Palliative surgical procedures to restore shoulder function in obstetric brachial palsy. Critical analysis of Narakas' series.

Dr. Narakas intended to study a series of 61 cases of shoulder sequelae of obstetric palsy. His vast experience would have enriched our clinical knowledge of this ailment. The authors carry on with that study to clarify his therapeutic approach and share the benefit of his experience.

Heuristic procedures for solving the General Assembly Line Balancing Problem with Setups (GALBPS)

The General Assembly Line Balancing Problem with Setups (GALBPS) was recently defined in the literature. It adds sequence-dependent setup time considerations to the classical Simple Assembly Line Balancing Problem (SALBP) as follows: whenever a task is assigned next to another at the same workstation, a setup time must be added to compute the global workstation time, thereby providing the task sequence inside each workstation. This paper proposes over 50 priority-rule-based heuristic procedures to solve GALBPS, many of which are an improvement upon heuristic procedures published to date.

Procedures for evaluating the tolerance of cassava genotypes to postharvest physiological deterioration

Abstract: The objective of this work was to define procedures to assess the tolerance of cassava genotypes to postharvest physiological deterioration (PPD) and to microbial deterioration (MD). Roots of six cassava genotypes were evaluated in two experiments, during storage under different environmental conditions: high temperature and low soil moisture; or low temperature and high soil moisture. Roots were treated or not with fungicide (carbendazim) before storage. Genotype reactions to MD and PPD were evaluated at 0, 2, 5, 10, 15, 20, and 30 days after harvest (DAH), in the proximal, medial, and distal parts of the roots. A diagrammatic scale was proposed to evaluate nonperipheral symptoms of PPD. Fungicide treatment and root position did not influence PPD expression; however, all factors had significant effect on MD severity. Genotypes differed as to their tolerance to PPD and MD. Both deterioration types were more pronounced during periods of higher humidity and lower temperatures. The fungicide treatment increased root shelf life by reducing MD severity up to 10 DAH. Whole roots showed low MD severity and high PPD expression up to 10 DAH, which enabled the assessment of PPD without significant interference of MD symptoms during this period.

Comorbidity and nutritional indices as predictors of morbidity after transurethral procedures: A prospective cohort study.

INTRODUCTION: Preoperative scores are widely used predictors of complications after major surgery. These scores, however, are not widely used in transurethral procedures. The aim of this study was to assess the value of the Charlson Comorbidity Index (CCI), the age-adjusted CCI, the American Society of Anesthesiologist score (ASA) and the Nutritional Risk Score (NRS) in predicting early morbidity after transurethral urological procedures. METHODS: Consecutive patients undergoing transurethral resection of the bladder or the prostate were prospectively enrolled. The scores were calculated preoperatively; 30-day complications were prospectively recorded according to the Dindo-Clavien classification. Univariate logistic regression was performed to investigate the value of each score and of other factors (i.e., age, sex, body mass index, anemia, smoking habit, type of operation and anaesthesia) as predictors of complications. A multivariate model was then calculated using these predictors. RESULTS: Overall, 197 patients were included. The mean age was 72 (standard deviation ± 10). In total, 26.9% patients had at least 1 complication. Using univariate analysis, we found that each score significantly predicted complications. In multivariate analysis, only the ASA (odds ration [OR] 2.11; 95% confidence interval [CI] 1.01-4.43) and the NRS (OR 2.42; 95% CI 1.56-3.74) remained independent predictors. The best model incorporated ASA, NRS and gender, and predicted morbidity with an area under the curve of 76%. Our study's main limitations are population heterogeneity and limited sample size. CONCLUSION: The ASA and the NRS are important and independent determinants of early morbidity after transurethral procedures. The use of these indices may assist clinicians in the decision-making process to balance the possible benefits of transurethral procedures with the potential risks.

HMG CoA reductase inhibitors (statins) for preventing acute kidney injury after surgical procedures requiring cardiac bypass.

BACKGROUND: Acute kidney injury (AKI) is common in patients undergoing cardiac surgery among whom it is associated with poor outcomes, prolonged hospital stays and increased mortality. Statin drugs can produce more than one effect independent of their lipid lowering effect, and may improve kidney injury through inhibition of postoperative inflammatory responses. OBJECTIVES: This review aimed to look at the evidence supporting the benefits of perioperative statins for AKI prevention in hospitalised adults after surgery who require cardiac bypass. The main objectives were to 1) determine whether use of statins was associated with preventing AKI development; 2) determine whether use of statins was associated with reductions in in-hospital mortality; 3) determine whether use of statins was associated with reduced need for RRT; and 4) determine any adverse effects associated with the use of statins. SEARCH METHODS: We searched the Cochrane Renal Group's Specialised Register to 13 January 2015 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA: Randomised controlled trials (RCTs) that compared administration of statin therapy with placebo or standard clinical care in adult patients undergoing surgery requiring cardiopulmonary bypass and reporting AKI, serum creatinine (SCr) or need for renal replacement therapy (RRT) as an outcome were eligible for inclusion. All forms and dosages of statins in conjunction with any duration of pre-operative therapy were considered for inclusion in this review. DATA COLLECTION AND ANALYSIS: All authors extracted data independently and assessments were cross-checked by a second author. Likewise, assessment of study risk of bias was initially conducted by one author and then by a second author to ensure accuracy. Disagreements were arbitrated among authors until consensus was reached. Authors from two of the included studies provided additional data surrounding post-operative SCr as well as need for RRT. Meta-analyses were used to assess the outcomes of AKI, SCr and mortality rate. Data for the outcomes of RRT and adverse effects were not pooled. Adverse effects taken into account were those reported by the authors of included studies. MAIN RESULTS: We included seven studies (662 participants) in this review. All except one study was assessed as being at high risk of bias. Three studies assessed atorvastatin, three assessed simvastatin and one investigated rosuvastatin. All studies collected data during the immediate perioperative period only; data collection to hospital discharge and postoperative biochemical data collection ranged from 24 hours to 7 days. Overall, pre-operative statin treatment was not associated with a reduction in postoperative AKI, need for RRT, or mortality. Only two studies (195 participants) reported postoperative SCr level. In those studies, patients allocated to receive statins had lower postoperative SCr concentrations compared with those allocated to no drug treatment/placebo (MD 21.2 µmol/L, 95% CI -31.1 to -11.1). Adverse effects were adequately reported in only one study; no difference was found between the statin group compared to placebo. AUTHORS' CONCLUSIONS: Analysis of currently available data did not suggest that preoperative statin use is associated with decreased incidence of AKI in adults after surgery who required cardiac bypass. Although a significant reduction in SCr was seen postoperatively in people treated with statins, this result was driven by results from a single study, where SCr was considered as a secondary outcome. The results of the meta-analysis should be interpreted with caution; few studies were included in subgroup analyses, and significant differences in methodology exist among the included studies. Large high quality RCTs are required to establish the safety and efficacy of statins to prevent AKI after cardiac surgery.

The Criminal Justice Approach : Case Exemples

This article provides an overview of the various forms of proceedings available within 11 European criminal justice systems and reflects upon their core features. It also provides a picture of how far alternative, non-criminal proceedings are used by some of the systems as a different path to imposing a state reaction upon wrong-doers.

Hypertension and intra-operative incidents: a multicentre study of 125000 surgical procedures in Swiss hospitals

Background: It is debated whether chronic hypertension increases the risk of cardiovascular incidents during anaesthesia. Methods: We studied all elective surgical operations performed in adults under general or regional anaesthesia between 2000 and 2004, in 24 hospitals collecting computerised clinical data on all anaesthetia since 1996. The focus was on cardiovascular incidents, though other anaesthesia-related incidents were also evaluated. Results: Among 124 939 interventions, 27 881 (22%) were performed in hypertensive patients. At least one cardiovascular incident occurred in 7549 interventions (6% [95% CI 5.9-6.2%]). The average adjusted odds ratio of cardiovascular risk in patients with chronic hypertension was 1.38 (95% CI 1.27-1.49). However, across hospitals, adjusted odd ratios varied from 0.41 up to 2.25. Hypertension did not increase the risk of other incidents. Conclusions: Hypertensive patients are still at risk of intra-operative cardiovascular incidents. The heterogeneity of the risk to develop cardiovascular incidents varied across hospitals, despite taking into account casemix and hospital characteristics. These variations suggest that anaesthetic practices differ across anesthesia services

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.

La nueva política criminal de la seguridad vial. Reflexiones a propósito de la LO 15/2007, de 30 de noviembre, y del Proyecto de Reforma del Código Penal

La reforma de los delitos contra la seguridad en el tráfico operada por LO 15/2007, de 30 de noviembre, constituye la expresión de un programa político-criminal de más amplio alcance, presente en el Proyecto de Reforma del Código Penal de 2007. En este trabajo se exponen las causas de la emergencia del nuevo derecho penal de la seguridad vial a la luz del paradi gma explicativo que ofrece el derecho penal postmoderno del riesgo -sometido aquí a necesarios ajustes- y se ofrece un análisis crítico de dos de los nuevos tipos: la conducción a velocidad por encima de determinados límites (art. 379.1) y la conducción con concentraciones de alcohol en aire espirado o en sangre superiores a determinadas tasas (0.6 mgr. o 1,2 gr. respectivamente) –art. 379.2-. Igualmente se analiza la propuesta del Proyecto de Reforma del Código de elevar a la categoría de delito las imprudencias leves con resultado de muerte. Tres piezas clave de un programa que trasluce una gran desconfianza hacia el estamento judicial y un optimismo infundado en las posibilidades del derecho penal para reducir eficazmente la siniestralidad vial.

Sistema de sanciones y política criminal: un estudio de Derecho comparado europeo

El trabajo aborda una comparación de los diversos sistemas de penas estatales en Europa, con el objetivo de sistematizar los diversos modelos político-criminales y de calibrar la aflictividad de los mismos. A través de determinados indicadores se pone de relieve que los sistemas jurídicos que abren un mayor espacio a la discrecionalidad judicial en la selección y la determinación de la pena muestran una mayor moderación del rigor punitivo y están en mejores condiciones de dar respuesta a una fenomenología criminal cada vez más diversa.

Política criminal con bases empíricas en España

La dimensión real de la actual política criminal española carece de adecuados niveles de racionalidad, entre sus múltiples causas, podemos mencionar el fenómeno de la creciente dinámica punitivista, la ausencia de una adecuada cultura de evaluación, el menosprecio a la criminología, la escasa consideración de los responsables políticos hacia las opiniones expertas de la dogmática, y la constante indiferencia de ésta hacia la realidad que debe enfrentar. Se configura así un decepcionante panorama donde la política criminal real aparece como carente de una sólida base empírica. La dimensión teórica de la política criminal, no puede soslayar el aporte de las investigaciones criminológicas, ya que aquellos tendrían la virtualidad de ser condición necesaria aunque no suficiente de la utilización racional del sistema punitivo. Hay que optar por una reducción de la privación de libertad y promover otras sanciones en cuyo contenido se armonicen los conceptos de incapacitación y responsabilización. Además, se requiere el desarrollo de una victimología que se dirija a inhibir los impulsos punitivos de las víctimas en función de orientar la política criminal hacia una cultura jurídica reparatoria que enfrente la actual expansión del derecho penal.