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Background: The current diagnostic workup for chronic dizziness in elderly patients often neglects neuropsychological assessment, thus missing a relevant proportion of patients, who perceive dizziness as a subjective chief complaint of a concomitant cognitive impairment. This study aimed to establish risk prediction models for cognitive impairment in chronic dizzy patients based on data sources routinely collected in a dizziness center. Methods: One hundred patients (age: 74.7 ± 7.1 years, 41.0% women) with chronic dizziness were prospectively characterized by (1) neuro-otological testing, (2) quantitative gait assessment, (3) graduation of focal brain atrophy and white matter lesion load, and (4) cognitive screening (MoCA). A linear regression model was trained to predict patients' total MoCA score based on 16 clinical features derived from demographics, vestibular testing, gait analysis, and imaging scales. Additionally, we trained a binary logistic regression model on the same data sources to identify those patients with a cognitive impairment (i.e., MoCA < 25). Results: The linear regression model explained almost half of the variance of patients' total MoCA score (R2 = 0.49; mean absolute error: 1.7). The most important risk-predictors of cognitive impairment were age (β = − 0.75), pathological Romberg's sign (β = − 1.05), normal caloric test results (β = − 0.8), slower timed-up-and-go test (β = − 0.67), frontal (β = − 0.6) and temporal (β = − 0.54) brain atrophy. The binary classification yielded an area under the curve of 0.84 (95% CI 0.70–0.98) in distinguishing between cognitively normal and impaired patients. Conclusions: The need for cognitive testing in patients with chronic dizziness can be efficiently approximated by available data sources from routine diagnostic workup in a dizziness center. [ABSTRACT FROM AUTHOR]

Introduction: Primary orthostatic tremor (OT) is characterized by high-frequency lower limb muscle contractions and a disabling sense of unsteadiness while standing. To date, therapeutic options for OT are limited. Here, we examined the effects of proprioceptive leg muscle stimulation via muscle tendon vibration (MTV) on tremor and balance control in patients with primary OT.Methods: Tremor in nine patients with primary OT was examined during four conditions: standing (1), standing with MTV on the bilateral soleus muscles (2), lying (3), and lying with MTV (4). Tremor characteristics were assessed by frequency domain analysis of surface EMG recordings from four leg muscles. Body sway was analyzed using posturographic recordings.Results: During standing, all patients showed a coherent high-frequency tremor in leg muscles and body sway that was absent during lying (p < 0.001). MTV during standing did not reset tremor frequency, but resulted in a decreased tremor intensity (p < 0.001; mean reduction: 32.5 ± 7.1%) and body sway (p = 0.032; mean reduction: 37.2 ± 6.8%). MTV did not affect muscle activity during lying. Four patients further reported a noticeable relief from unsteadiness during stimulation.Conclusion: Proprioceptive stimulation did not reset tremor frequency consistent with the presumed central origin of OT. However, continuous MTV influenced the emergence of OT symptoms resulting in reduced tremor intensity, improved posture, and a relief from unsteadiness in half of the examined patients. These findings indicate that MTV either directly interferes with the peripheral manifestation of the central oscillatory pattern or prevents proprioceptive afferent feedback from becoming extensively synchronized at the tremor frequency. [ABSTRACT FROM AUTHOR]

The repair and maintenance of components in the aerospace industry play an increasingly important role due to rising manufacturing costs. Besides welding, vacuum brazing is a well-established repair process for turbine blades made of nickel-based alloys. After the coating of the worn turbine blade has been removed, the manual application of the nickel-based filler metal follows. Subsequently, the hot gas corrosion-protective coating is applied by thermal spraying. The brazed turbine blade is aluminized to increase the hot gas corrosion resistance. The thermal spray technology is used to develop a two-stage hybrid technology that allows shortening the process chain for repair brazing turbine blades and is described in the present paper. In the first step, the coating is applied on the base material. Specifically, the coating system employed here is a layer system consisting of nickel filler metal, NiCoCrAlY and aluminum. The second step represents the combination of brazing and aluminizing of the coating system which is subjected to a heat treatment. The microstructure, which results from the combined brazing and aluminizing process, is characterized and the relevant diffusion processes in the coating system are illustrated. The properties of the coating and the ramifications with respect to actual applications will be discussed. [ABSTRACT FROM AUTHOR]

Vertigo and dizziness are among the most common chief complaints in the emergency department. Etiologies can be categorized into three subgroups: neurootological (vestibular), medical (especially cardiovascular, metabolic), and psychiatric disorders. The diagnostic approach in the emergency department is based on a systematic analysis of case history (type, time course of symptoms, modulating factors, associated symptoms), clinical examination of the vestibular, ocular motor, and cerebellar systems (head impulse test, nystagmus, skew deviation, positioning maneuver, test of gait and stance), as well as a basal monitoring (vital signs, 12-lead ECG, blood tests). For differentiation of peripheral and central etiologies in acute vestibular syndrome, the HINTS exam (head impulse test, nystagmus, test of skew) and examination of smooth pursuit and saccades should be applied. Nonselective use of neuroimaging is not indicated due to a low diagnostic yield. Cranial imaging should be done in the following constellations: (1) detection of focal neurological or central ocular motor and vestibular signs on clinical exam, (2) acute abasia with only minor ocular motor signs, (3) presence of various cardiovascular risk factors, (4) headache of unknown quality as an accompanying symptom. Besides the symptomatic therapy of vertigo and dizziness with antiemetics or analgesics, further diagnostic differentiation is urgent to guide proper treatment. Examples are the acute therapy in cerebral ischemia, the execution of positioning maneuvers in benign paroxysmal positional vertigo, the use of corticosteroids in acute unilateral vestibulopathy, as well as the readjustment of metabolic homeostasis in medical disorders. [ABSTRACT FROM AUTHOR]

Particle in-flight characteristics in atmospheric plasma spraying process are determined by impulse and heat energy transferred between the plasma jet and injected powder particles. One of the important factors for the quality of the plasma-sprayed coatings is thus the distribution of plasma gas temperatures and velocities in plasma jet. Plasma jets generated by conventional single-arc plasma spraying systems and their interaction with powder particles were subject matter of intensive research. However, this does not apply to plasma jets generated by means of multi-arc plasma spraying systems yet. In this study, a numerical model has been developed which is designated to dealing with the flow characteristics of the plasma jet generated by means of a three-cathode spraying system. The upstream flow conditions, which were calculated using a priori conducted plasma generator simulations, have been coupled to the plasma jet simulations. The significances of the relevant numerical assumptions and aspects of the models are analyzed. The focus is placed on to the turbulence and diffusion/demixing modelling. A critical evaluation of the prediction power of the models is conducted by comparing the numerical results to the experimental results determined by means of emission spectroscopic computed tomography. It is evident that the numerical models exhibit a good accuracy for their intended use. [ABSTRACT FROM AUTHOR]

The optimum and efficient way of machining is linked to the choice of the most appropriate cutting tool and cutting tool material. High performance cutting ceramics are characterized by excellent hardness properties at elevated temperatures. For this reason, cutting ceramics meet the requirements for machining with high cutting speeds to increase process productivity. Whereas cutting ceramics are widely used in turning and milling operations, their use in drilling processes, using ceramic insert tipped tools, is limited to larger diameter applications due to design restrictions. Beyond small diameters, solid ceramic tools were of negligible interest for industrial applications owing to their excessive tool manufacturing costs. This paper presents a new tool concept which addresses this challenge and permits a more productive machining process for drilling small diameter holes using ceramics as the cutting material. An active brazed compound drill combines the advantageous properties of ceramics and cemented carbide as the cutting tool material and basic holder material, respectively. The investigations presented here describe the manufacturing chain as well as the application of a compound drill, and compares it to a widely used industrial reference tool. [ABSTRACT FROM AUTHOR]

The main aim of this study is to improve the coating properties of three-cathode atmospheric plasma-sprayed coatings with respect to porosity and residual stresses. This was done by means of numerical simulation coupled with advanced diagnostic methods. A numerical model for the triple injection of alumina feedstock, as well as acceleration and heating of the powder particles in the characteristic threefold symmetrical plasma jet cross section produced by a three-cathode-plasma torch, was developed. The modeling results for the standard injector's position '0' were calculated and experimentally verified by laser Doppler anemometry. Based on the criteria defined for the concentrated feedstock transport and homogeneous thermal treatment of powder particles in the plasma jet, the optimal injection position was found. In the next step, a previously developed, coupled CFD-FEM-simulation model was used for simulations of the coating build-up, describing flattening, solidification, and deformation due to shrinkage for alumina particles on a rough substrate surface. [ABSTRACT FROM AUTHOR]