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Obwohl durchgängige CIM- und Logistik-Konzepte zur Erfüllung der permanent steigenden Kundenforderungen hinsichtlich spezifischer Produktausführungen bei qualitätsgerechter und termintreuer Auslieferung in den meisten Unternehmen noch nicht realisiert sind, beginnt bereits die Diskussion um eine neue Unternehmensstrategie: die "Lean Production". Das Ziel heißt diesmal, in allen Bereichen Ressourcen zu minimieren, um mit Hilfe einer schlanken Fertigung bei den Kosten Weltstandard zu erreichen.
Purpose: Radiology reports mostly contain free-text, which makes it challenging to obtain structured data. Natural language processing (NLP) techniques transform free-text reports into machine-readable document vectors that are important for creating reliable, scalable methods for data analysis. The aim of this study is to classify unstructured radiograph reports according to fractures of the distal fibula and to find the best text mining method.
Materials & Methods: We established a novel German language report dataset: a designated search engine was used to identify radiographs of the ankle and the reports were manually labeled according to fractures of the distal fibula. This data was used to establish a machine learning pipeline, which implemented the text representation methods bag-of-words (BOW), term frequency-inverse document frequency (TF-IDF), principal component analysis (PCA), non-negative matrix factorization (NMF), latent Dirichlet allocation (LDA), and document embedding (doc2vec). The extracted document vectors were used to train neural networks (NN), support vector machines (SVM), and logistic regression (LR) to recognize distal fibula fractures. The results were compared via cross-tabulations of the accuracy (acc) and area under the curve (AUC).
Results: In total, 3268 radiograph reports were included, of which 1076 described a fracture of the distal fibula. Comparison of the text representation methods showed that BOW achieved the best results (AUC = 0.98; acc = 0.97), followed by TF-IDF (AUC = 0.97; acc = 0.96), NMF (AUC = 0.93; acc = 0.92), PCA (AUC = 0.92; acc = 0.9), LDA (AUC = 0.91; acc = 0.89) and doc2vec (AUC = 0.9; acc = 0.88). When comparing the different classifiers, NN (AUC = 0,91) proved to be superior to SVM (AUC = 0,87) and LR (AUC = 0,85).
Conclusion: An automated classification of unstructured reports of radiographs of the ankle can reliably detect findings of fractures of the distal fibula. A particularly suitable feature extraction method is the BOW model.
Key Points:
- The aim was to classify unstructured radiograph reports according to distal fibula fractures.
- Our automated classification system can reliably detect fractures of the distal fibula.
- A particularly suitable feature extraction method is the BOW model.
For indexing archived documents the Dutch Parliament uses a specialized thesaurus. For good results for full text retrieval and automatic classification it turns out to be important to add more synonyms to the existing thesaurus terms. In the present work we investigate the possibilities to find synonyms for terms of the parliaments thesaurus automatically. We propose to use distributional similarity (DS). In an experiment with pairs of synonyms and non-synonyms we train and test a classifier using distributional similarity and string similarity. Using ten-fold cross validation we were able to classify 75% of the pairs of a set of 6000 word pairs correctly.
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 aim of this cross-sectional study was to investigate the occurrence of bacteremia in severe mastitis cases of dairy cows. Milk and corresponding blood samples of 77 cases of severe mastitis were bacteriologically examined. All samples (milk and blood) were incubated aerobically and anaerobically to also investigate the role of obligate anaerobic microorganisms in addition to aerobic microorganisms in severe mastitis. Bacteremia occurred if identical bacterial strains were isolated from milk and blood samples of the same case. In addition, pathogen shedding was examined, and the data of animals and weather were collected to determine associated factors for the occurrence of bacteremia in severe mastitis. If Gram-negative bacteria were detected in milk samples, a Limulus test (detection of endotoxins) was also performed for corresponding blood samples without the growth of Gram-negative bacteria. In 74 cases (96.1%), microbial growth was detected in aerobically incubated milk samples. The most-frequently isolated bacteria in milk samples were Escherichia (E.) coli (48.9%), Streptococcus (S.) spp. (18.1%), and Klebsiella (K.) spp. (16%). Obligatory anaerobic microorganisms were not isolated. In 72 cases (93.5%) of the aerobically examined blood samples, microbial growth was detected. The most-frequently isolated pathogens in blood samples were non-aureus Staphylococci (NaS) (40.6%) and Bacillus spp. (12.3%). The Limulus test was positive for 60.5% of cases, which means a detection of endotoxins in most blood samples without the growth of Gram-negative bacteria. Bacteremia was confirmed in 12 cases (15.5%) for K. pneumoniae (5/12), E. coli (4/12), S. dysgalactiae (2/12), and S. uberis (1/12). The mortality rate (deceased or culled) was 66.6% for cases with bacteremia and 34.1% for cases without bacteremia. High pathogen shedding and high humidity were associated with the occurrence of bacteremia in severe mastitis.
In order to reduce antimicrobial treatment and prevent environmental mastitis, the aim of the present study was to investigate associations between herd level factors and microbial load on teat ends with environmental mastitis pathogens. Quarterly farm visits of 31 dairy farms over a one-year period were used for statistical analysis. During each farm visit, teat-skin swabs, bedding and air samples were taken and management practices and herd parameters were documented. Total mesophilic bacteria, esculin-positive streptococci and coliform bacteria were examined in the laboratory procedures from teat skin and environmental samples. Esculin-positive streptococci and coliform bacteria on teat ends increased with high temperature–humidity indices (THI) in the barn during the spring and summer. Significantly more coliform bacteria on teat ends were found in herds with an increased percentage of normal or slightly rough teat ends. Cleaning cubicles more frequently, pre-cleaning teats before milking as well as post-dipping them after milking had a decreasing effect of teat-skin load with total mesophilic and coliform bacteria at the herd level. To conclude, teat-skin bacterial load with environmental pathogens is subject to fluctuations and can be influenced by aspects of farm hygiene.
Complex Event Processing (CEP) is a modern software technology for the dynamic analysis of continuous data streams. CEP is able of searching extremely large data streams in real time for the presence of event patterns. So far, specifying event patterns of CEP rules is still a manual task based on the expertise of domain experts. This paper presents a novel batinspired swarm algorithm for automatically mining CEP rule patterns that express the relevant causal and temporal relations hidden in data streams. The basic suitability and performance of the approach is proven by extensive evaluation with both synthetically generated data and real data from the traffic domain.
Die Anpassungsfähigkeit eines Unternehmens an rasch wechselnde Wettbewerbssituationen bei kundenwunschorientierter Produktion mit veränderlichen Losgrößen und unterschiedlichen Terminrestriktoren kann nur über ausgefeilte Strategien und durch DV-Einsatz erzeugt werden. Anforderungsgerechte CIM- und Logistik-Konzepte sind eine wesentliche Vorraussetzung, damit die geforderte Flexibilität erreicht wird. Den unabdingbaren Informationsfluss schafft hierbei die Betriebsdatenerfassung.
Wegen der Vielzahl unterschiedlicher Teile in variierenden Losgrößen ist es in der spanenden Fetigung besonders wichtig, Hardware und Software für logistische Aufgaben anforderungsgerecht auszuwählen. Ausgehend von den logistischen Grundfunktionen im Betrieb sind die Grunddatenbereitstellung, die Prozessstruktur, die Produktgestaltung, das Beschaffen und das Lagern auf die rechnergestützte Logistik auszurichten.
In der philosophischen Ethik wird unterschieden zwischen deskriptiver Ethik, normativer Ethik und Metaethik. In diesem Beitrag steht die normative Ethik im Mittelpunkt. Es soll die Frage erörtert werden, welche ethischen Kriterien für die Praxis von Beratung gelten sollten. Zu diesem Zweck werden zunächst beratungskritische Traditionen angeführt und im Anschluss professionsethische Überlegungen mit Rückgriff auf Impulse aus Foucaults Philosophie angestellt.
Es werden die Kosten der H-Milchabteilung bei drei verschiedenen Kapazitätsgrößen mit jeweils variierter Kapazitätsauslastung nach einer speziellen Form der Teilkostenrechnung bestimmt. Die Kapazitätsgrößen betragen 3300, 6600 und 9900 1-l-Packungen pro Stunde. Im Jahr werden zwischen 2,9 und 53,6 Mio. Einheiten hergestellt; dabei variieren die Stückkosten zwischen 30,65 und 18,85 Pf/1-l-Packung. Es zeigt sich dabei, daß die Kostendegression entscheidend stärker durch den Grad der Kapazitätsauslastung als durch die Kapazitätsgröße beeinflußt wird.
Im Rahmen dieser Veröffentlichungsreihe wird der Kostenverlauf von ausgewählten Molkereiabteilungen in Abhängigkeit von der Kapazitätsgröße und -auslastung ermittelt. Die Bestimmung der Kosten erfolgt mit Hilfe von Modellkalkulationen, deren Daten in zahlreichen Molkereibetrieben sowie bei Herstellern von Molkereimaschinen, Verpackungsmaterial und sonstigen Bedarfsartikeln erhoben wurden. Die Grundlage der Verrechnung dieser Daten bildet eine spezielle Form der Teilkostenrechnung.
Für die Produktion von drei Sorten stichfestem Joghurt (Natur, mit unterlegter Frucht und Mix) werden die Kosten nach einer speziellen Form der Teilkostenrechnung in Abhängigkeit von der Kapazitätsauslastung bestimmt. Es werden drei Modelle mit unterschiedlicher Kapazitätsgröße dargestellt: 6500, 13.000 und 26.000 Becher/h. Durch Variationen der Produktmenge, Produktionstage und Produktanteile ergeben sich Kosten zwischen 12,6 und 9,3 Pf/Becher Joghurt Natur bzw. 18,7 und 15,5 Pf/Becher Joghurt mit unterlegter Frucht bzw. 17,0 und 14,0 Pf/Becher Joghurt Mix. Je nach Produktionsbedingungen können Stückkostendifferenzen von über 20 Pfennig je kg Produkt auftreten.
Im Rahmen dieser Veröffentlichungsreihe wird der Kostenverlauf von ausgewählten Molkereiabteilungen in Abhängigkeit von der Kapazitätsgröße und -auslastung ermittelt. Die Bestimmung der Kosten erfolgt mit Hilfe von Modellkalkulationen, deren Daten in umfangreichen Feldanalysen erhoben wurden. Die Grundlage der Verrechnung dieser Daten bildet eine spezielle Form der Teilkostenrechnung.
Im Rahmen dieser Veröffentlichungsreihe wird der Kostenverlauf von ausgewählten Molkereiabteilungen in Abhängigkeit von der Kapazitätsgröße und -auslastung ermittelt. Die Bestimmung der Kosten erfolgt mit Hilfe von Modellkalkulationen, deren Daten in umfangreichen Feldanalysen erhoben wurden. Die Grundlage der Verrechnung dieser Daten bildet eine spezielle Form der Teilkostenrechnung.
In der vorliegenden Arbeit werden die Produktionskosten für Sauerrahmbutter nach einer speziellen Form der Teilkostenrechnung in Abhängigkeit der Kapazitätsgröße und -auslastung bestimmt. Die untersuchten 3 Modelle haben eine Kapazität von 1350, 2700 und 4050 kg Butter/h. Durch Variation der Produktionsmengen von rd. 1600 bis 24 000 t/Jahr und der Produktionstage (360/252/180) ergeben sich Kosten der Buttereiabteilung zwischen 19,3 Pf/kg und 34,3 Pf/kg Butter. Bei einer mittleren Auslastung von 50% bewegen sich die Kosten von 20,3 bis 23,6 Pf/kg. Die Kostenanalyse zeigt, daß die Kostendegression bedeutend stärker durch den Kapazitätsauslastungsgrad als durch die Kapazitätsgröße beeinflußt wird.
In dieser Arbeit werden die Grundlagen zur Bestimmung des Kostenverlaufs einzelner ausgewählter Molkereibetriebsabteilungen bei unterschiedlichen Kapazitätsgrößen und -auslastungen bestimmt. Den Produkten (Abteilungen) werden die mengenproportionalen Produkteinzelkosten zugerechnet sowie die Gemeinkosten der Abteilung, die sich aus jahresfixen, tagesfixen und chargenfixen Kosten zusammensetzen. Für Energie werden lediglich mengenproportionale Kosten in Ansatz gebracht. Die sonstigen Kosten der Hilfskostenstellen werden grundsätzlich nicht auf die Produkte bzw. Abteilungen umgelegt; sie werden im letzten Teil dieser Veröffentlichungsreihe behandelt. Die objektive Vergleichbarkeit der Kosten kann so gewährleistet werden. Ein wichtiger Bestandteil dieser Arbeit war die Entwicklung eines für alle Abteilungen brauchbaren Simulationsmodells, das für den Einsatz in der EDV konzipiert wurde. Neben der Berechnung der anfallenden Kosten bei unterschiedlichen Anlagengrößen sind bei dem Computermodell beliebige Variationen der folgenden Faktoren möglich. Dadurch können die Auswirkungen eines veränderten Beschäftigungsgrades bzw. einer anderen Kapazitätsauslastung auf die Stückkosten der einzelnen Produkte ermittelt werden. Es ist vorgesehen, die Daten über Jahre hinaus auf dem neuesten Stand zu halten und zu veröffentlichen.
In der vorliegenden Arbeit werden die Kosten der Sprühtrocknung bei drei verschiedenen Kapazitätsgrößen mit jeweils variierender Kapazitätsauslastung nach einer speziellen Form der Teilkostenrechnung bestimmt. Die Kapazitätsgrößen betragen 10800, 21600 und 32400 kg Magermilch pro Stunde. Die verarbeiteten Milchmengen liegen
zwischen 12,8 Mio. und 256,6 Mio. kg im Jahr; dabei variieen die Stückkosten zwischen 4,80 und 1,78 Pf/kg Mm. Es hat sich dabei gezeigt, daß die Kostendegression bedeutend stärker durch den Grad der Kapazitätsauslastung als durch die Kapazitätsgröße beeinflußt wird.
In der vorliegenden Arbeit werden die Kosten für die Produktion von Speisequark mager und Speisequark 40 % F.i.Tr. für zwei Kapazitätsgrößen von 4.800 bzw. 9.500 kg Km/h nach einer speziellen Form der Teilkostenrechnung bestimmt. Bei Variationen der Kapazitätsauslastung (Pro
duktionstage X Produktionsstunden/Tag) und der Produktanteile ergeben sich Kosten zwischen 11,99 und 18,95 Pf pro Becher Speisequark mager bzw. 11,73 und 18,45 Pf je Becher Speisequark 40% F.i.Tr. Das entspricht einer Differenz in den Stückkosten von durchschnittlich 27,5 Pf/kg Speisequark. Es zeigt sich dabei, daß die Kostendegression bedeutend stärker durch den Grad der Kapazitätsauslastung als durch die Kapazitätsgröße beeinflußt wird.
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.
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.
Mastitis is one of the most important diseases threatening modern dairy herds. The idea of fighting the disease through colonising the udder with lactic acid bacteria (LAB), thereby building a beneficial biofilm, is the base for a probiotic approach towards mastitis control. The purpose of this study was to screen 13 LAB strains (eleven wild strains, two ATCC strains) inhibitory to the growth of mastitis-causing pathogens for their in vitro ability to form a biofilm and to adhere to bovine glandular mammary epithelium in order to assess their probiotic potential. Furthermore, we aimed to gain knowledge about the chemical nature of the adhesins involved by subjecting the bacteria to various chemical and enzymatical pre-treatments. The biofilms were grown on hydrophilic glass and on hydrophobic polypropylene in de Man, Rogosa and Sharpe (MRS) broth and afterwards quantified with a crystal violet assay. Biofilm formation was observed in all strains. However, the extent strongly depended on the strain, surface charge and medium. The adhesion assay also revealed a strong strain dependency, but this trait was also present in all of the investigated LAB isolates. Depending on the strain, chemical or enzymatical pre-treatment revealed carbohydrate molecules as well as proteins and lipids to be crucial for the adhesion of LAB to epithelial cells. The seven strains showing the strongest biofilm formation and/or adhesion represent promising candidates for further investigation in order to develop a probiotic remedy for the treatment of mastitis. Still, their safety for consumers and patients as well as their capability to colonise the udder remain to be investigated in in vivo studies.
A decline in the CD4 count is a common feature in HIV/AIDS, suggesting a compromise in immunity of patients. In response, highly active antiretroviral therapy (HAART) is prescribed to slow-down a diminution in the CD4 count and risk of AIDS-related malignancies. However, exercise may improve both the utility and population of innate immune cell components, and may be beneficial for patients with HIV infection. Comparing the effects of different exercises against HAART, on CD4 count, helps in understanding the role and evidence-based application of exercises to ameliorate immune deficiency.
Streptococcus (S.) uberis is a causative agent for clinical and subclinical bovine mastitis which significance for the udder health has increased over the last decades. Molecular diagnosis methods revealed that S. uberis may be subdivided into many different varieties with different epidemiological properties. In addition, some varieties were reclassified as Streptococcus parauberis and Globicatella sanguinis. The present paper reviews S. uberis and its role in modern dairy farming. This pathogen is ubiquitous for which it is considered as environment- associated. Straw bedding and pasture, but also the bovine skin and digestive mucosae are typical localizations inhabited by S. uberis. Due to its capacity to persist within the mammary tissue, some infections may eventually turn cow-associated. In other cases, the infection is short, but in any case, there is a high risk of re-infection. Although many varieties remain susceptible to most antimicrobial agents, the problem for the dairy farm lies in the high rate of re-infection. This paper also reviews risk factors, therapies and measures to control S. uberis at farm level.
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?
Dieser hier um die Einleitung ergänzte Text ist zuerst in leicht gekürzter Fassung im Ifo-Schnelldienst 17/2010 in München erschienen; ebenso unter: http://www.brainlogs.de/Geschlechtsverwirrung und unter http://www.streitbar.eu sowie unter http://www.odww.de/Hochschulpolitik. Der Autor geht der Frage nach, ob Frauenquoten ein legitimes Instrument zur Durchsetzung der Gleichberechtigung sind.
Objective: To determine the burden and factors associated with post-stroke depression in East central Nigeria.
Method: We carried out this cross-sectional study of 50 stroke survivors (mean age=54.8 ± 8.8 years), at the physiotherapy Department of the University of Nigeria Teaching Hospital, Enugu. Data were collected using Becks Depression Inventory , it was analyzed using Z-scores, Chi-square test and univariate logistic regression.
Results: PSD was more common in females (45.45%); middle-age(60%) adults(27-36/47-56 years respectively); living with spouse (45%); left cerebral lesions (40.74%). Self-employed and unemployed (66.67%), respectively. Age was significantly associated with depression (p=0.03), and was related to the risk ofOR3.7 (95% CI 1.1-12.0 )
Conclusion: Age could be a risk factor for PSD, which was more prevalent in the elderly than young/middle-age adults, female gender, left cerebral lesion, complications, cold case; those living with a spouse, self-employed and unemployed.
Social comparison theories suggest that ingroups are strengthened whenever important outgroups are weakened (e.g., by losing status or power). It follows that ingroups have little reason to help outgroups facing an existential threat. We challenge this notion by showing that ingroups can also be weakened when relevant comparison outgroups are weakened, which can motivate ingroups to strategically offer help to ensure the outgroups' survival as a highly relevant comparison target. In three preregistered studies, we showed that an existential threat to an outgroup with high (vs. low) identity relevance affected strategic outgroup helping via two opposing mechanisms. The potential demise of a highly relevant outgroup increased participants’ perceptions of ingroup identity threat, which was positively related to helping. At the same time, the outgroup’s misery evoked schadenfreude, which was negatively related to helping. Our research exemplifies a group's secret desire for strong outgroups by underlining their importance for identity formation.
Background
In the past years, it became apparent that health status and performance differ considerably within dairy farms in Northern Germany. In order to obtain clues with respect to possible causes of these differences, a case-control study was performed. Case farms, which showed signs of health and performance problems, and control farms, which had none of these signs, were compared. Risk factors from different areas such as health management, housing, hygiene and nutrition were investigated as these are known to be highly influential. The aim of this study was to identify major factors within these areas that have the strongest association with health and performance problems of dairy herds in Northern Germany.
Results
In the final model, a lower energy density in the roughage fraction of the diet, more pens with dirty lying areas and a low ratio of cows per watering spaces were associated with a higher risk for herd health problems. Moreover, case farms were affected by infections with intestinal parasites, lungworms, liver flukes and Johne’s Disease numerically more often than control farms. Case farms more often had pens with raised cubicles compared to the deep bedded stalls or straw yards found in control farms. In general, the hygiene of the floors and beddings was worse in case farms. Concerning nutrition, the microbiological and sensory quality of the provided silages was often insufficient, even in control farms. Less roughage was provided to early lactating cows and the feed was pushed to the feeding fence less frequently in case farms than in control farms.
Conclusions
The results show that milk yield and health status were associated with various factors from different areas stressing the importance of all aspects of management for good animal health and performance. Moreover, this study confirmed well-known risk factors for health problems and performance losses. These should better be taken heed of in herd health management.
Catholic Ownership, Physician Leadership and Operational Strategies: Evidence from German Hospitals
(2022)
Previous research has revealed that Catholic hospitals are more likely follow a strategy of horizontal diversification and maximization of the number of patients treated, whereas Protestant hospitals follow a strategy of horizontal specialization and focus on vertical differentiation. However, there is no empirical evidence pertaining to this mechanism. We conduct an empirical study in a German setting and argue that physician leadership mediates the relationship between ownership and operational strategies. The study includes the construction of a model combining data from a survey and publicly available information derived from the annual quality reports of German hospitals. Our results show that Catholic hospitals opt for leadership structures that ensure operational strategies in line with their general values, i.e., operational strategies of maximizing volume throughout the overall hospital. They prefer part-time positions for chief medical officers, as chief medical officers are identified to foster strategies of maximizing the overall number of patients treated. Hospital owners should be aware that the implementation of part-time and full-time leadership roles can help to support their strategies. Thus, our results provide insights into the relationship between leadership structures at the top of an organization, on the one hand, and strategic choices, on the other.
Background and Objectives:
Drawing causal conclusions from real-world data (RWD) poses methodological challenges and risk of bias. We aimed to systematically assess the type and impact of potential biases that may occur when analyzing RWD using the case of progressive ovarian cancer.
Methods:
We retrospectively compared overall survival with and without second-line chemotherapy (LOT2) using electronic medical records. Potential biases were determined using directed acyclic graphs. We followed a stepwise analytic approach ranging from crude analysis and multivariable-adjusted Cox model up to a full causal analysis using a marginal structural Cox model with replicates emulating a reference randomized controlled trial (RCT). To assess biases, we compared effect estimates (hazard ratios [HRs]) of each approach to the
HR of the reference trial.
Results:
The reference trial showed an HR for second line vs. delayed therapy of 1.01 (95% confidence interval [95% CI]: 0.82e1.25). The corresponding HRs from the RWD analysis ranged from 0.51 for simple baseline adjustments to 1.41 (95% CI: 1.22e1.64) accounting for immortal time bias with time-varying covariates. Causal trial emulation yielded an HR of 1.12 (95% CI: 0.96e1.28).
Conclusion:
Our study, using ovarian cancer as an example, shows the importance of a thorough causal design and analysis if one is expecting RWD to emulate clinical trial results.
To optimise udder health at the herd level, identifying incurable mastitis cases as well as providing an adequate therapy and culling strategy are necessary. Cows with clinical mastitis should be administered antibiotic medication if it is most likely to improve mammary cure. The somatic cell count (SCC) in milk of the monthly implemented Dairy Herd Improvement (DHI) test represents the most important tool to decide whether a cow has a promising mammary cure rate. Differential cell count (DCC) facilitates the specification of the immunological ability of defence, for example by characterising leukocyte subpopulations or cell viability. The aim of this study was to assess the DCC and cell viability in DHI milk samples regarding the cytological (CC) and bacteriological cure (BC) of the udder within a longitudinal study, thereby gaining a predictive evaluation of whether a clinical mastitis benefits from an antibiotic treatment or not. The cows enrolled in this study had an SCC above 200,000 cells/mL in the previous DHI test. Study 1 assessed the CC by reference to the SCC of two consecutive DHI tests and included 1010 milk samples: 28.4% of the mammary glands were classified as cytologically cured and 71.6% as uncured. The final mixed logistic regression model identified the total number of non-vital cells as a significant factor associated with CC. An increasing amount of non-vital cells was related to a lower individual ability for CC. Cows which were in the first or second lactation possessed a higher probability of CC than cows having a lactation number above two. If animals developed a clinical mastitis after flow cytometric investigation, the BC was examined in study 2 by analysing quarter foremilk samples microbiologically. Taking 48 milk samples, 81.3% of the mammary glands were classified as bacteriologically cured and 18.7% as uncured. The percentage of total non-vital cells tended to be lower for cows which were cured, but no significance could be observed. This study revealed that the investigation of the proportion of non-vital cells in DHI milk samples can enhance the prognosis of whether an antibiotic treatment of clinical mastitis might be promising or not. Prospectively, this tool may be integrated in the DHI tests to facilitate the decision between therapy or culling.
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 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.
Since child maltreatment has highly negative effects on child adjustment, early identification of at-risk families is important. This study focuses on longitudinal risk factors for child maltreatment and associations between abuse risk and occurrence. It also examines whether abuse risk and involvement in early childhood intervention are associated. The sample comprises 197 German caregivers with children under 3 years of age. Data was collected in two waves. The Brief Child Abuse Potential Inventory assessed abuse risk. Socio-demographic, parent, child and family-related risk factors were measured using screening tools. The analysis revealed that parental characteristics (psychopathology, own maltreatment experiences etc.) were associated with concurrent abuse risk. Longitudinal changes in abuse risk were linked to caregiver education and child-related factors. Cumulative risk did not explain more variance than specific risk factors. Significant associations with caregiverreported abuse were found, and data suggest that some burdened families cannot be reached by early childhood intervention.
Eine ganzheitliche CIM-Einführung setzt neben einer Veränderung der Organisation vor allem ein integratives Informationsmanagement voraus. Die Notwendigkeit zu gesamtheitlichem Denken in funktionsübergreifenden Zusammenhängen erfordert in erster Linie Führungsqualität und Mitarbeiterqualifikation. Diesem Umstand wird in dem vom Autor vorgestellten CIM-house-Modell ausdrücklich Rechnung getragen.
Aus den Veröffentlichungen über CIM-Projekte geht immer häufiger hervor, dass der von den Anbietern vertretene hohe Anspruch einer umfassenden CIM-Anwendung und die Ergebnisse durchgeführter CIM-Realisierungen in der Praxis nicht übereinstimmen. Es wäre jedoch falsch, aufgrund dieser Beobachtungen die CIM-Strategie als solche in Frage zu stellen. Der Ausweg aus diesem Missstand ist vielmehr über geeignete CIM-Einführungsstrategien zu suchen.
Clinical scores and motion-capturing gait analysis are today’s gold standard for outcome measurement after knee arthroplasty, although they are criticized for bias and their ability to reflect patients’ actual quality of life has been questioned. In this context, mobile gait analysis systems have been introduced to overcome some of these limitations. This study used a previously developed mobile gait analysis system comprising three inertial sensor units to evaluate daily activities and sports. The sensors were taped to the lumbosacral junction and the thigh and shank of the affected limb. The annotated raw data was evaluated using our validated proprietary software. Six patients undergoing knee arthroplasty were examined the day before and 12 months after surgery. All patients reported a satisfactory outcome, although four patients still had limitations in their desired activities. In this context, feasible running speed demonstrated a good correlation with reported impairments in sports-related activities. Notably, knee flexion angle while descending stairs and the ability to stop abruptly when running exhibited good correlation with the clinical stability and proprioception of the knee. Moreover, fatigue effects were displayed in some patients. The introduced system appears to be suitable for outcome measurement after knee arthroplasty and has the potential to overcome some of the limitations of stationary gait labs while gathering additional meaningful parameters regarding the force limits of the knee.
Ever since the 1996 revision of the Declaration of Helsinki, the World Medical Association has attempted to address ethical and scientific concerns of its diverse stakeholders for Articles 33 (use of placebo) and 34 (posttrial provisions), most recently in 2013. Both are inextricably linked to standard of care, an essential element of any comparative, interventional clinical trial. But has this now 20-year-long ethical debate truly been put to rest? The choice of standard of care in clinical trials remains a complex issue, particularly for comparative trials conducted in emerging countries.
Was bedeutet es beratungswissenschaftlich und beratungspraktisch, wenn
wie bei Astrid Schreyögg Coaching als Instrument einer Personalentwicklung im Sinne Oswald Neubergers verstanden wird, der ausdrücklich betont: „Der Mensch ist Mittel. Punkt.“ Wie ist ein solches Coachingverständnis diskursanalytisch zuzuordnen, in dem eine bestimmte Arbeits‐ und Organisationspsychologie sich in den Dienst eines bestimmten Verständnisses von Personalwirtschaft stellt? Wie wirkt sich dies in der konkreten Beratungspraxis aus? Welches Menschenbild liegt einem solchen Coaching zugrunde? Lassen sich historisch Modelle rekonstruieren, in denen psychologische Methoden und Techniken im Interesse einer bestimmten ökonomistischen Weltanschauung und Haltung instrumentalisiert wurden? Der Autor vertritt die These, dass „Psychotechnik“ und „Menschenökonomie“ aus den 1910er‐ und 1920er‐Jahren charakteristische Ähnlichkeiten mit einem personalentwicklungsorientierten Coaching aufweisen, wie es Schreyögg unter Rückgriff auf Neubergers Lehrbuch vertritt.
Aim:
The most suitable method for assessment of response to peptide receptor radionuclide therapy (PRRT) of neuroendocrine tumors (NET) is still under debate. In this study we aimed to compare size (RECIST 1.1), density (Choi), Standardized Uptake Value (SUV) and a newly defined ZP combined parameter derived from Somatostatin Receptor (SSR) PET/CT for prediction of both response to PRRT and overall survival (OS).
Material and Methods:
Thirty-four NET patients with progressive disease (F:M 23:11; mean age 61.2 y; SD ± 12) treated with PRRT using either Lu-177 DOTATOC or Lu-177 DOTATATE and imaged with Ga-68 SSR PET/CT approximately 10–12 weeks prior to and after each treatment cycle were retrospectively analyzed. Median duration of follow-up after the first cycle was 63.9 months (range 6.2–86.2). A total of 77 lesions (2–8 per patient) were analyzed. Response assessment was performed according to RECIST 1.1, Choi and modified EORTC (MORE) criteria. In addition, a new parameter named ZP, the product of Hounsfield unit (HU) and SUVmean (Standard Uptake Value) of a tumor lesion, was tested. Further, SUV values (max and mean) of the tumor were normalized to SUV of normal liver parenchyma. Tumor response was defined as CR, PR, or SD. Gold standard for comparison of baseline parameters for prediction of response of individual target lesions to PRRT was change in size of lesions according to RECIST 1.1. For prediction of overall survival, the response after the first and second PRRT were tested.
Results:
Based on RECIST 1.1, Choi, MORE, and ZP, 85.3%, 64.7%, 61.8%, and 70.6% achieved a response whereas 14.7%, 35.3%, 38.2%, and 29.4% demonstrated PD (progressive disease), respectively. Baseline ZP and ZPnormalized were found to be the only parameters predictive of lesion progression after three PRRT cycles (AUC ZP 0.753; 95% CI 0.6–0.9, p 0.037; AUC ZPnormalized 0.766; 95% CI 0.6–0.9; p 0.029). Based on a cut-off-value of 1201, ZP achieved a sensitivity of 86% and a specificity of 67%, while ZPnormalized reached a sensitivity of 86% and a specificity of 76% at a cut-off-value of 198. Median OS in the total cohort was not reached. In univariate analysis amongst all parameters, only patients having progressive disease according to MORE after the second cycle of PRRT were found to have significantly shorter overall survival (median OS in objective responders not reached, in PD 29.2 months; p 0.015). Patients progressive after two cycles of PRRT according to ZP had shorter OS compared to those responding (median OS for responders not reached, for PD 47.2 months, p 0.066).
Conclusions:
In this explorative study, we showed that Choi, RECIST 1.1, and SUVmax-based response evaluation varied significantly from each other. Only patients showing progressive disease after two PRRT cycles according to MORE criteria had a worse prognosis while baseline ZP and
ZPnormalized performed best in predicting lesion progression after three cycles of PRRT.
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.
According to the third-person effect or the influence of presumed media influence approach, the presumption that the media has strong effects on other people can affect individuals’ attitudes and behavior. For instance, if people believe in strong media influences on others, they are more likely to increase their communication activities or support demands for restrictions on media. A standardized online survey among German journalists (N = 960) revealed that the stronger the journalists perceive the political online influence on the public to be, the more frequently they contradict unwanted political views in their articles. Moreover, even journalists are more likely to approve of restrictions on the Internet’s political influence, the stronger they believe the effects of online media to be. The data reveal no connections between communication activities and demands for restrictions.
Continuous Fiber-Reinforced Material Extrusion with Hybrid Composites of Carbon and Aramid Fibers
(2022)
An existing challenge in the use of continuous fiber reinforcements in additively manufactured parts is the limited availability of suitable fiber materials. This leads to a reduced adaptability of the mechanical properties to the load case. The increased design freedom of additive manufacturing allows the flexible deposition of fiber strands at defined positions, so that even different fiber materials can be easily combined in a printed part. In this work, therefore, an approach is taken to combine carbon and aramid fibers in printed composite parts to investigate their effects on mechanical properties. For this purpose, tensile, flexural and impact tests were performed on printed composite parts made of carbon and aramid fibers in a nylon matrix with five different mixing ratios. The tests showed that the use of hybrid composites for additive manufacturing is a reasonable approach to adapt the mechanical properties to the loading case at hand. The experiments showed that increasing the aramid fiber content resulted in an increase in impact strength, but a decrease in tensile and flexural strength and a decrease in stiffness. Microstructural investigations of the fracture surfaces showed that debonding and delamination were the main failure mechanisms. Finally, Rule of Hybrid Mixture equations were applied to predict the mechanical properties at different mixture ratios. This resulted in predicted values that differed from the experimentally determined values by an average of 5.6%.