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Search Results: 1 - 10 of 148 matches for " Ostermann "
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Acute kidney injury on admission to the intensive care unit: where to go from here?
Marlies Ostermann
Critical Care , 2008, DOI: 10.1186/cc7096
Abstract: Acute kidney injury (AKI) has been the focus of numerous publications and research projects in the past 5 years [1-4], including the study by Kolhe and colleagues [1] in Critical Care. Interestingly, as facts about AKI and its impact on prognosis emerged, areas of uncertainty and controversy became apparent [5,6]. It is now well known that AKI affects a large number of patients (although the exact incidence is variable), that AKI per se is associated with an increased risk of death, and that patients who need renal replacement therapy (RRT) have a higher risk of dying [2-4,7,8]. There is also evidence that AKI is a dynamic process, with many patients progressing through different stages of severity, and that early AKI appears to have a better prognosis than late AKI [7]. Numerous studies have identified factors that influence the prognosis of patients with AKI, including inherent patient characteristics as well as modifiable factors (ie, nephrotoxic drugs, fluid status, haemodynamics) and non-patient related aspects like size of ICU and type of hospital [2-4].Despite this progress, several areas in the field of AKI remain uncertain, the issue of RRT being a particularly controversial one [5]. There is wide variation in clinical practice regarding mode, indication, timing, dose and provision of RRT [9]. Despite a widely held perception that a continuous mode may be better for critically ill patients with AKI, especially those with haemodynamic instability, clinical studies have failed to show a consistent survival advantage for patients on continuous RRT compared to intermittent haemodialysis [10]. The Hemodiafe Study (randomized controlled trial comparing intermittent haemodialysis with continuous haemodiafiltration in 21 centres in France) not only showed similar mortality rates in both groups but also confirmed that nearly all patients with AKI as part of multiple-organ dysfunction syndrome could be treated with intermittent haemodialysis provided strict guideline
A Strange Detail Concerning the Variational Principle of General Relativity Theory
Peter Ostermann
Physics , 2004,
Abstract: A mathematical complication due to an unnecessary formal assumption concerning the variational principle of general relativity theory, which apparently bothered Einstein and Hilbert, is shown and cleared up. Some historical confusion seems caused by the impossibility to use the conventional Euler-Lagrange formalism directly there, which even otherwise is nothing but one of various possible procedures to apply the superior principle of least action. Correspondingly to the absence of any direct calculation in the literature so far, only a numerical modification in parts - explicitly taken into account now after once mentioned by Hilbert without implementation - would allow to compute the fundamental Einstein tensor density from these authors' initial formulae, which must not be taken literally. Nevertheless adhering to a merely symbolic Euler-Lagrange formalism, this needs a clear distinction between 'component differentiation' and 'tensor differentiation' defined here. Various corresponding solutions are shown including the probably most natural one. Two of them are additionally verified in the detailed supplementary material appended to the electronic edition of the note.
Relativity Theory and a Real Pioneer Effect
Peter Ostermann
Physics , 2002,
Abstract: Keeping the relativistic laws of motion a non-conventional Pioneer effect would prove an increase of the scale rate of atomic clocks in comparison with planetary ones. Together with a slowly decreasing amount of about 60% due to anisotropic radiation this would be a thinkable explanation for an apparent anomalous acceleration of the Pioneer 10/11 probes. Such a difference between atomic time and ephemeris time, however, (coincidentally corresponding to that of atomic time and cosmic time as derived from any cosmological model of general relativity, where the cosmic 'coordinate' speed of light is fixed to be c* = c) is ruled out by solar system's observational facts. Thus a non-conventional Pioneer effect would inevitably contradict relativity theory.
The One-Way Speed of Light on Rotating Earth and the Definition of the Meter
Peter Ostermann
Physics , 2002,
Abstract: Since 1983 the meter is defined to be the "length of the path travelled by light in vacuum during a time interval of 1/299792458 of a second". If there was exactly one single consistent method of synchronizing clocks, or if all corresponding methods were equivalent, one could infer from the validity of special relativity theory on a definite value of the one-way speed of light c in inertial frames. It is true that sufficiently slowly separated clocks always show middle in time reflection when sending and receiving light signals. But a simple consideration proves that the one-way speed of light is not a constant in rotating systems, in principle detectable with only one clock. On basis of a new internal synchronization method, this also affects all local inertial frames on rotating Earth, too, violating an absolute constancy of the one-way speed of light. This is not a contradiction to Einstein's original theory of relativity but to the present definition of the meter. Based on the constant local average value c of light going there and back, however, a modification for the definition of the meter is suggested, which would not depend on synchronization of any distant clocks. Appendix: FitzGerald-Lorentz contraction and time dilation, according to Einstein's generally accepted understanding, should be purely kinematic effects and would not need any dynamic explanation. But an analysis of Ehrenfest's paradox of the rotating disk shows that it is not possible to separate exactly relativistic kinematics from dynamics. The necessity of such a fundamental restriction is well known for a long time - though only from quantum mechanics till now.
The Concordance Model - a Heuristic Approach from a Stationary Universe
Peter Ostermann
Physics , 2003,
Abstract: Given there has been something where a big-bang origin of our evolutionary cosmos took place: What is the relativistic line element describing the energy density and pressure of such a pre-existing universal background? The simplest conceivable ansatz leads to a Stationary-Universe Model (SUM), which instead of the 'Steady-state Theory' is shown to be an arguable alternative to the Cosmological Concordance Model (CCM) commonly accepted today. The SUM stands out with redshift values statistically independent of time; a significant Hubble parameter is proved in contrast to the conventional one. It requires a negative gravitational 'dark' pressure of -1/3 the critical density. Intrinsic limitations of proper length and time are derived, which cause a struggle of local SRT (quantum mechanics) and universal GRT (gravitation). Using one macroscopic constant H in addition to c and G only, the model describes a background free of coincidences or horizon problems. While the CCM's key parameter Omega_Lambda seems determined by SUM 'boundary' conditions, there is a chance of having already observed parts of a stationary universe: With no need for 'dark energy', this alternative explains straightforwardly the SNe-Ia data on universal scales. In addition to its currently assumed parts, a non-lensing homogeneous background of matter might fill the gap to critical density. A mathematical solution for a perfect black-body spectrum composed of redshifted microwave radiation emitted from 'dark' sources within the universe is derived; thus the CMB might exist as a special part of the extragalactic background light. Given the law of entropy restricted to evolutionary processes, an open concept is revealed to imply a 'chaotic' quasi-inflation background, embedding 'local-bang' cosmoses therein. - The SUM is shown to be the only arguable solution of Einstein's original equations without cosmological constant.
A Stationary Universe and the Basics of Relativity Theory
Peter Ostermann
Physics , 2002,
Abstract: A stationary line element of general relativity seems to be compatible to essential cosmological facts (though only as far as one can expect solving the nonlinear Einstein equations neglecting local cosmic evolution and all spatial inhomogeneities as well). There is a preferred spatially Euclidean cosmic reference frame where the extra-galactic speed of light is constant c* = c, and the galaxies are statistically at rest. Spectral rods and atomic clocks, however, do not indicate this cosmic space and this cosmic time. The solutions put up here for discussion are suitable to avoid serious difficulties in physics such as a beginning of the universe as a whole or the necessity of continuous creation of matter or an empty universe with a cosmological constant but no matter at all. Especially from the stationary line element, it follows a negative cosmic gravitational pressure of one third the critical energy density. In addition, there is an average baryonic radiation density equivalent to a black body radiation of approximately 3 K. The resulting increase of the time rate of natural clocks in comparison with cosmic time is a simple explanation for the redshift of starlight. This redshift turns out to be independent of time, thus indicating a stationary universe.
Care of the Critically Ill Emergency Department Patient with Acute Kidney Injury
Jennifer Joslin,Marlies Ostermann
Emergency Medicine International , 2012, DOI: 10.1155/2012/760623
Abstract: Introduction. Acute Kidney Injury (AKI) is common and associated with significant mortality and complications. Exact data on the epidemiology of AKI in the Emergency Department (ED) are sparse. This review aims to summarise the key principles for managing AKI patients in the ED. Principal Findings. Timely resuscitation, goal-directed correction of fluid depletion and hypotension, and appropriate management of the underlying illness are essential in preventing or limiting AKI. There is no specific curative therapy for AKI. Key principles of secondary prevention are identification of patients with early AKI, discontinuation of nephrotoxic medication where possible, attention to fluid resuscitation, and awareness of the risks of contrast-induced nephropathy. In patients with advanced AKI, arrangements for renal replacement therapy need to be made before the onset of life-threatening uraemic complications. Conclusions. Research and guidelines regarding AKI in the ED are lacking and AKI practice from critical care departments should be adopted. 1. Introduction Acute kidney injury (AKI) is common in hospitalised patients, especially in those who are critically ill [1, 2]. The Kidney Disease Improving Global Outcomes (KDIGO) working group estimates a worldwide AKI prevalence of ~2100 people per million population [3]. There is increasing recognition that even a minor acute reduction in renal function is independently associated with a poor outcome, including higher risk of complications, longer stay in hospital, high mortality, and increased risk of needing long-term dialysis [4–9]. Although there is no curative therapy for AKI, research over the past decade has identified various means to prevent or limit AKI. Unfortunately, these are not widely known and are variably practised worldwide resulting in lost opportunities to improve the care and outcomes of patients with AKI. Importantly, there is no unifying approach to the care of these patients. There is a worldwide need to recognise patients at risk of AKI, to intervene early, and to circumvent the need for renal replacement therapy (RRT). Although a large proportion of patients presenting to the Emergency Department (ED) either have AKI or develop AKI later in hospital, the literature regarding epidemiology and management of such patients in the ED setting is lacking. In the UK, the recent National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) report found that AKI is often underrecognised and poorly managed. The report made a strong call for better education and training [10]. To our best
Home-based music therapy - a systematic overview of settings and conditions for an innovative service in healthcare
Wolfgang Schmid, Thomas Ostermann
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-291
Abstract: The following databases were used to find articles on home-based music therapy: AMED, CAIRSS, EMBASE, MEDLINE, PsychINFO, and PSYNDEX. The search terms were "home-based music therapy" and "mobile music therapy". Included articles were analyzed with respect to participants as well as conditions and settings of HBMT. Furthermore, the date of publication, main outcomes, and the design and quality of the studies were investigated.A total of 20 international publications, 11 clinical studies and nine reports from practice, mainly from the United States (n = 8), were finally included in the qualitative synthesis. Six studies had a randomized controlled design and included a total of 507 patients. The vast majority of clients of HBMT are elderly patients living at home and people who need hospice and palliative care. Although settings were heterogeneous, music listening programs played a predominant role with the aim to reduce symptoms like depression and pain, or to improve quality of life and the relationship between patients and caregivers as primary endpoints.We were able to show that HBMT is an innovative service for future healthcare delivery. It fits with the changing healthcare system and its conditions but also meets the therapeutic needs of the increasing number of elderly and severely impaired people. Apart from music therapists, patients and their families HBMT is also interesting as a blueprint for home based care for other groups of caregivers.The use of music as a therapeutic option to support health dates back to ancient times. According to Bailey [1] some of the earliest notable mentions in Western history are found in the writings of ancient Greek philosophers Aristotle and Plato. In contemporary history, Michigan State University offered the first music therapy degree program worldwide in 1944. From that point, music therapy has established itself as a growing health profession for inpatients treatment of psychiatric diseases like schizophrenia or schizo
THE EFFECT OF WELLNESS BRAND AWARENESS ON EXPECTED AND PERCEIVED SERVICE QUALITY
Gerhard Bertsch,Herwig Ostermann
Tourismos : an International Multidisciplinary Journal of Tourism , 2011,
Abstract: Enterprises in the tourism sector are being exposed to ever fiercer national and international competition and are confronted with difficulties in market positioning. One possibility for achieving differentiation on the market is high service quality and the creation of strong wellness brands. The aim of the present work is to investigate whether brands suggest a promise of quality that also appears to be especially important in wellness tourism. In this connection the study ascertains whether the brand awareness of wellness guests influences the perception of quality. The study also investigates whether demographic differences exist between brand aware and non-brand aware wellness guests. The results show that brands of wellness cluster are relatively weakly anchored in people's minds. There are demographic differences between brand aware and non-brand aware wellness guests. The existence of brand awareness raises the expected quality but not the perceived quality.
Automatisierte VHDL-Code-Generierung eines Delta-Sigma Modulators
R. Spilka,T. Ostermann
Advances in Radio Science : Kleinheubacher Berichte , 2006,
Abstract: Im vorliegenden Beitrag wird eine automatische Generierung des VHDL-Codes eines Delta-Sigma Modulators pr sentiert. Die Koeffizientenmultiplikation wird hierbei durch Bit-Serielle-Addition durchgeführt. Mit Hilfe zweier neuer Matlab Funktionen wird der Systementwurf durch die bekannte Delta-Sigma Toolbox von R. Schreier erweitert und direkt synthesef higer VHDL Code erzeugt.
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