Veröffentlichte Fassung/Verlagsversion
Refine
Year of publication
Document Type
- Article (354)
- Conference Proceeding (168)
- Part of a Book (44)
- Book (31)
- Moving Images (26)
- Working Paper (17)
- Other (7)
- Doctoral Thesis (2)
- Part of Periodical (1)
Language
- English (650) (remove)
Keywords
- Nutritional footprint (5)
- Sustainability (5)
- physiotherapy (5)
- Danube (4)
- Public Health (4)
- Sustainable nutrition (4)
- Ultrasound (4)
- performing artists (4)
- selenium (4)
- Amino acid (3)
- Electroporation (3)
- Energy (3)
- Epidemiology (3)
- Hay transfer (3)
- Landscape Planning (3)
- Lemnaceae (3)
- Monitoring (3)
- Sustainable consumption (3)
- Transition (3)
- Water lentils (3)
- manual therapy (3)
- 25-hydroxycholecalciferol (2)
- Aesthetics (2)
- Animal welfare (2)
- Biodiversity (2)
- Bone metabolism (2)
- COVID-19 (2)
- Cancer registry (2)
- Carbon sequestration (2)
- Catchment order (2)
- Chronic pain (2)
- Climate Resilience (2)
- Clinical (2)
- Cognition (2)
- Conservation planning (2)
- Cross-industry innovation (2)
- Ecological restoration (2)
- Ecological study (2)
- Elderly (2)
- Environment (2)
- Food waste (2)
- Functional ingredient (2)
- Gazebo (2)
- Generalized additive models (2)
- Germany (2)
- Green Fingers (2)
- Health (2)
- Inactivation (2)
- Industry (2)
- Kinetics (2)
- Landscape Design (2)
- Leftovers (2)
- LiDAR (2)
- Mapping (2)
- Materialermüdung (2)
- Mortality (2)
- Moss (2)
- Neurodynamics (2)
- Nitrogen (2)
- Novel ecosystems (2)
- Nutritional Policy (2)
- Nutritional Sciences (2)
- Ohmic heating (2)
- Out-of-home catering (2)
- PEF (2)
- Power Consumption (2)
- Probiotics (2)
- Pulsed electric fields (2)
- Quality (2)
- Quantitative sensory testing (2)
- Risk factors (2)
- Robot operating system (ROS) (2)
- SMEs (2)
- Secondary succession (2)
- Seeding (2)
- Simulation and Modeling (2)
- Species composition (2)
- Species distribution modelling (2)
- Succession (2)
- Sustainable diet (2)
- Urban green infrastructure (2)
- Urban restoration (2)
- Vitamin D (2)
- agriculture (2)
- agronomic biofortification (2)
- apple (2)
- biofortification (2)
- biomechanics (2)
- clinical examination (2)
- eHealth (2)
- electromyography (2)
- eye-tracking (2)
- foliar sprays (2)
- growing media (2)
- health information technology (2)
- iodine biofortification (2)
- metabolomics (2)
- muscle activity (2)
- muscle fatigue (2)
- musculoskeletal (2)
- musicians (2)
- nitrate (2)
- phenolic compounds (2)
- temporomandibular disorders (2)
- time synchronization (2)
- validation (2)
- (DPSIR) framework (1)
- 3,4-Dimethylpyrazole phosphate (1)
- 5:2 fasting (1)
- 5G (1)
- 802.1AS (1)
- ADL (1)
- AFL (1)
- AI compliance (1)
- Abandoned farmland (1)
- Acceptance (1)
- Accident prevention (1)
- Adaptive performance (1)
- Additives (1)
- Age Period Cohort Modelling (1)
- Agri-environment scheme (1)
- Agri-environment schemes (1)
- Agricultural Automation (1)
- Agricultural abandonment (1)
- Agricultural streering system (1)
- Agriculture (1)
- Agrobiodiversity (1)
- Agroecosystem (1)
- Agrophysics (1)
- Alar ligaments (1)
- Alluvial forest (1)
- Alternative peeling methods (1)
- Amino acids (1)
- Ammonia (1)
- Ammonia background concentration (1)
- Amyloid fibril formation (1)
- Angiography (1)
- Animal health (1)
- Animal nutrition (1)
- Animal performance (1)
- Ankle injuries (1)
- Anticholinergic medication (1)
- Arable field (1)
- Arable land (1)
- Artificial drainage system (1)
- Artificial intelligent (1)
- Artificial neural networks (1)
- Aspergillus (1)
- Auftragschweißen (1)
- Augmented Reality (1)
- Augmented data (1)
- Augmented reality (1)
- Automated object detection (1)
- BPMN (1)
- Balance sheet (1)
- Base fertilization (1)
- Bass model (1)
- Bayesian Optimization (1)
- Behavior (1)
- Benzodiazepines (1)
- Beta-blocker therapy (1)
- Biennial (1)
- Bioactive compounds (1)
- Biodiversity conservation (1)
- Biofortification (1)
- Biomass production (1)
- Biotechnology (1)
- Birth (1)
- Bleaching (1)
- Bone (1)
- Bootstrap (1)
- Bootstrapping (1)
- Bottleneck (1)
- Bottom-up-influence (1)
- Brand activism (1)
- Brass instruments (1)
- Breast Cancer (1)
- Broiler (1)
- Broilers (1)
- Brown roof (1)
- Bubble formation (1)
- Business Process Modeling (1)
- Business catering (1)
- CEO (1)
- CEO-CIO relationship (1)
- CHRM2 (1)
- CHRM4 (1)
- Cafeteria (1)
- Calamagrostis epigeios (1)
- Cannulation (1)
- Carbon footprint (1)
- Cardiac anesthesia (1)
- Cardiac surgery (1)
- Cardiovascular (1)
- Casein micelle (1)
- Catheterization (1)
- Catheters (1)
- Cell type deconvolution (1)
- Central venous pressure (1)
- Cerebral palsy (1)
- Cerebral protection (1)
- Cervical (1)
- Cervical lateral glide (1)
- Cervical mucus plugs (1)
- Cervical radiculopathy (1)
- Cervical range of motion (1)
- Cervical spine (1)
- Cervicogenic headache (1)
- Chamber system contamination (1)
- Change (1)
- Change management (1)
- Change point detection (1)
- Change-supporting behavior (1)
- Characteristics (1)
- Chemical properties (1)
- Children (1)
- Children and adolescents (1)
- Chitin (1)
- Cholinesterase (1)
- Chromatography (1)
- Chronic renal failure (1)
- Circular economy (1)
- Citizen energy community (1)
- Classification (1)
- Climate change (1)
- Climate change mitigation (1)
- Climate efficiency (1)
- Clinical handover (1)
- Closed-loop control systems (1)
- Co-Creativity (1)
- Cognitive ageing (1)
- Cognitive enhancement technologies (1)
- Cognitive epidemiology (1)
- Commercial applications (1)
- Commercial farms (1)
- Commitment to change (1)
- Common ground (1)
- Communication (1)
- Community care (1)
- Community health nursing (1)
- Community of practice (1)
- Computed axial tomography (1)
- Computer-Human Interaction (1)
- Computerized patient records (1)
- Concentrate feed proportion (1)
- Consensus (1)
- Consortium research (1)
- Consumer attitudes (1)
- Consumer behavior (1)
- Consumer training (1)
- Consumption behavior (1)
- Continuity of care (1)
- Control (1)
- Controlled discharge (1)
- Converging industries (1)
- Convolutional neural networks (CNNs) (1)
- Coping (1)
- Corynebacterium glutamicum (1)
- Covid-19 (1)
- Cranial tissue (1)
- Credit rating agencies (CRAs) (1)
- Critical care (1)
- Croatia (1)
- Crop residues (1)
- Crop science (1)
- Cropland (1)
- Cross- cultural perspectives (1)
- Cross-beta sheet structures (1)
- Cross-border (1)
- Cross-country comparison (1)
- Cross-feeding (1)
- Cross-sectional (1)
- Crude protein (1)
- Cultivars (1)
- Cultivation (1)
- Cut Point (1)
- Cut Points (1)
- Cycling simulator (1)
- DMN (1)
- DNA methylation (1)
- DTNs (1)
- Dairy cows (1)
- Dance (1)
- Decision support application (1)
- Dehydration (1)
- Delirium (1)
- Design (1)
- Design Principles (1)
- Design framework (1)
- Design science research (1)
- Diagnostic medicine (1)
- Diagnostik (1)
- Diaspore transfer (1)
- Diet (1)
- Dietary Patterns (1)
- Dietary supplements (1)
- DiffServ (1)
- Diffusion of innovation (1)
- Digital divide (1)
- Digital innovation (1)
- Digital literacy (1)
- Digitalization (1)
- Discharge management (1)
- Discoloration (1)
- Dispersal (1)
- Driving force-pressure-state-impact-response (1)
- Driving forces (1)
- Dry grassland (1)
- Dry mass yield (1)
- Dry matter (1)
- Drying (1)
- Dual-energy X-ray Absorptiometry (1)
- Dynamic (1)
- Dynamic Adaptation (1)
- Dynamic Process Adaption (1)
- E-Health app (1)
- EDCA (1)
- EMG (1)
- EU energy law (1)
- EU-Regulation (1)
- EWAS (1)
- Eating out (1)
- Eating outside the home (1)
- Eco-building (1)
- Ecological Networks (1)
- Ecological footprint (1)
- Ecological theory (1)
- Ecology (1)
- Education (1)
- Effectivepopulation size (1)
- Einheitszelle (1)
- Elective surgical procedures (1)
- Electrical conductivity (1)
- Electrical treatments (1)
- Electromyography (1)
- Electron beam (1)
- Electronic Health Record (1)
- Electronic health records (1)
- Embedded Software Engineering (1)
- Embedded Systems (1)
- Emerging technology (1)
- Emotion recognition and expression (1)
- Emotional Exhaustion (1)
- Employee Assistance Program (1)
- Employee Health (1)
- Empowerment (1)
- Energy Bug (1)
- Energy Efficiency (1)
- Energy system modelling (1)
- Entrepreneurship (1)
- Environmental assessment (1)
- Environmental impact (1)
- Environmental indicators (1)
- Epigenome-wide association study (EWAS) (1)
- Equality (1)
- Escherichia coli (1)
- Estimands (1)
- Ethical AI (1)
- Etomidate (1)
- European Union policies (1)
- European freshwater (1)
- Event-related potentials (1)
- Ex-arable (1)
- Ex-arable field (1)
- Examination (1)
- Expert interviews (1)
- Expert standards, (1)
- Expertise (1)
- Expression analysis (1)
- Expressive suppression (1)
- Extraction (1)
- Eye-tracking (1)
- FIB-SEM tomography (1)
- Facial expression (1)
- Farm animals (1)
- Farmland biodiversity (1)
- Farmland bird (1)
- Fat-soluble bioactive substances (1)
- Fatigue-relevant scatter (1)
- FeNiCrAl (1)
- Feed intake (1)
- Field flow fractioning (1)
- Financial reporting (1)
- First impression (1)
- Flexion-rotation test (1)
- Flexion–rotation test (1)
- Floodplain (1)
- Flower strip (1)
- Flower strip effectiveness (1)
- Fluctuating water (1)
- Foam roll (1)
- Food (1)
- Food Choices (1)
- Food Security (1)
- Food choices (1)
- Food consumption (1)
- Food policy and nutrition (1)
- Freezing (1)
- French fries (1)
- Fresh mass yield (1)
- Freshwater (1)
- Freshwater fish (1)
- Fruits (1)
- Frying (1)
- Frühe Hilfen (1)
- Functional Status (1)
- Functional food (1)
- Functional safety (1)
- Game engine (1)
- Gamification (1)
- Gastrointestinal tract (1)
- Gaze Analytics (1)
- Gelation (1)
- Gender (1)
- Generalized estimation equations (1)
- Generalized linear mixed models (1)
- Generalized periodicity (1)
- Genetic diversity (1)
- Genome-wide association study (1)
- Geriatric depression score, (1)
- Geriatrics (1)
- German dairy farming (1)
- German dairy sector (1)
- German women (1)
- Gingiva (1)
- Graded Motor Imagery (1)
- Grain belt (1)
- Grazing (1)
- Greater occipital nerve (1)
- Green Infrastructure (1)
- Green roof (1)
- Greenhouse gas emissions (1)
- Grounded theory (1)
- HIV-1 (1)
- HTML (1)
- HYDRUS-1D (1)
- Habitat fragmentation (1)
- Habitat restoration (1)
- Hardfacing (1)
- Head and facial pain (1)
- Headache (1)
- Health Promotion Intervention (1)
- Health care utilization (1)
- Health claims (1)
- Health indicators (1)
- Health inequalities (1)
- Health literacy (1)
- Health policy (1)
- Health promotion (1)
- Health service (1)
- Health-related quality of life (1)
- Heat and mass transfer (1)
- Hebamme (1)
- Heuristic Theorizing (1)
- High pressure processing (1)
- High-throughput screening (1)
- Higher Education Institutions (1)
- Holistic Design (1)
- Homologous (1)
- Hospital information system (1)
- Hot Spot Analysis (1)
- Human-computer interaction (1)
- Human-made habitats (1)
- Hybrid data (1)
- Hydrochory (1)
- Hydrophobic interactions (1)
- Hydroponics (1)
- Hyperhydricity (1)
- IADL (1)
- IFRS (1)
- INLA (1)
- ISFET-sensor module (1)
- IT decision making (1)
- IT knowledge (1)
- IT-adoption (1)
- IT4Sustainability (1)
- Identity-based brand management (1)
- Incidnece (1)
- India (1)
- Indicators (1)
- Industry convergence (1)
- Infection (1)
- Inflammation (1)
- Innovation (1)
- Innovative methods (1)
- Instantiation (1)
- Intensive care (1)
- Intensive care medicine (1)
- Intensive care unit (1)
- Interactions (1)
- Interdisciplinary (1)
- Intermolecular beta-sheet structures (1)
- Internal heat generation rate (1)
- Internet of Things (1)
- Interprofessionelle Kooperation (1)
- Interview based (1)
- Intralogistics services (1)
- Invasive species (1)
- Iron biofortification (1)
- Irradiation (1)
- Ischemia (1)
- Key indicators (1)
- Kreislaufwirtschaft (1)
- LSAS (1)
- Land-use change (1)
- Landscape context (1)
- Language Extension (1)
- Latent class analysis (1)
- Lateralization (1)
- Law (1)
- Laying hens (1)
- Lehrkräfte (1)
- Life cycle assessment (LCA) (1)
- Life cycle concept (1)
- Limits to Growth (1)
- Linear mixed models (1)
- LoRaWAN (1)
- Local provenance (1)
- Location factors of the creative class (1)
- Locomotion (1)
- Long-term care insurance (1)
- Lormetazepam (1)
- Low protein (1)
- Luikov's model (1)
- Lyophilization (1)
- MARTE (1)
- Machine learning (1)
- Magnetic resonance imaging (1)
- Mammography screening (1)
- Mandible position (1)
- Mandibular nerve (1)
- Manual dishwashing (1)
- Manual therapy (1)
- Manufacturing (1)
- Manufacturing location (1)
- Mass transfer (1)
- Maternal well-being (1)
- McDonald’s Germany (1)
- Meadow steppe (1)
- Meal box (1)
- Meal kit (1)
- Median nerve (1)
- Medical informatics (1)
- Mental health (1)
- Mesentric arteries (1)
- Meta Modeling (1)
- Metabolic responses (1)
- Methylation (1)
- Microbial consortia (1)
- Microbial efficiency (1)
- Micronutrients (1)
- Microorganisms (1)
- Microwave drying (1)
- Midazolam (1)
- Migraine (1)
- Migration (1)
- Minimal Important Difference (1)
- Mitral valve repair (1)
- Mobile information systems engineering (1)
- Mobility (1)
- Mobility decisions of students and skilled professionals (1)
- Mobilization (1)
- Model-Driven Development (1)
- Modeling (1)
- Modelling (1)
- Moderate electric fields (1)
- Moderated indirect effect (1)
- Mother–infant bonding (1)
- Motion analysis (1)
- Mucins (1)
- Mulching (1)
- Multi-plot field trials (1)
- Multilevel models (1)
- Multimethod research design (1)
- Multimodal Data Analysis (1)
- Multiple contrast tests (1)
- Multiple testing (1)
- Municipalities (1)
- Musculoskeletal assessments (1)
- Musculoskeletal health status (1)
- Musculoskeletal manipulations (1)
- Musculoskeletal pain (1)
- Musicians (1)
- Musicians´ health (1)
- Mycotoxin (1)
- N min concentration (1)
- N recovery (1)
- N-acetylglucosamine (1)
- N-analysis plants (1)
- Nachhaltigkeit (1)
- Narrative (1)
- National monitoring system (1)
- Native forb (1)
- Native plant species (1)
- Natural living strategies (1)
- Neck-arm pain (1)
- Network structure (1)
- Neurocognitive disorder (1)
- Neuropathic pain (1)
- No-till farming (1)
- Noncardiac surgery (1)
- Nonnative species (1)
- Nudge (1)
- Nutrient flows (1)
- Nutrient medium (1)
- Nutrition (1)
- Nutrition Security (1)
- Nutritional Behavior (1)
- Nutritional Patterns (1)
- Nutritional therapy (1)
- OMNeT++ (1)
- Occupation (1)
- Offshoring (1)
- Oil droplet distribution (1)
- Oil-in-water emulsions (1)
- Old field (1)
- Online-sensor (1)
- Operating room (1)
- Opioids (1)
- OppNets (1)
- Optical properties (1)
- Optimization (1)
- Organ Transplantation (1)
- Organic (1)
- Organizational behaviour (1)
- Organizational change (1)
- Organizational identification (1)
- Out-of-home (1)
- Out-of-home consumption (1)
- Out-of-home gastronomy (1)
- Outcome (1)
- Ovalbumin (1)
- Overdispersion (1)
- Overgrowing (1)
- Overshoot (1)
- P13K/AKT/mTOR pathway (1)
- PESTEL (1)
- PRMD (1)
- PTP4A3 (1)
- Pain measurement (1)
- Pandemic (1)
- Parents (1)
- Participation (1)
- Participation rates (1)
- Particle size (1)
- Paste (1)
- Patatin (1)
- Peeling improvement (1)
- Perennial wildflower strip (1)
- Performing Artists (1)
- Performing artists (1)
- Periodontitis (1)
- Perioperative allogeneic blood transfusion (1)
- Peripheral (1)
- Permeabilization (1)
- Pflegekonzept (1)
- Phenotyping (1)
- Physical function (1)
- Physical properties (1)
- Physical therapy (1)
- Physiotherapy (1)
- Phytate (1)
- Pig farming (1)
- Place quality evaluation (1)
- Plant communities (1)
- Plant disease (1)
- Plant diversity (1)
- Plant protein (1)
- Policy (1)
- Poly(propylene) (1)
- Polymere (1)
- Post-intensive care syndrome (1)
- Postoperative complications (1)
- Postpartal period (1)
- Potato (1)
- Potato chips (1)
- Powder (1)
- Practice theory (1)
- Pre-morbid IQ (1)
- Pre-stress shot peening (1)
- Preferred temperature (1)
- Pregnancy (1)
- Pregnancy Loss (1)
- Preoperative anemia (1)
- Preventive home visits (1)
- Privacy (1)
- Procedural justice (1)
- Process Robustness Verification (1)
- Professional identity (1)
- Propofol (1)
- Protein aggregation (1)
- Protein production (1)
- Prävention (1)
- Psychosocial strains (1)
- Public catering (1)
- Public reporting (1)
- Pulsed electric field (1)
- Pulsed electric field (PEF) (1)
- QoS (1)
- Qualitative research (1)
- Quality evaluation (1)
- ROBO2 (1)
- ROC (1)
- Radiation (1)
- Radiologists (1)
- Raked material (1)
- Range of movement (1)
- Realistic traffic simulation (1)
- Reality gap (1)
- Rebound effect (1)
- Receiver Operating Characteristics (1)
- Recycled aggregate (1)
- Red List species (1)
- Red pepper (1)
- Red pepper paste (1)
- Red pepper powder (1)
- Reflective Learning (1)
- Reflexive Learning (1)
- Regional provenance (1)
- Rehabilitation (1)
- Rehabilitation, Person Tracking, Usability, Reliability (1)
- Reliability (1)
- Reliable Communication (1)
- Remote sensing (1)
- Repeated measurements (1)
- Repetitive negativethinking (1)
- Reproducible research (1)
- Requirements (1)
- Reshoring (1)
- Resident satisfaction (1)
- Resistance heating (1)
- Resistance training (1)
- Resource productivity (1)
- Restoration (1)
- Restoration ecology (1)
- Restoration success (1)
- Riparian vegetation, (1)
- Robina pseudoacacia (1)
- Rosa canina (1)
- Ruminal pH (1)
- SOC (1)
- SPAI (1)
- Safety Climate (1)
- Safety margin (1)
- Sampling design (1)
- Scandinavie (1)
- Scene Perception (1)
- School meals (1)
- Secondary protein structure (1)
- Sedation (1)
- Sedation index (1)
- Seed bank (1)
- Seed collection (1)
- Seed introduction (1)
- Seed traps (1)
- Self-assessment (1)
- Self-restoration (1)
- Semi-natural grasslands (1)
- Semi-solid alloys (1)
- Semi-solid materials Simulation Thixoforming Rheology (1)
- Sensitivity (1)
- Sepsis (1)
- Sequential sampling (1)
- Shear strain mobility (1)
- Shot peening intensity (1)
- Shoulder (1)
- Sieve analysis (1)
- Sign-out (1)
- Signal detection theory (1)
- Simulation (1)
- Simulation-based Optimization (1)
- Simultaneous confidence intervals (1)
- Simultaneous contrast tests (1)
- Smart Glasse (1)
- Smart farming (1)
- Social practices (1)
- Social work education (1)
- Software Design Pattern (1)
- Soil columns (1)
- Soil organic carbon (1)
- Soil pH variability (1)
- Soil seed bank (1)
- Soil translocation (1)
- Sowing (1)
- Soziale Kompetenz (1)
- Spatio-temporal modelling (1)
- Species assembly (1)
- Species introduction (1)
- Species turnover (1)
- Species-area-relationship (1)
- Spectral analysis (1)
- Spinach (Spinacia oleracea L.) (1)
- Spinacia oleracea L (1)
- Spinacia oleracea L. (1)
- Spontaneous succession (1)
- Stability (1)
- Standardized production (1)
- Standardized protocol (1)
- Starch digestibility (1)
- Storytelling (1)
- Strain (1)
- Stroke (1)
- Structural equation model (1)
- Subjective examination (1)
- Sufficiency (1)
- Suicide (1)
- Surfaces (1)
- Surgery (1)
- Surgical and invasaive (1)
- Survival (1)
- Survivors (1)
- Suspension (1)
- Sustainability assessment (1)
- Sustainability transition (1)
- Sustainable food (1)
- Sustainable food consumption (1)
- Sustainable product-service-systems (1)
- Synthetic data (1)
- System cost (1)
- T-Scores (1)
- TCA (1)
- TSN (1)
- Tannin (1)
- Target group analysis (1)
- Technology (1)
- Telecommunication networks (1)
- Temporomandibular (1)
- Temporomandibular disorder (1)
- Temporomandibular joint (1)
- Tendons/pathology (1)
- Test of dementia (1)
- Texture (1)
- Theoretical models (1)
- Theories of social practice (1)
- Thermal denaturation (1)
- Thermal properties (1)
- Thioflavin T (1)
- Thixotropy (1)
- Thoracolumbar fascia (1)
- Thresholds (1)
- Timed Up and Go Test (1)
- Tissue and Organ Procurement (1)
- Tomato peeling (1)
- Top dressing (1)
- Topography (1)
- Topsoil removal (1)
- Total revision hip surgery (1)
- Transdisciplinary Research (1)
- Transformational leadership (1)
- Transformative Resilience (1)
- Transplantation (1)
- Transport system (1)
- Trust (1)
- UML (1)
- Ulsed electric field (PEF) (1)
- Unit cell (1)
- Unmanned aerial vehicles (UAVs) (1)
- Unreliable Communication Environments (1)
- Upper cervical spine (1)
- Upscaling (1)
- Upstream area (1)
- Uptake (1)
- Urban garden (1)
- Urban management, (1)
- Urban vegetation (1)
- Urinary Incontinence (1)
- Usability (1)
- Use cases (1)
- Ustainability assessment (1)
- Variable liming strategies (1)
- Venous congestion (1)
- Verfestigungsstrahlen (1)
- Verschleiss (1)
- Vibration (1)
- Viscosity (1)
- Visualization (1)
- Vitamin C (1)
- Vulnerable groups (1)
- WNT/β-catenin pathway (1)
- Walking (1)
- Wasteland (1)
- Water binding capacity (1)
- Water consumption (1)
- Web (1)
- Web-Components (1)
- Web-Engineering (1)
- Webpages (1)
- Website (1)
- Website evaluation (1)
- Welding (1)
- Welfare (1)
- Willingness to purchase (1)
- Women's Heath (1)
- Xerophytic grassland (1)
- Yield (1)
- Yield stress (1)
- Zero plots (1)
- abdominal muscles (1)
- acetate (1)
- acute care (1)
- adventitious root formation (1)
- agricultural vehicular network (1)
- agriculture robotics (1)
- ambulante geburtshilfliche Versorgung (1)
- ammonia and ammonium toxicity (1)
- ammonium (1)
- antioxidant activity (1)
- antioxidant properties (1)
- apples (1)
- application time and mode (1)
- artificial intelligence (1)
- back care (1)
- balance sheet (1)
- barriers (1)
- best practices in Higher Education quality management (1)
- bile acids (1)
- bioeconomy (1)
- biotechnological processes (1)
- bio‐based chemicals (1)
- bootstrap (1)
- brand equity (1)
- brand valuation (1)
- butyrate (1)
- capital markets (1)
- cervical spine (1)
- cervicogenic headache (1)
- change management (1)
- chlorotic cotyledons (1)
- cholangiocarcinoma (1)
- chronic disease (1)
- chronic leg ulcer (1)
- chronic wound (1)
- classification (1)
- clinical information logistics (1)
- clinical tests (1)
- clinical workflows (1)
- cognition (1)
- color image processing (1)
- composite score (1)
- concept mobile field laboratory (1)
- concurrent relationships (1)
- construct (1)
- consumer behaviour (1)
- consumer communication (1)
- consumerism (1)
- consumption (1)
- continuity of care (1)
- corporate finance (1)
- couple (1)
- cross-cultural comparison (1)
- customer satisfaction (1)
- cut point (1)
- daily consumption (1)
- design (1)
- diet quality indices (1)
- dietary inflammatory index (1)
- dietary supplements (1)
- diffusion of innovation (1)
- digital competence (1)
- digital technologies (1)
- discrete choice (1)
- dry fasting (1)
- dysphonia (1)
- e-learning concepts (1)
- early prevention (1)
- economic disciplines (1)
- economic evaluation (1)
- educators (1)
- electronic health record system (1)
- embedded software engineering (1)
- emergent strategy (1)
- empty containers repositioning (1)
- energy bug (1)
- energy efficiency (1)
- energy efficient containers (1)
- energy-efficient operated living module (1)
- enterotypes (1)
- environmental impact (1)
- epidemiology (1)
- event management (1)
- factor analysis (1)
- family (1)
- fermentation (1)
- fertilization (1)
- field-lab (1)
- financial statements (1)
- food (1)
- food security (1)
- fruits (1)
- functional food (1)
- functional fresh food (1)
- functional type (1)
- functional voice disorders (1)
- future climate scenario (1)
- gPTP (1)
- grading system (1)
- greenhouse production (1)
- grief (1)
- gut microbiome (1)
- hamstrings (1)
- happiness (1)
- health claims (1)
- health information exchange (1)
- health information management (1)
- healthy aging (1)
- hepatoblastoma (1)
- hepatocellular carcinoma (1)
- high string musicians (1)
- high string players (1)
- higher education (1)
- histogram analysis (1)
- histology (1)
- home (1)
- hospital information systems (1)
- hybrid locomotion (1)
- hysteresis (1)
- iPOPY (1)
- idea assessment (1)
- idea definition (1)
- idea management (1)
- impairment test (1)
- information management (1)
- information visualisation (1)
- inter-therapist agreement (1)
- intermittent fasting (1)
- interprofessional cooperation (1)
- iodate (1)
- iodide (1)
- kinematics (1)
- lab on a chip (1)
- laser ablation (1)
- leafy vegetables (1)
- legumes (1)
- life consumption (1)
- life satisfaction (1)
- lipid (1)
- liquid amino acid fertilizer (1)
- long-term fasting (1)
- low back pain (1)
- management communication (1)
- marketing (1)
- matrurity level (1)
- mature compost (1)
- maturity model (1)
- measurement (1)
- measurement invariance (1)
- mechanosensivity (1)
- medical documentation (1)
- medical statistics (1)
- micronutrients (1)
- midwife (1)
- migraine (1)
- mineral micronutrients (1)
- miscarriage (1)
- mobile technologies (1)
- model building (1)
- model-driven development (1)
- model-in-the-loop (1)
- modelling (1)
- motion capture (1)
- motor learning (1)
- musicians health (1)
- musicians medicine (1)
- myofascial pain (1)
- neuro-orthopaedic activity-dependent plasticity (1)
- neurodynamic (1)
- neurodynamics (1)
- neuropathic pain (1)
- nitrate leaching (1)
- nitridation (1)
- nitrification (1)
- nitrite (1)
- nitrogen immobilization (1)
- nutrition and health claims (1)
- nutrition security (1)
- nutritional behavior (1)
- nutritional choices (1)
- nutritional footprint (1)
- organic (1)
- organic cultivation (1)
- organic fertilization (1)
- organizational communication (1)
- organizational cultures (1)
- organizational development (1)
- organizational innovation (1)
- orofacial pain (1)
- osteopathy (1)
- out-of-hospital obstetrical care (1)
- pain neuroscience education (1)
- palliative care (1)
- partner relationship constructions (1)
- peat (1)
- peat substitutes (1)
- peat substrate (1)
- personalized dietary recommendations (1)
- physical therapy (1)
- physiotherapeutical (1)
- phytotoxicity (1)
- posture (1)
- pot grown basil (Ocimum basilicum L.) (1)
- potted or-namental plants (1)
- precision farming (1)
- pressure pain threshold (1)
- preventive home visit (1)
- prioritization (1)
- professionalism (1)
- propionate (1)
- proprioceptive neuromuscular facilitation (1)
- qualitative research (1)
- quality assurance in Higher Education (1)
- quality of service (QoS) (1)
- quantitative research (1)
- rBPMN (1)
- ratings (1)
- receiver operating characteristics (1)
- regulation (1)
- remote experiments (1)
- resilience (1)
- resource efficiency (1)
- restoration (1)
- review (1)
- rheology (1)
- robotics (1)
- satisfaction of care (1)
- school meal (1)
- screening questionnaires (1)
- secondary education (1)
- second‐generation biorefineries (1)
- semantic interoperability (1)
- semi-solid materials (1)
- sensors in teaching (1)
- simulation (1)
- singers (1)
- singing voice (1)
- soccer (1)
- social anxiety (1)
- social media (1)
- social practices (1)
- soft tissue (1)
- soil nutrients analysis (1)
- soil sampling (1)
- soil2data (1)
- space robotics (1)
- spouses (1)
- stable isotopes (1)
- starch detection apples (1)
- stem cutting (1)
- students (1)
- substrate fertilization (1)
- substrate pH (1)
- sufficiency (1)
- supplements (1)
- supply chain management (1)
- suspensions (1)
- sustainability (1)
- sustainability assessment (1)
- sustainable nutrition (1)
- target groups (1)
- teaching process (1)
- terminology mapping (1)
- thixoforming (1)
- thixotropy (1)
- tillage date (1)
- tillage depth (1)
- topsoil removal (1)
- toxicity (1)
- tranversus abdominis (1)
- tryptophan (1)
- tsn (1)
- ultrasound (1)
- upcycling container house (1)
- upper body motion (1)
- validity – MRI (1)
- visual attention (1)
- visual merchandising (1)
- void formation (1)
- wall slippage (1)
- water content (1)
- water retention (1)
- wet fasting (1)
- wlan (1)
- wood fiber (1)
- wound care (1)
- wounding (1)
- Übersichtsarbeit (1)
Institute
- Fakultät WiSo (319)
- Fakultät AuL (240)
- Fakultät IuI (40)
- Institut für Management und Technik (26)
- Institut für Duale Studiengänge (20)
- Fakultät MKT (2)
- Institut für Kommunikationsmanagement (2)
- Institut für Musik (1)
- Präsidium Hochschule Osnabrück (1)
This chapter provides an overview of the gender aspects that are relevant to Talent Management, acknowledging gender as a social construction of the purportedly adequate behaviors and traits exhibited by males and females as the result of education and socialization processes. It discusses gendered perspectives and the needs of current and future key players, such as work–family balance and dual-career challenges, because they influence the decisions of talent to join, remain with, or leave organizations. The chapter focuses on well-qualified female professionals who are willing to invest in themselves and value their significant involvement in their work. By applying a gender lens, it addresses a gap in the Talent Management discussion and aims to contribute to the development of Talent Management on both the theoretical and practical level. If Talent Mangement systematically includes employees in mid- and late career and enables them to learn throughout their careers, it will expand its target groups.
Background and Objectives
Despite the long-standing consensus on the importance of tumor size, tumor number and carcinoembryonic antigen (CEA) levels as predictors of long-term outcomes among patients with colorectal liver metastases (CRLM), optimal prognostic cut-offs for these variables have not been established.
Methods
Patients who underwent curative-intent resection of CRLM and had available data on at least one of the three variables of interest above were selected from a multi-institutional dataset of patients with known KRAS mutational status. The resulting cohort was randomly split into training and testing datasets and recursive partitioning analysis was employed to determine optimal cut-offs. The concordance probability estimates (CPEs) for these optimal cut offs were calculated and compared to CPEs for the most widely used cut-offs in the surgical literature.
Results
A total of 1643 patients who met eligibility criteria were identified. Following recursive partitioning analysis in the training dataset, the following cut-offs were identified: 2.95 cm for tumor size, 1.5 for tumor number and 6.15 ng/ml for CEA levels. In the entire dataset, the calculated CPEs for the new tumor size (0.52), tumor number (0.56) and CEA (0.53) cut offs exceeded CPEs for other commonly employed cut-offs.
Conclusion
The current study was able to identify optimal cut-offs for the three most commonly employed prognostic factors in CRLM. While the per variable gains in discriminatory power are modest, these novel cut-offs may help produce appreciable increases in prognostic performance when combined in the context of future risk scores.
Acute post-operative delirium (POD) and long-term post-operative cognitive dysfunction (POCD) are frequent and associated with increased mortality, dependency on care giving and institutionalization rates. The POCD-related cost burden on the German long-term care insurance provides an indication for the savings potential from risk-adapted treatment schemes. Comprehensive estimates have not been assessed or published so far.
A model-based cost-analysis was designed to estimate POCD-related costs in the long-term care insurance. Comprehensive analysis of inpatient operations and procedures (OPS-codes) served as the base for case number calculations, which were then used as input to the actual cost model. POCD-incidence rates were obtained from the BioCog study. Various sensitivity analyses were performed to assess uncertainty of the model results.
Total POCD related annual costs in the German long-term care insurance account for approximately 1.6 billion EUR according to the base case of our analysis. Total annual costs for all POCD cases depend on surgery numbers, incidence rates, other assumptions, and uncertain input parameters.
The financial burden to the long-term care insurance is substantial, even in a conservative scenario of the cost model. Variability of results stems from uncertain assumptions, POCD-incidence rates and from uncertain patient numbers who are undergoing surgery and are therefore at risk to develop POCD.
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.
Background
There is no consensus on the instruments for diagnosis of post-intensive care syndrome (PICS). We present a proposal for a set of outcome measurement instruments of PICS in outpatient care.
Methods
We conducted a three-round, semi-structured consensus-seeking process with medical experts, followed each by exploratory feasibility investigations with intensive care unit survivors (n1 = 5; n2 = 5; n3 = 7). Fourteen participants from nine stakeholder groups participated in the first and second consensus meeting. In the third consensus meeting, a core group of six clinical researchers refined the final outcome measurement instrument set proposal.
Results
We suggest an outcome measurement instrument set used in a two-step process. First step: Screening with brief tests covering PICS domains of (1) mental health (Patient Health Questionnaire-4 (PHQ-4)), (2) cognition (MiniCog, Animal Naming), (3) physical function (Timed Up-and-Go (TUG), handgrip strength), and (4) health-related quality of life (HRQoL) (EQ-5D-5L). Single items measure subjective health before and after the intensive care unit stay. If patients report new or worsened health problems after intensive care unit discharge and show relevant impairment in at least one of the screening tests, a second extended assessment follows: (1) Mental health (Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder Scale-7 (GAD-7), Impact of Event Scale – revised (IES-R)); (2) cognition (Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Trail Making Test (TMT) A and B); (3) physical function (2-Minute Walk Test (2-MWT), handgrip strength, Short Physical Performance Battery (SPPB)); and (4) HRQoL (EQ-5D-5L, 12-Item WHO Disability Assessment Schedule (WHODAS 2.0)).
Conclusions
We propose an outcome measurement instrument set used in a two-step measurement of PICS, combining performance-based and patient-reported outcome measures. First-step screening is brief, free-of-charge, and easily applicable by health care professionals across different sectors. If indicated, specialized healthcare providers can perform the extended, second-step assessment. Usage of the first-step screening of our suggested outcome measurement instrument set in outpatient clinics with subsequent transfer to specialists is recommended for all intensive care unit survivors. This may increase awareness and reduce the burden of PICS.
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.
Background: In longitudinal studies, observations are made over time. Hence, the single observations at each time point are dependent, making them a repeated measurement. In this work, we explore a different, counterintuitive setting: At each developmental time point, a lethal observation is performed on the pregnant or nursing mother. Therefore, the single time points are independent. Furthermore, the observation in the offspring at each time point is correlated with each other because each litter consists of several (genetically linked) littermates. In addition, the observed time series is short from a statistical perspective as animal ethics prevent killing more mother mice than absolutely necessary, and murine development is short anyway. We solve these challenges by using multiple contrast tests and visualizing the change point by the use of confidence intervals.
Results: We used linear mixed models to model the variability of the mother. The estimates from the linear mixed model are then used in multiple contrast tests.There are a variety of contrasts and intuitively, we would use the Changepoint method. However, it does not deliver satisfying results. Interestingly, we found two other contrasts, both capable of answering different research questions in change point detection: i) Should a single point with change direction be found, or ii) Should the overall progression be determined? The Sequen contrast answers the first, the McDermott the second. Confidence intervals deliver effect estimates for the strength of the potential change point. Therefore, the scientist can define a biologically relevant limit of change depending on the research question.
Conclusion: We present a solution with effect estimates for short independent time series with observations nested at a given time point. Multiple contrast tests produce confidence intervals, which allow determining the position of change points or to visualize the expression course over time. We suggest to use McDermott’s method to determine if there is an overall significant change within the time frame, while Sequen is better in determining specific change points. In addition, we offer a short formula for the estimation of the maximal length of the time series.
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.
The effect of pulsed electric field (PEF) and ultrasound (US) on the frying behavior of potato chips was investigated. For this purpose, a special fryer with a window was designed to enable the investigation of water evaporation by the characterization of bubble formation during frying. The number of water vapor bubbles and the bubble volume distribution were analyzed in order to gain an insight into heat and mass transfer affected by PEF and US treatment. Quality parameters of the potato chips such as moisture, fat and acrylamide content were measured. Overall, the results of this study show for the first time impacting effects on the frying process that can be achieved by combining PEF as a volumetric cell disintegration technology and ultrasound as a mean to affect interface phenomena. The obtained results can be used to further optimize frying processes used for the production of chips and other products.
While the Food and Biotechnology industries often use unit operations that have been known for some time, sometimes these processes are not efficient or sustainable. The need to develop more efficient processing lines to obtain higher quality products is of utmost importance. Over the last years, pulsed electric fields (PEF) processing has attracted the interest of numerous researchers and companies due to its ability to reduce processing time, preserve thermolabile compounds, which are responsible for the aroma, nutritional and bioactive properties of food products.
Therefore, in this article, some of the most important studies regarding the application of PEF technology in food and biotechnology processing is discussed.
Transition road maps – an investigative approach to map the daily life consumption of individuals
(2014)
The present paper aims at investigating an innovative approach to guide consumers’ daily life choices in Germany towards a more sustainable way of acting. This should be achieved by introducing a new concept: transition road maps. Transition road maps bear the capability of illustrating courses of consumption behaviour without being prohibitive. These schemes foster self-determined behaviour and encourage the consumer to rethink and restructure his or her habits of consumption, with a focus on sustainability. The innovative thought is, not to simply stick to the usual triad of spheres of activity, consisting of nutrition, mobility and housing. Instead further aspects of consumers’ daily routines are considered, such as leisure activities, time usage or financial activities. Moreover the transition road maps are based on a new ideology of combining and connecting the qualitative algorithm of time use, financial spending and resource impact of social practices in the area of private consumption. In the long-term, the transition road maps could e.g. be used in sustainability communication or consumer counselling.
Background:
Etomidate is typically used as an induction agent in cardiac surgery because it has little impact on hemodynamics. It is a known suppressor of adrenocortical function and may increase the risk for post-operative infections, sepsis, and mortality. The aim of this study was to evaluate whether etomidate increases the risk of postoperative sepsis (primary outcome) and infections (secondary outcome) compared to propofol.
Methods:
This was a retrospective before–after trial (IRB EA1/143/20) performed at a tertiary medical center in Berlin, Germany, between 10/2012 and 01/2015. Patients undergoing cardiac surgery were investigated within two observation intervals, during which etomidate and propofol were the sole induction agents.
Results:
One-thousand, four-hundred, and sixty-two patients, and 622 matched pairs, after caliper propensity-score matching, were included in the final analysis. Sepsis rates did not differ in the matched cohort (etomidate: 11.5% vs. propofol: 8.2%, p = 0.052). Patients in the etomidate interval were more likely to develop hospital-acquired pneumonia (etomidate: 18.6% vs. propofol: 14.0%, p = 0.031).
Conclusion:
Our study showed that a single-dose of etomidate is not statistically associated with higher postoperative sepsis rates after cardiac surgery, but is associated with a higher incidence of hospital-acquired pneumonia. However, there is a notable trend towards a higher sepsis rate.
Background:
Cardiac surgery patients represent a high-risk cohort in intensive care units (ICUs). Central venous pressure (CVP) measurement seems to remain an integral part in hemodynamic monitoring, especially in cardio-surgical ICUs. However, its value as a prognostic marker for organ failure is still unclear. Therefore, we analyzed postoperative CVP values after adult cardiac surgery in a large cohort with regard to its prognostic value for morbidity and mortality.
Methods:
All adult patients admitted to our ICUs between 2006 and 2019 after cardiac surgery were eligible for inclusion in the study (n = 11,198). We calculated the median initial CVP (miCVP) after admission to the ICU, which returned valid values for 9802 patients. An ROC curve analysis for optimal cut-off miCVP to predict ICU mortality was conducted with consecutive patient allocation into a (a) low miCVP (LCVP) group (≤11 mmHg) and (b) high miCVP (HCVP) group (>11 mmHg). We analyzed the impact of high miCVP on morbidity and mortality by propensity score matching (PSM) and logistic regression.
Results:
ICU mortality was increased in HCVP patients. In addition, patients in the HCVP group required longer mechanical ventilation, had a higher incidence of acute kidney injury, were more frequently treated with renal replacement therapy, and showed a higher risk for postoperative liver dysfunction, parametrized by a postoperative rise of ≥ 10 in MELD Score. Multiple regression analysis confirmed HCVP has an effect on postoperative ICU-mortality and intrahospital mortality, which seems to be independent.
Conclusions:
A high initial CVP in the early postoperative ICU course after cardiac surgery is associated with worse patient outcome. Whether or not CVP, as a readily and constantly available hemodynamic parameter, should promote clinical efforts regarding diagnostics and/or treatment, warrants further investigations.
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.
The benzodiazepine, midazolam, is one of the most frequently used sedatives in intensive care medicine, but it has an unfavorable pharmacokinetic profile when continuously applied. As a consequence, patients are frequently prolonged and more deeply sedated than intended. Due to its distinct pharmacological features, including a cytochrome P450-independent metabolization, intravenous lormetazepam might be clinically advantageous compared to midazolam. In this retrospective cohort study, we compared patients who received either intravenous lormetazepam or midazolam with respect to their survival and sedation characteristics. The cohort included 3314 mechanically ventilated, critically ill patients that received one of the two drugs in a tertiary medical center in Germany between 2006 and 2018. A Cox proportional hazards model with mortality as outcome and APACHE II, age, gender, and admission mode as covariates revealed a hazard ratio of 1.75 [95% CI 1.46–2.09; p < 0.001] for in-hospital mortality associated with the use of midazolam. After additionally adjusting for sedation intensity, the HR became 1.04 [95% CI 0.83–1.31; p = 0.97]. Thus, we concluded that excessive sedation occurs more frequently in critically ill patients treated with midazolam than in patients treated with lormetazepam. These findings require further investigation in prospective trials to assess if lormetazepam, due to its ability to maintain light sedation, might be favorable over other benzodiazepines for sedation in the ICU.
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
In DNA methylation analyses like epigenome-wide association studies, effects in differentially methylated CpG sites are assessed. Two kinds of outcomes can be used for statistical analysis: Beta-values and M-values. M-values follow a normal distribution and help to detect differentially methylated CpG sites. As biological effect measures, differences of M-values are more or less meaningless. Beta-values are of more interest since they can be interpreted directly as differences in percentage of DNA methylation at a given CpG site, but they have poor statistical properties. Different frameworks are proposed for reporting estimands in DNA methylation analysis, relying on Beta-values, M-values, or both.
Results
We present and discuss four possible approaches of achieving estimands in DNA methylation analysis. In addition, we present the usage of M-values or Beta-values in the context of bioinformatical pipelines, which often demand a predefined outcome. We show the dependencies between the differences in M-values to differences in Beta-values in two data simulations: a analysis with and without confounder effect. Without present confounder effects, M-values can be used for the statistical analysis and Beta-values statistics for the reporting. If confounder effects exist, we demonstrate the deviations and correct the effects by the intercept method. Finally, we demonstrate the theoretical problem on two large human genome-wide DNA methylation datasets to verify the results.
Conclusions
The usage of M-values in the analysis of DNA methylation data will produce effect estimates, which cannot be biologically interpreted. The parallel usage of Beta-value statistics ignores possible confounder effects and can therefore not be recommended. Hence, if the differences in Beta-values are the focus of the study, the intercept method is recommendable. Hyper- or hypomethylated CpG sites must then be carefully evaluated. If an exploratory analysis of possible CpG sites is the aim of the study, M-values can be used for inference.
BACKGROUND:
Intraoperative electroencephalography (EEG) signatures related to the development of postoperative delirium (POD) in older patients are frequently studied. However, a broad analysis of the EEG dynamics including preoperative, postinduction, intraoperative and postoperative scenarios and its correlation to POD development is still lacking. We explored the relationship between perioperative EEG spectra-derived parameters and POD development, aiming to ascertain the diagnostic utility of these parameters to detect patients developing POD.
METHODS:
Patients aged ≥65 years undergoing elective surgeries that were expected to last more than 60 minutes were included in this prospective, observational single center study (Biomarker Development for Postoperative Cognitive Impairment [BioCog] study). Frontal EEGs were recorded, starting before induction of anesthesia and lasting until recovery of consciousness. EEG data were analyzed based on raw EEG files and downloaded excel data files. We performed multitaper spectral analyses of relevant EEG epochs and further used multitaper spectral estimate to calculate a corresponding spectral parameter. POD assessments were performed twice daily up to the seventh postoperative day. Our primary aim was to analyze the relation between the perioperative spectral edge frequency (SEF) and the development of POD.
RESULTS:
Of the 237 included patients, 41 (17%) patients developed POD. The preoperative EEG in POD patients was associated with lower values in both SEF (POD 13.1 ± 4.6 Hz versus no postoperative delirium [NoPOD] 17.4 ± 6.9 Hz; P = .002) and corresponding γ-band power (POD −24.33 ± 2.8 dB versus NoPOD −17.9 ± 4.81 dB), as well as reduced postinduction absolute α-band power (POD −7.37 ± 4.52 dB versus NoPOD −5 ± 5.03 dB). The ratio of SEF from the preoperative to postinduction state (SEF ratio) was ~1 in POD patients, whereas NoPOD patients showed a SEF ratio >1, thus indicating a slowing of EEG with loss of unconscious. Preoperative SEF, preoperative γ-band power, and SEF ratio were independently associated with POD (P = .025; odds ratio [OR] = 0.892, 95% confidence interval [CI], 0.808–0.986; P = .029; OR = 0.568, 95% CI, 0.342–0.944; and P = .009; OR = 0.108, 95% CI, 0.021–0.568, respectively).
CONCLUSIONS:
Lower preoperative SEF, absence of slowing in EEG while transitioning from preoperative state to unconscious state, and lower EEG power in relevant frequency bands in both these states are related to POD development. These findings may suggest an underlying pathophysiology and might be used as EEG-based marker for early identification of patients at risk to develop POD.
Background
Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) are frequent and serious complications after surgery. We aim to investigate the association between genetic variants in cholinergic candidate genes according to the Kyoto encyclopedia of genes and genomes - pathway: cholinergic neurotransmission with the development of POD or POCD in elderly patients.
Methods
This analysis 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 ≤ 23 points were excluded. POD was assessed up to seven days after surgery using the Nursing Delirium Screening Scale, Confusion Assessment Method and a patient chart review. POCD was assessed three months after surgery with a neuropsychological test battery. Genotyping was performed on the Illumina Infinium Global Screening Array. Associations with POD and POCD were analyzed using logistic regression analysis, adjusted for age, comorbidities and duration of anesthesia (for POCD analysis additionally for education). Odds ratios (OR) refer to minor allele counts (0, 1, 2).
Results
745 patients could be included in the POD analysis, and 452 in the POCD analysis. The rate of POD within this group was 20.8% (155 patients), and the rate of POCD was 10.2% (46 patients). In a candidate gene approach three genetic variants of the cholinergic genes CHRM2 and CHRM4 were associated with POD (OR [95% confidence interval], rs8191992: 0.61[0.46; 0.80]; rs8191992: 1.60[1.22; 2.09]; rs2067482: 1.64[1.10; 2.44]). No associations were found for POCD.
Conclusions
We found an association between genetic variants of CHRM2 and CHRM4 and POD. Further studies are needed to investigate whether disturbances in acetylcholine release and synaptic plasticity are involved in the development of POD.
Background
In mucosal barrier interfaces, flexible responses of gene expression to long-term environmental changes allow adaptation and fine-tuning for the balance of host defense and uncontrolled not-resolving inflammation. Epigenetic modifications of the chromatin confer plasticity to the genetic information and give insight into how tissues use the genetic information to adapt to environmental factors. The oral mucosa is particularly exposed to environmental stressors such as a variable microbiota. Likewise, persistent oral inflammation is the most important intrinsic risk factor for the oral inflammatory disease periodontitis and has strong potential to alter DNA-methylation patterns. The aim of the current study was to identify epigenetic changes of the oral masticatory mucosa in response to long-term inflammation that resulted in periodontitis.
Methods and results
Genome-wide CpG methylation of both inflamed and clinically uninflamed solid gingival tissue biopsies of 60 periodontitis cases was analyzed using the Infinium MethylationEPIC BeadChip. We validated and performed cell-type deconvolution for infiltrated immune cells using the EpiDish algorithm. Effect sizes of DMPs in gingival epithelial and fibroblast cells were estimated and adjusted for confounding factors using our recently developed “intercept-method”. In the current EWAS, we identified various genes that showed significantly different methylation between periodontitis-inflamed and uninflamed oral mucosa in periodontitis patients. The strongest differences were observed for genes with roles in wound healing (ROBO2, PTP4A3), cell adhesion (LPXN) and innate immune response (CCL26, DNAJC1, BPI). Enrichment analyses implied a role of epigenetic changes for vesicle trafficking gene sets.
Conclusions
Our results imply specific adaptations of the oral mucosa to a persistent inflammatory environment that involve wound repair, barrier integrity, and innate immune defense.