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  • 1
    In: Health Services Management Research, SAGE Publications, Vol. 36, No. 1 ( 2023-02), p. 63-74
    Abstract: The LMU University Hospital is among the largest healthcare facilities in Germany. The measures implemented prior to and during the first pandemic wave of COVID-19, were evaluated in preparation of a second pandemic wave. This paper presents the pandemic management concept, evaluation and adaptation of LMU University Hospital. Methods Between July and September 2020 the disaster management team of LMU University Hospital conducted a mixed-method evaluation of the hospital’s pandemic management. A workshop series based on the After Action Review working group format was organized to examine the management structure, decision-making processes, documentation, and crisis preparedness response for a second COVID-19 wave. Further, the satisfaction of employees with the hospital’s COVID-19 management was examined through an anonymous survey. Results The workshop series highlighted a need for structural and operational adaptation of the COVID-19 management at LMU University Hospital. The results of the employee survey ( N = 2182) provided positive feedback for the measures taken during the first pandemic wave. Specific actions were derived concerning the availability of personal protective equipment and emergency childcare services. A key outcome of both evaluation activities was the identified need for further improvement in communication between stakeholders. All changes were adopted prior to the second pandemic wave.
    Type of Medium: Online Resource
    ISSN: 0951-4848 , 1758-1044
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2035604-3
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  • 2
    In: Concurrent Engineering, SAGE Publications, Vol. 26, No. 1 ( 2018-03), p. 77-92
    Abstract: Despite popular belief, space missions are not always one-of-a-kind, but are frequently benefiting from explicit or implicit reuse of different types. The Venus Express mission is one example of cost savings by reusing existing hardware in a new mission context. Other examples are based on the platform approach, popular, for example, in geostationary telecommunication satellites, which benefits from a pre-planned reuse and its application to a family of missions with commonality. While the latter is handled more strategically, promising more gain in its execution, the Venus Express example is more of an ad hoc nature. Given the increasing importance of design reuse, the practical question to be answered in this article is how to promote it using effective engineering methods and processes. Model-based systems engineering often advertises itself as especially beneficial to reuse projects and we provide a systematic review of the respective capabilities in this article. Furthermore, we describe two reuse application examples: an asteroid nanolander based on the Mobile Asteroid Surface Scout lander currently flying onboard Hayabusa2 and a Small Satellite Platform for Earth science missions. With Mobile Asteroid Surface Scout’s heritage generating strong interest for future small body missions, this creates a case for what we call ad hoc reuse. Conversely, the Small Satellite Technology Platform, which is currently in its definition phase, can be classified as systematic reuse case with the aim of developing a commonality-based small satellite family, suitable for a set of rapidly recurring missions in low Earth orbit. Our study of the Mobile Asteroid Surface Scout-2 reuse case has provided insights into reuse requirements, which are mapped to typical model-based systems engineering features that create value beyond those offered by classical approaches. The article identifies key areas where model-based systems engineering provides benefits in reuse cases: requirements reuse, system context analysis as well as interface compatibility checking. It further outlines an overall approach regarding tools and development processes.
    Type of Medium: Online Resource
    ISSN: 1063-293X , 1531-2003
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2101005-5
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  • 3
    Online Resource
    Online Resource
    SAGE Publications ; 2016
    In:  Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine Vol. 230, No. 4 ( 2016-04), p. 326-334
    In: Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, SAGE Publications, Vol. 230, No. 4 ( 2016-04), p. 326-334
    Abstract: An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The computational model is based on the multi-body simulation software AnyBody. Multi body dynamic musculoskeletal models capable of predicting muscle forces and joint contact pressures simultaneously would be valuable for studying clinical issues related to wrist joint degeneration and restoration. In this study, the simulation model of the wrist joint was used for investigating deeper the biomechanical function of the wrist joint. In representative physiological scenarios, the joint behavior and muscle forces were computed. Furthermore, the load transmission of the proximal wrist joint was investigated. The model was able to calculate the parameters of interest that are not easily obtainable experimentally, such as muscle forces and proximal wrist joint forces. In the case of muscle force investigation, the computational model was able to accurately predict the computational outcome for flexion and extension motion. In the case of force distribution of the proximal wrist joint, the model was able to predict accurately the computational outcome for an axial load of 140 N. The presented model and approach of using a multi-body simulation model are anticipated to have value as a predictive clinical tool including effect of injuries or anatomical variations and initial outcome of surgical procedures for patient-specific planning and custom implant design. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation.
    Type of Medium: Online Resource
    ISSN: 0954-4119 , 2041-3033
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2032763-8
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  • 4
    In: The American Journal of Sports Medicine, SAGE Publications, Vol. 38, No. 3 ( 2010-03), p. 564-569
    Abstract: Tears of the rotator cuff are highly prevalent in patients older than 60 years, thereby presenting a population also suffering from osteopenia or osteoporosis. Suture fixation in the bone depends on the holding strength of the anchoring technique, whether a bone tunnel or suture anchor is selected. Because of osteopenic or osteoporotic bone changes, suture anchors in the older patient might pull out, resulting in failure of repair. Hypothesis The aim of our study was to analyze the bone quality within the tuberosities of the osteoporotic humeral head using high-resolution quantitative computed tomography (HR-pQCT). Study Design Descriptive laboratory study. Methods Thirty-six human cadaveric shoulders were analyzed using HR-pQCT. The mean bone volume to total volume (BV/TV) as well as trabecular bone mineral densities (trabBMDs) of the greater tuberosity (GT) and the lesser tuberosity (LT) were determined. Within the GT, 6 volumes of interest (VOIs) within the LT, and 2 VOIs and 1 control volume within the subchondral area beyond the articular surface were set. Results Comparing BV/TV of the medial and the lateral row, significantly higher values were found medially (P 〈 .001). The highest BV/TV, 0.030% ± 0.027%, was found in the posteromedial portion of the GT (P 〈 .05). Regarding the analysis of the LT, no difference was found comparing the superior (BV/TV: 0.024% ± 0.022%) and the inferior (BV/TV: 0.019% ± 0.016%) portion. Analyzing trabBMD, equal proportions were found. An inverse correlation with a correlation coefficient of —0.68 was found regarding BV/TV of the posterior portion of the GT and age (P 〈 .05). Conclusion Significant regional differences of trabecular microarchitecture were found in our HR-pQCT study. The volume of highest bone quality resulted for the posteromedial aspect of the GT. Moreover, a significant correlation of bone quality within the GT and age was found, while the bone quality within the LT seems to be independent from it. Clinical Relevance The shape of the rotator cuff tear largely determines the bony site of tendon reattachment, although the surgeon has distinct options to modify anchor positioning. According to our results, placement of suture anchors in a medialized way at the border to the articular surface might guarantee a better structural bone stock.
    Type of Medium: Online Resource
    ISSN: 0363-5465 , 1552-3365
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2010
    detail.hit.zdb_id: 2063945-4
    SSG: 31
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  • 5
    In: Molecular Imaging, SAGE Publications, Vol. 13, No. 2 ( 2014-03), p. 7290.2013.00074-
    Type of Medium: Online Resource
    ISSN: 1536-0121 , 1536-0121
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
    detail.hit.zdb_id: 2069848-3
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  • 6
    In: European Journal of Ophthalmology, SAGE Publications, Vol. 25, No. 3 ( 2015-05), p. 185-191
    Abstract: To evaluate the effectiveness of repeat trabeculectomy with risk factor–adjusted mitomycin C (MMC) application in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) over 2 years. Methods A total of 58 patients (43 with POAG, 15 with PEXG) who had undergone repeat trabeculectomy with MMC were included in this retrospective study. Exposure time of MMC 0.3 mg/mL was adjusted according to a standardized protocol. Main outcome measures were best-corrected visual acuity (BCVA), intraocular pressure (IOP) reduction, surgical success rate (criteria were defined as A: IOP ≤21 mm Hg and a reduction of IOP ≥20%; B: IOP ≤18 mm Hg and a reduction of IOP of ≥30%; C: IOP ≤15 mm Hg and a reduction of IOP of ≥40% from baseline), and number of medications at baseline, 3 months, and 2 years postoperatively. Results The BCVA remained stable for 2 years after surgery (0.47 ± 0.47 at baseline, 0.49 ± 0.64 logMAR units after 2 years, respectively). Mean IOP decreased from 22.2 ± 7.0 mm Hg at baseline to 12.7 ± 3.1 mm Hg at 3 months and 12.9 ± 4.3 mm Hg 2 years after surgery. The qualified success rate for criterion A was 75.4%, for criterion B 66.6%, and for criterion C45.6%. Complete success rates were 42.9%, 37.5%, and 32.1%, respectively. Two years after repeat trabeculectomy, the mean IOP was reduced by 38.8%, and the number of medications was reduced significantly. Conclusions Repeat trabeculectomy with MMC is successful at lowering IOP in POAG and PEXG and permits a significant and safe reduction of antiglaucomatous medication for at least 2 years after surgery.
    Type of Medium: Online Resource
    ISSN: 1120-6721 , 1724-6016
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 1475018-1
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  • 7
    In: Therapeutic Advances in Medical Oncology, SAGE Publications, Vol. 11 ( 2019-01), p. 175883591984640-
    Abstract: Efficacy of second-line systemic chemotherapy in recurrent gastric cancer with peritoneal metastasis (RGCPM) is limited. We assessed the feasibility, safety and possible efficacy of pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with RGCPM after ⩾1 line of palliative intravenous chemotherapy. Methods: In this open-label, single-arm, monocentric phase II ICH-GCP clinical trial, patients were scheduled for three courses of PIPAC with cisplatin 7.5 mg/m 2 and doxorubicin 1.5 mg/m 2 (PIPAC C/D) every 6 weeks. Patients with bowel obstruction or extraperitoneal metastasis were ineligible. The primary endpoint was clinical benefit rate (CBR) by Response Evaluation Criteria in Solid Tumors based on clinical records. Secondary endpoints included overall survival (OS), median time to progression (TTP), peritoneal carcinomatosis index (PCI), histological regression and ascites volume. Safety and tolerability were assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 4, quality of life (QoL) by EORTC-QLQ30 questionnaire. Results: A total of 25 patients were enrolled and available for the analysis of the primary endpoint. Of those 25 patients, 10 (40%) had a radiological complete, partial response or stable disease. Median OS [intention to treat (ITT)] was 6.7 months, median TTP was 2.7 months. Complete or major regression on histology were observed in 9/25 patients (36%, ITT) or 6/6 [100%, per protocol (PP)] patients. There were no suspected unexpected serious adverse reactions, no treatment-related deaths, no CTCAE grade 4 toxicity and three (12%) grade 3 toxicities. Changes in the QLQ-C30 scores during PIPAC C/D therapy were small and not significant. Conclusions: PIPAC C/D was well tolerated and active in patients with RGCPM. Survival was encouraging. Randomized controlled trials should now be designed in this indication.
    Type of Medium: Online Resource
    ISSN: 1758-8359 , 1758-8359
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
    detail.hit.zdb_id: 2503443-1
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  • 8
    Online Resource
    Online Resource
    SAGE Publications ; 2016
    In:  Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine Vol. 230, No. 4 ( 2016-04), p. 310-325
    In: Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, SAGE Publications, Vol. 230, No. 4 ( 2016-04), p. 310-325
    Abstract: An enhanced musculoskeletal biomechanical model of the wrist joint is presented in this article. The developed computational model features the two forearm bones radius and ulna, the eight wrist bones, the five metacarpal bones, and a soft tissue apparatus. Validation of the model was based on information taken from the literature as well as own experimental passive in vitro motion analysis of eight cadaver specimens. The computational model is based on the multi-body simulation software AnyBody. A comprehensive ligamentous apparatus was implemented allowing the investigation of ligament function. The model can easily patient specific personalized on the basis of image information. The model enables simulation of individual wrist motion and predicts trends correctly in the case of changing kinematics. Therefore, patient-specific multi-body simulation models are potentially valuable tools for surgeons in pre- and intraoperative planning of implant placement and orientation.
    Type of Medium: Online Resource
    ISSN: 0954-4119 , 2041-3033
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 2032763-8
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  • 9
    Online Resource
    Online Resource
    SAGE Publications ; 2018
    In:  Concurrent Engineering Vol. 26, No. 1 ( 2018-03), p. 55-76
    In: Concurrent Engineering, SAGE Publications, Vol. 26, No. 1 ( 2018-03), p. 55-76
    Abstract: Today, phase A studies of future space systems are often conducted in special design facilities such as the Concurrent Engineering Facility at the German Aerospace Center (DLR). Within these facilities, the studies are performed following a defined process making use of a data model for information exchange. Quite often it remains unclear what exactly such a data model is and how it is implemented and applied. Nowadays, such a data model is usually a software using a formal specification describing its capabilities within a so-called meta-model. This meta-model, often referred as conceptual data model, is finally used and instantiated as system model during these concurrent engineering studies. Such software also provides a user interface for instantiating and sharing the system model within the design team and it provides capabilities to analyze the system model on the fly. This is possible due to the semantics of the underlying conceptual data model creating a common language used to exchange and process design information. This article explains the implementation of the data model at DLR and shows information how it is applied in the concurrent engineering process of the Concurrent Engineering Facility. It highlights important aspects concerning the modeling capabilities during a study and discusses how they can be implemented into a corresponding conceptual data model. Accordingly, the article presents important aspects such as rights management and data consistency and the implications of them to the software’s underlying technology. A special use case of the data model is depicted and shows the flexibility of the implementation proven by a study of a multi-module space station.
    Type of Medium: Online Resource
    ISSN: 1063-293X , 1531-2003
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
    detail.hit.zdb_id: 2101005-5
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  • 10
    In: European Stroke Journal, SAGE Publications
    Abstract: Covert brain infarction (CBI) is highly prevalent and linked with stroke risk factors, increased mortality, and morbidity. Evidence to guide management is sparse. We sought to gain information on current practice and attitudes toward CBI and to compare differences in management according to CBI phenotype. Methods: We conducted a web-based, structured, international survey from November 2021 to February 2022 among neurologists and neuroradiologists. The survey captured respondents’ baseline characteristics, general approach toward CBI and included two case scenarios designed to evaluate management decisions taken upon incidental detection of an embolic-phenotype and a small-vessel-disease phenotype. Results: Of 627 respondents (38% vascular neurologists, 24% general neurologists, and 26% neuroradiologists), 362 (58%) had a partial, and 305 (49%) a complete response. Most respondents were university hospital senior faculty members experienced in stroke, mostly from Europe and Asia. Only 66 (18%) of respondents had established institutional written protocols to manage CBI. The majority indicated that they were uncertain regarding useful investigations and further management of CBI patients (median 67 on a slider 0–100, 95% CI 35–81). Almost all respondents (97%) indicated that they would assess vascular risk factors. Although most would investigate and treat similarly to ischemic stroke for both phenotypes, including initiating antithrombotic treatment, there was considerable diagnostic and therapeutic heterogeneity. Less than half of respondents (42%) would assess cognitive function or depression. Conclusions: There is a high degree of uncertainty and heterogeneity regarding management of two common types of CBI, even among experienced stroke physicians. Respondents were more proactive regarding the diagnostic and therapeutic management than the minimum recommended by current expert opinions. More data are required to guide management of CBI; meantime, more consistent approaches to identification and consistent application of current knowledge, that also consider cognition and mood, would be promising first steps to improve consistency of care.
    Type of Medium: Online Resource
    ISSN: 2396-9873 , 2396-9881
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
    detail.hit.zdb_id: 2851287-X
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