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This review aimed to synthesize the current evidence on the effectiveness of invasive treatments for complex regional pain syndrome in children and adolescents. Studies on children and adolescents with complex regional pain syndrome that evaluated the effects of invasive treatment were identified in PubMed (search March 2013). Thirty-six studies met the inclusion criteria. Articles reported on a total of 173 children and adolescents with complex regional pain syndrome. Generally, many studies lack methodological quality. The invasive treatments applied most often were singular sympathetic blocks, followed by epidural catheters and continuous sympathetic blocks. Rarely, spinal cord stimulation and pain-directed surgeries were reported. An individual patient frequently received more than one invasive procedure. Concerning outcome, for approximately all patients, an improvement in pain and functional disability was reported. However, these outcomes were seldom assessed with validated tools. In conclusion, the evidence level for invasive therapies in the treatment of complex regional pain syndrome in children and adolescents is weak.
Sustainable market economy
(2015)
BACKGROUND:
There is little knowledge regarding the association between psychological factors and complex regional pain syndrome (CRPS) in children. Specifically, it is not known which factors precipitate CRPS and which result from the ongoing painful disease.
OBJECTIVES:
To examine symptoms of depression and anxiety as well as the experience of stressful life events in children with CRPS compared with children with chronic primary headaches and functional abdominal pain.METHODS: A retrospective chart study examined children with CRPS (n=37) who received intensive inpatient pain treatment between 2004 and 2010. They were compared with two control groups (chronic primary headaches and functional abdominal pain; each n=37), who also received intensive inpatient pain treatment. Control groups were matched with the CRPS group with regard to admission date, age and sex. Groups were compared on symptoms of depression and anxiety as well as stressful life events.
RESULTS:
Children with CRPS reported lower anxiety and depression scores compared with children with abdominal pain. A higher number of stressful life events before and after the onset of the pain condition was observed for children with CRPS.
CONCLUSIONS:
Children with CRPS are not particularly prone to symptoms of anxiety or depression. Importantly, children with CRPS experienced more stressful life events than children with chronic headaches or abdominal pain. Prospective long-term studies are needed to further explore the potential role of stressful life events in the etiology of CRPS.
Attitudes Concerning Postmortem Organ Donation : A Multicenter Survey in Various German Cohorts
(2015)
BACKGROUND
The aim of this study was to characterize postmortem organ donation attitudes in various German cohorts.
MATERIAL AND METHODS
Employees of 2 German cities and 2 German university hospitals, employees of a German automobile enterprise, and members of a German Medical Society were administered a questionnaire about postmortem organ and tissue donation attitudes. Demographic data and general attitudes were questioned and focused on: I) willingness to donate organs, II) holding a donor card, and III) having discussed the topic with the family.
RESULTS
Of 5291 participants, 65.2% reported favoring postmortem organ donation. Missing negative experiences, the idea that donation is helpful, a non-medical professional environment, excellent general health, gender, agreement with the brain-death paradigm, and age significantly influenced the participants’ attitudes. Participants were more likely to possess donor cards and had discussed more often with family members if they agreed with the brain-death paradigm and considered donation to be helpful. Males and older participants were the most likely to neglect donor cards, and Catholics, Protestants, and participants with poor health were the least likely to donate organs. Interest in receiving more information was expressed by 38.1% and 50.6% of participants refusing donation of all or of specific organs, respectively, and suggested the internet (60.0%) and family doctors (35.0%) as preferred sources of information.
CONCLUSIONS
Public campaigns in Germany should focus on males and older people as regards donor cards, and females, younger, and religiously affiliated persons as regards the general willingness to donate organs postmortem.
he development of context-aware applications is a difficult and error-prone task. The dynamics of the environmental context combined with the complexity of the applications poses a vast number of possibilities for mistakes during the creation of new applications. Therefore it is important to test applications before they are deployed in a life system. For this reason, this paper proposes a testing tool, which will allow for automatic generation of various test cases from application description documents. Semantic annotations are used to create specific test data for context-aware applications. A test case reduction methodology based on test case diversity investigations ensures scalability of the proposed automated testing approach.
Clinically Significant Differences in Acute Pain Measured on Self-report Pain Scales in Children
(2015)
Objectives
The objective was to determine the minimum and ideal clinically significant differences (MCSD, ICSD) in pain intensity in children for the Faces Pain Scale–Revised (FPS-R) and the Color Analog Scale (CAS) and to identify any differences in these estimates based on patient characteristics.
Methods
This was a prospective study of children aged 4 to 17 years with acute pain presenting to two urban pediatric emergency departments. Participants self-reported their pain intensity using the FPS−R and CAS and qualitatively described their changes in pain. Changes in pain score reported using the FPS-R and CAS that were associated with “a little less” and “much less” pain (MCSD and ICSD, respectively) were identified using a receiver operating characteristic–based method and expressed as raw change score and percent reductions. Estimates of MCSD and ICSD were determined for each category of initial pain intensity (mild, moderate, and severe) and patient characteristics (age, sex, and ethnicity). Post hoc exploratory analyses evaluated categories of race, primary language, and etiology of pain.
Results
A total of 314 children with acute pain were enrolled; mean (±SD) age was 9.8 (±3.8) years. The FPS-R raw change score and percent reduction MCSD estimates were 2/10 and 25%, with ICSD estimates of 3/10 and 60%. For the CAS, raw change score and percent reduction MCSD estimates were 1/10 and 15%, with ICSD estimates of 2.75/10 and 52%. For both scales, raw change score and percent reduction estimates of the MCSD remained unchanged in children with either moderate or severe pain. For both scales, estimates of ICSD were not stable across categories of initial pain intensity. There was no difference in MCSD or ICSD based on age, sex, ethnicity, race, primary language, or etiology of pain.
Conclusions
The MCSD estimates can be expressed as raw change score and percent reductions for the FPS-R and CAS. These estimates appear stable for children with moderate to severe pain, irrespective of age, sex, and ethnicity. Estimates of ICSD were not stable across different categories of initial pain intensity, therefore limiting their potential generalizability.
Usability is a core construct of website evaluation and inherently defined as interactive. Yet, when analysing first impressions of websites, expected usability, i.e., before use, is of interest. Here we investigate to what extend ratings of expected usability are related to (a) experienced usability, i.e., ratings after use, and (b) objective usability measures, i.e., task performance. Furthermore, we try to elucidate how ratings of expected usability are correlated to aesthetic judgments. In an experiment, 57 participants submitted expected usability ratings after the presentation of website screenshots in three viewing-time conditions (50, 500, and 10,000 ms) and after an interactive task (experienced usability). Additionally, objective usability measures (task completion and duration) and subjective aesthetics evaluations were recorded for each website. The results at both the group and individual level show that expected usability ratings are not significantly related either to experienced usability or objective usability measures. Instead, they are highly correlated with aesthetics ratings. Taken together, our results highlight the need for interaction in empirical website usability testing, even when exploring very early usability impressions. In our study, user ratings of expected usability were no valid proxy neither for objective usability nor for experienced website usability.
In einer konsumorientierten Kultur ein Leben der Suffizienz zu führen, ist vielleicht eines der ehrgeizigsten Experimente, die ein Mensch unternehmen kann. Um diese Herausforderung zu untersuchen, haben wir einen sozial-praktischen Ansatz gewählt. Dieser Artikel basiert auf 42 qualitativen Interviews, in denen die Befragten gefragt wurden, warum und wie sie sich in einer westlichen Infrastruktur und Kultur suffizient verhalten. Die Ergebnisse deuten darauf hin, dass Suffizienz-orientierte Menschen bei ihren ressourcenintensiven Handlungen auf bestimmte Bedeutungen in der Alltagspraxis zurückgreifen. Diese Bedeutungen umfassen eine Mischung aus umweltfreundlichen Einstellungen, positiven sozialen Absichten und/oder persönlichen Verpflichtungen zur Sparsamkeit. Darüber hinaus haben wir eine Reihe spezifischer Praktiken identifiziert, darunter Teilen, Recycling und Wiederverwendung, die für einen ressourcenschonenden Lebensstil nützlich sind. Für unsere Befragten sind viele dieser Suffizienz-Praktiken regelmäßig im täglichen Leben anzutreffen und wurden nur selten hinterfragt. Anhand einer zusätzlichen Umfrage zeigen wir, dass diese Routinen zu einem weniger ressourcenintensiven Lebensstil führen und wie es einer kleinen Gruppe von Menschen gelungen ist, sich Suffizienzpraktiken anzugewöhnen. Die Mehrheit sieht jedoch keine Notwendigkeit für eine häufigere Umsetzung solcher Routinen, da die täglichen Entscheidungsprozesse weitgehend auf den Konsum von Produkten ausgerichtet sind.
In this paper we want to review and discuss research on the effects of occupational health management activities and services on different outcomes like employee health and well-being or absenteeism and other economic outcomes. In part I we outline goals and functions of occupational health management (OHM), then characterize typical occupational health promotion interventions and describe principles for implementing and organizing OHM. Part II focuses on different OHM activities and services such as creating healthy and safe workplace, reducing work-family conflicts, providing counselling via employee assistance programs and implementing health circles or stress management interventions. We will also discuss intervention design and sample studies as well as meta-analytic data relating to the effectiveness of these interventions. Finally, part III is about the economic impact of OHM. Findings from a management evaluation approach for OHM will be discussed. Then we will concentrate especially on data linking health promotion interventions to absenteeism and financial outcomes expressed as cost savings or cost-benefit ratios. The concluding part summarizes key findings of this paper.
Stainless steel made to rust: a robust water-splitting catalyst with benchmark characteristics
(2015)
The oxygen evolution reaction (OER) is known as the efficiency-limiting step for the electrochemical cleavage of water mainly due to the large overpotentials commonly used materials on the anode side cause. Since Ni–Fe oxides reduce overpotentials occurring in the OER dramatically they are regarded as anode materials of choice for the electrocatalytically driven water-splitting reaction. We herewith show that a straightforward surface modification carried out with AISI 304, a general purpose austenitic stainless steel, very likely, based upon a dissolution mechanism, to result in the formation of an ultra-thin layer consisting of Ni, Fe oxide with a purity >99%. The Ni enriched thin layer firmly attached to the steel substrate is responsible for the unusual highly efficient anodic conversion of water into oxygen as demonstrated by the low overpotential of 212 mV at 12 mA cm−2 current density in 1 M KOH, 269.2 mV at 10 mA cm−2 current density in 0.1 M KOH respectively. The Ni, Fe-oxide layer formed on the steel creates a stable outer sphere, and the surface oxidized steel samples proved to be inert against longer operating times (>150 ks) in alkaline medium. In addition Faradaic efficiency measurements performed through chronopotentiometry revealed a charge to oxygen conversion close to 100%, thus underpinning the conclusion that no “inner oxidation” based on further oxidation of the metal matrix below the oxide layer occurs. These key figures achieved with an almost unrivalled-inexpensive and unrivalled-accessible material, are among the best ever presented activity characteristics for the anodic water-splitting reaction at pH 13.
Although national eHealth strategies have existed now for more than a decade in many countries, they have been implemented with varying success. In Germany, the eHealth strategy so far has resulted in a roll out of electronic health cards for all citizens in the statutory health insurance, but in no clinically meaningful IT-applications. The aim of this study was to test the technical and organisation feasibility, usability, and utility of an eDischarge application embedded into a laboratory Health Telematics Infrastructure (TI). The tests embraced the exchange of eDischarge summaries based on the multiprofessional HL7 eNursing Summary standard between a municipal hospital and a nursing home. All in all, 36 transmissions of electronic discharge documents took place. They demonstrated the technical-organisation feasibility and resulted in moderate usability ratings. A comparison between eDischarge and paper-based summaries hinted at higher ratings of utility and information completeness for eDischarges. Despite problems with handling the electronic health card, the proof-of-concept for the first clinically meaningful IT-application in the German Health TI could be regarded as successful.
Restricted Versus Unrestricted Search Space : Experience from Mining a Large Japanese Database
(2015)
The aim of this study was to investigate whether standard Big Data mining methods lead to clinically useful results. An association analysis was performed using the apriori algorithm to discover associations among co-morbidities of diabetes patients. Selected data were further analyzed by using k-means clustering with age, long-term blood sugar and cholesterol values. The association analysis led to a multitude of trivial rules. Cluster analysis detected clusters of well and badly managed diabetes patients both belonging to different age groups. The study suggests the usage of cluster analysis on a restricted space to come to meaningful results.
Management of agricultural processes is often troubled by disconnections and data transfer failures. Limited cellular network coverage may prevent information exchange between mobile process participants.
The research projects KOMOBAR and ISOCom designed, implemented und field-tested a delay tolerant platform for robust communication in rural areas and challenging environments. An adaptable combination of infrastructure-based cellular networks and infrastructure-free multihop ad hoc communication (WLAN) leads to a variety of new communication opportunities. Temporal storage and forwarding of data on mobile farm machinery as well as dynamic platform configurations during process runtime strongly enhance reliability and robustness of data transfers.
For Delay-Tolerant Networks (DTNs) many routing algorithms have been suggested. However, their performance depends heavily on the applied scenario. Especially heterogeneous scenarios featuring known and unknown node movements as well as different kinds of data lead to either poor delivery ratios or exhausted network resources.
To overcome these problems this paper introduces Data-Driven Routing for DTNs. Data is categorized according to its requirements into priority queues. Each queue applies an appropriate DTN routing algorithm that fits the data requirements best. Simulation results show that Data-Driven Routing allows high delivery ratios for time-critical data while saving network resources during the transfer of less time-critical data at the same time.
Mind the gap
(2015)
Incidence of Tube Feeding in 7174 Newly Admitted Nursing Home Residents With and Without Dementias
(2015)
Background:
Tube feeding is a common form of long-term nutritional support, especially for nursing home residents, of whom many have dementia.
Objective:
Estimating the incidence of feeding tube placement in nursing home residents with and without dementia.
Methods:
Using claims data, we studied a cohort of newly admitted nursing home residents aged 65 years and older between 2004 and 2009. Analyses were stratified by dementia. We estimated incidence rates and performed multivariate Cox regression analyses.
Results:
The study cohort included 7174 nursing home residents. Over a mean follow-up of 1.3 years, 273 people received a feeding tube. The incidence per 1000 person-years was 28.4, with higher estimates for patients with dementia. When adjusting for age, sex, and level of care as a time-dependent covariate, influence of dementia decreased to a nonsignificant hazard ratio.
Conclusion:
It seems that not dementia itself but the overall clinical condition might be a predictor of tube feeding placement.
The concept of "quality" is quite complex and challenging. In higher education, quality might be defined very differently by the various stakeholders: the students and graduates might see quality in terms of making sure they get well-paid jobs, the academics might define quality from the perspective of being able to enter in scientific debates, the ministries might define quality in terms of the efficient use of resources for reaching certain goals. But even when such issues of clarification of meanings are solved, what are the tools which work. And what does quality mean with respect to internationalisation? A number of papers in this book address quality management from various angles, and provide food for thought for those who seek for good answers.
This book is the third in a series, and assembles contributions from authors who participated in the International Deans Course, a programme for leaders in higher education from East and West Africa and Southeast Asia respectively.
Background: Availability and usage of individual IT applications have been studied intensively in the past years. Recently, IT support of clinical processes is attaining increasing attention. The underlying construct that describes the IT support of clinical workflows is clinical information logistics. This construct needs to be better understood, operationalised and measured.
Objectives: It is therefore the aim of this study to propose and develop a workflow composite score (WCS) for measuring clinical information logistics and to examine its quality based on reliability and validity analyses.
Methods: We largely followed the procedural model of MacKenzie and colleagues (2011) for defining and conceptualising the construct domain, for developing the measurement instrument, assessing the content validity, pretesting the instrument, specifying the model, capturing the data and computing the WCS and testing the reliability and validity.
Results: Clinical information logistics was decomposed into the descriptors data and information, function, integration and distribution, which embraced the framework validated by an analysis of the international literature. This framework was refined selecting representative clinical processes. We chose ward rounds, pre- and post-surgery processes and discharge as sample processes that served as concrete instances for the measurements. They are sufficiently complex, represent core clinical processes and involve different professions, departments and settings. The score was computed on the basis of data from 183 hospitals of different size, ownership, location and teaching status. Testing the reliability and validity yielded encouraging results: the reliability was high with r(split-half) = 0.89, the WCS discriminated between groups; the WCS correlated significantly and moderately with two EHR models and the WCS received good evaluation results by a sample of chief information officers (n = 67). These findings suggest the further utilisation of the WCS.
Conclusion: As the WCS does not assume ideal workflows as a gold standard but measures IT support of clinical workflows according to validated descriptors a high portability of the WCS to other hospitals in other countries is very likely. The WCS will contribute to a better understanding of the construct clinical information logistics.