To prospectively evaluate the use and optimal timing of ultrasonographic (US) screening for posterior shoulder subluxation in infantswith brachial plexus birth injury (BPBI).
Approval of the ethics ...committee and informed consent of guardians was obtained. This population-based prospective study included neonates with BPBI who were born in Helsinki from January 1, 2003 through December 31, 2006, and in whom BPBI was verified with sequential clinical examinations. US was performed at 1, 3, 6, and 12 months. Size (width and height) of the humeral head and its ossification center and congruency of the shoulder (alpha angle) were measured. Frequency of BPBI and permanent changes were evaluated. This study also included patients who were referred from the tertiary catchment area. For statistical analysis, 95% confidence intervals were calculated, and analysis of variance was performed.
BPBI was seen in 132 of 41980 neonates (3.1 per 1000). In 27 cases (0.64 per 1000), BPBI did not heal during the 1st year of life and was considered permanent. The humeral head and its ossification center were smaller on the affected side in permanent BPBI. Nine patients with permanent palsy had posterior subluxation of the humeral head depicted with US (alpha angle, >30 degrees ). In five patients, posterior subluxation corrected was detected at 3 months. Nineteen of 21 patients with BPBI from the tertiary catchment area had permanent palsy. Ten of 19 patients developed posterior subluxation of the shoulder, which was verified with US. Altogether, three of these cases were not detected by surgeons. Posterior subluxation of the humeral head developed during the 1st year of life in one-third of patients with permanent BPBI. In more than one-half (55% five of nine) of the patients, posterior subluxation corrected was detected with US at 3 months, and in 89% (eight of nine), it was detected at 6 months.
US is a fast and useful tool for diagnosis of posterior subluxation of the humeral head, and examination of the glenohumeral joint should be performed at 3 and 6 months of age in infants with BPBI if symptoms persist.
This article compares the development of transport and energy use with a focus on carbon dioxide (CO
2) emissions in the EU15 countries between 1960 and 2000, and separately by each individual EU ...country between 1970 and 2000. Based on a review on the literature,
immaterialisation can be defined as the reduction of energy intensity and transport intensity;
dematerialisation can be defined as the reduction in carbon intensity of energy production and the carbon intensity of transport;
decarbonisation can be defined as the reduction in (total and transport) carbon intensity of the whole economy. Although there is a clear pattern of reduction in energy intensity of the economy and carbon intensity of energy production, a similar pattern cannot be found in transport. Neither the transport intensity of the economy nor the carbon intensity of transport has been reduced. In particular, freight transport intensity has grown between 1985 and 2000. Data presented by country have shown even more variation. The EU15 countries were aggregated into six groups by cluster analysis to establish the different patterns on each of the three measures. It is concluded that the EU15 countries will have problems in achieving the EU White Paper target of decoupling transport growth from economic growth and the Kyoto target of reducing total CO
2 emissions by 8% from the 1990 level between 2008 and 2012. However, there are some weak signals suggesting a more sustainable passenger transport system.
•Sustainability challenges require both specialized and integrative approaches.•Domination of specialism and reductionism calls for emphasis on comprehensiveness.•The GHH framework can be used as a ...tool to add comprehensiveness in education.•The framework consists of three dimensions: generalism, holism, and holarchism.•The dialectical approach combines comprehensive and differentiative approaches.
Sustainability challenges such as climate change, biodiversity loss, poverty and rapid urbanization are complex and strongly interrelated. In order to successfully deal with these challenges, we need comprehensive approaches that integrate knowledge from multiple disciplines and perspectives and emphasize interconnections. In short, they aid in observing matters in a wider perspective without losing an understanding of the details. In order to teach and learn a comprehensive approach, we need to better understand what comprehensive thinking actually is. In this paper, we present a conceptual framework for a comprehensive approach, termed the GHH framework. The framework comprises three dimensions: generalism, holism, and holarchism. It contributes to the academic community’s understanding of comprehensive thinking and it can be used for integrating comprehensive thinking into education. Also, practical examples of the application of the framework in university teaching are presented. We argue that an ideal approach to sustainability challenges and complexity in general is a balanced, dialectical combination of comprehensive and differentiative approaches. The current dominance of specialization, or the differentiative approach, in university education calls for a stronger emphasis on comprehensive thinking skills. Comprehensiveness should not be considered as a flawed approach, but should instead be considered as important an aspect in education as specialized and differentiative skills.
Background Many children with permanent brachial plexus birth injury (BPBI) develop shoulder problems, with subsequent joint deformity without treatment. We assessed the indications and outcome of ...shoulder operations for BPBI.
Patients and methods 31 BPBI patients who had undergone a shoulder operation in our hospital between March 2002 and December 2005 were included in the study. Relocation of the humeral head had been performed in 13 patients, external rotation osteotomy of the humerus in 5 patients, subscapular tendon lengthening in 5 patients, and teres major transposition in 8 patients. Subjective results were registered. Shoulder range of motion was measured, and function assessed according to the Mallet scale. Magnetic resonance imaging (MRI) was performed pre- and postoperatively. Glenoscapular angle (GSA) and percentage of humeral head anterior to the middle of the glenoid fossa (PHHA) were measured. Congruency of the glenohumeral joint (GHJ) was estimated. The mean follow-up time was 3.8 (1.7-6.8) years.
Results At follow-up, the subjective result was satisfactory in 30 of the 31 patients. There were 4 failures, which in retrospect were due to wrong choice of surgical method in 3 of these 4 patients. Mean increase in Mallet score was 5.5 after successful relocation, 1.4 after rotation osteotomy, 2.2 after subscapular tendon lengthening, and 3.1 after teres major transposition. Congruency of the shoulder joint improved in 10 of 13 patients who had undergone a relocation operation, with mean improvement in GSA of 33º and mean increase in PHHA of 25%. There were no substantial changes in congruency of the glenohumeral joint in patients treated with other operation types.
Interpretation Restriction of the range of motion and malposition of the glenohumeral joint can be improved surgically in brachial plexus birth injury. Remodeling of the joint takes place after successful relocation of the humeral head in young patients.
Celotno besedilo
Dostopno za:
DOBA, FSPLJ, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK, VSZLJ
We have applied Zeeman-Doppler imaging (ZDI) to an extensive spectropolarimetric HARPSpol data set of the magnetically active young solar analogue V889 Her, covering 35 spectra obtained during six ...nights in May 2011. The data set allows us to study Stokes V profiles of the star at almost identical rotational phases, separated by one or more stellar rotations. We use these data to study if the line profiles evolve from one rotation to the next, and find that some evolution does indeed occur. We consider two possible explanations for this: abrupt changes in the large-scale magnetic field or differential rotation. We find it quite difficult to distinguish between the two alternatives using ZDI alone. A strong differential rotation could, however, explain the changes in the line profiles, so we conclude that it must be present, and the abrupt magnetic field evolution is left uncertain. Commonly, rapidly rotating stars are assumed to have only weak differential rotation. If the strong differential rotation of V889 Her is indeed present, as has been found in other studies as well, it could indicate that the theoretical and numerical results of differential rotation still need to be revised. The rapid changes that may have occurred in the magnetic field indicate that one should be quite cautious when interpreting ZDI maps constructed from data over long time intervals.
Les possibilités d'utilisation du cadre du PPE peuvent être examinées par le biais des trois modes de la science mentionnés en introduction. Dans le mode « détaché », propre aux sciences ...fondamentales, le cadre serait utilisé par un chercheur individuel ou un groupe de chercheurs pour cadrer la recherche et pour cerner les questions les plus pertinentes. L'accent serait mis sur la partie supérieure du cadre, et l'objectif serait de fournir la meilleure description possible des causes et des effets des problèmes environnementaux. L'approche « gestionnaire » irait au-delà de la description, utilisant le cadre pour formuler les solutions les plus efficaces quant aux problèmes définis par le chercheur ou le groupe de chercheurs. L'intérêt serait donc focalisé sur les éléments qui se trouvent dans la partie inférieure du cadre : étant donné une définition du problème et une série d'objectifs, on s'interrogerait sur les meilleurs moyens pour résoudre le problème. Dans ces deux usages possibles, le cadre aiderait à adopter une vue plus large que celle qui se concentrerait sur quelques éléments séparés du cadre. Les chercheurs travaillant dans le cadre du mode « détaché » (sciences fondamentales) percevraient mieux comment la description des impacts influence les politiques tandis que ceux proches du mode « gestionnaire » comprendraient comment les objectifs politiques et les solutions dépendent de la description des impacts d'un côté et les influencent de l'autre. Finalement, la perspective critique centrée sur les problèmes mettrait au centre la question de l'utilisateur du cadre : la définition de chaque élément dans le cadre serait problématisée et la question centrale serait de savoir qui applique la définition particulière et à quelles fins. Sur quelles perceptions de l'incertitude, de la pluralité des valeurs et des prévisions les différentes interprétations et définitions sont-elles fondées? Aux porteurs de quels intérêts et valeurs les définitions et encadrements différents donnent-ils la priorité et quel est le rôle des experts dans ces processus de définition?
Previous studies have related surface temperature maps, obtained with the Doppler imaging (DI) technique, of LQ Hya with long-term photometry. We compare surface magnetic field maps, obtained with ...the Zeeman Doppler imaging (ZDI) technique, with contemporaneous photometry, with the aim of quantifying the star's magnetic cycle characteristics. We inverted Stokes IV spectropolarimetry into magnetic field and surface brightness maps using a tomographic inversion code that models high signal-to-noise ratio mean line profiles produced by the least squares deconvolution (LSD) technique. The magnetic field and surface brightness maps reveal similar patterns to previous DI and ZDI studies: non-axisymmetric polar magnetic field structure, void of fields at mid-latitudes, and a complex structure in the equatorial regions. There is a weak but clear tendency of the polar structures to be linked with strong radial field and the equatorial ones with the azimuthal. We find a polarity reversal in the radial field between 2016 and 2017 coincident with an activity minimum seen in the long-term photometry. The inverted field strengths cannot easily be related with the observed spottedness, but we find that they are partially connected with the retrieved field complexity. Comparing to global magnetoconvection models for rapidly rotating young Suns, this field topology and dominance of the poloidal field component could be explained by a turbulent dynamo, where differential rotation does not play a major role (so called alpha^2 Omega or alpha^2 dynamos), and axi- and non-axisymmetric modes are excited simultaneously. The complex equatorial magnetic field structure could arise from the twisted (helical) wreaths often seen in these simulations, while the polar feature would be connected to the mostly poloidal non-axisymmetric component having a smooth spatial structure.
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