Alternative Wohn- und Betreuungsanforderungen bei den Babyboomern

Laut Umfragen wandelt sich der Wunsch nach Wohnen im Alter. Heutige Ältere Menschen setzen noch nicht vermehrt auf Hilfe- und Pflegemöglichkeiten innerhalb ihrer Wohnung. Dabei ist die Tendenz bei einem Teil der Babyboomer zu erkennen, welche dies zunehmend ab einem Alter von 70 Jahren wünschen. Ziel war es herauszuarbeiten, wer zu den Babyboomern zählt, wie stark sie in der Bevölkerung insgesamt, in Sachsen-Anhalt und dem Saalekreis vertreten sind und welche Einflussfaktoren es auf ihre Wohnwünsche gibt. Außerdem erfolgte eine begriffliche Klärung von Hilfe- und Pflegebedarf und dazu ebenfalls Zahlen zu Pflegebedürftigen in der BRD, dem Land Sachsen-Anhalt und dem Saalekreis. Eine Auseinandersetzung mit den derzeitigen Wohnmöglichkeiten mit Hilfe und Pflege sollte eine kurze Übersicht zu den Angeboten aus heutiger Sicht bieten. Zukünftig auftretende Versorgungsdefizite zeigten auf, dass die jetzigen Wohn- und Versorgungsformen, der Zahl der Babyboomer und ihren Ansprüchen schwer gerecht werden können. Quartierskonzepte hingegen bieten die Chance, den Bedürfnissen der Babyboomer Rechnung zu tragen und die sich entwickelnden Versorgungsdefizite zu minimieren. Zwar gibt es auch Hürden zu einer intakten Quartiersstruktur, aber bereits umgesetzte Projekte an verschiedenen Standorten beweisen, dass diese überwunden werden können

Aiding diagnosis and risk stratification for carotid atherosclerosis using mobility and strain patterns of the arterial wall

Σε αυτή την εργασία προσεγγίστηκε μια σπουδαία κλινική πρόκληση, η υποστήριξη της διάγνωσης της καρωτιδικής αθηρωμάτωσης, που ευθύνεται για την πλειονότητα των εγκεφαλικών επεισοδίων. Σε αυτή τη κατεύθυνση εξετάστηκε η δυνατότητα διάκρισης μεταξύ ασταθών και μη, αθηρωματικών πλακών στη καρωτίδα αρτηρία, μέσω της ανάλυσης ακολουθιών εικόνων υπερήχου. Έχοντας στη διάθεση μας έναν εκτιμητή κίνησης, που είχε ήδη υλοποιηθεί, βελτιστοποιηθεί και αξιολογηθεί για την εκτίμηση της κίνησης του αρτηριακού τοιχώματος, εφαρμόστηκε σε ακολουθίες εικόνων υπερήχου Β-σάρωσης για ένα σύνολο 96 ασθενών που πάσχουν από καρωτιδική αθηρωμάτωση. Τα αποτελέσματα από την εκτίμηση κίνησης για τον κάθε ασθενή χρησιμοποιήθηκαν για την παραγωγή 146 κατηγοριών κυματομορφών κίνησης, που αναπαριστούν μοτίβα κινήσεων και παραμορφώσεων σε σχέση με : (α) κινήσεις της αθηρωματικής πλάκας και των υγιών μερών του αρτηριακού τοιχώματος πλησίον της πλάκας, όπως και (β) τοπικές παραμορφώσεις και σχετικές κινήσεις του αρτηριακού τοιχώματος, αντίστοιχα. Αυτές οι κυματομορφές κίνησης τροφοδότησαν τα Κρυφά Μαρκοβιανά Μοντέλα (HMMs), που έχουν χρησιμοποιηθεί με μεγάλη επιτυχία στην αναγνώριση φωνής αλλά και σε πολλές άλλες εφαρμογές μηχανικής μάθησης. Στην περίπτωσή μας, τα HMMs χρησιμοποιήθηκαν για να αναγνωρίσουν περιπτώσεις κυματομορφών συμπτωματικών και ασυμπτωματικών ασθενών, με την αναλογία του ότι ο εκάστοτε ασθενής συνεισφέρει με τη δική του καρωτιδική αρτηριακή "προφορά" στο μοντέλο. Η απόδοση (ακρίβεια κατηγοριοποίησης) στα HMMs κυμάνθηκε μεταξύ 57.05% και 81.44% για τις 146 κατηγορίες κυματομορφών, με μέση απόδοση 69.95%. Τα αποτελέσματα αυτά επαληθεύτηκαν με την χρήση Μηχανών Διανυσμάτων Υποστήριξης (SVMs) στο ίδιο σύνολο δεδομένων, που κατηγοριοποιήθηκαν με μέση απόδοση 59%. Στην περίπτωση που επιλέχθηκαν, μονάχα, αυτές οι κατηγορίες κυματομορφών που παρουσίασαν τα υψηλότερα ποσοστά απόδοσης, τα HMMs μπόρεσαν να διακρίνουν ασυμπτωματικούς και συμπτωματικούς ασθενείς με απόδοση 75.81% και 73.91% αντίστοιχα, ενώ τα SVMs έφεραν αποτελέσματα 78.66% και 69.84% αντίστοιχα. Με δεδομένη την υπεροχή των SVMs, επιλέχθηκαν από αυτό το μοντέλο, οι συγκεκριμένες κατηγορίες κυματομορφών και δημιουργήθηκε ένα σύστημα πλειοψηφίας, για την υποστήριξη της διάγνωσης της ασθένειας. Η πλήρης δυναμική του συστήματος μένει να αποδειχθεί στο πλαίσιο μελλοντικών μελετών, σε μεγάλο πλήθος ασθενών με καρωτιδική αθηρωμάτωση οι οποίοι θα υποβληθούν σε συχνούς επανελέγχους, ενώ το σύστημα μπορεί να εμπλουτιστεί με πρόσθετα χαρακτηριστικά με χρονική εξέλιξη, όπως η αρτηριακή πίεση και ο καρδιακός ρυθμός.This thesis addressed a major clinical challenge, namely valid risk stratification for carotid atherosclerosis, which constitutes the most common cause of stroke. Toward this direction, we investigated the potential of spatiotemporal ultrasound image analysis in discriminating between stable and vulnerable atherosclerotic plaques of the carotid artery. To this end, a motion estimator, which has previously been designed, optimized and evaluated for arterial wall motion estimation, was applied to B-mode ultrasound image sequences of 96 patients with carotid atherosclerosis. The results of motion estimation for each patient were used to produce 146 types of motion waveforms, which represented mobility and strain patterns that express: (a) the movements of the atherosclerotic lesion (plaque) and the healthy parts of the arterial wall adjacent to the plaque, and (b) local deformations and relative movements in the arterial wall, respectively. These sets of motion waveforms were fed to Hidden Markov Models (HMMs), which have been successfully used in voice recognition and several other tasks of machine learning. In this case, HMMs were used to recognize motion waveforms of symptomatic and asymptomatic cases, intuitively considering that, for each patient, a motion waveform represents the "accent" of the carotid-artery wall. The performance (classification accuracy) of HMMs ranged between 57.05% and 81.44% for the 146 types of motion waveforms, while the average performance was 69.95%. These results were cross-validated using Support Vector Machines (SVMs) on the same dataset, which reached, an average of 59% classification accuracy. In the case that only the motion waveforms with the highest discrimination power were used, the HMMs could identify asymptomatic and symptomatic patients with 75.81% and 73.91% accuracy, respectively; the corresponding results for SVMs were 78.66% and 69.84%, respectively. Given the high performance in the latter case, those motion waveforms and their incorporation in SVMs were used to create a majority voting system for risk stratification for the disease. The full potential of the system will be revealed on future prospective studies with frequent patient follow-ups, while the system could be further enriched with other temporal features, such as the arterial pressure and heart rate.Μαρίνος Δ. Πρεβένιο

Mycoplasma bovis and bovine respiratory disease: a risk factor study in Australian feeder cattle

Mycoplasma bovis can be a bacterial inhabitant of the upper respiratory tract of healthy bovines. In body regions other that the upper respiratory tract however, M. bovis is associated with a number of clinical syndromes such as bovine respiratory disease (BRD). This study used two enzyme-linked immunosorbent assays to assess the sero-status of M. bovis-specific antibodies in Australian feeder cattle at the time of feedlot induction and at approximately 42 days on feed (follow-up). The apparent sero-prevalence of M. bovis-specific antibody at induction was estimated to be 3.5% (95% confidence interval [CI] 2.0-5.0%, 47/1354) and 25.3% (95% CI 21.9-28.8%, 343/1354) at follow-up. Exposure to M. bovis between induction and follow-up as demonstrated by an increase in serum antibodies was estimated to be 19.4% (95% CI 16.2-22.6%, 261/1349). Risk factors associated with sero-positivity at feedlot induction included the region where animals were 28 days prior to induction and saleyard exposure at least 27 days prior to induction. Risk factors associated with a sero-increase between induction and follow-up included breed, source region and access to water shared with an adjoining pen of animals. Of these, shared pen water was considered the most important (odds ratio [OR] 3.3, 95% CI 1.5-7.4, p = 0.003). Animals exposed to M. bovis between induction and follow-up were at a substantially increased risk of BRD (OR 2.2, 95% CI 1.4-3.4, p = 0.001). This is the first Australian study that has identified risk factors for M. bovis sero-positivity and sero-increase and shown an association between sero-increase and the risk of BRD in the feeder cattle population. These findings suggest that M. bovis is a significant pathogen in the Australian feeder cattle population. In addition, identification of defined risk factors associated with an increased risk of exposure to M. bovis can assist in the development of targeted control measures to reduce the economic impact of M. bovis associated disease and BRD in feeder cattle

Comparison of Pro-Regenerative Effects of Carbohydrates and Protein Administrated by Shake and Non-Macro-Nutrient Matched Food Items on the Skeletal Muscle after Acute Endurance Exercise

Physical performance and regeneration after exercise is enhanced by the ingestion of proteins and carbohydrates. These nutrients are generally consumed by athletes via whey protein and glucose-based shakes. In this study, effects of protein and carbohydrate on skeletal muscle regeneration, given either by shake or by a meal, were compared. 35 subjects performed a 10 km run. After exercise, they ingested nothing (control), a protein/glucose shake (shake) or a combination of white bread and sour milk cheese (food) in a randomized cross over design. Serum glucose (n = 35), serum insulin (n = 35), serum creatine kinase (n = 15) and myoglobin (n = 15), hematologic parameters, cortisol (n = 35), inflammation markers (n = 27) and leg strength (n = 15) as a functional marker were measured. Insulin secretion was significantly stimulated by shake and food. In contrast, only shake resulted in an increase of blood glucose. Food resulted in a decrease of pro, and stimulation of anti-inflammatory serum markers. The exercise induced skeletal muscle damage, indicated by serum creatine kinase and myoglobin, and exercise induced loss of leg strength was decreased by shake and food. Our data indicate that uptake of protein and carbohydrate by shake or food reduces exercise induced skeletal muscle damage and has pro-regenerative effects.</jats:p

Associations between prior management of cattle and risk of bovine respiratory disease in feedlot cattle

Bovine respiratory disease (BRD) is the major cause of clinical disease and death in feedlot populations worldwide. A longitudinal study was conducted to assess associations between risk factors related to on-farm management prior to transport to the feedlot and risk of BRD in a population of feedlot beef cattle sourced from throughout the cattle producing regions of Australia. Exposure variables were derived from questionnaire data provided by farmers supplying cattle (N = 10,721) that were a subset of the population included in a nationwide prospective study investigating numerous putative risk factors for BRD. Causal diagrams were used to inform model building to allow estimation of effects of interest. Multilevel mixed effects logistic regression models were fitted within the Bayesian framework. Animals that were yard weaned were at reduced risk (OR: 0.7, 95% credible interval: 0.5-1.0) of BRD at the feedlot compared to animals immediately returned to pasture after weaning. Animals that had previously been fed grain (OR: 0.6, 95% credible interval: 0.3-1.1) were probably at reduced risk of BRD at the feedlot compared to animals not previously fed grain. Animals that received prior vaccinations against Bovine viral diarrhoea virus 1 (OR: 0.8, 95% credible interval: 0.5-1.1) or Mannheimia haemolytica (OR: 0.8, 95% credible interval: 0.6-1.0) were also probably at reduced risk compared to non-vaccinated animals. The results of this study confirm that on-farm management before feedlot entry can alter risk of BRD after beef cattle enter feedlots