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Objective
To demonstrate the influence and added value of a Standardized Assessment and Reporting System (StARS) upon the reporting of functioning outcomes for national rehabilitation quality reports. A StARS builds upon an ICF-based (International Classification of Functioning, Disability and Health) and interval-scaled common metric.
Design
Comparison of current ordinal-scaled Swiss national rehabilitation outcome reports including an expert-consensus-based transformation scale with StARS-based reports through descriptive statistical methods and content exploration of further development areas of the reports with relevant ICF Core Sets.
Setting
Swiss national public rehabilitation outcome quality reports on the clinic level.
Participants
A total of 29 Swiss rehabilitation clinics provided their quality report datasets including 18 047 patients.
Interventions
Neurological or musculoskeletal rehabilitation.
Main outcome measures
Functional Independence Measure™ or Extended Barthel Index.
Results
Outcomes reported with a StARS tended to be smaller but more precise than in the current ordinal-scaled reports, indicating an overestimation of achieved outcomes in the latter. The comparison of the common metric’s content with ICF Core Sets suggests to include ‘energy and drive functions’ or ‘maintaining a basic body position’ to enhance the content of functioning as an indicator.
Conclusions
A StARS supports the comparison of outcomes assessed with different measures on the same interval-scaled ICF-based common metric. Careful consideration is needed whether an ordinal-scaled or interval-scaled reporting system is applied as the magnitude and precision of reported outcomes is influenced. The StARS’ ICF basis brings an added value by informing further development of functioning as a relevant indicator for national outcome quality reports in rehabilitation.
Zahlensysteme und binäre Arithmetik – Nachricht und Information – Codierung und Datenkompression – Verschlüsselung – Schaltalgebra, Schaltnetze und Elemente der Computerhardware – Rechnerarchitekturen – Rechnernetze – Betriebssysteme – prozedurale und objektorientierte Programmierung (C und Java) – Automatentheorie und formale Sprachen – Berechenbarkeit und Komplexität – Suchen und Sortieren – Bäume und Graphen – Software-Engineering – Datenbanken – Anwendungsprogrammierung im Internet (HTML, CSS, JavaScript und PHP) – Deep Learning mit neuronalen Netzen
Study design
Cross-sectional.
Objectives
To examine the associations between activities, body structures and functions, and their relationship with aetiology, age and sex in persons with spinal cord injury (SCI) at discharge from first rehabilitation.
Setting
Swiss SCI Cohort Study (SwiSCI).
Methods
The study included 390 participants with newly acquired SCI and the International Classification of Functioning, Disability and Health (ICF) as conceptual frame of reference. Body structures were represented by injury level and severity; body functions by cardiovascular, pulmonary, skin, bowel and urinary functions and pain; mental functions by anxiety, depression, optimism and self-esteem; and activities by independence in performing activities of daily living (ADL). Using structural equation modelling (SEM), indirect effects of body structures and functions on independence in performing ADL through mental functions were tested for each mental function separately. For each structural model, fit was assessed using several indices and differences in aetiology, age and sex groups were explored.
Results
The structural model about optimism showed good fit in all indices; the models about anxiety, depression and self-esteem showed conflicting fit indices, respectively. Within all models, effects on independence in performing ADL were mainly direct. Pain showed significant (P < 0.05) indirect effects on independence in performing ADL within the depression, optimism and self-esteem models. The model about anxiety showed differences in aetiology groups.
Conclusions
Using an ICF-based modelling approach, this study presents an attempt towards a more comprehensive understanding of functioning in first rehabilitation of persons with SCI, which might be fundamental for rehabilitation planning.
Study design
Case study.
Objective
To present a framework for developing an International Classification of Functioning, Disability and Health (ICF)-based documentation system in spinal cord injury (SCI)-specific rehabilitation.
Setting
Data collection took place at Maharaj Hospital, Thailand. The preparatory studies and analysis were performed at Swiss Paraplegic Research, Switzerland.
Methods
Data collected from interviews and health records of four SCI cases across the continuum of care (acute, post-acute, early and late long term) were linked to ICF categories using established ICF linking rules. The resulting categories were compared with selected ICF sets (ICF Generic-30, ICF core sets for SCI and multiple sclerosis) to determine the extent of coverage. Furthermore, the context of applicable services was described systematically.
Results
Less than half of the ICF categories in the defined ICF sets were covered by clinical assessment tools. Low correspondence was found predominantly in acute and late long-term phase. Least well covered were categories of activities and participations and environmental factors. The correspondence of categories increased when considering the additional ICF categories identified from patient interviews. The description of rehabilitation services provided in each case classified according to the dimensions of service provider, funding, and service delivery.
Conclusions
There is a need to promote the systematic and standardized assessment of functioning among health professionals working in the field of SCI in developing countries. This study describes basic steps toward developing a standardized ICF-based system for assessing and reporting functioning outcomes in SCI rehabilitation and across the continuum of care.
The use of wood in geotechnical applications has seen renewed interest. However, concerns related to the durability and service life of wood in ground contact applications remain. Wood has the potential to substitute commonly used steel and concrete in the geotechnical engineering sector, but solutions to extending the service life and maintenance intervals require long-lasting wood protection systems capable of inhibiting fungal and bacterial decay. Cement, one of the constituents of concrete was identified as a potential coating material for wood used in soil stabilisation works. Spruce and beech wood rest rolls from commercial veneer peeling has been identified as a potential source for cement-coated geotechnical wood products. Norway spruce and European beech wood was subsequently used in this study.
In this study, a series of tests related to dimensional stability and fungal durability were undertaken to investigate the adhesion of a cement coating to wood and to assess the effect of a cement coating on the resistance to fungal decay. Swelling and shrinkage tests of uncoated specimens were undertaken to investigate dimensional stability. Laboratory fungal durability tests assessed changes in wood durability of specimens coated with a novel, flexural cement coating. Wood impregnated with Polyethyleneglycol-dimethacrylate (PEGDMA) prior to cement coating was investigated to improve wood dimensional stability and reduce cracking of the cement coating under changing wood moisture conditions. Cement coating thickness and delamination tests then assessed the durability of the novel cement coating itself. Results from fungal durability tests showed that a continuous, flexural, and crack-free cement coating was imperative to a wood durability improvement. Double cement-coated spruce wood showed improved resistance to decay by basidiomycetes (Coniphora puteana and Trametes versicolor). Results from swelling and shrinkage tests showed that an improvement in dimensional stability would assist in achieving a durable cement coating and impregnation with Polyethyleneglycol-dimethacrylate (PEGDMA) is one manner to improve dimensional stability and therefore cement adhesion to the wood substrate.
Freifeldcharakterisierung von PV-Anlagen im Rahmen des Projektes PV- FeldLab -ein Statusbericht-
(2020)
Das Projekt PV-FeldLab verfolgt das Ziel, ein umfassendes Konzept für eine messtechnisch sehr präzise elektrische Freifeld-Charakterisierung von PV-Generatoren zu entwickeln. Es beinhaltet eine optische Untersuchung mittels drohnengestützter Thermografie und eine genaue elektrische Charakterisierung von PV-Anlagen im Freifeld, auch bei räumlicher Inhomogenität von Bestrahlungsstärke, Temperatur und bei variablen Aufbauwinkeln von Modulen im Strang. Die Verknüpfung der elektrischen und optischen Messdaten erlaubt eine effiziente Untersuchung von PV-Anlagen und ermöglicht eine Präzisierung von Ertragsanalysen. Dieser Bericht beschreibt den ersten Projektabschnitt, in welchem der Fokus vor allem auf der Initialisierung der messtechnischen Komponenten, sowie ersten Messungen und Analysen liegt.
A quantitative physical model for potential induced degradation of the shunting type (PID-s) in solar modules is introduced. Based on a drift and diffusion approach for sodium ions and atoms, it gives insight into the kinetics of degradation and the corresponding regeneration. A simple drift/source term is used to describe the time-dependent flux of Na-ions towards stacking faults at the surface of the solar cell. The assumed transport mechanism for Na+ ions through the SiN-layer uses the modified Stern-Eyring rate theory but our approach can also be adapted to other mechanisms. Several PID-s and regeneration curves of one-cell solar modules at T = 49°C and T = 90°C with 1000V potential difference between modul frame and cell were measured and least-square fits of the in-situ measured parallel resistance Rsh to the model were performed giving very good accordance.
Based on a few measurements, the model can predict PID-s and regeneration characteristics of solar modules under different conditions.
Alle Menschen sollen an den sich schnell erweiternden Möglichkeiten, die Gesundheit wiederherzustellen, zu erhalten und zu bessern, in gleicher Weise teilhaben können. Die Diskussion um steigende Ausgaben für Gesundheit, Rationierung von Leistungen, Fachkräftemangel und Disparitäten im Zugang zur Versorgung zeigt aber: Dieses Versprechen steht in Frage.
Eine besser koordinierte, stärker patientenzentrierte und intersektoral angelegte Versorgung kann Teil der Lösung sein, das Versprechen weiter aufrecht zu halten. Voraussetzung hierfür ist ein Vergütungssystem, das die Sektorengrenzen tatsächlich überwinden kann und Qualität belohnt. Internationale Erfahrungen zeigen, dass sogenannte Capitation-Modelle, die auf mengenunabhängigen und sektorenübergreifenden Pro-Kopf-Pauschalen beruhen, – geeignet ausgestaltet – Anreize für eine derartige Versorgung schaffen können. In solchen Modellen übernehmen Leistungserbringer einen Teil des Versicherungsrisikos bzw. der finanziellen Verantwortung für Leistungen, die direkt von ihnen erbracht, veranlasst oder nicht vermieden werden. Das Potenzial ist deutlich sichtbar. Allerdings gibt es auch Herausforderungen und Risiken, die mit einem derartigen System einhergehen und entsprechend zu adressieren bzw. zu kontrollieren sind.
Deshalb prüft das vorliegende Buch differenziert die Voraussetzungen und Potenziale des Transfers eines derartigen populationsorientierten Vergütungsansatzes nach Deutschland und zeigt die Optionen einer möglichen Umsetzung in Form prospektiver regionaler Gesundheitsbudgets auf. Die Basis hierzu bildet eine fundierte Analyse von Modellen aus Spanien, Peru, den USA und der Schweiz.
Die im deutschen Gesundheitssystem implementierten Vergütungssysteme sind dringend reformbedürftig. Dies gilt insbesondere für den Krankenhaussektor, in dem die Auswirkungen diverser Fehlanreize zu einer Kaskade korrigierender Eingriffe geführt haben, ohne jedoch die tiefwurzelnden Probleme grundlegend zu adressieren. Eine alternative Vergütungsform stellen prospektive regionale Gesundheitsbudgets dar. Diese basieren auf Konzepten, die dem Prinzip der Capitation folgen und nicht für einzelne Fälle oder auch einzelne Patienten, sondern für ganze Gruppen von Versicherten eine sektorenübergreifende Vergütung beinhalten. Im Idealfall wird damit die gesamte Bevölkerung einer Region abgedeckt. Die Umsetzung derartiger pauschalierter Vergütungssysteme ist herausfordernd. Deshalb stellt dieser Beitrag Erfahrungen aus Spanien und den USA dar und diskutiert Implikationen für eine mögliche Implementierung in Deutschland. Das spanische Valencia-Modell steht dabei für einen unmittelbaren und weitreichenden Systemwechsel durch die Implementierung von Modellen, bei denen der Staat eine Konzession für die regionale Versorgung an private Akteure vergibt. Der am Beispiel einer Accountable Care Organisation dargestellte Ansatz der USA verfolgt hingegen die Strategie eines Transformationspfades , der schrittweise zu einer stärkeren Pauschalierung führt und kontinuierlich auf Basis aktueller Erkenntnisse angepasst wird. Es zeigt sich, dass die Modelle zwingend für alle Beteiligten einen Zusatznutzen gegenüber dem Status quo stiften müssen, um angenommen zu werden. Auf der wirtschaftlichen Ebene müssen die Risiken adäquat abgesichert werden, ohne dabei die gewünschten Anreize auszuhebeln. Gleichzeitig müssen wirksame Vorkehrungen getroffen werden, die Unterversorgung verhindern und positive Qualitätsanreize schaffen.
1. Understanding and explaining the structure of communities in response to environmental gradients is a central goal in ecology. Trait‐based approaches are promising but yet rarely applied to understand community dynamics in response to changing environmental conditions.
2. Here, we investigate seasonal succession patterns of functional traits in phytoplankton communities and how nutrient reductions (oligotrophication) alter these patterns. We used phytoplankton data from 40 years of observation from the Rappbode Reservoir (Germany), which underwent a strong shift in trophic conditions, and translated taxonomic composition into functional traits by assigning trait values compiled from the literature.
3. All studied traits (morphological, behavioural and physiological traits) responded to changing environmental conditions and showed consistent, reoccurring seasonal developments. The seasonal succession of phytoplankton communities was shaped by a trade‐off between small‐celled, fast‐growing species that are able to rapidly incorporate existing resources (r ‐strategists) and large‐celled species with more complex and efficient mechanisms to exploit scarce mineral nutrients or acquire previously unexploited nutrient pools (k ‐strategists). In summer, when nutrients were scarce, the k ‐strategy was prevailing (important traits: phosphate affinity, nitrogen fixation, motility and mixotrophy). During the rest of the year, nutrients and turbulence were high and r ‐strategists dominated (important traits: maximum growth rate and light affinity).
4. A comparison between eutrophic and oligotrophic years revealed that the main features of functional trait succession were largely preserved, but intra‐annual fluctuations from spring to summer were stronger during eutrophic years. Nutrient reductions mainly affected functional traits and biomass in spring, while in summer the functional community composition changed little.
5. Synthesis. This study provides for the first time a quantitatively supported functional template for trait‐based succession patterns in lakes under different nutrient conditions. By translating taxonomic composition into trait information, we demonstrate that the quantification of functional characteristics enables ecological interpretation of observed community dynamics and provides not only a testable template but also a powerful tool towards a more mechanistic understanding. The quantification of functional traits further improves the predictability of community shifts in response to changing environmental conditions and thus opens new perspectives for predictive limnology using lake ecosystem models.
Der Artikel diskutiert den praktischen Nutzen der Marktüberwachung von Bauprodukten im Geltungsbereich harmonisierter Normen unter der Bauproduktenrichtlinie. Neben formalen Aspekten kann die Marktüberwachung hier im wesentlichen sicherstellen, dass die tatsächlich vorhandenen Leistungen den erklärten Leistungen entsprechen. Dies entlastet den Verwender der Bauprodukte nicht von der Prüfung, ob die erklärten Leistungen die Anforderungen in der konkreten Verwendung erfüllen. Es wird kurz auf vorhandene Statistiken zur Marktüberwachung von Bauprodukten eingegangen.