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Background
Uncomplicated urinary tract infections (UTI) are common in general practice and usually treated with antibiotics. This contributes to increasing resistance rates of uropathogenic bacteria. A previous trial showed a reduction of antibiotic use in women with UTI by initial symptomatic treatment with ibuprofen. However, this treatment strategy is not suitable for all women equally. Arctostaphylos uva-ursi (UU, bearberry extract arbutin) is a potential alternative treatment. This study aims at investigating whether an initial treatment with UU in women with UTI can reduce antibiotic use without significantly increasing the symptom burden or rate of complications.
Methods
This is a double-blind, randomized, and controlled comparative effectiveness trial. Women between 18 and 75 years with suspected UTI and at least two of the symptoms dysuria, urgency, frequency or lower abdominal pain will be assessed for eligibility in general practice and enrolled into the trial. Participants will receive either a defined daily dose of 3 × 2 arbutin 105 mg for 5 days (intervention) or fosfomycin 3 g once (control). Antibiotic therapy will be provided in the intervention group only if needed, i.e. for women with worsening or persistent symptoms. Two co-primary outcomes are the number of all antibiotic courses regardless of the medical indication from day 0–28, and the symptom burden, defined as a weighted sum of the daily total symptom scores from day 0–7. The trial result is considered positive if superiority of initial treatment with UU is demonstrated with reference to the co-primary outcome number of antibiotic courses and non-inferiority of initial treatment with UU with reference to the co-primary outcome symptom burden.
Discussion
The trial’s aim is to investigate whether initial treatment with UU is a safe and effective alternative treatment strategy in women with UTI. In that case, the results might change the existing treatment strategy in general practice by promoting delayed prescription of antibiotics and a reduction of antibiotic use in primary care.
Marketing, get ready to rumble — How rivalry promotes distinctiveness for brands and consumers
(2018)
Scholars typically advise brands to stay away from public conflict with competitors as research has focused on negative consequences - e.g., price wars, escalating hostilities, and derogation. This research distinguishes between rivalry between firms (inter-firm brand rivalry) and rivalry between consumers (inter-consumer brand rivalry). Four studies and six samples show both types of rivalry can have positive consequences for both firms and consumers. Inter-firm brand rivalry boosts perceived distinctiveness of competing brands independent of consumption, attitude, familiarity, and involvement. Inter-consumer brand rivalry increases consumer group distinctiveness, an effect mediated by brand identification and rival brand disidentification. We extend social identity theory by demonstrating that: 1) outside actors like firms can promote inter-consumer rivalry through inter-firm rivalry and 2) promoting such conflict can actually provide benefits to consumers as well as firms. The paper challenges the axiom “never knock the competition,” deriving a counter-intuitive way to accomplish one of marketing's premier objectives.
Studien zeigen, dass Anhänger der PEGIDA-Bewegung die Medienberichterstattung als unangemessen wahrnehmen und ihr misstrauen. Diese Wahrnehmung und daraus resultierende kognitive, affektive und konative Konsequenzen wurden in einer standardisierten Online-Befragung untersucht (n= 800). Es zeigt sich, dass Anhänger der PEGIDA-Bewegung der Berichterstattung über PEGIDA mehr misstrauen als PEGIDA-Gegner. Diese Wahrnehmung wiederum hat politisch relevante Konsequenzen: Je stärker PEGIDA-Anhänger und neutral Eingestellte der Berichterstattung misstrauen, desto weniger Vertrauen bringen sie den Medien allgemein entgegen, desto unzufriedener sind sie mit der Demokratie in Deutschland und desto wütender sind sie auf die Berichterstattung. Die wütenden Reaktionen korrelieren mit einer Zustimmung zu radikalen Protestformen, was wiederum die Beteiligung an den Protestmärschen erhöht. Somit zeigen die Befunde, dass das Misstrauen in die Berichterstattung über PEGIDA auch über deren Anhängerkreis hinaus eng verbunden ist mit erodierendem Vertrauen in Medien und Politik sowie mit der Bereitschaft zu radikalen Protestformen.
The transfer of historically grown monolithic software architectures into modern service-oriented architectures creates a lot of loose coupling points. This can lead to an unforeseen system behavior and can significantly impede those continuous modernization processes, since it is not clear where bottlenecks in a system arise. It is therefore necessary to monitor such modernization processes with an adaptive monitoring concept to be able to correctly record and interpret unpredictable system dynamics. This contribution presents a generic QoS measurement framework for service-based systems. The framework consists of an XML-based specification for the measurement to be performed – the Information Model (IM) – and the QoS System, which provides an execution platform for the IM. The framework will be applied to a standard business process of the German insurance industry, and the concepts of the IM and their mapping to artifacts of the QoS System will be presented. Furtherm ore, design and implementation of the QoS System’s parser and generator module and the generated artifacts are explained in detail, e.g., event model, agents, measurement module and analyzer module.
We report the unambiguous detection of phenyl groups covalently attached to functionalised graphene using non-linear spectroscopy. Sum-frequency generation was employed to probe graphene on a gold surface after chemical functionalisation using a benzene diazonium salt. We observe a distinct resonance at 3064 cm1 which can clearly be assigned to an aromatic C–H stretch by comparison with a self-assembled monolayer on a gold substrate formed from benzenethiol. Not only does sum-frequency generation spectroscopy allow one to characterise functionalised graphene with higher sensitivity and much better specificity than many other spectroscopic techniques, but it also opens up the possibility to assess the coverage of graphene with functional groups, and to determine their orientation relative to the graphene surface.
The growing importance of renewable generation connected to distribution grids requires an increased coordination between transmission system operators (TSOs) and distribution system operators (DSOs) for reactive power management. This work proposes a practical and effective interaction method based on sequential optimizations to evaluate the reactive flexibility potential of distribution networks and to dispatch them along with traditional synchronous generators, keeping to a minimum the information exchange. A modular optimal power flow (OPF) tool featuring multi-objective optimization is developed for this purpose. The proposed method is evaluated for a model of a real German 110 kV grid with 1.6 GW of installed wind power capacity and a reduced order model of the surrounding transmission system. Simulations show the benefit of involving wind farms in reactive power support reducing losses both at distribution and transmission level. Different types of setpoints are investigated, showing the feasibility for the DSO to fulfill also individual voltage and reactive power targets over multiple connection points. Finally, some suggestions are presented to achieve a fair coordination, combining both TSO and DSO requirements.
Targeted panel sequencing in pediatric primary cardiomyopathy supports a critical role of TNNI3
(2019)
The underlying genetic mechanisms and early pathological events of children with primary cardiomyopathy (CMP) are insufficiently characterized. In this study, we aimed to characterize the mutational spectrum of primary CMP in a large cohort of patients ≤18 years referred to a tertiary center. Eighty unrelated index patients with pediatric primary CMP underwent genetic testing with a panel-based next-generation sequencing approach of 89 genes. At least one pathogenic or probably pathogenic variant was identified in 30/80 (38%) index patients. In all CMP subgroups, patients carried most frequently variants of interest in sarcomere genes suggesting them as a major contributor in pediatric primary CMP. In MYH7, MYBPC3, and TNNI3, we identified 18 pathogenic/probably pathogenic variants (MYH7 n = 7, MYBPC3 n = 6, TNNI3 n = 5, including one homozygous (TNNI3 c.24+2T>A) truncating variant. Protein and transcript level analysis on heart biopsies from individuals with homozygous mutation of TNNI3 revealed that the TNNI3 protein is absent and associated with upregulation of the fetal isoform TNNI1. The present study further supports the clinical importance of sarcomeric mutation-not only in adult-but also in pediatric primary CMP. TNNI3 is the third most important disease gene in this cohort and complete loss of TNNI3 leads to severe pediatric CMP.
This feasibility study investigates the flexural properties of biocomposites containing woven flax textiles (plain, twill, satin) and woven twill patterned hybrid textiles containing flax-/glass or flax-/carbon mixture for lightweight applications. Synthetic fibers are integrated as weft and flax fibers are integrated as warp yarns using a double-rapier weaving machine with a Jacquard attachment. The corresponding biocomposites are manufactured via vacuum infusion process using a biobased epoxy resin as a matrix. The manufactured biocomposites are analyzed with regard to their density and flexural properties. The results show that the use of hybrid textiles offers a promising solution for the manufacture of biocomposites with a higher biobased content and significantly improved flexural properties. Furthermore, the introduction of high-performance synthetic fibers in textiles enables the manufacture of biocomposites with an isotropic mechanical performance.
Background:
Promoting patient and occupational safety are two key challenges for hospitals. When aiming to improve these two outcomes synergistically, psychosocial working conditions, leadership by hospital management and supervisors, and perceptions of patient and occupational safety climate have to be considered. Recent studies have shown that these key topics are interrelated and form a critical foundation for promoting patient and occupational safety in hospitals. So far, these topics have mainly been studied independently from each other. The present study investigated hospital staffs’ perceptions of four different topics: (1) psychosocial working conditions, (2) leadership, (3) patient safety climate, and (4) occupational safety climate. We present results from a survey in two German university hospitals aiming to detect differences between nurses and physicians.
Methods:
We performed a cross-sectional study using a standardized paper-based questionnaire. The survey was conducted with nurses and physicians to assess the four topics. The instruments mainly consisted of scales of the German version of the COPSOQ (Copenhagen Psychosocial Questionnaire), one scale of the Copenhagen Burnout Inventory (CBI), scales to assess leadership and transformational leadership, scales to assess patient safety climate using the Hospital Survey on Patient Safety Culture (HSPSC), and analogous items to assess occupational safety climate.
Results:
A total of 995 completed questionnaires out of 2512 distributed questionnaires were returned anonymously. The overall response rate was 39.6%. The sample consisted of 381 physicians and 567 nurses. We found various differences with regard to the four topics. In most of the COPSOQ and the HSPSC-scales, physicians rated psychosocial working conditions and patient safety climate more positively than nurses. With regard to occupational safety, nurses
indicated higher occupational risks than physicians.
Conclusions:
The WorkSafeMed study combined the assessment of the four topics psychosocial working conditions, leadership, patient safety climate, and occupational safety climate in hospitals. Looking at the four topics provides an overview of where improvements in hospitals may be needed for nurses and physicians. Based on these results,
improvements in working conditions, patient safety climate, and occupational safety climate are required for health care professionals in German university hospitals – especially for nurses.
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.
The objective of this study was to investigate the association between teat skin colonization and intramammary infection (IMI) with Staphylococcus aureus or Streptococcus agalactiae at the quarter level in herds with automatic milking systems. Milk and teat skin samples from 1,142 quarters were collected from 300 cows with somatic cell count >200,000 cells/mL from 8 herds positive for Strep. agalactiae. All milk and teat skin samples were cultured on calf blood agar and selective media. A subset of samples from 287 quarters was further analyzed using a PCR assay (Mastit4 PCR; DNA Diagnostic A/S, Risskov, Denmark). Bacterial culture detected Staph. aureus in 93 (8.1%) of the milk samples and 75 (6.6%) of the teat skin samples. Of these, 15 (1.3%) quarters were positive in both the teat skin and milk samples. Streptococcus agalactiae was cultured in 84 (7.4%) of the milk samples and 4 (0.35%) of the teat skin samples. Of these, 3 (0.26%) quarters were positive in both the teat skin and milk samples. The PCR detected Staph. aureus in 29 (10%) of the milk samples and 45 (16%) of the teat skin samples. Of these, 2 (0.7%) quarters were positive in both the teat skin and milk samples. Streptococcus agalactiae was detected in 40 (14%) of the milk samples and 51 (18%) of the teat skin samples. Of these, 16 (5.6%) quarters were positive in both the teat skin and milk samples. Logistic regression was used to investigate the association between teat skin colonization and IMI at the quarter level. Based on bacterial culture results, teat skin colonization with Staph. aureus resulted in 7.8 (95% confidence interval: 2.9; 20.6) times higher odds of Staph. aureus IMI, whereas herd was observed as a major confounder. However, results from the PCR analyses did not support this association. Streptococcus agalactiae was isolated from the teat skin with both PCR and bacterial culture, but the number of positive teat skin samples detected by culture was too low to proceed with further analysis. Based on the PCR results, Strep. agalactiae on teat skin resulted in 3.8 (1.4; 10.1) times higher odds of Strep. agalactiae IMI. Our results suggest that Staph. aureus and Strep. agalactiae on teat skin may be a risk factor for IMI with the same pathogens. Focus on proper teat skin hygiene is therefore recommended also in AMS.
Background: Compromised immune function, associated with human immune deficiency virus (HIV) infection, is improved by antiretroviral therapy (ART) which also decreases bone mineral density (BMD), and possibly the quality of life (QoL). However, physical (aerobic/resistance) exercises, were reported to induce reverse effects in uninfected individuals and were appraised in the literature for evidence of similar benefits in people living with HIV/AIDS(PLWHA). The main study objective was to evaluate the impact of physical (aerobic and resistance) exercises on CD4+ count,
BMD and QoL in PLWHA.
Methods: A systematic review was conducted using the Cochrane Collaboration protocol. Searching databases, up to June 2017, only randomized control trials investigating the effects of either aerobic, resistance or a combination of both exercise types with a control/other intervention(s) for a period of at least 4 weeks among adults living with HIV, were included. Two independent reviewers determined the eligibility of the studies. Data were extracted and risk of bias (ROB) was assessed with the Cochrane Collaboration ROB tool. Meta-analyses were conducted using random effect models using the Review Manager (RevMan) computer software.
Results: Nineteen studies met inclusion criteria(n = 491 participants at study completion) comprising male and female with age range 22–66 years. Two meta-analyses across 13 sub-group comparisons were performed. However, there were no RCTs on the impact of physical exercises on BMD in PLWHA. The result showed no significant change in CD4+ count unlike a significant effect of 5.04 point (95%CI:-8.49,-3.74,p = 0.00001) for role activity limitation due to physical health (QoL sub-domain). Overall, the GRADE evidence for this review was of moderate quality.
Conclusions: There was evidence that engaging in moderate intensity aerobic exercises (55–85% Maximum heart rate-MHR), for 30–60 min, two to five times/week for 6–24 weeks significantly improves role activity limitation due to physical health problems, otherwise physical(aerobic or/and resistance) exercises have no significant effects on CD4+ count and other domains of QoL. Also, there is lack of evidence on the impact of exercises on BMD in PLWHA due to the paucity of RCTs. The moderate grade evidence for this review suggests that further research may likely have an important impact on our confidence in the estimate of effects and may change the estimate.
Mastitis poses a considerable threat to productivity and to animal welfare on modern dairy farms. However, the common way of antibiotic treatment does not always lead to a cure. Unsuccessful cures can, among other reasons, occur due to biofilm formation of the causative agent. This has attracted interest from researchers to introduce promising alternative therapeutic approaches, such as the use of beneficial lactic acid bacteria (LAB). In fact, using LAB for treating mastitis probably requires the formation of a beneficial biofilm by the probiotic bacteria. The present study investigated the ability of five LAB strains, selected on the basis of results from previous studies, to remove and to replace pathogenic biofilms in vitro. For this purpose, Staphylococcus (S.) aureus ATCC 12,600 and two strains—S. xylosus (35/07) and S. epidermidis (575/08)—belonging to the group of coagulase negative staphylococci (CNS) were allowed to form biofilms in a 96-well plate. Subsequently, the LAB were added to the well. The biofilm challenge was evaluated by scraping off and suspending the biofilm cells, followed by a plate count of serial dilutions using selective media. All the LAB strains successfully removed the staphylococcal biofilms. However, only Lactobacillus (L.) rhamnosus ATCC 7469 and L. plantarum 2/37 formed biofilms of their own to replace the pathogenic ones.
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.
In this study, we investigated injection molded wood-polypropylene composites based on various wood sources and their decay resistance against white rot (Trametes versicolor) and brown rot (Coniophora puteana) in a laboratory test according to EN 15534-1:2014. The manufactured composites consisted of poplar (Populus spp.), willow (Salix spp.), European beech (Fagus sylvatica L.), Norway spruce (Picea abies (L.) H. Karst.), and a commercial wood source (Arbocel® C100), respectively. All formulations were compounded on a co-rotating twin screw extruder and subsequently injection molded to wood–PP specimens with a wood content of 60% or 70% by weight. It was found that the test procedure had a significant effect on the mechanical properties. Loss in mechanical properties was primarily caused by moisture and less by fungal decay. Moisture caused a loss in the modulus of rupture and modulus of elasticity of 34 to 45% and 29 to 73%, respectively. Mean mass and wood mass losses were up to a maximum of 3.7% and 5.3%, respectively. The high resistance against fungal decay was generally attributed to the encapsulation of wood by the polymer matrix caused by sample preparation, and enhanced by reduced moisture uptake during the preconditioning procedure. Notable differences with respect to the wood particle source and decay fungi were also observed. Structural characterization confirmed the decay pattern of the fungi such as void cavities close the surface and the deposition of calcium oxalates.
Radioisotope-guided sentinel lymph node dissection (sLND) has shown high diagnostic reliability in prostate (PCa) and other cancers. To overcome the limitations of the radioactive tracers, magnetometer-guided sLND using superparamagnetic iron oxide nanoparticles (SPIONs) has been successfully used in PCa. This prospective study (SentiMag Pro II, DRKS00007671) determined the diagnostic accuracy of magnetometer-guided sLND in intermediate- and high-risk PCa. Fifty intermediate- or high-risk PCa patients (prostate-specific antigen (PSA) >= 10 ng/mL and/or Gleason score >= 7; median PSA 10.8 ng/mL, IQR 7.4–19.2 ng/mL) were enrolled. After the intraprostatic SPIONs injection a day earlier, patients underwent magnetometer-guided sLND and extended lymph node dissection (eLND, followed by radical prostatectomy. SLNs were detected in in vivo and in ex vivo samples. Diagnostic accuracy of sLND was assessed using eLND as the reference. SLNs were detected in all patients (detection rate 100%), with 447 sentinel lymph nodes SLNs (median 9, IQR 6–12) being identified and 966 LNs (median 18, IQR 15–23) being removed. Thirty-six percent (18/50) of patients had LN metastases (median 2, IQR 1–3). Magnetometer-guided sLND had 100% sensitivity, 97.0% specificity, 94.4% positive predictive value, 100% negative predictive value, 0.0% false negative rate, and 3.0% additional diagnostic value (LN metastases only in SLNs outside the eLND template). In vivo, one positive SLN/LN-positive patient was missed, resulting in a sensitivity of 94.4%. In conclusion, this new magnetic sentinel procedure has high accuracy for nodal staging in intermediate- and high-risk PCa. The reliability of intraoperative SLN detection using this magnetometer system requires verification in further multicentric studies.
Systematizing IT Risks
(2019)
IT risks — risks associated with the operation or use of information technology — have taken on great importance in business, and IT risk management is accordingly important in the science and practice of information management. Therefore, it is necessary to systematize IT risks in order to plan, manage and control for different risk-specific measures. In order to choose and implement suitable measures for managing IT risks, effect-based and causebased procedures are necessary. These procedures are explained in detail for IT security risks because of their special importance.
Due to demographic change the number of serious kidney diseases and thus required transplantations will increase. The increased demand for donor organs and a decreasing supply of these organs underline the necessity for effective early rejection diagnostic measures to improve the lifetime of transplants. Expert systems might improve rejection diagnostics but for the development of such systems data models are needed that encompass the relevant information to enable optimal data aggregation and evaluation. Results of a literature review concerning published data models and information systems concerned with kidney transplant rejection diagnostic lead to a set of data elements even if no papers could be identified that publish data models explicitly.
Ein Konferenzrückblick:
Das DFG-Forschungskolleg „Postwachstumsgesellschaften“ hatte gemeinsam mit der Deutschen Gesellschaft für Soziologie (DGS) zu einer gemeinsamen fünftägigen Konferenz vom 23. bis 27. September 2019 an die Friedrich Schiller-Universität Jena geladen, und rund 700 Wissenschaftler*innen und Studierende kamen aus dem In- und Ausland, um an den rund 150 Veranstaltungen teilzunehmen. Begleitet wurde die Konferenz von einem umfänglichen Kulturprogramm mit Konzerten, Kinofilmen und Kunst, und rechtzeitig zur Konferenz erschien als Tagungsband auch eine lesenswerte 600-seitige Sonderausgabe des Berliner Journals für Soziologie (Dörre et al. 2019).
Das Konferenzprogramm stand einerseits unter der Thematik der „Great Transformation“, also der auf Karl Polanyi (1886-1964) zurückgehenden These einer zunehmenden Vermarktlichung und Verselbstständigung der Wirtschaft gegenüber der Gesellschaft (vgl. Polanyi 1944), die das DFG-Forschungskolleg rund um die Soziologen Klaus Dörre, Hartmut Rosa und Stefan Lessenich als Titel gewählt hat. Andererseits tagten einige Sektionen der DGS als Regionalkonferenz, um sektionsspezifische Panels durchzuführen.
Mit Blick auf Cora Baltussens Leben, Wirken und Beratungsverständnis werden die demokratischen, emanzipatorischen und internationalen Wurzeln der Rezeption der Profession Supervision in Deutschland in den 1950er und 1960er Jahren betont. Das ist besonders notwendig angesichts kritischer Weiterentwicklungen von Supervision und Coaching, bei denen die professionsethischen Grundlagenfragen zum Teil aus dem Blick geraten.