Search

Abstract The paper gives a view on perspectives for metal forming processes rising due to the industry 4.0 discussion and its consequences. The discussion starts with a view at aims pursued by introducing 4.0 into metal forming. From the results of this the needed data and required sensors are discussed as well as the potential of their introduction into current processes. At this point the processes in metal forming and their respective demands have to be taken into account as well. From here the step to the specific challenges, e.g. originating from the machine tools at hand, can be elaborated on. [ABSTRACT FROM AUTHOR]

Abstract: The main aim of this study was to investigate the influence of perioperative anticoagulation on the clinical course and outcome of 144 patients who underwent surgery for chronic subdural hematoma (CSDH). The outcome was categorized according to the modified Rankin Scale (mRS), Barthel Index and postoperative quality of life (QoL) scale. There was a significant correlation between preoperative aspirin medication and reoperation (Mann–Whitney U-test, p <0.05). Moreover, dosage and duration of postoperative low-molecular-weight heparin (LMWH) administration were associated with a higher risk of reoperation (Mann–Whitney U-test, p <0.01) and a worse outcome on the mRS (Mann–Whitney U-test, p <0.05). Intraoperative treatment with prothrombin complex concentrate led to a poor outcome on the mRS (Craddock-Flood test, p <0.05). Reoperation is the strongest predictive factor of a poor QoL after surgical treatment of CSDH. Both preoperative and postoperative anticoagulation treatment may affect reoperation rate and, thus, postoperative QoL. [Copyright &y& Elsevier]

Overall Abstract This session, sponsored by the Public Policy Committee, will provide updates on recent federal and state mental health legislation and policy issues and will feature Public Policy Committee members who have been engaged advocates for geriatric mental health. Presenters from our advocacy partners in the APA Department of Government Relations will review the key current issues in aging and mental health policy, with specific focus on current federal and state health care legislation that may have impact on our patients and our practice. Dr. Scharrer will highlight opportunities and challenges in addressing disparities faced by older adults with substance use disorders. Dr. Joshi will present on policies aimed at reducing COVID-related risks for older adults with dementia and in long term care. Dr. Greenstein will briefly highlight the emerging role of geriatric psychiatry in value-based care models. [ABSTRACT FROM AUTHOR]

Background: The development of newer-generation endografts for the endovascular treatment of abdominal aortic aneurysms has resulted in considerable improvements in clinical performance. However, long-term outcome data are still scarce. To assess long-term clinical and radiographic outcomes after use of the Talent stent graft, a retrospective analysis was performed that was based on 165 patients treated with this endograft in Germany between October 1996 and December 1998. Methods: Data were collected according to the recommendation of the ad hoc committee for standardized reporting practices in vascular surgery and were evaluated statistically by using univariate and multivariate analyses. Results: A total of 165 patients were treated with a Talent endograft in 9 German centers before December 31, 1998. Most were asymptomatic (94.5%), male (97.6%), and treated with a bifurcated graft (86.7%). Two patients (1.2%) died within 30 days, and 28 (17%) died during the follow-up period. The cause of death was aneurysm rupture in one case. Survival was 95.4% ± 1.7% at 1 year, 89% ± 2.6% at 2 years, 78.1% ± 3.6% at 5 years, and 76.2% ± 4.1% at 7 years. Patients classified as American Society of Anesthesiologists grade IV had a significantly lower survival rate (24.9%) than those classified as American Society of Anesthesiologists grade II and III (91.9% and 77.3%). During a mean follow-up period of 53.2 ± 20.1 months (range, 1-84 months), 47 secondary procedures were performed in 31 patients (18.8%). Kaplan-Meier estimates showed a freedom from secondary intervention of 94.7% ± 1.8%, 81.7% ± 3.3%, and 77.4% ± 3.6% at 1, 3, and 7 years, respectively. The reason for secondary treatment was endograft thrombosis in 10 patients (6.1%), persisting primary endoleak in 9 (5.5%), late secondary endoleak in 6 (3.6%), graft migration in 3 (1.8%), aneurysm rupture in 2 (1.2%), and graft infection in 1 (0.6%). Device migration (≥10 mm) occurred in seven patients (4.2%). Other graft changes, such as graft kinking (n = 4; 2.4%), fracture of metallic stents (n = 2; 1.2%), erosion of the longitudinal bar (n = 2; 1.2%), or modular component separation (n = 1; 0.6%), were rare. Follow-up computed tomographic imaging revealed a decrease of the maximum aneurysm sac diameter (>5 mm) in 106 (64.2%) patients and an increase in 14 (8.5%) patients. The mean aneurysm diameter significantly decreased (P<.001). Of the factors recorded at baseline, only endoleaks showed a significant correlation with the risk of aneurysm increase during follow-up (P<.001). Adverse anatomy (neck diameter >28 mm, neck length <15 mm, and ’5 patent aortic branches) did not adversely influence the aneurysm shrinkage rate, the risk for a secondary procedure, or the clinical success rate. A significantly higher rate of clinical success (P < .05) was observed in patients older than 65 years of age. Conclusions: Implantation of the Talent endograft device is a safe and effective alternative to open surgery for exclusion of abdominal aortic aneurysm. In comparison with first-generation grafts, the device showed superior durability for as long as 5 to 7 years after implantation. Even if prototypes of the Talent device were implanted in this study, the graft was also successfully used in most patients, even in those with adverse anatomy. Because improvements of the endograft have been made to address connecting bar breaks, a lower incidence of graft limb occlusion can be expected in the future. [Copyright &y& Elsevier]

Introduction In the wake of the Vietnam war and Cambodian genocide, approximately 5,000 Hmong and 3,000 Cambodians have settled in the Madison area. A high percentage of these individuals live with severe health problems, such as depression, post- traumatic stress disorder, and chronic pain that were caused by their war and refugee experiences. The Hmong and Cambodian communities, through collaboration with local mental health agencies, academic centers for higher learning, refugee services, and local and federal government agencies, have developed a culturally-driven model of mental health care for Southeast Asian refugees. Methods In Hmong, the word "Kaj Siab" describes the relief of stress and the freedom from worrying about the safety of loved ones. Transitioning from village to western city, many elders found themselves physically, culturally, and linguistically isolated. Leaders from the Hmong and Cambodian community partnered with mental health professionals, starting in 1989. The design and building of the programs took place with groups at community locations and in home visits. Kajsiab was the idea of creating space where elders can be together and receive care for mental health issues. The community identified goals of engagement and socialization of community elders in a supportive environment. In 1995, the Cambodian community built a Buddhist temple, which facilitates community engagement in the Khmer heritage, including the care-taking of a Buddhist monk, the offering of devotion to ancestors, and the chance to meet with other Khmer speakers. In conjunction with traditional Buddhist teachings and meditation, on-site psychologists offer a culturally-driven model of cognitive behavioral therapy for Post Traumatic Stress Disorder, integrated with the daily rhythms of the temple. Psychiatric services are also available to participants. In 2000 Kajsiab was able to find a physical home with on-site gardens. The Southeast Asian project has developed innovative and collaborative models of healthcare. Both programs include a shared meal, which is prepared by community members in a traditional style. Participants can grow food and harvest seasonal vegetables in community gardens. Other services which have been offered include physical Therapy with Tai Chi movements, adapted to cultural movements familiar to traditional village life, such as grinding or harvesting rice. The Hmong Shaman provide traditional healing practices, such as soul-calling. Traditional massage or acupuncture has been made available and may be utilized in collaboration with western treatment recommendations. Traditional herbal medicine treatments are not discouraged and when used are taken into consideration if prescribing western medication. The women's groups provide a safe place in which to disclose sensitive concerns of substance use or domestic violence. When warranted, an intervention may involve the clan or community leadership. If necessary, clients are connected with mainstream social services for support. On-call mental health crisis intervention services are handled by case managers who are linguistically and culturally fluent. Psychiatrists are familiar with cultural idioms of anxiety, PTSD, or depression. Clients may be asked if they have experienced loss of soul, wind, thinking too much, or interaction with the spirit realm. Case managers provide social support, culture brokering and translation services for medical appointments, citizenship application, drivers licensing, and social services applications. The community centers have invited public health interventions such as flu shot clinics and blood pressure screening checks. Several intergenerational projects have supported cultural and familial ties for Hmong and Cambodian youth. The Teen Village model identified at-risk youth in middle and high schools for increased community and peer support in a traditional cultural framework. Art therapy and cultural dance have also utilized traditional forms of expression to facilitate healing and connect participants to deeper cultural values. Results For many reasons, Hmong and Cambodian communities experience mental health concerns, poverty, and isolation at higher rates than the general population. Consequently, both populations are at increased risk for hospitalization and suicide. Additionally, linguistic and cultural barriers limit access to healthcare resources, especially in the traditional western medical clinic model. Since 1985 there have been no suicides and no mental health hospitalizations. With a lack of control group, it is difficult to quantify the true effects of culture brokering during medical healthcare appointments and preventative psychiatric, medical, and social interventions at the clinic. However, it appears that these outcomes do separate from national trends in other Hmong and Cambodian communities. Primary care providers and case managers have stated that they value the services of the Southeast Asian Project, which cannot be replicated in the current HMO and insurance delivery models. Conclusions A community member may have summed the model up best: ""Being able to be with each other is a treatment". Community mental health care provides a unique opportunity to creatively partner with cultural communities overcoming traditional barriers in getting mental and physical healthcare needs met. Culturally Driven care begins in the community with the community definition of needs, goals, practices. When mental health care providers bring in scientifically verified processes or programs and adapt them to fit the clients' culture, the result is delivery of culturally competent care and healing in the community setting. This research was funded by No funding sources for this poster presentation. The Southeast Asian Project was initially, in part, funded by a SAMSHA grant. [ABSTRACT FROM AUTHOR]

Background: Postmortem confirmation of prenatally diagnosed congenital heart disease after termination of pregnancy and evaluation of potential cardiac defects after spontaneous fetal or neonatal death are essential. Conventional autopsy rates are decreasing, and 1.5Tesla magnetic resonance imaging has demonstrated limited diagnostic accuracy for postmortem cardiovascular assessment.Objective: This study aimed to evaluate the feasibility and image quality of cardiac 3Tesla postmortem magnetic resonance imaging and to assess its diagnostic accuracy in detecting fetal heart defects compared with conventional autopsy. Secondarily, the study aimed to explore whether clinical factors affect the quality of 3Tesla postmortem magnetic resonance imaging.Study Design: A total of 222 consecutive fetuses between 12 and 41 weeks' gestation, who underwent 3Tesla postmortem magnetic resonance imaging and conventional autopsy after spontaneous death or termination of pregnancy for fetal malformations, were included. First, 3Tesla postmortem magnetic resonance imaging of each fetus was rated as diagnostic or nondiagnostic for fetal cardiac assessment by 2 independent raters. The image quality of individual cardiac structures was then further evaluated by visual grading analysis. Finally, the presence or absence of a congenital heart defect was assessed by 2 radiologists and compared with autopsy results.Results: Overall, 87.8% of 3Tesla postmortem magnetic resonance imaging examinations were rated as diagnostic for the fetal heart. Diagnostic imaging rates of individual cardiac structures at 3Tesla postmortem magnetic resonance imaging ranged from 85.1% (atrioventricular valves) to 94.6% (pericardium), with an interrater agreement of 0.82 (0.78-0.86). Diagnostic imaging of the fetal aortic arch and the systemic veins at 3Tesla postmortem magnetic resonance imaging was possible from 12+5 weeks' gestation onward in 90.1% and 92.3% of cases, respectively. A total of 55 fetuses (24.8%) had at least 1 cardiac anomaly according to autopsy, 164 (73.9%) had a normal heart, and in 3 fetuses (1.4%), autopsy was nondiagnostic for the heart. Considering all examinations rated as diagnostic, 3Tesla postmortem magnetic resonance imaging provided high diagnostic accuracy for the detection of fetal congenital heart defects with a sensitivity of 87.8%, a specificity of 97.9%, and concordance with autopsy of 95.3%. 3Tesla postmortem magnetic resonance imaging was less accurate in young fetuses (<20 weeks compared with ≥20 weeks; P<.001), in fetuses with low birthweight (≤100 g compared with >100 g; P<.001), in cases after spontaneous fetal death (compared with other modes of death; P=.012), in cases with increasing latency between death and 3Tesla postmortem magnetic resonance imaging (P<.001), and in cases in which there was a high degree of maceration (maceration score of 3 compared with a score from 0 to 2; P=.004).Conclusion: Diagnostic 3Tesla postmortem magnetic resonance imaging assessment of the fetal heart is feasible in most fetuses from 12 weeks' gestation onward. In diagnostic images, sensitivity and, particularly, specificity in the detection of congenital heart disease are high compared with conventional autopsy. Owing to its high diagnostic accuracy, we suggest that 3Tesla postmortem magnetic resonance imaging may serve as a suitable imaging modality with which to direct a targeted conventional autopsy when pathology resources are limited or to provide a virtual autopsy when full autopsy is declined by the parents. [ABSTRACT FROM AUTHOR]

This session, sponsored by the Public Policy Caucus, will provide updates on recent federal and state mental health legislation and policy issues and will feature Public Policy Caucus members who have been engaged advocates for geriatric mental health over this past year. Presenters from our advocacy partners in the APA Department of Government Relations will review the key current issues in aging and mental health policy, with specific focus on current federal and state health care legislation that may have impact on our patients and our practice. Presenters will review their advocacy work this past year, which highlight ways in which AAGP members can be involved in: being engaged at the community and state level; representing AAGP in the AMA House of Delegates; and working on Capitol Hill. [ABSTRACT FROM AUTHOR]

In this session, we will discuss substance use disorders among older adults. We will start with Dr. Radue covering the epidemiology, recognition, screening, and diagnosis of these disorders. She will describe the most current evidence-based recommendations for screening tools to identify substance use problems among older adults. Dr. Scharrer will then cover opioid use disorders treatment in older adults, including unique challenges of utilizing medication-assisted therapies (MAT) in this population and across living and care transitions. Dr. Tumba will provide an overview of alcohol use disorders within the geriatric population, specifically focusing on evidenced-based recommendations pertaining to withdrawal management, behavioral management, and long-term medication and non-medication treatment. Dr. Tumba will also discuss alcohol-related dementias, and the unique challenges presented by behavioral and psychological symptoms of these dementias, as well as provide management recommendation. We will finish with Dr. Bessey leading a discussion on what we have covered, with ample time for active questions and engagement from the audience [ABSTRACT FROM AUTHOR]

Abstract Geriatric psychiatrists and other geriatric mental health providers face several competing demands for their attention and time. Numerous scientific advances in this growing field are published each year. Providers are expected to engage in lifelong learning and to practice evidence-based medicine. This session will provide busy geriatric psychiatrists and mental health providers a highlighted overview of several of the most relevant updates pertaining to the clinical practice of geriatric psychiatry that have been published from the year 2018. We hope that after attending this session, the audience will find the information presented useful for their clinical practice and can disseminate these updates to their colleagues. This will promote efficient learning, application of acquired knowledge to clinical practice, and help busy providers who also serve as experts in geriatric psychiatry to disseminate knowledge about up-to-date advances to their colleagues back home. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVE: Anterior ST-segment elevation myocardial infarction (STEMI) can be difficult to differentiate from early repolarization on the ECG. We hypothesize that, in addition to ST-segment elevation, T-wave amplitude to R-wave amplitude ratio (T-wave amplitude(avg)/R-wave amplitude(avg)), and R-wave amplitude in leads V2 to V4, computerized corrected QT interval (QTc) and upward concavity would help to differentiate the 2. We seek to determine which ECG measurements best distinguish STEMI versus early repolarization. METHODS: This was a retrospective study of patients with anterior STEMI (2003 to 2009) and early repolarization (2003 to 2005) at 2 urban hospitals, one of which (Minneapolis Heart Institute) receives 500 STEMI patients per year. We compared the ECGs of nonobvious ('subtle') anterior STEMI with emergency department noncardiac chest pain patients with early repolarization. ST-segment elevation at the J point and 60 ms after the J point, T-wave amplitude, R-wave amplitude, QTc, upward concavity, J-wave notching, and T waves in V1 and V6 were measured. Multivariate logistic regression modeling was used to identify ECG measurements independently predictive of STEMI versus early repolarization in a derivation group and was subsequently validated in a separate group. RESULTS: Of 355 anterior STEMIs identified, 143 were nonobvious, or subtle, compared with 171 early repolarization ECGs. ST-segment elevation was greater, R-wave amplitude lower, and T-wave amplitude(avg)/R-wave amplitude(avg) higher in leads V2 to V4 with STEMI versus early repolarization. Computerized QTc was also significantly longer with STEMI versus early repolarization. T-wave amplitude did not differ significantly between the groups, such that the T-wave amplitude(avg)/R-wave amplitude(avg) difference was entirely due to the difference in R-wave amplitude. An ECG criterion based on 3 measurements (R-wave amplitude in lead V4, ST-segment elevation 60 ms after J-point in lead V3, and QTc) was derived and validated for differentiating STEMI versus early repolarization, such that if the value of the equation ([1.196 x ST-segment elevation 60 ms after the J point in lead V3 in mm]+[0.059 x QTc in ms]-[0.326 x R-wave amplitude in lead V4 in mm]) is greater than 23.4 predicted STEMI and if less than or equal to 23.4, it predicted early repolarization in both groups, with overall sensitivity, specificity, and accuracy of 86% (95% confidence interval [CI] 79, 91), 91% (95% CI 85, 95), and 88% (95% CI 84, 92), respectively, with positive likelihood ratio 9.2 (95% CI 8.5 to 10) and negative likelihood ratio 0.1 (95% CI 0.08 to 0.3). Upward concavity, upright T wave in V1 or T wave, in V1 greater than T wave in V6, and J-wave notching did not provide important information. CONCLUSION: R-wave amplitude is lower, ST-segment elevation greater, and QTc longer for subtle anterior STEMI versus early repolarization. In combination with other clinical data, this derived and validated ECG equation could be an important adjunct in the diagnosis of anterior STEMI. [ABSTRACT FROM AUTHOR]