Nachhaltigkeit analysieren, bewerten und kommunizieren – Methodenvielfalt in der Agrar- und Ernährungswirtschaft

In response to calls that have been made to measure and control for the sustainability performance of companies in the agri-food sector, several approaches to analyzing, evaluating and communicating sustainability efforts have been developed. This paper provides a classification to systematically examine ten main approaches in terms of their use, field of application, focus of assessment, support in continuous improvement and the way in which the approaches support specific management functions

Lieferbeziehungen unter Druck: Eine Bestandsaufnahme fairer Handelspraktiken und ihr Einfluss auf Vertrauensbildung

Anhaltende Krisen rufen vielfältige Risiken hervor und sorgen für Unsicherheit in Lieferketten. Vertrauen stellt eine wichtige Ressource für die Stabilität von Geschäftsbeziehungen dar. Diese Fallstudie zeigt faire Handelspraktiken und ihren Einfluss auf Vertrauensbildung in Zeiten von Unsicherheit

Linking complement C3 and B cells in nasal polyposis

Nasal polyposis often is characterized by a persistent inflammation of the sinonasal mucosa, disease recurrence after medical or surgical intervention, and asthma comorbidity. Dysregulated complement activation may contribute to immunologic alterations and disease. To date, there is only scattered knowledge on the source and regulation of the central complement factors in the pathogenesis of nasal polyps. Here, we aim to study complement signatures, especially the C3-C3aR axis, and focus on cellular sources and targets in nasal polyps. Expression of complement factors, including C3, C5, and the anaphylatoxin receptors, was analyzed in nasal polyp tissue samples, the corresponding inferior turbinates, and healthy controls using transcriptomic methods and protein measurements. Distinct patterns of complement expression were found in nasal polyps compared to controls, characterized by an increased C3 activation and an increase in C3aR-bearing cells. In contrast, no difference was shown for epithelial-dependent C3 production. Besides low intracellular C3-expression levels for lymphocytes in general, we could identify an enlarged B lymphocyte population in nasal polyps displaying high amounts of intracellular C3. Our data suggest a prominent role for the C3-C3aR-axis in nasal polyps and, for the first time, describe a B cell population containing high levels of intracellular C3, suggesting a new role of B cells in the maintenance of the inflammation by complement

Fallstudien zu den Auswirkungen der Corona-Krise auf betriebliche Transformationsprozesse: Begleitforschung zur Arbeitsweltberichterstattung im Auftrag des BMAS, Bd. 3

Die Studie untersucht auf der Grundlage von fünf Branchen mit je vier Fallstudien Auswirkungen der Corona-Pandemie auf betriebliche Transformationsprozesse in Organisationen. Dazu wurden pro Fall zwei leitfadengestützte Interviews sowohl mit der Arbeitgeber- als auch mit der Arbeitnehmerseite im Winter 2020/21 und im Frühjahr 2021 im Längsschnitt geführt. Inhaltlich wurden zunächst Ziele, Maßnahmen und Herausforderungen der Transformationsprozesse beleuchtet. Die Transformationsprozesse umfassten dabei IT-bezogene Änderungen bzw. Digitalisierungsprojekte, personalbezogene Änderungen oder Änderungen in der Aufbau- oder Ablauforganisation. In vielen Fällen konnten innovationsförderliche Ressourcen wie Kompetenzen, Organisationsstrukturen und externe Netzwerke für den Prozess aktiviert werden. Anschließend befassen sich die Fallbeschreibungen mit den Auswirkungen der Corona-Pandemie auf die jeweilige Organisation. Dabei wird auf besondere Anpassungsmaßnahmen zum Umgang mit der Pandemie sowie auf die wirtschaftlichen und arbeitsorganisatorischen Folgen eingegangen. In vielen Fällen konnte auf fachliche und soziale Kompetenzen der Beschäftigten zurückgegriffen werden, diese zeigten allerdings auch zunehmend Ermüdungserscheinungen. Schließlich wurden die Einflüsse der Corona-Pandemie auf den Veränderungsprozess betrachtet. Die Pandemie hatte je nach Fall verstärkende oder hemmende Einflüsse; in mehreren Fällen erwiesen sich die Veränderungsprozesse als resistent gegenüber der Krise. Insbesondere Digitalisierungsprozesse wurden durch die Pandemie verstärkt. In einer abschließenden Bewertung legten die Interviewpartner:innen ihre "Lessons Learned" aus der Krise und ihre Erwartungen an die Politik dar.The study examines the effects of the corona pandemic on operational transformation processes in organizations on the basis of five industries with four case studies each. For this purpose, two guideline-based interviews were conducted in each case with both the employers and employees in winter of 2020/21 and in spring of 2021 in a longitudinal section. In terms of content, goals, measures and challenges of the transformation processes were examined first. The transformation processes included IT-related changes or digitization projects, personnel-related changes or changes in the structural or process organization. In many cases, innovation-promoting resources (competencies, organizational structures and external networks) could be activated for the process. The case descriptions then deal with the effects of the corona pandemic on the respective organization. Special adaptation measures for dealing with the pandemic as well as the economic and work-organizational consequences are discussed. In many cases it was possible to fall back on the technical and social skills of the employees, but these also increasingly showed signs of fatigue. Finally, the influences of the corona pandemic on the transformation process were considered. Depending on the case, the pandemic had intensifying or inhibiting influences, and in several cases the change processes proved to be resistant to the crisis. In particular, digitalization processes were intensified by the pandemic. In a final assessment, the case descriptions show the "lessons learned" from the crisis and expectations of politics

Identification of Ocular Autoantigens Associated With Juvenile Idiopathic Arthritis-Associated Uveitis

The purpose of the current study was to analyze the binding patterns of serum autoantibodies from juvenile idiopathic arthritis (JIA) and JIA-associated uveitis (JIAU) patients to proteomes from different ocular tissues and to identify potential ocular autoantigens in JIAU. Proteomes from porcine iris, ciliary body, or retina tissue were isolated, separated using 2D-gel electrophoresis, and transferred to a blotting membrane. The binding pattern of serum antibodies from JIA or JIAU patients or healthy controls to ocular proteins was visualized by using anti-human IgG secondary antibodies and chemiluminescence reaction. Selected protein spots were excised from silver-stained 2D gels and subjected to mass spectrometry. Serum antibodies binding to ocular proteins were detected in all patient groups and healthy controls. Irrespective of the patient groups, serum antibodies bound to 49 different protein spots of the retina proteome, to 53 of the ciliary body proteome, and to 44 of the iris proteome. The relative binding frequency of sera to these iris protein spots was significantly higher in JIAU than in JIA patients or healthy controls. Particularly in JIAU patients, cluster analyses indicated a broad range of serum antibodies directed against ocular antigens, mostly in the iris proteome. Iris proteins frequently bound by serum antibodies in all groups were identified as tubulin beta chain, vimentin, ATP synthase subunit beta, actin, and L-lactate dehydrogenase B chain. Iris proteins exclusively bound by JIAU serum antibodies were heat shock cognate 71 kDa protein and keratin. Although serum autoantibody binding to ocular antigens was not disease-specific, a significant diversity of autoantibodies against a broad range of antigens, particularly from the iris tissue, was detected in JIAU patients. As the iris is a major site of inflammation in JIAU, the present data give further evidence that autoantibodies may be involved in JIAU immunopathology

Care for the chronically ill in Germany – The challenges during the COVID-19 pandemic

The COVID-19 pandemic is posing major challenges to the health care sector. This scoping review compiles evidence concerning changes to health care service availability and utilisation as well as possible impacts on health for selected groups of chronically ill people in Germany. The focus is on cancer, cardiovascular diseases, diabetes mellitus and mental disorders. Most empirical data available concerned inpatient care and showed a clear decline in the utilisation of inpatient treatments in March and April 2020 in the areas of oncology and cardiology as well as in mental health. For cardiovascular emergencies such as heart attack and stroke, a decline was observed especially regarding less serious cases. Although there were indications of treatment delays, there was no evidence thus far that emergency care had been generally compromised due to adjustments to inpatient care capacities. In the outpatient setting, extensive adjustments to health care services availability were observed for all disease groups considered. Overall, very limited empirical data were available. In particular, hardly any data were available on how changes in care impacted population health. There is an urgent need for continuous surveillance and evaluation based on health care and epidemiological data.Peer Reviewe

Care for the chronically ill in Germany – The challenges during the COVID-19 pandemic

The COVID-19 pandemic is posing major challenges to the health care sector. This scoping review compiles evidence concerning changes to health care service availability and utilisation as well as possible impacts on health for selected groups of chronically ill people in Germany. The focus is on cancer, cardiovascular diseases, diabetes mellitus and mental disorders. Most empirical data available concerned inpatient care and showed a clear decline in the utilisation of inpatient treatments in March and April 2020 in the areas of oncology and cardiology as well as in mental health. For cardiovascular emergencies such as heart attack and stroke, a decline was observed especially regarding less serious cases. Although there were indications of treatment delays, there was no evidence thus far that emergency care had been generally compromised due to adjustments to inpatient care capacities. In the outpatient setting, extensive adjustments to health care services availability were observed for all disease groups considered. Overall, very limited empirical data were available. In particular, hardly any data were available on how changes in care impacted population health. There is an urgent need for continuous surveillance and evaluation based on health care and epidemiological data.Peer Reviewe

Versorgung von chronisch Kranken in Deutschland - Herausforderungen in Zeiten der COVID-19-Pandemie

Die medizinische Versorgung wird durch die COVID-19-Pandemie vor große Herausforderungen gestellt. Das vorliegende Scoping Review trägt Hinweise auf bisherige Veränderungen der Versorgungsangebote und der Inanspruchnahme sowie mögliche gesundheitliche Folgen für ausgewählte Gruppen chronisch kranker Menschen in Deutschland zusammen. Der Fokus liegt auf Krebserkrankungen, Herz-Kreislauf-Erkrankungen, Diabetes mellitus und psychischen Störungen. Empirische Daten liegen überwiegend für den stationären Bereich vor und zeigen einen deutlichen Rückgang stationärer Behandlungen im März/April 2020 im Bereich der Onkologie und der Kardiologie sowie bei psychischen Störungen. Für kardiovaskuläre Notfälle wie Herzinfarkt und Schlaganfall wurde ein Rückgang vor allem bei leichteren Fällen beobachtet. Bislang liegen einige Hinweise auf verzögerte Inanspruchnahme, jedoch keine Hinweise auf Beeinträchtigung der Notfallversorgung durch Anpassung stationärer Versorgungskapazitäten vor. Im ambulanten Bereich kam es für alle betrachteten Krankheitsgruppen zu umfassenden Anpassungen der Versorgungsangebote. Die empirische Datenlage ist insgesamt noch sehr begrenzt. Insbesondere liegen kaum Daten zu gesundheitlichen Auswirkungen durch Veränderungen in der Versorgung vor. Es besteht dringender Bedarf für kontinuierliche Begleit- und Evaluationsforschung auf der Basis von Versorgungsdaten und epidemiologischer Daten.Peer Reviewe

Teriflunomide treatment for multiple sclerosis modulates T cell mitochondrial respiration with affinity-dependent effects

International audienceInterference with immune cell proliferation represents a successful treatment strategy in T cell-mediated autoimmune diseases such as rheumatoid arthritis and multiple sclerosis (MS). One prominent example is pharmacological inhibition of dihydroorotate dehydrogenase (DHODH), which mediates de novo pyrimidine synthesis in actively proliferating T and B lymphocytes. Within the TERIDYNAMIC clinical study, we observed that the DHODH inhibitor teriflunomide caused selective changes in T cell subset composition and T cell receptor repertoire diversity in patients with relapsing-remitting MS (RRMS). In a preclinical antigen-specific setup, DHODH inhibition preferentially suppressed the proliferation of high-affinity T cells. Mechanistically, DHODH inhibition interferes with oxidative phosphorylation (OXPHOS) and aerobic glycolysis in activated T cells via functional inhibition of complex III of the respiratory chain. The affinity-dependent effects of DHODH inhibition were closely linked to differences in T cell metabolism. High-affinity T cells preferentially use OXPHOS during early activation, which explains their increased susceptibility toward DHODH inhibition. In a mouse model of MS, DHODH inhibitory treatment resulted in preferential inhibition of high-affinity autoreactive T cell clones. Compared to T cells from healthy controls, T cells from patients with RRMS exhibited increased OXPHOS and glycolysis, which were reduced with teriflunomide treatment. Together, these data point to a mechanism of action where DHODH inhibition corrects metabolic disturbances in T cells, which primarily affects profoundly metabolically active high-affinity T cell clones. Hence, DHODH inhibition may promote recovery of an altered T cell receptor repertoire in autoimmunity

Effectiveness of an intensive care telehealth programme to improve process quality (ERIC): a multicentre stepped wedge cluster randomised controlled trial

Purpose!#!Supporting the provision of intensive care medicine through telehealth potentially improves process quality. This may improve patient recovery and long-term outcomes. We investigated the effectiveness of a multifaceted telemedical programme on the adherence to German quality indicators (QIs) in a regional network of intensive care units (ICUs) in Germany.!##!Methods!#!We conducted an investigator-initiated, large-scale, open-label, stepped-wedge cluster randomised controlled trial enrolling adult ICU patients with an expected ICU stay of ≥ 24 h. Twelve ICU clusters in Berlin and Brandenburg were randomly assigned to three sequence groups to transition from control (standard care) to the intervention condition (telemedicine). The quality improvement intervention consisted of daily telemedical rounds guided by eight German acute ICU care QIs and expert consultations. Co-primary effectiveness outcomes were patient-specific daily adherence (fulfilled yes/no) to QIs, assessed by a central end point adjudication committee. Analyses used mixed-effects logistic modelling adjusted for time. This study is completed and registered with ClinicalTrials.gov (NCT03671447).!##!Results!#!Between September 4, 2018, and March 31, 2020, 1463 patients (414 treated on control, 1049 on intervention condition) were enrolled at ten clusters, resulting in 14,783 evaluated days. Two randomised clusters recruited no patients (one withdrew informed consent; one dropped out). The intervention, as implemented, significantly increased QI performance for 'sedation, analgesia and delirium' (adjusted odds ratio (99.375% confidence interval [CI]) 5.328, 3.395-8.358), 'ventilation' (OR 2.248, 1.198-4.217), 'weaning from ventilation' (OR 9.049, 2.707-30.247), 'infection management' (OR 4.397, 1.482-13.037), 'enteral nutrition' (OR 1.579, 1.032-2.416), 'patient and family communication' (OR 6.787, 3.976-11.589), and 'early mobilisation' (OR 3.161, 2.160-4.624). No evidence for a difference in adherence to 'daily multi-professional and interdisciplinary clinical visits' between both conditions was found (OR 1.606, 0.780-3.309). Temporal trends related and unrelated to the intervention were detected. 149 patients died during their index ICU stay (45 treated on control, 104 on intervention condition).!##!Conclusion!#!A telemedical quality improvement program increased adherence to seven evidence-based German performance indicators in acute ICU care. These results need further confirmation in a broader setting of regional, non-academic community hospitals and other healthcare systems