Die stufengerechte Hirnschlagversorgung – von der Akutphase bis zur Rehabilitation

In den letzten zwei Jahrzehnten hat vor allem die Behandlung von Patienten mit ischämischem Hirnschlag eine radikale Veränderung erlebt. Durch die Einführung kausaler Akuttherapien und der seit Kurzem ebenso evidenzbasierten endovaskulären katheterbasierten Rekanalisationsverfahren sowie der spezialisierten interdisziplinären Versorgung im Rahmen des Stroke-Unit-Konzeptes ist die Prognose für den Patienten heute um ein Vielfaches günstiger als zuvor. Auch im Bereich der Rehabilitation konnten aufgrund neuer Therapieverfahren wie der repetitiven transkraniellen Magnetstimulation (rTMS) und computerunterstützter Methoden wesentliche Fortschritte in der Verbesserung der Schlaganfallfolgen erzielt werden. Dieser Artikel gibt einen Überblick über die zeitgemässe und stufengerechte Hirnschlagversorgung.

Wirksamkeit der umfassenden kardiologischen Rehabilitation und Sekundärprävention: klinische und epidemiologische Evidenz

Zusammenfassung Die umfassende kardiologische Rehabilitation ist die Summe von koordinierten Maßnahmen, welche die Folgen von Herzerkrankungen vermindern, die Morbidität und Mortalität reduzieren und die gesundheitsbezogene Lebensqualität einschließlich der psychosozialen Situation der Patienten verbessern sollen. Dazu ist die Bereitstellung strukturierter sekundärpräventiver Strategien besonders wichtig. Schwerpunkte dieser Maßnahmen sind die Trainingstherapie und Aktivitätsberatung sowie Ernährungstherapie und -beratung, Raucherentwöhnung, psychosoziale Intervention und Pharmakotherapie (Ades 2001).

Evaluation of the relationship between nutrition and functional independence measures among stroke patients undergoing inpatient rehabilitation

Cerebrovascular accidents (CVA) or strokes are now the third leading cause of death in the United States. Many who suffer strokes are admitted to rehabilitation centers in order to receive therapy to help rebuild and recovery function. Nutrition plays a significant role in rehabilitation patient outcomes, and is an essential part of comprehensive care. The purpose of this study is to determine if nutrition and diet consistency are directly and independently associated with changes in the Functional Independence Measure (FIM) scores in stroke patients in an acute rehabilitation unit. This study was a retrospective secondary analysis review of medical chart records, and included a total of 84 patients. Patients were divided into groups based on their admission diet: Regular, Dysphagia Advanced, Dysphagia Mechanically Altered, Dysphagia Pureed, and Nutrition Support. Measurements included admission and discharge Total, Motor, and Cognitive FIM scores; BMI, albumin and prealbumin; age, sex, and race. Patients did show a significant improvement in their FIM scores during their stay, with patients on Regular diets having the highest FIM scores. Patients who were more debilitated and had lower FIM scores were usually in one of the altered texture diet groups, or on nutrition support. Prealbumin and BMI were also the highest in patients who had high FIM scores. Patients who were admitted on an altered diet also tended to advance in their diets, which show improvement in overall function. It is crucial to continue to improve nutrition administration to this population to help prevent morbidity and mortality. Proper nutrition in the acute phase of stroke can lay the essential groundwork for recovery.^

L -Sox5 and Sox6: Architectural transcription factors in chondrogenesis

Transcription factors often determine cell fate and tissue development. Chondrogenesis is the developmental process by which cartilages form. Recently, gene targeting studies have shown that two transcription factors, L-Sox5 and Sox6, play essential and redundant roles in chondrogenesis in vivo by converting precartilaginous cell condensations into cartilages. Both are highly similar High-Mobility-Group (HMG)-domain proteins that bind and subsequently bend DNA containing the 7bp HMG site (A/T)(A/T)CAA(A/T)G. They have no transactivation domain, but homo- and hetero-dimerize and preferentially bind DNA containing two HMG sites. They are thought to play an architectural role in transactivation by facilitating long-range DNA and protein interactions. To understand their molecular mechanism of action, we investigated how phasing, orientation, and spacing between HMG sites affect L-Sox5 and Sox6 DNA-binding. We determined that L-Sox5 and Sox6 dimers bind with high affinity to paired HMG sites in DNA rather than a single HMG site. Binding of paired sites is independent of DNA helical phasing, orientation of paired HMG sites and independent of distance up to 255 base pairs between sites. Mutational analysis demonstrated that binding of L-Sox5 and Sox6, independent of orientation of the sites, is critically dependent on the presence of paired HMG sites rather than one HMG site alone. Our data support a unique and novel model whereby L-Sox5 and Sox6 dimerize and bind DNA with pronounced spatial flexibility, possibly by a flexible hinge, and act as architectural transcription factors that bring distant DNA sites and proteins together to form higher order transcriptional complexes that are essential for the activation of their target genes in chondrogenesis. ^

Mejora del comportamiento térmico de los morteros de cal aditivados y su empleo en la rehabilitación de inmuebles = Improvement of thermal behaviour of additived lime mortars and their use in rehabilitation of buildings

La envolvente de la edificación es la responsable de equilibrar el intercambio energético entre el interior y el exterior, por lo tanto cualquier actuación encaminada a la reducción del consumo energético ha de establecer, como uno de sus objetivos prioritarios, la mejora del comportamiento de la misma. Las edificaciones anteriores a 1940 constituyen la mayor parte de las existentes en áreas rurales y centros urbanos. En ellas, la repercusión de la fachada sobre las transmitancias globales pone de manifiesto la necesidad de intervención. Sin embargo, su elevada inercia térmica y los importantes saltos térmicos característicos de gran parte de España plantean la importancia de que aquélla se efectúe por el exterior. A tal respecto, la falta de disponibilidad de espesor suficiente para implantar sistemas tipo SATE deriva en que, frecuentemente, la única solución viable sea la de aislar por el interior perdiendo con ello la capacidad de acumulación térmica del muro y con el asociado riesgo de condensaciones. La amplia tradición en el empleo de revestimientos, especialmente en base de cal, permiten que éstos sean utilizados no sólo como elemento estético o de protección de la obra de fábrica antigua sino también para la mejora del comportamiento térmico del soporte, si se aprovecha el mecanismo de transmisión térmica por radiación. Éste es el objetivo de la presente Tesis Doctoral en la que se estudia la modificación de las propiedades radiantes de los morteros de revestimiento para la mejora de la eficiencia energética de las construcciones históricas, principalmente las constituidas por muros monolíticos, aunque podría ser de aplicación a otro tipo de construcciones compuestas por diversas capas. Como punto de partida, se estudió y revisó la documentación disponible sobre las investigaciones de las tres áreas científico-tecnológicas que convergen en la Tesis Doctoral: rehabilitación, material y comportamiento térmico, a partir de lo cual se comprobó la inexistencia de estudios similares al objeto de la presente Tesis Doctoral. Complementariamente, se analizaron los revestimientos en lo concerniente a los materiales que los constituyen, la composición de las mezclas y características de cada una de las capas así como al enfoque que, desde el punto de vista térmico, se estimaba más adecuado para la obtención de los objetivos propuestos. Basándonos en dichos análisis, se preseleccionaron ochenta materiales que fueron ensayados en términos de reflectancia y emisividad para elegir cuatro con los que se continuó la investigación. Éstos, junto con la cal elegida para la investigación y el árido marmóreo característico de la última capa de revestimiento, fueron caracterizados térmicamente, de forma pormenorizada, así como química y físicamente. Los fundamentos teóricos y los estudios preliminares desarrollados con distintos materiales, en estado fresco y endurecido, fueron empleados en la dosificación de componentes de las mezclas, en dos proporciones distintas, para el estudio del efecto del agregado. Éstas se ensayaron en estado fresco, para comprobar su adecuación de puesta en obra y prever su VI adherencia al soporte, así como en estado endurecido a 28 y 90 días de curado, para conocer las propiedades que permitieran prever su compatibilidad con aquél y estimar el alcance de la reducción de transferencias térmicas lograda. Además, se estudiaron las características generales de las mezclas que sirvieron para establecer correlaciones entre distintas propiedades y entender los resultados mecánicos, físicos (comportamiento frente al agua) y energéticos. Del estudio conjunto de las distintas propiedades analizadas se propusieron dos mezclas, una blanca y otra coloreada, cuyas características permiten garantizar la compatibilidad con la obra de fábrica antigua, desde el punto de vista físico y mecánico, y preservar la autenticidad de los revestimientos, en cuanto a la técnica de aplicación tradicional en sistemas multicapa. El comportamiento térmico de las mismas, sobre una obra de fábrica de 40 cm de espesor, se estimó, en estado estacionario y pseudo-transitorio, demostrándose reducciones del flujo térmico entre 16-48%, en condiciones de verano, y entre el 6-11%, en invierno, en función de la coloración y de la rugosidad de la superficie, en comparación con el empleo de la mezcla tradicional. Por lo que, se constata la viabilidad de los materiales compuestos propuestos y su adecuación al objetivo de la investigación. VII ABSTRACT The envelope is responsible for balancing the energy exchange between the inside and outside in buildings. For this reason, any action aimed at reducing energy consumption must establish, as one of its key priorities, its improvement. In rural areas and urban centers, most of the constructions were built before 1940. In them, the impact of the façade on the global transmittance highlights the need for intervention. However, its high thermal inertia and fluctuation of temperatures in the majority of Spain bring up that it should be placed outside the insulation. In this regard, the lack of availability of enough thickness to implement systems such as ETICS results in that often the only viable solution is to isolate the interior, losing thereby the wall’s heat storage capacity with the associated risk of condensation. The tradition in the use of renders, especially lime-based, allows us to use them not only as an aesthetic element or to protect the ancient masonry, but also for improved thermal performance of the support by taking advantage of the heat transfer mechanism by radiation. This is the aim of this Doctoral Thesis in which the modification of the radiative properties of lime mortars for renders to improve the energy efficiency of historic buildings, mainly composed of monolithic walls, is studied, although it could be applied to other structures composed of several layers. As a starting point, the available literature in the three scientific-technological areas that converge at the Doctoral Thesis: rehabilitation, material and thermal behaviour, was reviewed, and confirmed the absence of researches similar to this Doctoral Thesis. Additionally, the renders were studied with regard to the materials that constitute them, the composition of the mixtures and the characteristics of each layer, as well as to the approach which, from a thermal point of view, was deemed the most suitable for achieving the objectives sets. Based on thre aforementioned analysis, eighty materials tested in terms of reflectance and emissivity were pre-selected, to choose four with which the research was continued. Common marble sand, used in the last layer of the renders, together with the appointed materials and hydrated lime were characterized thermally, in detail, as well as chemically and physically. The theoretical bases and preliminary studies with different materials, in fresh and hardened state, were used in the dosage of the composition of the mixtures. In order to study their effect they were used in two different proportions, that is, ten mixtures in total. These were tested in their fresh state to evaluate their setting-up suitability and foresee their adhesion to the support, as well as in their hardened state, at 28 and 90 days of curing, to establish the properties which enabled us to anticipate their compatibility with the old masonry walls and estimate the scope of the reduction of heat transfers achieved. In addition, the general characteristics of the mixtures used to establish correlations and to understand the mechanical, physical and energy results were studied. Two mixtures, one white and one colored, were proposed as the result of the different properties analysed, whose characteristics allow the guarantee of mechanical and physical compatibility VIII with the old masonry and preserve the authenticity of the renders. The thermal behavior of both, applied on a masonry wall 40 cm thick, was estimated at a steady and pseudo-transient state, with heat flow reductions between 16-48% during summertime and 6-11% during wintertime, depending on the color and surface roughness, compared to the use of the traditional mixture. So, the viability of the proposed composite materials and their fitness to the aim of the research are established.

Directives for a Correct Diagnosis

A special Working Group, to study and develop standars related to Building Restoration, Rehabilitation and Maintenance, was formed in January 2001 in AENOR (Spanish Association for Codes and Standars) under the management of the Department of Building Construction of the School of Architecture of Madrid (DCTA-UPM). Three groups were organized to deal with different topics: Diagnosis, Techiques and Materials, and Maintenance. In this paper the differents topics in which the Diagnosis Subgroup is working are described: historical studies, constructive description of the building and building pathology. These will be basic to carry out a correct diagnosis of any type of building, whether it is historic or not. In the development of such topics, the recognizable architectural values are justified as they are prior to the diagnosis stage. As an example of the subgroup work, several pathology cards are shown which include: longitudinal cracks of mechanical origin in beams of concrete structures, façade closings and claddings, and general symptoms of installation services.

Application of Deadlock Risk Evaluation of Architectural Models

Software architectural evaluation is a key discipline used to identify, at early stages of a real-time system (RTS) development, the problems that may arise during its operation. Typical mechanisms supporting concurrency, such as semaphores, mutexes or monitors, usually lead to concurrency problems in execution time that are difficult to be identified, reproduced and solved. For this reason, it is crucial to understand the root causes of these problems and to provide support to identify and mitigate them at early stages of the system lifecycle. This paper aims to present the results of a research work oriented to the development of the tool called ‘Deadlock Risk Evaluation of Architectural Models’ (DREAM) to assess deadlock risk in architectural models of an RTS. A particular architectural style, Pipelines of Processes in Object-Oriented Architectures–UML (PPOOA) was used to represent platform-independent models of an RTS architecture supported by the PPOOA –Visio tool. We validated the technique presented here by using several case studies related to RTS development and comparing our results with those from other deadlock detection approaches, supported by different tools. Here we present two of these case studies, one related to avionics and the other to planetary exploration robotics. Copyright © 2011 John Wiley & Sons, Ltd.

Architectural design and construction costs, tools towards territorial sustainability

This paper is presented in CIB: Management and Innovation Sustainable Built Environment 2011, as the study and analysis of the residential model of a rural area from the Iberian Peninsula, specifically applied to the case of the province of Cáceres, in the autonomous region of Extremadura, in Spain. To this end, from a database made up of building projects whose real costs are known, it is intended to establish the links of the different parameters studied through the corresponding functions of statistical analysis. One of the main objectives of this process is constituted by the possibility of establishing those design variables of higher economic importance, so as to keep an economic control of these parameters, generally geometrical and typological, from the very start of the project. And, in general, a higher optimization of resources in the construction of dwellings in the rural environment from their design is intended.

2D-Tasks for Cognitive Rehabilitation

Neuropsychological Rehabilitation is a complex clinic process which tries to restore or compensate cognitive and behavioral disorders in people suffering from a central nervous system injury. Information and Communication Technologies (ICTs) in Biomedical Engineering play an essential role in this field, allowing improvement and expansion of present rehabilitation programs. This paper presents a set of cognitive rehabilitation 2D-Tasks for patients with Acquired Brain Injury (ABI). These tasks allow a high degree of personalization and individualization in therapies, based on the opportunities offered by new technologies.

PREVIRNEC A new platform for cognitive tele-rehabilitation

Acquired Brain Injury (ABI), either caused by vascular or traumatic nature, is one of the most important causes for neurological disabilities. People who suffer ABI see how their quality of life decreases, due to the affection of one or some of the cognitive functions (memory, attention, language or executive functions). The traditional cognitive rehabilitation protocols are too expensive, so every help carried out in this area is justified. PREVIRNEC is a new platform for cognitive tele-rehabilitation that allows the neuropsychologist to schedule rehabilitation sessions consisted of specifically designed tasks, plus offering an additional way of communication between neuropsychologists and patients. Besides, the platform offers a knowledge management module that allows the optimization of the cognitive rehabilitation to this kind of patients.

Innovative self management system for guided cardiac rehabilitation

This paper describes the design and development of a system for cardio rehabilitation of patients that suffered a myocardial infarction. The proposed solution focuses on exercise prescriptions and the encouragement of healthy behaviors. The innovative strategy of the design takes into account health promotion models to provide safe, assistive exercise training sessions, personalized feedbacks, and educational contents.

ROAD: Domestic Assistant and Rehabilitation Robot

This study introduces the concept design and analysis of a robotic system for the assistance and rehabilitation of disabled people. Based on the statistical data of the most common types of disabilities in Spain and other industrialized countries, the different tasks that the device must be able to perform have been determined. In this study, different robots for rehabilitation and assistance previously introduced have been reviewed. This survey is focused on those robots that assist with gait, balance and standing up. The structure of the ROAD robot presents various advantages over these robots, we discuss some of them. The performance of the proposed architecture is analyzed when it performs the sit to stand activity.