bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of tooth profile and belt speed on cogged V-belt vibration and stress
Authors: Zeng Zechen , Zhang Xianglong , Kan Jiangming , Li Wenbin
Published: October 2018

With the aim of reducing the vibration and maximum stress of a cogged V-belt and determining the appropriate cogged V-belt for the vertical disc stump grinder (RG25HD), this paper analyses the relationship between, on the one hand, the horizontal displacement of the vibration and node stress and, on the other, the tooth profile and belt speed. In addition, the pattern of the vibration and node stress of the cogged V-belt is investigated using various tooth profiles and belt speeds. Our approach uses a rigid/flexible coupling simulation of belt power transmission based on a finite element flexible body method and employs Recurdyn multi-body dynamics software. After the simulation, we obtain the stress distribution of the belt, the lateral displacement curve and the node stress curve. Our results indicate that cog shape affects belt stress and vibration. When selecting or designing a cogged V-belt, a belt with trapezoidal cogs is preferable. Regarding the effect of belt speed, the trapezoidal cogged V-belt’s lateral vibrating displacement and maximal stress increase with an increase in belt speed. Therefore, when the stump grinder is in operation, its revolving speed should be maintained at a low rate to reduce vibration and prolong the belt’s life.
To Determine the Effect of Dimpled Poppet Valve on the Flow in Engine Cylinder by Port Flow Simulation
Authors: Singh Anirudh , Dubey Apoorv , Singh Raj Kumar
Published: October 2018

Intake system is one of the crucial sub-systems in engine, the geometrical configuration of the inlet ports and the valves and their opening schedule creates organized motions in the cylinder, known as swirl (about the cylinder axis) and tumble (orthogonal to the cylinder axis) which help in proper mixing of fuel and air. Surface texturing of intake valve can improve the performance of engine drastically by generating more swirl, turbulent kinetic energy and reducing the coefficient of skin friction in the valve proximity area. Making dimples on intake valve is one of the many ways in which surface texturing can be done and its effectiveness can be easily measured by conducting a steady-state port flow simulation on ANSYS IC fluent solver using standard k-omega model. Port flow analysis was carried on dimpled intake valve at a lift of 5mm for 5 dimple ratio ranging from 0.1 to 0.3 in steps of 0.05. The dimple depth-over diameter ratio is a very crucial parameter in determining the optimum geometry of dimple on which best results are obtained. The results showed that the maximum mass flow rate is obtained at dimple ratio of 0.2 with an increase of 0.005% over the simple intake valve and a 38.4% decrease in the area weighted average skin friction coefficient in valve proximity area was seen in case of dimpled valve.
Flexible procedure for concreting in hot and dry climate based on Phase Change Material
Authors: Hsino Mahmoud , Paslawski Jerzy
Published: October 2018

The article presents the possibilities of using a flexible approach in designing production processes in construction on an example of concreting in a hot and dry climate. The basic drawback of typical quality management system procedures is their rigidity. It is based on the assumption that building processes are carried out in favorable conditions. Meanwhile, these conditions often change to a large extent during the process, and the accuracy of weather forecasts is limited. The aim of the article is to demonstrate the advantages of flexibility procedures for concreting on the example of concrete modification with phase-change materials. The conducted research has shown a reduction in the risk of structure damage during maturing of young concrete due to the use of hybrid phase-change materials in the conditions of central Syria climate. Phase-change materials provide lowering of the thermal peak in the initial maturation period and unification of the temperature in the cross-section of the element (limitation of the thermal gradient). At the same time, PCM’s slightly reduce the compressive / tensile strength of the concrete. As a result, this reduces the risk of cracking of the concrete element, which is the basis for ensuring greater durability of the element and a longer life cycle of the building.
Simulation as a decision tool in construction process management in turbulent environment
Authors: Katafoni Kinga , Paslawski Jerzy
Published: October 2018

This paper is dedicated to simulation idea of construction process for decision-making aid. An aim is to improve technological decisions for concreting operation at low temperature. A risk of destruction of concrete structure is a critical problem in this situation. A sudden drop in temperature may result in disqualification of the concrete element or the entire structure. The proposed solution is based on a simulation of the process of maturing of the concrete element based on experiments in the laboratory (e.g. heat of hydration and dynamics of growth of compressive strength depending on the temperature). The case study proved that the traditional approach to the management of concreting technology (based on one 48-hour forecast) is extremely risky when operating in a turbulent and changing environment. The proposed flexible approach is based on systematically updated simulation and is more effective thanks to the possibility of activating active flexible procedures to prevent freezing of concrete in case of pessimistic scenario.
A comparative analysis of selected models of pedestrian-generated dynamic loads on footbridges – vertical loads
Authors: Marecik Kinga , Pańtak Marek
Published: October 2018

In the paper the characteristics of selected dynamic load models of vertical forces generated during pedestrian movement (Vertical Ground Reaction Forces - VGRFs) and the results of dynamic numerical analyses and dynamic field tests of an exemplary footbridge were presented. Numerical analyses of the footbridge were performed taking into account recommendations of different authors and standards relating to VGRFs models as well as VGRFs measured by authors during laboratory tests using force platform. For comparative purposes, the dynamic field tests of the footbridge were carried out. The results and conclusions from comparative analyses of the dynamic responses of the footbridge obtained for various load models and field tests were presented.
Estimation of certain parameters of Black-Scholes model in analysing effectiveness of development investments
Authors: Meszek Wiesław , Dziadosz Agnieszka
Published: October 2018

The option pricing theory has wide applicability in corporate finance, but it is also increasingly used to analyze the effectiveness of non-financial (material) investments. In traditional investment analysis, a project or a new investment should be accepted only if the returns on the project exceed the hurdle rate; in the context of cash flows and discount rates, this translates into projects with positive net present values (NPV). There is no doubt that it does not take full account of the numerous options that usually relate to developer investment. However, in many cases, the valuation of real options is more difficult than the valuation of options for financial assets. In this paper, we will analyze one of the options, which isembedded in capital budgeting projects - the option to delay a project, especially when a the company has exclusive rights to the project. The value of the option is largely derived from the variance in cash flows – the higher the variance, the higher the value of the project delay option. The variance in the present value of cash flows from the project can be estimated in different ways, however, in the case of non-financial investment projects, these methods are very limited. We are analyzing the possibility of estimating this volatility, taking into account the fact that the forecasted cash flows may show varying volatility in individual years. The paper shows, that by using a probability-based valuation model (using the Crystal Ball techniques) it is possible to incorporate uncertainty into the analysis. The method of presented volatility estimation can be applied by taking into account the randomness of many input data to the project.
Adaptability in buildings – housing context – literature review
Authors: Milwicz Roman , Pasławski Jerzy
Published: October 2018

Dynamic development of technology that influences social lifestyles has great impact over the way of understanding the house and thus the way of designing this special space. The buildings have to fulfill the sustainability conditions and a lot has been done to decrease impact of building on environment. Among many ways one is the flexibility, which strongly influences economical, social and environmental aspects. Authors tried to collect most significant papers and monographs that treat the flexibility and adaptability and thus show its importance in civil engineering especially in housing sector. In the conclusions Authors shears the ideas of investigations within housing adaptability filed.
Recovery of waste heat from engines: an AD view
Authors: Cavique Miguel , Fradinho João , Gabriel-Santos António , Mourão António , Gonçalves-Coelho António
Published: October 2018

The Newcomen engine (1705) and the Watt engine (1769) are good examples of coupled and uncoupled designs. The Watt engine had an efficiency of about 3%, a shallow value when compared to engines of nowadays while resulting in a significant increase at those times. According to Axiomatic Design, Watt engine had a better performance than the Newcomen design due to its uncoupled nature. This work aims at applying the same reasoning to choose between new inventions designed for recovering waste heat from engines as to produce work. The most popular of those inventions are the organic Rankine cycle (ORC) and the Kalina cycle. Marine applications use those inventions to improve the efficiency of Diesel engines because the increase of weight of the recovery system does not affect power propulsion. A controversial regarding what system to develop occurred in scientific community as well as in the industry. The application of AD to those cycles classifies ORC as an uncoupled design and the Kalina cycle as a coupled design. Therefore, the ORC might be pondered for future development regarding energy efficiency.
Complex Adaptive Blockchain Governance
Authors: John Thomas , Pam Mantri
Published: October 2018

The blockchain revolution upholds the decentralizing ideal of “control nothing.” It is natural that such a pursuit would face issues of governance that demand reasonable control; control that is both operational as well as adaptive in nature. Eliminating middlemen and handing over controls to a trusted system of trustless agents does not thereby bestow trust across time. This is especially true when relentless change is the order of the day. Issues of governance rise up when blockchain systems (especially those that have embedded smart contracts) are forced to operate increasingly away from their original intent. Smart contracts need governance when beset with the problem of the unknown-unknowns. Guided by the axiomatic approach, this paper looks at the paradoxical issue of blockchain governance from a Complex Adaptive Systems (CAS) perspective that helps frame the fundamental problem of decentralization. The objective is to solve the Blockchain Governance Kernel Design. Real-life examples are used to illustrate the findings.
Axiomatic Selection of Health and Social Care Web Services on the Basis of Use Cases
Authors: Parretti Chiara , Rolli Fernando , Pourabbas Elaheh , Citti Paolo
Published: October 2018

in recent years remote patient monitoring systems, which are conceived to monitor patient and store the recorded data, employ Service Oriented Architectures (SOA). In health care systems, if on the one hand the SOA features allow enriching the offer of services to patients and their families, on the other hand the problem arises of selecting the most appropriate set of web services for homogeneous groups of users or for each individual clinical case. In this paper, we propose a methodology based on the Axiomatic Design for the composition and selection of web services, which are based on the case stories studied, built using semi-structured interviews to different stakeholders involved in the care process. The proposed methodology detects in a systematic way all functional requirements by taking into account the different stakeholders involved in the process and their interactions. Thus, it identifies the interested actors for a specific health protocol, and consider all information to be exchanged and the Web Services to be implemented. The development of this methodology opens interesting scenarios even in areas not currently affected by such systems, such as health and safety at work for monitoring patients with chronic illnesses or for their work reintegration following acute clinical events. A specific case study is considered in order to illustrate the proposed approach.
Managing Functional Coupling Sequence to Decrease Complexity and Increase Modularity in Conceptual Design
Authors: Wang Chu-Yi , Lu Stephen C.-Y.
Published: October 2018

Conceptual design is the stage where the upstream objectives and downstream constraints meet, so both the ideality and practicality are important in conceptual design. Modularity supports designing complex system while the design can take advantages from the downstream resources. According to Axiomatic Design Theory (ADT), the design with the least complexity is the ideal design, and managing functional coupling sequence can lead to the minimal complexity of design concepts. In this paper, Design Coupling Sequence (DCS) was introduced to bridge the ADT and the modular design. The ‘precedence’ and ‘functional sets’ were defined in DCS to manage the coupled design concepts in order to support the modularity of the design concepts. The ‘precedence’ identified by the level of functional coupling helps realize the sequencing order. The two ‘functional sets’ were defined as the independent U-set: the collection of functionally dependent concepts, and the coupled C-set: the collection of the strongly coupled concepts. The faucet design case study shows how the DCS method and its strategy to decrease relative complexity and increase modularity, and the results between design by extra coupling elimination and design by the existing modules are compared. The DCS method bridges the design theory to design practice.
A Student’s Axiomatic Design Application Example of Battery Thermal Controller for High Altitude Balloon
Authors: Wang Yuchen , Liu Ang
Published: October 2018

The axiomatic design plays a critical role in transferring FRs into DPs and organising scattered design information. Nowadays, the axiomatic design is commonly applied to student engineering design education. Although it assists design organisation, some procedures can be challenging for invoice students. This paper is written to reflect benefits, challenges and potential mistakes when the axiomatic design is applied by invoice students. The reflection is based on a case study, a student lead battery thermal controller (BTC) on a high-altitude balloon is used as the example. Relevant background about the high-altitude balloon was introduced at first. Previous essential information of customer domain and functional domain was clarified before the axiomatic design. Design parameters(DPs) were generated with Morphological Chart to compose candidate concepts. FR-DP matrix was used to evaluate the independence of functional requirements(FRs). Candidate concepts were then selected by probability density function graphs. The most proper concept then was out of Pugh’s Matrix. Through this axiomatic design application, benefits, challenges and potential mistakes were reflected for invoice students. Benefits included convenient errors correction and competent concepts generation. Challenges contain the DPs performance value determination and physical integration of concept. Potential mistakes include generation of inconsistent performance value for bottom-level FRs and invalid DPs.
Prävention in Lebenswelten
Authors: Seidler Andreas , Moebus Susanne
Published: October 2018

Prävention in Lebenswelten lautet das Schwerpunktthema der DGSMP-Jahrestagung 2018. 30 Jahre nach Verabschiedung der Ottawa-Charta hat das Präventionsgesetz den Lebensweltansatz der Gesundheitsförderung und Prävention erstmals gesetzlich verankert. Unter den Lebenswelten (oder auch: Settings) werden im Präventionsgesetz explizit die sozialen Systeme „ …insbesondere des Wohnens, des Lernens, des Studierens, der medizinischen und pflegerischen Versorgung sowie der Freizeitgestaltung einschließlich des Sports“ (§20a(1) SGBV) genannt. Vor diesem Hintergrund stellt sich die DGSMP 2018 den folgenden Fragen:
Community-based Mental Healthcare: A Case Study in a Cross-border Region of Germany and the Netherlands
Authors: Lohmeyer Franziska , Commers Matthew , Leoncini Emanuele , Specchia Maria , Boccia Stefania , Ricciardi Walter , de Belvis Antonio
Published: October 2018

Background Community-based mental healthcare (CBMH) aims at supplying psychiatric patients with rehabilitative care outside the hospital. The aim of this study was to compare the organization of CBMH in a cross-border region of Germany and the Netherlands.

Method Semi-structured interviews gave insight into characteristics of CBMH approaches applied in the German region of Aachen (IHP) and the Dutch Province of Limburg (FACT). We applied a Delphi technique to select a performance indicator (PI) set for CBMH, which served as a conceptual model to allow comparison.

Results Both approaches are flexible, patient-centred and include the evaluation of quality. Both provide financial and administrative support for the access.

Conclusion CBMH approaches appear to be equally valid from several perspectives even if they revealed, at the same time, important differences related to scope, integration with non-CBMH care resources and geographic coverage. Secondarily, the study provides a contribution to the development of a PI set to compare and evaluate CBMH approaches.
Prädiktoren der Inanspruchnahme ambulanter medizinischer Leistungen älterer Erwachsener mit einer Arthrose, rheumatoiden Arthritis oder Osteoporose
Authors: Belau Matthias Hans , Razum Oliver , Fuchs Judith
Published: October 2018

Hintergrund Chronische Muskel-Skelett-Erkrankungen (MSE) verursachen erhebliche Kosten für das deutsche Gesundheitssystem, weshalb sowohl von Seiten der Leistungserbringer als auch von der Politik Informationen über die Nutzung der unterschiedlichen Versorgungsangebote benötigt werden. Wir untersuchen gemäß dem Verhaltensmodell nach Andersen Prädiktoren der Inanspruchnahme ambulanter medizinischer Leistungen der für chronische MSE relevanten Fachrichtungen Allgemeinmedizin, Orthopädie und Physiotherapie in der von einer Arthrose, rheumatoiden Arthritis oder Osteoporose betroffenen 65–79-jährigen Wohnbevölkerung Deutschlands.

Methoden Auf Grundlage der Daten der ersten Welle der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) wurden Zusammenhänge zwischen der ambulanten Inanspruchnahme und erklärender Variablen mithilfe von Zähldatenmodellen analysiert.

Ergebnisse Eine erhöhte Inanspruchnahme der Allgemeinmedizin ist mit individuellen Krankheitsfaktoren (erhebliche gesundheitliche Einschränkung: Incidence Rate Ratio (IRR) 1,64 (1,18–2,27); Gelenkschmerzen: IRR 1,38 (1,06–1,79)) assoziiert. Eine erhöhte Inanspruchnahme der Orthopädie geht mit einer vermehrten Inanspruchnahme der Allgemeinmedizin (IRR 1,05 (1,01–1,10)) einher. Die erhöhte Inanspruchnahme der Physiotherapie wird von strukturellen wie individuellen Faktoren bestimmt (Region Ost (inklusive Berlin)): IRR 0,66 (0,47–0,93); erhebliche gesundheitliche Einschränkung: IRR 1,84 (1,09–3,12); vermehrte Inanspruchnahme der Orthopädie: IRR 1,07 (1,01–1,14)).

Schlussfolgerung Erwartungsgemäß nehmen individuelle Krankheitsfaktoren eine bedeutende Rolle in der Erklärung der Nutzung medizinischer Versorgungsangebote ein. Zugleich zeigt sich mit dem Nichtvorhandensein einer Komorbidität ein bislang noch nicht berichteter Prädiktor für die reduzierte Inanspruchnahme der Allgemeinmedizin durch Personen mit einer MSE.
Sicherheit in der häuslichen Intensivversorgung beatmeter Patienten aus Sicht professioneller Akteure
Authors: Lehmann Yvonne , Ewers Michael
Published: October 2018

Einleitung In Deutschland gibt es zunehmend mehr beatmete und vergleichbar technikabhängige Patienten, die in der eigenen Häuslichkeit oder in Wohngemeinschaften versorgt werden. Fragen der Patientensicherheit wurden in diesem Kontext noch kaum wissenschaftlich beleuchtet. Anknüpfend an eine Befragung von Patienten und Angehörigen wurde die Perspektive professioneller Akteure auf das Thema Sicherheit in der häuslichen Intensivversorgung erkundet.

Methodik Im Rahmen einer qualitativen Versorgungsforschungsstudie wurden professionelle Akteure in 6 heterogenen, nicht-natürlichen Focus Groups mit Erfahrungen und Sichtweisen von beatmeten Patienten und deren Angehörigen konfrontiert und nach ihren Perspektiven auf das Thema Patientensicherheit in der häuslichen Intensivversorgung befragt. Die erhobenen Daten wurden diskurs- sowie inhaltsanalytisch ausgewertet.

Ergebnisse Die von den Patienten und deren Angehörigen angesprochenen subjektiven Sicherheitsdimensionen werden in vielerlei Hinsicht auch von den professionellen Akteuren als wichtig erachtet. Forderungen von Angehörigen nach mehr Partizipation werden aber eher skeptisch betrachtet. Die Sicherheit in der häuslichen Intensivversorgung sehen sie durch Kooperations- und Koordinationsmängel, Fachkräftemangel und Qualifikationsdefizite gefährdet. Insbesondere auf Seiten der Pflegenden, die zentrale Aufgaben der Versorgung übernehmen und denen damit besondere Verantwortung für die Patientensicherheit zugeschrieben wird, werden entsprechende Herausforderungen gesehen.

Schlussfolgerungen Die Ergebnisse bieten Anknüpfungspunkte für die Sicherheitsarbeit in der häuslichen Intensivversorgung. Sie unterstreichen u. a. die Notwendigkeit zur Entwicklung nutzerzentrierter Sicherheitskonzepte, einer Sicherheitskultur auf Organisationsebene sowie einer flankierenden rechtlichen Regulierung.
Der Nationale Aktionsplan Gesundheitskompetenz – Notwendigkeit, Ziel und Inhalt
Authors: Schaeffer Doris , Hurrelmann Klaus , Bauer Ullrich , Kolpatzik Kai , Gille Svea , Vogt Dominique
Published: October 2018

In den letzten Jahren sind in vielen Ländern Studien zur Gesundheitskompetenz der Bevölkerung erschienen. Fast immer zeigen sie, dass die Gesundheitskompetenz schlechter ausfällt als angenommen und große Teile der Bevölkerung eine niedrige Gesundheitskompetenz aufweisen. Um diese Situation zu verbessern, sind in vielen Ländern nationale Strategien und Aktionspläne zur Förderung von Gesundheitskompetenz erstellt worden. Diesen Beispielen folgend wurde jüngst auch für Deutschland ein Nationaler Aktionsplan Gesundheitskompetenz erarbeitet. An dem 2-jährigen Entwicklungsprozess waren 15 ausgewiesene Expertinnen und Experten beteiligt. Auf Basis einer Analyse vorliegender Literatur zur Gesundheitskompetenz und bestehender Aktionspläne wurden die Konzeption, Ziele und Schwerpunkte des Aktionsplans festgelegt und konkrete Empfehlungen erarbeitet. Der Nationale Aktionsplan Gesundheitskompetenz konzentriert sich auf die Handlungsbereiche alltägliche Lebenswelten, Gesundheitssystem, chronische Erkrankung und Forschung und formuliert für jeden konkrete Empfehlungen.
Die Bedeutung Psychiatrischer Institutsambulanzen in der somatischen Grundversorgung
Authors: Borbé Raoul , Pfäffle Christine , Eisele Frank , Längle Gerhard
Published: October 2018

Ziel der Studie Die somatische Grundversorgung ist primär Aufgabe des Allgemein-/Hausärztlichen Sektors. Menschen mit psychischen Störungen, insbesondere die mit komplexem Hilfebedarf, nehmen dessen Leistungen bei somatischen Beschwerden seltener wahr. Sie stellen aber die Kernklientel Psychiatrischer Institutsambulanzen (PIA) dar, denen daher möglicherweise auch eine Aufgabe in der somatischen Versorgung dieser Patientengruppe zufällt. Der Stellenwert Psychiatrischer Institutsambulanzen in der somatischen Grundversorgung sollte daher untersucht werden.

Methodik Ärztinnen und Ärzte in Psychiatrischen Institutsambulanzen des ZfP Südwürttemberg wurden hinsichtlich ihrer Einstellung bezüglich der Bedeutung somatischer Komorbiditäten, der somatischen Mitbehandlung und dem Verschreibungsverhalten von somatischen Medikamenten befragt. Ergänzend wurden Daten der PIA-BADO ausgewertet hinsichtlich der Behandlung durch Hausärzte sowie der dokumentierten somatischen Nebendiagnosen.

Ergebnisse 72% aller Patienten gaben an, einen Hausarzt zu haben. Seitens der PIA-Ärzte wurde besonders bei den Patienten, die nicht hausärztlich versorgt waren, eine hohe eigene Verantwortung bei der Mitbehandlung somatischer Erkrankungen gesehen. Die Häufigkeit und die Art somatischer Nebendiagnosen unterschieden sich zwischen allgemeinpsychiatrischen, gerontopsychiatrischen und abhängigkeitskranken Patienten teils deutlich.

Schlussfolgerung Die Ergebnisse zeigen, dass Psychiatrische Institutsambulanzen in der Erkennung und Mitbehandlung somatischer Erkrankungen eine wichtige Rolle spielen. Diese ist abhängig von der psychischen Störung und der Art der somatischen Erkrankung aber auch von der Form der PIA-Finanzierung.
Ungewöhnliche „Pseudoaneurysmose“ bei ePTFE-Loop-Shunt
Authors: Krönung Gerhard
Published: October 2018

Gefäßzugänge zeigen nach jahrelanger Funktion nicht selten ungewöhnliche morphologische und/oder funktionelle Befunde. Sie können im Einzelfall trotzdem lange
Zeit weiter funktionieren und sollten sowohl pflegerisch als auch shuntchirurgisch nicht vorschnell mit Bezug auf eine ohnehin kaum zu definierende
„Normvorstellung“ aufgegeben werden.
Ursachen und Hintergründe der Langzeiteinnahme von Benzodiazepinen und Z-Substanzen bei älteren Patienten
Authors: Verthein Uwe , Kuhn Silke , Holzbach Rüdiger , Mokhar Aliaksandra , Dirmaier Jörg , Härter Martin , Reimer Jens
Published: October 2018

Hintergrund Die Langzeitverordnung von Benzodiazepinen (BZD) und Z-Substanzen ist mit dem Risiko einer Abhängigkeitsentwicklung verbunden. Bei vielen älteren Patienten kommt es zu einer Langzeiteinnahme, häufig verbunden mit einer Niedrigdosisabhängigkeit ohne Dosissteigerung.

Studienziel Es sollen die Einnahmegründe, Beschwerden bzw. Indikationen und Nebenwirkungen sowie die Verschreibungsumstände unter älteren Patienten, denen innerhalb der letzten 12 Monate BZD oder Z-Substanzen verschrieben wurden, untersucht werden.

Methode 4000 Patienten der AOK-NordWest, stratifiziert nach Altersgruppe (50–65 Jahre;>65 Jahre) und Einnahmeverhalten (lang bzw. leitlinienabweichend; kurz bzw. leitliniengerecht), wurde ein 9-seitiger Fragebogen zugeschickt. Der Fragebogen enthielt eine ausführliche Liste von BZD und Z-Substanzen, für die angegeben werden sollte, ob man sie früher und/oder aktuell eingenommen hat. Zudem wurden die Gründe und zugrunde liegenden Symptome der Medikamenteneinnahme sowie mögliche Nebenwirkungen und Versuche, die Medikamente auszusetzen, erhoben.

Ergebnisse 466 AOK-Versicherte sendeten den Fragebogen ausgefüllt zurück (Rücklaufquote 11,7%). Weitere 43 Privatversicherte konnten über Apotheken erreicht werden. 169 Personen, vornehmlich aus der Gruppe mit leitliniengerechten Verschreibungen, gaben an, keine der vorgegeben Medikamente eingenommen zu haben. Die verbliebenen 340 Patienten sind zu 68,5% weiblich. Das Durchschnittsalter beträgt 72,1 Jahre. Im Vergleich zwischen Patienten mit leitlinienabweichenden und leitliniengerechten Verschreibungen nehmen Erstere zu einem deutlich größeren Anteil Z-Substanzen ein. Die Tagesdosis nach DDD ist signifikant höher als bei jenen mit leitliniengerechten Verschreibungen, wobei in beiden Patientengruppen die Medikamente durchschnittlich in niedriger Dosis (<1 DDD) eingenommen werden. Der dominierende Grund für die Einnahme von BZD oder Z-Substanzen ist in beiden Gruppen Schlafstörungen.

Schlussfolgerungen Vor dem Hintergrund der Empfehlungen, BZD und Z-Substanzen nur kurzzeitig bei schweren Schlafstörungen einzusetzen, ist das Ausmaß an Insomnie-Indikationen hoch. Die geringe Dosierung lässt für beide Gruppen auf ein vorsichtiges und kontrolliert durchgeführtes Verordnungsverhalten schließen, wobei sich bei der Mehrheit der Langzeiteinnehmer eine Niedrigdosisabhängigkeit entwickelt haben dürfte. Dies ist offensichtlich mit nur geringem Interventionsbedarf verbunden, da nur sehr wenige Medikamentenabhängige die Angebote der Suchtkrankenhilfe in Anspruch nehmen.
Sichelzellkrankheit unter Neugeborenen in Deutschland: Eine Studie an Routinedaten der AOK
Authors: Pattloch Dagmar
Published: October 2018

Hintergrund Die Sichelzellkrankheit (SCD, ICD-10:D57) ist eine autosomal rezessiv vererbte Hämoglobinkrankheit mit globaler Public-Health-Relevanz. In Deutschland kommen pro Jahr 70–150 Kinder mit SCD zur Welt (1–2 je 10 000 Neugeborene). Die Früherkennung im asymptomatischen ersten Vierteljahr wäre leitliniengerecht und sekundärpräventiv bedeutsam.

Ziel der Studie Das Ziel dieser Arbeit ist 1) die Ermittlung der Prävalenz von SCD in Routinedaten von AOK-versicherten Neugeborenen, 2) die Messung des Alters bei der Erstdiagnose D57, 3) die Zählung charakteristischer Krankenhausdiagnosen.

Methode Analysiert wurden ambulante und stationäre Routinedaten von 204 AOK-versicherten Kindern. Dies sind alle, die 2009–2010 geboren sind, mindestens einen Tag im Geburtsjahr AOK-versichert waren und innerhalb von 6 Kalenderjahren jemals einen Code D57 erhielten. Die Anzahl Neugeborener in der AOK 2009–2010 (Nennerpopulation) ist bekannt. SCD-Fälle (Zähler) gelten als validiert, wenn D57 (außer D57.3) in mindestens 2 Quartalen (Q) codiert wurde. Es wird die Prävalenzproportion mit Bootstrap-Konfidenzintervall (CI) berechnet. Pro Fall wird quartalsgenau ausgelesen, wann D57 erstmals auftaucht. Der Standardized Incidence Ratio (SIR) wird berechnet für Krankenhausfälle vom Monat 13 bis Monat 61 im Vergleich zur Bevölkerung gleichen Geschlechts und Alters (1 bis unter 5 Jahre). Die Auswertung erfolgt mit SPSS 22 und Excel.

Ergebnis Nach interner Validierung resultierten 78 Fälle von SCD. Die Prävalenz beträgt 1,96 (95% CI 1,53–2,41) pro 10 000 Neugeborene. Regionale Schwerpunkte zeigten sich in Berlin, Bremen, Hamburg (zusammengefasst) sowie in Nordrhein-Westfalen. Die Erstnennung von D57 erfolgte nur bei 15,4% der Fälle früh, d. h. in Q1–2. Der Median liegt in Q7. In 78 Fällen ereigneten sich 266 Krankenhausfälle mit einem SIR=6,8, d. h. die Hospitalisierungsrate ist 6,8fach höher als die der Bevölkerung. Unter den Entlassungsdiagnosen fanden sich gefürchtete Outcomes wie Pneumonie, Sepsis und Milzerkrankungen.

Schlussfolgerung SCD in Deutschland lässt sich mit Routinedaten der größten gesetzlichen Krankenkasse plausibel darstellen. Derzeit wird die Krankheit zu selten frühzeitig erkannt. Die Zeit bis zur Erkennung ließe sich entscheidend verkürzen durch Aufnahme von SCD in das Neugeborenenscreening. Bis eine solche Lösung erreicht ist, sollten Eltern mit Migrationshintergrund und Fachleute ihre Aufmerksamkeit für SCD erhöhen.
Übersicht über die Organisation des vertragsärztlichen Bereitschaftsdienstes in Deutschland: Auf welche Basis bauen Krankenhausstrukturgesetz und Versorgungsstärkungsgesetz auf?
Authors: Schmidt Felicitas Maria , Wildner Manfred
Published: October 2018

Als Reaktion auf die erhöhte Inanspruchnahme der Notaufnahmen, den steigenden Kostendruck der Krankenhäuser und die zunehmende Schwierigkeit, Bereitschaftsdienste im strukturschwachen Raum zu besetzen, wurde auf Bundesebene die Einführung von sog. Portalpraxen beschlossen. Viele KVen haben bereits vor dieser Gesetzesänderung mit der Reformierung des ärztlichen Bereitschaftsdienstes begonnen und befinden sich nun in unterschiedlichen Stadien des Reformprozesses. An vielen Krankenhäusern finden sich heute schon sog. Bereitschaftsdienstpraxen (BDP). Um den aktuellen Reformstand als Basis für Krankenhausstrukturgesetz und Versorgungsstärkungsgesetz beurteilen zu können, möchte die vorliegende Arbeit eine aktuelle Übersicht über die Organisationsformen des vertragsärztlichen Bereitschaftsdienstes (ÄBD) in den einzelnen Bezirken der Kassenärztlichen Vereinigung (KV) geben.

Methodik Es wurden alle 17 KV Bezirke telefonisch und/oder schriftlich kontaktiert, um ein teilstrukturiertes Interview zu den Bereichen der allgemeinen Organisation, des Personalschlüssels (v. a. Ärzte) und des Versorgungsauftrags zu führen. Die KV Brandenburg, KV Hamburg und KV Nordrhein (Tochtergesellschaft Gesundheitsmanagementgesellschaft mbH) haben den dafür entwickelten Fragebogen schriftlich ausgefüllt.

Ergebnisse In den KVen Hessen, Schleswig-Holstein, Thüringen und Westfalen-Lippe war zum Zeitpunkt der Erhebung 2016 der ÄBD ausschließlich in Bereitschaftsdienstpraxen organisiert. Baden-Württemberg, Niedersachsen, Nordrhein, Rheinland-Pfalz und das Saarland haben größtenteils flächendeckend auf Bereitschaftsdienstpraxen umgestellt. Jedoch gibt es große Organisationsunterschiede zwischen Ballungsräumen und strukturschwachen Regionen. Diese reflektieren die unterschiedlichen Herausforderungen an die Sicherstellung. Brandenburg, Mecklenburg-Vorpommern und Bayern haben in größeren Städten Praxen aus Wirtschaftlichkeitsgründen eingerichtet.

Schlussfolgerung Bereitschaftsdienstpraxen bieten eine Möglichkeit, mit den Herausforderungen des Ärztemangels und der Patientensteuerung an die Sicherstellung umzugehen. Sie sind in ihren unterschiedlichen Organisationsformen flexibel an regionale Unterschiede anpassbar und spielen bereits eine große Rolle für die Sicherstellung.
Eckpunkte zur stationsäquivalenten Behandlung (stäB)
Authors:   Arbeitsgruppe ärztlicher und psychologischer Verbände sowie Verbände im Bereich der Pflege und Gemeindepsychiatrie
Published: October 2018

Aufsuchende Angebote im Lebensumfeld durch ambulante Leistungserbringer reduzieren stationäre Behandlungen und erhöhen die Lebensqualität von psychisch erkrankten Menschen und ihren Angehörigen. Das neue Angebot der stationsäquivalenten Behandlung (stäB) erlaubt es nun auch allen Krankenhäusern mit Pflichtversorgung, Behandlung im Lebensumfeld anzubieten. Für den effektiven Einsatz der neuen Möglichkeiten haben die unterzeichnenden Fachgesellschaften und Verbände Prinzipien einer strukturierten sektorenübergreifenden Zusammenarbeit konsentiert. Dabei steht der betroffene Mensch mit seinem individuellen Behandlungsbedarf und seinem familiären und sozialen Umfeld im Mittelpunkt.
Characterization of Casearin X Metabolism by Rat and Human Liver Microsomes
Authors: Moreira da Silva Rodrigo , de Gaitani Cristiane , Marques Lucas , Fraige Baraco Karina , Cavalheiro Alberto , de Moraes Luiz , Lopes Norberto , de Oliveira Anderson
Published: October 2018

Casearin X (CAS X) is the major clerodane diterpene isolated from the leaves of Casearia sylvestris and has been extensively studied due to its powerful cytotoxic activity at low concentrations. Promising results for in vivo antitumor action have also been described when CAS X was administered intraperitoneally in mice. Conversely, loss of activity was observed when orally administered. Since the advancement of natural products as drug candidates requires satisfactory bioavailability for their pharmacological effect, this work aimed to characterize the CAS X metabolism by employing an in vitro microsomal model for the prediction of preclinical pharmacokinetic data. Rat and human liver microsomes were used to assess species differences. A high-performance liquid chromatography with diode-array detection (HPLC-DAD) method for the quantification of CAS X in microsomes was developed and validated according to European Medicines Agency guidelines. CAS X was demonstrated to be a substrate for carboxylesterases via hydrolysis reaction, with a Michaelis-Menten kinetic profile. The enzyme kinetic parameters were determined, and the intrinsic clearance was 1.7-fold higher in humans than in rats. The hepatic clearance was estimated by in vitro-in vivo extrapolation, resulting in more than 90% of the hepatic blood flow for both species. A qualitative study was also carried out for the metabolite identification by mass spectrometry and indicated the formation of the inactive metabolite CAS X dialdehyde. These findings demonstrate that CAS X is susceptible to first-pass metabolism and is a substrate for specific carboxylesterases expressed in liver, which may contribute to a reduction in antitumor activity when administered by the oral route.
Obstetric Outcomes Associated with Fetal Cyanotic Congenital Heart Disease
Authors: Rossi Robert M. , Divanovic Allison , DeFranco Emily A.
Published: October 2018

Objective To characterize obstetric outcomes associated with cyanotic congenital heart disease (CCHD) in a contemporary population.

Study Design We conducted a population-based retrospective cohort study of all livebirths in Ohio (2006–2015). Obstetric characteristics of pregnancies complicated by fetal CCHD were compared with those without CCHD, excluding those with other anomalies and aneuploidy. The primary objective was to determine the risk of cesarean delivery among CCHD affected pregnancies. Multivariate logistic regression estimated the influence of CCHD on these obstetric outcomes.

Results Among 1,463,506 live births in Ohio, there were 863 (0.06%) CCHD affected births. The overall cesarean rate was 45.9 versus 31.0% (p< 0.001) in CCHD compared with non-CCHD pregnancies. After adjusting for various confounders, CCHD affected pregnancies were associated with a higher risk for cesarean delivery (adjusted relative risk [aRR]: 2.0, 95% confidence interval [CI]: 1.6–2.4), preterm birth (PTB) (aRR: 1.5, 95% CI: 1.1–2.0), induction of labor (aRR: 1.2, 95% CI: 1.04–1.4), small for gestational age (SGA) birthweight (aRR: 2.4, 95% CI: 2.0–2.9), and fetal intolerance of labor (FIOL; aRR: 2.0, 95% CI: 1.6–2.4). Women with CCHD affected pregnancies were also less likely to undergo a trial of labor (aRR: 0.4, 95% CI: 0.3–0.5) prior to cesarean delivery.

Conclusion Obstetric outcomes associated with CCHD include higher risk for cesarean delivery, PTB, SGA, and FIOL.
The Association between Intended Mode of Delivery and Maternal Morbidity in Twin Pregnancies
Authors: Zafman Kelly B. , Naqvi Mariam , Melka Stephanie , Miller James , Rebarber Andrei , Fox Nathan S.
Published: October 2018

Objective To compare maternal morbidity between women undergoing delivery of twins who intend to labor with those women who do not intend to labor.

Study Design This was a retrospective cohort study of women undergoing delivery of twins in a single maternal–fetal medicine practice between January 2005 and February 2018. We identified women with a twin delivery at gestational age ≥24 weeks and determined if they intended or did not intend to labor. Maternal outcomes were compared between the groups.

Results A total of 788 patients were included, of whom 404 (51.3%) intended to labor and 384 (48.7%) did not intend to labor. Women who intended to labor had a high rate of vaginal delivery (VD; 79.7%). Overall, 45 (5.7%) women required blood transfusion; this was not significantly different between the groups (6.2 vs. 5.2%, p = 0.54). Women who intended to labor had a shorter hospital stay and lower blood loss. There were no significant differences for all other maternal outcomes.

Conclusion In patients undergoing twin delivery, women who intend to labor have similar maternal morbidity compared with women who do not intend to labor. This supports current guidelines recommending providers offer a trial of VD for twin pregnancies.
Effect of Oligohydramnios on Fetal Heart Rate Patterns during Term Labor Induction
Authors: Rhoades Janine S. , Stout Molly J. , Macones George A. , Cahill Alison G.
Published: October 2018

Objective To estimate the effect of oligohydramnios on fetal heart rate (FHR) patterns in patients undergoing induction of labor (IOL) at term.

Study Design Secondary analysis of a prospective cohort study of consecutive term, singleton deliveries from 2010 to 2015. We included all patients who underwent IOL. Our primary outcomes were electronic fetal monitoring (EFM) characteristics in the 2 hours preceding delivery. Outcomes were compared between those induced with oligohydramnios and those induced without a diagnosis of oligohydramnios. Our secondary outcome was composite neonatal morbidity. Logistic regression was used to control for confounders.

Results Of 3,787 patients who underwent IOL, 147 had a diagnosis of oligohydramnios and 3,640 were included in the no oligohydramnios group. There was no significant difference in EFM characteristics between the two groups. There was no difference in composite neonatal morbidity. In patients with oligohydramnios, EFM patterns with baseline tachycardia for 30 minutes or greater were significantly associated with composite neonatal morbidity (31.3 vs. 5.3% adjusted odds ratio 8.63, 95% confidence interval 2.18, 34.1]).

Conclusion Term patients undergoing IOL with oligohydramnios had EFM patterns that did not differ from their induced peers.
Results of Ten-Year Follow-Up of Alcohol Septal Ablation in Patients with Obstructive Hypertrophic Cardiomyopathy
Authors: Rzhannikova Anastasiya , Chernyshev Sergey , Kardapoltsev Lev , Idov Eduard , Berdnikov Sergey , Kashtanov Maksim
Published: October 2018

This study looks at 10-year follow-up outcomes of alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy.

Between 2000 and 2008, 40 patients with obstructive hypertrophic cardiomyopathy (27 males, 13 females) underwent alcohol septal ablation. The median follow-up period was 123 (2–179) months. The mean age ran to 43.8 + 13.9 years. The initial dose of ethanol (3 mL) was chosen for ablation in all cases.

The hospital mortality was 0%. Permanent pacemakers were implanted in 3 of 40 (7.5%) cases in the hospital period. The median clinical follow-up was 123 (2–179) months. Survival rates at 1, 5, 10, and 15 years after the procedure were as follows: 97.5% (95% confidence interval [CI], 95.1–99.9%), 92.5% (95% CI, 94.8–90.2%), 85.0% (95% CI, 82.9–87.1%), and 81.3% (95% CI, 79.3–83.3%), respectively. Seven patients died during follow-up. Sudden death was observed in two cases. Permanent pacemakers were implanted in 2 of 40 (5%) cases in the follow-up. The log-rank test revealed no statistically significant difference between the 15-year survival rate in our cohort and age- and sex-matched general Russian population (p = 0.11113).

Alcohol septal ablation provides long-term survival rates that look comparable with age- and sex-matched general population in the 15-year follow-up period.
Conceptualizing work-related mental distress in the British coalfields (c.1900–1950)
Authors: Long Vicky , Brown Victoria
Published: October 2018

The history of occupational health is now an established and growing field of study, yet to date comparatively little research has been undertaken on the history of work-related mental health issues, which currently account for 40% of all work-related illnesses in the UK. Work-related stress is usually seen as a post-war and post-industrial phenomenon, largely confined to white collar and service sectors, which developed as a consequence of changing working cultures. However, through a close reading of diverse source sets generated by, or pertaining to, the coal industry, this article unearths another history of work-related mental health issues; a history focussing on a heavy industry in the early years of the twentieth century. Through this analysis, we argue that the heavy industries more typically associated with physical illnesses and disabilities also generated mental distress amongst their workers, which reflected the distinctive pressures of these working environments. The article explores how understandings of the mental distress experienced by miners were shaped by medical, political, economic, occupational and industrial factors, and generated debates between different organizations as to the cause of these disorders and appropriate responses. Further analysis of work-related mental disorders in different occupational sectors may allow researchers to tease out the nuanced role played by workplace environments and working practices on mental health, and to examine the relationship between physical and mental health at work.
Superlinearity, saturation, and the PMT—Tailoring and calibration methodology for prompt radiation detectors
Authors: Buckles R. A. , Garza I. , Bellow J. N. , Moy K. J. , Chandler G. A. , Ruiz C. L. , Jones B. M.
Published: October 2018

This work illustrates predominant measureable nonlinearities in photomultiplier tubes (PMTs) and introduces a controllable one called “Superlinearity,” signifying both a positive nonlinear response and the ability to extend linear operation by counteracting gain saturation mechanisms — charge depletion, space-charge field limitation, and secondary emission surface effects. Recognizing superlinearity and its effect on the temporal step response leads to a true definition of linearity, free of a small-signal linear assumption. Furthermore, given the prevalent use of glass microchannel-plate (MCP) PMTs in favor of a faster impulse response in spite of a small charge limit, we are motivated to examine their nonlinear amplitude response and deploy tailored gain bias string methods to fully harness the maximum linear gain as is usually done for transmissive metal mesh and reflective metal dynode PMTs. Our characterization methodology applies standard NIST-traceable calibrated laboratory equipment with absolute input-referenced techniques, examining step responses over many orders of magnitude in controlled illumination. By doing so, we quantitatively reveal the superlinearity strength independent of charge depletion, yielding true linear responsivity and effectively doubling the small-signal linear limit; this is very relevant to PMT modeling and charge deconvolution efforts. With further development, the tailoring strategies we introduce could be applied to MCP detectors, extracting all useful capillary charge with a significant improvement in large linear signal quality.
The order of magnetic phase transitions in disordered double perovskite oxides Sm2FeCoO6 and Dy2FeCoO6
Authors: Haripriya G. R. , Pradheesh R. , Sethupathi K. , Sankaranarayanan V.
Published: October 2018

We present the results on the order of phase transition around the spin re-orientation region using isothermal magnetization data performed on the sol-gel synthesized disordered double perovskite oxides Sm2FeCoO6 and Dy2FeCoO6 by Arrott plot method. The temperature variation of the DC magnetization data of both the samples show that there are two magnetic phase transitions; one at high temperature regime, the conventional paramagnetic (PM) to ferro or ferrimagnetic (FM or FIM) and the other at low temperatures, ferro or ferrimagnetic (FM or FIM) to antiferromagnetic (AFM). From the Arrott plot method, it is inferred that spin re-orientation transitions of both the compounds has a first order nature corresponding to the FM (FIM) to AFM transition.
Schottky specific heat of the lightly Mn-substituted electron-doped SrTiO3
Authors: Okuda T. , Kajimoto R. , Noda M. , Kuwahara H.
Published: October 2018

Large changes in the low-temperature specific heat (low-T C) by applying magnetic fields up to 9 Tesla were found in the lightly Mn-substituted electron-doped perovskites Sr1−xLaxTiO3. The changes in the low-T C are qualitatively well explained by the Schottky specific heat (CSch) of localized spins of the Mn 3d electrons in weak internal magnetic fields via itinerant electrons. According to the analysis by using the conventional model, the doped Mn ions are apparently not Mn4+ (S = 3/2) ions, but are Jahn-Teller active Mn3+ (S = 2) ions or mixtures of Mn3+ and Mn2+ ions. However, the actual numbers of localized spins estimated from CSch are about 30% smaller than the expected values. Part of the localized spins of the Mn 3d electrons may disappear due to Kondo coupling with the itinerant electrons, leading to the observed enhancement of the electronic specific heat coefficients.