The importance of sonographer experience and machine quality with regards to the role of musculoskeletal ultrasound in routine care of rheumatoid arthritis patients.

OBJECTIVES: Regarding recent progress, musculoskeletal ultrasound (US) will probably soon be integrated in standard care of patient with rheumatoid arthritis (RA). However, in daily care, quality of US machines and level of experience of sonographers are varied. We conducted a study to assess reproducibility and feasibility of an US scoring for RA, including US devices of different quality and rheumatologist with various levels of expertise in US as it would be in daily care. METHODS: The Swiss Sonography in Arthritis and Rheumatism (SONAR) group has developed a semi-quantitative score using OMERACT criteria for synovitis and erosion in RA. The score was taught to 108 rheumatologists trained in US. One year after the last workshop, 19 rheumatologists participated in the study. Scans were performed on 6 US machines ranging from low to high quality, each with a different patient. Weighted kappa was calculated for each pair of readers. RESULTS: Overall, the agreement was fair to moderate. Quality of device, experience of the sonographers and practice of the score before the study improved substantially the agreement. Agreement assessed on higher quality machine, among sonographers with good experience in US increased to substantial (median kappa for B-mode and Doppler: 0.64 and 0.41 for erosion). CONCLUSIONS: This study demonstrated feasibility and reproducibility of the Swiss US SONAR score for RA. Our results confirmed importance of the quality of US machine and the training of sonographers for the implementation of US scoring in the routine daily care of RA.

Medical physicists' implication in radiological diagnostic procedures: results after 1 y of experience.

Since January 2008-de facto 2012-medical physics experts (MPEs) are, by law, to be involved in the optimisation process of radiological diagnostic procedures in Switzerland. Computed tomography, fluoroscopy and nuclear medicine imaging units have been assessed for patient exposure and image quality. Large spreads in clinical practice have been observed. For example, the number of scans per abdominal CT examination went from 1 to 9. Fluoroscopy units showed, for the same device settings, dose rate variations up to a factor of 3 to 7. Quantitative image quality for positron emission tomography (PET)/CT examinations varied significantly depending on the local image reconstruction algorithms. Future work will be focused on promoting team cooperation between MPEs, radiologists and radiographers and on implementing task-oriented objective image quality indicators.

Internationalization of Experience Pro concept

Diplomityö on tehty STTF:lle (Software Technology Transfer Finland), joka pyrkii kansainvälisille markkinoille Experience Pro -tuotekonseptillaan. Kansainvälistyminen on haasteellinen prosessi pk-yritykselle, ja haastetta haluttiin lähestyä strategisella suunnittelulla. Työn tavoitteena oli teoriatiedon ja löydettyjen kansainvälistymisesimerkkien avulla tuottaa STTF:lle kansainvälistymissuunnitelma strategiaan pohjautuen.Kaksi merkittävintä strategista valintaa STTF:n kansainvälistymisessä olivat kohdemaiden ja operaatiomuodon valinnat. Päätökset tehtiin strategisten analyysien perusteella. Analyysien avulla määritettiin myös yrityksen kilpailuedut. Löydettyjä vahvuuksia pyrittiin hyödyntämään myöhemmin kansainvälistymisen osastrategioita rakennettaessa. Tavoitteiden asettaminen ja markkinointi-mix:n kehittäminen olivat keskeisimmät osat markkinoinnin osastrategiassa. Jakelukanavan merkitystä korostettiin STTF:n kansainvälistymisessä ja yhteistyölle pyrittiin luomaan hyvät edellytykset. Strategia konkretisoitiin luomalla operatiiviset suunnitelmat markkinoinnin tukimateriaalien tuottamiseksi ja yhteistyökumppanien etsimiseksi. Markkinatutkimuksen perusteella potentiaaliset kohdemaat Experience Pro -konseptille olivat Australia, Hollanti, Irlanti, Iso-Britannia, Norja, Ruotsi, Saksa ja Tanska. STTF:llä on muutama sopiva vaihtoehtoinen operaatiomuoto valittavanaan riippuen kohdemaasta. Suomen maine vakaana, korkean teknologian maana voidaan nähdä maaetuna STTF:lle ja muita vahvuuksia ovat STTF:n teknologinen osaaminen, tuotteeseen liittyvät palvelut ja henkilökohtaiset kontaktit. SWOT-analyysi paljasti STTF:n heikkouksia voitettaviksi.Tulevaisuudessa STTF voi jatkaa kansainvälistymistään suunnitelman mukaisesti. Tavoitteiden saavuttaminen vaatii sitoutumista, aktiivista yhteistyökumppanien etsimistä ja jatkuvaa prosessien kehittämistä vastaamaan kansainvälisten markkinoiden vaatimuksia.

Longitudinal study of informed consent in innovative therapy research: experience and provisional recommendations from a multicenter trial of intracerebral grafting.

BACKGROUND: There is an urgent need to assess and improve the consent process in clinical trials of innovative therapies for neurodegenerative disorders. METHODS: We performed a longitudinal study of the consent of Huntington's disease patients during the Multicenter Fetal Cell Intracerebral Grafting Trial in Huntington's Disease (MIG-HD) in France and Belgium. Patients and their proxies completed a consent questionnaire at inclusion, before signing the consent form and after one year of follow-up, before randomization and transplantation. The questionnaire explored understanding of the protocol, satisfaction with the information delivered, reasons for participating in the trial and expectations regarding the transplant. Forty-six Huntington's disease patients and 27 proxies completed the questionnaire at inclusion, and 27 Huntington's disease patients and 16 proxies one year later. RESULTS: The comprehension score was high and similar for Huntington's disease patients and proxies at inclusion (72.6% vs 77.8%; P > 0.1) but only decreased in HD patients after one year. The information satisfaction score was high (73.5% vs 66.5%; P > 0.1) and correlated with understanding in both patients and proxies. The motivation and expectation profiles were similar in patients and proxies and remained unchanged after one year. CONCLUSIONS: Cognitively impaired patients with Huntington's disease were capable of consenting to participation in this trial. This consent procedure has presumably strengthened their understanding and should be proposed before signing the consent form in future gene or cell therapy trials for neurodegenerative disorders. Because of the potential cognitive decline, proxies should be designated as provisional surrogate decision-makers, even in competent patients.

Research networks and scientific production in Economics: the recent Spanish experience

This paper studies Spanish scientific production in Economics from 1994 to 2004. It focuses on aspects that have received little attention in other bibliometric studies, such as the impact of research and the role of scientific collaborations in the publications produced by Spanish universities. Our results show that national research networks have played a fundamental role in the increase in Spanish scientific production in this discipline.

Partial cricotracheal resection for paediatric subglottic stenosis: update of the Lausanne experience with 129 cases.

OBJECTIVES: Partial cricotracheal resection (PCTR) is widely accepted for treating severe paediatric laryngotracheal stenosis (LTS). However, it remains limited to a few experienced centres. Here we report an update of the Lausanne experience in paediatric PCTR performed or supervised by a senior surgeon (Philippe Monnier). METHODS: An ongoing database of 129 paediatric patients who underwent PCTR for benign LTS between March 1978 and July 2012 at our hospital was retrospectively reviewed. Demographic characteristics and information on preoperative status, stenosis and surgery were collected. Primary outcomes were measured as overall and operation-specific decannulation rates (ODR and OSDR, respectively), and secondary outcomes as morbidity, mortality and postoperative functional results. RESULTS: A total of 129 paediatric patients [79 males and 50 females; mean age, 4.1 years (1 month-16 years, median age of 2 years old)] underwent PCTR during the study period. ODR and OSDR were 90 and 81%, respectively. The decannulation rates were significantly superior for single-stage PCTR compared with double-stage PCTR in both ODR and OSDR. Eight patients died postoperatively for reasons unrelated to surgery. Partial anastomotic dehiscence was seen in 13 patients, 9 of whom were successfully treated by revision surgery. Respiratory, voice and swallowing functions were near normal or only minimally impaired in 86, 65 and 81% of patients, respectively. CONCLUSIONS: PCTR is effective and feasible with good ODR and OSDR for highgrade / severe LTS. Glottic involvement and the presence of comorbidities were negative predictive factors of decannulation. Early detection and reintervention of postoperative incipient dehiscence contribute to avoiding the progress to late restenosis; however, voice improvement remains a challenge.

Evaluation of the indication for surgical extraction of third molars according to the oral surgeon and the primary care dentist. Experience in the Master of Oral Surgery and Implantology at Barcelona University Dental School

Introduction: Third molar extraction is the most frequent procedure in oral surgery. The present study evaluates the indication of third molar extraction as established by the primary care dentist (PCD) and the oral surgeon, and compares the justification for extraction with the principal reason for patient consultation. Patients and method: A descriptive study was made of 319 patients subjected to surgical removal of a third molar in the context of the Master of Oral Surgery and Implantology (Barcelona University Dental School, Barcelona, Spain) between July 2004 and March 2005. The following parameters were evaluated: sex, age, molar, type of impaction, position according to the classifications of Pell and Gregory and of Winter, and the reasons justifying extraction. Results: The lower third molars were the most commonly extracted molars (73.7%). A total of 69.6% of the teeth were covered by soft tissues only. Fifty-six percent of the lower molars corresponded to Pell and Gregory Class IIB, while 42.1% were in the vertical position. The most common reason for patient reference to our Service of Oral Surgery on the part of the PCD was prophylactic removal (51.0% versus 46.1% in the case of the oral surgeon). Discussion and conclusions. Our results show prophylaxis to be the principal indication of third molar extraction, followed by orthodontic reasons. Regarding third molars with associated clinical symptoms or signs, infectious disease-including pericoronitis- was the pathology most often observed by the oral surgeon, followed by caries. This order of frequency was seen to invert in the case of third molars referred for extraction by the PCD. A vertical position predominated among the third molars with associated pathology

L'exploitation des peintures en spray en criminalistique: mise en place d'une procédure de gestion et de comparaison des spectres infrarouges à l'aide des statistiques multivariées

La spectroscopie infrarouge (FTIR) est une technique de choix dans l'analyse des peintures en spray (traces ou bonbonnes de référence), grâce à son fort pouvoir discriminant, sa sensibilité, et ses nombreuses possibilités d'échantillonnage. La comparaison des spectres obtenus est aujourd'hui principalement faite visuellement, mais cette procédure présente des limitations telles que la subjectivité de la prise de décision car celle-ci dépend de l'expérience et de la formation suivie par l'expert. De ce fait, de faibles différences d'intensités relatives entre deux pics peuvent être perçues différemment par des experts, même au sein d'un même laboratoire. Lorsqu'il s'agit de justifier ces différences, certains les expliqueront par la méthode analytique utilisée, alors que d'autres estimeront plutôt qu'il s'agit d'une variabilité intrinsèque à la peinture et/ou à son vécu (par exemple homogénéité, sprayage, ou dégradation). Ce travail propose d'étudier statistiquement les différentes sources de variabilité observables dans les spectres infrarouges, de les identifier, de les comprendre et tenter de les minimiser. Le deuxième objectif principal est de proposer une procédure de comparaison des spectres qui soit davantage transparente et permette d'obtenir des réponses reproductibles indépendamment des experts interrogés. La première partie du travail traite de l'optimisation de la mesure infrarouge et des principaux paramètres analytiques. Les conditions nécessaires afin d'obtenir des spectres reproductibles et minimisant la variation au sein d'un même échantillon (intra-variabilité) sont présentées. Par la suite une procédure de correction des spectres est proposée au moyen de prétraitements et de sélections de variables, afin de minimiser les erreurs systématiques et aléatoires restantes, et de maximiser l'information chimique pertinente. La seconde partie présente une étude de marché effectuée sur 74 bonbonnes de peintures en spray représentatives du marché suisse. Les capacités de discrimination de la méthode FTIR au niveau de la marque et du modèle sont évaluées au moyen d'une procédure visuelle, et comparées à diverses procédures statistiques. Les limites inférieures de discrimination sont testées sur des peintures de marques et modèles identiques mais provenant de différents lots de production. Les résultats ont montré que la composition en pigments était particulièrement discriminante, à cause des étapes de corrections et d'ajustement de la couleur subies lors de la production. Les particularités associées aux peintures en spray présentes sous forme de traces (graffitis, gouttelettes) ont également été testées. Trois éléments sont mis en évidence et leur influence sur le spectre infrarouge résultant testée : 1) le temps minimum de secouage nécessaire afin d'obtenir une homogénéité suffisante de la peinture et, en conséquence, de la surface peinte, 2) la dégradation initiée par le rayonnement ultra- violet en extérieur, et 3) la contamination provenant du support lors du prélèvement. Finalement une étude de population a été réalisée sur 35 graffitis de la région lausannoise et les résultats comparés à l'étude de marché des bonbonnes en spray. La dernière partie de ce travail s'est concentrée sur l'étape de prise de décision lors de la comparaison de spectres deux-à-deux, en essayant premièrement de comprendre la pratique actuelle au sein des laboratoires au moyen d'un questionnaire, puis de proposer une méthode statistique de comparaison permettant d'améliorer l'objectivité et la transparence lors de la prise de décision. Une méthode de comparaison basée sur la corrélation entre les spectres est proposée, et ensuite combinée à une évaluation Bayesienne de l'élément de preuve au niveau de la source et au niveau de l'activité. Finalement des exemples pratiques sont présentés et la méthodologie est discutée afin de définir le rôle précis de l'expert et des statistiques dans la procédure globale d'analyse des peintures. -- Infrared spectroscopy (FTIR) is a technique of choice for analyzing spray paint speciments (i.e. traces) and reference samples (i.e. cans seized from suspects) due to its high discriminating power, sensitivity and sampling possibilities. The comparison of the spectra is currently carried out visually, but this procedure has limitations such as the subjectivity in the decision due to its dependency on the experience and training of the expert. This implies that small differences in the relative intensity of two peaks can be perceived differently by experts, even between analysts working in the same laboratory. When it comes to justifying these differences, some will explain them by the analytical technique, while others will estimate that the observed differences are mostly due to an intrinsic variability from the paint sample and/or its acquired characteristics (for example homogeneity, spraying, or degradation). This work proposes to statistically study the different sources of variability observed in infrared spectra, to identify them, understand them and try to minimize them. The second goal is to propose a procedure for spectra comparison that is more transparent, and allows obtaining reproducible answers being independent from the expert. The first part of the manuscript focuses on the optimization of infrared measurement and on the main analytical parameters. The necessary conditions to obtain reproducible spectra with a minimized variation within a sample (intra-variability) are presented. Following that a procedure of spectral correction is then proposed using pretreatments and variable selection methods, in order to minimize systematic and random errors, and increase simultaneously relevant chemical information. The second part presents a market study of 74 spray paints representative of the Swiss market. The discrimination capabilities of FTIR at the brand and model level are evaluated by means of visual and statistical procedures. The inferior limits of discrimination are tested on paints coming from the same brand and model, but from different production batches. The results showed that the pigment composition was particularly discriminatory, because of the corrections and adjustments made to the paint color during its manufacturing process. The features associated with spray paint traces (graffitis, droplets) were also tested. Three elements were identified and their influence on the resulting infrared spectra were tested: 1) the minimum shaking time necessary to obtain a sufficient homogeneity of the paint and subsequently of the painted surface, 2) the degradation initiated by ultraviolet radiation in an exterior environment, and 3) the contamination from the support when paint is recovered. Finally a population study was performed on 35 graffitis coming from the city of Lausanne and surroundings areas, and the results were compared to the previous market study of spray cans. The last part concentrated on the decision process during the pairwise comparison of spectra. First, an understanding of the actual practice among laboratories was initiated by submitting a questionnaire. Then, a proposition for a statistical method of comparison was advanced to improve the objectivity and transparency during the decision process. A method of comparison based on the correlation between spectra is proposed, followed by the integration into a Bayesian framework at both source and activity levels. Finally, some case examples are presented and the recommended methodology is discussed in order to define the role of the expert as well as the contribution of the tested statistical approach within a global analytical sequence for paint examinations.