External urethral sphincter electromyography in asymptomatic women and the influence of the menstrual cycle.

OBJECTIVE: To investigate by electromyography (EMG), the presence of complex repetitive discharges (CRDs) and decelerating bursts (DBs) in the striated external urethral sphincter during the menstrual cycle in female volunteers with no urinary symptoms and complete bladder emptying. SUBJECTS AND METHODS: Healthy female volunteers aged 20-40 years, with regular menstrual cycles and no urinary symptoms were recruited. Volunteers completed a menstruation chart, urinary symptom questionnaires, pregnancy test, urine dipstick, urinary free flow and post-void ultrasound bladder scan. Exclusion criteria included current pregnancy, use of hormonal medication or contraception, body mass index of >35 kg/m(2) , incomplete voiding and a history of pelvic surgery. Eligible participants underwent an external urethral sphincter EMG, using a needle electrode in the early follicular phase and the mid-luteal phase of their menstrual cycles. Serum oestradiol and progesterone were measured at each EMG test. RESULTS: In all, 119 women enquired about the research and following screening, 18 were eligible to enter the study phase. Complete results were obtained in 15 women. In all, 30 EMG tests were undertaken in the 15 asymptomatic women. Sphincter EMG was positive for CRDs and DBs at one or both phases of the menstrual cycle in eight (53%) of the women. Three had CRDs and DBs in both early follicular and mid-luteal phases. Five had normal EMG activity in the early follicular phase and CRDs and DBs in the mid-luteal phase. No woman had abnormal EMG activity in the early follicular phase and normal activity in the luteal phase. There was no relationship between EMG activity and age, parity or serum levels of oestradiol and progesterone. CONCLUSIONS: CRDs and DB activity in the external striated urethral sphincter is present in a high proportion of asymptomatic young women. This abnormal EMG activity has been shown for the first time to change during the menstrual cycle in individual women. CRDs and DBs are more commonly found in the luteal phase of the menstrual cycle. The importance of CRDs and DBs in the aetiology of urinary retention in young women remains uncertain. The distribution and or quantity of abnormal EMG activity in the external urethral sphincter may be important. In a woman with urinary retention the finding of CRDs and DBs by needle EMG does not automatically establish Fowler's syndrome as the explanation for the bladder dysfunction. Urethral pressure profilometry may be helpful in establishing a diagnosis. Opiate use and psychological stress should be considered in young women with urinary retention.

External Validation of the Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale (ISAN) Score for Predicting Stroke-Associated Pneumonia in the Athens Stroke Registry.

BACKGROUND AND PURPOSE: The Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale (ISAN) score was developed recently for predicting stroke-associated pneumonia (SAP), one of the most common complications after stroke. The aim of the present study was to externally validate the ISAN score. METHODS: Data included in the Athens Stroke Registry between June 1992 and December 2011 were used for this analysis. Inclusion criteria were the availability of all ISAN score variables (prestroke independence, sex, age, National Institutes of Health Stroke Scale score). Receiver operating characteristic curves and linear regression analyses were used to determine the discriminatory power of the score and to assess the correlation between actual and predicted pneumonia in the study population. Separate analyses were performed for patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). RESULTS: The analysis included 3204 patients (AIS: 2732, ICH: 472). The ISAN score demonstrated excellent discrimination in patients with AIS (area under the curve [AUC]: .83 [95% confidence interval {CI}: .81-.85]). In the ICH group, the score was less effective (AUC: .69 [95% CI: .63-.74]). Higher-risk groups of ISAN score were associated with an increased relative risk of SAP; risk increase was more prominent in the AIS population. Predicted pneumonia correlated very well with actual pneumonia (AIS group: R(2) = .885; β-coefficient = .941, P < .001; ICH group: R(2) = .880, β-coefficient = .938, P < .001). CONCLUSIONS: In our external validation in the Athens Stroke Registry cohort, the ISAN score predicted SAP very accurately in AIS patients and demonstrated good discriminatory power in the ICH group. Further validation and assessment of clinical usefulness would strengthen the score's utility further.

'A pilot study to investigate external urethral sphincter electromyographic activity and the influence of hormonal changes in the menstrual cycle'

But de l'étude Un enregistrement spécifique EMG du sphincter strié urétral avec décharges répétitives et complexes ainsi que salves de décélération a été décrit comme pathognomonique du syndrome de Fowler, un trouble de la relaxation du sphincter strié urétral chez la femme jeune responsable d'une retention urinaire. Nous avons souhaité étudier la présence de cet enregistrement EMG spécifique chez la femme asymptomatique, ceci à différents moments du cycle menstruel. Matériel et Méthode Nous avons recruté des femmes volontaires saines âgées entre 20 et 40 ans, ayant un cycle hormonal régulier, et ne présentant aucun symptôme urinaire. Les critères d'exclusion étaient la presence d'une dysfonction mictionnelle, d'une infection urinaire, la grossesse, la prise d'une thérapie hormonale ou d'hormone contraceptive, une obésité et des antécédants d'intervention pelvienne. Nous avons procédé à deux enregistrements EMG du sphincter strié urétral des participantes éligibles, utilisant une aiguille concentrique, ceci dans la première phase du cycle (phase folliculaire) et dans la dernière phase du cycle (phase lutéale). Les taux sériques de progestérone et d'oestrogène étaient mesurés à chaque enregistrement. Résultats 15 participantes ont complété l'étude. L' enregistrement EMG du sphincter a été positif avec présence de décharges répétitives et de salves de décélération lors d'une ou des deux phases du cycle menstruel chez 8 participantes (53%). Trois participantes présentaient cet enregistrement spécifique lors des deux phases du cycle et cinq participantes présentaient cet enregistrement spécifique lors de la phase lutéale uniquement. Aucune femme ne présentait cet enregistrement spécifique en début de cycle uniquement. Il n'y avait pas de relation avec l'âge, la parité ou les taux hormonaux. Conclusions L'enregistrement EMG spécifique du sphincter strié urétral, avec décharges répétitives et salves de décélération, se retrouve chez une proportion élevée de femmes asymptomatiques. Il a été montré que ce tracé change lors du cycle menstruel, en étant retrouvé plus fréquemment dans la dernière phase du cycle. L'importance de cet enregistrement EMG dans l'étiologie de la retention urinaire de la femme jeune reste à éclaircir. Nous devons considérer que sa présence ne pose pas automatiquement un diagnostic de syndrome de Fowler chez la femme en rétention urinaire.

Improving coronary artery bypass graft durability: use of the external saphenous vein graft support.

Coronary bypass grafting remains the best option for patients suffering from multivessel coronary artery disease, and the saphenous vein is used as an additional conduit for multiple complete revascularizations. However, the long-term vein graft durability is poor, with almost 75% of occluded grafts after 10 years. To improve the durability, the concept of an external supportive structure was successfully developed during the last years: the eSVS Mesh device (Kips Bay Medical) is an external support for vein graft made of weft-knitted nitinol wire into a tubular form with an approximate length of 24 cm and available in three diameters (3.5, 4.0 and 4.5 mm). The device is placed over the outer wall of the vein and carefully deployed to cover the full length of the graft. The mesh is flexible for full adaptability to the heart anatomy and is intended to prevent kinking and dilatation of the vein in addition to suppressing the intima hyperplasia induced by the systemic blood pressure. The device is designed to reduce the vein diameter of about 15-20% at most to prevent the vein radial expansion induced by the arterial blood pressure, and the intima hyperplasia leading to the graft failure. We describe the surgical technique for preparing the vein graft with the external saphenous vein graft support (eSVS Mesh) and we share our preliminary clinical results.

Resultate und ausser- gewöhnliche Komplikationen der Chirurgie der Gehörgangexostosen [Results and extraordinary complications of surgery for exostoses of the external auditory canal].

We present a retrospective study on 22 operations of exostosis of the external auditory canal in 20 patients. 8 patients were passionated by water sports. The most frequent indication for surgery (13 operations) was recurrent external otitis or ceruminal obstruction. In 7 cases the need for a wider access to the middle ear indicated surgery. Surgery was usually performed as an outpatient procedure, maximum hospitalization was 3 days. The mean healing period was 6 (3-10) weeks. Mean follow up was 43 (3-110) months. There were no severe intraoperative complications such as facial paresis, lesions of the ossicles or of the inner ear. As intraoperative complications we found 2 perforations of the tympanic membrane, 2 expositions of the capsule of the mandibular joint, one of which was followed by chronic pain. As postoperative complications we found an early soft tissue stenosis of the external auditory canal and one late soft tissue stenosis which recurred after revision surgery. No recurrence of exostosis was seen. We describe an up to now unknown complication: the appearance of bilateral petrositis caused by staphylococcus epidermidis after bilateral surgery in an otherwise healthy patient. This study confirms that severe complications are rare, minor ones however relatively common. And that also minor complications may have a troublesome follow. Therefore and because of the potential of severe complications indication for surgery must be made cautiously and risks of the operation must not be underestimated.

Tourism Demand in Catalonia: detecting external economic factors

There is a lack of studies on tourism demand in Catalonia. To fill the gap, this paper focuses on detecting the macroeconomic factors that determine tourism demand in Catalonia. We also analyse the relation between these factors and tourism demand. Despite the strong seasonal component and the outliers in the time series of some countries, overnight stays give a better indication of tourism demand in Catalonia than the number of tourists. The degree of linear association between the macroeconomic variables and tourism demand is also higher when using quarterly rather than monthly data. Finally, there are notable differences between the results obtained for the different countries analysed. These results indicate that the best way to model tourism demand in Catalonia is to specify a quarterly model of overnight stays, differentiating between an aggregate demand model for the total number of tourists and specific models for each of the countries analysed.

Multicointegration, polynomial cointegration and I(2) cointegration with structural breaks. An application to the sustainability of the US external deficit

In this paper we model the multicointegration relation, allowing for one structural break. Since multicointegration is a particular case of polynomial or I(2) cointegration, our proposal can also be applied in these cases. The paper proposes the use of a residualbased Dickey-Fuller class of statistic that accounts for one known or unknown structural break. Finite sample performance of the proposed statistic is investigated by using Monte Carlo simulations, which reveals that the statistic shows good properties in terms of empirical size and power. We complete the study with an empirical application of the sustainability of the US external deficit. Contrary to existing evidence, the consideration of one structural break leads to conclude in favour of the sustainability of the US external deficit.

Internal standard versus external standard calibration: an uncertainty case study of a liquid chromatography analysis

Traditionally, in the cigarettes industry, the determination of ammonium ion in the mainstream smoke is performed by ion chromatography. This work studies this determination and compares the results of this technique with the use of external and internal standard calibration. A reference cigarette sample presented measurement uncertainty of 2.0 μg/cigarette and 1.5 μg/cigarette, with external and internal standard, respectively. It is observed that the greatest source of uncertainty is the bias correction factor and that it is even more significant when using external standard, confirming thus the importance of internal standardization for this correction.

Carbon footprint as part of a company’s external environmental communication

The aim of this thesis was to find out how the carbon footprint calculations can be utilized in the company’s external environmental communication, what is the demand for carbon footprint from the market, and how the other actors in the forest industry have approached the issue. The aim was to recognize the best practises to communicate carbon footprints and to find possibilities to extend the UPM-Kymmene Wood Oy’s mill specific carbon footprints. This research included a literature review, an inquiry to the UPM-Kymmene Wood Oy’s sales offices, and Internet survey concerning the external environmental communication in the forest industry and three small case studies based on mill specific parameters. The inquiry to the sales offices showed that the carbon footprint is not yet a common demand from the customers in the wood product sector. In addition, the Internet survey showed that generally in the forest industry, not much has been done concerning carbon footprint communication so far. The biggest challenge in carbon footprint communication is the variation in the knowledge level of the receivers. In addition btob and btoc communication situations demand a different approach to the issue. Carbon profile brochures developed in the company can be seen as suitable for btob communication situations. Case studies have shown that the contribution of final product transport to the overall carbon footprint was significant. It was recommended to include post mill transport in the carbon footprint information supplied to the btob customers. When discussing environmental communication on a general level it can be stated that a good external environmental communication is based on facts, is open and proactive and takes into account the needs of the receiver. However, the openness and the quality of external environmental communication are essentially strategic decisions. The significance of internal communication as well as the knowhow in the communication and marketing networks play a major role in achieving success in external environmental communication. Carbon footprints are only one part of good balanced external environmental communication. One specific environmental feature like carbon footprint should not be over emphasized to the detriment of other important environmental aspects.

External knowledge transfer mechanisms in service business acquisition

In knowledge-intensive economy an effective knowledge transfer is a part of the firm’s strategy to achieve a competitive advantage in the market. Knowledge transfer related to a variety of mechanisms depends on the nature of knowledge and context. The topic is, however, very little empirical studied and there is a research gap in scientific literature. This study examined and analyzed external knowledge transfer mechanisms in service business and especially in the context of acquisitions. The aim was to find out what kind of mechanisms was used when the buyer began to transfer data e.g. their own agendas and practices to the purchased units. Another major research goal was to identify the critical factors which contributed to knowledge transfer through different mechanisms. The study was conducted as a multiple-case study in a consultative service business company, in its four business units acquired by acquisition, in various parts of the country. The empirical part of the study was carried out as focus group interviews in each unit, and the data were analyzed using qualitative methods. The main findings of this study were firstly the nine different knowledge transfer mechanisms in service business acquisition: acquisition management team as an initiator, unit manager as a translator, formal training, self-directed learning, rooming-in, IT systems implementation, customer relationship management, codified database and ecommunication. The used mechanisms brought up several aspects as giving the face to changing, security of receiving right knowledge and correctly interpreted we-ness atmosphere, and orientation to use more consultative touch with customers. The study pointed out seven critical factors contributed to different mechanisms: absorption, motivation, organizational learning, social interaction, trust, interpretation and time resource. The two last mentioned were new findings compared to previous studies. Each of the mechanisms and the related critical factors contributed in different ways to the activity in different units after the acquisition. The role of knowledge management strategy was the most significant managerial contribution of the study. Phenomenon is not recognized enough although it is strongly linked in knowledge based companies. The recognition would help to develop a better understanding of the business through acquisitions, especially in situations such as where two different knowledge strategies combines in new common company.

Elemental analysis of wood materials by external millibeam thick target PIXE

PIXE (Particle Induce X-ray Emission spectrometry) was used for analysing stem bark and stem wood of Scots pine, Norway spruce and Silver birch. Thick samples were irradiated, in laboratory atmosphere, with 3 MeV protons and the beam current was measured indirectly using a photo multiplicator (PM) tube. Both point scans and bulk analyses were performed with the 1 mm diameter proton beam. In bulk analyses, whole bark and sectors of discs of the stem wood were dry ashed at 550 ˚C. The ashes were homogenised by shaking and prepared to target pellets for PIXE analyses. This procedure generated representative samples to be analysed, but the enrichment also enabled quantification of some additional trace elements. The ash contents obtained as a product of the sample preparation procedure also showed to be of great importance in the evaluation of results in environmental studies. Spot scans from the pith of pine wood outwards, showed clearly highest concentrations of manganese, calcium and zinc in the first spot irradiated, or 2-3 times higher than in the surrounding wood. For stem wood from the crown part of a pine this higher concentration level was found in the first four spots/mms, including the pith and the two following growth rings. Zinc showed increasing concentrations outwards in sapwood of the pine stem, with the over-all lowest concentrations in the inner half of the sapwood. This could indicate emigration of this element from sapwood being under transformation to heartwood. Point scans across sapwood of pine and spruce showed more distinct variations in concentrations relative to hearth wood. Higher concentrations of e.g. zinc, calcium and manganese were found in earlywood than in denser latewood. Very high concentrations of iron and copper were also seen for some earlywood increments. The ash content of stem bark is up to and order higher than for the stem wood. However, when the elemental concentration in ashes of bark and wood of the same disc were compared, these are very similar – this when trees are growing at spots with no anthropogenic contamination from the atmosphere. The largest difference was obtained for calcium which appeared at two times high concentrations in ashes of bark than in ashes of the wood (ratio of 2). Pine bark is often used in monitoring of atmospheric pollution, where concentrations in bark samples are compared. Here an alternative approach is suggested: Bark and the underlying stem wood of a pine trees are dry ashed and analysed. The elemental concentration in the bark ash is then compared to the concentration of the same element in the wood ash. Comparing bark to wood includes a normalisation for the varying availability of an element from the soil at different sites. When this comparison is done for the ashes of the materials, a normalisation is also obtained for the general and locally different enrichment of inorganic elements from wood to bark. Already a ratio >2 between the concentration in the bark ash and the concentration in the wood ash could indicate atmospheric pollution. For monitoring where bark is used, this way of “inwards” comparison is suggested - instead of comparing to results from analyses of bark from other trees (read reference areas), growing at sites with different soil and, locally, different climate conditions. This approach also enables evaluation of atmospheric pollution from sampling of only relative few individual trees –preferable during forest felling.

Climate variations in greenhouse cultivated with gerbera and relationship with external conditions

Black meshes used in greenhouses provide shade to plants, affecting photosynthesis and presenting certain properties that change the microclimatic conditions in these environments. The objective of this study was to evaluate the variation in climate elements in greenhouse cultivated with gerbera (Gerbera jamesonii, Vr. Rambo) in relation to external conditions and the reference evapotranspiration (ETo) at Teresina, State of Piauí, Brazil. The measurements were obtained from July to October 2007 by an automatic data acquisition system installed inside and outside the greenhouse. The global solar radiation, evapotranspiration, precipitation, temperature, relative humidity, and wind speed were estimated. The results showed that major effect of the shading occurred on the mean air temperature during the 120 days, making it higher than the external environment. Inside the greenhouse, mean values of relative air humidity, reference evapotranspiração, global solar radiation and wind speed were lower compared to those outside the greenhouse.