Analysen zur intraindividuellen Variabilität der residuellen Thrombozytenaggregation unter dualer antithrombozytärer Therapie mit Clopidogrel und Acetylsalicylsäure und ihrer Einflussfaktoren

Die kombinierte antithrombozytäre Therapie mit Clopidogrel und Acetylsalicylsäure ist die Standardtherapie nach elektiver Koronarintervention mit Stentimplantation zur Vermeidung von Stentthrombosen. Jedoch ist bekannt, dass ein beträchtlicher Anteil der Patienten nicht adäquat auf diese Behandlung anspricht und eine große interindividuelle Variabilität des Thrombozytenaggregationsniveaus unter dualer Plättchenhemmung vorliegt. Wenig ist bislang über die intraindividuelle Variabilität der Aggregationswerte bekannt. Ziel dieser Dissertation waren die Untersuchung der intraindividuellen Variabilität der Aggregationswerte und ihrer Einflussfaktoren sowie der Vergleich mit den Einflussfaktoren auf das initiale Aggregationsniveau. Anhand von 255 Patienten, bei denen mindestens zwei Aggregationsmessungen im zeitlichen Abstand von im Durchschnitt 80 Tagen unter kontinuierlicher Clopidogrel-Therapie durchgeführt wurden, konnte gezeigt werden, dass eine signifikante positive Korrelation zwischen erstem und zweitem Messwert besteht. Des Weiteren wurde dargestellt, dass bei einem Großteil der Patienten, die in der ersten Messung eine hohe Aggregation im Sinne einer Clopidogrel-Resistenz aufwiesen, auch in der zweiten Messung deutlich erhöhte Aggregationswerte vorlagen. Zwischen erster und zweiter Messung zeigte sich eine Tendenz zu einem leicht rückläufigen Aggregationsniveau, wobei das Vorliegen eines Diabetes mellitus auf diese Tendenz eine signifikante Auswirkung hatte. In der Subgruppe der Patienten mit akutem Koronarsyndrom konnte zudem eine Korrelation der intraindividuellen Messwertdifferenz mit dem zeitlichen Abstand der Messungen gefunden wurden. In einem zweiten Schritt wurde in einem Kollektiv von 1376 Patienten untersucht, welche Faktoren für den zuerst gemessenen Aggregationswert, der mindestens 8 Stunden nach Clopidogrel-Aufsättigung erhoben wurde, von Bedeutung sind. Zunächst konnte gezeigt werden, dass die Zeitspanne zwischen Clopidogrel-Aufsättigung und Messung keinen Einfluss auf die ermittelte Aggregationsstärke hatte. Der Aggregationswert war unter dem Einfluss folgender Faktoren signifikant erhöht: Übergewicht, weibliches Geschlecht, Alter über 65 Jahre, Diabetes mellitus, Linksherzinsuffizienz sowie Vorliegen eines akuten Koronarsyndroms zum Zeitpunkt der ersten Messung. Die intraindividuelle Konstanz der Messwerte einerseits und der Nachweis äußerer Einflussfaktoren andererseits bestätigen die bisherige Annahme, dass sowohl konstante Einflussfaktoren wie genetischer Polymorphismus und Geschlecht als auch vorübergehende und therapierbare Einflussfaktoren wie akutes Koronarsyndrom und Linksherzinsuffizienz das Aggregationsniveau beeinflussen können

Contactless Gait Assessment in Home-like Environments

Gait analysis is an important part of assessments for a variety of health conditions, specifically neurodegenerative diseases. Currently, most methods for gait assessment are based on manual scoring of certain tasks or restrictive technologies. We present an unobtrusive sensor system based on light detection and ranging sensor technology for use in home-like environments. In our evaluation, we compared six different gait parameters, based on recordings from 25 different people performing eight different walks each, resulting in 200 unique measurements. We compared the proposed sensor system against two state-of-the art technologies, a pressure mat and a set of inertial measurement unit sensors. In addition to test usability and long-term measurement, multi-hour recordings were conducted. Our evaluation showed very high correlation (r>0.95) with the gold standards across all assessed gait parameters except for cycle time (r=0.91). Similarly, the coefficient of determination was high (R2>0.9) for all gait parameters except cycle time. The highest correlation was achieved for stride length and velocity (r≥0.98,R2≥0.95). Furthermore, the multi-hour recordings did not show the systematic drift of measurements over time. Overall, the unobtrusive gait measurement system allows for contactless, highly accurate long- and short-term assessments of gait in home-like environments

Effects of immersive virtual reality on sensory overload in a random sample of critically ill patients.

BACKGROUND Sensory overload and sensory deprivation have both been associated with negative health outcomes in critically ill patients. While there is a lack of any clear treatment or prevention strategies, immersive virtual reality is a promising tool for addressing such problems, but which has not been repetitively tested in random samples. Therefore, this study aimed to determine how critically ill patients react to repeated sessions of immersive virtual reality. METHODS This exploratory study was conducted in the mixed medical-surgical intermediate care unit of the University Hospital of Bern (Inselspital). Participants (N = 45; 20 women, 25 men; age = 57.73 ± 15.92 years) received two immersive virtual reality sessions via a head-mounted display and noise-canceling headphones within 24 h during their stay in the unit. Each session lasted 30-min and showed a 360-degree nature landscape. Physiological data were collected as part of the participants' standard care, while environmental awareness, cybersickness, and general acceptance were assessed using a questionnaire designed by our team (1 = not at all, 10 = extremely). RESULTS During both virtual reality sessions, there was a significant negative linear relationship found between the heart rate and stimulation duration [first session: r(43) = -0.78, p < 0.001; second session: r(38) = -0.81, p < 0.001] and between the blood pressure and stimulation duration [first session: r(39) = -0.78, p < 0.001; second session: r(30) = -0.78, p < 0.001]. The participants had a high comfort score [median (interquartile range {IQR}) = 8 (7, 10); mean = 8.06 ± 2.31], did not report being unwell [median (IQR) = 1 (1, 1); mean = 1.11 ± 0.62], and were not aware of their real-world surroundings [median (IQR) = 1 (1, 5); mean = 2.99 ± 3.22]. CONCLUSION The subjectively reported decrease in environmental awareness as well as the decrease in the heart rate and blood pressure over time highlights the ability of immersive virtual reality to help critically ill patients overcome sensory overload and sensory deprivation. Immersive virtual reality can successfully and repetitively be provided to a randomly selected sample of critically ill patients over a prolonged duration

An Instrumented Apartment to Monitor Human Behavior: A Pilot Case Study in the NeuroTec Loft

For patients suffering from neurodegenerative disorders, the behavior and activities of daily living are an indicator of a change in health status, and home-monitoring over a prolonged period of time by unobtrusive sensors is a promising technology to foster independent living and maintain quality of life. The aim of this pilot case study was the development of a multi-sensor system in an apartment to unobtrusively monitor patients at home during the day and night. The developed system is based on unobtrusive sensors using basic technologies and gold-standard medical devices measuring physiological (e.g., mobile electrocardiogram), movement (e.g., motion tracking system), and environmental parameters (e.g., temperature). The system was evaluated during one session by a healthy 32-year-old male, and results showed that the sensor system measured accurately during the participant’s stay. Furthermore, the participant did not report any negative experiences. Overall, the multi-sensor system has great potential to bridge the gap between laboratories and older adults’ homes and thus for a deep and novel understanding of human behavioral and neurological disorders. Finally, this new understanding could be utilized to develop new algorithms and sensor systems to address problems and increase the quality of life of our aging society and patients with neurological disorders

Ökonomie der alternativen Milchvermarktung: Ökonomische Berechnungen zu beispielhaften Lösungen in der alternativen Milchvermarktung

Der vorliegende Bericht schafft die erforderliche Datengrundlage für ökonomische Bewertungen der alternativen Milcherzeugung, -verarbeitung und -vermarktung. Er unterteilt sich in einen ökonomischen und einen analytischen Teil. Im ersten Teil wird die Herstellung von Heumilch, Weidemilch und Bio-Milch als alternative Produktionsweisen ökonomisch bewertet, die Produktionskosten von Trinkmilch, Joghurt und Hartkäse ermittelt sowie die Direktvermarktung und Vermarktung über den regionalen LEH ökonomisch betrachtet. Als Datengrundlage diente hierzu die Erhebung der Produktionskosten auf sächsischen Milchbetrieben. Redaktionsschluss: 30.11.202

A systems approach towards remote health-monitoring in older adults: Introducing a zero-interaction digital exhaust.

Using connected sensing devices to remotely monitor health is a promising way to help transition healthcare from a rather reactive to a more precision medicine oriented proactive approach, which could be particularly relevant in the face of rapid population ageing and the challenges it poses to healthcare systems. Sensor derived digital measures of health, such as digital biomarkers or digital clinical outcome assessments, may be used to monitor health status or the risk of adverse events like falls. Current research around such digital measures has largely focused on exploring the use of few individual measures obtained through mobile devices. However, especially for long-term applications in older adults, this choice of technology may not be ideal and could further add to the digital divide. Moreover, large-scale systems biology approaches, like genomics, have already proven beneficial in precision medicine, making it plausible that the same could also hold for remote-health monitoring. In this context, we introduce and describe a zero-interaction digital exhaust: a set of 1268 digital measures that cover large parts of a person's activity, behavior and physiology. Making this approach more inclusive of older adults, we base this set entirely on contactless, zero-interaction sensing technologies. Applying the resulting digital exhaust to real-world data, we then demonstrate the possibility to create multiple ageing relevant digital clinical outcome assessments. Paired with modern machine learning, we find these assessments to be surprisingly powerful and often on-par with mobile approaches. Lastly, we highlight the possibility to discover novel digital biomarkers based on this large-scale approach

Efficacy of a novel online integrated treatment for problem gambling and tobacco smoking: Results of a randomized controlled trial

Background and aimsProblem gambling and tobacco use are highly comorbid among adults. However, there are few treatment frameworks that target both gambling and tobacco use simultaneously (i.e., an integrated approach), while also being accessible and evidence-based. The aim of this two-arm open label RCT was to examine the efficacy of an integrated online treatment for problem gambling and tobacco use.MethodsA sample of 209 participants (M$_{age}$ = 37.66, SD = 13.81; 62.2% female) from North America were randomized into one of two treatment conditions (integrated [n = 91] or gambling only [n = 118]) that lasted for eight weeks and consisted of seven online modules. Participants completed assessments at baseline, after treatment completion, and at 24-week follow-up.ResultsWhile a priori planned generalized linear mixed models showed no condition differences on primary (gambling days, money spent, time spent) and secondary outcomes, both conditions did appear to significantly reduce problem gambling and smoking behaviours over time. Post hoc analyses showed that reductions in smoking and gambling craving were correlated with reductions in days spent gambling, as well as with gambling disorder symptoms. Relatively high (versus low) nicotine replacement therapy use was associated with greater reductions in gambling behaviours in the integrated treatment condition.Discussion and conclusionsWhile our open label RCT does not support a clear benefit of integrated treatment, findings suggest that changes in smoking and gambling were correlated over time, regardless of treatment condition, suggesting that more research on mechanisms of smoking outcomes in the context of gambling treatment may be relevant

The Drinker’s Effect on the Social Environment: A Conceptual Framework for Studying Alcohol’s Harm to Others

The paper considers conceptual and methodological issues in studying the scope of alcohol’s harm to others. Reasons are suggested for the relative neglect of the topic. The approaches in two relevant research traditions are considered: population surveys on alcohol problems, and economic cost of alcohol studies. Ways of conceptualizing and measuring aspects of the drinker’s effects on others are considered, in terms of main types of relationship with the other, and in terms of major societal response institutions. The main types of data tend to measure different levels of severity, with population survey data dominated by less severe problems, and response institution data by more severe problems; so both are needed for a three-dimensional view. Research questions for the field and its policy significance are noted

Benefits and barriers among volunteer teaching faculty: comparison between those who precept and those who do not in the core pediatrics clerkship

Background: Community-based outpatient experiences are a core component of the clinical years in medical school. Central to the success of this experience is the recruitment and retention of volunteer faculty from the community. Prior studies have identified reasons why some preceptors volunteer their time however, there is a paucity of data comparing those who volunteer from those who do not. Methods: A survey was developed following a review of previous studies addressing perceptions of community-based preceptors. A non-parametric, Mann&#x2013;Whitney U test was used to compare active preceptors (APs) and inactive preceptors (IPs) and all data were analyzed in SPSS 20.0. Results: There was a 28% response rate. Preceptors showed similar demographic characteristics, valued intrinsic over extrinsic benefits, and appreciated Continuing Medical Education (CME)/Maintenance of Certification (MOC) opportunities as the highest extrinsic reward. APs were more likely to also precept at the M1/M2 level and value recognition and faculty development opportunities (p&#x3C;0.05). IPs denoted time as the most significant barrier and, in comparison to APs, rated financial compensation as more important (p&#x3C;0.05). Conclusions: Community preceptors are motivated by intrinsic benefits of teaching. Efforts to recruit should initially focus on promoting awareness of teaching opportunities and offering CME/MOC opportunities. Increasing the pool of preceptors may require financial compensation