Article
Refine
Year of publication
Document Type
- Article (155) (remove)
Language
- English (155) (remove)
Has Fulltext
- yes (155) (remove)
Keywords
- Lemnaceae (4)
- Energy (3)
- Nutritional footprint (3)
- Out-of-home catering (3)
- Sustainability (3)
- Sustainable consumption (3)
- Sustainable nutrition (3)
- Transition (3)
- Water lentils (3)
- Aesthetics (2)
Institute
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.
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.
During gestation, the most drastic change in oxygen supply occurs with the onset of ventilation after birth. As the too early exposure of premature infants to high arterial oxygen pressure leads to characteristic diseases, we studied the adaptation of the oxygen sensing system and its targets, the hypoxia-inducible factor- (HIF-) regulated genes (HRGs) in the developing lung. We draw a detailed picture of the oxygen sensing system by integrating information from qPCR, immunoblotting, in situ hybridization, and single-cell RNA sequencing data in ex vivo and in vivo models. HIF1α protein was completely destabilized with the onset of pulmonary ventilation, but did not coincide with expression changes in bona fide HRGs. We observed a modified composition of the HIF-PHD system from intrauterine to neonatal phases: Phd3 was significantly decreased, while Hif2a showed a strong increase and the Hif3a isoform Ipas exclusively peaked at P0. Colocalization studies point to the Hif1a-Phd1 axis as the main regulator of the HIF-PHD system in mouse lung development, complemented by the Hif3a-Phd3 axis during gestation. Hif3a isoform expression showed a stepwise adaptation during the periods of saccular and alveolar differentiation. With a strong hypoxic stimulus, lung ex vivo organ cultures displayed a functioning HIF system at every developmental stage. Approaches with systemic hypoxia or roxadustat treatment revealed only a limited in vivo response of HRGs. Understanding the interplay of the oxygen sensing system components during the transition from saccular to alveolar phases of lung development might help to counteract prematurity-associated diseases like bronchopulmonary dysplasia.
The increased consumption of reduced-fat or non-fat products leads to a reduced intake of fat-soluble bioactive substances, such as fat-soluble vitamins. Due to their natural role as transport systems for hydrophobic substances, casein micelles (CM) might depict a viable system. The structure of CM is characterized by a lipophilic core stabilized by an electric double layer-like structure. Modification allows accessibility of the core and, therefore, the inclusion of fat-soluble bioactive substances. Well-known modifications are pH reduction and use of rennet enzyme. A completely new procedure to modify CM structure is offered by pulsed electrical fields (PEF). The principle behind PEF is called electroporation and affects the electric double layer of CM so that it is interrupted. In this way, lipophilic substances can be incorporated into CM. In this work, we evaluated integration of β-carotene into native CM by an industry-compatible process to overcome disadvantages associated with the use of Na-caseinate and avoid great technical effort, e.g., due to treatment with high hydrostatic pressure. Our research has shown that PEF can be used for disintegration of CM and that significant amounts of β-carotene can be incorporated in CM. Furthermore, after disintegration using PEF, a combination of another PEF and thermal treatment was applied to restructure CM and trap significant amounts of β-carotene, permanently, ending up with an encapsulation efficiency of 78%.
Introduction: Patients undergoing revision total hip surgery (RTHS) have a high prevalence of mild and moderate preoperative anemia, associated with adverse outcomes. The aim of this study was to investigate the association of perioperative allogeneic blood transfusions (ABT) and postoperative complications in preoperatively mild compared to moderate anemic patients undergoing RTHS who did not receive a diagnostic anemia workup and treatment before surgery. Methods: We included 1,765 patients between 2007 and 2019 at a university hospital. Patients were categorized according to their severity of anemia using the WHO criteria of mild, moderate, and severe anemia in the first Hb level of the case. Patients were grouped as having received no ABT, 1–2 units of ABT, or more than 2 units of ABT. Need for intraoperative ABT was assessed in accordance with institutional standards. Primary endpoint was the compound incidence of postoperative complications. Secondary outcomes included major/minor complications and length of hospital and ICU stay. Results: Of the 1,765 patients, 31.0% were anemic of any cause before surgery. Transfusion rates were 81% in anemic patients and 41.2% in nonanemic patients. The adjusted risks for compound postoperative complication were significantly higher in patients with moderate anemia (OR 4.88, 95% CI: 1.54–13.15, p = 0.003) but not for patients with mild anemia (OR 1.93, 95% CI: 0.85–3.94, p < 0.090). Perioperative ABT was associated with significantly higher risks for complications in nonanemic patients and showed an increased risk for complications in all anemic patients. In RTHS, perioperative ABT as a treatment for moderate preoperative anemia of any cause was associated with a negative compound effect on postoperative complications, compared to anemia or ABT alone. Discussion: ABT is associated with adverse outcomes of patients with moderate preoperative anemia before RTHS. For this reason, medical treatment of moderate preoperative anemia may be considered.
The relevance of cross-industry innovation has increased in recent decades with a growing number of inter-industry fields emerging on the borderline between formerly distinct industries. The aim of this paper is to analyse industry convergence in four probiotics innovation value chains based on the following indicators: cross-industry relationships along the innovation value chain as well as knowledge, technological, regulatory and competence convergence. In so doing, the study delivers a framework of indicators for scrutinising industry convergence processes. In order to identify industry convergence, we analyse companies in the converging area of foods and drugs based on products containing the four bacteria strains: Lactobacillus caseii DN 114001, Bifidobacterium lactis Bb12, Lactobacillus acidophilus LA5 and Lactobacillus rhamnosus. Hence, the commercial availability of the strains on the market serves as a selection criterion. Altogether 12 companies stemming from four industrial backgrounds, food and agriculture (5), pharmaceutics (5), chemistry (1) and personal care (1), as well as one research organisation are identified. Cross-industry relationships occur along the innovation value chains of the four strains. Clear signs of knowledge and technological convergence are found as companies are not only publishing and patenting in the usual area of their own industrial field but also in the area of other industrial fields. Companies with different industrial backgrounds show activities in obtaining health claims indicating regulatory convergence. Companies' competence bases seem to converge as companies with different industrial backgrounds are involved in acquisitions, licencing agreements and strategic alliances (competence convergence). We contribute to the existing body of literature by assessing industry convergence from an innovation value chain perspective with a set of indicators reflecting the intensity of industry convergence. This framework of indicators stemming from literature has not yet been used in a combined comprehensive analysis. Furthermore, we tried to show the characteristics of strategic types driving industry convergence in probiotics.
Background:
Contact tracing apps are potentially useful tools for supporting national COVID-19 containment strategies. Various national apps with different technical design features have been commissioned and issued by governments worldwide.
Objective:
Our goal was to develop and propose an item set that was suitable for describing and monitoring nationally issued COVID-19 contact tracing apps. This item set could provide a framework for describing the key technical features of such apps and monitoring their use based on widely available information.
Methods:
We used an open-source intelligence approach (OSINT) to access a multitude of publicly available sources and collect data and information regarding the development and use of contact tracing apps in different countries over several months (from June 2020 to January 2021). The collected documents were then iteratively analyzed via content analysis methods. During this process, an initial set of subject areas were refined into categories for evaluation (ie, coherent topics), which were then examined for individual features. These features were paraphrased as items in the form of questions and applied to information materials from a sample of countries (ie, Brazil, China, Finland, France, Germany, Italy, Singapore, South Korea, Spain, and the United Kingdom [England and Wales]). This sample was purposefully selected; our intention was to include the apps of different countries from around the world and to propose a valid item set that can be relatively easily applied by using an OSINT approach.
Results:
Our OSINT approach and subsequent analysis of the collected documents resulted in the definition of the following five main categories and associated subcategories: (1) background information (open-source code, public information, and collaborators); (2) purpose and workflow (secondary data use and warning process design); (3) technical information (protocol, tracing technology, exposure notification system, and interoperability); (4) privacy protection (the entity of trust and anonymity); and (5) availability and use (release date and the number of downloads). Based on this structure, a set of items that constituted the evaluation framework were specified. The application of these items to the 10 selected countries revealed differences, especially with regard to the centralization of the entity of trust and the overall transparency of the apps’ technical makeup.
Conclusions:
We provide a set of criteria for monitoring and evaluating COVID-19 tracing apps that can be easily applied to publicly issued information. The application of these criteria might help governments to identify design features that promote the successful, widespread adoption of COVID-19 tracing apps among target populations and across national boundaries.
Abstract
Background
The clinical presentation of neck-arm pain is heterogeneous with varying underlying pain types (nociceptive/neuropathic/mixed) and pain mechanisms (peripheral/central sensitization). A mechanism-based clinical framework for spinally referred pain has been proposed, which classifies into (1) somatic pain, (2) neural mechanosensitivity, (3) radicular pain, (4) radiculopathy and mixed pain presentations. This study aims to (i) investigate the application of the clinical framework in patients with neck-arm pain, (ii) determine their somatosensory, clinical and psychosocial profile and (iii) observe their clinical course over time.
Method
We describe a study protocol. Patients with unilateral neck-arm pain (n = 180) will undergo a clinical examination, after which they will be classified into subgroups according to the proposed clinical framework. Standardized quantitative sensory testing (QST) measurements will be taken in their main pain area and contralateral side. Participants will have to complete questionnaires to assess function (Neck Disability Index), psychosocial factors (Tampa Scale of Kinesiophobia, Pain Catastrophizing Scale, Depression, anxiety and stress scale), neuropathic pain (Douleur Neuropathique 4 Questions, PainDETECT Questionnaire) and central sensitization features (Central Sensitization Inventory). Follow-ups at three, six and 12 months include the baseline questionnaires. The differences of QST data and questionnaire outcomes between and within groups will be analyzed using (M)AN(C)OVA and/or regression models. Repeated measurement analysis of variance or a linear mixed model will be used to calculate the differences between three, six, and 12 months outcomes. Multiple regression models will be used to analyze potential predictors for the clinical course.
Conclusion
The rationale for this study is to assess the usability and utility of the proposed clinical framework as well as to identify possible differing somatosensory and psychosocial phenotypes between the subgroups. This could increase our knowledge of the underlying pain mechanisms. The longitudinal analysis may help to assess possible predictors for pain persistency.
Applications of pulsed electric fields for processing potatoes: Examples and equipment design
(2022)
In the last two decades, pulsed electric fields (PEF) have successfully been introduced into the food industry, as one of the most promising and "game changing" technologies. This review is devoted to the recent applications of pulsed electric fields used in processing potatoes. The potato processing market size was estimated to be ca. USD 24.83 billion (2018) and with an annual growth rate of 5.2%. The physicochemical characteristics of potatoes and the specificity of potato processing lines makes a pulsed electric field very versatile and flexible allowing one to achieve different technological aims by its implementation into technological lines. In this paper, a short analysis of the potato structure and its nutritional properties, applications of moderate electric fields, ohmic heating, and pulsed electric fields are presented. Moreover, the basic electroporation effects, metabolic responses, texture modification and different PEF assisted processes applied to the potato are discussed. Finally, some examples of commercial applications and a brief description of the available equipment for the PEF processing of potatoes are presented.
Die Landwirtschaft ist ein Wirtschaftszweig mit massiven Auswirkungen auf die biologische und agrobiodiverse Vielfalt. Nachhaltige Ernährung ist ein entscheidender politischer Hebel und eine realistische Chance, die Umweltauswirkungen des Agrar- und Ernährungssektors zu verringern und gleichzeitig die menschliche Gesundheit zu verbessern. Auswärts essen ist für viele Verbraucher eine immer häufiger anzutreffende Gewohnheit, und indem sie nachhaltige Gerichte anbieten, können Catering-Unternehmen eine zentrale Rolle spielen. Dazu müssen sie die Nachhaltigkeit ihres Lebensmittelangebots verstehen und richtig einschätzen können, aber es gibt noch keine gut etablierten Bewertungsinstrumente. Im Rahmen des NAHGAST-Projekts, zu dem diese Studie gehörte, wurde ein Instrument zur Bewertung der Nachhaltigkeit für Catering-Unternehmen entwickelt und getestet, das auf konkreten, pro Mahlzeit definierten Zielen basiert. Diese Studie befasst sich mit dem Mangel an Methoden zur Bewertung der Auswirkungen von Lebensmitteln auf die biologische Vielfalt, wobei der Schwerpunkt auf der Agrobiodiversität liegt. Die Arbeit veranschaulicht eine kontextspezifische Anwendung eines erweiterten DPSIR-Modells zur Strukturierung von Informationen und Auswahl von Indikatoren und schlägt eine transdisziplinäre Nutzung bestehender Messgrößen vor. Weitere Forschungsarbeiten sind erforderlich, um wissenschaftlich fundierte Zielwerte oder Nachhaltigkeitsspannen für jeden Indikator pro Mahlzeit zu definieren, damit diese berechnet werden können.
Die Stärken und Grenzen der Studie werden diskutiert.
The management of patients experiencing chronic orofacial pain is a great challenge, due to the complexity of chronic pain itself, combined with an increased peripheral sensitization in the craniofacial itself. Therefore, patients with orofacial pain may present a clear distortion of the somatorepresentation after some time. In this review, the authors develop a neurophysiological explanation of orofacial distortion, as well as propose assessment and treatment options, based on scarcely available scientific evidence and their own clinical experience. The assessments of facial somatosensory, cognitive-affective and motor dysfunctions are crucial to establish the most accurate treatment; the assessment tools are described in the article. Two-point discrimination, laterality recognition and emotion recognition are altered in patients with orofacial pain. Other sensorimotor assessment tools, such as motor acuity and auditory acuity, are also explained. Finally, the authors review their treatment proposals, based on the integration of brain training techniques and biobehavioral interventions. Somatosensory reintegration (tactile acuity training), facial emotion recognition, movement representation techniques, orofacial motor training and therapeutic patient education are explained in detail, and this may challenge new directions in rehabilitation and research.
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/Aim
This study aimed to establish the somatosensory profile of patients with lumbar radiculopathy at pre-and post-microdiscectomy and to explore any association between pre-surgical quantitative sensory test (QST) parameters and post-surgical clinical outcomes.
Methods
A standardized QST protocol was performed in 53 patients (mean age 38 ± 11 years, 26 females) with unilateral L5/S1 radiculopathy in the main pain area (MPA), affected dermatome and contralateral mirror sites and in age- and gender-,and body site-matched healthy controls. Repeat measures at 3 months included QST, the Oswestry Disability Index (ODI) and numerous other clinical measures; at 12 months, only clinical measures were repeated. A change <30% on the ODI was defined as ‘no clinically meaningful improvement’.
Results
Patients showed a significant loss of function in their symptomatic leg both in the dermatome (thermal, mechanical, vibration detection p < .002), and MPA (thermal, mechanical, vibration detection, mechanical pain threshold, mechanical pain sensitivity p < .041) and increased cold sensitivity in the MPA (p < .001). Pre-surgical altered QST parameters improved significantly post-surgery in the dermatome (p < .018) in the symptomatic leg and in the MPA (p < .010), except for thermal detection thresholds and cold sensitivity. Clinical outcomes improved at 3 and 12 months (p < .001). Seven patients demonstrated <30% change on the ODI at 12 months. Baseline loss of function in mechanical detection in the MPA was associated with <30% change on the ODI at 12 months (OR 2.63, 95% CI 1.09–6.37, p = .032).
Conclusion
Microdiscectomy resulted in improvements in affected somatosensory parameters and clinical outcomes. Pre-surgical mechanical detection thresholds may be predictive of clinical outcome.
Significance
This study documented quantitative sensory testing (QST) profiles in patients with lumbar radiculopathy in their main pain area (MPA) and dermatome pre- and post-microdiscectomy and explored associations between QST parameters and clinical outcome. Lumbar radiculopathy was associated with loss of function in modalities mediated by large and small sensory fibres. Microdiscectomy resulted in significant improvements in loss of function and clinical outcomes in 85% of our cohort. Pre-surgical mechanical detection thresholds in the MPA may be predictive of clinical outcome.
Attitudes Concerning Postmortem Organ Donation : A Multicenter Survey in Various German Cohorts
(2015)
BACKGROUND
The aim of this study was to characterize postmortem organ donation attitudes in various German cohorts.
MATERIAL AND METHODS
Employees of 2 German cities and 2 German university hospitals, employees of a German automobile enterprise, and members of a German Medical Society were administered a questionnaire about postmortem organ and tissue donation attitudes. Demographic data and general attitudes were questioned and focused on: I) willingness to donate organs, II) holding a donor card, and III) having discussed the topic with the family.
RESULTS
Of 5291 participants, 65.2% reported favoring postmortem organ donation. Missing negative experiences, the idea that donation is helpful, a non-medical professional environment, excellent general health, gender, agreement with the brain-death paradigm, and age significantly influenced the participants’ attitudes. Participants were more likely to possess donor cards and had discussed more often with family members if they agreed with the brain-death paradigm and considered donation to be helpful. Males and older participants were the most likely to neglect donor cards, and Catholics, Protestants, and participants with poor health were the least likely to donate organs. Interest in receiving more information was expressed by 38.1% and 50.6% of participants refusing donation of all or of specific organs, respectively, and suggested the internet (60.0%) and family doctors (35.0%) as preferred sources of information.
CONCLUSIONS
Public campaigns in Germany should focus on males and older people as regards donor cards, and females, younger, and religiously affiliated persons as regards the general willingness to donate organs postmortem.
Making solar thermal systems less expensive, often results in a lower system efficiency. However, the cost-benefit ratio is relevant from the perspective of the consumer. The complex impact of component-related and system-related design parameters on the economics of a complete system makes the evaluation and economical optimization difficult.
Therefore, a complete simulation environment has been developed, which can automatically optimize solar-thermal systems,including collector and system parameters. The main collector module consists of a one-dimensional thermal model that was validated with a commercial solar collector. The efficiency curve and the production cost werecalculated as a function of several design and construction parameters. The collector module was linked to the commercial software Polysun®, so that parametric studies can be performed with minimaleffort. Optimization problems can be solved by using the Matlab® optimization toolbox.
The simulation environment wasused for sensitivity studies and optimization problems in order to analyze the impact of collector design-parameters with respect to system cost, system yield andeconomic values. We will demonstrate how a collector can be optimized and how the ideal system parameters like collector number and storage volume can be easily calculated. Finally, we will show how the optimizer is used for a given system in order to find ideal values for the absorber-sheet thickness and the number of pipes. Due to the holistic approach, the application of this tool set can be used for collector development as well as for system planning.
Greenwashing, defined by the Oxford Dictionary as “disinformation disseminated by an organization so as to present an environmentally responsible public image” can cause multifarious problems for companies. The phenomenon of greenwashing has, however, not attracted much attention in the event marketing literature to date. The purpose of this paper is twofold. It first describes and analyses the specific characteristics and features of greenwashing in event marketing. It then seeks to identify the current fundamental approaches of how to avoid greenwashing in event marketing and to assess their potential. A two-step literature analysis with complementary search approaches served as a methodical framework. First, journals related to event marketing were screened for the keywords “greenwashing” and “greenwash”. Next, the general literature was consulted for the same keywords. The results clearly demonstrate that the subject of greenwashing has been widely neglected in the event literature. There appears to be no overall concept or approach that allows event actors to avoid greenwashing, albeit various individual initiatives exist. However, it also became clear that initiatives against greenwashing in event marketing can be developed and implemented in the short and long term, for example by integrating different stakeholders. Additional political and juridical efforts based on specific guidelines are also necessary to prevent greenwashing in the future. The study is the first one to provide a systematic approach to the topic of greenwashing in the context of event marketing, including relevant approaches for its avoidance. It can thus help practitioners to better detect and avoid greenwashing in the event industry and to guide similar research in the future.
One challenge of the EU energy transition is the integration of renewable electricity generation in the distribution system. EU energy law proposes a possible solution by introducing “citizen energy communities” (Directive 2019/944/EU) which may be open for “cross-border participation”. This article proposes an innovative way of implementing such cross-border communities by linking distribution systems via a “switchable element”, a generation, storage, or consumption asset with a connection to each country. An optimization model has been developed to calculate the system cost savings of such a connection. Linking regions with complementary characteristics regarding electricity generation and demand via a switchable element leads to more efficient system utilization. Findings are relevant for the transposition of “citizen energy communities” in national laws.
Advances in high-throughput DNA sequencing have propelled research into the human microbiome and its link to metabolic health. We explore microbiome analysis methods, specifically emphasizing metabolomics, how dietary choices impact the production of microbial metabolites, providing an overview of studies examining the connection between enterotypes and diet, and thus, improvement of personalized dietary recommendations. Acetate, propionate, and butyrate constitute more than 95% of the collective pool of short-chain fatty acids. Conflicting data on acetate’s effects may result from its dynamic signaling, which can vary depending on physiological conditions and metabolic phenotypes. Human studies suggest that propionate has overall anti-obesity effects due to its well-documented chemistry, cellular signaling mechanisms, and various clinical benefits. Butyrate, similar to propionate, has the ability to reduce obesity by stimulating the release of appetite-suppressing hormones and promoting the synthesis of leptin. Tryptophan affects systemic hormone secretion, with indole stimulating the release of GLP-1, which impacts insulin secretion, appetite suppression, and gastric emptying. Bile acids, synthesized from cholesterol in the liver and subsequently modified by gut bacteria, play an essential role in the digestion and absorption of dietary fats and fat-soluble vitamins, but they also interact directly with intestinal microbiota and their metabolites. One study using statistical methods identified primarily two groupings of enterotypes Bacteroides and Ruminococcus. The Prevotella-dominated enterotype, P-type, in humans correlates with vegetarians, high-fiber and carbohydrate-rich diets, and traditional diets. Conversely, individuals who consume diets rich in animal fats and proteins, typical in Western-style diets, often exhibit the Bacteroides-dominated, B-type, enterotype. The P-type showcases efficient hydrolytic enzymes for plant fiber degradation but has limited lipid and protein fermentation capacity. Conversely, the B-type features specialized enzymes tailored for the degradation of animal-derived carbohydrates and proteins, showcasing an enhanced saccharolytic and proteolytic potential. Generally, models excel at predictions but often struggle to fully elucidate why certain substances yield varied responses. These studies provide valuable insights into the potential for personalized dietary recommendations based on enterotypes
Career Decisions of Indian Female Talent: Implications for Gender-sensitive Talent Management
(2020)
Purpose: Talent scarcity in emerging economies such as India poses challenges for companies,and limited labour market participation among well-educated women has been observed. The reasons that professionals decide not to pursue a further corporate career remain unclear. By investigating career decision making, this article aims to highlight (1) the contextual factors that impact those decisions, (2) individuals’ agency to handle them, and (3) the implications for talent management (TM).
Design/methodology/approach: Following a qualitative research design, computer-aided analysis was conducted on interviews with 24 internationally experienced Indian business professionals. A novel application of neo-institutionalism in the Indian context was combined with the family-relatedness of work decisions (FRWD) model.
Findings: Career decisions indicate that rebellion against Indian societal and family expectations is essential to following a career path, especially for women. TM as part of the current institutional framework serves as a legitimising façade veiling traditional practices that hinder females’ careers.
Research limitations: Interviewees adopted a retrospective perspective when describing their career decisions; therefore, different views might have existed at the moment of decision making.
Practical implications: Design and implementation of gender-sensitive TM adjusted to fit the specific Indian context can contribute to retaining female talent in companies and the labour market.
Originality/value: The importance of gender-sensitive TM can be concluded from an empirical study of the context-based career decision making of experienced business professionals from India. The synthesis of neo-institutionalism, the FRWD model and the research results provides assistance in mapping talent experiences and implications for overcoming the challenges of talent scarcity in India.
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.
Background
To detect changes in biological processes, samples are often studied at several time points. We examined expression data measured at different developmental stages, or more broadly, historical data. Hence, the main assumption of our proposed methodology was the independence between the examined samples over time. In addition, however, the examinations were clustered at each time point by measuring littermates from relatively few mother mice at each developmental stage. As each examination was lethal, we had an independent data structure over the entire history, but a dependent data structure at a particular time point. Over the course of these historical data, we wanted to identify abrupt changes in the parameter of interest - change points.
Results
In this study, we demonstrated the application of generalized hypothesis testing using a linear mixed effects model as a possible method to detect change points. The coefficients from the linear mixed model were used in multiple contrast tests and the effect estimates were visualized with their respective simultaneous confidence intervals. The latter were used to determine the change point(s). In small simulation studies, we modelled different courses with abrupt changes and compared the influence of different contrast matrices. We found two contrasts, both capable of answering different research questions in change point detection: The Sequen contrast to detect individual change points and the McDermott contrast to find change points due to overall progression. We provide the R code for direct use with provided examples. The applicability of those tests for real experimental data was shown with in-vivo data from a preclinical study.
Conclusion
Simultaneous confidence intervals estimated by multiple contrast tests using the model fit from a linear mixed model were capable to determine change points in clustered expression data. The confidence intervals directly delivered interpretable effect estimates representing the strength of the potential change point. Hence, scientists can define biologically relevant threshold of effect strength depending on their research question. We found two rarely used contrasts best fitted for detection of a possible change point: the Sequen and McDermott contrasts.
Our world and our lives are changing in many ways. Communication, networking, and computing technologies are among the most influential enablers that shape our lives today. Digital data and connected worlds of physical objects, people, and devices are rapidly changing the way we work, travel, socialize, and interact with our surroundings, and they have a profound impact on different domains,such as healthcare, environmental monitoring, urban systems, and control and management applications, among several other areas. Cities currently face an increasing demand for providing services that can have an impact on people’s everyday lives. The CityPulse framework supports smart city service creation by means of a distributed system for semantic discovery, data analytics, and interpretation of large-scale (near-)real-time Internet of Things data and social media data streams. To goal is to break away from silo
applications and enable cross-domain data integration. The CityPulse framework integrates multimodal, mixed quality, uncertain and incomplete data to create reliable, dependable information and continuously adapts data processing techniques to meet the quality of information requirements from end users. Different than existing solutions that mainly offer unified views of the data, the CityPulse framework is also equipped with powerful data analytics modules that perform intelligent data aggregation, event detection, quality
assessment, contextual filtering, and decision support. This paper presents the framework, describes ist components, and demonstrates how they interact to support easy development of custom-made applications for citizens. The benefits and the effectiveness of the framework are demonstrated in a use-case scenario
implementation presented in this paper.
Land cover change is a dynamic phenomenon driven by synergetic biophysical and socioeconomic effects. It involves massive transitions from natural to less natural habitats and thereby threatens ecosystems and the services they provide. To retain intact ecosystems and reduce land cover change to a minimum of natural transition processes, a dense network of protected areas has been established across Europe. However, even protected areas and in particular the zones around protected areas have been shown to undergo land cover changes. The aim of our study was to compare land cover changes in protected areas, non-protected areas, and 1 km buffer zones around protected areas and analyse their relationship to climatic and socioeconomic factors across Europe between 2000 and 2012 based on earth observation data. We investigated land cover flows describing major change processes: urbanisation, afforestation, deforestation, intensification of agriculture, extensification of agriculture, and formation of water bodies. Based on boosted regression trees, we modelled correlations between land cover flows and climatic and socioeconomic factors. The results show that land cover changes were most frequent in 1 km buffer zones around protected areas (3.0% of all buffer areas affected). Overall, land cover changes within protected areas were less frequent than outside, although they still amounted to 18,800 km2 (1.5% of all protected areas) from 2000 to 2012. In some parts of Europe, urbanisation and intensification of agriculture still accounted for up to 25% of land cover changes within protected areas. Modelling revealed meaningful relationships between land cover changes and a combination of influencing factors. Demographic factors (accessibility to cities and population density) were most important for coarse-scale patterns of land cover changes, whereas fine-scale patterns were most related to longitude (representing the general east/west economic gradient) and latitude (representing the north/south climatic gradient).
The current narrative literature review aims to discuss clinical reasoning based on nociceptive pain mechanisms for determining the most appropriate assessment and therapeutic strategy and to identify/map the most updated scientific evidence in relation to physical therapy interventions for patients with temporomandibular disorders (TMDs). We will also propose an algorithm for clinical examination and treatment decisions and a pain model integrating current knowledge of pain neuroscience. The clinical examination of patients with TMDs should be based on nociceptive mechanisms and include the potential identification of the dominant, central, or peripheral sensitization driver. Additionally, the musculoskeletal drivers of these sensitization processes should be assessed with the aim of reproducing symptoms. Therapeutic strategies applied for managing TMDs can be grouped into tissue-based impairment treatments (bottom-up interventions) and strategies targeting the central nervous system (top-down interventions). Bottom-up strategies include joint-, soft tissue-, and nerve-targeting interventions, as well as needling therapies, whereas top-down strategies include exercises, grade motor imagery, and also pain neuroscience education. Evidence shows that the effectiveness of these interventions depends on the clinical reasoning applied, since not all strategies are equally effective for the different TMD subgroups. In fact, the presence or absence of a central sensitization driver could lead to different treatment outcomes. It seems that multimodal approaches are more effective and should be applied in patients with TMDs. The current paper also proposes a clinical decision algorithm integrating clinical diagnosis with nociceptive mechanisms for the application of the most appropriate treatment approach.
To investigate the influence of two dietary sources of vitamin D on the vitamin D status, bone metabolism, welfare and birth progress of gestating and lactating sows, forty-nine multiparous sows were randomly assigned to one of two diets: “CON” (n = 25; 50 μg vitamin D3/kg feed) and “HYD” (n = 24; 50 μg 25-hydroxycholecalciferol/kg feed). The basal diets were protein- and phosphorus-reduced. The trial started on day 3 ante insemination of the sows and ended with weaning of the piglets on day 28 postpartum. Dietary supplementation of 25-hydroxycholecalciferol resulted in improved maternal vitamin D status (p < 0.001), fewer gait changes (p < 0.01) and longer standing time after feeding (day 5 ante partum; p < 0.05) compared to vitamin D3. However, the bone markers CrossLaps and osteocalcin were not affected. Overall, the present results suggest that sows fed 25-hydroxycholecalciferol instead of vitamin D3 showed improved locomotion and stance strength. However, this outcome is probably not related to altered bone metabolism. The underlying mechanisms must be investigated in further studies.
Consumer Acceptance and Market Potential of Iodine-Biofortified Fruit and Vegetables in Germany
(2021)
Biofortification of food crops with iodine is a novel approach to preventing iodine deficiency in humans. The present study analyses the consumer target groups and the market potential of iodine-biofortified fruit and vegetables in Germany. For this purpose, an online survey of 1016 German fruit and vegetable consumers was conducted to investigate the acceptance of different product categories as well as relevant criteria for the market launch. The results show that io-dine-biofortified fruit and vegetables are particularly attractive to consumers who purchase at farmers’ markets, organic food shops, and farm stores. Out of this group, 39% of consumers rate such iodine-rich foods as very appealing. They attach importance to food that naturally contains iodine and prefer produce from integrated domestic cultivation. With their focus on sustainability and naturalness, this group of consumers clearly differs from typical users of dietary supplements, who are primarily concerned with health benefits. However, overall about 85% of respondents would prefer biofortified fruits and vegetables to supplements to improve their iodine supply. The greatest market potential for iodine-biofortified fruit and vegetables is to be expected in super-markets, as this is the preferred food shopping location for most consumers. A total of 28% of those who buy here rate the biofortified foods presented as very appealing. Nevertheless, a successful market launch requires that the benefits of the new products are communicated according to the potential consumer group needs.
Abstract: Thermal response curves that depict the probability of occurrence along a thermal gradient are used to derive various species’ thermal properties and abilities to cope with warming. However, different thermal responses can be expected for different portions of a species range. We focus on differences in thermal response curves (TRCs) and thermal niche requirements for four freshwater fishes (Coregonus sardinella, Pungitius pungitius, Rutilus rutilus, Salvelinus alpinus) native to Europe at (1) the global and (2) European continental scale. European ranges captured only a portion of the global thermal range with major differences in the minimum (Tmin), maximum (Tmax) and average temperature (Tav) of the respective distributions. Further investigations of the model-derived preferred temperature (Tpref), warming tolerance (WT = Tmax − Tpref), safety margin (SM = Tpref − Tav) and the future climatic impact showed substantially differing results. All considered thermal properties either were under- or overestimated at the European level. Our results highlight that, although continental analyses have an impressive spatial extent, they might deliver misleading estimates of species thermal niches and future climate change impacts, if they do not cover the full species ranges. Studies and management actions should therefore favor whole global range distribution data for analyzing species responses to environmental gradients.
Thermal response curves that depict the probability of occurrence along a thermal gradient are used to derive various species’ thermal properties and abilities to cope with warming. However, different thermal responses can be expected for different portions of a species range. We focus on differences in thermal response curves (TRCs) and thermal niche requirements for four freshwater fishes (Coregonus sardinella, Pungitius pungitius, Rutilus rutilus, Salvelinus alpinus) native to Europe at (1) the global and (2) European continental scale. European ranges captured only a portion of the global thermal range with major differences in the minimum (Tmin), maximum (Tmax) and average temperature (Tav) of the respective distributions. Further investigations of the model-derived preferred temperature (Tpref), warming tolerance (WT = Tmax − Tpref), safety margin (SM = Tpref − Tav) and the future climatic impact showed substantially differing results. All considered thermal properties either were under- or overestimated at the European level. Our results highlight that, although continental analyses have an impressive spatial extent, they might deliver misleading estimates of species thermal niches and future climate change impacts, if they do not cover the full species ranges. Studies and management actions should therefore favor whole global range distribution data for analyzing species responses to environmental gradients.
Jede Ernährung hat Auswirkungen auf den Gesundheitszustand des Einzelnen, auf die Umwelt und auf soziale Belange. Eine wachsende Zahl von Mahlzeiten wird in der Außer-Haus-Verpflegung eingenommen, in der eine systematische Nachhaltigkeitsbewertung nicht zur gängigen Praxis gehört. Um diese Lücke zu schließen, wurde im Rahmen des NAHGAST-Projekts ein Instrument entwickelt. Nach mehr als einem Jahr des Einsatzes des NAHGAST-Online-Tools soll nun überprüft werden, welche positiven Umwelteinflüsse durch den Einsatz des Instruments realisiert werden können. Aus diesem Grund befasst sich dieser Artikel mit der Frage, ob ein Online-Tool Akteure aus dem Bereich des Außer-Haus-Verzehrs in die Lage versetzen kann, ihre Mahlzeiten im Hinblick auf Aspekte einer nachhaltigen Ernährung zu überarbeiten. Darüber hinaus wird die Frage beantwortet, wie sich konkrete Rezeptüberarbeitungen der beliebtesten Mittagsgerichte auf den materiellen Fußabdruck sowie auf den Carbon Footprint auswirken.
Zusammenfassend lässt sich sagen, dass ein Online-Tool individuelle Nachhaltigkeitspfade für Akteure im und ermöglicht eine eigenständige Rezeptüberarbeitung für bereits bestehende Gerichte. Mahlzeiten. Die Ergebnisse zeigen, dass bereits geringfügige Änderungen in den Rezepten zu Einsparungen von bis zu einem Drittel führen können beim CO2-Fußabdruck sowie beim Materialfußabdruck führen können. Bezogen auf den Außer-Haus-Verzehr Außer-Haus-Verzehr ergibt sich daraus das Potenzial für erhebliche Multiplikationseffekte, die den Weg für die Verbreitung von nachhaltiger Ernährung ebnen.
HRM processes are increasingly AI-driven, and HRM supports the general digital transformation of companies’ viable competitiveness. This paper points out possible positive and negative effects on HRM, workplaces, and workersorganizations along the HR processes and its potential for competitive advantage in regard to managerial decisions on AI implementation regarding augmentation and automation of work.
A systematic literature review that includes 62 international journals across different disciplines and contains top-tier academic and German practitioner journals was conducted. The literature analysis applies the resource-based view (RBV) as a lens through which to explore AI-driven HRM as a potential source of organizational capabilities.
The analysis shows four ambiguities for AI-driven HRM that might support sustainable company development or might prevent AI application: job design, transparency, performance and data ambiguity. A limited scholarly discussion with very few empirical studies can be stated. To date, research has mainly focused on HRM in general, recruiting, and HR analytics in particular.
The four ambiguities’ context-specific potential for capability building in firms is indicated, and research avenues are developed.
This paper critically explores AI-driven HRM and structures context-specific potential for capability building along four ambiguities that must be addressed by HRM to strategically contribute to an organization’s competitive advantage.
BACKGROUND: The Craniofacial Pain and Disability Inventory (CF-PDI) is a cross-culturally adapted instrument designed from a biopsychosocial perspective to measure pain, disability, and function in orofacial head and neck pain with shown psychometric properties; however, the German cross-cultural adaption is lacking.
OBJECTIVES: To carry out a transcultural translation of CF-PDI into German and assess its psychometric properties in patients with painful temporomandibular disorders (TMD) with respect to construct and clinical validity, internal consistency and reproducibility.
STUDY DESIGN: Multicenter, prospective, cross-sectional design.
SETTING: Patients (n = 398) were recruited from dental and physical therapy clinics in middle and south Germany.
METHODS: Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We investigated know-group validity by means of the scale’s potential to discriminate between affected and unaffected subjects. Multiple linear regression analysis was used to estimate convergent validity. We tested test-retest reliability by the intraclass correlation coefficient and the Internal consistency by Cronbach’s alpha, or each dimension separately, and the total score. Multiple linear regression analysis was used to estimate convergent validity.
RESULTS: Two hundred forty-six heterogeneous chronic craniofacial pain patients and 152 patients without complaints were recruited from the middle and south of Germany. The German version CF-PDI-G presents 21 items, 4 factors, and adequate psychometric properties. The test-retest reliability and internal consistency of the CF-PDI-G were both excellent for the entire instrument and also for all sub-scales (intraclass correlation coefficient [ICC] > 0.90) except for the comorbidities and interference with work which was acceptable (ICC = 0.69). Standard error of the measurement (SEM) and minimal detectable change values are sufficiently low. Assessment of clinical validity shows good potential of discrimination and classification into categories “no,” “mild,” “moderate,” and “severe.” The multiple linear regression model showed a strong association between neck disability index, Visual Analog Scale, and anamnestic questionnaire (supporting the scale’s convergent validity).
LIMITATIONS: Our sample has a higher prevalence of women and the sample was not recruited consecutively, which may lead to a biased estimation of psychometric properties.
CONCLUSIONS: The CF-PDI-G represents valid and reliable instrument to assess pain and disability in patients with orofacial pain and headache suitable for research and clinical practice.
Purpose
This study operationalizes risks in stakeholder dialog (SD). It conceptualizes SD as co-produced organizational discourse and examines the capacities of organizers' and stakeholders' practices to create a shared understanding of an organization’s risks to their mutual benefit. The meetings and online forum of a German public service media (PSM) organization were used as a case study.
Design/methodology/approach
The authors applied corpus-driven linguistic discourse analysis (topic modeling) to analyze citizens' (n = 2,452) forum posts (n = 14,744). Conversation analysis was used to examine video-recorded online meetings.
Findings
Organizers suspended actors' reciprocity in meetings. In the forums, topics emerged autonomously. Citizens' articulation of their identities was more diverse than the categories the organizer provided, and organizers did not respond to the autonomous emergence of contextualizations of citizens' perceptions of PSM performance in relation to their identities. The results suggest that risks arise from interactionally achieved occasions that prevent reasoned agreement and from actors' practices, which constituted autonomous discursive formations of topics and identities in the forums.
Originality/value
This study disentangles actors' practices, mutuality orientation and risk enactment during SD. It advances the methodological knowledge of strategic communication research on SD, utilizing social constructivist research methods to examine the contingencies of organization-stakeholder interaction in SD.
Oleamide is used as a lubricant in the manufacturing and application of polypropylene (PP) medical devices. Samples of PP were prepared with 0, 1500, and 15 000 ppm oleamide content as lubricant. The samples were either left non-sterile, sterilized with ethylene oxide (ETO), γ-radiation (γ) or autoclaved (A) and stored for up to 4 weeks. To determine the oleamide bulk-to-surface distribution depending on sterilization method and storage time an extraction method and a washing technique were applied. The oleamide content was determined by gas chromatography (GC-FID) and compared with the coefficient of friction (COF). The COF dependent on the measured lubricant content at the surface. The content of lubricant on the surface depends on the type of sterilization: ETO increased the lubricant content to some extent, γ-sterilization and autoclaving reduced it. After storage, no migration of the lubricant to the surface could be detected.
Objectives: This paper addresses recent steps for reforming the eligibility criteria of the German long-term care insurance that have been initiated to overcome shortcomings in the current system.
Methods: Based on findings of a survey of international long-term care systems, assessment tools and the relevant literature on care needs a new tool for determining eligibility in the German long-term care insurance was developed.
Results: The new tool for determining long-term care eligibility broadens the understanding of what ‚dependency on nursing care' implies for the person affected. The assessment results in a degree of dependency from personal help provided by formal or informal caregivers. This degree of dependency can be used for determining eligibility for and the amount of long-term care benefits.
Discussion: The broader understanding of "dependency on nursing care' and the new tool are important steps to adapt the German long-term care insurance to the challenges of the demographic and societal changes in the future
A systematic study was performed to understand the effects of the devulcanizing agent dibenzamido diphenyl disulfide (DBD) on the vulcanization and devulcanization process of a sulfur-cured ethylene-propylene-diene monomer (EPDM) rubber. The influence of DBD on vulcanization was investigated by mixing DBD with virgin rubber and curative system. The devulcanization of rubber waste was achieved with varying amounts of DBD ranging from 0.4 to 13.8 wt% and temperatures from 150 to 200°C. The quality of vulcanizates and devulcanizates was evaluated by rheometer tests, temperature scanning stress relaxation measurements, and analysis of mechanical properties. During vulcanization, DBD acts as an accelerator in the presence of sulfur. When accelerators are added, the scorch time increases, and the cure rate decreases. Thus, DBD acts as a retarder. In the presence of activators, DBD leads to a significant reduction of crosslink density. This results in composites with high elongation at break and poor compression set values. The efficiency of the devulcanization of rubber waste depends strongly on DBD concentration and temperature. The monosulfidic crosslinks are cleaved by low concentrations of DBD, while polysulfidic crosslinks require higher concentrations. These results show that DBD is effective as a devulcanizing agent and degrades the network below 200°C.
25-hydroxycholecalciferol (25-OHD3) formed via hepatic hydroxylation from vitamin D, cholecalciferol, represents the precursor of the biologically active vitamin D hormone, 1,25-dihydroxyvitamin D. Due to a higher absorption rate and the omission of one hydroxylation, dietary supplementation of 25-OHD3 instead of vitamin D3 is considered to be more efficient as plasma concentrations of 25-OHD3 are increased more pronounced. The present review summarises studies investigating potential beneficial effects on mineral homeostasis, bone metabolism, health status and performance in sows, piglets and fattening pigs. Results are inconsistent. While most studies could not demonstrate any or only a slight impact of partial or total replacement of vitamin D3 by 25-OHD3, some experiments indicated that 25-OHD3 might alter physiological processes when animals are challenged, for example, by a restricted mineral supply.
Extending assessments of climate change-induced range shifts via correlative species distribution models by including species traits is crucial for conservation planning. However, comprehensive assessments of future distribution scenarios incorporating responses of biotic factors are poorly investigated. Therefore, the aim of our study was to extend the understanding about the combined usage of species traits data and species distribution models for different life stages and distribution scenarios. We combine global model predictions for the 2050s and thermal performances of Salmo trutta and Salmo salar under consideration of different life stages (adults, juveniles, eggs), timeframes (monthly, seasonally, yearly), and dispersal scenarios (no dispersal, free dispersal, restricted dispersal). We demonstrate that thermal performances of different life stages will either increase or decrease for certain time periods. Model predictions and thermal performances imply range declines and poleward shifts. Dispersal to suitable habitats will be an important factor mitigating warming effects; however, dams may block paths to areas linked to high performances. Our results emphasize enhanced inclusion of critical periods for species and proper dispersal solutions in conservation planning.
The BBI is a first step toward putting biodiversity conservation into practice in the OHC context. The results are consistent with studies related to nutrition However, the results also show that there is room for improvement and that there are further areas to be addressed. It is also clear that commercial kitchens currently have only limited room for maneuver. If OHC is to become more biodiversity-friendly, greater transparency is needed in terms of origin labels and species/variety identifiers, and a wide range of options will also be required in terms of procurement. That being the case, it is essential to focus on the entire value chain. Furthermore, in addition to the initial recommendations, much more knowledge is required about the impacts of farming methods and heritage varieties and species, as well as about the use of fish, other marine animals and game meat. In principle, however, the BBI can already be implemented in commercial kitchens by identifying recipe optimizations that kitchens can feasibly implement, that align with their budgets, and that maintain acceptance among patrons. In addition, this approach has the potential to be integrated into the assessment framework of the NAHGAST calculator, making it readily accessible and free for OHC facilities to use. In the OHC context in particular, this could be leveraged to drive sustainable change in the food system.
The increasing diversity of cultural backgrounds offers potential for a more elaborated information processing, yet has been shown to be challenging for individuals, due to intergroup hostility, prejudices, and difficulties of intercultural communication. Current research thus focusses on the interaction of employees with different cultural heritages, as well as on their intergroup attitudes and competences. Thereby, leaders have been shown to shape the way diversity is considered in their teams in a top-down process. However, their perception of diversity as well as related challenges and chances are poorly investigated. The current paper thus aims to contribute to the understanding of leader’s perspective on and role in diversity-management by building on a comparative qualitative study with sixteen employees and twenty-two leaders. Research questions are how employees and leaders perceive cultural diversity from their specific point of view, which experiences are likely to contribute to their opinion on and perception of diversity and in how far do employees and leaders differ in these aspects. The results show that employees are aware of the topic of diversity in general but have poor competences in dealing with diversity in their daily working life. This seems to be associated with lack of experience with intercultural interaction and a lack of support from the respective organizations/leaders. Leaders are rarely aware of this lack of support. The results indicate that leaders’ experiences with cultural and age diversity, their identification with the company and previous diversity measures in the context of the companies’ policy towards diversity seem to be relevant for the formation of leaders’ attitudes. As a consequence, most participants focus on the question whether they do or do not want diversity within their teams and companies, while they actually fail to perceive the diversity that is already there.
Objectives: To measure and assess the economic impact of adherence to a single quality indicator (QI) regarding weaning from invasive ventilation.
Design: Retrospective observational single-centre study, based on electronic medical and administrative records.
Setting: Intensive care unit (ICU) of a German university hospital, reference centre for acute respiratory distress syndrome.
Participants: Records of 3063 consecutive mechanically ventilated patients admitted to the ICU between 2012 and 2017 were extracted, of whom 583 were eligible adults for further analysis. Patients’ weaning protocols were evaluated for daily adherence to quality standards until ICU discharge. Patients with <65% compliance were assigned to the low adherence group (LAG), patients with ≥65% to the high adherence group (HAG).
Primary and secondary outcome measures: Economic healthcare costs, clinical outcomes and patients’ characteristics.
Results: The LAG consisted of 378 patients with a median negative economic results of −€3969, HAG of 205 (−€1030), respectively (p<0.001). Median duration of ventilation was 476 (248; 769) hours in the LAG and 389 (247; 608) hours in the HAG (p<0.001). Length of stay (LOS) in the LAG on ICU was 21 (12; 35) days and 16 (11; 25) days in the HAG (p<0.001). LOS in the hospital was 36 (22; 61) days in the LAG, and within the HAG, respectively, 26 (18; 48) days (p=0.001).
Conclusions: High adherence to this single QI is associated with better clinical outcome and improved economic returns. Therefore, the results support the adherence to QI. However, the examined QI does not influence economic outcome as the decisive factor.
The aim of the study was to examine different pH parameters, such as variations throughout the day, depending on differing concentrate feed proportions. Moreover, special attention was payed to individual variation in microbial efficiencies (microbial crude protein/fermented organic matter) and their relation to ruminal pH, nutrient flows and digestibilities. For this, cows were grouped according to microbial efficiency (more, n = 5, vs. less efficient cows, n = 4). After calving, thirteen ruminally cannulated pluriparous cows, including nine duodenally cannulated animals, were divided into groups offered rations with a lower (35% on dry matter basis, n = 7) or a higher (60% on dry matter basis, n = 6) concentrate feed proportion. Ruminal pH parameters were assessed continuously by using intraruminal probes. Nutrient flows, nutrient digestibility and microbial efficiency were determined for duodenally cannulated cows. For most ruminal pH parameters it seemed that individual variability was higher than the treatment effect. However, a positive relationship between actual concentrate intake and diurnal pH fluctuations was found. Besides, the effect of individually different microbial efficiencies was assessed. Again, there were no group differences for pH parameters. However, nutrient flows were significantly higher in more efficient cows, whereas digestibilities were lower in in more efficient cows.
Objectives: This study aimed at the construction of what the core of eHealth policy making is, offering new perspectives about high priority procedures along the policy making process
Methods: Following Grounded Theory methodology, 59 qualitative telephone interviews with a broad variety of stakeholders from Austria, Switzerland and Germany were conducted
Results: The findings hinted at five priorities of eHealth policy making: strategy, consensus-building, decision-making, implementation and evaluation that emerged from the stakeholders’ perception of the eHealth policy. Hereby strategy, consensus-building and implementation gained the highest attention
Conclusions: These findings suggest three high priorities in eHealth policy: 1) developing and pursuing a consistent eHealth strategy, 2) investing time and resources into consensus-building to clear up difficulties early on in the process, 3) governing implementation towards serving patient care through systems fit for practice.
Public Interest Summary: Digitalisation is playing an increasingly crucial role in providing high quality health care. However, different countries have pursued different political paths. In this study, we wanted to know how the stakeholders perceived the political process in their country to identify strengths and weaknesses. We, therefore, conducted interviews about digital health policy with experts from Austria, Switzerland and Germany covering the full spectrum of stakeholders. The findings suggest three political musts: 1) a convincing and coherent strategy followed throughout the entire process, 2) consensus- building among the stakeholders, 3) using “fit for practice” as the yardstick to measure political success.
We investigated whether design experts or laypersons evaluate webpages differently. Twenty participants, 10 experts and 10 laypersons, judged the aesthetic value of a webpage in an EEG-experiment. Screenshots of 150 webpages, judged as aesthetic or as unaesthetic by another 136 participants, served as stimulus material. Behaviorally, experts and laypersons evaluated unaesthetic webpages similarly, but they differed in their evaluation of aesthetic ones: experts evaluated aesthetic webpages as unaesthetic more often than laypersons did. The ERP-data show main effects of level of expertise and of aesthetic value only. There was no interaction of expertise and aesthetics. In a time-window of 110–130 ms after stimulus onset, aesthetic webpages elicited a more negative EEG-amplitude than unaesthetic webpages. In the same time window, experts had more negative EEG-amplitudes than laypersons. This patterning of results continued until a time window of 600–800 ms in which group and aesthetic differences diminished. An interaction of perceiver characteristics and object properties that several interactionist theories postulate was absent in the EEG-data. Experts seem to process the stimuli in a more thorough manner than laypersons. The early activation differences between aesthetic and unaesthetic webpages is in contrast with some theories of aesthetic processing and has not been reported before.
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.
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.
1. Flower strips are a fundamental part of agri-environment schemes (AESs) introduced by the European Union to counteract the loss of biodiversity and related ecosystem services in agricultural landscapes. Although vegetation composition of the strips is essential for most fauna groups, comprehensive studies analysing vegetation development and influencing factors are rare.
2. From 2017 to 2019, we investigated the vegetation composition of 40 perennial wildflower strips (WFSs) implemented in 2015 or 2016, and 20 cereal fields without WFS across Saxony-Anhalt, Germany. We analysed environmental factors on plot (cover of grasses, shading, soil fertility) and four landscape-scale levels (habitat diversity, proportion of WFS and open habitats). The provision of nectar and pollen resources was estimated by the newly developed Pollinator Feeding Index (PFI). All strips had been implemented by farmers as AES with species- rich seed mixtures comprising 30 native forbs.
3. In all study years, forb species richness, cover and related nectar and pollen supply were much higher on WFSs than on controls, confirming the effectiveness of this AES. Although sown native forbs contributed the most to the high PFI values, spontaneously established forbs expanded the total range of species considerably, especially in winter and spring. While sown forb communities remained similar over time, spontaneous forbs showed a higher species turnover. Altogether, shading and grass cover had the greatest negative effect on the performance of the sown forbs. Landscape variables had only minor effects and were inconsistent in their importance across scale levels and years.
4. Synthesis and applications. Successfully established perennial wildflower strips (WFSs) sown with species-rich native seed mixtures provided a forb-rich and diverse vegetation throughout the AES funding period of 5 years. By supplying feeding resources for pollinators under various landscape situations, WFSs have significant potential to promote farmland biodiversity and related ecosyste services. We recommend the mandatory use of species-rich wildflower mixtures for perennial flower strips and to avoid their creation in heavily shaded field edges. Advisory services for farmers are necessary to prevent failures in WFS implementation and management and to improve their ecological effectiveness.
Easy and inexpensive methods for measuring ammonia emissions in multi-plot field trials allow the comparison of several treatments with liquid manure application. One approach that might be suitable under these conditions is the dynamic tube method (DTM). Applying the DTM, a mobile chamber system is placed on the soil surface, and the air volume within is exchanged at a constant rate for approx. 90 s. with an automated pump. This procedure is assumed to achieve an equilibrium ammonia concentration within the system. Subsequently, a measurement is performed using an ammonia-sensitive detector tube. Ammonia fluxes are calculated based on an empirical model that also takes into account the background ammonia concentration measured on unfertilized control plots. Between measurements on different plots, the chamber system is flushed with ambient air and cleaned with paper towels to minimize contamination with ammonia. The aim of this study was to determine important prerequisites and boundary conditions for the application of the DTM.
We conducted a laboratory experiment to test if the ammonia concentration remains stable while performing a measurement. Furthermore, we investigated the cleaning procedure and the effect of potential ammonia carryover on cumulated emissions under field conditions following liquid manure application. The laboratory experiment indicated that the premeasurement phase to ensure a constant ammonia concentration is not sufficient. The concentration only stabilized after performing more than 100 pump strokes, with 20 pump strokes (lasting approximately 90 s) being the recommendation.
However, the duration of performing a measurement can vary substantially, and linear conversion accounts for those differences, so a stable concentration is mandatory. Further experiments showed that the cleaning procedure is not sufficient under field conditions. Thirty minutes after performing measurements on high emitting plots, which resulted in an ammonia concentration of approx.
10 ppm in the chamber, we detected a residual concentration of 2 ppm. This contamination may affect measurements on plots with liquid manure application as well as on untreated control plots. In a field experiment with trailing hose application of liquid manure, we subsequently demonstrated that the calculation of cumulative ammonia emissions can vary by a factor of three, depending on the degree of chamber system contamination when measuring control plots. When the ammoni background values were determined by an uncontaminated chamber system that was used to measure only control plots, cumulative ammonia emissions were approximately 9 kg NH3-N ha1.
However, when ammonia background values were determined using the contaminated chamber system that was also used to measure on plots with liquid manure application, the calculation of cumulative ammonia losses indicated approximately 3 kg NH3-N ha1. Based on these results, it can be concluded that a new empirical DTM calibration is needed for multi-plot field experiments with high-emitting treatments.
Usability is a core construct of website evaluation and inherently defined as interactive. Yet, when analysing first impressions of websites, expected usability, i.e., before use, is of interest. Here we investigate to what extend ratings of expected usability are related to (a) experienced usability, i.e., ratings after use, and (b) objective usability measures, i.e., task performance. Furthermore, we try to elucidate how ratings of expected usability are correlated to aesthetic judgments. In an experiment, 57 participants submitted expected usability ratings after the presentation of website screenshots in three viewing-time conditions (50, 500, and 10,000 ms) and after an interactive task (experienced usability). Additionally, objective usability measures (task completion and duration) and subjective aesthetics evaluations were recorded for each website. The results at both the group and individual level show that expected usability ratings are not significantly related either to experienced usability or objective usability measures. Instead, they are highly correlated with aesthetics ratings. Taken together, our results highlight the need for interaction in empirical website usability testing, even when exploring very early usability impressions. In our study, user ratings of expected usability were no valid proxy neither for objective usability nor for experienced website usability.
Information systems (IS) play a central role in promoting corporate sustainability and pro-environmental behavior. This study explores the use of mobile apps for fostering sustainability-oriented corporate culture. It accentuates issues relating to sustainability-oriented corporate culture (RQ1), app meta-requirements as a strategic approach to addressing these issues (RQ2), as well as design and implementation principles (RQ3). Referring to the literature on sustainability apps, gamification, and nudging, our qualitative research design combines an analysis of four corporate apps intending to promote sustainable behavior and expert interviews (Grounded Theory). The proposed framework supports the planning, realization, and monitoring of this targeted app use. Single cultural dimensions inform seven issues in culture development. Five meta-requirements address this multi-dimensionality, challenges provided by new digital working environments, and principles of Green IT. Four design principles support, extend, and integrate current knowledge on app features, nudging, and gamification. Five variables determine the app intervention and maturity level. We conclude that this targeted app use should intend to foster the sustainability orientation within all dimensions of corporate culture instead of being limited to promoting sustainable behavior.
Background:
Chronic health conditions are on the rise and are putting high economic pressure on health systems, as they require well-coordinated prevention and treatment. Among chronic conditions, chronic wounds such as cardiovascular leg ulcers have a high prevalence. Their treatment is highly interdisciplinary and regularly spans multiple care settings and organizations; this places particularly high demands on interoperable information exchange that can be achieved using international semantic standards, such as Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT).
Objective:
This study aims to investigate the expressiveness of SNOMED CT in the domain of wound care, and thereby its clinical usefulness and the potential need for extensions.
Methods:
A clinically consented and profession-independent wound care item set, the German National Consensus for the Documentation of Leg Wounds (NKDUC), was mapped onto the precoordinated concepts of the international reference terminology SNOMED CT. Before the mapping took place, the NKDUC was transformed into an information model that served to systematically identify relevant items. The mapping process was carried out in accordance with the ISO/TR 12300 formalism. As a result, the reliability, equivalence, and coverage rate were determined for all NKDUC items and sections.
Results:
The developed information model revealed 268 items to be mapped. Conducted by 3 health care professionals, the mapping resulted in moderate reliability (κ=0.512). Regarding the two best equivalence categories (symmetrical equivalence of meaning), the coverage rate of SNOMED CT was 67.2% (180/268) overall and 64.3% (108/168) specifically for wounds. The sections general medical condition (55/66, 83%), wound assessment (18/24, 75%), and wound status (37/57, 65%), showed higher coverage rates compared with the sections therapy (45/73, 62%), wound diagnostics (8/14, 57%), and patient demographics (17/34, 50%).
Conclusions:
The results yielded acceptable reliability values for the mapping procedure. The overall coverage rate shows that two-thirds of the items could be mapped symmetrically, which is a substantial portion of the source item set. Some wound care sections, such as general medical conditions and wound assessment, were covered better than other sections (wound status, diagnostics, and therapy). These deficiencies can be mitigated either by postcoordination or by the inclusion of new concepts in SNOMED CT. This study contributes to pushing interoperability in the domain of wound care, thereby responding to the high demand for information exchange in this field. Overall, this study adds another puzzle piece to the general knowledge about SNOMED CT in terms of its clinical usefulness and its need for further extensions.
Aim: The aim of this study was to give an overview of family caregiver satisfaction within the home palliative care situation in North Rhine-Westphalia, Germany.
Design: A cross-sectional study.
Methods: An anonymous questionnaire, with seven validated scales, and comprising of 71 items, was used. The items investigated perceived needs and burdens of families within a home-based palliative care situation.
The satisfaction of the family caregivers with the services delivered by palliative care teams was measured by the FAMCARE-2 Scale. Descriptive statistics and analysis of covariance (ANCOVA) were performed.
Results: A convenience sample of 106 family members agreed to participate in the study. Overall, we found high satisfaction within our sample. There was high satisfaction with how the services respected the dignity of families, and how they provided comfort to patients. Satisfaction was lower with regard to information about patients.
Conclusion: High or low satisfaction with palliative care, tells us little about the quality of services. The high satisfaction within this study could be interpreted as a sign that palliative care was important to families at the time of availability. Regular and continuous assessment can serve to inform the continuous quality of care provision for patients and their families.
Background and aims
In 2008, the International Association for the Study of Pain Special Interest Group on Neuropathic Pain (NeuPSIG) proposed a clinical grading system to help identify patients with neuropathic pain (NeP). We previously applied this classification system, along with two NeP screening tools, the painDETECT (PD-Q) and Leeds Assessment of Neuropathic Symptoms and Signs pain scale (LANSS), to identify NeP in patients with neck/upper limb pain. Both screening tools failed to identify a large proportion of patients with clinically classified NeP, however a limitation of our study was the use of a single clinician performing the NeP classification. In 2016, the NeuPSIG grading system was updated with the aim of improving its clinical utility. We were interested in field testing of the revised grading system, in particular in the application of the grading system and the agreement of interpretation of clinical findings. The primary aim of the current study was to explore the application of the NeuPSIG revised grading system based on patient records and to establish the inter-rater agreement of detecting NeP. A secondary aim was to investigate the level of agreement in detecting NeP between the revised NeuPSIG grading system and the LANSS and PD-Q.
Methods
In this retrospective study, two expert clinicians (Specialist Pain Medicine Physician and Advanced Scope Physiotherapist) independently reviewed 152 patient case notes and classified them according to the revised grading system. The consensus of the expert clinicians’ clinical classification was used as “gold standard” to determine the diagnostic accuracy of the two NeP screening tools.
Results
The two clinicians agreed in classifying 117 out of 152 patients (ICC 0.794, 95% CI 0.716–850; κ 0.62, 95% CI 0.50–0.73), yielding a 77% agreement. Compared to the clinicians’ consensus, both LANSS and PD-Q demonstrated limited diagnostic accuracy in detecting NeP (LANSS sensitivity 24%, specificity 97%; PD-Q sensitivity 53%, specificity 67%).
Conclusions
The application of the revised NeP grading system was feasible in our retrospective analysis of patients with neck/upper limb pain. High inter-rater percentage agreement was demonstrated. The hierarchical order of classification may lead to false negative classification. We propose that in the absence of sensory changes or diagnostic tests in patients with neck/upper limb pain, classification of NeP may be further improved using a cluster of clinical findings that confirm a relevant nerve lesion/disease, such as reflex and motor changes. The diagnostic accuracy of LANSS and PD-Q in identifying NeP in patients with neck/upper limb pain remains limited. Clinical judgment remains crucial to diagnosing NeP in the clinical practice.
Implications
Our observations suggest that in view of the heterogeneity in patients with neck/upper limb pain, a considerable amount of expertise is required to interpret the revised grading system. While the application was feasible in our clinical setting, it is unclear if this will be feasible to apply in primary health care settings where early recognition and timely intervention is often most needed. The use of LANSS and PD-Q in the identification of NeP in patients with neck/upper limb pain remains questionable.
Duckweed is a promising resource for future feed and food production as well as wastewater treatment. However, diseases and pests can critically limit the performance of the production systems. Patches of discolored and bleached duckweed (Lemna minor L.) appeared in hydroponic systems and spread rapidly through the crop. Pythium myriotylum was confirmed as the causing pathogen by microbiological and molecular biological analysis. This is the first report of P. myriotylum on duckweed in Germany. The result and possible countermeasures are discussed.
Ohmic heating (OH) is an alternative sustainable heating technology that has demonstrated its potential to modify protein structures and aggregates. Furthermore, certain protein aggregates, namely amyloid fibrils (AF), are associated with an enhanced protein functionality, such as gelation. This study evaluates how Ohmic heating (OH) influences the formation of AF structures from ovalbumin source under two electric field strength levels, 8.5 to 10.5 and 24.0–31.0 V/cm, respectively. Hence, AF aggregate formation was assessed over holding times ranging from 30 to 1200 sunder various environmental conditions (3.45 and 67.95 mM NaCl, 80, 85 and 90 °C, pH = 7). AF were formed under all conditions. SDS-PAGE revealed that OH had a higher tendency to preserve native ovalbumin molecules. Furthermore, Congo Red and Thioflavin T stainings indicated that OH reduces the amount of AF structures. This finding was supported by FTIR measurements, which showed OH samples to contain lower amounts of beta-sheets. Field flow fractioning revealed smaller-sized aggregates or aggregate clusters occurred after OH treatment. In contrast, prolonged holding time or higher treatment temperatures increased ThT fluorescence, beta-sheet structures and aggregate as well as cluster sizes. Ionic strength was found to dominate the effects of electric field strength under different environmental conditions.
The distribution of a species along a thermal gradient is commonly approximated by a unimodal response curve, with a characteristic single optimum near the tempera‐ture where a species is most likely to be found, and a decreasing probability of occur‐rence away from the optimum. We aimed at identifying thermal response curves (TRCs) of European freshwater species and evaluating the potential impact of climate warming across species, taxonomic groups, and latitude. We first applied generalized additive models using catchment‐scale global data on distribution ranges of 577 freshwater species native to Europe and four different temperature variables (the current annual mean air/water temperature and the maximum air/water temperature of the warmest month) to describe species TRCs. We then classified TRCs into one of eight curve types and identified spatial patterns in thermal responses. Finally, we in‐tegrated empirical TRCs and the projected geographic distribution of climate warm‐ing to evaluate the effect of rising temperatures on species’ distributions. For the different temperature variables, 390–463 of 577 species (67.6%–80.2%) were char‐acterized by a unimodal TRC. The number of species with a unimodal TRC decreased from central toward northern and southern Europe. Warming tolerance (WT = maxi‐mum temperature of occurrence—preferred temperature) was higher at higher lati‐tudes. Preferred temperature of many species is already exceeded. Rising temperatures will affect most Mediterranean species. We demonstrated that fresh‐water species’ occurrence probabilities are most frequently unimodal. The impact of the global climate warming on species distributions is species and latitude depend‐ent. Among the studied taxonomic groups, rising temperatures will be most detri‐mental to fish. Our findings support the efforts of catchment‐based freshwater management and conservation in the face of global warming.
The present study investigates consumers’ acceptance of Se-biofortified apples, as well as Se health and nutrition claims that have been approved by the European Commission. Despite indications that such statements are more likely to be accepted if the carrier product itself has a healthy image, unprocessed fruits biofortified with Se have not been investigated in this context yet. Apples as the most frequently-consumed type of fresh fruit in Germany may offer the potential to improve the Se status of consumers when the produce is enriched with Se. Therefore, an online survey of 356 German adults was conducted to analyze different aspects that could affect the perception of and preference for the proposed product concept by consumers. The findings indicate a moderate acceptance of Se-biofortified apples, as well as of Se health and nutrition claims among the participants. Additional information about beneficial health effects of Se had a significant impact on consumer acceptance. People who regularly eat convenience food and prefer to buy apples at supermarkets were particularly attracted by the product idea. In conclusion, the results of the study indicate good prospects for a successful introduction of Se-rich apples in the German food market, if the produce is advertised with approved health and nutrition claims.
After hesitating until the mid-2010s, German industry has now embraced the energy transition and moved to a driver. The pioneers of change are the major energy companies, followed large parts of industry which have initiated radical changes. Even the energy-intensive industries steel and chemistry are phasing out fossil fuels.
While developing traffic-based cognitive enhancement technology (CET), such as bike accident prevention systems, it can be challenging to test and evaluate them properly. After all, the real-world scenario could endanger the subjects’ health and safety. Therefore, a simulator is needed, preferably one that is realistic yet low cost. This paper introduces a way to use the video game Grand Theft Auto V (GTA V) and its sophisticated traffic system as a base to create such a simulator, allowing for the safe and realistic testing of dangerous traffic situations involving cyclists, cars, and trucks. The open world of GTA V, which can be explored on foot and via various vehicles, serves as an immersive stand-in for the real world. Custom modification scripts of the game give the researchers control over the experiment scenario and the output data to be evaluated. An off-the-shelf bicycle equipped with three sensors serves as a realistic input device for the subject’s movement direction and speed. The simulator was used to test two early-stage CET concepts enabling cyclists to sense dangerous traffic situations, such as trucks approaching from behind the cyclist. Thus, this paper also presents the user evaluation of the cycling simulator and the CET used by the subjects to sense dangerous traffic situations. With the knowledge of the first iteration of the user-centered design (UCD) process, this paper concludes by naming improvements for the cycling simulator and discussing further research directions for CET that enable users to sense dangerous situations better.
Quantitative Umweltbewertungen sind von entscheidender Bedeutung, wenn es darum geht, effektiv auf nachhaltige Produktions- und Verbrauchsmuster hinzuarbeiten. In den letzten Jahrzehnten haben sich Lebenszyklusanalysen (LCA) als praktikables Mittel zur Messung der Umweltauswirkungen von Produkten entlang der Lieferkette etabliert. In Bezug auf Nutzer- und Konsummuster wurden jedoch methodische Schwächen festgestellt, und es wurden mehrere Versuche unternommen, Ökobilanzen entsprechend zu verbessern, beispielsweise durch Einbeziehung von Effekten höherer Ordnung und verhaltenswissenschaftlicher Unterstützung. In einer Diskussion solcher Ansätze zeigen wir, dass den Konzepten des Verbrauchs keine explizite Aufmerksamkeit geschenkt wurde, was häufig zu produktzentrierten Bewertungen führt. Wir führen Theorien sozialer Praktiken ein, um Konsummuster für LCA zugänglich zu machen. Soziale Praktiken sind routinierte Handlungen, die aus miteinander verbundenen Elementen (Materialien, Kompetenzen und Bedeutungen) bestehen, die sie als eine Einheit denkbar machen (z. B. Kochen). Da die meisten sozialen Praktiken eine Art von Verbrauch (Material, Energie, Luft) beinhalten, konnten wir einen Rahmen entwickeln, der soziale Praktiken mit der Ökobilanz verbindet. Der vorgeschlagene Rahmen bietet eine neue Perspektive für quantitative Umweltbewertungen, indem er den Schwerpunkt von Produkten oder Nutzern auf soziale Praktiken verlagert. Dementsprechend sehen wir die Chance darin, die reduktionistische Sichtweise zu überwinden, dass Menschen nur Nutzer von Produkten sind, und sie stattdessen als Praktiker in sozialen Praktiken zu sehen. Dieser Wandel könnte neue Methoden der interdisziplinären Konsumforschung ermöglichen, die beabsichtigte Sozialwissenschaften und wirkungsorientierte Bewertungen einbeziehen. Allerdings bedarf der Rahmen einer weiteren Überarbeitung und vor allem einer empirischen Validierung.
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.
Household income determines access to specialized pediatric chronic pain treatment in Germany
(2016)
Background
Families with lower socioeconomic status (SES) often face problems with gaining access to health care services. Information is scarce on the relationship between SES and health care delivery for children suffering from chronic pain.
Methods
Families presenting to a specialized pain center (N = 1,001) provided information on ‘household income, ‘parental education’ and ‘occupation’ to aid the evaluation of their SES. To assess whether the SES of the clinical sample is representative of the general population, it was compared to data from a community sample (N = 14,558). For the clinical sample, travel distance to the clinic was described in relation to the 75 % catchment area. Multiple logistic regression was used to analyze the association between SES and the journey from outside the catchment area.
Results
The SES was significantly higher in the clinical sample than in the community sample. Within the clinical sample, the distance traveled to the pain center increased with increasing SES. The 75 % catchment area was 143 miles for families with the highest SES and 78 miles for the lowest SES. ‘Household income’ predicted travel distance (OR 1.32 (1.12–1.56)). Education and occupational status were not significant predictors of travel from outside the catchment area.
Conclusions
In Germany, specialized care for children with chronic pain is subject to disparities in access. Future activities should focus on identifying barriers to access and seeking to prevent inequalities in specialized pediatric health care delivery. Increasing the number of specialized treatment facilities could improve access to specialized pediatric pain treatment, regardless of socioeconomic determinants.
Dieser Artikel befasst sich mit dem bundesweiten Niveau der Treibhausgas (THG)-Emissionen und des Ressourcenverbrauchs in der deutschen Gemeinschaftsverpflegung im Segment "Business" und deren Einsparpotenziale durch verschiedene Szenarien der ungestützten und gestützten Rezeptüberarbeitung. Unter "ungestützt" verstehen wir in dieser Arbeit die intuitive Optimierung von Rezepten durch die Mitarbeiter von Betrieben der Gemeinschaftsverpflegung. Die "unterstützten" Ansätze mussten dagegen bestimmte Zielvorgaben erfüllen, zum Beispiel der Deutschen Gesellschaft für Ernährung; engl. Deutschen Gesellschaft für Ernährung oder das nachhaltige Niveau. Konkret Konkret wird getestet, wie sich (A) eine ungestützte Rezeptüberarbeitung, (B) eine Rezeptüberarbeitung auf Basis von Ernährungsempfehlungen und (C) eine Rezeptüberarbeitung mit wissenschaftlicher Begleitung die Umweltauswirkungen eines Gerichtes beeinflussen. Als methodischer Rahmen diente eine Online-Befragung von Unternehmen der Gemeinschaftsverpflegung sowie eine Szenarioanalyse auf Menüebene und auf nationaler Ebene durchgeführt. Die Ergebnisse basieren zum einen auf empirischen Daten und zum anderen auf Hochrechnungen. Die Ergebnisse zeigen, dass die die bundesweite Umsetzung der Rezepturüberarbeitung nach wissenschaftlichen Vorgaben - wie konkrete Zielvorgaben für die THG Emissionen pro Portion - bis zu 44% des Ressourcenverbrauchs in der deutschen Betriebsgastronomie einsparen kann (das entspricht 3,4 Millionen Tonnen Ressourcen pro Jahr) und bis zu 40 % der THG-Emissionen (0,6 Millionen Tonnen THG-Emissionen pro Jahr) einsparen.
Power consumption has become a major design constraint, especially for battery-powered embedded systems. However, the impact of software applications is typically considered in later phases, where both software and hardware parts are close to their finalization. Power-related issues must be detected in early stages to keep the development costs low, satisfy time-to-market, and avoid cost-intensive redesign loops. Moreover, the variety of hardware components, architectures, and communication interfaces make the development of embedded software more challenging. To manage the complexity of software applications, approaches such as model-driven development (MDD) may be used. This article proposes a power-estimation approach in MDD for software application models in early development phases. A unified modeling language (UML) profile is introduced to model power-related properties of hardware components. To determine the impact of software applications, we defined two analysis methods using simulation data and a novel in-the-loop concept. Both methods may be applied at different development stages to determine an energy trace, describing the energy-related behavior of the system. A novel definition of energy bugs is provided to describe power-related misbehavior. We apply our approach to a sensor node example, demonstrate an energy bug detection, and compare the runtime and accuracy of the analysis methods.
The apple fruit (Malus domestica L. Borkh) is one of the most popular fruits worldwide. Beyond their beneficial properties, apples contain proteins that trigger allergic reactions in susceptible consumers. Mal d1 to d4 are allergens present in a variety of different isoforms in apples. In this study, we used proteomics to quantify all four Mal d proteins in 52 apple genotypes with varying allergenic potentials. A total of 195, 17, 14, and 18 peptides were found to be related to Mal d1, d2, d3, and d4 proteins, respectively of which 25 different Mal d proteins could be unambiguously identified. The allergenic potential of the Mal d isoforms was characterized by comparing the isoform abundance with the allergenic score of genotypes from oral challenge tests. The detected Mal d peptides presumably have different IgE binding properties and could be used as potential molecular markers to discriminate between hypoallergenic and hyperallergenic cultivars.
Multiple-group confirmatory factor analysis (MG-CFA) is among the most productive extensions of.structural equation modeling. Many researchers conducting cross-cultural or longitudinal studies are interested in testing for measurement and structural invariance. The aim of the present paper is to provide a tutorial in MG-CFA using the freely available R-packages lavaan, semTools, and semPlot. The combination of these packages enable a highly efficient analysis of the measurement models both for normally distributed as well as ordinal data. Data from two freely available datasets – the first with continuous the second with ordered indicators - will be used to provide a walk-through the individual steps.
The development of non-precious metal-based electrodes that actively and stably support the oxygen evolution reaction (OER) in water electrolysis systems remains a challenge, especially at low pH levels. The recently published study has conclusively shown that the addition of haematite to H2 SO4 is a highly effective method of significantly reducing oxygen evolution overpotential and extending anode life. The far superior result is achieved by concentrating oxygen evolution centres on the oxide particles rather than on the electrode. However, unsatisfactory Faradaic efficiencies of the OER and hydrogen evolution reaction (HER) parts as well as the required high haematite load impede applicability and upscaling of this process. Here it is shown that the same performance is achieved with three times less metal oxide powder if NiO/H2 SO4 suspensions are used along with stainless steel anodes. The reason for the enormous improvement in OER performance by adding NiO to the electrolyte is the weakening of the intramolecular O─H bond in the water molecules, which is under the direct influence of the nickel oxide suspended in the electrolyte. The manipulation of bonds in water molecules to increase the tendency of the water to split is a ground-breaking development, as shown in this first example.
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
Beta-blocker (BB) therapy plays a central role in the treatment of cardiovascular diseases. An increasing number of patients with cardiovascular diseases undergoe noncardiac surgery, where opioids are an integral part of the anesthesiological management. There is evidence to suggest that short-term intravenous BB therapy may influence perioperative opioid requirements due to an assumed cross-talk between G-protein coupled beta-adrenergic and opioid receptors. Whether chronic BB therapy could also have an influence on perioperative opioid requirements is unclear.
Methods
A post hoc analysis of prospectively collected data from a multicenter observational (BioCog) study was performed. Inclusion criteria consisted of elderly patients (≥ 65 years) undergoing elective noncardiac surgery as well as total intravenous general anesthesia without the use of regional anesthesia and duration of anesthesia ≥ 60 min. Two groups were defined: patients with and without BB in their regular preopreative medication. The administered opioids were converted to their respective morphine equivalent doses. Multiple regression analysis was performed using the morphine-index to identify independent predictors.
Results
A total of 747 patients were included in the BioCog study in the study center Berlin. 106 patients fulfilled the inclusion criteria. Of these, 37 were on chronic BB. The latter were preoperatively significantly more likely to have arterial hypertension (94.6%), chronic renal failure (27%) and hyperlipoproteinemia (51.4%) compared to patients without BB. Both groups did not differ in terms of cumulative perioperative morphine equivalent dose (230.9 (BB group) vs. 214.8 mg (Non-BB group)). Predictive factors for increased morphine-index were older age, male sex, longer duration of anesthesia and surgery of the trunk. In a model with logarithmised morphine index, only gender (female) and duration of anesthesia remained predictive factors.
Conclusions
Chronic BB therapy was not associated with a reduced perioperative opioid consumption.
Duckweeds can be potentially used in human and animal nutrition, biotechnology or wastewater treatment. To cultivate large quantities of a defined product quality, a standardized production process is needed. A small-scale, re-circulating indoor vertical farm (IVF) with artificial lighting and a nutrient control and dosing system was used for this purpose. The influence of different light intensities (50, 100 and 150 µmol m−2 s−1) and spectral distributions (red/blue ratios: 70/30, 50/50 and 30/70%) on relative growth rate (RGR), crude protein content (CPC), relative protein yield (RPY) and chlorophyll a of the duckweed species Lemna minor and Wolffiella hyalina were investigated. Increasing light intensity increased RGR (by 67% and 76%) and RPY (by 50% and 89%) and decreased chlorophyll a (by 27% and 32%) for L. minor and W. hyalina, respectively. The spectral distributions had no significant impact on any investigated parameter. Wolffiella hyalina achieved higher values in all investigated parameters compared to L. minor. This investigation proved the successful cultivation of duckweed in a small-scale, re-circulating IVF with artificial lighting.
In order to produce protein-rich duckweed for human and animal consumption, a stable cultivation process, including an optimal nutrient supply for each species, must be implemented. Modified nutrient media, based on the N-medium for duckweed cultivation, were tested on the relative growth rate (RGR) and crude protein content (CPC) of Lemna minor and Wolffiella hyalina, as well as the decrease of nitrate-N and ammonium-N in the media. Five different nitrate-N to ammonium-N molar ratios were diluted to 10% and 50% of the original N-medium concentration. The media mainly consisted of agricultural fertilizers. A ratio of 75% nitrate-N and 25% ammonium-N, with a dilution of 50%, yielded the best results for both species. Based on the dry weight (DW), L. minor achieved a RGR of 0.23 ± 0.009 d−1 and a CPC of 37.8 ± 0.42%, while W. hyalina’s maximum RGR was 0.22 ± 0.017 d−1, with a CPC of 43.9 ± 0.34%. The relative protein yield per week and m2 was highest at this ratio and dilution, as well as the ammonium-N decrease in the corresponding medium. These results could be implemented in duckweed research and applications if a high protein content or protein yield is the aim.
Vanadium carbide (VC) reinforced FeCrVC hardfacings have become important to improving the lifetime of tools suffering abrasive and impressive loads. This is because the microstructural properties of such hardfacings enable the primary VCs to act as obstacles against the penetrating abrasive. Because dilution is supposed to be the key issue influencing the precipitation behaviour of primary carbides during surfacing, the development of deposit welding processes exhibiting a reduced thermal impact, and hence lower dilution to the base material, is the primary focus of the current research. By inserting an additional hot wire in the melt, an approach was developed to separate the material and energy input during gas metal arc welding (GMAW) and hence realised low dilution claddings. The carbide content could be increased, and a grain refinement was observed compared with conventional GMAW. These effects could be attributed to both the reduced dilution and heterogeneous nucleation.
Introduction Development and implementation of appropriate health policy is essential to address the rising global burden of non-communicable diseases (NCDs). The aim of this study was to evaluate existing health policies for integrated prevention/management of NCDs among Member States of the Organisation for Economic Co-operation and Development (OECD). We sought to describe policies’ aims and strategies to achieve those aims, and evaluate extent of integration of musculoskeletal conditions as a leading cause of global morbidity.
Methods Policies submitted by OECD Member States in response to a World Health Organization (WHO) NCD Capacity Survey were extracted from the WHO document clearing-house and analysed following a standard protocol. Policies were eligible for inclusion when they described an integrated approach to prevention/management of NCDs. Internal validity was evaluated using a standard instrument (sum score: 0–14; higher scores indicate better quality). Quantitative data were expressed as frequencies, while text data were content-analysed and meta-synthesised using standardised methods.
Results After removal of duplicates and screening, 44 policies from 30 OECD Member States were included. Three key themes emerged to describe the general aims of included policies: system strengthening approaches; improved service delivery; and better population health. Whereas the policies of most countries covered cancer (83.3%), cardiovascular disease (76.6%), diabetes/endocrine disorders (76.6%), respiratory conditions (63.3%) and mental health conditions (63.3%), only half the countries included musculoskeletal health and pain (50.0%) as explicit foci. General strategies were outlined in 42 (95.5%) policies—all were relevant to musculoskeletal health in 12 policies, some relevant in 27 policies and none relevant in three policies. Three key themes described the strategies: general principles for people-centred NCD prevention/management; enhanced service delivery; and system strengthening approaches. Internal validity sum scores ranged from 0 to 13; mean: 7.6 (95% CI 6.5 to 8.7).
Conclusion Relative to other NCDs, musculoskeletal health did not feature as prominently, although many general prevention/management strategies were relevant to musculoskeletal health improvement.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial.
Possessing skills in social and intercultural interaction is vitally important for employees who work in globalized environments, especially as people's working lives tend to involve an increasingly large amount of service-related activities. As a consequence, universities offer cultural studies courses and strive to enable their students to study abroad for a period of time. However, there is still no widely shared agreement on how intercultural experiences and cultural preparation courses predict the perception, thinking and acting of individuals. Therefore, the study at hand uses a cross-sectional design with N = 430 participants in order to investigate whether students of cultural studies gain more intercultural competencies during the time spent studying abroad, compared to studies of other subjects. The results reveal that students of cultural subjects show significantly higher levels of cultural empathy and openness in the post hoc measurement, even though there was no interaction effect with the amount of time spent studying abroad. Length of stay abroad had a significant indirect effect on social competence via all the dimensions of the Multicultural Personality Questionnaire. Moreover, results indicate that flexibility to adapt one's behaviour to cultural norms may predict problems when returning to one's home country.
Objective: To pilot benchmark measures of health information and communication technology (ICT) availability and use to facilitate cross-country learning.
Materials and Methods: A prior Organization for Economic Cooperation and Development–led effort involving 30 countries selected and defined functionality-based measures for availability and use of electronic health records, health information exchange, personal health records, and telehealth. In this pilot, an Organization for Economic Cooperation and Development Working Group compiled results for 38 countries for a subset of measures with broad coverage using new and/or adapted country-specific or multinational surveys and other sources from 2012 to 2015. We also synthesized country learnings to inform future benchmarking.
Results: While electronic records are widely used to store and manage patient information at the point of care—all but 2 pilot countries reported use by at least half of primary care physicians; many had rates above 75%—patient information exchange across organizations/settings is less common. Large variations in the availability and use of telehealth and personal health records also exist.
Discussion: Pilot participation demonstrated interest in cross-national benchmarking. Using the most comparable measures available to date, it showed substantial diversity in health ICT availability and use in all domains. The project also identified methodological considerations (e.g., structural and health systems issues that can affect measurement) important for future comparisons.
Conclusion: While health policies and priorities differ, many nations aim to increase access, quality, and/or efficiency of care through effective ICT use. By identifying variations and describing key contextual factors, benchmarking offers the potential to facilitate cross-national learning and accelerate the progress of individual countries.
Background:
One of the main problems of Internet-delivered interventions for a range of disorders is the high dropout rate, yet little is known about the factors associated with this. We recently developed and tested a Web-based 6-session program to enhance motivation to change for women with anorexia nervosa, bulimia nervosa, or related subthreshold eating pathology.
Objective:
The aim of the present study was to identify predictors of dropout from this Web program.
Methods:
A total of 179 women took part in the study. We used survival analyses (Cox regression) to investigate the predictive effect of eating disorder pathology (assessed by the Eating Disorders Examination-Questionnaire; EDE-Q), depressive mood (Hopkins Symptom Checklist), motivation to change (University of Rhode Island Change Assessment Scale; URICA), and participants’ age at dropout. To identify predictors, we used the least absolute shrinkage and selection operator (LASSO) method.
Results:
The dropout rate was 50.8% (91/179) and was equally distributed across the 6 treatment sessions. The LASSO analysis revealed that higher scores on the Shape Concerns subscale of the EDE-Q, a higher frequency of binge eating episodes and vomiting, as well as higher depression scores significantly increased the probability of dropout. However, we did not find any effect of the URICA or age on dropout.
Conclusions:
Women with more severe eating disorder pathology and depressive mood had a higher likelihood of dropping out from a Web-based motivational enhancement program. Interventions such as ours need to address the specific needs of women with more severe eating disorder pathology and depressive mood and offer them additional support to prevent them from prematurely discontinuing treatment.
The central objective of early prevention in Germany is an improved cooperation between professional groups of the health services and child and youth welfare in interprofessional networks. This objective derives from the realisation that proper care for families with infants can only be achieved if the various groups act in close integration. The ‘Federal Initiative early prevention’ explicitly calls for freelance midwives to be integrated in this context. However, only a few scientific findings on midwives’ cooperation in networks of early prevention have been published to date. This integrative review aims to identify the central themes of interprofessional cooperation of midwives in out-of-hospital obstetrical care from national and international research literature. A systematic search of five research databases for publications between 2005 and 2015 was performed, complemented by a manual search. 25 studies were identified describing various contexts where midwives in out-of-hospital obstetrical care cooperate with other professional groups. Four key themes were analysed: contexts of cooperation, benefits of cooperation, facilitating and restrictive factors of cooperation, and competencies of cooperation. The studies show that there is only limited research coverage of the midwives’ perspective regarding interprofessional cooperation. The existing studies examine the cooperation of midwives primarily with health care professionals, and secondarily with professionals in the social services. In order to expand knowledge on the cooperation of freelance midwives in the networks of early prevention, future research should focus on the perspective of midwives regarding cooperation with other professional groups, both in the health care sector and in the field of social services.
The political geography of central government debt has hardly been investigated. We propose a method for calculating implicit interregional transfers stemming from central government debt.
We apply this method to Belgium over the 1970-2016 period. The share of poorer Francophone Belgium in debt-financed central government spending was persistently larger than its share in central government revenue used to pay the resulting interest bills. The opposite holds for richer Flanders. Also, a primary deficit in one particular year leads to an interest bill in each of the following years as long as debt caused by that primary deficit is not repaid. All the above caused debt-related transfers from Flanders to Francophone Belgium of over 7% of Flemish GDP during many years.
Interregional interest transfers may also be large in the many other democracies suffering from both high central government debt and considerable geographic income disparities.
The size of these transfers may in turn explain the size and persistence of central government deficits. This is also because poorer, less densely populated regions such as Francophone Belgium tend to be overrepresented within central governments. This strengthens their ability to cause deficits.
We recommend more fiscal decentralisation or at least smaller central government deficits.
Background: The majority of health IT adoption research focuses on the later stages of the IT adoption process: namely on the implementation phase. The first stage, however, which is defined as the knowledge-stage, remains widely unobserved. Following Rogers’ Diffusion of Innovation Theory (DOI) this paper presents a research framework to examine the possible lack of shared IT awareness-knowledge, i.e. an information gradient, of two crucial stakeholders, the Chief Information Officer (CIO) and the Director of Nursing (DoN). This study shall answer the following research questions: (1.) Does this gradient exist? (2.) Which direction does it have? (3.) Are certain health IT (HIT) attributes associated with a potential gradient? (4.) Which determinants of diffusion go along with this gradient?
Method: Results of two surveys that focused on the topic “IT support of clinical workflows” from the viewpoint of CIOs and DoNs with corresponding datasets from 75 hospitals were used in a secondary data analysis. The gradient was operationalised by measuring the disagreement of CIOs and DoNs on the availability and implementation status of 29 IT functions. HIT attributes tested were relevance and market penetration of the IT functions, determinants of diffusion were inter-professional leadership and IT service density.
Results: The analysis revealed a significant disagreement on the availability of 9 out of 29 HIT functions. In 23 HIT functions, the CIOs reported a higher implementation status than the DoNs, which pointed to a trend for a unidirectional gradient. The disagreement was significantly lower when the relevance of the IT function was high. Both determinants of diffusion correlated significantly negative with the degree of disagreement.
Conclusion: This is the first study to empirically examine shared awareness-knowledge of two IT-stakeholders that are crucial for triggering IT adoption on the frontline level in hospitals. It could be shown that a gradient and thus a lack of shared awareness-knowledge existed and was associated with certain factors. In conclusion, hospitals should implement improved cooperation between IT staff and clinicians and IT service density when establishing the prerequisites for successful IT adoption processes.
Background: IT adoption is a process that is influenced by different external and internal factors. This study aimed
1. to identify similarities and differences in the prevalence of medical and nursing IT systems in Austrian and German hospitals, and
2. to match these findings with characteristics of the two countries, in particular their healthcare system, and with features of the hospitals.
Methods: In 2007, all acute care hospitals in both countries received questionnaires with identical questions. 12.4% in Germany and 34.6% in Austria responded.
Results: The surveys revealed a consistent higher usage of nearly all clinical IT systems, especially nursing systems, but also PACS and electronic archiving systems, in Austrian than in German hospitals. These findings correspond with a significantly wider use of standardised nursing terminologies and a higher number of PC workstations on the wards (average 2.1 PCs in Germany, 3.2 PCs in Austria). Despite these differences, Austrian and German hospitals both reported a similar IT budget of 2.6% in Austria and 2.0% in Germany (median).
Conclusions: Despite the many similarities of the Austrian and German healthcare system there are distinct differences which may have led to a wider use of IT systems in Austrian hospitals. In nursing, the specific legal requirement to document nursing diagnoses in Austria may have stimulated the use of standardised terminologies for nursing diagnoses and the implementation of electronic nursing documentation systems. Other factors which correspond with the wider use of clinical IT systems in Austria are: good infrastructure of medical-technical devices, rigorous organisational changes which had led to leaner processes and to a lower length of stay, and finally a more IT friendly climate. As country size is the most pronounced difference between Germany and Austria it could be that smaller countries, such as Austria, are more ready to translate innovation into practice.
The last two decades have been characterized by a fundamental change in the approaches, tools and instruments in the quality management at Higher Education Institutions. Comparison of two Higher Education Institutions in the Slovak Republic and Germany highlights similarities and trends in quality assurance. Both case studies show how multifaceted the quality management is, and the needs to be approached if a meaningful progress is to be made. Complexity has to be explicitly recognized and built into the approach chosen. Higher Education Institutions have to develop internal quality assurance processes. Quality culture is key for addressing the challenges.
Introduction: Handovers are a central process for ensuring information continuity in patient care and, therefore, possess a major influence on patient safety as errors due to poor handovers can lead to life-threatening events. Education to improve handovers and ensure safe patient care can be supported by using critical incident reporting systems (CIRS). The aim of the study is to perform a content analysis of a national CIRS-database with regard to identifying adverse events in handovers situations and to derive competencies for the development of continuing education from these findings.
Methods: A meta model served as a research framework to merge the empirical findings with the London protocol of analysing critical events and the Canadian framework of safety competencies. Relevant cases to be investigated were searched in a freely accessible German CIRS database.
Results: A total of 253 case descriptions were found and analysed. Team factors emerged as the most frequently reported influencing factors following the analysis of the London protocol. Communication errors and missing information as well as a lack of appropriate standards and processes appeared to be the main reasons for critical events to occur. Most of the events happened in units involving surgery and intensive care. A mapping of patient safety competences with the reasons for critical events was conducted in order to determine the practical, concrete and handover related competencies.
Conclusion: Data from a CIRS database and theoretical frameworks can be combined to extract meaningful information about patient safety risks in handover situations. The results are useful for developing curricula to improve handovers based on patient safety competencies.
Background: Pancreatic cancer is one of the malignant diseases with the highest cancer-specific mortality. At the time of diagnosis, life expectancy is often already very limited, as it is usually discovered late and in an advanced stage. Coping with cancer is a complex process. Coping strategies of patients with pancreatic cancer probably differ from those of other malignancies. Yet to date, there exists no pancreatic cancer-specific coping model.
Objective: The objective of this scoping review is to explore and characterize the academic literature related to coping processes in patients with pancreatic cancer.
Methods/Design: The JBI's three-step search strategy, combined with the Arksey and O'Malley framework, will be used to identify articles via PubMed/MEDLINE, CINAHL, Cochrane Library, Google Scholar, CAMbase, CareLit, CC Med, Scopus, and PsycARTICLES (Arksey & O'Malley, 2005; Peters et al., 2017). It follows the PRISMA guidelines for scoping reviews (Tricco et al., 2018). Primary and secondary studies and reviews which report on coping with pancreatic cancer (adenocarcinoma) in adults in English or German language will be included in this scoping review, regardless of publication date or study design.
Discussion: This scoping review will add new insights on coping with pancreatic cancer by summarizing current knowledge, and identifying research
The study aimed to investigate inactivation of naturally occurring microorganisms and quality of red pepper paste treated by high pressure processing (HPP). Central composite rotatable design was employed to determine the impacts of pressure (100–600 MPa) and holding time (30–600 s). HPP at 527 MPa for 517 s reduced aerobic mesophilic bacteria count by 4.5 log CFU/g. Yeasts and molds counts were reduced to 1 log CFU/g at 600 MPa for 315 s. Total phenols, carotenoids and antioxidants activity ranged from 0.28 to 0.33 g GAE/100 g, 96.0–98.4 mg βc/100 g and 8.70–8.95 μmol TE/g, respectively. Increase (2.5–6.7%) in these variables was observed with increasing pressure and holding time. Total color difference (ΔE∗) values (0.2–2.8) were within the ranges of ‘imperceptible’ to ‘noticeable’. Experimental results were fitted satisfactorily into quadratic model with higher R2 values (0.8619–0.9863). Optimization process suggested treatment of red pepper paste at 536 MPa for 125 s for maximum desirability (0.622). Validation experiments confirmed comparable percentage of relative errors. Overall, this technique could be considered as an efficient treatment for the inactivation of microorganisms that naturally occur in red pepper paste with minimal changes in its characteristics.
Background
Spinach is a nitrogen (N) demanding crop with a weekly N uptake of up to 60 kg ha–1. Consequently, a high N supply is required, which can temporarily lead to high quantities of nitrate (NO3–) being at risk of leaching.
Aims
The objective of this study was to develop a N fertilization approach to reduce the risk of NO3– leaching in field-grown spinach production without adversely affecting crop yield and quality at an early and late harvest stage.
Methods
Ten fertilization trials were conducted to compare different base fertilization rates and splits of top dressings. For top dressings, granulated fertilizers or foliar sprays were used. In a further treatment, N supply was reduced by withholding the second top dressing of 50–70 kg ha−1.
Results
Nitrate concentration at risk of leaching was considerably reduced by decreasing the base fertilizer rate as well as by splitting the top dressing. However, at an early harvest stage, total aboveground dry mass was reduced by, on average, 6% by these measures across all seasons. In contrast, at a later harvest stage, spinach was less affected by the fertilizer schedule. Urea foliar sprays proved to be insufficient in promoting plant growth and caused leaf necrosis. A reduced N supply led to impaired plant growth and yellowish leaves in both spring and winter.
Conclusions
Base N fertilization of spinach is only required in spring, but not in other seasons. Despite slight yield reduction, the top dressing should be split to reduce the risk of NO3− leaching after an early harvest.
Objectives: To identify emancipatory strategies to strengthen the social protagonism of recyclable materials collectors in the light of entrepreneurial Nursing care.
Methods: Qualitative study carried out in two stages: field approach from healthcare interventions in a Recycling Materials Association, and individual interviews conducted between October and December 2018.
Results: The analysis resulted in three thematic categories: Social contribution of recyclable materials collectors; From the assistentialist perception to entrepreneurial Nursing care; Emancipatory strategies of recycling work.
Final Considerations: The emancipatory strategies to strengthen the social protagonism of recyclable materials collectors in the light of entrepreneurial Nursing care are related to the appreciation, recognition and enhancement of social work that has been already performed by these professionals, and to the creation of spaces for the socialization of experiences, expectations and perspectives.
Objective:
to carry out a theoretical reflection on the Nursing Now Campaign and the experience of the unexpected irruptions facing the pandemic period.
Method:
a theoretical-reflective study, supported by the theoretical framework of complexity thinking. It aims at understanding the dialogic between the notions of order, disorder and organization, which translate the transition from simplification to complexity of the pandemic phenomenon and its relation to the theme of Nursing Now and Nursing in the future.
Results:
the universe of phenomena is simultaneously composed of order, disorder and organization. Reasserting the central role of Nursing in the health team, facing the irruptions and uncertainties caused by the current pandemic, implies the ability to dialog with disorder and raise a new and more complex global (re)organization of the being and doing Nursing.
Conclusion:
in addition to answers, theoretical reflection raises new questions and irruptions. The inseparability between the notions of order and disorder in the evolutionary dynamics of the Nursing system is conceived and the promotion of even more complex levels of organization, management and Nursing assistance to achieve universal access to health is advocated.
Objectives: Among varied challenges of COVID-19, challenges in food and nutrition security world-over are critical. We compared the nutritional policy responses in India and Germany since both countries differ on the Human Development Index, yet both have committed to the G20 common policy response to COVID-19, besides the comparability of two large and heterogeneously populated countries, both having democratic governments.
Methods: Policy research publications were reviewed using qualitative meta-policy approach. We used comparative case-study. Recent food and nutrition policies of G20 nations of India and Germany were evaluated.
Results: India has primarily targeted her public distribution system and Germany has primarily targeted her food markets in order to manage the food and nutrition security in response to COVID-19. Both countries are coordinating additional associated nutritional policies, policies and strategies to effect an integrated sectoral approach to COVID-19 management. Both are using corrective measures of the process management strategies as well. However, the Indian management of micronutrient security for her population has over COVID-19 times acerbated and the German loan management to nutrition and agricultural small-scale industry appears to be functioning sub-optimally.
Conclusions: Our analysis indicates both India and Germany have responded to COVID-19 in a timely and appropriate manner regarding the food and nutrition security measures. Even so not all measures employed to tackle COVID-19 food and nutrition security have been effectively implemented, It appears, that both countries are using integrated policy in their nutrition and food security response to COVID-19.
Current discussions about the concept of nutritional sustainability show a high complexity of this topic leading to many different definitions. Regarding communication issues of nutritional sustainability between actors of food chains this complexity should be reduced. One opportunity to tackle these challenges of reducing complexity might be the concept of ingredient branding. Therefore, the aim of this mini-review is the identification of conditions for ingredient branding application as a communication strategy for nutritional sustainability which might overcome challenges in communicating the complexity between the different stakeholders of supply chains. In doing so, the specific case of agrifood chains is discussed based on the selected characteristics of globalization, increasing consumer demands, foods incorporating credence attributes and price. Along the agrifood chain, a sourcing strategy reflecting nutritional and sustainable aspects might lead to an ingredient branding strategy implying a brand policy for a special ingredient within the final product which is an important component but cannot be clearly recognized by the user. A “nutritional sustainability inside” strategy should reflect the multifaceted information along the agrifood chain and should be based on standardized criteria for nutritional sustainability.
Duckweed is gaining attention in animal nutrition and is considered as a potential alternative protein source for broiler chickens. In order to evaluate the nutritional value of duckweed, three individual batches were investigated. They consisted of a mixture of Lemna minuta and Lemna minor (A, 17.5% crude protein), Spirodela polyrhiza (B, 24.6% crude protein) and Lemna obscura (C, 37.0% crude protein). Treatment diets contained 50% batch A, 50% batch B, and 25, 50 and 75% of batch C. All diets were fed to broiler chickens (Ross 308) from an age of 21 to 27 days. Diets with a share of 50 and 75% of batch C led to decreased feed intake (109.3 and 74.9 g/day, respectively) compared to the control. Standardized ileal digestibility of crude protein and amino acids differed significantly between duckweed batches, at values for methionine between 49.9 and 90.4%. For all amino acids, batch A consistently had the lowest and batch C the highest digestibility. Batches had different tannin contents of 2943, 2890 and 303 mg/kg for batches A, B and C, respectively. The apparent ileal digestibility of phosphorus differed significantly between all batches (50.8–78.9%). Duckweed can be used as a protein feed for broiler chickens. However, a defined and stable biomass composition optimized for the requirements of broiler chickens is needed.
Objectives
The aim of this Delphi survey was to establish an international consensus on the most useful outcome measures for research on the effectiveness of non-pharmacological interventions for migraine. This is important, since guidelines for pharmacological trials recommend measuring the frequency of headaches with 50% reduction considered a clinically meaningful effect. It is unclear whether the same recommendations apply to complementary (or adjunct) non-pharmacological approaches, whether the same cut-off levels need to be considered for effectiveness when used as an adjunct or stand-alone intervention, and what is meaningful to patients.
Setting
University-initiated international survey.
Participants
The expert panel was chosen based on publications on non-pharmacological interventions in migraine populations and from personal contacts. 35 eligible researchers were contacted, 12 agreed to participate and 10 completed all 3 rounds of the survey. To further explore how migraine patients viewed potential outcome measures, four migraine patients were interviewed and presented with the same measurement tools as the researchers.
Procedures
The initial Delphi round was based on a systematic search of the literature for outcome measures used in non-pharmacological interventions for headache. Suggested outcome measures were rated by each expert, blinded towards the other members of the panel, for its usefulness on a 5-point Likert scale ranging from definitely not useful to extremely useful. Results were combined using median values and IQRs. Tools rated overall as definitely or probably not useful were excluded from subsequent rounds. Experts further suggested additional outcome measures that were presented to the panel in subsequent rounds. Additionally, experts were asked to rank the most useful tools and provide information on feasible cut-off levels for effectiveness for the three highest ranked tools.
Results
Results suggest the use of the Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT-6) and headache frequency as primary outcome measures. Patient experts suggested the inclusion of a measure of quality of life and evaluation of associated symptoms and fear of attacks.
Conclusions
Recommendations are for the use of the MIDAS, the HIT-6 and headache frequency, in combination with an outcome measure for quality of life. Associated symptoms and fear of attacks should also be considered as secondary outcomes, if relevant for the individual target population. The cut-off level for effectiveness should be lower for non-pharmacological interventions, especially when used as an adjunct to medication.
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.
Over the past decade, the proliferation of entrepreneurial ventures and small firms with sustainable business models have pushed the sustainability agenda in the fashion industry. Despite prominent success stories, these companies often encounter significant operative challenges that hinder growth or even cause business failure. This paper adopts a qualitative research design and uses data gathered during 18 expert interviews with entrepreneurs and executive managers of 18 firms from 13 countries to identify and explore the dominant challenges that micro- and small-sized sustainable fashion companies struggle with. The results indicate that communicating with consumers is perceived as surprisingly difficult, especially because sustainable brands need to justify higher prices and explain the added benefits of their products. Second, resource constraints lead to operative friction and overburdening of the decision makers and their small management teams. Third, sustainable sourcing and production processes are economically difficult in an industry that continues to occupy a mass and low-cost logic. Against the background of these insights, a range of managerial recommendations are developed and contextualized in the framework of the Business Model Canvas. This novel approach makes the suggestions which are rooted in the resource-based view actionable and supports sustainable businesses to better manage their operations and achieve growth. For example, collaborative approaches with different stakeholders may mitigate constraints across all three identified problem areas.
The assessment of somatosensory function is a cornerstone of research and clinical practice in neurology. Recent initiatives have developed novel protocols for quantitative sensory testing (QST). Application of these methods led to intriguing findings, such as the presence lower pain-thresholds in healthy children compared to healthy adolescents. In this article, we (re-) introduce the basic concepts of signal detection theory (SDT) as a method to investigate such differences in somatosensory function in detail. SDT describes participants’ responses according to two parameters, sensitivity and response-bias. Sensitivity refers to individuals’ ability to discriminate between painful and non-painful stimulations. Response-bias refers to individuals’ criterion for giving a “painful” response. We describe how multilevel models can be used to estimate these parameters and to overcome central critiques of these methods. To provide an example we apply these methods to data from the mechanical pain sensitivity test of the QST protocol. The results show that adolescents are more sensitive to mechanical pain and contradict the idea that younger children simply use more lenient criteria to report pain. Overall, we hope that the wider use of multilevel modeling to describe somatosensory functioning may advance neurology research and practice.
Complete diets for laying hens are usually offered in meal form. This form initially promotes the laying hens’ natural feed intake behavior and allows them to satisfy their pecking behavior. At the same time, it can also cause difficulties, because it consists of different particles and is not a homogeneous unit. A homogeneous mixture is essential to ensure that each laying hen in the flock can meet its nutritional needs. If feed exhibits a wide particle size distribution, this can promote feed segregation during transport and selective feed intake behavior of laying hens. These two processes sometimes lead to significant differences between the composition of the feed produced and the composition of the feed that is finally ingested by the laying hens. Multi-stage sampling can be used to investigate progressing differences in feed composition. In this study, samples of different complete diets for laying hens (n = 76) were collected from ten organic farms in Germany to examine their particle size distributions (dry sieve analysis). Samples were taken at four different locations (V1 = loading, V2 = silo, V3 = at the beginning of the feed chain, V4 = at the end of the feed chain) in each farm. There was a tendency for V1 and V2 to be characterized by high proportions of particles between 1400 and 3150 µm (V1 = 61.2%, V2 = 43.5%). V3 and V4 consisted mainly of particles of size 500–800 µm and 200–400 µm, respectively. The lowest proportions across all variants were in the range above 3150 µm (V1 = 2.20%, V2 = 1.30%, V3 = 1.00%, V4 = 0.400%) and between 400 and 500 µm (V1 = 2.50%, V2 = 4.50%, V3 = 5.70%, V4 = 6.60%). The mean value comparison of the proportions of sieve mesh sizes from 200 to 1000 µm resulted in: V1 < V2 < V3 < V4; and of sieve mesh sizes between 1400 and 2000 µm in: V1 > V2 > V3 > V4. This observation can be explained by segregation of the feed during transport and a selective feeding behavior of the laying hens. However, trends were discontinuous and varied between the farms. Deviations from the guideline values were found in particular for particle sizes in the range of 1000 to 1400 µm.
Background
Digital health technologies enable patients to make a personal contribution to the improvement of their health by enabling them to manage their health. In order to exploit the potential of digital health technologies, Internet-based networking between patients and health care providers is required. However, this networking and access to digital health technologies are less prevalent in sociodemographically deprived cohorts. The paper explores how the use of digital health technologies, which connect patients with health care providers and health insurers has changed during the COVID-19 pandemic.
Methods
The data from a German-based cross-sectional online study conducted between April 29 and May 8, 2020, were used for this purpose. A total of 1.570 participants were included in the study. Accordingly, the influence of sociodemographic determinants, subjective perceptions, and personal competencies will affect the use of online booking of medical appointments and medications, video consultations with providers, and the data transmission to health insurers via an app.
Results
The highest level of education (OR 1.806) and the presence of a chronic illness (OR 1.706) particularly increased the likelihood of using online booking. With regard to data transmission via an app to a health insurance company, the strongest increase in the probability of use was shown by belonging to the highest subjective social status (OR 1.757) and generation Y (OR 2.303). Furthermore, the results show that the higher the subjectively perceived restriction of the subjects' life situation was due to the COVID-19 pandemic, the higher the relative probability of using online booking (OR 1.103) as well as data transmission via an app to a health insurance company (OR 1.113). In addition, higher digital literacy contributes to the use of online booking (OR 1.033) and data transmission via an app to the health insurer (OR 1.034).
Conclusions
Socially determined differences can be identified for the likelihood of using digital technologies in health care, which persist even under restrictive conditions during the COVID-19 pandemic. Thus, the results indicate a digital divide with regard to the technologies investigated in this study.