Treatment of Prosthetic Joint Infections

Prosthetic joint replacement is one of the most successful surgical procedures of the last century and the number of implanted artificial joints is rapidly growing. While the result of the procedure is generally positive, infections may occur leading to patient suffering, surgeon's frustration and important costs to the health system. Infection after prosthetic joint replacement is thus a feared complication as healing rates can be low, functional result poor and satisfaction of the patient abysmal. However, if a patient-adapted treatment of infected total joints is used, an overall success rate of above 90 % can be obtained. The patient-adapted treatment concept is based on five strong pillars: teamwork, understanding biofilm, proper diagnostics, proper definition and classification and patient-tailored treatment.

HouSI: Heuristic for delimitation of housing submarkets and price homogeneous areas

This paper seeks to address the problem of the empirical identification of housing market segmentation,once we assume that submarkets exist. The typical difficulty in identifying housing submarkets when dealing with many locations is the vast number of potential solutions and, in such cases, the use of the Chow test for hedonic functions is not a practical solution. Here, we solve this problem by undertaking an identification process with a heuristic for spatially constrained clustering, the"Housing Submarket Identifier" (HouSI). The solution is applied to the housing market in the city of Barcelona (Spain), where we estimate a hedonic model for fifty thousand dwellings aggregated into ten groups. In order to determine the utility of the procedure we seek to verify whether the final solution provided by the heuristic is comparable with the division of the city into ten administrative districts.

Step-by-step of ultrasound-guided core-needle biopsy of the breast: review and technique

Ultrasound-guided core-needle biopsy has high sensitivity in the diagnosis of breast cancer. The present study is aimed at detailing the main steps of such procedure, including indications, advantages, limitations, follow-up and description of the technique, besides presenting a checklist including the critical steps required for an appropriate practice of the technique. In the recent years, an increasing number of patients have required breast biopsy, indicating the necessity of a proportional increase in the number of skilled professionals to carry out the procedures and histological diagnoses. A multidisciplinary approach involving the tripod clinical practice-radiology-pathology is responsible for the highest rate of accuracy of the technique and must always be adopted.

Preparation and management of complications in prostate biopsies

Transrectal ultrasonography-guided biopsy plays a key role in prostate sampling for cancer detection. Among interventional procedures, it is one of the most frequent procedures performed by radiologists. Despite the safety and low morbidity of such procedure, possible complications should be promptly assessed and treated. The standardization of protocols and of preprocedural preparation is aimed at minimizing complications as well as expediting their management. The authors have made a literature review describing the possible complications related to transrectal ultrasonography-guided prostate biopsy, and discuss their management and guidance to reduce the incidence of such complications.

Health Migration Policies and Ethical Controversies: the Case of African Nurses in the UK

The United Kingdom (UK) for last few decades has been faced with a growing need for health personnel and has therefore attracted professionals, particularly overseas nurses. The country has been characterised by a historical migration policy favourable to the recruitment of foreign health staff. However, in the context of deep shortage and high level of diseases and health system weakness, the international health professional recruitment from Sub Saharan Africa has created unprecedented ethical controversies which have pushed the UK to the centre of discussions because of its liberal policies towards international recruitment that have been considered as aggressive. While the 'brain drain' controversy is well known, less attention has been devoted to the specific international health migration controversy and the pivotal role of the UK in the diffusion of ethical code of practice. Using mainly the perspective of the policy analysis of controversy (Roe 1994) and the analysis of discourses (de Haas 2008), our paper comes back respectively to the nature of the controversy and the pivotal role of the UK. It also analyses how the implementation of UK ethical policies - Code of Practice, banned countries list of recruitment, restrictive immigration policies - have been considered as inefficient and unethical in their contents and their targets.

Development of a flotation-spectrophotometric method for determination of cetylpyridinium chloride in pharmaceutical products

A new simple and sensitive flotation-spectrophotometric method for the determination of cetylpyridinium chloride (CPC) is reported. The method is based on the formation of an ion- associate between CPC and Orange II (OR) which is floated in the interface of aqueous phase and n-hexane by vigorous shaking. The aqueous solution was discarded and the adsorbed ion associate on to the wall of a separating funnel was dissolved in a small volume of methanol solvent and its absorbance was measured at 480 nm. The apparent molar absorptivity (Ε) of the ion associate was determined to be 4.12 x 10(5) L mol-1 cm-1. The calibration graph was linear in the concentration range of 15-800 ng mL-1 of CPC with a correlation coefficient of 0.9988. The limit of detection (LOD) was 10.8 ng mL-1. The relative standard deviation (RSD) for determination of 100 and 800 ng mL-1 of CPC was 3.47 and 2.04% (n=7), respectively. The method was successfully applied to the determination of CPC in a commercial mouth washer product.

Synthesis and characterization of Fe(III)-piperazine-derived complexes encapsulated in zeolite Y

Zeolite-encapsulated complexes have been widely applied in hydrocarbon oxidation catalysis. The "ship-in-a-bottle" encapsulation of iron(III) complexes containing piperazine and piperazine-derivative ligands in zeolite-Y is described. The flexible ligand methodology was employed and the efficiency and reproducibility of the procedure was investigated. The catalysts were characterized employing several techniques and the results indicate the presence of coordinated and uncoordinated iron(III) ions inside and outside the zeolitic cage.

Hallinnollinen sanktiointi

Tausta Suomessa lainsäätäjä reagoi helposti yhteiskunnalliseen häiriötekijään rikosoikeuden keinoin. Tästä on osoituksena se, että syksyllä 2010 varsinaisen rikoslain lisäksi rikoksesta oli säädetty 256 eri laissa. Suomalainen, lähtökohdiltaan maltillinen kontrolli- ja kriminaalipolitiikka on 1970-luvulla linjatun vastaisesti johtanut 2000-luvulle tultaessa rikosoikeudellisen kontrollin lisääntymiseen ja jopa kiristymiseen. Raja rikosten ja rikkomusten välillä on liudentunut ja paikoitellen kadonnut ja erityisesti turvallisuudesta on kehittynyt – käsitteeseen liittyvistä oikeudellisista jännitteistä huolimatta – keskeinen rikosoikeudellisen sääntelyn oikeutusperuste. Rikosoikeuden käyttäminen vähäisten rikosten kontrollointiin on aiheuttanut Suomeen viivästymisen ongelman. Yleisessä tiedossa on se, että Euroopan ihmisoikeustuomioistuin on antanut 2000-luvulla Suomelle kymmeniä tuomioita siksi, että rikosjuttuja on käsitelty viranomaisissa ja tuomioistuimissa liian kauan. Vähemmän on sen sijaan keskusteltu siitä, että myös vähäiset rikokset viivästyvät rikosoikeuden alan laajetessa ja viranomaisten voimavarojen ehtyessä. Suomessa ongelmaa on pyritty hoitamaan rikosoikeudellista toimivaltaa hallintoviranomaisille delegoimalla tilanteen ollessa nyt se, että uuden sakkomenettelylain voimaan tullessa noin 90 % rikosoikeudellisesta kompetenssista on poliisilla ja muilla hallintoviranomaisilla. Se taasen on ongelmallista perustuslain 3 §:ssä säädetyn vallanjakoperiaatteen kannalta. Välttämätöntä on korostaa myös sitä, että pääosin rikosoikeudelliseen kontrolliin perustuva systeemi aiheuttaa rikosoikeuden inflaatiota: rikosoikeuden arvostuksen vähenemisestä aiheutuvia ei-mittavissa olevia kuluja. Rikosoikeuden laajenemista vastaan esitetään kuitenkin harvoin kritiikkiä. Rikosoikeustieteen piirissäkään sille ei ole esitetty vakavasti otettavaa vaihtoehtoa. Esimerkiksi hallinnollisia sanktioita ei ole Suomessa – ei tosin muissa Pohjoismaissakaan – koettu rikosoikeuden vaihtoehtona, vaan usein rikosoikeutta täydentävänä järjestelmänä. Hallinnollisten sanktioiden käyttäminen rikosoikeuden ohessa ei ole ollut yksiselitteistä ja jäsenneltyä, yleisiin oppeihin perustuvaa. Kontrollin erityisille alueille, esimerkiksi sotilaskontrolliin, on lisäksi kehittynyt rikos- ja hallinto-oikeuden sekajärjestelmiä. Tutkimuskysymykset Käsillä olevassa artikkelimuotoisessa väitöskirjatutkimuksessa pyritään hahmottelemaan rikos- ja hallinto-oikeudellisten rangaistusjärjestelmien välisiä eroavaisuuksia Suomessa. Tutkimuksen keskeisin tehtävä on sen pohtiminen, millä tavalla 2010-luvulle tultaessa olisi tutkimuksen empiiriset ja teoreettiset lähtökohdat huomioon ottaen järkevää ja tarkoituksenmukaista rangaista. Tällä perusteella kehitetään yksikertaista hallintosanktiointiteoreettista mallia, että sitä hyväksikäyttäen lainvalmisteluprosessin sanktiointitilanteessa, sanktiosta päätettäessä, olisi mahdollista asettaa oikeusturvan vähimmäistakeet täyttävällä tavalla oikeus- ja muilta vaikutuksiltaan rationaalinen seuraamus sekä säätää sen määräämiseksi yhteiskunnallisilta vaikutuksiltaan tehokas ja riittävän oikeusturvallinen menettely. Tutkimustehtävä on tiivistetysti 1) hallinnollisten sanktioiden ja rikosoikeudellisten rangaistusten ja niiden alan määrittäminen, 2) hallinnollisten sanktioiden sääntelymallien valintaperusteluiden selvittäminen, 3) hallintosanktioteoreettisen mallin kehittäminen lainvalmisteluprosessia varten sekä 4) de lege ferenda -suositusten tekeminen rangaistavuuden hyväksyttävyyden ja joutuisuuden parantamiseksi. Menetelmä ja aineistot Tutkimus kytkeytyy teoreettisen rikosoikeustieteen, hallinto-oikeustieteen ja prosessioikeustieteen alalle ja se on luonteeltaan ongelmakeskeinen. Tieteenalojen väliset painotukset ja niiden vaikutus vaihtelevat tutkimuksessa. Vaikka tutkimus on monella tavalla luonteeltaan teoreettinen, siinä rakennetaan nimenomaan lainsäädäntötyötä ja lainvalmistelua tukevaa tutkimusta ja teoriaa. Tältä osin näkökulma liittyy kriminalisointiteoreettisessa tutkimuksessa hahmotettuun lainsäätäjän oikeuslähdeoppia koskevaan uuteen näkökulmaan, jolla on yhteyksiä lainsäädäntötutkimukseen ja oikeusteoriassa hahmotettuun legisprudence-tutkimusuuntaukseen, näkökulman suuntautuessa lainsäädäntötasolle. Tutkimuksen lähteistä suurin osa on oikeustieteellistä kirjallisuutta, jonka pääosa muotoutuu suomalaisesta oikeustieteellisestä kirjallisuudesta. Myös pohjoismaalaista, saksalaista ja hieman myös anglosaksista kirjallisuutta on käytetty. Kansainvälisten kirjallisuuslähteiden merkitys ei ole ollut merkittävä, koska kattava eurooppalainen näkemys aihepiiristä on pyritty saamaan Euroopan ihmisoikeustuomioistuimen ratkaisukäytäntöä hyödyntäen. Tutkimuksen lähteinä on käytetty laajasti myös kansallista lainvalmisteluaineistoa, erityisesti hallituksen esityksiä ja perustuslakivaliokunnan lausuntokäytäntöä. Johtopäätökset Kriminaali- ja/tai kontrollipolitiikassa on juuri nyt tärkeää pohtia, millä tavalla 2010-luvulle tultaessa on järkevää ja tarkoituksenmukaista rangaista. Tähän voisi olla mahdollista vastata tutkimuksessa kehitettävällä hallintosanktiointiteoreettisella mallilla. Mallin kehittäminen on edellyttänyt yhteiskunnallisten sanktiokäytäntöjen oikeusvaltioopillista tarkastelua, jolloin sanktioiden yhteiskunnalliseen merkitykseen pureutuminen kuvailee myös sitä, millainen modernin oikeusvaltion tila tällä hetkellä on. Perinteisten oikeusvaltioiden paradigmojen käyttäminen ei välttämättä edistä relevantin oikeusvaltiollisen sanktiointiteoreettisen mallin kehittämistä. Voi olla niinkin, että klassinen oikeusvaltio-oppi ja oletetunlaiset rikosoikeuden erityiset elementit eivät enää vastaa yhteiskuntatodellisuutta. Näin rankaisemisen yleiset opit voivat nousta kehittämisen kohteeksi oikeusvaltiollisuuden elementtien toteuttamiseksi valtavasta kasvaneessa hallintoyhteiskunnassa – hallinto-johtoisessa yhteiskunnallisessa todellisuudessa. Suomen rikoslaki sisältää laajassa merkityksessä sadoittain erilaatuisia kriminalisointeja, joiden merkitys on usein hallinnon toimintaa subventoiva, symbolinen tai jonkin toisen kriminalisoinnin vaikutusta tehostamaan pyrkivä. Tällainen rikoslaki on tehtävänsä, vaikuttavuutensa ja hyväksyttävyytensä kannalta ongelmallinen. Suomalainen hallinnollisten sanktioiden järjestelmä ei sekään ole järkevä ja tarkoituksenmukainen, yleisiin oppeihin perustuva systeemi. Myös yleiseurooppalainen kehitys näyttäisi viittaavan siihen, että Suomessa on tarve kehittää sekä rikosoikeutta että sille vaihtoehtoista hallintosanktioiden järjestelmää, sanktio-oikeutta. Tämä edellyttää lainsäädäntöuudistuksia.

Identification of extractives and polysaccharides as foulants in membrane filtration of pulp and paper mill effluents

The search for new renewable materials has intensified in recent years. Pulp and paper mill process streams contain a number of potential compounds which could be used in biofuel production and as raw materials in the chemical, food and pharmaceutical industries. Prior to utilization, these compounds require separation from other compounds present in the process stream. One feasible separation technique is membrane filtration but to some extent, fouling still limits its implementation in pulp and paper mill applications. To mitigate fouling and its effects, foulants and their fouling mechanisms need to be well understood. This thesis evaluates fouling in filtration of pulp and paper mill process streams by means of polysaccharide model substance filtrations and by development of a procedure to analyze and identify potential foulants, i.e. wood extractives and carbohydrates, from fouled membranes. The model solution filtration results demonstrate that each polysaccharide has its own fouling mechanism, which also depends on the membrane characteristics. Polysaccharides may foul the membranes by adsorption and/or by gel/cake layer formation on the membrane surface. Moreover, the polysaccharides interact, which makes fouling evaluation of certain compound groups very challenging. Novel methods to identify wood extractive and polysaccharide foulants are developed in this thesis. The results show that it is possible to extract and identify wood extractives from membranes fouled in filtration of pulp and paper millstreams. The most effective solvent was found to be acetone:water (9:1 v/v) because it extracted both lipophilic extractives and lignans at high amounts from the fouled membranes and it was also non-destructive for the membrane materials. One hour of extraction was enough to extract wood extractives at high amounts for membrane samples with an area of 0.008 m2. If only qualitative knowledge of wood extractives is needed a simplified extraction procedure can be used. Adsorption was the main fouling mechanism in extractives-induced fouling and dissolved fatty and resin acids were mostly the reason for the fouling; colloidal fouling was negligible. Both process water and membrane characteristics affected extractives-induced fouling. In general, the more hydrophilic regenerated cellulose (RC) membrane fouled less that the more hydrophobic polyethersulfone (PES) and polyamide (PA) membranes independent of the process water used. Monosaccharide and uronic acid units could also be identified from the fouled synthetic polymeric membranes. It was impossible to analyze all monosaccharide units from the RC membrane because the analysis result obtained contained degraded membrane material. One of the fouling mechanisms of carbohydrates was adsorption. Carbohydrates were not potential adsorptive foulants to the sameextent as wood extractives because their amount in the fouled membranes was found to be significantly lower than the amount of wood extractives.

Animal Lovers, Bridge-Builders, and Supervising Watchdogs: Framing and Civil Society Construction by Japanese Pro-Animal Organizations in the Kansai and Tokyo Areas

Unlike their counterparts in Europe and America, the citizen organizations acting for the well-being of animals in Japan have not received scholarly attention. In this research, I explore the activities of twelve Japanese pro-animal organizations in Tokyo and Kansai area from the perspective of social movement and civil society studies. The concept of a ‘pro-animal organization’ is used to refer generally to the collectives promoting animal well-being. By using the collective action frame analysis and the three core framing tasks – diagnostic, prognostic, and motivational – as the primarily analytical tools, I explore the grievances, tactics, motivational means, constructions of agency and identity as well as framing of civil society articulated in the newsletters and the interviews of the twelve organizations I interviewed in Japan in 2010. As the frame construction is always done in relation to the social and political context, I study how the organizations construct their roles as civil society actors in relation to other actors, such as the state, and the idea of citizen activism. The deficiencies in the animal welfare law and lack of knowledge among the public are identified as the main grievances. The primary tactic to overcome these problems was to educate and inform the citizens and authorities, because most organizations lack the channels to influence politically. The audiences were mostly portrayed as either ignorant bystanders or potential adherents. In order to motivate people to join their cause and to enforce the motivation within the organization, the organizations emphasized their uniqueness, proved their efficiency, claimed credit and celebrated even small improvements. The organizations tended to create three different roles for citizen pro-organizations in civil society: reactive, apolitical and emphatic animal lovers concentrating on saving individual animals, proactive, educative bridge-builders seeking to establish equal collaborative relations with authorities, and corrective, supervising watchdogs demanding change in delinquencies offending animal rights. Based on the results of this research, I suggest that by studying how and why the different relations between civil society and the governing actors of the state are constructed, a more versatile approach to citizens’ activism in its context can be achieved.

Adaptation of "Niagara Rosada" grape must to winemaking by partial cluster dehydration

This study aimed to verify the influence of partial dehydration of "Niagara Rosada" grape clusters in physicochemical quality of the pre- fermentation must. In Brazil, during the winemaking process it is common to need to adjust the grape must when the physicochemical characteristics of the raw material are insufficient to produce wines in accordance with the Brazilian legislation for classification of beverages, which establishes the minimum alcohol content of 8.6 % for the beverage to be considered wine. Therefore, given that the reduction in the water content of grape berries allows the concentration of chemical compounds present in its composition, especially the concentration of total soluble solids, we proceeded with the treatments that were formed by the combination of two temperatures (T1-37.1ºC and T2-22.9 ºC) two air speeds (S1: 1.79 m s-1 and S2: 3.21 m s-1) and a control (T0) that has not gone through the dehydration treatment. Analysis of pH, Total Titratable Acidity (TTA) were performed in mEq L-1, Total Soluble Solids (TSS) in ºBrix, water content on a dry basis and Concentration of Phenolic Compounds (CPC) in mg of gallic acid per 100g of must. The average comparison test identified statistically significant modifications for the adaptation of must for winemaking purposes, having the treatment with 22.9 ºC and air speed of 1.79 m s-1 shown the largest increase in the concentration of total soluble solids, followed by the second best result for concentration of phenolic compounds.

Incidence of uterine post abortion infection at Hospital de Clínicas de Porto Alegre. Is prophylactic antibiotic necessary?

OBJECTIVE: To identify the incidence of pelvic infection after miscarriage undergoing uterine evacuation in a tertiary hospital in southern Brazil and to compare with the international literature.METHODS: we reviewed electronic medical records of the Hospital de Clinicas de Porto Alegre of all patients who underwent uterine evacuation for miscarriage between August 2008 and January 2012 were reviewed. We included all patients submitted to uterine curettage due to abortion and who had outpatient visits for review after the procedure. We calculated emographic and laboratory data of the study population, number needed for treatment (NNT) and number needed to harm (NNH).RESULTS: of the 857 revised electronic medical records, 377 patients were subjected to uterine evacuation for miscarriage; 55 cases were lost to follow-up, leaving 322 cases that were classified as not infected abortion on admission. The majority of the population was white (79%); HIV prevalence and positive VDRL was 0.3% and 2%, respectively. By following these 322 cases for a minimum of seven days, it was found that the incidence of post-procedure infection was 1.8% (95% CI 0.8 to 4). The NNT and NNH calculated for 42 months were 63 and 39, respectively.CONCLUSION: The incidence of post-abortion infection between August 2008 to January 2012 was 1.8% (0.8 to 4).

Evaluation of prognostic factors of decompressive craniectomy in the treatment of severe traumatic brain injury

OBJECTIVE: to determine predictive factors for prognosis of decompressive craniectomy in patients with severe traumatic brain injury (TBI), describing epidemiological findings and the major complications of this procedure.METHODS: we conducted a retrospective study based on analysis of clinical and neurological outcome, using the extended Glasgow outcome in 56 consecutive patients diagnosed with severe TBI scale treated in the emergency department from February 2004 to July 2012. The variables assessed were age, mechanism of injury, presence of pupillary changes, Glasgow coma scale (GCS) score on admission, CT scan findings (volume, type and association of intracranial lesions, deviation from the midline structures and classification in the scale of Marshall and Rotterdam).RESULTS: we observed that 96.4% of patients underwent unilateral decompressive craniectomy (DC) with expansion duraplasty, and the remainder to bilateral DC, 53.6% of cases being on the right 42.9% on the left, and 3.6% bilaterally, with predominance of the fourth decade of life and males (83.9%). Complications were described as transcalvarial herniation (17.9%), increased volume of brain contusions (16.1%) higroma (16.1%), hydrocephalus (10.7%), swelling of the contralateral lesions (5.3%) and CSF leak (3.6%).CONCLUSION: among the factors studied, only the presence of mydriasis with absence of pupillary reflex, scoring 4 and 5 in the Glasgow Coma Scale, association of intracranial lesions and diversion of midline structures (DML) exceeding 15mm correlated statistically as predictors of poor prognosis.

Aplication of videothoracoscopy in trauma - experience of a service

Objective: To evaluate patients with chest trauma submitted to videothoracoscopy during hospitalization. In 2007, the Trauma Surgery Group was created in the General Surgery Department of the Hospital Municipal Lourenço Jorge of Rio de Janeiro-RJ, and started following all trauma victims who were admitted to the Hospital. Methods : We conducted a retrospective analysis of patients submitted to thoracoscopy from July 2007 to May 2015, based on a database started at the beginning of this period and on data collection from patients who underwent thoracoscopy. We evaluated the following parameters: procedure effectiveness, indication of the procedure, conversion rate, complications and mortality. We included patients who presented post-traumatic pleural collections, such as retained hemothorax and pleural empyema, and penetrating injury in the thoracoabdominal transition. All patients were hemodynamic stable and signed an informed consent. Results: In the analyzed period 53 patients were submitted to videothoracoscopy; 24 had penetrating trauma (45.3%) and 29, blunt (54.7%), with a predominance of males (75.5%). The procedure was performed in 26 cases of retained hemothorax (49%), 14 cases of empyema (26.5%) and in 13 patients for evaluation of injury in the thoracoabdominal transition (24.5%). The thoracoscopy was effective in resolution of 36 cases (80%), without need for further procedure. There was a conversion rate of 15.5% and 3 procedure complications related (6.6%). Mortality was nil. Conclusion: In this series, videothoracoscopy proved that this diagnostic and therapeutic procedure is safe and effective, if performed by a surgeon with appropriate training, especially when it is indicated in cases of retained hemothorax and evaluation of penetrating thoracoabdominal trauma.

The effect of timing temporary cements to treat induced pulp necrosis in the teeth of dogs

During endodontic therapy (pulpectomy, root canal debridement and root canal filling) microbiological management is a major concern. Bacteria present in dentine tubules, apical foramina and apical delta are causally related to failure of the procedure. Studies have shown that during single session endodontic treatment bacteria remain within dental structures. The aim of the present study was to evaluate endodontic treatment performed as two sessions, using temporary endodontic dressing materials for different periods in four groups of experimental dogs. A total of 80 roots of second and third upper premolar teeth and second, third and fourth lower premolar teeth were divided into four groups. The pulp chamber was opened with burrs and the pulp exposed for 60 days to induce pulpal inflammation and necrosis. Groups II, III and IV were treated with calcium hydroxide plus camphorated paramono-chlorophenol (PMCC) for 7, 15 and 30 days, respectively. In all groups, the root canals were filled with zinc oxide-eugenol and gutta-percha cones. Clinical and radiographical measurements were performed every 2 weeks. After 60 days a small block section containing the teeth, surrounding periapical tissues and the periodontium was removed for histological and microbiological study. Histological analysis revealed intense inflammatory response in all groups. Microbiological analysis showed microbial reduction inversely proportional to the period of time that the intracanal temporary medicament was left in place.