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The aim of this study was to evaluate a case-mix system to classify inpatients with mental disorders in Germany by means of self-report and expert-rated instruments. The use of case-mix systems enhances the transparency of performance and cost structure and can thus improve the quality of mental health care. We analysed a consecutive sample of 1677 inpatients with mental disorders from 11 hospitals using regression tree analysis. The model assigns patients to 17 groups, accounting for 17% of the variance for duration of stay. Patients with eating disorders had a longer duration of stay than patients with anxiety disorder, duration of mental illness of less than 3–5 years, lower levels of interpersonal problems and higher occupational position. The results showed that besides diagnosis, variables such as duration of illness and interpersonal problems are important for classifying inpatients with mental disorders. The results of the study should be critically reviewed regarding the empirical results of other studies and the appropriateness of case group concepts for inpatients with mental disorders.
The origin of malnutrition in older age is multifactorial and risk factors may vary according to health and living situation. The present study aimed to identify setting-specific risk profiles of malnutrition in older adults and to investigate the association of the number of individual risk factors with malnutrition.
Data of four cross-sectional studies were harmonized and uniformly analysed. Malnutrition was defined as BMI < 20 kg/m2 and/or weight loss of >3 kg in the previous 3–6 months. Associations between factors of six domains (demographics, health, mental function, physical function, dietary intake-related problems, dietary behaviour), the number of individual risk factors and malnutrition were analysed using logistic regression.
Community (CD), geriatric day hospital (GDH), home care (HC), nursing home (NH).
CD older adults (n 1073), GDH patients (n 180), HC receivers (n 335) and NH residents (n 197), all ≥65 years.
Malnutrition prevalence was lower in CD (11 %) than in the other settings (16–19 %). In the CD sample, poor appetite, difficulties with eating, respiratory and gastrointestinal diseases were associated with malnutrition; in GDH patients, poor appetite and respiratory diseases; in HC receivers, younger age, poor appetite and nausea; and in NH residents, older age and mobility limitations. In all settings the likelihood of malnutrition increased with the number of potential individual risk factors.
The study indicates a varying relevance of certain risk factors of malnutrition in different settings. However, the relationship of the number of individual risk factors with malnutrition in all settings implies comprehensive approaches to identify persons at risk of malnutrition early.
Empirical data on the use of services due to mental health problems in older adults in Europe is lacking. The objective of this study is to identify factors associated with service utilization in the elderly.
As part of the MentDis_ICF65+ study, N = 3,142 people aged 65–84 living in the community in six European and associated countries were interviewed. Based on Andersen's behavioral model predisposing, enabling, and need factors were analyzed with logistic regression analyses.
Overall, 7% of elderly and 11% of those with a mental disorder had used a service due to mental health problems in the last 12 months. Factors significantly associated with underuse were male sex, lower education, living in the London catchment area, higher functional impairment and more comorbid mental disorders. The most frequently reported barrier to service use was personal beliefs, e.g. “I can deal with my problem on my own” (90%).
Underutilization of mental health services among older people in the European community is common and interventions are needed to achieve an adequate use of services.
Except for dementia and depression, little is known about common mental disorders in elderly people.
To estimate current, 12-month and lifetime prevalence rates of mental disorders in different European and associated countries using a standardised diagnostic interview adapted to measure the cognitive needs of elderly people.
The MentDis_ICF65+ study is based on an age-stratified, random sample of 3142 older men and women (65–84 years) living in selected catchment community areas of participating countries.
One in two individuals had experienced a mental disorder in their lifetime, one in three within the past year and nearly one in four currently had a mental disorder. The most prevalent disorders were anxiety disorders, followed by affective and substance-related disorders.
Compared with previous studies we found substantially higher prevalence rates for most mental disorders. These findings underscore the need for improving diagnostic assessments adapted to the cognitive capacity of elderly people. There is a need to raise awareness of psychosocial problems in elderly people and to deliver high-quality mental health services to these individuals.
Operation of single crystalline Ca3TaGa3Si2O14 (CTGS) and La3Ga5SiO14 (LGS) bulk acoustic wave resonators is demonstrated up to 1270 °C and 1470 °C, respectively. The mass sensitivity of such devices is about 35 cm2 Hz/μg at 800 °C. Therefore, they are sensitive transducers suited to monitoring, for example, mass deposition processes at high temperatures. The electromechanical loss in CTGS is found to be significantly lower than that in LGS. Platinum coated CTGS samples show a remarkable long-term stability at 1000 °C in air. After an initial period of 300 h, the conductivity is found to remain nearly constant for at least 2400 h. Measurements of resonance frequency of CTGS for 1000 h show a qualitatively similar sequence, with an initial systematic increase followed by nearly constant values. In contrast, measurements on platinum-coated LGS plates show a conductivity decreasing by 15 % over a period of 5000 h.
CTGS (Ca3TaGa3Si2O14) is a commercially available, Czochralski-grown piezoelectric material from the langasite family that has an ordered crystal structure. It can be excited piezoelectrically up to at least 1285 °C, which is very close to the melting temperature of 1350 °C. In order to determine the loss at elevated temperatures, two different resonance techniques are used. A contactless transduction method is employed up to about 600 °C, whereas transduction involving standard keyhole-shaped film electrodes is employed up to 1285 °C. Comparison of the temperature-dependent inverse Q factor shows that contactless measurements are best suited for the lower temperature range, where sample clamping and losses caused by the electrodes contribute significantly to the total loss. However, at higher temperatures, measurement of the electrical impedance of samples with film electrodes in the vicinity of the resonance frequency proves to be suitable. Even at 1100 °C, 5 MHz CTGS resonators are found to have a Q factor of about 1200, which is great enough to enable numerous bulk-acoustic-wave applications. Further, a nearly linear temperature dependence of the resonance frequency with a temperature coefficient of 210 Hz/K makes Y-cut CTGS well suited for temperature-sensing applications.
The electrical and electromechanical properties of lithium niobate single crystals are investigated at high-temperatures. The total electrical conductivity is determined as a function of temperature by impedance spectroscopy for Z-cut crystals with different lithium content. For stoichiometric lithium niobate (sLN) the activation energy is found to be (1.49 ± 0.03) eV in the temperature range from 500 to 900 °C.
Further, the piezoelectric properties (resonance frequency, Q-factor) of X-cut lithium niobate crystals are determined at high temperatures for samples with compositions ranging from congruent to stoichiometric and, subsequently, compared to the conductivity data in order to identify loss contributions.
In this context, the high-temperature stability is examined for X- and Z-cut samples with compositions ranging from congruent to stoichiometric. Series of samples with and without additional alumina protection layers are annealed in air at 900 °C for approximately 50 h. Subsequently, depth profiles are measured by SNMS. In all cases, no lithium loss is observed and, therefore, a high-temperature stability of sLN for at least 50 h at 900 °C can be assumed in ambient air.
Further, the influence of protective layers with different thicknesses and compositions is investigated for X- and Z-cut samples. A lithium loss in the first 300 nm is observed for the Z-cut samples, while the X-cut samples show a behavior dependent on the type of protecting layer.
The availability of high-temperature stable surface acoustic wave (SAW) devices would enable realization of wireless sensors for monitoring high-temperature processes. One of the most promising substrate materials for SAW based high-temperature sensors is langasite (LGS, La3Ga5SiO14). It can be excited piezoelectrically up to its melting point at 1470 °C. However, gallium evaporation and degradation of the electrodes limit the application of LGS in SAW sensors for harsh environments to some extent.
The objectives of this work include the investigation of the gallium loss in the vicinity of the langasite surface in oxidizing, reducing and vacuum conditions at temperatures up to 900 °C. The gallium content in the vicinity of the LGS surface is not decreased after annealing the samples in air, while a significant gallium loss occurs in vacuum and reducing atmospheres (0.5 % H2/Ar). The latter results in a gallium oxide deficient region of 1.5 μm below the surface after annealing for 12 hours at 900 °C. The gallium loss is virtually completely suppressed after protecting the surface with a thin alumina film.
Further, thin-film electrodes based on platinum and platinum/rhodium are tested. While conventional platinum based electrodes are completely destroyed at 900 °C within hours due to agglomeration, alumina protected electrodes can be operated at least for several days at this temperature. After 400 hours at 700 °C, the alumina protected platinum electrodes show insignificant degradation. The influence of alumina passivation layers on the stability of the SAW devices is examined. Different electrode configurations are tested with respect to their long-term frequency stability at 650 °C.
Although cognitive–behavioural therapy (CBT) and psychodynamic therapy (PDT) are both effective treatments for mental disorders, they show clear dissimilarities concerning their therapeutic models and treatment rationales.
To determine the effectiveness of systematic treatment selection (STS) to CBT or PDT in a mental healthcare setting compared with a control procedure of random treatment selection (RTS).
A randomised controlled trial in a consecutive sample of 291 in-patients with at least one ICD–10 mental disorder was performed. The primary outcome was symptom severity (General Severity Index of the Symptom Checklist–14) at 6-month follow-up. Health-related quality of life was the secondary outcome, determined using the Short Form–8.
Analyses revealed no general effect for systematic treatment selection. However, there was a differential effect: systematic selection resulted in a better longer-term outcome for PDT, but not for CBT; STS–PDT patients showed a significantly larger reduction in symptom severity than RTS–PDT patients. This difference was not observed in CBT.
Since systematic treatment selection seems to be able to optimise treatment outcome, at least for PDT, pursuing systematic treatment assignment strategies in mental healthcare settings is a worthwhile endeavour.
The formation and evolution of hydrogen- and vacancy-related donor and acceptor states were studied in helium-implanted and subsequently hydrogen plasma-treated n-type Float-Zone (FZ) silicon wafers by means of two-point-probe Spreading Resistance (SR) measurements. He+-implantation was executed at 3.75 MeV and 11 MeV at fluences of 1×1014 cm−2. Post-implantation 13.56-MHz RF-plasma hydrogenations were carried out at 150 W either for 15 min or 1 hour, applying substrate temperatures between 350 °C and 500 °C. Enhanced donor concentrations as well as acceptor-like states were observed in the subsurface layers of the treated FZ Si samples after 15-min post-implantation H-plasma exposures. Under appropriate process conditions, the latter ones compensated for the n-type doping, so that even buried p-type layers were created. The experimental results indicated that oxygen played a central role in the formation of the acceptor-like states.
By means of two-point-probe Spreading Resistance (SR) analyses, the formation and evolution of hydrogen-related and vacancy-related donor and acceptor states were studied in helium implanted and subsequently hydrogen plasma-treated n-type Float-Zone (FZ) silicon wafers. He-implantation was carried out at 3.75 MeV, applying fluences of 1×1014 cm-2 and 2×1013 cm-2. After 15-min post-implantation H-plasma exposures at substrate temperatures between 350 °C and 500 °C, distinct surplus doping profiles were observed in the subsurface layers of the treated FZ Si samples down to about 20 μm depth. Enhanced donor concentrations could be observed as well acceptor-like states, at least partially compensating for the initial n-type doping, so that even buried p-type layers can be created under appropriate process conditions. The nature of the defect complexes that were responsible for the observed doping profiles in the subsurface layer of the studied samples will be discussed.
Objective: Recent years have shown an increase in the use of
questionnaires measuring health-related quality of life to verify the
quality of treatment in the field of oncology. An often used
cancer-specific questionnaire is the “Quality of Life Core
Questionnaire of the European Organization for the Research and Treatment
of Cancer” (EORTC QLQ-C30). The purpose of this study is to analyze
the psychometric properties of the EORTC QLQ-C30 (version 1) in order to
determine the feasibility and appropriateness for its use in inpatient
cancer rehabilitation in Germany with heterogeneous diagnoses.
Methods: The questionnaire was administrated to a sample of
972 cancer patients at the beginning of treatment and to 892 patients
after treatment. Besides descriptive analysis, the statistical analyses
include confirmatory analysis and the multitrait/multimethod approach
to test the questionnaire's postulated scale structure (factorial
validity) and its reliability (internal consistencies). The analysis also
includes a comparison of responsiveness indices (effect size, reliable
change index) to test the sensitivity of the instrument.
Results: The EORTC QLQ-C30 showed satisfactory levels of
reliability and sensitivity, but the postulated scale structure could not
be confirmed. The results illustrate that the varimax-rotated solution of
a principal component analysis does not confirm the scale structure
postulated by the authors. Correspondingly, the selected fit indices
within the scope of the confirmatory factor analysis do not show
satisfactory results either.
Significance of results: We therefore consider version 1 of
the EORTC QLQ-C30 to be only limitedly useful for the routine assessment
of changes in the quality of life of cancer patients in inpatient
rehabilitation in Germany, especially because of the instrument's
length and possible redundancies. For this reason, a scoring procedure
limited to a subset of items is suggested, revealing satisfactory to good
psychometric indices. However, further psychometric tests are necessary,
especially with regard to validity and sensitivity.
Very often, the performance of modern electron microscopes is limited by the poor quality of the laboratory rather than by the specifications of the microscope. Therefore, with microscopes aiming at subangstrom resolution microscopy and highest performing holography methods, special measures have to be taken to reach the needed low level of AC-stray fields, vibrations, and acoustic noise. in an ”organically“ grown institute, this is very difficult to realize, if possible at all.
• The Triebenberg Lab is newly built well outside the city of Dresden, in an area essentially free from disturbances, i.e. free from power lines, away from roads, trains and airplanes; fortunately, the site is shielded from wind by means of a dense belt of trees. The lab houses six microscope units each consisting of a microscope room, a room for peripheral devices (power supply, cooling units, computers, etc), and an office for up to three scientists. in view of the nearly ideal environment, the main challenge is to avoid any self-made disturbances which might arise by the operation of the lab. Therefore, without any compromise using the best art of engineering, we designed a special lab virtually free from disturbances. in the following, the main guidelines for the construction are sketched.
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