bluuebunny/crossref_metadata_2025 huggingface dataset:
Vortex Loops Based Method for Subsonic Aerodynamic Loads Calculation
Authors: Shcheglov Georgy A. , Dergachev Sergey A.
Published: October 2018

The new modification of vortex method is considered. It is based on closed vortex loops that can be considered as the separate vortex “superelement”. It is shown that such approach has number of advantages for vortex wakes evolution simulation. The loops generation algorithm permits to simulate the separation zone due to the self-organization of the loops. In this case, there is no need to determine the location of the vortex sheet separation zones. The developed software package can be used in the calculation of aerodynamic loads on unmanned aerial vehicles, as well as in solving the aeroelasticity problems of structural elements of these aircraft.
Methods of construction quality issues elimination with use of modern technology
Authors: Dubas Sebastian , Pasławski Jerzy
Published: October 2018

The purpose of this article is to indicate possibility of improving quality in construction thanks to use of new technological solutions. A problem of poor construction defect management, low quality assurance expenses and significant defect costs has been defined. Proposal of quality management tools has been suggested. Article presents set of defects collected throughout construction inspections. Defects were analysed (FMEA), further proposal of quality improvement based on proactive approach with use of modern technology solutions and their estimated influence on risk analysis has been described. The article is summed up with conclusions.
Impact of the adopted strategy on the result of multi-criteria analysis of technology solution based on AHP (BOCR)
Authors: Dziadosz Agnieszka , Banach Dominika , Meszek Wiesław , Rejment Mariusz
Published: October 2018

The complexity of problems and the necessity to find a comprehensive approach to their solution favours the search for various methods that support the decision making process in the construction industry. At present, the multi-criteria methods lead the way. They enable the assessment of the problem in many aspects and with taking into account qualitative and quantitative data. Moreover, these methods do not limit the decision-maker in terms of the number of considered variants as well as the scope and the type of adopted assessment criteria. The aim of the article is to present the procedure of assessment of proposed building material solutions with taking into account the division of criteria due to their character – benefits (B) and costs (C). It was shown the dependence adopted by the decision maker strategy on the final ranking of solutions using the BOCR approach in the AHP method.
Contactless approach to determine pavement skid resistance for Pavement Management System
Authors: Fengier Jakub , Słowik Mieczysław , Pożarycki Andrzej
Published: October 2018

Standard method to assess the pavement profile is to calculate the MPD (Mean Profile Depth) index based on results obtained usually by usage of laser techniques. In analysis the models of the surface pavements have been used in order to calculate the s1, s2, s3 parameters values corresponding to mega-, macro- and microtexture respectively. The values of the developed parameters s1, s2, s3 are calculated from the specific power spectral density values of surface roughness obtained for the threshold pavement roughness wavelength equal to 0.1, 0.05, 0.005 and 0.0005 m. The skid resistance has been correlated to the s1, s2, s3 parameters using 11 varied cases related to asphalt and concrete pavements. Skid resistance tests have been performed using CSR (Continuous Skid Resistance) device with fixed slip ratio equal to 13%. Three different test speed values 45, 65 and 95 km/h have been used. The obtained results lead to factorial correlation equations between developed parameters and skid resistance indices. Correlation results for uncontaminated pavement surface can be characterized by the coefficient of determination values in range between 0.55 and 0.94. The results can be used for contactless determination of pavement skid resistance in Pavement Management System.
Scientific activities in Construction Technology Management filed of Construction Innovations Academic Association
Authors: Jasińska Marcela
Published: October 2018

Poznan University of Technology is a university with a technical profile, with 10 faculties, including the Faculty of Civil and Environmental Engineering. The university is also open to developing interests and passions of students, through the existence of numerous scientific circles. Officially, there are 74 academic and 15 student organizations. Among them is the Scientific Circle Constructon Innovations, whose history dates back to 2010, although it has been officially started in 2011. It associates students not only of Polish origin, but also from distant countries, such as: Democratic Republic of Congo, Iraq or India. Its main goal is to promote the Poznan University of Technology, Faculty of Civil Engineering and Environmental Engineering and the specialties of Construction Technology Management in the student environment and in the nationwide construction industry. From year to year there is an increase in its members The article confirms that the activity of scientific clubs has a very positive impact on the development of students’ interests. Confirmation of this thesis, on the example of ConInno are research projects from year to year, with a variety of interesting topics
Delays in construction works in Polish construction industry from the contractors’ point of view
Authors: Kowalczyk Anna , Meszek Wiesław , Rejment Mariusz , Dziadosz Agnieszka
Published: October 2018

The construction industry is sensitive to changing random conditions that determine the occurrence of various disturbances during the construction investment process. These disturbances are the source of numerous delays during realization of the construction project. The identification of the reasons for delays and their impact on the progress of construction works allows for the efficient management of the construction project and planning of protective measures, which reduce the risk of their occurrence. The purpose of this article is to identify and then to assess, on the basis of the conducted questionnaire survey, the impact of disturbances on delays in construction works. In addition, the factors were ranked in terms of the degree of impact on the construction project by calculating the rank of the factor.
Analysis of selected input data impact on energy demand in office building - case study
Authors: Sinacka Joanna , Ratajczak Katarzyna
Published: October 2018

In the building designing process special attention should be paid to energy calculations - with analysis of different input data low energy or passive house can be obtained and decision of which parameters can or cannot be changed may be made. The following input data was analysed: shape factor A/V, glazed area, internal heat gains, air tightness, efficiency of heat recovery. The results show that the input data for the energy calculations are crucial for the obtained result.
Axiomatic decomposition of a zero-sum game: the penalty shoot-out case
Authors: Rolli Fernando , Fradinho João , Giorgetti Alessandro , Citti Paolo , Arcidiacono Gabriele
Published: October 2018

The game of soccer has offered matter of wide scientific analysis about the effective application of the game theory in real-life. The field observations have often detected divergent behaviors from theoretical predictions. The basic problem comes from the fact that it is difficult to build scientific models reflecting reality as closely as possible. Axiomatic Design offers us a powerful tool of rational decomposition of a real and complex issue into elementary components. Independence Axiom guarantees that game decomposition will define a set of elementary actions logically consistent and free of redundancies. At the same time, Information Axiom can allow to select among alternative strategies, those that they predict the actions with a higher probability rate of success. In this paper, it is suggested the use of the Axiomatic Design methodology in the Collectively Exhaustive and Mutually Exclusive (CEME) mode, as a tool of analysis of the penalty shoot-out in extra time. This methodology allows to define the game strategies for goalkeepers and penalty takers. It will be analyzed both, the case when the opponents' behavior is well known and the situation when the statistics about the opponents are unknown. Axiomatic Design allows the process of decomposition to be simplified, enabling the selection of optimal game strategies. These strategies correspond to Nash’s equilibrium solutions when you already know about your opponents' game behavior. On the contrary, when penalty takers whose behavior is unknown, then it is always possible to define a strategy corresponding to the Bayesian equilibrium game solutions.
Design of a tablet holder with the help of Axiomatic Design International Conference of Axiomatic Design 2017
Authors: Herjólfsson Auðunn , Helgason Haraldur , Ingvason Sindri S. , þórarinsson þráinn , Foley Joseph Timothy
Published: October 2018

With the explosion of smart devices, tablets can currently be found everywhere. From schools to kiosks to watching movies in bed, these devices are prevalent everywhere in modern life. The problem with watching movies in bed using tablets is the necessity of hand usage. The market currently holds a few products that attempt to solve this, but none truly frees the user, allowing them hands-free usage with an easy exit of the bed. In this paper, we will describe a design which, utilizing axiomatic design, will out-perform anything currently existing in the same field, by giving a stable viewing experience while fitting to nearly any bed or sofa. Axiomatic Design ensured a comprehensive design process by ensuring customer needs were transformed into carefully thought out functional requirements and design parameters while maintaining modularity.
Students List FRs Chronologically and DPs Spatially, and Need to Integrate FRs Functionally and DPs Physically
Authors: Nakao Masayuki , Iino Kenji
Published: October 2018

The authors have students draw Functional Requirement (FR) – Design Parameter (DP) charts for their free subject design assignments before teaching them Axiomatic Design (AD) in detail. The students cannot list all important FRs and DPs even with Zigzag thinking between FR and DP from higher level to lower; then, they tend to list FRs chronologically like flowcharts and DPs spatially like bill of material. The strategy, however, often results in different counts of FRs and DPs and a number of interferences among them. When this happens, we lead the students to carry out the thinking processes of functional integration of FRs and physical integration of DPs so they can reach a regular matrix for the design equation. Once regularization is reached, the students can apply independence axiom to improve their designs.
Axiomatic Design based Design of a Software Prototype for Smart Shopfloor Management
Authors: Rauch Erwin , Vickery Andrew , Garcia Manuel , Rojas Rafael , Matt Dominik T.
Published: October 2018

Shopfloor management systems are currently undergoing a change. With the era of Industry 4.0, traditional shop floor management concepts are changing to new and digitally supported approaches for the coordination and management of production at the shop floor level. In order to investigate this change, the research project “Smart Shopfloor” is aiming to develop a software prototype for production management in the era of Industry 4.0. Requirements of industry are collected through literature review and workshops with industry and are translated into software functionalities. These functionalities lead, via an Axiomatic Design (AD) decomposition to design solutions for Smart Shop Floor Management systems. The results of the AD study form the basis for the software architecture and the definition of core and add-on functionalities of the software prototype. The focus of this paper lies on the AD decomposition of the design concept and further gives an overview of potential functionalities. In future, the developed concept will then be implemented in a lab environment before implementing and testing it in industrial case studies.
Development of a Design Procedure for Class E Amplifiers
Authors: Siri Mattison S. , Cochran David S.
Published: October 2018

Here, the step-by-step design procedure for a Class E amplifier is presented. An existing Class E amplifier system is described using a systems architecture approach. The design decomposition for the case study is written so that Physical Solutions (PSs; equivalent to Design Parameters) are in terms of component parameters (such as frequency or capacitance). Coupling issues are found to arise given constraints on transistor use. The design decomposition is altered to reflect the case where an amplifier is required to power a specific load. A discussion of transistor failure enables a design procedure to be developed by observing path-dependent coupling. The design procedure is tested through the design of a real amplifier. The designed amplifier is built and its performance measured.
Axiomatic Design Based Complexity Measures to Assess Product and Process Structures
Authors: Modrak Vladimir , Soltysova Zuzana
Published: October 2018

Definitions of complexity often depend on several circumstances, such as the nature of investigated complex system, the kind of complexity, the conceptual framework used for a study, the theoretical approach taken, and the like. In this paper, two complexity measures that are based on Boltzmann’s entropy concept and AD theory are proposed and described. The first measure quantifies product variety complexity and the second one focuses on process structure complexity. Such complexity techniques will be used to determine product platform complexity and related process complexity for early stage of design decision-making. The method focused on product platform complexity assumes that the distribution of FR-DP couplings offers a suitable complexity concept, which prescribes that coupled designs should be decoupled, if possible, since uncoupled design is ideal and a decoupled design is less good, while a coupled design is the least satisfactory. Analogically, the same principle is used for the purpose to quantify topological process complexity by transforming input components into process variables and product modules including final product into design parameters. Subsequently, relevant properties of these measures will be analysed by computational experiments. Finally, practical findings for mass customization practice will be presented.
Axiomatic Design in Obtaining a Device for Ultrasonic Machining
Authors: Dodun Oana , Panaite Ema , Duşa Petru , Nagît Gheorghe , Coteată Margareta , Slătineanu Laurentiu
Published: October 2018

Ultrasonic abrasive cavitational machining is a nonconventional machining method applied to remove surfaces in workpieces made of brittle, hard, or non-conductive materials that cannot be efficiently machined by other classical or nonconventional machining methods. Among the factors that can affect the values of the parameters of technological interest for the ultrasonic machining process, the relative pressure between the ultrasonic tool and the workpiece surface to be machined could be considered. The main objective of the research presented in this paper was to analyze the possibilities of selecting the most convenient solution among many such available solutions to ensure the tool feed motion, when designing a device for achieving an ultrasonic drilling process. At present, this selection could be achieved by means of an optimal selection method. Taking into consideration some functional requirements of the device, the method of analytic hierarchy process and the axiomatic design theory were used to solve some problems met in the design process.
Industrial Feedback on Implementing Functional Decomposition Design Processes for Reliability and Functional Safety
Authors: Pallaver Matt , Qaddoura Ahed , Do Sung-hee
Published: October 2018

The value of Axiomatic Design functional decomposition as a design analysis point tool has been widely reported. This paper reports on the implementation of functional decomposition design processes as a system design tool on 23 industrial projects over a 5 year period with product development teams ranging from 6 to 35 engineers. The products developed were systems of systems with mechanical, electrical, firmware, software, and operational interface elements. Functional decompositions ranged from about 200 to 1600 Functional Requirements. A number of these projects are now in commercial production. This paper reviews the process definition and implementation process steps that evolved from these experiences. The paper then reports on the implementation lessons learned and the value propositions noted. Conclusions and recommendations are made. The experiences demonstrated that functional requirement decomposition processes aid in achieving on-time, on-cost and on-specification project development targets. The authors propose this paper summarizes the “Endgame” design process impact that axiomatic design can reasonably expect in industry design practices for system development.
Alleinerziehende Eltern in Deutschland: Der Zusammenhang zwischen sozialer Unterstützung und psychosozialer Gesundheit
Authors: Borgmann Lea-Sophie , Rattay Petra , Lampert Thomas
Published: October 2018

Die Lebenssituation alleinerziehender Mütter und Väter geht mit spezifischen Anforderungen einher, aus denen im Vergleich zu Eltern in Partnerschaft höhere psychosoziale und körperliche Belastungen entstehen können. Dabei wird sozialer Unterstützung als Ressource eine protektive Rolle zugeschrieben. Der vorliegende Beitrag untersucht, inwiefern soziale Unterstützung das Ausmaß der psychosozialen Belastungen von Alleinerziehenden moderiert. Datenbasis bilden die Erhebungen 2009, 2010 und 2012 der Studie „Gesundheit in Deutschland aktuell“ (GEDA) des Robert Koch-Instituts. Die Stichprobe alleinerziehender Eltern umfasst 2062 Mütter und 242 Väter. Mit logistischen und negativ-binomialen Regressionen wird für Alleinerziehende die Bedeutung sozialer Unterstützung für seelische Belastungen (selbstberichtete Anzahl seelisch belasteter Tage in den letzten 4 Wochen) sowie Depressionen (12-Monats-Prävalenz) geschätzt (adjustiert für familiäre und sozioökonomische Faktoren). Alleinerziehende Mütter mit geringer sozialer Unterstützung haben eine doppelt so hohe statistische „Chance“ (OR=2,0; 95%-KI: 1,35–2,87) für mindestens einen seelisch belasteten Tag im Vergleich zu alleinerziehenden Müttern mit starker sozialer Unterstützung. Bei alleinerziehenden Vätern ist diese „Chance“ bei geringer sozialer Unterstützung um das 3,3-Fache (95%-KI: 1,09–10,23) erhöht. Die Anzahl seelisch belasteter Tage unter alleinerziehenden Müttern steigt bei geringer sozialer Unterstützung um das 1,4-Fache (95%-KI: 1,20–1,66) (IRR). Für alleinerziehende Väter zeigt sich ein IRR von 1,7 (95%-KI: 0,97–3,01). Die „Chance“ für eine Depression in den letzten 12 Monaten ist bei alleinerziehenden Müttern mit geringer sozialer Unterstützung um das 1,8-Fache (95%-KI: 1,18–2,67) und für alleinerziehende Väter um das 2,1-Fache (95%-KI: 0,51–8,83) erhöht. Die Ergebnisse zeigen, dass soziale Unterstützung für alleinerziehende Eltern eine wichtige Ressource für die psychosoziale Gesundheit ist und unabhängig von den Lebensumständen wirkt. Forschungsbedarf besteht in Hinblick auf weitere Einflussfaktoren sowie Interaktionen zwischen sozioökonomischem Status (SES) und sozialer Unterstützung.
Präventive Hausbesuche für ältere Menschen:
eine systematische Bestandsaufnahme ihrer praktischen Anwendung in
Deutschland
Authors: Renz Jörg-Christian , Meinck Matthias
Published: October 2018

Ziel der Studie Präventive Hausbesuche (PHB) zeigten als
Maßnahme zur Gesundheitsförderung älterer Menschen in
den vergangenen 40 Jahren internationaler Erprobung ein heterogenes Bild
hinsichtlich Zielgruppen, eingesetzter Strukturen oder Interventionsinhalten.
Ein eindeutiger Nachweis ihrer Wirksamkeit auf Endpunkte wie Mortalität,
Pflegebedürftigkeit, Krankenhaus- oder Pflegeheimaufnahmen wurde bislang
nicht erbracht. Die dennoch zu beobachtende Zunahme an PHB-Programmen in
Deutschland gab Anlass, ihre aktuelle Praxis zu untersuchen.

Material/Methoden Im Rahmen einer systematischen
Internetrecherche (01/2018) wurden PHB-Programme in Deutschland
identifiziert und anhand neun vorab definierter Kriterien systematisch
verglichen.

Ergebnisse 38 PHB-Programme wurden eingeschlossen: 27 werden aktuell noch
angeboten, 11 wurden wieder eingestellt. Diese zeigten eine erhebliche Vielfalt
ihrer Programmkomponenten. Idealtypisch ließen sich medizin- und
sozialraumorientierte Programme (n=8 vs. n=24) unterscheiden.
Maßgebliche Unterscheidungskriterien waren Trägerschaft,
Profession der Hausbesucher und Interventionsinhalte. Demnach wird die Praxis in
Deutschland durch folgende Ausgestaltung geprägt: Kommunale
Trägerschaft, Sozialarbeiter als Hausbesucher und Beratungsleistungen
ohne integriertes Casemanagement. Programme dieses Typs entstanden
überwiegend erst in diesem Jahrzehnt.

Schlussfolgerungen PHB für ältere Menschen entwickeln
sich von anfangs medizin- zu eher sozialraumorientierten Programmen der
kommunalen Daseinsfürsorge. Sie zielen dabei auf ältere Menschen
mit unklarem Unterstützungsbedarf, die zugleich Barrieren für
die Inanspruchnahme geeigneter Leistungen aufweisen. Von PHB wird primär
ein positiver Effekt auf die Sicherung sozialer Teilhabe erwartet. Belege
für ihre Wirksamkeit stehen jedoch noch aus. Diese sollten vor einer
breiten oder gar gesetzlich verankerten Anwendung vorliegen.
Evaluation zum Nationalen Gesundheitsziel „Depressive Erkrankungen: verhindern, früh erkennen, nachhaltig behandeln“ – Die Entwicklung 10 Jahre nach Verabschiedung
Authors: Kocalevent Rüya Daniela , Härter Martin
Published: October 2018

Hintergrund Überprüfung des in 2006 entwickelten Evaluationskonzepts zum Nationalen Gesundheitsziel: „Depressive Erkrankungen: verhindern, früher erkennen, nachhaltig behandeln“.

Ziel Ziel ist es, verfügbare Erkenntnisse, Studien und Datenquellen der letzten 10 Jahre darzustellen und zu untersuchen, inwieweit die formulierten Teilziele erreicht wurden.

Methoden Zur Bewertung wurde die 2006 entwickelte Aufteilung in Teilziele (Aufklärung; Prävention; Diagnostik, Indikationsstellung und Therapie; Versorgungsstruktur; Stärkung der Patienten und Rehabilitation) und der daraus abgeleiteten Maßnahmen genutzt, um den Grad der Zielerreichung zu beurteilen.

Ergebnisse Zum Bereich Prävention existierten bereits nach Verabschiedung der Gesundheitsziele relevante Datenquellen. Zu den Bereichen Aufklärung, Diagnostik und Indikationsstellung und Versorgungsstruktur liegen aus den letzten Jahren generierte Datenquellen vor, die im Wesentlichen von Kostenträgern und der Wissenschaft zur Verfügung gestellt wurden. Einen wichtigen Meilenstein stellte hier die S3-/Nationale Versorgungsleitlinie „Unipolare Depression“ im Rahmen des Aktionsfeldes Diagnostik/Indikationsstellung/Therapie dar. Am ehesten fanden sich Datenlücken für die Aktionsfelder Stärkung der Patienten und Rehabilitation.

Diskussion Die Teilziele haben weiterhin Gültigkeit. Dennoch ist die Aussagekraft der überwiegend querschnittlichen Quellen zur Bewertung bzw. Evaluation der Erreichung des im Fokus stehenden Gesundheitsziels sehr begrenzt. Nach den jetzigen Erfahrungen sollten für eine Evaluation longitudinale Indikatoren der Teilziele, die quantitativ gemessen und beobachtet werden können, von Indikatoren unterschieden werden, bei denen primär ein qualitativer Zugang angemessen ist.
Gesundheitskompetenz im höheren Lebensalter
Authors: Vogt Dominique , Berens Eva-Maria , Schaeffer Doris
Published: October 2018

Hintergrund Gesundheitskompetenz – international als Health
Literacy bezeichnet – ist ein zunehmend diskutiertes Thema. Obschon
die Studienlage in Deutschland noch lückenhaft ist, deutet sich an,
dass bestimmte Gruppen sich häufiger vor Schwierigkeiten im Umgang
mit Gesundheitsinformationen gestellt sehen als die
Allgemeinbevölkerung. Dazu gehören auch ältere
Menschen. In der deutschsprachigen Forschung zur Gesundheitskompetenz wurden
sie bisher jedoch kaum untersucht oder nur als homogene Gruppe
betrachtet.

Ziele und Methode Ziel des vorliegenden Beitrags ist eine Analyse der
Gesundheitskompetenz bzw. Health Literacy von Menschen im höheren
Lebensalter. Auf der Basis der Daten der HLS-GER-Studie wird die
Gesundheitskompetenz von Menschen im Alter von 65 Jahren und älter
unterteilt in 3 Altersgruppen untersucht. Der Fokus liegt auf den Bereichen
Krankenversorgung, Prävention und Gesundheitsförderung und
den unterschiedlichen Dimensionen der Informationsverarbeitung (finden,
verstehen, beurteilen und anwenden). Die Gesundheitskompetenzniveaus in den
einzelnen Bereichen und Dimensionen werden differenziert nach Altersgruppen
deskriptiv dargestellt. Mögliche Altersgruppenunterschiede werden
mit Hilfe einfaktorieller Varianzanalyse auf Basis der Mittelwerte der
einzelnen Subskalen auf Signifikanz geprüft.

Ergebnisse Von den 475 einbezogenen Menschen ab 65 Jahren sehen sich
mehr als zwei Drittel vor Schwierigkeiten im Umgang mit
Gesundheitsinformation gestellt und haben eine eingeschränkte Health
Literacy. Besonders im Bereich Krankenversorgung wird der Umgang mit
Gesundheitsinformationen von älteren Menschen als schwierig
eingeschätzt; ähnliches gilt für die Suche und
Beurteilung von gesundheitsrelevanten Informationen. Dabei zeigen sich
statistisch signifikante Unterschiede zwischen den betrachteten
Altersgruppen.

Schlussfolgerung Die Analyse unterstreicht die Notwendigkeit weiterer
altersdifferenzierter Studien zur Gesundheitskompetenz. Auch bei der
Interventionsentwicklung sind unterschiedliche, nach Altersgruppen
differenzierte Strategien erforderlich.
Die Inanspruchnahme gynäkologischer Krebsfrüherkennungsuntersuchungen bei 20- bis 35-jährigen Frauen mit Bezug sozialer Transferleistungen nach Sozialgesetzbuch II
Authors: Ulbricht Sabina , Beyer Angelika , John Ulrich
Published: October 2018

Ziel der Studie waren Analysen von Zusammenhängen zwischen der Inanspruchnahme gynäkologischer Krebsfrüherkennungsuntersuchungen (GKF) und der Dauer des Bezugs von Transferleistungen nach Sozialgesetzbuch II bei Frauen im Alter von 20 bis 35 Jahren. Es liegen vollständige Daten von 223 Frauen vor (Teilnahmerate: 69,0%). Die Daten zeigen, dass von denen mit kurzem Leistungsbezug (<12 Monate) mehr an GKF teilnahmen als von denen mit langem Leistungsbezug (>36 Monate).
Modellierung der Effektivität von Infektionsschutzmaßnahmen zur Elimination der Masern unter besonderer Berücksichtigung der nach 1970 geborenen Erwachsenen
Authors: Georg Ines , Wildner Manfred
Published: October 2018

Hintergrund Bezogen auf den „Nationalen Aktionsplan“ zur Umsetzung des WHO-Ziels einer Masernelimination bestehen erhebliche Herausforderungen bei Erwachsenen und beim Ausbruchsmanagement.

Methode Die Beschreibung der Ziel-Bevölkerungsgruppe der nach 1970 geborenen Erwachsenen sowie weiterer potentiell vulnerabler Gruppen erfolgte mittels einer systematischen Literaturübersicht. Mithilfe einer weiteren systematischen Literaturübersicht wurden Handlungsoptionen zur Verhinderung von Neuinfektionen aufgezeigt und Handlungsempfehlungen diskutiert. Eine Modellierung zur Verdeutlichung des Einflusses der verschiedenen infektionsepidemiologischen Parameter wurde durchgeführt.

Ergebnisse Für die 20–39-Jährigen beträgt die anzunehmende Impfquote 79,8% bei 20–29-Jährigen und 46,7% bei 30–39-Jährigen, die erhobenen Seroprävalenzen wiesen dem gegenüber für die 20–29-Jährigen eine Seropositivität von ca. 91,5% und für die 30–39-Jährigen von ca. 95% nach. Vulnerable Subgruppen mit religiös oder weltanschaulich begründeter ablehnender Einstellung (Impfquoten von 50 bis 75%) sowie Migranten (85,9–95,1%) und Asylsuchende (89,9%) wurden identifiziert. Die systematische Literaturübersicht zeigt, dass Interventionen zur Erhöhung der prä- bzw. postexpositionellen Durchimpfungsquote sowie zur Verringerung der Kontaktrate effektiv sind bzw. sein können. Bei idealer Absonderung kann schon eine Impfquote von 73% ausreichen, um ein Ausbruchsgeschehen unter Kontrolle zu bringen. Die durchgeführte Modellierung verdeutlicht die Relevanz der hohen Basisimmunisierung gegenüber anderen Einflussfaktoren für eine effektive Ausbruchskontrolle. Es wird ferner berechnet, wie hoch die Effektivität weiterer Interventionen sein müsste, um einen Ausbruch einzudämmen.

Schlussfolgerungen Die Ergebnisse legen nahe, die Basisimmunität weiter zu erhöhen und zusätzlich im Ausbruchsfall eine konsequente Absonderung durchzuführen. Die Zielgruppe der jungen Erwachsenen insbesondere mit Migrationshintergrund aus Ländern mit bekannter hoher Suszeptibilität und weitere vulnerable Subgruppen sollten gezielt bezüglich einer ggf. nachzuholenden Masernimpfung angesprochen und der bisherige Fokus von Kindern- und Jugendlichen auf Erwachsene ausgedehnt werden. Hierbei erscheinen diversity-sensible Maßnahmen der Informationsvermittlung und ein erleichterter Zugang zu Impfungen besonders geeignet.
Zur Situation der Versorgungsforschung an deutschen Universitäten, Hochschulen und Fachhochschulen
Authors: Ernstmann Nicole , Heuser Christian , Pfaff Holger
Published: October 2018

Ziel der Studie Bislang mangelt es an Wissen zur Situation der Versorgungsforschung an deutschen Universitäten, Hochschulen und Fachhochschulen. Daher ist es das Ziel der vorliegenden Untersuchung, eine erste Bestandsaufnahme zu Versorgungsforschungsstrukturen im Bereich Lehre und Forschung zu liefern.

Methodik Es wurde von Februar bis April 2017 eine Online-Befragung deutscher Versorgungsforschungs-Hochschullehrer durchgeführt. Die Befragung enthielt 25 offene und geschlossene faktische Fragen. Die quantitativen Antworten wurden deskriptiv mit IBM SPSS Statistics 24 analysiert. Die offenen Fragen wurden qualitativ inhaltsanalytisch ausgewertet.

Ergebnisse N=42 Hochschullehrer nahmen teil (Rücklauf 97,6%). Die Versorgungsforschung wird im Studiengang Humanmedizin sowie in gesundheitswissenschaftlichen Studiengängen unterrichtet. Spezifische Studiengänge der Versorgungsforschung konnten an 3 Standorten ausgemacht werden. Die Promotions- und Habilitationsmöglichkeiten im Fach Versorgungsforschung sind heterogen. Im Bereich der Forschungsmethoden dominieren quantitative Methoden, insbesondere Patient Reported Outcome-Forschung mit Primärdaten. Die häufigsten theoretischen Kooperationsfächer sind die Biometrie/Epidemiologie und die Gesundheitsökonomie.

Schlussfolgerung Neben der Ausbildung in den Bezugsdisziplinen existiert ein weitergehender Fortbildungsbedarf für Versorgungsforscher in spezifischer Terminologie, Rahmenmodellen, Datenquellen und -auswertungsmethoden, Datenschutzaspekten und gesundheitspolitischen Aspekten. Neben der Ausbildung der Versorgungsforscher gilt es, die Promotions- und Habilitationsmöglichkeiten im Fach Versorgungsforschung an den Fakultäten zu verbessern, um den wissenschaftlichen Nachwuchs in der Versorgungsforschung weiter zu fördern.
Die Rolle der Dialysatzusammensetzung und -temperatur
Authors: Bokemeyer Dirk
Published: October 2018

Die Wahl der Dialysatzusammensetzung ist für die Verträglichkeit und die Vermeidung von Komplikationen einer Hämodialyse von elementarer Bedeutung. Während der
Dialyse ist die Salzbilanz für die kardiovaskuläre Stabilität und die Blutdruckkontrolle relevant. Die Natriumkonzentration im Dialysat sollte an den
individuellen Sollwert für die extrazelluläre Osmolarität angepasst werden. Ziel der Festlegung des Dialysatkaliums ist die sichere Vermeidung von
Hyperkaliämien. Darüber hinaus sollte während der Dialyse eine neutrale Kalziumbilanz angestrebt werden, dies wird bei den meisten Patienten bei einer
Kalziumkonzentration des Dialysats von 1,25 mmol/l erreicht. Auch das Bikarbonat sollte bei jedem Patienten so gewählt werden, dass zur Mitte der Woche ein
Serumbikarbonat von über 22 mmol/l erreicht wird. Letztendlich ist auch die Wahl der richtigen Dialysattemperatur zur Vermeidung intradialytischer Hypotonien
wichtig. Zusammengefasst sollte zur Steigerung der Verträglichkeit der Dialyse und zur Vermeidung von Spätkomplikationen das Dialysat individuell verordnet
werden.
Die Rolle von Hämodynamik und Biosignalen für eine „verträgliche“ Hämodialyse
Authors: Beige Joachim
Published: October 2018

Die „verträgliche Dialyse“ bedarf einer naturwissenschaftlich exakten Definition unter Beachtung der verschiedenen Dimensionen der Zielqualität von
Dialyseverordnung, Freiheit von intradialytischen Ereignissen (intradialytic morbid events: IME) sowie körperlichen Symptomen und psychosozialer
Verträglichkeit. Der heute am ehesten gangbare Weg besteht in der Integration verfügbarer intradialytischer Biosignale mit technischen Behandlungsparametern.
Als Hypothese kann das Ziel der Erhaltung einer sympathovagalen Balance formuliert werden. Zur Erreichung dieses Ziels sind in der (Dialyse)medizin neuartige
technische Ansätze unter Einbeziehung künstlicher Intelligenz nötig. Gefundene und benutzte Algorithmen müssen zwingend offengelegt werden (Open Source
Prinzip).
Verträglichkeit bei Heimdialyseverfahren
Authors: Karger Claudia , Beige Joachim , Kitsche Benno
Published: October 2018

Stärker als die zentrumsbasierten Verfahren bieten Heimverfahren die Möglichkeit, die sozialen und die mit Lebensqualität assoziierten Unverträglichkeiten der
Nierenersatztherapie zu adressieren. Im vorliegenden Artikel werden die Aspekte einer nicht nur medizinischen Verträglichkeit beschrieben und zu den
Möglichkeiten, die Heimverfahren bieten, in Beziehung gesetzt. Dennoch können auch schwerpunktmäßig medizinische Probleme wie hämodynamische Instabilität,
Blutdruck- und Volumenregulation mittels der flexibleren Möglichkeiten der Heimdialyseverfahren erfolgreich angegangen werden. Der Artikel zeigt geeignete
Herangehensweisen und stellt vor allem das Verständnis und die Lösungsansätze durch betroffene Patienten selbst in den Mittelpunkt der Überlegungen. Dieses
„Shared Decision Making“ und die unter anderem darauf basierenden Bewältigungsstrategien stellen einen sowohl neuartigen als auch notwendigen Ansatz bei der
Versorgung unserer lebenslang erkrankten Patienten dar.
Synthesis of 8-Oxabicyclo[3.2.1]octanes by TiCl4-Mediated Reactions of 3-Alkoxycyclobutanones and Allenylsilanes
Authors: Matsuo Jun-ichi , Onnagawa Tatsuo , Yamazaki Mizuki , Yoshimura Tomoyuki
Published: October 2018

1-Substituted allenylsilanes reacted with 3-alkoxycyclobutanones in the presence of TiCl4 to afford 8-oxabicyclo[3.2.1]octan-3-ones stereoselectively. Nucleophilic attack of allenylsilanes to a 1,4-zwitterionic intermediate formed from 3-alkoxycyclobutanones and TiCl4­ followed by 1,2-silyl migration, five-membered cyclization with an alkoxy group, and seven-membered cyclization of titanium enolate was proposed. Deuteration and one-pot Peterson olefination suggested that alkyl titanium species were formed after cyclization to 8-oxabi­cyclo[3.2.1]octane skeletons.
Potencial hidrogeniônico da água e sua influência no organismo humano: um artigo de revisão
Authors: Nogueira-de-Almeida Carlos , Filho Durval
Published: October 2018

Introdução Há um conceito disseminado de que o pH dos alimentos tem relação direta com o aparecimento e a progressão de doenças crônicas como osteoporose, câncer, doenças cardiovasculares entre outras e águas com pH ácido também contribuiriam para esse cenário.

Objetivos Sistematizar o conhecimento científico produzido acerca do potencial hidrogeniônico da água e sua relação com o funcionamento do organismo humano.

Métodos Revisão nas bases de dados Medline/Pubmed e Environmental Engineering Abstracts (Proquest), entre os meses de abril e maio de 2018. Utilizaram-se os seguintes descritores: acidez da água, alcalinidade da água, características físico-químicas da água, água alcalina, água ácida. Foram incluídos artigos publicados em português e inglês.

Conclusões Os benefícios à saúde alegados em relação à água alcalina não estão relacionados diretamente ao pH da água e sim ao seu teor elevado de bicarbonato, acima de 2 g por litro. Entretanto as diferenças relativas das populações estudadas e ao conteúdo das intervenções dificultam a generalização dos resultados obtidos.
Total Intravenous Anesthesia in Neurosurgery
Authors: Kannabiran Narmadhalakshmi , Bidkar Prasanna Udupi
Published: October 2018

In recent years, neurosurgical anesthesia has been rapidly evolving in the fields of pharmacotherapy and techniques to administer safe anesthesia. Intravenous (IV) anesthetic agents reduce both cerebral blood flow and intracranial pressure besides maintaining flow–metabolism coupling in contrast to inhalational agents. In neuroanesthesia, the technique and choice of drugs directly influence the outcome of the patients. The purpose of this review is to provide the updated information of total intravenous anesthesia (TIVA) in neuroanesthesia. Administration of TIVA using target-controlled infusion technique is emerging as a standard method to administer safe anesthesia in neurosurgical patients. The propofol–remifentanil combination has become very popular due to their favorable pharmacokinetic and pharmacodynamic properties for neurosurgery cases. Plasma-effect site concentration monitoring from target TCI devices together with electroencephalogram or bispectral index monitors allows easy titration of anesthetic agents to ensure adequate depth of anesthesia depending upon the nociceptive stimulus. TIVA is associated with smooth induction and rapid emergence with less postoperative nausea and vomiting.
Risk of Maternal Morbidity with Increasing Number of Cesareans
Authors: Wan Leping , Rampersad Roxane , Stout Molly , Macones George , Cahill Alison , Tuuli Methodius , Sondgeroth Kristina
Published: October 2018

Objective To estimate the risk of perioperative morbidity with increasing number of cesareans.

Study Design We conducted a retrospective cohort study from 2004 to 2010. Patients delivered by cesarean were included. Outcome measures were a composite organ injury (bowel or bladder), hysterectomy, hemorrhage requiring transfusion, severe morbidity, or surgical site complications. The Cochran–Armitage's test of trend was used to assess increasing incidence of each morbidity with number of prior cesareans. Multivariable logistic regression was used to estimate adjusted risks for each morbidity with increasing number of cesareans compared with primary cesarean.

Results Of the 15,872 women in the cohort, 5,144 had cesarean delivery: 3,113 primary, 1,310 one prior, 510 two prior, and 211 three or more prior cesareans. There was a significant increase in organ injury, hysterectomy, and surgical site complications with increasing number of cesareans. In multivariable analysis, the risk of organ injury and hysterectomy was increased compared with primary cesarean after two prior cesareans, and after three or more cesareans for hemorrhage requiring transfusion and surgical site complications.

Conclusion The risks of organ injury and hysterectomy are increased after two or more prior cesareans, and risks of hemorrhage and surgical site complications are increased after three or more cesareans.
Plastic and Orthopaedic Interventions and Long-Term Sequelae in Children with Meningococcal Septicemia—40 Years of Experience at the University Children's Hospital Zurich
Authors: Elrod Julia , Mannhard Doris , Mohr Christoph , Lienert Christine , Hagemann-Gysling Kerstin , Schiestl Clemens , Mazzone Luca
Published: October 2018

Introduction Meningococcal septicemia is not merely an acute disease with a high lethality, but patients surviving the fulminant phase can suffer from serious long-term sequelae.

Materials and Methods The records of 165 patients admitted to the hospital from 1968 to 2008 with the diagnosis of meningococcal septicemia were retrospectively reviewed for early signs at presentation, intensive care management, acute symptoms, the necessity of plastic and orthopaedic surgical management, and long-term orthopaedic sequelae. Possible predictors of these conditions were determined.

Results Overall lethality was 17.5%, and mean time of hospitalization time was 28 days. Integument involvement occurred in 45%, often resulting in the necessity of plastic surgical procedures. Young age is a significant indicator or skin involvement. Amputations were necessary in 9% of all cases, affecting the lower extremities more often than the upper extremities. Six percent of all children suffered from long-term orthopaedic sequelae, such as growth retardation and angular deformities, appearing up to 11 years (mean 4.9 years) after onset of the acute disease. The incidence of amputations and long-term orthopaedic sequelae correlated significantly with severity of the disease.

Conclusion Meningococcal septicemia can entail devastating long-term consequences in children surviving the acute phase of the disease. Sequelae may become apparent only years later and cause further damage. To prevent this, a systematic follow-up till adulthood is necessary.
Child Migrant Health: The Role of Pediatric Surgery in the Migrants' Route across Balkan Countries to North-West Europe
Authors: Marjanovic Zoran , Raicevic Maja , Slavkovic Andjelka , Zivanovic Dragoljub , Filipovic Ivan , Bojovic Nikola
Published: October 2018

Introduction Child migrants are the most vulnerable population, prone to various health conditions due to trauma and the bad living conditions that they experience during their migration. The objective of this study was to determine the pediatric surgical conditions of migrant children treated in our hospital on their way toward North-West Europe.

Materials and Methods A retrospective analysis was performed on all admitted migrants in one tertiary and one secondary level hospital from 2016 to 2018. Only migrant children with surgical issues who had been hospitalized or treated in outpatient clinics were included in the study.

Results There were 47 migrants admitted to hospitals and outpatient clinics; 32 from Afghanistan, 11 from Iraq, 1 from Syria, 2 from Iran, and 1 from Algeria. There were 27 boys and 20 girls, average age 7.96 years (range: 3 months–17 years). The average length of hospitalization was 14.1 days (range: 1–48), and average stay in the intensive care unit (ICU) was 7.4 days (range: 1–15). There were 29 migrants treated in outpatient clinics, and 18 were hospitalized. The cause of seeking surgical treatment was trauma in 33 and non-traumatic surgical problems in 14. The most common types of trauma were isolated fractures which occurred in one, followed by isolated head injury in eight. Polytrauma occurred in five. A lethal outcome occurred in one 9-year-old boy from Afghanistan due to severe polytrauma.

Conclusion Trauma, predominantly fractures and head injuries, was the leading cause of morbidity in migrant children treated in these two hospitals.
Comparison of Corticosteroid and Vincristine in Treating Kaposiform Hemangioendothelioma and Tufted Angioma: A Systematic Review and Meta-Analysis
Authors: Yao Wei , Li Kai , Wang Zuopeng , Pei Jiahao , Liu Xiangqi , Zheng Shan , Dong Kuiran
Published: October 2018

Objective To evaluate the outcome and safety of corticosteroids and vincristine (VCR) in the treatment of kaposiform hemangioendothelioma (KHE) and tufted angioma (TA).

Materials and Methods Clinical studies involving corticosteroids and VCR therapies in treating KHE/TA were identified by using PubMed, Cochrane Library, OVID, EBSCO, CNKI, VIP, and Wanfang databases from their establishment date to December 2017. Randomized controlled trials, case–control, or case series with more than five cases were included. The following data were extracted: study sample, demographics, responses rate, recurrence rate, and adverse reactions. Two reviewers completed screening and extraction. Methodological quality was evaluated with quality appraisal tool.

Results A total of 266 studies were found, and 27 studies were finally included in this research; quality of all studies was low. Seven studies with a total of 123 participants, which compared the effect of systemic corticosteroids with that of VCR, were performed for the meta-analysis. The results indicated that the effect of VCR was significantly higher than that of corticosteroids (relative risk [RR] = 2.08, 95% confidence interval [CI]: 1.38–3.16). The recurrence rate of VCR (11.1%) was lower than that of corticosteroids (50%), but there was no statistical difference between the two therapies (p = 0.1312). The result of pooled adverse reactions response rate for VCR was 18.2%, significantly lower than that for corticosteroids, which was 52.0%.

Conclusion The present profile shows that VCR is relatively more effective and safer in treating KHE/TA than corticosteroids are. So, we believe VCR could be used as a first-line medication agent in the treatment of KHE/TA.
Incidence and Risk Factors for Postpartum Severe Hypertension in Women with Underlying Chronic Hypertension
Authors: Glover Angelica V. , Tita Alan , Biggio Joseph R. , Anderson Sarah B. , Harper Lorie M.
Published: October 2018

Objective To determine risk factors and time to diagnosis of postpartum severe hypertension (PHTN) in women with chronic hypertension (CHTN).

Study Design Retrospective cohort of singleton pregnancies with CHTN at a tertiary care center. The primary outcome was PHTN, defined as hypertension ≥160/ ≥ 110 mm Hg during an emergency room (ER) or outpatient visit, or hospitalization within 8 weeks postpartum. Multivariable logistic regression was used to assess independent risk factors for PHTN.

Results Two-hundred thirty-five women had CHTN: 30 (12.8%) were diagnosed with PHTN, and 17 (7.2%) were hospitalized or seen in the ER for PHTN. Women with PHTN had more severe superimposed pre-eclampsia (p < 0.05), higher average systolic blood pressures at discharge (141 vs. 135 mm Hg, p = 0.04), and required antihypertensives after delivery (p < 0.01). The number of antihypertensive medications (adjusted odds ratio [aOR] 1.78, 95% confidence interval [CI], 1.25–2.55) and a systolic blood pressure >135 mm Hg (aOR 4.55, 95% CI, 1.64–12.61) at discharge remained independently associated with PHTN. Median time to diagnosis of PHTN was 10 days (interquartile range [IQR] 6–32 days); time to diagnosis among women requiring readmission or ER evaluation was 8 days (IQR 5–11 days).

Conclusion PHTN occurred in 13% of women with CHTN, and was associated with blood pressure level and number of medications at discharge.
Women with a Preterm Cesarean Have High Rates of Successful Trial of Labor in a Subsequent Term Pregnancy
Authors: Rietveld Anna L. , Heestermans Lotte A. P. H. , Kazemier Brenda M. , Teunissen Pim W. , de Groot Christianne J. M.
Published: October 2018

Objective The rate of cesareans has increased worldwide. Therefore, an increasing number of women has to decide how to deliver in a subsequent pregnancy. Individualized information on risks and success chances is helpful. This study investigates the effect of a preterm cesarean on success of subsequent term trial of labor.

Study Design Ten-year Dutch cohort (2000–2009) of women with one previous cesarean and a subsequent term trial of labor. Subgroups were made based on gestational age at first cesarean delivery (25–28, 28–30, 30–32 and 32–34 weeks) and stratified based the way in which second delivery started. Rates of vaginal deliveries, maternal, and neonatal outcomes were compared with women who had a first-term cesarean (37–43 weeks).

Results Four thousand three-hundred forty-two women delivered by preterm cesarean in the first pregnancy. These women had high rates of successful trial of labor, both after spontaneous onset (86.2–96.2%) and induction (72.8–75.4%). Rates of adverse outcomes were low and similar compared with women with a previous term cesarean.

Conclusion In this 10-year nationwide cohort, women with a preterm first cesarean who opted for trial of labor in a subsequent pregnancy had high rates of successful trial of labor.