14043 research outputs found
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Blockchain-based smart contract realization in BIM environment
No full textDas Baumanagement steht aufgrund ineffizienter Zusammenarbeit, fragmentierter Abläufe und uneinheitlicher Dokumentation vor großen Herausforderungen. Diese Probleme behindern Vertragsverwaltung, Prozessverfolgung und Datenaustausch und führen oft zu Streitigkeiten, Verzögerungen und Kostenüberschreitungen. Blockchain-basierte Smart Contracts bieten Potenzial für Automatisierung, Transparenz und Sicherheit, werden jedoch bisher nur unzureichend genutzt und in BIM integriert, um branchenspezifische Anforderungen zu erfüllen. Diese Arbeit untersucht, wie Smart Contracts das digitale Baumanagement verbessern können - mit Fokus auf BIM-Datennutzung, automatischer Vorlagenerzeugung, Prozessüberwachung und Systemintegration. Die Lösung umfasst drei Verfahren: Datenmodellierung, Prozessvorlagendefinition und Smart-Contract-Implementierung. Validiert durch drei Anwendungsfälle und entwickelte Prototypen legt sie die Grundlage für ein zuverlässigeres und stärker kollaborativeres Baumanagement.Construction management faces persistent challenges due to inefficient collaboration, fragmented workflows, and inconsistent documentation. These issues hinder contract administration, process tracking, and data exchange, often causing disputes, delays, and cost overruns. Blockchain-based smart contracts offer strong potential for automation, transparency, and security but remain underused and poorly integrated with Building Information Modeling (BIM) to fully fulfill construction-specific needs. This thesis investigates how smart contracts can enhance digital construction management, focusing on BIM data use, automated template generation, process monitoring, and system integration. A solution is developed including three procedures: data modelling, process template definition, and smart contract implementation. Validated through three use cases and developed prototypes, the study lays the groundwork for enhancing reliability and collaboration in construction management
Neurological post-COVID syndrome is associated with substantial impairment of verbal short-term and working memory
No full textA substantial proportion of patients suffer from Post-COVID Syndrome (PCS) with fatigue and impairment of memory and concentration being the most important symptoms. We here set out to perform in-depth neuropsychological assessment of PCS patients referred to the Neurologic PCS clinic compared to patients without sequelae after COVID-19 (non-PCS) and healthy controls (HC) to decipher the most prevalent cognitive deficits. We included = 60 PCS patients with neurologic symptoms, = 15 non-PCS patients and = 15 healthy controls. Basic socioeconomic data and subjective complaints were recorded. This was followed by a detailed neuropsychological test battery, including assessments of general orientation, motor and cognitive fatigue, screening of depressive and anxiety symptoms, information processing speed, concentration, visuomotor processing speed, attention, verbal short-term and working memory, cognitive flexibility, semantic and phonematic word fluency, as well as verbal and visual memory functions. Neurologic PCS patients had more complaints with significantly higher fatigue scores as well as higher levels of depressive and anxiety symptoms compared to Non-PCS and HC. Deep neuropsychological assessment showed that neurologic PCS patients performed worse in a general screening of cognitive deficits compared to HC. Neurologic PCS patients showed impaired mental flexibility as an executive subfunction, verbal short-term memory, working memory and general reactivity (prolonged reaction time). Multiple regression showed fatigue affected processing speed; depression did not. Self-reported cognitive deficits of patients with neurologic PCS including fatigue, concentration, and memory deficits, are well mirrored in impaired performance of cognitive domains of concentration and working memory. The present results should be considered to optimize treatment algorithms for therapy and rehabilitation programs of PCS patients with neurologic symptoms
Assessment of the GLIDE Score for prediction of mild tricuspid regurgitation following Tricuspid transcatheter edge-to-edge repair
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The GLIDE Score is an anatomical scoring system designed to predict moderate residual tricuspid regurgitation (TR) immediately following transcatheter tricuspid edge-to-edge repair (T-TEER).
The purpose of this study was to evaluate the GLIDE Score's predictive capability for achieving a postprocedural TR grade of mild or better.
This retrospective analysis included 336 patients from a multicenter registry who underwent T-TEER between January 2017 and November 2022. Anatomical features were assessed using transesophageal echocardiography to calculate the GLIDE Score, which ranges from 0 to 5. The primary endpoint was a postprocedural TR grade of mild or better, assessed via periprocedural imaging. Outcomes were compared between patients with GLIDE Scores of 0 to 1 and those with scores 2 using logistic regression and ROC curve analysis.
Median age was 81 years, with no significant differences in BMI, EuroScore II, or NYHA Class across GLIDE Score cohorts. The GLIDE Score 2 cohort had a larger median RV basal diameter (48 mm vs 45 mm, < 0.001) and more torrential TR cases (35.9% vs 3.1%, < 0.001). Postprocedural mild TR was achieved in 74.7% of patients with a GLIDE Score of 0 to 1, versus 13.4% in the 2 cohort ( < 0.001). Ordinal regression analysis found a strong correlation between the GLIDE Score and postprocedural TR severity (coefficient = 1.41, t = 12.92), with an AUC to predict mild TR of 0.87 (95% CI: 0.83-0.90).
The GLIDE Score is a valuable tool for predicting postprocedural TR severity in T-TEER patients, guiding patient selection and refining treatment strategies
Acute suicide risk - from risk assessment to suicide prevention
No full textDie Erfassung und Behandlung akuter Suizidalität stellt eine zentrale Aufgabe in der Gesundheitsversorgung dar. Jedoch lässt sich das Suizidrisiko anhand traditioneller Risikofaktoren, wie dem Vorhandensein von Suizidgedanken, nicht verlässlich vorhersagen. Ein neuer Ansatz zur Prädiktion akuter Suizidalität ist das sogenannte Suizidkrisensyndrom ( Suicide Crisis Syndrome, SCS), welches unabhängig von Suizidgedanken fünf symptomatische Dimensionen umfasst (Gefühl des Gefangenseins, affektive Dysregulation, Verlust der kognitiven Kontrolle, Hyperarousal und sozialer Rückzug). Ziel dieser Dissertation ist es, einen systematischen Überblick über den aktuellen Forschungsstand zum SCS zu geben und die zugehörigen Messinstrumente, darunter das Suicide Crisis Inventory (SCI-2-G) sowie die Kurzversion (SCI-2-SF), psychometrisch zu validieren. Darüber hinaus befasst sich diese Dissertation mit der Rolle der therapeutischen Allianz in der ambulanten Psychotherapie suizidaler Patient:innen
Assessing decision-making skills with the Script Concordance Test (SCT) in clinical neurology and emergency medicine
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Clinical reasoning is an essential medical competence that should be taught and assessed from the beginning of medical studies. These skills can be evaluated using the Script Concordance Test (SCT), which presents daily clinical scenarios characterised by uncertainty. Due to the lack of validated research on this method in Germany, particularly in the field of neurology, we developed and implemented an SCT at Ruhr University Bochum. We compared different teaching methods (clinical seminar vs. digital video course) and their outcomes on the examination.
A group of 6th-year medical students who had received the same education completed an SCT after participating in either a clinical seminar or a digital video course. The SCT was developed using blueprints on stroke and epilepsy. The test consisted of 40 case vignettes with a total of 120 items. Initially, experts completed the test to establish the reference panel. The final high-stakes examination was created using the aggregate scoring method and an item analysis.
The SCT was completed by 15 experts and 59 students. The final SCT consisted of 112 items and achieved a Cronbach’s alpha of 0.85. A significant difference ( < 0.05) was observed between the experts, who achieved a mean score of 81.75, and the students on the first assessment day, who achieved a mean score of 68.92. No significant differences were found between the groups (interactive video course and seminar) or assessment time points. The questionnaire revealed a sense of insecurity in clinical decision-making before the SCT and highlighted the need to incorporate clinical reasoning practices from the beginning of medical studies to mitigate fear in uncertain situations. The SCT helped students structure decision-making processes and and improved their confidence in making decisions.
The SCT is a reliable and valid tool for assessing medical students throughout their university education. Regular exposure to the SCT format would facilitate familiarity with its structure. We propose utilising the SCT as a learning tool rather than solely for assessment purposes. For instance, it could be integrated into teaching methodologies as a think-aloud exercise or incorporated into progress tests
The unfairness we feel
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Relative deprivation (RD), the belief of being unfairly disadvantaged compared to a standard, has frequently been linked to aggressive behaviors. This study explored how affective experiences are associated with the perception of unfairness (i.e., RD) and, thus, influence aggressive behavior indirectly.
= 184 participants were randomly assigned to one of two conditions of a game task, in which they experienced either deprivation or no deprivation as the difference between own rewards and the rewards of a fictitious other player. We assessed the subjective perception of RD and affective experiences attributed to the game before measuring aggressive behavior towards the other player in a point subtraction task.
Sequential mediation analysis suggested that increases in aggressive affect and decreases in positive affect could be linked to perceiving the game as more unfair for deprived participants, which in turn increased rates of aggressive behavior.
Adding to the existing literature, these findings suggest that RD could not only lead to aggression through an affective route but that affective experiences potentially alter perceptions of RD and thus aggressive behavior indirectly
Expression of GDAP1 gene correlates with alcohol deprivation effect
No full textAlcohol addiction is a widespread disease, and the exact causes and consequences are still not fully determined. Neurotransmitters and neuronal circuits are not only the target structure of alcohol and responsible for its direct effects but also play a central role in the development of addiction. A gene that has been linked to alcohol use disorder in recent studies is the gene. The present study focuses on the hippocampus, a brain region particularly vulnerable to alcohol and rich in gene expression. Using an established drinking model, alcohol drinking behavior was induced in adult male Long Evans rats. After 6 weeks of voluntary alcohol intake, followed by 2 weeks of deprivation, the animals were divided into two groups based on the alcohol deprivation effect (ADE). gene expression was measured with real-time PCR in the hippocampus. Results reveal significantly decreased mRNA expression in the high ADE group compared to the low ADE group. This decrease was specifically detected within the cornu ammonis 3 (CA3) region. expression in this region also negatively correlated with ADE in all animals. Taken together, results indicate that might not only be associated with alcohol consumption but might even play a role in alcohol dependence
Adverse socioeconomic factors are associated with a widening gap in one-year health-related quality of life after acute myocardial infarction
No full textAcute myocardial infarction (AMI) has a significant impact on the health-related quality of life (HRQoL) and is influenced by unfavorable socioeconomic factors. We aimed to evaluate the association between adverse socioeconomic factors including low educational level, low occupational qualification and financial hardship with presenting symptoms and HRQoL in patients hospitalized for an AMI. We hypothesized a detectable effect on a spatial level and therefore assessed the HRQoL in 298 patients with AMI using the EQ-5D-5L generic measure for health status. Sociodemographic characteristics, clinical data, medical history, and prevalence of cardiovascular risk factors were obtained. Self-reported HRQoL was determined upon hospital admission and after 12 months. Patients with lower educational attainment were more likely to report dyspnea at hospital admission, had a worse renal function and more frequently hypertension. One year post-AMI the health state of the cohort worsened in terms of the mobility, activity, pain, and anxiety/depression domains but not the self-care domain. Patients with a lower education level or a poor financial situation reported a worse HRQoL and health state at baseline and follow-up (change in EQ VAS baseline-follow-up − 7.7 and − 11.0, respectively, lowest category). In contrast, the health state of patients with a higher education level or better financial situation improved (change in EQ VAS baseline-follow-up + 4.0 and + 2.6, highest category). Our study demonstrates a substantially widening gap in the health state and HRQoL between patients with lower and higher educational attainment within the first year after AMI, already measurable on a spatial level
Immunohistochemical characterisation of the interstitial inflammatory environment
No full text Hidradenitis suppurativa (HS) is a chronic inflammatory disease with a complex immune response. Given the considerable heterogeneity of the clinical phenotype of HS, this study aimed to analyse the immunohistochemical pattern of interstitial inflammation.
Immunohistochemical analysis was performed on skin samples from 49 patients with HS. The immunohistochemical markers CD3, CD4 and CD8 for T-cells, CD20 for B-cells, CD138 for plasma cells and CD30, CD56, Bcl-2 and Bcl-6 were stained on lesional skin.
The analysis of immune cell dominance in patients with HS revealed that 33.3% of the cohort exhibited B-cell dominance, defined as a ratio of the sum of CD20+ and CD138+ cells to CD3+ cells greater than 1, while the majority (66.7%) demonstrated T-cell dominance, defined as a ratio of CD3+ cells to the sum of CD20+ and CD138+ cells greater than 1. B-cell-dominant HS is associated with a significantly elevated probability of mammary involvement (13.3% vs. 0%; = 0.041). T-cell-dominant HS patients tended to demonstrate a higher mean tobacco consumption, but not significantly (20 vs. 5 tobacco pack-years; = 0.06). CD4-dominant HS patients exhibited a significantly greater involvement of the mons pubis (62.5% vs. 28.6%, = 0.023) compared to CD8-dominant patients, who demonstrated a significantly higher number of abscesses ( = 0.027).
For the first time, we describe the clinical and immunohistochemical characteristics of T-cell- and B-cell-dominant HS. Although HS seems to be more dominated by T-cells, a B-cell dominance was found in 33% of cases
Coronary artery calcium scoring using virtual versus true noncontrast images from photon-counting coronary CT angiography
No full textDas koronare Kalziumscoring erfordert üblicherweise eine native CT zusätzlich zur kontrastmittelgestützten CT-Angiographie (CTA) der Koronararterien. Die Photon-counting CT (PCCT) bietet mit dem PureCalcium-Algorithmus die Möglichkeit, virtuell-native Bilder aus CTA-Daten zu rekonstruieren. Ziel dieser Studie war der Vergleich von PureCalcium zu dem nativen Kalziumscoring. Bei 170 retrospektiv analysierten Patienten wurden Agatston-Scores beider Verfahren bestimmt und statistisch verglichen. Die Mediane unterschieden sich nicht signifikant (p = 0,99), die Korrelation war stark (ICC = 0,98). 74 % der Patienten wurden übereinstimmend in Schweregrade eingeteilt ( = 0,88). Es konnte aber keine statistische Äquivalenz belegt werden. Der native Scan trug zu 19,7 8,8 % der Strahlendosis bei. PureCalcium Kalziumscoring zeigte eine hohe Übereinstimmung und könnte den zusätzlichen nativen Scan zukünftig überflüssig machen