Fatigue in people with Parkinson's Disease: the effects of exercise

This thesis comprises a systematic review and an intervention study. The systematic review included a meta-analysis and investigated treatment methods for fatigue. Fourteen studies (n=1890) were included in the systematic review and results from the meta-analyses (mean difference -0.25; CI -0.67:0.16; z-score 1.20 and mean difference -0.36; CI -0.78:0.06; z-score 1.67) concluded that currently there are no effective methods for the treatment of fatigue in people with Parkinson’s disease. The intervention study (n=105; intervention group: n=54; control group: n=51) comprised three parts. In the first part different measures of fatigue were explored in relation to activity levels and exercise tolerance. The second part investigated the adherence to the community based six-month exercise programme. The final part of the main study explored the effects of the exercise programme in a single blinded randomised controlled trial. In the first part of the main study significant negative correlations were found between self-reported fatigue and respiratory exchange rate (r=-0.309; p=0.002); Rate of Perceived Exertion breath (r=-0.282; p=0.024); Rate of Perceived Exertion of the legs (r=-0.261; p=0.033) and GENEActiv light activity (r=-0.209; p=0.049). The correlation between self-reported fatigue and the respiratory exchange rate implies that self-reported fatigue may decrease if exercise tolerance is improved by for example an exercise programme. The second part of the main study demonstrated an adherence of 24 out of 54 in participants that were randomly assigned to the exercise programme, with no intervention-related adverse events, showing that the proposed programme was feasible for people with Parkinson’s disease. The final part of the study, exploring the effects of the exercise programme in all patients, showed a small reduction in disease severity (Unified Parkinson’s disease Rating Scale part III, Cohen’s d: 0.25; 95% confidence interval: 0.02-0.49) in the treatment group compared to the control group. Scores on the self-reported fatigue decreased slightly in both groups subsequent to the exercise programme, but did not reach significance. This is the first study to explore the effects of a combined (aerobic and anaerobic) exercise community based longer term (six months) exercise programme on fatigue in people with Parkinson’s disease. Results show that both arms of the interventions were adhered to reasonably well and small effects were found showing exercise improved disease severity in people with Parkinson’s disease; no effects were found in relation to fatigue

Präoperative Diagnostik des Pankreaskarzinoms

Das präoperative Staging des Pankreaskarzinoms ist wenig normiert und oft bezüglich der Resektabilität mäßig informativ. Ziel dieser Studie ist, aus der Vielzahl der Stagingmethoden die für die Operationsplanung aussagekräftigsten herauszufinden. Es wurden hierzu 28 Patienten mit Pankreas- und Papillenkarzinom mittels MRT, 55 mittels CT, 45 mittels IDUS und 47 mittels EUS, sowie 18 Patienten mit allen vier Methoden untersucht. Die Ergebnisse der Untersuchungen wurden mit der postoperativen Histologie und dem Operationsbefund nach der TNM-Klassifikation verglichen. Die Accuracy der Beurteilung der Irresektabilität konnte durch die Kombination von CT und IDUS bzw. MRT und IDUS im Vergleich zu den Einzeluntersuchungen deutlich gesteigert werden. Eine Kombination aller Untersuchungsmethoden erbrachte unwesentlich bessere Ergebnisse bei nahezu identischen 95 %-Konfidenzintervallen und erheblichen Mehrkosten und Mehraufwand. Die Kombination einer schnittbildgebenden mit einer invasiven Methode erbringt somit eine Verbesserung der Aussagekraft des präoperativen Stagings und sollte zur Standarddiagnostik werden

Septic Arthritis Caused by Legionella dumoffii in a Patient with Systemic Lupus Erythematosus-Like Disease

We describe a patient with systemic lupus erythematosus (SLE)-like disease on immunosuppressive treatment who developed septic arthritis of the knee involving Legionella dumoffii. Cultures initially remained negative. A broad-range 16S PCR using synovial fluid revealed L. dumoffii rRNA genes, a finding that was subsequently confirmed by positive Legionella culture results

Energy spread of ultracold electron bunches extracted from a laser cooled gas

Ultrashort and ultracold electron bunches created by near-threshold femtosecond photoionization of a laser-cooled gas hold great promise for single-shot ultrafast diffraction experiments. In previous publications the transverse beam quality and the bunch length have been determined. Here the longitudinal energy spread of the generated bunches is measured for the first time, using a specially developed Wien filter. The Wien filter has been calibrated by determining the average deflection of the electron bunch as a function of magnetic field. The measured relative energy spread $\frac{\sigma_{U}}{U} = 0.64 \pm 0.09\%$ agrees well with the theoretical model which states that it is governed by the width of the ionization laser and the acceleration length

Calculation of a Tunnel Cross Section Subjected to Fire – with a New Advanced Transient Concrete Model for Reinforced Structures

The paper presents the structural application of a new thermal induced strain model for concrete – the TIS-Model. An advanced transient concrete model (ATCM) is applied with the material model of the TIS-Model. The non-linear model comprises thermal strain, elastic strain, plastic strain and transient temperature strains, and load history modelling of restraint concrete structures subjected to fire.The calculations by finite element analysis (FEA) were done using the SAFIR structural code. The FEA software was basically new with respect to the material modelling derived to use the new TIS-Model (as a transient model considers thermal induced strain). The equations of the ATCM consider a lot of capabilities, especially for considering irreversible effects of temperature on some material properties. By considering the load history during heating up, increasing load bearing capacity may be obtained due to higher stiffness of the concrete. With this model, it is possible to apply the thermal-physical behaviour of material laws for calculation of structures under extreme temperature conditions.A tunnel cross section designed and built by the cut and cover method is calculated with a tunnel fire curve. The results are compared with the results of a calculation with the model of the Eurocode 2 (EC2-Model). The effect of load history in highly loaded structures under fire load will be investigated.A comparison of this model with the ordinary calculation system of Eurocode 2 (EC2) shows that a better evaluation of the safety level was achieved with the new model. This opens a space for optimizing concrete structure design with transient temperature conditions up to 1000 °C.

Propagation and termination steps in Rh-mediated carbene polymerisation using diazomethane

Rh-mediated carbene (co)polymerisation of diazomethane works best in the presence of Rh-III catalyst precursors, the use of which leads to a significant increase in polymer yield and molecular weight. Chain termination via beta-hydride elimination is severely suppressed for these species, although this process does still occur leading to unsaturated chain ends. Subsequent chain walking leading to the formation of branched polymers seems not to occur. Computational studies describing pathways for both chain propagation and chain termination using a (cycloocta-2,5-dien-1-yl)Rh-III(alkyl) species as a representative model for the active species revealed that chain propagation is favoured for these species, although beta-hydride elimination is still viable at the applied reaction temperatures. The computational studies are in excellent agreement with all experimental results, and further reveal that chain propagation via carbene insertion (leading to linear poly-methylene) occurs with a much lower energy barrier than insertion of 1-alkenes into either the Rh-H bond after beta-hydride elimination or into the Rh-C bond of the growing polymer chain (leading to branched polymers). These energetic differences conveniently explain why experimentally the formation of branches is not observed in (co) polymerisation reactions employing diazomethane. The formation of substantial amounts of low-M-w oligomers and dimers in the experimental reactions can be ascribed to the presence of (1,5-cyclooctadiene)Rh-I species in the reaction mixture, for which chain termination via beta-hydride elimination is clearly favoured over chain propagation. These two species stem from a non-selective catalyst activation process during which the catalyst precursors are in situ activated towards carbene polymerisation, and as such the results in this paper might contribute to further improvements of this reaction

Analysis of the impact of climate change on groundwater related hydrological fluxes: a multi-model approach including different downscaling methods

Climate change related modifications in the spatio-temporal distribution of precipitation and evapotranspiration will have an impact on groundwater resources. This study presents a modelling approach exploiting the advantages of integrated hydrological modelling and a broad climate model basis. We applied the integrated MIKE SHE model on a perialpine, small catchment in northern Switzerland near Zurich. To examine the impact of climate change we forced the hydrological model with data from eight GCM-RCM combinations showing systematic biases which are corrected by three different statistical downscaling methods, not only for precipitation but also for the variables that govern potential evapotranspiration. The downscaling methods are evaluated in a split sample test and the sensitivity of the downscaling procedure on the hydrological fluxes is analyzed. The RCMs resulted in very different projections of potential evapotranspiration and, especially, precipitation. All three downscaling methods reduced the differences between the predictions of the RCMs and all corrected predictions showed no future groundwater stress which can be related to an expected increase in precipitation during winter. It turned out that especially the timing of the precipitation and thus recharge is very important for the future development of the groundwater levels. However, the simulation experiments revealed the weaknesses of the downscaling methods which directly influence the predicted hydrological fluxes, and thus also the predicted groundwater levels. The downscaling process is identified as an important source of uncertainty in hydrological impact studies, which has to be accounted for. Therefore it is strongly recommended to test different downscaling methods by using verification data before applying them to climate model data