Cardiac rehabilitation in Austria: long term health-related quality of life outcomes

<p>Abstract</p> <p>Background</p> <p>The goal of cardiac rehabilitation programs is not only to prolong life but also to improve physical functioning, symptoms, well-being, and health-related quality of life (HRQL). The aim of this study was to document the long-term effect of a 1-month inpatient cardiac rehabilitation intervention on HRQL in Austria.</p> <p>Methods</p> <p>Patients (N = 487, 64.7% male, age 60.9 ± 12.5 SD years) after myocardial infarction, with or without percutaneous interventions, coronary artery bypass grafting or valve surgery underwent inpatient cardiac rehabilitation and were included in this long-term observational study (two years follow-up). HRQL was measured with both the MacNew Heart Disease Quality of Life Instrument [MacNew] and EuroQoL-5D [EQ-5D].</p> <p>Results</p> <p>All MacNew scale scores improved significantly (p < 0.001) and exceeded the minimal important difference (0.5 MacNew points) by the end of rehabilitation. Although all MacNew scale scores deteriorated significantly over the two year follow-up period (p < .001), all MacNew scale scores still remained significantly higher than the pre-rehabilitation values. The mean improvement after two years in the MacNew social scale exceeded the minimal important difference while MacNew scale scores greater than the minimal important difference were reported by 40-49% of the patients.</p> <p>Two years after rehabilitation the mean improvement in the EQ-5D Visual Analogue Scale score was not significant with no significant change in the proportion of patients reporting problems at this time.</p> <p>Conclusion</p> <p>These findings provide a first indication that two years following inpatient cardiac rehabilitation in Austria, the long-term improvements in HRQL are statistically significant and clinically relevant for almost 50% of the patients. Future controlled randomized trials comparing different cardiac rehabilitation programs are needed.</p

A sintering model for plasma-sprayed zirconia thermal barrier coatings. Part II: Coatings bonded to a rigid substrate

The sintering model described in Part I, which relates to free-standing plasma-sprayed thermal barrier coatings, is extended here to the case of a coating attached to a rigid substrate. Through-thickness shrinkage measurements have been carried out for coatings attached to zirconia substrates, and these experimental data are compared with model predictions. The model is then used to explore the influence of the substrate material (zirconia vs. a nickel superalloy), and of the in-plane coating stiffness. Both differential thermal expansion stresses and tensile stresses arising from the constraint imposed on in-plane shrinkage can be relaxed via two diffusional mechanisms: Coble creep and microcrack opening. This relaxation allows progression towards densification, although the process is somewhat inhibited, compared with the case of a free-standing coating. Comparison of the stored elastic strain energy with the critical strain energy release rate for interfacial cracking allows estimates to be made of whether debonding is energetically favoured

Multi-scale simulations of rearrangement effects and anisotropic behavior during sintering

Numerical modeling of sintering by continuum mechanical simulations is successfully applied today to predict e.g. the distortions developing during sintering. Several examples that demonstrate the possibilities of such simulations especially for industrial applications have been published recently. However, there are sill open questions regarding the influence of grain rearrangement, crack formation and anisotropic starting configuratins (e.g. due to prior compaction). By using the Discrete Element Method the sintering process can be investigated on a more fundamental mesoscopic scale. This method also considers effects due to particle rearrangement or anisotropic configurations as well as crack developments automatically. Their influence on various macroscopic properties like densification rate and viscosities is studied. Suggestions how to use these insights to improve existing continuum mechanical models are given

Simulation of the material behaviour of metal powder during compaction

This article describes a direct numerical homogenization method for investigating the deformation mechanisms in, and the material behaviour of metal powder during and after compaction. An assembly of elasto-plastic spherical particles in frictional contact with one another is considered, and the stress response to some prescribed deformation history as well as the resulting yield surface of the aggregate is computed with the finite-element method. This is done by applying periodic boundary conditions to the assembly, in a manner that allows arbitrary stress or strain control, and by monitoring the dissipated energies during re-loading simulations with prescribed stress space directions. Closed die and isostatic compaction are considered in particular; the resulting yield surfaces are compared and the role of plastic deformation and frictional sliding on the micro-scale is investigated. Significant deviations from isotropic phenomenological models are found and the development of anisotropy is demonstrated

Increase in Warpage Prediction Accuracy for Glass Filled Polyamide Material (PA66) through Integrative Simulation Approach

The warpage prediction accuracy of the simulation software depends on part geometry, material model and methodology. However, the material model in the existing simulation software’s does not consider factors such as nonlinear mechanical properties, temperature dependent behaviour, viscoelastic behaviour and transient description of warpage leading to less accuracy. Using an integrative simulation approach, BASF has developed Ultrasim® tool to overcome limitations in the material model of existing simulation software. In the new material model thermomechanical properties, stress relaxation behaviour and nonlinear mechanical properties were considered and this new material model is added to Ultrasim® tool. The model also considers time dependent descriptions of the warpage starting from packing phase of the moulding process, followed by actual ejection and cooling. In this paper warpage results predicted through new integrative simulation approach and existing simulation approach are compared with actual experimental results for 50% glass filled polyamide material (Ultramid®A3WG10). The results revealed that warpage values predicted by integrative simulation based Ultrasim® tool are closer to actual experimental results compared to values predicted by existing simulation technologies. Therefore an integrative simulation approach can be used prior to making real parts to reduce manufacturing cost.</jats:p