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Many doubts accompany both the resource potential of hardwoods and their softwood substituting potential within its material utilisation. However, as the feedstock demand will rise with more and more wood-based biorefineries entering the market, wood supply security is an increasingly pressing topic. Currently, hardwood flow models are lacking, but are an essential basis for estimating future hardwood supply security. This study investigates the actual hardwood flows in Germany by applying a Material Flow Analysis (MFA). Visualising the results of the MFA for the reference year 2016. The MFA displays 4.44 +/- 0.12 million m³ (fob) recorded fellings in privately-owned forests, 8.60 +/- 0.15 million m³ (fob) recorded fellings in state forests, 9.31 +/- 0.52 million m³ (fob) as unrecorded harvest from forests (i.e. 37% of the total harvest) and 2.65 +/- 0.35 million m³ (fob) unrecorded fellings from non-forest area (11% of total harvest). Of that, almost 30% were used for materials and 70% were used for energy. Consequently, the potential for material use of hardwood in Germany lies beyond its current usage, especially given that good qualities are being used for energy due to actual low material consumer demand. Thus, the MFA assessed the quality and quantity of the German hardwood potential and showed that it offers significant possibilities for value added usage options such as, for example, producing innovative products in biorefineries using degraded high-quality assortments. Due to the low data consistency, heterogeneous datasets for the forest and wood industry sector were calibrated through data reconciliation and error propagation. Additionally, the lack of statistical data for specific wood industry sectors raised a problem, for instance, actual data on private combustion of wood, established hardwood uses, or new innovative products. Severe data issues regarding the German hardwood flow were confirmed.
Holz statt Braunkohle
(2020)
Modern production facilities are becoming increasingly complex, as companies battle to meet the increasingly customer-specific demands with shorter lead times and higher efficiency. For the employees in the factory, who often bear the brunt of making short-term process decisions, this complexity is becoming unmanageable. The PhD project presented in the following aims to decrease the complexity of modern manufactory facilities by means of artificial intelligence. The focus is on product data analysis and manufactory process planning. Different approaches of artificial intelligence for use in a Self-Adapting Smart System (SASS) are to be investigated.
Driving forest machines on wet soils causes irreversible soil compaction, often associated with intensive rut formation and inaccessibility of wheeled forest machines for future forest operations. The German forestry equipment manufacturer FHS, Forsttechnik Handel & Service GmbH, engineered a forwarder, the Trac 81/11, equipped with conventional, well-proved bogie-axles embraced by a closed rubber track. At the center of the bogie-axle, four additional supportive rollers are placed to increase the load-carrying section between the tires of the bogie-axle. The study aimed to characterize the principle concept and the trafficability of the forwarder by analyzing the footprint area, the contact pressure, the rut formation on forest sites and the slippage during driving. Therefore, the effective contact area was measured on steel plates and rut formation was analyzed on a case study basis. Results showed that the supportive rollers increase the contact surface area by about 1/3. By this, a decrease of peak loads below the wheels and a more homogenous load distribution were observed. However, the contact surface area is still clearly divided into three parts; the area between the supportive rollers and the wheels does not take any load. Results of the rut formation were diverse: After 20 passes with 26,700 kg total mass, rut depth varied between 12.6 and 212.5 mm. Overall, the new undercarriage concept of FHS demonstrated a generally positive performance. The engineered forwarder contributes to reduce the environmental impact associated with log extraction.
Introduction: In Germany, all new, innovative medicines are subject to an early benefit assessment by the German Federal Joint Committee with subsequent price negotiation and optional arbitration. The purpose of this study was to identify drivers of negotiated (including arbitrated) prices of new, non-orphan innovative medicines in Germany.
Methods: The analysis considered all non-orphan drugs that underwent a benefit appraisal between January 2011 and June 2016, and displayed a reimbursement price in the German Drug Directory (Lauer-Taxe®) in November 2017. Negotiated annual treatment costs were analyzed with respect to 11 explanatory variables in regression models.
Results: The total sample included 106 non-orphan drugs. The analysis showed a significant and positive association of log-transformed negotiated annual treatment cost of new medicines with log-transformed annual treatment cost of its comparator(s), extent of added benefit, and log-transformed size of the target population. Analyzing the effects of specific endpoints instead of the overall added benefit revealed that the single endpoint with the largest impact on price is adverse events (AEs). Surprisingly, an increase in AEs significantly increased the price. Various subgroup and sensitivity analyses demonstrated the robustness of the results. The adjusted R squared for all models was above 80%.
Conclusions: The analysis was able to confirm that variables whose consideration is mandated by law are, in fact, the key drivers of negotiated prices. Somewhat puzzling, the analysis also found an increase in AEs to move prices significantly upward.
A DDR3 SDRAM test setup implemented on the Griffin III test system from HILEVEL Technologies is used to analyse the row hammer bug. Row hammer pattern experiments are compared to standard retention tests for different manufacturing technologies. The row hammer effect is depending on the number of stress activation cycles. The analysis is extended to an avoidance scheme with refreshes similar to the Target Row Refresh scheme for the DDR4 SDRAM technology.
A novel approach to optically distinguish plastics based on fluorescence lifetime measurements
(2020)
Plastic waste is one of the biggest growing factors contributing to environmental pollution. So far there has been no established method to detect and identify plastics in environmental matrices. Thus, a method based on their characteristic fluorescence behavior is used to investigate whether plastics can be detected and identified in tap water under laboratory conditions. The experiments show that the identification of plastics as a function of water depth is possible. As the identification becomes more difficult with higher water depths, investigations with a highly sensitive imaging method were carried out to obtain an areal integration of the fluorescent light and thus better results.
Hintergrund: Die COVID-19-Pandemie ist eine Ausnahmesituation ohne Präzedenz und erforderte zahlreiche Ad-hoc-Anpassungen in den Strukturen und Prozessen der akutstationären Versorgung.
Ziel: Ziel war es zu untersuchen, wie aus Sicht von Führungspersonen und Hygienefachkräften in der Pflege die stationäre Akutversorgung durch die Pandemiesituation beeinflusst wurde und welche Implikationen sich daraus für die Zukunft ergeben.
Methoden: Qualitative Studie bestehend aus semistrukturierten Interviews mit fünf Verantwortlichen des leitenden Pflegemanagements und drei Hygienefachkräften in vier Krankenhäusern in Deutschland. Die Interviews wurden mittels qualitativer Inhaltsanalyse ausgewertet.
Ergebnisse: Die Befragten beschrieben den auf die prioritäre Versorgung von COVID-19-Fällen hin umstrukturierten Klinikalltag. Herausforderungen waren Unsicherheit und Angst bei den Mitarbeiter_innen, relative Ressourcenknappheit von Material und Personal und die schnelle Umsetzung neuer Anforderungen an die Versorgungleistung. Dem wurde durch gezielte Kommunikation und Information, massive Anstrengungen zur Sicherung der Ressourcen und koordinierte Steuerung aller Prozesse durch bereichsübergreifende, interprofessionelle Task Forces begegnet.
Schlussfolgerungen: Die in der COVID-19-Pandemie vorgenommenen Anpassungen zeigen Entwicklungspotenziale für die zukünftige Routineversorgung auf, z. B. könnten neue Arbeits- und Skill Mix-Modelle aufgegriffen werden. Für die Konkretisierung praktischer Implikationen sind vertiefende Analysen der Daten mit zeitlichem Abstand erforderlich.
Objective: Many different assessment tools are used to assess functioning in rehabilitation; this limits the comparability and aggregation of respective data. The aim of this study was to outline the development of an International Classification of Functioning, Disability and Health (ICF)-based interval-scaled common metric for 2 assessment tools assessing activities of daily living: the Functional Independence Measure (FIMTM) and the Extended Barthel Index (EBI), used in Swiss national rehabilitation quality reports.
Methods: The conceptual equivalence of the 2 tools was assessed through their linking to the ICF. The Rasch measurement model was then applied to create a common metric including FIMTM and EBI.
Subjects: Secondary analysis of a sample of 265 neurological patients from 5 Swiss clinics.
Results: ICF linking found conceptual coherency of the tools. An interval-scaled common metric, including FIMTM and EBI, could be established, given fit to the Rasch model in the related analyses.
Conclusion: The ICF-based and interval-scaled common metric enables comparison of patients and clinics functioning outcomes when different activities of daily living tools are used. The common metric can be included in a Standardized Assessment and Reporting System for functioning information in order to enable data aggregation and comparability.
Keywords: Barthel Index; Functional Independence Measure; Rasch Measurement Model; activities of daily living; outcome assessment (healthcare); psychometrics; quality in healthcare; rehabilitation.
Aquifers are typically perceived as rather stable habitats, characterized by low biogeochemical and microbial community dynamics. Upon contamination, aquifers shift to a perturbed ecological status, in which specialized populations of contaminant degraders establish and mediate aquifer restoration. However, the ecological controls of such degrader populations, and possible feedbacks between hydraulic and microbial habitat components, remain poorly understood. Here, we provide evidence of such couplings, via 4 years of annual sampling of groundwater and sediments across a high-resolution depth-transect of a hydrocarbon plume. Specialized anaerobic degrader populations are known to be established at the reactive fringes of the plume. Here, we show that fluctuations of the groundwater table were paralleled by pronounced dynamics of biogeochemical processes, pollutant degradation, and plume microbiota. Importantly, a switching in maximal relative abundance between dominant degrader populations within the Desulfobulbaceae and Desulfosporosinus spp. was observed after hydraulic dynamics. Thus, functional redundancy amongst anaerobic hydrocarbon degraders could have been relevant in sustaining biodegradation processes after hydraulic fluctuations. These findings contribute to an improved ecological perspective of contaminant plumes as a dynamic microbial habitat, with implications for both monitoring and remediation strategies in situ.
Implementation of robotic devices in nursing care. Barriers and facilitators: an integrative review
(2020)
Background: Robots in healthcare are gaining increasing attention; however, their implementation is challenging due to the complexity of both interventions themselves and the contexts in which they are implemented. The objective of this integrative review is to identify barriers to and facilitators of the implementation of robotic systems in nursing.
Methods: Articles published from 2002 to 2019 reporting on projects to implement robotic devices in nursing care were searched on Medline (via PubMed), CINAHL and databases on funded research projects (Community Research and Development Information Services and Technische Informationsbibliothek) and in journals for robotic research in November 2017 and July 2019 for an update. No restrictions regarding study designs were imposed. All included articles underwent quality assessments with design-specific critical appraisal tools. Barriers to and facilitators of implementation were classified using the Context and Implementation of Complex Interventions framework.
Results: After removing all duplicates, the search revealed 11 204 studies, of which 17 met the inclusion criteria and were included in the synthesis. The majority of the studies dealt with the implementation of robots designed to support individuals, either living at home or in nursing homes (n=11). The studies were conducted in Europe, the USA and New Zealand and were carried out in nursing homes, individual living environments, hospital units and laboratories. The quality of reporting and quality of evidence were low in most studies. The most frequently reported barriers were in socioeconomic and ethical domains and were within the implementation outcomes domain. The most frequently reported facilitators were related to the sociocultural context, implementation process and implementation strategies.
Discussion: This review identified barriers to and facilitators of the implementation of robotic devices in nursing within different dimensions. The results serve as a basis for the development of suitable implementation strategies to reduce potential barriers and promote the integration of elements to facilitate implementation.
PROSPERO registration number: CRD42018073486.
Abstract
Objectives: To develop a common reference metric of functioning, incorporating generic and health condition-specific disability instruments, and to test whether this reference metric is invariant across 2 health conditions.
Design: Psychometric study using secondary data analysis. Firstly, the International Classification of Functioning, Disability and Health (ICF) Linking Rules were used to examine the concept equivalence between the World Health Organization Disability Assessment Schedule (WHODAS 2.0), Health Assessment Questionnaire (HAQ), and Functional Independence Measure (FIMTM). Secondly, a scale-bank was developed using a reference metric approach to test-equating, based on the Rasch measurement model.
Participants: Secondary analysis was performed on data from 487 people; 61.4% with rheumatoid arthritis and 38.6% with stroke.
Results: Three sub-domains of the WHODAS 2.0 and all items of the HAQ and FIMTM motor mapped on to the ICF chapters d4 Mobility, d5 Self-care and d6 Domestic life. Test-equating of these scales resulted in good model fit, indicating that a scale bank and associated reference metric across these 3 instruments could be created.
Conclusion: This study provides a transformation table to enable direct comparisons among instruments measuring physical functioning commonly used in rheumatoid arthritis (HAQ) and stroke (FIMTM motor scale), as well as in people with disability in general (WHODAS 2.0).
Keywords: FIM; Functional Independence Measure; HAQ; Health Assessment Questionnaire; WHODAS 2.0; World Health Organization Disability Assessment Schedule; outcome assessment; rheumatoid arthritis; stroke; psychometrics.
We present a numerical and experimental design study for reducing conducted common mode noise for frequencies below 10MHz generated in switching cells comprising sub-nH commutation loops. Compared to conventional methods of adding external gate resistors our approach does not degrade efficiency. A parallel plate loop design (characterized by a minimum loop inductance and small board area usage) is found suboptimal in terms of conducted EMI compared to a micro-strip line loop geometry. The net ground impedance rather than the net ground inductance is found to mainly contribute to the observed EMI noise.
The dynamic behavior and position stability of servo drives are influenced by many parameters. One major influencing parameter is the pulse width modulation (PWM) frequency. With inverters based on wide bandgap semiconductors, the PWM frequency can be increased. This enables a substantial increase in the current control bandwidth. The paper focuses on the influence of the PWM frequency on the dynamics of control loops and position stability, which are derived from theoretical correlations. The theory is verified using a test bench for high dynamic and position stability. The test bench is equipped with a voice coil motor and power electronic with gallium nitride (GaN) power semiconductors for switching frequencies of 100kHz and over. The achieved position stability, measured with a laser-based comparator at the tool center point, is lower than "+-1nm" with a standard deviation of "0.16nm" at a PWM frequency of "f_PWM=100kHz".
Background
Joint contractures in frail older people are associated with serious restrictions in participation. We developed the Participation Enabling CAre in Nursing (PECAN) intervention, a complex intervention to enable nurses to promote participation in nursing home residents with joint contractures. The aim of this study was to examine the feasibility of the implementation strategy and to identify enablers and barriers for a successful implementation.
Methods
The implementation of PECAN was investigated in a 6-month pilot cluster-randomised controlled trial (c-RCT). As a key component of the implementation strategy, nominated nurses were trained as facilitators in a one-day workshop and supported by peer-mentoring (visit, telephone counselling). A mixed-methods approach was conducted in conjunction with the pilot trial and guided by a framework for process evaluations of c-RCTs. Data were collected using standardised questionnaires (nursing staff), documentation forms, problem-centred qualitative interviews (facilitators, therapists, social workers, relatives, peer-mentors), and a group discussion (facilitators). A set of predefined criteria on the nursing home level was examined. Quantitative data were analysed using descriptive statistics. Qualitative data were analysed using directed content analysis.
Results
Seven nursing homes (n = 4 intervention groups, n = 3 control groups) in two regions of Germany took part in the study. Facilitators responded well to the qualification measures (workshop participation: 14/14; workshop rating: “good”; peer-mentor visit participation: 10/14). The usage of peer-mentoring via telephone varied (one to seven contacts per nursing home). Our implementation strategy was not successful in connection with supplying the intervention to all the nurses. The clear commitment of the entire nursing home and the respect for the expertise of different healthcare professionals were emphasised as enablers, whereas a lack of impact on organisational conditions and routines and a lack of time and staff competence were mentioned as barriers.
Conclusion
The PECAN intervention was delivered as planned to the facilitators but was unable to produce comprehensive changes in the nursing homes and subsequently for the residents. Strategies to systematically include the management and the nursing team from the beginning are needed to support the facilitators during implementation in the main trial.
Trial registration
German clinical trials register, DRKS00010037. Registered 12 February 2016.
Ein zweistufiger Operationsverstärker wird parallel in einer 180nm CMOS Technologie in der Entwicklungsumgebung von Cadence ADE und in MATLAB/Simulink in einem modellbasierten Ansatz entworfen und simuliert. Für den Entwurf in MATLAB/Simulink wird das Kleinsignalersatzschaltbild der physikalischen Schaltung verwendet. Mit Hilfe der Co-Simulation zwischen Cadence und MATLAB/Simulink wird das Verhalten simuliert und ausgewertet. Die Ergebnisse aus beiden Modellen stimmen überein, wodurch festgestellt werden kann, dass die Co-Simulation erfolgreich war.
Für eine Einführung in die fertigungstechnischen Grundlagen der Aufbau- und Verbindungstechnik sind im Wahlfach „Leiterplattentechnik Praktikum“ an der Technischen Hochschule (TH) Rosenheim Inhalte der Prozesstechnik und des Leiterplattendesigns miteinander kombiniert. Zu Beginn der Veranstaltung zeichnen die Praktikumsteilnehmer ein Layout für eine Leiterbahn-Teststruktur, welche anschließend im Haus gefertigt wird. Nach der Fertigung folgt eine elektrische und optische Charakterisierung zur Kontrolle der Prozessqualität. Die praxisnahe Erstellung eines einlagigen Layouts für eine LED-Taschenlampe auf Basis eines vorgegebenen Schaltplans und innerhalb einer begrenzten Platinenfläche sowie dessen Fertigung befähigen die Kursteilnehmer später, eigene Layouts für elektronische Schaltungen selbstständig zu entwickeln. Die anspruchsvolle, teilautomatische Bestückung einer zweilagigen, vorgegebenen SMT(Surface Mount Technology)-Leiterplatte, die ein FM-Radio mit Capacitive Touch-Steuerung bildet, rundet die erfolgreiche Qualifizierung in der Leiterplattentechnik ab.
Background:
Care pathways (CPWs) are complex interventions that have the potential to reduce treatment errors and optimize patient outcomes by translating evidence into local practice. To design an optimal implementation strategy, potential barriers to and facilitators of implementation must be considered.
The objective of this systematic review is to identify barriers to and facilitators of the implementation of CPWs in primary care (PC).
Methods:
A systematic search via Cochrane Library, CINAHL, and MEDLINE via PubMed supplemented by hand searches and citation tracing was carried out. We considered articles reporting on CPWs targeting patients at least 65 years of age in outpatient settings that were written in the English or German language and were published between 2007 and 2019. We considered (non-)randomized controlled trials, controlled before-after studies, interrupted time series studies (main project reports) as well as associated process evaluation reports of either methodology. Two independent researchers performed the study selection; the data extraction and critical appraisal were duplicated until the point of perfect agreement between the two reviewers. Due to the heterogeneity of the included studies, a narrative synthesis was performed.
Results:
Fourteen studies (seven main project reports and seven process evaluation reports) of the identified 8154 records in the search update were included in the synthesis. The structure and content of the interventions as well as the quality of evidence of the studies varied.
The identified barriers and facilitators were classified using the Context and Implementation of Complex Interventions framework. The identified barriers were inadequate staffing, insufficient education, lack of financial compensation, low motivation and lack of time. Adequate skills and knowledge through training activities for health professionals, good multi-disciplinary communication and individual tailored interventions were identified as facilitators.
Conclusions:
In the implementation of CPWs in PC, a multitude of barriers and facilitators must be considered, and most of them can be modified through the careful design of intervention and implementation strategies. Furthermore, process evaluations must become a standard component of implementing CPWs to enable other projects to build upon previous experience.
Living with spinal cord injury in Mongolia: A qualitative study on perceived environmental barriers
(2020)
Context: Environmental factors play a key role in the lives of individuals with a spinal cord injury (SCI). This study identifies environmental barriers and their impacts on daily lives as perceived by individuals living with SCI in Mongolia.
Design: A qualitative study with semi-structured interviews was conducted. A topic guide for the interviews was structured around the components of the International Classification of Functioning, Disability, and Health.
Setting: Urban and rural areas of Mongolia.
Participants: A purposive sample of 16 persons with traumatic SCI.
Interventions: Not applicable.
Outcome Measures: Not applicable.
Results: Seven categories of environmental barriers were mentioned, such as poor access to the physical environment, absence of wheelchair-friendly transportation, negative societal attitudes, inadequate health and rehabilitation services, lack of access to assistive devices and medicines, limited financial resources for healthcare, and inaccurate categorization of disabilities in laws. These barriers were claimed to have an impact on physical and psychological health, limit activities, and restrict participation in almost all areas of life.
Conclusion: This study contributes to the identification of targets for interventions aimed at improving the lived experience of persons with SCI in a low-resource context. The findings reveal that while the Mongolian government already has laws and policies in place to improve access to the physical environment, transportation, assistive devices and employment, much more has to be done in terms of enforcement. Specialized SCI care and rehabilitation services are highly demanded in Mongolia.
Background
Modification of the home environment, together with rehabilitative interventions, is important for maximizing the level of functioning after an individual with disability undergoes rehabilitation in the hospital.
Objectives
We developed a simple screening scale – the home environment checklist (HEC) – to identify any mismatch between an individual's abilities and their home environment to help clinicians monitor the appropriateness of the home environment to which individuals with disability will be discharged. We also examined the psychometric properties of the HEC.
Methods
The HEC was developed by a multidisciplinary panel of rehabilitation experts using information routinely collected in rehabilitation clinics before discharge. The reliability of the checklist was assessed in 60 individuals undergoing rehabilitation. The inter-rater agreement and internal consistency of the scale were assessed by weighted kappa statistics and Cronbach's alpha, respectively. Rasch analysis was performed with 244 rehabilitation individuals to evaluate the internal construct validity, and the known-groups validity was confirmed by a comparison of the daily activity levels of 30 individuals with disabilities under rehabilitation to the HEC score.
Results
The HEC was developed as a simple, 10-item checklist. The weighted kappa statistics ranged from 0.73 to 0.93, indicating excellent inter-rater reliability. Cronbach's alpha was 0.92, indicating high internal consistency. Rasch analysis with a testlet approach on 3 subscales demonstrated a good fit with the Rasch model (χ2 = 13.2, P = 0.153), and the demonstrated unidimensionality and absence of differential item functioning supported the internal construct validity of the HEC. HEC scores were significantly different (P < .01) among individuals with disability and 3 levels of restrictions in their activities (no limitation, home-bound, and bed-bound), which demonstrates the known-groups validity of the HEC.
Conclusions
The HEC has good reliability and validity, which supports its utility in rehabilitation clinics.
Making one's own choices is an important part of leading a fulfilling life within society. However, people with IDs often face significant obstacles when making their own decisions. Article 12 (Equal recognition before the law) of the United Nations Convention on the Rights of Persons with Disabilities (CRPD) aims to ensure firstly that people with IDs and others with compromised capacity are nonetheless recognized as legal individuals, and secondly that assistance is provided in the form of supported decision‐making in order to exercise this resulting legal capacity. It is unclear whether current national legislation in any country satisfies these requirements in practice. This study utilizes institutional ethnography to reveal how decision‐making is coordinated in practice for people with mild to moderate IDs living in supported residential environments in England, and to determine whether these processes are compliant with Article 12 of the CRPD. Data collection was based on observations, semi‐structured interviews, and documentary analysis, involving 29 participants including people with mild to moderate IDs. The results point to the complexity of supported decision‐making and identify three main categories of decision‐making: spontaneous decisions, mid‐term decisions, and strategic decisions. The data also show that people with mild to moderate IDs are able to exercise their legal capacity through support decision‐making in their everyday life. Immediate and informal supported decision‐making exists in daily practice for people with mild to moderate IDs living in supported residential environments. Although there are structures in place for implementing supported decision‐making, various barriers persist that limit the overall efficacy and consistency of the realization of supported decision‐making, for example, multiple use of mental capacity assessments. Such practices move away from the supported decision‐making model toward substituted decision‐making.
Background
The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) in 2001 and has been in the process of implementing it in clinics since then. Current international efforts to implement ICF in rehabilitation clinics include the implementation of ICF Core Sets and the development of simple, intuitive descriptions for the ICF Generic-30 Set (also called Rehabilitation Set). The present study was designed to operationalize these ICF tools for clinical practice in Japan. This work included 1) the development of the Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set, 2) the development of a rating reference guide for Activity and Participation categories, and 3) the examination of the interrater reliability of rating Activity and Participation categories.
Methods
The Japanese version of the simple, intuitive descriptions for the ICF Generic-30 Set was developed following the process employed to develop the Chinese and Italian versions.
For further operationalization of this ICF Set in practice, a rating reference guide was developed. The development of the rating reference guide involved the following steps: 1) a trial of rating patients by several raters, 2) cognitive interviewing of the raters to analyse the thinking process involved in rating, 3) drafting of the rating reference guide, and 4) review by ICF specialists to confirm consistency with the original ICF concepts.
After the rating reference guide was developed, interrater reliability of the rating with the reference guide was determined. Interrater reliability was examined using weighted kappa statistics with linear weight.
Results
Through the pre-defined process, the Japanese version of the simple, intuitive descriptions for 30 categories of the ICF Generic-30 Set and the rating reference guides for 21 Activity and Participation categories were successfully developed. The weighted kappa statistics ranged from 0.61 to 0.85, showing substantial to excellent agreement of the ratings between raters.
Conclusions
The present study demonstrates that ICF categories can be translated into clinical practice. Collaboration between clinicians and researchers would further enhance the implementation of the ICF in Japan.
Impact of spasticity on functioning in spinal cord injury: an application of graphical modelling
(2020)
Abstract
Objective: To identify the impact of moderate-to-severe spasticity on functioning in people living with spinal cord injury.
Design: Secondary analysis of cross-sectional survey data using graphical modelling.
Subjects: Individuals (n = 1,436) with spinal cord injury aged over 16 years with reported spasticity problems.
Methods: Spasticity and 13 other impairments in body functions were assessed using the spinal cord injury Secondary Conditions Scale. Impairments in mental functions were assessed using the Mental Health subscale of the 36-item Short Form (SF-36). Independence in activities was measured with the Spinal Cord Injury Independence Measure Self-Report. Restrictions in participation were measured with the Utrecht Scale for Evaluation Rehabilitation – Participation.
Results: Fifty-one percent of participants reported moderate-to-severe spasticity. Graphical modelling showed that Chronic pain, Contractures, Tiredness, Doing housework, and Respiratory functions were associated with spasticity and were the top 5 potential targets for interventions to improve the experience of spasticity. The associations and intervention targets were dependent on the level and completeness of the lesion.
Conclusion: This is the first application of graphical modelling in studying spasticity in people living with spinal cord injury. The results can be used as a basis for studies aiming to optimize rehabilitation interventions in people with moderate-to-severe spasticity.
Lay Abstract
Spasticity is one of the most common complications of spinal cord injury. It influences limitations in functioning. Comprehensive evidence on the impact of spasticity on all domains of functioning may be beneficial to optimize rehabilitation interventions aimed at reducing the effects of spasticity. This is the first application of graphical modelling to study and visualize the impact of moderate-to-severe spasticity on functioning in people living with spinal cord injury. The results show that chronic pain, contractures, tiredness, doing housework, and respiratory functions were the functioning domains associated with spasticity. These are therefore the top 5 potential targets for interventions to improve the experience of spasticity. In addition, the level and completeness of lesions should be considered when studying spasticity in relation to all domains of functioning. These results should be used as a basis for studies aiming to optimize rehabilitation interventions in people with moderate-to-severe spasticity.
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.