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Growing demand for genetic counselling and testing has created a need for innovative service delivery models to provide quality care in an efficient manner. The goal of this study was to develop and evaluate a patient-facing webinar providing pre-test genetic counselling to individuals with hypertrophic cardiomyopathy. A patient-facing webinar was developed and implemented between April 2019 and January 2021. It was evaluated using the Alberta Quality Matrix for Health framework, which considers the patient experience across the domains of effectiveness, appropriateness, acceptability, accessibility, and efficiency. The webinar group showed comparable scores to controls with regard to self-perceived knowledge and decisional conflict. The majority of patients reported that the webinar met their expectations and was an acceptable replacement for a 1:1 genetic counselling appointment. Finally, the webinar reduced genetic counsellor time to an average of 24 min per patient. Providing pre-test genetic counselling to index hypertrophic cardiomyopathy patients via a group webinar has achieved a high quality of care, and optimized use of provider and space resources. Supplementary Information The online version contains supplementary material available at 10.1007/s12687-021-00564-x.

Graphical abstract Nursery cultivation is recognized globally as an intensive production system to support quality seedlings as well as to manage resources efficiently. Apart from other factors, potting media (PM) play a crucial role in determining the success of nursery cultivation. Worldwide, peat is the most commonly used substrate in PM because of its favorable physicochemical properties. However, due to ascending environmental and ecological concerns regarding the use of peat, a variety of new substrates have been used/tested by researchers/practitioners/growers as PM. Bark, coir pith, wood fiber, compost derived from various agro-residues, and vermicompost either alone or in combination are some of the commonly explored substrates and found to have the potential to replace peat to a greater extent. In lieu of availability, abundance, low cost, and no/low processing requirement, the use of agro-industrial residue (AIR) in the PM is the current trend. However, challenges associated with their adoption cannot be ignored. The present review is focused on providing collective information, scientific knowledge and detailed analysis of various AIR used in PM. The critical evidence-based review would help in developing a consistent approach for the identification, selection and characterization of a new renewable substrate. In addition, it would help in developing a rationale understanding of the practical and economic realities involved in the adoption of the same in PM. Supplementary Information The online version contains supplementary material available at 10.1007/s13399-021-01998-6.

As the most well-known and popular video-sharing platform around the world, YouTube is an influential tool for the dissemination of health-related information. In addition, considering the increase in obtaining information from internet-based sources in pandemic conditions, YouTube has become more important in the presentation of information related to COVID-19. Therefore, the aim of this study was to evaluate videos related to COVID-19 vaccination in rheumatic diseases (RD) on YouTube. In this descriptive study, 334 video URLs listed with six search terms were recorded (26 July 2021). Three quality groups (high, intermediate, and low) were created based on the Global Quality Scores (GQS). Video sources were identified and various video parameters were compared between the quality groups. Following the implementation of the exclusion criteria, 56 videos remained for further analysis; of which 37 (66.07%) were evaluated as high quality, 12 (21.42%) as intermediate quality, and 7 (12.51%) as low quality. No significant difference was determined between the quality groups in per day values of views, likes, dislikes, and comments. The sources of high-quality videos were pharmaceutical company (n = 1; 100%), pharmacist (n = 1; 100%), society-organization (n = 17; 85%), and academic (n = 3; 75%). Although two-thirds of the videos were high quality, it should be kept in mind that intermediate and low-quality videos are also available. Users should not assume the quality of the videos based on the number of views, likes, dislikes, and comments, but should focus more on video sources.

This paper examines the robustness of the optimal lockdown strategy to the postulated social welfare criterion. We show that utilitarianism can, under some conditions, imply a COVID-19 variant of Parfit's (1984) Repugnant Conclusion: for any (interior) lockdown with life periods of low quality, there must be a stricter lockdown that is regarded as better, even though this reduces the quality of life periods even more. On the contrary, the ex post egalitarian criterion (giving priority to the worst-off ex post) implies zero lockdown. Varying between its minimal and its maximal levels, the optimal lockdown is not robust to the postulated ethical criterion. We also identify a general ethical dilemma between the goal of saving lives (modeled by the Survivors Number Count axiom) and the goal of giving priority to the worst-off (Hammond Equity).

Forecasting academic performance of student has been a substantial research inquest in the Educational Data-Mining that utilizes Machine-learning (ML) procedures to probe the data of educational setups. Quantifying student academic performance is challenging because academic performance of students hinges on several factors. The in hand research work focuses on students’ grade and marks prediction utilizing supervised ML approaches. The data-set utilized in this research work has been obtained from the Board of Intermediate & Secondary Education (B.I.S.E) Peshawar, Khyber Pakhtunkhwa. There are 7 areas in BISEP i.e., Peshawar, FR-Peshawar, Charsadda, Khyber, Mohmand and Upper and Lower Chitral. This paper aims to examine the quality of education that is closely related to the aims of sustainability. The system has created an abundance of data which needs to be properly analyzed so that most useful information should be obtained for planning and future development. Grade and marks forecasting of students with their historical educational record is a renowned and valuable application in the EDM. It becomes an incredible information source that could be utilized in various ways to enhance the standard of education nationwide. Relevant research study reveals that numerous methods for academic performance forecasting are built to carryout improvements in administrative and teaching staff of academic organizations. In the put forwarded approach, the acquired data-set is pre-processed to purify the data quality, the labeled academic historical data of student (30 optimum attributes) is utilized to train regression model and DT-classifier. The regression will forecast marks, while grade will be forecasted by classification system, eventually analyzed the results obtained by the models. The results obtained show that machine learning technology is efficient and relevant for predicting students performance.

This study aims to present a novel Self-regulating and Intelligence Meta-Heuristic-Fuzzy approach (As Methodological Contribution) for integrated and optimal Human Resource Allocation (HRA) in normal and critical conditions at SMEs (As Conceptual Contribution). In this research, a mathematical model of human resource allocation problem is presented, and then Sugeno Fuzzy Inference (SFI) model is used in the tasks rate adjustment layer. The SFI model is the main part of developing Gray Wolf Optimization (GWO) algorithm to reach the integrated and optimal allocation of available human resources under self-regulating attribute in the novel approach. The novel approach has tested and compared to the best researches using data previous researches and by the top five proposed methods in the researches (Includes: SGA, PRS, SRS, MIP, HM) based on three methods of evaluating the quality of solutions (GA-FSGS, MP-FSGS, GA-SGS). The results showed that increase of Ω from 15,000 to 25,000, and HM and SGA clearly performed better than other previous cases in the larger B100 and B200 datasets. Also, it is verified that the method had better results compare to all previous solving methods, and the quality of the solutions have been the best.

The strict contactless management measures that have been implemented to control the spread of the COVID-19 pandemic have severely limited the ability of hotel staff to provide guest services in a quarantine scenario. This study examines the effect of lodgers’ perceptions of the services provided in hotels under quarantine on their satisfaction and intentions to revisit. A self-administered questionnaire was distributed to 250 interviewees who had experienced lodging in quarantined hotel in Mainland China and Taiwan. A structural equation modeling technique was used to study the relationship between the model and the developed hypotheses. The study findings revealed that service perception dimensions are significantly related to customer satisfaction, and there is a positive correlation between customer satisfaction and their intentions to revisit. Moreover, the quality of hotel staff members’ reliability and responsiveness was shown to be the most significant dimension of lodgers’ perceptions of the services received in a quarantined hotel. Therefore, hoteliers who manage hotels that are under quarantine should carefully consider their service provisions in order to encourage lodgers to revisit. Supplementary Information The online version contains supplementary material available at 10.1007/s11628-021-00445-w.

While tumour mutation burden (TMB) is emerging as a possible biomarker for immune-checkpoint inhibitors (ICI), methods for testing have not been standardised as yet. In April 2019, the International Quality Network for Pathology (IQN Path) launched a survey to assess the current practice of TMB testing. Of the 127 laboratories that replied, 69 (54.3%) had already introduced TMB analysis for research purposes and/or clinical applications. Fifty laboratories (72.5%) used targeted sequencing, although a number of different panels were employed. Most laboratories tested formalin-fixed paraffin-embedded material (94.2%), while 18/69 (26%) tested also cell-free DNA. Fifty-five laboratories used both single nucleotide variants and indels for TMB calculation; 20 centers included only non-synonymous variants. In conclusion, the data from this survey indicate that multiple global laboratories were capable of rapidly introducing routine clinical TMB testing. However, the variability of testing methods raises concerns about the reproducibility of results among centers. Supplementary Information The online version contains supplementary material available at 10.1007/s00428-021-03093-7.

In recent years, a growing number of scholars have employed various proxies of environmental degradation to understand the reasons behind rising environmental degradation. However, very few studies have considered consumption-based carbon emissions, even though a clear understanding of the impact of consumption patterns is essential for redirecting the pattern to more sustainable consumption. Thus, this study takes a step forward by using consumption-based carbon emissions (CCO2) as a proxy of environmental degradation using the novel non-linear ARDL technique for Chilefrom 1990 to 2018. To the best understanding of the investigators, no prior studies have investigated the drivers of consumption-based carbon emissions utilizing non-linear ARDL. The study employed ADF and KSS (non-linear) tests to check the data series' stationary level. Additionally, the symmetric and asymmetric ARDL approaches are utilized to explore cointegration and long-run linkages. According to the results, there is no symmetric cointegration among the variables; however, the empirical estimates reveal a long-run asymmetric connection between the indicators and CCO2 emissions. The novel results from the asymmetric ARDL indicate that negative and positive changes in economic growth deteriorate the quality of the environment. Interestingly, a reduction in economic growth makes a more dominant contribution to environmental degradation. Moreover, positive changes in renewable energy usage improve the quality of Chile's environment, inferring that the country can achieve a reduction in environmental degradation by boosting renewable energy consumption. Surprisingly, the study found that technological innovation is ineffective in reducing consumption-based carbon emissions, which implies that Chile's technological innovation is not directed towards manufacturing green technology. Finally, the policy implications are discussed with respect to reducing consumption-based carbon emissions.

*Önder, Mustafa Erkut ( Aksaray, Yazar ), YouTube is a popular video-sharing platform commonly visited by patients and healthcare professionals for medical information. Gout is the most frequent cause of inflammatory arthritis in adults. However, the accuracy and quality of gout-related information on YouTube are not fully known. Thus, the aim of this study was to assess the reliability and quality of YouTube videos pertaining to gout. A YouTube search was conducted using the keywords “gout”, “gout arthritis”, “gout treatment”, and “gout diet”. Of the 240 videos screened, 114 that met the inclusion criteria were included in the study. The number of days since upload, number of views, likes, dislikes, comments and duration of the videos were recorded. A Modified DISCERN tool and the Global Quality Scale (GQS) were used to evaluate the reliability and quality of the videos. Of the 114 analyzed videos, 87.72% were deemed as useful while 12.28% contained misleading information with higher viewership. The most common topic was “gout diet”. The majority of the videos demonstrated high quality (57.89%), followed by intermediate quality (28.95%) while the percentage of low-quality videos was 13.16%. Videos posted by academic institutions/professional organizations and physicians had higher modified DISCERN and GQS scores indicating higher reliability and quality. This study demonstrated that the majority of YouTube videos on gout provide useful information. However, physicians should be aware of the limited nature of YouTube and correct any misinformation during face-to-face meetings. YouTube should consider avoiding misleading videos using validity scales such as modified DISCERN and GQS.

Abstract Machine learning offers great opportunities to streamline and improve clinical care from the perspective of cardiac imagers, patients, and the industry and is a very active scientific research field. In light of these advances, the European Society of Cardiovascular Radiology (ESCR), a non-profit medical society dedicated to advancing cardiovascular radiology, has assembled a position statement regarding the use of machine learning (ML) in cardiovascular imaging. The purpose of this statement is to provide guidance on requirements for successful development and implementation of ML applications in cardiovascular imaging. In particular, recommendations on how to adequately design ML studies and how to report and interpret their results are provided. Finally, we identify opportunities and challenges ahead. While the focus of this position statement is ML development in cardiovascular imaging, most considerations are relevant to ML in radiology in general. Key Points • Development and clinical implementation of machine learning in cardiovascular imaging is a multidisciplinary pursuit. • Based on existing study quality standard frameworks such as SPIRIT and STARD, we propose a list of quality criteria for ML studies in radiology. • The cardiovascular imaging research community should strive for the compilation of multicenter datasets for the development, evaluation, and benchmarking of ML algorithms.

The only reliable remedy against anxiety is information, and reliable information and news are of crucial value in times of crises, such as COVID-19. Contemporary social media offers almost everyone a platform to publish one’s own thoughts, opinions, political statements and others, some of which may gain significant interest of others and thereby become so called “influencers”. This role has in the past been held by news agencies primarily, but this role is increasingly adopted also by private people and among them, also some who do not necessarily adhere the high standards of good journalism or scientific ethics. These give rise to fake news, spreading as unconfirmed rumors and possibly causing dramatic impacts to a society. With information available almost everywhere in the internet today, the distinction between good and bad sources has become a challenge, and highly difficult task. Even more intricate is the question of verifying information against multiple independent sources. If many people say something, does this make it true or any more plausible? Do we need to trust information in lack of better information? Is it possible to judge information and make our own opinion about its validity, quality, relevance or usefulness for our own business? This article shall provide pointers towards answers to the above questions. We discuss some technical means of judging the quality of information and what anyone, even without much technical background can do to avoid falling victim to fake information and fake news.

Vertigo and dizziness are amongst the most common symptoms in medicine and often have a major impact on activities of daily life. Although many causes of vertigo and dizziness can easily be recognized, patients often receive inappropriate and ineffective treatment. The reasons for this are various. Because vertigo/dizziness is an interdisciplinary symptom and there is a lack of standardised diagnostic tools, it is easy to lose the overview of the possible differential diagnoses. There is evidence though, that the management of patients with vertigo/dizziness can be optimized using standardized care pathways with digital support. The present study (within the framework of “PoiSe—prevention, online feedback, and interdisciplinary therapy of acute vestibular syndromes by e-health”) aims to evaluate the implementation of a program with several interlocking components. The three main components are a computerized clinical decision system, a mobile application, a counselling and interdisciplinary educational program developed by the German Center for Vertigo and Balance Disorders (DSGZ). The study is a cluster-randomized controlled trial with a parallel-group design, as well as a detailed process evaluation. Clusters comprise of primary care physician practices in Bavaria, Germany. In the scope of the study the effectiveness, acceptability and efficiency of the intervention will be evaluated. It is anticipated that the intervention will improve the quality and efficiency of the management of dizzy patients. A higher diagnostic accuracy, optimized treatment, and disease progression monitoring is expected to improve patient-relevant outcomes and reduce health-care costs.

Purpose Providing high-quality care for the dying is essential in palliative care. Quality of care can be checked, compared, and improved by assessing responses from bereaved next-of-kin. The objectives of this study are to examine quality of care in the last 2 days of life of hospitalized patients considering specific aspects of their place of care. Methods The “Care of the Dying Evaluation” (CODE™) questionnaire, validated in German in 2018 (CODE-GER), examines quality of care for the patient and support of next-of-kin, allocating values between 0 (low quality) and 4 (high quality). The total score (0–104) is divided into subscales which indicate support/time given by doctors/nurses, spiritual/emotional support, information/decision-making, environment, information about the dying process, symptoms, and support at the actual time of death/afterwards. Next-of-kin of patients with an expected death in specialized palliative care units and other wards in two university hospitals between April 2016 and March 2017 were included. Results Most of the 237 analyzed CODE-GER questionnaires were completed by the patient’s spouse (42.6%) or children (40.5%) and 64.1% were female. Patients stayed in hospital for an average of 13.7 days (3–276; SD 21.1). Half of the patients died in a specialized palliative care unit (50.6%). The CODE-GER total score was 85.7 (SD 14.17; 25–104). Subscales were rated significantly better for palliative care units than for other wards. Unsatisfying outcomes were reported in both groups in the subscales for information/decision-making and information about the dying process. Conclusion The overall quality of care for the dying was rated to be good. Improvements of information about the dying process and decision-making are needed. Trial registration DRKS00013916

Key message Background-independent (BI) and stably expressed (SE) quantitative trait loci (QTLs) were identified using two sets of introgression lines across multiple environments. Genetic background more greatly affected fiber quality traits than environmental factors. Sixty-one SE-QTLs, including two BI-QTLs, were novel and 48 SE-QTLs, including seven BI-QTLs, were previously reported. Abstract Cotton fiber quality traits are controlled by QTLs and are susceptible to environmental influence. Fiber quality improvement is an essential goal in cotton breeding but is hindered by limited knowledge of the genetic basis of fiber quality traits. In this study, two sets of introgression lines of Gossypium hirsutum × G. barbadense were used to dissect the QTL stability of three fiber quality traits (fiber length, strength and micronaire) across environments using 551 simple sequence repeat markers selected from our high-density genetic map. A total of 76 and 120 QTLs were detected in the CCRI36 and CCRI45 backgrounds, respectively. Nine BI-QTLs were found, and 78 (41.71%) of the detected QTLs were reported previously. Thirty-nine and 79 QTLs were SE-QTLs in at least two environments in the CCRI36 and CCRI45 backgrounds, respectively. Forty-eight SE-QTLs, including seven BI-QTLs, were confirmed in previous reports, and 61 SE-QTLs, including two BI-QTLs, were considered novel. These results indicate that genetic background more strongly impacts on fiber quality traits than environmental factors. Twenty-three clusters with BI- and/or SE-QTLs were identified, 19 of which harbored favorable alleles from G. barbadense for two or three fiber quality traits. This study is the first report using two sets of introgression lines to identify fiber quality QTLs across environments in cotton, providing insights into the effect of genetic backgrounds and environments on the QTL expression of fiber quality and important information for the genetic basis underlying fiber quality traits toward QTL cloning and molecular breeding.

Main conclusion A comprehensive understanding of LMA from the underlying molecular aspects to the end-use quality effects will greatly benefit the global wheat industry and those whose livelihoods depend upon it. Abstract Late-maturity α-amylase (LMA) leads to the expression and protein accumulation of high pI α-amylases during late grain development. This α-amylase is maintained through harvest and leads to an unacceptable low falling number (FN), the wheat industry’s standard measure for predicting end-use quality. Unfortunately, low FN leads to significant financial losses for growers. As a result, wheat researchers are working to understand and eliminate LMA from wheat breeding programs, with research aims that include unraveling the genetic, biochemical, and physiological mechanisms that lead to LMA expression. In addition, cereal chemists and quality scientists are working to determine if and how LMA-affected grain impacts end-use quality. This review is a comprehensive overview of studies focused on LMA and includes open questions and future directions.

Purpose Work ability can be measured by the work ability index (WAI), and work-related questions measuring productivity loss in terms of quality and quantity of work. Dentists have high occupational risk of musculoskeletal pain and the exposure of ergonomic strain is already high during dental education. The aim was to evaluate work ability and productivity among dentists, and to identify gender differences and associations with sleep, stress, and reported frequent pain. Methods The study population comprised 187 dentists (123 women and 64 men) who had been working as dentists between 5 and 12 years. Participants completed a questionnaire regarding sleep, stress, presence of pain at different sites, work ability assessed by WAI, and productivity in terms of quality and quantity of work. Results Poor sleep quality and high level of stress were reported by 31% and 48.1% of participants, respectively, with no gender differences and no association with age. The prevalence of frequent pain ranged 6.4–46.5% with shoulders being the most prevalent site. Thirty-three percent reported reduced work ability. Poor sleep, high amount of stress, and multi-site pain were associated with decreased work ability. Conclusions A high prevalence of pain was shown among dentists. Decreased work ability in terms of productivity loss was associated with poor sleep quality, high amount of stress, and multi-site pain. Preventive actions at the workplace should promote good musculoskeletal health, and measures taken, both individual and organizational, to minimize the risk of high, persistent stress and work-related pain.

The bacterium Escherichia coli is a major host for recombinant protein production of non-glycosylated products. Depending on the expression strategy, the recombinant protein can be located intracellularly, which often leads to protein aggregates inside of the cytoplasm, forming so the called inclusion bodies (IBs). When compared to other protein expression strategies, inclusion body formation allows high product titers and also the possibility of expressing proteins being toxic for the host. In the past years, the comprehension of inclusion bodies being only inactive protein aggregates changed, and the new term of non-classical inclusion bodies emerged. These inclusion bodies are believed to contain a reasonable amount of active protein within their structure. However, subsequent downstream processing, such as homogenisation of cells, centrifugation or solubilisation of IBs, is prone to variable process performance and is often known to result in low extraction yields. It is hypothesised that variations in IB quality attributes are responsible for those effects and that such attributes can be controlled by upstream process conditions. In this review, we address the impact of process design (process parameters) in the upstream on defined inclusion body quality attributes. The following topics are therefore addressed: (i) an overview of the range of inclusion body applications (including emerging technologies); (ii) analytical methods to determine quality attributes; and (iii) screws in process engineering to achieve the desired quality attributes for different inclusion body–based applications. Process parameters in the upstream can be used to trigger different quality attributes including protein activity, but are not exploited to a satisfying content yet. Design by quality approaches in the upstream are already considered for a multitude of existing processes. Further intensifying this approach may pave the industrial application for new IB-based products and improves IB processing, as discussed within this review.

Subject motion can introduce noise into neuroimaging data and result in biased estimations of brain structure. In-scanner motion can compromise data quality in a number of ways and varies widely across developmental and clinical populations. However, quantification of structural image quality is often limited to proxy or indirect measures gathered from functional scans; this may be missing true differences related to these potential artifacts. In this study, we take advantage of novel informatic tools, the CAT12 toolbox, to more directly measure image quality from T1-weighted images to understand if these measures of image quality: (1) relate to rigorous quality-control checks visually completed by human raters; (2) are associated with sociodemographic variables of interest; (3) influence regional estimates of cortical surface area, cortical thickness, and subcortical volumes from the commonly used Freesurfer tool suite. We leverage public-access data that includes a community-based sample of children and adolescents, spanning a large age-range (N = 388; ages 5–21). Interestingly, even after visually inspecting our data, we find image quality significantly impacts derived cortical surface area, cortical thickness, and subcortical volumes from multiple regions across the brain (~ 23.4% of all areas investigated). We believe these results are important for research groups completing structural MRI studies using Freesurfer or other morphometric tools. As such, future studies should consider using measures of image quality to minimize the influence of this potential confound in group comparisons or studies focused on individual differences. Supplementary Information The online version contains supplementary material available at 10.1186/s40708-021-00128-2.

Care pathways (CPW) are used worldwide to structure care processes within the patient-centered care concept. Rare diseases (RD), defined as those affecting less than 5 persons per 10,000 and including up to 10,000 different diseases, present unique challenges to CPW development due to their rarity and a large number of disease entities, chronic and frequently disabling nature, heterogeneous manifestation, multisystem involvement, and complexity in diagnostics and treatment. However, failure to develop RD CPWs eventually leads to long diagnostic odysseys, limited and unequal access to RD treatments, and a huge burden of complex care coordination that lies on the shoulders of patients and their families, imposing many personal, professional and social life difficulties, and diminishing their quality of life. In the development of RD CPW, there is a need to ensure smooth horizontal and vertical care integration, multiple transitions, and long-term care coordination across many geographically distant care providers and to find a fine balance between centralized expertise-based, complex, highly specialized services and possibilities for local care provision, patient empowerment and self-management, and digital healthcare. Established in 2017, European Reference Networks may have a high added value through an increase in accessibility and quality of services, economies of scale, scope and speed in the development of lacking evidence-based, educational and other resources for RD CPW, and speeding up innovation development and translation into RD CPW. However, their full benefits may only be reaped through a pan-European collaboration, universal acceptance of common European values and open-mindedness for sometimes disruptive innovation in the provision of healthcare across all Member States of the European Union.

Background and objective Teleemergency doctors support ambulance cars at the emergency site by means of telemedicine. Currently, each district has its own teleemergency doctor office (decentralized solution). This paper analyses the advantages and disadvantages of a centralized solution where several teleemergency doctors work in parallel in one office to support the ambulances in more districts. Methods The service of incoming calls from ambulances to the teleemergency doctor office can be modelled as a queuing system. Based on the data of the district of Vorpommern-Greifswald in the Northeast of Germany, we assume that arrivals and services are Markov chains. The model has parallel channels proportionate to the number of teleemergency doctors working simultaneously and the number of calls which one doctor can handle in parallel. We develop a cost function with variable, fixed and step-fixed costs. Results For the district of Greifswald, the likelihood that an incoming call has to be put on hold because the teleemergency doctor is already fully occupied is negligible. Centralization of several districts with a higher number of ambulances in one teleemergency doctor office will increase the likelihood of overburdening and require more doctors working simultaneously. The cost of the teleemergency doctor office per ambulance serviced strongly declines with the number of districts cooperating. Discussion The calculations indicate that centralization is feasible and cost-effective. Other advantages (e.g. improved quality, higher flexibility) and disadvantages (lack of knowledge of the location and infrastructure) of centralization are discussed. Conclusions We recommend centralization of telemedical emergency services. However, the number of districts cooperating in one teleemergency doctor office should not be too high and the distance between the ambulance station and the telemedical station should not be too large.

The laser is the only tool that can address all six main manufacturing groups of the German standard DIN 8580 simply by applying different processing parameters. Given the present state of technology, however, different dedicated machine concepts are still being used for the respective applications. To enable digital manufacturing in its full consistency, novel, fully reconfigurable machines need to be developed. We therefore outline the further developments that are required to combine all presently known laser-based manufacturing processes on one and the same machine. As both the laser devices and the knowledge about the fundamentals of laser materials processing are already very advanced, research must now be intensified on system engineering. The vision is an intelligent machine, which is fed with CAD data, semi-finished products, or sub-components and that is capable to autonomously produce the desired components with a 100% quality guarantee at a batch size of 1 – “first time right” – and at the costs of comparable mass-produced items. The machine independently selects the best production strategy, i.e. the best combination and sequence of different manufacturing processes. Such a fully flexible and autonomous laser machine will not only boost the implementation of digital manufacturing on a broad scale and provide an approach to resolve the “polylemma of production” but will also enable the relocalization of value creation and manufacturing back into high-wage countries and by this potentially disrupt today’s globalized value creating networks.

Manufacturing processes of carbon fiber reinforced plastics (CFRP) components are often characterized by a high fraction of manual activities especially in terms of handling, cleaning and edge sealing. The innovative machining process introduced in the project CFKComplete comprises a fully integrated and automated workflow reducing unnecessary handling and transportation activities. The concept has been realized on a 5-axis machine tool, providing enough workspace for large structural workpieces and the developed technology units. The units themselves are defined by their modularity, scalability and independency of the guiding machine. Key aspect of the innovative concept are four purpose built and developed interchangeable technology units, which are driven by the base machinery. Thus, the machine’s working scope is being enhanced from machining to a fully integrated workflow including quality inspection, cleaning, sealing and curing.

(a) Situation faced: Raiffeisen Bank Kosovo provides a wide range of banking products and services to all categories of customers in the individual and business segments. Online banking channels have increased to the point at which customers do more than 80% of their transactions through e-banking, mobile phone, or ATMs. Raiffeisen Bank adopted BPM in 2006 as a systemic and structured approach to analyzing, improving, controlling, and managing processes with the goal of improving the quality of products and services. However, the questions remain: How well has BPM been adopted and implemented in the bank, and what impact has BPM had on the bank’s strategic goals? (b) Action taken: This chapter addresses these questions from two angles. First, a literature review clarifies the concept of BPM and its scope. Then data is collected from nine semi-structured interviews with participants who hold high-level positions with Raiffeisen Bank Kosovo. The research both offers an evaluation of the significant aspects of the implementation process and examines the key factors’ effects on the alignment of BPM with the firm’s organization strategy. (c) Results achieved: The study reveals that BPM is well understood and considered an important practice at the bank and its implementation is familiar to the top management. Process visualization in particular is considered a core element in BPM projects, so existing projects can benefit further from BPM by applying process ownership and defining responsibilities in the end-to-end processes in every department in which these processes are performed. This study also provides evidence that strategic objectives can be led by BPM. (d) Lessons learned: Applying BPM initiatives comes with many challenges, but once applied, BPM initiatives help firms achieve their strategic objectives. Two main challenges of implementing BPM at Raiffeisen Bank Kosovo are the lack of sufficient IT support and the lack of sufficient budget to cover staff training. BPM initiatives should be strategy-driven and treated in a holistic way by including several methodologies, such as Six Sigma, Lean, and Agile. Doing so would help the bank think about how its product and services are delivered to its customers.

In Sect. 5.1 we considered binary regression models, that is, regression situations where the response is observed in two categories. In many applications, from social science to medicine, response variables often have more than two categories. For example, consumers may choose between different brands of a product or they may express their opinion about some product in ordered categories ranging from “very satisfied” to “not satisfied at all.” Similarly, voters choose between several parties or they assess the quality of candidates in ordered categories. In medicine, we may, for example, not only distinguish between “infection” and “no infection” but also between several types of infection, as in Example 6.1 below.

The aim of acceptance tests on machine tools is primarily to assess the component quality or the cycle time required to produce a single component on the machine. One of the most important methods for this is the production of test workpieces followed by appropriate measurement. Depending on the requirements, these workpieces are usually standardized components or individual samples or volume components.

Against the backdrop of the economically and ecologically optimal management of electrical energy systems, accurate predictions of consumption load profiles play an important role. On this basis, it is possible to plan and implement the use of controllable energy generation and storage systems as well as energy procurement with the required lead-time, taking into account the technical and contractual boundary conditions.The recorded electrical load profiles will increase considerably in the course of the digitization of the energy industry. In order to make the most accurate predictions possible, it is necessary to develop and investigate models that take account of the growing quantity structure and, due to the significantly higher number of observations, improve the forecasting quality as far as possible.Artificial neural networks (ANN) are increasingly being used to solve non-linear problems for a growing amount of data that is affected by human and other unpredictable influences. Consequently, the model approach of an ANN is chosen for predicting load profiles. Aim of the thesis is the simulative investigation and the evaluation of the quality and optimality of a prediction model based on an ANN for electrical load profiles.

Background Attendance teaching is the predominant teaching method at universities but needs to be questioned in the context of digital transformation. This study establishes and evaluates a method to accomplish electronic learning to supplement traditional attendance courses. Materials and methods Surgery was transmitted in real-time conditions via an online live stream from the surgical theater. Visualization was transferred from a fully digital surgical microscope, an endoscope or an environmental camera in high definition quality. Students were able to participate at home from their personal computer. After following the surgery, they participated in an online-evaluation. Results A total of 65 students participated in the live stream. The majority of students (61.54%) indicated a significant subjective increase in knowledge after participation. The majority of students (53.85%) indicated that live surgeries should be offered as a permanent component in addition to classroom teaching. Likewise, a broader offer was desired by many students (63.08%). Conclusions Live streaming of surgery is a promising approach as an alternative or supplement to traditional attendance teaching. An expansion of digital teaching can be explicitly supported on the basis of this study.

With steadily increasing demands for high product quality and production reliability as well as safety in industrial processes, FTC has received considerable attention in recent years, in both research and industrial application domains. This trend is well reflected by the great number of publications on FTC methods, some of them are given at the end of this chapter.

As applications of Additive Manufacturing (AM) extend from rapid prototyping into series production, new challenges of digital information integration arise. In order to obtain transparency of overall costs and part quality, the relevant information of each process step needs to be gathered from different sources and combined in a meaningful way. Thus, a digitally integrated process chain can provide added value for manufacturers and their clients.

In times of competitive market environments, offering customized products becomes a crucial success factor for manufacturing companies. High variance in the product portfolio leads to expanding costs along the value chain. These costs are not allocated cause-related, which results in cross-subsidization and competitive disadvantage. Process-oriented approaches proved high potential to improve cost allocation. The determination effort often is uneconomically high and results are arbitrarily imprecise. That might result in wrong decisions according the product portfolio and production system. The increasing execution of activities in information systems allows reductions in costs and time as well as increasing quality in process-oriented cost accounting. The aim of this paper is to develop a methodology that uses event data gathered in information systems to determine variant-specific process costs using Process Data Mining.

The development of this work is based on the philosophy of quality and the efficient application of its tools; one of its objectives is the creation and implementation of a systematic quality-oriented approach for the analysis of laser beam ablation and based on the Deming cycle (illustrated in chapter 1, in figure 2). As a part of the state of the art of this thesis, under the phase plan in the structure (see figure 4), the quality tools are responsible to assure a quality-oriented process, that is efficient and reliable, and adaptable to changing environments, like new materials and systems (flexible). Based on the phases, this work pursues the systematic identification, description and quantification of significant influencing parameters on the ps laser beam ablation of WC, targeting ablation (e.g., ablated volume, ablation depth and ablation rate).

In this chapter we show how functional and non-functional product characteristics are planned and realized in early phases of product engineering, even with high product complexity. We present “Design-for-X” as a universal approach that can be applied to all quality attributes.

In the wake of demographic change and increasing knowledge of potentially harmful activities and work areas, technical support systems like exoskeletons are used to minimize the risk of musculoskeletal disorders (MSDs) by supporting employees during tasks with high biomechanical load. In addition, the increasing quality requirement and individualized demand make production activities more complex and changeable. Not least because of the well-trained abilities and skills of humans, employees have a central role in current and future value chains. One possibility for physically supporting manual tasks is the exoskeleton. During the development and implementation of the exoskeletons, many of their effects and performances have been evaluated. Mostly, developers or end-users focus on selected biomechanical effects like reduction of musculoskeletal stress. The effects on cognitive structures as well as the impact on work quality are less known. The current study analyzed the cognitive effects during the use of the active exoskeleton Lucy for tasks performed at or above head level in a real environment (training center for scaffolders). The study was conducted with 18 participants. Our experiment was able to show that participants who were supported by the exoskeleton Lucy made significantly fewer mistakes in a work task (53,8%). In addition, a significantly higher cognitive performance (concentration achievement, processing of target objects and error frequencies) was found in supported participants, compared to the unsupported condition, in a psychometric test after each work task.

In addition to sideline coverage at games (the most visible aspect of a team physician’s job), the team physician is often responsible for clinical-based care, traveling with the team, and developing policy and procedures to provide all related health-care and safety measures for the athletes and members of the traveling party. Team physicians are often subspecialty trained to handle both sport-specific injuries and non-sport-specific emergencies. They work in tandem with the athletic training and coaching staff to ensure quality and timely care for their athletes. In addition to a deep knowledge of sports medicine, it is crucial a team physician be an effective leader and communicator as they are looked to as the “gatekeeper” for the health and safety of their team.

Functional movement testing is commonly used in elite basketball in effort to identify subtle and gross movement deviations. Depending on resources available, the testing process may vary from clinical observation, possibly using a standard 2D camera, to a comprehensive laboratory-based biomechanical analysis utilizing force plates and 3D motion capture analysis. Regardless of the level of technology used, it is best practice to select functional movements to be tested that replicate the physical demands athletes endure during high-level basketball competition. While the most recent evidence in the literature does not support the use of functional movement testing as an injury prediction tool, corrective and performance interventions following testing have been found to be useful in reducing the risk of injury optimizing quality of movement on the court.

The growing amount of municipal solid wastes (MSW) per inhabitant is increasing in most of the European countries. The organization of efficient logistics for MSWs’ collection and recovery is crucial in order to improve the quality of environment and the human wellbeing. In European Union the municipalities are responsible to adopt measures to recycling and recovering of waste streams. The aim of this chapter is to identify the drivers and barriers inter-municipal solid waste. The data from over 230 Polish municipalities is analyzed. Our research contributes to the sustainability literature by providing the empirical evidence in this area.

Standardisation is a systematically initiated common harmonisation of processes, systems, terms or product characteristics for the benefit of a user group. The creation of standards is a uniform approach which, on one hand, makes it possible to measure quality and thus make it comparable. On the other hand, standardisation increases efficiency by eliminating uncertainties in planning as well as reducing technical and financial adjustments or coordination, thus simplifying the movement of goods and services. This chapter deals with the basic structure of EN 9100.

Auxiliary processes are relevant element of the production process, due to the fact that they affect the technical and economic efficiency. In the modern production process there are many material flows between which or during which technological operations that process the input material into a finished product are carried out. Incorrect design or inadequate organization of supporting processes can cause serious disruptions or even financial losses, what may be analyzed from the perspective of sustainability. The chapter is focused on the process of internal transport, what is justified by influence of that process on the company’s economic effects, the quality of employees’ work and the quality of the natural environment. Authors analyze the internal transport process in a company representing recycling industry which is End-of-Life Vehicles disassembling enterprise. This sector is affecting People and Planet during generating Profits (3P concept). In disassembling company internal transport process includes transport of: ELV’s, vehicles parts, waste, but also it covers handling of materials including laying, fixing and measuring. Material flow is complex because of diversity in terms of materials’ size, shape, mass and quantity. In the result the internal transport process requires precise organization, which should be adopted to the company to ensure safe shipment of cargo with minimal costs. The basic purpose of the chapter is to prepare a proposal of method for internal transport assessment in terms of sustainability. Authors use the following research methods: literature review, case study, brainstorming. Chapter consists of three parts. The first part shows the role of the internal transport process as well as the differences between the transport process in a typical enterprise and disassembling company. In the second part, material flows occurring in disassembling facility are described. In the last part problems were identified and the directions of further research were indicated.

The injection moulding process for the production of plastic parts is a very complex process. Therefore, a lot of experience and expert knowledge is necessary to produce parts with high quality. Changes in granule-batches, environmental influences and wear of the machine and the mould can strongly affect the quality of the produced parts. For this reason an injection moulding machine needs an experienced operator, who reacts properly to changing input variables and sets appropriate countermeasures. Modern injection moulding machines are able to record all countermeasures and have access to a wealth of internal machine data. Consequently, an adequate machine learning (ML) method should be able to observe, to learn the proper countermeasures and to evaluate their effectiveness. With deep learning (DL), a state of the art technology in ML, it will be possible to predictively detect process anomalies for the first time, based only on the knowledge about the internal machine data. If an operator changes the setting parameters of the injection moulding machine, the correlation between the adjustment and the anomaly is being learnt. The aim is to get process adjustment recommendations from the machine learning system.

In recent years, the increased use of digital tools within the Peruvian tourism industry has created a corresponding increase in revenues. However, both factors have caused increased competition in the sector that in turn puts pressure on small and medium enterprises' (SME) revenues and profitability. This study aims to apply neural network based sentiment analysis on social networks to generate a new information search channel that provides a global understanding of user trends and preferences in the tourism sector. A working data-analysis framework will be developed and integrated with tools from the cloud to allow a visual assessment of high probability outcomes based on historical data, to help SMEs estimate the number of tourists arriving and places they want to visit, so that they can generate desirable travel packages in advance, reduce logistics costs, increase sales, and ultimately improve both quality and precision of customer service.

Children acquire language inherently from a strong genetic determination. The extent and quality to which they develop language, however, depend on both environmental input—from parent-child interaction, early literacy, a language-stimulating familial and social surrounding—and genome-environment interplay. A language-stimulating environment with sufficient verbal input helps to prevent developmental disorders of speech and language (DDSL) and their adverse social, emotional and educational impact on children’s development. Furthermore, the early identification of risk factors of DDSL and first symptoms is desirable. From the end of the second year of life on, valid and reliable assessment instruments are available, particularly parent questionnaires, which detect children at risk for developing DDSL. For later ages mass screenings or screenings for children at risk, or for those suspected, of having a DDSL are possible. Mass screenings face methodological problems but are possible if they aim to identify DDSL in general, including comorbidities or any developmental language abnormalities. If there is a suspicion of a language abnormality, testing for a hearing loss is recommended. Counselling of parents in cases of a familial history of DDSL, a potentially language-relevant disease of their child or a risk for heritable language-relevant diseases of their offspring, may be useful to prevent or early identify a DDSL.

The aim of this study was to establish a web-based platform for exchanging medical device management and maintenance experiences to enhance the professional competency of clinical engineers (CEs), which ensures the quality of medical devices and increases patients' satisfaction with medical services. Medical devices play an essential role in diagnosis and disease management. CEs are responsible for providing functional medical devices that contribute worthwhile functions to a medical service to improve patients' health and safety. The purpose of the platform is to facilitate collection and sharing of medical device incidents experiences to improve CEs' capability. To provide useful and practical information for CEs, an event review committee, composed of experts with more than 20 years of clinical engineering experience who were recruited as reviewers, was established under the platform. Cases submitted to the platform were required to have comprehensive descriptions of the device and events. Each case was evaluated by at least two reviewers based on five evaluation indices: (1) severity, (2) breadth, (3) frequency, (4) insidiousness, and (5) correctness. After being reviewed, each final report was published on the platform to be shared with the event submitters and other members. The results show that 116 staffs from 32 different hospitals, registered to join this platform. From January 2015 to December 2016, 70 events were submitted with 56 reports. This study also assessed the platform's benefits for CEs. A total of 93 respondents completed a questionnaire survey: 93% of the CEs agreed that the information from the platform helped them do their job. The web-based platform has high value as an experience-sharing interface for medical devices. The CEs obtained extremely useful information from the platform for medical device management and their daily duties. This study provided an online training model with systematic methods to improve the quality and effectiveness of medical device management.

Critically ill adolescents are usually treated on intensive care units optimised for much older adults or younger children. The way they access and experience health services may be very different to most adolescent service users, and existing quality criteria may not apply to them. The objectives of this pilot study were, firstly, to determine whether adolescents and their families were able to articulate their experiences of their critical care admission and secondly, to identify the factors that are important to them during their intensive care unit (ICU) or high dependency unit (HDU) stay. Participants were 14–17 year olds who had previously had an emergency admission to an adult or paediatric ICU/HDU in one of four UK hospitals (two adult, two paediatric) and their parents. Semi-structured interviews were conducted with eight mother-adolescent dyads and one mother. Interviews were transcribed and analysed using framework analysis. Conclusion: The main reported determinant of high-quality care was the quality of interaction with staff. The significance of these interactions and their environment depended on adolescents’ awareness of their surroundings, which was often limited in ICU and changed significantly over the course of their illness. Qualitative interview methodology would be difficult to scale up for this group. What is known • Critically ill adolescents are usually treated on intensive care units optimised for older adults or younger children.• The way they access and experience health services may be different to most adolescent patients; existing quality criteria may not apply. What is new • Reported determinants of high-quality care were age-appropriateness of the environment, respectfulness and friendliness of staff, communication and inclusion in healthcare decisions.• The significance of these depended on adolescents’ awareness of their surroundings, which was often limited and changed over the course of their illness.

According to literature data, some of the main factors which significantly affect the quality of the indoor environment in residential households or apartments are human activities such as cooking, smoking, cleaning, and indoor exercising. The paper presents a literature overview related to air quality in everyday use spaces dedicated to specific purposes which are integral parts of residential buildings, such as kitchens, basements, and individual garages. Some aspects of air quality in large-scale car parks, as a specific type of indoor environment, are also discussed. All those areas are characterized by relatively short time use. On the other hand, high and very high concentration levels of xenobiotics can be observed, resulting in higher exposure risk. The main compounds or group of chemical compounds are presented and discussed. The main factors influencing the type and amount of chemical pollutants present in the air of such areas are indicated.

Objective To assess the evidence on the validity and responsiveness of five commonly used preference-based instruments, the EQ-5D, SF-6D, HUI3, 15D and AQoL, by undertaking a review of reviews. Methods Four databases were investigated using a strategy refined through a highly sensitive filter for systematic reviews. References were screened and a search for grey literature was performed. Identified citations were scrutinized against pre-defined eligibility criteria and data were extracted using a customized extraction template. Evidence on known group validity, convergent validity and responsiveness was extracted and reviewed by narrative synthesis. Quality of the included reviews was assessed using a modified version of the AMSTAR checklist. Results Thirty reviews were included, sixteen of which were of excellent or good quality. The body of evidence, covering more than 180 studies, was heavily skewed towards EQ-5D, with significantly fewer studies investigating HUI3 and SF-6D, and very few the 15D and AQoL. There was also lack of head-to-head comparisons between GPBMs and the tests reported by the reviews were often weak. Where there was evidence, EQ-5D, SF-6D, HUI3, 15D and AQoL seemed generally valid and responsive instruments, although not for all conditions. Evidence was not consistently reported across reviews. Conclusions Although generally valid, EQ-5D, SF-6D and HUI3 suffer from some problems and perform inconsistently in some populations. The lack of head-to-head comparisons and the poor reporting impedes the comparative assessment of the performance of GPBMs. This highlights the need for large comparative studies designed to test instruments’ performance. Electronic supplementary material The online version of this article (doi:10.1007/s10198-017-0902-x) contains supplementary material, which is available to authorized users.

This study aims to identify European radiographers’ challenges in clinical performance in mammography and the main areas of mammography that require more and better training. An extensive search was performed to identify relevant studies focused on clinical practice, education and training in mammography published between January 2010 and December 2015 in the English language. The data were analysed by using deductive thematic analysis. A total of 27 full text articles were read, evaluating their quality. Sixteen articles out of 27 were finally selected for this integrative review. The main challenges of radiographers’ mammography education/training can be divided into three groups: training needs, challenges related to radiographers, and challenges related to the organization of education. The most common challenges of clinical performance in mammography among European radiographers involved technical performance, the quality of practices, and patient-centeredness. The introduction of harmonized mammography guidelines across Europe may serve as an evidence-based tool to be implemented in practice and education. However, the variability in human and material resources as well as the different cultural contexts should be considered during this process. • Radiographers’ awareness of their professional identity and enhancing multiprofessional cooperation in mammography. • Radiographers’ responsibilities regarding image quality (IQ) and optimal breast imaging performance. • Patient-centred mammography services focusing on the psychosocial needs of the patient. • Challenges: positioning, QC-testing, IQ-assessment, optimization of breast compression, communication, teamwork, and patient-centred care. • Introduction of evidence-based guidelines in Europe to harmonize mammography practice and education.