Tendinopathie d'Achille [Achilles tendinopathy].

Achilles tendinopathy (AT) is the most common cause of posterior heel pain. It is most often due to mechanical stress related to overload or overuse of muscle-tendon unit. It also may be associated in a minority of cases with inflammatory arthritis. Pain secondary to AT is generally located in the corporeal part of the tendon or its attachment to the bone and is worsened by exercise. Examination can reveal a painful swelling or thickening on palpation. Additional tests are not routinely recommended but may be useful. Treatment should be tailored to the stage of tendinopathy and to functional disability, and should include an assessment of predisposing factors, analgesia and physiotherapy. Other treatments (shock waves, ultrasound) are less well documented. The indications and effectiveness of infiltrations are controversial and are reserved for chronic AT. The risk benefit ratio should be well discussed with the patient.

A Descriptive Study of Gambling Among Emerging Adult Males in French-Speaking Switzerland.

The aims were twofold: to examine the gambling habits of emerging adult males in the French-speaking regions of Switzerland and to what extent these habits predict problem gambling within this population. We also evaluated problem gambling rates and provided data concerning variables such as gambling location, level of information about problem gambling and awareness of treatment centers. 606 Swiss male conscripts, aged 18-22 years, completed a self-report questionnaire. This was administered during their army recruitment day in 2012. Problem gambling was assessed through the Problem Gambling Severity Index (PGSI) (Ferris and Wynne 2001). 78.5% of the respondents were lifetime gamblers, 56.1% were past-year gamblers. Four out of ten past-year gamblers played in private spaces and in back rooms. The PGSI indicated that 10.8% of past-year gamblers presented with moderate gambling problems, whilst 1.4% appeared to be problem gamblers. The majority of respondents had never received information about problem gambling. Moreover, they were unaware of the existence of treatment centers for problem gambling in their region. PGSI scores were significantly predicted by the variety of games played. Problem gambling rates among young men appear to be higher than those of the general Swiss population. This confirms that emerging adult males are a particularly vulnerable population with regards to gambling addiction. The implications of this are considered for youth gambling-prevention programs.

Avaliação da reprodutibilidade da tomografia computadorizada no estadiamento da pancreatite aguda

OBJETIVO: Medir a reprodutibilidade da tomografia computadorizada sem e com contraste na avaliação da gravidade da pancreatite aguda. MATERIAIS E MÉTODOS: Cinqüenta e um exames de tomografia computadorizada abdominal sem e com contraste de pacientes com pancreatite aguda foram analisados por dois radiologistas (observadores 1 e 2). Calculamos o índice morfológico pela tomografia computadorizada sem e com contraste, separadamente, e o índice de gravidade da tomografia computadorizada para pancreatite aguda. Medimos a reprodutibilidade intra- e interobservador da tomografia computadorizada através do índice kappa (kapa). RESULTADOS: Para a concordância interobservador obtivemos kapa de 0,666, 0,705, 0,648, 0,547 e 0,631 para índice morfológico sem e com contraste, presença de necrose pancreática, extensão da necrose pancreática e índice de gravidade da tomografia computadorizada, respectivamente. Para a concordância intra-observador dos observadores 1 e 2 obtivemos, respectivamente, kapa de 0,796 e 0,732 para o índice morfológico sem contraste; 0,725 e 0,802 para o índice morfológico com contraste; 0,674 e 0,849 para a presença de necrose pancreática; 0,606 e 0,770 para a extensão da necrose pancreática; e 0,801 e 0,687 para o índice de gravidade da tomografia computadorizada. CONCLUSÃO: O estadiamento da pancreatite aguda pela tomografia computadorizada por meio do índice morfológico e do índice de gravidade da tomografia computadorizada é um método bastante reprodutível. O não-uso do contraste não afeta a reprodutibilidade da tomografia computadorizada para o cálculo do índice morfológico.

Customer driven business model – connecting customer value to firm resources in ICT value networks

The objective of this thesis is to provide a business model framework that connects customer value to firm resources and explains the change logic of the business model. Strategic supply management and especially dynamic value network management as its scope, the dissertation is based on basic economic theories, transaction cost economics and the resource-based view. The main research question is how the changing customer values should be taken into account when planning business in a networked environment. The main question is divided into questions that form the basic research problems for the separate case studies presented in the five Publications. This research adopts the case study strategy, and the constructive research approach within it. The material consists of data from several Delphi panels and expert workshops, software pilot documents, company financial statements and information on investor relations on the companies’ web sites. The cases used in this study are a mobile multi-player game value network, smart phone and “Skype mobile” services, the business models of AOL, eBay, Google, Amazon and a telecom operator, a virtual city portal business system and a multi-play offering. The main contribution of this dissertation is bridging the gap between firm resources and customer value. This has been done by theorizing the business model concept and connecting it to both the resource-based view and customer value. This thesis contributes to the resource-based view, which deals with customer value and firm resources needed to deliver the value but has a gap in explaining how the customer value changes should be connected to the changes in key resources. This dissertation also provides tools and processes for analyzing the customer value preferences of ICT services, constructing and analyzing business models and business concept innovation and conducting resource analysis.

Investigation of CCL18 and A1AT as potential urinary biomarkers for bladder cancer detection

BACKGROUND: In this study, we further investigated the association of two biomarkers, CCL18 and A1AT, with bladder cancer (BCa) and evaluated the influence of potentially confounding factors in an experimental model. METHODS: In a cohort of 308 subjects (102 with BCa), urinary concentrations of CCL18 and A1AT were assessed by enzyme-linked immunosorbent assay (ELISA). In an experimental model, benign or cancerous cells, in addition to blood, were added to urines from healthy controls and analyzed by ELISA. Lastly, immunohistochemical staining for CCL18 and A1AT in human bladder tumors was performed. RESULTS: Median urinary protein concentrations of CCL18 (52.84 pg/ml vs. 11.13 pg/ml, p < 0.0001) and A1AT (606.4 ng/ml vs. 120.0 ng/ml, p < 0.0001) were significantly elevated in BCa subjects compared to controls. Furthermore, the addition of whole blood to pooled normal urine resulted in a significant increase in both CCL18 and A1AT. IHC staining of bladder tumors revealed CCL18 immunoreactivity in inflammatory cells only, and there was no significant increase in these immunoreactive cells within benign and cancerous tissue and no association with BCa grade nor stage was noted. A1AT immunoreactivity was observed in the cytoplasm of epithelia cells and intensity of immunostaining increased with tumor grade, but not tumor stage. CONCLUSIONS: Further development of A1AT as a diagnostic biomarker for BCa is warranted.

De Noacho arcam ingrediente

Dedicatio: Jacobus Ax[elius] Lindblom.

Termoestabilidade de processos extrativos de Nasturtium officinale R. Br., brassicaceae por sistema Soxhlet modificado

This work had as objective verified the term-stability of the Soxhlet modified system with analytical and pharmacothecnical application in extractive processes of Nasturtium officinale. It has proven that the process is thermo-stable. The analysis with analytical have determined 3.606 mg g-1 in chlorogenic acid and 11.813 mg g-1 in rutin (extract 1:20 w/v) and with pharmacotecnical 3.427 mg g-1 in chlorogenic acid and 11.278 mg g-1 in rutin (extract 1:6 w/v). The income of the pharmacothecnical process was inferior to the analytical, suggesting that the pharmacothecnical process would need of at least the double of time in each extraction system.

Prelude nocturne

Soitinnus: piano.

L'Univers

1868/12/22 (Numéro 606).

Avaliação da progressão cognitiva no internato de clínica médica

Este artigo investiga o crescimento cognitivo de estudantes de Medicina durante o internato de Clínica Médica do Centro Universitário Serra dos Órgãos, de janeiro de 1999 a dezembro de 2004. Foram analisados os resultados das avaliações teóricas realizadas no primeiro e no último dia do internato - cujos conteúdos exigidos eram os mesmos - de 606 estudantes do décimo primeiro e do décimo segundo períodos. Os resultados mostram melhor desempenho na segunda avaliação (média = 6,7) em relação à primeira (média = 4,1), o que aponta um "ganho" cognitivo no período de três meses. Discute-se se tais resultados podem ser comparados a outras avaliações com objetivos semelhantes.

Perdas de solo e de água em sistemas de captação in situ no Semi-Árido brasileiro

Os sistemas de cultivo utilizados no semi-árido brasileiro apresentam riscos de perda devido à irregularidade das chuvas, devendo-se associá-los a práticas que propiciem maior infiltração e, conseqüentemente, menor erosão, o que pode ser obtido por meio de técnicas de captação de água de chuva in situ. Neste trabalho, teve-se o objetivo de avaliar as perdas de água e de solo em área cultivada com milho (Zea mays L.), submetida a diferentes sistemas de preparo do solo, correspondendo aos tratamentos Guimarães Duque (T1); aração profunda (T2); aração parcial (T3) e sulcos barrados (T4), comparados com o sistema tradicional (T5), que corresponde ao plantio sem preparo do solo. Após cada evento de chuva, a água e o solo escoados foram coletados e medidos. A umidade do solo em diferentes profundidades foi monitorada durante o ciclo de produção da cultura e avaliada a produtividade dos grãos por meio da análise de variância. A partir dos resultados, pode-se observar que o método Guimarães Duque (T1) proporcionou maiores perdas de água (6.696 L) e de solo (15.225 kg ha-1), enquanto as menores perdas foram obtidas com os sulcos barrados (T4), correspondendo a 1.066 L e 1.022 kg ha-1, respectivamente. Nesse tratamento (T4), também foi obtida a maior produtividade de grãos (606 kg ha-1), apresentando-se como o sistema mais indicado para as condições analisadas.

Kansainvälinen Itä-Suomi : Itä-Suomen maahanmuuttostrategia 2017, Pohjois-Savo, Etelä-Savo ja Pohjois-Karjala

Vuoteen 2017 ulottuva viisivuotinen strategia on laadittu Pohjois-Savon ELY-keskuksen johdolla ja kattaa Pohjois-Savon lisäksi Etelä-Savon ja Pohjois-Karjalan maakunnat. Itä-Suomen maahanmuuttostrategian toimet tähtäävät kansainvälistymisen kautta alueen hyvinvoinnin lisäämiseen ja osaavan työvoiman saatavuuden turvaamiseen. Itä-Suomen maahanmuuttostrategiassa toimintalinjoja on kolme ja niiden keskinäistä suhdetta kuvataan kolmiomallin avulla. Strategian terävin kärki on kolmion huipulla sijaitseva elinkeinoelämän kansainvälistymistä ja ulkomaalaistaustaisten työllistymistä koskeva toimintalinja 1. Toimintalinjan visio on, että ulkomaalaistaustaiset työllistyvät ja perustavat yrityksiä. Lisäksi alueen väestömäärä kasvaa. Elinkeinoelämä saa tarvitsemaansa työvoimaa ja osaamista viennin ja kansainvälistymisen edistämiseksi. Kuntia ja kotouttamista koskevan toimintalinjan 3 painoarvoa kolmiomallin avulla kuvataan strategian kivijalkana ja siksi se on sijoitettu kolmion alaosaan. Toimintalinjan visio on, että ulkomaalaistaustaisten kotouttaminen kunnissa on toimiva osa normaaleja peruspalveluja. Lisäksi kunnat ovat aktiivisia tarjoamaan kuntapaikkoja pakolaisille. Ilman kunnan tärkeää roolia kotouttamispalvelujen ja muiden kunnan peruspalvelujen tarjoajana ei voida saavuttaa elinkeinoelämää koskevia tavoitteita, sillä jokainen maahanmuuttaja asuu kuntalaisena jossakin kunnassa. Asenteita ja osallistumista koskeva toimintalinja 2 sijaitsee kahden muun toimintalinjan välissä kolmion keskellä. Toimintalinjan visio on, että Itä-Suomen ilmapiiri on kansainvälinen ja erilaisuutta arvostava. Lisäksi ulkomaalaistaustaiset osallistuvat monipuolisesti yhteiskunnan toimintaan. Asenteet ulkomaalaistaustaisia kohtaan ja alueen ilmapiiri vaikuttavat merkittävästi sekä strategian elinkeinoelämää että kuntia koskevien tavoitteiden saavuttamiseen. Ulkomaalaistaustaisten monipuolinen osallistuminen yhteiskunnan toimintaan rikastuttaa myös alueen elinkeinoelämää, kuntia ja muita toimijoita eri kulttuurien tuntemuksen ja uusien kansainvälisten yhteyksien kautta. Toimintalinjojen tavoitteet on konkretisoitu toimenpiteiksi ja ryhmitelty toimenpidekokonaisuuksiksi. Maahanmuuttostrategian kullekin toimenpidekokonaisuudelle on määritelty koordinaatiovastuutahot. Kullekin toimenpiteelle on määritelty myös yksityiskohtaisemmat vastuutahot, joiden kanssa koordinaatiovastuutahot tekevät yhteistyötä. Maakunnittain toimivat alueelliset maahanmuuttoasiain toimikunnat vastaavat maahanmuuttostrategian tarkempien indikaattoreiden määrittelemisestä ja strategian seurannasta. Strategian toimenpiteiden pääpaino tavoitteiden saavuttamisessa on viranomais- ja muun toiminnan tehostamisessa ja ne kohdentuvat erityisesti alueen maahanmuuttotoimijoihin ja päättäjiin. Strategian on tarkoitus toimia alueen maahanmuuttoa ja sen tulevaisuuden tavoitteita linjaavana asiakirjana, jota hyödynnetään monipuolisesti eri maahanmuuttotoimijoiden työssä ja muiden kansainvälistymiseen ja maahanmuuttoon liittyvien strategisten asiakirjojen laadinnassa. Maahanmuuttostrategian tavoitteet tulee myös ottaa huomioon myönnettäessä eri instrumenttien kautta kansallista tai kansainvälistä rahoitusta strategian mukaisiin kehittämishankkeisiin ja toimiin.

Customer value assessment in business markets

Understanding how firms create, communicate, and deliver value to customers is a key factor when firms seek to differentiate in increasingly competitive and commoditized business markets. As product and price have become less important differentiators in many industries, suppliers are increasingly seeking ways to differentiate themselves based on delivered customer value. Therefore, to gain a holistic understanding on what their offerings are worth to the customer, suppliers need to conduct customer value assessment, which quantifies the impact of a supplier´s offering to customers’ costs and returns. However, from a managerial perspective, customer value assessment is the single most critical challenge for firms in business markets. Consequently, developing holistic frameworks for customer value assessment is seen as one of the most important research priorities for marketing research. The purpose of this study is to explore the process of customer value assessment in business markets. Business markets represent a context where an increasing number of industrial firms are transitioning from basic product offerings towards service-based and solution-oriented hybrid offerings, which emphasize value co-creation and realization in the long term, thus making it difficult to quantify their monetary value. This study employs exploratory and qualitative research design by applying inductive and discovery-oriented grounded theory and multiple case research methods. The empirical data comprise interviews with 61 managers from 12 industrial firms, including seven best practice firms in customer value assessment. The findings of this study show that customer value assessment is essentially a crossfunctional process, which involves several organizational functions. The process begins well before and continues long after the actual delivery, often until the end of a supplier´s offering’s life-cycle. Furthermore, the findings shed light on alternative strategies that firms in business markets can adopt to implement the customer value assessment process. Overall, the findings contribute to customer value research, the sales and organizational management literature, the service marketing and solutions business literature, and suggest several managerial implications on how firms in business markets can adopt a holistic approach to assess value created for customers.