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Building a well-founded understanding of the concepts, tasks and limitations of IT in all areas of society is an essential prerequisite for future developments in business and research. This applies in particular to the healthcare sector and medical research, which are affected by the noticeable advances in digitization. In the transfer project “Zukunftslabor Gesundheit” (ZLG), a teaching framework was developed to support the development of further education online courses in order to teach heterogeneous groups of learners independent of location and prior knowledge. The study at hand describes the development and components of the framework.
The increasing variety of combinations of different building technology components offers a high potential for energy and cost savings in today's buildings. However, in most cases, this potential is not yet fully exploited due to the lack of intelligent supervisory control systems that are required to manage the complexity of the resulting overall systems. In this article, we present the implementation of a mixed-integer nonlinear model predictive control approach as a smart realtime building energy management system. The presented methodology is based on a forward-looking optimization of the overall energy costs. It takes into account energy demand forecasts and varying electricity market prices. We achieve real-time capability of the controller by applying a decomposition approach, which approximates the optimal solution of the underlying mixed-integer optimal control problem by convexification and rounding of the relaxed solution. The quality of the suboptimal solution is evaluated by comparison with the globally optimal solution obtained by the dynamic programming method. Based on a real-world scenario, we demonstrate that utilization of the real-time capable mixedinteger nonlinear model predictive control approach in a building control system leads to savings of 16% in the total operating costs and 13% in primary energy compared to the state-of-the-art control strategy without any loss of comfort for the residents.
In this paper the workflow of the project 'Untersuchungs-, Simulations- und Evaluationstool für Urbane Logistik` (USEfUL) is presented. Aiming to create a web-based decision support tool for urban logistics, the project needed to integrate multiple steps into a single workflow, which in turn needed to be executed multiple times. While a service-oriented system could not be created, the principles of service orientation was utilized to increase workflow efficiency and flexibility, allowing the workflow to be easily adapted to new concepts or research areas.
Microservices build a deeply distributed system. Although this offers significant flexibility for development teams and helps to find solutions for scalability or security questions, it also intensifies the drawbacks of a distributed system. This article offers a decision framework, which helps to increase the resiliency of microservices. A metamodel is used to represent services, resiliency patterns, and quality attributes. Furthermore, the general idea for a suggestion procedure is outlined.
Microservices are meanwhile an established software engineering vehicle, which more and more companies are examining and adopting for their development work. Naturally, reference architectures based on microservices come into mind as a valuable thing to utilize. Initial results for such architectures are published in generic and in domain-specific form. Missing to the best of our knowledge however, is a domain-specific reference architecture based on microservices, which takes into account specifics of the insurance industry domain. Jointly with partners from the German insurance industry, we take initial steps to fill this gap in the present article. Thus, we aim towards a microservices-based reference software architecture for (at least German) insurance companies. As the main results of this article we thus provide an initial such reference architecture together with a deeper look into two important parts of it.
A Look at Service Meshes
(2021)
Service meshes can be seen as an infrastructure layer for microservice-based applications that are specifically suited for distributed application architectures. It is the goal to introduce the concept of service meshes and its use for microservices with the example of an open source service mesh called Istio. This paper gives an introduction into the service mesh concept and its relation to microservices. It also gives an overview of selected features provided by Istio as relevant to the above concept and provides a small sample setup that demonstrates the core features.
Cloud Computing: Serverless
(2021)
A serverless architecture is a new approach to offering services over the Internet. It combines BaaS (Backend-as-a-service) and FaaS (Function-as-a-service). With the serverless architecture no own or rented infrastructures are needed anymore. In addition, the company does not have to worry about scaling any longer, as this happens automatically and immediately. Furthermore, there is no need any longer for maintenance work on the servers, as this is completely taken over by the provider. Administrators are also no longer needed for the same reason. Finally, many ready-made functions are offered, with which the development effort can be reduced. As a result, the serverless architecture is very well suited to many application scenarios, and it can save considerable costs (server costs, maintenance costs, personnel costs, electricity costs, etc.). The company only must subdivide the source code of the application and upload it to the provider’s server. The rest is done by the provider.
This study investigates the influence of traumatic events on the mental health of North Korean refugee women by examining the prevalence and severity of posttraumatic stress disorder (PTSD), depression, and anxiety in comparison with their male counterparts (women = 496; men = 131). Our results suggest that women are at greater risk of developing mental health problems than men. In particular, symptoms of PTSD and anxiety were higher among women who experienced forced repatriation to North Korea, which is operationalized as a constellation of gendered traumatic incidents such as sexual abuse, rape, witnessing infanticides, and forced abortion. The policy implications of our results and suggestions for future studies are discussed.
Background: This basically anatomical study focuses on two items; firstly, the establishment of a system for the cartographic subdivision of the neopallium; secondly, the topographical correlation of extracranial landmarks and intracranial sites on the neopallium.
Materials and methods: The surface of the neopallium was subdivided into 15 sectors with reference to a newly introduced pattern of Primary Sulci. The topographical link between extracranial landmarks and certain intracranial sites (i.e. neopallium sectors) was elaborated by using a simple stereotactic device and a computer-assisted measurement device. Measurements were performed between points on the head's outer surface and on the isolated brain.
Results and Conclusions: The introduction of an anatomical three-dimensional coordinate system was an essential key issue for this investigation. This setting facilitated the measurements and calculations of the so-called indirect distances that were characterised by their alignment along the three orthogonal axes (x, y, z) of the anatomical coordinate system. The inter-individual comparison (16 adult horses [Equus caballus]) of the indirect distances revealed that each sector centre lay within a distinct morphometric residence area. The measured and calculated data also showed that each sector centre could be assigned to its proper extracranial landmark that - in comparison with other landmarks - was best suited for the optimal allocation of the sector centre point.
In this study, we calculated the energetics of hydrogen atoms adsorbing on and diffusing into the first few layers of γ-Fe for the (100), (110) and (111) surfaces and for the non-magnetic (NM), ferromagnetic (FM), and antiferromagnetic single (AFM1) and double layer (AFMD) structures. These studies are relevant as they atomistically simulate the early stages of hydrogen embrittlement in steels. We employed density functional theory to establish adsorption sites and energies for each plane and the minimum energy pathways for diffusion through the first few layers with associated activation barriers. Adsorption energies for all cases vary between ∼3.7 and 4.4 eV, and the energy barriers to diffusion in the bulk region vary between ∼0.2 and 1.2 eV for the twelve cases, with the highest and lowest bulk diffusion barriers occurring in the NM(111) and the FM(100) case, respectively. We conclude that the texturing of steels in order to expose certain cleavage planes or magnetic structures can decrease the likelihood of hydrogen embrittlement.
This Innovative Practice Full Paper presents our learnings of the process to perform a Master of Science class with eduScrum integrating real world problems as projects. We prepared, performed, and evaluated an agile educational concept for the new Master of Science program Digital Transformation organized and provided by the department of business computing at the University of Applied Sciences and Arts - Hochschule Hannover in Germany. The course deals with innovative methodologies of agile project management and is attended by 25 students. We performed the class due the summer term in 2019 and 2020 as a teaching pair. The eduScrum method has been used in different educational contexts, including higher education. During the approach preparation, we decided to use challenges, problems, or questions from the industry. Thus, we acquired four companies and prepared in coordination with them dedicated project descriptions. Each project description was refined in the form of a backlog (list of requirements). We divided the class into four eduScrum teams, one team for each project. The subdivision of the class was done randomly.
Since we wanted to integrate realistic projects into industry partners’ implementation, we decided to adapt the eduScrum approach. The eduScrum teams were challenged with different projects, e.g., analyzing a dedicated phenomenon in a real project or creating a theoretical model for a company’s new project management approach. We present our experiences of the whole process to prepare, perform and evaluate an agile educational approach combined with projects from practice. We found, that the students value the agile method using real world problems. However, the results are mainly based on the summer term 2019, this paper also includes our learnings from virtual distance teaching during the Covid 19 pandemic in summer term 2020. The paper contributes to the distribution of methods for higher education teaching in the classroom and distance learning.
Agile methods require constant optimization of one’s approach and leading to the adaptation of agile practices. These practices are also adapted when introducing them to companies and their software development teams due to organizational constraints. As a consequence of the widespread use of agile methods, we notice a high variety of their elements:
Practices, roles, and artifacts. This multitude of agile practices, artifacts, and roles results in an unsystematic mixture. It leads to several questions: When is a practice a practice, and when is it a method or technique? This paper presents the tree of agile elements, a taxonomy of agile methods, based on the literature and guidelines of widely used agile methods. We describe a taxonomy of agile methods using terms and concepts of software engineering, in particular software process models. We aim to enable agile elements to be delimited, which should help companies, agile teams, and the research community gain a basic understanding of the interrelationships and dependencies of individual components of agile methods.
During the European debt crisis, German and Greek media frequently reported on the political conflict between the two countries. This article examines to what extent the media coverage in one country about the other is considered by German and Greek citizens to be hostile (‘hostile media perception’) and influential (‘influence of presumed influence’). Data from a comparative survey in Germany (n = 492) and Greece (n = 484) show that news coverage by foreign media on the European debt crisis is perceived by respondents as hostile against their own country and as influential. Moreover, both media-related perceptions are linked with intensified perceptions of hostility, such as assumptions that an individual’s country is not respected in the other country or that the other country’s citizens are demanding that the individual’s country be punished. Based on these results, it is discussed whether media-related perceptions can have a conflict-intensifying effect in international crises.
HOXA9 and MEIS1 are frequently upregulated in acute myeloid leukemia (AML), including those with MLL‐rearrangement. Because of their pivotal role in hemostasis, HOXA9 and MEIS1 appear non‐druggable. We, thus, interrogated gene expression data of pre‐leukemic (overexpressing Hoxa9) and leukemogenic (overexpressing Hoxa9 and Meis1; H9M) murine cell lines to identify cancer vulnerabilities. Through gene expression analysis and gene set enrichment analyses, we compiled a list of 15 candidates for functional validation. Using a novel lentiviral multiplexing approach, we selected and tested highly active sgRNAs to knockout candidate genes by CRISPR/Cas9, and subsequently identified a H9M cell growth dependency on the cytosolic phospholipase A2 (PLA2G4A). Similar results were obtained by shRNA‐mediated suppression of Pla2g4a. Remarkably, pharmacologic inhibition of PLA2G4A with arachidonyl trifluoromethyl ketone (AACOCF3) accelerated the loss of H9M cells in bulk cultures. Additionally, AACOCF3 treatment of H9M cells reduced colony numbers and colony sizes in methylcellulose. Moreover, AACOCF3 was highly active in human AML with MLL rearrangement, in which PLA2G4A was significantly higher expressed than in AML patients without MLL rearrangement, and is sufficient as an independent prognostic marker. Our work, thus, identifies PLA2G4A as a prognostic marker and potential therapeutic target for H9M‐dependent AML with MLL‐rearrangement.
We present a feedback-corrected optimal scheduling approach to reduce the demand of electrical energy of batch processes, exemplified at the sand preparation in foundry. The main energy driver in the exemplary foundry is the idle time of the batch-wise working sand mixers. In this novel approach, we use linear integer programming to minimize the demand of energy of the sand mixers by scheduling the batches in real-time. For the optimization we use a physical model of the sand preparation, which takes dwell-times of the processes as dead-time systems into account. In this paper, we present the steps to make the optimal scheduling approach applicable for the production process. The application at the real production plant proves the performance of the suggested approach. Compared to the conventional control, the feedback-corrected optimal scheduling approach leads to an reduction in energy consumption of approximately 6.5 % without modifying the process or the aggregates.
For anomaly-based intrusion detection in computer networks, data cubes can be used for building a model of the normal behavior of each cell. During inference an anomaly score is calculated based on the deviation of cell metrics from the corresponding normality model. A visualization approach is shown that combines different types of diagrams and charts with linked user interaction for filtering of data.
The negative effects of traffic, such as air quality problems and road congestion, put a strain on the infrastructure of cities and high-populated areas. A potential measure to reduce these negative effects are grocery home deliveries (e-grocery), which can bundle driving activities and, hence, result in decreased traffic and related emission outputs. Several studies have investigated the potential impact of e-grocery on traffic in various last-mile contexts. However, no holistic view on the sustainability of e-grocery across the entire supply chain has yet been proposed. Therefore, this paper presents an agent-based simulation to assess the impact of the e-grocery supply chain compared to the stationary one in terms of mileage and different emission outputs. The simulation shows that a high e-grocery utilization rate can aid in decreasing total driving distances by up to 255 % relative to the optimal value as well as CO 2 emissions by up to 50 %.
A new type of rotary compressor, called “rotary-chamber compressor”, consists of two interlocking rotors with 4 wings each, that perform non-uniform rotary movements. Both rotors have the same direction of rotation, while one rotor is accelerating, the other rotor is retarding. After surpassing a specific mark, the sequence changes and the leading rotor begins to retard and vice versa. Due to the resulting relative phase difference, the volume between the two wings is changing periodically, which allows pulsating working chambers. The technology was first introduced by its founder Jürgen Schukey in 1987. Since then, no further development on this machine is known to us except our own. In this contribution, a study on the kinematics of the rotary-chamber-compressor is presented. Initial studies have shown that changes in the kinematics of the rotors will have a direct influence on the thermodynamical variables, which, if optimized, can lead to an increased performance of the machine. Therefore, a mathematical model has been developed to obtain the performance parameters from different kinematic concepts by using numerical CFD analysis. Furthermore, additional optimization possibilities will be listed and discussed.
Nowadays, most recommender systems are based on a centralized architecture, which can cause crucial issues in terms of trust, privacy, dependability, and costs. In this paper, we propose a decentralized and distributed MANET-based (Mobile Ad-hoc NETwork) recommender system for open facilities. The system is based on mobile devices that collect sensor data about users locations to derive implicit ratings that are used for collaborative filtering recommendations. The mechanisms of deriving ratings and propagating them in a MANET network are discussed in detail. Finally, extensive experiments demonstrate the suitability of the approach in terms of different performance metrics.
We present a small case study on citations of conference posters using poster collections from both Figshare and Zenodo. The study takes into account the years 2016–2020 according to the dates of publication on the platforms. Citation data was taken from DataCite, Crossref and Dimensions. Primarily, we want to know to what extent scientific posters are being cited and thereby which impact posters potentially have on the scholarly landscape and especially on academic publications. Our data-driven analysis reveals that posters are rarely cited. Citations could only be found for 1% of the posters in our dataset. A limitation in this study however is that the impact of academic posters was not measured empirical but rather descriptive.
One of the main concerns of this publication is to furnish a more rational basis for discussing bioplastics and use fact-based arguments in the public discourse. Furthermore, “Biopolymers – facts and statistics” aims to provide specific, qualified answers easily and quickly for decision-makers in particular from public administration and the industrial sector. Therefore, this publication is made up like a set of rules and standards and largely foregoes textual detail. It offers extensive market-relevant and technical facts presented in graphs and charts, which means that the information is much easier to grasp. The reader can expect comparative market figures for various materials, regions, applications, process routes, agricultural land use, water use or resource consumption, production capacities, geographic distribution, etc.
Requirements for an energy data information model for a communication-independent device description
(2021)
With the help of an energy management system according to ISO 50001, industrial companies obtain the opportunities to reduce energy consumption and to increase plant efficiencies. In such a system, the communication of energy data has an important function. With the help of so-called energy profiles (e.g. PROFIenergy), energy data can be communicated between the field level and the higher levels via proven communication protocols (e.g. PROFINET). Due to the fact that in most cases several industrial protocols are used in an automation system, the problem is how to transfer energy data from one protocol to another with as less effort as possible. An energy data information model could overcome this problem and describe energy data in a uniform and semantically unambiguous way. Requirements for a unified energy data information model are presented in this paper.
In the area of manufacturing and process automation in industrial applications, technical energy management systems are mainly used to measure, collect, store, analyze and display energy data. In addition, PLC programs on the control level are required to obtain the energy data from the field level. If the measured data is available in a PLC as a raw value, it still has to be processed by the PLC, so that it can be passed on to the higher layers in a suitable format, e.g. via OPC UA. In plants with heterogeneous field device installations, a high engineering effort is required for the creation of corresponding PLC programs. This paper describes a concept for a code generator that can be used to reduce this engineering effort.
Introduction: Piper crocatum Ruiz & Pav (P. crocatum) has been reported to accelerate the diabetic wound healing process empirically. Some studies showed the benefits of P. crocatum in treating various diseases but its mechanisms in diabetic wound healing have never been reported. In the present study we investigated the diabetic wound healing activity of the active fraction of P. crocatum on wounded hyperglycemia fibroblasts (wHFs).
Methods: Bioassay-guided fractionation was performed to get the most active fraction. The selected active fraction was applied to wHFs within 72 h incubation. Mimicking a diabetic condition was done using basal glucose media containing an additional 17 mMol/L D-glucose. A wound was simulated via the scratch assay. The collagen deposition was measured using Picro-Sirius Red and wound closure was measured using scratch wound assay. Underlying mechanisms through p53, aSMA, SOD1 and Ecadherin were measured using western blotting.
Results: We reported that FIV is the most active fraction of P. crocatum. We confirmed that FIV\(7.81 mg/ml, 15.62 mg/ml, 31.25 mg/ml, 62.5 mg/ml, and 125 mg/ml) induced the collagen deposition and wound closure of wHFs. Furthermore, FIV treatment (7.81 mg/ml, 15.62 mg/ml, 31.25 mg/ml) down-regulated the protein expression level of p53 and up-regulated the protein expression levels of aSMA, E-cadherin, and SOD1.
Discussion/conclusions: Our findings suggest that ameliorating collagen deposition and wound closure through protein regulation of p53, aSMA, E-cadherin, and SOD1 are some of the mechanisms by which FIV of P. crocatum is involved in diabetic wound healing therapy.
Background: Continuity of care is associated with many benefits for patients and health care systems. Therefore measuring care coordination - the deliberate organization of patient care activities between two or more participants - is especially needed to identify entries for improvement. The aim of this study was the translation and cultural adaptation of the Medical Home Care Coordination Survey (MHCCS) into German, and the examination of the psychometric properties of the resulting German versions of the MHCCS-P (patient version) and MHCCS-H (healthcare team version).
Methods: We conducted a paper-based, cross-sectional survey in primary care practices in three German federal states (Schleswig-Holstein, Hamburg, Baden-Württemberg) with patients and health care team members from May 2018 to April 2019. Descriptive item analysis, factor analysis, internal consistency and convergent, discriminant and predictive validity of the German instrument versions were calculated by using SPSS 25.0 (Inc., IBM).
Results: Response rates were 43% (n = 350) for patients and 34% (n = 141) for healthcare team members. In total, 300 patient questionnaires and 140 team member questionnaires could be included into further analysis. Exploratory factor analyses resulted in three domains in the MHCCS-D-P and seven domains in the MHCCS-D-H: “link to community resources”, “communication”, “care transitions”, and additionally “self-management”, “accountability”, “information technology for quality assurance”, and “information technology supporting patient care” for the MHCCS-D-H. The domains showed acceptable and good internal consistency (α = 0.838 to α = 0.936 for the MHCCS-D-P and α = 0.680 to α = 0.819 for the MHCCS-D-H).
As 77% of patients (n = 232) and 63% of health care team members denied to have or make written care plans, items regarding the “plan of care” of the original MHCCS have been removed from the MHCCS-D.
Conclusions: The German versions of the Medical Home Care Coordination Survey for patients and healthcare team members are reliable instruments in measuring the care coordination in German primary care practices. Practicability is high since the total number of items is low (9 for patients and 27 for team members).
Improving Risk Assessment in Clinical Trials: Toward a Systematic Risk-Based Monitoring Approach
(2021)
Regulatory authorities have encouraged the usage of a risk-based monitoring (RBM) system in clinical trials before trial initiation for detection of potential risks and inclusion of a mitigation plan in the monitoring strategy. Several RBM tools were developed after the International Council for Harmonization gave sponsors the flexibility to initiate an approach to enhance quality management in a clinical trial. However, various studies have demonstrated the need for improvement of the available RBM tools as each does not provide a comprehensive overview of the characteristics, focus, and application. This research lays out a rationale for a risk methodology assessment (RMA) within the RBM system. The core purpose of RMA is to deliver a scientifically based evaluation and decision of any potential risk in a clinical trial. Thereby, a monitoring plan can be developed to elude prior identified risk outcome. To demonstrate RMA’s theoretical approach in practice, a Shiny web application (R Foundation for Statistical Computing) was designed to describe the assessment process of risk analysis and visualization tools that eventually aid in focusing monitoring activities. RMA focuses on the identification of an individual risk and visualizes its weight on the trial. The scoring algorithm of the presented approach computes the assessment of the individual risk in a radar plot and computes the overall score of the trial. Moreover, RMA’s novelty lies in its ability to decrease biased decision making during risk assessment by categorizing risk influence and detectability; a characteristic pivotal to serve RBM in assessing risks, and in contributing to a better understanding in the monitoring technique necessary for developing a functional monitoring plan. Future research should focus on validating the power of RMAs to demonstrate its efficiency. This would facilitate the process of characterizing the strengths and weaknesses of RMA in practice.
Agility is considered the silver bullet for survival in the VUCA world. However, many organisations are afraid of endangering their ISO 9001 certificate when introducing agile processes. A joint research project of the University of Applied Sciences and Arts Hannover and the DGQ has set itself the goal of providing more security in this area. The findings were based on interviews with managers and team members from various organisations of different sizes and industries working in an agile manner as well as on common audit practices and a literature analysis. The outcome presents a clear distinction of agility from flexibility as well as useful guidelines for the integration of agile processes in QM systems - for QM practitioners and auditors alike.
With regard to climate change, increasing energy efficiency is still a significant issue in the industry. In order to acquire energy data at the field level, so-called energy profiles can be used. They are advantageous as they are integrated into existing industrial ethernet standards (e.g. PROFINET). Commonly used energy profiles such as PROFIenergy and sercos Energy have been established in industrial use. However, as the Industrial Internet of Things (IIoT) continues to develop, the question arises whether the established energy profiles are sufficient to fullfil the requirements of the upcoming IIoT communication technologies. To answer this question the paper compares and discusses the common energy profiles with the current and future challenges of energy data communication. Furthermore, this analysis examines the need for further research in this field.
The Ethernet-APL Engineering Process - A brief look at the Ethernet-APL engineering guideline
(2021)
The vision of an “Industrial Ethernet down to the sensors and actors” has become reality. At the Achema fair in June 2021 Ethernet-APL was introduced. This technology is based on a 2-wire Ethernet that conveys information as well as energy to the sensors and actuators of the automation system. Ethernet-APL is based on the 2-wire Ethernet standard IEEE 802.3cg running at 10 Mbit/s. An additional specification, the Ethernet-APL Port Profile Specification, defines additional parameters for the use of the technology in the process industry, especially in areas with potentially explosive atmospheres. As a next step, potential users need to become familiar with the engineering process of Ethernet-APL networks. For this purpose, the Ethernet-APL project provides the Ethernet-APL Engineering Guideline that covers the main areas of planning, installation and acceptance testing.
Investigations on Transfer of Pathogens between Foster Cows and Calves during the Suckling Period
(2021)
To date, there have been few studies on the health effects of foster cow systems, including the transmission of mastitis-associated pathogens during suckling. The present study aimed to compare the pathogens detected in the mammary glands of the foster cow with those in the oral cavities of the associated foster calves and to evaluate the resulting consequences for udder health, calf health and internal biosecurity. Quarter milk sampling of 99 foster cows from an organic dairy farm was conducted twice during the foster period. Oral cavity swabs were taken from 345 foster calves. Furthermore, quarter milk samples were collected from 124 biological dams to investigate possible transmission to the foster cows via the suckling calves. All samples were microbiologically examined and confirmed by MALDI-TOF (matrix-assisted laser desorption time-offlight mass-spectrometry). Using RAPD-PCR (randomly amplified polymorphic DNA polymerase chain reaction), strain similarities were detected for Pasteurella multocida, Staphylococcus aureus, S. sciuri and Streptococcus (Sc.) suis. Transmission of P. multocida and S. aureus probably occurred during suckling. For S. sciuri and Sc. suis, environmental origins were assumed. Transmission from dam to foster cow with the suckling calf as vector could not be clearly demonstrated.
In order to ensure validity in legal texts like contracts and case law, lawyers rely on standardised formulations that are written carefully but also represent a kind of code with a meaning and function known to all legal experts. Using directed (acyclic) graphs to represent standardized text fragments, we are able to capture variations concerning time specifications, slight rephrasings, names, places and also OCR errors. We show how we can find such text fragments by sentence clustering, pattern detection and clustering patterns. To test the proposed methods, we use two corpora of German contracts and court decisions, specially compiled for this purpose. However, the entire process for representing standardised text fragments is language-agnostic. We analyze and compare both corpora and give an quantitative and qualitative analysis of the text fragments found and present a number of examples from both corpora.
Background: Mobile text reminder (SMS) system is considered a viable strategy for targeting/facilitating healthy behavioural change including adherence to prescribed physical exercises (PE) and medication (antiretroviral therapy-ART) which should improve the quality of life (Qol) in people living with HIV/AIDS(PLWHA). Thus, the literature was appraised for evidence of SMS effectiveness in improving ART and PE adherence behaviours and QoL in PLWHA.
Methods: Eight databases–AMED, CINAHL, Cochrane Library, EMBASE, EMCARE, Ovid MEDLINE, PsycINFO, and PubMed-were searched up to December 2020, using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol.This review included only randomised control trials (RCTs) investigating the effectiveness of SMS in improving QoL or PE or ART adherence behaviour or a combination of these variables in PLWHA >18 years.
Two independent reviewers determined the eligibility of the studies. Data were extracted and the quality of the study was assessed with the Physiotherapy Evidence Database (PEDro) tool. The primary outcomes were ART and PE adherence behaviours while the secondary outcome was QoL.
Result: A pooled estimate of effect was not calculated due to the heterogeneity of methods and outcome measures.
Therefore, a narrative synthesis of ten studies that met the inclusion criteria (n = 1621 participants at study completion) comprising males/females, aged ≥ 18 years, was done. There was a significant improvement in ART adherence behaviour except in three underpowered studies. Only the SMS interventions that were developed using the Starks 3-steps Adherence model was associated with positive outcome. The only study that evaluated QoL was underpowered and reported no significant change while there were no RCTs on PE.
Conclusion: Effects of SMS intervention trends towards a significant improvement in ART adherence behaviour in PLWHA. It is plausible that SMS reminders developed using the broader framework of the interpersonal health behaviour theory(ies) may have positive outcome. Nevertheless, the observed heterogeneity in the methods/outcome measures warrants a cautious interpretation of the findings. There is a lack/paucity of RCTs and therefore no evidence in support of the effectiveness of SMS intervention in improving PE adherence and QoL.
Worldwide, seagrass meadows are under threat. Consequently, there is a strong need for seagrass restoration to guarantee the provision of related ecosystem services such as nutrient cycling, carbon sequestration and habitat provision. Seagrass often grows in vast meadows in which the presence of seagrass itself leads to a reduction of hydrodynamic energy. By modifying the environment, seagrass thus serves as foundation species and ecosystem engineer improving habitat quality for itself and other species as well as positively affecting its own fitness. On the downside, this positive feedback mechanism can render natural recovery of vanished and destroyed seagrass meadows impossible. An innovative approach to promote positive feedback mechanisms in seagrass restoration is to create an artificial seagrass (ASG) that mimics the facilitation function of natural seagrass. ASG could provide a window of opportunity with respect to suitable hydrodynamic and light conditions as well as sediment stabilization to allow natural seagrass to re-establish. Here, we give an overview of challenges and open questions for the application of ASG to promote seagrass restoration based on experimental studies and restoration trials and we propose a general approach for the design of an ASG produced from biodegradable materials. Considering positive feedback mechanisms is crucial to support restoration attempts. ASG provides promising benefits when habitat conditions are too harsh for seagrass meadows to re-establish themselves.
This paper presents a novel approach for modelling the energy consumption of the coupled parallel moulding sand mixers of a foundry as an optimal control problem. The minimization of energy consumption is optimized by scheduling the mixing processes in a linear integer programming scheme. The sand flow through the foundry’s sand preparation is characterized by a physical model. This model considers the sand demand of the moulding machine as disturbance, the stored sand masses in the mixer hoppers and machine hoppers, respectively. The novel approach of handling dwell-times for dosing, mixing and transport processes using dead-time systems and constraint pushing allows the application of a linear model. The formulation of the optimal control problem aims at real-time application as model predictive control at the production plant. Initial application results indicate an improvement in energy consumption of approximately 8%.
Lack of knowledge regarding antibiotics use has been widely identified as a main reason for inappropriate antibiotics use which leads to antibiotic resistance phenomenon. This study aimed to evaluate the effects of pharmacist-initiated educational intervention on promoting appropriate use of antibiotics and reducing self-medication with antibiotics. A pre and post intervention study using two validated self-administered questionnaires was performed in Yogyakarta province. A-two hour session of course and case discussion was delivered as method of intervention. Pharmacy customers attended Gema Cermat program were invited conveniently to complete both of pre- and post-educational questionnaires. Descriptive presentation was conducted to show scores on questions. Knowledge scores were categorized as poor, adequate and high. Of 268 respondents, 34.22% respondents had poor level of knowledge before receiving educational intervention, but this number decreased into 12.21% after post-interventional phase. Another 28.23% respondents had adequate level of knowledge before and then elevated into 38.28% after receiving education about appropriate use of antibiotics. Pre-education, 37.43% participants had a high level of knowledge about antibiotics use and resistance, whereas after education the number became slightly higher (49.25%). A vast majority of respondents (75.24%) became more aware about appropriate antibiotics practice after receiving educational inter- vention. Overall, didactic educational intervention imposed higher knowledge and better practice regarding antibiotics use (p < 0.05). This study showed that using didactical education intervention towards antibiotics use and resistance can be an initial strategy that led to substantial improvement of appropriate antibiotics use. Further systemic interventions to educate people should be performed and evaluated in order to promote the appropriate use of antibiotics.
In this species differentiation study of Corynebacterium spp. (C. spp.), quarter foremilk samples from 48 farms were included. These were obtained from both clinically healthy cows and those with clinical mastitis. First, all samples were examined cyto-microbiologically and all catalase-positive rods were differentiated using the direct transfer method in MALDI-TOF MS. C. bovis, C. amycolatum, C. xerosis, and five other species were identified with proportions of 90.1%, 7.7%, and 0.8% for the named species, respectively, and 1.4% for the remaining unnamed species. In addition, somatic cell count (SCC) was determined by flow cytometry. Based on this, the isolates were classified into four udder health groups: “latent infection”, “subclinical mastitis”, “clinical mastitis” and “others”. Approximately 90% of isolates of C. bovis and C. amycolatum were from latently and subclinically infected quarters. Of the C. bovis isolates, 5.8% were obtained from milk samples from clinical mastitis, whereas C. amycolatum was not present in clinical mastitis. The distribution of groups in these two species differed significantly. The geometric mean SCC of all species combined was 76,000 SCC/mL, almost the same as the SCC of C. bovis. With 50,000 SCC/mL, the SCC of C. amycolatum was slightly below the SCC of C. bovis. Through the species-level detection and consideration of SCC performed here, it is apparent that individual species differ in terms of their pathogenicity. Overall, their classification as minor pathogens with an SCC increase is confirmed.
Introduction: Renal cell carcinoma (RCC), an immunogenic tumor, is the most common form of kidney cancer worldwide. Immune checkpoint inhibitors (ICIs) play an important role in the treatment of metastatic RCC. Programmed death-ligand (PD-L1) has already been proposed as a possible prognosticator for ICIs effectiveness. To elucidate the feasible role of ICIs in neoadjuvant settings, we have assessed the most common PD-L1 expression modalities [tumor proportion score (TPS), combined positivity score (CPS) and inflammatory cell (IC) score] in primary tumors (PTs) and venous tumor thrombi (VTT) in first diagnosed, previously untreated RCC patients with accompanying
VTT.
Methods: Between January 1999 and December 2016, 71 patients with a first diagnosed, untreated, locally advanced RCC (aRCC) (≥ pT3a) underwent surgery in Hanover Medical School (MHH). PD-L1 expression was examined separately in PTs and VTT using the CPS, IC score and TPS. We also considered the age at the time of the initial surgery and gender as probable influencing factors. By using a cutoff value of 1 (1%), PD-L1 expression levels in PTs and VTT were assessed to enable the determination of any frequency differences.
Results: Positive scores for PTs were shown by 54 (CPS), 53 (IC score) and 34 (TPS) patients, whereas in VTT, positive scores were evaluated
for a total of 50 (CPS), 47 (IC-score) and 36 (TPS) patients. No statistically significant differences were obtained between the PD-L1 expression immunoscores for PTs and VTT. The covariates age at the time of the initial surgery and gender could not be statistically proven to influence the differences in PD-L1 expression between the
VTT and PTs.
Conclusion: To the best of our knowledge, this research is the largest study to investigate PD-L1 expression in PTs and VTT in 71 cases. It could have relevance for the future development of neoadjuvant immunotherapy options, particularly in aRCC with VTT.
To reduce ineffective antimicrobial usage in the treatment of non-severe clinical mastitis (CM) in cows with long-lasting udder diseases, non-antibiotic therapy with a non-steroidal anti-inflammatory drug (NSAID) was conducted and evaluated in a non-blinded, positively controlled, non-inferiority trial. Therefore, three-time systemic ketoprofen treatment at intervals of 24 h was evaluated in comparison with the reference treatment of solely antibiotic therapy in a field study on nine free-stall dairy farms located in Northern Germany. Cows with previous CM cases in current lactation and/or with long-lasting high somatic cell counts in preceding dairy herd improvement test days were randomly allocated to one of the two treatment groups in cases of mild to moderate CM. Quarter foremilk samples of the affected quarters were taken for cyto-bacteriological investigation before treatment as well as ~14 and 21 d after termination of therapy. Both treatment groups were compared regarding the bacteriological cure (BC) as the primary outcome. Clinical cure (CC) and no CM relapse within 60 d after the end of treatment (no R60) were chosen as secondary outcomes. The study resulted in the following outcomes: Streptococcus uberis was most frequently identified in microbiological culture from pre-treatment samples, followed by Staphylococcus aureus and Escherichia coli and other coliforms. No significant differences between the NSAID treatment and the reference treatment were detected regarding CC and CM recurrence (no R60). Although the sole ketoprofen therapy resulted in a numerically lower likelihood of BC, there were no significant differences to the reference treatment. Considering the selection criteria in this study, the results indicate that in mild to moderate CM cases exclusive treatment with ketoprofen may constitute an alternative to antimicrobial intramammary therapy, providing an opportunity for reduction of antibiotic usage. However, non-inferiority evaluations were inconclusive. Further investigations with a larger sample size are required to confirm the results and to make a distinct statement on non-inferiority.
Background
The business of clinical research has changed in the past two decades, shifting from industrialised Western countries to so-called emerging markets such as Eastern Europe, Latin America and Africa. An appraisal of the trends could identify associated factors that may have implications for the local populations and their endemic diseases.
Objectives
To identify potential reasons why emerging countries have become attractive places for international sponsors to conduct their clinical trials.
Methods
Using ClinicalTrials.gov, the Pan African Clinical Trials Registry, the National Health Research Database and the Nigeria Clinical Trials Registry, trend data on clinical research development were determined for two emerging African markets, Nigeria and South Africa (SA), from 2010 to 2018. Also, health data on the two countries from the fact sheets of health statistics of the World Health Organization were compared, as well as regulatory and ethical conditions. Available data were analysed using descriptive statistics and trend analysis.
Results
The impact of globalisation is evident from the upward trend in clinical trials in SA before 2010, and the clear downward trend thereafter. One reason for this change could be the alignment of SA’s regulatory and ethical frameworks with the Western world. In contrast,
the upward trend is only just beginning in Nigeria, with the introduction of ethical/regulatory frameworks, and supportive institutions making the business of clinical research more attractive on an international level. Although the number of international and local sponsors increased in Nigeria from 2010 to 2018, only the latter increased in SA, with the former decreasing over the same period. Overall, there is a mismatch between country-specific diseases and the drugs being tested, to the extent that leprosy, which is endemic in Nigeria, and tuberculosis in SA were not in the list of top 10 study areas in either country.
Conclusions
The globalisation trend is evident in the clinical trials business, but cannot be generalised to all emerging countries. Timing and intensity vary from country to country relative to factors that advance the existing profit-orientated business models of the sponsors. Furthermore, various diseases have been localised, which entails a diversely increasing need for research.
Since child maltreatment has highly negative effects on child adjustment, early identification of at-risk families is important. This study focuses on longitudinal risk factors for child maltreatment and associations between abuse risk and occurrence. It also examines whether abuse risk and involvement in early childhood intervention are associated. The sample comprises 197 German caregivers with children under 3 years of age. Data was collected in two waves. The Brief Child Abuse Potential Inventory assessed abuse risk. Socio-demographic, parent, child and family-related risk factors were measured using screening tools. The analysis revealed that parental characteristics (psychopathology, own maltreatment experiences etc.) were associated with concurrent abuse risk. Longitudinal changes in abuse risk were linked to caregiver education and child-related factors. Cumulative risk did not explain more variance than specific risk factors. Significant associations with caregiverreported abuse were found, and data suggest that some burdened families cannot be reached by early childhood intervention.
Objectives
Quality of care largely depends on successful teamwork, which in turn needs effective communication between health professionals. To communicate successfully in a team, health professionals need to strive for the same goals. However, it has been left largely unaddressed which goals professionals consider to be important. In this study, we aim to identify these goals and analyse whether differences between (1) personal and organisational goals, (2) different professions and (3) hierarchical levels exist in neonatal intensive care units (NICUs).
Design
Goals were identified based on a literature review and a workshop with health professionals and tested in a pilot study. Subsequently, in the main study, a cross-sectional employee survey was undertaken.
Setting and participants
1489 nurses and 537 physicians from 66 German NICUs completed the
questionnaire regarding personal and organisational goal importance between May and July 2013. Answers were given based on a 7-point Likert scale varying between none and exceptionally high importance.
Results
Results show that the goals can be subdivided into three main goal dimensions: patients, parents and staff. Furthermore, our results reveal significant differences between different professions and different hierarchical level: physicians rated patient goals with a
mean (95% CI) importance of 6.37 (3.32 to 6.43), which is significantly higher than nurses with a mean (95% CI) importance of 6.15 (6.12 to 6.19) (p<0.01). Otherwise, nurses classified parental goals as more important (p<0.01). Furthermore, professionals in leading positions rate patient goals significantly higher than professionals that are not in leading positions (6.36 (3.28 to 6.44) vs 6.19 (6.15 to 6.22), p<0.01).
Conclusions
Different employee goals need to be considered in decision-making
processes to enhance employee motivation and the effectiveness of teamwork.
The aim of this study was to define the time-related period of intramammary infections and its relation to risk factors for intramammary infections and clinical mastitis at cow and quarter levels. In total, 269 German Holstein Frisian dairy cows on three farms in Northern and Eastern Germany were included in this study. Quarter milk samples were collected at dry-off, 3 ± 1 days after calving and 17 ± 3 days after calving, for cytomicrobiological examination. Risk factors at quarter- and cow-level associated with intramammary infections and clinical mastitis were recorded during the trial period. Data were analyzed using logistic regression procedures and odds ratios were calculated. Calving for the second time increased the odds of clinical mastitis during the first 100 days of lactation compared to cows calving for the third time or more. A high milk yield after calving was a risk factor for new infections, with environmental pathogens 17 ± 3 days postpartum. A body condition score after calving less than 3.5 was associated with a decreased risk of having an intra-mammary infection (IMI) with non-aureus staphylococci and coryneforms 3 ± 1 days postpartum and consistent body condition between dry-off and early lactation decreased the risk of intramammary infections after calving. The absence of a ring of hyperkeratosis at the teat apex shown at dry-off was associated with a lower risk of intramammary infections with environmental pathogens 17 ± 3 days postpartum. This study shows the important influence of the dry period and early lactation on intramammary infections and clinical mastitis postpartum in dairy cows. Udder quarters may have eliminated pathogens during the dry period in 43.6% of cases in this study. Additionally, new infections occurred during early lactation, so 5.1% more quarters were infected 17 ± 3 days compared to 3 ± 1 days postpartum. New infections can be traced to non-aureus staphylococci and Staphylococcus aureus from dry-off up until 3 ± 1 days postpartum, and to non-aureus staphylococci, Staphylococcus aureus and Streptococcus uberis, after calving. In total, 88.7% of the infected quarters showed new infections with another pathogen species 3 ± 1 days postpartum than at dry-off, and 89.2% of the quarters 17 ± 3 days postpartum than 3 ± 1 days postpartum. In conclusion, the early lactation has just as important an influence on intramammary infections postpartum in dairy cows as the dry period. There is the possibility that udder quarters eliminate pathogens during the early lactation, especially during the dry period. However, there is also the danger that new infections manifest, with a large proportion of new infections occurring after calving. Thus, additional control strategies are of great importance to prevent new infections occurring during early lactation as well as during the dry period to reduce negative effects on milk yield and culling hazards in dairy cows by minimizing the associated risk factors
As noted by Roman poet Virgil already more than 2,000 years ago: “The greatest wealth is health.”. Without health, there is no happiness, no peace, and no success according to the Reflections Recovery Center from Arizona, United States (USA, U.S.). The goal of the Healthy People 2020-project (HP2020), which is led by the Office of Disease Prevention and Health Promotion (ODPHP), was to “promote quality life, healthy development, and health behaviors across all life stages” among the U.S. population. HP2020 measures progress by using so-called Leading Health Indicators (LHI), reliable data sources, baseline values as well as targets for LHI-individual improvements for every measurable objective to be achieved by 2020 and each following decade. In the further course, these values were compared to student populations from the U.S., Germany, and Poland. The goal of this master's thesis was to obtain more data on international health, particularly among student populations. For the statistical analysis, data were obtained from an online survey that was distributed to students in at least one university in each of the three countries. In total, data from 380 students were analyzed in terms of HP2020 goal attainment. To determine if statistically significant differences were present, the z-test was used. The biggest differences emerged on the following topics: access to healthcare, environmental quality, obesity as well as reproductive and sexual health.
The objective of this study was to investigate the occurrence of bacteremia in dairy cows with severe mastitis. Milk samples were collected from affected udder quarters, and corresponding blood samples were collected from dairy cows with severe mastitis at the time of diagnosis before any therapeutic measures were undertaken. The cultural detection of pathogens in blood classified a bacteremia. Further diagnostic tests were performed to provide evidence of bacteremia. This was realized by PCR with regard to S. aureus, E. coli and S. uberis and the Limulus test. Detection of culturable pathogens in the blood of cows with severe clinical mastitis was rare and occurred in only one of 70 (1.4%) cases. Overall, bacterial growth was detected in 53 of 70 (75.7%) milk samples. S. uberis (22/70), E. coli (12/70) and S. aureus (4/70) were the most frequently isolated pathogens from milk of cows with severe mastitis. PCR was performed in 38 of 70 (54.3%) blood samples. PCR was positive in eight of 38 cases. S. uberis was found most frequently in six blood samples (8.6%). E. coli was found on PCR in one blood sample (1.4%). S. aureus was identified in one blood sample (1.4%). When Coliforms were detected in the quarter milk sample, a Limulus test was performed in the corresponding blood sample. In three of 15 cases, the Limulus test was positive (4.3% of samples). Further studies are needed to investigate the occurrence of bacteremia in cows with severe mastitis in a higher population size.
Methods for standard meta-analysis of diagnostic test accuracy studies are well established and understood. For the more complex case in which studies report test accuracy across multiple thresholds, several approaches have recently been proposed. These are based on similar ideas, but make different assumptions. In this article, we apply four different approaches to data from a recent systematic review in the area of nephrology and compare the results. The four approaches use: a linear mixed effects model, a Bayesian multinomial random effects model, a time-to-event model and a nonparametric model, respectively. In the case study data, the accuracy of neutrophil gelatinase-associated lipocalin for the diagnosis of acute kidney injury was assessed in different scenarios, with sensitivity and specificity estimates available for three thresholds in each primary study. All approaches led to plausible and mostly similar summary results. However, we found considerable differences in results for some scenarios, for example, differences in the area under the receiver operating characteristic curve (AUC) of up to 0.13. The Bayesian approach tended to lead to the highest values of the AUC, and the nonparametric approach tended to produce the lowest values across the different scenarios. Though we recommend using these approaches, our findings motivate the need for a simulation study to explore optimal choice of method in various scenarios.
Objectives: Injury to major white matter pathways during language-area associated glioma surgery often leads to permanent loss of neurological function. The aim was to establish standardized tractography of language pathways as a predictor of language outcome in clinical neurosurgery.
Methods: We prospectively analyzed 50 surgical cases of patients with left perisylvian, diffuse gliomas. Standardized preoperative Diffusion-Tensor-Imaging (DTI)-based tractography of the 5 main language tracts (Arcuate Fasciculus [AF], Frontal Aslant Tract [FAT], Inferior Fronto-Occipital Fasciculus [IFOF], Inferior Longitudinal Fasciculus [ILF], Uncinate Fasciculus [UF]) and spatial analysis of tumor and tracts was performed. Postoperative imaging and the resulting resection map were analyzed for potential surgical injury of tracts. The language status was assessed preoperatively, postoperatively and after 3 months using the Aachen Aphasia Test and Berlin Aphasia Score. Correlation analyses, two-step cluster analysis and binary logistic regression were used to analyze associations of tractography results with language outcome after surgery.
Results: In 14 out of 50 patients (28%), new aphasic symptoms were detected 3 months after surgery. The preoperative infiltration of the AF was associated with functional worsening (cc = 0.314; p = 0.019). Cluster analysis of tract injury profiles revealed two areas particularly related to aphasia: the temporo-parieto-occipital junction (TPO; temporo-parietal AF, middle IFOF, middle ILF) and the temporal stem/peri-insular white matter (middle IFOF, anterior ILF, temporal UF, temporal AF). Injury to these areas (TPO: OR: 23.04; CI: 4.11 – 129.06; temporal stem: OR: 21.96; CI: 2.93 – 164.41) was associated with a higher-risk of persisting aphasia.
Conclusions: Tractography of language pathways can help to determine the individual aphasia risk profile presurgically. The TPO and temporal stem/peri-insular white matter were confirmed as functional nodes particularly sensitive to surgical injuries.