Tension-band wiring of olecranon fractures - Biomechanical analysis of different fixation techniques

Tension-band wiring is a recognised standard treatment for fixation of olecranon fractures. The classical operation technique is well known and widespread among the orthopaedic surgeons. Nevertheless complications like K-wire migration or skin perforation and difficult technical as well as anatomical prerequisites require better-adapted operation fixation methods. In older female patients a cut through of the Kirschner wires with concomitant secondary displacement was observed. We intent to develop a new, better adapted operation technique for olecranon fractures in the old patients, in order to decrease complications and follow-up procedures. In this study we compare two different K-wire positions: 10 models of the classical AO tension-banding to 10 models with adapted K-wire insertion. In this group the K-wire passes from the tip of the olecranon to the posterior cortical of the distal fragment of the ulna. We tested maximal failure load, maximal opening angle as well as maximal work to achieve maximal force. In either technique we were able to determine different variables: a maximal failure load of more than 600N (p = 0.94) for both fixation methods and a maximal opening angle for both techniques of about 10° (p = 0.86). To achieve the maximal force our modified technique required a slightly increased work (p = 0.16). In this study no statistical significant differences between the two fixation techniques was shown. This leads to the conclusion that the modified version is comparable to the classical operation technique considering the stability, but due to the adaption of the angle in the modified procedure, less lesions of neurovascular structures on the volar side can be expected. To support our findings cadaver studies are needed for further investigations.

Qualitative analysis of barriers and facilitators encountered by HIV patients in an ART adherence programme.

Background Medication adherence is a complex, dynamic and changing behaviour that is affected by a variety of factors, including the patient's beliefs and life circumstances. Studies have highlighted barriers to medication adherence (e.g., unmanaged side effects or a lack of social support), as well as facilitators of medication adherence (e.g., technical simplicity of treatment and psychological acceptance of the disease). Since August 2004, in Lausanne (Switzerland), physicians have referred patients who are either experiencing or are at risk of experiencing problems with their HIV antiretroviral treatment (ART) to a routine interdisciplinary ART adherence programme. This programme consists of multifactorial intervention including electronic drug monitoring (MEMS(TM)). Objective This study's objective was to identify the barriers and facilitators encountered by HIV patients with suboptimal medication adherence (≤90 % adherence over the study period). Setting The community pharmacy of the Department of Ambulatory Care and Community Medicine in Lausanne (Switzerland). Method The study consisted of a retrospective, qualitative, thematic content analysis of pharmacists' notes that were taken during semi-structured interviews with patients and conducted as part of the ART adherence programme between August 2004 and May 2008. Main outcome measure Barriers and facilitators encountered by HIV patients. Results Barriers to and facilitators of adherence were identified for the 17 included patients. These factors fell into three main categories: (1) cognitive, emotional and motivational; (2) environmental, organisational and social; and (3) treatment and disease. Conclusion The pharmacists' notes revealed that diverse barriers and facilitators were discussed during medication adherence interviews. Indeed, the results showed that the 17 non-adherent patients encountered barriers and benefited from facilitators. Therefore, pharmacists should inquire about all factors, regardless of whether they have a negative or a positive impact on medication adherence, and should consider all dimensions of patient adherence. The simultaneous strengthening of facilitators and better management of barriers may allow healthcare providers to tailor care to a patient's specific needs and support each individual patient in improving his medication-related behaviour.

Rewarding civil service performance through team bonuses : findings, analysis and recommendations

Performance-related pay within public organizations is continuing to spread. Although it can help to strengthen an entrepreneurial spirit in civil servants, its implementation is marred by technical, financial, managerial and cultural problems. This article identifies an added problem, namely the contradiction that exists between a managerial discourse that emphasizes the team and collective performance, on the one hand, and the use of appraisal and reward tools that are above all individual, on the other. Based on an empirical survey carried out within Swiss public organizations, the analysis shows that the team is currently rarely taken into account and singles out the principal routes towards an integrated system for the management and rewarding of civil servants.

Total Cost of Transportation Analysis of Road and Highway Issues, HR-388, 2002

In the administration, planning, design, and maintenance of road systems, transportation professionals often need to choose between alternatives, justify decisions, evaluate tradeoffs, determine how much to spend, set priorities, assess how well the network meets traveler needs, and communicate the basis for their actions to others. A variety of technical guidelines, tools, and methods have been developed to help with these activities. Such work aids include design criteria guidelines, design exception analysis methods, needs studies, revenue allocation schemes, regional planning guides, designation of minimum standards, sufficiency ratings, management systems, point based systems to determine eligibility for paving, functional classification, and bridge ratings. While such tools play valuable roles, they also manifest a number of deficiencies and are poorly integrated. Design guides tell what solutions MAY be used, they aren't oriented towards helping find which one SHOULD be used. Design exception methods help justify deviation from design guide requirements but omit consideration of important factors. Resource distribution is too often based on dividing up what's available rather than helping determine how much should be spent. Point systems serve well as procedural tools but are employed primarily to justify decisions that have already been made. In addition, the tools aren't very scalable: a system level method of analysis seldom works at the project level and vice versa. In conjunction with the issues cited above, the operation and financing of the road and highway system is often the subject of criticisms that raise fundamental questions: What is the best way to determine how much money should be spent on a city or a county's road network? Is the size and quality of the rural road system appropriate? Is too much or too little money spent on road work? What parts of the system should be upgraded and in what sequence? Do truckers receive a hidden subsidy from other motorists? Do transportation professions evaluate road situations from too narrow of a perspective? In considering the issues and questions the author concluded that it would be of value if one could identify and develop a new method that would overcome the shortcomings of existing methods, be scalable, be capable of being understood by the general public, and utilize a broad viewpoint. After trying out a number of concepts, it appeared that a good approach would be to view the road network as a sub-component of a much larger system that also includes vehicles, people, goods-in-transit, and all the ancillary items needed to make the system function. Highway investment decisions could then be made on the basis of how they affect the total cost of operating the total system. A concept, named the "Total Cost of Transportation" method, was then developed and tested. The concept rests on four key principles: 1) that roads are but one sub-system of a much larger 'Road Based Transportation System', 2) that the size and activity level of the overall system are determined by market forces, 3) that the sum of everything expended, consumed, given up, or permanently reserved in building the system and generating the activity that results from the market forces represents the total cost of transportation, and 4) that the economic purpose of making road improvements is to minimize that total cost. To test the practical value of the theory, a special database and spreadsheet model of Iowa's county road network was developed. This involved creating a physical model to represent the size, characteristics, activity levels, and the rates at which the activities take place, developing a companion economic cost model, then using the two in tandem to explore a variety of issues. Ultimately, the theory and model proved capable of being used in full system, partial system, single segment, project, and general design guide levels of analysis. The method appeared to be capable of remedying many of the existing work method defects and to answer society's transportation questions from a new perspective.

Simulation and Analysis of Arterial Traffic Operations Along the U.S. 61 Corridor in Burlington, Iowa, 1998

The Center for Transportation Research and Education (CTRE) used the traffic simulation model CORSIM to access proposed capacity and safety improvement strategies for the U.S. 61 corridor through Burlington, Iowa. The comparison between the base and alternative models allow for evaluation of the traffic flow performance under the existing conditions as well as other design scenarios. The models also provide visualization of performance for interpretation by technical staff, public policy makers, and the public. The objectives of this project are to evaluate the use of traffic simulation models for future use by the Iowa Department of Transportation (DOT) and to develop procedures for employing simulation modeling to conduct the analysis of alternative designs. This report presents both the findings of the U.S. 61 evaluation and an overview of model development procedures. The first part of the report includes the simulation modeling development procedures. The simulation analysis is illustrated through the Burlington U.S. 61 corridor case study application. Part I is not intended to be a user manual but simply introductory guidelines for traffic simulation modeling. Part II of the report evaluates the proposed improvement concepts in a side by side comparison of the base and alternative models.

The CerdàPlan for the Extension of Barcelona: A Constructivist Analysis of a Town-planning Controversy

Peer-reviewed

Fc block treatment, dead cells exclusion, and cell aggregates discrimination concur to prevent phenotypical artifacts in the analysis of subpopulations of tumor-infiltrating CD11b(+) myelomonocytic cells.

It is well established that cancer cells can recruit CD11b(+) myeloid cells to promote tumor angiogenesis and tumor growth. Increasing interest has emerged on the identification of subpopulations of tumor-infiltrating CD11b(+) myeloid cells using flow cytometry techniques. In the literature, however, discrepancies exist on the phenotype of these cells (Coffelt et al., Am J Pathol 2010;176:1564-1576). Since flow cytometry analysis requires particular precautions for accurate sample preparation and trustable data acquisition, analysis, and interpretation, some discrepancies might be due to technical reasons rather than biological grounds. We used the syngenic orthotopic 4T1 mammary tumor model in immunocompetent BALB/c mice to analyze and compare the phenotype of CD11b(+) myeloid cells isolated from peripheral blood and from tumors, using six-color flow cytometry. We report here that the nonspecific antibody binding through Fc receptors, the presence of dead cells and cell doublets in tumor-derived samples concur to generate artifacts in the phenotype of tumor-infiltrating CD11b(+) subpopulations. We show that the heterogeneity of tumor-infiltrating CD11b(+) subpopulations analyzed without particular precautions was greatly reduced upon Fc block treatment, dead cells, and cell doublets exclusion. Phenotyping of tumor-infiltrating CD11b(+) cells was particularly sensitive to these parameters compared to circulating CD11b(+) cells. Taken together, our results identify Fc block treatment, dead cells, and cell doublets exclusion as simple but crucial steps for the proper analysis of tumor-infiltrating CD11b(+) cell populations.

New directions in Stochastic Multicriteria Acceptability Analysis

Decisions taken in modern organizations are often multi-dimensional, involving multiple decision makers and several criteria measured on different scales. Multiple Criteria Decision Making (MCDM) methods are designed to analyze and to give recommendations in this kind of situations. Among the numerous MCDM methods, two large families of methods are the multi-attribute utility theory based methods and the outranking methods. Traditionally both method families require exact values for technical parameters and criteria measurements, as well as for preferences expressed as weights. Often it is hard, if not impossible, to obtain exact values. Stochastic Multicriteria Acceptability Analysis (SMAA) is a family of methods designed to help in this type of situations where exact values are not available. Different variants of SMAA allow handling all types of MCDM problems. They support defining the model through uncertain, imprecise, or completely missing values. The methods are based on simulation that is applied to obtain descriptive indices characterizing the problem. In this thesis we present new advances in the SMAA methodology. We present and analyze algorithms for the SMAA-2 method and its extension to handle ordinal preferences. We then present an application of SMAA-2 to an area where MCDM models have not been applied before: planning elevator groups for high-rise buildings. Following this, we introduce two new methods to the family: SMAA-TRI that extends ELECTRE TRI for sorting problems with uncertain parameter values, and SMAA-III that extends ELECTRE III in a similar way. An efficient software implementing these two methods has been developed in conjunction with this work, and is briefly presented in this thesis. The thesis is closed with a comprehensive survey of SMAA methodology including a definition of a unified framework.

Relative Technical Efficiency of European Transportation Systems

Talouden kasvaessa myös tavarankuljetusmäärät kasvavat. Kuljetusjärjestelmät ja niiden sujuva toiminta on erittäin tärkeää taloudellisen kasvun kannalta tällä hetkellä, ja se tulee olemaan yhä tärkeämpää tulevaisuudessa. Tulevaisuudessa tarvitaan kokonaisvaltainen ja selkeästi tehokkaampi kuljetusjärjestelmä, mikäli tulevaisuuden kuljetusvirrat halutaan hoitaa kestävästi. Tässä opinnäytetyössäni tutkin kolmen eurooppalaisen kuljetusjärjestelmän (rautatiet, lentoliikenne ja konttiliikenne meritse) suhteellista teknistä tehokkuutta ja menetelmänä on data envelopment analysis (DEA). Vertailtaessa kuljetusjärjestelmiä löytyi suuria eroja kuljetusmuotojen välille. lentoyhtiöt suoriutuivat huomattavan tasaisesti eli tehokkaiden ja ei-tehokkaiden toimijoiden välillä ei ollut suuria eroja. Rautatiepuolella erot venyivät huomattavan suuriksi niin eri yritysten välillä kuin jopa saman yrityksen sisällä eri vuosina. Pikaisemmassa laivayhtiöiden tarkastelussa erot niiden välillä olivat lähes yhtä pieniä kuin lentoyhtiöiden välillä. Tarkasteltaessa omistajuuden vaikutusta lentoyhtiöiden toiminnassa huomattiin, että yksityisessä omistuksessa olevat yritykset olivat huomattavasti tehokkaampia matkustajien kuljettamisessa. Rahtipuolella merkittäviä eroja ei havaittu. Merkittävät korrelaatiot eri mallien välillä antoivat joitain viitteitä myös kuljetuspoliittiseen päätöksentekoon; investoinnit matkustajienkuljetuksiin raiteilla parantaisivat koko rautatiepuolen teokkuutta, mutta myös samalla lentopuolen matkustajakuljetuksen tehokkuutta.

Logging residues from regeneration fellings for biofuel production - a GIS-based availability and supply cost analysis

Finland has large forest fuel resources. However, the use of forest fuels for energy production has been low, except for small-scale use in heating. According to national action plans and programs related to wood energy promotion, the utilization of such resources will be multiplied over the next few years. The most significant part of this growth will be based on the utilization of forest fuels, produced from logging residues of regeneration fellings, in industrial and municipal power and heating plants. Availability of logging residues was analyzed by means of resource and demand approaches in order to identify the most suitable regions with focus on increasing the forest fuel usage. The analysis included availability and supply cost comparisons between power plant sites and resource allocation in a least cost manner, and between a predefined power plant structure under demand and supply constraints. Spatial analysis of worksite factors and regional geographies were carried out using the GIS-model environment via geoprocessing and cartographic modeling tools. According to the results of analyses, the cost competitiveness of forest fuel supply should be improved in order to achieve the designed objectives in the near future. Availability and supply costs of forest fuels varied spatially and were very sensitive to worksite factors and transport distances. According to the site-specific analysis the supply potential between differentlocations can be multifold. However, due to technical and economical reasons ofthe fuel supply and dense power plant infrastructure, the supply potential is limited at plant level. Therefore, the potential and supply cost calculations aredepending on site-specific matters, where regional characteristics of resourcesand infrastructure should be taken into consideration, for example by using a GIS-modeling approach constructed in this study.

Dissatisfaction of hospital patients, their relatives, and friends: Analysis of accounts collected in a complaints center.

OBJECTIVE: This study aimed to analyze complaints of patients, their relatives, and friends who consulted a complaints center based (Espace Patients & Proches (EPP)) in a hospital so as to better understand the reasons that motivated them and their underlying expectations. METHODS: This study was based on the analysis of written accounts of the 253 situations that occurred during the first year of operation of the EPP. The accounts were analyzed qualitatively using an inductive, thematic analytic approach. RESULTS: We identified 372 different types of complaints and 28 main analytic themes. Five clustered themes emerged from the analysis of the interconnections among the core themes: (1) interpersonal relationship (N=160-the number of accounts including a complaint related to this general theme); (2) technical aspects of care (N=106); (3) health-care institution (N=69); (4) billing and insurance; (5) access to information (N=13). CONCLUSION: The main reason for patients, their relatives, and friends going to EPP was related to the quality of the interpersonal relationship with health-care professionals. Such complaints were markedly more frequent than those concerning technical aspects of care. PRACTICE IMPLICATIONS: These results raise important questions concerning changing patient expectations as well as how hospitals integrate complaints into the process of quality health care.

Technical Note: Dissolved organic matter fluorescence a finite mixture approach to deconvolve excitation-emission matrices

The analysis of the shape of excitation-emission matrices (EEMs) is a relevant tool for exploring the origin, transport and fate of dissolved organic matter (DOM) in aquatic ecosystems. Within this context, the decomposition of EEMs is acquiring a notable relevance. A simple mathematical algorithm that automatically deconvolves individual EEMs is described, creating new possibilities for the comparison of DOM fluorescence properties and EEMs that are very different from each other. A mixture model approach is adopted to decompose complex surfaces into sub-peaks. The laplacian operator and the Nelder-Mead optimisation algorithm are implemented to individuate and automatically locate potential peaks in the EEM landscape. The EEMs of a simple artificial mixture of fluorophores and DOM samples collected in a Mediterranean river are used to describe the model application and to illustrate a strategy that optimises the search for the optimal output.

Offering Analysis in New Product Launch and Sales Planning

This Master's Thesis has been written for Stora Enso Flexible Packaging Papers business unit. In the North-American mills, the business unit has developed a range of new flexible packaging paper grades. The Master's Thesis researches opportunities for sales of these new flexible packaging papers in selected Western-European markets. This study consists of theoretical and empirical part. Theoretical part presents supply chain of flexible packaging, discovering of customer requirements, concept of an offering, general market analysis, customer analysis and basis for sales planning. Empirical part includes preliminary market analysis based on secondary sources, results of lead user interviews and conclusions and recommendations. Potential customers' technical and commercial requirements were found and these were compared to current Stora Enso Flexible Packaging Papers offering. Also a list of potential new customers was made and sales action suggestions were presented in order to gain new accounts.

The conditions for the reproduction of the SAGUAPAC water cooperative in the city of Santa Cruz de la Sierra, Bolivia : discourse analysis

The SAGUAPAC cooperative in the city of Santa Cruz de la Sierra (Eastern Bolivia) is regularly presented as an example of cooperative successes regarding water supply and sanitation. Its efficiency, both economic and technical, is widely considered as the main reason for its attractiveness. However, without denying its importance, we show, through a discourse analysis from and about SAGUAPAC in local media, that moral and non-instrumental factors are crucial in the reproduction of the cooperative. These factors create attachment and affection toward the cooperative, through a storytelling using a four-dimensional rhetoric (mythification, identification, emotionalisation and personification). This storytelling technique, internalized in the local media discourse and materializing the so-called new spirit of capitalism, exploits the affects and instrumentalisation of local myths and legends, as well as the 'camba' ethnic identity. In that, it tends to retain SAGUAPAC members and to canvass new ones, by providing them with recognition in their quality of local community members. However, the mobilisation of social norms and power hierarchies might end up reinforcing the social exclusion of Andean non-camba immigrants, inspite of an a priori inclusive and democratic organisation.

Inter-rater Reliability of Criteria-Based Content Analysis of Children's Statements of Abuse.

The evaluation of children's statements of sexual abuse cases in forensic cases is critically important and must and reliable. Criteria-based content analysis (CBCA) is the main component of the statement validity assessment (SVA), which is the most frequently used approach in this setting. This study investigated the inter-rater reliability (IRR) of CBCA in a forensic context. Three independent raters evaluated the transcripts of 95 statements of sexual abuse. IRR was calculated for each criterion, total score, and overall evaluation. The IRR was variable for the criteria, with several being unsatisfactory. But high IRR was found for the total CBCA scores (Kendall's W = 0.84) and for overall evaluation (Kendall's W = 0.65). Despite some shortcomings, SVA remains a robust method to be used in the comprehensive evaluation of children's statements of sexual abuse in the forensic setting. However, the low IRR of some CBCA criteria could justify some technical improvements.