Silicone moulding for pressure sore debridement.

The radicality of wound debridement is an important feature of the surgical treatment of pressure sores. Several methods such as injection of methylene blue or hydrogen peroxide have been proposed to facilitate and optimise the surgical debridement technique, but none of them proved to be sufficient. We present an innovative modification of the pseudo-tumour technique consisting in the injection of fluid silicone. Vulcanisation of the silicone leads to pressure-sore moulding, permitting a more radical and sterile excision. In a series of 10 paraplegic patients presenting with ischial pressure sores, silicone moulding was used to facilitate debridement. Radical en bloc debridement was achieved in all patients. After a minimal follow-up of 2 years, no complications and recurrences occurred. A three-dimensional (3D) analysis of the silicone prints objectified the pyramidal shape of ischial pressure sores. Our study showed that complete resection without capsular lesion can be easily achieved. Further, it allows the surgeon to analyse the shape and size of the resected defect, which might be helpful to select the appropriate defect coverage technique.

Els primers llums del Delta

Treball de recerca realitzat per un alumne d'ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l'any 2009. El treball és un estudi de l’evolució, tan tècnica com estètica dels fars paral•lela als avenços tecnològics i prenent com a protagonistes els singulars fars de ferro que es varen construir durant la segona meitat del segle XIX i varen funcionar durant un llarguíssim període en el delta de l’Ebre. L’estructura de ferro, ancorada directament sobre les sorres del delta va donar un caràcter especial a aquestes construccions que, d’altra banda, constituïen una tipologia única a Catalunya i a Espanya. Aquests fars van rebre el nom del lloc on foren ubicats estratègicament. De sud a nord: far de la Banya, far de Buda i far del Fangar. Els van projectar conjuntament, es van encendre per primera vegada el mateix dia, van ser l’habitatge dels seus faroners, van anar evolucionant tècnicament tots tres però el final de cadascun d’ells va ser molt diferent. La història dels fars de ferro ha anat lligada al paisatge i la vida d’aquestes singulars terres del Delta i després de més d’un segle de servei foren substituïts per altres que estèticament i tècnicament res tenen a veure amb els seus antecessors.

Spontaneous subconjunctival orbital fat prolapse: presentation of four cases

BACKGROUND: Subconjunctival orbital fat prolapse is a benign entity characterized by orbital fat herniation through a dehiscence in Tenon's capsule, usually between the superior and lateral recti muscles. It is often associated with ocular trauma or surgery, although spontaneous cases have also been reported with a predilection for obese individuals. PATIENTS AND METHODS: A retrospective study of four subconjunctival orbital-fat prolapse cases with no history of ocular surgery or trauma was performed. A trans-conjunctival surgical approach with Tenon's capsule repair was offered to all subjects. Differential diagnosis is discussed. RESULTS: The diagnosis of subconjunctival orbital fat prolapse was confirmed in all cases by histopathological examination. Functional and aesthetic postoperative results were excellent, with no recurrences during follow-up, for all cases. CONCLUSIONS: Although rare, subconjunctival orbital fat prolapse should be recognized. Surgical management offers excellent results.

Data bases for the assessment of medical technologies: examples from Europe.

The assessment of medical technologies has to answer several questions ranging from safety and effectiveness to complex economical, social, and health policy issues. The type of data needed to carry out such evaluation depends on the specific questions to be answered, as well as on the stage of development of a technology. Basically two types of data may be distinguished: (a) general demographic, administrative, or financial data which has been collected not specifically for technology assessment; (b) the data collected with respect either to a specific technology or to a disease or medical problem. On the basis of a pilot inquiry in Europe and bibliographic research, the following categories of type (b) data bases have been identified: registries, clinical data bases, banks of factual and bibliographic knowledge, and expert systems. Examples of each category are discussed briefly. The following aims for further research and practical goals are proposed: criteria for the minimal data set required, improvement to the registries and clinical data banks, and development of an international clearinghouse to enhance information diffusion on both existing data bases and available reports on medical technology assessments.

Social mobility in 20th century, Switzerland

The study of social mobility enables us to assess the extent to which a given society is "open". Addressing this issue is particularly crucial in our democratic societies, where it is expected that the place of individuals in society should no longer be determined at birth, but rather by individual quality. The present inquiry investigates this issue in the context of Switzerland, a country characterised by specific institutional settings, notably through the close association its educational system shares with the labour market. Through a detailed empirical analysis based on robust statistical analyses carried out from a unique tailor-made dataset, I demonstrate that Swiss society has not become more open throughout the twentieth century. Although some barriers have lost some salience, Swiss society has overall remained extremely rigid. In particular, because it channels individuals into highly segmented tracks very early on, the Swiss educational system does not attenuate social background differences. Thus, Switzerland is found in a particular configuration where an individual's place in society is highly determined not only by his or her educational attainment, but also by his or her social background. In other words, Switzerland constitutes a sort of "non-meritocratic meritocracy". - L'étude de la mobilité sociale permet d'évaluer dans quelle mesure une société donnée est « ouverte ». S'intéresser à cette question est particulièrement crucial dans nos sociétés démocratiques, où il est attendu que la place des individus ne soit plus déterminée à la naissance, mais plutôt par les qualités individuelles. La présente étude examine cette question dans le cadre de la Suisse, un pays aux caractéristiques institutionnelles spécifiques, particulièrement de part le lien étroit que son système éducatif entretien avec le marché du travail. A travers une analyse empirique détaillée fondée sur des analyses statistiques robustes menées à partir d'un jeu de données unique construit sur-mesure, je démontre que la société suisse n'est pas devenue plus ouverte au cours du 20ème siècle. Même si certaines barrières ont perdu de l'importance, dans son ensemble, la société suisse est restée extrêmement rigide. En particulier, parce qu'il oriente très tôt les individus dans des filières fortement segmentées, le système éducatif suisse n'atténue pas les différences entre milieux sociaux. Ainsi, la Suisse se trouve dans une configuration particulière où, d'une part, la place d'un individu dans la société est hautement déterminée par son niveau d'étude et, d'autre part, par son origine sociale. En d'autres termes, la Suisse apparaît comme une sorte de « méritocratie non-méritocratique ».

The de facto independence of regulatory agencies and its consequences for policy making and regulatory outcomes

This dissertation focuses on the practice of regulatory governance, throughout the study of the functioning of formally independent regulatory agencies (IRAs), with special attention to their de facto independence. The research goals are grounded on a "neo-positivist" (or "reconstructed positivist") position (Hawkesworth 1992; Radaelli 2000b; Sabatier 2000). This perspective starts from the ontological assumption that even if subjective perceptions are constitutive elements of political phenomena, a real world exists beyond any social construction and can, however imperfectly, become the object of scientific inquiry. Epistemologically, it follows that hypothetical-deductive theories with explanatory aims can be tested by employing a proper methodology and set of analytical techniques. It is thus possible to make scientific inferences and general conclusions to a certain extent, according to a Bayesian conception of knowledge, in order to update the prior scientific beliefs in the truth of the related hypotheses (Howson 1998), while acknowledging the fact that the conditions of truth are at least partially subjective and historically determined (Foucault 1988; Kuhn 1970). At the same time, a sceptical position is adopted towards the supposed disjunction between facts and values and the possibility of discovering abstract universal laws in social science. It has been observed that the current version of capitalism corresponds to the golden age of regulation, and that since the 1980s no government activity in OECD countries has grown faster than regulatory functions (Jacobs 1999). Following an apparent paradox, the ongoing dynamics of liberalisation, privatisation, decartelisation, internationalisation, and regional integration hardly led to the crumbling of the state, but instead promoted a wave of regulatory growth in the face of new risks and new opportunities (Vogel 1996). Accordingly, a new order of regulatory capitalism is rising, implying a new division of labour between state and society and entailing the expansion and intensification of regulation (Levi-Faur 2005). The previous order, relying on public ownership and public intervention and/or on sectoral self-regulation by private actors, is being replaced by a more formalised, expert-based, open, and independently regulated model of governance. Independent regulation agencies (IRAs), that is, formally independent administrative agencies with regulatory powers that benefit from public authority delegated from political decision makers, represent the main institutional feature of regulatory governance (Gilardi 2008). IRAs constitute a relatively new technology of regulation in western Europe, at least for certain domains, but they are increasingly widespread across countries and sectors. For instance, independent regulators have been set up for regulating very diverse issues, such as general competition, banking and finance, telecommunications, civil aviation, railway services, food safety, the pharmaceutical industry, electricity, environmental protection, and personal data privacy. Two attributes of IRAs deserve a special mention. On the one hand, they are formally separated from democratic institutions and elected politicians, thus raising normative and empirical concerns about their accountability and legitimacy. On the other hand, some hard questions about their role as political actors are still unaddressed, though, together with regulatory competencies, IRAs often accumulate executive, (quasi-)legislative, and adjudicatory functions, as well as about their performance.

Dermatologie esthétique et correctrice: applications cliniques et rôle social [Esthetic and corrective dermatology: clinical applications and social role].

Skin diseases may have severe aesthetic and psychological repercussions leading sometimes to discriminations and social isolation. Dermatologists have contributed to the development of many cosmetic procedures: peelings, botulinum toxin or hyaluronic acid injections, lasers, blepharoplasty, facelift, etc. Many of these treatments have interesting clinical applications and may help numerous patients with skin diseases to return to a normal social life.

The metaphysics of quantum gravity : a causal approach

The dissertation investigates some relevant metaphysical issues arising in the context of spacetime theories. In particular, the inquiry focuses on general relativity and canonical quantum gravity. A formal definition of spacetime theory is proposed and, against this framework, an analysis of the notions of general covariance, symmetry and background independence is performed. It is argued that many conceptual issues in general relativity and canonical quantum gravity derive from putting excessive emphasis on general covariance as an ontological prin-ciple. An original metaphysical position grounded in scientific essential- ism and causal realism (weak essentialism) is developed and defended. It is argued that, in the context of general relativity, weak essentialism supports spacetime substantivalism. It is also shown that weak essentialism escapes arguments from metaphysical underdetermination by positing a particular kind of causation, dubbed geometric. The proposed interpretive framework is then applied to Bohmian mechanics, pointing out that weak essentialism nicely fits into this theory. In the end, a possible Bohmian implementation of loop quantum gravity is considered, and such a Bohmian approach is interpreted in a geometric causal fashion. Under this interpretation, Bohmian loop quantum gravity straightforwardly commits us to an ontology of elementary extensions of space whose evolution is described by a non-local law. The causal mechanism underlying this evolution clarifies many conceptual issues related to the emergence of classical spacetime from the quantum regime. Although there is as yet no fully worked out physical theory of quantum gravity, it is argued that the proposed approach sets up a standard that proposals for a serious ontology in this field should meet.

Improving Patient Safety - Building Public Confidence (PDF 440 KB)

A response by the Department of Health, Social Services & Public Safety to the recommendations contained in the Shipman Inquiry Reports 3, 4 & 5.

McCleery Report (EHSSB Report) (PDF 109 KB)

Executive Summary and Recommendations from the Report of the Inquiry Panel (McCleery) to the Eastern Health and Social Services Board - 11 May 2006

Narrative Diagrammatik. Mit einer Modellanalyse: Die Diagrammatik des "Decameron"

Taking as a starting point the seeming inconsistency of late-medieval romances notoriously 'run wild' (verwildert), this article is concerned with the description of an abstract form of narrative coherence that is based on the notion of the diagrammatic. In a first section, this concept is illustrated in a simplified manner by an analysis of Boccaccio's Decameron based on two levels of spatial structure: that of the autograph Berlin manuscript (Codex Hamilton 90) and that of the recipient's mental visualisation of the relations between the frame and the tales of the work. It is argued that the connectivity of the work as a whole depends on the perception of those two spatial representations of the plot. A second section develops this concept in a more theoretical fashion, drawing on Charles Sanders Peirce's notion of diagrammatic reasoning as a way of perceiving relations through mental and material topological representations. Correspondingly, a view of narrative is proposed that does not depend on the traditional perspective of temporal sequence but emphasizes the spatial structure of literary narrative. It is argued that these conditions form the primary ontological mode of narrative, whereas the temporal development of a story is an aesthetic illusion that has been specifically stimulated by the narrative conventions of approximately the past three centuries and must thus be considered a secondary effect. To conclude, an interpretation in miniature of an aspect of Heinrich von Neustadt's Apollonius von Tyrland that seems to have 'run wild' is undertaken from a diagrammatic perspective.

Does VAA popularity pay off ? : Smartvote users preferred candidates and their results in the 2007 Swiss federal elections

Voting is fundamental for democracy, however, this decisive democratic act requires quite an effort. Decision making at elections depends largely on the interest to gather information about candidates and parties, the effort to process the information at hand and the motivation to reach a vote choice. Especially in electoral systems with highly fragmented party systems and hundreds of candidates running for office, the process of decision making in the pre‐election sphere is highly demanding. In the age of information and communication technologies, new possibilities for gathering and processing such information are available. Voting Advice Applications (VAAs) provide guidance to voters prior to the act of voting and assist voters in choosing between different candidates and parties on the basis of issue congruence. Meanwhile widely used all over the world, scientific inquiry into the effect of such tools on electoral behavior is ongoing. This paper adds to the current debate by focusing on whether the popularity of candidates on the Swiss VAA smartvote eventually paid off at the 2007 Swiss federal elections and whether there is a direct link between the performance of a candidate on the tool and his or her electoral performance.

ERHA Report July 2003 (on the events surrounding the deferral of Roisin Ruddles surgery)

On being requested to complete an urgent report by the Minister for Health and Children the Authority undertook a preliminary review of the information known and drew up a series of questions for Our Ladyâ?Ts Hospital for Sick Children (OLHSC) in order to inform the writing of the report. A copy of the questions submitted to OLHSC is attached at Appendix 1. PDF 205kb

The v-y latissimus dorsi musculocutaneous flap in the reconstruction of large posterior chest wall defects.

Posterior chest wall defects are frequently encountered after excision of tumors as a result of trauma or in the setting of wound dehiscence after spine surgery. Various pedicled fasciocutaneous and musculocutaneous flaps have been described for the coverage of these wounds. The advent of perforator flaps has allowed the preservation of muscle function but their bulk is limited. Musculocutaneous flaps remain widely employed. The trapezius and the latissimus dorsi (LD) flaps have been used extensively for upper and middle posterior chest wounds, respectively. Their bulk allows for obliteration of the dead space in deep wounds. The average width of the LD skin paddle is limited to 10-12 cm if closure of the donor site is expected without skin grafting. In 2001 a modification of the skin paddle design was introduced in order to allow large flaps to be raised without requiring grafts or flaps for donor site closure. This V-Y pattern allows coverage of large anterior chest defects after mastectomy. We have modified this flap to allow its use for posterior chest wall defects. We describe the flap design, its indications, and its limitations with three clinical cases. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors at www.springer.com/00266 .