Dementia and Technology: Evidence Supporting Assistive Technology for Individuals with Alzheimer’s Disease and Related Dementias

The prevalence of Alzheimer’s disease in the Unites States is estimated to be 5.2 million (Alzheimer’s Association, 2013). Alzheimer’s disease and related dementias (ADRD) can impact an individual’s ability to independently participate in daily occupations within their environment due to executive dysfunction, memory loss, poor judgment, and decreased problem solving (Desai, Grossberg, & Sheth, 2004; Alzheimer’s Association, 2013). Due to the rising prevalence of dementia, Labelle and Mihailidis (2006) note the importance of occupational therapists finding innovative and evidence-based strategies to enable participation in daily occupations. The purpose of this presentation is to present the results of a literature review that examined the current evidence supporting the use of assistive technology (AT) to promote engagement in meaningful occupations for individuals with ADRD. The literature review examined 12 articles using four databases: CINAHL, Cochrane, OvidSP, and PubMed. Peer-reviewed journals published from 2000 to present, individuals with AD/RD, and the use of AT were included while articles discussing other populations were excluded. Two authors reviewed and completed Appendix M (Law & McDermid, 2008a) and Appendix N (Law & McDermid, 2008b) or the Qualitative Review Form (Law & McDermid, 2008c) to critically appraise the articles. Statistics state 60-70% of individuals with ADRD live within the community (Alzheimer’s Association, 2013), however there is limited research specifically supporting the implementation of AT devices within the home for individuals with ADRD. Results of this literature review indicate testing specific prototypes of AT that support individuals with ADRD is in the preliminary stages. These prototypes have shown the potential of promoting participation within the individual’s living space. Of importance, prototypes are continually being modified to maximize engagement in meaningful occupations within their environment. In addition to findings related to testing AT, the literature shows that the use of AT decreases caregiver assistance and interactions during daily occupations. The use of AT by individuals with ADRD and their caregivers is influenced by the simplicity and familiarity of the design of AT as well as their satisfaction with the device. Occupational therapists are equipped with the knowledge and skills to serve as consultants during the development of AT, in addition to incorporating these technologies while using a client-centered approach with individuals with ADRD. References: Alzheimer\u27s Association. (2013). Alzheimer\u27s Disease Facts and Figures, Alzheimer\u27s & Dementia, 7(2). Desai, A. K., Grossberg, G. T., & Sheth, D. N. (2004). Activities of Daily Living in patients with Dementia. CNS drugs, 18(13), 853-875. Labelle, K. L., & Mihailidis, A. (2006). The use of automated prompting to facilitate handwashing in persons with dementia. The American journal of occupational therapy, 60(4), 442-450. Law, M & MacDermid, J (2008a). Appendix M in Evidence-Based Rehabilitation: A Guide to Practice. Slack, Inc. Law, M & MacDermid, J (2008b). Appendix N in Evidence-Based Rehabilitation: A Guide to Practice. Slack, Inc. Law, M & MacDermid, J (2008c). Qualitative Review Form in Evidence-Based Rehabilitation: A Guide to Practice. Slack, Inc

Einfluss von Ursprungsquelle und Isolationsmethode auf zellbiologische Charakteristika equiner mesenchymaler Stromazellen

Multipotente mesenchymale Stromazellen (MSCs) stellen nicht nur beim humanen Patienten, sondern auch in der Veterinärmedizin einen vielversprechenden Therapieansatz in der Behandlung erkrankter muskuloskelettaler Gewebe dar. Ziel der Behandlung ist dabei die Regeneration der betroffenen Strukturen im Vergleich zur Reparation nach konservativer Therapie. Vor allem im Bereich von Sehnenerkrankungen können nach MSC-Applikation vielversprechende Ergebnisse im Hinblick auf niedrigere Rezidivraten beobachtet werden. Dennoch sind noch nicht alle Umstände einer optimalen MSC-Anwendung geklärt. Hierbei sind unter anderem Fragen bezüglich der Herkunft und Gewinnung von MSCs offen, da Unterschiede von MSCs aufgrund ihrer Gewebezugehörigkeit bereits nachgewiesen wurden. Grundlegende umfassende Arbeiten zum Vergleich von equinen MSCs aus verschiedenen Quellen sowie deren mögliche Beeinflussung durch die Isolierung aus dem Gewebe lagen bislang noch nicht vor. Ziel dieser Studie war es daher, equine MSCs aus verschiedenen Quellen zu gewinnen und mögliche Unterschiede in vitro aufzuzeigen. Weiterhin sollten Unterschiede zwischen den Zelleigenschaften nach Anwendung verschiedener Isolationsprotokolle untersucht werden. In der hier vorliegenden Studie wurden MSCs aus Fett- und Sehnengewebe, Knochenmark, Nabelschnurblut und Nabelschnurgewebe von Pferden isoliert und vergleichend charakterisiert. Dabei wurden für die soliden Körpergewebe zwei unterschiedliche Isolationsmethoden, die Digestion und die Explantation, angewendet, um mögliche Einflüsse auf die gewonnen Zellen zu ermitteln. Die untersuchten Kriterien beinhalteten Zellertrag, Proliferation, Differenzierungspotenz und das Migrationsverhalten von MSCs. Hinblickend auf eine Anwendung von MSCs bei Sehnenerkrankungen wurde auch die Expression von Sehnenmarkern verglichen. In der vorliegenden Studie konnte gezeigt werden, dass sich die MSCs aus verschiedenen Quellen hinsichtlich der Zellausbeute und ihres Wachstumspotentials unterschieden. Aus soliden Geweben konnten mittels Digestion im Vergleich zu Körperflüssigkeiten signifikant mehr MSCs isoliert werden (p < 0,001). Dabei erbrachte die Isolation von MSCs mittels Digestionsmethode einen deutlich höheren Zellertrag nach der Passage 0 im Vergleich zur Explantationsmethode (p < 0,05). Im weiteren Verlauf der Kultivierung zeigten MSCs aus Sehnengewebe und Fettgewebe ein signifikant besseres Proliferationsverhalten im Vergleich zu Knochenmark-MSCs und Nabelschnurblut-MSCs. Im Hinblick auf das Differenzierungspotential konnten signifikante Unterschiede zwischen den MSCs aus den verschiedenen Quellen beobachtet werden. MSCs aus Knochenmark zeigten eine sehr gute osteogene Differenzierungsfähigkeit im Vergleich zu MSCs aus den geburtsassoziierten Geweben (p < 0,05). Im Gegensatz dazu zeichneten sich diese MSCs durch eine deutlich bessere chondrogene Differenzierung im Vergleich zu Knochenmark-MSCs aus (p < 0,05). Im Hinblick auf die Isolationsmethode konnten keine Unterschiede im Differenzierungspotential beobachtet werden. Weitere Unterschiede aufgrund der Zellquelle lassen sich in der Genexpression der Sehnenmarker erkennen. MSCs aus Fettgewebe und Sehnengewebe exprimierten Kollagen 1A2 auf höchstem Niveau. Sklexaris hingegen wurde von MSCs aus Nabelschnurblut und Sehnengewebe am höchstem exprimiert. Dabei zeigten MSCs, die mittels Digestionsmethode isoliert worden waren, ein signifikant höheres Expressionslevel von Skleraxis im Vergleich zur Explantationsmethode (p < 0,05). Die Ergebnisse der vorliegenden Studie lassen einen Einfluss der Zellquelle auf die Zellcharakteristika erkennen. MSCs aus Fettgewebe stellen dabei eine vielversprechende Alternative zu Knochenmark-MSCs dar. Allerdings scheint für eine klinische Anwendung von MSCs eine selektive Auswahl der Zellquelle entsprechend der vorliegenden Erkrankung von Vorteil zu sein. Dabei ist eine Isolierung von MSCs aus soliden Geweben mittels Digestionsverfahren zu empfehlen, da hier deutlich höhere Zellzahlen gewonnen werden können. Eine negative Beeinflussung der Zelleigenschaften durch die enzymatische Digestion lässt sich nach den vorliegenden Ergebnissen nicht vermuten. Inwiefern die beobachteten Unterschiede bei in-vivo-Anwendungen von Bedeutung sind, muss jedoch noch umfassend untersucht werden.Not only in humans but also in veterinary medicine, multipotent mesenchymal stromal cells (MSCs) are a promising treatment option in the therapy of injured musculoskeletal tissues. This is due to the improved tissue regeneration instead of the insufficient reparation following conventional therapies. With regard to an application of MSCs for treatment of tendinopathies in horses, lower rates of reinjury have been reported. However, further investigations to optimize the MSC treatment are still outstanding. Differences in MSCs from different origins have been already reported, but there are still remaining questions about the influence of origin and isolation procedures of MSCs. Fundamental research on equine MSCs derived from different sources and their potential impact due to the isolation process has not been published so far. The aim of this study was to isolate equine MSCs from different sources and to demonstrate potential differences in vitro. Furthermore, differences in cell features following different isolation methods were investigated. In the present study, MSCs from horses were isolated from adipose tissue, tendon tissue, bone marrow, umbilical cord blood and umbilical cord tissue and subsequently subjected to comparative characterization. In case of the solid tissues, two different isolation methods, digestion and explantation, were performed in order to analyze influences on obtained cells. Investigated cell features included cell yield, proliferation, differentiation and migration potential. Furthermore, expression of tendon markers was evaluated with regard to an application of MSCs in tendinopathies. In the present study it was shown that MSCs derived from different sources differ distinctly in cell yield and proliferation potential. In comparison to body fluids, significantly more MSCs could be isolated from solid tissues when using the digestion method (p < 0.001). Furthermore, the cell yield at first cell harvest was distinctly higher when performing the isolation by digestion in comparison to isolation by explantation (p < 0.05). With regard to further cultivation, MSCs derived from tendon tissue and adipose tissue displayed a significantly better proliferation potential compared to MSCs derived from other sources. Considering the differentiation potential, significant differences were obvious between the MSCs derived from different sources. Bone marrow-MSCs showed an excellent osteogenic differentiation capacity in comparison to MSCs derived from umbilical cord blood and tissue (p < 0.05). In contrast, the birth-associated MSCs displayed a distinctly better chondrogenic differentiation than MSCs derived from bone marrow (p < 0.05). No difference in the differentiation potential was noticeable following the different isolation procedures. Furthermore, differences in the gene expression of tendon markers were evident with regard to the cell source. MSCs derived from adipose tissue and tendon tissue expressed collagen 1A2 on the highest level. On the other hand, scleraxis was expressed highest in MSCs derived from umbilical cord blood and tendon tissue. In these cells, MSCs isolated by the digestion method showed a significantly higher expression level of scleraxis in comparison to MSCs isolated by explantation (p < 0.05). Based on the results obtained so far, a relevant impact of the source of MSCs on cell features was evident. MSCs derived from adipose tissue are a promising alternative to bone marrow-MSCs. However, with regard to a clinical application of MSCs, a selection of the MSC source depending on the respective intended use seems to be advantageous. For routine isolation of MSCs from solid tissues, the digestion method could be recommended due to the higher obtainable cell numbers. Furthermore, a negative influence of the enzymatic digestion on the cell features was not detectable. However, to what extent the observed differences in vitro are relevant for in-vivo-applications needs to be further investigated

Lässt sich literarischer Wandel erklären? Struktur, Gültigkeitsbedingungen und Reichweite verschiedener Erklärungstypen in der Literaturgeschichtsschreibung [Abstract]

Although literary critics continue to make programmatic claims about not only describing but also explaining literary change, and numerous textbooks and individual studies in literary history insinuate or claim to explain literary change, explanations of literary change are as of yet insufficiently reflected in the field’s methodology. Is it at all possible to provide explanations in literary history, where no strict laws have been discovered yet? If yes, what do these explanations look like and in which circumstances are they valid? Understanding literary change as the variance in a specific genre’s instantiation over time, this paper works from the point of departure of explanatory pluralism, the assumption that scientific explanations are to a certain degree discipline-specific and that various different types of explanations exist. The paper aims at an interpenetration of theory and practice and therefore analyzes different types of explanations through a concrete example of literary change. In particular, it focuses on the boom of fictional essay writing that occurred during the first third of the 20th century in German-speaking countries, thus analyzing the two trends of the fictionalization of the essay and the insertion of essayistic passages into fictional texts (e. g., the essayistic novel). The paper examines causal, statistical, intentional, functional, teleological and structur­al explanations for this literary change. Causal explanations, it is argued, cannot be employed as long as no general laws for literary change have been identified. However, it is possible to identify certain causal factors for literary change through the interplay of biographic and intertextual studies, which can be further validated by statistical approaches. Intentional explanations of literary change can generally be created through the time-consuming process of collecting explanations for the writing of single works, but they face the problem that author’s intentions, as reported in self-commen­taries or poetological texts, are often too unspecific or too specific for the work being explained. Functional explanations face two difficulties. First, literature rarely solves social problems, and therefore the benefit that functional explanations presuppose can usually only consist in the thematization of social problems. Second, the causal feedback mechanism that underlies functional explanations presupposes a mechanism for social selection amongst works of literature that promotes works that have social benefit. However, only a very idealized literature market could provide for social selection along these lines. Teleological explanations, which ascribe inherent development trends to genres, are not only dubious from the perspective of the philosophy of science, but fail to explain why these trends manifest themselves in specific historical situations. Structural explana­tions identify underlying ›deep structures‹ of text corpora that might correspond to social or ideational structures. These explanations, however, are also question­able, because they usually don’t provide information about the causal mechanisms that may lead to this correspondence. Two consequences, this paper argues, can be drawn from the analysis of various types of explanation of literary change. Concluding that full-fledged explanations of literary change are either very time-consuming and laborious (statistical and additive intentional explanations), or only employable under specific conditions and idealizing background assumptions (functional explanations), it suggests the follow­ing. First, literary scholars could revise their practice of answering ›why‹ questions in literary history and abstain from explaining literary change except in those cases when they elaborated full-fledged explanations. Second, alternatively, they could continue their existing practice but refrain from describing it as ›explaining‹ literary change. Instead, they could describe their activity in less demanding terms, e. g. as ›the search for overarching narratives‹, which nevertheless is of value in terms of didactics, knowledge synthesis, or the reduction of complexity.Peer Reviewe

Aufbau eines neuen Knowledge Networks für den Bereich "Human Resources" der Winterthur Versicherung

Die seit Mitte des letzten Jahrhunderts geprägte Industriegesellschaft erfährt eine neue Wende. Das Zeitalter der Informations- und Wissensgesellschaft drängt sich aufgrund der Informationstechnologie (IT) in den Vordergrund. "Die Wissensgesellschaft ist keine ferne Vision. Sie ist längst Realität. Wir müssen sie nicht erfinden, sondern erfinderisch mit ihren Chancen umgehen". Im Gegensatz zur bisherigen Gesellschaft, in der die Produktion von Objekten zu möglichst geringen Kosten im Mittelpunkt stand, orientiert sich diese neue Gesellschaft mehr an der Entwicklung von neuen Ideen und neuem Wissen zur Produktion und Weiterentwicklung von Objekten. Auch die Organisationsform in Unternehmen erfuhr einen Wandel: von funktionalen zu prozessorientierten Organisationsformen. Diese prozessorientierte Organisation ist lernfähiger, da Barrieren, Abeilungsgrenzen und Hierarchieebenen leichter überwindbar geworden sind. In diesem Zusammenhang liegt die Wertschöpfung von Unternehmen darin, dass die Mitarbeiter der Unternehmung mit Geschick, Originalität und Schnelligkeit neue Probleme identifizieren, kreativ lösen und überzeugend kommunizieren. Zum wettbewerbsentscheidenden Faktor wird das Wissen, welches sich in verschiedensten Formen innerhalb des Unternehmens befindet. Dieses zu offenbaren und zu gebrauchen ist u.a. das Ziel des Knowledge Managements. Wie bei jeder Organisation empfiehlt es sich auch beim Knowledge Management, in zusammenhängenden Prozessen zu denken. Dazu müssen Unternehmen Knowledge Management als einen gestaltbaren Prozess verstehen, der sich auf alle internen Prozesse auswirkt

A geometric analysis of the Maxwell field in a vicinity of a multipole particle and new special functions

A method of solving Maxwell equations in a vicinity of a multipole particle (moving along an arbitrary trajectory) is proposed. The method is based on a geometric construction of a trajectory-adapted coordinate system, which simplifies considerably the equations. The solution is given in terms of a series, where a new family of special functions arises in a natural way. Singular behaviour of the field near to the particle may be analyzed this way up to an arbitrary order. Application to the self-interaction problems in classical electrodynamics is discussed.Comment: 33 pages, LaTeX fil

Rigid spheres in Riemannian spaces

Choice of an appropriate (3+1)-foliation of spacetime or a (2+1)-foliation of the Cauchy space, leads often to a substantial simplification of various mathematical problems in General Relativity Theory. We propose a new method to construct such foliations. For this purpose we define a special family of topological two-spheres, which we call "rigid spheres". We prove that there is a four-parameter family of rigid spheres in a generic Riemannian three-manifold (in case of the flat Euclidean three-space these four parameters are: 3 coordinates of the center and the radius of the sphere). The rigid spheres can be used as building blocks for various ("spherical", "bispherical" etc.) foliations of the Cauchy space. This way a supertranslation ambiguity may be avoided. Generalization to the full 4D case is discussed. Our results generalize both the Huang foliations (cf. \cite{LHH}) and the foliations used by us (cf. \cite{JKL}) in the analysis of the two-body problem.Comment: 23 page

Einfluss von Mutationen im NOD2 Gen auf den Krankheitsphänotyp und den klinischen Verlauf bei Patienten mit Morbus Crohn

In dieser retrospektiven Genotyp-Phänotyp-Assoziationsstudie wurden 161 Patienten mit Morbus Crohn eingeschlossen und über einen Zeitraum von 2 Jahren auf verschiedene klinische Merkmale hin untersucht. Sämtliche Patienten wurden dazu entsprechend genotypisiert und hinsichtlich der drei Hauptmutationen SNP8, SNP12 und SNP13 hin überprüft. Es sollte nun speziell erfasst werden, ob Patienten mit Mutationen im NOD2-Gen mit einem besonderen klinischen Phänotyp vergesellschaftet sind und so auch einen schwereren Krankheitsverlauf aufweisen. NOD2 als ein möglicher Biomarker und Vorhersageparameter