bluuebunny/crossref_metadata_2025 huggingface dataset:
Separate and Combined Influence of Cognitive Impairment and Dysarthria on Functional Communication in Multiple Sclerosis
Authors: Feenaughty Lynda , Tjaden Kris , Weinstock-Guttman Bianca , Benedict Ralph H. B.
Published: July 2018

Purpose

Dysarthria is a consequence of multiple sclerosis (MS) that can co-occur with cognitive impairment. Clinical management thus requires understanding the separate and combined effects of dysarthria and cognitive impairment on functional communication in MS. This study compared perceptual measures of intelligibility and speech severity that capture functional communication deficits for 4 operationally defined groups with MS. The relationship between communication participation and perceptual measures was also examined.

Method

Forty-eight adults with MS and 12 healthy controls participated. Cognitive testing and dysarthria diagnosis determined group assignment: (a) MS with cognitive impairment (MSCI), (b) MS with a diagnosis of dysarthria and no cognitive impairment (MSDYS), (c) MS with dysarthria and cognitive impairment (MSDYS + CI), and (d) MS without dysarthria or cognitive impairment (MS). Sentence Intelligibility Test scores, scaled speech severity obtained from the “Grandfather Passage,” and Communication Participation Item Bank (CPIB) scores were analyzed.

Results

Sentence Intelligibility Test scores approached 100% for all groups. Speech severity was greater for the MSDYS + CI and MSDYS groups versus controls. CPIB scores were greatest for the MSDYS + CI group and were not significantly correlated with either perceptual measure.

Conclusions

The CPIB and speech severity were sensitive to aspects of communication problems for some groups with MS not reflected in a measure of sentence intelligibility. Findings suggest the importance of employing a variety of measures to capture functional communication problems experienced by persons with MS.
Measuring Sound-Processor Thresholds for Pediatric Cochlear Implant Recipients Using Visual Reinforcement Audiometry via Telepractice
Authors: Hughes Michelle L. , Goehring Jenny L. , Sevier Joshua D. , Choi Sangsook
Published: July 2018

Purpose

The goal of this study was to test the feasibility of using telepractice for measuring behavioral thresholds (T levels) in young children with cochlear implants (CIs) using visual reinforcement audiometry (VRA). Specifically, we examined whether there were significant differences in T levels, test time, or measurement success rate between in-person and remote test conditions.

Method

Data were collected for 17 children, aged 1.1–3.4 years. A within-subject AB-BA (A, in-person; B, remote) study design was used, with data collection typically occurring over 2 visits. T levels were measured during each test session using VRA for one basal, middle, and apical electrode. Two additional outcome measures included test time and response success rate, the latter of which was calculated as the ratio of the number of electrode thresholds successfully measured versus attempted. All 3 outcome measures were compared between the in-person and remote sessions. Last, a parent/caregiver questionnaire was administered at the end of the study to evaluate subjective aspects of remote versus traditional CI programming.

Results

Results showed no significant difference in T levels between in-person and remote test conditions. There were also no significant differences in test time or measurement success rate between the two conditions. The questionnaires indicated that 82% of parents or caregivers would use telepractice for routine CI programming visits some or all of the time if the option was available.

Conclusion

Results from this study suggest that telepractice can be used successfully to set T levels for young children with CIs using VRA.
The Effects of Emotion Suppression During Language Planning and Production
Authors: Roche Jennifer M. , Arnold Hayley S.
Published: July 2018

Purpose

Emotion regulation and language planning occur in parallel during interactive communication, but their processes are often studied separately. It has been suggested that emotion suppression and more complex language production both recruit cognitive resources. However, it is currently less clear how the language planning and production system is impacted when required to emotionally suppress outward displays of affect (i.e., expressive suppression). The purpose of the current study was to evaluate the interactive effects of emotion regulation and language production processes.

Method

Through discourse analysis of a corpus of interactive dialogue, we evaluated the production of interjections (i.e., also termed “filled pauses,” a type of speech disfluency) when participants regulated outward displays of emotion and when language was lexically complex (i.e., via lexical diversity). One participant (the sender) was assigned to either express or suppress affective displays during the interaction. The other person (the receiver) was given no special instructions before the interaction. The interactions were transcribed, and their linguistic content (i.e., lexical diversity, lexical alignment, and interjections) was analyzed.

Results

Results indicated that participants actively suppressing outward displays of affect produced more interjections and that participants asked to emotionally regulate, both expressors and suppressors, were more disfluent when producing lexically diverse statements (2 cognitively demanding tasks).

Conclusions

The current research provides support that, when suppressing emotion, one might be more disfluent when speaking. However, also when engaged in 2 simultaneous, demanding tasks of having to either upregulate or downregulate emotions and utter lexically diverse statements, the combined cognitive load may impede fluency in language production. More specifically, in the context of language planning and production, emotion suppression may pilfer resources away from the language planning and production system, leading to higher rates of disfluent speech. This finding is of particular importance because understanding the interactive effects of emotion and language production may be impactful to interventions for communication disorders.
Incorporating a Peer-Mediated Approach Into Speech-Generating Device Intervention: Effects on Communication of Preschoolers With Autism Spectrum Disorder
Authors: Thiemann-Bourque Kathy , Feldmiller Sarah , Hoffman Lesa , Johner Stacy
Published: July 2018

Purpose

This study examined the effects of incorporating a peer-mediated approach into a speech-generating device (SGD) intervention on communication of 45 nonverbal and minimally verbal preschoolers with autism spectrum disorder (ASD) and 95 peers without disabilities. The SGD was an iPad 2 (Apple) with voice output app.

Method

Effects were evaluated using a multivariate randomized control trial design with repeated measures for 4 cohorts across baseline, intervention, generalization, and maintenance phases. Children were randomly assigned to an experimental treatment that trained peers on use of the SGD or a business-as-usual comparison condition with untrained peers. Communication outcomes were measured for both children with ASD and peers.

Results

Children receiving the treatment demonstrated significant increases in rates of communication and more balanced responses and initiations (a measure of reciprocity) than children in the comparison group. They were able to generalize improvements and maintain communication gains. Treatment fidelity was high for school staff and peer implementation.

Conclusions

Results support positive effects on communication of teaching young children with ASD and peers without disabilities to use the same SGD system in typical preschool activities. SGD interventions that utilize peer-mediated approaches may improve core deficits in communication and reciprocity and allow for greater classroom social participation and interactions with peers.
ResFusion: deeply fused scene parsing network for RGB‐D images
Authors: Dai Juting , Tang Xinyi
Published: July 2018

Scene parsing is a very challenging work for complex and diverse scenes. In this study, the authors address the problem of semantic segmentation of indoor scenes for red, green, blue‐depth (RGB‐D) images. Most existing works use only the colour or photometric information for this problem. Here, they present an approach to fusing feature maps between colour network branch and depth network branch to integrate the photometric information and geometric information, which improves the semantic segmentation performance. They propose a novel convolutional neural network that uses ResNet as a baseline network. Their proposed network adopts a spatial pyramid pooling module to make full use of different sub‐region representations. Their proposed network also adopts multiple feature maps fusion modules to integrate texture and structure information between the colour branch and depth branch. Moreover, their proposed network has multiple auxiliary loss branches together with the main loss function to prevent the gradient of frontal layers disappear and accelerate the training phase of the fusion part. Comprehensive experimental evaluations show that their proposed network ‘ResFusion’ improves the performance greatly over the baseline network and has achieved competitive performance compared with other state‐of‐the‐art methods on the challenging SUN RGB‐D benchmark.
Rotor position estimation method of wound‐rotor synchronous starter/generator
Authors: Zhu Yujie , Liu Weiguo , Peng Jichang , Meng Tao , Jiao Ningfei
Published: July 2018

This study proposes a novel rotor position estimation method for wound‐rotor synchronous starter/generator (WSSG). At the starting stage, WSSG needs a resolver to obtain the main machine's (MM's) rotor position. However, the use of resolver increases starting system's complexity, volume, weight and cost. In order to solve this problem, a novel kind of MM's rotor position estimation method is proposed, which considers the structure of WSSG as a resolver. The novel method injects a rotating voltage into MM's stator, detects main exciter's stator current and subsequently processes the current signals to estimate MM's rotor position. Experimental results show that the novel method can estimate rotor position accurately, which are in good agreement with the theoretical analyses and simulation results. Compared to the saliency tracking rotor position estimation method, the novel method does not rely on WSSG's parameters (including MM's saliency), and the signal processing procedures are more simple.
Origin of the hemispheric asymmetry of solar activity
Authors: Schüssler M. , Cameron R. H.
Published: July 2018

The frequency spectrum of the hemispheric asymmetry of solar activity shows enhanced power for the period ranges around 8.5 years and between 30 and 50 years. This can be understood as the sum and beat periods of the superposition of two dynamo modes: a dipolar mode with a (magnetic) period of about 22 years and a quadrupolar mode with a period between 13 and 15 years. An updated Babcock–Leighton-type dynamo model with weak driving as indicated by stellar observations shows an excited dipole mode and a damped quadrupole mode in the correct range of periods. Random excitation of the quadrupole by stochastic fluctuations of the source term for the poloidal field leads to a time evolution of activity and asymmetry that is consistent with the observational results.
New results from the OPERA experiment
Authors: Dmitrievsky Sergey
Published: July 2018

The OPERA experiment reached its main goal by proving the appearance of νη in the CNGS νμ beam. A total sample of 5 candidates fulfilling the analysis defined in the proposal was detected with a S/B ratio of about ten allowing to reject the null hypothesis at 5.1σ. The search has been extended to γη-like interactions failing the kinematical analysis defined in the experiment proposal to obtain a statistically enhanced, lower purity, signal sample. Based on the enlarged data sample the estimation of Δm223 in appearance mode is presented. The search for νe interactions has been extended over the full data set with a more than twofold increase in statistics with respect to published data. The analysis of the νμ μ νe channel is updated and the implications of the electron neutrino sample in the framework of the 3+1 sterile model is discussed. An analysis of νμ μ νπ interactions in the framework of the sterile neutrino model has also been performed. Moreover the results of the analysis of the annual modulation of the cosmic muon rate will be presented.
Augmented Lagrangian finite element methods for contact problems
Authors: Burman Erik , Hansbo Peter , Larson Mats G.
Published: July 2018

We propose two different Lagrange multiplier methods for contact problems derived from the augmented Lagrangian variational formulation. Both the obstacle problem, where a constraint on the solution is imposed in the bulk domain and the Signorini problem, where a lateral contact condition is imposed are considered. We consider both continuous and discontinuous approximation spaces for the Lagrange multiplier. In the latter case the method is unstable and a penalty on the jump of the multiplier must be applied for stability. We prove the existence and uniqueness of discrete solutions, best approximation estimates and convergence estimates that are optimal compared to the regularity of the solution.
Load Planning of Transport Aircraft Based on Hybrid Genetic Algorithm
Authors: Chenguang Yang , Hu Liu , Yuan Gao
Published: July 2018

Loading of transport aircraft attracts much attention as the airlift is developing rapidly. It refers to the process that various cargoes are loaded, in an appropriate manner, into kinds of transport aircrafts with constraints of volume, weight and gravity center. Based on two-dimensional bin packing with genetic algorithm (GA), a new hybrid algorithm is proposed to solve the multi-constraint loading problem of transport aircraft for seeking the minimum of fuel consumption. Heuristic algorithm is applied to optimize single-aircraft loading in GA decoding, and the procedure of hybrid GA is summarized for the multi-aircraft loading issues. In the case study, eight kinds of cargos are distributed in three different aircrafts. The optimal result indicates that this algorithm can rapidly generate the best plan for the loading problem regarding lower transport costs.
One Micro-thrust Measurement Method Based on the Acoustoelastic Theory
Authors: Ou Yang , Wu Jianjun , Zhang Yu , Li Jian , Tan Sheng
Published: July 2018

Concerning the traditional way of micro-thrust measurement cannot get the transient thrust value with high precision and the measuring process of piezoelectric sensors is sensitive to the electromagnetic interference, this paper builds one new measurement method basing on the acoustic elasticity theory. The acoustoelastic element is the core of the whole system as it can transform the thrust changes into the variation of acoustic time. Thus adopting a timer to record such variation so that the thrust changes in real-time could be obtained, which is helpful for studying the mechanism of micro thrusters. This method built in this paper is not only non-contact and non-destructive but also easy to operate with simple structure and high precision.
Prediction Method of Equipment Degradation State Based on Improved RVM
Authors: Cheng Lu , RuiQi Wang , TingXue Xu , YuQi Chen
Published: July 2018

In order to improve the prediction accuracy of the relevance vector machine model, an improved method for equipment condition prediction is proposed. First of all, an improved kernel function of variance Gauss kernel (VGKF) is constructed to improve the global performance and generalization ability of the kernel function. Then, by using the method of selecting the number of adjacent points in the chaotic sequence local prediction method, the H-Q criterion was used to optimize the embedding dimension of the training space to avoid the blindness of subjective selection. Through the prediction example of terminal guidance radar equipment test parameters, the effectiveness and superiority of the improved RVM were verified.
Research of the Frictional Characteristics of Piston Ring - Cylinder Liner Based on GT-Suite
Authors: SHI Chao-fan , WANG Pu-kai , LIU Jian-min , KANG Qi , DONG Yi
Published: July 2018

Establish the piston ring-cylinder liner frictional model using the software of GT-Suite combine both of the frictional condition and lubrication, analyze and compute the thickness of oil film between piston ring and cylinder liner, the distribution of oil stress, and the force and power of the friction in rated condition. Then, mainly analyze the thickness of oil film and power of friction at the first piston ring under different temperatures of lubrication oil and different speeds. The results indicate that: The lubrication effect at first piston ring is poor, and the consumption of frictional power is high. The frictional power is significantly reduced with the oil temperature increases. However, the thickness of the oil film will decrease with the oil temperature increases, which is bad to the lubricational condition. Considering both of the lubrication condition and the frictional power, the frictional characteristics are better when the oil temperature is maintained at 80-90°C. With the increase of rotational speed, the oil film thickness and frictional power increase, but comparing with the influence on the frictional power, the change of rotational speed has less influence on the oil film.
Complex Logic Control Algorithm and Simulation Application Based on Matrix Modeling
Authors: Li Yu , An Gang , Li Xin
Published: July 2018

The complex logic control of discrete signals is a common problem in engineering applications. The traditional program design using multi branch conditional transfer algorithm, program complexity increases with the complexity of the problems, therefore, the ability to solve logic control severely limits the scale and complexity of problems. The complex logic control algorithm based on matrix modeling is based on the analysis and modeling of logical relations, and the implementation of the two-dimensional matrix makes the complexity of the program irrelevant to the problem. The algorithm can well solve the display and control simulation problem of the multi-function display in aircraft cockpit display and control equipment. It has good expansibility and popularization.
Research on Thermal Insulation Performance of Lightweight Thermal Protection Materials for High Speed Aircraft under Different Boundary Conditions
Authors: Wang Feng , Wu Dafang , Ren Haoyuan
Published: July 2018

The determination of thermal insulation performance of thermal protection materials or structures is an indispensable and important step in the safety design of high speed flight vehicles. To obtain the temperature difference of the radiating surface for plate specimens under three different boundary conditions in heat insulation experiments (the specimens were placed either vertically or horizontally with the radiating surface facing down or horizontally with the radiating surface facing up), three thermal test setups were established to test the thermal insulation performance of light-weight ceramic specimens at different temperatures. The results show that the radiating surface temperature was the highest when the specimen was placed horizontally with the radiating surface facing down, while it was the lowest when the specimen was placed horizontally with the radiating surface facing up.The numerical calculation results agreed very well with the experimental ones, confirming the credibility and accuracy of the experimental results. The different thermal insulation performances of the plate specimens obtained under three different boundary conditions will provide important guidance for designers in the design of thermal protection systems for large cabins of high speed flight vehicles.
COMPRESSIVE PROPERTIES OF GEOPOLYMER MATRIX COMPOSITES
Authors: Hron Robin , Martaus František , Kadlec Martin
Published: July 2018

Polymer based resin is presently the most used resin for preparing of composites constructions, because of its undisputable benefits; however, there are some limits. The aircraft industry has especially strict requirements for fire, smoke and toxicity (FST) properties which are limited when using organic polymers. Conventional polymer resins resist to temperatures usually up to 120 °C and then they lose stiffness and strength. However, geopolymer matrix is a new type of resin with high potential for cost-efficient applications dealing with temperatures up to 1 200 °C. This paper presents compressive properties of a new geopolymer resin and a fibre reinforced composite with the geopolymer matrix (geocomposite). The effect of a harsh environment exposition on the strength was also evaluated, specifically the impact of the exposure in hot-wet and salt mist conditions. Samples were tested in accordance with ASTM D695 in case of pure resin and in accordance with ASTM D6641 in case of the geocomposite. All tests were performed at room temperature and additionally, pure geopolymer resin was tested at 400 °C. The high temperature caused 35 % decrease of the compressive strength in comparison with the room temperature. Geopolymers behaves like a ceramic and have some unique properties such as high thermal stability, non-flammability and do not generate toxic smoke and fumes.
Development of Gypsum Block of Energy Conservation and Waste Utilization
Authors: Hao Yafei , Li Lingxiao , Chen Xiongmu , Zhao Fengqing
Published: July 2018

Waste, parings and scraps (WPS) in shoemaking industry are difficult to deal with by traditional approaches, which will pollute the environment and results in waste of resources if not handled properly. In this paper, WPS, after modification, is used as reinforcing material in gypsum block, in which livestock-waste based retarder is used to control setting time. The result showed that the proper mass ratio of hemi-hydrate gypsum to WPS is 95:5. The optimal dosage of retarder is 0.23% (on the basis of total solid). The addition of modified WPS remarkably improved the characteristics of anti-cracking, water absorption, dry shrinkage and thermal conductivity of the gypsum block, with little decrease in mechanical strength values.
The design service life of wide-body commercial aircraft research based on airlines data
Authors: Wang Yue , Gao Dan , Si Jiangtao
Published: July 2018

To reasonably define the design service life of Chinese double aisles wide-body commercial aircraft, the exact market region and design condition are researched. The base market of Chinese double aisles wide-body commercial aircraft is China, Asia, Europe and the Pacific. In these zones, customers should be analyzed carefully, and the customers who are not available but play an important role in these zones should be picked off decisively. Besides, the flight length definition is also studied, which affects the design service life of aircraft obviously in small market region. After research, the results could reduce engineering difficulties, and also increase airlines adaptability and competitiveness in the specific market zone.
Is Engineering Ethics Important for Aerospace Engineers?
Authors: Haghighattalab Sakineh , Chen An , Saghamanesh Mohammadreza
Published: July 2018

Engineering as a profession has a direct effect on society and the environment. Engineering ethics is a part of the essence of engineering. One of the important branches of engineering profession is aerospace engineering. Furthermore, aerospace industry achievements play an undeniable role in our lives. Research and development in the aerospace domain have contributed to the progress of some new technologies in the last decades. The purpose of this study is to emphasize the importance of engineering ethics as an essential part of aerospace engineering. Engineering ethics examines professional responsibilities and ethical decision making of engineers. Moreover, codes of ethics help the engineers to apply ethical principles in critical conditions. The poor ethical decision-making of engineers leads to engineering failures which jeopardized human life and the environment. This paper by examining two case studies related to the field of aerospace engineering (Challenger and Columbia disasters) describes the role of the negligence of engineering ethics on the occurrence of engineering disasters.
Numerical Analysis of Bypass Mass Injection on Thrust Vectoring of Supersonic Nozzle
Authors: Islam Md Shafiqul , Hasan Md. Arafat , Toufique Hasan A.B.M.
Published: July 2018

High speed aerospace applications require rapid control of thrust (i.e. thrust vectoring) in order to achieve better manoeuvrability. Among the existing technologies, shock vector control is one of the efficient ways to achieve thrust vectoring. In the present study, bypass mass injection (passive control) was used to generate shock vectoring in a planar supersonic Converging-Diverging (CD) nozzle. Two diffenrent bypass lines were used to inject mass in the diverging section varying their dimension in the span wise direction (10 mm ×10 mm2 square channel and 2.68 mm×38 mm2 rectangular channel) in such a way that, the mass flow ratio in both the case remain the same (4.9%) in order to compare the effect of bypass channel dimension in the resulting thrust vector angle and thrust performance. Reynolds-averaged Navier-Stokes (RANS) equations with k-omega SST turbulence model have been implemented through numerical computations to capture the three-dimensional steady characterstics of the flow field. Results showed a significant change in the shock structure with the fromation of recirculation zone near the bypass injection port in both the case with a variation of shock structure and thrust performance for different geometry bypass lines. It was found that, thrust vector angle increases as injection length increases in the span wise direction.
Calculation Method of Stability Derivatives and Verification for Power-lift Aircraft
Authors: Yazhou Shi , Weijun Wang
Published: July 2018

It is difficult to realize the STOL and high-speed cruise at one time when designing an aircraft, whereas the application of power-lift technology has successfully solved this technical problem. The research about the dynamic characteristics of power-lift aircraft in hover and low speed flight regime is key important for the selection of control strategy in transition process. However, if adopting the traditional aerodynamic calculation method based on thrust coefficient concept, the hover and low speed forward flight of power-lift aircraft cannot be studied as a unified process and the stability derivatives cannot be accurately calculated in low speed. In this paper, a method for calculating the stability derivatives and model the aircraft by using full dimensional aerodynamic data is proposed, which can not only solve the problems mentioned above, and it is very convenient for the design of the control law in the transient process.
Preliminary Validation of the Wind Tunnel Based Flight Control System Evaluation Method
Authors: Huang Min , Wang Zhong-wei , Yang Xing-Bao , Guo Zhen-yun , Niu Yao-bin
Published: July 2018

As mathematical models of aircraft aerodynamics and rudder loadings always have to be built in the hardware-in-the-loop simulation, wind tunnel based flight control system (FCS) evaluation methods were proposed in order to test and evaluate the flight control systems under real aerodynamic and rudder loading environment. To validate the evaluation method, a wind tunnel based flight control system test was performed in a hypersonic wind tunnel facility. As the aircraft support rig in the wind tunnel is static, the aircraft angle of attack cannot be changed in this test. During the test, the elevator response, the lift force and the pitching moment were measured. By analysing the measured data, the elevator control performance of the pitch control system was determined, and the pitch angle was successfully predicted, but the open-loop pitch control performance was not determined. These results validate the feasibility of evaluating the elevator control performance and predicting the pitch angle of a FCS by the wind tunnel based FCS evaluation method.
Modeling and Simulation of Mission Planning Problem for Remote Sensing Satellite Imaging
Authors: Pan Yao , Chi Zhong Ming , Rao Qi Long , Sun Kai Peng , Liu Yi Nan
Published: July 2018

Mission planning problem for remote sensing satellite imaging is studied. Firstly, the time constraint satisfaction problem model is presented after analyzing the characteristic of time constraint. Then, An optimal path searching algorithm based on the discrete time window is proposed according to the non-uniqueness for satellite to mission in the visible time window. Simulation results verify the efficiency of the model and algorithm.
The Experimental Platform of Frosting by Vapor on Cryogenic Surface in Vacuum Environment
Authors: Qinliang Guo , Dianfu Qie , Yonghong Shang , Jing Wang , Yanqiang Bi
Published: July 2018

This paper introduces an experimental platform for studying frosting on the cryogenic surface in vacuum environment. This platform contains vacuum system, cold surface temperature control system, image acquisition system, data acquisition system and vapor generation device. The cold surface temperature can be varied in the range of -185 to 0°C, the vacuum degree of the chamber can be controlled in the range of 1 pa to 1bar, and the flow rate of water vapour can be controlled accurately. The experimental platform can be used to study the micro-morphology and the thermal conductivity of frost layer.
Contrat de travail : le danger du Contrat à Durée Déterminée
Authors: Bigey N.
Published: July 2018

Embaucher un salarié n’est pas sans risque, notamment dans le choix du contrat qui va lier l’employeur au salarié.

Il est fondamental de faire le choix d’un contrat adapté. Très souvent, le choix se porte sur le Contrat à Durée Déterminée. Si le motif du recours est contesté, les conséquences financières peuvent être exorbitantes.
Pourquoi est-il important de concevoir une identité visuelle pour son cabinet d’orthodontie ?
Authors: Castellani S.
Published: July 2018

Le cerveau humain ne met que quelques secondes pour se faire un premier avis sur ce qu’il voit. Cet avis dont l’impact est considérable chez l’individu va profondément influencer sa perception des choses…

L’identité visuelle (logo, couleurs, visuel) d’un cabinet d’orthodontie que l’on perçoit sur la carte de rendez-vous, le site Internet ou d’autres supports de communication, est la première image que le cabinet renvoie à ses patients actuels ou futurs. Il est donc primordial de se doter d’une image efficace, valorisante et en parfaite adéquation avec les valeurs que l’on défend et le service que l’on propose.

Au cœur de l’offre de santé, il est aujourd’hui important de communiquer des messages forts, différenciants et de qualité.
Primäre und sekundäre Sturzprävention in der Rehabilitation: Hinweise zur Sturzprophylaxe
Authors: Bujan Bartosz , Döring Christian , Sturzenegger Christian , Bürk Katrin
Published: July 2018

Eine aktive Sturzprävention bedarf einer genauen Analyse der Sturzursachen und der Einleitung gezielter Gegenmaßnahmen. Sie ist für die Qualitätssicherung der stationären Rehabilitation unentbehrlich. Von der primären Prävention mit allgemeinen Maßnahmen zur Sturzvermeidung ist die Sekundärprävention mit ihren spezifischen und individuell angepassten Maßnahmen zu differenzieren. Sie wird nach dem ersten Sturzereignis eingeleitet und berücksichtigt die mechanistische Sturzanalyse. Dieser Beitrag stellt einen praxisorientierten Leitfaden zur Sturzprävention in der Rehabilitation vor, die bei Erstellung von Rehabilitationskonzepten als ein wichtiger Bestandteil anzusehen ist.
Diabetes Mellitus in der medizinischen Rehabilitation – Inanspruchnahme rehabilitativer Maßnahmen im Zeitraum 2006–2013
Authors: Schmidt Christian , Baumert Jens , Gabrys Lars , Ziese Thomas
Published: July 2018

Hintergrund und Ziele Seit Jahren steigt die Prävalenz des Diabetes mellitus (DM) an. Aufgrund des Krankheitsbildes wird mit steigender Bedeutung rehabilitativer Leistungen gerechnet. In diesem Beitrag wird die Inanspruchnahme medizinischer Rehabilitation von 2006 bis 2013 untersucht.

Methodik Die Sekundärdatenanalyse basiert auf einem scientific use file. DM wird gemäß ICD-10 (E10-E14) definiert. Die Verläufe werden roh, altersstandardisiert und stratifiziert nach Alter und Geschlecht dargestellt. Die Inanspruchnahmen und Prävalenzen pro Bundesland werden korreliert.

Ergebnisse Die standardisierte Inanspruchnahme stieg von 2006 bis 2013 bei Männern von 170 auf 204,4 und Frauen von 99 auf 123,6 je 100 000. Während sie bei unter 60-Jährigen rückläufig ist, stieg sie in der Altersgruppe der 60–64-Jährigen um zirka 80%. Die Inanspruchnahme korreliert positiv (r=0,64) mit der bevölkerungsbezogenen Prävalenz.

Schlussfolgerung Aufgrund des zunehmend späteren Renteneintritts wächst die Bedeutung rehabilitativer Leistungen bei Personen mit DM.
Kosten von multiresistenten Erregern in der stationären Palliativversorgung
Authors: Adelhardt Thomas , Hessemer Stefanie , Heckel Maria , Herbst Franziska A. , Stiel Stephanie , Ostgathe Christoph , Schöffski Oliver
Published: July 2018

Die Studie beschäftigt sich mit den finanziellen Auswirkungen des Auftretens von multiresistenten Erregern auf einer palliativmedizinischen Station eines
deutschen Universitätskrankenhauses. Ziele der Studie sind eine Analyse der Kostentreiber sowie ein Kostenvergleich zwischen MRE-positiven und -negativen
Patienten. Zur Analyse der Kostendaten der auf der betreffenden Palliativstation behandelten Patienten wurde ein retrospektives Studiendesign mit einer
Fall-Kontroll-Analyse gewählt. Die analysierten Daten umfassen dabei neben Kostendaten wie beispielsweise den Gesamtkosten bzw. den Kosten für den Pflegedienst
auch die Verweildauer und demografische Daten der Patienten wie das Alter. Der Vergleich der Kostenunterschiede zwischen MRE-negativen und MRE-positiven
Patienten wurde mittels t-Test durchgeführt. Eine multivariate Regressionsanalyse wurde zur Identifikation der Kostentreiber verwendet.
Effects of Metformin and Metoprolol CR on Hormones and Fibrinolytic Variables during a Hyperinsulinemic, Euglycemic Clamp in Man
Authors: Landin Kerstin , Tengborn Lilian , Smith Ulf
Published: July 2018

The aim of this study was to characterize the acute effect of euglycemic (glucose 5.2 ± 0.6 mrnol/1) hyperinsulinemia (mean 118 ± 32 mU/1) on fibrinolytic variables, free fatty acids (FFA) and counter-regulatory hormones. In addition, the effect of chronic treatment with metformin, an oral antidiabetic agent which enhances insulin action, and metoprolol CR, a relatively betaj-selective adrenergic antagonist, was also evaluated. A randomized, double-blind, placebo-controlled, cross-over study including 18 non-obese men, aged 53 ± 6 years, was performed. The investigations were performed after each treatment period of 6 weeks in both the postabsorptive state and during a euglycemic, hyperinsulinemic clamp.

Compared to the postabsorptive state, plasminogen activator inhibitor (PAI-1) activity and antigen, tissue plasminogen activator (t-PA) antigen and FFA decreased (p <0.001) after 120 min of euglycemic hyperinsulinemia. In addition, t-PA activity increased (p <0.01) while blood levels of lipoprotein (a), catecholamines and cortisol remained unchanged. Growth hormone increased during the clamps and this was most pronounced after treatment with metoprolol CR.

When the effect of treatment was compared, postabsorptive levels of C-peptide, FFA and t-PA antigen were lower after metformin than after the placebo period (p <0.05). t-PA antigen also remained lower during the clamp after metformin treatment. No significant effects of metformin or metoprolol CR were seen on insulin-stimulated glucose uptake during the clamps or on postabsorptive levels of counterregulatory hormones, PAI-1 or Lp(a).

Thus, the rapidly increased fibrinolytic activity after 2 h hyperinsulinemia with maintained euglycemia can not be explained by the concomitant changes in counterregulatory hormones. It is more likely that the decreased FFA and/or triglyceride levels play a role.
Lupus Anticoagulant IgG's (LA) Are Not Directed to Phospholipids only, but to a Complex of Lipid-Bound Human Prothrombin
Authors: Bevers E M , Galli M , Barbui T , Comfurius P , Zwaal R F A
Published: July 2018

Plasmas from 16 patients that were found to be positive both for anticardiolipin antibodies (ACA) and lupus anticoagulants (LA) were incubated with liposomes that contained anionic phospholipids. In 11 of these plasmas, ACA could be cosedimented with the liposomes in a dose-dependent manner, whereas LA activity of the remaining supernatant was unaffected. LA activity of purified total IgG from 6 patients was measured in three different coagulation tests, using normal plasmas from different species. Prolongation of the aPTT, KCT and dRW clotting times was observed only with normal plasma from human origin, not with bovine, rat or sheep plasma.

Highly purified coagulation factors Xa, Va and prothrombin, both of human and bovine origin, were used to establish for two patient IgG's the effect of LA on the rate of thrombin formation in the presence and absence of lipid vesicles composed of 20 mole% phosphatidylserine and 80 mole% phosphatidylcholine. A strong and dose dependent inhibition by LA was observed only when human prothrombin was used as substrate in the prothrombinase complex in the presence of lipids. No inhibition was found when bovine prothrombin was used as substrate. The inhibitory effect observed in the presence of human prothrombin was independent of the source of factors Xa and Va, and was not found in the absence of lipid. Preliminary binding studies suggest that LA only associate with a lipid surface, provided that human prothrombin and calcium ions are present. These data indicate that LA are not directed to phospholipids alone, but presumably recognize an epitope which becomes exposed upon Ca2+-mediated binding of human prothrombin to phospholipids.
Enhancement of Clot Lysis In Vitro and In Vivo with a Bispecific Monoclonal Antibody Directed against Human Fibrin and against Urokinase-Type Plasminogen Activator
Authors: Kurokawa Tomofumi , Iwasa Susumu , Kakinuma Atsushi , Stassen Jean-Marie , Lijnen H Roger , Collen Desire
Published: July 2018

A hybrid hybridoma (FU1-74), secreting a bispecific monoclonal antibody (bs mAb), was obtained by fusion of a murine hybridoma secreting a monoclonal antibody (mAb) specific for human fibrin with a murine hybridoma secreting a mAb against urokinase-type plasminogen activator (u-PA). The bs mAb (MA-FU1-74), purified to homogeneity from mouse ascitic fluid, migrated as a single band with apparent M
r 150,000 on non-reduced SDS-PAGE and had an affinity for both human fibrin (K
a = 2 × 107 M–1) and for u-PA (K
a = 108 M–1) comparable to that of the mAbs obtained from the respective parental hybridomas. MA-FU1-74 did not influence the enzymatic activity of two-chain u-PA (tcu-PA) towards plasminogen or towards a chromogenic substrate. The complex of MA-FU1-74 with recombinant single chain u-PA (rscu-PA) or with tcu-PA (urokinase) enhanced the fibrinolytic potency of the plasminogen activator towards clotted human plasma 20-fold and 5-fold, respectively.

In a hamster pulmonary embolism model, the rscu-PA/MA-FU1-74 complex had a 13- to 17-fold increased thrombolytic potency (percent lysis per mg/kg u-PA administered) relative to that of rscu-PA. The specific thrombolytic activity (percent lysis per εg/ml steady state plasma level of u-PA antigen) of the complex was, however, not significantly different from that of rscu-PA. The complex of rscu-PA with the parental anti-u-PA mAb (MA-UK1-3) had only a 2-fold enhanced thrombolytic potency relative to that of rscu-PA and had a 5-fold decreased specific thrombolytic activity. The plasma clearance rates of the complexes of rscu-PA with both MA-FU1-74 and MA-UK1-3 were about 10-fold lower than that of rscu-PA. In a rabbit jugular vein thrombosis model, the rscu-PA/MA-FU1-74 complex had a 4-fold enhanced thrombolytic potency, an unchanged specific thrombolytic activity and 20-fold reduced plasma clearance. In both animal models, the rscu-PA/MA-FUl-74 complex did not cause more extensive systemic activation of the fibrinolytic system than rscu-PA.

It is concluded that the bispecific anti-fibrin/anti-u-PA mAb MA-FU1-74 targets u-PA to the fibrin clot, resulting in a significantly enhanced thrombolytic potency of the plasminogen activator.
The Effect of Interleukin-1 on Venous Endothelium – An Ultrastructural Study
Authors: Merton R E , Hockley D , Gray E , Poole S , Thomas D P
Published: July 2018

The effect of systemic interleukin-1 (IL-1) on venous endothelium in the presence and absence of stasis has been studied by scanning electron microscopy (SEM). Recombinant human IL-1β at a concentration of 1 εg/kg or saline was injected intravenously into rabbits and allowed to circulate for 0.5 or 4.0 h after which complete stasis was induced for 1 h in an isolated segment of each jugular vein. One vein segment was then excised and the contents examined macroscopically for thrombi, while the other segment was fixed for SEM examination. When examined by SEM the endothelium from rabbits injected with IL-1β was perturbed with increased surface microvilli, blebs and gaps at cell junctions when compared with saline controls. Fibrin deposition was also observed after IL-1β, as was the adherence of essentially non-activated platelets to intact endothelium. However, macroscopic thrombi were not formed in isolated vein segments. We conclude that although fibrin strands and platelets were deposited on the endothelium, IL-1 is not a sufficiently powerful procoagulant stimulus to lead to an occlusive thrombus in acute experiments.
The Measurement of Human Plasma Antiplasmin Activity by Radial Diffusion Assay
Authors: Andes W A
Published: July 2018

An assay of human antiplasmins has been developed utilizing radial diffusion of plasma from wells cut in plasmin-enriched, fibrinogen-agarose plates. After diffusion the fibrinogen is clotted. Zones of fibrin protected from background fibrinolysis develop as the result of plasma antiplasmin activity. A pooled plasma standard was taken to contain 100 % antiplasmin activity. Antiplasmin activity of 52 normal subjects varied from 64 to 132 %. Washed platelets contained 1-5 % antiplasmin activity. Using antisera to precipitate individual inhibitors, physical methods of separation, and electrophoresis of plasma in agarose, several different proteins were found to have antiplasmin activity in this assay. Thus, α2-macroglobulin contributed 56%, α1-antitrypsin 20%, antithrombin III 2%, and other proteins 22% of the total antiplasmin activity. 1 ml of whole plasma neutralized 7.0 CTA units of plasmin.
The Hemostatic Mechanism after Open-Heart Surgery
Authors: Cole E R , Bachmann F , Curry C A , Roby D
Published: July 2018

A prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p <0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p <0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p <0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.
The Influence of Residual Factor VII on the Sensitivity of Brain Thromboplastin
Authors: Spurling Neville W , Savory Janet
Published: July 2018

One-stage prothrombin times of normal and of factor VII-deficient beagle plasma were determined with two types of beagle brain thromboplastin, one prepared from normal beagles and the other from factor VII-deficient beagles. There was little difference between the reagents in the prothrombin times obtained for normal plasma. However, when factor VII-deficient plasma was tested, reagent prepared from factor VII-deficient beagles gave considerably longer prothrombin times than were obtained with the normal reagent and the difference increased with increasing reagent concentration to a maximum at 140 mg/ml.

Prothrombin times of a series of mixtures of normal and factor VII-deficient plasma indicated that the presence of only 1/90 part of normal plasma was necessary to compensate for the difference between the two reagents. Determination of the iron content of the reagent suggested that the microcirculation of an average brain contained some 1.8 g of whole blood.

The finding that brain thromboplastin prepared from factor VII-deficient beagles is more sensitive to a deficiency of factor VII in plasma, presumably a result of the smaller quantity of factor VII present in the reagent, is compatible with the known kinetics of extrinsic coagulation.
Human Pharmacokinetics and Pharmacodynamics of MF 701 Dermatan Sulfate Administered by Continuous Intravenous Infusion
Authors: Agnelli Giancarlo , Cosmi Benilde , Renga Cinzia , Federici Fiorella , Necil Giuseppe G , Houin Georges , Gianese Francesco
Published: July 2018

The pharmacokinetics and haemostatic effects of MF 701 dermatan sulfate (DS) administered by i. v. infusion were studied in 11 healthy volunteers. Each subject received 0.6 mg kg-1 h-1 MF 701 for 10 h. DS plasma concentrations were measured by a chromogenic assay based on the catalysis of thrombin inhibition by HCII. DS plasma levels followed a single compartment pharmacokinetic model, with a half-life of 1.28 ± 0.46 h, a plasma clearance of 2.75 ± 0.46 1/h and a volume of distribution of 4.92 ± 1.36 1 (means ± SD). Steady-state was reached 3 to 6 h after infusion started. The maximal DS plasma concentration was 16.4 ± 5.7 μg/ml. Maximal APTT prolongation over pre-infusion values was 42 ± 7%; TCT performed with bovine and human thrombin was prolonged by 16 ± 7% and 83 ± 35% respectively. No anti-IIa or anti-Xa activities were detected by chromogenic tests. The treatment was well tolerated. The pharmacokinetics of MF 701 infusion are consistent with those previously described after i. v. bolus administration. The infusion of MF 701 allows fast achievement and steady maintenance of elevated DS plasma concentrations.
HIV-Antibody Seroconversions in Dutch Haemophiliacs Using Heat-Treated and Non Heat-Treated Coagulation Factor Concentrates
Authors: Wolfs Tom F W , Breederveld Cees , Krone Willy J A , Hoek Lia v d , Bakker Margreet , Smit Lia , Goudsmit Jaap ,   The Dutch haemophilia group
Published: July 2018

A national multicentre study was performed to investigate the effects of donorselection and the use of heat-treated plasma products on seroconversion to HIV in 157 Dutch haemophiliacs. All patients included in the study were seronegative for HIV antibodies in 1983.

Thirteen percent (20/157) seroconverted between 1983 and 1986. Nineteen of 20 seroconversions could be related to the use of non heat-treated products in the year preceding HIV antibody seroconversion. One seroconversion occurred in a person using heat-treated non donor screened product.

Seroconversion rate decreased as a result of the policy to discourage high risk blood donors and no seroconversions were observed following the introduction of donor screening in 1985.