Traitement des plagiocéphalies postérieures d'origine positionnelle [Treatment of posterior positional plagiocephaly]

In 1992, the American academy of paediatrics has recommended that infants be placed on their backs to sleep, because prone sleeping has been correlated with sudden infant death syndrome. Following this article, medical paediatric community has documented an exponential increase in the diagnosis of posterior cranial deformities, which were considered as the consequence of unrelieved pressure onto the occiput during infant sleep. These last 15 years, management of posterior positional plagiocephaly has evolved but is still not standardized; it varies according to local specificities, and medical or parental preferences. Treatment of deformational plagiocephaly includes preventive counseling, repositioning adjustments and exercises, physiotherapy, osteopathy, treatment by dynamic cranial orthosis. On extremely rare occasions, corrective surgery is proposed. This article aims at reviewing the epidemiologic, diagnostic, and various therapeutic options of posterior positional plagiocephaly.

Interpretation of lesions of the cardiac conduction system in cocaine-related fatalities.

This study examines cases of chronic drug users who died suddenly after drug administration. Victims were young subjects, aged from 19 to 35 from Switzerland and known to the police as long-term drug users. The circumstances of death suggested the occurrence of a sudden, unexpected death. Some victims were undergoing methadone treatment. In each case, a forensic autopsy and toxicological analyses were performed at the Institute of Forensic Medicine in Lausanne in Switzerland between 2002 and 2004, including hair analysis as a means to establish chronic drug use in general, and cocaine use in particular. The conduction system was examined histologically and cases showing potentially lethal changes were chosen for this report. The most frequent lesions found were severe thickening of the atrioventricular node artery, intranodal and perinodal fibrosis, and microscopic foci of chronic inflammatory infiltration. The authors conclude that pathological lesions in the conduction tissue may play a role in the occurrence of death attributed to intoxication consecutive to cocaine ingestion.

Sovereign default, domestic banks and financial institutions

We present a model of sovereign debt in which, contrary to conventional wisdom, government defaultsare costly because they destroy the balance sheets of domestic banks. In our model, better financial institutionsallow banks to be more leveraged, thereby making them more vulnerable to sovereign defaults.Our predictions: government defaults should lead to declines in private credit, and these declines should belarger in countries where financial institutions are more developed and banks hold more government bonds.In these same countries, government defaults should be less likely. Using a large panel of countries, we findevidence consistent with these predictions.

Puristin- ja viiraosan vedenpoiston hallinta nopeudennoston yhteydessä

Koneuusintojen sekä täysin uusien konelinjojen myötä SC-paperin valmistuskapasiteettia on tullut ja tulee paljon lisää 2000-luvulla. Uudistettujen sekä uusien linjojen tuottavuudet ja laatutasot ylittävät huomattavasti Myllykoski Paperin PK7:n nykyisen tason. Tämän vuoksi PK7:lla tulee pystyä valmistamaan vähemmän kilpailtuja ja jalostusarvoltaan parempia laatuja kuin mitä suurimmat SC-tuottajat valmistavat. Työn tavoitteena oli antaa vastauksia investointitarpeisiin, jos PK7:n tuotesuuntaa ollaan muuttamassa. Toisena tavoitteena oli luoda puristin- ja viiraosan vedenpoiston kannalta ajoikkuna, jossa muuttujna ovat neliömassa, paperikoneen nopeus sekä massatärkkelyksen määrä Kirjallisuusosassa tarkasteltiin SC-paperikoneen viira- ja puristinosan vedenpoistoa. PK7:n nykyisen listakenkäformerin vedenpoistokapasiteetti voi olla riittämätön nykyisellä laatutasolla ja hiokemassoilla suurempia ajonopeuksia tavoiteltaessa. Ongelmiksi voivat tulla listakengän vedenpoisto ja viiraosan jälkeinen kuiva-aine. Puristinosalla paksut lajit, alhainen kuiva-aine sekä nopea ja äkillinen vedenpoisto voivat aiheuttaa telanipissä kurausta. Kokeellisessa osassa selvitettiin raskaiden ja ohuiden neliömassojen sekä eripaperilajien mahdolliset vedenpoiston rajoitukset viira- ja puristinosalla. Formeritelan ja listakengän sekä 1. puristimen vedenpoistokapasiteetit tulivat koeajon perusteella kriittiseksi raskailla lajeilla ja suurilla massatärkkelysmäärillä, kun koneen nopeus nousi yli 1240 m/min.

Decompression scenarios in a new underground transportation system

BACKGROUND: The risks of a public exposure to a sudden decompression, until now, have been related to civil aviation and, at a lesser extent, to diving activities. However, engineers are currently planning the use of low pressure environments for underground transportation. This method has been proposed for the future Swissmetro, a high-speed underground train designed for inter-urban linking in Switzerland. HYPOTHESIS: The use of a low pressure environment in an underground public transportation system must be considered carefully regarding the decompression risks. Indeed, due to the enclosed environment, both decompression kinetics and safety measures may differ from aviation decompression cases. METHOD: A theoretical study of decompression risks has been conducted at an early stage of the Swissmetro project. A three-compartment theoretical model, based on the physics of fluids, has been implemented with flow processing software (Ithink 5.0). Simulations have been conducted in order to analyze "decompression scenarios" for a wide range of parameters, relevant in the context of the Swissmetro main study. RESULTS: Simulation results cover a wide range from slow to explosive decompression, depending on the simulation parameters. Not surprisingly, the leaking orifice area has a tremendous impact on barotraumatic effects, while the tunnel pressure may significantly affect both hypoxic and barotraumatic effects. Calculations have also shown that reducing the free space around the vehicle may mitigate significantly an accidental decompression. CONCLUSION: Numeric simulations are relevant to assess decompression risks in the future Swissmetro system. The decompression model has proven to be useful in assisting both design choices and safety management.

Statin treatment is associated with improved prognosis in patients with AF-related stroke.

BACKGROUND/OBJECTIVES: The most recent ACC/AHA guidelines recommend high-intensity statin therapy in ischemic stroke patients of presumably atherosclerotic origin. On the contrary, there is no specific recommendation for the use of statin in patients with non-atherosclerotic stroke, e.g. strokes related to atrial fibrillation (AF). We investigated whether statin treatment in patients with AF-related stroke is associated with improved survival and reduced risk for stroke recurrence and future cardiovascular events. METHODS: All consecutive patients registered in the Athens Stroke Registry with AF-related stroke and no history of coronary artery disease nor clinically manifest peripheral artery disease were included in the analysis and categorized in two groups depending on whether statin was prescribed at discharge. The primary outcome was overall mortality; the secondary outcomes were stroke recurrence and a composite cardiovascular endpoint comprising of recurrent stroke, myocardial infarction, aortic aneurysm rupture or sudden cardiac death during the 5-year follow-up. RESULTS: Among 1602 stroke patients, 404 (25.2%) with AF-related stroke were included in the analysis, of whom 102 (25.2%) were discharged on statin. On multivariate Cox-proportional-hazards model, statin treatment was independently associated with a lower mortality (hazard-ratio (HR): 0.49, 95%CI:0.26-0.92) and lower risk for the composite cardiovascular endpoint during the median 22months follow-up (HR: 0.44, 95%CI:0.22-0.88), but not with stroke recurrence (HR: 0.47, 95%CI:0.22-1.01, p: 0.053). CONCLUSIONS: In this long-term registry of patients with AF-related stroke, statin treatment was associated with improved survival and reduced risk for future cardiovascular events.

Regulation of the expression of Nav1.5, the cardiac voltage-gated sodium channel

Abstract The cardiac sodium channel Nav1.5 plays a key role in cardiac excitability and conduction. Its importance for normal cardiac function has been highlighted by descriptions of numerous mutations of SCN5A (the gene encoding Nav1.5), causing cardiac arrhythmias which can lead to sudden cardiac death. The general aim of my PhD research project has been to investigate the regulation of Nav1.5 along two main axes: (1) We obtained experimental evidence revealing an interaction between Nav1.5 and a multiprotein complex comprising dystrophin. The first part of this study reports the characterization of this interaction. (2) The second part of the study is dedicated to the regulation of the cardiac sodium channel by the mineralocorticoid hormone named aldosterone. (1) Early in this study, we showed that Nav1.5 C-terminus was associated with dystrophin and that this interaction was mediated by syntrophin proteins. We used dystrophin-deficient mdx5cv mice to study the role of this interaction. We reported that dystrophin deficiency led to a reduction of both Nav1.5 protein level and the sodium current (INa). We also found that mdx5cv mice displayed atrial and ventricular conduction defects. Our results also indicated that proteasome inhibitor MG132 treatment of mdx5cv mice rescued Nav1.5 protein level and INa in cardiac tissue. (2) We showed that aldosterone treatment of mice cardiomyocytes led to an increase of the sodium current with no modification of Nav1.5 transcript and protein level. Altogether, these results suggest that the sodium current can be increased by distribution of intracellular pools of protein to the plasma membrane (e.g. upon aldosterone stimulation) and that interaction with dystrophin multiprotein complex is required for the stabilization of the channel at the plasma membrane. Finally, we obtained preliminary results suggesting that the proteasome could regulate Nav1.5 in mdx5cv mice. This study defines regulatory mechanisms of Nav1.5 which could play an important role in cardiac arrhythmia and bring new insight in cardiac conduction alterations observed in patients with dystrophinopathies. Moreover, this work suggests that Brugada syndrome, and some of the cardiac alterations seen in Duchenne patients may be caused by overlapping molecular mechanisms leading to a reduction of the cardiac sodium current.

Stable carbon isotopes in archaeobotanical remains and palaeoclimate

Es descriu una metodologia recent per a inferir la precipitació en el passat basada en l’anàlisi de la composició isotòpica del carboni (δ13C) en restes arqueobotàniques. Un cop descrita la base fisiològica de la tècnica, s’il·lustra l’aplicabilitat de δ13C mitjançant un exemple referent al NE peninsular. Hom pretén proporcionar una estimació quantitativa de l’evolució de la precipitació estacional (primavera) i anual al llarg dels darrers quatre mil anys basada en δ13C. Les mostres analitzades comprenen carbons (pi blanc) i llavors carbonitzades (blat i ordi), i s’obtenen estimes pluviomètriques superiors en el passat que actualment, amb una tendència gradual cap a condicions progressivament més àrides. No obstant això, aquesta tendència no esdevé uniforme, i es detecten dues fases de major precipitació (1800-900 aC; 300 aC - 300 dC) alternadament amb períodes relativament secs (900-300 aC; 900 dC - present). Dels resultats presentats també es desprèn que la importància relativa de la pluja primaveral en el passat fou variable. Des d’aproximadament el 300 aC en endavant, el període primaveral subministrà una major proporció de pluja anual que actualment. Contràriament, durant el període 1800-800 dC la seva contribució va esdevenir inferior, i va aparèixer una fase transitòria (800-300 aC) que mostra una recuperació sobtada en aportació primaveral. Posteriorment a aquesta fase la sincronia de canvis en δ13C en granes i carbons suggereix l’arribada del clima mediterrani a la regió.

Cardioinhibitory reflex due to a karate kick: a case report.

This article describes the case of a 17-year-old adolescent boy who received a foot kick in the trunk area from an expert in karate. He presented with immediate cardiocirculatory arrest. After a prolonged resuscitation, he was transferred to a hospital where he died 5 days later without ever regaining consciousness. Postmortem investigations including autopsy, radiology, histology, toxicology, and postmortem chemistry were performed that showed signs of multiple organ failure, an acute hemorrhage in the region of the celiac plexus, and signs of medical resuscitation. No preexisting disease, particularly those concerning the heart, was objectified. The cause of death was attributed to multiple organ failure after a prolonged cardiocirculatory arrest. Concerning the origin of the cardiac arrest, 2 hypotheses were considered-a cardioinhibitory reflex and a cardiac contusion (commotio cordis). Because of the presence of traumatic lesions in the celiac plexus, the first hypothesis was finally submitted. This case is reported because rare cases of sudden death from celiac reflex are described in the literature where it is almost impossible to find references with accurate documentation. The presented case confirms the importance of detailed documentation of the circumstances and postmortem investigations to establish a diagnosis of death due to cardioinhibitory reflex.

Ten years after the Prestige Oil Spill: seabird trophic ecology as indicator of long-term effects on the coastal marine ecosystem

Major oil spills can have long-term impacts since oil pollution does not only result in acute mortality of marine organisms, but also affects productivity levels, predator-prey dynamics, and damages habitats that support marine communities. However, despite the conservation implications of oil accidents, the monitoring and assessment of its lasting impacts still remains a difficult and daunting task. Here, we used European shags to evaluate the overall, lasting effects of the Prestige oil spill (2002) on the affected marine ecosystem. Using δ15N and Hg analysis, we trace temporal changes in feeding ecology potentially related to alterations of the food web due to the spill. Using climatic and oceanic data, we also investigate the influence of North Atlantic Oscillation (NAO) index, the sea surface temperature (SST) and the chlorophyll a (Chl a) on the observed changes. Analysis of δ15N and Hg concentrations revealed that after the Prestige oil spill, shag chicks abruptly switched their trophic level from a diet based on a high percentage of demersal-benthic fish to a higher proportion of pelagic/semi-pelagic species. There was no evidence that Chl a, SST and NAO reflected any particular changes or severity in environmental conditions for any year or season that may explain the sudden change observed in trophic level. Thus, this study highlighted an impact on the marine food web for at least three years. Our results provide the best evidence to date of the long-term consequences of the Prestige oil spill. They also show how, regardless of wider oceanographic variability, lasting impacts on predator-prey dynamics can be assessed using biochemical markers. This is particularly useful if larger scale and longer term monitoring of all trophic levels is unfeasible due to limited funding or high ecosystem complexity.

Pathological changes in anabolic androgenic steroid users.

Several classes of recreational and prescription drugs have additional effects on the heart and vasculature, which may significantly contribute to morbidity and mortality in chronic users. The study presented herein focuses on pathological changes involving the heart possibly due to anabolic androgenic steroid use. The role these hormones may play in their occurrence of sudden cardiac death is also investigated. 98 medico-legal cases including 6 anabolic androgenic steroid users were retrospectively reviewed. Autopsies, histology, immunohistochemistry, biochemistry and toxicology were performed in all cases. Pathological changes consisted of various degrees of interstitial and perivascular fibrosis as well as fibroadipous metaplasia and perineural fibrosis within the myocardium of the left ventricle. Within the limits of the small number of investigated cases, our results appear to confirm former observations on this topic and suggest anabolic androgenic steroid's potential causative role in the pathogenesis of sudden cardiac deaths in chronic users.

Cardiogene: an innovative multidisciplinary consultation for genetic arrhythmias

Introduction: Over the past decade clinically relevant progress has been made regarding the genetic origin of sudden cardiac death due to arrhythmic syndromes such as congenital long QT syndrome (LQTS), Brugada syndrome (BrS), catecholinergic polymorphic ventricular tachycardia (CPVT) and short QT (SQTS). An increased number of patients are diagnosed and their offspring sent for screening. In order to optimize care of these families we have set up a multidisciplinary consultation, "Cardiogene", consisting of a pediatric and an adult cardiologist and a clinical geneticist. All families are seen at a common consult in order to take the family history, genetic background and to explain the disease to patients and their families. Appropriate cardiac investigations and genetic testing are then performed and the families seen again in a multidisciplinary fashion for the results. We have reviewed all our cases over the past 5 years. Methods: retrospective review of all cases seen at Cardiogene Clinic for suspicion of arrhythmic syndromes since 2007. Results: 23 families were seen at the Cardiogene Clinic with a total of 41 children. The suspected arrhythmic syndrome was LQTS in 14 families (26 children), BrS in 7 families (14 children), SQTS in1 family (2 children) and CPVT in 1 family (3 children). Of the 41 children 17 were genetically positive for an arrhythmic syndrome: 14 were for LQTS, 3 for BrS. 24 children were genetically negative however 4 of those were phenotypically positive: 2 LQTS, 1 BrS and 1 CPVT. In 3 families the diagnosis was initially made in a child and then found in the parent. In 2 families the diagnosis was made after a sudden death of one of their children, 1 LQTS (3 week old child), 1 BrS (20 year old). Discussion: Genetic testing is an essential part of diagnosis and permits an improved targeting of patients needing follow-up and treatment. In our series, a mutation has been found in most families with LQTS. In all other genetic arrhythmias, the yield of genetic testing is less but nevertheless helpful for medical care of these pts. Conclusion: A multidisciplinary approach to genetic arrhythmias permits a better and more efficient screening and therapy in affected families. It helps families to better understand their disease and improves follow-up in the affected individuals.

Logistiikkavaraston henkilöstökustannusten optimointi

Tämän diplomityön tavoitteena on case-esimerkin kautta tutkia, kuinka hyvin vähittäiskaupan logistiikkavarastossa pystytään sovittamaan yhteen työn kysyntä ja tarjonta ja mikä on vuokratyövoiman rooli tässä yhtälössä. Diplomityössä käsitellään logistiikkavaraston työmäärän ennustettavuutta, työvoiman joustavuutta, lasketaan vertailukelpoiset kustannukset eri henkilöstöryhmille sekä esitetään ehdotuksia kokonaiskustannusten optimoimiseksi. Diplomityössä käy ilmi, että tutkittavassa yrityksessä henkilöstöresurssien käyttö ei ole aivan optimaalinen, vaan että tehdyistä työtunneista jopa 21% on ylimääräisiä, mikä aiheuttaa vuosittain 1,0 miljoonan euron kustannushukan. Tämä johtuu sekä työmäärän epätasaisesta jakautumisesta kuukausien kesken, että työvoimatarpeen heikosta suunnittelusta. Työmäärän vaikeasta ennustettavuudesta johtuen turhia työtunteja ei ole mahdollista kokonaan poistaa, mutta hyvällä etukäteissuunnittelulla henkilöstökustannuksia pystytään laskemaan noin 13%. Henkilöstöryhmistä tehtyjen vertailulaskelmien perusteella ylitöiden teettäminen vakituisella henkilökunnalla osoittautuu kannattamattomaksi. Määräaikaisen henkilöstön käyttäminen on kustannuksiltaan edullista, mutta mahdollista vain, jos työvoiman tarve on tilapäinen ja tiedossa hyvissä ajoin etukäteen. Vuokratyövoima on tuntikustannukseltaan kalliimpaa, mutta sen nopea saatavuus mahdollistaa työvoiman entistä paremman sopeuttamisen työn kysynnän mukaan. Kun vuokratyövoimaa on saatavilla, ei varastolla tarvitse pitää ylimääräistä työvoimaa nopeiden työmäärän muutosten varalta.

Fluid flow processes at basin scale

S u b s u r face fluid flow plays a significant role in many geologic processes and is increasingly being studied in the scale of sedimentary basins and geologic time perspective. Many economic resources such as petroleum and mineral deposits are products of basin scale fluid flow operating over large periods of time. Such ancient flow systems can be studied through analysis of diagenetic alterations and fluid inclusions to constrain physical and chemical conditions of fluids and rocks during their paleohy d r og e o l ogic evolution. Basin simulation models are useful to complement the paleohy d r og e o l ogic record preserved in the rocks and to derive conceptual models on hydraulic basin evolution and generation of economic resources. Different types of fluid flow regimes may evo l ve during basin evolution. The most important with respect to flow rates and capacity for transport of solutes and thermal energy is gr avitational fluid flow driven by the topographic configuration of a basin. Such flow systems require the basin to be elevated above sea level. Consolidational fluid flow is the principal fluid migration process in basins below sea level, caused by loading of compressible rocks. Flow rates of such systems are several orders of magnitude below topogr a p hy driven flow. Howeve r, consolidation may create significant fluid ove rpressure. Episodic dewatering of ove rpressured compart m e n t s m ay cause sudden fluid release with elevated flow velocities and may cause a transient local thermal and chemical disequilibrium betwe e n fluid and rock. This paper gives an ove rv i ew on subsurface fluid flow processes at basin scale and presents examples related to the Pe n e d è s basin in the central Catalan continental margin including the offshore Barcelona half-graben and the compressive South-Pyrenean basin.

Hankintariskienhallinta Suomen IVD-teollisuudessa

Kansainvälinen ja kiristyvä kilpailu on muuttanut yritysten liiketoimintaympäristöä yhä monimutkaisemmaksi ja riskialttiimmaksi. Yritysten keskittyessä yhä syvemmin omaan ydinosaamiseensa on ulkoisten resurssien hallinnan merkitys korostunut. Työnjakoa syventämällä tavoitellaan parempaa joustavuutta, ajanhallintaa sekä kustannustehokkuutta. Myös hankintatoimen tehtävät ja vastuualueet muuttuvat ennakoivampaan ja riskialttiimpaan suuntaan. Modernin hankintatoimen on kyettävä tunnistamaan, analysoimaan ja hallitsemaan riskejä yhä pirstaloituneemmista lähteistä ja muodoista. Proaktiivinen hankintatoimi osallistuu yrityksen strategiseen suunnitteluun ja riskienhallintaan. Hankintariskit voidaan luokitella seuraaviin kymmeneen riskiluokkaan: keskeytymisriskit, saatavuusriskit, hintariskit, varasto- ja aikatauluriskit, teknologiariskit, luottamuksellisen tiedon vuotoriskit, laaturiskit, konfiguraatioriskit, opportunismiriskit sekä riippuvuusriskit. Tässä tutkimuksessa hankintariskienhallintaa tarkastellaan hankintastrategian valinnan näkökulmasta. Hankintastrategian yksi elementti on toimittajasuhteen ja toimittajien lukumäärän valinta. Tilanteesta riippuen yhteistyöstrategialla tai perinteisellä kilpailuttamisella voidaan tavoitella parempaa riskienhallintaa. Yhteistyöstrategioita ovat eri tasoiset kumppanuussuhteet ja liittoutumat, jolloin suhde toimittajaan on syvä ja luottamuksellinen hyödyttäen aidosti molempia osapuolia. Riskienhallinnan näkökulmasta yhteistyöstrategia soveltuu parhaiten tilanteissa, joissa toimittajista on pitkä kokemus sekä hankintanimikkeen tuottama arvo on merkittävä. Kilpailuttamisstrategia eli hankintojen toteuttaminen usealta toimittajalta vaatii ostavalta organisaatiolta tehokkaasti hyödynnettynä suurempia resursseja kuin yhteistyöstrategian käyttö. Kilpailuttaminen soveltuu usein parhaiten silloin, kun hankintanimikkeet ovat tavanomaisia ja vaihtoehtoisia hankintalähteitä on runsaasti. Lisäksi usean toimittajan käyttö suojaa materiaalivirran katkoksilta sekä lisää hankintamarkkinoiden tuntemusta. Empiirisessä tutkimusosassa tutkitaan, miten soveltuviksi riskienhallintamenetelmiksi erilaiset hankintastrategiat koetaan Suomen IVD-teollisuudessa. Lisäksi tunnistetaan Suomen IVD-teollisuudessa merkittävimmiksi koetut hankintariskiluokat sekä selvitetään millä organisaation tasolla hankintariskienhallinta pääasiassa suoritetaan. Lisäksi selvitetään, millä menetelmin hankintariskejä pääasiassa analysoidaan.