trends and confounding

Ergebnisse zur Dekubitusprävalenz sind wichtige Indikatoren für das Ausmaß der Erkrankung in unterschiedlichen Sektoren und Bereichen des deutschen Gesundheitswesens. Valide und präzise Zahlen zur Prävalenz sind zur Bewertung des Ressourcenbedarfs und Planung von Gesundheitsleistungen dringend erforderlich. Durch die vorliegenden Studien kann das Ausmaß der Dekubitushäufigkeit in bundesdeutschen Pflegeheimen und Krankenhäusern bestimmt werden. Es bestehen Hinweise, dass von einer externen Validität der Studienergebnisse ausgegangen werden kann. Dabei muss die bisherig angenommene hohe Prävalenz von 30% in Pflegeheimen deutlich nach unten korrigiert werden. Die standardisierten jährlichen Erhebungen lassen den Schluss zu, dass sich die Dekubitusprävalenz seit 2001 sowohl in Pflegeheimen als auch in Krankenhäusern reduziert hat. War vor 10 Jahren noch jeder zehnte Bewohner/ Patient von Dekubitus betroffen, so ist es im Jahre 2011 nur noch jeder 20. Kranken-hauspatient und nur noch jeder 25. Pflegeheimbewohner. Der Vergleich von institutsbezogener Prävalenz sollte ausschließlich risikoadjustiert erfolgen, da nur dadurch faire Vergleiche zwischen unterschiedlichen Sektoren, Bereichen und Einrichtungen möglich sind und der Einfluss von Confoundern weitestgehend reduziert wird. Die durchgeführten Studien ermöglichen die Weiterentwicklung von statistischen Modellen. Analog zu dem im Rahmen dieser Studie vorgestellten SRISAG Modell sollten derartige Modelle einfach und handhabbar sein und dadurch eine sinnvolle Problem- und Qualitätsbestimmung des Pflegeproblems Dekubitus in unterschiedlichen Institutionen des deutschen Gesundheitswesens ermöglichen.Results of studies about pressure ulcer prevalence are important parameters about the size of the problem in different sectors and areas of the German health care services, because valid and precise figures about its prevalence are necessary for the adequate planning of actual care needs. The provided studies of this Habilitation provide this information for German Hospitals and nursing homes. The results can be considered as sufficiently external valid. Former estimation of a high pressure ulcer prevalence of about 30 percent in German nursing homes have to be adjusted downwards notably. The standardized annual studies lead to the conclusion, that the pressure ulcer prevalence has dropped since 2001 in nursing homes and hospitals. Ten years ago, every 10th hospital patient and nursing home resident had at least one pressure ulcer. In the year 2011 this is only the case in every 20th hospital patient and every 25th nursing home residents. The comparison of institutional related prevalence rates should always be done by applying risk adjustment measures. Thus fair comparison between different sectors, areas and institutions will be guaranteed and the influence of possible confounders will be minimized. The preformed studies allow the further development of statistical models. Alike the in this habilitation proposed SRISAG-Modell, these models should be easy and manageable and can be used to determine the size of the problem and the quality of the nursing problem pressure ulcer in different institutions of the German health care system

Tsunamis in Sweden: Occurrence and Characteristics

In the last 13,000 years, there are 17 tsunami events recorded in Sweden. This chapter highlights the characteristics of two high-magnitude events from the deglacial period and three events from Late Holocene age

Long-term genetic modification of the ocular outflow tract and the retinal pigment epithelium with feline immunodeficiency viral vectors

The central goal to engineer feline immunodeficiency viral (FIV) vectors into a more modular platform for long-term ocular gene therapy was accomplished collaboratively by separating envelope, packaging and transfer function, the latter of which I optimized. FIV mediated gene transfer to the aqueous humor outflow tract and to the retina was established and long-term vector function and biocompatibility were confirmed. Transduction of the outflow tract was highly efficient and resulted in genetic modification of nearly the entire trabecular meshwork. For this purpose, I developed methods for administration and sensitive monitoring of FIV vectors in the anterior chamber and a novel subretinal injection technique. Bicistronic FIV vectors generated high levels of two different transgenes eGFP and β-galactosidase, which allowed live in vivo tracking and sensitive yet specific cell labeling in tissue specimen, respectively. An integrase mutant control vector that differed in only one amino acid resulted in no significant transduction while preserving all other biochemical properties. I developed a novel protocol for scaled-up production FIV vectors using cell factories and large-volume concentration that proved useful in the animal studies of this thesis. Especially the results achieved in the larger animal model, the domestic cat, validated the protocol for large-scale production. Transient transfection of 10 times lessDNA into 293T cells within high surface area cell factories and high volume, fixed-angle ultracentrifugation resulted in high titer vectors

A predictive dynamic model of a smart cogeneration plant fuelled with fast pyrolysis bio-oil

Small scale biomass-based cogeneration has the potential to contribute significantly to a clean, flexible, secure, and cost-efficient energy system. It provides flexibility to future energy systems by balancing variable intermittent renewable energy sources. To exploit its flexibility, a smart control unit is needed. To enable smart control of a cogeneration unit, and to determine its optimal working points, a dynamic system model is required. The purpose of this study is to develop, parameterize and tune a dynamic model of a cogeneration plant fuelled with fast pyrolysis bio-oil. The system is a hybrid diesel generator/flue gas boiler plant for electricity generation and water/space heating. The plant has two unique features: (i) pyrolysis bio-oil is a new fuel for both engine and boiler, and as such it influences their operation and emissions, (ii) power and heat generation are partially decoupled hence non-linearly correlated. The paper presents the integration of the components’ dynamic models into a system model. The model is parameterized and partially validated using measurements from a turbocharged four-cylinder diesel engine and a swirl burner both running on FPBO. Preliminary controls are designed and evaluated. Results show applicability and usefulness of the model for cogeneration system analysis and control design evaluation