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Background: Currently, to the best of our knowledge, no findings exist concerning the needs of professionals in specialized pediatric palliative care (PPC) regarding electronic health records (EHRs). Several studies have highlighted benefits concerning the use of EHRs in pediatrics. However, usability is strongly affected by the degree of adaptivity to the context of application. The aim of this study is to examine the needs of professionals concerning an EHR in the specialized PPC inpatient and outpatient settings. Methods: A qualitative research design was chosen to address the complex aspects of user demands. Focus group interviews and semi-structured one-on-one interviews were conducted with PPC professionals. N = 23 participants from inpatient and N = 11 participants from outpatient settings of specialized PPC representing various professions took part in the study. Results: The findings could be grouped into four categories: (1) attitude towards the current methods of documentation, (2) attitude towards electronic documentation in general, (3) general requirements for an EHR, and (4) content requirements for an EHR. Conclusions: Professionals in specialized PPC expect and experience many benefits of using electronic documentation. Their requirements for an EHR for inpatient and outpatient settings of PPC are largely consistent with EHRs for pediatrics. However, individual specifications and adaptations are necessary for this particular setting.
Background: Pediatric palliative care (PPC) is characterized by years of multisectoral and multi-professional care. Sharing information between PPC professionals is, therefore, essential for quality care. The evidence shows that electronic cross-facility health records (ECHRs) provide useful support in this context. To our knowledge, no ECHRs have been developed through a user-centered approach for this specific setting in Germany. Methods: Guided by design thinking, first, qualitative interviews were conducted to assess the needs of PPC professionals. Second, the elicited needs were specified in focus groups (FGs). Based on the needs stated in the interviews, prototypes of the ECHR were developed and discussed in the FGs. The indicated needs were supplemented and specified in an iterative process. The prototypes were further adapted according to these results. The unified theory of acceptance and use of technology was the basic model in the evaluation of needs. Results: Across seven main categories, past and current medication, emergency view, and messaging functions were identified as the participants’ desired core components of an ECHR. Utilizing design thinking facilitated the explicit articulation of user needs. Conclusions: Developing an ECHR with the content identified would allow for real-time data during emergencies, tracking what other PPC professionals have done, and making the applied treatments visible to others. This would offer a broader picture of the complex conditions common to PPC.
Background: Electronic medical records (EMRs) offer a promising approach to mapping and documenting the complex information gathered in paediatric palliative care (PPC). However, if they are not well developed, poorly implemented EMRs have unintended consequences that may cause harm to patients. One approach to preventing such harm is the involvement of users in the participatory design to ensure user acceptance and patient safety. Therefore, the aim of this study is to evaluate the acceptance of a novel patient chart module (PCM) as part of an EMR from the perspective of potential users in PPC and to involve these professionals in the design process. Methods: A qualitative observational study with N = 16 PPC professionals (n = 10 nurses, n = 6 physicians) was conducted, including concurrent think aloud (CTA) and semi-structured interviews. A structured content analysis based on the Unified Theory of Acceptance and Use of Technology was applied. Results: The results can be summarized in terms of general observations, performance expectancy, effort expectancy and facilitating conditions, all of which are likely to have a positive influence on acceptance of the PCM from the user perspective in the context of PPC. Conclusions: The involvement of users in the development of EMRs is important for meeting the requirements in PPC. Further software adaptations are necessary to implement these requirements.
Electronic Medical Records for (Visceral) Medicine: An Overview of the Current Status and Prospects
(2021)
Background: Electronic medical records (EMRs) offer key advantages over analog documentation in healthcare. In addition to providing details about current and past treatments, EMRs enable clear and traceable documentation regardless of the location. This supports evidence-based, multi-professional treatment and leads to more efficient healthcare. However, there are still several challenges regarding the use of EMRs. Understanding these challenges is essential to improve healthcare. The aim of this article is to provide an overview of the current state of EMRs in the field of visceral medicine, to describe the future prospects in this field, and to highlight some of the challenges that need to be faced. Summary: The benefits of EMRs are manifold and particularly pronounced in the area of quality assurance and improvement of communication not only between different healthcare professionals but also between physicians and patients. Besides the danger of medical errors, the health consequences for the users (cognitive load) arise from poor usability or a system that does not fit into the real world. Involving users in the development of EMRs in the sense of participatory design can be helpful here. The use of EMRs in practice together with patients should be accompanied by training to ensure optimal outcomes in terms of shared decision-making. Key Message: EMRs offer a variety of benefits. However, it is critical to consider user involvement, setting specificity, and user training during development, implementation, and use in order to minimize unintended consequences.
Background: Pediatric palliative care (PPC) patients experience years of multisectoral and professional care. An electronic cross-facility health record (ECHR) system can support the immediate exchange of information among PPC professionals. Based on a needs assessment, a prototype ECHR system was developed. Methods: To evaluate potential users’ perspective regarding the system, a qualitative observational study was conducted consisting of a concurrent think-aloud session and a semi-structured qualitative interview. Results: Twenty PPC professionals (nurses, physicians) from specialized outpatient PPC teams, a PPC unit, and medical offices rated the ECHR system as a helpful tool to improve the exchange and collection of information, communication between PPC professionals, and treatment planning. From the user’s point of view, the basic logic of the ECHR system should be further adapted to improve the interaction of data remirrored from patient records of outpatient and inpatient care with those entered via the system. The users wished for further functions (text search) and content (information on therapies). Some content, such as the treatment process, needs to be further adapted. Conclusion: The developed ECHR system needs to be more specific in some features by offering all available information; while for other features, be less specific to offer a quick overview. The ability to share information promptly and automatically was seen as a tremendous improvement to the quality of care for PPC patients.
Adhärenz digitaler Interventionen im Gesundheitswesen: Definitionen, Methoden und offene Fragen
(2021)
AbstractMany digital interventions rely on the participation of their users to have a positive impact. In various areas it can be observed that the use of digital interventions is often reduced or fully discontinued by the users after a short period of time. This is seen as one of the main factors that can limit the effectiveness of digital interventions. In this context, the concept of adherence to digital interventions is becoming increasingly important. Adherence to digital interventions is roughly defined as “the degree to which the user followed the program as it was designed,” which can also be paraphrased as “intended use” or “use as it is designed.” However, both the theoretical–conceptual and practical discussions regarding adherence to digital interventions still receive too little attention.The aim of this narrative review article is to shed more light on the concept of adherence to digital interventions and to distinguish it from related concepts. It also discusses the methods and metrics that can be used to operationalize adherence and the predictors that positively influence adherence. Finally, needs for action to better address adherence are considered critically.
Introduction: Heroin overdose is a leading cause of mortality among drug users. This paper aims to identify individual and contextual factors associated with lethal and non-lethal heroin-related overdoses on the basis of case reports and semi-structured proxy interviews. Typical patterns within these cases are determined by means of cluster analysis. Methods: Within the CaRe (Case Reports of heroin-related overdoses) study, case reports (100 proxy reports of overdose events from 36 different facilities) were gathered and evaluated as part of a nationwide survey of experts conducted in Germany in 2019. Following initial descriptive analyses a two-step cluster analysis with the four binary variables of gender, age, time and place was conducted to identify patterns within the reported cases. Results: The case reports grouped into five clusters: 1) Younger male drug users, found in a public space during the daytime; 2) Female drug users; 3) Older male drug users, found in a public space during the daytime; 4) Drug users found at home at night; 5) Drug users found outside at night. Overdoses by female drug users and those which occurred at home and/or at night were significantly more likely to have a fatal outcome. Conclusion: Future prevention
and intervention measures should aim to consider the context, i.e.
The Effect of Ionic Defect Interactions on the Hydration of Yttrium-Doped Barium Zirconate, Phys
(2021)
Kinetic Monte Carlo Simulations for Solid State Ionics: Case Studies with the MOCASSIN Program, Diff
(2021)
Heading in soccer involves repetitive head accelerations that may be detrimental for brain health. One way to mitigate adverse effects may be to increase head-neck stabilization and thus reduce the kinematic response after intentional headers. This study aimed to (a) assess associations between neck strength and head kinematics and (b) evaluate an exercise intervention designed to increase strength and attenuate head acceleration during intentional heading in youth soccer players. In 22 athletes, we used accelerometers to assess associations between neck strength and peak linear acceleration (PLA). We attached the accelerometers to the occiput and sternum, allowing us to differentiate between total, trunk, and head PLA. Longitudinally, we evaluated the effects of a 14-week twice-weekly resistance training in a subsample of 14 athletes compared with regular soccer training (N = 13). Results showed that female athletes had lower isolated neck strength (p ≤ 0.004), lower functional neck strength (p ≤ 0.017), and higher total PLA during purposeful headers compared with males (17.2 ± 3.5 g and 13.0 ± 2.3 g, respectively, at 9.6 m·s−1 ball velocity during impact; p = 0.003). The intervention group showed moderate to large strength gains (η
= 0.16–0.42), resulting in lower PLA (total −2.4 g, trunk −0.8 g, and head −1.5 g) during headers. We conclude that a resistance training focusing on cervical and trunk musculature is practicable in youth soccer, elicits strength gains, and helps to mitigate PLA during purposeful heading. Results should encourage youth strength and conditioning professionals to incorporate neck exercises as a risk reduction strategy into their training routine.
This paper presents a seminar concept for the development of communication competence in pre-service vocational education teachers with the aid of video annotations, feedback, and peer microteaching. The seminar is offered within a teacher training program for students taking a master’s degree (MEd) in vocational education at the FH Münster University of Applied Sciences, Germany, and has been conducted three times. The advantages of the seminar concept are manifold. On the one hand, we create a learning environment in which students individually prepare and conduct five peer microteaching lessons in a row and receive prompt and constructive peer feedback on every performance. On the other hand, the quality of feedback improves so that our students are professional feedback providers by the end of the seminar. The provision of teacher feedback alone does not help our students become successful feedback providers. Nor, given the resources available at the university, is it a realistic alternative in terms of time constraints. In addition, due to recordings, the students gain a better insight into their teaching skills since their lessons can be observed and approached from an outside perspective.
Due to a limited number of available measurements on agricultural biogas plants, established process models, such as the Anaerobic Digestion Model No. 1 (ADM1), are rarely applied in practise. To provide a reliable basis for model-based monitoring and control, different model simplifications of the ADM1 were implemented for process simulation of semi-continuous anaerobic digestion experiments using agricultural substrates (maize silage, sugar beet silage, rye grain and cattle manure) and industrial residues (grain stillage). Individual model structures enable a close depiction of biogas production rates and characteristic intermediates (ammonium nitrogen, propionic and acetic acid) with equal accuracy as the original ADM1. The impact of different objective functions and standard parameter values on parameter estimates of first-order hydrolysis constants and microbial growth rates were evaluated. Due to the small number of required model parameters and suitable system characteristics, simplified model structures show clear advantages for practical application on agricultural biogas plants.
Rigorous process models provide a reliable basis for model-based monitoring and control of anaerobic digestion plants. Due to the complex model structure and non-linear system characteristics, the established Anaerobic Digestion Model No. 1 (ADM1) is rarely applied in industrial plant operation. The present investigation proposes a systematic procedure for successive model simplification and presents the description of five model variants of a mass-based ADM1. Individual model structures greatly differ in their number of implemented process phases, characteristic components and required parameters. Simplified model variants combine nutrient degradation and biogas formation based on first-order sum reactions, whereas complex model structures describe individual degradation pathways and intermediates during acido- and acetogenesis. Characteristic features of the derived model structures as well as the stoichiometric methane potentials and microbial biomass yields of the underlying degradation pathways of individual model variations are evaluated and discussed in detail.
Inter-laboratory reproducibility of biomethane potential (BMP) is dismal, with differences in BMP values for the same sample exceeding a factor of two in some cases. A large group of BMP researchers directly addressed this problem during a workshop held in Leysin, Switzerland, in June 2015. The workshop resulted in a new set of guidelines for BMP tests published in 2016, which is the subject of the present commentary. The work has continued with two international inter-laboratory studies and one additional workshop held in Freising, Germany, in 2018. The dataset generated by the two inter-laboratory studies were used to refine the validation criteria for BMP tests. Based on these new results an update to the original guidelines is proposed here.
A synthesis is made of 10 topics within climate research, where there have been significant advances since January 2020. The insights are based on input from an international open call with broad disciplinary scope. Findings include: (1) the options to still keep global warming below 1.5 °C; (2) the impact of non-CO2 factors in global warming; (3) a new dimension of fire extremes forced by climate change; (4) the increasing pressure on interconnected climate tipping elements; (5) the dimensions of climate justice; (6) political challenges impeding the effectiveness of carbon pricing; (7) demand-side solutions as vehicles of climate mitigation; (8) the potentials and caveats of nature-based solutions; (9) how building resilience of marine ecosystems is possible; and (10) that the costs of climate change mitigation policies can be more than justified by the benefits to the health of humans and nature.
As a salutogenic concept, “consumption corridors” aims to support what is necessary for sustainable wellbeing to be achieved in relation to the Earth system, with a deep consideration for justice and equity. Living in consumption corridors is a representation of everyday life whereby people live within limits, so that all people – now and in the future – can access what is needed to live a good life. In this special issue, a series of scholars and practitioners have come together to further develop the concept, engage with its ethodological implications, and relate it to consumption domains and policy implications. We begin by introducing how the concept emerged, in relation to the complexity of grappling with the societal transformations required for achieving more sustainable forms of consumption. We then present the different contributions, which demonstrate the importance of considering both maximum and minimum consumption standards, the relevance of human-need theories, as well as the difference between achieving wellbeing and the means necessary for doing so. We conclude by opening up to areas that merit further deliberation: how to relate consumption corridors to everyday-life dynamics, but also to the critical question of power relations at play in implementing consumption corridors.
Despite widespread recognition of the need to transition toward more sustainable production and consumption and numerous initiatives to that end, global resource extraction and corresponding socio-ecological degradation continue to grow. Understanding the causes of this persistent failure is a necessary step towards more effective action. This article contributes to that understanding by synthesizing theory and evidence that links unsustainable production-consumption systems to power and inequality. While sustainable consumption and production research and action mostly focuses on technological or behavioral change, the socio-ecological inequalities driving production-consumption systems built into the organization of our global political economy, remain largely overlooked. In response, we propose a structural political economy orientation that seeks explicitly to reduce these inequalities and advance environmental justice and, thus, create the conditions for sustainable production-consumption systems. We then propose three important arenas of research and action towards sustainable production-consumption systems: justice, governance, and co-production of knowledge and action. These arenas, collectively and individually, can serve as entry points to study and act on the dynamics of (un)sustainable production-consumption systems. This can be done at the micro level, with respect to specific commodity chains or systems of provisioning, or at meso and macro levels with respect to national and global production networks. Our proposed orientation helps distinguish research and practice proposals into those emphasizing management and compensation resulting often in persistence of unsustainability, from those proffering structural changes in unsustainable production-consumption systems. We invite critique and collaboration to develop this research and action agenda further.
The demand for energy storage is increasing massively due to the electrification of transport and the expansion of renewable energies. Current battery technologies cannot satisfy this growing demand as they are difficult to recycle, as the necessary raw materials are mined under precarious conditions, and as the energy density is insufficient. Metal–air batteries offer a high energy density as there is only one active mass inside the cell and the cathodic reaction uses the ambient air. Various metals can be used, but zinc is very promising due to its disposability and non-toxic behavior, and as operation as a secondary cell is possible. Typical characteristics of zinc–air batteries are flat charge and discharge curves. On the one hand, this is an advantage for the subsequent power electronics, which can be optimized for smaller and constant voltage ranges. On the other hand, the state determination of the system becomes more complex, as the voltage level is not sufficient to determine the state of the battery. In this context, electrochemical impedance spectroscopy is a promising candidate as the resulting impedance spectra depend on the state of charge, working point, state of aging, and temperature. Previous approaches require a fixed operating state of the cell while impedance measurements are being performed. In this publication, electrochemical impedance spectroscopy is therefore combined with various machine learning techniques to also determine successfully the state of charge during charging of the cell at non-fixed charging currents.
Keywords:
electrochemical impedance spectroscopy; artificial neural networks; support vector regression; zinc-air battery; state estimation; state of charge
The Anatomy of Glenoid Concavity-Bony and Osteochondral Assessment of a Stability-Related Parameter
(2021)
This review assessed population-based estimate rates of cancer patients with minor and young adult children (≤ 25 years), children and young adults having a parent with cancer as well as the psychosocial situation and well-being of children and young adults affected by parental cancer. Eighteen publications on population-based studies were included. Studies varied in the age ranges of both cancer patients and children. The prevalence rates of cancer patients having children ranged from 14 to 24.7% depending on the sample structure (e.g., age, gender). Studies reported that between 1.6 and 8.4% of children resp. young adult children have a parent with a history of cancer. Seven publications reported on the psychosocial situation or well-being in children and young adults affected by parental cancer. Estimate rates of psychosocial problems, psychiatric diagnoses or distress ranged between 2.5 and 34% of children depending on the method of measurement and outcome. The differences in the sample structure between the studies impeded the comparison of prevalence rates. However, the findings help to determine the need for specific support services and health care planning. The results emphazise the importance to routinely include issues on the parental role of patients and questions on the well-being and coping of children into psychooncological care. If necessary, support should be provided to families living with a cancer diagnosis.
Numerical Calibration of Three-Dimensional Printed Five-Hole Probes for the Transonic Flow Regime
(2021)
Background
During shortages of filtering face pieces (FFP) in a pandemic, it is necessary to implement a method for safe reuse or extended use. Our aim was to develop a simple, inexpensive and ecological method for decontamination of disposable FFPs that preserves filtration efficiency and material integrity.
Specific alterations in electroencephalography (EEG)-based brain activity have recently been linked to binge-eating disorder (BED), generating interest in treatment options targeting these neuronal processes. This randomized-controlled pilot study examined the effectiveness and feasibility of two EEG neurofeedback paradigms in the reduction of binge eating, eating disorder and general psychopathology, executive functioning, and EEG activity. Adults with BED and overweight (N = 39) were randomly assigned to either a food-specific EEG neurofeedback paradigm, aiming at reducing fronto-central beta activity and enhancing theta activity after viewing highly palatable food pictures, or a general EEG neurofeedback paradigm training the regulation of slow cortical potentials. In both conditions, the study design included a waiting period of 6 weeks, followed by 6 weeks EEG neurofeedback (10 sessions à 30 min) and a 3-month follow-up period. Both EEG neurofeedback paradigms significantly reduced objective binge-eating episodes, global eating disorder psychopathology, and food craving. Approximately one third of participants achieved abstinence from objective binge-eating episodes after treatment without any differences between treatments. These results were stable at 3-month follow-up. Among six measured executive functions, only decision making improved at posttreatment in both paradigms, and cognitive flexibility was significantly improved after food-specific neurofeedback only. Both EEG neurofeedback paradigms were equally successful in reducing relative beta and enhancing relative theta power over fronto-central regions. The results highlight EEG neurofeedback as a promising treatment option for individuals with BED. Future studies in larger samples are needed to determine efficacy and treatment mechanisms.
The quantum anomaly is written alternatively into a form violating conservation laws or as non-gauge invariant currents seen explicitly on the example of chiral anomaly. By reinterpreting the many-body averaging, the connection to Pauli–Villars regularization is established which gives the anomalous term a new interpretation as arising from quantum fluctuations by many-body correlations at short distances. This is exemplified using an effective many-body quantum potential which realizes quantum Slater sums by classical calculations. It is shown that these quantum potentials avoid the quantum anomaly but approach the same anomalous result by many-body correlations. Consequently, quantum anomalies might be a shortcut way of single-particle field theory to account for many-body effects. This conjecture is also supported since the chiral anomaly can be derived by a completely conserving quantum kinetic theory. A measure for the quality of quantum potentials is suggested to describe these quantum fluctuations in the mean energy. The derived quantum potentials might be used to describe quantum simulations in classical terms.
Effect of a community-based lifestyle intervention programme on quality of life among German women
(2021)
Background
Quality of life is an important concept in the field of health, which can be influenced by various lifestyle factors. The objective was to test if a community-based lifestyle programme would beneficially affect the health-related quality of life of German women.
Methods
The controlled intervention study had a total duration of 24 months. Quality of life (EQ-5D-3L), anthropometrics, vital and blood parameters as well as diagnosed diseases and health economic parameters were collected at baseline (t0), after 10 weeks (t1) and after 6 months (t2). For the intervention group (n = 65) a 10-week intensive lifestyle programme followed by monthly alumni meetings were conducted. The intensive phase consisted of 14 consecutive seminars about a healthy lifestyle, which focused on a plant-based diet, physical activity, stress management and community support. The control group (n = 35) received no intervention.
Results
The first descriptive health profile results of the subgroup analysis showed that 59% women of the intervention group at t0 (t1: 37%; t2: 48%) and 60% of the control group at t0 (t1: 54%; t2: 49%) reported problems in at least one of the EQ-5D dimensions (mobility, selfcare, activities, pain, and anxiety). A significant difference in EQ VAS change between women in intervention (7,15 [95% CI 4,32; 9,98]; EQ VAS t0: 75,35 [SD 13,71]) and control group (-2,63 [95% CI -5,40; 0,15]; EQ VAS t0: 78,80 [SD 18,51]) from t0 to t1 was observed (p < 001; adjusted for baseline). No significant differences in mean EQ VAS change from t0 to t2 and in mean EQ-5D index change from t0 to t1 and t0 to t2 between the groups were observed (p > 0,05; adjusted for baseline).
Conclusions
The preliminary results suggest that the lifestyle intervention programme can have a positive short-time effect on some aspects of quality of life, such as the health profile and EQ VAS. However, the long-term results will be shown in the future.
Key messages
- A healthy lifestyle can affect the quality of life in a positive way.
- The community-based lifestyle programme had a short-time influence on the descriptive health profile and EQ VAS of German women, whereby the EQ index didńt change significantly between the groups.
Experimental results are presented of a test of the theory of local turbulent heat transfer measurements proposed by Mocikat and Herwig in 2007. A miniaturized multi-layer heat transfer sensor was developed and employed in this study. The new heat transfer sensor was designed to work in air and liquids, and this capability enabled the simultaneous investigation of different Prandtl numbers. Two basic configurations, namely the flow past a blunt plate and the flow past an inclined square cylinder, were investigated in test sections of wind and water tunnels. Convective heat transfer coefficients were obtained through conventional testing (i.e., employing thoroughly heated test objects) and using the new miniaturized sensor approach (i.e., utilizing cold test objects without heating). The main prediction of the Mocikat-Herwig theory that a specific thermal adjustment coefficient of the employed actual miniaturized heat transfer sensor should exist in the fully turbulent flow regime was proven for developed two-dimensional flow. The observed effect of the Prandtl number on this coefficient was in good agreement with the prediction of the asymptotic expansion method. The square cylinder results indicated the inherent limits of the local turbulent heat transfer measurement approach, as suggested by Mocikat and Herwig.
Body shaming (BS) is a popular term for a type of negative social interaction, which frequently occurs in social media. However, there is a lack of a clear scientific definition of BS and data on its relation to other concepts in social aggression research. The present study therefore aimed at providing a definition and classification of BS. In an exploratory online-study, 25 participants (60%) provided personal definitions of BS and rated the fit of a suggested definition. In addition, they reported similarities with and differences to related concepts (appearance teasing, cyberbullying, trolling). We conducted qualitative analyses of the verbal definitions guided by the Grounded Theory approach and quantified the fit to existing concepts in the field of social aggression. The results show that BS is perceived as an unrepeated act in which a person expresses unsolicited, mostly negative opinions/comments about a target’s body, without necessarily intending to harm him/her. Still, the target perceives the comments as negative. BS can range from well-meant advice to malevolent insults and it can occur online and offline. Participants saw similarities between BS and appearance teasing. BS can be a tool for trolling and can evolve to cyberbullying with repetition over time. Altogether, BS is a form of social aggression that has a negative impact on individuals. The definition and classification help to investigate BS and its effects on body image and mental health in future research.
Background
Common carotid intima-media thickness (ccIMT) is an established risk marker for cardiovascular events, including myocardial infarction and stroke, which are of high public health relevance. While a higher fruit intake is generally considered beneficial for cardiovascular health, recent studies have shown that a fruit intake of > 2 portions per day may be harmful. Therefore, we tested if there is an association between categories of fruit intake and mean ccIMT.
Methods
We conducted an exploratory, non-prespecified, cross-sectional analysis of baseline values of 167 mostly middle-aged participants of a controlled lifestyle intervention, recruited from the general population in rural northwest Germany (male: n = 58; female: n = 109). Fruit intake was classified into low (<1 portion of fruit/day), intermediate (1-2 portions of fruit/day), and high (>2 portions of fruit/day). Mean ccIMT was measured in accordance with the Mannheim consensus. Between-group differences in mean ccIMT were assessed with analysis of covariance.
Results
Mean age was 57.3 ± 0.7 years (mean ± SEM). Mean fruit intake was 1.6 ± 0.1 portions/day. Average mean ccIMT was 0.679 ± 0.010 mm. There was a significant difference in mean ccIMT between subjects with low (0.676 ± 0.020 mm; n = 50), intermediate (0.653 ± 0.014 mm; n = 72), and high fruit intake (0.724 ± 0.019 mm; n = 45; p = 0.016). But this difference was attenuated when adjusting for age, sex, and homocysteine (p = 0.418).
Conclusions
We found only a non-significant association between consuming >2 portions of fruit per day and ccIMT. Thus, our study could not confirm a negative effect of fruit intake on ccIMT. Age, sex, and homocysteine may confound this association.
Key messages
Current recommendations of 2 portions of fruit per day seem adequate and do not negatively influence carotid intima-media thickness.
Future studies should address confounding of the association between fruit intake and cardiovascular risk markers.
Technical and organizational steps are necessary to mitigate cyber threats and reduce risks. Human behavior is the last line of defense for many hospitals and is considered as equally important as technical security. Medical staff must be properly trained to perform such procedures. This paper presents the first qualitative, interdisciplinary research on how members of an intermediate care unit react to a cyberattack against their patient monitoring equipment. We conducted a simulation in a hospital training environment with 20 intensive care nurses. By the end of the experiment, 12 of the 20 participants realized the monitors’ incorrect behavior. We present a qualitative behavior analysis of high performing participants (HPP) and low performing participants (LPP). The HPP showed fewer signs of stress, were easier on their colleagues, and used analog systems more often than the LPP. With 40% of our participants not recognizing the attack, we see room for improvements through the use of proper tools and provision of adequate training to prepare staff for potential attacks in the future.
Identifying Start-Up Partners: Which Search Practices and Combination Strategies are Effective?
(2021)
Start-ups are an important source of novel knowledge and product ideas for incumbents. We investigate which search strategies are positively related to the successful search for start-ups. We identify search instruments and their various uses: intensive or broad; stand-alone or combinatory. Finding 11 search practices in the literature, we evaluate how these practices were used by 97 respondents from a cross-industry and cross-national sample. Our results show that searching broadly and intensively is positively related to a successful search for start-ups and to firms’ radical innovation capability. Specific tools that are positively related to search success are online contacts, desk research, external scouting partners, and start-up pitch events. Decision tree analysis provides effective combinations of search practices that innovation managers and purchasing managers can use. Employing these search practice combinations, we make incumbents aware of the routines used in distant knowledge search. These practices are dynamic capabilities that help them to remain successful in high-velocity markets. In identifying these search practices, we contribute to the literature on innovation routines and dynamic capability research.
Purpose
Procurement professionals widely use purchasing portfolio models to tailor purchasing strategies to different product groups’ needs. However, the application of these approaches in hospitals and the impact of a pandemic shock remain largely unknown. This paper aims to assess hospital purchasers’ procurement strategies during the COVID-19 pandemic, the effects of factor-market rivalry (FMR) on strategies and the effectiveness of purchasing portfolio categorizations in this situation.
Design/methodology/approach
This qualitative study of hospital purchasing in the Netherlands is supported by secondary data from official government publications. Semi-structured interviews were conducted with 13 hospital purchasers at large hospitals. An interpretative approach is used to analyze the interviews and present the results.
Findings
The findings reveal that product scarcity forces purchasers to treat them as (temporary) bottleneck items at the hospital level. The strategies adopted largely aligned with expected behavior based on Kraljic’s commodity management model. Adding the FMR perspective to the model helped to further cluster crisis strategies into meaningful categories. Besides inventory management, increasing supply, reducing demand and increasing resource coordination were the other common strategies. An important finding is that purchasers and governments serve as gatekeepers in channeling FMR, thereby reducing potential harmful competition between and within hospitals.
Social implications
The devastating experience of the COVID-19 pandemic is unveiling critical weaknesses of public health-care provision in times of crisis. This study assesses the strategies hospital purchasers apply to counteract shortages in the supply chain. The findings of this study emphasize the importance of gatekeepers in times of crisis and present strategies purchasers can take to assure the supply of resources.
Originality/value
No research has been conducted on purchasing portfolio models and FMR implications for hospitals during pandemics. Therefore, the authors offer several insights: increasing the supply risk creates temporary bottleneck strategies, letting purchasers adopt a short-term perspective and emphasizing the high mobility of commodities in the Kraljic commodity matrix. Additionally, despite more collaboration uncovered in other studies regarding COVID-19, strong rivalry arose at the beginning of the pandemic, leading to increased competition and less collaboration. Given such increased FMR, procurement managers and governments become important gatekeepers to balance resource allocation during pandemics both within and between hospitals.
Food-processing companies are controlled by societal influences and economic interests, but their efforts with regard to reducing food loss and waste are very different. This qualitative study aims to identify basic recommendations of good practice for the food-processing industry in order to prevent and handle food loss and waste. For this purpose, a comprehensive literature review was conducted in the field of food waste prevention and data was collected from thirteen German companies. The findings summarize the recommendations of good practice, which cover the entire supply chain from supplier to consumer and beyond. The analysis showed that the participating companies are already partially aware of operational measures, even if they are applied or mentioned without a systematic approach. Furthermore, the analysis revealed that most activities relate to internal matters, like processing, employees and utilization. However, the responsibility of foodprocessing companies does not end with internal processes to reduce food waste. The results show that some companies are already aware of their responsibility to be involved along the entire supply chain. Finally, the results show that the needs of consumers and suppliers must also be considered in order to reduce food waste, in addition to direct reduction measures. This paper highlights nine important stages and 53 basic recommendations for companies to address food loss and waste in order to improve their practices.
Phenanthroline chromophore as efficient antenna for Tb3+ green luminescence: A theoretical study
(2021)
The quaternary tungstates Li3Ba2RE3(WO4)8 (RE = La-Nd, Sm-Ho) were obtained by a ceramic synthesis route and were characterized by powder and single crystal X-ray diffraction. The structures of Li3Ba2Pr3(WO4)8 and Li3Ba2Tb3(WO4)8 were refined from single crystal diffractometer data: RbLiBi2(MoO4)4 type, space group C2/c, a = 528.57(2), b = 1292.39(6), c = 1934.80(10) pm, b = 91.522(4)°, 2151 F2 values, 108 parameters for Li3Ba2Pr3(WO4)8 and a = 520.54(2), b = 1272.03(6), c = 1918.85(10) pm, b = 91.948(4)°, 2020 F2 values, 108 variables for Li3Ba2Tb3(WO4)8. Striking polyhedral building units in these tungstates are WO4 tetrahedra and LiO6 octahedra, while the mixed occupied site and the barium atoms have higher coordination numbers, i.e. RE/Li@O8 and Ba@O10. In addition to the powder quality assessment by means of reflection spectroscopy, the synthesized samples were studied for their suitability as a scintillator material. Therefore, X-ray excited luminescence measurements where performed. Apart from Li3Ba2Ce3(WO4)8 and Li3Ba2Nd3(WO4)8, all compounds show strong emission under X-ray irradiation. Li3Ba2La3(WO4)8 and Li3Ba2Gd3(WO4)8 show blue CT luminescence caused by tungstate units, while the other samples show typical and multiple lines due to well known [Xe]4fn → [Xe]4fn transitions.
We report on a watt-level highly efficient europium laser operating at the 5D0→7F4 transition. It is based on the stoichiometric KEu(WO4)2 crystal. Under pumping by a green laser at 532.1 nm, the KEu(WO4)2 laser generated a maximum peak output power of 1.11 W at ∼703nm with a slope efficiency of 43.2% and a linear polarization (????‖????????). A laser threshold as low as 64 mW was achieved. True continuous-wave operation was demonstrated. The polarized emission properties of monoclinic KEu(WO4)2 were determined.
What sparks academic engagement with society? A comparison of incentives appealing to motives
(2021)
The PosiThera project focuses on the management of chronic wounds, which is multi-professional and multi-disciplinary. For this context, a software prototype was developed in the project, which is intended to support medical and nursing staff with the assistance of artificial intelligence. In accordance with the user-centred design, national workshops were held at the beginning of the project with the involvement of domain experts in wound care in order to identify requirements and use cases of IT systems in wound care, with a focus on AI. In this study, the focus was on involving nursing and nursing science staff in testing the software prototype to gain insights into its functionality and usability. The overarching goal of the iterative testing and adaptation process is to further develop the prototype in a way that is close to care.
Teaching and learning in international and thus intercultural contexts places special demands on the conception of trainings. The same holds true for online or distance learning. Taken together, both factors – training in an intercultural and online context – pose specific didactic and technical challenges. Against the background of the COVID-19 pandemic all international training programmes under the umbrella of the Higher Education Management Programme at FH Münster –University of Applied Sciences had to be held online. In the article on hand we share our experiences with online training for actors in the higher education area from developing and emerging countries and discuss its specific demands along the lines of common criteria for effective learning.
ALPACA: Application Layer Protocol Confusion - Analyzing and Mitigating Cracks in TLS Authentication
(2021)
(1) Background: Schools report a high number of schoolchildren with poor attention and hyperactive behavior, with 5% being diagnosed with attention deficit/hyperactivity disorder (ADHD). This causes specific problems during homework and classroom times, and the extension of all-day schooling in German primary schools makes this a challenge for support staff working in the after-school programs. Such staff have a very wide variety of qualifications, ranging from no formal teacher training to full teaching qualifications. (2) Methods: This study documents the knowledge of 196 support staff working in all-day primary schools about ADHD, and their subjective view of whether they feel competent with regard to homework situations in general and ADHD in particular. (3) Results: Those with an educational background have significantly more knowledge than those without such a background, staff feel less prepared to supervise children with ADHD, and there is a small but significant correlation here with knowledge about ADHD. (4) Conclusions: The importance of trained pedagogical staff in the supervision of children with concentration problems is emphasized.
Background. Ketone bodies are a highly relevant topic in nutrition and medicine. -e influence of medium-chain triglycerides (MCT) on ketogenesis is well known and has been successfully used in ketogenic diets for many years. Nevertheless, the effects of MCTs and coconut oil on the production of ketone bodies have only partially been investigated. Furthermore, the increased mobilisation of free fatty acids and release of catabolic hormones by caffeine suggest an influence of caffeine on ketogenesis.
Methods. In a controlled, double-blind intervention study, seven young healthy subjects received 10mL of tricaprylin (C8), tricaprin (C10), C8/C10 (50% C8, 50% C10), or coconut oil with or without 150 mg of caffeine, in 250mL of decaffeinated coffee, over ten interventions. At baseline and after every 40 minutes, for 4 h, ßHB and glucose in capillary blood as well as caffeine in saliva were measured. Furthermore, questionnaires were used to survey sensory properties, side effects, and awareness of hunger and satiety. Results. -e interventions with caffeine caused an increase in ßHB levels—in particular, the interventions with C8 highly impacted ketogenesis. -e effect decreased with increased chain lengths. All interventions showed a continuous increase in hunger and diminishing satiety. Mild side effects (total � 12) occurred during the interventions. Conclusions. -e present study demonstrated an influence of caffeine and MCTon ketogenesis. -eaddition of caffeine showed an additive effect on the ketogenic potential of MCT and coconut oil. C8 showed the highest ketogenicity.
Different from negatively charged CuInS2 (CIS) based quantum dots (QDs), positively charged QDs are difficult to obtain in good optical quality, but are desirable for certain applications. We herein present a general synthesis strategy that allows for a universal surface modification of ternary CIS based QDs with thiol containing ligands.
The idea behind the synthesis design is, to apply a ZnS shell first for passivating and protecting the core QDs, and then add a second ZnS shell for the functionalization via ligand exchange. Whereby easy ligand exchange with thiolated molecules is systematically set up, by using a weak bonding amine ligand for the second shell. Molecules with various terminal groups were used to functionalize the nanoparticles and stabilize them in different media making any surface charge and polarity accessible. Surface defect chemistry seemed to play an important role in our synthesis strategy, therefore to gain a deeper understanding how these defect sites can alter the electronic structure of core/shell nanoparticles theoretical calculations based on density functional theory were performed, whilst structural, colloidal and optical properties were characterized experimentally (by dynamic light scattering, x-ray diffraction, infrared spectroscopy, zeta potential, absorption- and (time resolved) photoluminescence
measurements).
Effect of a 6-Month Controlled Lifestyle Intervention on Common Carotid Intima-Media Thickness
(2021)
Purpose:
Industrial revolutions have been induced by technological advances, but fundamentally changed business and society. To gain a comprehensive understanding of the fourth industrial revolution (I4.0) and derive guidelines for business strategy, it is, therefore, necessary to explore it as a multi-facet phenomenon. Most literature on I4.0, however, takes up a predominantly technical view. This paper aims to report on a project discussing a holistic view on I4.0 and its implications, covering technology, business, society and people.
Design/methodology/approach:
Two consecutive group discussions in form of academic world cafés have been conducted. The first workshop gathered multi-disciplinary experts from academia, whose results were further validated in a subsequent workshop including industry representatives. A voting procedure was used to capture participants perspectives.
Findings:
The paper develops a holistic I4.0 vision, focusing on five core technologies, their business potential, societal requests and people implications. Based on the model a checklist has been developed, which firms can use a tool to analyze their firm’s situation and draft their industry 4.0 business strategy.
Originality/value:
Rather than focusing on technology alone – which by itself is unlikely to make up for a revolution – this research integrates the entire system. In this way, a tool-set for strategy design results.