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Sex differences in pediatric sepsis mortality : a systematic review and meta-analysis
No full textObjectives: Pediatric sepsis remains a leading cause of childhood mortality worldwide. Sex differences have been shown to modify risk factors, treatment, and outcome of various diseases, and adult studies revealed sex differences in pathophysiological responses to septic shock. We aimed to perform a systematic review and meta-analysis on the association of sex with outcomes in hospitalized children with sepsis.
Data sources: Medline and Embase databases were searched for studies of children < 18 years with sepsis published between January 01, 2005, and March 31, 2022.
Study selection: We included cohort studies, and randomized controlled trials in children greater than or equal to 37-week-old postconception to 18 years which included sepsis, severe sepsis or septic shock, and mortality as an outcome.
Data extraction: Study characteristics, patient demographics, and illness severity scores were extracted from eligible articles. Random-effects meta-analysis was performed.
Data synthesis: We screened 14,791 studies, with 912 full-text reviews and inclusion of 124 studies. The total population involved 426,163 patients, of which 47% (201,438) were girls. Meta-regression showed moderate evidence for a higher mortality in boys compared with girls. The estimated risk difference of mortality between boys and girls with all types of sepsis was −0.005 (95% CI, −0.0099 to −0.00001; p = 0.049), indicating slightly higher mortality for boys. When including the World Bank income level as a moderator, the effect was −0.008 (95% CI, −0.013 to −0.002; p = 0.005).
Conclusions: This large systematic review and meta-analysis on sex differences in pediatric sepsis mortality showed moderate evidence for a higher sepsis mortality in boys compared with girls. The effect persisted when adjusting for country’s income level
The NERVE-ML (neural engineering reproducibility and validity essentials for machine learning) checklist : ensuring machine learning advances neural engineering
No full textObjective: Machine learning’s ability to capture intricate patterns makes it vital in neural engineering research. With its increasing use, ensuring the validity and reproducibility of machine learning methods is critical. Unfortunately, this has not always been the case in practice, as there have been recent retractions across various scientific fields due to the misuse of machine learning methods and validation procedures. To address these concerns, we propose the first version of the Neural Engineering Reproducibility and Validity Essentials for Machine Learning (NERVE-ML) checklist, a framework designed to promote the transparent, reproducible, and valid application of machine learning in neural engineering. Approach: We highlight some of the unique challenges of model validation in neural engineering, including the difficulties from limited subject numbers, repeated or non-independent samples, and high subject heterogeneity. Through detailed case studies, we demonstrate how different validation approaches can lead to divergent scientific conclusions, highlighting the importance of selecting appropriate procedures guided by the NERVE-ML checklist. Effectively addressing these challenges and properly scoping scientific conclusions will ensure that machine learning contributes to, rather than hinders, progress in neural engineering. Main Results: Our case studies demonstrate that improper validation approaches can result in flawed studies or overclaimed scientific conclusions, complicating the scientific discourse. The (NERVE-ML) checklist effectively addresses these concerns by providing guidelines to ensure that machine learning approaches in neural engineering are reproducible and lead to valid scientific conclusions. Significance: By effectively addressing these challenges and properly scoping scientific conclusions guided by the NERVE-ML checklist, we aim to help pave the way for a future where machine learning reliably enhances the quality and impact of neural engineering research
Designing community governance : learnings from DAOs
No full textThis work examines how decentralised autonomous organisations (DAOs) can improve transparency, fairness, and inclusivity in community-based decision-making, using the case of research grant allocation within a university community in Switzerland. The current voting mechanism has been criticised for fostering partiality and favouring personal networks over merit, highlighting the need to improve fairness and objectivity without increasing administrative effort. Drawing on insights from DAO governance, this study aims to propose methods for improving decision-making processes through innovative mechanisms. Adopting an action design research(ADR) methodology, the study integrates theoretical and practical perspectives to design and evaluate innovative methods that address real-world challenges. Schematic analysis of decision-making processes in DAOs provides the foundation for the development of methods applicable to the university’s community context. Proposed solutions are iteratively refined through workshops with community stakeholders to ensure relevance and feasibility. The results present a generalisable model for community-based decision-making processes inspired by DAOs, alongside tailored recommendations for the university’s community-based voting and decision-making process. The findings demonstrate that innovative mechanisms built for large online communities to reach consensus, such as DAO voting systems, can promote impartiality and increase inclusivity, ultimately fostering trust and encouraging broader participation in community governance. This study contributes to the discourse on community governance by bridging theoretical DAO insights with practical applications in a university community setting. Limitations and directions for future research, including implementation and evaluation of the proposed methods in practice, are discussed to pave the way for further exploration of DAO-informed community-based governance models
Holistic framework for LPWAN protocol development
Get PDFA critical problem for field installations of IoT devices is the connectivity of the individual nodes to the Internet. Specifically, with established LPWAN systems like LoRaWAN, accessing yet uncovered areas is only possible by setting up new gateways. Due to this, reaching nodes that are in an environment where no gateways can be set up is an open research problem. A promising idea to solve the proposed problem is to use a node within the range of a gateway for forwarding messages to nodes outside of its range. Such approaches have seen extensive discussion in literature. However, solutions for low-power embedded systems with limited resources heavily depend on the application and usually lead to creating a new protocol or protocol variant.
In this paper we present a framework to simplify this protocol development and efficiently develop new protocols to extend established LPWAN systems' reach. The framework consists of a simulator that allows testing the protocol's behaviour in various scenarios in software. The simulator is accompanied by a system for deploying the protocol onto multiple hardware nodes in a test installation. This test installation setup also allows the collection of log messages from each node in real time. In this holistic approach, both, the simulation and the field test installation run the same protocol implementation
Relatives Blasenrisiko bei Immobilien : eine erweiterte Analyse auf Basis verschiedener Assetklassen
No full textTraditionelle Indikatoren zur Messung von Immobilienblasen berücksichtigen die Preisentwicklungen anderer Assetklassen nicht. Um aus Investorensicht eine Einschätzung zu einer Blasenentwicklung relativ zu anderen Assetklassen zu erhalten, wird eine Analyse durchgeführt, die die Immobilienpreisentwicklung relativ zur Entwicklung anderer Assetklassen untersucht
Enhancing nursing team resilience to manage continuous change in practice : a qualitative descriptive study
No full textAim: The study explored nurses' perceptions of team resilience in coping with continuous changes and in developing nursing practices. Additionally, it sought to identify what nurses need to strengthen their team's resilience in adapting to change and how clinical nurse specialists can support these efforts.
Background: Persistent changes in healthcare require nursing teams to continuously adapt and develop their practices. However, development and implementation processes are often challenging, stressful, or unsuccessful. This can lead to change fatigue and, when combined with daily workload pressures, high job turnover. Currently, individual resilience is regarded as a key factor in coping with workplace stressors and burdens. Yet, growing critical perspectives emphasise the importance of team resilience, which differs from individual resilience. Despite practice development being mainly a team effort, nursing team resilience remains underexplored in the literature.
Study design and methods: This qualitative descriptive study involved 29 registered nurses from two nursing teams at a Swiss paraplegic rehabilitation clinic. Data were collected through eight semi-structured group discussions, and the analysis was conducted using structured qualitative content analysis.
Results: The nurses identified four key areas as crucial factors for team resilience in managing change: 1. A lack of knowledge about team resilience and interest in integrating the concept as fundamental resource. 2. Psychological safety within the nurse team and the desire to enhance interprofessional psychological safety, recognised as key factor in team resilience. 3. Readiness to learn. 4. Anticipated burdens. Furthermore, they expressed a need for support from clinical nurse specialists to strengthen team resilience.
Conclusion: Team resilience was identified as an unrecognised and neglected concept, yet it was acknowledged as being significant both intra- and interprofessionally for coping with challenges; weak team resilience was considered disadvantageous. Clinical nurse specialists should play a key role in supporting team resilience.
Recommendations for research and practice: Team resilience should be promoted among nurses across all education levels and fostered within nursing teams. Models for interprofessional collaboration and implementation could enhance team resilience factors that are essential for managing change. Additionally, the perspectives of other professionals on collaboration with nursing teams should be explored further.
What is already known?
Nursing teams must continuously adapt their practices due to persistent changes in healthcare. This process is often challenging and stressful, increasing daily workloads and potentially leading to change fatigue and job turnover.
The level of resilience in individuals, teams and organisations becomes evident when challenges and stresses arise. Currently, individual resilience is regarded as a key factor in coping with workplace challenges and burdens.
Hospital nursing relies on a strong team-based approach, and nurses face numerous challenges, including those arising from ongoing change.
What this study contributes:
This study highlights the importance of team resilience. A knowledge gap regarding this concept was identified and addressing it could enhance teams’ ability to cope with change.
Nurses recognised team resilience as an essential resource for managing persistent change and fostering future development. Consequently, they expressed a desire to gain knowledge about team resilience and to strengthen key factors such as psychological safety in interprofessional collaboration, readiness to learn, and the anticipation of burdens associated with change.
Integrating and strengthening team resilience in change implementation may facilitate more successful and sustainable development.
Clinical nurse specialists should play a key role in enhancing team resilience
Der Berufswahlparcours und seine Wirkungen auf die Jugendlichen im Berufswahlprozess
Get PDFViele Jugendliche beenden bereits im Alter von 15 Jahren die obligatorische Schulzeit und beginnen eine Berufsausbildung. Die dadurch bedingte frühe Berufswahl stellt für sie eine bedeutende Herausforderung dar. Damit die Jugendlichen diese Herausforderung besser bewältigen können, hat der Kanton Luzern verschiedene Unterstützungsmassnahmen in Form eines Berufswahlfahrplans implementiert. Darin werden verschiedene Aktionen wie beispielsweise Berufserkundungen oder der Besuch eines Berufswahlparcours aufgeführt. Um die Jugendlichen im Berufswahlprozess optimal unterstützen zu können, ist es notwendig, die Wirkungen der einzelnen Unterstützungsmassnahmen zu verstehen. Das Ziel dieser Arbeit ist es, die Wirkungen des Schweizer Berufswahlparcours auf Jugendliche im Berufswahlprozess zu klären. Dabei wird der Fokus auf den Sekundarschulunterricht und die Berufsberatung erweitert. Für die Klärung werden folgende Forschungsfragen gestellt: Wie wird der Berufswahlparcours im Unterricht integriert? Welchen Nutzen sehen Lehrpersonen in der Vorbereitung, Durchführung und Nachbereitung des Berufswahlparcours für die Förderung der Berufswahlbereitschaft der Jugendlichen und deren weiteren Berufswahlprozess? Wie kann die Kooperation zwischen Schule und Berufsberatung im Rahmen des Berufswahlparcours aus Sicht der Lehrpersonen optimiert werden, um die Berufswahlbereitschaft der Jugendlichen weiter zu steigern? Um die Forschungsfragen zu beantworten, wurde eine qualitative Studie im Kanton Luzern durchgeführt. Dazu wurden fünf Sekundarlehrpersonen befragt, die Jugendliche im Berufswahlprozess begleiten und mit dem Schweizer Berufswahlparcours vertraut sind. Die Datengewinnung erfolgte durch halbstrukturierte Leitfadeninterviews. Für die Datenauswertung wurde eine qualitative Inhaltsanalyse nach Mayring durchgeführt. Die Ergebnisse der Untersuchung zeigen, dass der Schweizer Berufswahlparcours, durchgeführt zu Beginn der zweiten Sek, von den Schulen primär zur Berufserkundung und als Übung für die bevorstehenden individuellen Schnupperlehren genutzt wird. Dabei wurden nicht nur positive Wirkungen auf den Erwerb von Berufswahlkompetenzen bei den Jugendlichen festgestellt, sondern auch auf deren Einstellungen und Persönlichkeitseigenschaften im Kontext des Berufswahlprozesses. Weiterhin zeigen die Ergebnisse, dass die Berufsberatung zurzeit nicht in den Berufswahlparcours involviert ist. Es konnten jedoch Ideen für eine effektive und nachhaltige Integration der Berufsberatung aufgezeigt werden, wie beispielsweise die Bereitstellung oder Durchführung geeigneter Berufsinteressenverfahren im Vorfeld des Berufswahlparcours. Darüber hinaus wurden weitere Forschungsideen zur Kooperation zwischen Schule und Berufsberatung identifiziert
How do nurses belonging to the LGBTIQ + community relate to patients? : a qualitative study from Switzerland
Get PDFBackground: The relationship between nurses and patients is particularly important, as nursing activities often require a high degree of intimacy. To promote an open, honest, reciprocal and equal relationship, nurses disclose personal information and experiences about themselves. Nurses belonging to the LGBTIQ + community, however, may fear stigmatisation or rejection from their patients if they disclose their sexual orientation or gender identity. This study aims to explore how nurses belonging to the LGBTIQ + community navigate their relationship with patients under these circumstances.
Methods: A qualitative descriptive approach with semi-structured interviews was applied.
Results: Interviews with eight nurses who identified themselves as members of the LGBTIQ + community, were conducted. When building relationships, nurses belonging to the LGBTIQ + community often experience a dilemma as to whether they want to come out to a patient in a care situation/encounter. When patient-carer relationships are being built, there is often a heightened focus on striking a balance between not revealing too much or too little information about themselves.
Conclusions: In everyday life, nurses belonging to the LGBTIQ + community often face the dilemma of a desire for authenticity and the fear of rejection. Disclosing personal information and experiences, (to the right degree), can help build relationships
Akteursorientierte Analyse des Vorprojets Burre für Biendli 2023-2025 : Schlussbericht
Get PDFDas Projekt „Buure für Biendli“ wurde von 2023 bis 2025 auf zwölf Landwirtschaftsbetrieben im Kanton Zürich durchgeführt. Ziel war es, praxisnahe und betrieblich integrierbare Massnahmen zur Förderung von Wildbienen zu erproben. Die teilnehmenden Betriebe wurden individuell beraten, begleitet und unterstützt. Die Zürcher Hochschule für Angewandte Wissenschaften (ZHAW) führte eine akteursorientierte Analyse durch, um hemmende und fördernde Faktoren für die Umsetzung der Massnahmen zu identifizieren und konkrete Empfehlungen für ein mögliches Folgeprojekt mit breiterer Wirkung abzuleiten. Die Ergebnisse, dass die teilnehmenden Landwirt:innen grundsätzlich motiviert waren, sich für die Förderung von Wildbienen zu engagieren. Besonders geschätzt wurden die persönliche, praxisnahe Beratung sowie die einfache Umsetzbarkeit der Massnahmen. Für eine erfolgreiche Weiterführung braucht es neben individuellen Unterstützungsangeboten auch finanzielle Anreize, Hilfestellungen beim Monitoring sowie Möglichkeiten zum Austausch und zur Öffentlichkeitsarbeit. Sichtbarkeit und Anerkennung des Engagements sind zentrale Faktoren für eine nachhaltige Wirkung