bluuebunny/crossref_metadata_2025 huggingface dataset:
Snow Depth Patterns in a High Mountain Andean Catchment from Satellite Optical Tristereoscopic Remote Sensing
Authors: Shaw Thomas E. , Gascoin Simon , Mendoza Pablo A. , Pellicciotti Francesca , McPhee James
Published: December 2019

Obtaining detailed information about high mountain snowpacks is often limited by insufficient ground‐based observations and uncertainty in the (re)distribution of solid precipitation. We utilize high‐resolution optical images from Pléiades satellites to generate a snow depth map, at a spatial resolution of 4 m, for a high mountain catchment of central Chile. Results are negatively biased (median difference of −0.22 m) when compared against observations from a terrestrial Light Detection And Ranging scan, though replicate general snow depth variability well. Additionally, the Pléiades dataset is subject to data gaps (17% of total pixels), negative values for shallow snow (12%), and noise on slopes >40–50° (2%). We correct and filter the Pléiades snow depths using surface classification techniques of snow‐free areas and a random forest model for data gap filling. Snow depths (with an estimated error of ~0.36 m) average 1.66 m and relate well to topographical parameters such as elevation and northness in a similar way to previous studies. However, estimations of snow depth based upon topography (TOPO) or physically based modeling (DBSM) cannot resolve localized processes (i.e., avalanching or wind scouring) that are detected by Pléiades, even when forced with locally calibrated data. Comparing these alternative model approaches to corrected Pléiades snow depths reveals total snow volume differences between −28% (DBSM) and +54% (TOPO) for the catchment and large differences across most elevation bands. Pléiades represents an important contribution to understanding snow accumulation at sparsely monitored catchments, though ideally requires a careful systematic validation procedure to identify catchment‐scale biases and errors in the snow depth derivation.
A Computationally Efficient and Physically Based Approach for Urban Flood Modeling Using a Flexible Spatiotemporal Structure
Authors: Saksena Siddharth , Dey Sayan , Merwade Venkatesh , Singhofen Peter J.
Published: December 2019

Recent unprecedented events have highlighted that the existing approach to managing flood risk is inadequate for complex urban systems because of its overreliance on simplistic methods at coarse‐resolution large scales, lack of model physicality using loose hydrologic‐hydraulic coupling, and absence of urban water infrastructure at large scales. Distributed models are a potential alternative as they can capture the complex nature of these events through simultaneous tracking of hydrologic and hydrodynamic processes. However, their application to large‐scale flood mapping and forecasting remains challenging without compromising on spatiotemporal resolution, spatial scale, model accuracy, and local‐scale hydrodynamics. Therefore, it is essential to develop techniques that can address these issues in urban systems while maximizing computational efficiency and maintaining accuracy at large scales. This study presents a physically based but computationally efficient approach for large‐scale (area > 103 km2) flood modeling of extreme events using a distributed model called Interconnected Channel and Pond Routing. The performance of the proposed approach is compared with a hyperresolution‐fixed‐mesh model at 60‐m resolution. Application of the proposed approach reduces the number of computational elements by 80% and the simulation time for Hurricane Harvey by approximately 4.5 times when compared to the fixed‐resolution model. The results show that the proposed approach can simulate the flood stages and depths across multiple gages with a high accuracy (R2 > 0.8). Comparison with Federal Emergency Management Agency building damage assessment data shows a correlation greater than 95% in predicting spatially distributed flooded locations. Finally, the proposed approach can estimate flood stages directly from rainfall for ungaged streams.
Evaluating the Sensitivity of Residential Water Demand Estimation to Model Specification and Instrument Choices
Authors: Puri Roshan , Maas Alexander
Published: December 2019

There is a substantial body of work that estimates residential water demand as a function of price, household characteristics, and weather. While most results suggest demand is inelastic, researchers have found qualitatively different estimates of price elasticity—both elastic (>1) and inelastic (<1). Inconsistency in the choice of the price signal, its instruments, and appropriate weather variables across studies makes it difficult to determine if the differences in elasticity estimates are real—due to location characteristics—or an artifice of model specification. Predicting accurate demand responses to price changes enables water utilities to stabilize and anticipate future revenue while meeting conservation goals. However, specifying residential water demand with the appropriate model (under block rate structure) is challenging for three reasons: (1) uncertainty around the appropriate price signal, (2) a lack of theoretical motivation for determining which (and how) weather variables affect demand, and (3) simultaneity issues in estimation require the use of instruments, which vary across studies. Therefore, to elucidate the effects of model choices on elasticity, we use a single location and systematically vary the specification of price, instruments, and weather variables across a suite of models. We reaffirm past results that households respond to the average price. We find reasonably stable and robust estimates of price elasticity across different weather and price instrument specification—with some notable exceptions—implying that low‐cost information like average temperature is sufficient to accurately reflect the data‐generating process, reducing costs and allowing for a parsimonious model.
Oxygen reduction using a metal-free naphthalene diimide-based covalent organic framework electrocatalyst
Authors: Royuela Sergio , Martínez-Periñán Emiliano , Arrieta Marina P. , Martínez José I. , Ramos M. Mar , Zamora Félix , Lorenzo Encarnación , Segura José L.
Published: December 2019

A novel naphthalene diimide-based covalent organic framework (NDI-COF) has been synthesized and successfully exfoliated into COF nanosheets (CONs) to provide an efficient electrocatalyst for the oxygen reduction reaction.
A core–shell type alkyl-Sn-oxo cluster of {Sn14As16} bridged by 4-aminophenylarsonate ligands and incorporated with a {Na6} cluster
Authors: Zhu Yu , Zhang Jian , Zhang Lei
Published: December 2019

A large organotin-oxo arsonate cluster, {Na6Sn14As16}, with a core–shell type structure consisting of a {Na6} core and a {Sn14As16} shell is successfully constructed, which shows high water stability and has potential application as an electrode decoration material in CO2 reduction.
Copper mediated C(sp2)–H amination and hydroxylation of phosphinamides
Authors: Sun Shang-Zheng , Shang Ming , Xu Hui , Cheng Tai-Jin , Li Ming-Hong , Dai Hui-Xiong
Published: December 2019

Copper mediated C(sp2)–H amination and hydroxylation of arylphosphinic acid are accomplished by adopting phosphinamide as the directing group.
Molecule occupancy by a n-butylamine treatment to facilitate the conversion of PbI2 to perovskite in sequential deposition
Authors: Li Zheng , Chen Ke , Cheng Zhenping , Lin Dongxu , Wang Jiming , Shi Tingting , Xie Weiguang , Liu Pengyi
Published: December 2019

New approach of molecule occupancy by a vapor treatment was proposed to facilitate the conversion of PbI2 to perovskite in sequential deposition.
J-PLUS: Tools to identify compact planetary nebulae in the Javalambre and southern photometric local Universe surveys
Authors: Gutiérrez-Soto L. A. , Gonçalves D. R. , Akras S. , Cortesi A. , López-Sanjuan C. , Guerrero M. A. , Daflon S. , Borges Fernandes M. , Mendes de Oliveira C. , Ederoclite A. , Sodré L. , Pereira C. B. , Kanaan A. , Werle A. , Vázquez Ramió H. , Alcaniz J. S. , Angulo R. E. , Cenarro A. J. , Cristóbal-Hornillos D. , Dupke R. A. , Hernández-Monteagudo C. , Marín-Franch A. , Moles M. , Varela J. , Ribeiro T. , Schoenell W. , Alvarez-Candal A. , Galbany L. , Jiménez-Esteban F. M. , Logroño-García R. , Sobral D.
Published: December 2019

Context. From the approximately 3500 planetary nebulae (PNe) discovered in our Galaxy, only 14 are known to be members of the Galactic halo. Nevertheless, a systematic search for halo PNe has never been performed.

Aims. In this study, we present new photometric diagnostic tools to identify compact PNe in the Galactic halo by making use of the novel 12-filter system projects, Javalambre Photometric Local Universe Survey (J-PLUS) and Southern-Photometric Local Universe Survey (S-PLUS).

Methods. We reconstructed the Isaac Newton Telescope Photometric Hα Survey of the Northern Galactic Plane diagnostic diagram and propose four new ones using (i) the J-PLUS and S-PLUS synthetic photometry for a grid of photo-ionisation models of halo PNe, (ii) several observed halo PNe, as well as (iii) a number of other emission-line objects that resemble PNe. All colour–colour diagnostic diagrams are validated using two known halo PNe observed by J-PLUS during the scientific verification phase and the first data release (DR1) of S-PLUS and the DR1 of J-PLUS.

Results. By applying our criteria to the DR1s (~1190 deg2), we identified one PN candidate. However, optical follow-up spectroscopy proved it to be a H II region belonging to the UGC 5272 galaxy. Here, we also discuss the PN and two H II galaxies recovered by these selection criteria. Finally, the cross-matching with the most updated PNe catalogue (HASH) helped us to highlight the potential of these surveys, since we recover all the known PNe in the observed area.

Conclusions. The tools here proposed to identify PNe and separate them from their emission-line contaminants proved to be very efficient thanks to the combination of many colours, even when applied – like in the present work – to an automatic photometric search that is limited to compact PNe.
Mythos Verklebung – Update Arthrofibrose
Authors: Traut Philipp , Rückert Uwe
Published: December 2019

Noch immer gilt die Arthrofibrose – die häufigste Komplikation nach Knie-TEP- oder Kreuzband-OP – als Verklebung. Neue Modelle zeigen jedoch, dass Fibroblasten mechanisch sensibel sind, und Behandlungen gegen eine Verklebung wie Dehnungen und Bewegen über die Schmerzschwelle hinaus absolut kontraproduktiv sind. Ein Update der Arthrofibrose-Spezialisten Dr. Phillip Traut und Uwe Rückert.
Sich selbst genug – Funktionelle Übungen mit Eigengewicht
Authors: Dirschauer Katrin , Clemens Thomas , Ehrhardt Dirk
Published: December 2019

Kniebeugen, Sit-ups und Co. sind altbekannte Klassiker. Ihr unschlagbarer Vorteil: Hilfsmittel und Geräte werden beim Training nicht gebraucht. Doch hat man die Übungen in der täglichen Praxis immer alle gleich parat? Ein ideales Nachschlagwerk bietet das neue Buch „Praxishandbuch funktionelles Training II“. physiopraxis stellt neun Übungen daraus vor.
Diagnostik und Therapie der kardialen Sarkoidose
Authors: Skowasch D. , Gaertner F. , Marx N. , Meder B. , Müller-Quernheim J. , Pfeifer M. , Schrickel J. W. , Yilmaz A. , Grohé C.
Published: December 2019

Während 90 % aller Sarkoidosepatienten eine parenchymatöse Beteiligung der Lunge aufweisen, ist die kardiale Sarkoidose (in weniger als 10 % der Fälle klinisch manifest) selten. Generell können alle Strukturen des Herzens von der Granulombildung betroffen sein. Meist jedoch sind das Myokard des linken Ventrikels sowie das Reizleitungssystem beeinträchtigt. Klinisch manifestiert sich die kardiale Sarkoidose als dilatative Kardiomyopathie oder in Form von Herzrhythmusstörungen wie Vorhofflimmern und/oder ventrikulären Tachykardien. Das Spektrum reicht von der benignen, subklinischen Manifestation als Zufallsbefund bis zur lebensbedrohlichen Komplikation, wie akuelle Kohortenstudien zeigen. Diagnostische Schritte und therapeutische Empfehlungen zur kardialen Sarkoidose sollten daher einem einheitlichen Standard unterliegen. Die vorliegende Arbeit ist die Expertenstellungnahme unter dem Schirm der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) und der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung (DGK). Die nachstehenden Empfehlungen ersetzen jedoch nicht die ärztliche Begutachtung des individuellen Patienten und Anpassung der Diagnostik und Therapie an dessen spezifische Situation.
Zeitgerechte Diagnosestellung bei Menschen mit Demenz: der Bayerische Demenz Survey (BayDem)
Authors: Wolff Franziska , Dietzel Nikolas , Karrer Linda , Kratzer André , Hess Manuela , Gräßel Elmar , Kolominsky-Rabas Peter
Published: December 2019

Hintergrund Demenzdiagnosen werden häufig erst bei fortgeschrittener Symptomatik gestellt. Die Sicherstellung einer zeitgerechten Diagnose stellt jedoch die Grundlage für die Inanspruchnahme von Therapie- und Unterstützungsleistungen für Menschen mit Demenz (MmD) sowie für deren pflegende Angehörige dar. Bisher haben nur wenige internationale Studien Einflussfaktoren auf die Dauer von den ersten subjektiv wahrgenommenen Symptomen bis zur Diagnosestellung analysiert. Ziel dieser Analyse ist es daher, die Zeitspanne von den ersten wahrgenommenen Symptomen aus der Perspektive der unterstützenden Angehörigen bis zur Erstdiagnose einer Demenz zu erfassen sowie potenzielle soziodemografische Prädiktoren für eine zeitgerechte Diagnose zu identifizieren.

Methode Der Bayerische Demenz Survey (BayDem) ist eine multizentrische Längsschnittstudie, die in 3 Regionen (Dachau, Erlangen, Kronach) in Bayern durchgeführt wurde. Projektteilnehmer/innen waren Menschen mit Demenz (MmD) nach ICD-10, sowie deren pflegende Angehörige. Die Verlaufsdaten wurden in standardisierten, persönlichen Interviews in enger Zusammenarbeit mit lokalen Akteuren vor Ort erhoben. Zur Analyse von potenziellen soziodemografischen Prädiktoren einer zeitgerechten Diagnosestellung innerhalb von 9 Monaten nach Erkennung der ersten Symptome wurden binäre-logistische Regressionen durchgeführt.

Ergebnisse Die mediane Dauer von der Wahrnehmung der ersten Symptome bis zur Diagnosestellung betrug bei den Teilnehmenden 16 Monate. Neben dem Alter (zum Zeitpunkt der ersten wahrgenommenen Symptome), ist die Schulbildung von männlichen MmD mit einer zeitgerechten Diagnosestellung innerhalb von 9 Monaten nach Wahrnehmung der ersten Demenzsymptome assoziiert. Es konnte keine Assoziation mit dem Wohnort oder der Wohnsituation belegt werden.

Schlussfolgerungen Es zeigte sich, dass die Diagnosestellung häufig mit deutlicher Verzögerung erfolgt. Deshalb erscheint es notwendig, dass im primärärztlichen Bereich strukturierte Zugangswege zu einer „zeitgerechten Diagnostik“ weiterentwickelt werden.
Symptombelastung, Inanspruchnahme des Gesundheitssystems und Todesumstände von Menschen mit Demenz in der letzten Lebensphase: der Bayerische Demenz Survey (BayDem)
Authors: Kratzer André , Karrer Linda , Dietzel Nikolas , Wolff Franziska , Hess Manuela , Kolominsky-Rabas Peter , Gräßel Elmar
Published: December 2019

Hintergrund Demenz ist in der Regel eine lebenslimitierende Erkrankung. Dennoch fehlen derzeit evidenzbasierte Leitlinien für eine angemessene Palliativversorgung von Menschen mit Demenz (MmD). Ein Grund hierfür ist der Mangel an belastbaren empirischen Daten zu MmD in der letzten Lebensphase. Ziel dieser Untersuchung ist daher, Symptombelastung, Inanspruchnahme des Gesundheitssystems sowie Todesumstände von MmD in der letzten Lebensphase zu beschreiben.

Methodik Der Bayerische Demenz Survey (BayDem) war eine multizentrische Längsschnittstudie, die in 3 Regionen Bayerns (Dachau, Erlangen, Kronach) durchgeführt wurde. Teilnehmende waren MmD nach ICD-10 sowie deren pflegende Angehörige. Die Verlaufsdaten wurden in standardisierten, persönlichen Interviews vor Ort erhoben. Es erfolgte ein 1:1-Propensity Score Matching zwischen verstorbenen und nicht verstorbenen MmD. Zur statistischen Analyse wurden McNemar-Tests sowie t-Tests für verbundene Stichproben verwendet.

Ergebnisse In der vorliegenden Analyse wurden 58 im Studienzeitraum verstorbene und 58 nicht verstorbene MmD untersucht (n=116). In den meisten Fällen sind MmD zuhause (36,2%), im Krankenhaus (25,9%) oder im Alten-/Pflegeheim (19,0%) verstorben, nie im Rahmen einer Palliativversorgung. Todesursachen waren meist Komplikationen des respiratorischen Systems (13,8%), kardiovaskuläre Komplikationen (12,1%) sowie Schlaganfälle (12,1%). MmD in der letzten Lebensphase wiesen stärker ausgeprägte körperliche Komorbiditäten auf als die übrigen MmD (Charlson-Index: M=2,75 vs. M=1,80; p=0,030, Cohen’s d=0,425) und wurden dementsprechend häufiger in ein Krankenhaus eingewiesen (46,6 vs. 12,1%, p<0,001, OR=6,250) und in einer Notaufnahme (22,4 vs. 3,4%, p=0,007, OR=6,500) behandelt. Psychische und Verhaltensauffälligkeiten waren stark ausgeprägt (NPI-Wert: M=31,67 vs. M=24,77, p=0,118, Cohen’s d=0,303). Ambulante Angebote wurden jedoch selten in Anspruch genommen.

Schlussfolgerungen Die Ergebnisse unterstreichen die Notwendigkeit, evidenzbasierte Leitlinien für eine angemessene, den speziellen Bedürfnissen von MmD in der letzten Lebensphase entsprechende, Palliativversorgung zu entwickeln. Die starke Ausprägung an psychischen und Verhaltensauffälligkeiten sollte dabei ebenso wie die stark ausgeprägten körperlichen Komorbiditäten berücksichtigt werden. Angesichts häufiger Krankenhausaufenthalte sollte zudem ein Fokus auf die Entwicklung fachlicher Empfehlungen für den stationären Bereich (Akutkrankenhaus, Palliativstation) gelegt werden.
Updates in the Medical Treatment of Pituitary Adenomas
Authors: Gheorghiu Monica Livia , Negreanu Francesca , Fleseriu Maria
Published: December 2019

Pituitary adenomas represent approximately 15% of brain tumors; incidence is significantly on the increase due to widespread use of magnetic resonance imaging. Surgery remains the first-line treatment for most tumors overall. The role of dopaminergic agonists (DAs) and somatostatin receptor ligands (SRLs) in the treatment of pituitary adenomas is quite well established for prolactinomas and growth hormone (GH) excess. However, over the last decade new multi-receptor binding SRLs are increasingly used for treatment of acromegaly and Cushing’s disease. SRLs/DA chimeric compounds seem to have enhanced potency and efficacy when compared to that of individual SRLs or DA receptor agonists according to preclinical data. However, following negative results, more research is needed to determine if this interesting mechanism will translate into positive clinical effects for acromegaly patients. Furthermore, new agents that block adrenal steroidogenesis have been developed in phase III clinical trials for Cushing’s disease and several new compounds working at the pituitary level and/or blocking the glucocorticoid receptor are also in development. Combination therapy of drugs with similar or different mechanisms (possibly synergistic) are also on the increase. A growing awareness regarding all mechanisms involved in both control of pituitary secretion and cellular proliferation might allow for sole medical treatment of pituitary adenomas, especially macroadenomas, rather than surgery and/or radiation therapy, in the future. Moreover, the underlying decision on how to treat patients with pituitary adenomas should be individualized on a case-by-case basis with not only a goal of tumor shrinkage and biochemical control, but also of improving patients’ quality of life.
Mortalität und ökonomische Auswirkungen der hepatischen Enzephalopathie bei Leberzirrhose in deutschen Krankenhäusern auf der Basis von G-DRG-Kostendaten
Authors: Gundling Felix , Rathmayer Markus , Koller Lisa , Wilke Michael , Kircheis Gerald , Wedemeyer Heiner , Labenz Joachim , Albert Jörg , Schepp Wolfgang , Lerch Markus M. ,   für die DRG-Projektgruppe der DGVS
Published: December 2019

Einleitung Die hepatische Enzephalopathie (HE) ist eine häufige Komplikation der Leberzirrhose, die für betroffene Patienten mit vielfältigen negativen Auswirkungen im Alltag verbunden ist. Die Prävalenz klinisch manifester Stadien wird auf 30–45 % geschätzt. Ungeachtet ihrer klinischen und prognostischen Bedeutung gilt die HE als unterdiagnostiziert.

Methoden Ziele der Studie waren neben der systematischen Analyse der Krankenhausletalität der HE erstmals eine Untersuchung der ökonomischen Auswirkungen und der Vergütungssituation einer HE bei Leberzirrhose in Deutschland. Für die retrospektive Studie standen die anonymisierten Fall- und Kostendaten (§ 21 Abs. 4 KHEntgG) von 74 Krankenhäusern des DRG-Projekts der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) aus den Jahren 2011 bis 2015 zur Verfügung. Außerdem wurden diese Ergebnisse mit denen aller deutschen Krankenhäuser auf der Basis der Falldaten des Statistischen Bundesamtes (Destatis, Wiesbaden) verglichen.

Ergebnisse In den Häusern des DRG-Projekts der DGVS wurden 59 093 Behandlungsfälle mit Leberzirrhose erfasst, bei denen in 14,6 % eine HE kodiert war. Die Krankenhausletalität von Zirrhose-Patienten mit HE war gegenüber derjenigen von Patienten ohne HE nahezu dreifach erhöht (20,9 versus 7,7 %). Die Zahl der Behandlungsfälle mit Leberzirrhose ebenso wie der Anteil von Patienten mit HE stieg kontinuierlich über den Erfassungszeitraum an. Im Gegensatz zu Patienten mit Zirrhose allgemein ist die Behandlung von Patienten mit HE nicht kostendeckend (Unterdeckung bis zu 634 € bei HE Grad 4).

Diskussion Die Letalität war bei Patienten mit Zirrhose dreifach erhöht, wenn gleichzeitig eine HE diagnostiziert wurde. In den am DGVS-DRG-Projekt teilnehmenden Häusern wurde die HE um 2 % häufiger erfasst als im Rest der Kalkulationshäuser, was entweder in einer höheren Fallschwere oder in einer besseren Kodierqualität begründet ist. Gegenwärtig ist die Behandlung der HE bei Zirrhose nicht kostendeckend im DRG-System.
Wenn es nicht mehr alleine geht – Inanspruchnahme ambulanter Unterstützungsangebote von Menschen mit Demenz: der Bayerische Demenz Survey (BayDem)
Authors: Karrer Linda , Dietzel Nikolas , Wolff Franziska , Kratzer André , Hess Manuela , Gräßel Elmar , Kolominsky-Rabas Peter
Published: December 2019

Einleitung Durch die alternden Gesellschaften steigt die Zahl der Menschen mit Demenz (MmD), wodurch die Versorgung der MmD zu einer der zentralen Herausforderungen wird. Diese wird häufig von Angehörigen geleistet, weshalb pflegende Angehörige einer Vielzahl an Belastungen ausgesetzt sind. Entlastende Angebote werden jedoch generell eher selten in Anspruch genommen. Ziel der vorliegenden Analyse ist es, die Inanspruchnahme ambulanter Pflege auf beeinflussende Faktoren hin zu untersuchen.

Methodik Der Bayerische Demenz Survey (BayDem) ist eine multizentrische Längsschnittstudie, die in 3 Regionen (Dachau, Erlangen, Kronach) in Bayern durchgeführt wurde. Projektteilnehmer/innen waren MmD nach ICD-10, sowie deren pflegende Angehörige. Die Verlaufsdaten wurden in standardisierten, persönlichen Interviews in enger Zusammenarbeit mit lokalen Akteuren vor Ort erhoben. In der vorliegenden Analyse wurde die Inanspruchnahme ambulanter Unterstützungsangebote, insbesondere der ambulanten Pflege, untersucht. Um beeinflussende Faktoren zu identifizieren, wurde eine binär-logistische Regression durchgeführt.

Ergebnisse In BayDem wurden zu Studienbeginn 364 MmD und 339 pflegende Angehörige eingeschlossen. Die Inanspruchnahme ambulanter Unterstützungsangebote war insgesamt gering. Unterstützung in Form von ambulanter Pflege wurde von etwa einem Drittel aller Befragten in Anspruch genommen, womit es das am häufigsten erhaltene Unterstützungsangebot war. Ein signifikanter Zusammenhang wurde zwischen dem Schweregrad des Demenzsyndroms und der Inanspruchnahme ambulanter Pflege 6 Monate nach Studienbeginn festgestellt. Die Chance ambulante Pflege zu beziehen war zudem signifikant höher, wenn ambulante Pflege bereits zu Studienbeginn genutzt wurde.

Schlussfolgerungen Ambulante Unterstützungsangebote werden, obwohl sie einen wichtigen Beitrag zur Entlastung pflegender Angehöriger leisten können, generell eher selten in Anspruch genommen. Um die Inanspruchnahme entlastender Unterstützungsangebote zu erhöhen, sollten die Zugangswege zu entsprechenden Angeboten niedrigschwellig gehalten werden. Neben mehr Öffentlichkeitsarbeit werden deshalb v. a. „zugehende“ Angebote benötigt, um den Betroffenen den Zugang zu Unterstützungsangeboten zu erleichtern.
Einflussfaktoren auf die Pflegebelastung der Angehörigen von Menschen mit Demenz: der Bayerische Demenz Survey (BayDem)
Authors: Dietzel Nikolas , Karrer Linda , Wolff Franziska , Kratzer André , Hess Manuela , Gräßel Elmar , Kolominsky-Rabas Peter
Published: December 2019

Hintergrund Demenz ist eine altersspezifische Erkrankung, verbunden mit einem hohen, im Verlauf der Krankheit ansteigenden Pflegebedarf, der überwiegend von pflegenden Angehörigen (pA) geleistet wird. Die Pflegebelastung ist dabei ein wesentliches Kriterium zur Beurteilung der Pflegesituation. Ziele dieser Untersuchung sind, Einflussfaktoren auf die Pflegebelastung zu identifizieren und den Verlauf der Pflegebelastung über 12 Monate zu untersuchen.

Methodik Der Bayerische Demenz Survey (BayDem) ist eine überregionale Längsschnittstudie, die in 3 Regionen (Dachau, Erlangen, Kronach) in Bayern durchgeführt wurde. Projektteilnehmer/innen waren Menschen mit Demenz (MmD) nach ICD-10, sowie deren pA. Die Verlaufsdaten wurden in standardisierten, persönlichen Interviews in enger Zusammenarbeit mit lokalen Akteuren vor Ort erhoben. Für die statistischen Analysen wurden ein multiples Regressionsmodell sowie eine mixed ANOVA (englisch: Analysis of Variance – Varianzanalyse) und einfaktorielle ANOVAs mit Messwiederholungen verwendet.

Ergebnisse In der vorliegenden Analyse wurden 295 MmD und 276 pA untersucht. Zentrale Einflussfaktoren auf die Pflegebelastung sind das Geschlecht der MmD, psychologische und verhaltensbezogene Symptome sowie eine Verschlechterung der Funktionsfähigkeit im Alltag der MmD, das Geschlecht der pA sowie ihre Stellung zum MmD und das Zusammenleben mit dem MmD. Bei der Betrachtung des Verlaufs der Pflegebelastung konnte ein signifikanter Haupteffekt der Zeit festgestellt werden.

Schlussfolgerungen Eine dauerhaft hohe Pflegebelastung kann sich negativ auf den gesundheitlichen Zustand der pA auswirken. Gleichwohl können pA entsprechend der spezifischen Faktoren der Pflegebelastung gezielt unterstützt werden. Ein Unterstützungsansatz könnte die Kombination pharmakologischer und nicht-pharmakologischer Interventionen zur Behandlung der Krankheitssymptome sowie einem „Empowerment“ und der Bereitstellung von Unterstützungsangeboten für die pA darstellen. Zudem könnten auf bestimmte Zielgruppen zugeschnittene Angebote sinnvoll sein.
Benefits and Harm of Treatment with P2Y12 Inhibitors beyond 12 Months in Patients with Coronary Artery Disease
Authors: Larsen Mads Lamm , Grove Erik Lerkevang , Kristensen Steen Dalby , Hvas Anne-Mette
Published: December 2019

The trade-off between the benefits and harm of long-term (> 12 months) treatment with P2Y12 inhibitors in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI) remains controversial. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed and Embase were searched without time restrictions to identify randomized controlled trials comparing > 12-month P2Y12 inhibition versus ≤ 12-month treatment in patients with acute coronary syndrome (ACS) or stable CAD undergoing PCI. A qualitative assessment was performed using the assessment tool from the National Heart, Lung, and Blood Institute of the National Institutes of Health. We performed a meta-analysis of the following endpoints: primary outcome (primarily major cardiovascular events), all-cause death, and major bleeding. Eight trials, comprising 40,218 patients, were included. Five studies were rated “good,” two studies “fair,” and one study “poor.” The meta-analysis showed that > 12-month P2Y12 inhibition significantly reduced the primary outcomes compared with ≤ 12-month treatment (hazard ratio [HR]: 0.85; 95% confidence interval (CI): 0.75–0.97; p = 0.01). No significant difference was demonstrated between groups in all-cause death (HR: 1.02; 95% CI: 0.76–1.36; p = 0.91) or major bleedings (HR: 1.26; 95% CI: 0.93–1.70; p = 0.14). I
2 test showed low to moderate heterogeneity among the included studies (21.6–62.3%). This systematic review and meta-analysis therefore demonstrates a reduction in major cardiovascular events during extended P2Y12-inhibitor treatment beyond 12 months compared with ≤ 12 months in patients with ACS or stable CAD undergoing PCI. There was no significant difference in all-cause death or major bleedings.
Are Footedness and Lateral Postures Better Predictors of Hemispheric Dominance Than Handedness: A Cross-sectional Questionnaire-Based Clinical and Pedigree Study
Authors: Muraleedharan Aparna , Ragavan Saranya , Devi Rema
Published: December 2019

Objective Approximately 9 out of 10 individuals show right-hand dominance. The remaining 10% include left-hand dominant and mixed handed/ambidextrous individuals. Laterality, lateral postures or lateral preference is defined by various authors as the most comfortable posture that an individual prefers to assume. The current study aims at finding the distribution of these lateral postures and their correlation with handedness/dominant side.

Materials and Methods The study was done in medical and nursing students in the age group 18 to 22 years. The patients were asked to fill a self-assessment questionnaire to determine handedness and footedness. The laterality traits were observed by asking the patients to do by themselves after an untailored demonstration.

Statistical Analysis The relationship between study parameters was assessed using Chi-square test. Pearson’s correlation test was done to assess the strength of association between comfort ratings of the various laterality postures.

Results In our study, 96.5% were right handed and 79.9% of patients were right footed. Also, 50.8% preferred right-hand clasping, 53.9% preferred left-arm folding, and 60.6% preferred right-leg folding. A statistically significant correlation was seen between foot preference and lateral postures and arm folding and hand clasping (p < 0.05). A significant association was also found between handedness and positive history of retraining. Sidedness did not follow any Mendelian pattern of inheritance.

Conclusions Handedness is affected by genetic and environmental factors. Since cultural and traditional practices can affect the lateral postures and handedness, it is important to know the relationship between laterality postures and sidedness and the impact of retraining on them. These postures are measures of cerebral dominance and are clinically important.
Comparative study of post-intervention soreness between dry needling and percutaneus needle electrolysis
Authors: JL Ciórraga López , P. Vega Moreu
Published: December 2019

Aims The aim of this research was to study the appearance of soreness after dry needling (DN) and percutaneous needle electrolysis (PNE) in latent trigger points of the extensor muscle of the posterior forearm region.

Material and Methods A pre-test/post-test pilot study was performed, in which 15 volunteers with latent trigger points in the extensor muscles of the posterior forearm region were randomly distributed into a group A who received treatment with DN and a group B who received treatment with PNE. Before and after the intervention, algometry measurements were performed at the site where the trigger point was found, and, after the intervention the patient was asked to complete two visual analog scales (VAS) to evaluate pain during the intervention and a second scale to measure pain once the needle had been removed. In addition, the same scale was performed after 24 hours, 72 hours, and 1 week after the dry needling. The statistical analysis was performed using the SPSS program version 24.0, evaluating the normality of the variables using the Shapiro-Wilk test, as the sample was less than 50 subjects. P values of > 0.05 were considered normal.

Results The ANOVA revealed a significant effect for time on the decrease of the VAS scores, both in the groups of dry needling (P < 0.001), as well as in the group of PNE (P < 0.001). In contrast, a group-time interaction was not observed (P = 0.824), ruling out statistically significant differences between the DN group and the PNE group. The Student's t-test showed a significantly decreased pain pressure threshold between the pre and post algometry, both in the group of DN (P < 0.001) and the group of PNE (P < 0.003). However, no statistically significant differences were found between both groups in pre and post algometry (P = 0.457).

Conclusion All patients presented post-needling soreness, without significant differences between DN and PNE interventions. The most intense pain was registered minutes after the dry needling, which then decreased without significant differences, reaching 0 after 72 hours, in most cases. Neither of the two techniques caused increased pain in response to pressure in a significantly different manner. No relationship was observed between a greater number of LTRs and post-needling pain. There was a correlation between pain experienced during the intervention and pain 24 hours after the needling. The levels of post-intervention pain secondary to the application of DN and PNE in latent trigger points of the extensor muscles of the posterior forearm region did not present significant differences among study subjects in both intervention groups.
Effectiveness of percutaneus needle electrolysis and eccentric exercise in chronic patellar tendinopathy
Authors: E. Entrellardat Tortillol
Published: December 2019

Aims The aim of this study was to evaluate the effect of percutaneous needle electrolysis together with exercise with eccentric loading for the treatment of chronic patellar tendinopathy.

Material and Methods An experimental study was performed including eight subjects medically diagnosed with chronic patellar tendinopathy. The sample included subjects with a mean age of 40 years old (SD:10), a sample of 10 tendons was obtained with over four months' evolution. Functionality was assessed using the VISA-P scale, pain was evaluated using the Visual Analog Scale (VAS), the tendon structure was evaluated by analyzing of ultrasound images which evaluated the AP diameter, perimeter and echogenicity. All study subjects belonged to the same group and were applied the same treatment. This consisted of three sessions of percutaneous needle electrolysis, following the protocol defined by Valera & Minaya with a dosage of 3:3:3, with 3 mA of intensity for 3 seconds and 3 current applications, together with a program of eccentric overloading which was developed in nine exercise sessions, which consisted of three series of 12 repetitions single-legged semi squats with maximum patient load on a decline board. A 48-hour window was left between the clinical session and sports practice with eccentric overloading.

Results In the initial assessment, a VISA-P score of 40.90 was obtained (SD:10.55), together with a VAS a score of 7.3 (SD:1.01), on the ultrasound exam all patients presented changes compatible with a degenerative process. After four weeks, the values of the VISA-P scale increased 35.8% at four weeks, VAS decreased 55.4% and slight changes were appreciated in ultrasound values in 42.4% of patients.

Conclusion Percutaneous needle electrolysis, together with eccentric overload exercise, represent a treatment which may be effective for most cases of chronic patellar tendinopathy.
Effects of ultrasound-guided percutaneous neuromodulation on the activation of hip abductors in a professional tennis player: a single case study
Authors: M. Lozano Ramos , AR Yáñez Álvarez , M. Rodríguez Rosal , M. Alcantarilla Pedrosa
Published: December 2019

Background Ultrasound-guided percutaneous neuromodulation (US-guided PNM) is defined as electric stimulation of a peripheral nerve at some point of its trajectory via a needle, with analgesic objectives and for the improvement of muscle function. Hip abductor muscles play an important role in the performance of tennis players, participating primarily in the transfer of forces in situations such as stopping and starting, changes in direction and even hitting the ball.

Aims The aims of this study were to confirm the effects of US-guided PNM on the superior gluteal nerve on strength and muscle activity in hip abductors and the reduction of the Q angle of the knee during a single-legged squat in a high performance athlete.

Material and Methods The subject was a high performance athlete aged 17, without traumatic injuries to the lower limb. The study was conducted in the installations of AY360° Salud y Deporte. The following variables were measured before and after the intervention: force (MVIC), muscle activity (RMS) using surface electromyography and the knee Q angle during a single-legged squat using Kinovea video analysis. A treatment protocol was performed under ultrasound guidance using a PES current with 6 Hz pulses and a pulse duration of 250 μs. In total, 5 applications of 15 seconds' duration were applied with the help of a pointer.

Results Improvements were obtained for strength measurements, from a MVIC of 0.13 mV (50.72%) to 0.26 mV (100%), for muscle activity RMS improved from 13.26% to 23.96%, and degrees changed from 23.6° to 21°.

Conclusions The US-guided PNM technique, according to the parameters studied, appears to be a useful tool for the improvement of the cited variables.
Do adaptative changes occur in the achilles tendons of endurance runners?
Authors: M. Serra Pol , A. Pons Hernández , E. Barea Vega , M. Gómez Luque
Published: December 2019

Introduction and Aim Several studies associate tendinopathies with structural changes in the Achilles tendon (AT). However, few studies have demonstrated whether long distance running training can generate structural changes at the level of the AT. The aim of this study was to determine whether adaptive changes exist, both structural and functional, in the AT of asymptomatic endurance runners with no history of lesions to the AT.

Material and Methods A cross-sectional descriptive study. In total, 14 subjects were selected and divided into two groups of 7 subjects each. The intervention group (IG) comprised all usual runners, running over 60 km per week, with no previous lesion to the AT. The control group (CG) included all active subjects but who did not perform competitive sports nor did they run more than 10 km per week. The ankle dorsal flexion (ADF) of each subject was measured together with the index of reactive force (IRF), and the width of the AT body was measured using ultrasound, together with the level of hypervascularization, the presence of hypoechoic areas and the presence of hyperechoic areas. To measure ADF, the validated measurement was used with the application (App) Dorsiflex for IPhone. To calculate IRF, the validated measure of the Drop Jump, test from the App My Jump 2 was used. The ultrasound assessment was always performed by the same examiner. The ultrasound machine was a General Electric, Logiq V2 model for measuring both feet: the width of the AT body, the degree of hyper vascularization, the presence of hypoechoic areas and the presence of calcifications. The subject was placed in prone, with the foot hanging off the table and the ankle was in 90° flexion. The examiner was placed on the same side as the lower limb examined.

Results The means of the results obtained and p-values of significance were as follows: ADF = 46° CG 43.6° IG (p > 0.005). IRF = 0.92 CG 1.07 IG (p > 0.005) Ultrasound = CG 43% presence of vascularization outside the tendon; IG 83% presence of vascularization outside the tendon.

Conclusions No significant evidence exists to support that the AT in endurance runners without a history of injuries, presents functional adaptations. However, it seems that in endurance runners, there is a greater presence of vessels in Kager's fat pad, although it is necessary to obtain data from a larger population to confirm and establish the possible relationships of these changes.
Case study on the effect of percutaneous needle electrolysis in mammary fistulae
Authors: JA García Vidal , JD Berna Serna , P. Escolar Reina , JD Berna Mestre
Published: December 2019

Background and Aims The mammary fistula (MF) was described by Zuska (1951) and is commonly associated with a non-lactational subareolar abscess, which is a particularly difficult condition due to the intense discomfort and tendency for recurrence. It is estimated to affect non-breastfeeding women aged between 20 and 50 years, and is responsible for 1-2% of all the symptomatic breast affections. Recent studies have highlighted a dermatological pathogenesis, confirming the existence of chronic inflammation of the pilosebaceous follicles and the surrounding tissue. To date, the first choice of treatment in initial phases has been the drainage and aspiration of the MF combined with the prescription of wide spectrum antibiotics. Other authors have defended the use of corticosteroid infiltrations (triamcinolone). However, these solutions are far from being definitive, as the recurrence rate is quite high, especially when purulent content exists. Percutaneous needle electrolysis (PNE) has demonstrated its effectiveness in pathologies which are accompanied with chronic inflammation, such as patellar and Achilles tendinopathy, subacromial syndromes and epicondyalgia. The aim of this study was to examine the effects produced by the application of PNE in 3 patients with MF.

Material and Methods Three patients with relapsing MF were recruited who fulfilled the inclusion criteria. All the exams and interventions were performed under ultrasound guidance by an expert radiologist. Two interventions were performed, separated 14 days and with a follow up of 15, 30, and 60 days after the application. Prior to treatment, an exhaustive ultrasound exam was performed (Phillips® ultrasound with a linear probe 14-5 MHz) in the intervention area. After the corresponding antiseptic measures were performed, the abscess was anesthetized and drained (1-2 mL mepivacaine and physiological saline), using an Introcan® Safety needle of 14G. For the application of PNE, the same needle was used, connected to the Physio Invasiva device (Grupo PRIM®), with a dose of 5 impacts of 5 mA during 5 seconds.

Results All the patients experienced an improvement in their clinical status. The ultrasound controls of the patients displayed a decrease of the abscess and changes in the echogenicity of the same after 30 days: Two of these reported a disappearance of suppuration episodes, whereas one experienced a decrease of the same, both in quantity as well as frequency.

Conclusion PNE can be an effective therapeutic option in the treatment of mammary fistulae. Further studies are required along these lines to verify and complete our preliminary findings.
Assessment of post-surgical pain after the application of ultrasound-guided percutaneous neuromodulation in total knee arthroplasty
Authors: M. Martín-Macho Martínez , A. Ventero Gómez , M. Carrió Font , A. Martín Buigues
Published: December 2019

Background and Aim The use of prosthetic knee replacements currently represent an alternative for patients who suffer from severe gonarthrosis. Treatment via the technique of ultrasound-guided percutaneous neuromodulation (US-guided PNM) is a therapeutic alternative worth considering as a new tool in physical therapy for the post-surgical recovery of total knee arthroplasty (TKA). The aim of this study was to evaluate the effectiveness of treatment with US-guided PNM in the post-surgical stage among patients intervened with TKA.

Material and Methods Patients were selected between February and May 2017 at the Hospital of Denia and were randomly assigned into two groups. The initial sample was 13 patients. The experimental group (n = 7) received treatment with US-guided PNM plus conventional treatment. The control group (n = 6) only received conventional physiotherapy treatment. Patients in the experimental group received an application of PNM, which consisted of an alternate low frequency current at 10 Hz¸ pulse width 250 μs, with an intensity to the pain threshold. The intervention was performed during four consecutive weeks after hospital discharge. The control group received conventional treatment based on manual therapy, active mobilization and the use of the arthromotor until 115° of knee flexion and 0° knee extension was achieved. The main clinical variables evaluated were pain, measured using the Visual Analog Scale (VAS), quality of life, based on physical and mental components, using the SF12 scale and functional assessment using the Oxford Knee Score. Lastly, pain, stiffness and functional capacity was measured using the WOMAC scale.

Results Both groups obtained statistically significant results in the four variables evaluated compared to the pre-surgery stage, however, the changes were more evident in the intervention group (p < 0.05). Furthermore, no significant differences were found in the variables evaluated regarding quality of life between the experimental and control group except for the emotional component of the SF-12 scale, where the result was only significant in the experimental group treated with US-guided PNM (P < 0.05). Regarding the improvement in the health status and decreased pain in the postoperative stage after TKA, no significant differences were observed between groups (p > 0.05).

Conclusion The application of the US-guided PNM technique provides greater benefits than conventional therapy for decreasing the post-surgical pain in patients who have undergone knee arthroplasty and for emotional function, evaluated using the SF-12 questionnaire.