MR morphometry of posterior tibialis muscle in adult acquired flat foot

We conducted magnetic resonance imaging of the posterior tibial (PT) and flexor digitorum longus (FDL) muscle bellies in 12 patients undergoing surgical treatment for unilateral posterior tibial tendon (PTT) dysfunction. All patients had atrophy of the PT muscle compared to the normal leg (mean 10.7%, p=0.008). In those patients with a complete rupture of PTT there was replacement of the PT muscle by fatty infiltration. Conversely, the FDL muscle showed a compensatory hypertrophy (mean 17.2%, p

Use of pulse transit time to distinguish respiratory events from tidal breathing in sleeping children

Study objectives: Currently, esophageal pressure monitoring is the "gold standard" measure for inspiratory efforts, hut its invasive nature necessitates a better tolerated and noninvasive method to be used on children. Pulse transit time (PTT) has demonstrated its potential as a noninvasive surrogate marker for inspiratory efforts. The principle velocity determinant of PTT is the change in stiffness of the arterial wall and is inversely correlated to BP. Moreover, PTT has been shown to identify changes in inspiratory effort via the BP fluctuations induced by negative pleural pressure swings. In this study, the capability of PTT to classify respiratory, events during sleep as either central or obstructive in nature was investigated. Setting and participants: PTT measure was used in adjunct to routine overnight polysomnographic studies performed on 33 children (26 boys and 7 girls; mean +/- SD age, 6.7 +/- 3.9 years). The accuracy of PTT measurements was then evaluated against scored corresponding respiratory events in the polysomnography recordings. Results: Three hundred thirty-four valid respiratory events occurred and were analyzed. One hundred twelve obstructive events (OEs) showed a decrease in mean PTT over a 10-sample window that had a probability of being correctly ranked below the baseline PTT during tidal breathing of 0.92 (p < 0.005); 222 central events (CEs) showed a decrease in the variance of PTT over a 10-sample window that had a probability of being ranked below the baseline PTT of 0.94 (p < 0.005). This indicates that, at a sensitivity of 0.90, OEs can be detected with a specificity of 0.82 and CEs can be detected with a specificity of 0.80. Conclusions: PTT is able to categorize CEs and OEs accordingly in the absence of motion artifacts, including hypopneas. Hence, PTT shows promise to differentiate respiratory, events accordingly and can be an important diagnostic tool in pediatric respiratory sleep studies.< 0.005); 222 central events (CEs) showed a decrease in the variance of PTT over a 10-sample window that had a probability of being ranked below the baseline PTT of 0.94 (p < 0.005). This indicates that, at a sensitivity of 0.90, OEs can be detected with a specificity of 0.82 and CEs can be detected with a specificity of 0.80. Conclusions: PTT is able to categorize CEs and OEs accordingly in the absence of motion artifacts, including hypopneas. Hence, PTT shows promise to differentiate respiratory, events accordingly and can be an important diagnostic tool in pediatric respiratory sleep studies.');"

Pulse transit time as a derived noninvasive mean to monitor arterial distensibility changes in children

Changes in arterial distensibility have been widely used to identify the presence of cardiovascular abnormalities like hypertension. Pulse wave velocity (PWV) has shown to be related to arterial distensibility. However, the lack of suitable techniques to measure PWV nonintrusively has impeded its clinical usefulness. Pulse transit time (PTT) is a noninvasive technique derived from the principle of PWV. PTT has shown its capabilities in cardiovascular and cardiorespiratory studies in adults. However, no known study has been conducted to understand the suitability and utility of PTT to estimate PWV in children. Two computational methods to derive PWV from PTT values obtained from 23 normotensive Caucasian children (19 males, aged 5-12 years old) from their finger and toe were conducted. Furthermore, the effects of adopting different postures on the PWV derivations were investigated. Statistical analyses were performed in comparison with two previous PWV studies conducted on children. Results revealed that PWV derived from the upper limb correlated significantly (P

Variability in time delay between two models of pulse oximeters for deriving the photoplethysmographic signals

Pulse oximetry is commonly used as an arterial blood oxygen saturation (SaO(2)) measure. However, its other serial output, the photoplethysmography (PPG) signal, is not as well studied. Raw PPG signals can be used to estimate cardiovascular measures like pulse transit time (PTT) and possibly heart rate (HR). These timing-related measurements are heavily dependent on the minimal variability in phase delay of the PPG signals. Masimo SET (R) Rad-9 (TM) and Novametrix Oxypleth oximeters were investigated for their PPG phase characteristics on nine healthy adults. To facilitate comparison, PPG signals were acquired from fingers on the same hand in a random fashion. Results showed that mean PTT variations acquired from the Masimo oximeter (37.89 ms) were much greater than the Novametrix (5.66 ms). Documented evidence suggests that I ms variation in PTT is equivalent to I mmHg change in blood pressure. Moreover, the PTT trend derived from the Masimo oximeter can be mistaken as obstructive sleep apnoeas based on the known criteria. HR comparison was evaluated against estimates attained from an electrocardiogram (ECG). Novametrix differed from ECG by 0.71 +/- 0.58% (p < 0.05) while Masimo differed by 4.51 +/- 3.66% (p > 0.05). Modem oximeters can be attractive for their improved SaO(2) measurement. However, using raw PPG signals obtained directly from these oximeters for timing-related measurements warrants further investigations.

Predictive regression equations and clinical uses of peripheral pulse timing characteristics in children

Studies have shown that increased arterial stiffening can be an indication of cardiovascular diseases like hypertension. In clinical practice, this can be detected by measuring the blood pressure (BP) using a sphygmomanometer but it cannot be used for prolonged monitoring. It has been established that pulse wave velocity (PWV) is a direct measure of arterial stiffening but its usefulness is hampered by the absence of non-invasive techniques to estimate it. Pulse transit time (PTT) is a simple and non-invasive method derived from PWV. However, limited knowledge of PTT in children is found in the present literature. The aims of this study are to identify independent variables that confound PTT measure and describe PTT regression equations for healthy children. Therefore, PTT reference values are formulated for future pathological studies. Fifty-five Caucasian children (39 male) aged 8.4 +/- 2.3 yr (range 5-12 yr) were recruited. Predictive equations for PTT were obtained by multiple regressions with age, vascular path length, BP indexes and heart rate. These derived equations were compared in their PWV equivalent against two previously reported equations and significant agreement was obtained (p < 0.05). Findings herein also suggested that PTT can be useful as a continuous surrogate BP monitor in children.

Age-related factors that confound peripheral pulse timing characteristics in Caucasian children

Characteristics obtained from peripheral pulses can be used to assess the status of cardiovascular system of subjects. However, nonintrusive techniques are preferred when prolonged monitoring is required for their comfort. Pulse transit time ( PTT) measurement has showed its potentials to monitor timing changes in peripheral pulse in cardiovascular and respiratory studies. In children, the common peripheries used for these studies are fingers or toes. Presently, there is no known study conducted on children to investigate the possible physiologic parameters that can confound PTT measure at these sites. In this study, PTT values from both peripheral sites were recorded from 55 healthy Caucasian children ( 39 male) with mean age of 8.4 +/- 2.3 years ( range 5 - 12 years). Peripheries' path length, heart rate, systolic blood pressure, diastolic blood pressure ( DBP) and mean arterial pressure ( MAP) were measured to investigate their contributions to PTT measurement. The results reveal that PTT is significantly related to all parameters ( P< 0.05), except for DBP and MAP. Age is observed to be the dominant factor that affects PTT at both peripheries in a child. Regression equations for PTT were derived for measuring from a finger and toe, ( 6.09 age + 189.2) ms and ( 6.70 age + 243.0) ms, respectively.

Pulse transit time changes observed with different limb positions

Pulse transit time (PTT) is a non-invasive measure of arterial compliance. It can be used to assess instantaneous blood pressure (BP) changes in continual cardiovascular measurement such as during overnight respiratory sleep studies. In these studies, periodic changes in limb position can occur randomly. However, little is known about their possible effects on PTT monitored on the various limbs. The objective of this study was to evaluate PTT differences on all four limbs during two positional changes (lowering and raising of a limb). Ten healthy adults (seven male) with a mean age of 27.0 years were recruited in this study. The results showed that the limb that underwent a positional change had significant (p < 0.05) local PTT differences when compared to its nominal baseline value, whereas PTT changes in the other remaining limbs were insignificant (p > 0.05). The mean PTT value measured from a vertically-raised limb increased by 42.7 ms, while it decreased by 28.1 ms with a half-lowered limb. The PTT differences observed during positional change can be contributed to by the complex interactions between hydrostatic pressure changes, autonomic and local autoregulation experienced in these limbs. Hence the findings herein suggest that PTT is able to reflect local circulatory responses despite changes in the position of other limbs. This can be useful in prolonged clinical observations where limb movements are expected.

Screening of obstructive and central apnoea/hypopnoea in children using variability: A preliminary study

Aim: Polysomnography (PSG) is the current standard protocol for sleep disordered breathing (SDB) investigation in children. Presently, there are limited reliable screening tests for both central (CE) and obstructive (OE) respiratory events. This study compared three indices, derived from pulse oximetry and electrocardiogram ( ECG), with the PSG gold standard. These indices were heart rate (HR) variability, arterial blood oxygen de-saturation (SaO(2)) and pulse transit time (PTT). Methods: 15 children (12 male) from routine PSG studies were recruited (aged 3 - 14 years). The characteristics of the three indices were based on known criteria for respiratory events (RPE). Their estimation singly and in combination was evaluated with simultaneous scored PSG recordings. Results: 215 RPE and 215 tidal breathing events were analysed. For OE, the obtained sensitivity was HR (0.703), SaO(2) (0.047), PTT (0.750), considering all three indices (0) and either of the indices (0.828) while specificity was (0.891), (0.938), (0.922), (0.953) and (0.859) respectively. For CE, the sensitivity was HR (0.715), SaO(2) (0.278), PTT (0.662), considering all indices (0.040) and either of the indices (0.868) while specificity was (0.815), (0.954), (0.901), (0.960) and (0.762) accordingly. Conclusions: Preliminary findings herein suggest that the later combination of these non-invasive indices to be a promising screening method of SDB in children.

Differentiating responses to obstructive sleep apnoea using pulse transit time

Conventional overnight polysomnography (PSG) used to determine the respiratory behaviour during sleep can be a complex and expensive procedure. Pulse transit time analysis (PTT) has shown potential to detect obstructive apnoeic and hypopnoeic events in adults. This study was undertaken to determine the potential of PTT to differentiate responses to upper airway obstruction. 103 obstructive respiratory events occurred in PSG studies performed on 11 children (10 male and 1 female, mean age 7.5years). PTT measurements were evaluated against the corresponding PSG results pre-scored by 2 blinded observers. Broadly, there were 2 types of responses. They can be either short period of rapid PTT decreases (Type 1) or prolonged but gradual PTT decreases (Type 2). Type 1 obstructive events showed a mean change of 51.77% (p

Confounding physiologic parameters in pulse transit time monitoring of children

Pulse Transit Time (PTT) measurement has showed potential in non-invasive monitoring of changes in blood pressure. In children, the common peripheral sites used for these studies are a finger or toe. Presently, there are no known studies conducted to investigate any possible physiologic parameters affecting PTT measurement at these sites for children. In this study, PTT values of both peripheral sites were recorded from 64 children in their sitting posture. Their mean age with standard deviation (SD) was 8.2 2.6years (ranged 3 to 12years). Subjects' peripheries path length, heart rate (HR), systolic (SBP) and diastolic blood pressure (DBP) were measured to investigate any contributions to PTT measurement. The peripheral pulse timing characteristic measured by photoplethysmography (PPG) shows a 59.5 8.5ms (or 24.8 0.4%) difference between the two peripheries (p

Use of regression equation of peripheral pulse timing characteristics to predict hypertension in children

Studies have shown that an increase in arterial stiffening can indicate the presence of cardiovascular diseases like hypertension. Current gold standard in clinical practice is by measuring the blood pressure of patients using a mercury sphygmomanometer. However, the nature of this technique is not suitable for prolonged monitoring. It has been established that pulse wave velocity is a direct measure of arterial stiffening. However, its usefulness is hampered by the absence of techniques to estimate it non-invasively. Pulse transit time (PTT) is a simple and non-intrusive method derived from pulse wave velocity. It has shown its capability in childhood respiratory sleep studies. Recently, regression equations that can predict PTT values for healthy Caucasian children were formulated. However, its usefulness to identify hypertensive children based on mean PTT values has not been investigated. This was a continual study where 3 more Caucasian male children with known clinical hypertension were recruited. Results indicated that the PTT predictive equations are able to identify hypertensive children from their normal counterparts in a significant manner (p < 0.05). Hence, PTT can be a useful diagnostic tool in identifying hypertension in children and shows potential to be a non-invasive continual monitor for arterial stiffening.

Relations between physiologic parameters and pulse transit time during loaded breathing

Pulse transit time (PTT) is a non-invasive measure, defined as time taken for the pulse pressure waves to travel from the R-wave of electrocardiogram to a selected peripheral site. Baseline PTT value is known to be influenced by physiologic variables like heart rate (HR), blood pressure (BP) and arterial compliance (AC). However, few quantitative data are available describing the factors which can influence PTT measurements in a child during breathing. The aim of this study was to investigate the effects of changes in breathing efforts on PTT baseline and fluctuations. Two different inspiratory resistive loading (IRL) devices were used to simulate loaded breathing in order to induce these effects. It is known that HR can influence the normative PTT value however the effect of HR variability (HRV) is not well-studied. Two groups of 3 healthy children ( 0.05) HR changes during all test activities. Results showed that HRV is not the sole contributor to PTT variations and suggest that changes in other physiologic parameters are also equally important. Hence, monitoring PTT measurement can be indicative of these associated changes during tidal or increased breathing efforts in healthy children.

A new creep test method for asphalt mixtures

A new creep test, Partial Triaxial Test (PTT), was developed to study the permanent deformation properties of asphalt mixtures. The PTT used two duplicate platens whose diameters were smaller than the diameter of the cylindrical asphalt mixtures specimen. One base platen was centrally placed under the specimen and another loading platen was centrally placed on the top surface of the specimen. Then the compressive repeated load was applied on the loading platen and the vertical deformation of the asphalt mixture was recorded in the PTTs. Triaxial repeated load permanent deformation tests (TRT) and PTTs were respectively conducted on AC20 and SMA13 asphalt mixtures at 40°C and 60°C so as to provide the parameters of the creep constitutive relations in the ABAQUS finite element models (FEMs) which were built to simulate the laboratory wheel tracking tests. The real laboratory wheel tracking tests were also conducted on AC20 and SMA13 asphalt mixtures at 40°C and 60°C. Then the calculated rutting depth from the FEMs were compared with the measured rutting depth of the laboratory wheeling tracking tests. Results indicated that PTT was able to characterize the permanent deformation of the asphalt mixtures in laboratory. The rutting depth calculated using the parameters estimated from PTTs' results was closer to and showed better matches with the measured rutting than the rutting depth calculated using the parameters estimated from TRTs' results. Main reason was that PTT could better simulate the changing confinement conditions of asphalt mixtures in the laboratory wheeling tracking tests than the TRT.

Oman pelikokemuksensa herra? Pelaajan valta, toimijuus ja vallan illuusio The Walking Dead -videopelissä

Tutkielma tarkastelee zombiteemaisessa The Walking Dead -videopelissä (Telltale Games 2012) ilmeneviä pelaajan toimijuuden ja vallan ulottuvuuksia sekä niiden merkitystä pelikokemuksille pelianalyysin avulla. Keskiössä ovat pelikokemuksen aikana syntyvät kuvitteellisen vallan tuntemukset. Tutkielman tarkoituksena on selvittää, mikä merkitys pelissä tehdyillä valinnoilla ja niiden seurauksilla voi pelikokemukselle olla sekä lisäksi pohtia erilaisia konkreettisen vaikuttamisen keinoja. Tutkielma tarkastelee lisäksi niitä tapoja, joilla peli itse osallistuu rakentamaan ja vahvistamaan pelaajan tuntemuksia pelitarinan ja -kokemuksen hallinnasta. Tutkielman aineistona toimivat videopeli sekä Telltale Community -verkkokeskustelupalstalta kerätyt kommentit, jotka avartavat käsiteltyjä näkökulmia sekä tuovat esille pelaajien kokemuksia. Kommenttien perusteella tehty analyysi on laadullista, eikä pyri kattavaan otantaan. Videopeli on aina jossain määrin ennalta rakennettu kokonaisuus, mutta sen tuottamia kokemuksia ei voida koskaan täysin säädellä ennalta. Vaikka pelin valinta- ja etenemismahdollisuudet ovat tarkoin rajattuja, voi peli synnyttää pelaajissa vahvoja vallassa olemisen tunteita sekä uniikkeja pelikokemuksia, joihin muilla pelaajilla ei ole pääsyä. Huomio ei kohdistu yksittäisen pelaajan kokemuksiin vaan nimenomaan siihen, millä kaikilla mahdollisilla tavoilla peli voidaan kokea. Pelissä koetuista valtatuntemuksista tulee kuvitteellisia vasta silloin, jos pelaaja tulee tietoiseksi toimijuutensa rajallisuudesta tai vaikutusvaltansa pinnallisuudesta. Illuusion rikkoutuminen vähentää tunnetta vaikutusvallasta, muttei poista pelikokemuksen ainutlaatuisuutta. Pelaajalla on vapaus päättää pelaamisestaan, tekemistään tulkinnoista sekä siitä, mitkä pelin tapahtumat ovat hänelle tärkeitä. Pelaaja on oman pelikokemuksensa herra, koska hän voi antaa pelin tapahtumille haluamansa merkitykset.

Kumpi päätti? Työsopimuksen päättäjää koskevien riitojen ratkaiseminen tuomioistuimissa

Olen tutkielmassani tutkinut sellaisia työsopimuksen päättämiseen liittyviä riitoja, joissa on riitaisaa, kumpi työsuhteen osapuoli, työnantajan edustaja vai työntekijä, on päättänyt työsopimuksen. Aiheesta ei ole Suomessa juurikaan kirjoitettu. Aineistonani on ollut noin kaksisataa hovioikeustuomiota kaikista Suomen hovioikeuksista 80-luvulta nykypäivään. Tutkielmassani esitän oikeustapausaineistosta tekemieni johtopäätösten perusteella, että työsopimuslain 8:3 §:ssä säädettyä työnantajan oikeutta käsitellä työsopimusta purkautuneena on kumpi päätti –tyyppisissä riidoissa tulkittava supistavasti. Työntekijän poistuminen epäselvän tilanteen jälkeen ja poissaolo työstä luo työnantajalle selonottovelvollisuuden eli velvollisuuden varmistaa, tarkoittaako työntekijä näin tekemällä päättää työsopimuksensa. Työnantaja voi suoriutua velvollisuudestaan pyrkimällä ottamaan yhteyttä työntekijään ennen purkautuneena käsittelemistä. Työntekijän suojelun periaatetta ilmaisee myös oikeuskäytännössä vahvistunut tulkinta, jonka mukaan työsuhteen päättäminen on niin merkittävä oikeustoimi, että se on toteutettava selkeästi ja yksiselitteisesti niin, ettei osapuolen tarkoituksesta jää epäselvyyttä. Velvollisuus varmistautua sopimusosapuolen tarkoituksesta on ensisijaisesti työnantajalla. Kun sellaisiin sanoihin, jotka on kiihtyneenä harkitsemattomasti lausuttu tai jotka eivät ole muutoin vastanneet osapuolen tahtoa esimerkiksi erehdyksen vuoksi, vedotaan päämääränä päättää työsuhde tai saada korvauksia perusteettomasta päättämisestä, katsotaan tuollainen päättämisilmoitus pätemättömäksi ja päättämis- ilmoitukseen vetoava osapuoli työsopimuksen päättäjäksi. Tutkimani tyyppiset riidat ovat usein oikeustosiseikastonsa suhteen riitaisia. Oikeudellisessa arvioinnissa annetaan tällöin usein erityistä merkitystä sille, miten osapuolet ovat toimineet ennen päättämistilannetta ja sen jälkeen ja mitä keskusteluja on käyty asianosaisten välillä muutoin, sekä kumman osapuolen intressinä on ollut päättää työsuhde. Vertailen tutkielmassani vallitsevaa oikeustilaa kansainvälisesti, erityisesti Ruotsiin, ja katson, että muotovaatimuksen sisällyttäminen lakiin saattaisi merkittävästi vähentää kumpi päätti –tyyppisiä riitoja.