Incidents occurring during anesthesia for total hip arthroplasty: a comparison of general versus regional anaesthesia

Background: The type of anesthesia to be used for total hip arthroplasty (THA) is still a matter of debate. We compared the occurrence of per- and post-anesthesia incidents in patients receiving either general (GA) or regional anesthesia (RA). Methods: We used data from 29 hospitals, routinely collected in the Anaesthesia Databank Switzerland register between January 2001 and December 2003. We used multi-level logistic regression models. Results: There were more per- and post-anesthesia incidents under GA compared to RA (35.1% vs 32.7 %, n = 3191, and 23.1% vs 19.4%, n = 3258, respectively). In multi-level logistic regression analysis, RA was significantly associated with a lower incidence of per-anesthetic problems, especially hypertension, compared with GA. During the post-anesthetic period, RA was also less associated with pain. Conversely, RA was more associated with post-anesthetic hypotension, especially for epidural technique. In addition, age and ASA were more associated with incidents under GA compared to RA. Men were more associated with per-anesthetic problems under RA compared to GA. Whereas increased age (>67), gender (male), and ASA were linked with the choice of RA, we noticed that this choice depended also on hospital practices after we adjusted for the other variables. Conclusions: Compared to RA, GA was associated with an increased proportion of per- and post-anesthesia incidents. Although this study is only observational, it is rooted in daily practice. Whereas RA might be routinely proposed, GA might be indicated because of contraindications to RA, patients' preferences or other surgical or anaesthesiology related reasons. Finally, the choice of a type of anesthesia seems to depend on local practices that may differ between hospitals.

Vertical Syndication-Proof Competitive Prices in Multilateral Markets

[eng] A multi-sided Böhm-Bawerk assignment game (Tejada, to appear) is a model for a multilateral market with a finite number of perfectly complementary indivisible commodities owned by different sellers, and inflexible demand and support functions. We show that for each such market game there is a unique vector of competitive prices for the commodities that is vertical syndication-proof, in the sense that, at those prices, syndication of sellers each owning a different commodity is neither beneficial nor detrimental for the buyers. Since, moreover, the benefits obtained by the agents at those prices correspond to the nucleolus of the market game, we provide a syndication-based foundation for the nucleolus as an appropriate solution concept for market games. For different solution concepts a syndicate can be disadvantageous and there is no escape to Aumman’s paradox (Aumann, 1973). We further show that vertical syndicationproofness and horizontal syndication-proofness – in which sellers of the same commodity collude – are incompatible requirements under some mild assumptions. Our results build on a self-interesting link between multi-sided Böhm-Bawerk assignment games and bankruptcy games (O’Neill, 1982). We identify a particular subset of Böhm-Bawerk assignment games and we show that it is isomorphic to the whole class of bankruptcy games. This isomorphism enables us to show the uniqueness of the vector of vertical syndication-proof prices for the whole class of Böhm-Bawerk assignment market using well-known results of bankruptcy problems.

Contexts and typologies in the analysis of welfare state legitimacy : a social psychological approach to political opinion formation

This dissertation analyses public opinion towards the welfare state across 29 European countries. Based on an interdisciplinary approach combining social psychological, sociological, and public opinion approaches to political opinion formation, it investigates how social position and shared beliefs shape perceived legitimacy of welfare institutions, and how social contexts impact on the processes of opinion formation. Drawing on social representations theory, as well as socialization and self-interest approaches, the dissertation analyses the role of social position in lay support for institutional solidarity. Normative beliefs-defined as preferred views regarding the organisation of social relations-mediate the effect of social position on welfare support. In addition, drawing on public opinion literature, the dissertation analyses opinion formation as a function of country-level structural (e.g., level of social spending, unemployment) and ideological factors (e.g., level of meritocracy). The dissertation comprises two theoretical and four empirical chapters. Three of the empirical chapters use data from the European Social Survey 2008. Using multilevel and typological approaches, the dissertation contributes to welfare attitude literature by showing that normative beliefs, such as distrust or egalitarianism, function as underlying mechanisms that link social position to policy attitudes (Chapter 3), and that characteristics of the national contexts influence the processes of political opinion formation (Chapters 3 and 4). Chapter 5 proposes and predicts a typology of the relationship between attitudes towards solidarity and attitudes towards control, reflecting the two central domains of government intervention. Finally, Chapter 6 examines welfare support in the realm of action and social protest, using data from a survey on Spanish Indigados activists. The findings of this dissertation inform contemporary debates about welfare state legitimacy and retrenchment. - Cette thèse avait pour but d'analyser l'opinion publique envers l'Etat social dans 29 pays européens. Basée sur une approche interdisciplinaire qui combine des perspectives psycho-sociales, sociologiques et d'opinion publique sur la formation d'opinion politique, la thèse étudie comment la position sociale et les croyances partagées façonnent la légitimité perçue des institutions de l'Etat social, et comment les contextes sociaux influencent les processus de formation d'opinion. Basée sur la théorie des représentations sociales, ainsi qu'une approche de socialisation et d'intérêt propre, cette thèse analyse le rôle des positions sociales dans le soutien envers la solidarité institutionnelle. Les croyances normatives-définies comme les visions préférées de l'organisation des rapports sociaux-médiatisent l'effet de la position sociale sur le soutien pour l'Etat social. De plus, s'inspirant de la littérature sur l'opinion publique, la thèse analyse la formation d'opinion en fonction des facteurs structurels (ex. le taux de dépenses sociales, le chômage) et idéologiques (ex. le degré de méritocratie). Cette thèse est composée de deux chapitres théoriques et quatre chapitres empiriques. Trois chapitres empiriques utilisent des données provenant de l'enquête European Social Survey 2008. Appliquant des approches multi-niveux et typoloqiques, la thèse contribue à la littérature sur les attitudes envers l'Etat social en montrant que les croyances normatives, telles que la méfiance ou l'égalitarisme, fonctionnent comme des mécanismes sous-jacents qui relient la position sociale aux attitudes politiques (Chapitre 3), et que les caractéristiques des contextes nationaux influencent les processus de formation d'opinion politique (Chapitres 3 et 4). Le chapitre 5 propose et prédit une typologie sur le rapport entre les attitudes envers la solidarité et celles envers le contrôle, renvoyant à deux domaines centraux de régulation étatique. Enfin, le chapitre 6 examine le soutien à l'Etat social dans le domaine de l'action protestataire, utilisant des données d'une enquête menée auprès des militants espagnols du mouvement des Indignés. Les résultats de cette thèse apportent des éléments qui éclairent les débats contemporains sur la légitimité de l'Etat social et son démantèlement.

From Empirical Bayes to Full Bayes: Methods for Analysing Traffice Safety Data, October 25, 2004

Traffic safety engineers are among the early adopters of Bayesian statistical tools for analyzing crash data. As in many other areas of application, empirical Bayes methods were their first choice, perhaps because they represent an intuitively appealing, yet relatively easy to implement alternative to purely classical approaches. With the enormous progress in numerical methods made in recent years and with the availability of free, easy to use software that permits implementing a fully Bayesian approach, however, there is now ample justification to progress towards fully Bayesian analyses of crash data. The fully Bayesian approach, in particular as implemented via multi-level hierarchical models, has many advantages over the empirical Bayes approach. In a full Bayesian analysis, prior information and all available data are seamlessly integrated into posterior distributions on which practitioners can base their inferences. All uncertainties are thus accounted for in the analyses and there is no need to pre-process data to obtain Safety Performance Functions and other such prior estimates of the effect of covariates on the outcome of interest. In this slight, fully Bayesian methods may well be less costly to implement and may result in safety estimates with more realistic standard errors. In this manuscript, we present the full Bayesian approach to analyzing traffic safety data and focus on highlighting the differences between the empirical Bayes and the full Bayes approaches. We use an illustrative example to discuss a step-by-step Bayesian analysis of the data and to show some of the types of inferences that are possible within the full Bayesian framework.

From Empirical Bayes to Full Bayes: Methods for Analyzubg Traffic Safey Data, October 25, 2004

Traffic safety engineers are among the early adopters of Bayesian statistical tools for analyzing crash data. As in many other areas of application, empirical Bayes methods were their first choice, perhaps because they represent an intuitively appealing, yet relatively easy to implement alternative to purely classical approaches. With the enormous progress in numerical methods made in recent years and with the availability of free, easy to use software that permits implementing a fully Bayesian approach, however, there is now ample justification to progress towards fully Bayesian analyses of crash data. The fully Bayesian approach, in particular as implemented via multi-level hierarchical models, has many advantages over the empirical Bayes approach. In a full Bayesian analysis, prior information and all available data are seamlessly integrated into posterior distributions on which practitioners can base their inferences. All uncertainties are thus accounted for in the analyses and there is no need to pre-process data to obtain Safety Performance Functions and other such prior estimates of the effect of covariates on the outcome of interest. In this light, fully Bayesian methods may well be less costly to implement and may result in safety estimates with more realistic standard errors. In this manuscript, we present the full Bayesian approach to analyzing traffic safety data and focus on highlighting the differences between the empirical Bayes and the full Bayes approaches. We use an illustrative example to discuss a step-by-step Bayesian analysis of the data and to show some of the types of inferences that are possible within the full Bayesian framework.

Vertical Syndication-Proof Competitive Prices in Multilateral Markets

[eng] A multi-sided Böhm-Bawerk assignment game (Tejada, to appear) is a model for a multilateral market with a finite number of perfectly complementary indivisible commodities owned by different sellers, and inflexible demand and support functions. We show that for each such market game there is a unique vector of competitive prices for the commodities that is vertical syndication-proof, in the sense that, at those prices, syndication of sellers each owning a different commodity is neither beneficial nor detrimental for the buyers. Since, moreover, the benefits obtained by the agents at those prices correspond to the nucleolus of the market game, we provide a syndication-based foundation for the nucleolus as an appropriate solution concept for market games. For different solution concepts a syndicate can be disadvantageous and there is no escape to Aumman’s paradox (Aumann, 1973). We further show that vertical syndicationproofness and horizontal syndication-proofness – in which sellers of the same commodity collude – are incompatible requirements under some mild assumptions. Our results build on a self-interesting link between multi-sided Böhm-Bawerk assignment games and bankruptcy games (O’Neill, 1982). We identify a particular subset of Böhm-Bawerk assignment games and we show that it is isomorphic to the whole class of bankruptcy games. This isomorphism enables us to show the uniqueness of the vector of vertical syndication-proof prices for the whole class of Böhm-Bawerk assignment market using well-known results of bankruptcy problems.

Outcome evaluation of ankle osteoarthritis treatments using spatio-temporal gait parameters and plantar pressure during unconstrained long distance walking : P25

Introduction: Ankle arthrodesis (AD) and total ankle replacement (TAR) are typical treatments for ankle osteoarthritis (AO). Despite clinical interest, there is a lack of their outcome evaluation using objective criteria. Gait analysis and plantar pressure assessment are appropriate to detect pathologies in orthopaedics but they are mostly used in lab with few gait cycles. In this study, we propose an ambulatory device based on inertial and plantar pressure sensors to compare the gait during long-distance trials between healthy subjects (H) and patients with AO or treated by AD and TAR. Methods: Our study included four groups: 11 patients with AO, 9 treated by TAR, 7 treated by AD and 6 control subjects. An ambulatory system (Physilog®, CH) was used for gait analysis; plantar pressure measurements were done using a portable insole (Pedar®-X, DE). The subjects were asked to walk 50 meters in two trials. Mean value and coefficient of variation of spatio-temporal gait parameters were calculated for each trial. Pressure distribution was analyzed in ten subregions of foot. All parameters were compared among the four groups using multi-level model-based statistical analysis. Results: Significant difference (p <0.05) with control was noticed for AO patients in maximum force in medial hindfoot and forefoot and in central forefoot. These differences were no longer significant in TAR and AD groups. Cadence and speed of all pathologic groups showed significant difference with control. Both treatments showed a significant improvement in double support and stance. TAR decreased variability in speed, stride length and knee ROM. Conclusions: In spite of a small sample size, this study showed that ankle function after AO treatments can be evaluated objectively based on plantar pressure and spatio-temporal gait parameters measured during unconstrained walking outside the lab. The combination of these two ambulatory techniques provides a promising way to evaluate foot function in clinics.

Systems medicine and integrated care to combat chronic noncommunicable diseases

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

Exploring the strategic impact of technological change - Studies on the role of Internet in magazine publishing

Over the past few decades, turbulent change has characterized the situation in the media industry. It has been noted that digitalization and new media are strongly influencing the industry: it is changing the existing market dynamics and requires new strategies. Prior research on the impact of digitalization and the Internet has emphasized news-focused media such as newspaper publishing and broadcasting, yet magazine publishing is very seldom the focus of the research. This study examines how the Internetimpacts magazine publishing. The work presents a multi-level analysis on the role and impact of the Internet on magazine products, companies and industry. The study is founded on strategic management, technology management and media economics literature. This study consists of two parts. The first part introduces the research topic and discusses the overall results of the study. The second part comprises five research publications. Qualitative research methods are used throughout. The results of the study indicate that the Internet has not had a disruptive effect on magazine publishing, and that its strategic implications could rather be considered complementary to the print magazine and the business as a whole. It seems that the co-specialized assets, together with market-related competencies and unchanged core competence have protected established firms from the disruptive effect of the new technology in magazine publishing. In addition, it seems that the Internet offers a valuable possibility to build and nourish customer relationships. The study contributes tomedia management and economics research by moving from product- or industry-level investigations towards a strategic-management perspective.

Tuning the design procedures for laser processed microwave mechanics

This research has been focused at the development of a tuned systematic design methodology, which gives the best performance in a computer aided environment and utilises a cross-technological approach, specially tested with and for laser processed microwave mechanics. A tuned design process scheme is also presented. Because of the currently large production volumes of microwave and radio frequency mechanics even slight improvements of design methodologies or manufacturing technologies would give reasonable possibilities for cost reduction. The typical number of required iteration cycles could be reduced to one fifth of normal. The research area dealing with the methodologies is divided firstly into a function-oriented, a performance-oriented or a manufacturability-oriented product design. Alternatively various approaches can be developed for a customer-oriented, a quality-oriented, a cost-oriented or an organisation-oriented design. However, the real need for improvements is between these two extremes. This means that the effective methodology for the designers should not be too limited (like in the performance-oriented design) or too general (like in the organisation-oriented design), but it should, include the context of the design environment. This is the area where the current research is focused. To test the developed tuned design methodology for laser processing (TDMLP) and the tuned optimising algorithm for laser processing (TOLP), seven different industrial product applications for microwave mechanics have been designed, CAD-modelled and manufactured by using laser in small production series. To verify that the performance of these products meets the required level and to ensure the objectiveness ofthe results extensive laboratory tests were used for all designed prototypes. As an example a Ku-band horn antenna can be laser processed from steel in 2 minutes at the same time obtaining a comparable electrical performance of classical aluminium units or the residual resistance of a laser joint in steel could be limited to 72 milliohmia.

Etelä-Karjala asuin- ja elinympäristönä: Korkeasti koulutettujen nuorten näkökulma

Tämän tutkimuksen keskeisenä tarkoituksena on tutkia Etelä-karjalaa asuin- ja työpaikkana. Tutkimuksen päätavoitteena on selvittää asuin- ja elinympäristön laadun merkitystä alueella viihtymiseen. Tutkimus luokitellaan kaupunkitutkimukseksi, jossa tarkastelun kohteena on asuin- ja elinympäristön laatu. Tutkimuksessa hyödynnetään survey-tutkimusmenetelmää. Tutkimuksen teoriaoosassa tarkastellaan globalisaation alueellisia vaikutuksia, alueiden kilpailukyvyn ja kilpailuedun muodostumista sekä alueen imagon merkitystä kilpailussa. Tutkimukseen liittyvä tutkimusaineisto kerättiin kirjekyselyllä Lappeenrannan teknillisestä yliopistosta vuosina 1997-2000 valmistuneiden diblomi-insinöörien ja kauppatieteiden maistereiden keskuudesta. Tutkimuksen empiirisessä osassa mitataan tekijöitä, jotka vaikuttavat asuinpaikkakunnan valintaan. Lisäksi mitataan Etelä-Karjalan asuin- ja elinympäristön laatua. Aineiston perusteella voidaan todeta, että Etelä-Karjalan asuin- ja elinympäristön laadun fyysiset, toiminnalliset ja sosiaaliset ominaisuudet edesaauttavat yliopistoststa valmistuneita jäämään alueelle. Ongelmatekijäksi nousi alueen kyky tarjota korkeasti koulutetuille nuorille työpaikkoja

Systems Medicine and Integrated Care to Combat Chronic Noncommunicable Diseases.

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.

Opinion Mining

In this thesis we study the field of opinion mining by giving a comprehensive review of the available research that has been done in this topic. Also using this available knowledge we present a case study of a multilevel opinion mining system for a student organization's sales management system. We describe the field of opinion mining by discussing its historical roots, its motivations and applications as well as the different scientific approaches that have been used to solve this challenging problem of mining opinions. To deal with this huge subfield of natural language processing, we first give an abstraction of the problem of opinion mining and describe the theoretical frameworks that are available for dealing with appraisal language. Then we discuss the relation between opinion mining and computational linguistics which is a crucial pre-processing step for the accuracy of the subsequent steps of opinion mining. The second part of our thesis deals with the semantics of opinions where we describe the different ways used to collect lists of opinion words as well as the methods and techniques available for extracting knowledge from opinions present in unstructured textual data. In the part about collecting lists of opinion words we describe manual, semi manual and automatic ways to do so and give a review of the available lists that are used as gold standards in opinion mining research. For the methods and techniques of opinion mining we divide the task into three levels that are the document, sentence and feature level. The techniques that are presented in the document and sentence level are divided into supervised and unsupervised approaches that are used to determine the subjectivity and polarity of texts and sentences at these levels of analysis. At the feature level we give a description of the techniques available for finding the opinion targets, the polarity of the opinions about these opinion targets and the opinion holders. Also at the feature level we discuss the various ways to summarize and visualize the results of this level of analysis. In the third part of our thesis we present a case study of a sales management system that uses free form text and that can benefit from an opinion mining system. Using the knowledge gathered in the review of this field we provide a theoretical multi level opinion mining system (MLOM) that can perform most of the tasks needed from an opinion mining system. Based on the previous research we give some hints that many of the laborious market research tasks that are done by the sales force, which uses this sales management system, can improve their insight about their partners and by that increase the quality of their sales services and their overall results.

DAI-DEPUR: an integrated and distributed architecture for wastewater treatment plants supervision

The activated sludge process - the main biological technology usually applied towastewater treatment plants (WWTP) - directly depends on live beings (microorganisms), and therefore on unforeseen changes produced by them. It could be possible to get a good plant operation if the supervisory control system is able to react to the changes and deviations in the system and can take thenecessary actions to restore the system’s performance. These decisions are oftenbased both on physical, chemical, microbiological principles (suitable to bemodelled by conventional control algorithms) and on some knowledge (suitable to be modelled by knowledge-based systems). But one of the key problems in knowledge-based control systems design is the development of an architecture able to manage efficiently the different elements of the process (integrated architecture), to learn from previous cases (spec@c experimental knowledge) and to acquire the domain knowledge (general expert knowledge). These problems increase when the process belongs to an ill-structured domain and is composed of several complex operational units. Therefore, an integrated and distributed AIarchitecture seems to be a good choice. This paper proposes an integrated and distributed supervisory multi-level architecture for the supervision of WWTP, that overcomes some of the main troubles of classical control techniques and those of knowledge-based systems applied to real world systems