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The current longitudinal study investigates the effects of practice on the outcome of psychotherapy for elderly persons. It follows 4 psychologists for the first 143 clients of their professional lives to explore whether increased practice leads to better outcomes for their clients. The participating psychologists routinely monitor the effect of their work with different psychometric outcome measures and receive weekly supervision. The clients consist of 267 primarily elderly persons above the age of 65, who receive psychotherapy to improve their overall well-being. Well-being is measured with the WHO-5 Well-being Index. Regression analyses with outcome improvement functioning as the dependent variable, were calculated as pre-treatment scores subtracted from post-treatment scores. There was no significant effect of the chronological rank of clients on the overall effect of treatment. Hence, no practice effects were found in terms of increased well-being. Variations in effect did not change either. However, the psychologists used significantly fewer sessions to achieve the same effect as time went on, as there was a significant effect of the chronological rank of clients on the number of sessions. Though significant, the size of this effect was small. Results are discussed in the light of the literature on expertise and expert performance, and possible ways to increase the effect in psychotherapy with elderly persons are suggested. Psychotherapy is regarded as a highly efficient treatment across many different types of psychological disturbances. In most arenas of life, practice tends to improve performance considerably. Surprisingly, this does not generally seem to be the case for psychotherapists. For some reason, they do not appear to improve in terms of efficiency as time goes by - at least not unless they deliberately attempt to improve. To our knowledge, the effects of practice has not yet been studied in psychotherapists working with older clients. The current study intends to investigate the effects of practice on the outcome of psychotherapy for elderly persons. It will follow 4 psychologists for the first 2 years of their professional lives to explore whether increased practice leads to better outcomes for their clients. The clients consist primarily of elderly persons above the age of 65, who receives psychotherapy to improve their overall well-being and lower feelings of anxiety and depression. Regression analyses are planned with outcome improvement functioning as the dependent variable, calculated as pre-treatment scores subtracted from post-treatment scores. To account for individual differences in skill, the dependent variable is mean centered for each psychologist. The independent variable is the chronological rank for each client for each psychologist. As the investigated psychotherapists work within a deliberate therapeutic praxis, which utilizes systematic outcome monitoring, we expect to find a significant, but small, effect of practice on the outcome of treatment.

As the population of elderly people continues to rise, the healthcare sector is increasingly faced with the challenge of maintaining high levels of well-being for elderly people who experience discontentment. This feeling of uneasiness, can be related to a number of issues, such as loneliness, anxiety, depression – or felt as a more generalised subjective sense of lowered well-being. The task facing the public health care sector, is to provide a reliable and broad method, in which these various issues are addressed. The current study aims to examine the effects of a public health initiative in the municipalities of Aarhus and Copenhagen, in which psychotherapy provided by psychologists is used for elderly people who experiences lowered well-being. The clients are primarily above the age of 65 and are either reffered to the initiatives by health care workers, family members or by themselves, if they experience lowered well-being. To asses the effects of treatment, anxiety and depression is measured through the use of the Common Mental Disorder Questionnaire, loneliness with the Three-Item Loneliness Scale and well-being with the WHO-5 Well-Being Index. We expect to replicate previous research by finding a large significant effect of treatment on well-being followed by significant moderate effects on anxiety and depression, with lesser - albeit significant, effects on loneliness.

While a growing literature links cardiac autonomic dysregulation to a variety of psychiatric disorders, the relationship between cardiac autonomic functioning and specific symptoms in schizophrenia (SZ) and bipolar disorder (BD) remains elusive. Thus, we investigated heart rate variability (HRV), a proxy for vagal activity, as a biological marker for symptom severity in patients with SZ and BD. HRV was calculated in 35 patients with SZ and 52 patients with BD, as well as in 149 healthy controls. In the patient groups, symptom severity and function were measured by the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning (GAF) scale. Results showed that HRV was significantly lower in both clinical groups compared to the healthy controls, with no significant HRV differences between patient groups. PANSS general psychopathology scores, GAF symptom scores, and GAF function scores showed statistically significant associations with HRV across groups. These results suggest that disease severity is associated with autonomic dysfunction and that HRV may provide a potential biomarker of disease severity in SZ and BD.

Hvordan er det at blive ældre, og hvilke mentale sundhedsinterventioner kan fremme trivsel hos belastede ældremennesker? Lars Larsen tager dels udgangspunkt i sin storeviden på feltet, dels egne kliniske erfaringer fra Center forLivskvalitet i Århus Kommune, herunder også effekten afindividuel psykoterapi til raske ældre. Lars vil desuden fortælle om, hvordan man kan måle på den ældres trivsel.Er der tilgange og interventioner, der kan varetages af andrefaggrupper, der ikke har psykologbaggrund, og som mødergamle mennesker i deres arbejde? Det får vi også et bud påi dette indlæg.

A one-year longitudinal study of subjective well-being in elderly home care recipients Larsen, L, Povlsen, T.K., Mortensen, S.L. & Christoffersen, M. Background: Old age is not a risk factor per se when it comes to low well-being. In most old people well-being is as high as, or higher than, it was earlier in life, despite age-related stressors. However, when these stressors cause loss of independence and a permanent need for help, it could be a different matter. Objectives: This study attempted to answer the following questions: How large a proportion of home care recipients had well-being levels indicating stress and risk of depression? Did the overall level of subjective well-being change during a one-year period? How did subjective well-being in elderly home care recipients compare to the national Danish average? Sample: 759 home care recipients 65 years or older in The Municipality of Aarhus, Denmark, all answered the WHO-5 Well-being Index as part of a yearly survey on the satisfaction with home care services provided by the municipality. All participants answered the questionnaire twice (in 2016 and 2017), either by telephone interview or by internet. Measures: The WHO-5 Well-being Index is a brief self-report inventory with five items. The overall result ranges from 0 to 100 with 0 being the lowest possible level of well-being and 100 being the optimal level. Scores of 50 and above are considered normal well-being by the Danish National Board of Health. Scores of 35 or lower indicate severe stress and a great risk of depression. Analyses: Descriptive statistics and Repeated measures ANOVA with WHO-5 score as within subject factor, and gender and data collection method as between subject factors. Results: 18% of the participants in 2016 had a WHO-5 score of 35 or lower, in 2017 it was 25%. Another 19% in 2016 and 16% in 2017 had a WHO-5 score below 50. Repeated measures ANOVA showed a significant small drop in overall well-being over a one-year period. There was a small significant interaction between WHO-5 and both gender and data collection method. Estimated marginal means were 56.9 in 2016 and 54.3 in 2017. The grand mean for both measure points was 55.6 (SD = .9) on WHO-5, which is considerably lower than the national Danish average which is 70. Discussion: Implications of the results were discussed in terms of the need for interventions aimed at improving well-being in home dwelling elderly people in need of care. Words: 382 Key words: Well-being, home care, elderly people Background: Old age is not a risk factor per se when it comes to low well-being. In most old people well-being is as high as, or higher than, it was earlier in life, despite age-related stressors. However, when these stressors cause loss of independence and a permanent need for help, it could be a different matter.Objectives: This study attempted to answer the following questions: How large a proportion of home care recipients had well-being levels indicating stress and risk of depression? Did the overall level of subjective well-being change during a one-year period? How did subjective well-being in elderly home care recipients compare to the national Danish average?Sample: 759 home care recipients 65 years or older in The Municipality of Aarhus, Denmark, all answered the WHO-5 Well-being Index as part of a yearly survey on the satisfaction with home care services provided by the municipality. All participants answered the questionnaire twice (in 2016 and 2017), either by telephone interview or by internet.Measures: The WHO-5 Well-being Index is a brief self-report inventory with five items. The overall result ranges from 0 to 100 with 0 being the lowest possible level of well-being and 100 being the optimal level. Scores of 50 and above are considered normal well-being by the Danish National Board of Health. Scores of 35 or lower indicate severe stress and a great risk of depression.Analyses: Descriptive statistics and Repeated measures ANOVA with WHO-5 score as within subject factor, and gender and data collection method as between subject factors.Results: 18% of the participants in 2016 had a WHO-5 score of 35 or lower, in 2017 it was 25%. Another 19% in 2016 and 16% in 2017 had a WHO-5 score below 50.Repeated measures ANOVA showed a significant small drop in overall well-being over a one-year period. There was a small significant interaction between WHO-5 and both gender and data collection method. Estimated marginal means were 56.9 in 2016 and 54.3 in 2017. The grand mean for both measure points was 55.6 (SD = .9) on WHO-5, which is considerably lower than the national Danish average which is 70.Discussion: Implications of the results were discussed in terms of the need for interventions aimed at improving well-being in home dwelling elderly people in need of care.

Nowadays, aerospace components made of carbon fiber reinforced plastics (CFRP) which are manufactured by a dry-fiber depositing process are produced almost exclusively by hand. In this type of process, hundreds of textile blanks with different contours are stored in a tool mould. For large components such as an aircraft fuselage, it is also necessary to transport the flexible blanks with cooperating robots. For this purpose, a system was developed which allows to generate robot paths on the basis of Computer Aided Design (CAD) data, which is automatically extended by information such as pickup and drop points for the robot. The system has already been successfully tested with sampling-based algorithms on a robot system with two KUKA KR210 R3100 robots on a common linear axis. However, the use of sampling-based algorithms a heuristic must be developed to solve the redundancy of linear axis which is usually only functional for the current scenario and must be adapted for another one. Evolutionary algorithms offer the advantage that they are also able to find a solution for the linear axis independent of the scenario. In this work. A path planning system that uses evolutionary algorithms to calculate collision-free paths reliably for cooperating robots on a common linear axis will be presented.

Parts made of carbon fiber reinforced plastics (CFRP) for airplane components can be so huge that a single industrial robot is no longer able to handle them, and cooperating robots are required. Manual programming of cooperating robots is difficult, but with large numbers of different sized and shaped cut-pieces, it is almost impossible. This paper presents an automated production system consisting of a camera for the precise detection of the position of each cut-piece and a collision-free path planner which can dynamically react to different positions for the transfer motions. The path is planned for multiple robots adhering to motion constrains, such as the requirement that the textile cut-piece must form a catenary which can change during transport. Additionally a technique based on machine learning has been implemented which correctly resolves redundancy for a linear axis during planning. Finally, all components are tested on a real robot system in industrial scale.

This work considers an autonomous multi-robot pick-and-place process for the manufacturing of aerospace structures, which consists of the steps picking, transfer, dropping and post-drop treatment. Autonomous production is achieved by combining computer vision assisted gripping, automated transfer path generation and generic process execution in one system. Test scenario is an airplane skin demonstrator made of tailored carbon fiber multiaxial fabrics that are placed in a half-shell shaped jig of approximately 4 m in diameter by two cooperating robots mounted on a common linear axis.

Gastrointestinal iron absorption was measured by whole body counting in 18 patients on regular peritoneal dialysis. Ten patients received regular oral iron treatment prior to the study (iron treated group), 8 patients did not receive iron treatment (non-iron treated group). Whole body retention 14 days after oral administration of 10 microCi 59Fe together with a carrier dose of 10 mg Fe2+ was used as an estimate of absorption. The erythrocyte iron incorporation, i.e. the percentage of administered 59Fe incorporated into the total erythrocyte mass, was measured. Geometric mean iron absorption in the non-iron treated groups was 7.4+/-3.3 (S.D.) % and in the iron treated group 2.8+/-2.5% (p less than 0.01). Absorption in the non-iron treated group did not differ significantly from the value in a normal control group (p greater than 0.3). Absorption in the iron treated group was distinctly lower than in the controls (p less than 0.01), due to the high iron supplementation. Several patients in the non-iron treated group had latent or overt iron deficiency, while patients in the iron treated group had satisfactory iron status. The correlation between iron absorption and erythrocyte iron incorporation was highly significant (r=0.95, p less than 0.001). Peritoneal dialysis patients on the whole have a normally functioning iron absorption. However, due to increased iron losses and insufficient dietary iron intake, the maintenance of a satisfactory iron balance implies an adequate oral iron supplementation.

Gastrointestinal iron absorption has been measured by whole body counting in 17 patients with chronic uremia undergoin regular hemodialysis. Absorption was expressed as whole body retention 14 days after oral administration of 10 muCi 59Fe together with a carrier dose of 10 mg Fe2+. The percentage incorporation in the total erythrocyte mass of administered 59Fe (erythrocyte incorporation) and absorbed 59Fe (red cell utilization) was estimated as well. Geometric mean iron absorption was 14.3 +/- 2.0 (S.D.)% and significantly higher than the value obtained in a normal control group (p less than 0.03). Geometric mean erythrocyte incorporation was 11.6 +/- 2.3 (S.D.)% and arithmetic mean red cell utilization was 84.4 +/- 6.0 (S.E.M.)%. Neither of these parameters differed from corresponding values in the control group (p greater than 0.1 and p greater than 0.2, respectively). The correlation between iron absorption and erythrocyte incorporation was highly significant (r=0.94, p less than 0.001). Patients on regular hemodialysis are subjected to considerable iron loss which should be treated by iron supplementation; oral iron administration is recommended in view of the adequate gastrointestinal absorption.

Gastrointestinal iron absorption has been measured in 27 apparently healthy subjects (8 males and 19 females) by means of whole body counting. Whole body retention 14 days after oral administration of 10 muCi59Fe with a carrier dose of 9.9 mg Fe2+ was used as an expression of absorption. The percentage incorporation of the orally applied 59Fe into the total erythrocyte mass within 14 days (erythrocyte incorporation) was estimated as well. Geometric mean iron absorption was 9.1 +/- 2.2 (S.D.) % in males and 8.3 +/- 2.1% in females; in the entire series it was 8.5 +/- 2.1%. The difference between males and females was not significant. Arithmetic mean red cell utilization of absorbed 59Fe was 92.9 +/- 4.0 (S.E.M.) % in the entire series. The correlation between iron absorption and erythrocyte incorporation was found to be highly significant (r=0.96, p less than 0.001).

Gastrointestinal iron absorption has been measured by means of whole body counting in 13 patients after renal allotransplantation. Whole body retention 14 days after oral administration of 10 muCi 59Fe together with a carrier dose of 9.9 mg Fe2+ was used as an expression of absorption. The percentage incorporation in the total erythrocyte mass of administered 59Fe (erythrocyte incorporation) and absorbed 59Fe (red cell utilization) was estimated as well. Geometric mean iron absorption was 12.4 +/- 2.5 (S.D.)% and geometric mean erythrocyte incorporation 11.1 +/- 3.0 (S.D.)% while arithmetic mean red cell utilization was 95.6 +/- 8.6 (S.E.M.)%. None of these parameters differed significantly from those obtained in normal subjects (p greater than 0.2, p greater than 0.1, pgreater than 0.3, respectively). Iron absorption and erythrocyte incorporation in renal transplanted patients did not differ significantly from the values measured in non-dialysed and dialysed patients with chronic renal failure (p greather than 0.1). The correlation between iron absorption and erythrocyte incorporation was highly significant (r = 0.96, p less than 0.001).

Due to rising energy costs aircraft should have a lower kerosine consumption. To achieve this aircraft manufacturers increase the usage of high performance, lightweight materials such as carbon fiber reinforced plastics (CFRP). At the moment production needs a lot of manual steps. However the airplane structures to be built e.g. a fuselage, are up to 30m long. It is strongly recommended to automate these processes. To build these parts automatically the German Aerospace Center (DLR) has developed and built a large (30m × 15m × 7 m) robotic facility where multiple robots which move on linear axes share the same workspace. The sharing is important because the production process requires that the robots cooperate. Intelligent methods are necessary to generate collision-free paths for these robots.

The aim of this study was to determine the prevalence of cognitive impairment (CI) in newly diagnosed and orchiectomized testicular cancer (TC) patients prior to systemic treatment, and to explore biological and psychological correlates.Sixty-six TC patients were compared with 25 healthy men on neuropsychological tests and a measure of cognitive complaints. CI status and a global composite score (representing overall neuropsychological performance) were calculated for each participant. Possible psychological (depression, anxiety, stress, and post-traumatic stress symptoms) and biological (cortisol, IL-6, TNF-α, and CRP) correlates and predictors of patients' cognitive functioning were explored.TC patients had lower scores on 6 out of 11 neuropsychological outcomes (p 0.01) in processing speed, attention, and working memory, verbal learning and memory, and verbal fluency. Prevalence of CI among TC patients was 58%, significantly exceeding the frequency in healthy men (p 0.01). Patients' cortisol levels predicted overall neuropsychological performance (p = 0.04). Cognitive complaints were associated with IL-6 (p = 0.02) and all psychological distress measures (p 0.001).The prevalence of CI in recently orchiectomized TC patients was unexpectedly high with patients performing more poorly than healthy controls on a majority of neuropsychological outcomes. Cortisol is a potential predictor of neuropsychological performance in TC patients prior to cytotoxic treatment.

Due to the rising demand in efficiency and sustainability in commercial aviation, aircraft manufacturers increase the usage of high performance, lightweight materials like carbon fiber reinforced plastics (CFRP). These materials pose new challenges to manufacturing processes concerning cost-effectiveness and quality requirements. To meet these challenges the Institute of Structures and Design within the German Aerospace Center (DLR) designed a flexible robotic manufacturing cell at the Center for Lightweight Production Technology (ZLP) in Augsburg. The multifunctional cell (MFZ) can integrate processes for production and inspection on an industrial scale. Due to large workpieces like fuselage components or wing skins and low production quantities, workshop space, and investment cost are major concerns for effective CFRP production. The large size of the cell (30 × 15 × 7 m) demands a highly reconfigurable space. The platform is composed of five ceiling mounted robots on a gantry like machine frame and may be divided in smaller independent cells. The multifunctional cell will improve the understanding of requirements of future production processes for lightweight components by providing a highly flexible platform on an industrial scale.

Olfactory dysfunction is a prodromal and prevalent nonmotor symptom of Parkinson's disease. Unlike olfactory dysfunction in Alzheimer's disease, it is believed to be unrelated to cognitive impairment. However, recent research has implicated cholinergic denervation in Parkinson's disease hyposmia and linked it to verbal memory. This research hypothesized that severe odor identification deficits may identify patients with Parkinson's disease at risk for cognitive impairment. The current study tested this hypothesis by comparing 24 functionally anosmic, nondemented patients with Parkinson's disease and 39 nonanosmic, nondemented patients with Parkinson's disease with 29 healthy control participants on composite scores of memory, processing speed, executive function, and language. The functionally anosmic group had significantly poorer visual and verbal memory than the nonanosmic group, which was indistinguishable from the control group. Furthermore, the functionally anosmic group had reduced processing speed compared with the nonanosmic patients with Parkinson's disease, who, in turn, were outperformed by the control group. On the composite language score, the score of the functionally anosmic group was significantly reduced compared with that of the control group, whereas the nonanosmic group scored in the medium range. The 2 patient groups did not differ on executive functioning. These findings demonstrate co-occurrence between reduced cognitive function and olfactory deficits in functionally anosmic patients with Parkinson's disease and support the notion of more severe cognitive deficits in this group.

The aim of the study was to describe the pattern of admissions to a medical department and to analyse whether acute admissions can be referred to hospitals with limited access to acute medical and surgical assistance and limited access to intensive care.All acute admissions to the medical department during a three-week period were registered. The medical officer in charge of the distribution of patients filled in a questionnaire at the time of telephone contact with the referring physician concerning the feasibility of referral to a medical department with limited access to acute assistance.Out of 113 patients judged suitable for referral to a hospital with limited access to acute assistance, 60% had or developed conditions judged to require hospitals with a specialised level of acute services.Contact with a medical officer by telephone seems to be an unsuitable way of selecting which patients do not need highly specialized medical assistance, surgical assistance or intensive care.

Acquired disease of the pulmonary valve requiring surgery is rare. We report the case of a 70-year-old male presenting with pulmonary valve insufficiency and pulmonary emboli originating from a thrombus formation adhering to the pulmonary valve occurring despite dicoumarol anticoagulation for previous aortic valve surgery. Two years ago he experienced Guillain-Barre syndrome and one year ago enterococcal sepsis which were treated medically. Apart from a previous prolonged ICU stay no predisposing factors for right sided endocarditis could be found. The pulmonary lesion was surgically corrected with removal of the thrombus and excision of the pulmonary valve. Reconstruction of the valve and pulmonary artery was performed with a semistentless xenograft valved conduit.