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The aim was to evaluate the effects of additional exercises during inpatient stays on bone mass in pediatric bone tumor patients. 21 patients were non-randomly allocated either to the exercise group (n=10) or the control group (n=11). DXA of the lumbar spine, the non-affected femur and both calcanei was performed after completion of neoadjuvant chemotherapy (baseline), as well as 6 and 12 months after baseline. Bone mineral content (BMC), bone mineral density (BMD) and height-corrected lumbar spine Z-scores were determined. Group changes after 6 and 12 months were compared by covariance analyses. Additionally, daily physical activities (PA) were assessed by means of accelerometry. After adjusting for initial age, height and weight, mean reductions in lumbar spine and femoral BMC were lower in the exercise group (not significant). Effect sizes during the observational period for lumbar spine and femur BMC were generally small (partial η²=0.03). The exercise group demonstrated substantially higher PA levels in terms of gait cycles per day, per hour and moderate PA (activities above 40 gait cycles per minute). Additional exercises for bone tumor patients are feasible during hospitalization. Though the intervention did not influence BMC, it appeared beneficial regarding PA promotion with respect to volume and intensity.
Objectives
Complex midfoot injuries could lead to severe functional impairment of mobility and quality of daily living. Aim of this study was to compare the clinical and functional outcomes of Chopart, Lisfranc fractures and multiple metatarsal shaft fractures.
Design
Retrospective case series.
Setting
Level one trauma center.
Intervention
Open or closed reduction and internal fixation with screws, K-wires, plates, external fixation or combination of different technics.
Main outcome measurements
The American Orthopaedic Foot and Ankle Society (AOFAS) Midfoot Score and the Maryland Foot Score were used to assess pain and functional outcome. 3D gait analysis, pedobarographic analysis and radiologic examinations were performed. The activity level was measured by a step counting accelerometer. All results were compared to an age-matched healthy control group.
Results
24 patients with a median age of 44 years (16–72) were included: 12 patients with multiple metatarsal shaft fractures, 6 patients with Chopart and 6 patients with Lisfranc fractures. The median follow-up was 2.6 years. The pedobarographic analysis reports reduced contact time of the total foot (p = 0.08), the forefoot (p = 0.008) and the hallux (p = 0.015) for the injured foot. A median score of 64 for the SF-36, 64 for the AOFAS Midfoot Score and 73 for the Maryland Foot Score indicated a poor restoration of foot function. Multiple metatarsal shaft fractures presented a significantly lower walking speed (p = 0.03) and cadence (p = 0.04).
Conclusion
The worst results were reported for multiple metatarsal shaft fractures on outcome scores, pedobarography, gait analysis and activity. Metatarsal serial fractures should not be underestimated as well as Chopart and Lisfranc fractures.
An experimental investigation of supercritical uniform and gradually varied open channel flows is presented for a wide range of Froude numbers and flume width-to-flow depth aspect ratios. The instantaneous streamwise and vertical flow velocities were measured in a laboratory flume over the entire width using a two dimensional–laser Doppler anemometry (2D-LDA) system to determine turbulence intensities, and bed and Reynolds shear stresses. The mean velocity patterns show undulation across the flume, indicating the presence of counterrotating secondary current cells. These currents redistribute turbulence intensities and bed and Reynolds shear stresses across the flume. For aspect ratios ≤ 4−5, i.e., narrow open channel flow, the velocity-dip phenomenon is identified both in the streamwise velocity and the Reynolds shear stress distributions. For high aspect ratios, i.e., wide open channel flow, the strength of secondary currents diminish toward the flume center, resulting in a 2D flow farther away from the walls and no velocity-dip phenomenon. Froude number effects on the flow characteristics are less pronounced compared to the aspect ratio effects. At high Froude numbers, the results for narrow and wide open channel flows agree well with literature data. The log-law holds in the inner region across the entire flume width for all investigated Froude numbers and aspect ratios. The Reynolds shear stress distribution agrees well with the computed spanwise bed shear stress distribution. At the flume side walls, the bed shear stresses are 20–50 % higher than the mean values. These results are verified with an engineering example in which high sediment transport and corresponding deep abrasion patterns at the side walls were observed.
Longitudinal Effects of Violent Media Usage on Aggressive Behavior—The Significance of Empathy
(2014)
In einer Pilotstudie wurden 31 Erzieherinnen (Alter: MW = 41,4; sd = 11,2 Jahre; Berufserfahrung: MW = 18,6; sd = 11,5 Jahre) von 17 Kindern mit Typ-1-Diabetes (Alter: MW = 4,5; sd = 1,3 Jahre; Betreuungszeit pro Woche: MW = 29,8; sd = 8,9 Stunden) zur Betreuungssituation in der Kindertageseinrichtung befragt. Über 70 % der Erzieherinnen verfügten nach eigenen Angaben über ein grundlegendes Krankheits- und Therapiewissen und fühlten sich bei der Betreuung des Kindes „sicher“ (35,5 %) bzw. „eher sicher“ (51,6 %). An einer Diabetesschulung hatten 64,5 % der Befragten teilgenommen; 22,6 % äußerten Schulungsbedarf. Die Erzieherinnen führten beim betreuten Kind ein- bis mehrmals täglich Blutzuckerkontrollen durch (MW = 3,8; sd = 1,6) und verabreichten Insulin (MW = 2,7; sd = 1,6) oder unterstützten das Kind bei diesen Therapieaufgaben. 41,9 % der Erzieherinnen vertraten die Ansicht, dass ihre zeitlichen Ressourcen nicht ausreichen, um ein Kind mit Typ-1-Diabetes angemessen zu betreuen. Während der Betreuungszeit in der Kindertageseinrichtung hatten 64,5 % der Erzieherinnen mehrfach eine Hypo- oder Hyperglykämie des Kindes erlebt. Im Hinblick auf das Verhalten in kritischen Situationen, die Berechnung von BE/KE sowie die Berechnung der Insulindosis äußerte jeweils mehr als ein Viertel der Befragten weiteren Informationsbedarf und Angst vor Behandlungsfehlern. Die Zusammenarbeit mit den Eltern wurde positiv wahrgenommen.