Contributo para a compreensão das causas de exclusão de ilicitude e da culpa no crime de acesso ilegítimo

Dissertação de mestrado em Direito e Informática

Acute flare induced by the calcific tendonitis of the rotator cuff: inhibition of IL-1 a potential therapeutic target?

Introduction: Calcific tendonitis of rotator cuff is observed on plainradiographs in 10% of adults, but remains asymptomatic in half thesecases. Sometimes, these calcifications induce acute flares withmassive inflammation similar to gout or CPPD crisis. Analgesics/anti-inflammatory medications are usually not sufficient to controlssymptoms in these situations. Local steroid infiltration with or withoutremoval of the calcific deposition with a needle aspiration may beuseful. A new approach could be IL-1 inhibitors. Indeed, basic calciumphosphate crystals are capable of stimulating the release of activeIL-1β in vitro. These crystals trigger IL-1β release, in an analogousmanner to MSU crystals in acute gout, suggesting that IL-1β blockademay be clinically useful.Case presentation: This report describes a 70-year old woman withacute rest pain of the right shoulder since 48 hours. On examination,we found massive limitations of active and passive movements. Thepatient evaluated, on the visual scale, her symptoms at 10/10 the nightand 5/10 the day. The radiography and showed a rounded, 8 mmcalcification in the subscapularis tendon. The ultrasound aspectrevealed a heterogeneous calcification partially non solid, surroundedby massive inflammation on Doppler. C-reactive protein anderythrocyte sedimentation rate were high (74 mg/ml, 54 mm/hour).The patient received subcutaneous injections of anakinra: 100 mgdaily for 3 days (D1-D3). We evaluated the patient in our consult at dayD1, D2, D3, D7, D16 and by phone at D70.This treatment rapidly relieved the inflammatory symptoms (within afew hours with no relapse). The mobility of the shoulder, the biologicsparameters improved and the size of the calcification as well thedegree of inflammation regressed on ultrasound after 3 days.Conclusion: This is the first report of a woman with an acute flareinduced by calcific tendonitis who received anakinra. IL-1 inhibitionmay be a therapeutic target in calcific tendonitis. To analyse thisresponse more precisely and elaborate definitive conclusions, aprospective pilot study is on-going in our ambulatory institute.

Incidence of second sarcomas: a cancer registry-based study.

BACKGROUND: In high-quality cancer registration systems, about one in eight incident cancers are second primary cancers. This is due to a combination of careful diagnostic ascertainment, shared genetic determinants, shared exposure to environmental factors and consequences of treatment for first cancer. METHODS: We used data derived from the Swiss population-based cancer Registries of Vaud and Neuchâtel, including 885,000 inhabitants. RESULTS: Among 107,238 (52% males) first cancers occurring between 1976 and 2010, a total of 126 second sarcomas were observed through active and passive follow-up versus 68.2 expected, corresponding to a standardized incidence ratio (SIR) of 1.85 (95 % CI 1.5-2.2). Significant excess sarcoma risks were observed after skin melanoma (SIR = 3.0), breast cancer (2.2), corpus uteri (2.7), testicular (7.5), thyroid cancer (4.2), Hodgkin lymphoma (5.7) and leukemias (4.0). For breast cancer, the SIR was 3.4 ≥5 years after sarcoma diagnosis. CONCLUSIONS: The common denominator of these neoplasms is the utilization of radiotherapy in their management. Some sarcomas following breast cancer may be due to shared genetic components (i.e., in the Li-Fraumeni syndrome), as well as possibly to shared environmental factors, with sarcomas, including overweight, selected dietary and reproductive factors which are, however, too little defined for any quantitative risk assessment.

Functional calibration procedure for 3D knee joint angle description using inertial sensors.

Measurement of three-dimensional (3D) knee joint angle outside a laboratory is of benefit in clinical examination and therapeutic treatment comparison. Although several motion capture devices exist, there is a need for an ambulatory system that could be used in routine practice. Up-to-date, inertial measurement units (IMUs) have proven to be suitable for unconstrained measurement of knee joint differential orientation. Nevertheless, this differential orientation should be converted into three reliable and clinically interpretable angles. Thus, the aim of this study was to propose a new calibration procedure adapted for the joint coordinate system (JCS), which required only IMUs data. The repeatability of the calibration procedure, as well as the errors in the measurement of 3D knee angle during gait in comparison to a reference system were assessed on eight healthy subjects. The new procedure relying on active and passive movements reported a high repeatability of the mean values (offset<1 degrees) and angular patterns (SD<0.3 degrees and CMC>0.9). In comparison to the reference system, this functional procedure showed high precision (SD<2 degrees and CC>0.75) and moderate accuracy (between 4.0 degrees and 8.1 degrees) for the three knee angle. The combination of the inertial-based system with the functional calibration procedure proposed here resulted in a promising tool for the measurement of 3D knee joint angle. Moreover, this method could be adapted to measure other complex joint, such as ankle or elbow.

Prevention of age-associated dementia.

The advancement of medical sciences during the last century has resulted in a considerable increase in life expectancy. As more people live to old age, one of the most fundamental questions of the 21st century is whether the number of individuals suffering from dementia will also continue to increase. Alzheimer's disease (AD) accounts for the majority of cases of dementia in the elderly, but there is currently no curative treatment available. Several strategies have been introduced for treatment, the most recent strategy of which was the immunization of patients using antibodies against Abeta, which is a naturally occurring, even though misfolded peptide in the AD brain. Both active and passive immunization routes have been shown to reduce the pathology associated with Abeta accumulation in brains of genetically designed animal models. However, despite tremendous efforts, no unequivocal proof of therapeutic efficacy could be shown in AD patients. Particularly, the persistence of the neurofibrillary tangles in immunized brains and the issue of inducing cerebral amyloid angiopathy are major limiting factors of antibody therapy. Furthermore, physical activity, a healthy immune system and nutritional habits are suggested to protect against the onset of age-associated dementia. Thus, accumulative evidence suggests that an early integrated strategy, combining pharmacological, immunological, nutritional and life-style factors, is the most pragmatic approach to delay the onset and progression of age-associated dementia.

Evaluation of the compliance with recommended procedures in newborns exposed to HBsAg-positive mothers: a multicenter collaborative study.

BACKGROUND: Maternal-infant transmission of hepatitis B virus (HBV) during birth carries a high risk for chronic HBV infection in infants with frequent subsequent development of chronic disease. This can be efficiently prevented by early immunization of exposed newborns. The purpose of this study was to determine the compliance with official recommendations for prevention of perinatal HBV transmission in hepatitis B surface antigen (HBsAg) exposed infants. METHODS: Records of pregnant women at 4 sites in Switzerland, admitted for delivery in 2005 and 2006, were screened for maternal HBsAg testing. In HBsAg-exposed infants, recommended procedures (postnatal active and passive immunization, completion of immunization series, and serological success control) were checked. RESULTS: Of 27,131 women tested for HBsAg, 194 (0.73%) were positive with 196 exposed neonates. Of these neonates, 143 (73%) were enrolled and 141 (99%) received simultaneous active and passive HBV immunization within 24 hours of birth. After discharge, the HBV immunization series was completed in 83%. Only 38% of children were tested for anti-HBs afterwards and protective antibody values (>100 U/L) were documented in 27% of the study cohort. No chronically infected child was identified. Analysis of hospital discharge letters revealed significant quality problems. CONCLUSIONS: Intensified efforts are needed to improve the currently suboptimal medical care in HBsAg-exposed infants. We propose standardized discharge letters, as well as reminders to primary care physicians with precise instructions on the need to complete the immunization series in HBsAg-exposed infants and to evaluate success by determination of anti-HBs antibodies after the last dose.

End-tidal carbon dioxide monitoring using a naso-buccal sensor is not appropriate to monitor capnia during non-invasive ventilation.

BACKGROUND: In acute respiratory failure, arterial blood gas analysis (ABG) is used to diagnose hypercapnia. Once non-invasive ventilation (NIV) is initiated, ABG should at least be repeated within 1 h to assess PaCO2 response to treatment in order to help detect NIV failure. The main aim of this study was to assess whether measuring end-tidal CO2 (EtCO2) with a dedicated naso-buccal sensor during NIV could predict PaCO2 variation and/or PaCO2 absolute values. The additional aim was to assess whether active or passive prolonged expiratory maneuvers could improve the agreement between expiratory CO2 and PaCO2. METHODS: This is a prospective study in adult patients suffering from acute hypercapnic respiratory failure (PaCO2 ≥ 45 mmHg) treated with NIV. EtCO2 and expiratory CO2 values during active and passive expiratory maneuvers were measured using a dedicated naso-buccal sensor and compared to concomitant PaCO2 values. The agreement between two consecutive values of EtCO2 (delta EtCO2) and two consecutive values of PaCO2 (delta PaCO2) and between PaCO2 and concomitant expiratory CO2 values was assessed using the Bland and Altman method adjusted for the effects of repeated measurements. RESULTS: Fifty-four datasets from a population of 11 patients (8 COPD and 3 non-COPD patients), were included in the analysis. PaCO2 values ranged from 39 to 80 mmHg, and EtCO2 from 12 to 68 mmHg. In the observed agreement between delta EtCO2 and deltaPaCO2, bias was -0.3 mmHg, and limits of agreement were -17.8 and 17.2 mmHg. In agreement between PaCO2 and EtCO2, bias was 14.7 mmHg, and limits of agreement were -6.6 and 36.1 mmHg. Adding active and passive expiration maneuvers did not improve PaCO2 prediction. CONCLUSIONS: During NIV delivered for acute hypercapnic respiratory failure, measuring EtCO2 using a dedicating naso-buccal sensor was inaccurate to predict both PaCO2 and PaCO2 variations over time. Active and passive expiration maneuvers did not improve PaCO2 prediction. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01489150.

Metsäteollisuuden kaatopaikkatoiminnan kehittäminen

Metsäteollisuuden kaatopaikoille läjitetään vuosittain jätteitä yli 400 000 kuiva-ainetonnia. Pääosa jätteestä on peräisin kemiallisen massan valmistuksesta sekä energiantuotannosta. Kaatopaikoille läjitetyn jätteen laatu on muuttunut huomattavasti vuosikymmenien kuluessa. Aikaisemmin kaatopaikoille on läjitetty runsain määrin bioperäistä jätettä, joka anaerobisesti hajotessaan aiheuttaa nykyisin huomattavia biokaasupäästöjä. Inerttien, biohajoamattomien ainesten osuus metsäteollisuuden kaatopaikoille läjitettävän jätteen määrästä on tällä hetkellä noin 75 % ja niiden osuus tullee kasvamaan edelleen. Metsäteollisuuden kaatopaikkakuormitusta pyritään tulevaisuudessa vähentämään prosesseja tehostamalla sivutuotteiden hyötykäyttömahdollisuuksia lisäämällä. Vuonna 1997 voimaan tulleen valtioneuvoston päätöksen mukaan kaatopaikoilla muodostuva biokaasu tulee kerätä ja käsitellä. Tämä koskee kaikkia kaatopaikkoja. Lainsäädäntö antaa kuitenkin mahdollisuuden toteuttaa nämä vaatimukset hieman eri tavoin kaatopaikkojen yksilölliset erot huomioiden. Tässä diplomityössä on kartoitettu voimassaolevaa kaatopaikkalainsäädäntöä ja siinä lähivuosina mahdollisesti tapahtuvia muutoksia. Työssä on esitelty metsäteollisuuden kaatopaikoilla syntyvien päästöjen syntymekanismit ja vertailtu päästöjen hallinnassa käytettäviä vaihtoehtoisia tekniikoita. Tässä työssä on erityisesti keskitytty kaatopaikoilla syntyviin kaasumaisiin päästöihin sekä vertailtu kaasumaisten päästöjen aktiivista ja passiivista käsittelyä. Biokaasun passiivisen käsittelyjärjestelmän aiheuttamat investointi- ja käyttökustannukset ovat vain murto-osa aktiivisen järjestelmän vastaavista kustannuksista. Diplomityön kokeellisessa osuudessa mitattiin erään passiivisen biokaasunkäsittelyjärjestelmän toimivuutta. Saatujen mittaustulosten mukaan biokaasun sisältämä metaani hapettui lähes täysin metrin paksuisessa kuorikerroksessa. Kaasunjakoa parantamalla voidaan kuoripatjan metaaninhapetustehokkuutta vielä hieman nostaa. Mittaustulosten mukaan biokaasun passiivinen käsittely toimii kyseisessä rakenteessa ja on siten varteenotettava vaihtoehto aktiivisille biokaasunkeräily- ja käsittelyjärjestelmille.

Sisäisten tuotevirtojen hallinta elintarviketeollisuudessa

Elintarvikealan yritysten tulee kehittää laadukkaita, kustannustehokkaita ja monipuolisen sisällön omaavia tuotteita elintarvikealan standardeja noudattaen nopeammin kuin koskaan. Uusien lopputuotteiden kehittämisen myötä myös puolivalmisteiden kokonaismäärä kasvaa, mikä vaikeuttaa erityisesti sisäisten tuotevirtojen hallittavuutta tehtaalla. Toimintaympäristön muutoksien seurauksena yritysten on automatisoitava toimintoja tehostaakseen tuotantoaan ja saavuttaakseen kilpailuetua. Tutkimuksen tekemiseen käytettiin kvalitatiivista eli laadullista lähestymistapaa, jonka tarkoituksena on tutkia kohdetta mahdollisimman monipuolisesti. Kvalitatiivisen tiedon hankkimiseen käytettiin haastatteluja sekä osallistuvaa ja passiivista tarkkailua. Toimintatutkimuksen tavoin tarkoituksena oli kehittää ratkaisu kohdeyrityksen ongelmaan soveltamalla olemassa olevaa teoreettista tietämystä ja kentällä tehtyjä havaintoja. Tutkimuksen tuloksena löydettiin parhaiten kohdeyrityksen tehdasympäristöön sisäisten tuotevirtojen hallintaan soveltuva seuranta- ja tunnistustekniikka. Lisäksi haastatteluiden pohjalta saatiin määritettyä liikkeellepanevat ja vastustavat voimat, jotka ohjaavat mahdollisen investointisuunnitelman etenemistä ja päätöksentekoa.

Aktiivisten ja passiivisten osakerahastojen suoriutuminen Suomen ja Euroopan markkinoilla

The performance of active and passive fund management has been extensively studied especially in the US. This thesis is focused on the performance of active and passive fund management in the Finnish and European stock markets during a five-year time span from 3/2011 to 3/2016. The aim of this study is to find out which strategy will result in better returns for the small-scale investor. The thesis questions also which strategy leads to a better profit-risk rate and how well the fund managers perform in creating added value. The data of the study consists of 44 active Finnish funds and two passive exchange traded funds available for Finnish investors. Indexes of both Finnish and European markets and a risk-free rate are used to support the analysis. The data for the thesis is collected from the DataStream database. Performance indicators that are used in the study are: return, volatility, Sharpe ratio and Jensen’s alpha. Based on the results of this study it can be concluded that in the Finnish stock market the passive strategy yielded a little better profits than the average of active funds. In the European stock market, the profits for the passive fund were significantly better than the average of active funds. Considering the profit-risk rate, neither strategy out- performed. The results of this thesis are in line with the previous studies, that encourage to favor the passive strategy.

Adaptation de la phase de planification et d’initiation du mouvement d’atteinte visuellement guidé à différentes dissociations visuomotrices.

L’hypothèse générale de ce projet soutient que le système moteur doit performer des transformations sensorimotrices afin de convertir les entrées sensorielles, concernant la position de la cible à atteindre, en commande motrice, afin de produire un mouvement du bras et de la main vers la cible à atteindre. Ce type de conversion doit être fait autant au niveau de la planification du mouvement que pour une éventuelle correction d’erreur de planification ou d’un changement inopiné de la position de la cible. La question de recherche du présent mémoire porte sur le ou les mécanismes, circuits neuronaux, impliqués dans ce type de transformation. Y a-t-il un seul circuit neuronal qui produit l’ensemble des transformations visuomotrices entre les entrées sensorielles et les sorties motrices, avant l’initiation du mouvement et la correction en temps réel du mouvement, lorsqu’une erreur ou un changement inattendu survient suite à l’initiation, ou sont-ils minimalement partiellement indépendants sur le plan fonctionnel? L’hypothèse de travail suppose qu’il n’y ait qu’un seul circuit responsable des transformations sensorimotrices, alors l’analyse des résultats obtenus par les participants devrait démontrer des changements identiques dans la performance pendant la phase de planification du mouvement d’atteinte et la phase de correction en temps réel après l’adaptation à des dissociations sensorimotrices arbitraires. L’approche expérimentale : Dans la perspective d’examiner cette question et vérifier notre hypothèse, nous avons jumelé deux paradigmes expérimentaux. En effet, les mouvements d’atteinte étaient soumis à une dissociation visuomotrice ainsi qu’à de rares essais composés de saut de cible. L’utilisation de dissociation visuomotrice permettait d’évaluer le degré d’adaptation des mécanismes impliqués dans le mouvement atteint. Les sauts de cible avaient l’avantage de permettre d’examiner la capacité d’adaptation à une dissociation visuomotrice des mécanismes impliqués dans la correction du mouvement (miroir : sur l’axe y, ou complète : inversion sur les axes x et y). Les résultats obtenus lors des analyses effectuées dans ce mémoire portent exclusivement sur l’habileté des participants à s’adapter aux deux dissociations visuomotrices à la première phase de planification du mouvement. Les résultats suggèrent que les mécanismes de planification du mouvement possèdent une grande capacité d’adaptation aux deux différentes dissociations visuomotrices. Les conclusions liées aux analyses présentées dans ce mémoire suggèrent que les mécanismes impliqués dans la phase de planification et d’initiation du mouvement parviennent relativement bien à s’adapter aux dissociations visuomotrices, miroir et inverse. Bien que les résultats démontrent une certaine distinction, entre les deux groupes à l’étude, quant aux délais nécessaires à cette adaptation, ils illustrent aussi un taux d’adaptation finale relativement similaire. L’analyse des réponses aux sauts de cible pourra être comparée aux résultats présentés dans ce mémoire afin de répondre à l’hypothèse de travail proposée par l’objectif initial de l’étude.

Design Considerations of Sonar Projector Arrays with Improved Performance

Systems which employ underwater acoustic energy for observation or communication are called sonar systems. The active and passive sonars are the two types of systems used for the detection and localisation of targets in underwater. Active sonar involves the transmission of an acoustic signal which, when reflected from a target, provides the sonar receiver with a basis for the detection and estimation. Passive sonar bases its detection and estimation on sounds which emanate from the target itself--Machinery noise, flow noise, transmission from its own active sonar etc.Electroacoustic transducers are used in sonar systems for the transmission and detection of acoustic energy. The transducer which is used for the transmission of acoustic energy is called projector and the one used for reception is called hydrophone. Since a single transducer is not sufficient enough for long range and directional transmission, a properly distributed array of transducers are to be used [9-11].The need and requirement for spatial processing to generate the most favourable directivity patterns for transducer systems used in underwater applications have already been analysed by several investigators [12-21].The desired directivity pattern can be either generated by the use of suitable focussing techniques or by an array of non-directional sensor elements, whose arrangements, spacing and the mode of excitation provide the required radiation pattern or by the combination of these.While computing that the directivity pattern, it is assumed strength of the elements are unaffected by the the source acoustic pressure at each source. However, in closely packed a r r a y s , the acoustic interaction effects experienced among the elements will modify the behaviour of individual elements and in turn will reduce the acoust ic source leve 1 wi t h respect to the maximum t heoret i cal va 1ue a s well as degrade the beam pa t tern. Th i s ef fect shou 1d be reduced in systems that are intended to generate high acoustic power output and unperturbed beam patterns [2,22-31].The work herein presented includes an approach for designing efficient and well behaved underwater transd~cer arrays, taking into account the acoustic interaction effect experienced among the closely packed multielement arrays.Architectural modifications reducing the interaction effect different radiating apertures.

Factores asociados a la infección para Clostridium difficile en un hospital universitario de Bogotá

Introducción La infección por Clostridium difficile, es una de las causas más frecuentes de diarrea nosocomial con una alta morbimortalidad, con un aumento exponencial en su incidencia, en Estados Unidos se duplicó, de 261 casos x 100.000 en 1993 pasó a 546 x 100.000 en 2003 2, y en Canadá se encontraron datos similares con un aumento de 4.5 veces, en 1991 de 35.6 casos x 100.000 a 156.3 casos por 100.000 en 2004 3 . Se han descrito varios factores asociados Materiales y Métodos Se trata de un estudio descriptivo de tipo serie de casos en el que se evaluaron pacientes con diagnóstico de infección por C. Difficile y los factores asociados en un Hospital Universitario entre febrero de 2010 hasta septiembre de 2011 Resultados Se recolectaron 31 pacientes la edad promedio fue de 58 años con un rango entre 18 y 93 años, de los cuales 19 (61%) fueron mujeres y 12 (39%) hombres. El factor asociado a la infección por C. Difficile más frecuentemente encontrado fue el uso de inhibidores de bomba de protones con 54.84% (n=17) .No se encontraron pacientes VIH positivos o con diagnóstico de enfermedad inflamatoria intestinal. Ningún paciente presentó complicaciones asociadas a la infección ni mortalidad alguna. Conclusión El factor asociado que más se presentó fue el uso de antimicrobianos en los quince dias previos al inicio del cuadro en el 74% de los pacientes lo que coincide con lo presentado en la literatura mundial.

La revisión de la relación jurídica tributaria (Tema Central)

Hasta mediados del pasado siglo, el estudio de la aplicación de la norma tributaria al caso concreto ha solido realizarse a partir del esquema de la relación jurídica tributaria. Pero con independencia del movimiento de revisión del concepto de relación jurídica obligacional que se ha producido en el ámbito del Derecho público, dentro del Derecho tributario no es posible agotar el estudio de la prestación tributaria a través de un análisis circunscrito al examen de la obligación tributaria y del derecho de crédito correspondiente. Si se desea llevar a término un examen profundo y articulado del fenómeno tributario, es necesario considerar las posiciones subjetivas activas y pasivas que derivan de la ley, pero en cuanto a las primeras, no en términos de derecho de crédito, sino como potestad de imposición, y respecto a las segundas, no limitándose a la obligación tributaria, sino extendiendo el análisis al conjunto de actos debidos previstos por la norma.

Kinematical analysis of redundant drive wire mechanisms with velocity constraint

In this paper, we propose a new velocity constraint type for Redundant Drive Wire Mechanisms. The purpose of this paper is to demonstrate that the proposed velocity constraint module can fix the orientation of the movable part and to use the kinematical analysis method to obtain the moving direction of the movable part. First, we discuss the necessity of using this velocity constraint type and the possible applications of the proposed mechanism. Second, we derive the basic equations of a wire mechanism with this constraint type. Next, we present a method of motion analysis on active and passive constraint spaces, which is used to find the moving direction of a movable part. Finally, we apply the above analysis method on a wire mechanism with a velocity constraint module and on a wire mechanism with four double actuator modules. By evaluating the results, we prove the validity of the proposed constraint type.