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The objective of this research project is to develop a solar-powered refrigerator in the lower capacity range of up to 5 kW of cooling power. With the use of liquid pistons and one of the most efficient thermodynamic cycles known, the Stirling cycle, this product has the potential to outperform rival solar cooling technologies while providing inexpensive, reliable, quiet, environmentally-friendly, and efficient solar cooling for residential use, due to its straightforward manufacturing, simple design and inert working gas. Presented in this paper are the newest results of the theoretical and experimental investigation into deducing the key design parameters and system configuration of the so-called Liquid Piston Stirling Cooler (LPSC), which will help lead to optimal performance. Computer models of the complex unconstrained system have been constructed and validated using the modelling software Sage and shown to replicate system behavior with reasonable accuracy in experiments. The models have been used to predict system improvements and identify limitations imposed by the use of liquid pistons. The results to date provide a unique insight into a relatively little studied area in Stirling cycle research.
Functioning information constitutes a relevant component for determining patients’ service needs and respective resource use. Diagnosis-Related Group (DRG) systems can be optimized by integrating functioning information.
First steps toward accounting for functioning information in the German DRG (G-DRG) system have been made; yet, there is no systematic integration of functioning information. The G-DRG system is part of the health system; it is embedded in and as such dependent on various stakeholders and vested interests.
This study explores the stakeholder’s perspective on integrating functioning information in the G-DRG system. A qualitative interview study was conducted with national stakeholders in 4 groups of the G-DRG system (health policy, administration, development, and consultations).
Interviews were analyzed using inductive thematic analysis. In total, 14 interviews were conducted (4 administration and 10 consultation group). Three main themes were identified: (1) functioning information in the G-DRG system: opportunities and obstacles, (2) general aspects concerning optimizing G-DRG systems by integrating additional information, and (3) ideas and requirements on how to proceed.
The study offers insights into the opportunities and obstacles of integrating functioning information in the G-DRG system. The relevance of functioning information was evident. However, the value of functioning information for the G-DRG system was seen critically. Integrating functioning information alone does not seem to be sufficient and a systems approach is needed.
Circular hollow sections of beech-laminated veneer lumber (LVL) for the use as temporary geotechnical soil nailing systems are currently being developed. Due to their permanent subsoil cement embedment, investigations of the bond line quality of the timber sections are essential. This paper presents the bonding properties of flat and curved beech LVL after cyclic conditioning in a water–cement grout solution aimed at inducing short- and long-term alkaline attack of the timber. In total, 409 and 69 samples were tested in tensile shear tests after short-term and long-term conditioning, respectively.
Three different adhesive systems, a one-component polyurethane adhesive, a melamine–urea–formaldehyde adhesive and a melamine–urea–formaldehyde adhesive modified by means of (polyvinyl)-acetate adhesive were investigated and compared. Short-term conditioning by submersion in boiling cement suspension was found to be a reliable method for testing the bonding performance rather than long-term conditioning. In the case of tensile shear tests of samples subjected to long-term treatment, wood material strength was the decisive criterion. Generally, tensile shear test samples of all investigated adhesives achieved reliable bonding for a pressing force up to 1.0 MPa. No relationship was recognised between the determined bonding failure and the wood properties tensile shear strength, wood failure percentage, fracture pattern and bulk density of veneers adjacent to the bond line.
For the determination of the bond line integrity of curved veneer poles, it was necessary to test bonding quality in a combined test using curved and flat samples and to compare tensile shear strength with data determined on reference samples in the same veneer population without bond line.
Innovative circular, hollow, laminated veneer lumber (LVL) beech sections for use as temporary geotechnical soil reinforcement members are currently being developed. Appropriate surface gluing quality between the veneers is fundamental to this subsoil application of the permanently cement-embedded, engineered timber product. The circular cross-section geometry and the permanently high-alkaline environment of the structural member is not covered by presently standardized testing and conditioning methods for examining LVL surface bond line quality. The sample conditioning and tensile shear test method compliant with EN 302-1 (Adhesives for load-bearing timber structures—test methods—part 1: determination of longitudinal tensile shear strength, European Committee for Standardization, Brussels, 2013) was modified to determine bonding parameters for circular, hollow LVL sections. Bond line curvature, groove cutting depth and sample geometry were found to greatly influence stress distribution, percentage of wood failure and tensile shear strength.
Short-term alkaline treatment of test samples did not significantly influence the bonding performance, wood failure percentage, tensile shear strength and fracture patterns. To improve tensile shear strength, adhesives with different material rigidities were used and compared. An orthotropic, elastic numerical analysis revealed a greater influence of adherent elasticity than adhesive elasticity on the stress distribution within the bond line. With regard to determining the bond line integrity of curved veneer poles, a sample geometry compliant with EN 302-1 (2013) was developed and numerically evaluated.
Objectives
To examine which professionals administered which assessment instruments in which patient in clinical practice during first rehabilitation after newly acquired spinal cord injury (SCI) and the differences in the frequencies of different assessments between patient groups.
Setting
Specialized SCI acute care and rehabilitation clinic.
Methods
Patients after SCI, aged 18 years and above, admitted for first rehabilitation between December 2014 and December 2015 were analyzed. Descriptive statistics of 54 selected assessments. p values based on the χ 2 test were calculated for assessments used in both paraplegic and tetraplegic patients.
Results
One hundred and nineteen patients were screened. Forty-one assessments were administered, of which 10 on average more than once per patient. The most frequently used assessments were Spinal Cord Independence Measure III (7.7 times per patient), Skin Assessment (3.6 times), and Manual Muscle Test (3.2 times for Lower Extremities; 2.5 times for Upper Extremities). The American Spinal Injury Association Impairment Scale was administered on average 1.9 times per patient. More variation in the number of assessments per patient was observed in patients with complete and incomplete lesions compared to patients with paraplegia and tetraplegia.
Conclusion
Assessments covering neurological functioning, mobility, and self-care are used in clinical practice during first rehabilitation of patients with SCI, while others covering autonomic functioning, pain, participation, or quality of life are still missing. Based on these observations and national and international requirements, a meaningful standard for an assessment toolkit, applicable in general and in specific subgroups, needs to be defined and implemented.
Objective: To examine the use of the term ‘metric’ in health and social sciences’ literature, focusing on the interval scale implication of the term in Modern Test Theory (MTT).
Materials and methods: A systematic search and review on MTT studies including ‘metric’ or ‘interval scale’ was performed in the health and social sciences literature. The search was restricted to 2001–2005 and 2011–2015. A Text Mining algorithm was employed to operationalize the eligibility criteria and to explore the uses of ‘metric’. The paradigm of each included article (Rasch Measurement Theory (RMT), Item Response Theory (IRT) or both), as well as its type (Theoretical, Methodological, Teaching, Application, Miscellaneous) were determined. An inductive thematic analysis on the first three types was performed.
Results: 70.6% of the 1337 included articles were allocated to RMT, and 68.4% were application papers. Among the number of uses of ‘metric’, it was predominantly a synonym of ‘scale’; as adjective, it referred to measurement or quantification. Three incompatible themes ‘only RMT/all MTT/no MTT models can provide interval measures’ were identified, but ‘interval scale’ was considerably more mentioned in RMT than in IRT.
Conclusion: ‘Metric’ is used in many different ways, and there is no consensus on which MTT metric has interval scale properties. Nevertheless, when using the term ‘metric’, the authors should specify the level of the metric being used (ordinal, ordered, interval, ratio), and justify why according to them the metric is at that level.
Zielsetzung
Seit 2011 werden in Deutschland neuartige Arzneimittel zum Zeitpunkt der Markteinführung einer frühen Nutzenbewertung (FNB) mit anschließender Preisverhandlung unterzogen (AMNOG). Zu diesem Zeitpunkt ist die Evidenz zum Nutzen des Arzneimittels limitiert. Eine erneute Nutzenbewertung (ENB) im gleichen Anwendungsgebiet auf Basis neuerer Evidenz ist allerdings nicht regelhaft, sondern nur in Einzelfällen vorgesehen. Ziel ist, die Ergebnisse von ENB im gleichen Anwendungsgebiet zu untersuchen.
Methodik Analyse sämtlicher Verfahren mit abgeschlossener ENB in den Jahren 2011–2016.
Ergebnisse
Unter den 228 Nutzenbewertungsverfahren sind 52 zu 26 Arzneimitteln mit FNB und ENB im gleichen Anwendungsgebiet. Überproportional viele ENB wurden bei Onkologika und Antidiabetika durchgeführt. Bei 15 Arzneimitteln mit nachgewiesenem Zusatznutzen hatte der G-BA den FNB-Beschluss befristet wegen unzureichender Datenlage zur Markteinführung, teils begründet durch bedingte Zulassungen. Die ENB fand nach 2,6 Jahren statt. Sie führte in 4 Fällen zu einer höheren und in 5 Fällen zu einer niedrigeren Nutzenbewertung. Für 7 Arzneimittel ohne Zusatznutzen beantragten die Hersteller eine ENB auf Basis neuer Evidenz nach ca. 1,7 Jahren. Drei dieser Arzneimittel konnten in der ENB einen Zusatznutzen nachweisen. 4 Orphan Drugs wurden gemäß gesetzlicher Vorgabe erneut bewertet, nachdem sie die Jahresumsatzschwelle von 50 Mio. € überschritten. Bei einem Orphan Drug kam es zu einer besseren, bei 2 zu einer schlechteren Nutzenbewertung. Die durchschnittliche Verbesserung beträgt 1,5 Punkte auf einer Bewertungsskala von −3 (Beleg für geringeren Zusatznutzen) bis 9 (Beleg für erheblichen Zusatznutzen) und ist begründet durch neue Datenschnitte und Studien. Die Verschlechterung beträgt durchschnittlich −1,4 Punkte. Es zeigt sich eine signifikante Korrelation der Veränderung der Nutzenbewertung mit der Veränderung des verhandelten Preises.
Schlussfolgerungen
Die ENB auf Basis einer breiteren Evidenzgrundlage führt nicht zu einer wesentlichen Änderung der Nutzenbewertung und kann die Aussagesicherheit auch nur geringfügig erhöhen. Eine generelle ENB erscheint daher vor dem Hintergrund des administrativen Aufwands nicht gerechtfertigt. Das selektive Verfahren, erneute Nutzenbewertungen durchzuführen, ist hinreichend für Adjustierungen der Nutzenbewertung, wenn die Datenlage zur Markteinführung unzureichend erscheint.
Anwendungsbeobachtung
(2018)