OPUS THD (Technischen Hochschule Deggendorf)
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Towards Sustainable Education by Design: Evaluating Pro-Ecological Architectural Solutions in Centers for Environmental Education
No full textThe imperative shift towards ecological consciousness in architectural design, driven by the pressing need to mitigate energy consumption and carbon emissions while fostering user well-being, has propelled the discourse on sustainable architecture to the forefront of contemporary dialogue. Concepts such as ecological architecture, sustainable, green, and regenerative design have emerged as pivotal frameworks aimed at aligning architectural practices with environmental imperatives. In this evolving architectural landscape, the centers for ecological education (CEEs) play an important role, embodying the intersection of architecture and ecological education. These centers, with their diverse educational initiatives, provide dedicated spaces for comprehensive ecological education. However, a gap exists in the literature regarding studies focusing on CEEs and the evaluation criteria for such facilities. This article seeks to bridge this gap by evaluating buildings designated for ecological education, aiming to present ecological content while exemplifying sustainable architectural principles. The study employs a research by design approach, combining a literature review with site investigations and qualitative assessments to elucidate the unique challenges and opportunities inherent in designing CEEs. Criteria for assessing the ecological quality of buildings are formulated. Through a comparative analysis, the article identifies key parameters for evaluating CEEs, considering their dual function as educational spaces and architectural exemplars. The evaluation framework developed in this study provides a valuable tool for architects, designers, and policymakers seeking to promote ecological education and sustainable architectural practices
Button shear testing for adhesion measurements of 2D materials
No full textTwo-dimensional (2D) materials are considered for numerous applications in microelectronics, although several challenges remain when integrating them into functional devices. Weak adhesion is one of them, caused by their chemical inertness. Quantifying the adhesion of 2D materials on three-dimensional surfaces is, therefore, an essential step toward reliable 2D device integration. To this end, button shear testing is proposed and demonstrated as a method for evaluating the adhesion of 2D materials with the examples of graphene, hexagonal boron nitride (hBN), molybdenum disulfide, and tungsten diselenide on silicon dioxide and silicon nitride substrates. We propose a fabrication process flow for polymer buttons on the 2D materials and establish suitable button dimensions and testing shear speeds. We show with our quantitative data that low substrate roughness and oxygen plasma treatments on the substrates before 2D material transfer result in higher shear strengths. Thermal annealing increases the adhesion of hBN on silicon dioxide and correlates with the thermal interface resistance between these materials. This establishes button shear testing as a reliable and repeatable method for quantifying the adhesion of 2D materials
Cost-Effectiveness of Test-and-Treat Strategies to Reduce the Antibiotic Prescription Rate for Acute Febrile Illness in Primary Healthcare Clinics in Africa
No full textBackground
Inappropriate antibiotic use increases selective pressure, contributing to antimicrobial resistance. Point-of-care rapid diagnostic tests (RDTs) would be instrumental to better target antibiotic prescriptions, but widespread implementation of diagnostics for improved management of febrile illnesses is limited.
Objective
Our study aims to contribute to evidence-based guidance to inform policymakers on investment decisions regarding interventions that foster more appropriate antibiotic prescriptions, as well as to address the evidence gap on the potential clinical and economic impact of RDTs on antibiotic prescription.
Methods
A country-based cost-effectiveness model was developed for Burkina Faso, Ghana and Uganda. The decision tree model simulated seven test strategies for patients with febrile illness to assess the effect of different RDT combinations on antibiotic prescription rate (APR), costs and clinical outcomes. The incremental cost-effectiveness ratio (ICER) was expressed as the incremental cost per percentage point (ppt) reduction in APR.
Results
For Burkina Faso and Uganda, testing all patients with a malaria RDT was dominant compared to standard-of-care (SoC) (which included malaria testing). Expanding the test panel with a C-reactive protein (CRP) test resulted in an ICER of 0.08 per ppt reduction in APR for Burkina Faso and Uganda, respectively. For Ghana, the pairwise comparison with SoC—including malaria and complete blood count testing—indicates that both testing with malaria RDT only and malaria RDT + CRP are dominant.
Conclusion
The use of RDTs for patients with febrile illness could effectively reduce APR at minimal additional costs, provided diagnostic algorithms are adhered to. Complementing SoC with CRP testing may increase clinicians’ confidence in prescribing decisions and is a favourable strategy
Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis
No full textBackground
It remains unclear whether the use of an orthopaedic traction table (TT) in direct anterior approach (DAA) total hip arthroplasty (THA) results in better outcomes. The aim of this systematic review and network meta-analysis was to compare the THA outcomes through DAA on a standard operating table and the THA outcomes through DAA on a TT.
Methods
PubMed, Epistemonikos, and Google Scholar were searched for relevant randomized controlled trials (RCTs) up to 01 January 2024. An indirect comparison in network meta-analysis was performed to assess treatment effects between DAA on a TT and DAA on a standard table, using fixed-effects and random-effects models estimated with frequentist approach and consistency assumption. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables.
Results
The systematic review of the literature identified 43 RCTs with a total of 2,258 patients. DAA with TT had a 102.3 mL higher intraoperative blood loss and a 0.6 mmol/L lower Hb 3 days postoperatively compared with DAA without TT (SMD = 102.33, 95% CI 47.62 to 157.04; SMD = − 0.60, 95% CI − 1.19 to − 0.00). DAA with TT had a 0.15 lower periprosthetic fracture OR compared with DAA without TT (OR 0.15, 95% CI 0.03 to 0.86). There were no further significant differences in surgical, radiological, functional outcomes and in complication rates.
Conclusion
Based on our findings and taking into account the limitations, we recommend that particular attention be paid to the risk of periprosthetic fracture in DAA on a standard operating table and blood loss in DAA with TT. Since numerous other surgical, radiological, functional outcome parameters and other complication rates studied showed no significant difference between DAA on a standard operating table and DAA with TT, no recommendation for a change in surgical technique seems justified.
Level of evidence
Level I evidence, because this is a systematic review and meta-analysis of randomized controlled trials
Spa Therapy Efficacy in Mental Health and Sleep Quality Disorders in Patients with a History of COVID-19: A Comparative Study
No full textThe COVID-19 pandemic has left behind mental health issues like anxiety, depression, and sleep disorders among survivors. This study assessed the efficacy of spa therapy in enhancing psychological well-being and sleep quality in individuals with chronic arthro-rheumatic, respiratory, and otorhinolaryngological diseases, including COVID-19 recoverees. Our prospective observational study included 144 Caucasian subjects from three Italian spas who underwent a 2-week spa therapy cycle, involving balneotherapy and/or inhalation treatments. Symptoms were assessed with the Visual Analogue Scale (VAS), psychological well-being with Depression Anxiety Stress Scales-21 items (DASS-21), and sleep quality with the Insomnia Severity Index (ISI). Significant reductions in VAS scores for arthro-rheumatic, respiratory, and otorhinolaryngological symptoms were observed after spa therapy, as well as for DASS-21 and ISI scores for sleep quality, transitioning to less severe insomnia categories. Females had more pronounced improvements in DASS-21 scores and sleep quality. Subjects with and without prior SARS-CoV-2 infection experienced significant reductions in anxiety, depression, and stress, with more pronounced improvements in those without prior infection. COVID-19 survivors also showed significant ISI score improvements. Spa therapy is a promising complementary treatment for improving mental health and sleep quality in chronic disease patients, including COVID-19 survivors
Repeat adolescent pregnancies in Southwestern Uganda: A cross-sectional study
No full textBackground:
Pregnancy in adolescents continues to remain a significant public health challenge, with repeat pregnancies in this age group often receiving insufficient attention. In Uganda, repeat adolescent pregnancy varies between 26.1% and 55.6%. Evidence shows that repeat pregnancy in adolescence is more common in settings of high poverty, low educational attainment and low use of long-acting reversible contraceptives among others.
Objectives:
The main aim of this study is to determine the underlying risk and protective factors of repeat adolescent pregnancy in Uganda.
Design:
This was a cross-sectional study among adolescent girls and young women aged between 13 and 22 years with single and repeat pregnancies in four districts in Southwestern Uganda.
Methods:
The questionnaire was administered on a portable PC to collect information on socio-demographic characteristics, sexual behaviours, sexual and reproductive health (SRH) knowledge, pregnancy outcome, experience of violence and mental health. Descriptive statistics and logistic regression were performed.
Results:
A total of 115 girls with single and 93 with repeat pregnancies participated in the survey. Of these, 42 (20.2%) were 18 years and younger. The majority (92%) had dropped out of school, having achieved primary-level education (67%). The mean age of sexual debut (15.6 versus 16.4 years) and the mean age at first pregnancy (16.4 versus 17.3 years) were lower among those in repeat-pregnancy group compared to those in single-pregnancy group. The odds of having repeat pregnancy were higher among participants who engaged in risky behaviour (AOR 3; 95% CI (1.28–7.37)) and experienced any form of violence (AOR 4.67; 95% CI (1.5–16.56)). Being single, having the first pregnancy in older age (16 and above) and having a positive first pregnancy outcome (live birth) served as protective factors for repeat pregnancy.
Conclusions:
Adolescents with repeat pregnancies have significantly more SRH risks compared to those with single pregnancies. These findings underscore the importance of multi-faceted and timely interventions for adolescent girls in this setting, with an emphasis on the mitigation of violence, and enhancing access to comprehensive sexuality education, and SRH services
The influence of operation time for hip hemiarthroplasty on complication rates and mortality in patients with femoral neck fracture: a retrospective data analysis
No full textBackground
The aim of the present study was to investigate the influence of various factors, in particular operation time, on mortality and complication rates in patients with femoral neck fractures who have undergone hip hemiarthroplasty (HHA) and to determine a cut-off value above which mortality and complication rates increase significantly.
Methods
Cases of patients with femoral neck fracture treated with HHA between 1 January 2017 and 31 December 2023 were screened for eligibility. Multiple logistic regressions were calculated to determine which factors (patient age, experience of surgeon, patient sex, ASA score, time to surgery, operation time) influenced the incidence of complications and mortality. The exact cut-off value for complications and mortality was determined using the Youden index of the ROC curve (sensitivity vs. specificity) of logistic regression.
Results
A total of 552 patients were considered eligible for this study. During the 90-day follow-up period after HHA, 50 deaths and 34 complications were recorded, giving a mortality rate of 9.1%, and a complication rate of 6.2%. Of the 34 complications recorded, 32.3% were infections, 14.7% dislocations, 20.7% trochanteric avulsions, 11.8% periprosthetic fractures, 11.8% nerve injuries, and 8.8% deep vein thrombosis. The odds ratio (OR) of a patient experiencing a complication is 2.2% higher for every minute increase in operation time (Exponential Beta − 1 = 0.022; p = 0.0363). The OR of a patient dying is 8.8% higher for each year increase in age (Exponential Beta − 1 = 0.088; p = 0.0007). When surgery was performed by a certified orthopaedic surgeon the mortality rate lowered by 61.5% in comparison to the surgery performed by a trainee (1 – Exponential Beta = 0.594; p = 0.0120). Male patients have a 168.7% higher OR for mortality than female patients (Exponential Beta − 1 = 1.687; p = 0.0017). Patients with an operation time of ≥ 86 min. have a 111.8% higher OR for mortality than patients with an operation time of < 86 min. (Exponential Beta – 1 = 1.118).
Conclusion
This retrospective data analysis found that the risk of a patient experiencing a complication was 2.2% higher for every minute increase in operation time. Patients with an operation time above the cut-off of 86 min had a 111.8% higher risk of mortality than those with an operation time below the cut-off. Other influencing factors that operators should be aware of include patient age, male sex, and operator experience
Offers to prevent social isolation and loneliness in older people living in rural areas
No full textZusammenfassung
Hintergrund
In ländlichen Regionen sind ältere Menschen besonders mit sozialer Isolation und Einsamkeit sowie deren gesundheitlichen Auswirkungen (z. B. erhöhte Gesamtmortalität, kardiovaskuläre Erkrankungen) konfrontiert. Um diesem zunehmenden Public-Health-Problem entgegenzuwirken, bedarf es Angebote zur Förderung von Sozialkontakten und gesellschaftlicher Teilhabe.
Fragestellung
Liegt ein Bedarf an Präventionsangeboten in Bezug auf soziale Isolation bzw. Einsamkeit vor und wie kann diesem begegnet werden?
Methoden
Eine quantitative, deskriptive Analyse mittels Paper-pencil-Fragebogen wurde von Dezember 2019 bis Januar 2020 durchgeführt, um das (1) Vorliegen von sozialer Isolation und Einsamkeit sowie deren Risikofaktoren, (2) Bedürfnisse und Bedarfe sowie (3) die Eignungsbewertung von und das Interesse an Angeboten zur Prävention von sozialer Isolation und Einsamkeit bei Einwohner/-innen ≥ 65 Jahre einer ländlichen Kommune zu erfassen.
Ergebnisse
Die Rücklaufquote betrug 48,9 % von N = 331. In der Studienpopulation lagen verschiedene Risikofaktoren für soziale Isolation und Einsamkeit vor (z. B. Kinderlosigkeit, eingeschränkte Mobilität). Zudem hat fast ein Fünftel der Personen innerhalb von 14 Tagen keinen persönlichen Kontakt zu Menschen aus dem öffentlichen Bereich. Über ein Fünftel gab an, sich „manchmal“ oder „oft“ einsam zu fühlen. Die Angebotsvorschläge „Gottesdienste, Nutzen von kirchlichen Angeboten“, „Ausflüge“, „Informationsveranstaltungen zu verschiedenen Themen“, „Gemeinsame Bewegung/Sport“ und eine „Unterstützungsgruppe, in der man anderen Personen seine Hilfe anbieten und/oder Hilfe bekommen kann“ wurden am häufigsten als geeignet sowie interessant beurteilt.
Schlussfolgerungen
Die Ergebnisse zeigen einen hohen Bedarf, Bedürfnisse und Interesse an Angeboten zur Prävention von sozialer Isolation und Einsamkeit auf. Angebote sollten die spezifischen Bedarfe und Bedürfnisse (z. B. geringe finanzielle Mittel, eingeschränkte Mobilität) älterer Menschen berücksichtigen.Abstract
Background
Older people living in rural areas are at high risk of social isolation and loneliness, as well as their associated health effects (e.g., increased all-cause mortality, cardiovascular diseases). To address this increasing public health problem, offers to promote and strengthen social contacts and participation are necessary.
Objectives
Is there a need for preventive offers regarding social isolation or loneliness, and how can this be met?
Methods
A quantitative, descriptive analysis using a paper–pencil questionnaire was conducted from December 2019 to January 2020 to analyze (1) the presence of social isolation and loneliness, as well as its risk factors, (2) needs and wants, and (3) the assessment of suitability and interest in offerings to prevent social isolation and loneliness among residents ≥ 65 years in a rural community.
Results
The response rate was 48.9% out of N = 331. Various risk factors for social isolation and loneliness (e.g., childlessness, restricted mobility) were present in the study population. Furthermore, almost a fifth did not have any personal contact with people from the public sector within the last 14 days. Over a fifth said they felt lonely “sometimes” or “often”. The proposed offerings “worship services, use of church-based measures”, “excursions”, “informational events on various topics”, “joint exercise/sports” and a “support group in which one can offer one’s help to other people and/or receive help” were most frequently rated as suitable and interesting.
Conclusions
The results show high demand, needs, and interest in offers which prevent social isolation and loneliness. Services should consider the specific needs (e.g., affordability) and wants (e.g., community actions) of older people
Wie viel Open Data kann es geben?
No full textIn Zeiten wachsender Datenmengen und eines zunehmenden Interesses an Open Data steht die Frage im Raum: “Wie viel Offenheit ist möglich?” Zentrale Zielsetzung jeder Veröffentlichung von Daten als Open Data ist deren Anonymität. Nur dann liegen die Daten außerhalb des Geltungsbereichs der Datenschutz-Grundverordnung. Die steigende Verfügbarkeit von personenbezogenen Zusatzinformationen aus öffentlichen Quellen wie sozialen Medien erschweren allerdings die Anonymisierung, weil mit zunehmender Datenmenge auch die Möglichkeiten einer Verknüpfung von Daten (Data Linkage) zunehmen und damit auch das Risiko einer möglichen Re-Identifizierung steigt. Die Veröffentlichung von anonymisierten Daten erfordert daher aufgrund des unumkehrbaren Charakters eine umfassende Analyse der Re-Identifizierungsrisiken
Welche Entscheidungs- und Beurteilungshilfen können Notfallsanitäter:innen beim prähospitalen geriatrischen Einsatz unterstützen?
No full textHintergrund
Notfallsanitäter:innen, Fachkrankenpfleger:innen für Notfallpflege und Notärzt:innen müssen sich ständig auf neue Herausforderungen im täglichen Versorgungsgeschehen einstellen. Dabei kann die Ersteinschätzung von älteren Patient:innen aufgrund von Kommunikationsbarrieren, limitierten diagnostischen Möglichkeiten und verfügbaren Informationen bei Polypharmazie und Multimorbidität von Herausforderungen geprägt sein.
Ziel der Arbeit
Mit dieser Arbeit sollen praxisnahe Anregungen zur Beurteilung von geriatrischen Patient:innen im Rettungsdienst gegeben werden.
Ergebnisse
Geriatrische Symptome sind vielfältig. Das Delir ist eine häufige und teils schwerwiegende Bedrohung, die Fallstricke in der Einschätzung generiert. Die Akronyme „KEIM“ (kardiale Ereignisse, Elektrolytentgleisung, Infektion, Medikamente) und „GEMS“ (geriatrischer Patient, Eindrücke der Umgebung, medizinische Beurteilung, soziale Beurteilung) sind als Hilfsbuchstaben in der Ersteinschätzung geriatrischer Patient:innen zu verstehen. Mit dem ISAR-Screening und weiteren Screeninginstrumenten, wie dem 4A-, 6CIT- oder O3DY-Test, stehen spezifische Hilfsmittel zur Risikoeinschätzung zur Verfügung.
Diskussion
„KEIM“, „GEMS“ und ISAR-Screening, als Erweiterung von X‑ABCDE, sind auch außerklinisch bei der Einschätzung geriatrischer Patient:innen hilfreich und sollten bedarfsgerecht durch den 4A-Test zum Delirscreening ergänzt werden. Diese Aspekte sind in der Aus- und Weiterbildung der versorgenden Berufsgruppen zu adressieren. Assessment- und Screeninginstrumente digital während des Einsatzes nutzen zu können, ist wünschenswert