EXonomy analysis for the Inter-domain comparison of electromechanical and pneumatic drives

Today the selection of drive technology for realizing of moving tasks is made by comparing of investment and energy costs in general. Pneumatic drives are characterized by their low purchase price, but at the same time they show high energy consumption in a comparison with electric drives. This general evaluation leads to the point, that in many cases the optimum drive structure for a certain handling task can’t be found regarding functionality and efficiency. To reach that goal, the dynamic, energy and costs characteristics of the actuator have to be observed and summarized. In this paper the EXonomy analysis is presented as a base for the inter-domain comparison of electric and pneumatic drives. Developed EXonomy approach enables the objective analysis and comparison of electric and pneumatic systems within 3 steps

Euthanasia and physician-assisted suicide in amyotrophic lateral sclerosis: a prospective study

The objective of this study is to determine if quality of care, symptoms of depression, disease characteristics and quality of life of patients with amyotrophic lateral sclerosis (ALS) are related to requesting euthanasia or physician-assisted suicide (EAS) and dying due to EAS. Therefore, 102 ALS patients filled out structured questionnaires every 3months until death and the results were correlated with EAS. Thirty-one percent of the patients requested EAS, 69% of whom eventually died as a result of EAS (22% of all patients). Ten percent died during continuous deep sedation; only one of them had explicitly requested death to be hastened. Of the patients who requested EAS, 86% considered the health care to be good or excellent, 16% felt depressed, 45% experienced loss of dignity and 42% feared choking. These percentages do not differ from the number of patients who did not explicitly request EAS. The frequency of consultations of professional caregivers and availability of appliances was similar in both groups. Our findings do not support continuous deep sedation being used as a substitute for EAS. In this prospective study, no evidence was found for a relation between EAS and the quality and quantity of care received, quality of life and symptoms of depression in patients with ALS. Our study does not support the notion that unmet palliative care needs are related to EAS

EXonomy analysis for the Inter-domain comparison of electromechanical and pneumatic drives

Today the selection of drive technology for realizing of moving tasks is made by comparing of investment and energy costs in general. Pneumatic drives are characterized by their low purchase price, but at the same time they show high energy consumption in a comparison with electric drives. This general evaluation leads to the point, that in many cases the optimum drive structure for a certain handling task can’t be found regarding functionality and efficiency. To reach that goal, the dynamic, energy and costs characteristics of the actuator have to be observed and summarized. In this paper the EXonomy analysis is presented as a base for the inter-domain comparison of electric and pneumatic drives. Developed EXonomy approach enables the objective analysis and comparison of electric and pneumatic systems within 3 steps

EXonomy analysis for the Inter-domain comparison of electromechanical and pneumatic drives

Today the selection of drive technology for realizing of moving tasks is made by comparing of investment and energy costs in general. Pneumatic drives are characterized by their low purchase price, but at the same time they show high energy consumption in a comparison with electric drives. This general evaluation leads to the point, that in many cases the optimum drive structure for a certain handling task can’t be found regarding functionality and efficiency. To reach that goal, the dynamic, energy and costs characteristics of the actuator have to be observed and summarized. In this paper the EXonomy analysis is presented as a base for the inter-domain comparison of electric and pneumatic drives. Developed EXonomy approach enables the objective analysis and comparison of electric and pneumatic systems within 3 steps

Cluster RCT of case management on patients' quality of life and caregiver strain in ALS

Objectives:To study the effect of case management on quality of life, caregiver strain, and perceived quality of care (QOC) in patients with amyotrophic lateral sclerosis (ALS) and their caregivers.Methods:We conducted a multicenter cluster randomized controlled trial with the multidisciplinary ALS care team as the unit of randomization. During 12 months, patients with ALS and their caregivers received case management plus usual care or usual care alone. Outcome measures were the 40-item ALS Assessment Questionnaire (ALSAQ-40), Emotional Functioning domain (EF); the Caregiver Strain Index (CSI); and the QOC score. These measures were assessed at baseline and at 4, 8, and 12 months.Results:Case management resulted in no changes in ALSAQ-40 EF, CSI, or QOC from baseline to 12 months. ALSAQ-40 EF scores in both groups were similar at baseline and did not change over time (p = 0.331). CSI scores in both groups increased significantly (p <0.0001). Patients with ALS from both groups rated their perceived QOC at baseline with a median score of 8, which did not change significantly during follow-up.Conclusion:Within the context of multidisciplinary ALS care teams, case management appears to confer no benefit for patients with ALS or their caregivers.Classification of evidence:This study provides Class III evidence that case management in addition to multidisciplinary ALS care does not significantly improve health-related quality of life of patients with AL

Euthanasia and physician-assisted suicide in amyotrophic lateral sclerosis: a prospective study.

The objective of this study is to determine if quality of care, symptoms of depression, disease characteristics and quality of life of patients with amyotrophic lateral sclerosis (ALS) are related to requesting euthanasia or physician-assisted suicide (EAS) and dying due to EAS. Therefore, 102 ALS patients filled out structured questionnaires every 3 months until death and the results were correlated with EAS. Thirty-one percent of the patients requested EAS, 69 % of whom eventually died as a result of EAS (22 % of all patients). Ten percent died during continuous deep sedation; only one of them had explicitly requested death to be hastened. Of the patients who requested EAS, 86 % considered the health care to be good or excellent, 16 % felt depressed, 45 % experienced loss of dignity and 42 % feared choking. These percentages do not differ from the number of patients who did not explicitly request EAS. The frequency of consultations of professional caregivers and availability of appliances was similar in both groups. Our findings do not support continuous deep sedation being used as a substitute for EAS. In this prospective study, no evidence was found for a relation between EAS and the quality and quantity of care received, quality of life and symptoms of depression in patients with ALS. Our study does not support the notion that unmet palliative care needs are related to EAS

Aerobic Exercise Therapy in Ambulatory Patients With ALS : A Randomized Controlled Trial

BACKGROUND: Weakness caused by motor neuron degeneration in amyotrophic lateral sclerosis (ALS) may result in avoidance of physical activity, resulting in deconditioning and reduced health-related quality of life (HRQoL). OBJECTIVE: To study the effectiveness of aerobic exercise therapy (AET) on disease-specific and generic HRQoL in ambulatory patients with ALS. METHODS: We conducted a multicenter, assessor-blinded, randomized controlled trial. Using a biphasic randomization model, ambulatory ALS patients were assigned (1:1) to AET+usual care (UC), or UC. AET consisted of a 16-week aerobic cycling exercise program. Primary outcome measures were the 40-item ALS assessment questionnaire (ALSAQ-40), and the mental component summary (MCS) and physical component summary (PCS) scores of the short-form survey (SF-36), using linear mixed effects models. Per-protocol (PP) analysis was performed for those patients who attended ≥75% of the training sessions; controls were matched (1:1) by propensity score matching. RESULTS: Of 325 screened patients, 57 were randomized: 27 to AET+UC and 30 to UC. No significant mean slope differences between groups were observed for ALSAQ-40 (-1.07; 95% confidence interval [CI] -2.6 to 0.5, P=0.172) nor for SF-36 MCS (0.24; -0.7 to 1.1, P=0.576) or PCS (-0.51; -1.4 to 0.38, P=0.263). There were no adverse events related to the AET. PP-analyses showed significantly less deterioration in ALSAQ-40 (-1.88, -3.8 to 0.0, P=0.046) in AET+UC compared to UC. CONCLUSIONS: AET+UC was not superior to UC alone in preserving HRQoL in ambulatory ALS patient. However, the study was unfortunately underpowered, because only 10 patients completed the protocol. AET+UC may preserve disease-specific HRQoL in slow progressors. CLINICAL TRIAL REGISTRATION NUMBER: Netherlands National Trial Register (NTR): 1616