Plato's Cave, Knowledge Management and the internet : some Theses

La relación entre lo real y lo virtual no es sólo una cuestión de "ser o no ser", es también una cuestión de "saber o no saber". Una cara de lo Real y lo Virtual es la relación entre la información y la desinformación, entre el saber, el significado y los malentendidos.The relation between the Real and the Virtual is not only a question of "to be or not to be" but it is also a question of "to know or not to know". One side of the Real and the Virtual is the relation between information and disinformation, between knowing, meaning and misunderstanding

Rehabilitation definition for research purposes. A global stakeholders’ initiative by Cochrane Rehabilitation

Negrini S, Selb M, Kiekens C, et al. Rehabilitation definition for research purposes. A global stakeholders initiative by Cochrane Rehabilitation. European Journal of Physical and Rehabilitation Medicine . 2022.Since its foundation, Cochrane Rehabilitation has faced challenges with rehabilitation definitions because existing definitions did not indicate what rehabilitation includes and what it excludes. We aimed to develop a comprehensive and shared rehabilitation definition for research purposes to: 1) support the conduct of primary studies and systematic reviews, and 2) identify relevant systematic reviews for knowledge translation purposes. We performed a multimodal study including seven preliminary research and discussion papers, four Consensus Meetings and three Delphi rounds with 80 rehabilitation stakeholders. The Delphi Study aimed to obtain agreement, refine and complete the items composing the definition and meanings of rehabilitation. These stakeholders covered 5 continents, representing 11 global and continental rehabilitation organizations, 11 scientific journals, 4 Cochrane Networks and 3 Cochrane Groups, and included invited experts, and representatives of low middle-income countries (LMICs) and consumers. We had a 70% to 82.5% response rate to the three Delphi rounds, during which participants responded to all items (100%) and provided relevant comments (range 5.5-50% per item). This participation led to several refinements to the rehabilitation definition through three preliminary versions, and the final items reached an agreement between 88.9% and 100%. We structured the definition using the PICO (Population, Intervention, Comparison, Outcome) framework. We concluded that "In a health care context," rehabilitation is defined as a "multimodal, person-centered, collaborative process" (Intervention-general), including interventions targeting a person's "capacity (by addressing body structures, functions, and activities/participation) and/or contextual factors related to performance" (Intervention-specific) with the goal of "optimizing" the "functioning" (Outcome) of "persons with health conditions currently experiencing disability or likely to experience disability, or persons with disability" (Population). Rehabilitation requires that all the items of the definition are satisfied. We defined a "rehabilitation intervention" as "any intervention provided within the rehabilitation process." We developed a rehabilitation definition for research purposes achieving a broad agreement with global stakeholders. This definition provides explicit criteria to define rehabilitation. Using the proposed definition will improve rehabilitation research by standardizing the description of interventions. Our definition may require revision in the future, as further research enhances understanding and communication of the essence and complexity of rehabilitation

How to improve walking, balance and social participation following stroke: a comparison of the long term effects of two walking aids--canes and an orthosis TheraTogs--on the recovery of gait following acute stroke. A study protocol for a multi-centre, single blind, randomised control trial

<p>Abstract</p> <p>Background</p> <p>Annually, some 9000 people in Switzerland suffer a first time stroke. Of these 60% are left with moderate to severe walking disability. Evidence shows that rehabilitation techniques which emphasise activity of the hemiplegic side increase ipsilesional cortical plasticity and improve functional outcomes. Canes are commonly used in gait rehabilitation although they significantly reduce hemiplegic muscle activity. We have shown that an orthosis "TheraTogs" (a corset with elasticated strapping) significantly increases hemiplegic muscle activity during gait. The aim of the present study is to investigate the long term effects on the recovery of gait, balance and social participation of gait rehabilitation with TheraTogs compared to gait rehabilitation with a cane following first time acute stroke.</p> <p>Methods/Design</p> <p>Multi-centre, single blind, randomised trial with 120 patients after first stroke. When subjects have reached Functional Ambulation Category 3 they will be randomly allocated into TheraTogs or cane group. TheraTogs will be applied to support hip extensor and abductor musculature according to a standardised procedure. Cane walking held at the level of the radial styloid of the sound wrist. Subjects will walk throughout the day with only the assigned walking aid. Standard therapy treatments and usual care will remain unchanged and documented. The intervention will continue for five weeks or until patients have reached Functional Ambulation category 5. Outcome measures will be assessed the day before begin of intervention, the day after completion, 3 months, 6 months and 2 years. Primary outcome: Timed "up and go" test, secondary outcomes: peak surface EMG of gluteus maximus and gluteus medius, activation patterns of hemiplegic leg musculature, temporo-spatial gait parameters, hemiplegic hip kinematics in the frontal and sagittal planes, dynamic balance, daily activity measured by accelerometry, Stroke Impact Scale. Significance levels will be 5% with 95% CI's. IntentionToTreat analyses will be performed. Descriptive statistics will be presented.</p> <p>Discussion</p> <p>This study could have significant implications for the clinical practice of gait rehabilitation after stroke, particularly the effect and appropriate use of walking aids.</p> <p>The results could be important for the development of clinical guidelines and for the socio-economic costs of post-stroke care</p> <p>Trial registration number</p> <p>ClinicalTrials.gov <a href="http://www.clinicaltrials.gov/ct2/show/NCT01366729">NCT01366729</a>.</p

Regional treatment intensity as an instrument for the evaluation of labour market policies

The effects of active labour market policies (ALMP) on individual employment chances and earnings are evaluated by nonparametric instrumental variables based on Swiss administrative data with detailed re-gional information. Using an exogenous variation in the participation probabilities across fairly autonomous regional units (cantons) generated by the federal government, we identify the effects of ALMP by comparing individuals living in the same local labour market but in different cantons. Taking account of small sample problems occurring in IV estimation, our results suggest that ALMP increases individual employment probabilities by about 15% in the short term for a weighted subpopulation of compliers.Local average treatment effect, active labour market policy, state borders, geographic variation, weak instruments, small sample problems of IV, Switzerland, Fuller estimator

Frequent concomitant presence of Desulfitobacterium spp. and " Dehalococcoides ” spp. in chloroethene-dechlorinating microbial communities

The presence of chloroethene dechlorination activity as well as several bacterial genera containing mainly organohalide-respiring members was investigated in 34 environmental samples from 18 different sites. Cultures inoculated with these environmental samples on tetrachloroethene and amended weekly with a seven organic electron donor mixture resulted in 11 enrichments with cis-DCE, ten with VC, and 11 with ethene as dechlorination end product, and only two where no dechlorination was observed. "Dehalococcoides” spp. and Desulfitobacterium spp. were detected in the majority of the environmental samples independently of the dechlorination end product formed. The concomitant presence of Dehalococcoides spp. and Desulfitobacterium spp. in the majority of the enrichments suggested that chloroethene dechlorination was probably the result of catalysis by at least two organohalide-respiring genera either in parallel or by stepwise catalysis. A more detailed study of one enrichment on cis-DCE suggested that in this culture Desulfitobacterium spp. as well as Dehalococcoides spp. dechlorinated cis-DCE whereas dechlorination of VC was only catalyzed by the latte

Isoanatomical bone-patellar tendon-bone single-bundle ACL reconstruction: the wedge that gives the edge!

The purpose of the present paper is to describe the isoanatomical, single bundle, bone-patellar tendon-bone A3B-ACL reconstruction technique (A3B=Anatomical Bruderholz, Burkart, Biedert) in detail. The technical key factors and the pitfalls are highlighted. In addition, the pros and cons of the technique are discusse

Airway wall remodeling in asthma : novel mechanisms of human bronchial smooth muscle cells in the induction of angiogenesis

Asthma is a global major health concern and it affects estimated 300 million people. The prevalence of asthma is rising and there is no cure for asthma, only the symptoms can be controlled. Acute asthma attacks are characterized by severe symptoms such as breathlessness, wheezing, tightness of the chest, and coughing, which may lead to hospitalization or death. Besides the acute symptoms, asthma is characterized by persistent airway inflammation and airway wall remodeling. The term airway wall remodeling summarizes the structural changes in the airway wall: epithelial cell shedding, goblet cell hyperplasia, hyperplasia and hypertrophy of the bronchial smooth muscle (BSM) bundles, basement membrane thickening and increased vascular density. Airway wall remodeling starts early in the pathogenesis of asthma and today it is suggested that remodeling is a prerequisite for other asthma pathologies. Furthermore, novel invasive therapies used to treat severe asthma provide evidence that the BSMC is a major effector cell in the pathology of asthma. In the present thesis novel mechanisms of BSMC regulation and their role in the induction of asthma-associated angiogenesis have been elucidated. Therefore, the differences in the angiogenic capacities of BSMC from asthma and non-asthma patients and their modification by different conditions, such as an (i) inflammatory microenvironment, (ii) the influence of low oxygen concentration, and (iii) the stimulation with the most potent asthma relevant allergen (house dust mite (HDM) allergen) on the angiogenic properties of BSMC have been studied. A major finding of this thesis is the increased angiogenic potential of BSMC from asthma patients and the altered release of CXCR2 ligands in an in vitro inflammatory environment. It has been demonstrated that BSMC from asthma patients release significantly more of the CXCR2 ligands ENA-78, GRO-a and IL-8, which may explain the increased vascular density in the sub-epithelial cell layers observed in the airways of asthma patients. These finding adds to previous studies showing that BSMC are a source of angiogenic factors (e.g. VEGF) and that CXCR2 ligands are elevated in the airway lining fluids of asthma patients. In this thesis BSMC have been shown to be a potential source of CXCR2 ligands, which induced spout outgrowth from endothelial cell spheroids in an in vitro model of angiogenesis. Furthermore, this thesis investigated the effect of hypoxia on BSMC. Local restricted hypoxia in the airways of asthma patients had only recently been suggested. The animal model based hypothesis that hypoxia directly causes BSMC hyperplasia was tested. This hypothesis was not confirmed in human BSMC but nonetheless it was demonstrated that hypoxia leads to increased release of inflammatory and angiogenic mediators; as conditioned medium from BSMC grown under hypoxia induced angiogenesis in an in vitro model via VEGF. These findings suggest that different conditions or stimuli induce angiogenesis in asthma through different pathways and therefore, different therapeutic strategies might be needed. In the third part of this thesis the effect of HDM allergen on the release of inflammatory and angiogenic mediators from BSMC was assessed. Animal models demonstrated that exposure to HDM allergens increased airway wall vascularization. No direct contribution of BSMC to HDM extract induced angiogenesis was observed. However, HDM extract proteases degraded ENA-78, which is an import chemokine for neutrophil recruitment into the inflamed lung. Thus HDM allergens may alter the bio-availability of ENA-78 in the airways of asthma patients and modulate the immune response. The findings of this thesis add a small piece to the knowledge of asthma pathology, the mechanisms underlying airway wall remodeling and in particular BSMC hyperplasia and neovascularization. This might represent novel targets for treatment, especially for the prevention or reversal of airway wall remodeling

Are local tax rates strategic complements or strategic substitutes?

The identification of strategic interactions among local governments is typically plagued by endogeneity problems. This paper proposes an identification strategy that makes use of a multi-tier federal system. State-level fiscal reforms provide an arguably exogenous source of variation in tax rates of local jurisdictions. Moreover, state borders spatially bound the effects of state-level fiscal reforms across areas that are otherwise highly integrated. Using the fact that local jurisdictions located close to a state border have some neighbors in another state, I propose to instrument the (average) tax rate of neighbor jurisdictions with the state-level tax rate of the neighboring state. I use this instrument to identify strategic personal income tax setting by local jurisdictions in Switzerland. In contrast to most of the existing empirical literature and to all results based on standard instruments, I find that tax rates are strategic substitutes in most cases. Tax rates are found to be strategic complements only in the context of large tax cuts

Morphological and Immunohistochemical Changes After Corneal Cross-Linking

Purpose: To present light and electron microscopic as well as immunohistochemical findings after corneal cross-linking (CXL). Methods: Six keratoconus corneas after CXL, 12 keratoconus corneas without CXL, and 7 normal corneas were examined by light microscopy, indirect immunohistochemistry using antibodies against proapoptotic BAX, antiapoptotic survivin, and BCL-2, and anti-smooth muscle actin and, in part, by transmission electron microscopy. Direct immunofluorescence with 4'6-diamidino-2-phenylindole was performed to analyze keratocytes/area in the anterior, middle, posterior, peripheral, and central corneal stroma. Results: The period between CXL and keratoplasty ranged from 5 to 30 months. All keratoconus corneas showed the typical histological changes. Increased proapoptotic BAX expression and/or antiapoptotic survivin expression were noticed in keratocytes and endothelium in 2 keratoconus specimens after CXL. Smooth muscle actin was only observed in subepithelial scar tissue of 2 keratoconus corneas without CXL. Keratoconus corneas after CXL revealed a significant reduction in keratocyte counts in the entire cornea (P = 0.003) compared with keratoconus corneas without CXL and normal corneas. This difference was because of a loss of keratocytes in the anterior (P = 0.014) and middle (P = 0.024) corneal stroma. Keratocytes in CXL corneas were reduced in the center (P = 0.028) and the periphery (P = 0.047). Conclusions: CXL in human keratoconus can cause considerable morphologic corneal changes up to 30 months postoperatively. Especially noteworthy is a long-lasting, maybe permanent, keratocyte loss in the anterior and middle corneal stroma involving the central and peripheral cornea. As long-term corneal damage after CXL is of genuine concern, particular care should be taken to perform this procedure only in accordance with investigational protocols