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Background Platelets play an important role in the pathogenesis of inflammatory and proliferative vascular changes. The aim of this study was to investigate whether human platelets are able to induce transplant arteriosclerosis in a humanized C57/Bl6-Rag2-/-γc-/- mouse xenograft model. Methods Nonactivated and in vitro activated human platelets were analyzed and phenotyped for surface markers by flow cytometry. Side branches of human mammary arteries were implanted into the infrarenal aorta of recipients, followed by daily application of human platelets and histological analyzed on day 30 after transplantation. Results Human platelets collected by apheresis had low levels of platelet activation markers. However, after in vitro activation, expression was markedly increased. 60 min after injection in recipient mice, nonactivated human platelets become significantly activated. Increased adhesion of platelets to the vascular endothelium was detected by in vivo fluorescence microscopy. After intravenous injection of nonactivated or activated platelets, human xenografts showed pronounced intimal proliferation. Immunohistological analysis showed that the group treated with activated human platelets exhibited significantly increased intragraft protein expression of ICAM-1 and PDGF receptor β and SMC migration into the neointima. Conclusions These data demonstrate that an isolated daily application of both in vivo and in vitro activated human platelets results in the development of transplant arteriosclerosis in a humanized mouse transplantation model.Visual Supplemental Abstract; http://links.lww.com/TP/C278.

Background Delirium has been long considered as a major contributor to cognitive impairments and increased mortality following a critical illness. Pharmacologic and non-pharmacologic strategies are used against delirium in the intensive care unit (ICU), despite these strategies remaining controversial. Previous studies have shown the feasibility of using virtual reality within the ICU setting, and we propose to use this technology to investigate the effect of immersive virtual reality stimulation on the incidence of delirium in the ICU. Moreover, we propose to use motion sensors to determine if patient movement patterns can lead to early prediction of delirium onset. Methods This study is conducted as a randomized clinical trial. A total of 920 critically ill patients in the ICU will participate. The control group will receive standard ICU care, whereas the intervention group will, in addition to the standard ICU care, receive relaxing 360-degree immersive virtual reality content played inside a head-mounted display with noise-cancelling headphones, three times a day. The first 100 patients, regardless of their group, will additionally have their movement patterns recorded using wearable and ambient sensors. Follow-up measurements will take place 6 months after discharge from the ICU. Discussion Delirium is widely present within the ICU setting but lacks validated prevention and treatment strategies. By providing patients with virtual reality stimulation presented inside a head-mounted display and noise-cancelling headphones, participants may be isolated from disturbances on an ICU. It is believed that by doing so, the incidence of delirium will be decrease among these patients. Moreover, identifying movement patterns associated with delirium would allow for early detection and intervention, which may further improve long-term negative outcomes associated with delirium during critical care. Trial registration ClinicalTrials.gov NCT04498585. Registered on August 3, 2020

The traditional approach to modeling the polymer melt flow in single-screw extruders is based on analytical and numerical analyses. Due to increasing computational power, data-driven modeling has grown significantly in popularity in recent years. In this study, we compared and evaluated databased modeling approaches (i. e., gradient-boosted trees, artificial neural networks, and symbolic regression models based on genetic programming) in terms of their ability to predict – within a hybrid modeling framework – the three-dimensional non-linear throughput-pressure relationship of metering channels in single-screw extruders. By applying the theory of similarity to the governing flow equations, we identified the characteristic dimensionless influencing parameters, which we then varied to create a large dataset covering a wide range of possible applications. For each single design point we conducted numerical simulations and obtained the dimensionless flow rate. The large dataset was divided into three independent sets for training, interpolation, and extrapolation, the first being used to generate and the remaining two to evaluate the models. Further, we added two features derived from expert knowledge to the models and analyzed their influence on predictive power. In addition to prediction accuracy and interpolation and extrapolation capabilities, we evaluated model complexity, interpretability, and time required to learn the models. This study provides a rigorous analysis of various data-based modeling approaches applied to simulation data in extrusion.

In sub-Saharan Africa there is increasing focus on identifying women’s trait preferences within crop breeding to enable gender-responsive product development. In the case of maize, breeding programs are ready to incorporate specific traits to increase gender-responsiveness but lack guidance on what these specific traits might be. We propose an inductive approach to determine a pathway towards increasing gender-responsiveness within maize breeding. A survey of 306 farmers was conducted to determine gender differences in maize varieties used together with key agronomic practices. Variety was a significant predictor of the gender of the plot manager and of the household head in contrast to previous surveys conducted in researcher-led on-farm trials. On-farm trials are conducted using pre-defined agronomic management practices and preferences identified at harvest are likely to centre around yield. This study highlighted significant differences in several agronomic practices used by female plot managers and female household heads. Although further studies are required to understand preferences associated with varietal choice, our results suggest that current researcher-led on-farm trials may not identify gender-specific trait preferences driving varietal choice. Furthermore, a trait-specific approach is not the only avenue towards increasing gender-responsiveness in maize breeding in southern Africa. The scope for increasing gender-intentionality in maize breeding could be expanded to incorporate selection environments more relevant to agronomic management practices used by female plot managers and households at advanced stages of the breeding pipeline. This approach could provide an immediate entry point to increase gender-intentional maize breeding in southern Africa.

Seit einigen Jahren ist eine stetige Zunahme des Einsatzes von mechanischen extrakorporalen Herz-Kreislauf- und Lungenunterstutzungssystemen (ECLS/ECMO) zu verzeichnen. So wurden seit 2015 in Deutschland jahrlich bei etwa 3000 Patienten ECLS/ECMO-Systeme implantiert. Trotz dieser haufigen Anwendung der passageren Unterstutzungssysteme existieren zurzeit national und international nur Leitlinien zum Einsatz der ECMO/ECLS, die erkrankungsbezogene Teilaspekte komplexer Therapiekaskaden adressieren. Vor diesem Hintergrund erschien es notwendig, evidenzbasierte Empfehlungen zur ECLS/ECMO-Therapie im Hinblick auf Indikationen und das komplexe Patientenmanagement zu verfassen, in denen personelle, prozessuale und infrastrukturelle Anforderungen definiert werden. Aus diesem Grund erfolgte im Juli 2015 durch die Deutsche Gesellschaft fur Thorax‑, Herz- und Gefaschirurgie (DGTHG) die Anmeldung einer diesbezuglichen S3-Leitlinie bei der zustandigen Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF). Im Mittelpunkt der Leitlinie steht die klinische Anwendung der ECLS/ECMO-Therapie; erganzend werden auch strukturelle und okonomische Aspekte adressiert. Unter Federfuhrung der DGTHG wurde mit Einbindung von Experten aus Deutschland, Osterreich und der Schweiz, delegiert aus 11 AWMF-Fachgesellschaften, 5 weiteren Fachgesellschaften sowie der Patientenvertretung, die S3-Leitlinie im Februar 2021 publiziert. Dieser Artikel stellt eine kurze Zusammenfassung des methodischen Konzepts sowie aller konsentierten Empfehlungen fur jede bearbeitete Fragestellung der Leitlinie dar.

Purpose Intensive care patients have increased risk of death and their care is expensive. We investigated whether risk-adjusted mortality and resources used to achieve survivors change over time and if their variation is associated with variables related to intensive care unit (ICU) organization and structure. Methods Data of 207,131 patients treated in 2008–2017 in 21 ICUs in Finland, Estonia and Switzerland were extracted from a benchmarking database. Resource use was measured using ICU length of stay, daily Therapeutic Intervention Scoring System Scores (TISS) and purchasing power parity-adjusted direct costs (2015–2017; 17 ICUs). The ratio of observed to severity-adjusted expected resource use (standardized resource use ratio; SRUR) was calculated. The number of expected survivors and the ratio of observed to expected mortality (standardized mortality ratio; SMR) was based on a mortality prediction model covering 2015–2017. Fourteen a priori variables reflecting structure and organization were used as explanatory variables for SRURs in multivariable models. Results SMR decreased over time, whereas SRUR remained unchanged, except for decreased TISS-based SRUR. Direct costs of one ICU day, TISS score and ICU admission varied between ICUs 2.5–5-fold. Differences between individual ICUs in both SRUR and SMR were up to > 3-fold, and their evolution was highly variable, without clear association between SRUR and SMR. High patient turnover was consistently associated with low SRUR but not with SMR. Conclusion The wide and independent variation in both SMR and SRUR suggests that they should be used together to compare the performance of different ICUs or an individual ICU over time. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-021-06546-4.

Successful inter-organisational new product development (NPD) is a key source of competitive advantage, yet many NPD projects are still failing. To generate new insights on the phenomenon, we examine the performance implications of knowledge inputs among collaborating organisations, both in terms of external input ratio and input concentration. We test a set of hypotheses using multi-industry primary and secondary data on 210 inter-organisational NPD projects. Results support our hypotheses about the negative effect of input concentration on design quality, which in turn is positively associated with product market performance. Although we surprisingly find a negative linear effect of external input ratio on design quality, our post-hoc analysis confirms the relationship to be an inverse U-shaped relationship. We also find support for the roles of technology interdependence in moderating the performance implications of external input ratio and input concentration. By clarifying how knowledge inputs affect project outcomes under different levels of technology interdependence, the study provides managerial implications regarding how to select innovation partners in order to create a knowledge portfolio that best improves NPD project performance., International Journal of Production Research, 60 (20), ISSN:0020-7543, ISSN:1366-588X

How does the bounded rationality of managers affect pricing? We examine this under-researched question by examining how different psychological traits of managers relate to new product pricing practices and how these pricing practices, in turn, relate to new product performance. To do so, we survey 302 American marketing, sales, and pricing managers responsible for new product pricing decisions in business markets. Among others, our study identifies conformity and intuition as distinct psychological traits associated with pricing practices that have a positive relationship with new product performance. The main contribution of this study is the empirical demonstration that psychological traits offer valuable insights into how managers determine prices for new products in business markets.

We measured plasma and cerebrospinal fluid (CSF) metabolite concentrations in a 5-day porcine sepsis model of fecal peritonitis. The objectives were: (i) to verify whether the expected pathways that had emerged in previous studies pertain only to the early inflammatory response or persist for the subsequent days; (ii) to identify metabolic derangements that arise later; (iii) to verify whether CSF metabolite concentrations were altered and if these alterations were similar to those in the blood or delayed. We observed an early response to inflammation and cytokine storms with alterations in lipid and glucose metabolism. The arginine/asymmetric dimethylarginine (ADMA) and phenylalanine/tyrosine balances changed 24 h after resuscitation in plasma, and later in CSF. There was a rise in ammonia concentration, with altered concentrations of metabolites in the urea cycle. Whether persistent derangement of these pathways have a role not only on short-term outcomes but also on longer-term comorbidities, such as septic encephalopathy, should be addressed in further studies.

ZusammenfassungAkutschmerztherapie nach operativen oder interventionellen Eingriffen ist ein Pflichtbestandteil im modernen perioperativen Management. Ihr strukturierter Einsatz führt unmittelbar zu einer Verbesserung der Lebensqualität behandelter Patienten, mittelfristig zu einer objektivierbaren Reduktion der Morbidität, langfristig zu einer Verhinderung einer Schmerzchronifizierung und parallel stets auch zu einer darstellbaren ökonomischen Effizienz durch beschleunigte Mobilisation, Verkürzung der Krankenhausverweildauer und Vermeidung komplikationsimmanenter Folgekosten.

Zusammenfassung. Die Behandlung von Personen mit COVID-19 stellt Intensivstationen vor grosse Herausforderungen: Die hohe Anzahl von Erkrankten in kurzer Zeit erfordert das Bereitstellen von zusätzlichen personellen und materiellen Ressourcen in einem sehr grossen Umfang. Die Behandlung der Betroffenen, viele mit Multiorganversagen, ist schwierig und aufwändig, insbesondere die Beatmung, da der Gasaustausch und die Compliance massiv eingeschränkt sein können und viele Patientinnen und Patienten regelmässig in Bauchlage gebracht werden müssen. Diese Arbeit stellt die vielfältigen Probleme der ersten Corona-Welle dar. Dazu gehört auch das Leiden der Angehörigen, die die Kranken nicht besuchen konnten.

Background: To share the results of a web-based expert panel discussion focusing on the management of acute and chronic aortic disease during the coronavirus (COVID-19) pandemic. Methods: A web-based expert panel discussion on April 18, 2020, where eight experts were invited to share their experience with COVID-19 disease touching several aspects of aortic medicine. After each talk, specific questions were asked by the online audience, and results were immediately evaluated and shared with faculty and participants. Results: As of April 18, 73.3% answered that more than 200 patients have been treated at their respective settings. Sixty-four percent were reported that their hospital was well prepared for the pandemic. In 57.7%, the percentage of infected healthcare professionals was below 5% whereas 19.2% reported the percentage to be between 10% and 20%. Sixty-seven percent reported the application of extracorporeal membrane oxygenationin less than 2% of COVID-19 patients whereas 11.8% reported application in 5%–10% of COVID-19 patients. Thirty percent of participants reported the occurrence of pulmonary embolism in COVID-19 patients. Three percent reported to have seen aortic ruptures in primarily elective patients having been postponed because of the anticipated need to provide sufficient ICU capacity because of the pandemic. Nearly70% reported a decrease in acute aortic syndrome referrals since the start of the pandemic. Conclusion: The current COVID-19 pandemic has—besides the stoppage of elective referrals—also led to a decrease of referrals of acute aortic syndromes in many settings. The reluctance of patients seeking medical help seems to be a major driver. The number of patients, who have been postponed due to the provisioning of ICU resources but having experienced aortic rupture in the waiting period, is still low. Further, studies are needed to learn more about the influence that the COVID-19 pandemic has on the treatment of patients with acute and chronic aortic disease.

Host plant defence mechanisms (resistance and tolerance) and plant nutrition are two of the most widely proposed components for the control of hemiparasitic weeds of the genus Striga in tropical cereal production systems. Neither of the two components alone is effective enough to prevent parasitism and concomitant crop losses. This review explores the potential of improved plant nutrition, being the chemical constituent of soil fertility, to fortify the expression of plant inherent resistance and tolerance against Striga. Beyond reviewing advances in parasitic plant research, we assess relevant insights from phytopathology and plant physiology in the broader sense to identify opportunities and knowledge gaps and to develop the way forward regarding research and development of combining genetics and plant nutrition for the durable control of Striga.

Background Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. Methods Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. Results Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). Conclusion In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.

Enteral feeding intolerance (EFI) is a common feature in critically ill patients worldwide. However, there is no clear, widely agreed-upon definition available, with various studies rarely using the same definition. The term EFI is frequently used to describe vomiting or large gastric residual volumes associated with enteral feeding as a result of gastroparesis/delayed gastric emptying. However, the syndrome of EFI may represent the consequence of various pathophysiological mechanisms, and this heterogeneity may explain varying associations with outcomes. In clinical practice, a pragmatic definition may be useful. A pragmatic definition of EFI is that a clinician has decided to reduce the amount of enteral nutrition specifically because features of gastrointestinal dysfunction appeared during enteral feeding. For research purposes, a more detailed definition of EFI is required to improve knowledge and explore interventions that may improve patient-centered outcomes. The objective of this review is to summarize available evidence on existing definitions, pathophysiological mechanisms, and the clinical relevance of EFI in critically ill patients. Based on current knowledge, we propose a conceptual framework for a definition of EFI for a future consensus process.

OBJECTIVES Recent mortality studies showed worse prognosis in patients (ARNS) with severe aortic regurgitation and preserved ejection fraction (EF) not fulfilling the criteria of current guidelines for surgery. The aim of our study was to analyse left ventricular (LV) systolic and diastolic function and mechanical energetics to find haemodynamic explanations for the reduced prognosis of these patients and to seek a new concept for surgery. METHODS Global longitudinal strain (GLS) and echo-based single-beat pressure–volume analyses were performed in patients with ARNS (LV end-diastolic diameter 50%, GLS > −19% n = 41), with indication for surgery (ARS; n = 19) and in mild hypertensive controls (C; n = 20). Additionally, end-systolic elastance (LV contractility), stroke work and total energy (pressure–volume area) were calculated. RESULTS ARNS demonstrated significantly depressed LV contractility versus C: end-systolic elastance (1.58 ± 0.7 vs 2.54 ± 0.8 mmHg/ml; P CONCLUSIONS ARNS patients almost matched the ARS patients in their haemodynamic and energetic deterioration, thereby explaining poor prognosis reported in literature. GLS has been shown to be a reliable surrogate for LV contractility, possibly overestimating contractility due to exhausted preload reserve in aortic regurgitation patients. GLS may outperform conventional echo parameters to predict more precisely the timing of surgery.

Background and purpose Pore-forming α subunits of the voltage- and Ca2+ -activated K+ channel with large conductance (BKα) promote malignant phenotypes of breast tumour cells. Auxiliary subunits such as the leucine-rich repeat containing 26 (LRRC26) protein, also termed BKγ1, may be required to permit activation of BK currents at a depolarized resting membrane potential that frequently occur in non-excitable tumour cells. Experimental approach Anti-tumour effects of BKα loss were investigated in breast tumour-bearing MMTV-PyMT transgenic BKα knockout (KO) mice, primary MMTV-PyMT cell cultures, and in a syngeneic transplantation model of breast cancer derived from these cells. The therapeutic relevance of BK channels in the context of endocrine treatment was assessed in human breast cancer cell lines expressing either low (MCF-7) or high (MDA-MB-453) levels of BKα and BKγ1, as well as in BKα-negative MDA-MB-157. Key results BKα promoted breast cancer onset and overall survival in preclinical models. Conversely, lack of BKα and/or knockdown of BKγ1 attenuated proliferation of murine and human breast cancer cells in vitro. At low concentrations, tamoxifen and its major active metabolites stimulated proliferation of BKα/γ1-positive breast cancer cells, independent of the genomic signalling controlled by the oestrogen receptor. Finally, tamoxifen increased the relative survival time of BKα KO but not of wild-type tumour cell recipient mice. Conclusion and implications Breast cancer initiation, progression, and tamoxifen sensitivity depend on functional BK channels thereby providing a rationale for the future exploration of the oncogenic actions of BK channels in clinical outcomes with anti-oestrogen therapy.

Background Parents may struggle to initiate healthy weight-related conversations with their children. Educational videos may be an effective tool for improving parents’ knowledge and self-efficacy on this topic. The aim of this pilot study was to develop an educational video to assist parents in weight-related conversations with their child, and to assess changes in parents’ self-efficacy on this topic. Methods Video development was based on a scoping review and semi-structured interviews with parents. Respondent demographics and user satisfaction were assessed at pre- and post- video, and 4–6 months later. Self-efficacy scores were compared between parent groups based on weight concerns over time. Results Fifty-seven parents participated in the video questionnaires, and 40 repeated measures 4–6 months later. Significant improvements in self-efficacy in “raising the issue of weight” and “answering questions or concerns” were found after watching the video (p ≤ 0.002) compared to baseline, and scores 4–6 months post baseline remained slightly elevated, but non-significant. Parents with concerns about their child being overweight had significantly lower perceived self-efficacy scores compared to parents with no concerns about their child’s weight (p = 0.031). The video was found to be positively received and of relevance to parents across a number of different domains. Conclusion(s) Preliminary findings suggest an educational video about initiating weight-related conversations may be an effective tool for increasing parents’ perceived self-efficacy in the short term. Further work is needed to validate findings in a randomized controlled trial, and with diverse parent populations. Trial registration ClinicalTrials.gov Identifier: NCT03664492. Registered 10 September 2018 – Retrospectively registered

According to the Valve Academic Resortium, underweight is one parameter in the definition of frailty, which is associated with increased mortality after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Aims of our study were (1) to examine the impact of underweight on mortality after TAVI and SAVR and (2) to determine the effect of intervention mode (TAVI vs SAVR) on mortality in underweight patients from the German Aortic Valve Registry. Overall, 35,109 patients treated with TAVI or SAVR were studied. Outcomes of underweight (body mass index [BMI]

To understand the challenges for thoracic transplantation and mechanical circulatory support during the current coronavirus disease 2019 pandemic, we propose separating the effects of the pandemic into 5 distinct stages from a healthcare system perspective. We discuss how the classical ethical principles of utility, justice, and efficiency may need to be adapted, and we give specific recommendations for thoracic transplantation and mechanical circulatory support centers to balance their clinical decisions and strategies for advanced heart and lung disease during the current pandemic.

Background Noise levels on intensive care units (ICUs) are typically elevated. While many studies reported negative effects of ICU ambient sounds on patients, only few investigated noise as a factor to influence well-being or performance in healthcare professionals. Methods An online survey in the German-speaking part of Switzerland was conducted to assess how ICU soundscapes are subjectively perceived by healthcare professionals. The questionnaire was answered by 348 participants. Additionally, effects of noise on working memory performance were evaluated in an experimental noise exposure setting. Twenty-six healthcare professionals and 27 healthy controls performed a 2-back object-location task while being exposed to either ICU or pink noise. Results Survey results demonstrate that a majority of participants was aware of heightened noise levels. Participants reported that mostly well-being, performance, and attention could be reduced, along with subjective annoyance and fatigue by ICU ambient sounds. Although no significant effects of noise exposure on working memory performance was observed, self-assessments revealed significantly higher stress levels, increased annoyance and distraction ratings as well as decreased confidence in performance after ICU-noise exposure. Conclusion Subjective assessments indicate that heightened noise levels on ICUs induce annoyance, with heightened stress levels, impaired well-being, and reduced performance being potential consequences. Empirical evidence with objective and physiological measures is warranted.

In this paper, we present a new evolution-based algorithm that optimizes cell detection image processing workflows in a self-adaptive fashion. We use evolution strategies to optimize the parameters for all steps of the image processing pipeline and improve cell detection results. The algorithm reliably produces good cell detection results without the need for extensive domain knowledge. Our algorithm also needs no labeled data to produce good cell detection results compared to the state-of-the-art neural network approaches. Furthermore, the algorithm can easily be adapted to different applications by modifying the processing steps in the pipeline and has high scalability since it supports multithreading and computation on graphical processing units (GPUs).

Background IT systems in the healthcare field can have a marked sociotechnical impact: they modify communication habits, alter clinical processes and may have serious ethical implications. The introduction of such systems involves very different groups of stakeholders because of the inherent multi-professionalism in medicine and the role of patients and their relatives that are often underrepresented. Each group contributes distinct perspectives and particular needs, which create specific requirements for IT systems and may strongly influence their acceptance and success. In the past, needs analysis, challenges and requirements for medical IT systems have often been addressed using consensus techniques such as the Delphi technique. Facing the heterogeneous spectrum of stakeholders there is a need to develop these techniques further to control the (strong) influence of the composition of the expert panel on the outcome and to deal systematically with potentially incompatible needs of stakeholder groups. This approach uses the strong advantages a Delphi study has, identifies the disadvantages of traditional Delphi techniques and aims to introduce and evaluate a modified approach called 360-Degree Delphi. Key aspects of 360-Degree Delphi are tested by applying the approach to the needs and requirements analysis of a system for managing patients’ advance directives and living wills. Methods 360-Degree Delphi (short 360°D), as a modified Delphi process, is specified as a structured workflow with the optional use of stakeholder groups. The approach redefines the composition of the expert panel by setting up groups of different stakeholders. Consensus is created within individual stakeholder groups, but is also communicated between groups, while the iterative structure of the Delphi process remains unchanged. We hypothesize that (1) 360-Degree Delphi yields complementary statements from different stakeholders, which would be lost in classical Delphi; while (2) the variation of statements within individual stakeholder groups is lower than within the total collective. A user study is performed that addresses five stakeholder groups (patients, relatives, medical doctors, nurses and software developers) on the topic of living will communication in an emergency context. Qualitative open questions are used in a Delphi round 0. Answer texts are coded by independent raters who carry out systematic bottom-up qualitative text analysis. Inter-rater reliability is calculated and the resulting codes are used to test the hypotheses. Qualitative results are transferred into quantitative questions and then surveyed in round 1. The study took place in Germany. Results About 25% of the invited experts (stakeholders) agreed to take part in the Delphi round 0 (three patients, two relatives, three medical doctors, two qualified nurses and three developers), forming a structured panel of the five stakeholder groups. Two raters created a bottom-up coding, and 238 thematic codes were identified by the qualitative text analysis. The inter-rater reliability showed that 44.95% of the codes were semantically similar and coded for the same parts of the raw textual replies. Based on a consented coding list, a quantitative online-questionnaire was developed and send to different stakeholder groups. With respect to the hypotheses, Delphi round 0 had the following results: (1) doctors had a completely different focus from all the other stakeholder groups on possible channels of communications with the patient; (2) the dispersion of codes within individual stakeholder groups and within the total collective – visualized by box plots – was approximately 28% higher in the total collective than in the sub-collectives, but without a marked effect size. With respect to the hypotheses, Delphi round 1 had the following results: different stakeholder groups had highly diverging opinions with respect to central questions on IT-development. For example, when asked to rate the importance of access control against high availability of data (likert scale, 1 meaning restrictive data access, 6 easy access to all data), patients (mean 4.862, Stdev +/− 1.866) and caregivers (mean 5.667, Stdev: +/− 0.816) highly favored data availability, while relatives would restrict data access (mean 2.778, stdev +/− 1.093). In comparison, the total group would not be representative of either of these individual stakeholder needs (mean 4.344, stdev +/− 1.870). Conclusion 360-Degree Delphi is feasible and allows different stakeholder groups within an expert panel to reach agreement individually. Thus, it generates a more detailed consensus which pays more tribute to individual stakeholders needs. This has the potential to improve the time to consensus as well as to produce a more representative and precise needs and requirements analysis. However, the method may create new challenges for the IT development process, which will have to deal with complementary or even contradictory statements from different stakeholder groups.

Nach den 2 Positionspapieren der Deutschen Gesellschaft fur Kardiologie (DGK) in 2015 und 2016 zum Thema der kathetergestutzten Aortenklappenimplantation (TAVI) haben sich die DGK und die Deutsche Gesellschaft fur Thorax‑, Herz- und Gefaschirurgie (DGTHG) entschlossen, ein Konsensuspapier vorzulegen, das die neuesten Ergebnisse von randomisierten und auch Beobachtungsstudien berucksichtigt, insbesondere bei Patienten mit hochgradiger Aortenklappenstenose (AS) und niedrigem operativem Risiko (STS-Score ≤4 %) sowie bei speziellen Indikationen wie „Klappe in Klappe“ und hochgradiger AS bei bikuspider Aortenklappe. Auserdem wird auf Komplikationen und Themen wie Haltbarkeit der perkutanen im Vergleich zu operativ eingesetzten Prothesen eingegangen – insbesondere unter dem Gesichtspunkt, dass Niedrigrisikopatienten junger sind. Nach diesem Konsensuspapier wird ein chirurgischer Aortenklappenersatz (AKE) bei Niedrigrisikopatienten empfohlen, die ≤70 Jahre alt sind und keine anderen, in den ublichen Scores nicht enthaltenen Risikofaktoren aufweisen. TAVI wird empfohlen bei Patienten >75 Jahre und einer fur TAVI geeigneten Anatomie nach Entscheidung im Herz-Team. Bei 70- bis 75-jahrigen Patienten wird eine Herz-Team-Entscheidung zu TAVI oder AKE unter Bewertung der Lebensperspektive fur den Patienten angesichts fehlender Langzeitdaten aus randomisierten Studien empfohlen. Unter Berucksichtigung des G‑BA(Gemeinsamer Bundesausschuss)-Beschlusses zur perkutanen Herzklappentherapie werden die Kriterien fur die personellen und strukturellen Voraussetzungen unter dem Aspekt der Qualifikation des TAVI-Zentrums und des TAVI-Operateurs mit der speziellen Rolle des interventionellen Kardiologen und des Herzchirurgen definiert.

Two field experiments were conducted at Regional Agricultural Research Station, Tarahara, Nepal during 2012 and 2013 to determine the effect of agronomic management on growth and yield of Swarna Sub1 under flash floods. The first experiment was laid out in a split plot design with three replications; and four different nutrient combinations at nursery as main plots and three age groups of rice seedlings as sub plots. The second experiment was laid out in a randomized complete block design and replicated thrice; with three post flood nutrient doses at six and 12 days after de-submergence (dad). The experiments were complete submerged at 10 days after transplanting for 12 days. The survival percentage, at 21 dad, was significantly higher in plots planted with 35 (90.25%) and 40 (91.58%) days-old seedlings compared to 30 days-old seedlings (81.75%). Plots with 35 days-old seedlings produced 5.15 t ha-1 with advantage of 18.83% over 30 days-old seedlings. Plots with 100-50-50 kg N-P2O5-K2O/ha at nursery recorded the highest grain filling of 79.41% and grain yield of 5.068 t/ha with more benefit. Post flood application of 20-20 N-K20kg/ha at 6 dad resulted in higher plant survival and taller plants, leading to significantly higher grain yield of 5.183 t/ha and straw yield of 5.315 t/ha. Hence, 35-40 days old seedlings raised with 100-50-50 kg N-P2O5-K2O /ha in nursery and the additional application of20-20 kg N-K2O /ha at 6 dad improved plant survival and enhanced yield of Swarna Sub1 under flash flood conditions. The practice has prospects of saving crop loss with getting rice yield above national average yield leading to enhanced food security in the flood prone areas of Nepal.

OBJECTIVE Prognostic models are key for benchmarking intensive care units (ICUs). They require up-to-date predictors and should report transportability properties for reliable predictions. We developed and validated an in-hospital mortality risk prediction model to facilitate benchmarking, quality assurance, and health economics evaluation. STUDY DESIGN AND SETTING We retrieved data from the database of an international (Finland, Estonia, Switzerland) multicenter ICU cohort study from 2015-2017. We used a hierarchical logistic regression model that included age, a modified Simplified Acute Physiology Score-II, admission type, premorbid functional status, and diagnosis as grouping variable. We used pooled and meta-analytic cross-validation approaches to assess temporal and geographical transportability. RESULTS We included 61,224 patients treated in the ICU (hospital mortality 10.6%). The developed prediction model had an area under the receiver operating characteristic curve 0.886, 95% confidence interval (CI) 0.882-0.890; a calibration slope 1.01, 95% CI (0.99-1.03); a mean calibration -0.004, 95% CI (-0.035-0.027). While the model showed very good internal validity and geographic discrimination transportability, we found substantial heterogeneity of performance measures between ICUs (I-squared: 53.4% to 84.7%). CONCLUSION A novel framework evaluating the performance of our prediction model provided key information to judge the validity of our model and its adaptation for future use. WHAT IS NEW?: : Key findings; Our mortality prediction model-which combined established clinically relevant predictors with premorbid functional status and diagnoses as modeling variables-showed very good internal validity, geographic discrimination and temporal transportability, with a substantial heterogeneity of performance measures between ICUs. What does this add to what is known? Premorbid functional status and diagnosis are known predictors of ICU-relevant study outcomes, but are not regularly implemented in established scoring systems. The inclusion of this information showed increased predictive model performance compared to predictions from established risk scoring systems, while showing good internal validation and transportability properties. What is the implication and what should change now? To the best of our knowledge, this is one of the first development and validation studies to investigate geographical and temporal transportability properties of an ICU mortality prediction model. Transportability properties are key in the reliable monitoring and benchmarking of ICUs and for their planning. They provide an important piece of information about the model validity in other study populations and settings, and should be quantified in future validation studies of ICU prediction models.

Our study aimed to describe the population pharmacokinetics (PK) of vancomycin in critically ill patients receiving extracorporeal membrane oxygenation (ECMO), including those receiving concomitant renal replacement therapy (RRT). Dosing simulations were used to recommend maximally effective and safe dosing regimens. Serial vancomycin plasma concentrations were measured and analyzed using a population PK approach on Pmetrics. The final model was used to identify dosing regimens that achieved target exposures of area under the curve (AUC(0-24)) of 400–700 mg · h/liter at steady state. Twenty-two patients were enrolled, of which 11 patients received concomitant RRT. In the non-RRT patients, the median creatinine clearance (CrCL) was 75 ml/min and the mean daily dose of vancomycin was 25.5 mg/kg. Vancomycin was well described in a two-compartment model with CrCL, the presence of RRT, and total body weight found as significant predictors of clearance and central volume of distribution (V(c)). The mean vancomycin renal clearance and V(c) were 3.20 liters/h and 29.7 liters respectively, while the clearance for patients on RRT was 0.15 liters/h. ECMO variables did not improve the final covariate model. We found that recommended dosing regimens for critically ill adult patients not on ECMO can be safely and effectively used in those on ECMO. Loading doses of at least 25 mg/kg followed by maintenance doses of 12.5–20 mg/kg every 12 h are associated with a 97–98% probability of efficacy and 11–12% probability of toxicity, in patients with normal renal function. Therapeutic drug monitoring along with reductions in dosing are warranted for patients with renal impairment and those with concomitant RRT. (This study is registered with the Australian New Zealand Clinical Trials Registry [ANZCTR] under number ACTRN12612000559819.)

Blockchain is a prominently discussed technology in operations and supply chain management and firms increasingly engage in blockchain initiatives. Yet, an understanding of the technology's financial value remains elusive. Based on 175 firm announcements between 2015 and 2019, we conduct an international event study to estimate the impact of blockchain initiatives on the market value of the firm. We empirically demonstrate that blockchain announcements are associated with a significant average abnormal return of 0.30% on the announcement day, and that there are indications of positive long-term effects on shareholder value. We further demonstrate how blockchain use case, project, and firm characteristics affect the stock market reaction. Specifically, we find that the stock market reaction to blockchain announcements is less positive when blockchain is used to trace physical objects or to share sensitive data, providing empirical evidence for the risk associated with current challenges in the design of blockchain use cases. Our results also suggest that the involvement of an external information technology service provider in a blockchain project attenuates the positive stock market reaction. Interestingly, more innovative firms do not experience a stronger stock market reaction to blockchain announcements. Leveraging the international scope of our sample, we further shed light on how the firm's competitive (i.e., industry factors) and macro environment (i.e., country factors) affect the stock market reaction. Our findings indicate that the industry's R&D intensity and the country's data restriction level play a crucial role in driving the value attributed to blockchain initiatives., Production and Operations Management, 31 (1), ISSN:1059-1478, ISSN:1937-5956

Purpose Despite its increased adoption by small, medium and large firms, pricing continues to be ignored in the C-suite. C-suite executives have minimal understanding of what pricing can do and how it impacts a firm’s performance. After two years in the COVID-19 pandemic and the resulting economic crisis, consultants agree that the next wave of strategies and business models will require the development of strategic pricing capabilities, including analytics and software. Design/methodology/approach The authors conducted 49 interviews with CXOs, VPs of pricing and CEOs of pricing software vendors to understand how the best-performing companies use pricing to drive profits and select pricing technologies. Then, supported by the Professional Pricing Society, the world’s largest organization dedicated to pricing, the authors conducted a 2020 survey of 540 pricing professionals to understand the perceptions of pricing in the C-suite and how top executives prioritize pricing investments. The authors complemented their own research with analysis of publicly available data, analyst presentations and public comments by CEOs on pricing. Findings The authors propose a portfolio of 15 activities to include in the CEO’s strategic agenda and 10 actions to get started with in the short term. The next normal will not be based on business-as-usual. For the next three to five years, developing strategic pricing capabilities will give firms a competitive advantage over those who continue to neglect this hidden gem. Originality/value In the context of the accelerating economic recovery, the authors address one of the most pressing priority for the C-suite. The authors focus on a series of actions and activities that the C-suite can take to accelerate recovery and focus on profitable growth.

Background The modifications to the standard intensive care unit (ICU) organization that had to be urgently implemented worldwide to overcome the surge of ICU admissions due to patients with a severe coronavirus disease 2019 (COVID-19) have resulted in increased workload and patients-to-nurse ratio. The aim of this study was to investigate whether level of critical care staffing could be associated with an increased risk of ICU mortality (primary endpoint), length of stay, mechanical ventilation and the evolution of disease (secondary study endpoints) in critically ill patients with COVID-19. Methods Retrospective multicenter analysis of the international Risk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry that prospectively enrolls patients developing critical illness due to COVID-19 in several countries worldwide. The analysis was limited to the period between March 1st, 2020 and May 31st, 2020, to ICUs in Switzerland that have collected additional data on nurse and physician staffing. Hierarchical regression models were used to investigate crude and adjusted effects of critical care staffing ratio on study endpoints. We adjusted for diseases severity and weekly caseload. Results Among the 38 Swiss participating ICUs, 17 recorded critical care staffing information. The study population included 437 patients and 2342 daily assessments of patient-to-nurse/physician ratio. Median of daily patient-to-nurse ratio started at 1.0 ([IQR] 0.5–1.5; calendar week 9) and peaked at 2.4 (IQR 0.4-2.0; calendar week 16), while the median of daily patient-to-physician ratio started at 4.0 (IQR 2.1-5.0; calendar week 9) and peaked at 6.8 (IQR 6.3–7.3; calendar week 19). Neither the patient-to-nurse ratio [adjusted Odds Ratio (OR) 1.28, 95% confidence interval (CI) 0.85–1.94; doubling of ratio] nor the patient-to-physician ratio [adjusted OR 1.08, 95% CI 0.87–1.32; doubling of ratio] was associated with ICU mortality. We found no association of critical care staffing on the investigated secondary study endpoints in adjusted models. COnclusion The Swiss health care system successfully overcame the first wave of the COVID-19 pandemic with regards to the unprecedented demand for ICU treatments. The reduced availability of critical care staffing resources per critically ill patient in Swiss ICUs did not translate in an overall increased risk of mortality.

As telecommunication technologies advance, efforts are being made to mitigate direct patient contact in the COVID-19 pandemic due to the risk of contagion. The ability to host telephone and video visits within patient portals within health care institutions will only become increasingly valuable. Neck pain, a common complaint seen in primary care clinics, is well-suited to telemedicine evaluation, as related etiologies are often comparatively straightforward. A good assessment of the cervical spine by telephone or video is possible with the right knowledge and practice. The purpose of this article is to propose questions and maneuvers that can be used to evaluate the cervical spine via telephone or video, as well as likely diagnoses that can be reached through these. Phone and video evaluation of the cervical spine can result in valuable data regarding symmetry, range of motion, functional movement patterns, modified strength testing, and provocative testing. The skill set necessary to do telephone and video visits should be included in the curriculum of physician learners.

Ventilator-associated pneumonia (VAP) is a frequent complication of mechanical ventilation and is associated with substantial morbidity and mortality. Accurate diagnosis of VAP relies in part on subjective diagnostic criteria. Surveillance according to ventilator-associated event (VAE) criteria may allow quick and objective benchmarking. Our objective was to create an automated surveillance tool for VAE tiers I and II on a large data collection, evaluate its diagnostic accuracy and retrospectively determine the yearly baseline VAE incidence. We included all consecutive intensive care unit admissions of patients with mechanical ventilation at Bern University Hospital, a tertiary referral center, from January 2008 to July 2016. Data was automatically extracted from the patient data management system and automatically processed. We created and implemented an application able to automatically analyze respiratory and relevant medication data according to the Centers for Disease Control protocol for VAE-surveillance. In a subset of patients, we compared the accuracy of automated VAE surveillance according to CDC criteria to a gold standard (a composite of automated and manual evaluation with mediation for discrepancies) and evaluated the evolution of the baseline incidence. The study included 22′442 ventilated admissions with a total of 37′221 ventilator days. 592 ventilator-associated events (tier I) occurred; of these 194 (34%) were of potentially infectious origin (tier II). In our validation sample, automated surveillance had a sensitivity of 98% and specificity of 100% in detecting VAE compared to the gold standard. The yearly VAE incidence rate ranged from 10.1–22.1 per 1000 device days and trend showed a decrease in the yearly incidence rate ratio of 0.96 (95% CI, 0.93–1.00, p = 0.03). This study demonstrated that automated VAE detection is feasible, accurate and reliable and may be applied on a large, retrospective sample and provided insight into long-term institutional VAE incidences. The surveillance tool can be extended to other centres and provides VAE incidences for performing quality control and intervention studies.

Importance A daily dose with 6 mg of dexamethasone is recommended for up to 10 days in patients with severe and critical COVID-19, but a higher dose may benefit those with more severe disease. Objective To assess the effects of 12 mg/d vs 6 mg/d of dexamethasone in patients with COVID-19 and severe hypoxemia. Design, Setting, and Participants A multicenter, randomized clinical trial was conducted between August 2020 and May 2021 at 26 hospitals in Europe and India and included 1000 adults with confirmed COVID-19 requiring at least 10 L/min of oxygen or mechanical ventilation. End of 90-day follow-up was on August 19, 2021. Interventions Patients were randomized 1:1 to 12 mg/d of intravenous dexamethasone (n���=���503) or 6 mg/d of intravenous dexamethasone (n���=���497) for up to 10 days. Main Outcomes and Measures The primary outcome was the number of days alive without life support (invasive mechanical ventilation, circulatory support, or kidney replacement therapy) at 28 days and was adjusted for stratification variables. Of the 8 prespecified secondary outcomes, 5 are included in this analysis (the number of days alive without life support at 90 days, the number of days alive out of the hospital at 90 days, mortality at 28 days and at 90 days, and ���1 serious adverse reactions at 28 days). Results Of the 1000 randomized patients, 982 were included (median age, 65 [IQR, 55-73] years; 305 [31%] women) and primary outcome data were available for 971 (491 in the 12 mg of dexamethasone group and 480 in the 6 mg of dexamethasone group). The median number of days alive without life support was 22.0 days (IQR, 6.0-28.0 days) in the 12 mg of dexamethasone group and 20.5 days (IQR, 4.0-28.0 days) in the 6 mg of dexamethasone group (adjusted mean difference, 1.3 days [95% CI, 0-2.6 days]; P���=���.07). Mortality at 28 days was 27.1% in the 12 mg of dexamethasone group vs 32.3% in the 6 mg of dexamethasone group (adjusted relative risk, 0.86 [99% CI, 0.68-1.08]). Mortality at 90 days was 32.0% in the 12 mg of dexamethasone group vs 37.7% in the 6 mg of dexamethasone group (adjusted relative risk, 0.87 [99% CI, 0.70-1.07]). Serious adverse reactions, including septic shock and invasive fungal infections, occurred in 11.3% in the 12 mg of dexamethasone group vs 13.4% in the 6 mg of dexamethasone group (adjusted relative risk, 0.83 [99% CI, 0.54-1.29]). Conclusions and Relevance Among patients with COVID-19 and severe hypoxemia, 12 mg/d of dexamethasone compared with 6 mg/d of dexamethasone did not result in statistically significantly more days alive without life support at 28 days. However, the trial may have been underpowered to identify a significant difference. Trial Registration ClinicalTrials.gov Identifier: NCT04509973 and ctri.nic.in Identifier: CTRI/2020/10/028731.

Our study aimed to describe the population pharmacokinetics (PK) of piperacillin and tazobactam in patients on extracorporeal membrane oxygenation (ECMO), with and without renal replacement therapy (RRT). We also aimed to use dosing simulations to identify the optimal dosing strategy for these patient groups. Serial piperacillin and tazobactam plasma concentrations were measured with data analyzed using a population PK approach that included staged testing of patient and treatment covariates. Dosing simulations were conducted to identify the optimal dosing strategy that achieved piperacillin target exposures of 50% and 100% fraction of time free drug concentration is above MIC (%fT(>MIC)) and toxic exposures of greater than 360 mg/liter. The tazobactam target of percentage of time free concentrations of >2 mg/liter was also assessed. Twenty-seven patients were enrolled, of which 14 patients were receiving concurrent RRT. Piperacillin and tazobactam were both adequately described by two-compartment models, with body mass index, creatinine clearance, and RRT as significant predictors of PK. There were no substantial differences between observed PK parameters and published parameters from non-ECMO patients. Based on dosing simulations, a 4.5-g every 6 hours regimen administered over 4 hours achieves high probabilities of efficacy at a piperacillin MIC of 16 mg/liter while exposing patients to a

Sepsis can influence blood volume, its distribution, vascular tone, and cardiac function. Persistent hypotension or the need for vasopressors after volume resuscitation is part of the definition of septic shock. Since increased positive fluid balance has been associated with increased morbidity and mortality in sepsis, timing of vasopressors in the treatment of septic shock seems crucial. However, conclusive evidence on timing and sequence of interventions with the goal to restore tissue perfusion is lacking. The aim of this narrative review is to depict the pathophysiology of hypotension in sepsis, evaluate how common interventions to treat hypotension interfere with physiology, and to give a resume of the results from clinical studies focusing on targets and timing of vasopressor in sepsis. The majority of studies comparing early versus late administration of vasopressors in septic shock are rather small, single-center, and retrospective. The range of “early” is between 1 and 12 hours. The available studies suggest a mean arterial pressure of 60 to 65 mm Hg as a threshold for increased risk of morbidity and mortality, whereas higher blood pressure targets do not seem to add further benefits. The data, albeit mostly from observational studies, speak for combining vasopressors with fluids rather “early” in the treatment of septic shock (within a 0–3-hour window). Nevertheless, the optimal resuscitation strategy should take into account the source of infection, the pathophysiology, the time and clinical course preceding the diagnosis of sepsis, and also comorbidities and sepsis-induced organ dysfunction.

I am sure Jerry Lee Lewis would excuse my witticism with the title of his famous rock ’n roll song. However, it depicts metaphorically that radiostereometric analysis (RSA) has become even more of ...

The COVID-19 lockdown in Australia forced Bond University to transition from their normal face-to-face delivery mode to a remote delivery mode during the first trimester of 2020. In this communicat...

The extent to which pricing executives consider consumer perceptions of deception, fairness, and social justice is positioned within an emerging area of research that triangulates the dynamic between legal constraints, ethical considerations, and algorithmic models to make pricing decisions. This paper builds a conceptual model from an analysis of literature describing how companies couple organizational and technology factors into the price-setting process. The legal frameworks of antitrust, data privacy, and antidiscrimination are tethered to the ethical frameworks of deception, fairness, and social justice to form a foundation of relevant organizational factors. A qualitative study is proposed to test the validity of the conceptual model. The primary contribution of this paper is to catalyze practitioner discussion and spur empirical research into the implications of personalized pricing using algorithmic models.

In this paper, we analyze the route efficiency trade-offs that emerge from combining first-mile pickup and last-mile delivery operations in an urban distribution system. We build on the extant literature on continuum approximation of optimal route distances and propose adjustment factors that account for the effects of integrated pickup and delivery operations. By means of comprehensive numerical experiments and regression analysis, we further propose a set of closed-form adjustment factors that improve existing continuum approximation-based route length estimations. These adjustment factors incorporate some non-trivial route efficiency trade-offs emerging from first-mile and last-mile integration that cannot easily be captured through continuum approximation. The proposed extensions are particularly relevant for the optimal strategic design and operational planning of large-scale, high-density last-mile distribution systems that are gaining in importance in light of e-commerce and omni-channel retailing. Our analyses suggest that the efficiency gains emerging from integrating first-mile pickup and last-mile delivery operations can be as high as 30%. However, the effective efficiency gains are sensitive to vehicle capacity constraints and other factors complicating the optimal stop sequence in integrated routes. We apply our proposed method to a real-world case study informed by operational data from one of India’s largest e-commerce platforms for the city of Bengaluru. We find that by properly integrating its first-mile and last-mile operations, the company could reduce its urban traffic and emissions impact by up to 16%, while increasing the asset utilization and reducing the cost of operations of its vehicle fleet.

The incidence rates of adverse events secondary to any operation are a well-known problem in any surgical field. One outstanding example of such adverse events is postoperative pain. Thus, the incidence of acute postoperative pain following any surgical procedure and its treatment are central issues for every surgeon. In the times of Enhanced Recovery After Surgery (ERAS) programs, acute pain therapy became an increasingly well investigated and accepted aspect in almost all surgical subspecialties. However, if it comes to the reduction of postoperative complications, in the actual context of postoperative pain, surgeons tend to focus on the operative process rather than on the perioperative procedures. Undoubtedly, postoperative pain became an important factor with regard to the quality of surgical care: both, the extent and the quality of the surgical procedure and the extent and the quality of the analgesic technique are decisive issues for a successful pain management. There is growing evidence that supports the role of acute pain therapy in reducing postoperative morbidity, and it has been demonstrated that high pain scores postoperatively may contribute to a complicated postoperative course. This overview comprises the current knowledge on the role of acute pain therapy with regard to the occurrence of postoperative complications. Most of the knowledge is derived from studies that primarily focus on the type and quality of postoperative pain therapy in relation to specific surgical procedures and only secondary on complications. As far as existent, data that report on the recovery period after surgery, on the rehabilitation status, on perioperative morbidity, on the development of chronic pain after surgery, and on possible solutions of the latter problem with the institution of transitional pain services will be presented.

Over the last 40 years, the pricing discipline has made tremendous progress in its organization and professionalization. More firms adopt progressive pricing approaches and invest in pricing technical tools. Progress has been made, but there is much more that is needed to bring pricing to the level of adoption seen in the supply chain and analytics functions. Very little is published on the level of penetration and adoption of pricing in general. In this paper, we conduct a thorough secondary research inquiry focused on assessing the level of penetration of the pricing function in global Fortune 500 firms. Our findings reveal a moderate level of penetration (22%) of the pricing function in these firms. The findings establish reference measures for future studies and provide benchmark information for pricing executives wishing to establish a pricing function and to justify greater pricing investments.