How could the service delivery process of dynamic arm supports be optimized?

BACKGROUND: The service delivery process of dynamic arm support (DAS) is complex. Obtaining an optimal match between user and DAS depends on a variety of interrelated factors, different professionals are involved, and the market of available solutions is evolving. OBJECTIVE: To determine how the service delivery process of DAS could be optimized. METHODS: Interviews with DAS users that retrospectively focused on the experienced service delivery process, which was compared to the general Dutch prescription guideline. Results were presented in a focus group session to seven DAS consultants, and subsequently verified by a member-check. RESULTS: Sixteen people who considered the Gowing (a DAS new on the market) as a solution and seven DAS consultants participated. Aspects that can be optimized in the current service delivery process included an improved cooperation between clients, professionals and consultants, increased knowledge of DAS in professionals, an embedded user evaluation, and timely delivery. CONCLUSIONS: It is recommended that the service delivery process is optimized by developing a DAS specific prescription framework. The issues identified in this study should be addressed in this framework. For this additional knowledge on how to optimally match persons and DAS is needed

Legal physician-assisted dying in Oregon and the Netherlands: evidence concerning the impact on patients in "vulnerable" groups

Journal ArticleIf physician-assisted suicide (PAS) and/or voluntary active euthanasia were legalised, would this disproportionately affect people in ‘‘vulnerable'' groups? Although principles of patient autonomy and the right to avoid suffering and pain may offer support for these practices, concerns about their impact on vulnerable populations speak against them. Warnings about potential abuse have been voiced by many task forces, courts and medical organisations in several countries where the issue is under debate. Box 1 presents some of these concerns

The tribological behaviour of skin equivalent materials and ex-vivo human skin during sliding contact with artificial turf

The use of synthetic materials for outdoor and indoor sport fields has increased over the last decades. Artificial turfs, commonly used on football fields, are basically infilled with recycled crumb rubber derived from old tires, the main of which are NBR (acrylonitrile butadiene rubber) and SBR (styrene-butadiene rubber) with fibers usually made of Polyethylene (PE) or Nylon. The use of these polymers for artificial turf designing purposes has caused controversy to whether their impact in human health, especially in skin abrasions during players sliding on the artificial turf. We have studied the tribological performance of different artificial human skin and real human skin against NBR, PE and Nylon 6.6 at different environmental conditions: normal conditions (25 ˚C and 50% of relative humidity) and high humidity conditions (37 ˚C and 80% of relative humidity) and forces of 2 and 4 N to achieve the association between friction and skin damage. The applied forces correspond to a range of pressures of 121 to 175 kPa and the experiments were conducted at 50 mm/s. The friction coefficient was obtained for different artificial skin samples: Lorica, Silicone L7350, pure PDMS, Cutinova and ESE (an epidermal skin equivalent developed by us), and these results were compared to those obtained from excised human skin samples obtained from healthy people after a surgery carried out at the Radboud Hospital of Nijmegen. Later on the human skin samples were analyzed with confocal microscopy and histological images to study the case of the surface properties of skin and determine any possible damage on the Stratum Corneum related to the tribological tests

Electromagnetic vertex function of the pion at T > 0

The matrix element of the electromagnetic current between pion states is calculated in quenched lattice QCD at a temperature of $T = 0.93 T_c$. The nonperturbatively improved Sheikholeslami-Wohlert action is used together with the corresponding ${\cal O}(a)$ improved vector current. The electromagnetic vertex function is extracted for pion masses down to $360 {\rm MeV}$ and momentum transfers $Q^2 \le 2.7 {\rm GeV}^2$.Comment: 17 pages, 8 figure

Dynamic shipments of inventories in shared warehouse and transportation networks

In shared warehouse and transportation networks, dynamic shipments of inventories are carried out based on up-to-date inventory information. This paper studies the effect of network structures on optimal decision-making. We propose a discrete time modeling framework with stochastic demand, capturing a wide variety of network structures. Using Markov decision processes, we obtain optimal order and dynamic shipment decisions for small networks. We compare optimal solutions of different four-node network structures. Results indicate product characteristics significantly influence the effectiveness of network structures. Surprisingly, two-echelon networks are occasionally costlier than any other network. Moreover, dynamic shipments yield considerable gains over static shipments

Is it possible to assess the effects of dynamic arm supports on upper extremity range of motion during activities of daily living in the domestic setting using a portable motion capturing device? - A pilot study

BACKGROUND: Understanding how dynamic arm supports affect the ability to perform activities of daily living (ADL) in daily life situations is essential for improved prescription. OBJECTIVE: To determine whether the newly developed MMAAS is a useful tool to assess the RoM at home. Secondly, to investigate differences in RoM and ADL performance with and without dynamic arm support. METHODS: Five dynamic arm support users performed nine activities with and without dynamic arm support at home. A reference group of five participants was included. Shoulder and elbow RoM were assessed for the three most difficult tasks. RESULTS: The measurement of the elbow joint RoM appeared unreliable. In most participants shoulder RoM increased with dynamic arm support, but the magnitude of change differed. Variation was also found regarding whether people could perform ADL with and without support. CONCLUSIONS: In its current state the MMAAS is not regarded a useful tool for assessing the RoM in the domestic setting. The ability to perform ADL and RoM seem influenced by the environment, users' needs and abilities. Future studies investigating effects and benefits of dynamic arm supports should be conducted in a broader daily life context

Positive Feedbacks in Seagrass Ecosystems – Evidence from Large-Scale Empirical Data

Positive feedbacks cause a nonlinear response of ecosystems to environmental change and may even cause bistability. Even though the importance of feedback mechanisms has been demonstrated for many types of ecosystems, their identification and quantification is still difficult. Here, we investigated whether positive feedbacks between seagrasses and light conditions are likely in seagrass ecosystems dominated by the temperate seagrass Zostera marina. We applied a combination of multiple linear regression and structural equation modeling (SEM) on a dataset containing 83 sites scattered across Western Europe. Results confirmed that a positive feedback between sediment conditions, light conditions and seagrass density is likely to exist in seagrass ecosystems. This feedback indicated that seagrasses are able to trap and stabilize suspended sediments, which in turn improves water clarity and seagrass growth conditions. Furthermore, our analyses demonstrated that effects of eutrophication on light conditions, as indicated by surface water total nitrogen, were on average at least as important as sediment conditions. This suggests that in general, eutrophication might be the most important factor controlling seagrasses in sheltered estuaries, while the seagrass-sediment-light feedback is a dominant mechanism in more exposed areas. Our study demonstrates the potentials of SEM to identify and quantify positive feedbacks mechanisms for ecosystems and other complex systems

Effect of chemical disorder on NiMnSb investigated by Appearance Potential Spectroscopy: a theoretical study

The half-Heusler alloy NiMnSb is one of the local-moment ferromagnets with unique properties for future applications. Band structure calculations predict exclusively majority bands at the Fermi level, thus indicating {100%} spin polarization there. As one thinks about applications and the design of functional materials, the influence of chemical disorder in these materials must be considered. The magnetization, spin polarization, and electronic structure are expected to be sensitive to structural and stoichiometric changes. In this contribution, we report on an investigation of the spin-dependent electronic structure of NiMnSb. We studied the influence of chemical disorder on the unoccupied electronic density of states by use of the ab-initio Coherent Potential Approximation method. The theoretical analysis is discussed along with corresponding spin-resolved Appearance Potential Spectroscopy measurements. Our theoretical approach describes the spectra as the fully-relativistic self-convolution of the matrix-element weighted, orbitally resolved density of states.Comment: JPD submitte