University of Applied Sciences Stralsund

It can be concluded that digital services can certainly add value to mental healthcare; however, the sustainable integration into care is linked to improvements in structural conditions (such as the cost-benefit ratio and better information for those providing treatment) as well as consideration and compensation for socially unequal access conditions.

AimsPatients with device-detected atrial fibrillation (DDAF) have a lower stroke risk than those with ECG-diagnosed AF, requiring careful evaluation of oral anticoagulation benefits vs. its inherent bleeding risk.Methods and resultsAn unmatched win ratio analysis was performed of the NOAH-AFNET 6 trial dataset, using components of the primary efficacy and safety outcomes of the trial. The primary analysis used this hierarchical order: (1) all-cause death, (2) stroke, (3) systemic or pulmonary embolism/myocardial infarction, and (4) major bleeding. Two additional analyses replaced all-cause death with cardiovascular death or included patient-reported outcomes. Win odds were calculated to account for undecided comparisons. Among 2534 patients 77 ± 7 years old, 947 (37%) women, median CHA2DS2-VA score 3 [interquartile range (IQR), 3–4], median follow-up 21 months (IQR, 10–38) 1 605 280 win ratio pairs were analyzed. The win ratio comparing edoxaban to no anticoagulation was 0.87 (95% CI: 0.68–1.10; P = 0.23). Most comparisons resulted in no clear winner (undecided pairs 84.9%). In the remaining comparisons, edoxaban won in 46% of the cases, placebo in 54%. Death and major bleeding were the most common events. The win odds was 0.98 (95% CI: 0.94–1.01; P = 0.23).ConclusionsThis hypothesis-generating win ratio analysis, integrating death, thrombotic events, and major bleeds with and without quality of life, did not find an advantage of anticoagulation with edoxaban over no anticoagulation in patients with DDAF. The most common events were death and major bleeding.

Background. Chronic kidney disease (CKD) is a leading risk factor for cardiovascular disease and all-cause mortality among older adults. Mecklenburg-West Pomerania has the highest CKD prevalence in Germany and Europe, however, its impact on frailty prevention strategies in primary care remains poorly understood. The SHIP-AGE/MV-FIT study aims to investigate the role of CKD in frailty incidence.Methods. The SHIP-AGE/MV-FIT cohort is a prospective, longitudinal, population-based observational study targeting individuals 65 years with mGFR >30 mL/min. The cohort will consist of approximately 820 elderly participants who will be monitored over a three-year period. They will undergo a comprehensive, multi-factorial geriatric assessment, along with a structured monitoring and management program aimed at preventing frailty. The program incorporates evidence-based, multi-component care, including physical activity, medication review, nutritional optimization, and fall prevention strategies.Discussion. SHIP-AGE/MV-FIT will clarify CKD’s role in frailty progression and identify mechanisms underlying frailty and pre-frailty. Additionally, the study aims to implement and evaluate multi-component healthcare strategies for frailty and fall prevention, assess patient adherence and quality of life, and explore elderly individuals’ experiences with primary care interventions. By integrating SHIP-AGE data with findings from the SHIP (Study of Health in Pomerania) cohorts in our region, this research will contribute to evidence-based strategies for maintaining health, independence, and well-being in aging populations, particularly in rural primary care settings, such as Mecklenburg-West Pomerania.

Telemedicine for the treatment of depression and anxiety disorders was found to be successful in a randomised controlled trial (RCT); this intervention was then implemented in routine care in the Western Pomerania region in Germany. This made it possible to investigate the effectiveness of the intervention under routine care conditions and compare it with the results of the RCT.For this retrospective controlled analysis, data from routine care (2011-2022) were analysed together with data from the previous RCT (2009-2010). A three-arm comparison (routine care, previous RCT intervention group, previous RCT control group) on the primary outcome of symptom severity (BSI-18) and a longitudinal analysis of the routine care data were conducted. The telemedical intervention was conducted in the university hospital's psychiatric outpatient clinic in north-eastern Germany. All adult patients with an ICD-10 diagnosis of depression, anxiety or somatoform disorders could participate after discharge from the hospital. The telemedicine sessions included structured verbal questionnaires and conversational therapy concerning treatment goals and tasks. Repeated measures Welch ANOVA with the BSI-18 Global Severity Index and subscales (depression, anxiety and somatisation) was performed. A multivariate regression was conducted on the longitudinal regular care data.The n=254 subjects in the telemedical care in routine care arm (181 women, mean [95%CI] age 45.5 [44.0-47.1] years; 6-month follow-up) showed a BSI-18 score improvement M=- 4.1 [-5.3,-2.9], F(2)=3.50, p<0.05 compared to the preceding RCT intervention arms (61 women, mean [95%CI] age 44.7 [41.7-47.6] years. Telemedical care showed a significant difference in BSI-18 scores over a 10-year follow-up: M=- 3.9 [-5.4,-2.5], p<0.0001.The positive results of the 2009 RCT were replicable in routine care. The more patient-centred approach resulted in improved outcomes in this telemedical intervention.

IntroductionThe intricate process of articular cartilage remodeling, pivotal for both physiological functions and osteoarthritis (OA) progression, is orchestrated through a balance of matrix synthesis and breakdown, which is mediated by matrix metalloproteinase enzymes (MMPs). At the heart of this remodeling lies the pericellular matrix (PCM), a specialized microenvironment encapsulating each chondrocyte and composed mainly of collagen type VI and perlecan. The aim of this study was to assess the impact of MMP-2, -3, and -7 on the structural integrity and biomechanical attributes of the PCM. MethodsHuman articular cartilage explants (N=10 patients) were incubated with activated MMP-2, -3, or -7, individually or in combination. Structural alterations in the PCM were evaluated by immunolabeling. The biomechanical properties of the PCM were measured using atomic force microscopy (AFM). ResultsCollagen type VI structural integrity and fluorescence intensity uniformly decreased across all enzyme groups, while perlecan was selectively affected by MMP-3 and -7. AFM measurements demonstrated decreased PCM stiffness after incubation with individual MMPs, leading to an overall ~31 % reduction in elastic modulus for each enzyme. Combinations of enzymes induced comparable significant biomechanical alterations (~35 %), except for MMP-2+MMP-7. DiscussionThis study highlights the significant influence of MMP-induced alterations in PCM composition on biomechanical properties, mirroring characteristics observed in early OA. Each MMP showed specificity in breaking down PCM, and an intriguing interplay, especially between MMP-2 and -7, indicated reduced efficacy in lowering PCM stiffness. Overall, MMP-2, -3, and -7 directly induce functional and structural PCM modifications.

when an Electrical Vehicle (EV) encounters an accident or the vehicle is taken to a service station, the DC-link capacitor in the inverter must be discharged to ensure safety of both the passengers and the operator. This paper examines the limitations of traditional discharge techniques and proposes a novel hybrid discharge solution that combines the existing winding-based discharge method with a flyback converter. The proposed technique enhances redundancy, decreases the discharge time and minimize the risk of DC-link voltage overshoot during the regeneration action caused by quadrature axis current injection. The study introduces a low-voltage discharge circuit enabled by a flyback converter using MOSFET in linear mode, presenting two distinct approaches. The paper includes a simulation comparison of winding-based discharge with the proposed Hybrid discharge technique. The proposed solution has a higher discharge rate and reduces the voltage overshoot on the DC-Link capacitor. The proposed hardware is verified using the simulation and experiments conducted on a high voltage supply test rig.