Secondary Aural Symptoms in Relation to Cranio-Cervical and General Disorders

The present thesis comprises two study populations. The first study sample (SS1) consisted of 411 adults examined and interviewed at three annual visits. The second study sample (SS2) consisted of 1720 adults who filled in a mailed questionnaire about secondary otalgia, tinnitus and fullness of ears. In the second phase of the SS2, 100 subjects with otalgia were examined and interviewed by specialist in stomatognathic physiology and otorhinolaryngology. In the third phase, 36 subjects participated in a randomized, controlled and blinded trial of effectiveness of occlusal appliance on secondary otalgia, facial pain, headache and treatment need of temporomandibular disorders (TMD). The standardized prevalence of recurrent secondary otalgia was 6%, tinnitus 15% and fullness of ears 8%. Aural symptoms were more frequent among young than old subjects. They were associated with other, simultaneous aural symptoms, TMD pain, head and neck region pain, and visits to a physician. The subjects with aural symptoms more often had tenderness on palpation of masticatory muscles and clinical signs of temporomandibular joint than the subjects without. 85% of the subjects reporting secondary otalgia had cervical spine or temporomandibular disorder or both. In SS1, the final model of secondary otalgia included active need treatment for TMD, elevated level of stress symptoms, and bruxism. In SS2, the final models of aural symptoms included associated aural symptoms, young age, TMD pain, headache and shoulder ache. Stabilization splint more effectively alleviated secondary otalgia and active treatment need for TMD than a palatal control splint. In patients with aural pain, tinnitus or fullness of ears, it is important to first rule out otologic and nasopharyngeal diseases that may cause the symptoms. If no explanation for aural symptoms is found, temporomandibular and cervical spine disorders should be rouled out to minimize unnecessary visits to a physician.

Globalization, Divergence and Stagnation

In a world where poor countries provide weak protection for intellectual property rights, market integration shifts technical change in favor of rich nations. Through this channel, free trade may amplify international income differences. At the same time, integration with countries where intellectual property rights are weakly protected can slow down the world growth rate. A crucial implication of these results is that protection of intellectual property is most beneficial in open countries. This prediction, which is novel in the literature, finds support in the data on a panel of 53 countries observed in the years 1965-1990.

Tailored thoracomyoplasty as a valid treatment option for chronic post-lobectomy empyema

Background: Chronic post-lobectomy empyema is rare but may require space obliteration for infection control. We report our experience by using a tailored thoracomyoplasty for this specific indication with respect to infection control and functional outcome. Patients and Methods: We retrospectively analysed 17 patients (11 men, 6 women) with chronic post-lobectomy empyema and treated by thoracomyoplasty in our institution between 2000 and 2011. All patients underwent an initial treatment attempt by use of chest tube drainage and antibiotics except those with suspicion of pleural aspergillosis (n=6). In 5 patients, bronchus stump insufficiency was identified at preoperative bronchoscopy. A tailored thoracoplasty was combined with a serratus anterior - rhomboid myoplasty which also served to close a broncho-pleural fistula, if present. The first rib was resected in 11/17 patients. Results: The 90-day mortality was 11.7%. Thoracomyoplasty was successful in all surviving patients with respect to infection control, space obliteration and definitive closure of broncho-pleural fistula, irrespective of the type of infection, the presence of a broncho-pleural fistula and whether a 1st rib resection was performed . Post-lobectomy pulmonary function testing before and after thoracoplasty revealed a mean predicted FEV1 of 63.0±8.5% and 51.5±4.2% (p=0.01), and a mean predicted DLCO of 59.8±11.6% and 54.5±12.5%, respectively. Postoperative shoulder girdle dysfunction and scoliosis were prevented in patients willing to undergo intense physiotherapy. Conclusions: Tailored thoracomyoplasty represents a valid option for patients with chronic post-lobectomy empyema without requiring a preceding open window thoracostomy. Space obliteration and infection control was equally obtained with and without first rib resection.

CT arthrography of the glenohumeral joint: CT fluoroscopy versus conventional CT and fluoroscopy--comparison of image-guidance techniques.

PURPOSE: To compare examination time with radiologist time and to measure radiation dose of computed tomographic (CT) fluoroscopy, conventional CT, and conventional fluoroscopy as guiding modalities for shoulder CT arthrography. MATERIALS AND METHODS: Glenohumeral injection of contrast material for CT arthrography was performed in 64 consecutive patients (mean age, 32 years; age range, 16-74 years) and was guided with CT fluoroscopy (n = 28), conventional CT (n = 14), or conventional fluoroscopy (n = 22). Room times (arthrography, room change, CT, and total examination times) and radiologist times (time the radiologist spent in the fluoroscopy or CT room) were measured. One-way analysis of variance and Bonferroni-Dunn posthoc tests were performed for comparison of mean times. Mean effective radiation dose was calculated for each method with examination data, phantom measurements, and standard software. RESULTS: Mean total examination time was 28.0 minutes for CT fluoroscopy, 28.6 minutes for conventional CT, and 29.4 minutes for conventional fluoroscopy; mean radiologist time was 9.9 minutes, 10.5 minutes, and 9.0 minutes, respectively. These differences were not statistically significant. Mean effective radiation dose was 0.0015 mSv for conventional fluoroscopy (mean, nine sections), 0.22 mSv for CT fluoroscopy (120 kV; 50 mA; mean, 15 sections), and 0.96 mSv for conventional CT (140 kV; 240 mA; mean, six sections). Effective radiation dose can be reduced to 0.18 mSv for conventional CT by changing imaging parameters to 120 kV and 100 mA. Mean effective radiation dose of the diagnostic CT arthrographic examination (140 kV; 240 mA; mean, 25 sections) was 2.4 mSv. CONCLUSION: CT fluoroscopy and conventional CT are valuable alternative modalities for glenohumeral CT arthrography, as examination and radiologist times are not significantly different. CT guidance requires a greater radiation dose than does conventional fluoroscopy, but with adequate parameters CT guidance constitutes approximately 8% of the radiation dose.

Measurements of three-dimensional glenoid erosion when planning the prosthetic replacement of osteoarthritic shoulders.

The three-dimensional (3D) correction of glenoid erosion is critical to the long-term success of total shoulder replacement (TSR). In order to characterise the 3D morphology of eroded glenoid surfaces, we looked for a set of morphological parameters useful for TSR planning. We defined a scapular coordinates system based on non-eroded bony landmarks. The maximum glenoid version was measured and specified in 3D by its orientation angle. Medialisation was considered relative to the spino-glenoid notch. We analysed regular CT scans of 19 normal (N) and 86 osteoarthritic (OA) scapulae. When the maximum version of OA shoulders was higher than 10°, the orientation was not only posterior, but extended in postero-superior (35%), postero-inferior (6%) and anterior sectors (4%). The medialisation of the glenoid was higher in OA than normal shoulders. The orientation angle of maximum version appeared as a critical parameter to specify the glenoid shape in 3D. It will be very useful in planning the best position for the glenoid in TSR.

An easy functional capacity evaluation in chronic low back pain

Lifting is said to be on of the major risk factors for the onset of low back pain, several different measures has been developed to study this. Several programs are available in order to measure these components, or to determine the ability of an individual to perform a certain job or to discover if the job creates dangerous positions for the worker. In these different fields reliable and valid instruments exist but they are costly and time spending. We present a simplified functional capacity measuring that we use daily in practise. Method: 280 patients have been evaluated on this base. The majority was referred to multidisciplinary rehabilitation treatment. The patients had recurrent back problems for months or years. Inclusion criteria were between 18 and 64 years, currently of work, no work compensation. Exclusion criteria were chronic low back pain with a specific cause. They followed a one-hour evaluation test as a functional capacity evaluation at the end of the multidisciplinary treatment period, it was compared to the PILE-test done at the beginning and at the end. Results: We included 280 subjects: 160 men and 120 women. Mean age 43.6 by the women and 44 years by the men. We studied the caring foot-hip, hip-shoulder, 5 m carrying, pushing and tiring and the global weight carried during the test. We found this global value to be 696 kg by men and 422 kg by women suffering from chronic lumbar pain. The increase in this value had a clear incidence on a greater work ability, as had a decrease. Conclusions: We were able to develop a lifting capacity program that is easy to reproduce and not expensive, giving us the possibility to have an idea on how to reorient the patients according to their work place and their capacities. We could also have an information of work performance and power consumption. It should be more tested and compared to standard capacity in the healthy population.

Adjustment to Target Capital, Finance, and Growth

Does financial development result in capital being reallocated more rapidly to industries where it is most productive? We argue that if this was the case, financially developed countries should see faster growth in industries with investment opportunities due to global demand and productivity shifts. Testing this cross-industry cross-country growth implication requires proxies for (latent) global industry investment opportunities. We show that tests relying only on data from specific (benchmark) countries may yield spurious evidence for or against the hypothesis. We therefore develop an alternative approach that combines benchmark-country proxies with a proxy that does not reflect opportunities specific to a country or level of financial development. Our empirical results yield clear support for the capital reallocation hypothesis.

Auditory motion affects visual biological motion processing.

The processing of biological motion is a critical, everyday task performed with remarkable efficiency by human sensory systems. Interest in this ability has focused to a large extent on biological motion processing in the visual modality (see, for example, Cutting, J. E., Moore, C., & Morrison, R. (1988). Masking the motions of human gait. Perception and Psychophysics, 44(4), 339-347). In naturalistic settings, however, it is often the case that biological motion is defined by input to more than one sensory modality. For this reason, here in a series of experiments we investigate behavioural correlates of multisensory, in particular audiovisual, integration in the processing of biological motion cues. More specifically, using a new psychophysical paradigm we investigate the effect of suprathreshold auditory motion on perceptions of visually defined biological motion. Unlike data from previous studies investigating audiovisual integration in linear motion processing [Meyer, G. F. & Wuerger, S. M. (2001). Cross-modal integration of auditory and visual motion signals. Neuroreport, 12(11), 2557-2560; Wuerger, S. M., Hofbauer, M., & Meyer, G. F. (2003). The integration of auditory and motion signals at threshold. Perception and Psychophysics, 65(8), 1188-1196; Alais, D. & Burr, D. (2004). No direction-specific bimodal facilitation for audiovisual motion detection. Cognitive Brain Research, 19, 185-194], we report the existence of direction-selective effects: relative to control (stationary) auditory conditions, auditory motion in the same direction as the visually defined biological motion target increased its detectability, whereas auditory motion in the opposite direction had the inverse effect. Our data suggest these effects do not arise through general shifts in visuo-spatial attention, but instead are a consequence of motion-sensitive, direction-tuned integration mechanisms that are, if not unique to biological visual motion, at least not common to all types of visual motion. Based on these data and evidence from neurophysiological and neuroimaging studies we discuss the neural mechanisms likely to underlie this effect.

A pedicled bone graft from the acromion: an anatomical investigation regarding surgical feasibility.

OBJECTIVE: To investigate the technical feasibility of harvesting a vascularized bone graft from the acromion pedicled on the acromial branch. BACKGROUND: Complex fractures of the proximal humerus may result in partial or total avascular necrosis of the head fragment. Treatment of avascular necrosis of the humeral head is dependent upon the stage of disease as well as the dimension and location of necrosis. In general, the outcome is poor and complete restoration of the shoulder function is rarely attained. Contrary to osteonecrosis of carpal bones (where vascularized bone grafts have been routinely carried out for decades), reports of analogous procedures at the humeral head are anecdotal. METHODS: Based on selective post-mortem computer-tomographic angiography of 5 and the dissection of 30 embalmed human cadaver shoulders, we describe the anatomy of the acromial branch of the thoracoacromial trunk. The main focus was the constancy of its anatomical course, its dimensions and potential use as a nutrient vessel for a pedicled bone graft from the acromion. RESULTS: The course of the acromial branch revealed a constant topographic relationship to anatomical landmarks. Its terminal branches reliably supplied the anterior part of the acromion. The vascularized bone graft could be sufficiently mobilized to allow tension-free transfer to the humeral head as well as to the lateral two-thirds of the clavicle. CONCLUSION: We demonstrated the feasibility of vascularized bone graft harvesting from the acromion. This technique could be a joint-preserving procedure for osteonecrosis of the humeral head or may assist in the revision of a clavicular pseudoarthrosis.

Changing Diets in China’s Cities: Empirical Fact or Urban Legend, November 2006

China’s economic reforms, which began in 1978, resulted in remarkable income growth, and urban Chinese consumers have responded by dramatically increasing their consumption of meat, other livestock products, and fruits and by decreasing consumption of grain-based foods. Economic prosperity, a growing openness to international markets, and domestic policy reforms have changed the food marketing environment for Chinese consumers and may have contributed to shifts in consumer preferences. The objective of this paper is to uncover evidence of structural change in food consumption among urban residents in China. Both parametric and nonparametric methods are used to test for structural change in aggregate household data from 1981 to 2004. The tests provided a reasonably clear picture of changing food consumption over the study period.

Molecular basis for changes in behavioral state in ant social behaviors.

A hallmark of behavior is that animals respond to environmental change by switching from one behavioral state to another. However, information on the molecular underpinnings of these behavioral shifts and how they are mediated by the environment is lacking. The ant Pheidole pallidula with its morphologically and behaviorally distinct major and minor workers is an ideal system to investigate behavioral shifts. The physically larger majors are predisposed to defend the ant nest, whereas the smaller minors are the foragers. Despite this predisposition, majors are able to shift to foraging according to the needs of the colony. We show that the ant foraging (ppfor) gene, which encodes a cGMP-dependent protein kinase (PKG), mediates this shift. Majors have higher brain PKG activities than minors, and the spatial distribution of the PPFOR protein differs in these workers. Specifically, majors express the PPFOR protein in 5 cells in the anterior face of the ant brain, whereas minors do not. Environmental manipulations show that PKG is lower in the presence of a foraging stimulus and higher when defense is required. Finally, pharmacological activation of PKG increases defense and reduces foraging behavior. Thus, PKG signaling plays a critical role in P. pallidula behavioral shifts.

Evaluation of Virtual Reality Snowplow Simulator Training: A Literature Review, September 2006

Each winter, the Iowa Department of Transportation (Iowa DOT) maintenance operators are primarily responsible for plowing snow off federal and state roads. Drivers typically work long shifts under treacherous conditions. In addition to properly navigating the vehicle, drivers are required to operate several plowing mechanisms simultaneously, such as plow controls and salt sprayers. However, operators have few opportunities during the year to practice and refine their skills. An ideal training program would provide operators with the opportunity to practice these skills under realistic yet safe conditions, as well as provide basic training to novice or less-experienced operators. Recent technological advancements have made driving simulators a desirable training and research tool. This literature review discusses much of the recent research establishing simulator fidelity and espousing its applicability. Additionally, this report provides a summary of behavioral and eye tracking research involving driving simulators. Other research topics include comparisons between novice and expert drivers’ behavioral patterns, methods for avoiding cybersickness in virtual environments, and a synopsis of current personality measures with respect to job performance and driving performance. This literature review coincides with a study designed to examine the effectiveness of virtual reality snowplow simulator training for current maintenance operators, using the TranSim VS III truck and snowplow simulator recently purchased by the Iowa DOT.

Quand faut-il opérer une fracture diaphysaire de l'humérus [When to operate humeral shaft fractures?].

Most humeral shaft fractures are amenable to nonoperative treatment. According to shoulder and elbow functions, humeral shaft malunions are well tolerated with deformities up to 30 degrees of varus, 20 degrees of anterior bowing and 15 degrees of internal rotation. Limitations to nonoperative treatment do exist. Open fractures with extensive soft-tissue lesions, penetrating open fractures with neurological or vascular impairment are best managed with immediate stabilization. However the appropriate treatment strategy has to be adapted for each patient. Patient expectations, fracture propensity for nonunion, ability to tolerate nonoperative treatment for medical or social reasons should be taken into consideration for operative indication.

In the context of a daycare center: nursing and their representations of child care as an educational act

This study aimed to analyze the social representations in the professionals of technical staff, who work with children at USP daycare centers. Eight professionals of the nursing field underwent a semi-structured interview. The interviews were recorded and transcribed in their entirety and the content of the discourse was subjected to thematic-categorical analysis. The categories were transformed into variables and processed by the software Classification Hiérarchique Classificatoire et Cohésitive (CHIC®) and analyzed by the hierarchical similarity tree. The results indicate that actions to promote health are reported as educational and transformative, in which health care gains new meaning through contextualized conceptions in the field of child education. We conclude that professionals attribute new meanings to their practices in the health care environment of daycare centers as their representations shifts from the logic of the biomedical field to a logic of educational care. In this sense, they perceive themselves as being challenged to establish an interaction with the children in terms of their activities related to the promotion of health and in an educational act.

The Alps Vegetation Database - a geo-referenced community-level archive of all terrestrial plants occurring in the Alps.

Mountain ranges are biodiversity hotspots worldwide and provide refuge to many organisms under contemporary climate change. Gathering field information on mountain biodiversity over time is of primary importance to understand the response of biotic communities to climate changes. For plants, several long-term observation sites and networks of mountain biodiversity are emerging worldwide to gather field data and monitor altitudinal range shifts and community composition changes under contemporary climate change. Most of these monitoring sites, however, focus on alpine ecosystems and mountain summits, such as the global observation research initiative in alpine environments (GLORIA). Here we describe the Alps Vegetation Database, a comprehensive community level archive (GIVD ID EU-00-014) which aims at compiling all available geo-referenced vegetation plots from lowland forests to alpine grasslands across the greatest mountain range in Europe: the Alps. This research initiative was funded between 2008 and 2011 by the Danish Council for Independent Research and was part of a larger project to compare cross-scale plant community structure between the Alps and the Scandes. The Alps Vegetation Database currently harbours 35,731 geo-referenced vegetation plots and 5,023 valid taxa across Mediterranean, temperate and alpine environments. The data are mainly used by the main contributors of the Alps Vegetation Database in an ecoinformatics approach to test hypotheses related to plant macroecology and biogeography, but external proposals for joint collaborations are welcome.