Beständigkeit von Klebstoffen schnell einschätzen

Klebstoffpolymere altern durch Temperatur- und Sauerstoffeinfluss je nach ihrer chemischen Basis unterschiedlich stark. DSC-Methoden können bei der Optimierung von Klebstoffsystemen langwierige Alterungsprüfungen ablösen und somit die Validierungsprozesse beschleunigen

Adhesive method for rapidly bonded wood panel joints of prefab house construction joints

This paper covers a recently completed research project in Germany aimed at using a new rapid adhesive bonding technology in wood panel construction for modular prefabricated houses, which is an increasingly popular way of building single-family houses in Central Europe. In general, the prefabricated panels are built up by planking a frame of woodensquare ribs with particleboards. Nailing or stapling has been the main joining technique so far. A new approach was established by applying an adhesive tape based on an adhesively coated metallic carrier inserted into the joint. By connecting it to an electric power supply and heating it within a short time to the melting point, the adhesive can wet the wood andcure in the compressed joint. Different thin metallic carriers made of sheets of steel, aluminum, and brass or expanded metal were used and combined with adhesives, such as polyurethane hotmelts (PUR), PUR adhesive dispersions, andco-polyamides. Because of the requirements for structural joining in the building industry, different European Standards, such as EN 15425 [EN 15425:2008, “Adhesives—One Component Polyurethane for Load Bearing Timber Structures—Classification and Performance Requirements,” CEN-CENELEC, Brussels, Belgium, 2008], and preparation according to EN 302-1 [EN 302-1:2013, “Adhesives for Load-Bearing Timber Structures—Test Methods—Part 1: Determination of Longitudinal Tensile Shear Strength,” CEN-CENELEC, Brussels, Belgium, 2013], were discussed and implemented to find out whether a combination of squared timber, new tapes, and attached panel materials are sufficient ornot. In this paper, this new method and the material testing are introduced, from early screening for suitable adhesives to semi-sized panelspecimens in the context of the European Standards

Training Physicians to Provide High-Value, Cost-Conscious Care A Systematic Review

Importance Increasing health care expenditures are taxing the sustainability of the health care system. Physicians should be prepared to deliver high-value, cost-conscious care. Objective To understand the circumstances in which the delivery of high-value, cost-conscious care is learned, with a goal of informing development of effective educational interventions. Data Sources PubMed, Embase, Eric, and Cochrane databases were searched from inception until September 5, 2015, to identify learners and cost-related topics. Study Selection Studies were included on the basis of topic relevance, implementation of intervention, evaluation of intervention, educational components in intervention, and appropriate target group. There was no restriction on study design. Data Extraction and Synthesis Data extractionwas guided by a merged and modified version of a Best Evidence in Medical Education abstraction form and a Cochrane data coding sheet. Articles were analyzed using the realist review method, a narrative review technique that focuses on understanding the underlying mechanisms in interventions. Recurrent patterns were identified in the data through thematic analyses. Resulting themes were discussed within the research team until consensus was reached. Main Outcomes and Measures Main outcomeswere factors that promote education in delivering high-value, cost-conscious care. Findings The initial search identified 2650 articles; 79 met the inclusion criteria, of which 14 were randomized clinical trials. The majority of the studieswere conducted in North America (78.5%) using a pre-post interventional design (58.2%; at least 1619 participants); they focused on practicing physicians (36.7%; at least 3448 participants), resident physicians (6.3%; n = 516), and medical students (15.2%; n = 275). Among the 14 randomized clinical trials, 12 addressed knowledge transmission, 7 reflective practice, and 1 supportive environment; 10 (71%) concluded that the interventionwas effective. The data analysis suggested that 3 factors aid successful learning: (1) effective transmission of knowledge, related, for example, to general health economics and prices of health services, to scientific evidence regarding guidelines and the benefits and harms of health care, and to patient preferences and personal values (67 articles); (2) facilitation of reflective practice, such as providing feedback or asking reflective questions regarding decisions related to laboratory ordering or prescribing to give trainees insight into their past and current behavior (56 articles); and (3) creation of a supportive environment in which the organization of the health care system, the presence of role models of delivering high-value, cost-conscious care, and a culture of high-value, cost-conscious care reinforce the desired training goals (27 articles). Conclusions and Relevance Research on educating physicians to deliver high-value, cost-conscious care suggests that learning by practicing physicians, resident physicians, and medical students is promoted by combining specific knowledge transmission, reflective practice, and a supportive environment. These factors should be considered when educational interventions are being developed

Peri-procedural use of rivaroxaban in elective percutaneous coronary intervention to treat stable coronary artery disease. The X-PLORER trial

Contains fulltext : 153620.pdf (Publisher’s version ) (Open Access)Patients on rivaroxaban requiring percutaneous coronary intervention (PCI) represent a clinical conundrum. We aimed to investigate whether rivaroxaban, with or without an additional bolus of unfractionated heparin (UFH), effectively inhibits coagulation activation during PCI. Stable patients (n=108) undergoing elective PCI and on stable dual antiplatelet therapy were randomised (2:2:2:1) to a short treatment course of rivaroxaban 10 mg (n=30), rivaroxaban 20 mg (n=32), rivaroxaban 10 mg plus UFH (n=30) or standard peri-procedural UFH (n=16). Blood samples for markers of thrombin generation and coagulation activation were drawn prior to and at 0, 0.5, 2, 6-8 and 48 hours (h) after start of PCI. In patients treated with rivaroxaban (10 or 20 mg) and patients treated with rivaroxaban plus heparin, the levels of prothrombin fragment 1 + 2 at 2 h post-PCI were 0.16 [0.1] nmol/l (median) [interquartile range, IQR] and 0.17 [0.2] nmol/l, respectively. Thrombin-antithrombin complex values at 2 h post-PCI were 3.90 [6.8]microg/l and 3.90 [10.1] microg/l, respectively, remaining below the upper reference limit (URL) after PCI and stenting. This was comparable to the control group of UFH treatment alone. However, median values for thrombin-antithrombin complex passed above the URL with increasing tendency, starting at 2 h post-PCI in the UFH-alone arm but not in rivaroxaban-treated patients. In this exploratory trial, rivaroxaban effectively suppressed coagulation activation after elective PCI and stenting

An Exploratory Study Investigating Factors Influencing the Outpatient Delivery of Geriatric Rehabilitation

BACKGROUND: Outpatient delivery of geriatric rehabilitation (GR) might contribute to preserving the accessibility and quality of GR, whilst dealing with an increasing demand for healthcare in an aging population. However, the application of outpatient GR differs between GR facilities. This study aimed to gain insight into factors influencing outpatient GR utilization. METHODS: In this case study, 24 semi-structured interviews were conducted with physicians, physiotherapists, nurse practitioners, occupational therapists, and managers in GR. Interviews were transcribed and analyzed using summative content analysis. RESULTS: Various patient-related barriers for using outpatient GR were mentioned including lacking social support and limited capacities and self-management skills. Additionally, professional-related barriers included a lack of awareness and consensus among care professionals regarding the possibilities and potential advantages of outpatient GR. Yet, most perceived barriers were related to efficiency and organization of outpatient GR (e.g., reimbursement system, lacking practical guidance). Still, most participants were in favor of increasing outpatient GR because of expected advantages for patients, GR organizations, and society. CONCLUSIONS: Despite experienced barriers, there seems to be agreement on the need to increase outpatient GR application. It is recommended to use the present findings to develop and evaluate new ways of organizing and reimbursing outpatient GR