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Background: Crowding in emergency departments (ED) has a negative impact on quality of care and can be averted by allocating additional resources based on predictive crowding models. However, there is a lack in effective external overall predictors, particularly those representing public activity.
Objectives: This study, therefore, examines public activity measured by regional road traffic flow as an external predictor of ED crowding in an urban hospital.
Methods: Seasonal autoregressive cross-validated models (SARIMA) were compared with respect to their forecasting error on ED crowding data.
Results: It could be shown that inclusion of inflowing road traffic into a SARIMA model effectively improved prediction errors.
Conclusion: The results provide evidence that circadian patterns of medical emergencies are connected to human activity levels in the region and could be captured by public monitoring of traffic flow. In order to corroborate this model, data from further years and additional regions need to be considered. It would also be interesting to study public activity by additional variables.
Niche-based species distribution models (SDMs) play a central role in studying species response to environmental change. Effective management and conservation plans for freshwater ecosystems require SDMs that accommodate hierarchical catchment ordering and provide clarity on the performance of such models across multiple scales. The scale-dependence components considered here are: (a) environment spatial structure, represented by hierarchical catchment ordering following the Strahler system; (b) analysis grain, that included 1st to 5th order catchments; and (c) response grain, the grain at which species respond most, represented by local and upstream catchment area effects. We used fish occurrence data from the Danube River Basin and various factors representing climate, land cover and anthropogenic pressures. Our results indicate that the choice of response grain – local vs. upstream area effects – and the choice of analysis grain, only marginally influence the performance of SDMs. Upstream effects tend to better predict fish distributions than corresponding local effects for anthropogenic and land cover factors, in particular for species sensitive to pollution. Key predictors and their relative importance are scale and species dependent. Consequently, choosing proper species dependent spatial scales and factors is imperative for effective river rehabilitation measures.
Optimised Nutrient Recovery from Biogas Digestate by Solid/Liquid Separation and Membrane Treatment
(2019)
Anaerobic digestion products of agricultural biogas plants are characterised by high nitrogen, phosphorus, and potassium content. In three scale-up steps, a membrane based digestate treatment process of solid-liquid-separation, ultrafiltration, and reverse osmosis for nutrient recovery was investigated. Lab-scale trials delivered a very good understanding of fluid properties and subsequent ultrafiltration performance, which is the limiting process step in terms of energy demand and operation costs. In semi-technical experiments, optimisation, and design parameters were developed, which were subsequently applied to pilot-scale tests at two full-scale biogas plants. The process optimisation resulted in 50 % energy reduction of the ultrafiltration step. About 36 % of the sludge volume was recovered as dischargeable water, 20 % as solid N/P-fertiliser, and 44 % as liquid N/K-fertiliser.
Symposion: Working for the greater good in services: risks and innovation impacts on employees’ wellbeing
Oral presentation: Kumbruck: Digitalization in Health and Old People’s Care and the Impacts on the Interaction Work
Purpose: Digitalization like roboter to lift or feed care receiver or like electronic patient documentation, e.g. on smartphones, changes interaction and communication between care givers and care receivers. From our research projects (Projektgruppe verfassungsverträgliche Technikgestaltung: Mobile information and communication tools in the hospital; Das Ethos fürsorglicher Praxis in der Pflege) shows impacts.
Design/Methodology/Approach/Intervention: Qualitative studies (simulation studies; narrative Interviews, observations,) with more than 60 experimentees in different health care institutions.
Results: The interaction is mediated by electronic tools. The nurses are confident by the electronic assistance and workload reduction; but they are afraid of more distance in the relationship to the patients, more mixing of private and working time activities or more observation by their superiors. The most critical aspect is seen in the patient documentation.
Limitations: These studies are explorative ones. Especially the simulation study is an experimental design.
Research/Practical Implications: There is need for more and quantitative studies. The results give a lot of indications that the organizational and political frameworks of health care are important moderators of the impacts of the digitalization in health care.
Originality/Value: The studies have an important perspective on the change in the relationship between health care givers and receivers by digitalization – a topic, which concerns everybody.
Background
Lay family caregivers of patients receiving palliative care often confront stressful situations in the care of their loved ones. This is particularly true for families in the home-based palliative care settings, where the family caregivers are responsible for a substantial amount of the patient’s care. Yet, to our knowledge, no study to date has examined the family caregivers’ exposure to critical events and distress with home-based palliative care has been reported from Germany. Therefore, we attempt to assess family caregiver exposure to the dying patient’s critical health events and relate that to the caregiver’s own psychological distress to examine associations with general health within a home-based palliative care situation in Germany.
Methods
A cross-sectional study was conducted among 106 family caregivers with home-based palliative care in the Federal State of North Rhine Westphalia, Germany. We administered the Stressful Caregiving Adult Reactions to Experiences of Dying (SCARED) Scale. Descriptive statistics and linear regression models relating general health (SF-36) were used to analyze the data.
Results
The frequency of the caregiver’s exposure, or witness of, critical health events of the patient ranged from 95.2% “pain/discomfort” to 20.8% “family caregiver thought patient was dead”. The highest distress scores assessing fear and helpfulness were associated with “family caregiver felt patient had enough’” and “family caregiver thought patient was dead”. Linear regression analyses revealed significant inverse associations between SCARED critical health event exposure frequency (beta = .408, p = .025) and total score (beta = .377, p = .007) with general health in family caregivers.
Conclusions
Family caregivers with home-based palliative care in Germany frequently experience exposure to a large number of critical health events in caring for their family members who are terminally ill. These exposures are associated with the family caregiver’s degree of fear and helplessness and are associated with their worse general health. Thus the SCARED Scale, which is brief and easy to administer, appears able to identify these potentially upsetting critical health events among family caregivers of palliative care patients receiving care at home. Because it identified commonly encountered critical events in these patients and related them to adverse general health of family caregivers, the SCARED may add to clinically useful screens to identify family caregivers who may be struggling.
We describe an automated approach, to easily track patients regaining their walking ability while recovering from neurological diseases like e.g. stroke. Based on captured gait data and objective measures derived out of it the rehabilitation process can be optimized and thus steered. In order to apply such system in clinical practice two key requirements have to be fulfilled: (i) the system needs to be applicable in terms of ease of use and performance; (ii) the derived measures need to be accurate.
Climate change is the biggest social challenge facing the globalised world. The aim of this paper is to investigate the requirements for governance structures in regional sustainability programmes against climate change.
The study is an explorative case study. It is based on a literature review and expert interviews. It also involves the participatory observation of working groups meetings, and a design thinking workshop.
In spite of their enormous importance, little is known about the institutional conditions of the regional governance of climate change projects in Germany.
For this reason, the research project focuses on the important aspect of networking and governance structures. Consequently, the investigation will contribute to answering the question of which institutional framework conditions can raise the likelihood of climate change projects having a sustainable effect.
The outcomes of the application
This research has not only practical implications for the single case. The exploration of the critical factors of success also offers other regions important food for thought in shaping their governance structures. In particular, the design thinking process and the business network in the District of Steinfurt offer valuable points of reference.
The usage of high-level synthesis (HLS) tools for FPGAs has increased significantly over the last years since they matured and allow software programmers to take advantage of reconfigurable hardware technology.
Most HLS tools employ methods to optimize for loops, e. g. by unrolling or pipelining them. But there is hardly any work on the optimization of while loops. This comes at no surprise since most while loops have loop-carried dependences involving the loop condition which result in large recurrence cycles in the dataflow graphs. Therefore typical while loops cannot be parallelized or pipelined.
We propose a novel transformation which allows to optimize while loops nested within a for loop. By interchanging the two loops, it is possible to pipeline (and thereby parallelize) the inner loop, resulting in a reduced execution time. We present two case studies on different hardware platforms and show the speedup factors - compared to a host processor and to an unoptimized hardware implementation - achieved by our while loop optimization method.
Since February 2019, the „Katholische Erwachsenenbildung“ has been collaborating with the Institute of Music of the University of Applied Sciences Osnabrück. An institute for adult education provides the framework for a concept in which German as a second language lessons are accompanied by musicalisation. In line with elemental musical practice, whole-body experiences with voice, movement, and body-percussion play an important role. Students with the career goal of „Educating Artist“ work alongside language teachers in this project, and are mentored by university teachers. The young musicians gain monitored teaching experience and have a great opportunity to witness and help shape the linguistic and social integration of refugees.
A consequence of increasing migration is that a large number of people need to learn the language of the country of immigration. Music and language are phenomenons that share many common characteristics, such as melody, rhythm, and timbre. Music draws attention and can cause positive emotions. Music and movement are deeply rooted in the communication of emotional states und are considered to be the evolutionary biological basis for language. Thus the close relationship between language, music, and dance is evident: They all rely on differentiating perception, are able, as systems designed for social interactions, to connect people, and allow for both collective and individual expression.
The contents and procedures of the lessons are documented in a digital diary. The entire team meets at regular intervals, in order to reflect on the experiences and conduct further planning. For these purposes, video documentation of the lessons is also used. The project will end in November 2019 with a language exam; a musical final presentation is also planned. By then at the latest, findings will be available as to if and how the musical course content was able to support language acquisition. The collaboration enables the partners to realize the combining of different objectives (learning a second language, cultural participation and music making) by bringing experts together.