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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.
Novel Orange Emitting Phosphor (Tb1-xSmx)2Mo3O12 with Highly Efficient Tb3+ to Sm3+ Energy Transfer
(2014)
Sediment bypass tunnels are an effective countermeasure against reservoir sedimenta-tion. They are operated at supercritical sediment-laden open channel flow conditions. The major drawback of these tunnels, besides high construction costs, is the severe invert abrasion caused by these flows provoking high annual maintenance costs. The project goal was to analyze the fundamental physical processes and to develop design criteria to decrease these negative effects. A laboratory study was performed in a scaled hydraulic model flume. The project was divided in three main test phases giving new insights into the dynamics of turbulence structures and particle motions, resulting bed abrasion and their interactions in a supercritical open channel flow, respectively. In phase A the mean and turbulent flow characteristics were investigated. In phase B single sediment particle motion was analyzed. In phase C the invert abrasion development in time and space was examined.
Phase A revealed that secondary current cells affect the turbulent flow pattern leading to high bed shear stress at the wall vicinity. In phase B it was found, that particles were dominantly transported in saltation. Relationships between the saltation probability, and particle hop lengths and heights to the flow Shields parameter were found. The specific impact energy was determined by the impact velocity, number of impacts and the amount of particles transported in time. In phase C the results show that bed abrasion progresses with time both in the lateral and vertical direction. Two lateral incision chan-nels developed along the flume side walls at narrow flow conditions occurring at low flume-width to flow-depth aspect ratios b/h < 4-5, whereas randomly distributed pot-holes were found at wide channels where b/h > 4-5. The observed abrasion patterns match well with the spanwise bed shear stress distributions found in phase A. Further-more it was found that the abraded mass linearly increases with the transported sedi-ment mass allowing for a linear fit. Further results showed that abrasion increased with flow intensity and sediment transport rate, with highest values for the mean particle diameter category, whereas abrasion decreased with increasing material strength.
Finally, a new formulation was developed based on Sklar’s saltation abrasion model. A new abrasion coefficient CA is introduced correlating the impact energy and material properties with the gravimetric abrasion rate.
Single glass sphere motion recordings were conducted in a transitional-rough bed open channel at steady and highly supercritical flow similar to hydraulic conditions in sediment bypass tunnels. A high speed camera with a maximum resolution of 2,560 × 2,160 pixels was used to record the movement of bedload particles with diameters of D = 5.3, 10.3 and 17.5 mm. An in-house developed Particle Tracking Velocimetry (PTV) program was used to determine the transport mode and velocities of each particle for a wide range of Froude numbers up to Fo = 6. The relative roughness defined as the ratio of the bed roughness height ks to the water depth h varied from ks/h = 0.02–0.03. Particles were observed to move in rolling and saltation modes depending on the Shields number. The particle velocity shows a linearly increasing relationship with both friction velocity and Froude number nearly independent on the particle diameter. A linear relationship was also found between rolling and saltating particle velocities indicating that particle velocity does not depend on the transport mode in the range of the investigated hydraulic conditions. Scaling of particle velocity with the wave celerity plotted as a function of the Froude number adequately merged external data sets with the present data. As a consequence, a linear fit for a large Froude number range was obtained.
Worldwide, a large number of reservoirs impounded by dams are rapidly filling up with sediments. As on a global level the loss of reservoir volume due to sedimentation increases faster than the creation of new storage volume, the sustainability of reservoirs may be questioned if no countermeasures are taken. This paper gives an overview of the amount and the processes of reservoir sedimentation and its impact on dams and reservoirs. Furthermore, sediment bypass tunnels as a countermeasure for small to medium sized reservoirs are discussed with their pros and cons. The issue of hydroabrasion is highlighted, and the main design features to be applied for sediment bypass tunnels are given.
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)
An international consensus for assessing internet gaming disorder using the new DSM-5 approach
(2014)
MEDIA PROTECT - a programme targeting parents to prevent children's problematic use of screen media
(2014)
The presence of cancer and additional parental responsibilities can increase strain for individual patients as well as for their children. The construct of health-related quality of life (HRQL) is appropriate to measure a combination of physical, mental and social consequences as a result of disease. However, previous research has merely focused on symptom checklists. This study addresses the following questions: (i) does HRQL in children and their parents with cancer differ compared to the general population? (ii) Are there any variables that are associated with HRQL in children? (iii) What are current psychosocial support needs? A population-based survey of 976 survivors (<6 years post diagnosis) with minor children between 6 and 18 years (n = 1,449) was conducted with two German cancer registries. HRQL was assessed using SF-8 (survivors) and Kidscreen (children). The results were compared to normative populations, and predictors associated with HRQL in children were evaluated within a multilevel model. We found that the HRQL in children was better compared to the norm. Only children with support needs had worse HRQL. Older age, having a mother with cancer, having a parent not living together with a partner, and worse parental physical and mental health influenced HRQL in children. Illness characteristics were irrelevant. Even with a mean of 3.5 years after diagnosis, survivors had lower physical and mental health compared to the norm. Our findings reinforce the need for health professionals to pay attention to younger patients and their children. Even years after diagnosis, life might not have returned to normal.
OBJECTIVE To compare the emotional and behavioral problems of children of patients suffering from cancer or a mental disorder and their association with parental quality of life. METHODS A total of 223 children from 136 families and their 160 parents were investigated from multiple perspectives in a cross-sectional study. The consistency of different adjustment reports between family members was examined. Through mixed models, the differences between parental HRQoL and the children's symptomatology were studied with regard to the type of parental illness. The prediction of children's adjustment through parental HRQoL was further examined. Additionally, gender and age of the children were considered. RESULTS Half of the children exhibited psychosocial problems. Gender and age differences were independent of the type of parental disease. In families with parental cancer, the reports of children's adjustment were more consistent between family members than in families where a parental mental disorder was present. We found differences in HRQoL between families with mentally ill parents and those with parental cancer patients. Specifically, the healthy partners of mentally ill parents showed worse HRQoL compared with healthy partners of cancer patients. Healthy parents' reduced HRQoL was associated with worse adjustment in their children, regardless of the type of parental illness, but this result was not found for ill parents. CONCLUSION Family members confronted with parental cancer or mental disorders are more burdened compared with those from the normal population, independently of the type of disease. Our results indicate that the type of a parental disease has no direct effect on children's adjustment. However, there are disease-specific effects on parental HRQoL, which are associated with children's adjustment.
BACKGROUND Children of patients with cancer are at increased risk for developing emotional and behavioral problems. This study explored the prevalence and predictors of emotional and behavioral problems in Children of cancer patients in a multisite research project. METHODS A cross-sectional sample of N = 235 families was recruited simultaneously in 5 university medical centers. The participants, including parents (N = 402) and children (N = 324; ages 11-21 years) completed standardized questionnaires. Emotional and behavioral problems in children were measured by the Strengths and Difficulties Questionnaire (SDQ). On the basis of previous research and using a mixed-model approach, child-, parent-, family- and cancer-related variables were examined in addition to socioeconomic status as potential predictors. Descriptive statistics and a multiple random coefficient model were used in the analyses. RESULTS Compared to norms, Children of cancer patients show increased mean levels of emotional and behavioral symptoms. The best predictor of emotional and behavioral problems from the perspectives of the child, the healthy parent, and the ill parent was general family dysfunction. Although family dysfunction was identified as the main predictor, the analysis revealed that the main part of variance was related to the individual child's level. CONCLUSIONS The results indicate that screening for child mental health problems and family dysfunction in oncological and psychosocial treatment units can identify the families most in need of psychosocial support. Psychological services need to be both family-oriented and child-centered and focus on family dysfunction to prevent mental health problems in children.