The effect of femoral component rotation on the five-year outcome of cemented mobile bearing total knee arthroplasty.

PURPOSE: Performing total knee replacement, accurate alignment and neutral rotation of the femoral component are widely believed to be crucial for the ultimate success. Contrary to absolute bone referenced alignment, using a ligament balancing technique does not automatically rotate the femoral component parallel to the transepicondylar axis. In this context we established the hypothesis that rotational alignment of the femoral component parallel to the transepicondylar axis (0° ± 3°) results in better outcome than alignment outside of this range. METHODS: We analysed 204 primary cemented mobile bearing total knee replacements five years postoperatively. Femoral component rotation was measured on axial radiographs using the condylar twist angle (CTA). Knee society score, range of motion as well as subjective rating documented outcome. RESULTS: In 96 knees the femoral component rotation was within the range 0 ± 3° (neutral rotation group), and in 108 knees the five-year postoperative rotational alignment of the femoral component was outside of this range (outlier group). Postoperative CTA showed a mean of 2.8° (±3.4°) internal rotation (IR) with a range between 6° external rotation (ER) and 15° IR (CI 95). No difference with regard to subjective and objective outcome could be detected. CONCLUSION: The present work shows that there is a large given natural variability in optimal rotational orientation, in this study between 6° ER and 15° IR, with numerous co-factors determining correct positioning of the femoral component. Further studies substantiating pre- and postoperative determinants are required to complete the understanding of resulting biomechanics in primary TKA.

Cost-effectiveness of opportunistic versus organised mammography screening in Switzerland

BACKGROUND: Various centralised mammography screening programmes have shown to reduce breast cancer mortality at reasonable costs. However, mammography screening is not necessarily cost-effective in every situation. Opportunistic screening, the predominant screening modality in several European countries, may under certain circumstances be a cost-effective alternative. In this study, we compared the cost-effectiveness of both screening modalities in Switzerland. METHODS: Using micro-simulation modelling, we predicted the effects and costs of biennial mammography screening for 50-69 years old women between 1999 and 2020, in the Swiss female population aged 30-70 in 1999. A sensitivity analysis on the test sensitivity of opportunistic screening was performed. RESULTS: Organised mammography screening with an 80% participation rate yielded a breast cancer mortality reduction of 13%. Twenty years after the start of screening, the predicted annual breast cancer mortality was 25% lower than in a situation without screening. The 3% discounted cost-effectiveness ratio of organised mammography screening was euro11,512 per life year gained. Opportunistic screening with a similar participation rate was comparably effective, but at twice the costs: euro22,671-24,707 per life year gained. This was mainly related to the high costs of opportunistic mammography and frequent use of imaging diagnostics in combination with an opportunistic mammogram. CONCLUSION: Although data on the performance of opportunistic screening are limited, both opportunistic and organised mammography screening seem effective in reducing breast cancer mortality in Switzerland. However, for opportunistic screening to become equally cost-effective as organised screening, costs and use of additional diagnostics should be reduced.

QuesTInSitu mobile: aplicació per a rutes de preguntes geolocalitzades

En plena era de la informació, les noves tecnologies s’han posat també al servei del’ensenyament. Per tal de proveir a l’estudiant dels mètodes més útils i eficients per donar suport al seu aprenentatge, han sorgit eines cada cop més acurades amb la intenció de proveird’una manera robusta tot allò que fins fa poc només es podia fer a les aules. Així va néixer el concepte d’e-learning.QuesTInSitu és una eina concebuda dins d’aquesta àrea que permet crear preguntesgeolocalitzades sobre mapes de GoogleMaps i organitzar-les com a rutes (qüestionaris), sobre el mapa que es desitgi del món. Aquest projecte ofereix la possibilitat de poder realitzar físicament l’activitat creada per QuesTInSitu mitjançant terminals mòbils amb connexió 3G i GPS. Per això, s’ha dissenyat un portal web adaptat, QuesTInSitu mobile, que permet realitzar les gimcanes geolocalitzades dissenyades prèviament. Malgrat aquest projecte està contingut enl’àrea del e-learning, ofereix un llarg ventall de possibilitats d’ús; publicitat o turisme en són alguns exemples.

Instrument for assessing the quality of mobile emergency pre-hospital care: content validation

OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K) and Content Validity Index (CVI), considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.

Mobile termination and mobile penetration

In this paper, we study how access pricing affects network competition when subscription demand is elastic and each network uses non-linear prices and can applytermination-based price discrimination. In the case of a fixed per minute terminationcharge, we find that a reduction of the termination charge below cost has two opposing effects: it softens competition but helps to internalize network externalities. Theformer reduces mobile penetration while the latter boosts it. We find that firms always prefer termination charge below cost for either motive while the regulator preferstermination below cost only when this boosts penetration.Next, we consider the retail benchmarking approach (Jeon and Hurkens, 2008)that determines termination charges as a function of retail prices and show that thisapproach allows the regulator to increase penetration without distorting call volumes.

Density and distribution of nests of Mycetophylax simplex (Emery) (Hymenoptera, Formicidae) in areas with mobile dunes on the northern coast of Rio Grande do Sul, Brazil

Studies on lower attines are scarce, especially on nesting and foraging ecology and behavior. This study aimed to contribute to the knowledge of an Attini in dunes ecosystems through the description of density and spatial distribution of Mycetophylax simplex (Emery, 1887) nests in a strip of mobile dunes in the Praia Grande beach, Torres, northern coast of Rio Grande do Sul, Brazil. The density and spatial distribution of nests were estimated in four plots of 2,500 m² each, in which were found 20, 209, 284 and 324 nests, with average densities of 0.01 nests/m², 0.09, 0.11 and 0.13 nests/m², respectively. The nests were found near to the vegetation and showed clumped distribution. The density and distribution pattern of the nests seem to be related to the availability of nesting places and foraging resources.

Sistema Web e Mobile para Apoio a Gestão de Projetos de Sistemas de Informação

A forma como um projeto é gerido tem vindo a evoluir ao longo dos tempos. Com a crescente preocupação em entregar os projetos dentro dos prazos estipulados, com qualidade e dentro do orçamento previsto, foi necessário melhorar a forma de gerir os mesmos. Neste sentido têm vindo a surgir várias metodologias e, principalmente, ferramentas informáticas que apoiam os gestores de projetos a gerir os mesmos. Tendo em conta que gerir projetos de desenvolvimento de sistemas de informação engloba desafios específicos dos projetos desta natureza e, no sentido de ajudar os gestores a enfrentarem tais desafios com sucesso, propôs-se efetuar o desenvolvimento de uma aplicação web e mobile de apoio a gestão de projetos desta natureza. Este trabalho procura fazer um mapeamento entre as principais metodologias de gestão de projetos, principalmente, as direcionadas para projetos de desenvolvimento de sistemas de informação, e os grupos de processos e áreas de conhecimento de gestão de projetos definidos no PMBOK. Toda essa informação é disponibilizada numa aplicação web, que está, igualmente, acessível nos dispositivos móveis. Com esta aplicação web e mobile, pretendeu-se desenvolver uma aplicação informática interativa de apoio a gestão de projetos de sistemas de informação, tendo em conta a metodologia adotada para a gestão do projeto e as linhas de orientação do PMBOK.

TBS discrimine les femmes avec ostéoporose fracturaire des femmes non ostéoporotiques indépendamment de la DMO, de l'âge et de l'IMC : Etude de la cohorte Ostéo-Mobile Vaud

Introduction. - « Ostéo-Mobile Vaud » est un projet pilote visant àinformer et promouvoir les mesures générales de prévention del'ostéoporose chez les femmes vaudoises de 60 ans et plus. Son butest également d'évaluer le risque de fracture dans cette populationen associant les facteurs de risque cliniques, la mesure de la DMOpar DXA de la colonne lombaire et du fémur proximal (Hologic Discovery),la recherche des fractures vertébrales préexistantes parVFA et une appréciation de la « qualité osseuse » par TBS. Une phaseprospective de 5 ans est prévue. Le Trabecular Bone Score (TBS) estun procédé qui consiste à appliquer un traitement informatique àl'image 2D de projection de la DXA basé sur la quantification desvariations locales de niveaux de gris. Un modèle mathématiquerelie le paramètre TBS avec des paramètres de microarchitecture 3Dtels la connectivité 3D, le nombre de travées et l'espace inter-trabéculaire.Ce modèle fait de TBS une mesure indirecte de microarchitectureosseuse.Résultats. - Fin juillet 2011, 510 femmes de ± 67 ans, IMC ± 26 kg/m2,ont été évaluées. Une ou plusieurs fractures de fragilité ont été rapportéeschez 72 femmes, parmi lesquelles 39 avec fractures vertébrales.TBS diminue avec l'âge (-0.005 par année, p < 0,001) etdiminue en fonction de l'IMC (- 0,011 par kg/m2, p < 0,001). La corrélationentre TBS et la DMO de la colonne lombaire est faible(r = 0,4, p < 0,001) et un grand pourcentage de la variabilité du TBSest indépendant de la DMO (> 84%). TBS discrimine les femmes avecfractures vertébrales des femmes sans fracture vertébrale et lesfemmes avec OP clinique (fractures de fragilité) de celles sans OPclinique. Ce pouvoir discriminatif est indépendant de la DMO de lacolonne lombaire ou du T-score le plus bas, après ajustement pourl'âge et l'IMC.Odd ratio (OR, 95 % IC) pour une diminution d'une déviation standarddu TBS, ajusté pour l'âge, l'IMC et la mesure de DMO :Conclusion. - TBS représente une plus-value par rapport à la DMOdans l'appréciation du risque de fracture chez les femmes vaudoisesde 60 ans et plus.

Designing mobile access to DSpace-based digital libraries

Developing countries face serious problems on building and using digital libraries (DL) due to low computer and Internet penetration rates, lack of financial resources, etc. Thus, since mobile phones are much more used than computers in these countries, they might be a good alternative for accessing DL. Moreover, in the developed world there has been an exponential growth on the usage of mobile phones for data traffic, establishing a good ground for accessing DL on mobile devices. This paper presents a design proposal for making DSpace-based digital libraries accessible on mobile phones. Since DSpace is a popular free and open source DL system used around the world, making it accessible through mobile devices might contribute for improving the global accessibility of scientific and academic publications.

Enabling mobile access to digital libraries in digital divide contexts

Digital libraries (DL) have had a tremendous impact on improving the accessibility of scientific and academic publications. In developing countries, they seem to be the great hope, due to the serious existing problems with the traditional publishing and distribution mechanisms and to the potential they have on enabling access to a great panoply of publications. Moreover, accessing digital libraries over mobile devices has the potential of reaching a broader community of users and on helping to bridge the digital divide, since there are very reduced computer and Internet penetration rates in these countries, along with a higher mobile phone usage. For developed countries, accessing digital libraries on the go might also bring important added value. This paper features an analysis of the major issues related to making digital libraries accessible over mobile devices. A specific study on the possibility of using mobile digital libraries in a developing country context is also presented along with a proposal for making DSpace based digital libraries accessible over mobile phones.

Variation in performance across Swiss mammography screening programmes: the influence of reading strategy and experience.

[Abstract] Reading volume and mammography screening performance appear positively correlated. Performance was compared across organised Swiss screening programmes, which target relatively small populations. Except for accreditation of 2nd readers radiologists (restrictive vs non-restrictive strategy), Swiss programmes have similar screening regimen/procedures and duration, which maximises comparability. Variation in performance was explored in order to improve mammography practice and optimise screening performance. Indicators of quality and effectiveness were evaluated for about 200,000 screens performed over 4 screening rounds in the 3 longest-standing Swiss cantonal programmes (of Vaud, Geneva and Valais). Interval cancers were identified by linkage with cancer registries records. Most European standards of performance were met with a favourable cancer stage shift. Several performance indicators showed substantial variation across programmes. In subsequent rounds, compared with programmes (Vaud and Geneva) which accredited few 2nd readers to increase their individual reading volume, proportions of in situ lesions and of small cancers (? 1cm) were one third lower and halved, respectively, and the proportion of advanced lesions (stage II+) nearly 50% higher in the programme without a restrictive selection strategy. Discrepancy in second-year proportional incidence of interval cancers appears to be multicausal. Differences in performance could partly be explained by a selective strategy for 2nd readers and a prior experience in service screening, but not by the levels of opportunistic screening and programme attendance. This study provides clues for enhancing mammography screening performance in low-volume Swiss programmes.

Comparison of the polynomial model against explicit measurements of noise components for different mammography systems.

Given the adverse impact of image noise on the perception of important clinical details in digital mammography, routine quality control measurements should include an evaluation of noise. The European Guidelines, for example, employ a second-order polynomial fit of pixel variance as a function of detector air kerma (DAK) to decompose noise into quantum, electronic and fixed pattern (FP) components and assess the DAK range where quantum noise dominates. This work examines the robustness of the polynomial method against an explicit noise decomposition method. The two methods were applied to variance and noise power spectrum (NPS) data from six digital mammography units. Twenty homogeneously exposed images were acquired with PMMA blocks for target DAKs ranging from 6.25 to 1600 µGy. Both methods were explored for the effects of data weighting and squared fit coefficients during the curve fitting, the influence of the additional filter material (2 mm Al versus 40 mm PMMA) and noise de-trending. Finally, spatial stationarity of noise was assessed.Data weighting improved noise model fitting over large DAK ranges, especially at low detector exposures. The polynomial and explicit decompositions generally agreed for quantum and electronic noise but FP noise fraction was consistently underestimated by the polynomial method. Noise decomposition as a function of position in the image showed limited noise stationarity, especially for FP noise; thus the position of the region of interest (ROI) used for noise decomposition may influence fractional noise composition. The ROI area and position used in the Guidelines offer an acceptable estimation of noise components. While there are limitations to the polynomial model, when used with care and with appropriate data weighting, the method offers a simple and robust means of examining the detector noise components as a function of detector exposure.

Modular support for developing mobile ad hoc applications

Abstract This PhD thesis addresses the issue of alleviating the burden of developing ad hoc applications. Such applications have the particularity of running on mobile devices, communicating in a peer-to-peer manner and implement some proximity-based semantics. A typical example of such application can be a radar application where users see their avatar as well as the avatars of their friends on a map on their mobile phone. Such application become increasingly popular with the advent of the latest generation of mobile smart phones with their impressive computational power, their peer-to-peer communication capabilities and their location detection technology. Unfortunately, the existing programming support for such applications is limited, hence the need to address this issue in order to alleviate their development burden. This thesis specifically tackles this problem by providing several tools for application development support. First, it provides the location-based publish/subscribe service (LPSS), a communication abstraction, which elegantly captures recurrent communication issues and thus allows to dramatically reduce the code complexity. LPSS is implemented in a modular manner in order to be able to target two different network architectures. One pragmatic implementation is aimed at mainstream infrastructure-based mobile networks, where mobile devices can communicate through fixed antennas. The other fully decentralized implementation targets emerging mobile ad hoc networks (MANETs), where no fixed infrastructure is available and communication can only occur in a peer-to-peer fashion. For each of these architectures, various implementation strategies tailored for different application scenarios that can be parametrized at deployment time. Second, this thesis provides two location-based message diffusion protocols, namely 6Shot broadcast and 6Shot multicast, specifically aimed at MANETs and fine tuned to be used as building blocks for LPSS. Finally this thesis proposes Phomo, a phone motion testing tool that allows to test proximity semantics of ad hoc applications without having to move around with mobile devices. These different developing support tools have been packaged in a coherent middleware framework called Pervaho.