Diagnostic algorithm for a validated displacement grading of pediatric supracondylar fractures.

Background: The first AO comprehensive pediatric long bone fracture classification system has been established following a structured path of development and validation with experienced pediatric surgeons. Methods: A follow-up series of agreement studies was applied to specify and evaluate a grading system for displacement of pediatric supracondylar fractures. An iterative process comprising an international group of 5 experienced pediatric surgeons (Phase 1) followed by a pragmatic multicenter agreement study involving 26 raters (Phase 2) was used. The last evaluations were conducted on a consecutive collection of 154 supracondylar fractures documented by standard anteroposterior and lateral radiographs. Results: Fractures were classified according to 1 of 4 grades: I = incomplete fracture with no or minimal displacement; II = Incomplete fracture with continuity of the posterior (extension fracture) or anterior cortex (flexion fracture); III = lack of bone continuity (broken cortex), but still some contact between the fracture planes; IV = complete fracture with no bone continuity (broken cortex), and no contact between the fracture planes. A diagnostic algorithm to support the practical application of the grading system in a clinical setting, as well as an aid using a circle placed over the capitellum was proposed. The overall kappa coefficients were 0.68 and 0.61 in the Phase 1 and Phase 2 studies, respectively. In the Phase 1 study, fracture grades I, II, III, and IV were classified with median accuracies of 91%, 82%, 83%, and 99.5%, respectively. Similar median accuracies of 86% (Grade I), 73% (Grade II), 83%(Grade III), and 92% were reported for the Phase 2 study. Reliability was high in distinguishing complete, unstable fractures from stable injuries [ie, kappa coefficients of 0.84 (Phase 1) and 0.83 (Phase 2) were calculated]; in Phase 2, surgeons' accuracies in classifying complete fractures were all above 85%. Conclusions: With clear and unambiguous definition, this new grading system for supracondylar fracture displacement has proved to be sufficiently reliable and accurate when applied by pediatric surgeons in the framework of clinical routine as well as research.

CT radiation dose in children: a survey to establish age-based diagnostic reference levels in Switzerland

This work aimed at assessing the doses delivered in Switzerland to paediatric patients during computed tomography (CT) examinations of the brain, chest and abdomen, and at establishing diagnostic reference levels (DRLs) for various age groups. Forms were sent to the ten centres performing CT on children, addressing the demographics, the indication and the scanning parameters: number of series, kilovoltage, tube current, rotation time, reconstruction slice thickness and pitch, volume CT dose index (CTDI(vol)) and dose length product (DLP). Per age group, the proposed DRLs for brain, chest and abdomen are, respectively, in terms of CTDI(vol): 20, 30, 40, 60 mGy; 5, 8, 10, 12 mGy; 7, 9, 13, 16 mGy; and in terms of DLP: 270, 420, 560, 1,000 mGy cm; 110, 200, 220, 460 mGy cm; 130, 300, 380, 500 mGy cm. An optimisation process should be initiated to reduce the spread in dose recorded in this study. A major element of this process should be the use of DRLs.

Development of Bridge Load Testing Process for Load Evaluation, TR-445, 2003

Recent reports indicate that of the over 25,000 bridges in Iowa, slightly over 7,000 (29%) are either structurally deficient or functionally obsolete. While many of these bridges may be strengthened or rehabilitated, some simply need to be replaced. Before implementing one of these options, one should consider performing a diagnostic load test on the structure to more accurately assess its load carrying capacity. Frequently, diagnostic load tests reveal strength and serviceability characteristics that exceed the predicted codified parameters. Usually, codified parameters are very conservative in predicting lateral load distribution characteristics and the influence of other structural attributes. As a result, the predicted rating factors are typically conservative. In cases where theoretical calculations show a structural deficiency, it may be very beneficial to apply a "tool" that utilizes a more accurate theoretical model which incorporates field-test data. At a minimum, this approach results in more accurate load ratings and many times results in increased rating factors. Bridge Diagnostics, Inc. (BDI) developed hardware and software that are specially designed for performing bridge ratings based on data obtained from physical testing. To evaluate the BDI system, the research team performed diagnostic load tests on seven "typical" bridge structures: three steel-girder bridges with concrete decks, two concrete slab bridges, and two steel-girder bridges with timber decks. In addition, a steel-girder bridge with a concrete deck previously tested and modeled by BDI was investigated for model verification purposes. The tests were performed by attaching strain transducers on the bridges at critical locations to measure strains resulting from truck loading positioned at various locations on the bridge. The field test results were used to develop and validate analytical rating models. Based on the experimental and analytical results, it was determined that bridge tests could be conducted relatively easy, that accurate models could be generated with the BDI software, and that the load ratings, in general, were greater than the ratings, obtained using the codified LFD Method (according to AASHTO Standard Specifications for Highway Bridges).

"Pied de Charcot": un diagnostic à ne pas manquer [Charcot osteoarthropathy: don't miss it!].

Charcot neuropathic osteoarthropathy (CNO) is a destructive process affecting the bone and joint structure of diabetic patients and resulting from peripheral neuropathy. It is a limb threatening condition resulting in dramatic deformities associated with severe morbi-mortality. The diagnosis is mostly made by the observation of inflammatory signs and higlight the importance of prompt foot evaluation. Imaging studies may help confirm the diagnosis and the severity of the condition but lack of specificity. The goal of the treatment is to maintain or achieve structural stability of the foot and ankle to prevent further deformity and plantar dislocation. The scientific evidences aren't strong enough to recommend bisphosphonates or acute surgical treatment. Surgery is unanimusly recommended to prevent secondary ulceration.

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.

Tendinopathies du sportif: étiologie, diagnostic et traitement [Tendinitis in athletes: etiology, diagnosis and treatment].

Tendinopathy is one of the most common diagnosis in sports. Knowledges about their etiology, the repair process to their diagnosis and their treatment have improved thanks to the development of imaging, especially ultra- sound. The disorder whose etiology could be mechanical or degenerative can cause long- term disability and sometimes the end of the sport carreer. The risk of reccurence is com- mon; this may lead to tendon rupture whose functional effects can be significative. The management should be early: it must respect the deadlines for tendon healing and pro- pose a gradual recovery efforts after elimina tion of the contributing factors involved.

Accuracy Analysis of Frequency Converter Estimates in Diagnostic Applications

Transportation of fluids is one of the most common and energy intensive processes in the industrial and HVAC sectors. Pumping systems are frequently subject to engineering malpractice when dimensioned, which can lead to poor operational efficiency. Moreover, pump monitoring requires dedicated measuring equipment, which imply costly investments. Inefficient pump operation and improper maintenance can increase energy costs substantially and even lead to pump failure. A centrifugal pump is commonly driven by an induction motor. Driving the induction motor with a frequency converter can diminish energy consumption in pump drives and provide better control of a process. In addition, induction machine signals can also be estimated by modern frequency converters, dispensing with the use of sensors. If the estimates are accurate enough, a pump can be modelled and integrated into the frequency converter control scheme. This can open the possibility of joint motor and pump monitoring and diagnostics, thereby allowing the detection of reliability-reducing operating states that can lead to additional maintenance costs. The goal of this work is to study the accuracy of rotational speed, torque and shaft power estimates calculated by a frequency converter. Laboratory tests were performed in order to observe estimate behaviour in both steady-state and transient operation. An induction machine driven by a vector-controlled frequency converter, coupled with another induction machine acting as load was used in the tests. The estimated quantities were obtained through the frequency converter’s Trend Recorder software. A high-precision, HBM T12 torque-speed transducer was used to measure the actual values of the aforementioned variables. The effect of the flux optimization energy saving feature on the estimate quality was also studied. A processing function was developed in MATLAB for comparison of the obtained data. The obtained results confirm the suitability of this particular converter to provide accurate enough estimates for pumping applications.

Utilizing analytic modelling process in industrial retail context

Nykypäivän monimutkaisessa ja epävakaassa liiketoimintaympäristössä yritykset, jotka kykenevät muuttamaan tuottamansa operatiivisen datan tietovarastoiksi, voivat saavuttaa merkittävää kilpailuetua. Ennustavan analytiikan hyödyntäminen tulevien trendien ennakointiin mahdollistaa yritysten tunnistavan avaintekijöitä, joiden avulla he pystyvät erottumaan kilpailijoistaan. Ennustavan analytiikan hyödyntäminen osana päätöksentekoprosessia mahdollistaa ketterämmän, reaaliaikaisen päätöksenteon. Tämän diplomityön tarkoituksena on koota teoreettinen viitekehys analytiikan mallintamisesta liike-elämän loppukäyttäjän näkökulmasta ja hyödyntää tätä mallinnusprosessia diplomityön tapaustutkimuksen yritykseen. Teoreettista mallia hyödynnettiin asiakkuuksien mallintamisessa sekä tunnistamalla ennakoivia tekijöitä myynnin ennustamiseen. Työ suoritettiin suomalaiseen teollisten suodattimien tukkukauppaan, jolla on liiketoimintaa Suomessa, Venäjällä ja Balteissa. Tämä tutkimus on määrällinen tapaustutkimus, jossa tärkeimpänä tiedonkeruumenetelmänä käytettiin tapausyrityksen transaktiodataa. Data työhön saatiin yrityksen toiminnanohjausjärjestelmästä.

Perceptions de personnes atteintes de cancer quant au soutien offert par l'IPO dans la période entourant l'annonce du diagnostic

L’annonce d’un diagnostic de cancer devrait être considérée par les professionnels de la santé, comme un processus constitué de plusieurs étapes que doit traverser la personne atteinte, plutôt que comme un évènement en soi (Tobin & Begley, 2008). Lors de la période entourant l’annonce du diagnostic, la personne peut être confrontée à des difficultés reliées à la navigation dans un système de santé complexe, en plus des sentiments négatifs engendrés par la crainte de la maladie. Pour soutenir les personnes atteintes de cancer, le programme québécois de lutte contre le cancer (PQLCC), a instauré le rôle de l’infirmière pivot en oncologie (IPO) en 2000. À l’heure actuelle, peu d’études, à notre connaissance, se sont attardées au soutien de l’IPO dans cette période. La présente étude avait pour but, d’explorer les perceptions de personnes atteintes de cancer quant au soutien offert par l’IPO, dans la période entourant l’annonce du diagnostic. L’étudiante-chercheuse s’est inspirée du Cadre de soins de soutien de Fitch (1994) pour entreprendre cette étude qualitative descriptive. Des entrevues individuelles auprès de sept personnes atteintes de différents cancers ont été réalisées. L’analyse de données a été effectuée à l’aide de la méthode de Miles et Huberman (2003), par la transcription intégrale des entrevues. Elle a permis d’identifier trois thèmes soit : le soutien formel requis pour faire face au chaos, le soutien informationnel et émotionnel à parfaire et le soutien disponible apportant sécurité et assurance. Les résultats ont mis en évidence les perceptions de personnes atteintes de cancer quant au soutien offert par l’IPO soit la nécessité de rendre accessible les soins et services de l’IPO plus tôt dans la période entourant l’annonce du diagnostic. Les personnes atteintes de cancer ont besoin d’être aidées à faire face aux difficultés rencontrées lors de cette période, notamment à l’incertitude reliée aux résultats d’examens diagnostics, à l’incompréhension des informations reçues et aux sentiments négatifs engendrés par la menace de la maladie. Les résultats évoquent le souhait des participants, à l’effet que, l’offre de soutien de l’IPO, soit axée sur leurs besoins essentiellement dans les domaines informationnel et émotionnel. Ils auraient souhaité pouvoir, partager leur expérience avec l’IPO, mieux comprendre le diagnostic de cancer et savoir davantage à quoi s’attendre lors du début des traitements. Par ailleurs, savoir que le soutien de l’IPO est disponible apporte aux personnes atteintes de cancer une assurance et une confiance en leur capacité à faire face aux traitements et leur apporte un sentiment de sécurité.

A Diagnostic and Modeling Study on the Onset of Summer Monsoon over South Asia

This study focuses on the onset of southwest monsoon over Kerala. India Meteorological Department (IMD) has been using a semi-objective method to define monsoon onset. The main objectives of the study are to understand the monsoon onset processes, to simulate monsoon onset in a GCM using as input the atmospheric conditions and Sea Surface Temperature, 10 days earlier to the onset, to develop a method for medium range prediction of the date of onset of southwest monsoon over Kerala and to examine the possibility of objectively defining the date of Monsoon Onset over Kerala (MOK). It gives a broad description of regional monsoon systems and monsoon onsets over Asia and Australia. Asian monsoon includes two separate subsystems, Indain monsoon and East Asian monsoon. It is seen from this study that the duration of the different phases of the onset process are dependent on the period of ISO. Based on the study of the monsoon onset process, modeling studies can be done for better understanding of the ocean-atmosphere interaction especially those associated with the warm pool in the Bay of Bengal and the Arabian Sea.

Antibody Based Diagnostic for Detection Of Vibrios and their Biological Control using Antagonistic Bacteria in Macrobrachium Rosenbergii Larval Rearing Systems

The main objective of the work undertaken here was to develop an appropriate microbial technology to protect the larvae of M.rosenbergii in hatchery from vibriosis. This technology precisely is consisted of a rapid detection system of vibrios and effective antagonistic probiotics for the management of vibrios. The present work was undertaken with the realizations that to stabilize the production process of commercial hatcheries an appropriate, comprehensive and fool proof technology is required primarily for the rapid detection of Vibrio and subsequently for its management. Nine species of Vibrio have been found to be associated with larvae of M. rosenbergii in hatchery. Haemolytic assay of the Vibrio and Aeromonas on prawn blood agar showed that all isolates of V. alginolyticus and Aeromonas sp., from moribund, necrotized larve were haemolytic and the isolates of V.cholerae, V.splendidus II, V.proteolyticus and V.fluvialis from the larvae obtained from apparently healthy larval rearing systems were non-haemolytic. Hydrolytic enzymes such as lipase, chitinase and gelatinase were widespread amongst the Vibrio and Aeromonas isolates. Dominance of V.alginolyticus among the isolates from necrotic larvae and the failure in isolating them from rearing water strongly suggest that they infect larvae and multiply in the larval body and cause mortality in the hatchery. The observation suggested that the isolate V. alginolyticus was a pathogen to the larvae of M.rosenbergii. To sum up, through this work, nine species of Vibrio and genus Aeromonas associated with M.rosenbergii larval rearing systems could be isolated and segregated based on the haemolytic activity and the antibodies (PA bs) for use in diagnosis or epidemiological studies could be produced, based on a virulent culture of V.alginolyticus. This could possibly replace the conventional biochemical tests for identification. As prophylaxis to vibriosis, four isolates of Micrococcus spp. and an isolate of Pseudomonas sp. could be obtained which could possibly be used as antagonistic probiotics in the larval rearing system of M.rosenbergii.

An environmental uncertainty-based diagnostic reference tool for evaluating the performance of supply chain value streams

This research has responded to the need for diagnostic reference tools explicitly linking the influence of environmental uncertainty and performance within the supply chain. Uncertainty is a key factor influencing performance and an important measure of the operating environment. We develop and demonstrate a novel reference methodology based on data envelopment analysis (DEA) for examining the performance of value streams within the supply chain with specific reference to the level of environmental uncertainty they face. In this paper, using real industrial data, 20 product supply value streams within the European automotive industry sector are evaluated. Two are found to be efficient. The peer reference groups for the underperforming value streams are identified and numerical improvement targets are derived. The paper demonstrates how DEA can be used to guide supply chain improvement efforts through role-model identification and target setting, in a way that recognises the multiple dimensions/outcomes of the supply chain process and the influence of its environmental conditions. We have facilitated the contextualisation of environmental uncertainty and its incorporation into a specific diagnostic reference tool.

Comparing diagnostic tests with missing data

When missing data occur in studies designed to compare the accuracy of diagnostic tests, a common, though naive, practice is to base the comparison of sensitivity, specificity, as well as of positive and negative predictive values on some subset of the data that fits into methods implemented in standard statistical packages. Such methods are usually valid only under the strong missing completely at random (MCAR) assumption and may generate biased and less precise estimates. We review some models that use the dependence structure of the completely observed cases to incorporate the information of the partially categorized observations into the analysis and show how they may be fitted via a two-stage hybrid process involving maximum likelihood in the first stage and weighted least squares in the second. We indicate how computational subroutines written in R may be used to fit the proposed models and illustrate the different analysis strategies with observational data collected to compare the accuracy of three distinct non-invasive diagnostic methods for endometriosis. The results indicate that even when the MCAR assumption is plausible, the naive partial analyses should be avoided.

Diagnostic de securite d'une entreprise bresilienne a partir de l'analyse des accidents du travail par la methode de l'arbre des causes

We present here the results of a study of 21 work-related accidents that occurred in a Brazilian manufacturing company. The aim was to assess the safety level of the company to improve its work accident prevention policy. In the last 6 months of 1992 and 1993, all accidents resulting in 15 days' absence from work, reported for social security purposes, were analyzed using the INRS causal tree method (ADC) and a questionnaire completed on site. Potential risk factors for accidents were identified based on the specific factors highlighted by the ADC. More universal trees were also compiled for the safety assessment. Three hundred and thirty specific accident factors were recorded (man of 15.71 per accident). This is consistent with there being multiple causes of accidents rather than the assertion of Brazilian business safety departments that accidents are due to 'dangerous' or 'unsafe' behavior. Introducing the idea of culpability into accidents prevents the implementation of an appropriate information feedback process, essential for effective prevention. However, the large number of accidents related to 'material' (78%) and 'environment' (70%) indicates that working conditions are poor. This shows that the technical risks, mostly due to unsafe machinery and equipment are not being dealt with. Seventy-five potential accident factors were identified. Of these, 35% were 'organizational', a high proportion for the company studied. Improvisation occurs at all levels, particularly at the organizational level. This is, thus a major determinant for entire series of, if not most, accident situations. The poor condition of equipment also plays a major role in accidents. The effects of poor equipment on safety exacerbate the organizational shortcomings. The company's safety intervention policy should improve the management of human resources (rules designating particular workers for particular workstations; instructions for the safe operation of machines and equipment; training of operators, etc.) and introduce programs to detect risks and to improve the safety of machines and equipment. We also recommend the establishment of a program to follow the results of any preventive measures adopted.

Diagnostic de sécurité d’une entreprise brésilienne à partir de l’analyse des accidents du travail par la méthode de l’arbre des causes

We present here the results of a study of 21 work-related accidents that occurred in a Brazilian manufacturing company. The aim was to assess the safety level of the company to improve its work accident prevention policy. In the last 6 months of 1992 and 1993, all accidents resulting in 15 days' absence from work, reported for social security purposes, were analyzed using the INRS causal tree method (ADC) and a questionnaire completed on site. Potential risk factors for accidents were identified based on the specific factors highlighted by the ADC. More universal trees were also compiled for the safety assessment. Three hundred and thirty specific accident factors were recorded (mean of 15.71 per accident). This is consistent with there being multiple causes of accidents rather than the assertion of Brazilian business safety departments that accidents are due to dangerous or unsafe behavior. Introducing the idea of culpability into accidents prevents the implementation of an appropriate information feedback process, essential for effective prevention. However, the large number of accidents related to material (78%) and environment (70%) indicates that working conditions are poor. This shows that the technical risks, mostly due to unsafe machinery and equipment are not being dealt with. Seventy-five potential accident factors were identified. Of these, 35% were organizational, a high proportion for the company studied. Improvisation occurs at all levels, particularly at the organizational level. This is thus a major determinant for entire series of, if not most, accident situations. The poor condition of equipment also plays a major role in accidents. The effects of poor equipment on safety exacerbate the organizational shortcomings. The company's safety intervention policy should improve the management of human resources (rules designating particular workers for particular workstations; instructions for the safe operation of machines and equipment; training of operators, etc.) and introduce programs to detect risks and to improve the safety of machines and equipment. We also recommend the establishment of a program to follow the results of any preventive measures adopted.