Refine
Year of publication
Document Type
- Article (525) (remove)
Has Fulltext
- yes (525)
Is part of the Bibliography
- no (525)
Keywords
- Milchwirtschaft (36)
- Molkerei (27)
- Euterentzündung (23)
- Logistik (20)
- Student (11)
- Supervision (11)
- Knowledge (10)
- Mumbai (10)
- Wissen (10)
- Bibliothek (9)
Die binäre Putzfrau
(1993)
The paper sheds light on the change in the concept of obedience within the Society of Jesus since the 1960s. In the aftermath of the Second Vatican Council, a so-called crisis of authority and obedience took place in the Catholic Church and the religious orders. As a consequence, the notions of responsibility and conscience came to the fore in the Jesuit definition of obedience. The religious concept of obedience, that is the obedience towards God, was reassessed as a service to humanity. The paper analyzes how the change in the concept of obedience gave rise to the promotion of social justice, which the Society of Jesus proclaimed at General Congregation 32 in 1974/75. By including the promotion of social justice into their central mission, Jesuits not only fundamentally transformed their self-conception, but also their ethical values. The paper argues that the pursuit of social justice became a form of religious obedience.
In this paper, we present a novel approach for real-time rendering of soft eclipse shadows cast by spherical, atmosphereless bodies. While this problem may seem simple at first, it is complicated by several factors. First, the extreme scale differences and huge mutual distances of the involved celestial bodies cause rendering artifacts in practice. Second, the surface of the Sun does not emit light evenly in all directions (an effect which is known as limb darkening). This makes it impossible to model the Sun as a uniform spherical light source. Finally, our intended applications include real-time rendering of solar eclipses in virtual reality, which require very high frame rates. As a solution to these problems, we precompute the amount of shadowing into an eclipse shadow map, which is parametrized so that it is independent of the position and size of the occluder. Hence, a single shadow map can be used for all spherical occluders in the Solar System. We assess the errors introduced by various simplifications and compare multiple approaches in terms of performance and precision. Last but not least, we compare our approaches to the state-of-the-art and to reference images. The implementation has been published under the MIT license.
Das Gesundheitsdatennutzungsgesetz – Potenzial für eine bessere Forschung und Gesundheitsversorgung
(2023)
Im Koalitionsvertrag der Ampel-Koalition wird für die laufende Legislaturperiode ein Gesundheitsdatennutzungsgesetz (GDNG) angekündigt. Dieses Gesetz soll „zu einer besseren wissenschaftlichen Nutzung in Einklang mit der DSGVO“ führen. Bekanntermaßen steht unser Gesundheitssystem vor großen Herausforderungen (Demografie, Digitalisierung, Fachkräftemangel, Klimakrise, regionale Unterschiede, etc.) und ist jetzt schon das teuerste in Europa bei mittelmäßiger Leistung. Diese Herausforderungen können effizienter und evidenzgeleitet bewältigt werden, wenn wie im geplanten GDNG angedacht, die Datenressourcen für die Evaluierung und Weiterentwicklung des Gesundheitssystems und der Gesundheitsversorgung optimal genutzt werden. In den folgenden Ausführungen werden aus Sicht von Versorgungsforscher*innen Voraussetzungen und Desiderata für eine optimale Ausgestaltung des Gesetzes formuliert. Das Papier wurde durch das Deutsche Netzwerk Versorgungsforschung (DNVF) und die Arbeitsgruppe Erhebung und Nutzung von Sekundärdaten (AGENS) der Deutschen Gesellschaft für Sozialmedizin und Prävention (DGSMP) und der Deutschen Gesellschaft für Epidemiologie (DGEpi) erstellt und wird von den unterzeichnenden Fachgesellschaften getragen. Das vorliegende Positionspapier und die hier aufgestellten Forderungen sind vor der Veröffentlichung und damit in Unkenntnis des Referentenentwurfs zum GDNG formuliert worden.
Mit der Analyse des Kostenverlaufes in der Abteilung "Pasteurisierte Konsummilch" wird die Aktualisierung der Modellabteilungsrechnung fortgeführt. Gegenüber dem 1975 durchgeführten Kostenvergleich verschiedener Trinkmilchverfahren (1) basiert diese Abteilungskalkulation auf der modellhaften Kostenermittlung einer Einproduktsimulation anhand eines Abpackverfahrens im Tetra-Rex-System. Unter Berücksichtigung des methodisch weiterentwickelten Kostenrechnungsprinzips (2) wird der Produktionsprozeß zur Herstellung pasteurisierter Vollmilch mit 3,5 % Fett in 1-l-Kartonverpackung hinsichtlich der Kostenverursachung untersucht. Drei Modellvarianten mit Abfülleistungen von 5.400 bis 22.800 Packungen/Stunde, die einer maximalen Produktion von 30,3 bis 128,0 Packungen/Jahr entsprechen, bilden den Ausgangspunkt für die Analyse der Produktionskosten der Abteilung. In Abhängigkeit von der täglichen Abfüllmenge und dem Produktionsprogramm werden spezifische Modellausrüstungen bestimmt, von denen sich unmittelbar die variablen und fixen Einsatzmengen der Produktionsfaktoren ableiten. Der Einfluß unterschiedlicher Kapazitätsgrößen und -auslastungen auf die Herstellungskosten wird mit simulierten Beschäftigungssituationen zwischen 15 und 100 % verdeutlicht, die eine Bestimmung der Kosten für Milchmengen zwischen 4,5 und 128,0 Mio. Packungen im Jahr ermöglichen. Gemäß der Kapazitätsgröße und der technischen Auslegung der Modelle betragen die Investitionen 1,7 Mio. DM im Modell 1 und 4,7 Mio. DM im Modell 3. Bezogen auf die jeweilige Outputmenge der Abteilung ergeben sich spezifische Investitionen, die mit zunehmender Modellgröße von 56 auf 37 DM je 1.000 Packungen sinken. Die Gesamtkosten der Abteilung “Pasteurisierte Konsummilch”, die sich aus den Produkt- und Abteilungseinzelkosten zusammensetzen, betragen im größten Modell bei 100 % Beschäftigung 73,8 Pf/Pckg. Abteilungs-Output und steigen mit abnehmender Modellgröße und sinkendem Beschäftigungsgrad (15 %) auf 83,1 Pf/Pckg.. In der beschäftigungsabhängigen Gesamtkostenentwicklung tritt zwischen dem 3- und 1-Schichtbetrieb eine Kostensenkung im Modell 1 von 3,0 Pf/Pckg. ein, die im Modell 3 2,0 Pf/Pckg. ausmacht. Der kapazltsgrößenbedingte Degressionseffekt Ist vom größten zum kleinsten Modell mit 1,7 Pf/Pckg. im 3-Schichtbetrieb und mit 2,7 Pf/Pckg. im 1-Schichtbetrieb markiert. Aus der prozentualen Zusammensetzung der Gesamtkosten bei einem Beschäftigungsgrad von 64 % dominieren die Rohstoffkosten mit modellspezifischen Anteilen von 72 - 73 %, die Betriebskosten beanspruchen 25 - 26 %, und die Anlagekosten sind anteilig mit 2 - 3 % vertreten. Mit der Darstellung der prozentualen Verteilung der Gesamtkosten ohne Rohstoffkosten treten die Kostenarten der Betriebskosten in den Vordergrund. Bei gleicher Ausgangssituation entfallen 83 - 89 % auf die Verpackungsmaterialkosten, 3 - 6 % auf die Personalkosten sowie 1 - 2 % auf die Energie- und Betriebsstoffkosten; 7 - 9 % ergeben sich hier für die Anlagekosten. Den Ergebnissen der Modellkalkulationen ist zu entnehmen, daß mit zunehmender Kapazitätsgröße und ansteigendem Beschäftigungsgrad nennenswerte Kosteneinsparungen zu erreichen sind. Dagegen zeichnen sich Kostendegressionen in Abhängigkeit von der Zahl der Produktionstage aufgrund des geringen Anteils der tagesfixen Kosten an den Gesamtkosten nur im minimalen Umfang ab.
The control of clinical mastitis on dairy farms is an essential part of animal health management. Knowledge of the causative microorganisms, the cure rates achievable in the field and essential associated factors are crucial for proper control. The objectives of the present study were to characterize clinical mastitis cases in Germany and to analyze factors influencing cure rates and the recurrence rate. Milk samples of every clinical mastitis case occurring on 12 participating farms were examined cytomicrobiologically. Post-treatment quarter samples were taken after 14 and 21 days. Treatments were performed according to existing farm protocols. Of 2883 clinical mastitis cases, the most prevalent pathogens were Streptococcus (S.) uberis (20.2%) and coliforms (11.6%). In 35% of the milk samples, no bacteriological growth was detected. The overall bacteriological cure rate was 73.3%, while the cytological cure rate was 22.3%, the full cure rate 21.4% and the recurrence rate 18.8%. Regarding the pathogen distribution of severe mastitis, coliform bacteria were detected in 30.5% of the cases, whereas S. uberis was detected in 26.5% thereof. The results show that severe mastitis is caused almost as frequently by Gram-positive as by Gram-negative microorganisms. The low cytological cure rates show that the therapy needs to be further developed with regard to calming the inflammation. The obtained data can be very helpful in assessing internal mastitis scenarios and the effect of measures and therapies.
Electrospinning with consequent thermal treatment consists in a carbon fiber production method that spins a polymer solution to create fibers with diameters around a few hundred nanometers. The thermal treatments are used for the cyclization and then carbonization of the material at 1700 °C for one hour. The unique structure of micro- and nano-carbon fibers makes them a promising material for various applications ranging from future battery designs to filtration. This work investigated the possibility of using milled gasification biochar, derived from a 20 kW fixed-bed gasifier fueled with vine pruning pellets, as an addictive in the preparation of electrospinning solutions. This study outlined that solvent cleaning and the consequent wet-milling and 32 µm sifting are fundamental passages for biochar preparation. Four different polyacrylonitrile-biochar shares were tested ranging from pure polymer to 50–50% solutions. The resulting fibers were analyzed via scanning electron microscopy, and energy-dispersive X-ray and infrared spectroscopy. Results from the morphological analysis showed that biochar grains dispersed themselves well among the fiber mat in all the proposed shares. All the tested solutions, once carbonized, exceeded 97%wt. of carbon content. At higher carbonization temperatures, the inorganic compounds naturally showing in biochar such as potassium and calcium disappeared, resulting in an almost carbon-pure fiber matrix with biochar grains in between.
Im Hinblick auf eine zunehmende Annäherung einzelner Fachlandschaften und der vermehrten Vernetzung von Informationssystemen befasst sich diese Arbeit mit der Fragestellung, ob ein Einsatz des Bibliotheksautomationssystems PICA (Project for Integrated Catalogue Automation) bei der Landesmedienstelle in Niedersachsen eine angemessene Lösung des Problems der unzureichenden Informationsvermittlung über verfügbare audiovisuelle Medien darstellen könnte. Dabei wird zur Verdeutlichung des Informationsbedarfs und des Informationsdefizits dem Abriss zur historischen Entwicklung des Bildstellenwesens und zum geschichtlichen Werdegang der Landesmedienstelle in Niedersachsen bewusst ein breiter Raum gegeben.
Introduction
Atopic dermatitis (AD) is a common inflammatory skin disease. Many patients are initiating a systemic therapy, if the disease is not adequately controlled with topical treatment only. Currently, there is little real-world evidence on the AD-related medical care situation in Germany. This study analyzed patient characteristics, treatment patterns, healthcare resource utilization and costs associated with systemically treated AD for the German healthcare system.
Methods
In this descriptive, retrospective cohort study, aggregated anonymized German health claims data from the InGef research database were used. Within a representative sample of four million insured individuals, patients with AD and systemic drug therapy initiation (SDTI) in the index year 2017 were identified and included into the study cohort. Systemic drug therapy included dupilumab, systemic corticosteroids (SCS) and systemic immunosuppressants (SIS). Patients were observed for one year starting from the date of SDTI in 2017.
Results
9975 patients were included (57.8% female, mean age 39.6 years [SD 25.5]). In the one-year observation period, the most common systemic drug therapy was SCS (> 99.0%). Administrations of dupilumab (0.3%) or dispensations of SIS were rare (cyclosporine: 0.5%, azathioprine: 0.6%, methotrexate: 0.1%). Median treatment duration of SCS, cyclosporine and azathioprine was 27 days, 102 days, and 109 days, respectively. 2.8% of the patients received phototherapy; 41.6% used topical corticosteroids and/or topical calcineurin inhibitor. Average annual costs for medications amounted to € 1237 per patient. Outpatient services were used by 99.6% with associated mean annual costs of € 943; 25.4% had at least one hospitalization (mean annual costs: € 5836). 5.3% of adult patients received sickness benefits with associated mean annual costs of € 5026.
Conclusions
Despite unfavorable risk–benefit profile, this study demonstrated a common treatment with SCS, whereas other systemic drug therapy options were rarely used. Furthermore, the results suggest a substantial economic burden for patients with AD and SDTI.
This paper proposes an extended Petri net formalism as a suitable language for composing optimal scheduling problems of industrial production processes with real and binary decision variables. The proposed approach is modular and scalable, as the overall process dynamics and constraints can be collected by parsing of all atomic elements of the net graph. To conclude, we demonstrate the use of this framework for modeling the moulding sand preparation process of a real foundry plant.
Background:
The increase in food intolerances poses a burgeoning problem in our society. Food intolerances not only lead to physical impairment of the individual patient but also result in a high socio-economic burden due to factors such as the treatment required as well as absenteeism. The present study aimed to explore whether lactose intolerant (LI) patients exhibit more frequent comorbidities than non-LI patients.
Methods:
The study was conducted on a case-control basis and the results were determined using routine data analysis. Routine data from the IMS Disease Analyzer database were used for this purpose. A total of 6,758 data records were processed and analyzed.
Results:
There were significant correlations between LI and the incidence of osteoporosis, changes in mental status, and the presence of additional food intolerances. Comparing 3,379 LI vs. 3,379 non-LI patients, 34.5% vs. 17.7% (P<0.0001) suffered from abdominal pain; 30.6% vs. 17.2% (P<0.0001) from gastrointestinal infections; and 20.9% vs. 16.0% (P=0.0053) from depression. Adjusted odds ratios (OR) were the highest for fructose intolerance (n=229 LI vs. n=7 non-LI; OR 31.06; P<0.0001), irritable bowel syndrome (n=247 LI vs. n=44 non-LI; OR 5.23; P<0.0001), and bloating (n=351 LI vs. n=68 non-LI; OR 4.94; P<0.0001).
Conclusion:
The study confirms that LI should not be regarded as an isolated illness but considered a possible trigger for further diseases. Additional research is necessary to assert more precise statements.
During machine milking, pathogenic microorganisms can be transmitted from cow to cow through liners. Therefore, in Germany, a spray method for the intermediate disinfection of the milking cluster is often used for prevention. This method of cluster disinfection is easy to perform, requires little time and no extra materials, and the disinfection solution is safe from outside contamination in the spray bottle. Since no data on a systematic efficacy trial are available, the aim of this study was to determine the microbial reduction effect of intermediate disinfection. Therefore, laboratory and field trials were conducted. In both trials, two sprays of 0.85 mL per burst of different disinfectant solutions were sprayed into the contaminated liners. For sampling, a quantitative swabbing method using a modified wet–dry swab (WDS) technique based on DIN 10113-1: 1997-07 was applied. Thus, the effectiveness of disinfectants based on Peracetic Acid, Hydrogen Peroxide and Plasma-Activated Buffered Solution (PABS) was compared. In the laboratory trial, the inner surfaces of liners were contaminated with pure cultures of Escherichia (E.) coli, Staphylococcus (S.) aureus, Streptococcus (Sc.) uberis and Sc. agalactiae. The disinfection of the contaminated liners with the disinfectants resulted in a significant reduction in bacteria with values averaging 1 log for E. coli, 0.7 log for S. aureus, 0.7 log for Sc. uberis and 0.8 log for Sc. agalactiae. The highest reduction was obtained for contamination with E. coli (1.3 log) and Sc. uberis (0.8 log) when PABS was applied and for contamination with S. aureus (1.1 log) and Sc. agalactiae (1 log) when Peracetic Acid Solution (PAS) was used. Treatment with sterile water only led to an average reduction of 0.4 log. In the field trial, after the milking of 575 cows, the liners were disinfected and the total microorganism count from the liner surface was performed. The reduction was measured against an untreated liner within the cluster. Although a reduction in microorganisms was achieved in the field trial, it was not significant. When using PAS, a log reduction of 0.3 was achieved; when using PABS, a log reduction of 0.2 was obtained. The difference between the two disinfection methods was also not significant. Treatment with sterile water only led to a reduction of 0.1 log. The results show that spray disinfection under these circumstances does result in a reduction in the bacteria on the milking liner surface, but for effective disinfection a higher reduction would be preferred.
Background: Epidemiological and experimental studies suggest that exposure to ultrafine particles (UFP) might aggravate the allergic inflammation of the lung in asthmatics.
Methods: We exposed 12 allergic asthmatics in two subgroups in a double-blinded randomized cross-over design, first to freshly generated ultrafine carbon particles (64 μg/m3; 6.1 ± 0.4 × 105 particles/cm3 for 2 h) and then to filtered air or vice versa with a 28-day recovery period in-between. Eighteen hours after each exposure, grass pollen was instilled into a lung lobe via bronchoscopy. Another 24 hours later, inflammatory cells were collected by means of bronchoalveolar lavage (BAL). (Trial registration: NCT00527462)
Results: For the entire study group, inhalation of UFP by itself had no significant effect on the allergen induced
inflammatory response measured with total cell count as compared to exposure with filtered air (p = 0.188). However, the subgroup of subjects, which inhaled UFP during the first exposure, exhibited a significant increase in total BAL cells (p = 0.021), eosinophils (p = 0.031) and monocytes (p = 0.013) after filtered air exposure and subsequent allergen challenge 28 days later. Additionally, the potential of BAL cells to generate oxidant radicals was
significantly elevated at that time point. The subgroup that was exposed first to filtered air and 28 days later to UFP did not reveal differences between sessions.
Conclusions: Our data demonstrate that pre-allergen exposure to UFP had no acute effect on the allergic inflammation. However, the subgroup analysis lead to the speculation that inhaled UFP particles might have a long-term effect on the inflammatory course in asthmatic patients. This should be reconfirmed in further studies with an appropriate study design and sufficient number of subjects.
The objective was to establish and standardise a broth microdilution susceptibility testing method for porcine Bordetella (B.) bronchiseptica. B. bronchiseptica isolates from different geographical regions and farms were genotyped by macrorestriction analysis and subsequent pulsed-field gel electrophoresis. One reference and one type strain plus two field isolates of B. bronchiseptica were chosen to analyse growth curves in four different media: cation-adjusted Mueller-Hinton broth (CAMHB) with and without 2% lysed horse blood, Brain-Heart-Infusion (BHI), and Caso broth. The growth rate of each test strain in each medium was determined by culture enumeration and the suitability of CAMHB was confirmed by comparative statistical analysis. Thereafter, reference and type strain and eight epidemiologically unrelated field isolates of B. bronchiseptica were used to test the suitability of a broth microdilution susceptibility testing method following CLSI-approved performance standards given in document VET01-A4. Susceptibility tests, using 20 antimicrobial agents, were performed in five replicates, and data were collected after 20 and 24 hours incubation and statistically analysed. Due to the low growth rate of B. bronchiseptica, an incubation time of 24 hours resulted in significantly more homogeneous minimum inhibitory concentrations after five replications compared to a 20-hour incubation. An interlaboratory comparison trial including susceptibility testing of 24 antimicrobial agents revealed a high mean level of reproducibility (97.9%) of the modified method. Hence, in a harmonization for broth microdilution susceptibility testing of B. bronchiseptica, an incubation time of 24 hours in CAMHB medium with an incubation temperature of 35°C and an inoculum concentration of approximately 5 x 105 cfu/ml was proposed.
Background: Improving the transparency of information about the quality of health care providers is one way to improve health care quality. It is assumed that Internet information steers patients toward better-performing health care providers and will motivate providers to improve quality. However, the effect of public reporting on hospital quality is still small. One of the reasons is that users find it difficult to understand the formats in which information is presented.
Objective: We analyzed the presentation of risk-adjusted mortality rate (RAMR) for coronary angiography in the 10 most commonly used German public report cards to analyze the impact of information presentation features on their comprehensibility. We wanted to determine which information presentation features were utilized, were preferred by users, led to better comprehension, and had similar effects to those reported in evidence-based recommendations described in the literature.
Methods: The study consisted of 5 steps: (1) identification of best-practice evidence about the presentation of information on hospital report cards; (2) selection of a single risk-adjusted quality indicator; (3) selection of a sample of designs adopted by German public report cards; (4) identification of the information presentation elements used in public reporting initiatives in Germany; and (5) an online panel completed an online questionnaire that was conducted to determine if respondents were able to identify the hospital with the lowest RAMR and if respondents’ hospital choices were associated with particular information design elements.
Results: Evidence-based recommendations were made relating to the following information presentation features relevant to report cards: evaluative table with symbols, tables without symbols, bar charts, bar charts without symbols, bar charts with symbols, symbols, evaluative word labels, highlighting, order of providers, high values to indicate good performance, explicit statements of whether high or low values indicate good performance, and incomplete data (“N/A” as a value). When investigating the RAMR in a sample of 10 hospitals’ report cards, 7 of these information presentation features were identified. Of these, 5 information presentation features improved comprehensibility in a manner reported previously in literature.
Conclusions: To our knowledge, this is the first study to systematically analyze the most commonly used public reporting card designs used in Germany. Best-practice evidence identified in international literature was in agreement with 5 findings about German report card designs: (1) avoid tables without symbols, (2) include bar charts with symbols, (3) state explicitly whether high or low values indicate good performance or provide a “good quality” range, (4) avoid incomplete data (N/A given as a value), and (5) rank hospitals by performance. However, these findings are preliminary and should be subject of further evaluation. The implementation of 4 of these recommendations should not present insurmountable obstacles. However, ranking hospitals by performance may present substantial difficulties.
Hintergrund:
Feedback von Patienten über erlebte Versorgungsaspekte erfolgt auch in der Rehabilitation inzwischen zunehmend online, beispielsweise auf Bewertungsportalen. Daher soll untersucht werden, welche von Rehabilitanden auf der für Reha-Kliniken führenden Bewertungsplattform Klinikbewertungen.de veröffentlichten Versorgungsaspekte mit der Weiterempfehlung einer Rehaklinik und welche negativen Aspekte mit der Nicht-Weiterempfehlung assoziiert sind.
Methode:
Eingeschlossen wurden Reha-Kliniken der Rentenversicherung Bund und federführend von ihr belegte Kliniken. Mit einem Mixed-Methods-Ansatz wurden aus acht Reha-Indikationsgruppen nach Zufriedenheitsstufen stratifizierte freitextliche Erfahrungsberichte von Rehabilitanden inhaltsanalytisch ausgewertet. Der Zusammenhang zwischen positiven (negativen) Aussagen mit der (Nicht-)Weiterempfehlung wurde in der jeweiligen Reha-Indikationsgruppe untersucht.
Ergebnisse:
Die Inhaltsanalyse von 911 Erfahrungsberichten ergab 20 thematische Kategorien. Der von Rehabilitanden wahrgenommene "Reha-Erfolg" war am häufigsten mit der Weiterempfehlung bzw. Nicht-Weiterempfehlung signifikant assoziiert. In fünf QS-Vergleichsgruppen war das Thema "Verpflegung" assoziiert. In allen QS-Vergleichsgruppen war mindestens ein prozessorientiertes Rehabilitationsthema assoziiert: "Reha-Maßnahmen", "Reha-Plan und Reha-Ziele" und/oder "Diagnose bis Entlassung".
Diskussion und Schlussfolgerung:
Reha-Kliniken können auf Basis der vorgestellten Ergebnisse indikationsspezifisch die für die Klinik-Weiterempfehlung relevanten Versorgungsaspekte identifizieren. Die Einbeziehung von Online-Erfahrungsberichten schafft zusätzliche Erkenntnisse über die Gründe der (Un-)Zufriedenheit von Rehabilitanden. Potenziellen Rehabilitanden steht das Erfahrungswissen als niederschwellige Informationsquelle und Entscheidungshilfe zur Verfügung
Durch die Covid-19-Pandemie und die damit einhergehenden Effekte auf die Arbeitswelt ist die Belastung der Mitarbeitenden in einen stärkeren Fokus gerückt worden. Dieser Umstand trifft unter anderem durch den umfassenden Wechsel in die Remote Work auch auf agile Software-Entwicklungsteams in vielen Unternehmen zu. Eine zu hohe Arbeitsbelastung kann zu diversen negativen Effekten, wie einem erhöhten Krankenstand, mangelndem Wohlbefinden der Mitarbeitenden oder reduzierter Produktivität führen. Es ist zudem bekannt, dass sich die Arbeitsbelastung in der Wissensarbeit auf die Qualität der Arbeitsergebnisse auswirkt. Dieser Forschungsbeitrag identifiziert potenzielle Faktoren der Arbeitsbelastung der Mitglieder eines agilen Software-Entwicklungsteams bei der Otto GmbH & Co KG. Auf der Grundlage der Faktoren präsentieren wir Maßnahmen zur Reduzierung von Arbeitsbelastung und erläutern unsere Erkenntnisse, die wir im Rahmen eines Experiments validiert haben. Unsere Ergebnisse zeigen, dass bereits kleinteilige Maßnahmen, wie das Einführen von Ruhearbeitsphasen während des Arbeitstages, zu positiven Effekten bspw. hinsichtlich einer gesteigerten Konzentrationsfähigkeit führen und wie sich diese auf die Qualität der Arbeitsergebnisse auswirken.
Background: We sought to develop and test an objective scorecard-based system for assessing and categorizing available research sites in Lassa fever-affected countries based on their preparedness and capability to host Lassa fever vaccine clinical trials.
Methods: We mapped available clinical research sites through interrogation of online clinical trial registries and relevant disease-based consortia. A structured online questionnaire was used to assess the capability of clinical trial sites to conduct Lassa fever vaccine clinical trials. We developed a new scoring template by allocating scores to questionnaire parameters based on perceived importance to the conduct of clinical trials as described in the WHO/TDR Global Competency Framework for Clinical Research. Cutoff points of 75% and 50% were used to categorize sites into categories A, B, or C.
Results: This study identified 44 clinical trial sites in 8 Lassa fever-affected countries. Out of these, 35 sites were characterized based on their capacity to hold Lassa fever vaccine clinical trials. A total of 14 sites in 4 countries were identified as ready to host Lassa fever vaccine trials immediately or with little support.
Conclusion: It is feasible to hold Lassa fever vaccine trials in affected countries based on the outcome of the survey. However, the findings are to be validated through sites' visits. This experience with a standardized and objective method of the site assessment is encouraging, and the site selection method used can serve as an orientation to sponsors and researchers planning clinical trials in the region.
Die gesetzlich vorgesehene Bereitstellung von Digitalisierungsangeboten stellt öffentliche Verwaltungen vor steigende Herausforderungen. Aufgrund der Heterogenität der Nutzerinnen und Nutzer ist es für öffentliche Verwaltungen häufig problematisch, klare Anforderungen zu erheben und zu erfüllen. Hinzukommen strukturelle und organisatorische Gegebenheiten wie beispielsweise ausgeprägte Entscheidungshierarchien, die eine nutzerzentrierte Vorgehensweise erschweren können. Darüber hinaus sieht sich die öffentliche Verwaltung zunehmend mit komplexer werdenden Problemen konfrontiert. Es stellt sich daher die Frage, wie in der öffentlichen Verwaltung ein moderner Ansatz zur Nutzerzentrierung und Problemlösung eingesetzt werden kann. Dieser Artikel präsentiert die Ergebnisse einer Einzelfallstudie bei der Niedersächsischen Landesbehörde für Straßenbau und Verkehr (NLStBV). Wir haben mit einer Fokusgruppe einen Design-Thinking-Workshop durchgeführt, um Potenziale und Anwendungsmöglichkeiten des Ansatzes in der öffentlichen Verwaltung zu identifizieren. Auf Basis einer SWOT-Analyse haben wir die Ergebnisse untersucht und geben vier konkrete Handlungsempfehlungen für die Einführung sowie Nutzung von Design Thinking.
Subclinical mastitis in heifers during early lactation affects udder health, future milk production and, therefore, the risk of premature culling. The aim of this cross-sectional study was to identify pre- and post-partum risk factors associated with a high heifer mastitis rate (HMR), and to find out which period (either pre- or post-partum) contains more risk factors and consequently should be the focus of mastitis control in heifers. A total of 77 herds were included in this study and the potential animal- and farm-related risk factors were recorded during a one-time farm visit. The HMR was provided by the dairy herd improvement test (DHI) as the annual average of the past 11 DHIs. For this study, data were analyzed in two models using generalized linear models. Each model examined the association between possible risk factors and HMR, one including only prepartum risk factors and the other one only post-partum risk factors. One identified pre-partum risk factor was the proportion of udder-healthy cows in the herd. Post-partum risk factors were the type of teat cleaning procedure before milking, teat disinfection, treatment of mastitis in heifers, a body condition score (BCS) of >3.0 in fresh heifers, and the combination of a teat cleaning procedure with a teat disinfectant. The results show the importance of the period shortly after calving for udder health in heifers, as four of the five significant risk factors were identified in this period and three of them were related to the milking process. However, further research with a higher number of herds is needed to minimize individual herd effects.
Background
To perform a systematic review about the effect of using clinical pathways on length of stay (LOS), hospital costs and patient outcomes. To provide a framework for local healthcare organisations considering the effectiveness of clinical pathways as a patient management strategy.
Methods
As participants, we considered hospitalized children and adults of every age and indication whose treatment involved the management strategy "clinical pathways". We include only randomised controlled trials (RCT) and controlled clinical trials (CCT), not restricted by language or country of publication. Single measures of continuous and dichotomous study outcomes were extracted from each study. Separate analyses were done in order to compare effects of clinical pathways on length of stay (LOS), hospital costs and patient outcomes. A random effects meta-analysis was performed with untransformed and log transformed outcomes.
Results
In total 17 trials met inclusion criteria, representing 4,070 patients. The quality of the included studies was moderate and studies reporting economic data can be described by a very limited scope of evaluation. In general, the majority of studies reporting economic data (LOS and hospital costs) showed a positive impact. Out of 16 reporting effects on LOS, 12 found significant shortening. Furthermore, in a subgroup-analysis, clinical pathways for invasive procedures showed a stronger LOS reduction (weighted mean difference (WMD) -2.5 days versus -0.8 days)).
There was no evidence of differences in readmission to hospitals or in-hospital complications. The overall Odds Ratio (OR) for re-admission was 1.1 (95% CI: 0.57 to 2.08) and for in-hospital complications, the overall OR was 0.7 (95% CI: 0.49 to 1.0). Six studies examined costs, and four showed significantly lower costs for the pathway group. However, heterogeneity between studies reporting on LOS and cost effects was substantial.
Conclusion
As a result of the relatively small number of studies meeting inclusion criteria, this evidence base is not conclusive enough to provide a replicable framework for all pathway strategies. Considering the clinical areas for implementation, clinical pathways seem to be effective especially for invasive care. When implementing clinical pathways, the decision makers need to consider the benefits and costs under different circumstances (e.g. market forces).
This paper presents a databased approach for improving the precision of the moulding sand compressibility in the moulding sand mixer of a foundry. In this approach, the deviation between the measured and the target compressibility is reduced by controlling the water addition. The complex dynamic behaviour of the process variables and their influence on the water addition is modelled with a long short-term memory (LSTM) network. Another LSTM network as control path simulates the impact of the water addition on the compressibility. Simulation and experimental results with the applied model for water prediction in a feedforward control yield relevant improvements of the moulding sand compressibility.
Die Sozialarbeiterin Yildiz Sahinde Demirer hat mit anderen Frauen das Projekt „Erzählcafés für geflüchtete Frauen“ in Trägerschaft der Landeshauptstadt Hannover (2018 bis 2021) konzipiert und umgesetzt. In fünf Stadtteilen konnten sich die Frauen regelmäßig treffen und austauschen, sich beteiligen und kamen zu Wort. Ihre Arbeit bezeichnet Demirer als Gemeinwesenarbeit mit politischen und feministischen Schwerpunkten. Die wissenschaftliche Begleitung durch Rebecca Hassan und Joachim Romppel von der Hochschule Hannover führte zur Dokumentation und Auswertung des Modellprojekts. Das Bundesamt für Migration und Flüchtlinge (BAMF) förderte das Projekt. Bemerkenswert sind die Erfolge dieser nonformalen Bildungsarbeit.
Gutes Arbeiten für Mitarbeiter ist je nach Arbeitskontext unterschiedlich zu bewerten, hängt jedoch von der Gestaltung bestimmter Kontextfaktoren ab. Die Kontextfaktoren guter Arbeit sind der zentrale Forschungsgegenstand dieser Arbeit. Dabei steht ein E‑Commerce-Team (EC-Team) von Otto im Fokus der Untersuchungen.
Das Ziel unseres Artikels ist es, die Kontextfaktoren zu analysieren, die dazu führen, dass gute Arbeit ermöglicht wird. Dabei ist eine auf Dauer funktionierende Arbeitsweise gesucht, welche eine hohe Arbeitsqualität und -quantität ermöglicht. Dazu sind die beiden primären Ziele zu definieren, was gutes Arbeiten ausmacht und zum anderen die Kontextfaktoren für gutes Arbeiten innerhalb des EC-Teams bei Otto zu identifizieren.
Unsere Forschungsfrage lautet: Welche Kontextfaktoren sind für gutes Arbeiten bei Otto im EC-Team in der derzeitigen Remote-Arbeit besonders relevant und entsprechend gestaltbar?
Um die Forschungsfrage beantworten zu können, wird zunächst eine Literaturrecherche zur Definition von guter Arbeit vorgenommen. Anschließend wird untersucht, welche Faktoren laut Literatur zu einer guten Arbeit beitragen, um aus den resultierenden Faktoren Cluster zu bilden.
Die Cluster werden dem Otto EC-Team zur Abstimmung mit der Mehrpunktabfrage über das virtuelle Kollaborations-Tool MiroFootnote 2 zur Verfügung gestellt. Aufbauend auf dem Ergebnis der Abstimmung, werden ein Gamification Board, Erinnerungsmails und ein Stimmungsbarometer erstellt, um die Auswirkungen des Clusters im Rahmen eines Experiments zu analysieren.
Diese Maßnahmen werden innerhalb von zwei Wochen durchgeführt. Um die Erfahrungen der Probanden zu sammeln, werden anschließend Interviews durchgeführt und ausgewertet. Die Ergebnisse der Interviews fließen in die anschließende Handlungsempfehlung ein.
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).
The Wnt signaling pathway has been associated with many essential cell processes. This study aims to examine the effects of Wnt signaling on proliferation of cultured HEK293T cells. Cells were incubated with Wnt3a, and the activation of the Wnt pathway was followed by analysis of the level of the β-catenin protein and of the expression levels of the target genes MYC and CCND1. The level of β-catenin protein increased up to fourfold. While the mRNA levels of c-Myc and cyclin D1 increased slightly, the protein levels increased up to a factor of 1.5. Remarkably, MTT and BrdU assays showed different results when measuring the proliferation rate of Wnt3a stimulated HEK293T cells. In the BrdU assays an increase of the proliferation rate could be detected, which correlated to the applied Wnt3a concentration. Oppositely, this correlation could not be shown in the MTT assays. The MTT results, which are based on the mitochondrial activity, were confirmed by analysis of the succinate dehydrogenase complex by immunofluorescence and by western blotting. Taken together, our study shows that Wnt3a activates proliferation of HEK293 cells. These effects can be detected by measuring DNA synthesis rather than by measuring changes of mitochondrial activity.
Energy- and angle-resolved photofragment distributions for ground-state Cl (²P₃/₂) and spin–orbit excited Cl* (²P₁/₂) have been recorded using the velocity map imaging technique after photodissociation of chloroform at wavelengths of 193 and ∼235 nm. Translational energy distributions are rather broad and peak between 0.6 and 1.0 eV. The spin–orbit branching ratios [Cl*]/[Cl] are 1 and 0.3 at 193 and 235 nm, respectively, indicating the involvement of two or more excited state surfaces. Considering the anisotropy parameters and branching ratios collectively, we conclude that the reaction at 193 nm takes place predominantly on the ¹Q₁ surface, while the ³Q₁ surface gains importance at lower dissociation energies around 235 nm.
Nur wenn eine klebgerecht ausgeführte Konstruktion mit dem richtigen Klebstoff nach optimaler Oberflächenbehandlung und mit angepssten Abbindebedingungen gefertigt wird, sind Klebverbindungen von maximaler Festigkeit und Alterungsbeständigkeit zu erzielen. Am Beispiel von Bremsbelägen wird gezeigt, dass bei einer entsprechenden Erprobung auch sogenannte Sicherheitsteile durch Kleben hergestellt werden könne.
Obwohl die Klebtechnik eines der ältesten Fügeverfahren der Welt ist, sind die Kenntnisse über diese Technik häufig noch sehr gering. Dies zeigt sich an vielen Stellen, beim Verkaufsgespräch von Klebstoffen, aber auch in Beiträgen zu klebtechnischen Seminaren. Es werden manchmal "Merk"würdige Ansichten über das Kleben geäußert.
Klebverbindungen werden häufig dem Zugscherversuch nach DIN 53 238, dem wohl wichtigsten Versuch der Klebtechnik, unterzogen. Die Belastung jedoch entspricht nicht den in der Praxis verkommenden Bedingungen. Es stellt sich die Frage, ob die im Zugscherversuch ermittelten Kenndaten zur Dimensionierung von Klebverbindungen überhaupt geeignet sind.
Am 12. und 13. Juni 1986 fand in Konstanz das Symposium Haftung von Verbundwerkstoffen und Werkstoffverbunden statt. Die Veranstaltung wird in vierjährigem Turnus von der Deutschen Gesellschaft für Metallkunde (DGM) in Zusammenarbeit mit dem Fraunhofer-Institut für angewandte Materialforschung (IFAM) in Bremen ausgerichtet. Als interdisziplinäres Thema stand die Haftung zwischen unterschiedlichen Stoffen auf dem Programm. In 18 Referaten sind Erkenntnisse und Probleme aus unterschiedlichen Arbeitsbereichen vorgetragen worden. Insgesamt nahmen etwas 100 Fachleute aus dem In- und Ausland teil.
Das Versagen von Klebungen kann durch ungenügende Adhäsion, Alterungsprozesse oder mechanische Spannungen erfolgen. In der SMD-Technologie werden Werkstoffe geklebt, die verschiedene Ausdehnungskoeffizienten besitzen. Bei SMD-Klebverbindungen gewährleistet die nachfolgende Lötung deren Langzeitfestigkeit. Wurde für eine gute Adhäsion reichlich Vorsorge getroffen und die Klebung versagt trotzdem, stellt sich die Frage: Spielen mechanische Eigenschaften für den Einsatz von SMD-Klebstoffen eine Rolle?
Der Zugscherversuch ist die am häufigsten angewandte Prüftechnik für Klebverbindungen. Die dabei ermittelte Klebfestigkeit ist jedoch eine wenig aussagefähige Größe. In keinem Fall kann sie als Werkstoffkennwert den Klebstoff charakterisieren. Als Ausgangsgröße für Berechnungen bei der Dimensionierung von Klebverbindungen ist das Ergebnis des Zugscherversuchs deshalb nicht geeignet.
Die Prüfung von Klebverbindungen erfolgt häufig im Zugscherversuch. Bei der Anwendung dieser Prüfmethode bei Polymer-Metall-Klebverbindungen tritt oft ein Bruch im Polymerteil auf. Dadurch wird die Aussagefähigkeit des Zugscherversuchs stark eingeschränkt. Das gilt vor allem für die Optimierung der Oberflächenvorbehandlung von Polymerteilen. Der vorliegende Beitrag untersucht die Beanspruchungsparameter von Polymer-Metall-klebverbindungen im Zugscherversuch und leitet daraus Forderungen an geeignete Prüfanordnungen ab.
Viele Kunststoffe besitzen nur schlechte Adhäsionseigenschaften. So lassen sich viele technisch wichtige Kunststoffe adhäsiv nur dann zufriedenstellend mit Adhäsionsklebstoffen kleben, wenn die Kunststoffteile vorbehandelt worden sind. Versuche mit einer Niederdruckplasmabehandlung führten zu brauchbaren Ergebnissen.
Kleben im Kraftfahrzeugbau
(1987)
Klebemöglichkeiten von PTFE
(1990)
Die hohe Beständigkeit und die antiadhäsiven Eigenschaften von Polytetrafluorethylen (PTFE) erschweren das Kleben dieses Kunststoffes beträchtlich. Da PTFE praktisch unlöslich ist, können Diffusionsklebverbindungen nicht hergestellt werden und Adhäsionsklebverbindungen haben nur eine geringe Festigkeit. Es ist jedoch durch entsprechende Behandlungen möglich, die Oberfläche so zu verändern, dass hochfeste Adhäsionsklebverbindungen möglich sind.
Conventional fluorescent tubes are increasingly being replaced with innovative light-emitting diodes (LEDs) for lighting poultry houses. However, little is known about whether the flicker frequencies of LED luminaires are potential stressors in poultry husbandry. The term “light flicker” describes the fluctuations in the brightness of an electrically operated light source caused by the design and/or control of the light source. In this context, the critical flicker frequency (CFF) characterizes the frequency at which a sequence of light flashes is perceived as continuous light. It is known that CFF in birds is higher than that in humans and that light flicker can affect behavioral patterns and stress levels in several bird species. As there is a lack of knowledge about the impact of flicker frequency on fattening turkeys, this study aimed to investigate the effects of flicker frequency on the behavior, performance, and stress response in male turkeys. In 3 trials, a total of 1,646 male day-old turkey poults of the strain B.U.T. 6 with intact beaks were reared for 20 wk in 12 barn compartments of 18 m² each. Each barn compartment was illuminated using 2 full-spectrum LED lamps. Flicker frequencies of 165 Hz, 500 Hz, and 16 kHz were set in the luminaires to illuminate the compartments. Analyses of feather corticosterone concentration were performed on fully grown third-generation primaries (P 3) of 5 turkeys from each compartment. No significant differences were found in the development of live weight, feed consumption, or prevalence of injured or killed turkeys by conspecifics reared under the above flicker frequencies. The flicker frequencies also did not significantly influence feather corticosterone concentrations in the primaries of the turkeys. In conclusion, the present results indicate that flicker frequencies of 165 Hz or higher have no detrimental effect on growth performance, injurious pecking, or endocrine stress response in male turkeys and, thus, may be suitable for use as animal-friendly lighting.
As part of the European Network for Optimization of Veterinary Antimicrobial Treatment (ENOVAT), a webinar on the topic “Mastitis Treatment in Lactation” was held, in which eight mastitis experts from different European countries (Spain, The Netherlands, Estonia, Ireland, Poland, Finland, Germany, and Italy) presented their treatment approaches for clinical mastitis in lactation. The aim of this study was to compare the therapeutic approaches to identify commonalities and differences. In all eight participating countries, the decision to start treatment is usually made by the veterinarians, while the farm personnel are responsible for treatment administration. Antibiotic treatment is then typically administered intramammarily. The treatment duration often depends on the label instructions and is frequently extended if Staphylococcus aureus or Streptococcus uberis is involved. Administering supportive therapy, especially non-steroidal anti-inflammatory drugs (NSAIDs) is an established practice in all countries. Penicillin is the first-choice drug for the treatment of mastitis in an increasing number of countries. The use of critically important antimicrobials (CIAs) such as quinolones and third- and fourth-generation cephalosporins is at a low level in Finland and The Netherlands. In Estonia, Germany, Italy, and Spain, the use of CIAs is declining and is only allowed if milk samples are analyzed in advance following the legal framework. Systems for monitoring antibiotic use are being introduced in more and more countries. This exchange of different views will help the European countries to move towards a common high standard of antimicrobial stewardship in veterinary medicine.
Der noch relativ junge Begriff Gemeinwesendiakonie signalisiert das notwendige Nachdenken über ein neues Verhältnisses zwischen Kirchengemeinde, Diakonie und weiteren Akteuren im Gemeinwesen. Es geht um die Entwicklung eines neuen Zusammenwirkens von diakonischer Gemeinde und gemeinwesenorientierter Diakonie, in Kooperation mit anderen gesellschaftlichen Akteuren.
Diakonie bildet Gemeinde, dies gilt dabei in zweierlei Hinsicht: Zum einen kann gemeinwesendiakonisches Engagement eine Bildungswirkung für die in Projekten und Initiativen Beteiligten entfalten wie auch den Prozess der Gemeindebildung befördern. Zum anderen bilden die in gemeinwesendiakonischen Projekten und Initiativen Beteiligten selbst Gemeinde.
Inwiefern eignet sich Gemeinde als Ort intergenerationeller Lern- und Bildungsprozesse? Zur Beantwortung dieser Frage werden drei Formen des Generationenverhältnisses sowie drei Grundkonzeptionen intergenerationellen Lernens beschrieben, um anschließend nach den didaktischen Herausforderungen und begünstigenden Rahmenbedingungen zu fragen.
Kirche und Religion begleiten Menschen an bestimmten biografischen Wendepunkten ihres Lebens, sie sind traditionelle Übergangsbegleiter insbesondere in Form der Kasualien. Angesichts zahlreicher weiterer Lebensübergänge auch jenseits der Kasualien, für die es typisch ist, dass sie individuell höchst ungleichzeitig auftreten, stellt sich die Frage, wie die gemeindepädagische Bildungsarbeit Menschen in biografischen Lebensumbrüchen bei der Bewältigung und Gestaltung solcher Lebensübergänge begleiten kann.
Ability of Black-Box Optimisation to Efficiently Perform Simulation Studies in Power Engineering
(2023)
In this study, the potential of the so-called black-box optimisation (BBO) to increase the efficiency of simulation studies in power engineering is evaluated. Three algorithms ("Multilevel Coordinate Search"(MCS) and "Stable Noisy Optimization by Branch and Fit"(SNOBFIT) by Huyer and Neumaier and "blackbox: A Procedure for Parallel Optimization of Expensive Black-box Functions"(blackbox) by Knysh and Korkolis) are implemented in MATLAB and compared for solving two use cases: the analysis of the maximum rotational speed of a gas turbine after a load rejection and the identification of transfer function parameters by measurements. The first use case has a high computational cost, whereas the second use case is computationally cheap. For each run of the algorithms, the accuracy of the found solution and the number of simulations or function evaluations needed to determine the optimum and the overall runtime are used to identify the potential of the algorithms in comparison to currently used methods. All methods provide solutions for potential optima that are at least 99.8% accurate compared to the reference methods. The number of evaluations of the objective functions differs significantly but cannot be directly compared as only the SNOBFIT algorithm does stop when the found solution does not improve further, whereas the other algorithms use a predefined number of function evaluations. Therefore, SNOBFIT has the shortest runtime for both examples. For computationally expensive simulations, it is shown that parallelisation of the function evaluations (SNOBFIT and blackbox) and quantisation of the input variables (SNOBFIT) are essential for the algorithmic performance. For the gas turbine overspeed analysis, only SNOBFIT can compete with the reference procedure concerning the runtime. Further studies will have to investigate whether the quantisation of input variables can be applied to other algorithms and whether the BBO algorithms can outperform the reference methods for problems with a higher dimensionality.
Background: Often preventive measures are not accessed by the people who were intended to be reached. Programs for older adults may target men and women, older adults, advanced old age groups and/or chronically ill patients with specific indications. The defined target groups rarely participate in the conception of programs or in the design of information materials, although this would increase accessibility and participation. In the German “Reaching the Elderly” study (2008–2011), an approach to motivating older adults to participate in a preventive home visit (PHV) program was modified with the participatory involvement of the target groups. The study examines how older men and women would prefer to be addressed for health and prevention programs.
Methods: Four focus groups (N = 42 participants) and 12 personal interviews were conducted (women and men in 2 age groups: 65–75 years and ≥ 76 years). Participants from two districts of a major German city were selected from a stratified random sample (N = 200) based on routine data from a local health insurance fund. The study focused on the participants’ knowledge about health and disease prevention and how they preferred to be approached and addressed. Videos of the focus groups were recorded and analysed using mind mapping techniques. Interviews were digitally recorded, transcribed verbatim and subjected to qualitative content analysis.
Results: A gender-specific approach profile was observed. Men were more likely to favor competitive and exerciseoriented activities, and they associated healthy aging with mobility and physical activity. Women, on the other hand, displayed a broader understanding of healthy aging, which included physical activity as only one aspect as well as a healthy diet, relaxation/wellness, memory training and independent living; they preferred holistic and socially oriented services that were not performance-oriented. The “older seniors” (76+) were ambivalent towards
certain wordings referring to aging.
Conclusions: Our results suggest that gender-specific needs must be considered in order to motivate older adults to participate in preventive services. Age-specific characteristics seem to be less relevant. It is more important to pay attention to factors that vary according to the individual state of health and life situation of
the potential participants.
The aim of the current study was to investigate the effects of the prepartum external treatment of teats with a combination of four lactic acid bacteria strains viz. Lactobacillus (Lb.) rhamnosus ATCC 7469, Lactococcus lactis subsp. lactis ATCC 11454, Lb. paracasei 78/37 (DSM 26911), and Lb. plantarum 118/37 (DSM 26912) on the postcalving udder health of dairy heifers. The study used a split-udder design. Two weeks before the expected calving date, one of two contralateral teats of a teat pair was dipped with an aqueous suspension of lactic acid bacteria (final bacterial counts 8.40–8.47 log10-transformed CFU/mL) once in a week until calving; the other teat of the pair was not treated. After calving, quarter foremilk samples were taken and investigated cyto-microbiologically. In total, 629 teat pairs of 319 heifers were included. There was an association between the treatment and intramammary infections caused by the major udder-pathogenic bacteria Staphylococcus aureus, Streptococcus dysgalactiae, and enterococci, as well as clinical mastitis in the first 100 days after calving. The present study indicates that intramammary infections with major pathogens and clinical mastitis may be prevented by regular prepartum external application of lactic acid bacteria in dairy heifers.
Background
The eResearch system “Prospective Monitoring and Management App (PIA)” allows researchers to implement questionnaires on any topic and to manage biosamples. Currently, we use PIA in the longitudinal study ZIFCO (Integrated DZIF Infection Cohort within the German National Cohort) in Hannover (Germany) to investigate e.g. associations of risk factors and infectious diseases. Our aim was to assess user acceptance and compliance to determine suitability of PIA for epidemiological research on transient infectious diseases.
Methods
ZIFCO participants used PIA to answer weekly questionnaires on health status and report spontaneous onset of symptoms. In case of symptoms of a respiratory infection, the app requested participants to self-sample a nasal swab for viral analysis. To assess user acceptance, we implemented the System Usability Scale (SUS) and fitted a linear regression model on the resulting score. For investigation of compliance with submitting the weekly health questionnaires, we used a logistic regression model with binomial response.
Results
We analyzed data of 313 participants (median age 52.5 years, 52.4% women). An average SUS of 72.0 reveals good acceptance of PIA. Participants with a higher technology readiness score at the beginning of study participation also reported higher user acceptance. Overall compliance with submitting the weekly health questionnaires showed a median of 55.7%. Being female, of younger age and being enrolled for a longer time decreased the odds to respond. However, women over 60 had a higher chance to respond than women under 60, while men under 40 had the highest chance to respond. Compliance with nasal swab self-sampling was 77.2%.
Discussion
Our findings show that PIA is suitable for the use in epidemiologic studies with regular short questionnaires. Still, we will focus on user engagement and gamification for the further development of PIA to help incentivize regular and long-term participation.
Background:
Huntington’s disease (HD) is a rare, genetic, neurodegenerative and ultimately fatal disease with no cure or progression-delaying treatment currently available. HD is characterized by a triad of cognitive, behavioural and motor symptoms. Evidence on epidemiology and management of HD is limited, especially for Germany. This study aims to estimate the incidence and prevalence of HD and analyze the current routine care based on German claims data.
Methods:
The source of data was a sample of the Institute for Applied Health Research Berlin (InGef) Research Database, comprising data of approximately four million insured persons from approximately 70 German statutory health insurances. The study was conducted in a retrospective cross-sectional design using 2015 and 2016 as a two-year observation period. At least two outpatient or inpatient ICD-10 codes for HD (ICD-10: G10) during the study period were required for case identification. Patients were considered incident if no HD diagnoses in the 4 years prior to the year of case identification were documented. Information on outpatient drug dispensations, medical aids and remedies were considered to describe the current treatment situation of HD patients.
Results:
A 2-year incidence of 1.8 per 100,000 persons (95%-Confidence interval (CI): 1.4–2.4) and a 2-year period prevalence of 9.3 per 100,000 persons (95%-CI: 8.3–10.4) was observed. The prevalence of HD increased with advancing age, peaking at 60–69 years (16.8 per 100,000 persons; 95%-CI: 13.4–21.0) and decreasing afterwards.
The most frequently observed comorbidities and disease-associated symptoms in HD patients were depression (42.9%), dementia (37.7%), urinary incontinence (32.5%), extrapyramidal and movement disorders (30.5%), dysphagia (28.6%) and disorders of the lipoprotein metabolism (28.2%).
The most common medications in HD patients were antipsychotics (66.9%), followed by antidepressants (45.1%). Anticonvulsants (16.6%), opioids (14.6%) and hypnotics (9.7%) were observed less frequently.
Physical therapy was the most often used medical aid in HD patients (46.4%). Nursing services and speech therapy were used by 27.9 and 22.7% of HD patients, respectively, whereas use of psychotherapy was rare (3.2%).
Conclusions:
Based on a representative sample, this study provides new insights into the epidemiology and routine care of HD patients in Germany, and thus, may serve as a starting point for further research.
Background:
Multiple Sclerosis (MS) is a chronic inflammatory, immune mediated disease of the central nervous system, with Relapsing Remitting MS (RRMS) being the most common type. Within the last years, the status of high disease activity (HDA) has become increasingly important for clinical decisions. Nevertheless, little is known about the incidence, the characteristics, and the current treatment of patients with RRMS and HDA in Germany. Therefore, this study aims to estimate the incidence of HDA in a German RRMS patient population, to characterize this population and to describe current drug treatment routines and further healthcare utilization of these patients.
Methods:
A claims data analyses has been conducted, using a sample of the InGef Research Database that comprises data of approximately four million insured persons from around 70 German statutory health insurances (SHI). The study was conducted in a retrospective cohort design, including the years 2012–2016. Identification of RRMS population based on ICD-10 code (ICD-10-GM: G35.1). For identification of HDA, criteria from other studies as well as expert opinions have been used. Information on incidence, characteristics and current treatment of patients with RRMS and HDA was considered.
Results:
The overall HDA incidence within the RRMS population was 8.5% for 2016. It was highest for the age group of 0–19 years (29.4% women, 33.3% men) and lowest for the age group of ≥ 50 years (4.3% women, 5.6% men). Mean age of patients with RRMS and incident HDA was 38.4 years (SD: 11.8) and women accounted for 67.8%.
Analyses of drug utilization showed that 82.4% received at least one disease-modifying drug (DMD) in 2016. A percentage of 49.8% of patients received drugs for relapse therapy. A share of 55% of RRMS patients with HDA had at least one hospitalization with a mean length of stay of 13.9 days (SD: 18.3 days) in 2016. The average number of outpatient physician contacts was 28.1 (SD: 14.0).
Conclusions:
This study based on representative Germany-wide claims data from the SHI showed a high incidence of HDA especially within the young RRMS population. Future research should consider HDA as an important criterion for the quality of care for MS patients.
Szenisches Spiel
(2009)
Die alltägliche Konfrontation mit gesellschaftlichen Tabus wie Alter, Krankheit, Tod, die Arbeit zwischen "Macht und Ohnmacht" verlangt von den Pflegenden ein hohes Maß an sozialer und personaler Kompetenz. Das szenische Lernen bzw. Spiel ist ein Ansatz, der sich hervorragend zur Förderung dieser Schlüsselqualifikationen eignet. In diesem Aufsatz werden zunächst die allgemein didaktischen Ursprünge und Hintergründe szenischen Lernens bzw. Spiels dargestellt, um anschließend seine pflegedidaktische Auslegung und Akzentuierung zu charakterisieren. Zum Schluss wird anhand der Lerneinheit „Reflexion der praktischen Ausbildung“ aufgezeigt, wie mit ausgewählten szenischen Spielverfahren in der pflegepädagogischen Praxis gearbeitet werden kann.
Ausgehend von der Theorie der digitalen Signalsynthese wird in diesem Beitrag ein rechnergestützter Funktionsgenerator vorgestellt, der den Entwickler in die Lage versetzt, diverse periodische Zeitfunktionen mit beliebig komplizierten spektralen Eigenschaften zu generieren. Die dabei relevanten Hard- und Softwaregesichtspunkte, die zur Berechnung einer Stützstellenfolge über Fouriersynthese mit einem IBM-PC in Turbo-Pascal erforderlich sind, werden in der folgenden Abhandlung näher erläutert.
Auch für das Teilnehmeranschlußnetz werden neben dem heute üblichen „Sternnetz" neuerdings „Ring-" und „Verzweigungsnetze" genannt, und es wird die Frage diskutiert, ob damit geringere Kosten zu erwarten sind. Mit Begriffen der Graphentheorie werden hier z.B. die Strukturen Stern, Ring, Baum definiert. Ein gedachtes Ortsnetz wird dann in quadratische Bereiche mit der Seitenlänge l und mit M Teilnehmern aufgeteilt. Für verschiedene Strukturen des Leiternetzes in der Teilnehmerebene werden die Mindestlängen der Leiter und der Kabelkanäle berechnet. Unter anderem zeigt sich, daß unabhängig von der Struktur des Leiternetzes die Kabelkanäle, ein dominierender Kostenanteil in der Teilnehmerebene, praktisch gleich lang sind, nämlich l/M^0,5 je Teilnehmer.
Innerhalb digitaler Nebenstellenanlagen können kurzfristig die verbesserten Kommunikationsmöglichkeiten eines „Integrated Services Digital Network" unabhängig von der Existenz eines nur langfristig realisierbaren, durchgehend digitalen öffentlichen Netzes angeboten werden. Beim Anschluß an die bestehenden öffentlichen Netze ergeben sich jedoch einige Probleme: Z. B. müssen die Bedingungen des bestehenden Dämpfungsplans eingehalten werden, auch im ungünstigsten Fall sind ausreichend hohe Signal-Quantisierungsgeräusch-Abstände sicherzustellen, für die Text- und Datenkommunikation mit den derzeit bestehenden öffentlichen Netzen sind u. U. zusätzliche Einrichtungen in der Nebenstellenanlage erforderlich. Diese Einführungsprobleme werden diskutiert und Lösungsmöglichkeiten hierzu vorgeschlagen.
In Zeitmultiplex-Vielfachzugriff-(TDMA-)Durchschalte-Vermittlungsnetzen mit verteilter Steuerung können Kollisionen von Zugriffsvorgängen auftreten. Es wird unterstellt, daß die den kollidierenden Zugriffsvorgängen zugehörigen Verbindungswünsche nicht weiterbehandelt werden und deshalb wegen Kollision zu Verlust gehen. Die zugehörige Verlustwahrscheinlichkeit -genannt Kollisionsverlust BK - wird allgemein berechnet. Die numerische Auswertung zeigt, daß für Fernsprechverkehr diese - gegenüber Systemen mit konzentrierter Steuerung - zusätzlichen Kollisionsverluste vernachlässigt werden können gegenüber den üblichen Planungsverlusten wegen Abnehmermangels.
"Coded Mark Inversion" (CMI) und "Manchester" (MAN) sind häufig verwendete binäre Leitungscodes. Die Synthese von Decodierer-Schaltungen kann mit Booleschen Funktionstabellen und Automatendiagrammen erfolgen. Diese Daten lassen sich in ein Logiksynthese-Softwarepaket eingeben und liefern als Ergebnis eine standardisierte Datei zur Programmierung eines geeigneten Logikbausteins. Die einzelnen Entwicklungsschritte von der umgangssprachlichen Problembeschreibung bis zur Programmierung sind hier erläutert.
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
To reduce the negative effects of mastitis in dairy heifers in early lactation on the future milking performance, the aim of this study was to define the time-related period of intramammary infections and to relate this to risk factors at heifer and quarter level for intramammary infections and subclinical mastitis. In total, 279 German Holstein Frisian heifers in three farms in Northern and Eastern Germany were included in this study. Quarter milk samples for cytomicrobiological examination were collected 3 +- 1 days after calving and 17 +- 3 days after calving, and risk factors
at heifer and quarter 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 at older ages increased the odds of intramammary infections with non-aureus staphylococci (NAS) and coryneforms 17 +- 3 days after calving compared to heifers calving at a younger age. Detaching of milking cups during milking is a risk factor for new infections between day 3 +- 1 and 17 +- 3 postpartum. The milk yield after calving is associated with a decrease in intramammary infections with environmental pathogens and clinical mastitis. A high milk yield assists the development of udder edema with an increased risk of intramammary infections with NAS and coryneforms. An increased somatic cell count (SCC) after calving increased the odds of intramammary infections with contagious pathogens 17 +- 3 days postpartum. The early lactation has an important influence on udder health and intramammary infections postpartum in dairy heifers. Udder quarters eliminated pathogens during early lactation by 6.9% for cases in
this study. New infections manifest themselves up until 17 +- 3 days postpartum, especially with Corynebacterium spp. and NAS. In total, 82.9% of the infected quarters showed new infections with another pathogen species 17 +- 3 days postpartum than 3 +- 1 days postpartum. In conclusion, the early lactation has an important influence on udder health and intramammary infections postpartum in heifers with the possibility that udder quarters eliminate pathogens, but also the danger that new infections manifest themselves. Thus, the prevention of new infections by minimizing the associated risk factors is of great importance.
Der vorliegende Beitrag beschreibt Einsatzpotenziale des Energiemanagementprofils PROFIenergy in der Prozessindustrie.
Der Blick auf den Status von Energieeffizienzmaßnahmen in der Prozessindustrie zeigt, dass diese im Wesentlichen innerhalb der verfahrenstechnischen Optimierung angesiedelt sind. Noch hat sich der durchgängige Einsatz von technischen Energiemanagementsystemen
(tEnMS) nicht etabliert. Diese Arbeit fokussiert Vorteile des tEnMS-Einsatzes und präsentiert „Best Practice“- Beispiele in der Prozessindustrie. Abschließend wird aufgezeigt, welches Potenzial das Energiemanagementprofil PROFIenergy liefern kann und welche Anwendungsfälle sich damit abdecken lassen.
The PROFINET protocol has been extended in the current version to include security functions. This allows flexible network architectures with the consideration of OT security requirements to be designed for PROFINET, which were not possible due to the network segmentation previously required. In addition to the manufacturers of the protocol stacks, component manufacturers are also required to provide a secure implementation in their devices. The necessary measures go beyond the use of a secure protocol stack. Using the example of an Ethernet-APL transmitter with PROFINET communication, this article shows which technical and organizational conditions will have to be considered by PROFINET device manufacturers in the future.
Das PROFINET Protokoll wurde in der aktuellen Version um Security-Funktionen erweitert. Damit können für PROFINET flexible Netzwerkarchitekturen unter Berücksichtigung von OT-Security Anforderungen entworfen werden, die durch die bisher erforderliche Netzwerksegmentierung nicht möglich waren. Neben den Herstellern der Protokollstacks sind nachfolgend auch die Komponentenhersteller gefordert, eine sichere Implementierung in ihren Geräten umzusetzen. Die erforderlichen Maßnahmen gehen dabei über die Nutzung eines sicheren Protokollstacks hinaus. Der Beitrag zeigt am Beispiel eines Ethernet-APL Messumformers mit PROFINET-Kommunikation die künftig von PROFINET-Geräteherstellern zu berücksichtigenden technischen und organisatorischen Rahmenbedingungen.
This paper reflects the content of the presentation “The Next Generation: Ethernet-APL for Safety Systems” at the NAMUR Annual General Meeting 2022. It deals with the use of the Ethernet Advanced Physical Layer (Ethernet-APL) in combination with the PROFINET/PROFIsafe protocol for safety applications. It describes the virtues of the digital communication between the field and safety system. In parallel the aspect of OT security for this use case is touched as well. The paper proposes a secure architecture, where safety- and non-safety field communications are still separated. At the end a set of requirements for the development of future APL devices is described.
Die Konvergenz von Netzwerken ist ein zunehmender Trend im Bereich der Automatisierung. Immer mehr Anlagenbetreiber streben eine Vereinheitlichung der Netzwerke in ihren Anlagen an. Dies führt zu einer nahtlosen Netzwerkstruktur, einer vereinfachten Überwachung und einem geringeren Schulungsaufwand für das Personal, da nur eine einheitliche Netzwerktechnologie gehandhabt werden muss. Ethernet-APL ist ein Teil des Puzzles für ein solches konvergentes Netzwerk und unterstützt verschiedene Echtzeitprotokolle wie PROFINET, EtherNet, HART-IP sowie das Middleware-Protokoll OPC UA. Dieses Papier gibt einen Überblick über die Auswirkungen von Ethernet-APL-Feldgeräten auf die OT-Sicherheit und schlägt vor, wie die OT-Sicherheit für diese Geräte gewährleistet werden kann.
Network convergence is an increasing trend in the automation domain. More and more plant owners strive for a unification of networks in their plants. This yields a seamless network structure, simplified supervision, and reduced training effort for the personnel, as only one unified network technology needs to be handled. Ethernet-APL is one piece of the puzzle for such a converged network, supporting various real time protocols like PROFINET, EtherNet, HART-IP as well as the middleware protocol OPC UA. This paper gives an overview on the impact of Ethernet-APL field devices to OT security and proposes how to ensure OT security for them.
Betreiber von Produktionsanlagen stehen oft vor der Frage, welche Norm für die Absicherung der Anlage gegen Cyberangriffe heranzuziehen ist. Aus dem IT-Bereich ist die Normreihe ISO 27000 bekannt. Im Produktionsbereich wird häufig die Normreihe IEC 62443 herangezogen. Dieser Beitrag gibt einen Überblick über beide Normreihen und schlägt einen Ansatz zur gemeinsamen Nutzung beider Standards vor.
Das Thema Elektromagnetische Verträglichkeit (EMV) ist noch immer ein wesentlicher Aspekt bei der Planung, bei der Installation und beim Betrieb von Automatisierungssystemen. Kommunikationsnetzwerke wie zum Beispiel PROFIBUS und PROFINET sind als robuste und zuverlässige Übertragungssysteme bekannt. Dennoch ist für deren Funktion die Beachtung einiger grundlegender Prinzipien wichtig, um einen störungsfreien Betrieb über ein langes Anlagenleben zu gewährleisten. Der Beitrag beschreibt zunächst einige Grundlagen der EMV. Basierend auf diesen Grundlagen werden dann sechs Handlungsempfehlungen abgeleitet, die bei der Planung eines Automatisierungssystems für den Einsatz in der Fertigungsindustrie zu beachten sind. Abschließend wird ein Ausblick auf die weiterführenden Arbeiten für Anlagen der Prozessindustrie gegeben.
Organisation der IT-Sicherheit in der Produktion : in zehn Schritten zur sicheren Produktionsanlage
(2018)
Der folgende Beitrag befasst sich mit der IT-Sicherheit von Produktionsanlagen aus Betreibersicht. Hierbei liegt der Fokus auf den organisatorischen Aspekten der IT-Sicherheit. In einer Bestandsaufnahme werden zunächst die Probleme herausgearbeitet, die entstehen, sofern sich eine Organisation im Wesentlichen auf technische Aspekte der IT-Sicherheit konzentriert. Daraus wird die Notwendigkeit organisatorischer Maßnahmen abgeleitet. Eine Betrachtung von Normen und Standards, die sich mit den organisatorischen Aspekten der IT-Sicherheit in der Produktion befassen, liefert das Grundgerüst für die Ableitung eines Maßnahmenplans. Der daraus resultierende 10-Punkte-Plan zur Umsetzung der IT-Sicherheit in der Produktion schließt den Beitrag ab.
The topic of electromagnetic compatibility (EMC) remains an important aspect during the planning, installation and operation of automation systems. Communication networks, such as PROFIBUS and PROFINET, are known to be robust and reliable transmission systems. Nevertheless, it is important that a number of fundamental principles needs to be observed to ensure fault-free operation over a long plant lifetime. This paper first describes a number of principles of EMC. On the basis of these principles, six recommendations for action are then developed which are to be observed during the planning of an automation system for use in the manufacturing industry. Finally, an overview is provided of future work for systems in the process industry.
Die Vision „Industrial Ethernet bis zu den Sensoren und Aktoren“ wurde Realität. Auf der Achema im Juni 2021 wurde Ethernet-APL in den Markt eingeführt. Basis dieser Technologie ist ein 2-Draht-Ethernet (engl. 2-wire-Ethernet), das sowohl Informationen als auch Energie zu den Sensoren und Aktoren des Automatisierungssystems überträgt. Ethernet-APL basiert auf dem Ethernet-Standard IEEE 802.3cg und arbeitet mit einer Datenrate von 10 Mbit/s. Eine zusätzliche Spezifikation, die Ethernet-APL Port Profile Specification, definiert zusätzliche Parameter für den Einsatz in der Prozessindustrie, insbesondere in explosionsgefährdeten Bereichen. In einem nächsten Schritt müssen sich potenzielle Anwender mit dem Engineering-Prozess von Ethernet-APL-Netzwerken vertraut machen. Zu diesem Zweck stellt das Ethernet-APL-Projekt die Ethernet-APL-Engineering-Richtlinie zur Verfügung, welche die wichtigsten Bereiche der Planung, Installation und Abnahmeprüfung abdeckt. Dieser Artikel soll einen Überblick über den Ethernet-APL-Engineering-Prozess geben und die relevanten Planungsschritte aufzeigen.
Deutsche Übersetzung des englischen Beitrags, abrufbar unter https://doi.org/10.25968/opus-2087
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.
Antimicrobials are widely used to cure intramammary infections (IMI) in dairy cows during the dry period (DP). Nevertheless, the IMI cure is influenced by many factors and not all quarters benefit from antimicrobial dry cow treatment (DCT). To evaluate the true effect of antibiotic DCT compared to self-cure and the role of causative pathogens on the IMI cure, a retrospective cross-sectional study was performed. The analysis included 2987 quarters infected at dry-off (DO). Information on DCT, causative pathogens, somatic cell count, milk yield, amount of lactation, Body Condition Score, and season and year of DO were combined into categorical variables. A generalized linear mixed model with a random cow, farm and year effect and the binary outcome of bacteriological cure of IMI during the DP was conducted. In the final model, a significant effect (p < 0.05) on DP cure was seen for the DO season and the category of causative pathogens (categories being: Staphylococcus aureus, non-aureus staphylococci, streptococci, coliforms, ‘other Gram-negative bacteria’, ‘other Gram positive bacteria’, non-bacterial infections and mixed infections), while antibiotic DCT (vs. non-antibiotic DCT) only showed a significant effect in combination with the pathogen categories streptococci and ‘other Gram-positive bacteria’.
Background
In Germany, up to 50% of nursing home residents are admitted to a hospital at least once a year. It is often unclear whether this is beneficial or even harmful. Successful interprofessional collaboration and communication involving general practitioners (GPs) and nurses may improve medical care of nursing home residents. In the previous interprof study, the six-component intervention package interprof ACT was developed to facilitate collaboration of GPs and nurses in nursing homes. The aim of this study is to evaluate the effectiveness of the interprof ACT intervention.
Methods
This multicentre, cluster randomised controlled trial compares nursing homes receiving the interprof ACT intervention package for a duration of 12 months (e.g. comprising appointment of mutual contact persons, shared goal setting, standardised GPs’ home visits) with a control group (care as usual). A total of 34 nursing homes are randomised, and overall 680 residents recruited. The intervention package is presented in a kick-off meeting to GPs, nurses, residents/relatives or their representatives. Nursing home nurses act as change agents to support local adaption and implementation of the intervention measures. Primary outcome is the cumulative incidence of hospitalisation within 12 months. Secondary outcomes include admissions to hospital, days admitted to hospital, use of other medical services, prevalence of potentially inappropriate medication and quality of life. Additionally, health economic and a mixed methods process evaluation will be performed.
Discussion
This study investigates a complex intervention tailored to local needs of nursing homes. Outcomes reflect the healthcare and health of nursing home residents, as well as the feasibility of the intervention package and its impact on interprofessional communication and collaboration. Because of its systematic development and its flexible nature, interprof ACT is expected to be viable for large-scale implementation in routine care services regardless of local organisational conditions and resources available for medical care for nursing home residents on a regular basis. Recommendations will be made for an improved organisation of primary care for nursing home residents. In addition, the results may provide important knowledge and data for the development and evaluation of further strategies to improve outpatient care for elderly care-receivers.
Background: Given both the increase of nursing home residents forecast and challenges of current interprofessional interactions, we developed and tested measures to improve collaboration and communication between nurses and general practitioners (GPs) in this setting. Our multicentre study has been funded by the German Federal Ministry of Education and Research (FK 01GY1124).
Methods: The measures were developed iteratively in a continuous process, which is the focus of this article. In part 1 “exploration of the situation”, interviews were conducted with GPs, nurses, nursing home residents and their relatives focusing on interprofessional interactions and medical care. They were analysed qualitatively. Based on these results, in part 2 “development of measures to improve collaboration”, ideas for improvement were developed in nine focus groups with GPs and nurses. These ideas were revisited in a final expert workshop. We analysed the focus groups and expert workshop using mind mapping methods, and finally drew up the compilation of measures. In an exploratory pilot study "study part 3" four nursing homes chose the measures they wanted to adopt. These were tested for three months. Feasibility and acceptance of the measures were evaluated via guideline interviews with the stakeholders which were analysed by content analyses.
Results: Six measures were generated: meetings to establish common goals, main contact person, standardised pro re nata medication, introduction of name badges, improved availability of nurse/GP and standardised scheduling/ procedure for nursing home visits. In the pilot study, the measures were implemented in four nursing homes. GPs and nurses reviewed five measures as feasible and acceptable, only the designation of a “main contact person” was not considered as an improvement.
Conclusions: Six measures to improve collaboration and communication could be compiled in a multistep qualitative process respecting the perspectives of involved stakeholders. Five of the six measures were positively assessed in an exploratory pilot study. They could easily be transferred into the daily routine of other nursing homes, as no special models have to exist in advance. Impact of the measures on patient oriented outcomes should be examined in further research.
Trial registration: Not applicable.
Staphylococcus aureus is recognized worldwide as one of the major agents of dairy cow intra-mammary infections. This microorganism can express a wide spectrum of pathogenic factors used to attach, colonize, invade and infect the host. The present study evaluated 120 isolates from eight different countries that were genotyped by RS-PCR and investigated for 26 different virulence factors to increase the knowledge on the circulating genetic lineages among the cow population with mastitis. New genotypes were observed for South African strains while for all the other countries new variants of existing genotypes were detected. For each country, a specific genotypic pattern was found. Among the virulence factors, fmtB, cna, clfA and leucocidins genes were the most frequent. The sea and sei genes were present in seven out of eight countries; seh showed high frequency in South American countries (Brazil, Colombia, Argentina), while sel was harboured especially in one Mediterranean country (Tunisia). The etb, seb and see genes were not detected in any of the isolates, while only two isolates were MRSA (Germany and Italy) confirming the low diffusion of methicillin resistance microorganism among bovine mastitis isolates. This work demonstrated the wide variety of S. aureus genotypes found in dairy cattle worldwide. This condition suggests that considering the region of interest might help to formulate strategies for reducing the infection spreading.
Recent progress that has been made towards understanding the dynamics of collisions at the gas–liquid interface is summarized briefly. We describe in this context a promising new approach to the experimental study of gas–liquid interfacial reactions that we have introduced. This is based on laser-photolytic production of reactive gas-phase atoms above the liquid surface and laser-spectroscopic probing of the resulting nascent products. This technique is illustrated for reaction of O(³P) atoms at the surface of the long-chain liquid hydrocarbon squalane (2,6,10,15,19,23-hexamethyltetracosane). Laser-induced fluorescence detection of the nascent OH has revealed mechanistically diagnostic correlations between its internal and translational energy distributions. Vibrationally excited OH molecules are able to escape the surface. At least two contributions to the product rotational distributions are identified, confirming and extending previous hypotheses of the participation of both direct and trapping-desorption mechanisms. We speculate briefly on future experimental and theoretical developments that might be necessary to address the many currently unanswered mechanistic questions for this, and other, classes of gas–liquid interfacial reaction.
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.
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.
Background: Fall events contribute significantly to mortality, morbidity and costs in our ageing population. In order to identify persons at risk and to target preventive measures, many scores and assessment tools have been developed. These often require expertise and are costly to implement. Recent research investigates the use of wearable inertial sensors to provide objective data on motion features which can be used to assess individual fall risk automatically. So far it is unknown how well this new method performs in comparison with conventional fall risk assessment tools. The aim of our research is to compare the predictive performance of our new sensor-based method with conventional and established methods, based on prospective data.
Methods: In a first study phase, 119 inpatients of a geriatric clinic took part in motion measurements using a wireless triaxial accelerometer during a Timed Up&Go (TUG) test and a 20 m walk. Furthermore, the St. Thomas Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) was performed, and the multidisciplinary geriatric care team estimated the patients’ fall risk. In a second follow-up phase of the study, 46 of the participants were interviewed after one year, including a fall and activity assessment. The predictive performances of the TUG, the STRATIFY and team scores are compared. Furthermore, two automatically induced logistic regression models based on conventional clinical and assessment data (CONV) as well as sensor data (SENSOR) are matched.
Results: Among the risk assessment scores, the geriatric team score (sensitivity 56%, specificity 80%) outperforms STRATIFY and TUG. The induced logistic regression models CONV and SENSOR achieve similar performance values (sensitivity 68%/58%, specificity 74%/78%, AUC 0.74/0.72, +LR 2.64/2.61). Both models are able to identify more persons at risk than the simple scores.
Conclusions: Sensor-based objective measurements of motion parameters in geriatric patients can be used to assess individual fall risk, and our prediction model’s performance matches that of a model based on conventional clinical and assessment data. Sensor-based measurements using a small wearable device may contribute significant information to conventional methods and are feasible in an unsupervised setting. More prospective research is needed to assess the cost-benefit relation of our approach.
Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups
(2012)
Background: Hospital in-patient falls constitute a prominent problem in terms of costs and consequences. Geriatric institutions are most often affected, and common screening tools cannot predict in-patient falls consistently. Our objectives are to derive comprehensible fall risk classification models from a large data set of geriatric in-patients’ assessment data and to evaluate their predictive performance (aim#1), and to identify high-risk subgroups from the data (aim#2).
Methods: A data set of n = 5,176 single in-patient episodes covering 1.5 years of admissions to a geriatric hospital were extracted from the hospital’s data base and matched with fall incident reports (n = 493). A classification tree model was induced using the C4.5 algorithm as well as a logistic regression model, and their predictive performance was evaluated. Furthermore, high-risk subgroups were identified from extracted classification rules with a support of more than 100 instances.
Results: The classification tree model showed an overall classification accuracy of 66%, with a sensitivity of 55.4%, a specificity of 67.1%, positive and negative predictive values of 15% resp. 93.5%. Five high-risk groups were identified, defined by high age, low Barthel index, cognitive impairment, multi-medication and co-morbidity.
Conclusions: Our results show that a little more than half of the fallers may be identified correctly by our model, but the positive predictive value is too low to be applicable. Non-fallers, on the other hand, may be sorted out with the model quite well. The high-risk subgroups and the risk factors identified (age, low ADL score, cognitive impairment, institutionalization, polypharmacy and co-morbidity) reflect domain knowledge and may be used to screen certain subgroups of patients with a high risk of falling. Classification models derived from a large data set using data mining methods can compete with current dedicated fall risk screening tools, yet lack diagnostic precision. High-risk subgroups may be identified automatically from existing geriatric assessment data, especially when combined with domain knowledge in a hybrid classification model. Further work is necessary to validate our approach in a controlled prospective setting.
Wearable sensors in healthcare and sensor-enhanced health information systems: all our tomorrows?
(2012)
Wearable sensor systems which allow for remote or self-monitoring of health-related parameters are regarded as one means to alleviate the consequences of demographic change. This paper aims to summarize current research in wearable sensors as well as in sensor-enhanced health information systems. Wearable sensor technologies are already advanced in terms of their technical capabilities and are frequently used for cardio-vascular monitoring. Epidemiologic predictions suggest that neuro-psychiatric diseases will have a growing impact on our health systems and thus should be addressed more intensively. Two current project examples demonstrate the benefit of wearable sensor technologies: long-term, objective measurement under daily-life, unsupervised conditions. Finally, up-to-date approaches for the implementation of sensor-enhanced health information systems are outlined. Wearable sensors are an integral part of future pervasive, ubiquitous and person-centered health
care delivery. Future challenges include their integration into sensor-enhanced health information systems and sound evaluation studies involving measures of workload reduction and costs.
A nonblinded, positively controlled, noninferiority trial was conducted to evaluate the efficacy of an alternative, nonantibiotic therapy with Masti Veyxym® to reduce ineffective antibiotic usage in the treatment of nonsevere clinical mastitis (CM) in cows with longer lasting udder diseases. The solely intramammary treatment with Masti Veyxym® (three applications, 12 hr apart) and the combined treatment with Masti Veyxym® and antibiotics as usual on the farm according to label of the respective product were compared with the reference treatment of solely antibiotic therapy. The matched field study was conducted on eight free-stall dairy farms located in Eastern Germany. Cases of mild-to-moderate CM in cows with longer lasting high somatic cell counts in preceding dairy herd improvement test days and with previous CM cases in current lactation were randomly allocated to one of the three treatment groups. A foremilk sample of the affected quarter was taken before treatment and again approximately 14 days and 21 days after the end of therapy for cyto-bacteriological examination. Primary outcomes were clinical cure (CC) and no CM recurrence within 60 days after the end of treatment (no R60). Bacteriological cure (BC) and quarter somatic cell count (QSCC) cure were chosen as secondary outcomes although low probabilities of BC and QSCC cure for selected cows were expected. The study resulted in the following findings: the pathogens mostly cultured from pretreatment samples were Streptococcus uberis, followed by Staphylococcus aureus and coagulase-negative staphylococci. There were no significant differences between the two test treatments in comparison with the reference treatment regarding all outcome variables. The sole therapy with Masti Veyxym® resulted in a numerically lower likelihood of BC without significant differences to the reference treatment. The combined therapy group showed a numerically higher nonrecurrence rate than the two other treatment groups and noninferiority compared to the reference treatment was proven. Having regard to the selection criteria of cows in this study, the findings indicated that sole treatment with Masti Veyxym® in nonsevere CM cases may constitute an alternative therapy to reduce antibiotics. However, noninferiority evaluations were mostly inconclusive. Further investigations with a larger sample size are required to confirm the results and to make a clear statement on noninferiority.
Forschungsdatenzentrum Gesundheit – Vision für eine Weiterentwicklung aus Sicht der Forschung
(2023)
Das Forschungsdatenzentrum (FDZ) Gesundheit nach der Datentransparenzverordnung (DaTraV), angesiedelt am Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM) wird Routinedaten der Gesetzlichen Krankenversicherung für die Forschung bereitstellen. Die Bereitstellung der Daten von knapp 90% der Bevölkerung in Deutschland dient dem übergeordneten Ziel, die gesundheitliche Versorgung im Hinblick auf Unter-, Über- und Fehlversorgung zu evaluieren und daraus Handlungsempfehlungen für eine evidenzbasierte Gesundheitsversorgung abzuleiten. Der gesetzliche Rahmen wird im Sozialgesetzbuch (§§ 303a-f SBG V) und zwei dazu gehörigen Verordnungen gesteckt, lässt jedoch hinreichend großen Spielraum für die Ausgestaltung auf der Organisations- und Arbeitsebene. Hier setzt das vorliegende Papier an. Aus Forscher*innensicht wurden zehn Statements für eine Weiterentwicklung formuliert, die das Potential eines Forschungsdatenzentrums aufzeigen und Ideen für die weitere zukunftsfähige Ausgestaltung und Entwicklung mit Bestandskraft darlegen.
Background:
Hereditary angioedema (HAE) is a rare genetic disease and characterized by clinical features such as paroxysmal, recurrent angioedema of the skin, the gastrointestinal tract, and the upper airways. Swelling of the skin occurs primarily in the face, extremities and genitals. Gastrointestinal attacks are accompanied by painful abdominal cramps, vomiting and diarrhea. Due to the low prevalence and the fact that HAE patients often present with rather unspecific symptoms such as abdominal cramps, the final diagnosis is often made after a long delay. The aim of this German-wide survey was to characterize the period between occurrence of first symptoms and final diagnosis regarding self-perceived health, symptom burden and false diagnoses for patients with HAE.
Results:
Overall, 81 patients with HAE were included and participated in the telephone-based survey. Of those, the majority reported their current health status as “good” (47.5%) or “very good” (13.8%), which was observed to be a clear improvement compared to the year before final diagnosis (“good” (16.3%), “very good” (11.3%)). Edema in the extremities (85.2%) and in the gastrointestinal tract (81.5%) were the most currently reported symptoms and occurred earlier than other reported symptoms (mean age at onset 18.1 and 17.8 years, respectively). Misdiagnoses were observed in 50.6% of participating HAE patients with appendicitis and allergy being the most frequently reported misdiagnoses (40.0 and 30.0% of those with misdiagnosis, respectively). Patients with misdiagnosis often received mistreatment (80.0%) with pharmaceuticals and surgical interventions as the most frequently carried out mistreatments (65.6 and 56.3% of those with mistreatment, respectively). The mean observed diagnostic delay was 18.1 years (median 15.0 years). The diagnostic delay was higher in older patients and index patients.
Conclusions:
This study showed that self-perceived status of health for patients is much better once the final correct diagnosis has been made and specific treatment was available. Further challenge in the future will still be to increase awareness for HAE especially in settings which are normally approached by patients at occurrence of first symptoms to assure early referral to specialists and therefore increase the likelihood of receiving an early diagnosis.
Für die Studiengang-Auswahl existiert eine Reihe i. d. R. Fragebogen-gestützter Online-Studiengangfinder. Eine Analyse zeigte Optimierungspotenziale: Studienangebote sind meist auf ein Bundesland oder eine Hochschule beschränkt oder, allgemein beschrieben, die individuelle Studiengang-Auswahl ist nur mit Unschärfen möglich. Letzteres wirkt sich z. B. bei Bindestrich-Studiengängen (z. B. Wirtschaftsingenieurwesen) aus, die je nach Hochschule inhaltlich variieren können. Hier setzt das Portal an. Ziele sind: Bereitstellung der in der Sprachwelt Studieninteressierter gehaltenen Fragebögen, Möglichkeit für Hochschulen/Einrichtungen, Studiengänge bereitzustellen.
Corynebacterium spp. are frequently detected in bovine quarter milk samples, yet their impact on udder health has not been determined completely. In this longitudinal study, we collected quarter milk samples from a dairy herd of approximately 200 cows, ten times at 14 d intervals. Bacteriologically, Catalase-positive and Gram-positive rods were detected in 22.7% of the samples. For further species diagnosis, colonies were analyzed by MALDITOF MS. Corynebacterium bovis, C. amycolatum, C. xerosis and 10 other Corynebacterium spp. were detected. The three aforementioned species accounted for 88.4%, 8.65% and 0.94% of all cultured Corynebacterium spp., respectively. For further evaluation of infection dynamics, the following three infection definitions were applied: A (2/3 consecutive samples positive for the same species), B (≥1000 cfu/mL in one sample), C (isolated from a clinical mastitis case). Infections according to definition B occurred most frequently and clinical mastitis with Corynebacterium spp. occurred once during sampling. Life tables were used to determine the duration of infection. According to infection definition A, infection durations of 111 d and 98 d were obtained for C. bovis and C. amycolatum, respectively. Exemplarily, longer lasting infections were examined for their strain diversity by RAPD PCR. A low strain diversity was found in the individual quarters that indicates a longer colonization of the udder parenchyma by C. bovis and C. amycolatum.