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Small-fiber neuropathy and pain sensitization in survivors of pediatric acute lymphoblastic leukemia
(2018)
Background:
Chemotherapy-induced Peripheral Neuropathy (CIPN) of large-fibers affects up to 20% of survivors of pediatric acute lymphoblastic leukemia (ALL). We aimed to describe small-fiber toxicity and pain sensitization in this group.
Methods:
In a cross-sectional, bicentric study we assessed 46 survivors of pediatric ALL (Mean age: 5.7 ± 3.5 years at diagnosis, median 2.5 years after therapy; males: 28). Inclusion criteria: ≥6 years of age, ≥3 months after last administration of Vincristine, and cumulative dose of Vincristine 12 mg/m2. We used a reduced version of the Pediatric-modified Total Neuropathy Score (Ped-mTNS) as bedside test and Quantitative Sensory Testing (QST) for assessment of small- and large-fiber neuropathy as well as pain sensitization. We employed Nerve Conduction Studies (NCS) as the most accurate tool for detecting large-fiber neuropathy.
Results:
Fifteen survivors (33%) had abnormal rPed-mTNS values (≥4 points) and 5 survivors (11%) reported pain. In QST, the survivor group showed significant (p < 0.001) inferior large-fiber function and pain sensitization when compared to healthy matched peers. We identified deficits of vibration in 33 (72%) and tactile hypoesthesia in 29 (63%), hyperalgesia to blunt pressure in 19 (41%), increased mechanical pain sensitivity in 12 (26%) and allodynia in 16 (35%) of 46 survivors. Only 7 survivors (15%) had pathologic NCS.
Conclusion:
QST is a sensitive tool that revealed signs of large-fiber neuropathy in two thirds, small-fiber neuropathy and pain sensitization in one third of survivors. Prospective studies using QST in pediatric oncology may help to elucidate the pathophysiology of small-fiber neuropathy and pain sensitization as well as their relevance for quality of survival.
Simulation von Laserscannern in Pflanzenbeständen für die Entwicklung umfeldbasierter Funktionen
(2018)
Es werden drei Modellierungsansätze zur Simulation von Laserscannern in Pflanzenbeständen für die Entwicklung umfeldbasierter Fahrzeugfunktionen beschrieben. Das Sensorsignal der Distanzmessung wird dabei anhand realer Messwerte oder phänomenologisch und auf der Basis empirisch ermittelter Kennwerte in Abhängigkeit von objekt- und sensorspezifischen Einflussfaktoren abgebildet. Basierend auf den Methoden zur Simulation von Distanzmesssystemen der Open Source Simulationsumgebung Gazebo wurden die Modellierungsansätze als spezifische Sensor- und Umfeldmodelle implementiert. Die Modelle wurden insbesondere für den Einsatz an mobilen landwirtschaftlichen Arbeitsmaschinen und für die Anwendung in der Getreideernte optimiert.
Background
Forced migration significantly endangers health. Women face numerous health risks, including sexual violence, lack of contraception, sexually transmitted disease, and adverse perinatal outcomes. Therefore, sexual and reproductive healthcare is a significant aspect of women asylum seekers’ health.
Even when healthcare costs of asylum seekers are covered by the government, there may be strong barriers to healthcare access and specific needs may be addressed inadequately. The study’s objectives were a) to assess the accommodation and healthcare services provided to women asylum seekers in standard and specialised health care, b) to assess the organisation of healthcare provision and how it addresses the sexual and reproductive healthcare needs of women asylum seekers.
Methods
The study utilised a multi-method approach, comprising a less-dominant quantitative component and dominant qualitative component. The quantitative component assessed accommodation conditions for women in eight asylum centres using a survey. The qualitative component assessed healthcare provision on-site, using semi-structured interviews with health and social care professionals (n = 9). Asylum centres were selected to cover a wide range of characteristics. Interview analysis was guided by thematic analysis.
Results
The accommodation in the asylum centres provided gender-separate rooms and sanitary infrastructure. Two models of healthcare were identified, which differed in the services they provided and in their organisation: 1) a standard healthcare model characterised by a lack of coordination between healthcare providers, unavailability of essential services such as interpreters, and fragmented healthcare, and 2) a specialised healthcare model specifically tailored to the needs of asylum-seekers. Its organisation is characterised by a network of closely collaborating health professionals. It provided essential services not present in the standard model. We recommend the specialised healthcare model as a guideline for best practise.
Conclusions
The standard, non-specialised healthcare model used in some regions in Switzerland does not fully meet the healthcare needs of women asylum seekers. Specialised healthcare services used in other regions, which include translation services as well as gender and culturally sensitive care, are better suited to address these needs. More widespread use of this model would contribute significantly toward protecting the sexual and reproductive integrity and health of women asylum seekers.
SeniorenCampus 1
(2018)
Reconnection of floodplains to rivers to enhance fluvial dynamics is a favored method of floodplain restoration in Europe. It is believed that the restoration of hydrological conditions of the floodplain facilitates natural dispersal of target species, and hence the reestablishment, of typical plant communities. The aim of our study was to investigate whether floodplain target species could reach restoration sites via hydrochorous dispersal. We analyzed seed inflow from the river and seed dispersal in different sectors of a new watercourse in the Danube floodplain. Seeds were captured using 27 seed traps during three sampling periods of 3 weeks each from summer 2011 to spring 2012. After germination seedlings were identified, we detected a total of almost 39,000 seeds of 176 species, including 80 target species of riparian habitats. We found significant differences between seasons (most seeds in autumn/winter) and between stream sectors. Fewer seeds came in from the Danube (2,800 seeds) than were transported within the floodplain. Several new floodplain target species were detected, which had not been found in the aboveground vegetation or soil seed bank before the start of the restoration. Seeds of nonnative species did not disperse further than approximately 1 km. Our results indicated that hydrochorous seed dispersal from upstream habitats along the new watercourse was important for the establishment of target species and hence for the success of floodplain restoration. Technical water diversion weirs must be traversable for seeds, and small donor sectors upstream might enhance the reestablishment of target vegetation along new sectors downstream.
Species dispersal, establishment, and assembly are crucial stages of the life history of plants, and clear understanding ofthe governing forces and rules that shape species composition in a particular community is vital for successful ecologicalrestoration. In this article, we focus on five aspects of seed dispersal and plant establishment, which should be consideredduring habitat restoration actions. In the first two sections, we discuss the success of spontaneous dispersal and establishmenton restoration based on either spatial dispersal or local seed banks. In the third section, we assess the possibilities ofspecies introduction and assisted dispersal. In the fourth section, we introduce some possibilities for the improvement ofestablishment success of spontaneously dispersed or introduced species. Finally, we highlight issues influencing long-termpersistence and sustainability of restored habitats, related to the alteration of management type and intensity, climate change,and spread of non-native species. With the present article, we introduce the special issue entitled “Seed dispersal and soil seedbanks – promising sources for ecological restoration” containing 15 papers by 62 authors from 10 countries arranged in theabovementioned five topics.
Health IT systems are employed to support continuity of care via information continuity, while management continuity is often neglected. This study aims at investigating issues of management continuity when developing a collaborative decision support system for chronic wounds. Thirty-three experts from a variety of professions and disciplines discussed problems and possible solutions in four workshops. The following topics emerged from the discussion: existing networks involving payers, responsibilities as well as good discharge management. These topics clearly address management continuity and are also relevant for the scenario of inter-professional wound care across different settings.
Regionaler Hochwasserschutz
(2018)
Mehrere Hochwasserereignisse haben in den letzten Jahren zu erheblichen Vermögensschäden in der Region Osnabrück / Emsland geführt. Studien zur Klimaforschung prognostizieren eine Zunahme der Hochwassergefahren. Wie ist der Stand des regionalen Hochwasserschutzes nach den Erfahrungen aus dem Ereignis 2010? Welche Vorsorgemaßnahmen wurden getroffen und wo besteht noch Handlungsbedarf?
Die Tagung bietet einen Überblick über die aktuelle Situation des regionalen Hochwasserschutzes mit Vorträgen und Einschätzungen ausgewiesener Fachleute aus den Blickwinkeln der
• genehmigenden Behörden
• kommunalen Verantwortungsträger
• planenden Ingenieure
• Unterhaltungsverbände.
Sabine Krener ist enttäuscht. Sie bereitet sich auf einen Halbmarathon vor, hat aber zunehmend Probleme beim Laufen. Dass ihre Achillessehne schmerzt, kennt sie schon seit Jahren – nun wird es aber schlimmer, und es treten zudem ständig Krämpfe im rechten Bein auf. Zu allem Überfluss hat sie in den letzten sechs Wochen acht Kilo zugenommen.
Recognition of Emotional Facial Expressions and Alexithymia in Patients with Chronic Facial Pain
(2018)
Objectives
Alexithymia, conceived as difficulties to identify emotions, is said to be related with several pain syndromes. This study examined the recognition of facially expressed emotions and its relation to alexithymia in subjects with chronic facial pain.
Methods
A total of 62 subjects were recruited, with n=20 patients with chronic facial pain and n=42 healthy controls. All subjects were tested for the recognition of facially expressed emotions (Facially Expressed Emotion Labelling Test (FEEL test). The Toronto Alexithymia Scale (TAS-26) was used for the diagnosis of alexithymia.
Results
Patients with chronic facial pain performed worse than controls at the FEEL task (p<.001) and showed higher total TAS scores (p<.001). This indicates the presence of alexithymia and facial emotion recognition deficits in the facial pain group.
Discussion
It was concluded from the results that both the recognition of facially expressed emotions, and the ability to identify and describe one’s own feelings (TAS), are restricted in chronic orofacial pain patients. This relationship is particularly important in the treatment of chronic facial pain, indicating that it should become part of the treatment in addition to the therapeutic key issues, to influence the quality of life of the affected patients positively.
Recht auf gute Pflege
(2018)
Die Entwicklung von Virtual Realitiy-Technologien spielt im digitalen Zeitalter des 21. Jahrhundert eine immer bedeutendere Rolle und bietet Potential für zahlreiche Branchen. In der Branche des Garten- und Landschaftsbaus lässt sich dies beispielsweise durch die Einbettung von Baummodellen in interaktive Planungsprozesse ableiten, um Fehler und Missverständnisse im Planungsprozess zu vermeiden. Die vorliegende Arbeit beschäftigt sich in diesem Zuge mit den Möglichkeiten und Potentialen von generierten Echtzeit-Baummodellen auf der Grundlage von terrestrischem Laserscanning.
Aufgrund von fehlenden Erfahrungswerten und Messuntersuchungen wird durch diese Arbeit ein optimiertes Standardverfahren für die Baumaufnahme mittels terrestrischem Laserscanning aufgestellt. Dies geschieht auf der Basis von mehreren Baumaufnahmen und Programmuntersuchungen. Das Standardverfahren beinhaltet alle Bearbeitungsschritte von der Aufnahme bis zum Echtzeit-Visualisierungsmodell. In diesem Zuge werden zu erwartende Einschränkungen durch Windeinflüsse, Dateigrößen und verschiedene Vegetationsperioden genauer untersucht. Durch den Wind entstehende Messrauschfehler lassen sich mittels Filtervorgänge reduzieren, jedoch nicht ganzheitlich entfernen.
Sowohl das terrestrische Laserscanning als auch die 3D-Visualisierung bieten ein breit gefächertes Grundlagenspektrum, mit dem sich vor der Bearbeitung auseinander gesetzt werden muss. Weiterhin spielen Faktoren der menschlichen Wahrnehmung eine wichtige Rolle, um eine zielgerichtete Visualisierung umzusetzen.
Auf der Basis von Probeaufnahmen werden Scaneinstellungsparameter getestet, um Qualitätsmerkmale zu definieren. Weiterhin werden insgesamt 9 auf dem Markt vertretene Weiterverabeitungsprogramme detailliert untersucht und auf Funktionen getestet. In Abhängigkeit von der Baumgröße und Vegetationsperiode ergeben sich unterschiedlich anzuwendende Scaneinstellungen. Aufgrund der besten Ergebniserzielung und geringsten Gesamtzeitaufwendung wird Faro Scene als geeignetes Weiterverarbeitungsprogramm ausgewählt und in das Standardverfahren eingebettet. Da im Zuge einer Vermaschung keine zielführenden Ergebnisse erreicht werden, erfolgt die Darstellung der Baummodelle in Form einer Punktwolkenvisualisierung. Hierzu wird 3ds Max Design mit einem Vray Renderer als geeignetes Programm ausgewählt. Durch den Vergleich mit bestehenden 3D-Gehölzdatenbanken wird die Tauglichkeit der Punktwolkenvisualisierung bekräftigt.
Die aus den Probeaufnahmen gewonnenen Erkenntnisse werden für die Aufnahmen weiterer Baummodelle angewendet. Hierzu wird das entwickelte Standardverfahren mit einem Anwendungsbeispiel von 2 Bäumen gleicher Gattung und Art unterschiedlichen Alters durchgeführt.
Current frameworks postulate the success of health IT innovations to be determined by the professionalism of the information management (PIM). Still, empirical knowledge about PIM is scarce up until today. This study seeks to answer three research questions: (1.) How can PIM be measured in a reliable and valid way, (2.) how pronounced is PIM in German hospitals and (3.) do hospital characteristics have an impact on the degree of PIM? Based on the results of an expert workshop and frameworks for information management (IM) items for a PIM inventory were developed and the inventory sent to 1349 chief information officers of German hospitals. A principle component analysis based on the responses of 196 hospitals confirmed the three components that had been proposed by the frameworks: the strategic, the tactical and the operational level. The full inventory implied satisfying reliability and allowed a PIM composite-score to be calculated. The PIM scores for strategic and tactical IM were found to be far lower than for operational IM which hints at strong deficits in these areas. A stepwise regression model indicated that the degree of PIM significantly increased with the size of the hospital, which had been expected and hints the validity of the PIM inventory. This tool offers potentials for hospitals to classify and improve their IM.
Introduction:
Many patients with cerebral palsy (CP) suffer chronic pain as one of the most limiting factors in their quality of life. In CP patients, pain mechanisms are not well understood, and pain therapy remains a challenge. Quantitative sensory testing (QST) might provide unique information about the functional status of the somatosensory system and therefore better guide pain treatment.
Objectives:
To understand better the underlying pain mechanisms in pediatric CP patients, we aimed to assess clinical and pain parameters, as well as QST profiles, which were matched to the patients' cerebral imaging pathology.
Patients and methods:
Thirty CP patients aged 6–20 years old (mean age 12 years) without intellectual impairment underwent standardized assessments of QST. Cerebral imaging was reassessed. QST results were compared to age- and sex-matched controls (multiple linear regression; Fisher's exact test; linear correlation analysis).
Results:
CP patients were less sensitive to all mechanical and thermal stimuli than healthy controls but more sensitive to all mechanical pain stimuli (each p < 0.001). Fifty percent of CP patients showed a combination of mechanical hypoesthesia, thermal hypoesthesia and mechanical hyperalgesia; 67% of CP patients had periventricular leukomalacia (PVL), which was correlated with mechanic (r = 0.661; p < 0.001) and thermal (r = 0.624; p = 0.001) hypoesthesia.
Conclusion:
The combination of mechanical hypoesthesia, thermal hypoesthesia and mechanical hyperalgesia in our CP patients implicates lemniscal and extralemniscal neuron dysfunction in the thalamus region, likely due to PVL. We suspect that extralemniscal tracts are involved in the original of pain in our CP patients, as in adults.
Die Entwicklung und Sicherstellung pflegerischer Qualität wird nicht erst seit der Einführung der Pflegeversicherung intensiv diskutiert. Im Zuge dieser Auseinandersetzung zeigt sich, dass insbesondere in der ambulanten Versorgung unterschiedliche Ansichten darüber bestehen, wie Pflegequalität zu definieren, zu entwickeln und zu sichern ist. Dieser Beitrag stellt daher zentrale Merkmale sowie Rahmenbedingungen ambulanter Pflege dar, zeigt auf, welche unterschiedlichen Formen der Pflege und Unterstützung in der häuslichen Versorgung zum Tragen kommen und wie die Diskussion um die Qualität der ambulanten Pflege durch die unterschiedlichen Perspektiven der beteiligten Akteure bestimmt wird. Daran anschließend werden Ansatzpunkte für eine weitere Diskussion um die Qualität in der ambulanten Pflege aufgezeigt.
„Wissen ist Macht“. Diese Redewendung ist sicherlich keine Neuheit. Im Rahmen des Knowledge Managements wird die aktuelle Gültigkeit dieses geflügelten Wortes jedoch mehr denn je unterstrichen. Das Wissen über den Kunden gilt als zentraler Erfolgsfaktor, wodurch den Methoden zur Generierung dieses Wissens eine signifikante Bedeutung zukommt. Immer mehr Unternehmen beschäftigen sich mit dem Thema Kundentracking im stationären Handel und das Angebot von Dienstleistungen in diesem Bereich steigt folglich stetig. Durch die gewonnen Daten können Vertriebs- und Marketingaktivitäten zielgerichtet durchgeführt werden, wodurch das Einkaufserlebnis der Kunden und die Verkaufszahlen von Einzelhändlern nachhaltig gesteigert werden können. Die beidseitigen Vorteile des Kundentrackings hat auch das Modehaus Lengermann und Trieschmann GmbH & Co. KG aus Osnabrück erkannt. Hierbei handelt es sich um das größte inhabergeführte Modehaus Norddeutschlands.
Introduction:
Due to demographic change and lack of health care personnel new solutions like preventive home visits (PHV) are necessary. PHV reduces the risk of long-term care and therefore, enables older people to live in their home as long as possible.
Aim of the study:
The aim of this study is to analyse the acceptance of PHV and the effect of PHV on health status of the older people.
Methods:
In this mixed method study PHV as a nursing intervention will be offered to people older than 65 years, not yet eligible for benefits from the long-term care insurance and living in Emlichheim, a region in the northwestern part of Lower Saxony. A sample of 75 people is determined. The health status will be recorded with the Short Form 12 questionnaire. Fifteen semi-structured interviews will be performed to investigate acceptance of the PHV intervention. Quantitative data will be analysed using inferential statistics, qualitative data will be analysed using content analysis. Ethical approval has been obtained.
Results:
It is expected that the findings of this study complete current knowledge about the concept of PHV.
Practical relevance:
This study is of high practical relevance, because additional insights of acceptance might enable the adaption of the PHV concept. Furthermore, increased knowledge and motivation for preventive behaviour of the older people is anticipated in order to extend their autonomy. The results of this study could contribute to the implementation of PHV in Germany, especially in rural areas. It tends to allow a self-determined life in their familiar environment for the older people, as the biggest need of this group.