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Search Results: 1 - 10 of 7470 matches for " Benjamin Gedrose "
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The disease management program for type 2 diabetes in Germany enhances process quality of diabetes care - a follow-up survey of patient's experiences
Ingmar Sch?fer, Claudia Küver, Benjamin Gedrose, Falk Hoffmann, Barbara Ru?-Thiel, Hans-Peter Brose, Hendrik van den Bussche, Hanna Kaduszkiewicz
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-55
Abstract: Cohort study with a baseline interview and a follow-up after 10.4 ± 0.64 months. Data on process and outcome measures were collected by telephone interviews with 444 patients enrolled and 494 patients not enrolled in the German DMP for type 2 diabetes. Data were analyzed by multivariate logistic regression analyses.DMP enrolment was significantly associated with a higher process quality of care. At baseline enrolled patients more often reported that they had attended a diabetes education course (OR = 3.4), have ≥ 4 contacts/year with the attending physician (OR = 3.3), have at least one annual foot examination (OR = 3.1) and one referral to an ophthalmologist (OR = 3.4) and possess a diabetes passport (OR = 2.4). Except for the annual referral to an ophthalmologist these parameters were also statistically significant at follow-up. In contrast, no differences between enrolled and not enrolled patients were found concerning outcome quality indicators, e.g. self-rated health, Glycated hemoglobin (GHb) and blood pressure. However, 16-36% of the DMP participants reported improvements of body weight and/or GHb and/or blood pressure values due to enrolment - unchanged within one year of follow-up.In the light of patient's experiences the DMP enhances the process quality of medical care for type 2 diabetes in Germany. The lack of significant differences in outcome quality between enrolled and not enrolled patients might be due to the short program duration. Our data suggest that the DMP for type 2 diabetes should not be withdrawn unless an evidently more promising approach is found.Health care improvement for patients with type 2 diabetes is an important target of health care policy in Germany. In summer 2003 a disease management program (DMP) for type 2 diabetes was introduced on a nationwide basis within the statutory health insurance, which covers 86% of the German population. Participation in the DMP is voluntary for physicians and patients and connected with financial
Selection effects may account for better outcomes of the German Disease Management Program for type 2 diabetes
Ingmar Sch?fer, Claudia Küver, Benjamin Gedrose, Eike-Christin von Leitner, András Treszl, Karl Wegscheider, Hendrik van den Bussche, Hanna Kaduszkiewicz
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-351
Abstract: Case control study comparing DMP patients with usual-care patients at baseline and follow up; mean follow-up period of 36 ± 14 months. We used chart review data from 51 GP surgeries. Participants were 586 DMP and 250 usual-care patients with type 2 diabetes randomly selected by chart registry. Data were analysed by multivariate logistic and linear regression analyses. Significance levels were p ≤ 0.05.There was a better chance for enrolment if patients a) had a lower risk status for diabetes complications, i.e. non-smoking (odds ratio of 1.97, 95% confidence interval of 1.11 to 3.48) and lower systolic blood pressure (1.79 for 120 mmHg vs. 160 mmHg, 1.15 to 2.81); b) had higher activity rates, i.e. were practicing blood glucose self-monitoring (1.67, 1.03 to 2.76) and had been prescribed a diabetes patient education before enrolment (2.32, 1.29 to 4.19) c) were treated with oral medication (2.17, 1.35 to 3.49) and d) had a higher GP-rated motivation for diabetes education (4.55 for high motivation vs. low motivation, 2.21 to 9.36).At baseline, future DMP patients had a lower risk for diabetes complications, were treated more intensively and were more active and motivated in managing their disease than usual-care patients. This finding a) points to the problem that the German DMP may not reach the higher risk patients and b) selection bias may impair the assessment of differences in outcome quality between enrolled and usual-care patients. Suggestions for dealing with this bias in evaluation studies are being made.Sufficient evaluation is a precondition for deciding whether the implementation of any new health care policy was successful. Policy makers depend on this scientific evidence, but their decisions sometimes restrain researchers from generating evidence in a valid way. This is the case with the nationwide disease management program (DMP) for type 2 diabetes, which was introduced in Germany in 2003.The DMP was started in a rush with no preceding randomized con
Clinical Profile of the Patients with Newly Detected Left Bundle Branch Block in the Outpatient Department  [PDF]
Bino Benjamin
World Journal of Cardiovascular Diseases (WJCD) , 2018, DOI: 10.4236/wjcd.2018.82014
Abstract: Objective: The purpose of this study was to evaluate cardiac features associated with newly detected left bundle branch block (LBBB) in the outpatient department. Methods: A total of 57 patients with LBBB pattern were evaluated using electrocardiography (ECG). Patients were assessed based on their sex, age, detailed history, and cardiovascular symptoms. Cardiac investigations including ECG and echocardiography were performed. Results:The study included 30 (52.6%) males and 27 (47.5%) females, aged between 35 and 80 years. Dyspnoea (35.1%) and chest pain (22.8%) were the most common symptoms. 54.4% were hypertensive and 17.5% were diabetics. 28% had Left ventricular systolic dysfunction, and 24.5% had aortic valve disease. Left ventricular hypertrophy without any other structural heart disease was present in 28% of the patients. Only 24.5% patients presented with LBBB had a structurally normal heart in echocardiography. Myocardial performance index in echocardiography was abnormal in LBBB irrespective of the presence of structural heart disease. Conclusion: The prevalence of LBBB was found to increase with age and had slight male preponderance. Dyspnoea on effort was the most common presenting complaint, followed by chest pain and incidental detection of ECG abnormality. Most of the patients were hypertensive. Only 24.5% patients with LBBB had a structurally normal heart. MPI was abnormally high in the presence of LBBB despite having a normal left ventricular ejection fraction.
Representative Government in the Era of Improved Communication  [PDF]
Benjamin Barrowes
Open Journal of Political Science (OJPS) , 2019, DOI: 10.4236/ojps.2019.92019
Abstract: Technology is allowing communication to become inexpensive, ubiquitous, secure, and instantaneous, in the process transforming individual lives and societies. Representative government was conceived in an era of laborious, slow, insecure, local, and high-cost communication modalities. These modalities imposed burdensome but inescapable limitations on both the representatives who were entrusted to aggregate and adjudicate public sentiment while making decisions on the behalf of others, as well as the public who faced trust crises, participation barriers, and ignorance of facts and issues. This paper explores positive and negative consequences that improved communication has for representatives. Consequences for a better educated and informed citizenry often with unprecedented discretionary time are also examined. Conclusions include deliberate power divestment on the part of representatives and an open source government model for citizens.
Vulnerabilities of LDAP As An Authentication Service  [PDF]
Charlie Obimbo, Benjamin Ferriman
Journal of Information Security (JIS) , 2011, DOI: 10.4236/jis.2011.24015
Abstract: Lightweight Directory Access Protocol (LDAP) servers are widely used to authenticate users in enterprise level networks. Organizations such as universities and small to medium-sized businesses use LDAP for a variety of applications including e-mail clients, SSH, and workstation authentication. Since many organizations build dependencies on the LDAP service, a Denial-of-Service (DoS) attack to the service can cause a greater number of services disrupted. This paper examines the danger in the use of LDAP for user authentication by executing a DoS attack exploiting the TCP three-way handshake required when initializing a connection to an LDAP server.
Large square baling and bale handling efficiency—A case study  [PDF]
Benjamin Kemmerer, Jude Liu
Agricultural Sciences (AS) , 2012, DOI: 10.4236/as.2012.32020
Abstract: Large square baling is currently recognized as a high efficiency biomass harvesting system. Baling, bale collecting, and storing at a commercial wheat straw farm was studied as a typical large square bale harvesting system. Factors that affect large square bale production and handling logistics were quantified. Field operations of a large square baler, two bale handlers, and three bale trucks were observed in a full day field operation. System performance was analyzed and material capacities of all machines used in this system were determined based on field measurements. System limitations were quantified, and means to increase system efficiency or reduce production costs were discussed. Results showed that 340 wheat straw bales at a density of 116 kg·m-3 (wet matter) were made with a single large square baler during 8 h field operations. The number of bales produced was the system limitation when one baler, two bale handlers and three bale trucks were used. Adding a baler or reduce the number of operators can increase system efficiency. The large square baler used in this study had a material capacity of 13 Mg·h-1. Similar baling trials were conducted in a switchgrass field and results indicated that the baler had the same material capacity.
New Evidence, Conditions, Instruments & Experiments for Gravitational Theories  [PDF]
Benjamin T. Solomon
Journal of Modern Physics (JMP) , 2013, DOI: 10.4236/jmp.2013.48A018
Abstract:

Two significant findings compel a rethink of physical theories. First, using a 7-billion-year-old gamma-ray burst, Nemiroff (2012) showed that quantum foam could not exists. And second, Solomon (2011) showed that gravitational acceleration is not associated with the gravitating mass, that gravitational acceleration g is determined solely by τ the change in time dilation over a specific height multiplied by c2 or g = τc2. Seeking consistency with Special Theory of Relativity, as means to initiate this rethink, this paper examines 12 inconsistencies in physical theories that manifest from empirical data. The purpose of this examination is to identify how gravitational theories need to change or be explored, to eliminate these 12 inconsistencies. It is then proposed that spacetime is much more sophisticated than just a 4-dimensional continuum. And, that the Universe consists of at least two layers or “kenos” (Greek for vacuous), the 4-dimensional kenos, spacetime (x, y, z,

Vertical Heterogeneity of Genotypic Structure and Toxic Potential within Populations of the Harmful Cyanobacterium Microcystis aeruginosa  [PDF]
Benjamin Misson, Delphine Latour
Advances in Microbiology (AiM) , 2013, DOI: 10.4236/aim.2013.36A004
Abstract: We investigated the vertical variability of toxic potential (i.e. proportions of cells containing microcystin genes) and genotypic structure within different populations of Microcystis aeruginosa that developed in deep artificial reservoirs on the Loire River (France). We demonstrated that a great qualitative vertical heterogeneity could exist within a single bloom of this cyanobacterium in deep lakes. Indeed, we observed important vertical shifts of both toxic potential and genotypic structure, whatever the bloom magnitude. These variations occurred mainly within the euphotic zone and proved to occur independently from abundance vertical shifts. One of the most striking results of this study is that the genotypic structure of a population of M. aeruginosa was more variable between different depths sampled at a single site than between different sites of the same reservoir sampled on top of the water column. In the same way the proportion of potentially toxic cells was sometimes more variable vertically than horizontally. The occurrence of such vertical heterogeneity in three different blooms suggests that this could be a frequent pattern within populations of M. aeruginosa.
Influences on the Marking of Examinations  [PDF]
Christina Bermeitinger, Benjamin Unger
Psychology (PSYCH) , 2014, DOI: 10.4236/psych.2014.52014
Abstract:

In the present work, we examined a phenomenon highly relevant in the educational field for assessing or judging performance, that is, the question how the second examiner’s marking is influenced by the evaluation of the first examiner. This phenomenon is known as anchoring in cognitive psychology. In general, in anchoring effects numeric information (i.e., the anchor) pulls estimations or judgments towards the anchor. One domain which is highly important in real life has been investigated only occasionally, that is, the marking of examinations. In three experiments, participants were asked to evaluate a written assignment. The mark (either good or bad) of a ficticious first examiner was used as the anchor. We found clear anchoring effects that were unaffected by feedback in a preceding task (positive, neutral, negative) or the expert status of the presumed first examiner. We discussed the problems related to this effect.

Dependence of Manual Grasping on the Behavioral Context: A Comparison between Arms and between Age Groups  [PDF]
Otmar Bock, Benjamin Baak
Psychology (PSYCH) , 2013, DOI: 10.4236/psych.2013.412144
Abstract:

We evaluated the kinematics and dynamics of grasping in a typical laboratory situation (L) and in a more everyday-like situation (E), using right-handed subjects. Performance was compared when young subjects used their right versus left arm, and when young versus old subjects used their left arm. As in our previous work, multiple differences emerged between parameter values in the two contexts, L and E. These context differences were, however, more pronounced for the left rather than for the right arm of young subjects, and more pronounced for the left arm of young rather than older subjects. We propose an explanation based on the differential involvement of the dorsal and ventral cortical processing stream in L and in E: The differential involvement would be accentuated for the left arm of young, but not for the left arm of older subjects.

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