Identifying Fallers Using Clinical Balance Measures in Community-Dwelling Adults with Lower Extremity Amputation: A Cross-Sectional Study

The purpose of this study was to administer clinical balance measures in community-dwelling adults with unilateral lower extremity (LE) amputations and determine optimal cut-off scores for identifying fallers. A cross-sectional study was conducted on a convenience sample of 40 independently ambulatory participants with unilateral LE amputations and a prosthetic device (20 fallers and 20 nonfallers) who were tested during a single session using: the Amputee Mobility Predictor with Prosthesis (AMP PRO), Functional Reach (FR), Single Limb Stance (SLS) and the Timed-Up-and-GO (TUG). There was a statistically significant difference on the AMP PRO (4.75 points.; 95% CI 1.10–8.40) for fallers (36.95 out of 47, SD 7.43) compared with nonfallers (41.70 out of 47, SD 3.13) and on the TUG (4.17 s., 95% CI 0.65–7.69) for fallers (14.84 s, SD 7.33) versus nonfallers (10.67 s, SD 2.64). The AMP PRO had a moderate Area Under the Curve (AUC) predictive value of 0.70 with an optimal cut-off score of 39.5 out of 47 total points (sensitivity 80%, specificity 60%) for identification of fallers. For the TUG, there was a moderate AUC value of 0.68 (sensitivity 70%, specificity 60%) when using a cut-off score of 10.03 s. There was a moderate to high correlation between the AMP PRO and TUG both between (r?=??0.77) and within (r?=??0.68) groups indicating that they measure similar constructs. Limitations included a heterogeneous sample and self-report of fall history. Both the AMP PRO and the TUG provide acceptable sensitivity and specificity for identifying fallers among community-dwelling adults with LE amputation.     

Irrigation drainage and fibrinolysis for treatment of parapneumonial pleural empyema

We report on our experiences on 336 patients suffering from manifest pleural empyema within a period of 10 years (1985-1995). Considering the pathogenesis, particularly the results of 218 patients with "parapneumonic pleural empyema" were analysed retrospectively. Definite healing could be achieved by chest tube placement and pleural irrigation in 201 patients (= 92.2%). Other 11 patients finally needed surgical interventions (= 5%). Only 6 patients could not be cured: An indwelling tube was palliatively inserted once and 5 patients died in the course of the medical treatment (mortality = 2.3%). Within the first years the irrigation therapy was performed using a single chest tube (n = 38%) but since 1989 a double-lumen drainage was used (n = 158). Since 1987 in most cases (n = 182) intrapleural medicinal fibrinolysis was performed by instillation of streptokinase (Varidase N). If outward invasively pretreated patients (n = 30) are analysed separately, a statistical dependency can be found between the duration and the way of treatment. Without significant difference between the groups (Gr) the average duration of treatment using a single tube without fibrinolysis (Gr1) was 31.8 days, but 26.5 days using a single tube combined with fibrinolysis (Gr2). A clear shortening of the duration is detectable if patients were treated with a combination of double lumen drainage and fibrinolysis: If 2 tubes were used (Gr4) the treatment lasted 20.6 days, using one double-lumen tube (Gr5) it took 19.8 days. There is a proof of significance at comparison of Gr4 with Gr1 (p = 0.005). Gr5 with Gr1 (p < 0.001) and Gr5 with Gr2 (p = 0.014) respectively. A significant longer duration of treatment (40.6 days, p < 0.001) is found for the group of the pretreated patients, if compared with the corresponding groups Gr4 or Gr5. CONCLUSION: Parapneumonic empyemas most often can be cured by irrigation drainage. The mortality is comparatively low. The shortest duration of treatment is needed using the combination of a double-lumen tube with intrapleural instillation of a fibrinolytic agent (Varidase N). Invasively pretreated patients need significantly longer durations at same form of treatment.     

From CO2‐Based Multifunctional Polycarbonates With a Controlled Number of Functional Groups to Graft Polymers

Copolymerization of CO₂ and epoxides is employed to generate functional polycarbonates. The introduction of reactive double bonds at a poly(propylene carbonate) (PPC) backbone is realized by the copolymerization of aliphatic alkene epoxides with propylene oxide (PO) and carbon dioxide (CO₂). A series of copolymers with random structure and varying comonomer content (3–22%) with molecular weights in the range of 22 000–34 000 g mol^?1 is synthesized and characterized with respect to their microstructure and thermal properties. The facile transformation of the double bonds is verified by a thiol‐ene reaction, resulting in quantitative conversion of the double bonds. Polycarbonate derivatives with multiple functionalities are prepared, providing suitable moieties for further grafting.