Die Problematik sedentären Verhaltens hospitalisierter Demenzpatienten – Entwicklung eines lebensstil-integrierten Bewegungsansatzes zur Steigerung der körperlichen Aktivität

Thema der vorliegenden Arbeit ist die Beschreibung sedentären Verhaltens und iatrogener Immobilität ospitalisierter, geriatrischer Patienten mit beginnender bis mittelschwerer kognitiver Einschränkung. Die Einflüsse intramuraler Strukturen sowie immobilisierender Faktoren der geriatrischen Akutstation sollen dabei untersucht werden. Darüber hinaus steht die Entwicklung eines in den Klinikalltag integrierbaren Übungsansatzes und der damit zusammenhängenden Beibehaltung der relevanten motorischen Leistungen, wie Kraft, Ausdauer und Gleichgewicht, während eines Krankenhausaufenthaltes sowie einem Aufenthalt in der stationären Rehabilitation im Fokus der Untersuchung. Die Möglichkeit der intersektoralen Fortsetzung des Trainingsprogrammes nach Entlassung ist zukünftig eine zu berücksichtigende Komponente. Manuskript 1 zeigt eine systematische Analyse der Wirksamkeit von lebensstilintegriertem funktionalem Training zur Verbesserung motorischer Funktionen bei älteren Erwachsenen und möglichen Vorteilen dieses Interventionstyps im Vergleich zu strukturierten Trainingsansätzen (Stand 2018). Während Programme, die beide Ansätze kombinieren bereits im institutionellen Umfeld mit positiven Effekten bewertet werden konnten, sind bei anderen Zielgruppen und Umfeldern kaum Erkenntnisse vorhanden. Der lebensstilintegrierte funktionelle Trainingsansatz stellt eine vielversprechende und ressourceneffiziente Alternative zu strukturiertem Training dar und kann darüber hinaus komplementär und vermutlich intersektoral nach Entlassung eingesetzt werden. Manuskript 2 stellt die erste Untersuchung eines alltagsintegrierten funktionellen Trainingsansatzes mit kognitiv eingeschränkten, geriatrischen Rehabilitationspatienten dar. Funktionelle Übungen aus dem originalen LiFE (Lifestyle-integrated functional exercise)-Programm wurden hierbei in der Zielgruppe evaluiert. Die nachgewiesenen Bodeneffekte wiesen auf einen zu hohen Schwierigkeitsgrad der Übungen hin. Dies führte zu der Entscheidung die Übungen anzupassen ehe eine weitere Testung auf der geriatrischen Akutstation mit einer noch vulnerableren Patientengruppe stattfand. Manuskript 3 ist eine systematische Analyse geriatrischer Assessments hinsichtlich ihrer Eignung zur Messung der Effekte unterschiedlicher frührehabilitativer Interventionen auf der geriatrischen Akutstation. Es zeigt, dass die Auswahl der Ergebnisparameter spezifisch mit den Interventionsinhalten in Zusammenhang gebracht werden muss, da sie einen Schlüsselfaktor für das Auffinden von Interventionseffekten der Frührehabilitation bei geriatrischen Patienten auf der Akutstation darstellt. Eine unangemessene Auswahl von Outcome-Parametern und Tests kann sonst zu inkonsistenten Ergebnissen hinsichtlich der Wirksamkeit einer frührehabilitativen Intervention führen. Manuskript 4 beinhaltet die Analyse der intramuralen Strukturen, Prozesse und häufiger iatrogener Faktoren, die eine Immobilisation der Patienten begünstigen. Mittels einer teilnehmenden Beobachtung sowie Interviews mit den auf der Station tätigen Berufsgruppen wurden Tagesroutinen und Abläufe erfasst und analysiert

Endodontia minimamente invasiva: comparação entre as limas VDW.ROTATE™ e TruNatomy™ - revisão narrativa

A endodontia é uma área da Medicina Dentária que trata das patologias da polpa dentária e dos tecidos periapicais. Ao longo do tempo, a prática da endodontia progrediu para tratamentos cada vez mais conservadores da estrutura dentária. Isso foi possível devido, à evolução e inovação no campo dos instrumentos endodônticos Surgiram novos tipos de limas, com a particularidade de serem instrumentos finos e flexíveis de forma a conseguir uma instrumentação segura, minimamente invasiva e suficientemente eficaz. É o caso, por exemplo, dos sistemas VDW.ROTATE™ e TruNatomy™, que foram criados para cumprir estes requisitos. O objetivo deste trabalho é apresentar a evolução da instrumentação endodôntica até o desenvolvimento desses dois novos sistemas, comparando o seu comportamento em relação à fadiga cíclica.Endodontics is an area of dentistry that deals with pathologies of the dental pulp and periapical tissues. Over time, the practice of endodontics has progressed to increasingly conservative treatments for the tooth structure. This was possible due to the evolution and innovation in the field of endodontic instruments. New types of files emerged, with the particularity of being thin and flexible instruments in order to achieve safe, minimally invasive and sufficiently effective instrumentation. This is the case, for example, of the VDW.ROTATE™ and Trunatomy™ systems, which were created to fulfill these requirements. The objective of this work is to present the evolution of endodontic instrumentation up to the development of these two new systems, comparing their behavior in relation to cyclic fatigue

Transport aircraft loading and balancing system: Using a CLIPS expert system for military aircraft load planning

The requirement for improving aircraft utilization and responsiveness in airlift operations has been recognized for quite some time by the Canadian Forces. To date, the utilization of scarce airlift resources has been planned mainly through the employment of manpower-intensive manual methods in combination with the expertise of highly qualified personnel. In this paper, we address the problem of facilitating the load planning process for military aircraft cargo planes through the development of a computer-based system. We introduce TALBAS (Transport Aircraft Loading and BAlancing System), a knowledge-based system designed to assist personnel involved in preparing valid load plans for the C130 Hercules aircraft. The main features of this system which are accessible through a convivial graphical user interface, consists of the automatic generation of valid cargo arrangements given a list of items to be transported, the user-definition of load plans and the automatic validation of such load plans

La Drépanocytose Chez Les Enfants Hospitaliers Au Service De Pédiatrie (CHR El Idriss De Kénitra, Maroc): A Propos De 53 Cas.

The objective of this work is to study sickle cell in children 1 to 16 years at El Idrissi regional hospital of Kenitra (Morocco) The study was conducted between March and June 2012. The population includes 53 patients, 39 male and 14 female. The studied parameters were age, sex, socioeconomic status, origin, age of diagnosis and schooling. Data on sickle cell patients was collected from information sheets available from the archives department at the El Idrissi regional hospital of Kenitra and a patient's verbal consent or that of the child's parents. Sickle cell disease is the third leading cause of admission (10.16 % of total admissions). 47.16 % of patients are under the age of 6 years. The diagnosis of disease is made in 32.07 % of the cases around 9 months. In 94.3% of cases, patients are from family whose father has a low and irregular income. The main causes of hospitalization are painful crises (69.81 %), acute anemia (28.30%), and infections (28.30%). As a medical treatment, the rehydration, analgesics, antibiotics and blood transfusions are the most prescribed. The transfusion was performed in 96.22 % of cases. The lack of early detection and socio –economic pressures and environmental conditions seems to put our patients in a vulnerable state.The focus should be on prevention and strengthening the capacity of families

On formalizing UML2 activities using TPNets: case studies

ABSTRACT: Transactional Petri Nets (TPNets) are a new class of high-level Zero-Safe Nets (ZSNs), defined as a more suitable semantic framework for UML2 activity diagrams. Indeed, they ensure reactivity and synchronization of concurrent flows triggering with their junction. Reactivity is guaranteed due to the real time massive cancellation semantics based on the definition of new dynamic enabling rules and the imposed priority among executions. Global synchronization in turn is assured thanks to non-locality principle, an outcome of exploiting atomic stable transactions. Rewriting logic is defined as the operational semantics framework of TPNets

Early inpatient rehabilitation for acutely hospitalized older patients: a systematic review of outcome measures

Background: Selecting appropriate outcome measures for vulnerable, multimorbid, older patients with acute and chronic impairments poses specific challenges, which may have caused inconsistent findings of previous intervention trials on early inpatient rehabilitation in acutely hospitalized older patients. The aim of this review was to describe primary outcome measures that have been used in randomized controlled trials (RCTs) on early rehabilitation in acutely hospitalized older patients, to analyze their matching, and to evaluate the effects of matching on the main findings of these RCTs. Methods: A systematic literature search was conducted in PubMed, Cochrane CENTRAL, CINAHL, and PEDro databases. Additional studies were identified through reference and citation tracking. Inclusion criteria were: RCT, patients aged ≥65 years, admission to an acute hospital medical ward (but not to an intensive medical care unit), physical exercise intervention (also as part of multidisciplinary programs), and primary outcome measure during hospitalization. Two independent reviewers extracted the data, assessed the methodological quality, and analyzed the matching of primary outcome measures to the intervention, study sample, and setting. Main study findings were related to the results of the matching procedure. Results: Twenty-eight articles reporting on 24 studies were included. A total of 33 different primary outcome measures were identified, which were grouped into six categories: functional status, mobility status, hospital outcomes, adverse clinical events, psychological status, and cognitive functioning. Outcome measures differed considerably within each category and showed a large heterogeneity in their matching to the intervention, study sample, and setting. Outcome measures that specifically matched the intervention contents were more likely to document intervention-induced benefits. Mobility instruments seemed to be the most sensitive outcome measures to reveal such benefits. Conclusions: This review highlights that the selection of outcome measures has to be highly specific to the intervention contents as this is a key factor to reveal benefits attributable to early rehabilitation in acutely hospitalized older patients. Inappropriate selection of outcome measures may represent a major cause of inconsistent findings reported on the effectiveness of early rehabilitation in this setting. Trial registration: PROSPERO CRD42017063978

Etude Ecologique Et Entomologique Des Culicides Larvaires Des Gites De La Province De Kenitra (Maroc)

Mosquitoes are considered the source of nuisances and used as vectors of major pathogens for humans and animals. Despite the existence of many ways of control, supervising their populations remains a challenge forced by a delicate knowledge of their dynamics in space and time. Hence the need to conduct an entomological and ecological study of breeding sites in the province of Kenitra in order to acheive an inventory of culicidiennes species collected at eight stations of surface water with the measurement of physical-chemical parameters of these waters during several month from April to June 2012. The results revealed the presence of two species of mosquitoes, the Anopheles labranchiae and the Culex pipiens. The first type has a very low density at three stations, while the second one has a very high density in five stations. Furthermore, concentrations and measured values of the physico-chemical parameters allowed to highlight a correlation between the quality of waterin the stations and dynamics of mosquitoes. Thus, the Anopheles attend frequently the well-oxygenated and unpolluted stations (O2 between 2,53 and 3,65 mg/l; BOD5 between 3 and 15 mg/l) against the Culex (O2 between 3,85 and 8,12mg/l, BOD5 between 10 and 100 mg/ l)

Platon, critique de la démocratie. Politique, histoire et philosophie de la Grèce antique d'un point de vue platonicien

Can we criticize democracy? Above all, can we criticize democracy objectively, that is to say, criticize the democratic regime without supporting dictatorships and tyrannies. Furthermore, it is the prejudice that Platonic political philosophy has endured. We have often seen Platonic hatred towards the democracy as a love of political elites and a contempt for the people who are not able to understand philosophical and metaphysical subtleties, leaning towards the control of life privacy and a will to subdue the city to the authority, almost natural to philosopher king. The problem that interests us in this work is precisely to attempt to overcome this prejudice by inquiring the political and philosophical reasons for the hatred of democracy. To respond appropriately to this problem and to understand the Platonic's definition of democracy (and the political art in general), we have analyzed Platonic political philosophy in the light of Athens political history by focusing on crisis and reforms to give a better appreciation of the originality of Plato's philosophy. This historical analysis will allow us to understand the distance that the Founder of the Academy took as regards to tyranny but also to democracy. The disagreement that Plato expresses against the politicians, the sophists and against the presocratics is not merely a critical attitude towards the scholars of his time, but it is about returning to the concepts, definitions that they must have in order to come closer as possible to the truth.Peut-on critiquer la démocratie ? Surtout, peut-on critiquer la démocratie de manière objective, c’est-à-dire critiquer le régime démocratique sans pour autant soutenir les dictatures et et les tyrannies ? C’est d’ailleurs le préjugé dont a souffert la philosophie politique platonicienne. On a souvent vu la haine platonicienne vis-à-vis de la démocratie comme un amour des élites politiques et un mépris du peuple qui n’est pas apte à saisir les subtilités philosophiques et métaphysique, un penchant pour le contrôle de la vie privée et une volonté de soumettre la cité à l’autorité quasi naturelle du philosophe-roi. La problématique qui nous intéresse dans ce travail est justement de tenter de dépasser ce préjugé en posant les raisons politiques et philosophiques de la haine de la démocratie. Pour répondre adéquatement à cette problématique et pour comprendre la définition platonicienne de la démocratie (et de l’art politique en général), nous avons analysé la philosophie politique platonicienne à l’aune de l'histoire politique d'Athènes, en se focalisant sur les crises et les réformes pour mieux apprécier l'originalité de la philosophie de Platon. Cette analyse historique va nous permettre alors de comprendre la distance que prend le Fondateur de l'Académie quant à la tyrannie mais également en ce qui concerne la démocratie. L'opposition que manifeste Platon contre les politiques et les sophistes et contre les présocratiques n'est pas uniquement une marque d'attitude critique envers les savants de son temps, mais il s'agit de redonner aux concepts les définitions qu'ils doivent avoir afin de se rapprocher autant que faire se peut de la vérité

Nature et politique. Histoire d'Athènes et philosophie platonicienne

In terms of a political approach, it is absolutely necessary to study the question of law. Does the law have to be opposed to nature as was done by the sophists? Or, on the contrary, does it find its foundations in nature itself? The problematic we are concerned with in this body of research is the link between law and nature according to Platonic definitions. It is also an attempt to question antic theories on the link between law and nature. In order to answer adequately, and to understand Plato's definition of the law, we started by analysing Athens’ political history by focusing on crises and reforms, in order to better appreciate Plato’s own originality and philosophy. This historical analysis will enable us to understand the distance created by the Founder of the Academy with regards to tyranny and democracy. The opposition manifested by Plato against the sophists and the presocrastics is not only a critical attitude towards scholars of his time, but the need to give concepts their needed definition, in order for truth to prevail. Thus, it is the definition of nature which will determine whether the opposition between nature and law can be considered viable...La question de la loi est absolument nécessaire à étudier dans une démarche politique. La loi doit-elle être mise en opposition avec la nature comme l'ont fait les sophistes ou au contraire la loi trouve-t-elle son fondement dans cette nature ? La problématique qui nous intéresse dans ce travail de recherche est de poser le lien qui pourrait exister entre la loi et la nature à travers des définitions platoniciennes et de tenter de faire discuter les théories antiques concernant le rapport entre la nature et la loi. Pour répondre adéquatement à cette problématique et pour comprendre la définition platonicienne de la loi, nous avons tout d'abord analysé l'histoire politique d'Athènes en se focalisant sur les crises et les réformes pour mieux apprécier l'originalité de la philosophie de Platon. Cette analyse historique va nous permettre alors de comprendre la distance du Fondateur de l'Académie vis-à-vis de la tyrannie mais également vis-à-vis de la démocratie. L'opposition que manifeste Platon contre les sophistes et contre les présocratiques n'est pas uniquement une marque d'attitude critique envers les savants de son temps, mais il s'agit de redonner aux concepts les définitions qu'ils doivent avoir afin de se rapprocher autant que faire se peut de la vérité. Ainsi, c'est la définition de la nature qui va déterminer si l'opposition entre la nature et la loi peut être considérée comme viable..