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The Role of Thrombelastography in Multiple Trauma
Victor Jeger,Heinz Zimmermann,Aristomenis K. Exadaktylos
Emergency Medicine International , 2011, DOI: 10.1155/2011/895674
Abstract: Hemorrhage and traumatic coagulopathyis are major causes of early death in multiply injured patients. Thrombelastography (TEG) seems to be a fast and accurate coagulation test in trauma care. We suggest that multiply injured trauma patients would benefit the most from an early assessment of coagulation by TEG, mainly RapidTEG, to detect an acute traumatic coagulopathy and especially primary fibrinolysis, which is related with high mortality. This review gives an overview on TEG and its clinical applications. 1. Introduction Hemorrhage is a major cause of early death in multiply injured patients. One of the reasons of uncontrolled hemorrhage may be acute traumatic coagulopathy. It has been first discussed by Brohi and colleagues, and it is now thought to be induced by trauma and hypoperfusion [1, 2]. The pathomechanism of acute traumatic coagulopathy is extensively reviewed by Hess et al. [3] 25% of major trauma patients suffer from coagulopathy at admission to the hospital, and its presence is associated with a fourfold increase in mortality [2]. The initial treatment of bleeding trauma patients is not limited any more to damage control surgery but to damage control resuscitation, using a balanced administration of blood products in the ratio of red blood cells: fresh frozen plasma as 1?:?1 or 1?:?2, which is able to correct hypovolemia, anemia, and, to a certain degree, the acute traumatic coagulopathy [4, 5]. Additionally, the acute traumatic coagulopathy may also occur in absence of acute bleeding, for example, due to massive blunt injury and hypothermia. This pattern is typical for our patients population in a Level 1 trauma center in Switzerland, where we face mainly car accidents and injuries related to outdoor sports (skiing, climbing, base jumping, avalanches, etc.). In situations where coagulopathy is frequent but less obvious at admission of the patient to the resuscitation bay, the decisions should rely on evidence based point of care devices to correct coagulopathy. In reality, the trauma physician is somehow blinded to the current state of coagulation because of long turnover times of standard coagulation screening from the lab and he/she has to base decisions on experience and gut feeling [6]. The search for appropriate point of care devices in trauma care brought thrombelastography (TEG) back in focus in 1997 by Kaufmann et al. after the technique had been used for years in cardiac and liver surgery [7, 8]. 2. Thrombelastography—Assessing the Viscoelastic Properties of the Thrombus The concept of thrombelastography had been first
A Variant of the Gr?bner Basis Algorithm for Computing Hilbert Bases
Natalia Dück,Karl-Heinz Zimmermann
Mathematics , 2013,
Abstract: Gr\"obner bases can be used for computing the Hilbert basis of a numerical submonoid. By using these techniques, we provide an algorithm that calculates a basis of a subspace of a finite-dimensional vector space over a finite prime field given as a matrix kernel.
Universal Gr?bner Bases for Binary Linear Codes
Natalia Dück,Karl-Heinz Zimmermann
Mathematics , 2013, DOI: 10.12732/ijpam.v86i2.9
Abstract: Each linear code can be described by a code ideal given as the sum of a toric ideal and a non-prime ideal. In this way, several concepts from the theory of toric ideals can be translated into the setting of code ideals. It will be shown that after adjusting some of these concepts, the same inclusion relationship between the set of circuits, the universal Gr\"obner basis and the Graver basis holds. Furthermore, in the case of binary linear codes, the universal Gr\"obner basis will consist of all binomials which correspond to codewords that satisfy the Singleton bound and a particular rank condition. This will give rise to a new class of binary linear codes denoted as Singleton codes.
Graver Bases and Universal Gr?bner Bases for Linear Codes
Natalia Dück,Karl-Heinz Zimmermann
Mathematics , 2014,
Abstract: Two correspondences have been provided that associate any linear code over a finite field with a binomial ideal. In this paper, algorithms for computing their Graver bases and universal Gr\"obner bases are given. To this end, a connection between these binomial ideals and toric ideals will be established.
Coordination of Decisions in a Spatial Agent Model
Frank Schweitzer,Joerg Zimmermann,Heinz Muehlenbein
Computer Science , 2001, DOI: 10.1016/S0378-4371(01)00486-1
Abstract: For a binary choice problem, the spatial coordination of decisions in an agent community is investigated both analytically and by means of stochastic computer simulations. The individual decisions are based on different local information generated by the agents with a finite lifetime and disseminated in the system with a finite velocity. We derive critical parameters for the emergence of minorities and majorities of agents making opposite decisions and investigate their spatial organization. We find that dependent on two essential parameters describing the local impact and the spatial dissemination of information, either a definite stable minority/majority relation (single-attractor regime) or a broad range of possible values (multi-attractor regime) occurs. In the latter case, the outcome of the decision process becomes rather diverse and hard to predict, both with respect to the share of the majority and their spatial distribution. We further investigate how a dissemination of information on different time scales affects the outcome of the decision process. We find that a more ``efficient'' information exchange within a subpopulation provides a suitable way to stabilize their majority status and to reduce ``diversity'' and uncertainty in the decision process.
D-Bees: A Novel Method Inspired by Bee Colony Optimization for Solving Word Sense Disambiguation
Sallam Abualhaija,Karl-Heinz Zimmermann
Computer Science , 2014,
Abstract: Word sense disambiguation (WSD) is a problem in the field of computational linguistics given as finding the intended sense of a word (or a set of words) when it is activated within a certain context. WSD was recently addressed as a combinatorial optimization problem in which the goal is to find a sequence of senses that maximize the semantic relatedness among the target words. In this article, a novel algorithm for solving the WSD problem called D-Bees is proposed which is inspired by bee colony optimization (BCO)where artificial bee agents collaborate to solve the problem. The D-Bees algorithm is evaluated on a standard dataset (SemEval 2007 coarse-grained English all-words task corpus)and is compared to simulated annealing, genetic algorithms, and two ant colony optimization techniques (ACO). It will be observed that the BCO and ACO approaches are on par.
Lunar Tractive Forces and Renal Stone Incidence
Spyridon Arampatzis,George N. Thalmann,Heinz Zimmermann,Aristomenis K. Exadaktylos
Emergency Medicine International , 2011, DOI: 10.1155/2011/813460
Abstract: Background. Several factors are implicated in renal stone formation and peak incidence of renal colic admissions to emergency departments (ED). Little is known about the influence of potential environmental triggers such as lunar gravitational forces. We conducted a retrospective study to test the hypothesis that the incidence of symptomatic renal colics increases at the time of the full and new moon because of increased lunar gravitational forces. Methods. We analysed 1500 patients who attended our ED between 2000 and 2010 because of nephrolithiasis-induced renal colic. The lunar phases were defined as full moon ± 1 day, new moon ± 1 day, and the days in-between as “normal” days. Results. During this 11-year period, 156 cases of acute nephrolithiasis were diagnosed at the time of a full moon and 146 at the time of a new moon (mean of 0.4 per day for both). 1198 cases were diagnosed on “normal” days (mean 0.4 per day). The incidence of nephrolithiasis in peak and other lunar gravitational phases, the circannual variation and the gender-specific analysis showed no statistically significant differences. Conclusion. In this adequate powered longitudinal study, changes in tractive force during the different lunar phases did not influence the incidence of renal colic admissions in emergency department. 1. Introduction Kidney stone formation is usually due to environmental, metabolic, or genetic factors. A precise causative factor is not identified in most nephrolithiasis patients. A family history of kidney stones, insulin resistance, hypertension, obesity, low urine volume, and dietary habits is associated with an increased risk [1]. Stone disease also shows marked geographic variability, and the phenomenon of the “stone season” has been attributed to both increased environmental temperatures and sunlight levels [2]. The expected environmentally related increase in the prevalence of nephrolithiasis can cause a significant increase in renal colics admissions, with the corresponding strain on healthcare delivery and related costs [3]. Apart from this well-known risk factor, little is known about the impact of other potential triggers on nephrolithiasis, such as lunar gravitational forces. The lunar phases have been held responsible for affecting human health since antiquity. The effect of the lunar phases on human physiology is well documented, and relevant studies have shown an associated increase in seizures, deregulation of the cardiovascular system, aggressive behavior, changes in menstruation, and spontaneous full-term deliveries [4–8]. Studies
Personal experience with whole-body, low-dosage, digital X-ray scanning (LODOX-Statscan) in trauma
Dimitrios S Evangelopoulos, Simone Deyle, Heinz Zimmermann, Aristomenis K Exadaktylos
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2009, DOI: 10.1186/1757-7241-17-41
Abstract: We performed a PubMed search to retrieve all references with 'Lodox' and 'Stat-scan' used as search terms. We furthermore used the google search engine to identify existing alternatives. To the best of our knowledge, this is the only FDA-approved device of its kind currently used in trauma.The intention of our review has been to sensitize the readership that such alternative devices exist. The key message is that low dosage full body radiography may be an alternative to conventional resuscitation room radiography which is usually a prelude to CT scanning (ATLS algorithm). The combination of both is radiation intensive and therefore we consider any reduction of radiation a success. But only the future will show whether LS will survive in the face of low-dose radiation CT scanners and magnetic resonance imaging devices that may eventually completely replace conventional radiography.The Lodox-Statscan device (LS) was originally developed for the South African diamond-mining industry to perform low-dose, whole-body scans on mining workers. It has been almost ten years since the LS was first used for medical applications, as reported on by Beningfield in 1999 [1]. The device was approved by the Food and Drug Adminsitration (FDA) in the USA in 2002 for the radiographic examination of both trauma patients and standard emergency patients (Fig. 1). About 25 trauma centers worldwide have now incorporated this technology into their emergency management protocols [2].LS has also emerged as a useful diagnostic tool in other areas of medicine: recent publications have reported on the effective use of the device in pediatric trauma, pediatrics, neurosurgery, internal medicine, and even in forensic medicine. To the best of our knowledge, this is the only FDA-approved device of its kind currently used in emergency departments. A new full body low dosage 2D/3D scanner (EOS http://www.biospacemed.com webcite) has been recently introduced to the international market, but does not seem
Injuries, Sequelae, and Treatment of Lightning-Induced Injuries: 10 Years of Experience at a Swiss Trauma Center
Carmen A. Pfortmueller,Yang Yikun,Monika Haberkern,Erwin Wuest,Heinz Zimmermann,Aristomenis K. Exadaktylos
Emergency Medicine International , 2012, DOI: 10.1155/2012/167698
Abstract: Principals. Lightning is one of the most powerful and spectacular natural phenomena. Lightning strikes to humans are uncommon but can cause devastating injuries. We analyzed lightning-related admissions to our emergency department from January 2000 to December 2010 to review and highlight the main features of lightning-related injuries. Methods. All data were collected prospectively and entered in the emergency department’ database (Qualicare Switzerland) and retrospectively analyzed. Results. Nine patients with lightning-related injuries presented to our emergency department. Four were female, and five were male. The most common site of injury was the nervous system (6 out of 9 patients) followed by the cardiovascular system (5 out of 9 patients). The third most common injuries occurred to the skin (3 out of 9 patients). Four of the patients had to be hospitalized for further observation. Conclusion. Reports of lightning strikes and related injuries are scarce. The establishment of an international register would therefore benefit the understanding of their injury patterns and facilitate specific treatment. 1. Introduction Lightning is one of the most powerful and spectacular natural phenomena [1]. It is the transfer of electrical charges between clouds or between the ground and clouds and occurs when a difference in potential of 30,000?V or higher exceeds the inherent resistance of the air [2]. Lightning strikes the earth more than 8 million times per day [3]. It is the second leading cause of weather-related death after flooding [4–6]. The risk of being struck by lightning is dependent on regional, seasonal and temporal factors [5, 7–9]. Lightning injuries peak during the summer months throughout the world [5, 7]. Most lightning accidents occur outdoors [10]. People involved in golfing, fishing, swimming, boating, camping, or hiking are particularly at risk [10]. Reviews of lightning injuries have, however, found that one-third or more occur indoors [9, 11]. As an injury mechanism, it is postulated that if lightning strikes a house, for example, the electrical energy can be transmitted through plumbing fixtures such as sinks, showers, or toilets [11]. According to a review by Lederer et al., about 10% of lightning injures occur during transport in motor vehicles [2]. Men are generally at greater risk of suffering lightning strikes than women [2, 4, 10, 12]. In reviews, a male?:?female ratio of 5?:?1 was found [7, 11]. Lightning strikes in humans are an uncommon but potentially devastating cause of injury [5, 13, 14]. In contrast to other high-voltage
Do We Need New Personalized Emergency Telehealth Solutions? A Survey of 100 Emergency Department Patients and a First Report of the Swiss Limmex Emergency Wristwatch: An Original Study
Malek Tabbara,Thomas Hodel,Urs Müller,Gabi Briner,Heinz Zimmermann,Aristomenis K. Exadaktylos
International Journal of Telemedicine and Applications , 2012, DOI: 10.1155/2012/736264
Abstract: Development of new personal mobile and wireless devices for healthcare has become essential due to our aging population characterized by constant rise in chronic diseases that consequently require a complex treatment and close monitoring. Personal telehealth devices allow patients to adequately receive their appropriate treatment, followup with their doctors, and report any emergency without the need of the presence of any caregivers with them thus increasing their quality of life in a cost-effective fashion. This paper includes a brief overview of personal telehealth systems, a survey of 100 consecutive ED patients aged >65 years, and introduces “Limmex” a new GSM based technology packaged in a wristwatch. Limmex can by a push of a button initiate multiple emergency call and establish mobile communication between the patient and a preselected person, institution, or a search and rescue service. To the best of our knowledge, Limmex is the first of its kind worldwide. 1. Background Patients with complex comorbidities who receive traditional healthcare services fail to show long-term compliance with prescribed regimens, medications, and dietary restrictions [1]. It has been shown, however, that strategies that include extrinsic motivators promote long-term compliance and reduce recidivism [2]. As the population is aging, chronic disease requiring complex treatment and close monitoring is increasing. Moreover, the number of medical personnel is dropping and both homecare nursing and medical staff are expensive. It has therefore become necessary to search for ambitious alternative solutions, which could help the patient to receive adequate treatment and followup from their doctors and to report any emergency, even in the absence of any caregivers and without having to memorize or save emergency numbers, especially when the primary contact is not available. In an ongoing pilot study at our university hospital emergency department, 40% of interviewed patients (>65 years) were not able to recall emergency telephone numbers. Forty-two percent (42%) of them did not own a mobile phone. Thirty-three percent (33%) thought that, in an emergency, more than one hour might pass until somebody noticed. Thirty-seven patients (37%) thought that up to 30 minutes might pass before anyone was notified of their emergency. Almost 40% of the patients communicated their wish to have faster access to medical assistance. Telemedicine and telehealth, especially personalized handheld devices, can offer a new approach to these problems. Telemedicine (TM) is the use of medical
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