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Reasons and potential solution approaches for the shortage of nursing staff in German hospitals
(2021)
The aim of this scientific paper was to find out the reasons for the shortage of nursing staff in German hospitals and to provide potential solution approaches for this shortage. Over the last years, the shortage of nursing staff has become a more and more important topic in the news: Not only due to the increasing amount of missing nurses, but also due to the ageing population in Germany, which leads to an increasing amount of patients in German hospitals. To reach this aim two surveys were done, of which one was for nursing staff only and the other one was for people from all occupational groups with the intention of creating comparative values. The surveys were done from March to April 2019 and were analysed afterwards. After a detailed analysis of the survey results, it can be summarized that the reasons for the shortage of nursing staff in German hospitals are very diverse: Starting with a weak salary, improvable working conditions – for example the shift work and the high amount of physical and psychological stress -, a difficult compatibility of family and job as well as the unattractive image of the job as a nurse in the society. It can be concluded that the solution for the shortage of nursing staff is very difficult. The future will show whether the governmental support will help to make the job as a nurse more attractive – not only for the current nurses, but also for potential future nurses.
Aim: The aim of this scientific paper was to examine important trends and developments influencing the nursing care in order to forecast future opportunities and challenges and how to deal with them in the best possible way.
Background: The Corona-pandemic demonstrated the importance of nursing care in the entire world and had drawn attention to the issue of a well-educated and enough nursing staff. The nursing care will face opportunities and challenges due to current trends and developments, which are important to examine in order to provide the best possible nursing care.
Methods: To reach the above-mentioned aim, intensive research was done by using secondary sources and surveys.
Results/Findings: After a detailed analysis of the research it can be summarized that there are three important topics influencing the nursing care: The demographical development with an increasing life expectancy leading to an increasing amount of old people with a demand for care and decreasing birth rates leading to less working people. Cultural transformation and diversity imply many opportunities because the employment market can fill gaps with foreign workers and the immigrating people can compensate the decreasing birth rates. Nevertheless, it can imply many challenges and potential problems which need to be solved by the society and the immigrating people. Furthermore, the changing gender roles can lead to more men becoming a nurse, which might have a significant impact on the shortage of nursing staff. The third important topic influencing the nursing care is technological trends which can help to decrease physiological stress, by facilitating the nurses’ work and by taking over some work from them.
Conclusion: It can be concluded that the trends and developments influencing the nursing care are very diverse and imply many different opportunities as well as challenges.
Background: The extramuscular connective tissue (ECT) has been shown to play a significant role in mechanical force transmission between musculoskeletal structures. Due to this and owing to its tight connection with the underlying muscle, the ECT may be vulnerable to excessive loading. The present study aimed to investigate the effect of eccentric elbow flexor exercise on the morphology of the biceps brachii ECT. In view of the high nociceptive capacity of the ECT, an additional objective was to elucidate the potential relationship between ECT damage and the occurrence of delayed onset muscle soreness (DOMS).
Methods: Eleven healthy participants (♂ = 7; 24 ± 2 years) performed fatiguing dumbbell elbow flexor eccentric exercise (EE) for one arm and concentric exercise (CE) for the other arm in random order and with random arm allocation. Before, immediately after and 24–96 h post-exercise, maximal voluntary isometric contraction torque of the elbow flexors (dynamometer), pressure pain (algometer), palpation pain (100 mm visual analog scale), biceps brachii ECT thickness and ECT/muscle mobility during passive movement (both high-resolution ultrasound) were examined.
Results: Palpation pain, suggestive of DOMS, was greater after EE than CE, and maximal voluntary isometric contraction torque decreased greater after EE than CE (p < .05). Relative to CE, EE increased ECT thickness at 48 (+ 17%), 72 (+ 14%) and 96 (+ 15%) hours post-exercise (p < .05). At 96 h post-EE, the increase in ECT thickness correlated with palpation pain (r = .68; p < .05). ECT mobility was not different between conditions, but compared to CE, muscle displacement increased at 24 (+ 31%), 72 (+ 31%) and 96 (+ 41%) hours post-EE (p < .05).
Conclusion: Collectively, these results suggest an involvement of the ECT changes in delayed onset muscle soreness.
Vibroarthrography measures joint sounds caused by sliding of the joint surfaces over each other. and can be affected by joint health, load and type of movement. Since both warm-up and muscle fatigue lead to local changes in the knee joint (e.g., temperature increase, lubrication of the joint, muscle activation), these may impact knee joint sounds. Therefore, this study investigates the effects of warm-up and muscle fatiguing exercise on knee joint sounds during an activity of daily living. Seventeen healthy, physically active volunteers (25.7 ± 2 years, 7 males) performed a control and an intervention session with a wash-out phase of one week. The control session consisted of sitting on a chair, while the intervention session contained a warm-up (walking on a treadmill) followed by a fatiguing exercise (modified sit-to-stand) protocol. Knee sounds were recorded by vibroarthrography (at the medial tibia plateau and at the patella) at three time points in each session during a sit-to-stand movement. The primary outcome was the mean signal amplitude (MSA, dB). Differences between sessions were determined by repeated measures ANOVA with intra-individual pre-post differences for the warm-up and for the muscle fatigue effect. We found a significant difference for MSA at the medial tibia plateau (intervention: mean 1.51 dB, standard deviation 2.51 dB; control: mean -1.28 dB, SD 2.61 dB; F = 9.5; p = .007; η2 = .37) during extension (from sit to stand) after the warm-up. There was no significant difference for any parameter after the muscle fatiguing exercise (p > .05). The increase in MSA may mostly be explained by an increase in internal knee load and joint friction. However, neuromuscular changes may also have played a role. It appears that the muscle fatiguing exercise has no impact on knee joint sounds in young, active, symptom-free participants during sit to stand.
Organic semiconductor distributed feedback laser fabricated by direct laser interference ablation
(2007)
We use a pulsed, frequency tripled picosecond Nd:YAG laser for holographic ablation to pattern a surface relief grating into an organic semiconductor guest-host system. The resulting second order distributed feedback lasers exhibit laser action with laser thresholds being comparable to those obtained with resonators structured by standard lithographic techniques. The details of the interference ablation of tris-(8-hydroxyquinoline) aluminum (Alq(3)) doped with the laser dye 4- dicyanomethylene-2-methyl-6-(p-dimethylaminostyryl)-4H-pyran (DCM) are presented and discussed. Lasing action is demonstrated at a wavelength of 646.6 nm, exploiting second order Bragg reflection in a relief grating with a period of 399 nm.
The aim of the study is to find out how SMEs used Social Media during Corona and how customers received it, to determine what should be continued or avoided by SMEs in the future. In this study, an interpretivist approach was adopted through problem-centred interviews with three SMEs. The second part of the study used an objectivist approach, where an online-based survey with a purpose sampling was conducted. The results were evaluated by means of thematic analysis.The SMEs interviewed considered Social Media essential during Corona. This was due to limited resources and the feeling of being overwhelmed by the situation. For customers a Social Media presence is also considered indispensable, and that the followership is based on the desire for the latest information. However, it also became clear that the survey participants do not believe the information on Social Media and prefer information on the website or at the location itself. No answers could be found about how the experts would answer sans or post Corona. Furthermore, due to anonymisation efforts, it was not possible to clarify the attitude of the survey participants specifically to the individual SMEs.
The implementation of single-use technologies offers several major advantages, e.g. prevention of cross-contamination, especially when spore-forming microorganisms are present. This study investigated the application of a single-use bioreactor in batch fermentation of filamentous fungus Penicillium sp. (IBWF 040-09) from the Institute of Biotechnology and Drug Research (IBWF), which is capable of intracellular production of a protease inhibitor against parasitic proteases as a secondary metabolite. Several modifications to the SU bioreactor were suggested in this study to allow the fermentation in which the fungus forms pellets. Simultaneously, fermentations in conventional glass bioreactor were also conducted as reference. Although there are significant differences in the construction material and gassing system, the similarity of the two types of bioreactors in terms of fungal metabolic activity and the reproducibility of fermentations could be demonstrated using statistic methods. Under the selected cultivation conditions, growth rate, yield coefficient, substrate uptake rate, and formation of intracellular protease-inhibiting substance in the single-use bioreactor were similar to those in the glass bioreactor.
This study introduced an automated long-term fermentation process for fungals grown in pellet form. The goal was to reduce the overgrowth of bioreactor internals and sensors while better rheological properties in the fermentation broth, such as oxygen transfer and mixing time, can be achieved. Because this could not be accomplished with continuous culture and fed-batch fermentation, repeated-batch fermentation was implemented with the help of additional bioreactor internals (“sporulation supports”). This should capture some biomass during fermentation. After harvesting the suspended biomass, intermediate cleaning was performed using a cleaning device. The biomass retained on the sporulation support went through the sporulation phase. The spores were subsequently used as inocula for the next batch. The reason for this approach was that the retained pellets could otherwise cause problems (e.g., overgrowth on sensors) in subsequent batches because the fungus would then show undesirable hyphal growth. Various sporulation supports were tested for sufficient biomass fixation to start the next batch. A reproducible spore concentration within the range of the requirements could be achieved by adjusting the sporulation support (design and construction material), and an intermediate cleaning adapted to this.
Disconnection in a left-hemispheric temporo-parietal network impairs multiplication fact retrieval
(2023)
Arithmetic fact retrieval has been suggested to recruit a left-lateralized network comprising perisylvian language areas, parietal areas such as the angular gyrus (AG), and non-neocortical structures such as the hippocampus. However, the underlying white matter connectivity of these areas has not been evaluated systematically so far. Using simple multiplication problems, we evaluated how disconnections in parietal brain areas affected arithmetic fact retrieval following stroke. We derived disconnectivity measures by jointly considering data from n = 73 patients with acute unilateral lesions in either hemisphere and a white-matter tractography atlas (HCP-842) using the Lesion Quantification Toolbox (LQT). Whole-brain voxel-based analysis indicated a left-hemispheric cluster of white matter fibers connecting the AG and superior temporal areas to be associated with a fact retrieval deficit. Subsequent analyses of direct gray-to-gray matter disconnections revealed that disconnections of additional left-hemispheric areas (e.g., between the superior temporal gyrus and parietal areas) were significantly associated with the observed fact retrieval deficit. Results imply that disconnections of parietal areas (i.e., the AG) with language-related areas (i.e., superior and middle temporal gyri) seem specifically detrimental to arithmetic fact retrieval. This suggests that arithmetic fact retrieval recruits a widespread left-hemispheric network and emphasizes the relevance of white matter connectivity for number processing.
In relation to the fast development of e-commerce and rapid increasing of parcels, urban logistic sector is facing the challenge of sustainability. Especially, last-mile delivery as the last step of goods transport, it connects to customers’ satisfaction, cost efficiency of logistic companies, and more and more public expectations to sustainability of urban logistics. To handle with the complexity of urban logistics conditions, governments and logistics companies should develop a co-operating strategy for sustainability of urban last-mile delivery. This paper is based on data collection from the long-term empirical research and a survey to the e-commerce users in Germany and China to develop a sustainable concept for the urban last-mile delivery. The key to the development of concept is to create a balance among the requirements of customers, the competition abilities of logistics companies and the public interest.
In recent years, the retail virtual store has become the main trend in social services. More and more people tend to shop in retail virtual stores. With the development of 3D virtual reality, this trend is getting stronger and stronger. Therefore, the development prospect of virtual retail stores has attracted much attention. This paper examines the impact of companies' and users' popularization of helmet gadgets on in-store traffic and analyzes how virtual reality (VR) could enhance the customer experience throughout the shopping trip. A qualitative research design has been used, which also included conversations with both professionals and consumers. Moreover, this paper seeks to break new ground by attempting to use the current literature to help predict future directions and trends for online shopping.
E-commerce has been keeping fast increasing worldwide since beginning of the 21st century. Rapid growth of e-commerce & parcel shipping is a booming business. However, how to handle with many hard-to-solve sustainability issues of transport in urban areas, is becoming a serious challenge for urban logistic sector and numerous stakeholders. The sustainability issues contain the problems of air pollution, congestion, and sub-contractors. This paper reported those issues in the context of growth of e-commerce and analyzed their efforts on the sustainable urban logistics development.
Many SMEs still face a problematic fact that their corporate structures and processes are not designed for efficient development and market positioning and there is a lack of appropriate methods and tools. SMEs are often inefficiently targeted to the internal or external demands for services. The goal of the research regarding contents and methodology was to investigate the practice of strategic planning and the implementation and application of service engineering in young SMEs on the one hand, and on the other hand specifically for young SMEs, whose performance and the probability of success can be increased by its application. These two goals have been achieved.
Many SMEs are still faced with the problematic fact that their corporate structures and processes are not designed for efficient development and market positioning and there is a lack of appropriate methods and tools. SMEs are often inefficiently targeted to the internal or external demands for services. The following key questions are answered in this article: 1) Which studies are available in terms of strategic planning in young SMEs? 2) Which aspects should be considered in the implementation and control of these instruments?
The services sector is also called “tertiary sector” and has become increasingly important in the last few decades. The process of this structural change occurrence is characterized by a significant increase in employment in the services sector. On the other hand, the former economic importance in traditional areas, such as agriculture and forestry, as well as manufacturing, is declining. In this article the research field of the service sector is shown beginning from the 70s up to the present. The goal of the article is to demonstrate the necessity of service engineering research.
The introduction of functionalized magnetizable particles for the purification of enzymes or for the multi-use of pre-immobilized biocatalysts offers a great potential for time and cost savings in biotechnological process design. The selective separation of the magnetizable particles is performed for example by a high-gradient magnetic separator. In this study FEM and CFD simulations of the magnetic field and the fluid flow field within a filter chamber of a magnetic separator were carried out, to find an optimal separator design. The motion of virtual magnetizable particles was calculated with a one-way coupled Lagrangian approach in order to test many geometric and parametric variations in reduced time. It was found that a flow homogenisator smoothed the fluid flow, so that the linear velocity became nearly equal over the cross section in the direction of flow. Furthermore the retention of magnetizable particles increases with a high total edge length within the filter matrix.
The introduction of functionalized magnetizable particles and high-gradient magnetic separation represents a time and money saving alternative to conventional purification and separation unit operations in the biotechnical sector. This technique has some advantages especially for the recycling of immobilized enzymes. A new magnetic filter with sight glasses was constructed and produced to study the performance of high-gradient magnetic separation at varied parameters. By optical analysis the buildup of a clogging was identified as the major parameter which affected the separation performance. For the cleaning procedure, a two-phase flow of water with highly dispersed air bubbles was tested which led to a nearly complete cleaning of the filter chamber.
Major financial institutions operate in different regions of the world facing different regulatory landscapes for Supply Chain risks. In this environment, the optimization issue arises how to best comply with the different regulations and reaching cost efficiency at the same time. In this research, the international regulatory landscape for Supply Chain risks of Financial Institutions is introduced and compared internationally. It is understood as an integral part of Supply Chain Risk Management of Financial Institutions, yet the latter is analysed as the research background. Additionally, expert interviews are conducted in order to link the regulation analysis to the current challenges that Financial Institutions face. Finally, recommendations are developed on how banks can be cost efficient, while remaining regulatory compliant, facing increased international regulation in the area of Supply Chain Risk Management. The outcome of the underlying research shows that banking regulation in the area of Supply Chain risks is an important lever in the banking sector to secure customers and financial markets. However, the regulatory landscape is heterogeneous and not consistent on an international scale. Regulation in Asia is highly diverse across different countries due to different states of economic development. The US applies a rather pragmatical approach towards supply chain risk regulation applying different standards of standard setting institutions. Lastly, the EU is very restrictive and strives to unify regulation across member states. Banks should follow a consistent management approach keeping in mind international locations and the strictest regulatory environment they are operating in, to improve cost efficiency yet being regulatory compliant. Also, collaboration with and amongst regulators and other banks internationally is recommended for improved cost efficiency.
Radar systems for contactless vital sign monitoring are well known and an actual object of research. These radar-based sensors could be used for monitoring of elderly people in their homes but also for detecting the activity of prisoners and to control electrical devices (light, audio, etc.) in smart living environments. Mostly these sensors are foreseen to be mounted on the ceiling in the middle of a room. In retirement homes the rooms are mostly rectangular and of standardized size. Furniture like beds and seating are found at the borders or the corners of the room. As the propagation path from the center of the room ceiling to the borders and corners of a room is 1.4 and 1.7 time longer the power reflected by people located there is 6 or even 10 dB lower than if located in the center of the room. Furthermore classical antennas in microstrip technology are strengthening radiation in broadside direction. Radar systems with only one single planar antenna must be mounted horizontally aligned when measuring in all directions. Thus an antenna pattern which is increasing radiation in the room corners and borders for compensation of free space loss is needed. In this contribution a specification of classical room sizes in retirement homes are given. A method for shaping the antenna gain in the E-plane by an one-dimensional series-fed traveling wave patch array and in the H-plane by an antenna feeding network for improvement of people detection in the room borders and corners is presented for a 24 GHz digital beamforming (DBF) radar system. The feeding network is a parallel-fed power divider for microstrip patch antennas at 24 GHz. Both approaches are explained in theory. The design parameters and the layout of the antennas are given. The simulation of the antenna arrays are executed with CST MWS. Simulations and measurements of the proposed antennas are compared to each other. Both antennas are used for the transmit and the receive channel either. The sensor topology of the radar system is explained. Furthermore the measurement results of the protoype are presented and discussed.
Der Automobilhandel befindet sich in einer momentanen Phase des Umbruchs. Der Trend zum Kauferlebnis online, verstärkt durch die Pandemie, und die durch die Dieselproblematik entfachte Diskussion zum Emissionsausstoß und Fahrverboten für Verbrennungsmotoren im Fahrzeugbereich, treibt den Wandel zu elektrischen Antriebstechnologien an. Durch diese Umstellung ergeben sich neue Möglichkeiten für das Fahrzeug im Bereich der Digitalisierung. Die branchenübergreifende Digitalisierung findet sich auch in den neuen Vertriebssystemen der Automobilhersteller wieder. Hierbei ist zudem eine Veränderung der Absatzkanäle zu beobachten. Der Kunde weicht beim Autokauf davon ab, exklusiv zu dem Händler seines Vertrauens zu gehen und sich hier durch den gesamten Verkaufsprozess hinweg betreuen zu lassen. Vielmehr verschieben sich einzelne Teilbereiche in das Internet. So müssen etablierte Prozesse neugestaltet werden, um weiterhin im Markt und im Wettbewerb bestehen zu können.
Das Ziel dieser Arbeit ist die Beantwortung zweier Forschungsfragen. Zum einen soll der Status-Quo der Digitalisierung von Vertriebsinstrumenten im Autohaus untersucht werden. Konkret geht es dabei um die Frage, in welcher Art und Weise die Digitalisierung den Vertrieb beeinflusst und welche Effekte sich daraus ergeben. Zum anderen stellt sich die Frage wie die Digitalisierung in Form des Internets, als Absatzkanal für die Automobilindustrie geeignet ist, und ob derart komplexe Produkte wie ein Neufahrzeug über diesen Kanal abgesetzt werden können. Weiterhin soll betrachtet werden, welche Veränderungen in den Vertriebsstrukturen das beim stationären Autohändler verursacht.
Die Arbeit befasst sich ausschließlich mit der Digitalisierung bei Vertragshändlern mit Volumenzielen im Neuwagen-Bereich. Damit sind die Luxus- oder Premiummarken ausgeschlossen. Außerdem wird im Autohaus in zwei Kundenkategorien unterschieden. Es gibt die Großabnehmer und die Einzelkunden. Die Großabnehmer sind Unternehmen, die durch eine vordefinierte Anzahl an Mindestabnahmen einen besonderen Status und Konditionen genießen. Die Einzelkunden sind private Abnehmer oder gewerbliche Kunden, die die Mindestabnahme nicht erreichen. Die Arbeit beschränkt sich ausschließlich auf die Analyse und Auswirkungen der Veränderungen im Segment der Einzelkunden.