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Empirische Untersuchungen zur Dienstleistungsqualität und Kundenzufriedenheit bei Architekturbüros
(2011)
Purpose
The diagnosis of a malignant bone tumor in the lower limb is a risk factor for physical disability, limiting physical performance. Walking ability especially, which is essential for most activities of daily living, is limited in those patients. In the present study, the extent of limitations during the course of treatment was investigated to determine when the assessment of functional parameters is meaningful in those patients.
Methods
In the present study, activity levels were determined in 20 patients with a malignant bone tumor in the lower limb who received endoprosthetic replacement of the affected bone and in 20 healthy individuals. A uniaxial accelerometer was used to investigate patients at five different time points after surgery.
Results
Patients performed significantly less amounts and intensities of activity than control individuals at all measurements. Significant increases in the volume of activity were observed after cessation of treatment. However, the intensity of activity only showed minor increases. Patients experiencing complications of surgery revealed greater restriction than those without even 18 months after surgery.
Conclusions
After cessation of treatment for their disease, patients recovered markedly and showed great improvements in physical activity. However, some limitations appeared to persist. Comparisons with patients with longer follow-up revealed that meaningful functional assessment does not make sense within the first 12 months after surgery. More research is needed to show if longer follow-up periods reveal further improvements. Based on such information, it should be more promising to develop individually tailored activity recommendations and intervention programs.
Zur Bestimmung der Messgenauigkeit handelsüblicher Bewegungssensoren wurden ein Akzelerometer und acht Pedometer von Schulkindern und jungen Erwachsenen unter kontrollierten Bedingungen und unter Alltagsbedingungen im Rahmen einer 24-stündigen Aktivitätsmessung getragen. Die präzisesten Ergebnisse unter kontrollierten Bedingungen wurden mit einem piezoelektrischen Pedometer erzielt. Die absoluten Abweichungen (Median) lagen für diesen Schrittzähler bei den Kindern zwischen 0,2 und 1,0%, bei den Erwachsenen zwischen 0,2 und 1,4%. Die absoluten Abweichungen für den Akzelerometer lagen zwischen 0,8 und 3,1% für die Schulkinder sowie zwischen 0,6 und 3,2% für die Erwachsenen. Die Messpräzision stieg unter kontrollierten Bedingungen mit zunehmender Bewegungsgeschwindigkeit an. Besonders bei den Schulkindern wiesen einige Schrittzähler mit Pendelarm-Mechanismus hohe absolute Abweichungen von über 50% auf. Die Unterschiede unter Alltagsbedingungen verdeutlichen, dass Schrittzahlangaben diverser Monitore nicht direkt miteinander verglichen werden können. In jedem Fall sollten Schrittzähler vor ihrem Einsatz in wissenschaftlichen Untersuchungen auf Gütekriterien wie Validität und Reliabilität gestestet werden.
Bracing is an established method of conservative treatment for adolescent idiopathic scoliosis and kyphosis. Compliance among adolescents is frequently inadequate due to the discomfort of wearing a brace, cosmetic issues, and fear on the part of patients and parents that bracing may reduce everyday physical activities. The aim of this prospective, controlled study was to objectify the impact of spinal bracing on daily step activity in patients receiving conservative treatment for adolescent idiopathic scoliosis (AIS) or adolescent kyphosis (AK). Forty-eight consecutive patients (mean age 13.4 ± 2.3 years), consisting of 38 AIS patients (33 girls, 5 boys) and 10 AK patients (6 girls, 4 boys) were included. Once the decision to carry out bracing had been taken and while the patients were waiting for the individual brace to be built, step activity was assessed without braces by means of step activity monitoring (SAM) for seven consecutive days. After 8 weeks of brace wearing, step activity was assessed during regular brace treatment, again for seven consecutive days. In addition, brace-wearing times were simultaneously recorded using temperature probes implanted in the braces to measure compliance. Before and during brace treatment, patients completed the Scoliosis Research Society (SRS-22) questionnaire. The SAM was worn for an average of 12.7 ± 1.5 h/day during the first measurement and 12.3 ± 1.9 h on average during the second measurement. The mean gait cycles (GCs) per day and per hour before treatment were 5,036 ± 1,465 and 395 ± 105, respectively. No significant reduction in step activity was found at the follow-up measurement during bracing, at 4,880 ± 1,529 GCs/day and 403 ± 144 GCs/h. Taking the 23-h recommended time for brace wearing as a basis (100%), patients wore the brace for 72.7 ± 27.6% of the prescribed time, indicating an acceptable level of compliance. Girls showed a higher compliance level (75.6 ± 25.6%) in comparison with boys (56.7 ± 31.9%), although the difference was not significant (P = 0.093). The SRS-22 total score showed no differences between the two measurements (2.57 ± 0.23 vs. 2.56 ± 0.28). Implementing a simultaneous and objective method of assessing step activity and brace-wearing times in everyday life proved to be feasible, and it expands the information available regarding the impact of bracing on patients’ quality of life. The results clearly show that brace treatment does not negatively interfere with daily step activity in AIS and AK patients. This is an important finding that should help reduce patients’ and parents’ worries concerning bracing.
On the PL Efficiency and Stability of (Ca,Sr,Ba)SiN2:Eu2+ Phosphors for Solid State Light Sources
(2011)
Pr3+ - The Multitasking Ion
(2011)
Reservoir sedimentation is increasingly affecting the majority of reservoirs all over the world. As many dams are more than 50 years of age, this problem is becoming more and more seriou403s nowadays. Reservoir sedimentation leads to various severe problems such as a decisive decrease of the active reservoir volume leading to both loss of energy production and water available for water supply and irrigation. These problems will intensify in the very next future, because sediment supply tends to increase due to climate change. Therefore coun-termeasures have to be developed. They can be divided into the three main categories sediment yield reduction, sediment routing and sediment removal. This paper focuses on sediment routing by means of sediment bypass tunnels. Sediment bypass tunnels are an effective measure to stop or at least decrease the reservoir sedimentation process. By routing the sediments around the reservoir into the tailwater in case of flood events sediment accumulation of both bed load and suspended load is reduced significantly. However, the number of sediment bypass tunnels in the world is limited primarily due to high investment and above all maintenance costs. The state-of-the-art design criteria of constructing bypass tunnels are summarized herein; major problems such as tunnel invert abrasion are discussed. The need for further research regarding sediment transport in bypass tunnels and invert abrasion is highlighted.
Reservoir sedimentation, a serious problem affecting the majority of reservoirs worldwide, was not systematically accounted for in the past. After 50 years of operation, a constantly decreasing reservoir volume becomes currently a serious challenge for reservoir owners, against which countermeasures have to be developed. This research focuses on sediment routing using a bypass tunnel to convey sediments past a dam.
By transporting sediments into the tailwater past a dam, their accumulation in the reservoir is reduced significantly. However, the global number of sediment bypass tunnels is limited primarily due to high investment and maintenance cost. The main problem of all bypass tunnels is the massive invert abrasion due to high flow velocities combined with high sediment transport rates. Therefore, VAW started two research projects to counter this problem. The main goal of the first project Layout and design of sediment bypass tunnels is to investigate the invert abrasion process by conducting hydraulic laboratory tests and to establish general design criteria for optimal flow conditions in which both sediment depositions in the tunnel are avoided and the resulting abrasion damages are kept at a minimum. The second project Optimizing hydroabrasive-resistant materials at sediment bypass tunnels and hydraulic structures investigates the hydraulic resistance of different tunnel invert materials, such as high performance concrete or cast basalt plates in prototype tests at the Solis bypass tunnel. The sediment transport measurement technique used in this project was optimized during preliminary model tests.
Eltern, die finanzielle Unterstützung für eine wissenschaftlich fundierte Förderung (Autismusspezfische Verhaltenstherapie, im angloamerikanischen Raum „Applied Behavior Analysis“) ihres autistischen Kindes beantragen möchten, stoßen bei Behörden und Institutionen häufig auf Ablehnung.
Die aktuelle Finanzierungssituation evidenzbasierter Fördermaßnahmen für autistische Kinder ist in Deutschland geprägt durch Komplexität und Unübersichtlichkeit, die in vielen Fällen eine starke Belastung für betroffene Eltern mit sich bringen. Hierzu trägt zum einen die Unklarheit der gesetzlichen Grundlagen, zum anderen die mangelnde Unterstützung der Eltern von Seiten der zuständigen Institutionen bei. Die aktuelle gesetzliche Lage ist für Laien schwer überschaubar und lässt eine klare Zuständigkeitsregelung für die Finanzierung autismusspezifischer Therapien vermissen. Daher kommt es häufig zu einem Zuständigkeitsgerangel zwischen den gesetzlichen Krankenkassen und den Leistungsträgern der Sozial- und Jugendhilfe. In vielen Fällen wird dadurch eine bestmögliche Förderung sozialer und kognitiver Potenziale bei autistischen Kindern verzögert oder sogar verhindert.
Das vorliegende Buch bietet einen detaillierten Überblick über die gesetzlichen Grundlagen und Möglichkeiten zur finanziellen Förderung autismusspezifischer Verhaltenstherapie. Somit bietet es betroffenen Eltern Hilfestellung, um die Möglichkeiten im Sinne ihres Kindes optimal nutzen zu können.
Parallelsystem Frühe Hilfen?
(2011)
Keine Angst vor Konflikten. Bei positiver Einstellung verbessern sie sogar den Kommunikationsfluss
(2011)
Wirksame Weiterbildung braucht kontinuierliche Bildungspolitik. Interview mit Dr. Thomas Prescher
(2011)