A systematic review of the surgical treatment of large incisional hernia.

PURPOSE: Incisional hernia (IH) is one of the most frequent postoperative complications. Of all patients undergoing IH repair, a vast amount have a hernia which can be defined as a large incisional hernia (LIH). The aim of this study is to identify the preferred technique for LIH repair. METHODS: A systematic review of the literature was performed and studies describing patients with IH with a diameter of 10 cm or a surface of 100 cm2 or more were included. Recurrence hazards per year were calculated for all techniques using a generalized linear model. RESULTS: Fifty-five articles were included, containing 3,945 LIH repairs. Mesh reinforced techniques displayed better recurrence rates and hazards than techniques without mesh reinforcement. Of all the mesh techniques, sublay repair, sandwich technique with sublay mesh and aponeuroplasty with intraperitoneal mesh displayed the best results (recurrence rates of <3.6%, recurrence hazard <0.5% per year). Wound complications were frequent and most often seen after complex LIH repair. CONCLUSIONS: The use of mesh during LIH repair displayed the best recurrence rates and hazards. If possible mesh in sublay position should be used in cases of LIH repair.

L'ultrasonographie endorectale dans les cancers du rectum [Endorectal ultrasound of rectal cancers].

Endorectal ultrasonography has become the preferred exam to assess the local extent of rectal cancers. From 1990 to 1992, we have examined 28 patients with a rectal cancer. The tumours were classified according to the TNM. The objective of this exam is to identify patients whose tumours have invaded the perirectal fat. These patients are first treated in our clinic by an accelerated hyperfractionated radiotherapy and then operated. The preoperative staging made with the endorectal ultrasound was then compared with the anatomopathologic staging. The depth of the invasion was assessed precisely in 78.5% of cases. The exam's sensitivity to detect the invasion of the perirectal fat was 96% and its specificity 75%. Lymph node involvement was accurately identified in 67.8% of cases with a sensitivity of 81% and a specificity of 50%. This short retrospective study confirms that endorectal ultrasonography is a highly accurate tool for the staging of rectal carcinoma prior to operation and hence to select the patients that can benefit from preoperative irradiation.

Multi-scale effects of nestling diet on breeding performance in a terrestrial top predator inferred from stable isotope analysis

Inter-individual diet variation within populations is likely to have important ecological and evolutionary implications. The diet-fitness relationships at the individual level and the emerging population processes are, however, poorly understood for most avian predators inhabiting complex terrestrial ecosystems. In this study, we use an isotopic approach to assess the trophic ecology of nestlings in a long-lived raptor, the Bonelli"s eagle Aquila fasciata, and investigate whether nestling dietary breath and main prey consumption can affect the species" reproductive performance at two spatial scales: territories within populations and populations over a large geographic area. At the territory level, those breeding pairs whose nestlings consumed similar diets to the overall population (i.e. moderate consumption of preferred prey, but complemented by alternative prey categories) or those disproportionally consuming preferred prey were more likely to fledge two chicks. An increase in the diet diversity, however, related negatively with productivity. The age and replacements of breeding pair members had also an influence on productivity, with more fledglings associated to adult pairs with few replacements, as expected in long-lived species. At the population level, mean productivity was higher in those population-years with lower dietary breadth and higher diet similarity among territories, which was related to an overall higher consumption of preferred prey. Thus, we revealed a correspondence in diet-fitness relationships at two spatial scales: territories and populations. We suggest that stable isotope analyses may be a powerful tool to monitor the diet of terrestrial avian predators on large spatio-temporal scales, which could serve to detect potential changes in the availability of those prey on which predators depend for breeding. We encourage ecologists and evolutionary and conservation biologists concerned with the multi-scale fitness consequences of inter-individual variation in resource use to employ similar stable isotope-based approaches, which can be successfully applied to complex ecosystems such as the Mediterranean.

Mobile terminal adaptation in portal for better usability

Elektroniset finanssipalvelut, erityisesti Internetin kautta käytettynä, on kasvava alue. Elektronisten finanssipalveluiden tarjoajan tulee pystyä tarjoamaan laaja käytettävyys kaikkien kanavien kautta. Laajan käytettävyyden avulla asiakas voi valita haluamansa kanavan haluamanaan aikana. Palveluntarjoajalla tulee olla joustava arkkitehtuuri pystyäkseen tukemaan asiakkaiden muuttuvia vaatimuksia. Joustavalla arkkitehtuurilla päätelaitteeseen mukautuminen on mahdollista ja näin palveluntarjoaja pystyy tarjoamaan tuen monille eri päätelaitteille ja teknologioille helposti ja nopeasti. Diplomityö keskittyy tutkimaan mahdollisuutta monen kanavan tukeen ja päätelaitteeseen mukautumista Nordean tulevassa finanssiportaaliratkaisussa. Tämä pitäisi olla mahdollista uuden arkkitehtuurin kanssa, jonka TietoEnator on toteuttanut yhteistyössä Nordean kanssa. Sivujen rakenteen uudelleenjärjestelyillä saatiin hyviä tuloksia. Nykyisestä arkkitehtuurissa löydettiin myös puutteita ja jäljelle jäi avoimia kysymyksiä, jotka kirjattiin ylös. On selvästi nähtävissä, että tehokas päätelaitteeseen mukautuminen ja tuki monelle kanavalle tuo hyötyjä sekä pankille että asiakkaalle.

Diet-related buccal dental microwear patterns in central african pygmy foragers and bantu-speaking farmer and pastoralist populations.

Pygmy hunter-gatherers from Central Africa have shared a network of socioeconomic interactions with non-Pygmy Bantu speakers since agropastoral lifestyle spread across sub-Saharan Africa. Ethnographic studies have reported that their diets differ in consumption of both animal proteins and starch grains. Hunted meat and gathered plant foods, especially underground storage organs (USOs), are dietary staples for pygmies. However, scarce information exists about forager-farmer interaction and the agricultural products used by pygmies. Since the effects of dietary preferences on teeth in modern and past pygmies remain unknown, we explored dietary history through quantitative analysis of buccal microwear on cheek teeth in well-documented Baka pygmies. We then determined if microwear patterns differ among other Pygmy groups (Aka, Mbuti, and Babongo) and between Bantu-speaking farmer and pastoralist populations from past centuries. The buccal dental microwear patterns of Pygmy hunter-gatherers and non-Pygmy Bantu pastoralists show lower scratch densities, indicative of diets more intensively based on nonabrasive foodstuffs, compared with Bantu farmers, who consume larger amounts of grit from stoneground foods. The Baka pygmies showed microwear patterns similar to those of ancient Aka and Mbuti, suggesting that the mechanical properties of their preferred diets have not significantly changed through time. In contrast, Babongo pygmies showed scratch densities and lengths similar to those of the farmers, consistent with sociocultural contacts and genetic factors. Our findings support that buccal microwear patterns predict dietary habits independent of ecological conditions and reflect the abrasive properties of preferred or fallback foods such as USOs, which may have contributed to the dietary specializations of ancient human populations.

Teleoperaattorin suurasiakasmyynnin myyntiprosessin kehittäminen

Diplomityön tavoitteena oli selvittää erään teleoperaattorina toimivan yrityksen sisäisen liiketoimintayksikön nykyisiä kumppanuusmalleja ja toimintatapoja sekä tehdä vaiheistettu ehdotus toiminnan tehostamisesta uudella mallilla. Tämä yksikkö toimii yrityksen suurasiakasmyyntiyksikkönä. Tavoitteena on luoda kehitettävistä uusista toimintamalleista uusi myyntiprosessi ja ottaa se käytäntöön vaiheistetusti. Tutkimuksen ensimmäisessä vaiheessa selvitettiin yrityksen suurasiakasmyyntiyksikön nykyiset kumppanuusmallit ja myyntiprosessi. Tässä keskityttiin myyntiyksikön kannalta merkittäviin toimintoihin. Yrityksen suurasiakasmyynnin toiminnassa havaittiin ongelmana myyntihenkilöstön ajankäyttö, jonka taustoja selvitettiin. Suurin osa myyjien ajasta kului päivittäisrutiinien suorittamiseen ja ongelmatilanteiden selvittämiseen. Tällaisia tilanteita olivat mm. laskutusepäselvyydet, asennustöiden viivästymiset ja tarjousten teknisten ratkaisuiden tekeminen. Nämä toiminnot veivät yli puolet myyjien ajasta, josta tavoitteellisesti yli 80 prosenttia pitäisi kulua asiakkaiden kanssa suoraan toimimiseen. Tutkimuksen teoriataustana käytettiin kahta prosessijohtamisen koulukuntaa; BPR:ää (Business Process Reengineering) ja TQM:ää (Total Quality Management). Niihin perehdyttiin kirjallisuuden ja artikkeleiden avulla ja tähän työhön niistä kirjoitettiin merkitykselliset osat. Yrityksen suurasiakasmyyntiyksikön uuden myyntiprosessin kehittäminen aloitettiin segmentoimalla sen asiakkaat avain-, kanta-, kasvu- ja arvoasiakkaisiin. Näille segmenteille kehitettiin omat myyntimallinsa, joihin liittyi niille suunnattava tarjooma (tuotevalikoima). Tämän jälkeen myyntimallit koulutettiin henkilöstölle ja samalla kerättiin informaatiota uuden myyntiprosessin luomista varten. Uusi myyntiprosessi jakautuu viiteen vaiheeseen. Pre sales –vaiheessa (1) keskitytään asiakkuuksien johtamiseen, yrityksen myyjien oman organisaation ja liiketoimintaympäristön tuntemukseen ja uusasiakashankintaan. Ehdotusvaiheessa (2) tehdään asiakkaalle ehdotus kehitysprojektista, jonka tähtäimenä on luoda asiakkaalle tarve hyödyntää tietoliikennettä omassa toiminnassaan. Tämän toiminnan tavoitteena on päästä mukaan mahdollisimman syvälle asiakkaan liiketoimintaan ja sitä kautta kasvattaa liikevaihtoa ja kannattavuutta. Myyntivaiheessa (3) asiakkaalta on saapunut tarjouspyyntö ja sen pohjalta valmistellaan tarjous. Tämän jälkeen käydään tarkentavia neuvotteluita ja pyritään saamaan suotuisa päätös ja sitä kautta tilaus asiakkaalta. Toimitusvaiheessa (4) myydyt tuotteet ja palvelut syötetään tilausjärjestelmiin ja toimitetaan asiakkaalle. Tämän jälkeen seuraa toimituksen kertalaskutus ja jälkimyynti/markkinointi, jolla jo kertaalleen myydyt tuotteet ja palvelut ikään kuin myydään asiakkaalle uudestaan. Viimeinen vaihe on after sales –vaihe (5), jossa varmistetaan myytyjen tuotteiden ja palveluiden ja niiden kausilaskutuksen toimivuudet, tehdään raportointia ja myydään asiakkaalle jo myytyjen tuotteiden lisäksi uusia lisäpalveluita.

Single breath-hold 3D measurement of left atrial volume using compressed sensing cardiovascular magnetic resonance and a non-model-based reconstruction approach.

BACKGROUND: Left atrial (LA) dilatation is associated with a large variety of cardiac diseases. Current cardiovascular magnetic resonance (CMR) strategies to measure LA volumes are based on multi-breath-hold multi-slice acquisitions, which are time-consuming and susceptible to misregistration. AIM: To develop a time-efficient single breath-hold 3D CMR acquisition and reconstruction method to precisely measure LA volumes and function. METHODS: A highly accelerated compressed-sensing multi-slice cine sequence (CS-cineCMR) was combined with a non-model-based 3D reconstruction method to measure LA volumes with high temporal and spatial resolution during a single breath-hold. This approach was validated in LA phantoms of different shapes and applied in 3 patients. In addition, the influence of slice orientations on accuracy was evaluated in the LA phantoms for the new approach in comparison with a conventional model-based biplane area-length reconstruction. As a reference in patients, a self-navigated high-resolution whole-heart 3D dataset (3D-HR-CMR) was acquired during mid-diastole to yield accurate LA volumes. RESULTS: Phantom studies. LA volumes were accurately measured by CS-cineCMR with a mean difference of -4.73 ± 1.75 ml (-8.67 ± 3.54%, r2 = 0.94). For the new method the calculated volumes were not significantly different when different orientations of the CS-cineCMR slices were applied to cover the LA phantoms. Long-axis "aligned" vs "not aligned" with the phantom long-axis yielded similar differences vs the reference volume (-4.87 ± 1.73 ml vs. -4.45 ± 1.97 ml, p = 0.67) and short-axis "perpendicular" vs. "not-perpendicular" with the LA long-axis (-4.72 ± 1.66 ml vs. -4.75 ± 2.13 ml; p = 0.98). The conventional bi-plane area-length method was susceptible for slice orientations (p = 0.0085 for the interaction of "slice orientation" and "reconstruction technique", 2-way ANOVA for repeated measures). To use the 3D-HR-CMR as the reference for LA volumes in patients, it was validated in the LA phantoms (mean difference: -1.37 ± 1.35 ml, -2.38 ± 2.44%, r2 = 0.97). Patient study: The CS-cineCMR LA volumes of the mid-diastolic frame matched closely with the reference LA volume (measured by 3D-HR-CMR) with a difference of -2.66 ± 6.5 ml (3.0% underestimation; true LA volumes: 63 ml, 62 ml, and 395 ml). Finally, a high intra- and inter-observer agreement for maximal and minimal LA volume measurement is also shown. CONCLUSIONS: The proposed method combines a highly accelerated single-breathhold compressed-sensing multi-slice CMR technique with a non-model-based 3D reconstruction to accurately and reproducibly measure LA volumes and function.

Urinary and plasma catecholamines and metanephrines in dogs with pheochromocytoma, hypercortisolism, nonadrenal disease and in healthy dogs.

BACKGROUND: Diagnosis of pheochromocytoma (PC) is based on a combination of clinical suspicion, finding an adrenal mass, increased plasma, and urine concentrations of catecholamine metabolites and is finally confirmed with histopathology. In human medicine, it is controversial whether biochemically testing plasma is superior to testing urine. OBJECTIVES: To measure urinary and plasma catecholamines and metanephrines in healthy dogs, dogs with PC, hypercortisolism (HC), and nonadrenal diseases (NAD) and to determine the test with the best diagnostic performance for dogs with PC. ANIMALS: Seven PC dogs, 10 dogs with HC, 14 dogs with NAD, 10 healthy dogs. METHODS: Prospective diagnostic clinical study. Urine and heparin plasma samples were collected and stored at -80°C before analysis using high-pressure liquid chromatography (HPLC) coupled to electrochemical detection or tandem mass spectrometry were performed. Urinary variables were expressed as ratios to urinary creatinine concentration. RESULTS: Dogs with PC had significantly higher urinary normetanephrine and metanephrine : creatinine ratios and significantly higher plasma-total and free normetanephrine and plasma-free metanephrine concentrations compared to the 3 other groups. There were no overlapping results of urinary normetanephrine concentrations between PC and all other groups, and only one PC dog with a plasma normetanephrine concentration in the range of the dogs with HC and NAD disease. Performances of total and free plasma variables were similar. Overlap of epinephrine and norepinephrine results between the groups was large with both urine and plasma. CONCLUSION AND CLINICAL IMPORTANCE: Measurement of normetanephrine is the preferred biochemical test for PC and urine was superior to plasma.

Financing public education when altruistic agents have retirement concerns

[cat]El capital humà i, per tant, l’educació tenen un impacte en el benestar futur de la societat. En aquest treball s’estudia la connexió entre el suport dels votants per una educació pública i les preocupacions sobre la seva jubilació. Mostrem com els votants anticipen els efectes positius que té l’educació sobre les pensions futures. Així, el recolzament a un sistema educatiu públic s’incrementa si el sistema de pensions és més redistributiu, cosa que també es dóna entre els ciutadans que prefereixen una educació privada. També mostrem que el tipus d’equilibri “ends against the middle” pot ocórrer fins i tot quan la taxa impositiva preferida pels votants és decreixent amb la renda.

Financing public education when altruistic agents have retirement concerns

[cat]El capital humà i, per tant, l’educació tenen un impacte en el benestar futur de la societat. En aquest treball s’estudia la connexió entre el suport dels votants per una educació pública i les preocupacions sobre la seva jubilació. Mostrem com els votants anticipen els efectes positius que té l’educació sobre les pensions futures. Així, el recolzament a un sistema educatiu públic s’incrementa si el sistema de pensions és més redistributiu, cosa que també es dóna entre els ciutadans que prefereixen una educació privada. També mostrem que el tipus d’equilibri “ends against the middle” pot ocórrer fins i tot quan la taxa impositiva preferida pels votants és decreixent amb la renda.

Detection of Clinically Significant Prostate Cancer Using Magnetic Resonance Imaging-Ultrasound Fusion Targeted Biopsy: A Systematic Review.

CONTEXT: The current standard for diagnosing prostate cancer in men at risk relies on a transrectal ultrasound-guided biopsy test that is blind to the location of the cancer. To increase the accuracy of this diagnostic pathway, a software-based magnetic resonance imaging-ultrasound (MRI-US) fusion targeted biopsy approach has been proposed. OBJECTIVE: Our main objective was to compare the detection rate of clinically significant prostate cancer with software-based MRI-US fusion targeted biopsy against standard biopsy. The two strategies were also compared in terms of detection of all cancers, sampling utility and efficiency, and rate of serious adverse events. The outcomes of different targeted approaches were also compared. EVIDENCE ACQUISITION: We performed a systematic review of PubMed/Medline, Embase (via Ovid), and Cochrane Review databases in December 2013 following the Preferred Reported Items for Systematic reviews and Meta-analysis statement. The risk of bias was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. EVIDENCE SYNTHESIS: Fourteen papers reporting the outcomes of 15 studies (n=2293; range: 13-582) were included. We found that MRI-US fusion targeted biopsies detect more clinically significant cancers (median: 33.3% vs 23.6%; range: 13.2-50% vs 4.8-52%) using fewer cores (median: 9.2 vs 37.1) compared with standard biopsy techniques, respectively. Some studies showed a lower detection rate of all cancer (median: 50.5% vs 43.4%; range: 23.7-82.1% vs 14.3-59%). MRI-US fusion targeted biopsy was able to detect some clinically significant cancers that would have been missed by using only standard biopsy (median: 9.1%; range: 5-16.2%). It was not possible to determine which of the two biopsy approaches led most to serious adverse events because standard and targeted biopsies were performed in the same session. Software-based MRI-US fusion targeted biopsy detected more clinically significant disease than visual targeted biopsy in the only study reporting on this outcome (20.3% vs 15.1%). CONCLUSIONS: Software-based MRI-US fusion targeted biopsy seems to detect more clinically significant cancers deploying fewer cores than standard biopsy. Because there was significant study heterogeneity in patient inclusion, definition of significant cancer, and the protocol used to conduct the standard biopsy, these findings need to be confirmed by further large multicentre validating studies. PATIENT SUMMARY: We compared the ability of standard biopsy to diagnose prostate cancer against a novel approach using software to overlay the images from magnetic resonance imaging and ultrasound to guide biopsies towards the suspicious areas of the prostate. We found consistent findings showing the superiority of this novel targeted approach, although further high-quality evidence is needed to change current practice.

The potential of different fruit species as food for Harmonia axyridis (Pallas, 1773) (Coleoptera: Coccinellidae)

Harmonia axyridis was detected for the first time in Brazil in 2002. Since then, it has been recorded from the South to the Midwest of the country. Until now, almost all the registered cases were associated with the presence of aphids, its preferred source of food. Due to the occurrence of this species in areas of fruit growing in the South and Southeast of Brazil, the aim of this study was to analyze the preference and use of three different cultivars of fruit. The tests were set at 25ºC ± 1ºC, RH 70% ± 10%, and in a photophase of 12 h and with apples (Gala and Fuji), grapes (Niágara and Rubi), and pears (Williams and Asian). In the undamaged fruit experiment, the insects did not cause any noticeable damage. In the damaged and undamaged fruit experiment, a higher and statistically significant percentage of H. axyridis adults were found in the three damaged fruits. In the different cultivar experiment the Niágara grape, the Gala apple, and the Williams pear were significantly preferred by H. axyridis adults. These results may help in the management of this insect, preventing damage, which have been observed in other places where H. axyridis was introduced.

INFLUENCE OF INFORMATION ABOUT THE BENEFITS OF CONSUMING FRUIT ON CONSUMER PREFERENCES IN TEMUCO, REGION OF THE ARAUCANÍA

ABSTRACT With the aim of identifying strategies to increase fruit consumption in Temuco, consumer segments were classified according to the importance and preference of theattributes type of fruit, package/ brand, benefit associated with fruit consumption and price. A survey was applied to 400 people in Temuco,Chile, distributed using a simple allocation: 200 working adults and 200university students. The questionnaire included the SWFL (Satisfaction with Food-related Life) scale, respondents’ fruit consumption habits and their characteristics. Using conjoint and cluster analyses, three segments were distinguished: Group 1 (22.0%) gave greatest importance to the package/brand and preferred themessage “prevents diseases” and “without information”; Group 2 (47.5%) gave greatest importance to the package/brand and preferred the message “prevents diseases”; Group 3 (30.5%) assigned greatest importance to the price and preferred the message “contains antioxidants”. The segments differed in their level of satisfaction with food-related life, self-declared lifestyle, age and presence of university students. The results provide input to promote fruit consumption in working adults and university students.

Customer Expectations and Organizational Buying Behavior in the Flexible Packaging Markets

Tämä työ on tehty yhteistyössä kansainvälisen metsäteollisuusyrityksen Stora Enson kanssa. Työ on osa Stora Enson strategiaa kehitettäessä uusia ja innovatiivisia pakkausmateriaaleja ja ratkaisuja joustopakkausmarkkinoille. Työn päätavoitteina oli selvittää, millaisia odotuksia tuotemerkkienomistajilla ja jatkojalostajilla on joustopakkauksista ja kuinka pakkausten ostopäätökset syntyvät monitahoisessa liikeympäristössä. Työn teoreettinen viitekehys jaettiin kahteen osaan. Asiakasodotuksia lähestyttiin tutkimalla eri palvelu- ja tuotelaadun ulottuvuuksia, ja teollisuuden ostokäyttäytymistä tutkittiin organisaatioiden ostokäyttämistä kuvaavien mallien avulla. Työn empiirisessä osuudessa käytettiin laadullista tutkimusmenetelmää käsittäen asiakashaastatteluja lähinnä Yhdysvalloissa. Haastateltavat yritykset koostuivat maailman johtavista kuluttajatuotteita valmistavista yrityksistä sekä jatkojalostajista. Tutkimustulosten mukaan odotukset pakkauksista liittyvät lähinnä tuotteen suojaamiseen sekä myynnin edistämiseen. Pääodotuksina on myös saada mahdollisimman edullisia papereita, mahdollisimman hyvillä barrier- ja paino-ominaisuuksilla. Tutkimustulokset osoittavat myös, että paperiyhtiöt ovat epäonnistuneet tekemään itseään tunnetuksi teollisuudelle ja heidän odotetaan olevan tulevaisuudessa aggressiivisempia ja innovatiivisempia. Tuotemerkkienomistajat ostavat pakkaukset ja pakkausmateriaalit normaalisti mieluiten jatkojalostajiensa kautta, mutta silti he toivovat yhteistyötä paperintoimittajien kanssa kunhan vain myös jatkojalostajat sisällytetään toimintaan mukaan.

Students support demographically-based quotas with distributive justice rules favoring their selection at university

We manipulate distributive justice rules of demographic quotas in university selection. Results show that quotas involving students' need are preferred over equity and authority ranking quotas. International students also differentiate more between quotas than locals, preferring those advantaging them. This suggests that universities should consider students' need in their selection.