Biomechanischer Stabilitätsvergleich am distalen Femur: retrograde Nagelung versus polyaxiale, winkelstabile Plattenosteosynthese

Die distale Femurfraktur ist eine sehr komplexe Fraktur, für die sich unterschiedliche Therapiemöglichkeiten anbieten. Neben intramedullären Kraftträgern stehen mit der neuesten Generation polyaxialer, winkelstabiler Plattenosteosynthesen auch adäquate extramedulläre Verfahren zur Verfügung. In der vorliegenden Arbeit soll der retrograde M/DN-Femurnagel (Fa. Zimmer) mit der polyaxialen NCB-DF Platte (Fa. Zimmer) hinsichtlich der biomechanischen Stabilität und Belastbarkeit verglichen werden. Verwendet wurden acht paarige, formalinfixierte Leichenfemora. Vorbestehende Frakturen und Osteolysen wurden mittels radiologischer Kontrolle ausgeschlossen. Ein standardisiertes Frakturmodel (AO 33-A3) mit einer Defektzone von 2 cm wurde etabliert. Nach der Randomisierung wurden je vier M/DN Femurnägel am rechten bzw. linken Knochen eines jeden Paares implantiert. Entsprechend wurde beim jeweiligen Gegenstück der Paare die NCB-DF Platte eingesetzt. Die Verriegelung erfolgte bei den Nägeln mit Hilfe horizontal zum Nagel eingebrachter Verriegelungsbolzen. Die Platte wurde durch Verschlusskappen verriegelt. Nach Einbetten der Femurkondylen in einen ca. 2 cm hohen Technovit-Sockel erfolgt die zyklische Druckbelastung in einer Materialprüfmaschine der Firma Instron (Modell 5566). Das standardisierte Prüfprotokoll sah den Beginn bei 1.000 N vor. Nach je 500 Zyklen wurde die Druckkraft um je 500 N bis zu einer maximalen Belastung von 5.000 N erhöht. Als Abbruchkriterien galten außerdem ein Druckkraftverlust von 20 % und eine Druckverformung > 30 mm. Alle Osteosynthesen hielten einer Druckkraft von mindestens 2.500 N stand. Unter dieser Belastung wurde eine mittlere plastische Verformung von 0,29 mm bei der Nagelosteosynthese und 0,76 mm bei der Plattenosteosynthese beobachtet. Der Unterschied in der plastischen Verformung ist auf dem Belastungsniveau von 2.500 N nicht signifikant (p=0,056). Eine mittlere plastische Gesamtverformung betrug beim Nagel 2,76 mm und bei der Platte 5,64 mm. Für die Druckverformung ergab sich bei 2.500 N ein signifikanter Unterschied mit p=0,0036. Die durchschnittliche Verformung betrug 1,99 mm (Nagelosteosynthese) und 3,99 mm (NCB-Plattenosteosynthese). Im Druckkraftbereich von 4.000 N – 5.000 N versagten je 5 Nagel- und 5 Plattenosteosynthesen. Dabei konnte kein signifikanter Unterschied festgestellt werden (p=0,943). Bei 3 von 8 Nagelosteosynthesen und 1 von 8 Plattenosteosynthesen kam es nicht zum Osteosyntheseversagen. Im Versagensfall riss bei den meisten Proben die proximale Verschraubung aus. Allein bei der Probe 2 mit NCB-Plattenosteosynthese kam es zum distalen Osteosyntheseversagen durch einen Kondylenbruch. Bei den Proben 3 und 4 der Plattenosteosynthese wurde ein Versagen durch plastische Deformierung erreicht. In dieser Studie konnte gezeigt werden, dass im geriatrischen Knochen beide Systeme eine ausreichende Primärstabilität, eine vergleichbare biomechanische Stabilität unter axialer, zyklischer Belastung sowie einander entsprechende Osteosyntheseversagen aufweisen. Hinsichtlich der Druckverformung unterscheiden sich Nagel- und. Plattenosteosynthese jedoch signifikant. Die NCB-Plattenosteosynthese manifestierte sich als das elastischere von beiden Systemen. In wie weit dieser Elastizitätsgewinn der NCB-Plattenosteosynthese im klinischen Alltag hinsichtlich der Frakturheilung von Vorteil ist, kann aus dem Studienaufbau nicht abgeleitet werden

Wissensstandsanalyse zu Qualität, Verbraucherschutz und Verarbeitung ökologischer Lebensmittel

Zielsetzung des Projektes war es, den aktuellen Stand des Wissens zur Qualität und Verarbeitung ökologischer Lebensmittel sowie zum Verbraucherschutz aufzuzeigen und zu bewerten. Das Projektteam setzte sich aus Wissenschaftlern des Forschungsinstituts für biologischen Landbau (Deutschland und Schweiz), des Büros für Lebensmittelkunde, des Forschungsrings für Biologisch-Dynamische Wirtschaftsweise e.V. sowie des Fachgebiets Ökologische Lebensmittelqualität und Ernährungskultur der Universität Kassel zusammen. In dem zeitlich sehr begrenzten Projekt fokussierte die Arbeitsgruppe die Betrachtung auf folgende Themenkomplexe und Produktgruppen: Bereich Qualität - Ernährung - Sensorik - Ökospezifische Qualitäten - Authentizität und Rückverfolgbarkeit Bereich Verarbeitung - Rohwaren/Lagerung und Technologien für die Produktgruppen: -- Getreide -- Milch -- Fleisch -- Obst und Gemüse und Erzeugnisse aus diesen - Nachhaltigkeit im Unternehmen und entlang der Prozesskette - Verpackung Vorhandenes Wissen, aktuelle Fragestellungen und Entwicklungsrichtungen wurden nach thematisch angepassten Vorgehensweisen identifiziert und anhand internationaler Literatur und Experteninterviews diskutiert. Zu allen Themenkomplexen wurden kurze und allgemeinverständliche Reports erstellt, die einen schnellen und fundierten Überblick zum aktuellen Stand des Wissens und zu eventuellen Wissenslücken geben. Der Abschlussreport wurde in deutscher und englischer Sprache veröffentlicht. Insgesamt wurde festgestellt, dass in den betrachteten Themenkomplexen erheblicher Bedarf an Forschung und Entwicklung sowie an Wissenstransfer besteht. Neben einer Reihe von Detailfragen sind grundlegende Themen, wie beispielsweise das Anforderungsprofil an eine „ökologische Verarbeitung“, nicht hinreichend erforscht und geklärt. Diese Arbeiten sind jedoch Voraussetzung für die Bearbeitung von Detailthemen, da hier Aufgabenstellungen, Schwerpunktsetzungen und Methoden definiert werden

UNEP-SETAC guideline on global land use impact assessment on biodiversity and ecosystem services in LCA

Purpose As a consequence of the multi-functionality of land, the impact assessment of land use in Life Cycle Impact Assessment requires the modelling of several impact pathways covering biodiversity and ecosystem services. To provide consistency amongst these separate impact pathways, general principles for their modelling are provided in this paper. These are refinements to the principles that have already been proposed in publications by the UNEP-SETAC Life Cycle Initiative. In particular, this paper addresses the calculation of land use interventions and land use impacts, the issue of impact reversibility, the spatial and temporal distribution of such impacts and the assessment of absolute or relative ecosystem quality changes. Based on this, we propose a guideline to build methods for land use impact assessment in Life Cycle Assessment (LCA). Results Recommendations are given for the development of new characterization models and for which a series of key elements should explicitly be stated, such as the modelled land use impact pathways, the land use/cover typology covered, the level of biogeographical differentiation used for the characterization factors, the reference land use situation used and if relative or absolute quality changes are used to calculate land use impacts. Moreover, for an application of the characterisation factors (CFs) in an LCA study, data collection should be transparent with respect to the data input required from the land use inventory and the regeneration times. Indications on how generic CFs can be used for the background system as well as how spatial-based CFs can be calculated for the foreground system in a specific LCA study and how land use change is to be allocated should be detailed. Finally, it becomes necessary to justify the modelling period for which land use impacts of land transformation and occupation are calculated and how uncertainty is accounted for. Discussion The presented guideline is based on a number of assumptions: Discrete land use types are sufficient for an assessment of land use impacts; ecosystem quality remains constant over time of occupation; time and area of occupation are substitutable; transformation time is Negligible; regeneration is linear and independent from land use history and landscape configuration; biodiversity and multiple ecosystem services are independent; the ecological impact is linearly increasing with the intervention; and there is no interaction between land use and other drivers such as climate change. These assumptions might influence the results of land use Life Cycle Impact Assessment and need to be critically reflected. Conclusions and recommendations In this and the other papers of the special issue, we presented the principles and recommendations for the calculation of land use impacts on biodiversity and ecosystem services on a global scale. In the framework of LCA, they are mainly used for the Assessment of land use impacts in the background system. The main areas for further development are the link to regional ecological models running in the foreground system, relative weighting of the ecosystem services midpoints and indirect land use.Fil: Koellner, Thomas . University of Bayreuth. Faculty of Biology, Chemistry and Geosciences; AlemaniaFil: De Baan, Laura. Institute for Environmental Decisions. Natural and Social Science Interface; SuizaFil: Beck, Tabea. University of Stuttgar. Department Life Cycle Engineering; AlemaniaFil: Brandão, Miguel. Joint Research Centre. Institute for Environment and Sustainability, Sustainability. Assessment Unit, European Commission; ItaliaFil: Civit, Bárbara María. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Mendoza. Instituto de Ciencias Humanas, Sociales y Ambientales; Argentina. Universidad Tecnológica Nacional. Facultad Regional Mendoza; ArgentinaFil: Margni, Manuele . École Polytechnique de Montréal. Département de génie chimique; CanadáFil: Milà i Canals, Llorenç. Unilever R&D. Safety and Environmental Assurance Centre; Reino UnidoFil: Saad, Rosie. École Polytechnique de Montréal. Département de génie chimique; CanadáFil: De Souza, Danielle Maia. Joint Research Centre. Institute for Environment and Sustainability, Sustainability. Assessment Unit, European Commission; ItaliaFil: Müller Wenk, Ruedi . University of St. Gallen. Institute for Economy and the Environment; Alemani

Healthcare Costs and Health-Related Quality of Life in Older Multimorbid Patients After Hospitalization.

OBJECTIVES We identified factors associated with healthcare costs and health-related quality of life (HRQoL) of multimorbid older adults with polypharmacy. METHODS Using data from the OPERAM (OPtimising thERapy to prevent Avoidable hospital admissions in the Multimorbid older people) trial, we described the magnitude and composition of healthcare costs, and time trends of HRQoL, during 1-year after an acute-care hospitalization. We performed a cluster analysis to identify groups with different cost and HRQoL trends. Using multilevel models, we also identified factors associated with costs and HRQoL. RESULTS Two months after hospitalization monthly mean costs peaked (CHF 7'124) and HRQoL was highest (0.67). They both decreased thereafter. Age, falls, and comorbidities were associated with higher 1-year costs. Being female and housebound were negatively associated with HRQoL, while moderate alcohol consumption had a positive association. Being independent in daily activities was associated with lower costs and higher HRQoL. CONCLUSION Although only some identified potential influences on costs and HRQoL are modifiable, our observations support the importance of prevention before health deterioration in older people with multimorbid illness and associated polypharmacy

Cost-effectiveness of a structured medication review approach for multimorbid older adults: Within-trial analysis of the OPERAM study

BACKGROUND Inappropriate polypharmacy has been linked with adverse outcomes in older, multimorbid adults. OPERAM is a European cluster-randomized trial aimed at testing the effect of a structured pharmacotherapy optimization intervention on preventable drug-related hospital admissions in multimorbid adults with polypharmacy aged 70 years or older. Clinical results of the trial showed a pattern of reduced drug-related hospital admissions, but without statistical significance. In this study we assessed the cost-effectiveness of the pharmacotherapy optimisation intervention. METHODS We performed a pre-planned within-trial cost-effectiveness analysis (CEA) of the OPERAM intervention, from a healthcare system perspective. All data were collected within the trial apart from unit costs. QALYs were computed by applying the crosswalk German valuation algorithm to EQ-5D-5L-based quality of life data. Considering the clustered structure of the data and between-country heterogeneity, we applied Generalized Structural Equation Models (GSEMs) on a multiple imputed sample to estimate costs and QALYs. We also performed analyses by country and subgroup analyses by patient and morbidity characteristics. RESULTS Trial-wide, the intervention was numerically dominant, with a potential cost-saving of CHF 3'588 (95% confidence interval (CI): -7'716; 540) and gain of 0.025 QALYs (CI: -0.002; 0.052) per patient. Robustness analyses confirmed the validity of the GSEM model. Subgroup analyses suggested stronger effects in people at higher risk. CONCLUSION We observed a pattern towards dominance, potentially resulting from an accumulation of multiple small positive intervention effects. Our methodological approaches may inform other CEAs of multi-country, cluster-randomized trials facing presence of missing values and heterogeneity between centres/countries

The price of tumor control: an analysis of rare side effects of anti-CTLA-4 therapy in metastatic melanoma from the ipilimumab network

Background: Ipilimumab, a cytotoxic T-lymphocyte antigen-4 (CTLA-4) blocking antibody, has been approved for the treatment of metastatic melanoma and induces adverse events (AE) in up to 64% of patients. Treatment algorithms for the management of common ipilimumab-induced AEs have lead to a reduction of morbidity, e.g. due to bowel perforations. However, the spectrum of less common AEs is expanding as ipilimumab is increasingly applied. Stringent recognition and management of AEs will reduce drug-induced morbidity and costs, and thus, positively impact the cost-benefit ratio of the drug. To facilitate timely identification and adequate management data on rare AEs were analyzed at 19 skin cancer centers. Methods and Findings: Patient files (n = 752) were screened for rare ipilimumab-associated AEs. A total of 120 AEs, some of which were life-threatening or even fatal, were reported and summarized by organ system describing the most instructive cases in detail. Previously unreported AEs like drug rash with eosinophilia and systemic symptoms (DRESS), granulomatous inflammation of the central nervous system, and aseptic meningitis, were documented. Obstacles included patientś delay in reporting symptoms and the differentiation of steroid-induced from ipilimumab-induced AEs under steroid treatment. Importantly, response rate was high in this patient population with tumor regression in 30.9% and a tumor control rate of 61.8% in stage IV melanoma patients despite the fact that some patients received only two of four recommended ipilimumab infusions. This suggests that ipilimumab-induced antitumor responses can have an early onset and that severe autoimmune reactions may reflect overtreatment. Conclusion: The wide spectrum of ipilimumab-induced AEs demands doctor and patient awareness to reduce morbidity and treatment costs and true ipilimumab success is dictated by both objective tumor responses and controlling severe side effects

Can cognitive insight predict symptom remission in a first episode psychosis cohort?

BACKGROUND: The outcome of first episode psychosis (FEP) is highly variable and difficult to predict. Cognitive insight measured at illness onset has previously been found to predict psychopathology 12-months later. The aims of this study were to examine whether the prospective relationship between cognitive insight and symptom severity is evident at four-years following FEP and to examine some psychological correlates of cognitive insight. METHODS: FEP participants (n = 90) completed the Beck Cognitive Insight Scale (BCIS) at illness onset, and associations between BCIS scores with symptom severity outcomes (4-years after FEP) were assessed. The BCIS scales (self-reflectiveness and self-certainty) were examined as a composite score, and individually compared to other cognitive measures (IQ and jumping to conclusions (JTC) bias). RESULTS: Regression analyses revealed that the cognitive insight composite did not predict 4-year symptom remission in this study while the self-reflection subscale of the BCIS predicted severity of symptoms at 4-years. Self-certainty items of the BCIS were not associated with symptom severity. Significant correlations between the JTC bias, self-certainty and IQ were found, but self-reflection did not correlate with these other cognitive measures. CONCLUSIONS: Self-reflective capacity is a more relevant and independent cognitive construct than self-certainty for predicting prospective symptom severity in psychosis. Improving self-reflection may be a useful target for early intervention research

Optimasi Portofolio Resiko Menggunakan Model Markowitz MVO Dikaitkan dengan Keterbatasan Manusia dalam Memprediksi Masa Depan dalam Perspektif Al-Qur`an

Risk portfolio on modern finance has become increasingly technical, requiring the use of sophisticated mathematical tools in both research and practice. Since companies cannot insure themselves completely against risk, as human incompetence in predicting the future precisely that written in Al-Quran surah Luqman verse 34, they have to manage it to yield an optimal portfolio. The objective here is to minimize the variance among all portfolios, or alternatively, to maximize expected return among all portfolios that has at least a certain expected return. Furthermore, this study focuses on optimizing risk portfolio so called Markowitz MVO (Mean-Variance Optimization). Some theoretical frameworks for analysis are arithmetic mean, geometric mean, variance, covariance, linear programming, and quadratic programming. Moreover, finding a minimum variance portfolio produces a convex quadratic programming, that is minimizing the objective function ðð¥with constraintsð ð 𥠥 ðandð´ð¥ = ð. The outcome of this research is the solution of optimal risk portofolio in some investments that could be finished smoothly using MATLAB R2007b software together with its graphic analysis

Search for heavy resonances decaying to two Higgs bosons in final states containing four b quarks

A search is presented for narrow heavy resonances X decaying into pairs of Higgs bosons (H) in proton-proton collisions collected by the CMS experiment at the LHC at root s = 8 TeV. The data correspond to an integrated luminosity of 19.7 fb(-1). The search considers HH resonances with masses between 1 and 3 TeV, having final states of two b quark pairs. Each Higgs boson is produced with large momentum, and the hadronization products of the pair of b quarks can usually be reconstructed as single large jets. The background from multijet and t (t) over bar events is significantly reduced by applying requirements related to the flavor of the jet, its mass, and its substructure. The signal would be identified as a peak on top of the dijet invariant mass spectrum of the remaining background events. No evidence is observed for such a signal. Upper limits obtained at 95 confidence level for the product of the production cross section and branching fraction sigma(gg -> X) B(X -> HH -> b (b) over barb (b) over bar) range from 10 to 1.5 fb for the mass of X from 1.15 to 2.0 TeV, significantly extending previous searches. For a warped extra dimension theory with amass scale Lambda(R) = 1 TeV, the data exclude radion scalar masses between 1.15 and 1.55 TeV

Search for supersymmetry in events with one lepton and multiple jets in proton-proton collisions at root s=13 TeV

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