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Background: Current health systems are increasingly challenged to meet the needs of a growing number of patients living with chronic and often multiple health conditions. The primary outcome of care, it is argued, is not merely curing disease but also optimizing functioning over a person’s life span. According to the World Health Organization, functioning can serve as foundation for a comprehensive picture of health and augment the biomedical perspective with a broader and more comprehensive picture of health as it plays out in people’s lives. The crucial importance of information about patient’s functioning for a well-performing health system, however, has yet to be sufficiently appreciated.
Methods: This paper argues that functioning information is fundamental in all components of health systems and enhances the capacity of health systems to optimize patients’ health and health-related needs.
Results and conclusion: Beyond making sense of biomedical disease patterns, health systems can profit from using functioning information to improve interprofessional collaboration and achieve cross-cutting disease treatment outcomes.
- Implications for rehabilitation
- Functioning is a key health outcome for rehabilitation within health systems.
- Information on restoring, maintaining, and optimizing human functioning can strengthen health system response to patients’ health and rehabilitative needs.
- Functioning information guides health systems to achieve cross-cutting health outcomes that respond to the needs of the growing number of individuals living with chronic and multiple health conditions.
- Accounting for individuals functioning helps to overcome fragmentation of care and to improve interprofessional collaboration across settings
Objectives: To examine metric properties and responsiveness of the International Classification of Functioning, Disability and Health (ICF) Generic Set when used in routine clinical practice to assess functioning.
Design: Prospective multicentre study.
Setting: 50 hospitals from 20 provinces of Mainland China.
Participants: 4510 adult inpatients admitted to the departments of Pulmonology, Cardiology, Neurology, Orthopaedics, Cerebral Surgery or Rehabilitation Medicine.
Main outcome measures: The ICF Generic Set (ICF Generic 6 Set) applied with an 11-point numeric rating scale (0-no problem to 10-complete problem) was fit to the Partial Credit Model (PCM) to create an interval score of functioning.
Results: PCM assumptions were found to be fulfilled after accounting for Differential Item Functioning. With an average improvement by 7.86 points of the metric ICF Generic 6 score (95% CI 7.53 to 8.19), the ICF Generic 6 Set proved sensitive to change (Cohen’s f2=0.41). Ceiling and floor effects on detecting change in functioning were cancelled or reduced by using the metric score.
Conclusion: The ICF Generic 6 Set can be used for the assessment of functioning in routine clinical practice and an interval score can be derived which is sensitive to change.
BACKGROUND: In clinical practice and research a variety of clinical data collection tools are used to collect information on people’s functioning for clinical practice and research and national health information systems. Reporting on ICF-based common metrics enables standardized documentation of functioning information in national health information systems. The objective of this methodological note on applying the ICF in rehabilitation is to demonstrate how to report functioning information collected with a data collection tool on ICF-based common metrics. We first specify the requirements for the standardized reporting of functioning information. Secondly, we introduce the methods needed for transforming functioning data to ICF-based common metrics. Finally, we provide an example.
METHODS: The requirements for standardized reporting are as follows: 1) having a common conceptual framework to enable content comparability between any health information; and 2) a measurement framework so that scores between two or more clinical data collection tools can be directly compared. The methods needed to achieve these requirements are the ICF Linking Rules and the Rasch measurement model. Using data collected incorporating the 36-item Short Form Health Survey (SF-36), the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and the Stroke Impact Scale 3.0 (SIS 3.0), the application of the standardized reporting based on common metrics is demonstrated.
RESULTS: A subset of items from the three tools linked to common chapters of the ICF (d4 Mobility, d5 Self-care and d6 Domestic life), were entered as “super items” into the Rasch model. Good fit was achieved with no residual local dependency and a unidimensional metric. A transformation table allows for comparison between scales, and between a scale and the reporting common metric.
CONCLUSIONS: Being able to report functioning information collected with commonly used clinical data collection tools with ICF-based common metrics enables clinicians and researchers to continue using their tools while still being able to compare and aggregate the information within and across tools.
Outdoor-I-U-Messungen an Photovoltaik- (PV) - Modulen haben den Vorteil, dass Effekte wie „light soaking“ oder „light-induced degradation“ unter natürlichen Bedingungen untersucht werden können. Solche Outdoor-Analysen können unter Anwendung des Selbstreferenzierungsalgorithmus (SRA) die Zuverlässigkeit von Indoor-Flasher-Messungen erreichen. Dieses neue Konzept liefert I-UEigenschaften für wesentlich mehr Testbedingungen als vom Standard IEC 61853 gefordert und so können Schwachlichtkurven aller relevanten elektrischen I-U-Parameter für bestimmte Temperaturen erzeugt werden. Wir berichten über experimentelle Ergebnisse einer 6-tägigen Outdoor-Messkampagne an Dünnschicht-PV-Modulen. Wir evaluieren darüber hinaus die Möglichkeiten, Temperaturkoeffizienten, STC- und NOCT-Daten zu bestimmen und I-U-Kennlinien als Basis für Fitting-Analysen abzuleiten. Abschließend wird die Genauigkeit der neuen Outdoor-Methode untersucht.
Im Handbuch werden die wichtigsten gesellschaftlichen Bedingungen und Entwicklungen des Aufwachsens und Erwachsenwerdens von Kinder und Jugendlichen dargestellt. Neben den theoretischen Implikationen des Verständnisses von Kindheit und Jugend werden auch konkrete Forschungsfelder und methodische Herangehensweisen an kindheits- und jugendsoziologische Themen vorgestellt.
Der Lüftung von Wohnräumen und damit der Versorgung von Menschen mit guter Luftqualität wird immer noch eine relative geringe Bedeutung beigemessen. Das ist umso bemerkenswerter als wir einen Großteil unserer Lebenszeit in geschlossenen Räumen verbringen. Die gültige DIN 1946 Teil 6 regelt zum einen den nutzerun¬abhängigen Luftwechsel zum Feuchteschutz und legt zum andere Planungsvorgaben für einen hygienischen Luftwechsel fest. Die wesentliche Neuerung in dieser Norm aus dem Jahre 2009 war die verpflichtende Sicherstellung des Luftwechsels zum Feuchteschutz ohne Nutzereingriff für jeden Neubau und bei lüftungs¬technisch relevanten Sanierungen. Das Gebäude oder die Wohnung muss diesen Mindestluftwechsel von selbst sicherstellen. Reicht dazu der Infiltrationsluftwechsel durch Leckagen nicht aus, sind geeignete lüftungstech¬nische Maßnahmen zu planen und umzusetzen. Somit wurde für Wohnungen die Erstellung eines Lüftungskonzeptes nötig.
In der überarbeiteten Norm wurde dieses Grund¬prinzip beibehalten. Einige der wesentlichen Änderungen sind:
• Neue Berechnung der Infiltration und der Luft¬volumenströme zur Ermittlung der Notwen¬digkeit einer lüftungstechnischen Maßnahme.
• Bei der Berechnung der Volumenströme werden typische Belegungsdichten der Nut-zungseinheiten berücksichtigt.
• Neuaufnahme und definierte Beschreibung von kombinierten Lüftungssystemen, z.B. Kombinationen aus freier und ventilatorge-stützter Systeme.
Über die Auswirkungen der neuen Berechnungs¬ansätze insbesondere auf die Fensterlüftung berichtet der Vortrag.
Soil nailing systems are a common way to stabilize slopes and construction pits. Their design is usually based on the mechanical equilibrium of a rigid body motion and therefore, only tensile stresses are considered and accompanying forces like bending (shear stresses) in the soil nails are neglected. Continuous strain measurements along nails could verify this assumption, but may not be performed using conventional sensing technologies.
This paper reports about monitoring of a soil nailed slope stabilization using distributed fiber optic sensing. Soil nails in different anchoring horizons were instrumented and autonomously monitored over several weeks, in which the construction pit was excavated continuously. After the excavation, the final load bearing capacity of one selected nail was determined within a classical geotechnical load test. In addition to the field measurements, the bending behavior of the instrumented nail system was analyzed under laboratory conditions.
The presented studies demonstrate the high potential of distributed fiber optic sensing systems and their capability to extend traditional measurement methods in foundation engineering applications.
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.
This paper investigates the long-term tensile properties of laminated veneer lumber (LVL) beech sections coated with cement and exposed to fungal decay. A set of LVL coupon (dog-bone) samples was stored in compost, tested in tension after 6 and 12 months and compared to reference samples stored at 20 °C and 65% relative humidity. Results showed that after 26 weeks of compost exposure, a fungus of the Ascomycota genus was identified in cement-coated samples using a molecular biology polymerase chain reaction (PCR) technique, which analyses the internal transcribed spacer (ITS) region of the ribosomal DNA. However, no visual deterioration was noticed.
Still in cement-covered samples and after 12 months of exposure, a common white rot fungus was determined by DNA chip technology, but no fungal wood decay was visible in areas where the applied coating had a thickness of at least 5 mm. Decay in uncoated LVL samples was significant with the samples having an average residual strength equal to 7%. This compares to the tensile strength of coated samples, which only decreased by 65% relative to the reference samples. Strength and stiffness of coated samples did not differ significantly between 6 and 12 months of exposure. Preliminary investigations tend to show that the strength reduction in cement-coated samples is due to an alkaline degradation of the wood. The observed influence of the coating thickness on the visual fungal decay can probably be ascribed to the protection mechanism due to a physical fungal barrier with a high pH.
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.
1. To counteract the severe consequences of eutrophication on water quality and ecosystem health, nutrient inputs have been reduced in many lakes and reservoirs during the last decades. Contrary to expectations, in some lakes phytoplankton biomass did not decrease in response to oligotrophication (nutrient reduction). The underlying mechanisms preventing a decrease in biomass in these lakes are the subject of ongoing discussion.
2. We used a hitherto unpublished long-term data set ranging from 1961 until 2016 from a German drinking water reservoir (Rappbode Reservoir) to investigate the underlying mechanisms preventing a decrease in biomass. Total phosphorus (TP) concentrations in the Rappbode Reservoir dropped abruptly in 1990 from 0.163 to 0.027 mg/L within three consecutive years, as a result of banning phosphate-containing detergents. Despite substantial reductions in TP, total annual phytoplankton biomass did not decline in the long-run, and therefore, the yield of total phytoplankton biomass per unit phosphorus largely increased.
3. Regression analysis revealed a positive association between the yield and potentially phagotrophic mixotrophs (R2 = .465, p < .001). We infer that by ingesting bacteria, mixotrophic species were capable of exploiting additional P sources that are not accessible to obligate autotrophic phytoplankton, eventually preventing a decrease in algal biomass after TP reductions.
4. Long-term epilimnetic phosphorus concentrations during the winter mixing period decreased to a greater degree than summer phosphorus concentrations. Apparently, TP losses over the season were less intense. Spring diatom biomass also markedly decreased after oligotrophication. In fact, spring diatom biomass was positively related to the TP loss over the season suggesting diatoms play an
important role in P reduction. However, this intraannual P processing was not the primary factor when focusing on the average yearly yield, which remained to be fully explained by mixotrophs.
5. Our study demonstrates this ecosystem’s ability to compensate for changes in resource availability through changes in phytoplankton community composition and functional strategies. We conclude that an increase in mixotrophy and the ability to make bacterial phosphorus available for phytoplankters were the main factors that allowed the phytoplankton community of the Rappbode Reservoir to adapt to lower nutrient levels without a loss in total biomass.
Electric-current-assisted sintering (ECAS) is a novel process that can potentially replace the conventional sintering method. It is hypothesized that the process can reduce the sintering time and can be used in situ; thus, can be more cost effective. The purpose of this research is to investigate the effect of direct current on the sintered properties of iron-copper powder metal. Experiments were conducted at various conditions to determine the optimal process parameters for this particular powder metal. The parameters investigated were electric current levels and energizing time. Experiments also included sintering the powder using a conventional furnace. Samples from both types of experiments were compared to determine the metallurgical differences due to the sintering process. Mechanical and microstructure examination were conducted to aid in determining the feasibility of ECAS.
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.
The Impact of Missing Values and Single Imputation upon Rasch Analysis Outcomes: A Simulation Study
(2018)
Imputation becomes common practice through availability of easy-to-use algorithms and software. This study aims to determine if different imputation strategies are robust to the extent and type of missingness, local item dependencies (LID), differential item functioning (DIF), and misfit when doing a Rasch analysis. Four samples were simulated and represented a sample with good metric properties, a sample with LID, a sample with DIF, and a sample with LID and DIF. Missing values were generated with increasing proportion and were either missing at random or completely at random. Four imputation techniques were applied before Rasch analysis and deviation of the results and the quality of fit compared. Imputation strategies showed good performance with less than 15% of missingness. The analysis with missing values performed best in recovering statistical estimates. The best strategy, when doing a Rasch analysis, is the analysis with missing values. If for some reason imputation is necessary, we recommend using the expectation-maximization algorithm.
Objective: To describe functioning in people living with spinal cord injuries (SCI) in Switzerland.
Design: Secondary analysis of cross-sectional survey data. Setting Community, Switzerland.
Participants: Individuals (N=1549) 16 years of age or older with a history of traumatic or nontraumatic SCI and permanently residing in Switzerland.
Interventions: Not applicable.
Main Outcome Measures: Functioning was operationalized through 4 domains: (1) impairments in body functions; (2) impairments in mental functions; (3) independence in performing activities; and (4) performance problems in participation.
Results: Univariate analysis indicated a high prevalence of problems in 5 areas: (1) housework; (2) climbing stairs; (3) tiredness; (4) spasticity; and (5) chronic pain. Graphical modeling showed a strong association among the four domains of functioning. Moreover, we found that the differences in the dependence structures were significant between the paraplegia SCI population and the tetraplegia SCI population.
Conclusions: This study is a first study in the epidemiology of functioning of people living with SCI in Switzerland. Using univariate and graphical modeling approaches, we proposed an empirical foundation for developing hypotheses on functioning in each domain and category that could inform health systems on people’s health needs.
Background: Patient reported outcome measures (PROMs) have been integrated in national quality registries or specific national monitoring initiatives to inform the improvement of quality of care on a national scale. However there are many unanswered questions, such as: how these systems are set up, whether they lead to improved quality of care, which stakeholders use the information once it is available. The aim of this study was to examine supporting and hindering factors relevant to integrating patient-reported outcome measures (PROMs) in selected health information systems (HIS) tailored toward improving quality of care across the entire health system.
Methods: First, a systematic search and review was conducted to outline previously identified factors relevant to the integration of PROMs in the selected HIS. A social network analysis was performed to identify networks of experts in these systems. Second, expert interviews were conducted to discuss and elaborate on the identified factors. Directive content analysis was applied using a HIS Evaluation Framework as the frame of reference. This framework is structured into four components: Organization, Human, Technology, and Net benefits.
Results: The literature review revealed 37 papers for the NHS PROMs Programme and 26 papers for the SHPR and SKAR: Five networks of researchers were identified for the NHS PROMs Programme and 1 for the SHPR and SKAR. Seven experts related to the NHS PROMs Programme and 3 experts related to the SKAR and SHPR participated in the study. The main themes which revealed in relation to Organization were Governance and Capacity building; to Human: Reporting and Stakeholder Engagement; to Technology: the Selection and Collection of PROMs and Data linkage. In relation to Net benefits, system-specific considerations are presented.
Conclusion: Both examples succeeded in integrating PROMs into HIS on a national scale. The lack of an established standard on what change PROMs should be achieved by an intervention limits their usefulness for monitoring quality of care. Whether the PROMs data collected within these systems can be used in routine clinical practice is considered a challenge in both countries.