L'arthroplastie totale de genou: évolution et résultats actuels

Avec 95% de bons résultats à 10 ans, on peut considérer aujourd'hui que l'arthroplastie totale du genou est un traitement fiable des gonarthroses chez des patients âgés à demande fonctionnelle raisonnable. Les quatre complications potentielles principales après la mise en place d'une prothèse totale du genou sont le descellement aseptique, l'infection, le manque de flexion et les douleurs persistantes. En cas de problème avec une prothèse totale du genou, il faut toujours exclure la présence d'une infection avant d'envisager une autre raison. Les innovations actuelles en arthroplastie du genou doivent viser à améliorer les résultats chez les patients jeunes et actifs i.e. tant au niveau de la conception des nouveaux implants, voire des matériaux plus résistants, que des techniques chirurgicales elles-mêmes. Total knee arthroplasty: current advances and results With a 95% success rate at 10 years, total knee arthroplasty can be regarded today as a reliable way of treating knee osteoarthritis in elderly patients with reasonable functional demands. The four main potential complications after placing of a total knee prosthesis are aseptic loosening, infection, lack of flexion and persistent pain. If a problem arises with a total knee prosthesis, infection must always be ruled out before considering other causes. Current innovations in knee arthroplasty should be aimed at improving results in young and active patients, i.e. in regard to both the design of new implants, or tougher materials, and to the surgical techniques themselves.

Speed Limit Questions? Here’s Your Answer, February 8, 2010

Iowa’s speed regulations are based on the same basic speed law that is used in all 50 states: “Any person driving a motor vehicle on a highway shall drive the same at a careful and prudent speed not greater than nor less than is reasonable and proper, having due regard to the traffic, surface, and width of the highway and of any other conditions then existing, and no person shall drive any vehicle upon a highway at a speed greater than will permit the person to bring it to a stop within the assured clear distance ahead, such driver having the right to assume, however, that all persons using said highway will observe the law.” Statutory limits are based on the concept that uniform categories of highways can be traveled safely at certain preset maximum speeds under ideal conditions. Whether the speed limit is posted or unposted, drivers should reduce their speed below these values in poor weather, heavy traffic, and under other potentially hazardous conditions.

Incentives and promotion in wage hierarchies

Most of the large firms organization schemes consist in hierarchical structures of tiers with different wage levels. Traditionally the existence of this kind of organizations has been associated to the separation of productive and managerial or supervision tasks and to differences in the skills of the workers. However, many firms now employ workers with similar skills, and then the hierarchical structure can be related to an incentive scheme to ensure that workers supply effort. The model we present investigates how firm owners should determine the optimal wage distribution in order to maximize profits.

The maximun and the addition of assigment games

[cat] En el context dels mercats a dues bandes, considerem, en primer lloc, que els jugadors poden escollir on dur a terme les seves transaccions. Mostrem que el joc corresponent a aquesta situació, que es representa pel màxim d’un conjunt finit de jocs d’assignació, pot ser un joc no equilibrat. Aleshores proporcionem condicions per a l’equilibri del joc i, per aquest cas, analitzem algunes propietats del core del joc. En segon lloc, considerem que els jugadors poden fer transaccions en diversos mercats simultàniament i, llavors, sumar els guanys obtinguts. El joc corresponent, representat per la suma d’un conjunt finit de jocs d’assignació, és equilibrat. A més a més, sota certes condicions, la suma dels cores dels dos jocs d’assignació coincideix amb el core del joc suma.

Coalitionally monotonic set-solutions for cooperative TU games

A static comparative study on set-solutions for cooperative TU games is carried out. The analysis focuses on studying the compatibility between two classical and reasonable properties introduced by Young (1985) in the context of single valued solutions, namely core-selection and coalitional monotonicity. As the main result, it is showed that coalitional monotonicity is not only incompatible with the core-selection property but also with the bargaining-selection property. This new impossibility result reinforces the tradeoff between these kinds of interesting and intuitive economic properties. Positive results about compatibility between desirable economic properties are given replacing the core selection requirement by the core-extension property.

Etudes Coût-efficacité: ce que devraient retenir les médecins [Cost-effectiveness analyses: what doctors should know]

The resources of our heath care system are limited. Choices in the attribution of resources are necessary to ensure its stability. A cost-effectiveness analysis compares the effects of one health intervention to another, taking into account the costs (including the saved costs) and the saved life years, adjusted for the quality of life (cost-utility). Cost-effectiveness analyses should take the societal perspective and the studied intervention should be compared to a relevant intervention actually in use. Physicians, at the interface between patients and payers, are in an ideal position to interpret, or even perform cost-effectiveness analysis, and to promote the interventions that are most effective and that have a reasonable cost.

Low Water Stream Crossing: Design and Construction Recommendations, December 2001

Most counties have bridges that are no longer adequate, and are faced with large capital expenditure for replacement structures of the same size. In this regard, low water stream crossings (LWSCs) can provide an acceptable, low cost alternative to bridges and culverts on low volume and reduced maintenance level roads. In addition to providing a low cost option for stream crossings, LWSCs have been designed to have the additional benefit of stream bed stabilization. Considerable information on the current status of LWSCs in Iowa, along with insight of needs for design assistance, was gained from a survey of county engineers that was conducted as part of this research (Appendix A). Copies of responses and analysis are included in Appendix B. This document provides guidelines for the design of LWSCs. There are three common types of LWSCs: unvented ford, vented ford with pipes, and low water bridges. Selection among these depends on stream geometry, discharge, importance of road, and budget availability. To minimize exposure to tort liability, local agencies using low water stream crossings should consider adopting reasonable selection and design criteria and certainly provide adequate warning of these structures to road users. The design recommendations included in this report for LWSCs provide guidelines and suggestions for local agency reference. Several design examples of design calculations are included in Appendix E.

Carrière sportive et socialisation secondaire en cyclisme sur route : les cas de la Belgique, la France et la Suisse. Rapport de fin de recherche financé par l'Agence Mondiale Antidopage

Le projet s'intéresse aux socialisations des jeunes cyclistes sur route dans la phase de la carrière où ils deviennent des espoirs nationaux. Pour certains, cela correspond au passage d'une structure sportive amateur de haut niveau vers une équipe professionnelle. Cette phase semble constituer un moment clé de la consommation de produits dopants. Ces espoirs sont exposés à un nouvel environnement et une nouvelle logique professionnelle s'impose à eux, avec ses espoirs de carrière et de profits et ses risques. Ils sont confrontés à de nouveaux groupes sociaux avec lesquels s'établit un système d'interactions. Avec le temps, ces groupes vont notamment inculquer aux jeunes coureurs de nouvelles normes en matière de santé, de fatigue, d'expériences, d'éthique et d'entraînement.Il s'agit plus particulièrement d'observer les modes de socialisation des jeunes espoirs du cyclisme pour comprendre comment s'immiscent les pratiques de dopage dans les biographies des sportifs. Dans une optique de prévention, ce travail se propose d'étudier les effets de la socialisation. Comme le souligne H. Becker (1985), la déviance est le fruit d'un acte collectif. Il s'agit alors de comprendre comment, au contact de divers groupes encadrants (pairs, entraîneurs, dirigeants, médecins), les savoir-faire mais aussi les normes, les valeurs se construisent au cours de la phase de socialisation professionnelle. Il est important de comprendre les effets des interactions entre ces groupes et le jeune espoir. Cette socialisation semble correspondre à l'inculcation d'une culture cycliste qu'il s'agira de décrire en prenant en compte deux formes de transmission des normes : une explicite, à certains moments de la journée, où sont abordées les techniques de course, les tactiques, les modes d'entraînement et une implicite, pendant laquelle sont diffusées des valeurs qui conduisent le sportif à faire le choix du dopage. Dans le cas du dopage, nous nous intéresserons notamment aux normes de santé, d'éthique, aux conceptions de la pratique sportive en adéquation avec le suivi médical pendant la phase amateur puis néo-professionnelle. La formation, ou transformation, de ces représentations sera appréhendée à travers les interactions entre coureurs et encadrement lors des différents moments de leur quotidien. Il s'agira également d'étudier le cadre social de ces interactions. A partir des récits de vie collectés, nous essayerons de déterminer les moments où les choix s'opèrent et nous y analyserons les conduites.L'acquisition des représentations associées au dopage est le produit du double mouvement de l'action sociale des individus et des effets des structures organisationnelles et institutionnelles. En conséquence, nous nous intéresserons également à l'influence des différents dispositifs tels que la famille, l'école, le club, la structure médicale, la fédération nationale, sur les représentations des coureurs.Cette étude reposera sur une analyse comparée des cyclistes belges, français et suisses. Les carrières seront analysées à partir d'entretiens semi-directifs (75) auprès de (1) jeunes athlètes (18-23 ans) qui vivent les phases de professionnalisation, (2) d'anciens cyclistes ayant vécu les normes de socialisation du milieu et (3) des acteurs clefs de l'organisation des différents dispositifs (entraîneurs, dirigeants, médecins). Notre démarche méthodologique s'adosse à celles déjà expérimentées dans des travaux antérieurs (notamment, Brissonneau, 2003).

Evaporation and coarsening dynamics with open boundaries

We present a study of the evaporation dynamics of a substance undergoing a coarsening process. The system is modeled by the Cahn-Hilliard equation with absorbing boundaries. We have found that the dynamics, although of a diffusive nature, is much slower than the usual one without coarsening. Analytical and simulation results are in reasonable agreement.

Quand faut-il opérer une rupture de la coiffe des rotateurs [When to operate a rotator cuff tear?]

Rotator cuff disease is the most common pathology causing shoulder pain with an overall prevalence rate of 30%. There is a significant association between increasing age and the presence of rotator cuff tears. Spontaneous healing of clinically relevant tears has not been observed. Although satisfactory pain relief is possible without rotator cuff tendon healing, functional outcome is better for healed repairs. Operative treatment must be considered in the context of the reasonable expectations for success. Repairability and potential of surgically tendon construct to heal are important considerations in surgical indications. There is no difference of outcomes between the arthroscopic and the open techniques.

Preserved capillary density of dorsal finger skin in treated hypertensive patients with or without type 2 diabetes.

OBJECTIVES: Capillary rarefaction is a hallmark of untreated hypertension. Recent data indicate that rarefaction may be reversed by antihypertensive treatment in nondiabetic hypertensive patients. Despite the frequent association of diabetes with hypertension, nothing is known on the capillary density of treated diabetic patients with hypertension. METHODS: We enrolled 21 normotensive healthy, 25 hypertensive only, and 21 diabetic (type 2) hypertensive subjects. All hypertensive patients were treated with a blocker of the renin-angiotensin system, and a majority had a home blood pressure ≤135/85 mmHg. Capillary density was assessed with videomicroscopy on dorsal finger skin and with laser Doppler imaging on forearm skin (maximal vasodilation elicited by local heating). RESULTS: There was no difference between any of the study groups in either dorsal finger skin capillary density (controls 101 ± 11 capillaries/mm(2) , nondiabetic hypertensive 99 ± 16, diabetic hypertensive 96 ± 18, p > 0.5) or maximal blood flow in forearm skin (controls 666 ± 114 perfusion units, nondiabetic hypertensive 612 ± 126, diabetic hypertensive 620 ± 103, p > 0.5). CONCLUSIONS: Irrespective of the presence or not of type 2 diabetes, capillary density is normal in hypertensive patients with reasonable control of blood pressure achieved with a blocker of the renin-angiotensin system.

Microscopic calculations of the excitation spectrum of one 3He impurity in liquid 4He

We calculate the chemical potential ¿0 and the effective mass m*/m3 of one 3He impurity in liquid 4He. First a variational wave function including two- and three-particle dynamical correlations is adopted. Triplet correlations bring the computed values of ¿0 very close to the experimental results. The variational estimate of m*/m3 includes also backflow correlations between the 3He atom and the particles in the medium. Different approximations for the three-particle distribution function give almost the same values for m*/m3. The variational approach underestimates m*/m3 by ~10% at all of the considered densities. Correlated-basis perturbation theory is then used to improve the wave function to include backflow around the particles of the medium. The perturbative series built up with one-phonon states only is summed up to infinite order and gives results very close to the variational ones. All the perturbative diagrams with two independent phonons have then been summed to compute m*/m3. Their contribution depends to some extent on the form used for the three-particle distribution function. When the scaling approximation is adopted, a reasonable agreement with the experimental results is achieved.

Looking for orders of magnitude : five essays in trade and the environment and economic geography

General Summary Although the chapters of this thesis address a variety of issues, the principal aim is common: test economic ideas in an international economic context. The intention has been to supply empirical findings using the largest suitable data sets and making use of the most appropriate empirical techniques. This thesis can roughly be divided into two parts: the first one, corresponding to the first two chapters, investigates the link between trade and the environment, the second one, the last three chapters, is related to economic geography issues. Environmental problems are omnipresent in the daily press nowadays and one of the arguments put forward is that globalisation causes severe environmental problems through the reallocation of investments and production to countries with less stringent environmental regulations. A measure of the amplitude of this undesirable effect is provided in the first part. The third and the fourth chapters explore the productivity effects of agglomeration. The computed spillover effects between different sectors indicate how cluster-formation might be productivity enhancing. The last chapter is not about how to better understand the world but how to measure it and it was just a great pleasure to work on it. "The Economist" writes every week about the impressive population and economic growth observed in China and India, and everybody agrees that the world's center of gravity has shifted. But by how much and how fast did it shift? An answer is given in the last part, which proposes a global measure for the location of world production and allows to visualize our results in Google Earth. A short summary of each of the five chapters is provided below. The first chapter, entitled "Unraveling the World-Wide Pollution-Haven Effect" investigates the relative strength of the pollution haven effect (PH, comparative advantage in dirty products due to differences in environmental regulation) and the factor endowment effect (FE, comparative advantage in dirty, capital intensive products due to differences in endowments). We compute the pollution content of imports using the IPPS coefficients (for three pollutants, namely biological oxygen demand, sulphur dioxide and toxic pollution intensity for all manufacturing sectors) provided by the World Bank and use a gravity-type framework to isolate the two above mentioned effects. Our study covers 48 countries that can be classified into 29 Southern and 19 Northern countries and uses the lead content of gasoline as proxy for environmental stringency. For North-South trade we find significant PH and FE effects going in the expected, opposite directions and being of similar magnitude. However, when looking at world trade, the effects become very small because of the high North-North trade share, where we have no a priori expectations about the signs of these effects. Therefore popular fears about the trade effects of differences in environmental regulations might by exaggerated. The second chapter is entitled "Is trade bad for the Environment? Decomposing worldwide SO2 emissions, 1990-2000". First we construct a novel and large database containing reasonable estimates of SO2 emission intensities per unit labor that vary across countries, periods and manufacturing sectors. Then we use these original data (covering 31 developed and 31 developing countries) to decompose the worldwide SO2 emissions into the three well known dynamic effects (scale, technique and composition effect). We find that the positive scale (+9,5%) and the negative technique (-12.5%) effect are the main driving forces of emission changes. Composition effects between countries and sectors are smaller, both negative and of similar magnitude (-3.5% each). Given that trade matters via the composition effects this means that trade reduces total emissions. We next construct, in a first experiment, a hypothetical world where no trade happens, i.e. each country produces its imports at home and does no longer produce its exports. The difference between the actual and this no-trade world allows us (under the omission of price effects) to compute a static first-order trade effect. The latter now increases total world emissions because it allows, on average, dirty countries to specialize in dirty products. However, this effect is smaller (3.5%) in 2000 than in 1990 (10%), in line with the negative dynamic composition effect identified in the previous exercise. We then propose a second experiment, comparing effective emissions with the maximum or minimum possible level of SO2 emissions. These hypothetical levels of emissions are obtained by reallocating labour accordingly across sectors within each country (under the country-employment and the world industry-production constraints). Using linear programming techniques, we show that emissions are reduced by 90% with respect to the worst case, but that they could still be reduced further by another 80% if emissions were to be minimized. The findings from this chapter go together with those from chapter one in the sense that trade-induced composition effect do not seem to be the main source of pollution, at least in the recent past. Going now to the economic geography part of this thesis, the third chapter, entitled "A Dynamic Model with Sectoral Agglomeration Effects" consists of a short note that derives the theoretical model estimated in the fourth chapter. The derivation is directly based on the multi-regional framework by Ciccone (2002) but extends it in order to include sectoral disaggregation and a temporal dimension. This allows us formally to write present productivity as a function of past productivity and other contemporaneous and past control variables. The fourth chapter entitled "Sectoral Agglomeration Effects in a Panel of European Regions" takes the final equation derived in chapter three to the data. We investigate the empirical link between density and labour productivity based on regional data (245 NUTS-2 regions over the period 1980-2003). Using dynamic panel techniques allows us to control for the possible endogeneity of density and for region specific effects. We find a positive long run elasticity of density with respect to labour productivity of about 13%. When using data at the sectoral level it seems that positive cross-sector and negative own-sector externalities are present in manufacturing while financial services display strong positive own-sector effects. The fifth and last chapter entitled "Is the World's Economic Center of Gravity Already in Asia?" computes the world economic, demographic and geographic center of gravity for 1975-2004 and compares them. Based on data for the largest cities in the world and using the physical concept of center of mass, we find that the world's economic center of gravity is still located in Europe, even though there is a clear shift towards Asia. To sum up, this thesis makes three main contributions. First, it provides new estimates of orders of magnitudes for the role of trade in the globalisation and environment debate. Second, it computes reliable and disaggregated elasticities for the effect of density on labour productivity in European regions. Third, it allows us, in a geometrically rigorous way, to track the path of the world's economic center of gravity.

Decision-making in pediatrics: a practical algorithm to evaluate complementary and alternative medicine for children.

We herein present a preliminary practical algorithm for evaluating complementary and alternative medicine (CAM) for children which relies on basic bioethical principles and considers the influence of CAM on global child healthcare. CAM is currently involved in almost all sectors of pediatric care and frequently represents a challenge to the pediatrician. The aim of this article is to provide a decision-making tool to assist the physician, especially as it remains difficult to keep up-to-date with the latest developments in the field. The reasonable application of our algorithm together with common sense should enable the pediatrician to decide whether pediatric (P)-CAM represents potential harm to the patient, and allow ethically sound counseling. In conclusion, we propose a pragmatic algorithm designed to evaluate P-CAM, briefly explain the underlying rationale and give a concrete clinical example.

Revisiting the S-index for soil physical quality and its use in Brazil

The S-index was introduced in 2004 in a publication by A.R. Dexter. S was proposed as an indicator of soil physical quality. A critical value delimiting soils with rich and poor physical quality was proposed. At present, Brazil is world leader in citations of Dexter's publication. In this publication the S-theory is mathematically revisited and extended. It is shown that S is mathematically correlated to bulk density and total porosity. As an absolute indicator, the value of S alone has proven to be incapable of predicting soil physical quality. The critical value does not always hold under boundary conditions described in the literature. This is to be expected because S is a static parameter, therefore implicitly unable to describe dynamic processes. As a relative indicator of soil physical quality, the S-index has no additional value over bulk density or total porosity. Therefore, in the opinion of the author, the fact that bulk density or total porosity are much more easily determined than the water retention curve for obtaining S disqualifies S as an advantageous indicator of relative soil physical quality. Among the several equations available for the fitting of water retention curves, the Groenevelt-Grant equation is preferable for use with S since one of its parameters and S are linearly correlated. Since efforts in soil physics research have the purpose of describing dynamic processes, it is the author's opinion that these efforts should shift towards mechanistic soil physics as opposed to the search for empirical correlations like S which, at present, represents far more than its reasonable share of soil physics in Brazil.