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Chitin is an abundant waste product from shrimp and mushroom industries and as such, an appropriate secondary feedstock for biotechnological processes. However, chitin is a crystalline substrate embedded in complex biological matrices, and, therefore, difficult to utilize, requiring an equally complex chitinolytic machinery. Following a bottom-up approach, we here describe the step-wise development of a mutualistic, non-competitive consortium in which a lysine-auxotrophic Escherichia coli substrate converter cleaves the chitin monomer N-acetylglucosamine (GlcNAc) into glucosamine (GlcN) and acetate, but uses only acetate while leaving GlcN for growth of the lysine-secreting Corynebacterium glutamicum producer strain. We first engineered the substrate converter strain for growth on acetate but not GlcN, and the producer strain for growth on GlcN but not acetate. Growth of the two strains in co-culture in the presence of a mixture of GlcN and acetate was stabilized through lysine cross-feeding. Addition of recombinant chitinase to cleave chitin into GlcNAc2, chitin deacetylase to convert GlcNAc2 into GlcN2 and acetate, and glucosaminidase to cleave GlcN2 into GlcN supported growth of the two strains in co-culture in the presence of colloidal chitin as sole carbon source. Substrate converter strains secreting a chitinase or a β-1,4-glucosaminidase degraded chitin to GlcNAc2 or GlcN2 to GlcN, respectively, but required glucose for growth. In contrast, by cleaving GlcNAc into GlcN and acetate, a chitin deacetylase-expressing substrate converter enabled growth of the producer strain in co-culture with GlcNAc as sole carbon source, providing proof-of-principle for a fully integrated co-culture for the biotechnological utilization of chitin.
A brief questionnaire for measuring alarm fatigue in nurses and physicians in intensive care units
(2023)
When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop “alarm fatigue” (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the “alarm stress scale” and the “alarm coping scale”). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.
Background
A peripheral venous catheter (PVC) is the most widely used device for obtaining vascular access, allowing the administration of fluids and medication. Up to 25% of adult patients, and 50% of pediatric patients experience a first-attempt cannulation failure. In addition to patient and clinician characteristics, device features might affect the handling and success rates. The objective of the study was to compare the first-attempt cannulation success rate between PVCs with wings and a port access (Vasofix® Safety, B. Braun, abbreviated hereon in as VS) with those without (Introcan® Safety, B. Braun, abbreviated hereon in as IS) in an anesthesiological cohort.
Methods
An open label, multi-center, randomized trial was performed. First-attempt cannulation success rates were examined, along with relevant patient, clinician, and device characteristics with univariate and multivariate analyses. Information on handling and adherence to use instructions was gathered, and available catheters were assessed for damage.
Results
Two thousand three hundred four patients were included in the intention to treat analysis. First-attempt success rate was significantly higher with winged and ported catheters (VS) than with the non-winged, non-ported design (IS) (87.5% with VS vs. 78.2% with IS; PChi < .001). Operators rated the handling of VS as superior (rating of “good” or “very good: 86.1% VS vs. 20.8% IS, PChi < .001). Reinsertion of the needle into the catheter after partial withdrawal—prior or during the catheterization attempt—was associated with an increased risk of cannulation failure (7.909, CI 5.989–10.443, P < .001 and 23.023, CI 10.372–51.105, P < .001, respectively) and a twofold risk of catheter damage (OR 1.999, CI 1.347–2.967, P = .001).
Conclusions
First-attempt cannulation success of peripheral, ported, winged catheters was higher compared to non-ported, non-winged devices. The handling of the winged and ported design was better rated by the clinicians. Needle reinsertions are related to an increase in rates of catheter damage and cannulation failure.
A comparison study on modeling of clustered and overdispersed count data for multiple comparisons
(2021)
Data collected in various scientific fields are count data. One way to analyze such data is to compare the individual levels of the factor treatment using multiple comparisons. However, the measured individuals are often clustered – e.g. according to litter or rearing. This must be considered when estimating the parameters by a repeated measurement model. In addition, ignoring the overdispersion to which count data is prone leads to an increase of the type one error rate. We carry out simulation studies using several different data settings and compare different multiple contrast tests with parameter estimates from generalized estimation equations and generalized linear mixed models in order to observe coverage and rejection probabilities. We generate overdispersed, clustered count data in small samples as can be observed in many biological settings. We have found that the generalized estimation equations outperform generalized linear mixed models if the variance-sandwich estimator is correctly specified. Furthermore, generalized linear mixed models show problems with the convergence rate under certain data settings, but there are model implementations with lower implications exists. Finally, we use an example of genetic data to demonstrate the application of the multiple contrast test and the problems of ignoring strong overdispersion.
Objectives
Cervical movement impairment has been identified as a core component of cervicogenic headache evaluation. However, normal range of motion values in children has been investigated rarely and no study has reported such values for the flexion–rotation test (FRT). The purpose of this study was to identify normal values and side-to-side variation for cervical spine range of motion (ROM) and the FRT, in asymptomatic children aged 6–12 years. Another important purpose was to identify the presence of pain during the FRT.
Methods
Thirty-four asymptomatic children without history of neck pain or headache (26 females and 8 males, mean age 125.38 months [SD 13.14]) were evaluated. Cervical spine cardinal plane ROM and the FRT were evaluated by a single examiner using a cervical ROM device.
Results
Values for cardinal plane ROM measures are presented. No significant gender difference was found for any ROM measure. Mean difference in ROM for rotation, side flexion, and the FRT were less than one degree. However, intra-individual variation was greater, with lower bound scores of 9.32° for rotation, 5.30° for side flexion, and 10.89° for the FRT. Multiple linear regression analysis indicates that movement in the cardinal planes only explains 19% of the variance in the FRT. Pain scores reported following the FRT were less than 2/10.
Discussion
Children have consistently greater cervical spine ROM than adults. In children, side-to-side variation in rotation and side flexion ROM and range recorded during the FRT indicates that the clinician should be cautious when using range in one direction to determine impairment in another. Range recorded during the FRT is independent of cardinal movement variables, which further adds to the importance of the FRT, as a test that mainly evaluates range of movement of the upper cervical spine.
Currently, the treatment of musicians is an interprofessional approach. Playing-related health complaints may impact the performance of a musician. In Germany, a medical consulting hour for musicians exists, but those for athletes in sports medicine are not so common. The diagnosing and treatment procedure within the physiotherapy consultation for musicians follows a specific concept-b and requires knowledge of instruments and musician-specific complaints. Based on the consulting hour in a clinic in Osnabrueck, 614 case reports were part of this sample, of which 558 data sets were complete. The focus of the analysis is the instrument and the primary complaint. Also, the type of therapy is characterized, and the amount is calculated. Primary complaints of musicians, in general, are found most frequently in the spine and upper extremity. Musician complaints are different between instruments. Instrumentalists have a significantly higher chance to suffer from a primary complaint in the area of the upper extremity. Furthermore, the groups without an instrument (e.g., singing or dancing) are developing complaints in the anatomical area which they primarily use. Therefore, these types of therapy were used: physiotherapy, manual therapy, and osteopathy with an average of 5.9 treatment units. This study underpinned the importance of musician-specific physiotherapy as a profession to treat musicians. Also, an interdisciplinary approach is necessary to treat all aspects of complaints.
The objective of this review is a global assessment of the economics of second‐generation biorefineries, with a focus on the use of food waste and agricultural residues for chemical production by applying biotechnological processes. Analyses are conducted on feedstock and product distribution, applied economic models, and profitability figures for the period 2013–2018. In a study of 163 articles on different biorefinery systems, the production of chemicals is identified as the second major product class, after bioenergy. Bagasse and straw are frequently analyzed second‐generation feedstocks. Based on the evaluation of 22 articles, second‐generation biorefineries producing chemicals by applying biotechnological processes proves to be economically feasible. On average, both the internal rate of return (IRR) and the return on investment (ROI) are 20% and the payback period (PP) is 6 years. The cost share of feedstock in biorefineries is between 0–50%. The price of the end product and the fermentation yields have the most impact on profitability. The processing of food waste that has industrial and municipal origins appears more economical than the processing of agricultural residues. Scientists, policy makers and entrepreneurs with an appropriate risk tolerance are advised to pay particular attention to municipal food waste and the potential economic production of carboxylic acids. For various economic issues related to biorefineries, dynamic‐deterministic models are recommended, which can be extended by a stochastic model. This review provides an initial overview of the economic feasibility of second‐generation biorefineries. Further techno‐economic analyses are required to produce statistically significant statements on key profitability figures. © 2020 The Authors. Biofuels, Bioproducts, and Biorefining published by Society of Chemical Industry and John Wiley & Sons, Ltd.
Business-driven development favors the construction of process models
at different abstraction levels and by different people. As a consequence, there is a demand for consolidating different versions of process models by merging them. In this paper, we study a basic scenario, derive requirements and present a prototype for detecting and resolving changes between process models.
Transport operations are climate sensitive. Despite this, scientific literature and corporate practice present little evidence on how corporate actors use climate adaptation measures to prepare their transport operations for climate change. This paper explores two research questions: How can the acceptance among corporate decision-makers towards climate adaptation measures for their transport operations be explained? Based on the Theory of Planned Behavior and the Diffusion of Innovations we develop a theoretical framework for dealing with climate adaptation measures for transport operations (step 1). We support the use of this framework through a literature review (1989–2020) (step 2) and semi-structured interviews with German companies that have implemented best practice measures (step 3). The results show that the handling of climate adaptation measures for transport operations can be described in three acceptance phases: acceptance of attitude, action, and use. We conclude that these phases determine the approaches required for promoting climate change adaptation.
Objective:
To compare the short- and long-term effects of a structural-oriented (convential) with an activity-oriented physiotherapeutic treatment in patients with frozen shoulder.
Design:
Double-blinded, randomized, experimental study.
Setting:
Outpatient clinic.
Subjects:
We included patients diagnosed with a limited range of motion and pain in the shoulder region, who had received a prescription for physiotherapy treatment, without additional symptoms of dizziness, a case history of headaches, pain and/or limited range of motion in the cervical spine and/or temporomandibular joint.
Interventions:
The study group received treatment during the performance of activities. The comparison group was treated with manual therapy and proprioceptive neuromuscular facilitation (conventional therapy). Both groups received 10 days of therapy, 30 minutes each day.
Main measures:
Range of motion, muscle function tests, McGill pain questionnaire and modified Upper Extremity Motor Activity Log were measured at baseline, after two weeks of intervention and after a three-month follow-up period without therapy.
Results:
A total of 66 patients were randomized into two groups: The activity-oriented group (n = 33, mean = 44 years, SD = 16 years) including 20 male (61%) and the structural-oriented group (n = 33, mean = 47 years, SD = 17 years) including 21 male (64%). The activity-oriented group revealed significantly greater improvements in the performance of daily life activities and functional and structural tests compared with the group treated with conventional therapy after 10 days of therapy and at the three-month follow-up (p < 0.05).
Conclusions:
Therapy based on performing activities seems to be more effective for pain reduction and the ability to perform daily life activities than conventional treatment methods.