bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental study of effect additional water on high performance geopolymer concrete
Authors: Rachmansyah  , Hardjasaputra Harianto , Cornelia Meilanie
Published: February 2019

The Earth Summit 1997 in Kyoto (Japan), industrialized countries agreed to reduce gas emissions by 21% to avoid global warming due to greenhouse effect with the release of CO2 into the air. From the research result, cement industry sector all over the world contributes about 8 - 10% of total CO2 emission. This number is quite high and if there is not a special action to reduce, CO2 emissions will continue to increase along with the rapid development of infrastructure in various parts of the world including in Indonesia. To support greenhouse effect reduction efforts due to CO2 emissions and environmental conservation, civil engineers in the world are taking steps to achieve Sustainable Concrete Technology, in order to create “Green Concrete”. For that reason in the direction of “Green Concrete”, innovation is needed to reduce or replace cement in the concrete mixing. The ash waste electrical power generating plants of fly ash is a material containing many SiO2 and Al2O3 which can be used to replace the overall of cement in concrete. Geopolymer concrete is a fly ash-based concrete that replaces the entire cement in its manufacture. Workability in mixing geopolymer concrete is very low, due to the rapid reaction of the alkaline solution when it reacts with fly ash. To improve the workability can be added water at the time of mixing. The fly ash used in the mixing from the Paiton power plant in East Java with grain size 12.06 μm with round granules and chemical composition of fly ash containing SiO2, Al2O3 and Fe2O3 with a total of 75.151%. The planned compressive strength of the concrete is 45 MPa, with a variation of 8M, 12M and 16M NaOH molarity and the ratio of NaOH and Na2SiO3 is 1. Addition of water in concrete mixing with variations of 15, 17.5, 20, 22.5 and 25 liters / m3. The results of this study indicate that the more addition of water in the manufacture of geopolymer concrete can also increase the value of slump, but the excessive addition of water will result in a decrease in the compressive strength of the concrete caused by a decrease in the concentration of the alkaline solution. High molarity values will require additional water to reach the same slump value compared to lower NaOH molarity. With the same mix design, the optimal compressive strength at 8M NaOH was 48.18 MPa with 17.5 liters/m3 of water added with a slump of 12 cm, for 12M NaOH the optimal compressive strength was 51.65 MPa with the addition of 20 liter/m3 with 10 cm slump, while for 16M NaOH the optimum compressive strength is 59.70 MPa with 22.5 liters/m3 of water added with a 5 cm slump. The higher the NaOH molarity will result in a higher compressive strength value and geopolymer concrete compressive strength at early age is higher than conventional concrete.
Study on confined end-regions of RC walls under monotonic and cyclic loadings
Authors: Taleb Rafik , Kono Susumu
Published: February 2019

A study was conducted to clarify the influence of reinforcement detailing, slenderness and loading type on the capacity, damages and failure modes of confined boundary regions of reinforced concrete (RC) cantilever walls. It was found that the tensile strain prior to compressive strain affected the performance of thin wall boundaries and may lead to different failure modes compared to compression load only. It was also found that dense transverse reinforcement detailing in thin confined boundaries did not improve their performance. Some design and detailing practices were evaluated to determine their accuracy in preventing global buckling and bar buckling under extreme lateral loading. Numerical model that take into account reinforcing bar buckling was proposed to simulate the behaviour of specimens tested under monotonic condition. The model could simulate the observed response with good accuracy.
Evaluation of rigid pavement on apron of terminal 3 Soekarno-Hatta International Airport using finite element method
Authors: Prawesti Pamahayu , Suhendro Bambang , Hapsoro Suryo
Published: February 2019

The development of transportation technology is indicated by the appearance of a new aircraft gear configuration, dual trim. The load repetitions of the movement of aircraft with dual-tridem gears, such as B-777-300ER aircraft with MTOW 28 tons, on Terminal 3 Soekarno-Hatta International Airport (SHIA) apron may cause pavement deformation, resulting in long-term fatigue and structural failures. Therefore, the performance of the existing rigid pavements to hold the loads for the next 20 years should be evaluated. Firstly, the equivalent annual departure and coverage of the aircraft in the airport up to 2037 is calculated. Next, the existing rigid pavement structure of the apron in the airport is modeled using a finite element method to calculate thermal stress and fatigue analysis for either the dowel or the slab. Our study result shows that the coverage value for the next 20 years is 86,534 with the maximum deflection of 0.055 mm and the maximum stress of 0.496834 MPa. The calculated thermal stress is 1.55 MPa, resulting in load repetition for the slab 1,241,484 and an infinite load repetition for the dowel.
Constructing pedestrian level of service based on the perspective of visual impairment person
Authors: Bona Frazila Russ , Zukhruf Febri , Ornando Simorangkir Cavin , Tsavalista Burhani Jzolanda
Published: February 2019

Comfortability level of pedestrian facilities is practically implied by the pedestrian level of service (i.e., PLOS), which defines the performance level of pedestrian facilities. The level is set by applying certain criteria, which may influence by the heterogeneity and the pedestrian behavior. On the other side, the growth attention is given to the inclusive pedestrian environment that pay a great consideration to the persons with disabilities (PWDs), including the visual impairment person (i.e., VIP). Moreover, the universal design of the public facilities, which has minimum barriers for the PWDs needs to be promoted more, to attain better accessibility for the public. This paper then proposes a method for calculating of PLOS by taking into account the VIP perspective to the pedestrian facilities performance.
A resource sharing (sharing platform) scheme on online taxi services
Authors: Burhan Helen , Soehodho Sutanto , Yusuf Nahry
Published: February 2019

This paper will review the match between single driver and single rider in online taxi services through a resource sharing (sharing platform) for the operators with the objectives to maximize the profit for drivers (operators) and minimize waiting time for passengers so that the matching rate is higher. A low matching rate between rider and driver can cause the consumer to drop the services. The matching between single driver and single rider in online taxi services through a sharing platform scheme is formulated in maximum weighted bipartite matching problem. To solve the proposed model, we use Kuhn Munkres Algorithm, while to solve the shortest path for the driver to pick up the passenger and the shortest path of passenger's origin destination, modified Dijkstra with adaptive algorithm based on Wei Peng et.al (2012) is used. Based on illustrative example with several cases, we found a resource sharing scenario can optimize the matching between driver and rider and moreover can solve the surge pricing problem which is deemed as less transparant to customer
Identification of cumulative prospect theory parameters for mode choice model
Authors: Indriany Sylvia , Sjafruddin Ade , Kusumawati Aine , Weningtyas Widyarini
Published: February 2019

The use of Cumulative Prospect Theory (CPT) in decision making related to transportation risk is still much debated. Mainly because of the travel and socio-economic characteristics of the traveller it possible for different responses to the specified Reference Point (RP) as well as the loss aversion. This difference can be seen from the value of Cumulative Prospect Theory parameters. Therefore, this paper will discuss about the determination of parameters CPT which affect public transportation mode choice model in the course of work trip activity. The reference point as an essential part of this study is determined based on the average travel time of commuter worker from South Tangerang City to Jakarta. Data obtained from stated preference survey, Feeder Busway/Busway and Commuter Line Jabodetabek as mode alternative and travel time attribute as a risk factor. The Binomial Logit model which has transformed utility distribution and probability with CPT and the Least Square Method to be obtained the parameters. Finally, some conclusions can be drawn that the CPT parameters produced by this study, have closed the range of value requirements in the CPT theory. So that the parameter value can be used to model the probability of mode choice with the risk of travel time in the study area.
Analysis of flood propagation and its impact on Negeri Lima Village due to the failure of Way Ela Dam
Authors: Pramono Yakti Bagus , Bagus Adityawan Mohammad , Kridasantausa Hadihardaja Iwan , Suryadi Yadi , Nugroho Joko , Adi Kuntoro Arno
Published: February 2019

Way Ela dam is a dam to be built in the Negeri Lima village. In the negeri lima village there was also a dam that formed naturally by landslide due to high rainfall on 13 July 2012. A year after it was formed, on 25 July 2013 flooding occurred due to an extreme rainfall that caused the failure of the natural dam. The event of the failure on 2012 generated flood that severely damaged houses and various public facilities to negeri lima village down toward to the coast. As a result of this event, a small-scale reservoir is formed. The Government plans to utilize the established reservoir to build the new Way Ela Dam. This study was conducted to analyze floods with scenarios in the event of a failure in the new Way Ela Dam. The overland flow is simulate with two dimensional numerical model HEC-RAS v.5. Determining strategies for mitigation needs to be assessed comprehensively, by simulating disaster scenarios on the dam, analyzing the impacts and then planning recommendations for disaster risk. The results are expected to be a reference for mitigation plans for the new Way Ela Dam.
Critical success factors of collaborative approach in delivering sustainable construction
Authors: Hui Liu Shia , Rahmawati Yani , Amila Wan Abdullah Zawawi Noor
Published: February 2019

The essential aspect of sustainability in construction lead the complexities and involvement of multi parties in the construction project as well as its process. Conflicts of interests may appear in the process. Collaborative approach is essential for supporting decision making in delivering sustainable construction. This research identifies the collaboration critical factors. Scatter plot of mean and standard deviation analysis is done to rank the criticality of each collaboration factors in delivering sustainable construction. Eventually, factor analysis is done to identify the similarities between all the factors. There are twelve (12) factors identified from previous studies. Among all the collaboration factors, coordination among project stakeholders is identified as the most critical in delivering sustainable construction and followed by sharing responsibilities and mutual support. Based from factor analysis, five new factors of collaborative approach have been found.
Delay model for Engineering Procurement Construction (EPC): a case of Liquefied Natural Gas (LNG) projects in Indonesia
Authors: Kaming Peter F. , Koesmargono Ambrosius , Wahyu Aji Bimo
Published: February 2019

Development of Liquefied Natural Gas (LNG) projects in Indonesia mostly utilized Engineering Procurement Construction) EPC as type of contract. The contract is particularly applied in large-scale project such as LNG because it needed to be realized with comprehensively planning and to be on time, and on budget for the benefit for all stakeholders. In maximizing the utilization of the resources, LNG plant project depended on detailed work plans and tightly work schedule. This research aims at analyzing factors influencing causes of project delay in construction LNG projects. Data were collected using survey method by mean of distributing questionnaire to respondent that representing skilled staffs of the contractor LNG construction. Grouping variables were carried out using factors analysis, and the generated factors and delay of the projects then were analyzed their relationship using Structural Equation Modelling (SEM). Results of this study generated seven factors that influenced the delay of the EPC contract in LNG projects. The factors are: Human Resources; Management; Material; External; Plant Equipment; Method; Quality. From the result of SEM analysis it generated a model for analyzing the delay of the EPC for LNG projects in Indonesia.
Brave New World: Can Positive Developments in Safety Science and Practice also have Negative Sides?
Authors: Busch Carsten
Published: February 2019

The last few decades have brought advances and positive developments in safety. Traditional approaches to prevent accidents are supplemented and enhanced with approaches that stress positive instead of negatives, that humanize, that are more systemic, that appreciate complexity, context, variability and adaptability. One must wonder, however, are there any negative effects we should be wary about? This paper reflects about this question by using five mechanisms: 1) the language we use to discuss things, 2) the emergence of professional tribalism, 3) the evolution of ideas and concepts, 4) side-effects of success, and 5) ethical dilemmas we may encounter in our everyday work. New developments will come with by-products that we cannot prevent. Suggestions to deal with this include open, critical minds, and awareness of possible pitfalls. Being prepared to deal with the inevitable variations that will occur is important, as are balanced approaches in how professionals discuss and handle concepts and tools.
Risks Associated with Aircraft Maintenance in European Commercial Air Transport
Authors: Hieminga Jelle , Turkoglu Cengiz
Published: February 2019

In the 2016 EASA Annual Safety Report, 1318 incidents were categorised as involving a safety issue related to aircraft maintenance. All the Key Risk Areas, or most frequent outcomes, for aircraft maintenance as a safety issue were shown to be related but associated Rulemaking Tasks have not yet appeared in the 2017-2021 European Plan for Aviation Safety. Categorising EU-wide incident reports appears to be difficult due to the use and construction of the ‘Event Types’, or contributing causes, taxonomy used in the reporting tool. Previously developed taxonomies are either limited in the number of categories due to limited information in reports, or they are aimed more at an investigation than straight reporting. As a result, these taxonomies are not suited for use in a reporting tool, and these taxonomies lack the detail for focused feedback to the maintenance industry. Thus, a two-level taxonomy has been developed within this study, using a high-level overview of the maintenance process as a basis for the first level and a variation of descriptions, both specific and more broad-spectrum, for the second level. A set of 3910 incident reports from the central repository were analysed, causing 2677 incidents to be excluded for a variety of reasons such as a lack of information (the narrative was empty in 1100 reports or 28%), or the use of a language other than English (814 incidents, 21%). The remaining 1232 incident reports were categorised using the new taxonomy. Of these, 361 incidents occurred during installation of components (29%) and 308 incidents were related to maintenance control (25%). The increased level of detail from the new taxonomy allows for identification of procedure types that are more susceptible to errors, such as installing or removing components or deferral of a defect so that an aircraft can be dispatched. This will hopefully lead to increased vigilance as well as further measures to increase safety.
WebSTAMP: a Web Application for STPA & STPA-Sec
Authors: Souza Fellipe G.R. , Pereira Daniel P. , Pagliares Rodrigo M. , Nadjm-Tehrani Simin , Hirata Celso M.
Published: February 2019

STAMP (System-Theoretic Accident Model and Processes) techniques such as STPA (System- Theoretic Process Analysis) and STPA-Sec (STPA for Security) have been applied only in an adhoc manner, without the aid of tools. More recently, tools have been proposed to help the application of STPA and STPA-Sec. Most of the tools focus on user experience issues and do not cover all the aspects of STPA and STPA-Sec. Three aspects of tools are systematization, automation and analysis completeness. Systematization allows the analysis to be performed in a more disciplined way while automation allows a more time efficient analysis. Analysis’ completeness is the analysis coverage in a given domain. We identify the essential requirements supporting business and stakeholders' needs for a STAMP based tool. We propose a STAMPcompliant web application, named WebSTAMP, for STPA and STPA-Sec. WebSTAMP is intended to aid analysts throughout the analysis process in a more automated and comprehensive way, and it aims to be a collaborative tool. We illustrate how the requirements are implemented in the current version of WebSTAMP with an example of use. The results show that WebSTAMP assists analysts to conduct safety and security analyses in a more systematic, automated and comprehensive manner.
Challenges in Future Mathematical Modelling of Hierarchical Functional Safety Control Structures within STAMP Safety Model
Authors: Or Liran Bar , Arogeti Shai , Hartmann Daniel
Published: February 2019

In the STAMP model, based on control theory, the control relationships between various system elements enforced by the closed Control Loops (CLs) are logical and functional. A literature survey emphasized the fact that for the moment STAMP and its main tools STPA and CAST are not associated with any numerical tools. The main rationale of our work is to understand whether STAMP matches to be a quantitative model. Furthermore, in a case that we find that numerical tools can be used in STAMP, we intend to bridge the gap between the logical-functional approach in STAMP and any of the suitable quantitative approaches applied in Engineering Control Theory (ECT). As a first step, a literature comparison was performed between the basic control parameters existing explicitly at the moment in the STAMP model, and those well known in the literature of ECT. The results reveal that there are many similar terms, especially related to conceptual and general definitions. However, we have observed that there are also basic quantitative parameters from ECT which are not yet referred to in STAMP as quantitative safety evaluation parameters. Another main finding is an inherent difference in various ECT related parameters and the CLs at the various hierarchical levels. ECT was originally developed to deal with physical systems. Thus, any machine related internal control loops within the lower-physical level of a Sociotechnical System (STS) can be directly addressed with quantitative methods from ECT. However, most of the human-machine interactions in the lower levels and the human and societal controls in the higher levels are at the moment not suitable for those methods. We assume these ECT parameters may have an important role in designing and examining systems safety and hence we suggest, should be integrated into STAMP model, in purpose to be able to enhance systems safety.
Stabilisation of high-sulphide tailings with alkali activated fly ash – mechanical performance
Authors: Nuno Cristelo , João Coelho , Tiago Miranda , Luis Sousa , Ana Fernández-Jiménez , Mafalda Oliveira
Published: February 2019

Mine tailings could represent a step forward in terms of the quality of the aggregates that usually accepted in civil engineering applications, due to their specific weight and compressive strength. The Neves-Corvo copper mine produces approximately 3 million tons of tailings every year, which could supply several construction works, at least in the south of Portugal. Nevertheless, this industrial waste requires stabilisation, not only due to their high sulphur content, but also due to mechanical performance demands. This paper focus on the stabilisation, without previous thermal treatment, of the mine tailings from Neves-Corvo.
Alkali-activated binary concrete based on natural pozzolan; a real and eco-friendly alternative to the OPC concrete
Authors: Robayo-Salazar Rafael , Mejía De Gutiérrez Ruby
Published: February 2019

This research shows the obtaining and characterization of an Alkali Activated Binary Concrete (AABC), based on 70% of a natural volcanic pozzolan (NP) and 30% ground blast furnace slag (GBFS), as a real and environmentally sustainable alternative of replacement to the Portland cement (OPC)-based concrete. As the alkaline activator a mixture of sodium hydroxide and silicate was used. The alkaline binder was characterized prior to the design of the concrete, this included the determination of its compressive strength, setting time and heat of reaction. The mix design of the AABC was performed by adapting the absolute volume methodology used for conventional concretes. AABC was compared equivalently with a concrete based on OPC. The characterization of concretes included the determination of properties such as: slump, compressive strength, density and porosity. In addition, the carbon footprint of the concretes was determined by analysing its life cycle using the LCA methodology. These results are considered as a contribution to the standardization of a real-scale production process of alkaline pre-mixed concretes in countries with deposits of NP such as Colombia.
Oral metastasis of pulmonary adenocarcinoma: diagnosis and treatment
Authors: Picot Etienne , Jouan Robin , Bach Emma , Murcier Gregory , Borgnat Florent
Published: February 2019

Introduction:Oral metastases are rare and represent 1% oro-facial neoplasms. The lung is the most common primary site for oral metastatic tumors. The diagnosis is based on histological analysis. Oral metastases have been associated with poor prognosis and is no longer a proven treatment. It was found in a 58-year old man diagnosed with lung cancer with a voluminous mandibular tumefaction following dental avulsion. The panoramic X-ray showed an area of ​​osteolysis compared to the extraction site. The histological and immunohistochemistry of the lesion showed a positivity of the marker CK7 and a negativity of TTF1, in favor of a lung origin. The biomolecular analysis revealed a mutation on the BRAF gene confirming the metastasis primitive origin. Treatment by surgical resection was performed palliatively.Comments:The diagnosis of an oral metastasis remains difficult and is based on the histological analysis and finding immune markers. Molecular biology is sometimes required for theranostics. Treatment options include surgical resection, radiotherapy, and/or chemotherapy. They are sometimes limited to preserve the quality of life. The prognosis of patients with oral metastases is very poor.Conclusion:Oral metastases are rare, and the diagnosis remains difficult.
Upper lip reconstruction after a dog bite
Authors: Guillemin Maxime , Giran Guillaume
Published: February 2019

Observation: In traumatology, wounds of the lips are frequent and their care is often summarized in a suture in one or more planes. Defects at this level are rather rare. When they occur, it is important to study their areas and their size in order to offer the best reconstruction. When Abbes' flap is appropriate, surgical procedure is always achieved remotely from the trauma. Comments: This technique allows rebuilding one-third of the upper lip and gives good functional results and a satisfactory aesthetic result. A weaning of the flap at three weeks, regular follow-up, and prospective surgical revisions will be necessary.
Knowledge and practices of dentists in France regarding oral mucosal diseases: a national survey
Authors: Roume Maud , Azogui-Levy Sylvie , Lescaille Geraldine , Descroix Vianney , Rochefort Juliette
Published: February 2019

Introduction:One of the dental surgeon's roles is to identify, diagnose and supervise the treatment of oral pathologies (OP), and/or to refer patients to the appropriate specialists. Today, the delay in diagnosing patients with OP is very long and may impact their prognosis.Objective:We conducted a national survey of French practitioners to estimate their knowledge and practices regarding the management of these pathologies.Methods:About 15,000 dentists were contacted by email to complete a questionnaire designed to assess the diagnoses and management of OP.Results:Overall, for 560 answers (3.8%), DS did not declare any significant difficulties in diagnosing and managing any kind of pathologies. However, we were able to distinguish statistical differences among practitioners depending on the type of lesions and between the practitioners themselves. The associated factors were gender, graduation year, mode of practice and continuing education over the last 5 years. The majority of DS justified their diagnostic difficulties by the fact that they do not encounter patients with these types of pathology frequently enough, and by insufficient education.Conclusion:According to our study, it is necessary to reinforce the training and the continuing medical education of DS regarding OP, especially through the use of practical cases.
Assessing Foot Loads in Continuous Passive Motion (CPM) and Active Knee Joint Motion Devices
Authors: Stolz Benedikt , Grim Casper , Lutter Christoph , Gelse Kolja , Schell Monika , Swoboda Bernd , Carl Hans-Dieter , Hotfiel Thilo
Published: February 2019

Background Continuous passive motion (CPM) and active knee joint motion devices are commonly applied after various surgical procedures. Despite the growing use of active motion devices, there is a paucity of data comparing plantar loads between the different mobilization techniques. The aim of this study was to investigate foot loads during knee joint mobilization in continuous passive and active knee joint motion devices and to compare this data to the physiological load of full weight-bearing.

Patients/Material and Methods Fifteen healthy participants (7 women and 8 men, 25 ± 3 years, 66 ± 6 kg, 175 ± 10 cm, BMI 21.9 ± 2) were recruited. Plantar loads were measured via dynamic pedobarography using a continuous passive motion device (ARTROMOT-K1, ORMED GmbH, Freiburg, Germany) and an active motion device (CAMOped, OPED AG, Cham, Switzerland), each with a restricted range of motion of 0-0-90° (ex/flex) and free ROM for the knee joint. For the active motion device, cycles were performed at four different resistance levels (0-III). Data were assessed using the pedar® X system (Novel Inc., Munich, Germany), which monitors loads from the foot-sole interface. Force values were compared between motion devices and normal gait, which served as the reference for conditions of full weight-bearing. P-values of < 0.05 were considered statistically signiﬁcant.

Results Normal gait revealed peak forces of 694 ± 96 N, defined as 100 %. The CPM device produced plantar forces of less than 1.5 N. Using the active motion device in the setting of 0-0-90° produced foot loads of < 1.5 N (resistance 0-II) and 3.4 ± 9.3 N with a resistance of III (p < 0.001). Conditions of free ROM resulted in foot loads of 4.5 ± 4.5 N (resistance 0), 7.7 ± 10.7 N (resistance I), 6.7 ± 10.4 (resistance II) and 6.7 ± 6.9 N with a resistance of III (p < 0.001), corresponding to 0.6 %, 1.1 %, 1.0 % and 1.0 % of full weight-bearing, respectively.

Conclusion Motion exercises of the knee joint can be performed both with passive and active devices in accordance with strict weight-bearing restrictions, which are often recommended by surgeons. Also, active motion devices can be used when the ankle joint or foot have to be offloaded. Further studies assessing intraarticular joint load conditions have to be performed to confirm the findings obtained in this study.
Die dunkle Seite von Geschwisterbeziehungen
Authors: Witte Susanne , Walper Sabine , Fegert Jörg M.
Published: February 2019

Häufig kommt es in Geschwisterbeziehungen zu Feindseligkeit und Rivalität sowie körperlicher und psychischer Gewalt. Diese haben zum Teil langanhaltende Auswirkungen auf die psychische Befindlichkeit. Vorangegangene Forschungsarbeiten haben bisher jedoch meist nur eine Dimension der negativen Interaktionsmuster, z. B. körperliche Gewalt, untersucht. Anhand einer Stichprobe von 4568 Erwachsenen, die zu ihrer Geschwisterbeziehung in der Kindheit und ihrer aktuellen psychischen Belastung befragt wurden, wird die Häufigkeit und das Ausmaß unterschiedlicher negativer Interaktionsmuster in der Geschwisterbeziehung beleuchtet. Merkmale der Geschwisterkonstellation, die diese begünstigen, werden herausgestellt sowie Zusammenhänge mit der aktuellen psychischen Belastung aufgezeigt. Die Ergebnisse verweisen darauf, dass es in Geschwisterbeziehungen zu einem hohen Ausmaß an Konflikten kommt. Auch die Häufigkeit von körperlicher Gewalt und Feindseligkeit unter Geschwistern ist als hoch einzuschätzen. Für alle Skalen negativer Merkmale ist ein geringer Altersabstand zwischen den Geschwistern besonders vorhersagekräftig. Im Hinblick auf die psychische Belastung im Erwachsenenalter sind vor allem Rivalität und Feindseligkeit zwischen den Geschwistern sowie Ausschluss durch das Geschwister prädiktiv. Bei der Interpretation der Ergebnisse sind Besonderheiten der Stichprobe, wie Alters- und Geschlechtsverteilung, sowie das retrospektive Design zu beachten.
Die interdisziplinäre Notaufnahme im Zusammenspiel mit Chest Pain Units, Brustschmerzambulanzen und Cardiac Arrest Centern
Authors: Post Felix , Lutz Matthias , Frey Norbert , Münzel Thomas
Published: February 2019

Die notfall- bzw. akutmedizinische Versorgung der Bevölkerung von Patienten gewinnt mehr und mehr an Bedeutung. In Deutschland stellen sich zum Beispiel pro Jahr hunderttausende Patienten mit Brustschmerzen in Notaufnahmen vor, wobei sich bei ca. 5 – 20% ein akutes Koronarsyndrom nachweisen lässt. Zudem werden pro Jahr 75 000 prähospitale Reanimationen durchgeführt, von denen mehr als 60% kardial bedingt sind. Die primäre Anlaufstelle dieser kardialen Patienten ist in der Regel eine Notaufnahme, die, wenn möglich, Strukturen vorhalten soll, um diese Patienten rasch und effizient zu diagnostizieren und zeitnah lebensrettende Maßnahmen einzuleiten. Gefordert werden heutzutage, dass der interdisziplinären Notaufnahme Chest Pain Units (CPU), Stroke Units, Brustschmerzambulanzen (BSA) und, falls möglich, Cardiac-Arrest-Zentren (CAC) angegliedert sind, die es wiederum ermöglichen, durch eine optimale interdisziplinäre Betreuung durch Internisten, Neurologen und Anästhesisten die Prognose der Patienten durch Diagnostik und Therapie zu optimieren. In unserem Übersichtsartikel wollen wir uns auf die Interaktionen der interdisziplinären Notaufnahme mit den CPU, BSA und CAC fokussieren.
Evaluation eines Pilotprojekts zur strukturierten Fortbildung pädagogischer Fach- und Lehrkräfte im Umgang mit Typ-1-Diabetes bei Kindern und Jugendlichen in Rheinland-Pfalz
Authors: Gutzweiler Raphael , Neese Marlies , Reichert Dorothea , Kraus Laura , In-Albon Tina
Published: February 2019

Einleitung Typ-1-Diabetes (T1D) im Kindes- und Jugendalter ist eine häufige und zunehmende chronische Erkrankung. Um Bedürfnissen Betroffener in Kindergarten und Schule gerecht zu werden, sind strukturierte Fortbildungen für pädagogische Fach- und Lehrkräfte erforderlich. In Deutschland gibt es bislang keine standardisierten Seminare zum Umgang mit T1D bei Kindern und Jugendlichen, die in Weiterbildungsveranstaltungen für pädagogische Fach- und Lehrkräfte aufgenommen wurden. Initiiert durch den Verein „Hilfe für Kinder und Jugendliche bei Diabetes mellitus e. V.“, fanden im Rahmen eines Pilotprojekts 41 Seminare in Rheinland-Pfalz statt.

Material und Methoden Die teilnehmenden pädagogischen Fach- und Lehrkräfte (N = 825) füllten vor und nach dem Seminar sowie nach 6 Monaten Fragebögen zum Kompetenzerleben und zum Wissensstand aus. Zudem wurde direkt nach dem Seminar eine Einschätzung der Seminarinhalte erhoben.

Ergebnisse Es zeigte sich eine hohe Akzeptanz der Seminare durch die Teilnehmer*innen. Im Vergleich zum Stand vor dem Seminar verfügten die pädagogischen Fach- und Lehrkräfte im Anschluss über mehr diabetesspezifisches Wissen (Cohens d = 1,34), das nach sechs Monaten (d = 1,3) auf einem stabil hohen Niveau blieb. Die selbsteingeschätzte Kompetenz im Umgang mit T1D stieg mit dem Besuch des Seminars deutlich an (d = 1,67), nahm im Katamnesezeitraum ab (d = – 0,38), blieb jedoch weiterhin auf einem höheren Niveau als vor Beginn des Seminars (d = 1,17).

Diskussion Die Ziele des Pilotprojekts können mit der Steigerung des diabetesspezifischen Wissens und der selbsteingeschätzten Kompetenz im Umgang mit T1D bei den teilnehmenden pädagogischen Fach- und Lehrkräften als erreicht angesehen werden. Die Aufnahme von Seminaren in die Regelfortbildung der pädagogischen Fach- und Lehrkräfte kann diese im Umgang mit T1D unterstützen und zur besseren Versorgung von Kindern und Jugendlichen mit T1D beitragen.
A novel device for the endoscopic management of buried bumper syndrome
Authors: Hindryckx Pieter , Dhooghe Barbara , Wannhoff Andreas
Published: February 2019

Background Buried bumper syndrome (BBS) is a complication of percutaneous endoscopic gastrostomy (PEG) in which the internal bumper is overgrown by the gastric mucosa. Apart from loss of patency of the PEG tube, the buried bumper may evoke symptoms such as abdominal pain or peritubular leakage. While the management of an incompletely buried bumper is fairly straightforward, this is not the case for a completely buried bumper. Different approaches to remove completely buried bumpers have been described, including endoscopic knife- or papillotome-based techniques. However, these devices are used off-label and the procedures can be laborious.

Methods The Flamingo device has recently been introduced as the first tool specifically designed to remove a completely buried bumper.

Results We describe the technique and our first experience in five patients with a completely (n = 4) or almost completely (n = 1) buried bumper. Fast and save removal of the buried bumper was obtained in all patients.

Conclusion We believe that this device has the potential to become the standard first-line tool for the management of completely buried bumpers.
Shared-Decision-Making
Authors: Bubenzer Rainer
Published: February 2019

Auch in der Onkologie hat das Thema Patientenbeteiligung zunehmend an Bedeutung gewonnen. Ein häufig genanntes Mantra dazu lautet: Viele Patienten wünschen sich eine aktivere Rolle bei der eigenen Gesundheitsversorgung, am besten auf „Augenhöhe“. Ein Ansatz, der solche Wünsche berücksichtigt, ist die partizipative Entscheidungsfindung (PEF, shared-decision-making). Auch auf gesundheitspolitischer Ebene spielt PEF eine wachsende Rolle, wird z. B. im Rahmen des Nationalen Krebsplans spezifisch gefördert (►siehe Kasten). Ob und wieweit diese ambitionierten Ziele in der Onkologie in der Versorgungswirklichkeit angekommen sind, war eines der Themen beim 17. Deutschen Kongress für Versorgungsforschung in Berlin. Es zeigte sich: PEF ist in vielen Bereichen der Onkologie noch längst nicht angekommen.
Extended Pterional Approach for Medial Sphenoid Wing Meningioma: A Series of 47 Patients
Authors: Lynch Jose Carlos , Pereira Celestino Esteves , Gonçalves Mariangela , Zanon Nelci
Published: February 2019

Background To describe our operative strategy and analyze its safety and effectiveness for the removal of medial sphenoid wing meningiomas (MSWMs) through the extended pterional approach.

Method We identified 47 patients with MSWMs who were operated using this approach between 1986 and 2016. Medical charts, operative reports, imaging results, and clinical follow-up evaluations were reviewed and retrospectively analyzed.

Results No surgical mortality was observed in this sample. Gross total resection was achieved in 30 (63.8%) patients. Intradural clinoidectomy was performed in 16 (34%) patients. The median length of follow-up was 8.5 years (range, 1–30 years).

Conclusion The extended pterional approach associated with microsurgery techniques provided excellent results for the removal of MSWMs.
Clinical Challenges: Assessing Toddler Speech Sound Productions
Authors: DeVeney Shari
Published: February 2019

When assessing toddler speech sound productions, speech-language pathologists (SLPs) must be mindful of several important but not insurmountable limitations inherent to working with this young population for whom speech sound production may be of concern. These limitations include: (1) inconsistencies in recommended connected speech sampling size and phonetic transcription accuracy, (2) the prevalence of typical intraword variability for toddlers, (3) limited information regarding the reliability of informal measures of analysis, and (4) irregularities in available normative data for referencing speech sound development and mastery. This article includes a discussion of these factors, an overview of key assessment tools for single-word and connected-speech sampling, advice for current evidence-based practice procedures, and a thorough but not exhaustive listing of opportunities to improve clinical practice in this area. Despite limitations, SLPs working with toddlers have some tools and resources available to facilitate diagnostic procedures that allow for authentic decision-making regarding access to therapeutic services.
Analysis of Clinical and Radiographic Outcomes of the Angle between Clivus and Supraocciput in Patients with Chiari's Malformation Type I Following Surgical Decompression
Authors: Wang Xin , Gao Jun , Han Shiyuan , Li Zhimin , Li Yongning
Published: February 2019

Background The objective of this study was to investigate whether different angles between the clivus and supraocciput (C–SO angle) in patients with Chiari's malformation type I (CMI) after posterior fossa decompression lead to different clinical and radiographic outcomes.

Methods A total of 73 patients who underwent surgical decompression at our institution between 2010 and 2016 were retrospectively divided into two groups: group A, with an angle less than 96 degrees, and group B, with an angle ≥ 96 degrees. Patient clinical outcomes were determined using the Chicago Chiari Outcome Scale (CCOS), and radiographic outcomes were determined by changes in the syrinx size before and after surgery. Direct comparisons were made between the two groups.

Results There were no statistically significant differences between the two groups regarding demographics, preoperative symptoms or radiographic characteristics (p > 0.05), except for the cerebellar tonsillar descent (p ≤ 0.001). The mean overall CCOS score was 13.11 ± 1.99. The total CCOS score was significantly different between the two patient groups (p < 0.05). Moreover, group A demonstrated significantly better postoperative improvements than group B in clinical outcome measures based on the CCOS system (p = 0.035). For radiographic outcomes, the change in the syrinx between the two groups was also significantly different, with a value p = 0.024.

Conclusions A direct comparison between the two groups revealed that a smaller C–OS angle (< 96 degrees) was related to unsatisfactory clinical and radiographic outcomes. Thus, the C–OS angle may emerge as a predictor of clinical or radiographic outcomes following surgical decompression in patients with CMI.
Colon capsule versus computed tomography colonography for colorectal cancer screening in patients with positive fecal occult blood test who refuse colonoscopy: a randomized trial
Authors: Pioche Mathieu , Ganne Christell , Gincul Rodica , De Leusse Antoine , Marsot Julien , Balique Julien , Fond Alain , Bretagnolle Michel , Henry Luc , Billaud Yann , Malezieux Romain , Lapalus Marie-Georges , Chambon-Augoyard Christine , Del Tedesco Emilie , Scalone Olivia , Montoy Jean-Charles , Russias Benoit , Detry Antoine , Veniat Frédéric , Qiu Jin , Valette Pierre-Jean , Taillandier Annabel , Saurin Jean-Christophe , Tomczyk-Ferrero Josiane , Gandilhon Clémentine , Vecchiato Léa , Soler-Michel Patricia , Ponchon Thierry
Published: February 2019

Objective Some patients (10 % – 32 %) with a positive guaiac fecal occult blood test (gFOBT) do not undergo the recommended colonoscopy. The aim of this study was to compare video capsule endoscopy (VCE) and computed tomography colonography (CTC) in terms of participation rate and detection outcomes when offered to patients with a positive gFOBT who did not undergo the recommended colonoscopy.

Methods An invitation letter offering CTC or VCE was sent to selected patients after randomization. Acceptance of the proposed (or alternative) procedure and procedure results were recorded. Sample size was evaluated according to the hypothesis of a 13 % increase of participation with VCE.

Results A total of 756 patients were targeted. Following the invitation letter, 5.0 % (19/378) of patients underwent the proposed VCE and 7.4 % (28/378) underwent CTC, (P = 0.18). Following the letter, 9.8 % (37/378) of patients in the VCE group underwent a diagnostic procedure (19 VCE, 1 CTC, 17 colonoscopy) vs. 10.8 % in the CTC group (41/378: 28 CTC, 13 colonoscopy; P = 0.55). There were more potentially neoplastic lesions diagnosed in the VCE group than in the CTC group (12/20 [60.0 %] vs. 8/28 [28.6 %]; P = 0.04). Thus, 15/20 noninvasive procedures in the VCE group (19 VCE, 1 CTC; 75.0 %) vs. 10/28 in the CTC group (35.7 %; P = 0.01) resulted in a recommendation of further colonoscopy, but only 10/25 patients actually underwent this proposed colonoscopy.

Conclusion Patients with a positive gFOBT result who do not undergo the recommended colonoscopy are difficult to recruit to the screening program and simply proposing an additional, less-invasive procedure, such as VCE or CTC, is not an effective strategy.
Emergence of extreme events in networks of parametrically coupled chaotic populations
Authors: Moitra Promit , Sinha Sudeshna
Published: February 2019

We consider a collection of populations modelled by the prototypical chaotic Ricker map, relevant to the population growth of species with non-overlapping generations. The growth parameter of each population patch is influenced by the local mean field of its neighbourhood, and we explore the emergent patterns in such a parametrically coupled network. In particular, we examine the dynamics and distribution of the local populations, as well as the total biomass. Our significant finding is the following: When the range of coupling is sufficiently large, namely, when enough neighbouring populations influence the growth rate of a population, the system yields remarkably large biomass values that are very far from the mean. These extreme events are relatively rare and uncorrelated in time. We also find that at any point in time, exceedingly large population densities emerge in a few patches, analogous to an extreme event in space. Thus, we suggest a new mechanism in coupled chaotic systems that naturally yield extreme events in both time and space.
Data assimilation and resolvent analysis of turbulent flow behind a wall-proximity rib
Authors: He Chuangxin , Liu Yingzheng , Gan Lian , Lesshafft Lutz
Published: February 2019

This study aims to detect the unsteady features of the turbulent flow behind a wall-proximity rib using resolvent analysis, based on the mean flow field determined using an adjoint-based data assimilation (ABDA) model. The rib is located at gap ratios G/d = 0.25 and 0.50 with a flow Reynolds number Re = 7600 based on the rib size (d = 10 mm) and the free-stream velocity U0. The split fiber measurements at x/d = −0.25, 1.25, 4.25, and 9.25 are solely used as observational data, while the temperature sensitive paint and particle image velocimetry (PIV) results are used as the complement for the analysis and validation. First, the mean flows at both gap ratios are reproduced with the ABDA model using the streamwise velocity constraint of the observational data. It is shown that the global fields are accurately recovered, including the wall jet originating from the gap, which is absent from the PIV results. This finding indicates substantial heat transfer enhancement immediately behind the rib. Subsequently, the resolvent modes at Strouhal numbers St = 0.02, 0.05, 0.15, and 0.30 are obtained from the mean flows using a stochastic approach instead of performing the singular value decomposition directly on the resolvent operator, due to the large matrix size. With the help of the power spectral density of the split fiber measurement, the resolvent analysis identifies the large-scale flapping motion and the wall-jet fine scales that enhance the heat transfer in the case of G/d = 0.25, in addition to the Karman vortex shedding, which makes little contribution to the wall heat transfer in the case of G/d = 0.50. The flow dynamical features in both cases are reconstructed using the leading five resolvent modes at St = 0.15, showing good agreement with the proper orthogonal decomposition modes.
A new approximation to modulation-effect analysis based on empirical mode decomposition
Authors: Altıntaş A. , Davidson L. , Peng S. H.
Published: February 2019

The modulation effect, namely, the amplification or attenuation of near-wall small-scale (SS) structures by outer large-scale (LS) structures, is one of two commonly accepted ways that outer LS turbulent fluctuations can influence near-wall ones. Mode decomposition based on filtering is widely used to analyze the modulation effect. In the present study, a new approximation is proposed based on empirical mode decomposition (EMD) to investigate the aforementioned amplitude modulation effect. Both methods are used, and their results are compared for two-point and single-point analyses. It has been shown that the LS and SS signals that are decomposed by filtering and EMD follow identical paths. Despite the similarities of the signals, the suggested method exhibits a slightly higher correlation coefficient R compared to the method based on filtering for the two-point analysis. For the one-point analysis, however, the suggested method gives a rational correlation coefficient for the one-point analysis compared to the two-point analysis, while the existing method seems far from giving a rational correlation coefficient value, which is too low compared to that of the two-point analysis. The suggested method is relevant to many recent studies that questioned the reliability of calculating the correlation coefficient with the existing method. The variation of R for identical signals extends the discussion of the correlation-coefficient calculations to the very first process, namely, obtaining LS and SS data from the original signal.