897 resultados para Bryant angles
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Malposition of the acetabular component during hip arthroplasty increases the occurrence of impingement, reduces range of motion, and increases the risk of dislocation and long-term wear. To prevent malpositioned hip implants, an increasing number of computer-assisted orthopaedic systems have been described, but their accuracy is not well established. The purpose of this study was to determine the reproducibility and accuracy of conventional versus computer-assisted techniques for positioning the acetabular component in total hip arthroplasty. Using a lateral approach, 150 cups were placed by 10 surgeons in 10 identical plastic pelvis models (freehand, with a mechanical guide, using computer assistance). Conditions for cup implantations were made to mimic the operating room situation. Preoperative planning was done from a computed tomography scan. The accuracy of cup abduction and anteversion was assessed with an electromagnetic system. Freehand placement revealed a mean accuracy of cup anteversion and abduction of 10 degrees and 3.5 degrees, respectively (maximum error, 35 degrees). With the cup positioner, these angles measured 8 degrees and 4 degrees (maximum error, 29.8 degrees), respectively, and using computer assistance, 1.5 degrees and 2.5 degrees degrees (maximum error, 8 degrees), respectively. Computer-assisted cup placement was an accurate and reproducible technique for total hip arthroplasty. It was more accurate than traditional methods of cup positioning.
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OBJECTIVES: The aim of this study was to evaluate new electrocardiographic (ECG) criteria for discriminating between incomplete right bundle branch block (RBBB) and the Brugada types 2 and 3 ECG patterns. BACKGROUND: Brugada syndrome can manifest as either type 2 or type 3 pattern. The latter should be distinguished from incomplete RBBB, present in 3% of the population. METHODS: Thirty-eight patients with either type 2 or type 3 Brugada pattern that were referred for an antiarrhythmic drug challenge (AAD) were included. Before AAD, 2 angles were measured from ECG leads V(1) and/or V(2) showing incomplete RBBB: 1) α, the angle between a vertical line and the downslope of the r'-wave, and 2) β, the angle between the upslope of the S-wave and the downslope of the r'-wave. Baseline angle values, alone or combined with QRS duration, were compared between patients with negative and positive results on AAD. Receiver-operating characteristic curves were constructed to identify optimal discriminative cutoff values. RESULTS: The mean β angle was significantly smaller in the 14 patients with negative results on AAD compared to the 24 patients with positive results on AAD (36 ± 20° vs. 62 ± 20°, p < 0.01). Its optimal cutoff value was 58°, which yielded a positive predictive value of 73% and a negative predictive value of 87% for conversion to type 1 pattern on AAD; α was slightly less sensitive and specific compared with β. When the angles were combined with QRS duration, it tended to improve discrimination. CONCLUSIONS: In patients with suspected Brugada syndrome, simple ECG criteria can enable discrimination between incomplete RBBB and types 2 and 3 Brugada patterns.
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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.
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Why does not gravity make drops slip down the inclined surfaces, e.g., plant leaves? The current explanation is based on the existence of surface inhomogeneities, which cause a sustaining force that pins the contact line. Following this theory, the drop remains in equilibrium until a critical value of the sustaining force is reached. We propose an alternative analysis, from the point of view of energy balance, for the particular case in which the drop leaves a liquid film behind. The critical angle of the inclined surface at which the drop slips down is predicted. This result does not depend explicitly on surface inhomogeneities, but only on the drop size and surface tensions. There is good agreement with experiments for contact angles below 90° where the formation of the film is expected, whereas for greater contact angles great discrepancies arise
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CONTEXT: Hamstrings strains are common and debilitating injuries in many sports. Most hamstrings exercises are performed at an inadequately low hip-flexion angle because this angle surpasses 70° at the end of the sprinting leg's swing phase, when most injuries occur. OBJECTIVE: To evaluate the influence of various hip-flexion angles on peak torques of knee flexors in isometric, concentric, and eccentric contractions and on the hamstrings-to-quadriceps ratio. DESIGN: Descriptive laboratory study. SETTING: Research laboratory. Patients and Other Participants: Ten national-level sprinters (5 men, 5 women; age = 21.2 ± 3.6 years, height = 175 ± 6 cm, mass = 63.8 ± 9.9 kg). Intervention(s): For each hip position (0°, 30°, 60°, and 90° of flexion), participants used the right leg to perform (1) 5 seconds of maximal isometric hamstrings contraction at 45° of knee flexion, (2) 5 maximal concentric knee flexion-extensions at 60° per second, (3) 5 maximal eccentric knee flexion-extensions at 60° per second, and (4) 5 maximal eccentric knee flexionextensions at 150° per second. Main Outcome Measure(s): Hamstrings and quadriceps peak torque, hamstrings-to-quadriceps ratio, lateral and medial hamstrings root mean square. RESULTS: We found no difference in quadriceps peak torque for any condition across all hip-flexion angles, whereas hamstrings peak torque was lower at 0° of hip flexion than at any other angle (P < .001) and greater at 90° of hip flexion than at 30° and 60° (P < .05), especially in eccentric conditions. As hip flexion increased, the hamstrings-to-quadriceps ratio increased. No difference in lateral or medial hamstrings root mean square was found for any condition across all hip-flexion angles (P > .05). CONCLUSIONS: Hip-flexion angle influenced hamstrings peak torque in all muscular contraction types; as hip flexion increased, hamstrings peak torque increased. Researchers should investigate further whether an eccentric resistance training program at sprint-specific hip-flexion angles (70° to 80°) could help prevent hamstrings injuries in sprinters. Moreover, hamstrings-to-quadriceps ratio assessment should be standardized at 80° of hip flexion.
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BACKGROUND: The correction of oculomotor disorder in Grave's disease is applied on pathological extraocular muscles. Based on the global muscular restriction (bilateral forced duction test) and angular measurements, we have used a non-adjustable technique. PATIENTS AND METHODS: We performed a retrospective analysis of 21 patients (23 operations) with thyroid-associated orbitopathy operated for persisting diplopia. The angles of deviation in the 9 diagnostic directions of gaze and the field of binocular vision were measured with the Harm's tangent scale before and after surgery. Sixteen patients were operated only on vertical muscles. The mean follow-up was 45 months. RESULTS: 76 % of the patients (95 % confidence interval [CI], 58-94 %) obtained a large and centred field of binocular vision without prisms. 14 % (95 % CI, 0-29 %) had binocular vision with the use of prisms. Diplopia persisted in one patient despite 3 operations. Taking into consideration the interventions done before the patient was referred to us, the reintervention rate was 13 % (95 % CI, 0-28 %). CONCLUSIONS: A binocular field of vision can be successfully restored in the majority of patients with Graves' orbitopathy, using a non-adjustable surgical technique.
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The availability of high resolution Digital Elevation Models (DEM) at a regional scale enables the analysis of topography with high levels of detail. Hence, a DEM-based geomorphometric approach becomes more accurate for detecting potential rockfall sources. Potential rockfall source areas are identified according to the slope angle distribution deduced from high resolution DEM crossed with other information extracted from geological and topographic maps in GIS format. The slope angle distribution can be decomposed in several Gaussian distributions that can be considered as characteristic of morphological units: rock cliffs, steep slopes, footslopes and plains. A terrain is considered as potential rockfall sources when their slope angles lie over an angle threshold, which is defined where the Gaussian distribution of the morphological unit "Rock cliffs" become dominant over the one of "Steep slopes". In addition to this analysis, the cliff outcrops indicated by the topographic maps were added. They contain however "flat areas", so that only the slope angles values above the mode of the Gaussian distribution of the morphological unit "Steep slopes" were considered. An application of this method is presented over the entire Canton of Vaud (3200 km2), Switzerland. The results were compared with rockfall sources observed on the field and orthophotos analysis in order to validate the method. Finally, the influence of the cell size of the DEM is inspected by applying the methodology over six different DEM resolutions.
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The joint angles of multi-segment foot models have been primarily described using two mathematical methods: the joint coordinate system and the attitude vector. This study aimed to determine whether the angles obtained through these two descriptors are comparable, and whether these descriptors have similar sensitivity to experimental errors. Six subjects walked eight times on an instrumented walkway while the joint angles among shank, hindfoot, medial forefoot, and lateral forefoot were measured. The angles obtained using both descriptors and their sensitivity to experimental errors were compared. There was no overall significant difference between the ranges of motion obtained using both descriptors. However, median differences of more than 6° were noticed for the medial-lateral forefoot joint. For all joints and rotation planes, both descriptors provided highly similar angle patterns (median correlation coefficient: R>0.90), except for the medial-lateral forefoot angle in the transverse plane (median R=0.77). The joint coordinate system was significantly more sensitive to anatomical landmarks misplacement errors. However, the absolute differences of sensitivity were small relative to the joints ranges of motion. In conclusion, the angles obtained using these two descriptors were not identical, but were similar for at least the shank-hindfoot and hindfoot-medial forefoot joints. Therefore, the angle comparison across descriptors is possible for these two joints. Comparison should be done more carefully for the medial-lateral forefoot joint. Moreover, despite different sensitivities to experimental errors, the effects of the experimental errors on the angles were small for both descriptors suggesting that both descriptors can be considered for multi-segment foot models.
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BACKGROUND/AIMS: Switzerland's drug policy model has always been unique and progressive, but there is a need to reassess this system in a rapidly changing world. The IMPROVE study was conducted to gain understanding of the attitudes and beliefs towards opioid maintenance therapy (OMT) in Switzerland with regards to quality and access to treatment. To obtain a "real-world" view on OMT, the study approached its goals from two different angles: from the perspectives of the OMT patients and of the physicians who treat patients with maintenance therapy. The IMPROVE study collected a large body of data on OMT in Switzerland. This paper presents a small subset of the dataset, focusing on the research design and methodology, the profile of the participants and the responses to several key questions addressed by the questionnaires. METHODS: IMPROVE was an observational, questionnaire-based cross-sectional study on OMT conducted in Switzerland. Respondents consisted of OMT patients and treating physicians from various regions of the country. Data were collected using questionnaires in German and French. Physicians were interviewed by phone with a computer-based questionnaire. Patients self-completed a paper-based questionnaire at the physicians' offices or OMT treatment centres. RESULTS: A total of 200 physicians and 207 patients participated in the study. Liquid methadone and methadone tablets or capsules were the medications most commonly prescribed by physicians (60% and 20% of patient load, respectively) whereas buprenorphine use was less frequent. Patients (88%) and physicians (83%) were generally satisfied with the OMT currently offered. The current political framework and lack of training or information were cited as determining factors that deter physicians from engaging in OMT. About 31% of OMT physicians interviewed were ≥60 years old, indicating an ageing population. Diversion and misuse were considered a significant problem in Switzerland by 45% of the physicians. CONCLUSION: The subset of IMPROVE data presented gives a present-day, real-life overview of the OMT landscape in Switzerland. It represents a valuable resource for policy makers, key opinion leaders and drug addiction researchers and will be a useful basis for improving the current Swiss OMT model.
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The application of the Fry method to measure strain in deformed porphyritic granites is discussed. This method requires that the distribution of markers has to satisfy at least two conditions. It has to be homogeneous and isotropic. Statistics on point distribution with the help of a Morishita diagram can easily test homogeneity. Isotropy can be checked with a cumulative histogram of angles between points. Application of these tests to undeformed (Mte Capanne granite, Elba) and to deformed (Randa orthogneiss, Alps of Switzerland) porphyritic granite reveals that their K-feldspars phenocrysts both satisfy these conditions and can be used as strain markers with the Fry method. Other problems are also examined. One is the possible distribution of deformation on discrete shear-bands. Providing several tests are met, we conclude that the Fry method can be used to estimate strain in deformed porphyritic granites. (c) 2006 Elsevier Ltd. All rights reserved.
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The infinite slope method is widely used as the geotechnical component of geomorphic and landscape evolution models. Its assumption that shallow landslides are infinitely long (in a downslope direction) is usually considered valid for natural landslides on the basis that they are generally long relative to their depth. However, this is rarely justified, because the critical length/depth (L/H) ratio below which edge effects become important is unknown. We establish this critical L/H ratio by benchmarking infinite slope stability predictions against finite element predictions for a set of synthetic two-dimensional slopes, assuming that the difference between the predictions is due to error in the infinite slope method. We test the infinite slope method for six different L/H ratios to find the critical ratio at which its predictions fall within 5% of those from the finite element method. We repeat these tests for 5000 synthetic slopes with a range of failure plane depths, pore water pressures, friction angles, soil cohesions, soil unit weights and slope angles characteristic of natural slopes. We find that: (1) infinite slope stability predictions are consistently too conservative for small L/H ratios; (2) the predictions always converge to within 5% of the finite element benchmarks by a L/H ratio of 25 (i.e. the infinite slope assumption is reasonable for landslides 25 times longer than they are deep); but (3) they can converge at much lower ratios depending on slope properties, particularly for low cohesion soils. The implication for catchment scale stability models is that the infinite length assumption is reasonable if their grid resolution is coarse (e.g. >25?m). However, it may also be valid even at much finer grid resolutions (e.g. 1?m), because spatial organization in the predicted pore water pressure field reduces the probability of short landslides and minimizes the risk that predicted landslides will have L/H ratios less than 25. Copyright (c) 2012 John Wiley & Sons, Ltd.
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La thèse traite de projets de classes enfantines avec de l'activité physique, projets pilotes ayant entre autres le but d'évaluer les effets d'un apport d'activité physique auprès d'enfants de 4 à 6 ans. Le projet de recherche saisit l'opportunité de pouvoir observer les effets de l'AP sur de jeunes enfants (n=86, classes AP=40, classes contrôles=46) et ceci par trois regards distincts : une quantification de l'activité physique, l'influence de cette dernière sur certaines composantes cognitives (créativité, intelligence et concentration) des jeunes enfants et, enfin, l'influence de l'activité physique au niveau psychosocial (microsystèmes familial et scolaire). La méthodologie mélange des méthodes qualitatives (entretiens, observations) et quantitatives (accéléromètres (GT1M), tests de créativité (Krampen, 1996), d'intelligence (Cattell, Weiss & Osterland, 1997), de concentration (Krampen, 2007)). Les principaux résultats démontrent que ce type de projet permet d'augmenter l'AP durant le temps scolaire et les résultats sont plus contrastés en extrascolaire. Un temps supérieur consacré à l'AP ne démontre aucune diminution des capacités cognitives dans cette tranche d'âge-là. L'analyse du microsystème familial nous informe sur le fait que les parents qui ont placé leurs enfants dans ce type de classes sont eux-mêmes plus actifs que la moyenne de la population suisse (Lamprecht, Fischer, & Stamm, 2008a). Enfin, un apport d'AP ne permet pas d'augmenter le nombre de feedbacks tournés vers l'autonomie et le style contrôlant est même renforcé. Nos résultats sont discutés sur la base des études de Kriemler et al. (2010) qui démontrent toute la difficulté d'une intervention scolaire pour modifier les comportements familiaux en extrascolaire. La fonction exécutive (Tomporowski et al., 2008) offre un regard neurophysiologique éclairant les effets de l'AP sur les différentes capacités étudiées. Enfin, il semble que la pression générée par la mise en place de projets liés à un apport d'AP en école enfantine va dans le sens d'une augmentation d'un style contrôlant (Tessier, 2006). Ce choix d'approcher les observations selon plusieurs angles d'étude est audacieux car il se situe en situation écologique mais il représente en même temps le seul moyen d'observer les effets en tenant davantage compte de la complexité des conduites des interactions entre différents facteurs. - The aim of the study is to evaluate the effect of physical activity (PA) in kindergartens with children aged from 4 to 6 years old. The project seizes the opportunity to observe the effects of PA on young children (n=86, classes AP=40, control classes=46) with three different axes: a quantification of PA, the influence of PA on cognitive functions (creativity, intelligence and concentration), and the influence on the family and the climate in the class. The methodology is based on a mix of qualitative (interviews, observations) and quantitative (accelerometer (GT1M), creativity test (Krampen, 1996), intelligence test (Cattell, Weiss & Osterland, 1997), concentration test (Krampen, 2007)) methods. The main results show that PA during the schooltime increased and the results outside of the school present more contrasts. More time spent for PA doesn't influence negatively the evolution of the cognitive functions at this age. The parents, who have interest for this kind of kindergartens for their children move significantly more than the Swiss population (Lamprecht, et al., 2008a). More PA during the lessons doesn't increase the feedbacks given with autonomy and more control is even observed. The results show the difficulty of changing the behaviors of a family linked to PA outside of the school (Kriemler et al., 2010). The discussion of the results of the cognitive functions is based on the executive function, which seems to be linked to PA (Tomporowski et al., 2008). Finally, it seems that the pressure occurred by those projects with PA tend to foster a climate with more control (Tessier, 2006). The choice of structuring the thesis with three different axes represents a risk because it is established in ecological conditions, but it also allows to observe the effects of PA taking into consideration the interactions between the different factors.
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H. Bryant, citado por David Morley na obra Pediatria no Mundo em Desenvolvimento, retrata a chegada de um jovem médico colocado pelo governo no seu primeiro posto: “Designado para trabalhar num distrito rural, com uma população de 70.000 pessoas, aproximadamente. É o único médico do lugar. O hospital conta com 70 leitos, mas os pacientes internados são 110. A enfermeira - apenas uma - acompanha-o durante a primeira visita ao hospital. Uma verdadeira multidão se comprime no ambulatório. Ele fica sabendo que diariamente vêm 200 a 400 pacientes. O médico só é chamado para ver casos difíceis. O hospital é limpo e bem cuidado. Uma parteira está tomando conta de duas mulheres em trabalho de parto, sem complicações. Há um aparelho de Rx que provavelmente voltará a funcionar quando for trocada a ampola. A farmácia está limpa mas o suprimento existente é pequeno. Na última remessa de medicamentos não veio a penicilina, e somente metade da cloroquina solicitada. Na região, as infecções são comuns e a malária endémica. O refrigerador não funciona. O pequeno laboratório possui um microscópio diminuto, uma centrífuga manual e algumas lâminas não rotuladas. O gabinete de delegado de saúde está localizado ao lado do hospital. No distrito há quatro unidades sanitárias, todas com auxiliares, e um jeep que fica muitas vezes parado por falta de gasolina. Enquanto realiza a visita, a enfermeira diz ao médico que uma mulher esteve em trabalho de parto durante dois dias, sem resultado, e agora apresenta sinais de rotura do útero. O hospital regional com cirurgião fica a 220 km. Um menino está em coma, com suspeita de malária cerebral. Seu pai é um chefe local muito importante.
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L'Observance est le premier mouvement de réforme avant la Contre-réforme promu par l'Eglise elle-même, dès la fin du XlVème siècle. Visant à restaurer une plus grande observance de la Règle au sein des Ordres religieux, par l'importance accordée à la vie commune, à la formation intellectuelle de ses membres et à l'oraison mentale, elle joue un rôle de premier plan dans la vie des cités au XVème siècle. Tantôt instrument du pouvoir civil tantôt de la papauté, elle est un acteur fondamental dans le panorama urbain, aspirant à contrôler la vie religieuse des laïcs, grâce à ses prédicateurs et son intense activité pastorale, fondée sur l'édition de traités dévotionnels et de manuels pour la prière. L'objet de cette thèse est l'étude des relations entre ce mouvement de réforme religieuse et la production artistique, afin de comprendre la contribution de l'Observance aux transformations importantes que l'image de culte tant publique que privée connaît entre le XVème et le XVIème siècle. Elle montre que l'Observance et les formes de dévotion qu'elle promeut participent non seulement des choix iconographiques mais également formels, et pose la question de l'existence et de la définition d'une esthétique observante. L'analyse se concentre sur la ville de Venise et les Dominicains à partir de 1391, date de l'introduction de l'Observance dans la cité, jusqu'en 1545, qui marque le début du Concile de Trente. La perspective diachronique adoptée a permis de révéler une véritable politique artistique de l'Observance dominicaine, qui fait un usage réfléchi et conscient des images. Celles-ci permettent, d'une part de décliner l'identité de l'Ordre de diverses manières en fonction de la situation religieuse et historique et des destinataires, d'autre part de contrôler et informer la dévotion du fidèle. La perspective diachronique éclaire également comment l'Observance dominicaine a fait face à des mouvements religieux importants, qui promeuvent des pratiques dévotionnelles christocentriques, fondées sur un rapport direct et individuel avec le divin. Il s'agit au XVème siècle de la Devotio moderna, puis au XVIème siècle de la Réforme protestante, mais aussi des divers mouvements de spiritualité évangélique dont Venise est un centre de diffusion. Pour un Ordre voué à la défense de la papauté et de l'Eglise, ces formes de dévotion individuelles constituaient des menaces auxquelles il fallait opposer des formes de dévotion individuelles contrôlées. A cette fin, l'utilisation des images s'est révélée un instrument puissant. Après une première partie historique qui offre une reconstruction de certaines églises dominicaines détruites et établit un corpus d'oeuvres, les rapports de l'Observance et des oeuvres d'art sont analysés selon trois angles d'approche. Le premier se concentre sur la question des femmes, et aborde le problème de l'utilisation des images dans la direction spirituelle des nonnes ainsi que dans la construction d'une identité féminine dominicaine. Le deuxième prend en considération l'utilisation des images dans la dévotion privée des frères eux-mêmes. Le troisième et dernier angle d'approche concerne l'utilisation des images pour définir l'identité de l'Ordre face aux représentants des autorités politiques et religieuses, mais aussi des fidèles.
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OBJECTIVE: To determine the means and the reference intervals of the quantitative morphometric parameters of femoroacetabular impingement (FAI) in normal hips with high-resolution computed tomography (CT). METHODS: We prospectively included 94 adult individuals who underwent CT for thoracic, abdominal or urologic pathologies. Patients with a clinical history of hip pathology and/or with osteoarthritis on CT were excluded. We calculated means and 95 % reference intervals for imaging signs of cam-type (alpha angle at 90° and 45° and femoral head-neck offset) and pincer-type impingement (acetabular version angle, lateral centre-edge angle and acetabular index). RESULTS: The 95 % reference interval limits were all far beyond the abnormal thresholds found in the literature for cam-type and to a lesser extent for pincer-type FAI. The upper limits of the reference intervals for the alpha angles (at 90°/45°) were 68°/83° (men) and 69°/84° (women), compared to thresholds from the literature (50°, 55° or 60°). Reference intervals were similar between genders for cam-type parameters, and slightly differed for pincer-type. CONCLUSION: The 95 % reference intervals of morphometric measurements of FAI in asymptomatic hips were beyond the abnormal thresholds, which was especially true for cam-type FAI. Our results suggest the need for redefining the current morphometric parameters used in the diagnosis of FAI. KEY POINTS: ? 95 % reference intervals limits of FAI morphotype were beyond currently defined thresholds. ? Reference intervals of pincer-type morphotype measurements were close to current definitions. ? Reference intervals of cam-type morphotype measurements were far beyond the current definitions. ? Current morphometric definitions of cam-type morphotype should be used with care.