOS).
Methods
This was a single-site, prospective, observational study of hospitalized inpatients on one day during 2016, with a subsequent survey over the following 11 days (unless discharge or death occurred sooner).
Results
Data were collected from 343 patients (75% of the hospitalized cohort). A third of patients (n = 108) reported BP on admission, and almost a fifth (n = 63) developed new BP during their hospitalization. Patients who described BP at any time during their hospital stay had a higher chance of having had a history of BP, with odds increasing after adjustment for age and gender (odds ratio 5.89; 95% confidence interval (CI) 3.0 to 11.6; p < 0.001). After adjusting for age and gender, those experiencing BP had a significantly longer LOS (median 13 days; CI 10.8 to 15.3) than those who did not (median 10 days; CI 8.4 to 11.6; p = 0.034).
Conclusions
Hospital LOS for patients who complained of BP at any time during their admission was 3 days longer than those who had no BP, and a history of BP predicted a higher likelihood of BP during admission. Screening of patients on admission to identify any history of BP, and application of a package of care including early mobilization and analgesia may prevent the onset of BP and reduce LOS.
Thirty years ago, the Fourth King of Bhutan famously proclaimed that ―Gross National Happiness is more important than Gross National Product, thereby setting Bhutan on a holistic development path. Following this historic declaration, Bhutan developed a Gross National Happiness (GNH) Index and screening tool to evaluate all new policies, proclaiming that:
―Gross National Happiness measures the quality of a country in more holistic way [than GNP] and believes that the beneficial development of human society takes place when material and spiritual development occur side by side to complement and reinforce each other.
In July 2011, 68 nations joined Bhutan in co-sponsoring its UN General Assembly resolution on ―Happiness: Towards a Holistic Approach to Development.
Background: Muscle fatigue has been reported as a risk factor for the
development of performance-related musculoskeletal disorders (PRMD) in
musicians. However, little research exists to support this claim. The aim of
this study was to investigate whether changes occur in muscle activity
patterns during high string performance over a prolonged playing period, and
whether this is influenced by PRMD.
Methods: High string musicians were divided into a PRMD and a non-PRMD
group. They played a chromatic scale pre and post and a self-chosen “hard”
(Borg scale 16-17) piece of music for one hour. Electromyography data
recorded from arm, shoulder and trunk muscles was analyzed: the amplitude
to measure muscle activity characteristics and the lower frequency to
measure muscle fatigue. Differences between and within groups and the
frequency spectrum were analyzed using linear mixed models.
Results: Fifteen musicians participated (7 PRMD: 22.8 years, 2 male/5 female
and 8 non-PRMD: 34.3 years, 2 male/6 female). Changes in muscle activation
patterns were observed between and within both groups, however changes
varied significantly depending on group affiliation. Significant low frequency
spectrum changes between groups were observed in overall muscles of the
right arm (p=0.04) and left forearm flexors (p=0.05) following one hour of
playing.
Conclusions: Muscle activity and frequency spectrum shifts differ in high
string musicians with and without PRMD, suggesting possible differential
muscle fatigue effects between the groups.
This review gives an overview about the existing research concerning siblings' perspective within the familial experiences of childhood chronic illness. Besides attaining a conception of their world, it was intended to identify the unacknowledged issues concerning siblings' experience. Four databases were systematically searched. The analysis was concentrated on nine literature reviews. As a result, we identified a map of dimensions of experiences—well-elaborated as well as fragmentary. Many of the studies were conducted by a proxy and not from the sole siblings' perspective. Further research should concentrate on the sole siblings' perspective, in order to make siblings' voices audible.
The nutritional footprint – An assessment tool for health and environmental effects of nutrition
(2014)
Aufgrund seiner starken Umweltauswirkungen gilt der Lebensmittelsektor durch Effekte in Produktion, Verarbeitung, Konsum und Entsorgung gemeinhin als ein wichtiges Handlungsfeld, soll eine gesellschaftliche Transformation in Richtung Nachhaltigkeit weiter vorangetrieben werden. Da Ernährungsgewohnheiten sowohl ökologische Auswirkungen induzieren als auch gesundheitliche Folgen für die Verbraucher haben, sind Konzepte gefragt, die ökologische mit gesundheitlichen Indikatoren kombinieren; diese sind jedoch bislang rar. Das vorgestellte Instrument des Nutritional Footprint greift diese Problemstellung auf und verbindet in einem innovativen Konzept jeweils vier Kernindikatoren beider Dimensionen. Mithilfe des Konzepts erhalten Verbraucher einen Überblick zu Umwelt- und Gesundheitswirkungen ihrer Ernährung. Unternehmen können wiederum interne Datensätze verwalten, Benchmarking betreiben und ihre externe Kommunikationsleistung erweitern.
Der Bereich Ernährung wird in den kommenden Jahrzehnten vor zahlreichen Herausforderungen stehen, die sich aus den veränderten Lebensgewohnheiten und globalen Konsummustern bei gleichzeitig hohem Ressourcenverbrauch ergeben. Vor diesem Hintergrund wird in diesem Papier ein neu entwickeltes Instrument zur Verringerung der Auswirkungen auf die Ernährung vorgestellt, der sogenannte Ernährungsfußabdruck. Das Instrument basiert auf der Umsetzung des Konzepts einer nachhaltigen Ernährung in Entscheidungsprozessen und der Unterstützung einer ressourcenschonenden Gesellschaft. Das Konzept integriert jeweils vier Indikatoren aus den beiden ernährungsrelevanten Bereichen Gesundheit und Umwelt und verdichtet sie zu einem leicht kommunizierbaren Ergebnis, das sich in seinen Ergebnissen auf eine Wirkungsebene beschränkt. Anhand von acht Mittagsmahlzeiten werden die Methodik und ihre Berechnungsverfahren detailliert vorgestellt. Die Ergebnisse unterstreichen die allgemeine wissenschaftliche Sichtweise auf Lebensmittel; Mahlzeiten auf der Basis von tierischem Eiweiß sind im Hinblick auf ihre Gesundheits- und Umweltauswirkungen relevanter. Das Konzept scheint für Verbraucher nützlich zu sein, um ihre eigene Wahl zu bewerten, und für Unternehmen, um ihre internen Daten, ihre Benchmarking-Prozesse oder ihre externe Kommunikationsleistung zu erweitern. Methodische Unzulänglichkeiten und die Interpretation der Ergebnisse werden erörtert, und die Schlussfolgerung zeigt das Potenzial der Instrumente für die Gestaltung von Übergangsprozessen und für die Verringerung des Verbrauchs natürlicher Ressourcen durch die Unterstützung von Entscheidungen und Wahlmöglichkeiten von Lebensmittelanbietern und Verbrauchern.
Continuity of care is a concept that is defined as the uninterrupted and coordinated care provided to a patient and that includes an informational dimension which describes the information exchange between the parties involved. In nursing, the nursing summary is the main instrument to ensure informational continuity of care. The aim of this paper is to present an HL7 Clinical Document Architecture based document standard for the eNursing Summary and to discuss the need for harmonizing these results at international level. The eNursing Summary proposed in this paper was developed on the basis of several internationally accepted concepts, primarily the nursing process, the ISO 18104 Reference Terminology Model for Nursing and various data sets. The standardisation process embraced several phases of involving nursing experts for validating its structure and content. It was finally evaluated by a network of 100 healthcare organizations. We argue that the eNursing Summary is a good starting point for standardising nursing discharge and transfer documents on a global level. However, further work is needed to bring together the different national and international strands in standardisation.
In this article, we build on Stigler and Becker’s (1977) “consumption capitaltheory” and propose a novel conceptualization of film quality for the analysisof motion picture franchises. Generally, this theorypredicts that the utilityconsumers derive from a particular goodor service increases with prior con-sumption. We test our theoretical conjectures by drawing on the population ofsequels that were running in the US between 1992 and 2011. The empiricalresults point to the explanatory power of the proposed framework. Filmexecutives may use our findings to improve the profitability of their sequelproductions. From a theoretical point of view, consumption capital theoryallows for a more refined analysis of sequel performance along differentdimensions. Moreover, it may provide a fruitful basis for the analysis of otherserial media content, including books, TV, music, and games.
Objective: To understand the significance of healthy living for users, professionals and managers of the Family Health Strategy (FHS) team.
Methods: Research of a qualitative nature, based on grounded theory. For data collection, interviews were conducted with 25 participants, including users, professionals and managers of a FHS team, during the period between March and December, 2009. Results: The collection and analysis of data was conducted in a systematic and comparative manner, demonstrating that healthy living can be characterized as a selforganizing process, mediated by the action of the FHS team professionals, especially by the community health agent, through creation of bonds of trust and stimulation of interactions and community associations. Conclusion: We concluded that healthy living is a singular phenomenon, complex, interactive, associative, political and social, coupled with the active involvement and participation of the users and by the engagement of effective and socially responsible professionals, managers and established political authorities.
Objective: to understand the meaning of the Adult Intensive Care Unit environment of care,
experienced by professionals working in this unit, managers, patients, families and professional
support services, as well as build a theoretical model about the Adult Intensive Care Unit
environment of care. Method: Grounded Theory, both for the collection and for data analysis.
Based on theoretical sampling, we carried out 39 in-depth interviews semi-structured from
three different Adult Intensive Care Units. Results: built up the so-called substantive theory
“Sustaining life in the complex environment of care in the Intensive Care Unit”. It was bounded
by eight categories: “caring and continuously monitoring the patient” and “using appropriate
and differentiated technology” (causal conditions); “Providing a suitable environment” and
“having relatives with concern” (context); “Mediating facilities and difficulties” (intervenienting
conditions); “Organizing the environment and managing the dynamics of the unit” (strategy)
and “finding it difficult to accept and deal with death” (consequences). Conclusion: confirmed
the thesis that “the care environment in the Intensive Care Unit is a living environment, dynamic
and complex that sustains the life of her hospitalized patients”.
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.
Objective: To understand the meaning of the Learning Incubator as a teaching and learning technology in the nursing area.
Method: Qualitative research, supported by grounded theory. Data was collected from March to November 2019, through interviews with guiding questions and hypotheses directed at two different groups. The analysis was done by comparative data analysis and included open, axial and integrated coding, as proposed by the method. The theoretical sample included 23 participants, which were nurses, technicians, and nursing students.
Results: The delimitation of the categories converged in the phenomenon (Re)signifying knowledge and practices in the Learning Incubator. Guided by the paradigmatic model, the categories were named according to the three following components: Condition: Recognizing that the being and the professional practice are inextricable; Action/interaction: Revisiting professional practices that are repetitive and mechanic; Consequence: Referring to the reflections and knowledge constructed in the Learning Incubator.
Conclusion: The Learning Incubator, as seen by the study participants, is not limited to the Incubator meetings or the themes addressed in it. Beyond a welcoming physical space, the Incubator expands itself and becomes a tool that promotes self-reflection and self-assessment of professional behaviors and attitudes.
The impact of Pulsed Electric Fields (PEF) on the peeling ability of different fruits and vegetables in particular tomatoes, peaches, peppers, and oranges were investigated. Samples were exposed to a fixed electric field strength of 2.15 kV/cm. The specific energy ranged from 0.6 kJ/kg to 50.3 kJ/kg. The treated raw materials were analysed regarding to the peeling ability, skin size and weight and firmness. The best result for tomatoes at a specific energy of 1.2 kJ/kg induced a high score of peeling ability that led to less product loss and could therefore increase the yield by 33.84%–41.53% compared to untreated samples. Moreover, an increased skin size by a factor of 3.7 was observed. However, PEF had no significant impact on peeling ability of oranges, peppers, and peaches. Although oranges showed an improvement in peeling ability by up to 32%, this cannot be traced back to the PEF treatment. The different properties and structures of the raw materials were discussed and provided indications about the limitation of PEF.
Intensive care units (ICU) are often overflooded with alarms from monitoring devices which constitutes a hazard to both staff and patients. To date, the suggested solutions to excessive monitoring alarms have remained on a research level. We aimed to identify patient characteristics that affect the ICU alarm rate with the goal of proposing a straightforward solution that can easily be implemented in ICUs. Alarm logs from eight adult ICUs of a tertiary care university-hospital in Berlin, Germany were retrospectively collected between September 2019 and March 2021. Adult patients admitted to the ICU with at least 24 h of continuous alarm logs were included in the study. The sum of alarms per patient per day was calculated. The median was 119. A total of 26,890 observations from 3205 patients were included. 23 variables were extracted from patients' electronic health records (EHR) and a multivariable logistic regression was performed to evaluate the association of patient characteristics and alarm rates. Invasive blood pressure monitoring (adjusted odds ratio (aOR) 4.68, 95%CI 4.15–5.29, p < 0.001), invasive mechanical ventilation (aOR 1.24, 95%CI 1.16–1.32, p < 0.001), heart failure (aOR 1.26, 95%CI 1.19–1.35, p < 0.001), chronic renal failure (aOR 1.18, 95%CI 1.10–1.27, p < 0.001), hypertension (aOR 1.19, 95%CI 1.13–1.26, p < 0.001), high RASS (aOR 1.22, 95%CI 1.18–1.25, p < 0.001) and scheduled surgical admission (aOR 1.22, 95%CI 1.13–1.32, p < 0.001) were significantly associated with a high alarm rate. Our study suggests that patient-specific alarm management should be integrated in the clinical routine of ICUs. To reduce the overall alarm load, particular attention regarding alarm management should be paid to patients with invasive blood pressure monitoring, invasive mechanical ventilation, heart failure, chronic renal failure, hypertension, high RASS or scheduled surgical admission since they are more likely to have a high contribution to noise pollution, alarm fatigue and hence compromised patient safety in ICUs.
Objective
The aim of this study was to assess the influence of cranio-cervical posture on the maximal mouth opening (MMO) and pressure pain threshold (PPT) in patients with myofascial temporomandibular pain disorders.
Materials and Methods
A total of 29 patients (19 females and 10 males) with myofascial temporomandibular pain disorders, aged 19 to 59 years participated in the study (mean years±SD; 34.69±10.83 y). MMO and the PPT (on the right side) of patients in neutral, retracted, and forward head postures were measured. A 1-way repeated measures analysis of variance followed by 3 pair-wise comparisons were used to determine differences.
Results
Comparisons indicated significant differences in PPT at 3 points within the trigeminal innervated musculature [masseter (M1 and M2) and anterior temporalis (T1)] among the 3 head postures [M1 (F=117.78; P<0.001), M2 (F=129.04; P<0.001), and T1 (F=195.44; P<0.001)]. There were also significant differences in MMO among the 3 head postures (F=208.06; P<0.001). The intrarater reliability on a given day-to-day basis was good with the interclass correlation coefficient ranging from 0.89 to 0.94 and 0.92 to 0.94 for PPT and MMO, respectively, among the different head postures.
Conclusions
The results of this study shows that the experimental induction of different cranio-cervical postures influences the MMO and PPT values of the temporomandibular joint and muscles of mastication that receive motor and sensory innervation by the trigeminal nerve. Our results provide data that supports the biomechanical relationship between the cranio-cervical region and the dynamics of the temporomandibular joint, as well as trigeminal nociceptive processing in different cranio-cervical postures.
Background and Aims
Early identification of nerve lesions and associated neuropathic pain in spine-related pain disorders is important for tailored treatment. Management may consist of surgical intervention for compressive neural lesions.
With a growing waitlist for public surgical outpatient clinics in Western Australia and wait times exceeding the recommended wait time for initial assessment (Category 1 – assessment within 1 months, Category 2 within 3 months, category 3 within 12 months), a call to support new models of care has been made1, including the evaluation and expansion of workforce models supporting advanced skills in allied health.1
An Advanced Scope Physiotherapy (ASP) led Neurosurgery Spinal Clinic operates at Sir Charles Gairdner Hospital in Western Australia. The ASPs (2FTE) examine patients from the neurosurgery waitlist for their suitability for spinal surgery. Recommendation of either further investigation and possible assessment by a neurosurgeon or appropriate non-surgical management of the patients’ pain condition is suggested. Patient assessment is conducted either ‘in person’ at the hospital or via telehealth due to the remoteness of some rural patients. Patient cases are discussed with a neurosurgery consultant on a weekly basis. The aim of this project is to evaluate the ASP service in the year 2022.
Method
A retrospective descriptive analysis of patient data captured in 2022 was performed.
Results
In 2022, 1337 new patient referrals were managed plus 267 follow-ups from the previous year. Category 1 patients (n=81) waited on average 31 days for their first appointment, Category 2 patients (n=394) waited 76 days and Category 3 patients (n=854) waited 376 days.
287 (18%) referrals were discharged without physical assessment of the patient (DNA, cancellations, declined). Of the 1317 patients physically assessed by the ASPs (57%) were discharged directly after assessment, for 290 patients (22%) their outcome was still pending at time of analysis (March 2023) and 281 (22%) patients were referred for review with a neurosurgeon. Of the 229 patients assessed by a neurosurgeon (including patients from 2022), 103 patients (45%) were offered surgery, 52 (23%) were not offered surgery, 46 ( 20%) patients had to be reviewed, and for the remaining (n=18) their outcome was unknown.
Conclusion
Of the 1604 patients managed in the Neurosurgery Spinal Clinic, only 17% needed to see a neurosurgeon. The conversion rate to surgery of 45% is higher compared to an estimated 5%-10% in a non-triaged clinic.
The ASP model of care has proved invaluable to (i) provide access of patient care within the recommended wait times (ii) optimize neurosurgeons’ time, (iii) educate patients and, in case of non-suitability for surgery, advise and refer them for alternative appropriate management.
Relevance for Patient Care
The Advanced Scope Physiotherapy model of care at the Neurosurgery Spinal Clinic allows timely assessment of patients with spine-related disorders and supports targeted management of their condition.
Ethical Permissions
This project is registered as a Quality Improvement Project at Sir Charles Gairdner Hospital (QI35728) and as per the National Statement on Ethical Conduct in Human Research was exempt from review by the Sir Charles Gairdner Hospital Human Research and Ethics Committee
References
1Sustainable Health Review (2019). Sustainable Health Review: Final report to the Western Australian Government of Health, Western Australia
In idea creation and assessment processes the accruement and the description of an idea are mostly allocated to a fixed point in time, defined as the end of the generating process and the start of the idea assessment. This static approach does not fit the reality in industrial idea processes. A dynamic approach for idea assessment is therefore introduced. An idea is not seen as a static but as a dynamic state, characterized by different degrees of maturity. Maturity is understood as a measure of the assessability of the individual evaluation characteristics.
Based on Crosby’s maturity model and on classical Capability Maturity Models, a new Idea Maturity Model (IMM) has been developed and is introduced for the first time. The five Idea Maturity Levels (IML) are named Initial, Awareness, Appraisability, Valuation, and Realisability and harmonize well with other maturity models. The levels are described by general characteristics, although the development of the maturity model focussed on new product or service development. The compatibility of the IMM with idea assessment processes and conditions in organisations and companies has been checked.
Der Lebensmittel- und Landwirtschaftssektor wird in den nächsten Jahrzehnten vor zahlreichen Herausforderungen stehen, die sich aus den sich verändernden globalen Produktions- und Verbrauchsmustern ergeben, die derzeit mit einem hohen Ressourcenverbrauch einhergehen und ökologische und sozioökonomische Auswirkungen haben. Ziel dieses Beitrags ist es, die praktische Anwendbarkeit der Hot-Spot-Analyse-Methode im Kontext des Lieferkettenmanagements in Unternehmen zu veranschaulichen und zu bewerten.
Die HSA ist eine Methode zur Identifizierung sozialer und ökologischer Probleme entlang des gesamten Lebenszyklus eines Produkts. Besonderes Augenmerk wird auf eine maßgeschneiderte Umsetzung in der Wertschöpfungskette Rindfleisch von McDonald's Deutschland gelegt. Die HSA der Wertschöpfungskette Rindfleisch von McDonald's zeigt, dass die größten ökologischen Probleme in der Phase der Rohstoffgewinnung auftreten, während die größten sozialen Probleme in der Phase der Schlachtung identifiziert werden können. Abschließend zeigt der Beitrag Potenziale und Defizite einer solchen maßgeschneiderten Anwendung und wie die Ergebnisse im Nachhaltigkeitsmanagement eines Unternehmens umgesetzt werden können. in das Nachhaltigkeitsmanagement eines Unternehmens implementiert werden können.
Aims and Objectives:
Preventive home visits are a low-threshold counselling and support approach. They have been reported to achieve heterogeneous effects. However, preventive home visits have the potential to reduce the risk of becoming dependent on long-term care. The aim of this study is to investigate the effect of preventive home visits as a nursing intervention on health-related quality of life of older people in a longitudinal survey and to develop recommendations for which target groups preventive home visits have the highest benefit. The sample consisted of 75 people, aged between 65 and 85, who were able to understand and speak German, had not yet been eligible for benefits from the long-term care insurance and lived in the municipality under study.
Methodological Design and Justification:
A quantitative longitudinal study in order to investigate the effects of preventive home visits.
Ethical Issues and Approval:
There were no ethical concerns. Accordingly, ethical approval was granted.
Research Methods, Results and Conclusions:
The health-related quality of life was recorded four times between 01/2017 and 08/2020 with the Short-Form- Health- Survey- 12 and analysed using descriptive statistics. Results reveal that the physical health status cannot be easily influenced over a short period of time. The main effect, however, is that preventive home visits have a significant positive effect on the mental health status. The main topics during the home visits were mobility, nutrition and social participation. Increased knowledge and motivation for preventive behaviour extended the autonomy of older people. Accordingly, preventive home visits can support a self-determined life in a familiar environment. The results of the present study show that preventive home visits as a nursing intervention in rural areas are successful. In Germany, preventive home visits have not yet been implemented on a regular basis. In order to do so, a general definition of the concept is needed. Preventive home visits should be officially included in the regular health care services in Germany.
Novel foods by process are a special case in the catalogue of the ten novel food categories according to Article 3 (2) point (a) of the Novel Food Regulation (EU) 2015/2283, since the other nine categories derive their assessment as possible novel foods from their purely substantial properties. In the case of novel foods by process, the problem of dealing with the reference date of 15 May 1997, which is in the end a random reference date, is particularly significant. It would make more sense to have a dynamic reference date that ‘moves along the timeline’ or at least is reset from time to time and is more up-to-date. The characteristic that a process causes ‘significant changes in the composition or structure of the food, affecting its nutritional value, metabolism or level of undesirable substances’ must be understood in such a way that it is only a question of the generation of undesirable substances through the application of the process, but not their reduction, e.g. the reduction of undesirable microorganisms. Finally, the question also arises as to how the assessment of the process technology relates to the assessment of a food in the context of a novel food by composition category. This concerns the exemption for foods that have a history of use as safe foods, which, according to the view taken here, must also be interpreted into the category of novel foods by process.
Objective:
To understand the meaning of entrepreneurial nursing care as inducer of healthy practices in vulnerable communities.
Method:
Grounded theory, whose data collection took place between March and December 2019, from interviews with 19 participants from the central region of Rio Grande do Sul, Brazil and comparative data analysis.
Results:
The phenomenon was delimited: Experiencing small/big transformations in the invisibility of everyday life in promoting healthy practices in vulnerable communities. Conducted by the paradigmatic model, the categories were named based on the components: Condition: Making choices and negotiating non-negotiable exchanges; Action/interaction: Motivating oneself to maintain basic human needs; Consequence: Broadening perspectives and transcending personal and collective boundaries.
Conclusion:
Entrepreneurial nursing care as inducer of healthy practices in vulnerable communities is not reduced to a scientific theory or to the linear and decontextualized apprehension of healthy living, but extends to reach small/big transformations that occur in the invisibility of everyday life.
This study describes the eHealth4all@eu course development pipeline that builds upon the TIGER educational recommendations and allows a systematic development grounded on scientific and field requirements of competencies, a case/problem-based pedagogical approach and finally results in the syllabus and the course content. The pipeline is exemplified by the course Learning Healthcare in Action: Clinical Data Analytics.
Background
Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far.
Objective
The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee.
Methods
MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach.
Results
The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=−0.31, 95% CI −0.58 to −0.04, low quality; QoL SMD=0.24, 95% CI 0.05-0.43, moderate quality) and long-term effects (pain −0.30, 95% CI −0.07 to −0.53, moderate quality; physical function 0.41, 95% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95% CI 0.06-0.47, high quality).
Conclusions
eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence.
Background:
Neck pain is one of the most common musculoskeletal pains and among the fourth leading causes of years of life lost due to disability, following back pain, depression, and arthralgia. (1)
In the course of their lives, about 70% of all people will experience a clinically relevant episode of neck pain, (2) so finding a good therapy to treat it is of high interest. Aerobic exercise is associated with pain reduction in patients with different types of MSK pain. Recent studies have shown a positive impact of aerobic exercises on brain function, memory processing, cognition, and motor function. (3, 4)
Therefore, the influence of aerobic exercise on pain modulation seems to be of particular interest for individuals with chronic MSK pain, since brain imaging studies have shown that these patients have structural and functional changes, as well as abnormal brain features in various areas of the brain. The evidence regarding the effectiveness of aerobic exercise for neck pain seems limited and outdated.
Thus, a systematic review evaluating the effects of aerobic exercise in patients with neck pain is needed. Therefore, this review aims to investigate the effectiveness of aerobic exercise interventions when compared to other conservative and non-conservative interventions (e.g., localized exercises, medication, acupuncture, physical agents, manual therapy) to decrease pain intensity in people with neck pain.
Materials and methods:
Electronic literature searches were conducted in a total of six databases such as Medline, Embase, CINAHL, Cochrane Library, Web of Science, and Scopus. The review considered randomised controlled trials (RCTs) including patients over 18 years having musculoskeletal pain in the neck area. The Neck Pain Task Force's classification of pain severity describes four levels of neck pain, with the first three levels considered in this review. (5)These must be clinically diagnosed by a health care provider according to signs and symptoms or based on standardized criteria specific for each disease. Studies involving subjects with any pre-existing conditions, previous surgery, or pain not clearly related to the musculoskeletal system were excluded. No limits were applied in terms of sex, ethnicity, and living country. Data were extracted using a standardized data extraction form.
Methodological quality was determined using the Cochrane Collaboration Risk of Bias Tool (CCRBT) and the strength of the evidence with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were extracted and evaluated by two independent reviewers.
Results:
A total of 21585 records were identified and screened independently for eligibility by two reviewers. A total of six unique studies, reported on ten manuscripts met the specified inclusion criteria. Different types of aerobic exercise were used in the studies. Studies included isolated and combined aerobic exercise using interventions such as cycling on an ergometer or walking outdoors at a moderate intensity. Comparison groups were for example strength training or education. The most common outcome was pain assessed with the Visual Analogue Scale (VAS) or the Nordic questionnaire.
The included studies had a high risk of bias and the overall quality of the evidence for this systematic review was considered low. There was high heterogeneity in the included studies regarding interventions applied and study results.
When looking at the effect of aerobic exercise versus control group or other intervention groups measured with VAS, it can be observed, that there was a great heterogeneity between studies results (different magnitudes and directions). Although none of the comparisons showed a statistically significant difference between aerobic exercise and control (MD 6.24 mm, 95% CI [-11.21; 23.96]) or active intervention groups (MD -9.52 mm, 95% CI [-18.48; -0.56]) on pain intensity; it seems that aerobic exercise is slightly better than a control group, and equally effective as other active treatments such as strength exercise or education.
In addition, when combined with other therapeutic modalities, aerobic exercise, could potentially help to reduce pain intensity (MD 7.71 mm, 95% CI [1.07; 14.35]). Especially in the long term, the combination of strength and aerobic exercise showed promising results. Statistically significant differences in favour of aerobic exercise for pre vs. three months follow up (MD 11.20 mm, 95% CI [2.85;19.55]) and pre vs. six moths follow up (MD 15.10 mm, 95% CI [6.99; 23.21]) were found.
Conclusions:
Although there is currently limited evidence on the effectiveness of aerobic exercise in individuals with chronic neck pain, aerobic exercise was found to not only reduce pain intensity, but also to improve disability as well as physical and emotional functioning. However, as the evidence is limited, low quality, and heterogeneous, further research is needed in this area to obtain more accurate results.
Methods: Systematic review of randomized controlled trials (RCT). Searches were conducted in five electronic databases. Studies were selected if they included patients with NP over 18 years old treated with aerobic exercise (AE) (e.g., cycling, running, hiking, and walking). The main outcome of interest was pain intensity. Qualitative and quantitative data were extracted. The risk of bias (RoB) was determined using the Cochrane RoB Tool-2 and the overall certainty of the evidence with the GRADE recommendations.
Results: Out of 21,585 initial records screened, a total of six individual studies published in ten manuscripts were included. There was a great heterogeneity between protocols, comparisons, and studies’ results (different magnitudes and directions). When looking at the effect of aerobic exercise versus control groups or other interventions on pain intensity measured with the VAS, not statistically (nor clinical) significant differences between aerobic exercise and control groups (MD [95%CI] 5.16 mm [-6.38, 16.70]) were identified. The combined effect of AE plus other interventions seems to be effective. Strength exercise obtained better effects than aerobic exercises (MD [95%CI]: -11.34 mm [-21.6, -1.09]).
Conclusions: Aerobic exercise presented positive results to reduce pain intensity, and improving disability, and physical and emotional functioning. However, the evidence is restricted, low quality, and heterogeneous.
Methods: The searches were conducted on five electronic databases. RCTs or CTs with patients over 18 years old of both sexes with OFP diagnoses were targeted. The intervention of interest was AE (i.e., walking, cycling, and running), compared to any other conservative and non-conservative therapy. The primary outcome was pain intensity. Risk of bias (RoB) was done with the Cochrane RoB tool (RoB 2). The overall certainty of the evidence was evaluated with GRADE.
Results: Out of 21,585 initial records found in the initial database search, only one study (reported on three manuscripts) was included. The diagnosis of interest was headache plus temporomandibular disorders (TMD). Three treatment groups (strengthening (Str) exercise + manual therapy (MT) (G1); AE + MT + Str exercises (G2); AE (G3)) were compared. The main outcome was pain; the secondary outcomes included disability, strength, anxiety, and quality of life. The combined treatment (AE+MT+Str exercises) had the strongest effect to decrease pain and headache intensity in patients with OFP (SMD: 9.99 [95%CI: 7.19, 12.80].
Conclusions: a multimodal treatment strategy achieved the greatest positive effects on pain and other outcomes in the short/medium term. AE seems to be an important component of this strategy. However, the scientific evidence supporting AE’s isolated effect is limited, indicating a research gap in this scientific field.
Introduction: Hamstring injuries are among the most common injuries in soccer players. Especially the danger of hamstring injuries increases in the final third of each half, with the biceps femoris muscle being highly susceptible, but currently there is no supporting evidence in soccer players. It is important to investigate to provide a basis for further clinical investigations in order to reduce the risk of hamstring injuries.
Objective: To investigate a soccer-specific muscle fatigue protocol has an effect on the activation patterns of the biceps and semitendinosus muscles and correlates with the subjectively perceived exertion of the soccer players.
Methods: 19 healthy soccer players aged 19 - 35 years were included and underwent a standardized procedure that included: (1) performance of the nordic hamstring curls (NHC) and a 10m sprint (pre-test), (2) a soccer-specific muscle fatigue loading protocol for 30 minutes with subsequent rating of perceived exertion (RPE), (3) re-assessed like pre-assessment (post- test). Electromyography (EMG) data were recorded the biceps and
semitendinosus muscles of both legs. Two parameters were analyzed: the peak amplitude during the NHC and the mean amplitude during the 10m sprint.
Results: The RPE score (9.5, p<0.001) and 10m sprint shows significant differences between pre- and post- test for the biceps (standing leg: -82.45, kicking leg: -81.77; p<0.01) and semitendinosus muscle (standing leg: -60.08, p=0.001); kicking leg: -65.30, p=0.03). Significant correlation exists between RPE score and biceps muscles at posttest (standing leg: r=-0.54, kicking leg: r=-0.51; p<0.05).
Conclusion: Muscle fatigue leads to significant changes in the activation behavior of the hamstring muscles. In particular, the biceps muscle shows a correlation with perceived exertion, the higher the exertion, the lower the muscle activity. This may help explain the higher prevalence of the biceps muscle in hamstring injuries and offers a basis for further clinical investigations
Background:
Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes.
Objective:
The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved.
Methods:
We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects.
Results:
The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities.
Conclusions:
The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.
This study examined the relation between employees' perceived extent of change and adaptive performance, focusing on the roles of expressive suppression (i.e. the habit of suppressing overt expressions of emotion) at work and perceived strain. Analysing survey data of 153 employees in Germany with different occupational backgrounds via bootstrapping, the conceptual moderated indirect effect scheme was supported. As hypothesized, greater changes were associated with higher strain. Strain, in turn, was negatively related to adaptive performance. Although extent of change did not directly affect adaptive performance, the data supported the expected indirect relationship via strain. Finally, expressive suppression at work acted as a buffer of this indirect effect: extent of change was only negatively related to strain for employees low in suppression. In line with newer evidence, our results indicate that the suppression of overt emotional expressions at work can have positive effects under certain circumstances.
Background:
Children with severe psychomotor impairment (SPMI) often experience sleep disturbances that severely distress both the child and his or her parents. Validated questionnaires for the assessment of parents’ distress related to their child’s sleep disturbances are lacking.
Methods:
We developed and validated a new questionnaire, the HOST (holistic assessment of sleep and daily troubles in parents of children with SPMI) to assess the effect of the sleep disturbances in children with SPMI on their parents. The questionnaire was developed based on published data and expert opinion, and it was refined via direct consultation with affected parents. Its psychometric characteristics were assessed in a sample of parents of 214 children with SPMI. It was retested using a random subsample of the participants.
Results:
Explorative factor analysis revealed that the HOST was composed of four scales. Fit indices, item analysis, and convergent validity (coherence with preexisting instruments of sleep disturbances and health status) were adequate. Retest analysis (n = 62) revealed high stability of the HOST questionnaire and adequate replication validity.
Conclusion:
Sleep-related difficulties significantly impact the sociomedical characteristics of the parents of children with complex neurologic diseases. Typically, parents are severely affected in various aspects of daily life (i.e., medical health, social life, professional life). The HOST proved to be a valid, reliable and economical assessment tool of sleep-related difficulties in parents and relatives of children with SPMI. The HOST is capable of identifying individuals and specific areas requiring intervention.
The ability of film stars to attract viewers is a widely accepted rationale for hiring expensive actors. However, the precise mechanisms behind this ‘drawing power’ remain unclear. By reviewing the existing literature, six possible antecedents of drawing power are identified. Artists with high acting abilities (i) increase a film’s artistic appeal, (ii) function as markers of quality and (iii) facilitate the matching process with the right audiences. Widely popular, commonly perceived as beautiful/handsome but often less talented actors, on the other hand, rather (iv) facilitate the marketing campaigns of films, (v) offer entertaining interactions with famous personalities and (vi) provide manifold opportunities for gossiping. Based on a discussion of the implications for theory and a preliminary analysis of a sample of Hollywood actors, managerial recommendations for those who have and those who depend on star drawing power are developed.
Functional foods are still of increasing interest among the scientific community. Based on the extensive literature about functional foods, four main research areas can be identified: functional food innovation (1); the scientific background of the health benefits of functional foods (2); the regulation of functional foods (3); and consumer acceptance of functional foods (4). These research areas are not detached from each other, and each presents a consumer perspective. Although multifaceted studies focus on consumer acceptance of functional foods, literature regarding a structured framework of the determinants of functional food acceptance is limited. The aim of this review is to provide the reader with an overview of the recent literature on consumer attitudes towards functional foods and with an extensive structured framework of the determinants of functional food acceptance and their intertwined relationships. The scientific literature discusses a plethora of determinants of consumer acceptance of functional foods. These determinants can be categorized into consumer and market attributes, which show interwoven relationships with each other. On the one hand, consumer attributes are widely discussed in the literature, while on the other hand structured analyses of the market perspective are inadequately represented. Additionally, the ongoing development of new scientific findings regarding health benefits of different functional ingredients leads to a large amount of new functional food products in the market. Consequently, the research area of functional foods and in particular consumer acceptance of functional food innovation will remain an important research field in the coming years.
The way in which brands are economically represented in the context of financial reporting is controversial in theory and practice. This holds especially against the background of the ever- increasing importance of intangible assets. Brands and the economic success associated with them are thus regarded as a key variable for overall corporate success: cash flows can be accelerated and expanded through the use of brand-strategic options, while existing risks may be mitigated. In addition to a large number of theoretical definitions, the determination of brand value from both a marketing and an accounting perspective is also characterized by a complex interaction of numerous influencing factors. This is where the International Accounting Standards IAS 38: "Intangible Assets" (isolated acquisition of a brand) and IFRS 3: "Business Combinations" (acquisition of a brand as part of a business combination) take effect: These are intended to ensure a comparable and reliable "true and fair view" for the presentation of intangible assets in international accounting. In addition to various recognition criteria, the accounting regulation here also includes the accounting valuation of intangible assets and thus also of brands. In principle, valuation in accordance with IAS 38 is based on acquisition costs. The determination of the operating life for impact evaluation is highly controversial both in literature and in practice. Under IFRS 3, acquisition costs are to be replaced by the fair value. Regardless of the method used, possible subjectivity is one of the central issues. The current discussion approach of the International Accounting Standards Board also clearly shows the need for simplification and concretization that still exists for practice: In particular, the accounting distinction between goodwill and intangible assets is the subject of discussions with the Global Preparers Forum, among others. The interests of users, preparers and auditors of corporate financial reporting must be taken into account equally. In particular, the prohibition on recognizing self-created brands in the balance sheet makes it difficult to assess their value. Furthermore, it creates a weak point in the presentation of the true and fair view of a company's financial position and financial performance that is generally required. Regardless of the previous, the current rules provide preparers and users with a basic overview of existing intangible assets. Irrespective of how valuation is determined individually, the IASB's rules thus help to create a fundamental structure. In which approach the future discussion will result in remains open.
Der Konsumbereich „Ernährung“ verantwortet in Deutschland rund 15 % der Treibhausgasemissionen (THG). Aufgrund der hohen Nachfrage hat die Außer-Haus-Verpflegung eine starke Hebelwirkung, um eine klimaeffiziente Ernährung voranzutreiben – so auch Schulküchen. Aktuell sind der Verpflegung jedes Schulkindes, welches ganzjährig an der Mittagsverpflegung teilnimmt, pro Jahr etwa 264 kg THG-Emissionen zuzuschreiben.
Im Projekt KEEKS „Klima- und energieeffiziente Küche in Schulen” wurden deshalb in 22 Schulküchen von Ganztagsschulen mit täglich insgesamt 5 000 Mittagessen der Status Quo ermittelt. Dies geschah mittels Energiemessungen, Analyse von Ausstattung, Technik und Prozessen der Küchen sowie leitfadengestützten Interviews mit den Küchenleitungen. Treibhausgasemissionen von Menüs und Küchenprozessen wurden bilanziert, Einsparpotenziale identifiziert sowie Handlungsempfehlungen entwickelt und erprobt. Die effektivsten Maßnahmen – die Reduktion und Substitution von Fleisch und Fleischprodukten sowie der Aufbau eines effizienten Abfallmanagements – sparen rund 10 % des Treibhausgasausstoßes einer Schulküche ein. Die erarbeiteten Handlungsempfehlungen können Küchenpersonal dabei unterstützen, eine klimafreundliche, kindgerechte, gesunde und bezahlbare Schulküche zu gestalten.
Innovations are typically characterised by their relative newness for the user. In order for new eHealth applications to be accepted as innovations more criteria were proposed including “use” and “usability”. The handoverEHR is a new approach that allows the user to translate the essentials of a clinical case into a graphical representation, the so-called cognitive map of the patient. This study aimed at testing the software usability. A convenience sample of 23 experienced nurses from different healthcare organisations across the country rated the usability of the handoverEHR after performing typical handover tasks. All usability scales of the IsoMetricsL questionnaire showed positive values (4 “I agree”) with the exception of “error tolerance” (3 “neutral statement”). A significant improvement was found in self-descriptiveness as compared to an initial usability testing prior to this study. Different subgroups of users tended to rate the usability of the system differently. This study demonstrated the benefits of formative evaluations in terms of improving the usability of an entirely new approach. It thus helps to transform a novel piece of software towards becoming a real innovation. Our findings also hint at the importance of user characteristics that could affect the usability ratings.
Objective:
The cervical mucus plugs are enriched with proteins of known immunological functions. We aimed to characterize the anti-HIV-1 activity of the cervical mucus plugs against a panel of different HIV-1 strains in the contexts of cell-free and cell-associated virus.
Design:
A cohort of consenting HIV-1-negative and HIV-1-positive pregnant women in labour was recruited from Mthatha General Hospital in the Eastern Cape province of South Africa, from whom the cervical mucus plugs were collected in 6 M guanidinium chloride with protease inhibitors and transported to our laboratories at −80 °C.
Methods:
Samples were centrifuged to remove insoluble material and dialysed before freeze--drying and subjecting them to the cell viability assays. The antiviral activities of the samples were studied using luminometric reporter assays and flow cytometry. Time-of-addition and BlaM-Vpr virus-cell fusion assays were used to pin-point the antiviral mechanisms of the cervical mucus plugs, before proteomic profiling using liquid chromatography-tandem mass spectrometry.
Results:
The proteinaceous fraction of the cervical mucus plugs exhibited anti-HIV-1 activity with inter-individual variations and some degree of specificity among different HIV-1 strains. Cell-associated HIV-1 was less susceptible to inhibition by the potent samples whenever compared with the cell-free HIV-1. The samples with high antiviral potency exhibited a distinct proteomic profile when compared with the less potent samples.
Conclusion:
The crude cervical mucus plugs exhibit anti-HIV-1 activity, which is defined by a specific proteomic profile.
BACKGROUND: Postoperative delirium (POD) is an acute and common complication after surgery that can increase morbidity and mortality. Few previous studies with inconsistent findings have examined the association of preoperative pain and POD. Our purpose is to investigate the association of preoperative chronic pain and POD.
METHODS: This prospective observational cohort study included 200 patients ≥ 18 years scheduled for elective surgery under general anaesthesia in a tertiary care hospital. POD was defined as meeting diagnostic criteria during the study visits (according to delirium screening tests and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), or by diagnosis of the responsible physicians. Chronic pain was defined as pain lasting six months or longer. Features of chronic pain were assessed with the German Pain Questionnaire, including the Depression Anxiety and Stress Scale-21 (DASS-21). Associations with POD were assessed using logistic regression analysis adjusting for confounding factors.
RESULTS: Thirty-nine (22%) out of 176 patients developed POD. Chronic pain was not associated with POD after adjustment for ASA physical status, duration of anesthesia and DASS-21 Anxiety score (Odds ratio [OR], 95%-Confidence Interval [CI], 2.216 [0.968;5.070], P=0.060). A subgroup analysis of chronic pain patients revealed that current pain intensity was higher in patients with POD.
CONCLUSIONS: Preoperative chronic pain was no independent predictor for POD. Current pain intensity was higher in chronic pain patients with POD. This indicates that certain features of pain might be influential. Further research is needed to examine different forms of preoperative pain and their possible influence on POD.
Background
The continuous rise in caesarean rates across most European countries raises multiple concerns. One factor in this development might be the type of care women receive during childbirth. ‘Supportive care during labour’ by midwives could be an important factor for reducing fear, tension and pain and decreasing caesarean rates. The presence and availability of midwives to support a woman in line with her needs are central aspects for ‘supportive care during labour’.
To date, there is no existing research on the influence of effective ‘supportive care’ by German midwives on the mode of birth. This study examines the association between the attendance and workload of midwives with the mode of birth outcomes in a population of low-risk women in a German multicentre sample.
Methods
The data are based on a prospective controlled multicentre trial (n = 1,238) in which the intervention ‘midwife-led care’ was introduced. Four German hospitals participated between 2007 and 2009.
Secondary analyses included a convenience sample of 999 low-risk women from the primary analyses who met the selection criterion ‘low-risk status’. Participation was voluntary. The association between the mode of birth and the key variables ‘attendance of midwives’ and ‘workload of midwives’ was assessed using backward logistic regression models.
Results
The overall rate of spontaneous delivery was 80.7% (n = 763). The ‘attendance of midwives’ and the ‘workload of midwives’ did not exhibit a significant association with the mode of birth. However, women who were not satisfied with the presence of midwives (OR: 2.45, 95% CI 1.54-3.95) or who did not receive supportive procedures by midwives (OR: 3.01, 95% CI 1.50-6.05) were significantly more likely to experience operative delivery or a caesarean. Further explanatory variables include the type of hospital, participation in childbirth preparation class, length of stay from admission to birth, oxytocin usage and parity.
Conclusion
Satisfaction with the presence of and supportive procedures by midwives are associated with the mode of birth. The presence and behaviour of midwives should suit the woman’s expectations and fulfil her needs. For reasons of causality, we would recommend experimental or quasi-experimental research that would exceed the explorative character of this study.
In view of the rapid depletion of natural resources and the associated overloading of the biological ecosystem, the concept of circular business models (CBMs) is increasingly discussed in the literature as well as in business practice. CBMs have the potential to significantly reduce the demand for natural resources. Despite their increasing relevance, the diffusion of CBMs in business practice is largely unexplored. Consequently, this article investigates the extent to which CBMs have already been adopted by large German companies. To answer this question, the annual and sustainability reports of the members of the DAX40 are analyzed for the presence of five specific types of CBMs. Data was gathered for the years 2015 and 2020 in order to describe the development over time. The results show an increasing prevalence of CBMs in the DAX companies. In addition, it is noticeable that CBM types that serve to close material cycles are implemented more frequently than those that decelerate material cycles. In particular Sharing Platforms and Product as a Service stand out due to comparatively low adoption. Potential reasons for these findings are discussed and managerial as well as policy implications suggested.
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.