A common cause of profound deafness is hair cell dysfunction in the cochlea. Cochlear implants (CI) bypass the hair cells via an electrode and stimulate the cochlear nerve directly. Nowadays, it is possible to preserve residual hair cell function and hearing through flexible electrodes and a-traumatic CI surgery techniques; called hearing preservation CI surgery. This may suit partially deaf patients who can use natural low frequency hearing in combination with electric high frequency hearing; so-called hybrid hearing. The aim of this thesis was to elucidate the effectiveness of hearing preservation CI surgery. The thesis demonstrates human cochlear anatomy in relation to CI and evaluates hearing and patient satisfaction after hearing preservation CI surgery. Analyses of human cochlear moulds belonging to the Uppsala collection showed large variations in dimensions and coiling characteristics of the cochlea. Each cochlea was individually shaped. The size and shape of the cochlea influences the position of the electrode. The diameter of the basal cochlear turn could predict insertion depth of the electrode, which is crucial for hearing preservation. The first 21 patients operated with hearing preservation CI surgery in Uppsala, showed preserved hearing. Nine-teen partially deaf patients receiving implants intended for hybrid hearing, were evaluated concerning pure tone audiometry, monosyllables (MS) and hearing in noise test (HINT). They also responded to a questionnaire, consisting of the IOI-HA, EQ-5D VAS and nine questions about residual hearing. The questionnaire results indicated a high degree of patient satisfaction with improved speech perception in silence and noise. This was also reflected by improved results in MS and HINT. Hearing was preserved in all patients, but there was an on-going deterioration of the residual hearing in the operated ear which surpassed the contralateral ear. There were no correlations between the amount of residual hearing and patient satisfaction or speech perception results. Electric stimulation provides a major contribution to speech comprehension in partially deaf patients. All the patients showed a high degree of satisfaction with their CI, regardless of varying hearing preservation.

Background: Open and closed fractures can be associated with posttraumatic or postoperative soft tissue defects caused by initial trauma, operative procedures, or infections. This study evaluated the postoperative outcomes in patients with open or closed lower leg fractures, related soft tissue defects, and subsequent flap coverage. Methods: We performed a retrospective single-center cohort study in a level 1 trauma center. We analyzed the patients treated from January 2012 through December 2017 and recorded demographics, treatment, and outcome data. The outcome data were measured via patient-reported Foot and Ankle Outcomes Scores (FAOS) and EQ-5D-5L scores. Results: We included 22 patients with complicated fractures (11 open and 11 closed) and subsequent soft tissue defects and flap coverages. The mean follow-up time was 41.2 months. Twenty-one patients developed infections, and necrosis at the site of surgery manifested in all closed fractures. Therefore, all patients needed soft tissue reconstructions. Preoperatively, 16 patients underwent arterial examinations via angiography and six underwent ultrasound examinations of the venous system. Ten patients had complications involving the flaps due to ischemia and consequent necrosis. The mean EQ-5D index was 0.62 ± 0.27, and EQ-5D VAS score was 57.7 ± 20.2. The mean FAOS was 60.7 ± 22.2; in particular, quality of life was 32.3 ± 28.8. The rate of returning to work in our patient group was 37.5% after 1 year. Conclusions: Distal tibial fractures often require revisions and soft tissue reconstruction. The evaluated patient population had poor outcomes in terms of function, quality of life, and return to work. Furthermore, patients suffering from flap ischemia have worse outcomes than those without flap ischemia.

Background: Data regarding both drug-related and non-drug-related costs in patients with Parkinson's disease (PD) are scarce, mainly due to the difficulties in data acquisition in experimental designs. Likewise, the reported impact of drug costs on total direct costs varies across different studies. In addition, the influence of comorbidities on both treatment costs and health-related quality of life has not been adequately evaluated. Methods: A sample of office-based neurologists (n = 315) in Germany was asked to examine up to five consecutive patients with PD (n = 1449) on a specified day during the study period. Patients of all ages were eligible and their evaluation was performed using standardized questionnaires. Results: PD-specific therapy costs increased with the stage of the disease, early onset of the disease and disease duration. The major costs were due to PD-related therapy, whereas other medications only resulted in minor costs. Disease stage mainly influenced direct therapy costs, with an observed increase of total daily costs from €7.3 to €11.3/day. In addition, disease onset at age < 65 years resulted in total daily costs of €11.2 compared to late onset of disease (> 75 years) with daily therapy costs of €5.3. In this patient group neuropsychiatric comorbidities such as dementia and depression were only insufficiently treated. In addition, these comorbidities severely affected health-related quality of life. Conclusion: Therapy costs were influenced by disease stage, disease onset as well as present comorbidities. Furthermore, comorbidities such as depression and dementia were diagnosed but were not adequately treated.

The overall aim of the thesis was to add some pieces to the etiological puzzle of LCPD with special focus on vascular origin and hyperactivity. Furthermore we wanted to evaluate some consequences of LCPD in adulthood. Swedish registry data were used to identify a cohort of patients with the diagnosis of LCPD. This cohort was compared with a general population– based cohort without LCPD to assess the relative risk of cardiovascular diseases, blood or coagulation defects, injury, ADHD, depression and mortality. In a clinical study we assessed health-related quality of life (EQ-5D-3L), physical activity level (IPAQ) and screened for ADHD (ASRSv1.1) in 116 patients with a history of LCPD who were diagnosed or treated in Uppsala University Hospital between 1978 and 1995. The results confirmed our hypothesis: Patients with a history of LCPD had a 1.7-fold higher risk of cardiovascular diseases, and a 1.4-fold higher risk for blood or coagulation defects compared with gender- and age-matched individuals without LCPD. We found a 1.2-fold higher risk for injuries requiring hospital admission than in gender- and age-matched individuals without LCPD. The risk was more pronounced among females. Furthermore, we found a 1.5-fold higher risk for ADHD. Stratified analysis revealed a 2.1-fold higher risk for ADHD among females with LCPD than among females without LCPD. The risk for depression was 1.3-fold higher, and more pronounced among females with LCPD. Patients with LCPD had a slightly higher mortality risk with higher risk for death from suicide and cardiovascular causes. Patients with a history of LCPD reported a lower health-related quality of life and were more physically active than the Swedish population norm. 28% of 116 patients were likely to have ADHD or had already been diagnosed with ADHD. Both vascular and blood diseases could be present even in childhood and could, in combination with hyperactive behavior pattern and a high physical activity level, contribute to the etiology of LCPD. The lower health-related quality of life and higher risk for depression might reflect the mental burden of LCPD. Patients with LCPD have a higher mortality risk with higher risk for death from suicide and cardiovascular causes.

As teorias de gravitação invariante por escala propõem uma variação com relação ao tempo da constante gravitacional ou da massa dos objetos que constituem o universo. Desta forma a intensidade da interação gravitacional também se torna variável, modificando sensivelmente o comportamento do universo. Algumas teorias foram propostas no decorrer do século, porém, descartadas devido a problemas técnicos e de concordância com dados observacionais. trabalho a ser apresentado nesta dissertação está fundamentado em uma teoria de gravitação invariante por escala, a qual vem atualmente sendo desenvolvida e é denominada teoria penta-dimensional Espaço-Tempo-Massa. Tal teoria propõe a quantidade de massa de repouso como uma quantidade extensiva, de maneira a introduzi-la na métrica e torná-la variável. Diversos trabalhos foram realizados com esta teoria, incluindo alguns, o estudo de modelos cosmológicos. Investigaremos aqui a extensão do modelo cosmológico de Bianchi tipo V, que é um dos mais importantes modelos do universo. Duas métricas foram propostas e as soluções das equações de campo da teoria SD-Espaço-Tempo-Massa para tais métricas foram obtidas. Tais soluções correspondem a espaços não-planos. Um estudo sobre singularidades na métrica e na curvatura foi realizado para ambas as métricas, em adição, o tensor de energia-momento induzido foi obtido para as métricas e as suas propriedades investigadas. Através da análise do tensor de Kretschmann verificou-se a ausência de singularidades efetivas nos modelos 5D abordados, sugerindo uma distribuição finita de energia devido a inclusão da massa de repouso. / The scale invariant gravitational theories propose the time variation either in the gravitational constant or in the rest mass of the objects that constitute the universe. By this way the intensity of the gravitational interaction varies as well, changing accordingly the behavior of the universe. Several theories have been proposed in the literature, however most of them have been discharged due to drawbacks in thecnicalities or lack of agreement with observational data. The work conducted here takes into account a 5-dimensional theory called SpaceTime- Mass, which proposes that the rest mass be na extensible quantity that change with time. Severa! investigations have been done so far with this theory, some o f them including cosmological studies. Here we will investigate the 5D extension of the Bianchi type V cosmological model, which is one of the most important model of the universe. Two metrics are proposed and the solution of the corresponding 5D-Spae-Time-Mass field equations are found. Both solutions shown to be non-flat spaces. The singularity behavior of the metric and curvature were done, the induced energy-momentum tensor for both metrics were determined and their properties were investigated. Through the analysis of the Kretschmann tensor, it has been shown that there is no effective singularity in the space, which suggest that there is a finite distribution of energy due to the inclusion of the rest mass variable.

Theoretical foundation Arterial disease which gradually leads to narrowing of artery, up to complete vascular closure and to subsequent manifestation of ischaemia is called ischaemic disease of the lower extremities (IDLE). We need to understand ischaemic disease of the lower extremities not only as a disease causing patients a range of difficulties and significantly impacting their life quality, but also as a very important indicator of overall cardiovascular condition of whole organism. Ischaemic disease of the lower extremities becomes more and more accepted as a chronic disease associated with a substantial cardiovascular risk. This disease causes primarily walking limitation by which it impacts daily activities and significantly decrease the life quality. Goal of the thesis: A goal was set for the thesis: Finding out in which areas the ischaemic disease of the lower extremities impacts the life quality. Hypotheses: 6 hypotheses were set for the thesis: H1: Patients with IDLE feel pain H2: Patients with IDLE are limited in moving H3: Patients with IDLE are limited socially H4: Patients with IDLE feel concern for their future H5: Patients with IDLE perceive their life quality as a low one. H6: Patients with IDLE are limited in the area of basic daily activities. Methodology: The research part of the thesis was implemented based on quantitative inquiry within the grant Project No. 120/2012/S ?Reflection of life quality in nursing?. For the empirical part of the thesis the quantitative method was used, the survey was carried out in form of questionnaires, more precisely a standardized questionnaire EQ-5D-5L, selected questions from a questionnaire WHOQOL 100 and specific non-standardized complementary questions for patients with ischaemic disease of the lower extremities. The survey was carried out by addressing practising physicians , doctors from specialized outpatient departments and inpatient wards. Nurses who were, along with the doctors, responsible for explaining the significance of the survey to the patients were an integral part to the data gathering process. The respondents were selected intentionally, the basic factor of selection was presence of the ischaemic disease of the lower extremities. The selection sample was designed using selective quota, the only quota being the age of respondent. Results: All results obtained were statistically processed in the SASD (Statistical Analysis of Social Data) software. The results were divided into three areas. Firstly results describing the structure of selection sample, secondly results depicted graphically and thirdly results processed using a descriptive statistics. The last two areas were then arranged according to the used questionnaire. The results provided us with information regarding patients' perceiving of pain, the difficulties in moving, the social area, the basic daily activities, the concerns for the future and subjective perceiving ot the life quality. Based on the results, the set hypotheses were evaluated as follows: H1: Patients with IDLE feel pain ? confirmed, H2: Patients with IDLE are limited in moving - confirmed, H3: Patients with IDLE are limited socially - confirmed, H4: Patients with IDLE feel concern for their future - confirmed, H5: Patients with IDLE perceive their life quality as a low one ? not confirmed, H6: Patients with IDLE are limited in the area of basic daily activities - confirmed. Conclusion: The thesis provides a comprehensive view on the areas impacting the life quality of patients with ischaemic disease of the lower extremities. In practice the results can facilitate the choice of effective intervention and improve communication with patients, especially due to the gained knowledge. The results will be published in journals and presented at conferences. The results could also be used as a foundation for another survey and as a studying material for students of nursing.

As teorias de gravitação invariante por escala propõem uma variação com relação ao tempo da constante gravitacional ou da massa dos objetos que constituem o universo. Desta forma a intensidade da interação gravitacional também se torna variável, modificando sensivelmente o comportamento do universo. Algumas teorias foram propostas no decorrer do século, porém, descartadas devido a problemas técnicos e de concordância com dados observacionais. trabalho a ser apresentado nesta dissertação está fundamentado em uma teoria de gravitação invariante por escala, a qual vem atualmente sendo desenvolvida e é denominada teoria penta-dimensional Espaço-Tempo-Massa. Tal teoria propõe a quantidade de massa de repouso como uma quantidade extensiva, de maneira a introduzi-la na métrica e torná-la variável. Diversos trabalhos foram realizados com esta teoria, incluindo alguns, o estudo de modelos cosmológicos. Investigaremos aqui a extensão do modelo cosmológico de Bianchi tipo V, que é um dos mais importantes modelos do universo. Duas métricas foram propostas e as soluções das equações de campo da teoria SD-Espaço-Tempo-Massa para tais métricas foram obtidas. Tais soluções correspondem a espaços não-planos. Um estudo sobre singularidades na métrica e na curvatura foi realizado para ambas as métricas, em adição, o tensor de energia-momento induzido foi obtido para as métricas e as suas propriedades investigadas. Através da análise do tensor de Kretschmann verificou-se a ausência de singularidades efetivas nos modelos 5D abordados, sugerindo uma distribuição finita de energia devido a inclusão da massa de repouso. / The scale invariant gravitational theories propose the time variation either in the gravitational constant or in the rest mass of the objects that constitute the universe. By this way the intensity of the gravitational interaction varies as well, changing accordingly the behavior of the universe. Several theories have been proposed in the literature, however most of them have been discharged due to drawbacks in thecnicalities or lack of agreement with observational data. The work conducted here takes into account a 5-dimensional theory called SpaceTime- Mass, which proposes that the rest mass be na extensible quantity that change with time. Severa! investigations have been done so far with this theory, some o f them including cosmological studies. Here we will investigate the 5D extension of the Bianchi type V cosmological model, which is one of the most important model of the universe. Two metrics are proposed and the solution of the corresponding 5D-Spae-Time-Mass field equations are found. Both solutions shown to be non-flat spaces. The singularity behavior of the metric and curvature were done, the induced energy-momentum tensor for both metrics were determined and their properties were investigated. Through the analysis of the Kretschmann tensor, it has been shown that there is no effective singularity in the space, which suggest that there is a finite distribution of energy due to the inclusion of the rest mass variable.

As teorias de gravitação invariante por escala propõem uma variação com relação ao tempo da constante gravitacional ou da massa dos objetos que constituem o universo. Desta forma a intensidade da interação gravitacional também se torna variável, modificando sensivelmente o comportamento do universo. Algumas teorias foram propostas no decorrer do século, porém, descartadas devido a problemas técnicos e de concordância com dados observacionais. trabalho a ser apresentado nesta dissertação está fundamentado em uma teoria de gravitação invariante por escala, a qual vem atualmente sendo desenvolvida e é denominada teoria penta-dimensional Espaço-Tempo-Massa. Tal teoria propõe a quantidade de massa de repouso como uma quantidade extensiva, de maneira a introduzi-la na métrica e torná-la variável. Diversos trabalhos foram realizados com esta teoria, incluindo alguns, o estudo de modelos cosmológicos. Investigaremos aqui a extensão do modelo cosmológico de Bianchi tipo V, que é um dos mais importantes modelos do universo. Duas métricas foram propostas e as soluções das equações de campo da teoria SD-Espaço-Tempo-Massa para tais métricas foram obtidas. Tais soluções correspondem a espaços não-planos. Um estudo sobre singularidades na métrica e na curvatura foi realizado para ambas as métricas, em adição, o tensor de energia-momento induzido foi obtido para as métricas e as suas propriedades investigadas. Através da análise do tensor de Kretschmann verificou-se a ausência de singularidades efetivas nos modelos 5D abordados, sugerindo uma distribuição finita de energia devido a inclusão da massa de repouso. / The scale invariant gravitational theories propose the time variation either in the gravitational constant or in the rest mass of the objects that constitute the universe. By this way the intensity of the gravitational interaction varies as well, changing accordingly the behavior of the universe. Several theories have been proposed in the literature, however most of them have been discharged due to drawbacks in thecnicalities or lack of agreement with observational data. The work conducted here takes into account a 5-dimensional theory called SpaceTime- Mass, which proposes that the rest mass be na extensible quantity that change with time. Severa! investigations have been done so far with this theory, some o f them including cosmological studies. Here we will investigate the 5D extension of the Bianchi type V cosmological model, which is one of the most important model of the universe. Two metrics are proposed and the solution of the corresponding 5D-Spae-Time-Mass field equations are found. Both solutions shown to be non-flat spaces. The singularity behavior of the metric and curvature were done, the induced energy-momentum tensor for both metrics were determined and their properties were investigated. Through the analysis of the Kretschmann tensor, it has been shown that there is no effective singularity in the space, which suggest that there is a finite distribution of energy due to the inclusion of the rest mass variable.

Background: Data regarding both drug-related and non-drug-related costs in patients with Parkinson's disease (PD) are scarce, mainly due to the difficulties in data acquisition in experimental designs. Likewise, the reported impact of drug costs on total direct costs varies across different studies. In addition, the influence of comorbidities on both treatment costs and health-related quality of life has not been adequately evaluated. Methods: A sample of office-based neurologists (n = 315) in Germany was asked to examine up to five consecutive patients with PD (n = 1449) on a specified day during the study period. Patients of all ages were eligible and their evaluation was performed using standardized questionnaires. Results: PD-specific therapy costs increased with the stage of the disease, early onset of the disease and disease duration. The major costs were due to PD-related therapy, whereas other medications only resulted in minor costs. Disease stage mainly influenced direct therapy costs, with an observed increase of total daily costs from €7.3 to €11.3/day. In addition, disease onset at age < 65 years resulted in total daily costs of €11.2 compared to late onset of disease (> 75 years) with daily therapy costs of €5.3. In this patient group neuropsychiatric comorbidities such as dementia and depression were only insufficiently treated. In addition, these comorbidities severely affected health-related quality of life. Conclusion: Therapy costs were influenced by disease stage, disease onset as well as present comorbidities. Furthermore, comorbidities such as depression and dementia were diagnosed but were not adequately treated.

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