Search

Reformer und Moderate um Präsident Hassan Ruhani sind die Gewinner der Parlamentswahl im Iran. In der Hauptstadt Teheran können die Reformer sogar alle Sitze holen.

A 67-year-old man known with systemic sarcoidosis was admitted to the department of internal medicine because of cough and chest pain for several weeks. Thoracic tomodensitometry demonstrated multiple pulmonary nodules. Biopsies revealed features compatible with abscesses. Cultures and serologic tests were negative and the patient was successfully treated with prednisone. Three years later, a thoraco-abdominal tomodensitometry showed a relapse in the lung and also the apparition of similar lesions in the liver. Blood test revealed elevated CRP level at 40 mg/L and mild cholestasis. Biopsies of the liver excluded neoplastic or infectious diseases and showed inflammatory granulation tissue with abscess formation. A diagnosis of sarcoidosis-associated aseptic abscesses syndrome was then made, which was successfully treated with corticosteroids.

The building and construction industries worldwide are experiencing ever closer scrutiny of their operations as pressure mounts from clients to address the inefficiencies inherent therein. The issue of quality is of pivotal concern in this regard and this paper examines the status quo of a number of South African architectural practices with respect to how they are managing quality, and tests their opinions with regard to ISO 9000 certification as a means of addressing the issue. The results indicate that the architects in question generally have a poor grasp of quality management theory, although many of the eight main principles required for its implementation are already intrinsically present in the way they manage their practices; probably as a result of the small size of the average practice. A systematic and documented approach to quality management is however largely lacking in the profession and a great deal of negativity exists with regard to ISO 9000 certification.

Purpose: Investigation of adverse events associated with anesthetic procedures is a method of quality control that identifies topics to improve clinical care and patient safety. Most research to date has been based on closed claim registries and anonymous reports which have specific limitations. Therefore, to evaluate a hospital’s reporting system, the present study was designed to describe critical incidents that anesthesiologists voluntarily and non-anonymously reported through an anesthesia information management system. Methods: This is a historical observational cohort study on patients (age > 18 yr) undergoing anesthetic procedures in a tertiary referral hospital. A 20-item list of complications, as developed by the Netherlands Society of Anesthesiologists, was prospectively completed for each procedure. All critical incidents registered in the anesthesia information management system were then reclassified into 95 different critical incidents in a reproducible way. Results: There were 110,310 procedures performed in 65,985 patients, and after excluding 158 reports that did not depict a critical incident, 3,904 critical incidents in 3,807 (3.5%) anesthetic procedures remained. Technical difficulties with regional anesthesia (n = 445; 40 per 10,000 anesthetics; 95% confidence interval [CI], 36 to 44), hypotension (n = 432; 39 per 10,000 anesthetics; 95% CI, 35 to 43), and unexpected difficult intubation (n = 216; 20 per 10,000 anesthetics; 95% CI, 18 to 23) were the most frequently documented critical incidents. Conclusion: Accurate measurement and monitoring of critical incidents is crucial for patient safety. Despite the risk of underreporting and probable misclassification of manual reporting systems, our results give a comprehensive overview on the occurrence of voluntarily reported anesthesia-related critical incidents. This overview can direct development of a new reporting system and preventive strategies to decrease the future occurrence of critical incidents.

British commercial and political hopes to expand trade in the new Soviet state after 1920 were to an extent disappointed. Despite successful ventures by individual companies, in aggregate business fell short of expectations, especially compared with German and American competitors. The reasons were both (micro and macro) economic variables and political factors, in Britain and the USSR. From 1926 the Soviet regime was committed to rapid industrialization and a pattern of imports in which Germany enjoyed some comparative advantage. But, in contrast to major rivals, British governments occasionally tried to use trade as a political instrument to the disadvantage of commercial operations.

Team games, initially and principally cricket but later other games, were played in mental asylums in various parts of Britain from the mid-nineteenth century, before being abandoned in the move to 'care in the community' from c.1980s. Taking as a detailed example the Norfolk Lunatic Asylum (later St Andrew's Hospital), this article examines the use of games in patient therapy. Games were originally confined to male patients but later included women. Using archival and interview sources we assess the value of such therapy, the response of the patients and the demise of the idea before the final closure of the hospital.

Readers will be familiar with the work of such luminaries as the late Jim Riordan or Robert Edelman on sport in the USSR. This work examines, in detail, the formative years of the 1920s and 1930s w...

(2003). The Games Ethic and Industrial Capitalism Before 1914: The Provision of Company Sports. Sport in History: Vol. 23, No. 1, pp. 45-63.

Very-long-baseline interferometry (VLBI) for high-resolution astronomical imaging requires phase-stable frequency references at widely separated radio-telescope antennas. For the first time to our knowledge, we have disseminated a suitable radio-frequency (RF) reference for VLBI over a “real-world” telecom optical-fiber link between radio telescopes that are >100 km apart, by means of an innovative phase-conjugation technique. Bidirectional optical amplification is used in parallel with live traffic, and phase perturbations in the effective optical-fiber path length are compensated. This RF-over-fiber approach obviates the need for separate hydrogen masers at each antenna, offering significant advantages for radio-astronomy facilities such as the Square Kilometer Array.

Tom Mather, Best in the Northern Union: The Pioneering 1910 Rugby League Lions Tour of Australia and New Zealand (London: London League Publications Ltd., 2010). Pp. 149. £12.95 (pb). ISBN 978-1903...

Background: The simultaneous performance of a postural and suprapostural task has been shown to result in the deterioration of the performance of one or both tasks. For people with spinal cord injury (SCI), whose standing balance is challenged, it is unknown the extent to which they rely on attentional resources to maintain quiet stance. The overall aim of this study was to use a dual task paradigm to investigate the attentional requirements for maintaining standing balance in people with SCI. Methods: We recruited 9 adults with incomplete SCI and 8 matched able-bodied controls. Subjects were asked to perform two suprapostural tasks: a mathematical task (counting backwards by 3s) and an auditory reaction time (RT) task with eyes open/closed. Three single task (ST) trials were recorded: i) standing on force plates; ii) math task while seated; iii) RT task while seated. Two dual-task (DT) trials were recorded: i) standing + math task; ii) standing + RT task. The primary outcome measures were the change in performance between ST and DT between SCI and controls for: i) RT, ii) maximum standing time, iii) error ratio and total number of words uttered, and iv) movement reinvestment. Secondary outcomes such as center of pressure (CoP) measures from force plates as well as perceptual measures such as fear, confidence and perceived mental workload were also recorded. Results: SCI subjects stood for shorter duration during DT (stand and count) than ST (stand) compared to controls during eyes closed. Main effects between groups were observed for movement reinvestment, CoP performance, perceived mental effort, fear and confidence. No significant effects were observed for RT task or math task performance. Conclusion: Total standing time during eyes closed is adversely affected with the addition of a math task for SCI subjects. Perceptual measures such as increased fear and perceived mental workload and decreased confidence correspond to increases in postural sway and conscious control of standing in subjects with SCI. Individuals who can stand for >60 seconds eyes closed do not appear to be significantly affected by the addition of a concurrent secondary task of minimal mental workload.

In the spine, cancellous bone quality is usually assessed for the whole vertebral body in a transverse central slice. Correct identification and assessment of the weakest parts of the cancellous bone may lead to better prediction of fracture risk. The density and structural parameters were systematically investigated inside the thoracic (T-9), thoracolumbar (T12-L1), and lumbar (L-4) vertebral bodies of nine subjects. On both sides of the median sagittal plane, anterior and posterior 8.2 mm vertical cores were harvested in the thoracic vertebra. In the thoracolumbar and lumbar vertebrae, external samples were also cored. Peripheral quantitative computed tomographic (pQCT) density analysis of the 136 cores was performed at four different levels, from the lower to the upper endplate. The relatively thin slice thickness (300 microm) and small pixel size (70 microm x 70 microm) was considered sufficient to investigate the structural parameters on the four transverse slices and in the sagittal and coronal planes (total of 816 images). Using a constant threshold a binary image was generated and the morphometric data were extracted. The binary image was further skeletonized and classical strut analysis was performed. Cancellous bone density was 20% higher in the posterior cores than in the anterior and external cores. Moreover, clear vertical inhomogeneity was noted because the lowest half of the vertebral body presented lower density than the upper half (differences ranging from 25% to 15%). All structural parameters were strongly dependent on the location of the measurement. Structural differences between anterior, posterior, and external areas were mild and followed the density patterns. On the other hand, vertical inhomogeneity of the structural parameters was important. For example, in the thoracolumbar and lumbar vertebrae, the numbers of nodes or node-to-node struts were almost twofold higher in the inferior half than in the superior half (p < 0.01), whereas trabecular thickness and number of free-ends presented a center/close-to-endplate structural pattern, with central trabeculae being 15% thicker (p < 0.05) and presenting 30% fewer free-ends (p < 0.01) than the close-to-endplate ones. Variability of density and structural parameters was high and a substantial part of this variability could be explained by the place inside the vertebral body where the measurement was made. The weak part was not in the center of the body but in its upper half where the lower density did not seem to be compensated by a higher structural architecture. Further clinical investigation could enhance fracture prediction by tracking and focusing on the weakest part of the vertebral body.

Lotteries were used frequently for public revenue purposes in Britain in the eighteenth century, but were abandoned in the 1820s. Before its introduction in 1994, a national lottery in some form was considered in Britain several times: in the 1930s, 1960s (it was even proposed in the budget of 1968), 1970s and 1990s. In the USA, and to a lesser extent Australia and New Zealand, lotteries had also had some historical significance which was overridden in the nineteenth century. In much of continental Europe, this provision was not altogether dismissed as a policy but, in all cases, gambling was restricted. Renewed ‘liberalization’ in the twentieth century was brought about by the pressure of popular demand and, more important, governments seeking revenue. Thus, lotteries were revived and extended in the post-war years as supplementary sources of government finance. The political acceptability of state-sponsored or supported gambling in turn led to the growth of other gambling media. In Britain, by contrast, almost all forms of gambling were gradually permitted in law, under strict controls, before a national lottery was revived. Thus, the social acceptability of gambling was well established beforehand. The major reason for a return to a lottery, however, was to raise money for public expenditure as a politically acceptable tax. For government to support and to depend on revenue from gambling marks a major turning point in public policy and control.

After total hip arthroplasty with a medullary stem, significant loss of bone mineral density (BMD) has been demonstrated in the proximal-medial femoral cortex. In an attempt to prevent bone loss, a stemless femoral component was designed. Owing to promising experimental results, a prospective clinical trial was undertaken in a limited group of patients, all below the age of 50. Yearly BMD measurements were carried out in the vicinity of the implant and compared with the BMD values obtained in the immediate perioperative period and with the values on the unaffected side. The follow-up period in this study was 4 to 6 years, involving 32 hips in 31 patients. Maintenance of BMD in the operated femur was demonstrated. A statistically significant increase in the BMD of the proximal medial femoral cortex was observed in those patients who had low initial values. In active patients with a life expectancy greater than 30 years, preservation of the proximal bone stock after total hip arthroplasty appears beneficial, as these patients are most likely to need revision surgery, which is more difficult if significant bone loss has occurred. The data further reinforce the crucial role of mechanical stress in BMD maintenance.

Purpose: Since the Spine Tango registry was founded over a decade ago it has become established internationally. An annual report has been produced using the same format as the SWEspine group to allow for first data comparisons between the two registries. Methods: Data was captured with the latest generation of surgery and follow-up forms. Also, the Core Outcome Measures Index (COMI) from interventions performed in the year 2012 with follow-up to June 2013 was analyzed. Groups of patients with the most common degenerative lumbar spine diseases and a single group of patients with degenerative cervical spine diseases were created. The demographics, risk factors, previous treatments, current treatment, short-term outcomes, patient satisfaction and complications were analyzed. Pre- and postoperative pain and function scores were derived from the COMI. Results: About 6,500 procedures were captured with Spine Tango in 2012. The definitions and composition of all the degenerative groups could not completely be matched between the two registries with the consequence that the age and sex distributions were partially different. Preoperative pain levels were similar. The short-term outcomes available did not allow for evaluation of the final result of surgical intervention. This will be possible with the longer term data in the next annual report. There was a distinct disparity in reported complication rates between surgeons and patients. Conclusions: This is a valuable first step in creating comparable reports for SWEspine and Spine Tango. The German spine registry may be able to collaborate in the future because of similar items and data structure as Spine Tango. There needs to be more work on understanding the harmonization of the different degenerative subgroups. The Spine Tango report is weakened by the short and incomplete follow-up. The visual presentation of data may be a useful model for aiding decision making for surgeons and patients in the future

Given the relatively short survival time of total hip replacement in young patients, a different concept of femoral implant was designed and evaluated biomechanically prior to clinical application. The femoral component has no intramedullary stem and fits into an angular resection of the femoral neck. A trans-trochanteric screw provides immediate strong fixation. A comparative biomechanical study with cadaver femora and a dynamic hip simulator was performed. The study had three objectives. (1) The strains generated under loading in the intact proximal femur were compared to those generated in the presence of the experimental implant and a classic cemented implant. (2) The short-term stability of the experimental prosthesis under loading conditions encountered during fast walking was evaluated. (3) Most importantly, the implant design was improved in the light of the experimental observations prior to any clinical trial. Indeed, the prototype underwent several important modifications in the course of the study. With the modified design, later used in a clinical trial, it was demonstrated that if accurate fit and position of the prosthesis were provided, fixation remained sound for over one million loading cycles with peak loads of three times the body weight. The measured interface micromotion was compatible with direct bone apposition and ingrowth. No statistical difference was found between the strain measurements obtained before and after implantation of the experimental prosthesis whereas significant stress shielding was observed with a stemmed, cemented prosthesis.

Fragestellung: Das Ziel der Studie ist der Vergleich des Outcomes nach Dekompression (Deko) durch Laminotomie, versus Deko durch Laminektomie oder Deko mit Instrumentierung bei lumbaler Spinalkanalstenose (LSS). Es besteht die Vermutung, dass die Invasivität des Eingriffs auf das Ergebnis Einfluss[for full text, please go to the a.m. URL], Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2012)