The scarf osteotomy for the treatment of hallux valgus deformity: a review of 84 cases.

This study reviewed the subjective, clinical and radiological outcome of 71 patients (84 feet) treated by scarf osteotomy for hallux valgus deformity at our institution from 1995 to 1998 with an average follow-up time of 22 months (range, 17 to 48 months). At the time of follow-up, 39% of the patients were very satisfied, 50% were satisfied and 11% were not satisfied. The mean AOFAS score raised significantly from 43 points (14-68) preoperatively to 82 points (39 to 100) at follow-up (p < 0.001). The radiological angles including M1-M2, M1-P1, M1-M5 and DMAA improved significantly (p < 0.001). Among the 16 complications recorded, seven (8%) were minor and nine (11%) required an additional procedure. The scarf osteotomy of the first metatarsal coupled with a lateral soft-tissue release and, in three-quarters of our cases, with a basal closing wedge varisation osteotomy of the first phalanx, resulted in overall high satisfaction rate as well as significant clinical and radiological improvements in our series. Nevertheless, the range of motion of the first MP joint remained low: 30 degrees to 74 degrees in 52 patients (62%) and <30 degrees in four patients (5%). Furthermore, the mobility of the first ray as well as the consequences of the procedure in the sagittal plane need to be assessed more accurately, and this may be achieved by incorporating measurement of the plantar pressures in the forefoot area into the global rating system.

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule.

BACKGROUND: Chest pain can be caused by various conditions, with life-threatening cardiac disease being of greatest concern. Prediction scores to rule out coronary artery disease have been developed for use in emergency settings. We developed and validated a simple prediction rule for use in primary care. METHODS: We conducted a cross-sectional diagnostic study in 74 primary care practices in Germany. Primary care physicians recruited all consecutive patients who presented with chest pain (n = 1249) and recorded symptoms and findings for each patient (derivation cohort). An independent expert panel reviewed follow-up data obtained at six weeks and six months on symptoms, investigations, hospital admissions and medications to determine the presence or absence of coronary artery disease. Adjusted odds ratios of relevant variables were used to develop a prediction rule. We calculated measures of diagnostic accuracy for different cut-off values for the prediction scores using data derived from another prospective primary care study (validation cohort). RESULTS: The prediction rule contained five determinants (age/sex, known vascular disease, patient assumes pain is of cardiac origin, pain is worse during exercise, and pain is not reproducible by palpation), with the score ranging from 0 to 5 points. The area under the curve (receiver operating characteristic curve) was 0.87 (95% confidence interval [CI] 0.83-0.91) for the derivation cohort and 0.90 (95% CI 0.87-0.93) for the validation cohort. The best overall discrimination was with a cut-off value of 3 (positive result 3-5 points; negative result <or= 2 points), which had a sensitivity of 87.1% (95% CI 79.9%-94.2%) and a specificity of 80.8% (77.6%-83.9%). INTERPRETATION: The prediction rule for coronary artery disease in primary care proved to be robust in the validation cohort. It can help to rule out coronary artery disease in patients presenting with chest pain in primary care.

Early co-occurrence of a neurologic-psychiatric disease pattern in Niemann-Pick type C disease: a retrospective Swiss cohort study.

BackgroundNiemann-Pick disease type C (NP-C) is a rare autosomal recessive disorder of lysosomal cholesterol transport. The objective of this retrospective cohort study was to critically analyze the onset and time course of symptoms, and the clinical diagnostic work-up in the Swiss NP-C cohort.MethodsClinical, biochemical and genetic data were assessed for 14 patients derived from 9 families diagnosed with NP-C between 1994 and 2013. We retrospectively evaluated diagnostic delays and period prevalence rates for neurological, psychiatric and visceral symptoms associated with NP-C disease. The NP-C suspicion index was calculated for the time of neurological disease onset and the time of diagnosis.ResultsThe shortest median diagnostic delay was noted for vertical supranuclear gaze palsy (2y). Ataxia, dysarthria, dysphagia, spasticity, cataplexy, seizures and cognitive decline displayed similar median diagnostic delays (4¿5y). The longest median diagnostic delay was associated with hepatosplenomegaly (15y). Highest period prevalence rates were noted for ataxia, dysarthria, vertical supranuclear gaze palsy and cognitive decline. The NP-C suspicion index revealed a median score of 81 points in nine patients at the time of neurological disease onset which is highly suspicious for NP-C disease. At the time of diagnosis, the score increased to 206 points.ConclusionA neurologic-psychiatric disease pattern represents the most characteristic clinical manifestation of NP-C and occurs early in the disease course. Visceral manifestation such as isolated hepatosplenomegaly often fails recognition and thus highlights the importance of a work-up for lysosomal storage disorders. The NP-C suspicion index emphasizes the importance of a multisystem evaluation, but seems to be weak in monosymptomatic and infantile NP-C patients.

Genetic variants of the FADS gene cluster and ELOVL gene family, colostrums LC-PUFA levels, breastfeeding, and child cognition

Introduction: Breastfeeding effects on cognition are attributed to long-chain polyunsaturated fatty acids (LC-PUFAs), but controversy persists. Genetic variation in fatty acid desaturase (FADS) and elongase (ELOVL) enzymes has been overlooked when studying the effects of LC-PUFAs supply on cognition. We aimed to: 1) to determine whether maternal genetic variants in the FADS cluster and ELOVL genes contribute to differences in LC-PUFA levels in colostrum; 2) to analyze whether these maternal variants are related to child cognition; and 3) to assess whether children's variants modify breastfeeding effects on cognition. Methods: Data come from two population-based birth cohorts (n = 400 mother-child pairs from INMA-Sabadell; and n = 340 children from INMA-Menorca). LC-PUFAs were measured in 270 colostrum samples from INMA-Sabadell. Tag SNPs were genotyped both in mothers and children (13 in the FADS cluster, 6 in ELOVL2, and 7 in ELOVL5). Child cognition was assessed at 14 mo and 4 y using the Bayley Scales of Infant Development and the McCarthy Scales of Children"s Abilities, respectively. Results: Children of mothers carrying genetic variants associated with lower FADS1 activity (regulating AA and EPA synthesis), higher FADS2 activity (regulating DHA synthesis), and with higher EPA/AA and DHA/AA ratios in colostrum showed a significant advantage in cognition at 14 mo (3.5 to 5.3 points). Not being breastfed conferred an 8- to 9-point disadvantage in cognition among children GG homozygote for rs174468 (low FADS1 activity) but not among those with the A allele. Moreover, not being breastfed resulted in a disadvantage in cognition (5 to 8 points) among children CC homozygote for rs2397142 (low ELOVL5 activity), but not among those carrying the G allele. Conclusion: Genetically determined maternal supplies of LC-PUFAs during pregnancy and lactation appear to be crucial for child cognition. Breastfeeding effects on cognition are modified by child genetic variation in fatty acid desaturase and elongase enzymes.

Development and validation of a clinical prediction rule for chest wall syndrome in primary care.

ABSTRACT: BACKGROUND: Chest wall syndrome (CWS), the main cause of chest pain in primary care practice, is most often an exclusion diagnosis. We developed and evaluated a clinical prediction rule for CWS. METHODS: Data from a multicenter clinical cohort of consecutive primary care patients with chest pain were used (59 general practitioners, 672 patients). A final diagnosis was determined after 12 months of follow-up. We used the literature and bivariate analyses to identify candidate predictors, and multivariate logistic regression was used to develop a clinical prediction rule for CWS. We used data from a German cohort (n = 1212) for external validation. RESULTS: From bivariate analyses, we identified six variables characterizing CWS: thoracic pain (neither retrosternal nor oppressive), stabbing, well localized pain, no history of coronary heart disease, absence of general practitioner's concern, and pain reproducible by palpation. This last variable accounted for 2 points in the clinical prediction rule, the others for 1 point each; the total score ranged from 0 to 7 points. The area under the receiver operating characteristic (ROC) curve was 0.80 (95% confidence interval 0.76-0.83) in the derivation cohort (specificity: 89%; sensitivity: 45%; cut-off set at 6 points). Among all patients presenting CWS (n = 284), 71% (n = 201) had a pain reproducible by palpation and 45% (n = 127) were correctly diagnosed. For a subset (n = 43) of these correctly classified CWS patients, 65 additional investigations (30 electrocardiograms, 16 thoracic radiographies, 10 laboratory tests, eight specialist referrals, one thoracic computed tomography) had been performed to achieve diagnosis. False positives (n = 41) included three patients with stable angina (1.8% of all positives). External validation revealed the ROC curve to be 0.76 (95% confidence interval 0.73-0.79) with a sensitivity of 22% and a specificity of 93%. CONCLUSIONS: This CWS score offers a useful complement to the usual CWS exclusion diagnosing process. Indeed, for the 127 patients presenting CWS and correctly classified by our clinical prediction rule, 65 additional tests and exams could have been avoided. However, the reproduction of chest pain by palpation, the most important characteristic to diagnose CWS, is not pathognomonic.

Smart antennas in software radio base stations

The application of adaptive antenna techniques to fixed-architecture base stations has been shown to offer wide-ranging benefits, including interference rejection capabilities or increased coverage and spectral efficiency.Unfortunately, the actual implementation ofthese techniques to mobile communication scenarios has traditionally been set back by two fundamental reasons. On one hand, the lack of flexibility of current transceiver architectures does not allow for the introduction of advanced add-on functionalities. On the other hand, theoften oversimplified models for the spatiotemporal characteristics of the radio communications channel generally give rise toperformance predictions that are, in practice, too optimistic. The advent of software radio architectures represents a big step toward theintroduction of advanced receive/transmitcapabilities. Thanks to their inherent flexibilityand robustness, software radio architecturesare the appropriate enabling technology for theimplementation of array processing techniques.Moreover, given the exponential progression ofcommunication standards in coexistence andtheir constant evolution, software reconfigurabilitywill probably soon become the only costefficientalternative for the transceiverupgrade. This article analyzes the requirementsfor the introduction of software radio techniquesand array processing architectures inmultistandard scenarios. It basically summarizesthe conclusions and results obtained withinthe ACTS project SUNBEAM,1 proposingalgorithms and analyzing the feasibility ofimplementation of innovative and softwarereconfigurablearray processing architectures inmultistandard settings.

Description of a robotics-oriented relational positioning methodology

This paper presents a relational positioning methodology for flexibly and intuitively specifying offline programmed robot tasks, as well as for assisting the execution of teleoperated tasks demanding precise movements.In relational positioning, the movements of an object can be restricted totally or partially by specifying its allowed positions in terms of a set of geometric constraints. These allowed positions are found by means of a 3D sequential geometric constraint solver called PMF – Positioning Mobile with respect to Fixed. PMF exploits the fact that in a set of geometric constraints, the rotational component can often be separated from the translational one and solved independently.

Developing Processes and Learning in a Project-based Firm

Tämän diplomityön tavoitteena on kuvata tiedonkulkua projektiliiketoimintaa harjoittavassa yrityksessä sekä analysoida kuvausta määrittäen mahdolliset kehityskohdat. Työssätuotetut kuvaukset ja kehityskohtien määrittäminen toimivat pohjana yrityksen kehittäessä projektien hallintaansa tulevaisuudessa. Työssä valitaan tietojohtamisen näkökulma sopivaksi lähestymistavaksi yrityksen toiminnananalysointiin. Haastatteluin kerätyn tutkimusmateriaalin perusteella luodaan prosessikuvaukset jotka mallintavat tietovirtoja yrityksen projektien aikana tapahtuvien prosessien välillä. Kuvausta peilataan tietämyksen luomisen sekä projektien tietojohtamisen teoriaan ja määritetään kehityskohteita. Kehityskohteiden määrittämisen lisäksi ehdotetaan mahdollisia toimenpiteitä tiedon ja tietämyksen hallinnan kehittämiseksi. Kokemusten ja opittujen asioiden sekäpalautteen kerääminen projektien aikana sekä niiden jälkeen havaittiin tärkeimmäksi kehityskohdaksi. Näiden keräämisen voidaan todeta vaativan järjestelmällisyyttä jotta projektien onnistumiset sekä niissä saavutetut parannukset voidaan toistaa jatkossa ja virheet sekä epäonnistumiset sitä vastoin välttää.

Verkkonaapuruston valvontatehtävien siirto mobiililaitteelta kiinteälle laitteelle PeerHood -verkossa

PeerHood -verkon mobiililaitteiden akkutehon säästämiseksi siirretään mobiililaitteen verkkonaapuruston valvontatehtävät kiinteälle laitteelle. Valvontatehtävien siirto on tarkoitus tehdä silloin, kun laite pysyy paikallaan, esimerkiksi toimisto tiloissa. Laitteen pysyessä paikallaan voidaan verkkonaapurustoa seurata kiinteän laitteen resursseilla ja päivittää verkkomuutokset mobiililaitteelle tarvittaessa. Mobiililaitteen ollessa vain kuuntelutilassa laite säästää akkutehoa, koska sen ei tarvitse aktiivisesti lähettää dataa verkkolaitteillaan. Verkkolaitteet pysyvät lepotilassa ja odottavat vain tulevaa dataa. Verkkonaapuruston valvontatehtävien siirto ei kuitenkaan vaikuta käyttäjän palveluiden hyödyntämiseen, joten verkkolaitteen akkutehon säästö riippuu suuresti käyttäjän toimista, käyttäjä voi edelleen käyttää muiden PeerHood laitteiden palveluita tai tarjota omiaan.

Extreme-value distributions and renormalization group

In the classical theorems of extreme value theory the limits of suitably rescaled maxima of sequences of independent, identically distributed random variables are studied. The vast majority of the literature on the subject deals with affine normalization. We argue that more general normalizations are natural from a mathematical and physical point of view and work them out. The problem is approached using the language of renormalization-group transformations in the space of probability densities. The limit distributions are fixed points of the transformation and the study of its differential around them allows a local analysis of the domains of attraction and the computation of finite-size corrections.

Sostenibilidad de la producción porcina en Cataluña (España). Aplicación del análisis multicriterio

La evaluación de la sostenibilidad en modelos de producción porcina en Cataluña (España), mediante el análisis multicriterio, se estructura en dos partes. Una primera de establecimiento del marco de análisis donde, de forma participativa, se fijan los criterios de evaluación, sus indicadores y las escalas de evaluación. En la segunda se implementa la metología expuesta para evaluar la sostenibilidad de tres modelos productivos y detectar posibles conflictos entre los diferentes grupos de interés. Los resultados obtenidos demuestran que desde el punto de vista de la sostenbilidad, en base a los criterios considerados y bajo distintas opciones de robustez, el modelo productivo más sostenible es el ecológico, seguido del familiar y, en último puesto, el del modelo denominado de integración. En cuanto a la formación de coaliciones se observa que hay un importante grupo de actores que apuestan, en primer lugar, por el modelo de integración. Los anteriores resultados avalan la necesidad de potenciar modelos intermedios entre el ecológico y el de integración. Una opción conciliadora, entre las existentes, podría ser el tipo familiar, aplicando algunas mejoras en el manejo si se quieren satisfacer plenamente los requerimientos de sostenibilidad.

Propuesta de un protocolo de evaluación de la calidad ecológica de ríos andinos (CERA) y su aplicación a dos cuencas de Ecuador y Perú

ABSTRACT Proposal for an evaluation protocol of the ecological quality of Andean rivers (CERA) and its use in two basins in Ecuador and Peru A Rapid Protocol is presented for Evaluation of the Ecological Status of Andean Rivers (CERA) localized over 2000 m.a.s.l. from the Northern Andes (Venezuela) through the Altiplano in the Central Andes (Bolivia). This protocol was used in 45 sampling sites in the Guayllabamba River Basin in Ecuador and in 42 sampling sites in the Ca nete River Basin in Peru. Previously, and in order to test if the sampling stations may or not be considered reference stations, we constructed a method that assesses 24 basin attributes, hydrology, reach and riverbed and that uctuates from 24 to 120 points; sites with values higher than 100 were considered as potential reference sites. Besides the benthic macroinvertebrats" evaluation, the river habitat and riparian vegetation were also evaluated through of the application of the indices ABI (R´ os et al., submitted), IHF (Pardo et al., 2002) and QBR-And, respectively. The convenience of the initial allocation of the reference sites was evaluated as well. These indices have been properly adapted to the conditions and characteristics of the high Andes rivers. The results obtained for both basins were compared and discussed. Through the use of the CERA protocol, the particular perturbation gradients and the natural variability of the reference sites in both countries were recognized. RESUMEN Propuesta de un protocolo de evaluación de la calidad ecológica de ríos andinos (CERA) y su aplicaci´on a dos cuencas en Ecuador y Perú Se presenta un protocolo rápido de evaluación de la Calidad Ecológica de Ríos Andinos (CERA), situados sobre los 2000 m.s.n.m, desde los Andes del Norte (Venezuela) hasta el Altiplano de los Andes Centrales (Bolivia). Este protocolo ha sido aplicado en 45 estaciones de muestreo en la cuenca del río Guayllabamba en Ecuador y en 42 estaciones de muestreo en la cuenca del río Cañete en Perú. Previamente, para probar si las estaciones de muestreo pueden o no ser estaciones de referencia construimos un método que valora 24 atributos de cuenca, hidrología, tramo y lecho y que fluctúa de 24 a 120 puntos; valores superiores a 100 fueron considerados como sitios potencialmente de referencia. Además del estudio de los macroinvertebrados bentónicos, se evaluó el hábitat fluvial y la comunidad vegetal de ribera a través de la aplicación de los índices ABI (Ríos et al., sometido), IHF (Pardo et al., 2002) y QBR-And respectivamente; así como la conveniencia de la asignación inicial de las estaciones de referencia. Estos índices han sido adecuadamente adaptados a las condiciones y características propias de los ríos altoandinos. Los resultados obtenidos fueron comparados y discutidos entre ambas cuencas. Mediante la aplicación del protocolo CERA se han reconocido los respectivos gradientes de perturbación y la variabilidad natural de las estaciones de referencia en ambos países.

Juegos digitales en el aula: un caso de estudio

Durante el año 2011 se diseño, implementó y estudió un juego digital que muestra la vida de un científico Catalán: El paleontólogo Miquel Crusafont. El juego fue creado como un recurso para el aprendizaje cognitivo y posteriormente fue utilizado en aulas de primaria con el fin de obtener la visión de los profesores involucrados. Como método de recolección de datos se ha utilizado la observación, la entrevista en profundidad y el grupo focal. El objetivo principal de este estudio se centra en reunir la visión de profesores de primaria, al hacer uso de juegos en el aula. Las conclusiones nos muestran las percepciones que los miembros del grupo de estudio tiene sobre el uso de juegos digitales.

Palveluyrityksen strateginen ohjaus ja tavoiteasetanta tiimiorganisaatiossa. Case: Etelä-Karjalan Osuuspankki

Tutkielman tavoitteena oli selvittää talouden ohjauksen tila case -yrityksessä, pyrkiä tunnistamaan kehityskohteita ohjauksessa ja ehdottaa mallia, joka huomioi tunnistetut kehittämiskohteet. Teoriaosassa analysoidaan yrityksen ohjausta aiemman teoreettisen kirjoittelun perusteella ja esitetään käsitteet sekä viitekehys. Empiirisessä osassa analysoidaan case -yrityksen ohjauksen nykytilaa ja tunnistetaan kehityskohteita ohjauksessa. Tutkielmassa on käytetty sekä hermeneuttista että normatiivista tutkimusotetta Tutkimuksessa havaittiin strategian jalkautumisen jäävän puutteelliseksi ja tämän vaikeuttavan tavoitteiden takana olevan ajattelun ymmärtämistä. Tavoitteisiin sitoutumista vaikeutti myös näkemys, jonka mukaan tavoitteet tulivat liikaa annettuina tekijöinä. Tutkielman lopuksi kehitettiin case-yritykselle tavoiteasetantamalli, jonka nähtiin auttavan strategian jalkauttamista ja sitouttamista yrityksen myyntitavoitteisiin.

Progressive multifocal leukoencephalopathy in common variable immunodeficiency: mitigated course under mirtazapine and mefloquine.

Demonstration of survival and outcome of progressive multifocal leukoencephalopathy (PML) in a 56-year-old patient with common variable immunodeficiency, consisting of severe hypogammaglobulinemia and CD4+ T lymphocytopenia, during continuous treatment with mirtazapine (30 mg/day) and mefloquine (250 mg/week) over 23 months. Regular clinical examinations including Rankin scale and Barthel index, nine-hole peg and box and block tests, Berg balance, 10-m walking tests, and Montreal Cognitive Assessment (MoCA) were done. Laboratory diagnostics included complete blood count and JC virus (JCV) concentration in cerebrospinal fluid (CSF). The noncoding control region (NCCR) of JCV, important for neurotropism and neurovirulence, was sequenced. Repetitive MRI investigated the course of brain lesions. JCV was detected in increasing concentrations (peak 2568 copies/ml CSF), and its NCCR was genetically rearranged. Under treatment, the rearrangement changed toward the archetype sequence, and later JCV DNA became undetectable. Total brain lesion volume decreased (8.54 to 3.97 cm(3)) and atrophy increased. Barthel (60 to 100 to 80 points) and Rankin (4 to 2 to 3) scores, gait stability, and box and block (7, 35, 25 pieces) and nine-hole peg (300, 50, 300 s) test performances first improved but subsequently worsened. Cognition and walking speed remained stable. Despite initial rapid deterioration, the patient survived under continuous treatment with mirtazapine and mefloquine even though he belongs to a PML subgroup that is usually fatal within a few months. This course was paralleled by JCV clones with presumably lower replication capability before JCV became undetectable. Neurological deficits were due to PML lesions and progressive brain atrophy.