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Multilingual chance encounters between unacquainted people in public space
Get PDFIt is a common occurrence for people to spontaneously strike up a conversation with unknown others in public places. In such first-contact situations, one fundamental issue hovering over the early moments of interaction concerns language choice. Especially in multilingual environments, a generic practical problem for previously unacquainted people is having to find out what the available and adequate language options are for the encounter, and establishing here and now what shared linguistic resources they can rely on so that each party can communicate competently, for all practical purposes. Such impromptu public interactions, which have thus far largely evaded systematic interactional analysis, present a perspicuous site for investigating the practices through which language choice is locally negotiated and invite examination of how individuals mobilize their multiple linguistic and embodied resources as they engage in interaction. It is these moments of language contact, their characteristics and interactional organization, that are the focus of this dissertation.
Drawing on ethnomethodology and conversation analysis (EMCA), and making use of video recordings collected across a range of multilingual public places in French-, German-, and Italian-speaking Switzerland, the dissertation examines how multilingual chance encounters between previously unacquainted people are organized in naturally-occurring interaction. Chance encounters between people with differing linguistic competencies and preferences for language use are a quotidian part of public social life, and a closer look into their emergence provides an opportunity to highlight that, far from being pre-determined, language choice is a contingent, in-situ interactional achievement. The dissertation describes in detail some of the local practices through which coincidentally co-present persons who have never met before spontaneously move into interaction in a variety of public settings, display to each other their preferences for language use and (lack of) linguistic competencies, recipient-design language choice, and request and offer help in the face of emerging language-related difficulties. The analyses report on how previously unknown individuals – during the nascent moments of their chance encounter – emergently discover the linguistic options they have for efficiently engaging in interaction, and interactionally negotiate a mode of language use that they deem adequate for whatever it is they are doing. These options can range from the choice of one shared language-of-interaction to the exclusion of others (Chapters 4 and 5); to multilingual modes of interaction in which speakers alternate languages during sequences of language negotiation (Chapter 5); to third-party mediated interactions involving ad hoc language brokers (Chapter 6); to conversations in which participants practice receptive multilingualism by each speaking a different language (Chapter 7).
Taken together, the dissertation has distinctive empirical and conceptual contributions to make to research both within and outside of EMCA. It contributes to a praxeological approach to language choice and multilingualism-in-interaction, and explores the intersections between research into multilingual practices, an EMCA approach to the sequential, embodied, and categorial organization of openings, and a Goffman-inspired take on interaction between “strangers” in public places
Four terminal devices for anisotropic thermal transport experiments
Get PDFThe investigation of heat flow in nanostructures and low-dimensional system is one of the major challenge in microtechnology. However, the deviation of miniaturization trend of transistors fromtheMoore’s law indicates the increasing importance of an effective thermal management of microdevices. Therefore, the examination of the heat properties of different nano-size materials is paving the way for more efficient microchips. To guide these efforts, it is of uttermost importance to characterize the intrinsic properties of the materials with a consistent and reliable method with a high signal-to-noise ratio. To meet these requirements, a novel four-terminal device is proposed which involves fabricating suspended four transducers, which can act as thermometer as well as heater, combined with the suspension of a two-dimensional material. In this work, we present the fabrication and characterization of a device designed to measure the in-plane thermal properties of nanomaterials in multiple directions. Additionally, the device allows to perform electrical and optical measurements simultaneously. This allows to spatially resolve eventual thermal property anisotropies and the correction of measurements by accounting for the contact resistances
Logarithmic equidistribution and other problems involving torsion points of the algebraic torus
Get PDFOne main result of this thesis is the proof of a conjecture of Ih for a certain class of polynomials. Let be a finite set of primes. The conjecture states that, if is a Lautrent polynomial over a number field in variables, then the set of torsion points of the -dimensional algebraic torus , such that is an -unit is not dense in , unless the zero set of is a finite union of torsion cosets.
As main tools we use equidistribution theorems in the archimedean setting and for all places above primes in . In the first case we use a recent result of Dimitrov and Habegger and with the same method we prove the analog statements in the -adic case. Since the Theorem of Tate and Voloch is crucial here, we tried to understand how the size of the constant depends on the height of the coefficients if all of them are algebraic.
We also had a look at other problems of logarithmic equidistribution. A very specific one is considered for -extensions of elliptic curves which admit a maximal compact subgroup . The function we look at is the logarithm of the absolute value of a coordinate of the embedding of into found by Masser using results of Serre. We show that the average over the Galois orbit of a torsion point of the evaluation of tends to the integral over with respect to the Haar measure as the order of the torsion point tends to infinity.
Further we consider the function on the complex plane, where is an algebraic number on the unit circle which is not a root of unity. Instead of considering roots of unity, we work with strict sequences of algebraic numbers whose height tends to zero. The question is, whether the conclusion of Bilu's equidistribution theorem is true in this case. We can show that the answer is no using results about simultaneous approximation. The question has a natural -adic analogue, which is proved in a similar way.
In another chapter we describe all sums of at most four roots of unity which add to an algebraic unit. The main trick is due to Dimitrov and uses Kronecker's theorem to translate the condition of being a unit to a necessary condition given by an equation.
Finally, we count torsion points in algebraic subvarieties of the algebraic torus. We estimate the growth rate of the number of torsion points of order bounded by as tends to infinity. There is a general bound which is sharp. If the algebraic subvariety does not contain a torsion coset of maximal dimension we get a power saving improvement of the general bound. The main tools are the theorems of Minkowski
Antibody mediated autoimmunity: characterizing the pathomechanism of autoantibodies derived from myasthenia gravis patients and healthy donors
Get PDFBackground and rationale: Myasthenia gravis (MG) represents a prototypic autoimmune disease in which hypermutated, autoreactive B cells produce antibodies against proteins located at the post-synaptic membrane of the neuromuscular junction. Despite decades of prolific research that determined the acetylcholine receptor (AChR) as most prevalent autoantibody target and described several processes that mediate the clinical symptoms, little is known about the fundamental pathomechanisms of AChR-specific autoantibodies and the B cells producing them. We established a method to isolate B cells from the peripheral blood of patients and healthy donors that recognize a specific membrane-antigen, which provided the exceptional opportunity to characterize AChR-specific, monoclonal antibodies and B cells.
Results: We produced six monoclonal MG patient-derived IgG antibodies that bound specifically to the human AChR, of which none exhibited pathogenic properties when tested in vitro and in vivo. However, combinations of autoantibodies with distinct AChR-subunit specificities generated an increased complement activation even if the individual antibodies were incapable of activating complement. Similarly, an antibody combination with synergistic subunit-specificities proved pathogenic when tested in live rats. With a subsequent animal study, which included the pathogenic antibody combination and additionally a C5 complement inhibitor we demonstrated the causal relationship between increased complement activation and myasthenic symptoms. To explain the observation of enhanced activation by antibody combinations we constructed three different hypotheses: the density model, the antigen array model, and the hexamer model. All three competing hypotheses postulated distinct structural patterns for the antigen-antibody interaction. The opposing predictions for complement activation depending on specified antibody characteristics allowed us to experimentally test the three models. We used anti-AChR IgG antibodies with different properties and even included somatically hypermutated, AChR-specific IgM isolated from MG patients and healthy donors. At present, the results of the antibodies tested individually and in combination suggest that the antigen array hypothesis is the most accurate. Further evaluation of the AChR-targeting IgM antibodies revealed that neither the relative binding strength nor the number of hypermutations had a positive impact on complement activation and a class switch to IgG caused a loss of binding capacity.
Conclusion: The antibody repertoire is a determining factor for the pathology in MG, as single, seemingly non-pathogenic antibodies can induce disease symptoms if included in a combination with synergistic AChR-subunit specificities. Even antibodies incapable of complement activation due to an inept IgG subclass can participate in complement-driven pathogenicity by cross-linking receptors and stabilizing an advantageous antigen arrangement. A hexameric arrangement according to the prevalent model might not be necessary nor sufficient to activate the complement cascade, as indicated by IgM antibodies with strong specific binding to the AChR but without the ability to activate the complement system. These hypermutated IgM B cells that lose their binding when switched to IgG do not constitute a pathogenic precursor of the autoimmune disease. Finally, the population of somatically hypermutated, AChR-specific IgM B cells encountered in MG patients and healthy donors alike, probably reflect a regulatory B cell phenotype
Andreev bound states in semiconducting double nanowires
Get PDFParafermions, which can be intuitively seen as fractional Majoranas, offer the advantage of a wider universal set of operations for topological quantum computing when braided. We set out with the ambitious goal of realising a parafermion-hosting double nanowire device. Working towards this goal led us to develop fabrication techniques and yielded measurements that allowed the investigation of multiple phenomena of a double wire semiconductor-superconductor hybrids.
In this thesis, we thus laid the focus on improving the fabrication process in order to reliably individually contacted the wires, as well as understanding the individual phenomena involved in generating the conditions required for the observation of the Majorana modes. We first present a summary presentation of the key theoretical concepts used in this thesis, followed by a chapter where the experimental techniques required for the fabrication and measurement of our devices are introduced. Then we present the core of this work, consisting of the results of three series of experiments. In the first, we design a double wire N-S junction, enabling straightforward access to the properties of our device which allows us to demonstrate the excellent quality of the wire to superconductor interface. In the second experimental chapter, we focus on the Josephson effect, analysing a double nanowire Josephson junction and characterising its RNIC product. In the last chapter we design and report on a quasiparticle trap, which dramatically enhances the critical current of a Josephson junction. We tentatively attribute this effect to the superconducting shell of the wire transitioning to a mixed state, trapping quasiparticles in normal regions close to the Josephson junction
Bacterial reasons for treatment failure in Mycobacterium abscessus
No full textMycobacterium abscessus (MAB), a gram-positive, non-tuberculous mycobacterium is an emerging pathogen comprising three subspecies; M. a. abscessus, M. a. massiliense, and M. a. bolletii. MAB is predominantly associated with pulmonary infections and leads to accelerated lung damage, imposing a significant burden, particularly on patients with conditions like Cystic Fibrosis and other pre-existing lung conditions. The incidence of MAB infection is on the rise worldwide, often requiring extended periods of multidrug therapy spanning several months to years. Nonetheless, treatment of this pathogen leads to unfavourable clinical outcomes; with treatment failures frequently exceeding 50%.
MAB is intrinsically resistant to most antibiotics including all first line drugs for tuberculosis. Moreover, MAB frequently acquires new resistance, particularly against macrolides and aminoglycosides. However, there exists limited knowledge about the evolutionary trajectory driving mutations and de novo resistance in this pathogen. Classical drug resistance, measured by the minimum inhibitory concentration (MIC), is a poor predictor of treatment outcome in chronic respiratory infections. Therefore, other reasons for treatment failure including host determinants, pharmacokinetics as well as other bacterial mechanisms may contribute to the success of treatment.
This thesis focusses on highlighting and understanding bacterial mechanisms that may contribute to treatment failures in MAB infections. My goal was to identify factors driving the evolution of de novo resistance. An invitro assay was established to assess the trajectory of evolved mutations in MAB. Subsequently, I explored heteroresistance, a phenomenon which depicts a bacterial subpopulation displaying different antibiotic susceptibility levels compared to the dominant population. After evaluating heteroresistance using population analysis profile, the gold standard method, I particularly aimed to establish whether these phenotypes were stable within the population. Finally, a significant portion of this thesis was devoted to exploring drug tolerance in MAB. Drug tolerance is a crucial survival strategy that enables bacterial subpopulations to persist during drug treatment. Drug tolerance is evident in the kinetics of bacterial killing, yet it eludes detection through traditional MIC measures and may correlate with poor treatment outcomes.
I discovered that MAB readily acquired a high-level aminoglycoside resistance through a point mutation (A1408G) in the 16S rRNA gene. This resistance was identified across all three subspecies, with its emergence irrespective of the growth phase. Additionally, I identified heteroresistant phenotypes in certain antibiotics, including imipenem, linezolid, and clarithromycin. Subsequent evaluations showed that the imipenem heteroresistant phenotypes were transient and reverted to features of the dominant population.
In the area of drug tolerance, the traditional method of assessing bacterial killing using colony forming units (CFUs) posed significant challenges due to its highly time-consuming and labour-intensive nature, hindering scalability. Overcoming this hurdle marked a significant achievement: the establishment of the Antimicrobial Single Cell Testing (ASCT), a collaborative project in our laboratory where I established the wet lab part. ASCT, an imaging-based platform, enabled us to evaluate drug tolerance at the single-cell level across an international cohort comprising 191 MAB clinical isolates.
With this platform, we demonstrate a highly diverse killing kinetics in MAB across and within clinically relevant drugs, indicating that bacterial killing is a fundamental bacterial phenotype and a drug feature. We detected that cefoxitin and imipenem kill-kinetics, which were most rapid and presumably drive microbial sterilization in MAB, were predictive for clearing infections independent of MICs. In contrast, only macrolide MICs showed an association with treatment outcome. Lastly, we illustrate that time-kill kinetics of drugs sharing a similar mode of action are correlated, underscoring a shared underlying killing mechanism specific to certain drug targets.
Overall, in this doctoral thesis, I tackled critical aspects of MAB resistance and heteroresistance, and delved into drug tolerance in detail. I show that combining drug tolerance and classical resistance metrics could enhance the prediction of treatment outcomes. These findings underscore the significance of mechanisms involved in bacterial killing, offering valuable insights to guide the treatment of mycobacterial diseases
Bridging the Gap: Wirkung von langjährigem funktionellen Krafttraining auf die Beinkraft von Jugendlichen mit Zerebralparese
No full textHintergrund: Bisherige Untersuchungen zeigen, dass Trainingsinterventionen die Kraft bei Ju-gendlichen mit zerebraler Parese (CP) steigern können, sie im Vergleich zu gesunden Gleich-altrigen dennoch signifikant schwächer sind. Diese Studie wurde initiiert, um zu erforschen, ob regelmässiges hochintensives funktionelles Krafttraining im Gruppensetting eine Chance bie-tet, Defizite in Bezug auf die Beinkraft der neuromuskulären Krankheit bei Jugendlichen mit CP zu verringern oder auf ein vergleichbares Kraft-Niveau zu ihren gesunden Peers zu bringen.
Methoden: In dieser Querschnittsstudie wurde die Auswirkung von Trainingsstatus und CP-Diagnose auf die Maximalkraft (Fmax) und die Kraftentwicklungsrate (RFD) untersucht. Ver-glichen wurden fünf trainierte Jugendliche (im Alter von 14 bis 23 Jahren) mit CP, die über 2.5 Jahre am Trainingsangebot togetherfit teilnahmen, mit vier untrainierten CP-Jugendlichen so-wie 18 gesunden Gleichaltrigen (9 trainiert, 9 untrainiert). Die Messungen erfolgten mit dem IsoMed® 2000-Dynamometer. Die gesunden, untrainierten Jugendlichen dienten als Referenz-gruppe zur Berechnung der "Health Distance" zu den anderen Gruppen.
Ergebnisse: Das Training verbessert die Beinkraft bei Jugendlichen mit CP, wobei besonders in der RFD des dominanten Beins höhere Werte als bei gesunden trainierten Altersgenossen er-reicht wurden. Die "Health Distance" zwischen trainierten CP-Jugendlichen und gesunden Gleichaltrigen ist im dominanten Bein deutlich reduziert im Vergleich zu untrainierten CP-Ju-gendlichen.
Schlussfolgerungen: Obwohl das Kraftniveau der trainierten CP-Jugendlichen nicht das der ge-sunden Vergleichsgruppe erreicht (Ausnahme RFD), verdeutlichen die Ergebnisse eine Annä-herung und unterstreichen damit die Effektivität und den Wert des Trainings. Das Angebot to-getherfit dient als wirksame Therapieform bei CP. Zukünftige Studien sollten die zugrundelie-genden neuromuskulären Mechanismen weiter erforschen und prüfen, ob diese Effekte auch in grösseren Stichproben signifikant sind
Exploring strategies to target JAK2-mutant hematopoietic stem cells in myeloproliferative neoplasms
Get PDFMyeloproliferative Neoplasms (MPNs) are a group of clonal diseases of the hematopoietic stem cell (HSC), in which a gain-of-function mutation in JAK2, CALR or MPL hyperactivates the JAK-STAT signaling pathway, leading to an excess production of erythroid, megakaryocytic and myeloid cells. Because no curative therapies are available, there is a medical need for novel therapeutic strategies that could counteract the hyperproliferation and selectively eliminate the reservoir of mutated HSCs, which is responsible for the maintenance of the MPN clone. Here, I examined two approaches that could open new therapeutic opportunities for patients
with MPN caused by the JAK2-V617F mutation, and I established an experimental system to study the clonal dynamics of JAK2-mutant HSCs in a mouse model of MPN.
In the first part of this thesis I show that targeting the increased metabolic demands of MPN cells by blocking the usage of glutamine (Gln) with the glutaminase inhibitor CB-839 improves most of the clinical manifesta
Epidemiology and control of hypertension in Somaliland
Get PDFBackground: Hypertension is the leading risk factor for morbidity worldwide, responsible for approximately 11 million deaths annually, accounting for nearly 19.2% of total deaths. Hypertension is also a significant cause of disability. In 2019, an estimated 1.28 billion people worldwide had hypertension and the Global Burden of Disease 2020 study reported a 5% increase in the prevalence of high blood pressure from 2010 to 2019. This increase is attributed to several factors, including population growth, aging and behavioural risk factors, such as alcohol and tobacco use, physical inactivity, unhealthy diets and obesity. Obesity and overweight increased by 18% from 2010 to 2019 and these risk factors can also cause other conditions such as diabetes and dyslipidemia, which further increase the risk of complications of hypertension, including cardiac failure, stroke and renal failure.
Low- and middle-income countries (LMICs) have the highest number of people with hypertension and the highest prevalence of hypertension. According to data from the World Health Organization (WHO), the prevalence of hypertension is highest in the African region, at 27%. LMICs have weaker health systems and the proportion of undiagnosed, untreated and uncontrolled hypertension is higher in these countries than in high-income countries (HICs).
The increasing incidence of hypertension and its complications have a devastating impact not only on health and well-being, but also on socio-economic development. Patients with hypertension in LMICs often face prohibitively expensive care, leading to catastrophic expenditures that push patients and families into dependency and impoverishment. Indeed, families of patients spend a substantial amount of their income on hospitalization and patient care due to recurrent and chronic morbidities associated with hypertension, such as heart failure, stroke and kidney failure.
Somalia has long been suffering from a lack of organised public health service and the private sector and international organisations have been the main source of health service in the country for the last three decades. In particular, non-communicable diseases (NCDs) have been left behind as infectious diseases and nutritional deficiencies were prioritised in the packages to promote the provision of essential health services. In Somalia, hypertension is estimated to have caused 2,643 deaths (50.1 per 100,000 of the population) in 2020 and its incidence is increasing. Diabetes, cardiovascular diseases (CVDs) and cancers are also on the rise not only in Somalia but also in other sub-Saharan African countries.
Somaliland is an autonomous self-declared republic but officially unrecognised region of Somalia, with a population estimated at 5.7 million in 2021. Somaliland has six administrative regions and 30 districts and the Ministry of Health Development (MoHD) is the main actor and coordinator of healthcare in Somaliland. Hospitals are the main source of service and a network of health posts and mother and child health clinics make up another important tier for health service delivery. As public health service in Somaliland exhibits an exceptionally low level of performance, private institutions (i.e. privately owned hospitals, clinics and pharmacies) remain the main source of care for people. Often, financially poor people make up the largest proportion of patients seeking service from public institutions.
Information on the state of hypertension in Somaliland is extremely scarce and little data are available to measure the impact of hypertension and track its trend. Thus, understanding the epidemiology and control of hypertension in Somaliland will offer an opportunity to deepen the understanding of the current state of the problem and will serve as a valuable guide to set foundations for an integrated preventive programme to tackle NCDs in Somaliland. Hence, the overall objective of this thesis was to evaluate the status of hypertension and risk for CVD among patients seeking care from Hargeisa group hospital, Hargeisa, Somaliland.
Methodology: A health facility-based cross-sectional study was conducted at the main referral hospital of Hargeisa city, Somaliland, from June 13 to August 15, 2022. Built in 1951, Hargeisa group hospital (HGH) is the national and largest referral hospital in Somaliland. With more than 260 daily patient visits and 400 beds, it provides essential health services to more than 1 million inhabitants of Hargeisa, the capital city of Somaliland. It also offers referral care for other regions and districts of the country. The study was given approval by the Research Ethics Committee of the University of Hargeisa and was granted permission by the Somaliland Ministry of Health Development. The study enrolled participants aged 18 years and above, after obtaining written informed consents, using the WHO STEPwise surveillance approach to obtain patient information. Trained staff interviewed patients and collected data on their blood pressure, weight and height. The care of hypertension was analysed using a cascade of care approach. Logistic regression was applied to assess the association between risk factors and outcomes of interest, including hypertension, uncontrolled hypertension, awareness, treatment and control.
The 2019 revised WHO/International Society of Hypertension (ISH) risk score charts for the Eastern sub-Saharan Africa were used to assess the 10-year risk of developing CVDs. The scores were determined based on five CVD risk factors, including sex, age, smoking habits, body mass index (BMI) and systolic blood pressure.
Principal findings: Of the 469 individuals invited to participate, 319 (54.2% males; mean age 40.4 years) had complete data records (interviews and physical measurements). The prevalence of hypertension was 22.6% (95% confidence interval (CI); 18.2–27.6%), with a higher prevalence in males (24.9%, 95% CI: 18.8–32.1%) than females (19.9%, 95% CI: 13.9–27.4%). Age, cholesterolaemia and obesity were significantly associated with hypertension. Obesity was significantly associated with hypertension in females, but not in males, while cholesterolaemia was significantly associated with hypertension in males but not in females.
We found a high awareness of hypertension among outpatients, with 91.7% (95% CI; 82.1–96.5) knowing their condition. Among patients who were aware of hypertension, 92.4% (95% CI; 82.5–97.2%) were on treatment for blood pressure control, but only 9.8% (95% CI; 4.1–20.9%) had their blood pressure level under control. The logistic regression model revealed that individuals aged ≥65 years, females, those who consumed Khat, those who were obese and those with hypercholesterolaemia had higher odds of uncontrolled blood pressure.
Out of the 319 participants with complete data records, 134 were 40 years or older. Based on the 2019 revised WHO/ISH chart for Eastern sub-Saharan Africa, 58 (43.3%) had a risk level below 5% and were at very low risk of fatal or non-fatal cardiovascular (CV) events (CHD or stroke) over the next 10 years. A risk level between 5% and 10% was predicated for 33 (24.6%) who were at low risk of CV events. Another 33 (24.6%) had a risk level between 10% and 20% and were at moderate risk of CV events. Additionally, 10 (7.5%) of the participants had a risk level higher than 20%, and hence, were at high risk of CV events.
Conclusion/significance: The results of our study indicate that nearly a quarter of the outpatient population in Hargeisa suffer from hypertension. Moreover, 86% of the outpatient population who has been prescribed antihypertensive medications did not achieve their treatment goals and one-third of outpatients are at a high or very high risk of developing non-fatal or fatal CV events over the next decade. This increased risk for CV events underscores the need for early detection and monitoring of risk factors and outcomes associated with hypertension and other NCDs. Our findings also suggest that hypertension is linked to low levels of education, smoking, Khat consumption and obesity. Therefore, reducing obesity, implementing public health education programmes and strengthening policies and programmes against smoking and Khat consumption can have a significant impact on lowering hypertension and reducing the risk of CVD. These observations highlight the importance of strategies to prevent and properly manage hypertension and other chronic NCDs in Somaliland. Consequently, there is a need for a multipronged intervention and surveillance programme on risk factors and outcomes of hypertension and other NCDs, as well as strategies to screen, prevent and control such diseases in Somaliland. Research on the challenges associated with the prevention and management of NCDs in Somaliland is also critical.
Our study has significant policy implications. First, the substantial proportion of individuals with high risk for CV events indicates the need for strategies targeting high-risk individuals. Second, the high prevalence of individuals with low- to moderate-risk necessitates public policies that focus on the whole population. Finally, the overall low level of predicted risk and the increase of risk with age demand comprehensive CV care. Our findings should encourage the development of a national programme to improve public awareness of hypertension and to train healthcare providers for better screening and treatment of hypertension. Appropriate screening strategies are crucial for the early identification of people with raised blood pressure, but to date, there are no standard clinical guidelines for either screening or treatment of hypertension in Somaliland. The implementation of a pilot project adapting the WHO Package of Essential Non-communicable Disease (PEN) intervention using total CVD risk-based assessment approach in primary care settings might be valuable for the prevention and control of hypertension. Such a project may set a foundation for a national programme on the integrated management of NCDs and their underlying risk factors in Somaliland. Measurable improvement in awareness, treatment and control of hypertension has been achieved in countries where PEN interventions were implemented. In addition, such interventions might enable concerned stakeholders to better understand the operational prospects and value for investment for early detection and management of NCDs and their risk factors. Given the scarcity of available evidence and the absence of established clinical guidelines in Somaliland, we do not provide a decision-making algorithm for hypertension. However, we suggest the implementation of contextually appropriate collaborative interventions to prevent and combat NCDs
Teilbelastung nach orthopädischen Operationen: biofeedbackbasierte Instruktion im Vergleich zur konventionellen Methode
No full textDiese Studie untersucht, ob Sensorsohlen mit direktem Feedback Patienten dabei helfen können, die vorgegebene Teilbelastung von 15 kg einzuhalten. Zwei Gruppen wurden verglichen: eine Kontrollgruppe mit Standardanweisungen der Physiotherapie und eine Interventionsgruppe, die Sensorsohlen für ein zweiwöchiges Biofeedback-Training nutzte. Die Ergebnisse zeigen keinen signifikanten Unterschied zwischen den Gruppen in Bezug auf den prozentualen Anteil der überbelasteten Schritte. Boxplots deuten jedoch auf einen um 30,1 % niedrigeren Median in der Interventionsgruppe hin. Die subjektive Einschätzung der Belastung stimmte in beiden Gruppen kaum mit den objektiven Messungen überein, was Ergebnisse einer früheren Studie bestätigen. Technische Probleme, wie instabile Verbindungen und Artefakte bei der linken Sohle, führten zu einer hohen Ausschlussrate, sodass anstelle der geplanten 60 Datensätze nur 20 verwendet werden konnten. Dies führte dazu, dass die statistische Aussagekraft erheblich eingeschränkt wurde. Die Ergebnisse verdeutlichen die Herausforderungen bei der Entwicklung verlässlicher Feedback-Systeme für die Rehabilitation. Kabellose Sensorsohlen benötigen Verbesserungen, insbesondere bei der Verbindungssicherheit und der Reduzierung von Artefakten. Zukünftige Studien sollten grössere, homogenere Stichproben umfassen und die Übertragbarkeit des Feedback-Trainings auf Situationen ohne Unterstützung untersuchen. Fortschrittliche Technologien, die eine kontinuierliche und automatische Überwachung ermöglichen, könnten in Zukunft ein wichtiger Bestandteil der Rehabilitation sein