Segmentstabilität von resorbierbaren INION-Osteosynthesen in der Dysgnathiechirurgie

Resorbierbare Osteosynthesen haben zwar schon vor längerer Zeit Einzug in die Dysgnathiechirurgie gehalten, müssen aber immer noch dem Vorwurf der Instabilität standhalten. Die vorgelegte Arbeit vergleicht ein modernes resorbierbares Osteosynthesesystem (INION CPS) mit konventionellen Titanminiplatten in der orthognathen Chirurgie. Insgesamt wurden die 50 Patienten der Studiengruppe neu untersucht, die Patienten der Kontrollgruppe mit Titanminiplatten rekrutierten sich aus einem bereits veröffentlichten Kollektiv des Autors. Die Beurteilung der Stabilität erfolgte radiologisch anhand von Fernröntgen-Seiten-Aufnahmen durch einen Vergleich von präoperativen Aufnahmen zu postoperativen und Verlaufsaufnahmen. Die zwei Hauptgruppen wurden dann zum einen nach Verlagerungsrichtung unterteilt als auch nach Art des Eingriffs (Monomaxillär vs. Bimaxillär). Zusätzlich wurden getrennt von diesen Gruppen noch Patienten mit Lippen-Kiefer-Gaumenspalte untersucht. Diese Studie konnte zeigen, dass die Stabilität von den untersuchten resorbierbaren Platten im Besonderen von der Richtung der Verlagerung abhängt. In einigen Verlagerungsrichtungen (Impaktion, horizontale Bewegung im Oberkiefer, Unterkiefervorverlagerung) sind die resorbierbaren Systeme gleichwertig, in anderen (Elongation, Unterkieferrückverlagerung) schneiden sie schlechter ab. Keinen Unterschied gibt es hingegen beim Vergleich der Art der Verlagerungen. Bei Risikopatienten die Vertikalbewegungen benötigen sollte allerdings zu Gunsten der Sicherheit lediglich mit Titanosteosynthesen versorgt werden. Eine Reihe von Studien konnte jedoch zeigen, dass gerade die neuesten resorbierbaren Materialien in ihren Eigenschaften kaum hinter denen der Titanplatten zurückstehen. Allerdings trägt auch weiterhin der höhere Preis der resorbierbaren Osteosynthesen zu deren zurückhaltendem Einsatz bei. Hier ist fraglich ob sich daran mittelfristig etwas ändern wird. Im Rahmen der Fragebogenuntersuchung zeigte sich, das heute mehr denn je mit dem Patienten offen über die Veränderung die diese Eingriffe mit sich bringen gesprochen werden sollte um übersteigerte oder falsche Hoffnungen abzubauen und dem Patienten das Gefühl der Entscheidungsfreiheit und Gleichberechtigung zu geben. Unstrittig ist die Frage nach der Notwendigkeit dieser Operationen. In welchem Umfang und mit welchem Budget die modernen Verfahren wie das MRT zur Basisdiagnostik und die virtuelle Planung als Ersatz für die konventionellen Röntgenbilder Einzug halten werden bleibt abzuwarten.Although resorbable osteosynthesis has found its way into orthognatic surgery over the last two decades, it is still defending itself against allegations of instability. The work presented here compares a modern resorbable osteosynthesis system (INION CPS) to conventional titanium miniplates in orthognatic surgery. Altogether, 50 patients were analyzed in the study group. The control group, treated with titanium, was taken from a former study presented by the author. The assessment of stability was done on lateral cephalometric x-rays, which were taken before, soon after and one year after the operation. The two main groups were then subdivided by the direction of movement for one and the procedure (monomaxillary vs. bimaxillary) for another. Additionally, patients with a cleft lip and palate have been investigated. This study showed that the stability of this osteosynthesis system mainly depends on the direction of movement. In some directions (impaction, horizontal movement in the maxilla, advancement in the mandible), the resorbables are as effective as titanium miniplates; in others (elongation, setback of the mandible), they are less stable. In contrast, there is no difference in comparisons based on the procedure. In high-risk patients where vertical movement is needed, titanium miniplates should be the primary choice. Many studies have shown that resorbables are hardly inferior to titanium osteosynthesis but the higher price of the resorbable plates adds to their lesser usage. It is doubtful that the price for the plates will change in the medium term. The questionnaire-based investigation showed that now, more than ever, doctors have to speak openly with their patients about the changes that these operations bring with them to decrease exaggerated or false hopes and to give the patients a sense of equality and that the decision is in their hands. That these operations are necessary is beyond dispute. The cost allocation and the extent to which modern methods like MRI will become basic diagnostic procedure and virtual treatment planning will replace conventional radiology remains to be seen

4-Jahres-Stabilität von resorbierbaren Miniplattenosteosynthesen in der Dysgnathiechirurgie

Osteosynthesematerialien aus resorbierbaren Materialien finden aufgrund ihrer zunehmenden biomechanischen Stabilität eine immer höhere Akzeptanz. Die vorgelegte Untersuchung vergleicht die knöcherne und okklusale Stabilität von solchen Osteosynthesesystemen aus resorbierbaren Materialien im Vergleich mit konventionellen Titanminiplatten in der orthognathen Chirurgie. Untersucht wurden 100 Patienten in einem Nachsorgezeitraum von bis zu 4 Jahren. Die Beurteilung erfolgte klinisch und röntgenologisch anhand von Fernröntgen-Seiten-Aufnahmen. In die Studie gingen ein fünfzig Patienten, die mit resorbierbaren Platten versorgt worden waren, 16 davon mit Polylactid-Polyglycolid Copolymer Platten und 34 Patienten mit 70:30 Poly-L/DL-Lactid Copolymer Platten; fünfzig weitere Patienten, versorgt mit einem Titanminiplattensystem wurden als Kontrollgruppe gewertet. Zunächst konnte gezeigt werden, dass die Gruppen zueinander homogen waren, es unterschieden sich die effektiven intraoperativen Bewegungen von Studien und Kontrollgruppe statistisch nicht signifikant, gleiches galt im Vergleich der resorbierbaren Platten untereinander. Bei der Datenauswertung konnte nachgewiesen werden, dass die absolute und relative Instabilität weder zwischen den Studiengruppen noch der Kontrollgruppe noch zwischen den resorbierbaren Plattensystemen untereinander signifikant unterschiedlich war. Die postoperative 1-Jahres Stabilität unterschied sich dabei ebenfalls nicht signifikant von der 4-Jahres Stabilität. Alle untersuchten Osteosynthesesysteme zeigten im Oberkiefer eine höhere Stabilität als im Unterkiefer und gleichzeitig eine größere Stabilität in der anterior-posterioren Richtung als in der inferior-superioren Richtung. Es wurden keine signifikanten Unterschiede zwischen der klinischen Stabilität von PLGA oder P(L/DL)LA-Miniplatten gefunden. Allerdings konnte auch belegt werden, dass der Einsatz resorbierbarer Unterkieferosteosynthesen eine sehr gute Compliance des Patienten bezüglich geführter Okklusion und Nachsorge voraussetzte. Als nachteilig bei den resorbierbaren Systemen konnte sowohl für den Oberkiefer als auch für den Unterkiefer eine leicht erhöhte Mobilität bis zu 6 Wochen nach der Operation festgestellt werden, die jedoch in keinem Fall das operative Ergebnis beeinflusste. Vielmehr ermöglichten resorbierbare Osteosynthesen eine bessere postoperative okklusale Einstellung. Weiteren Nachteil der resorbierbaren Osteosynthesesysteme bedeuten die hohen Kosten, die heute noch weit über denen von Titanminiplatten liegen. Zukünftige Entwicklungen gehen dahin, das Plattendesign weiter zu optimieren, wie z.B. neuartige pinbasierte Fixationssysteme einzusetzen, wie sie in der Extremitätenchirurgie teils bereits benutzt werden. Fernziel für die Zukunft ist die Entwicklung eines resorbierbaren Osteosynthesesystems, das sich bei geringen Herstellungskosten und miniaturisiertem Plattendesign auch minimalinvasiv einbringen lässt.Resorbable materials for osteosynthesis gain more and more acceptance through their rising biomechanical stability. This clinical study compares the osseous and occlusal stability of resorbable osteosynthesis systems to titanium miniplates in orthognatic surgery. The study examines 100 patients in a 1 to 4 year clinical and radiological follow-up. The analysis was done on lateral cephalograms. The study contains fifty patients treated with resorbable osteosynthesis, 16 of them with polylactide-polyglycolide copolymer plates and 34 patients with 70:30 poly-L/DL-lactide copolymer plates; 50 patients were treated with titanium miniplates, they were counted as the controlgroup. It has been shown, that both study groups were homogenius, the effective intraoperative movement between study- and controlgroup was nonsignificantly different. The same result was shown between the resorbable plate systems. The absolute and relative instability was nonsignificant weather between study and control group nor between the resorbable plating systems. The postoperative 1 year stability was nonsignificantly different from the 4 year stability in study- and controlgroup. Both systems showed more stability in the maxilla and more in the anterior-posterior direction than in the superior-inferior direction. Furthermore, there were no significant differences found in the clinical stability between PLGA and P(L/DL)LA miniplates. In the mandible, the resorbable osteosynthesis systems request a high complience of the patients for guided occlusion and recall. In the maxilla as well as the mandible, the resorbables plates show slight mobility postoperative for up to 6 weeks, which did not negatively influence the outcome of the study but yield faster occlusal and potentcially condylar settling in the mandible. Another disadventage of the resorbable systems are the costs, that are, at present, above the costs of titanium plates. Further inventions will try to optimize the plate design, like new pinbased fixationsystems, that are already used in handsurgery. The goal for the far future will be the invention of a resorbable osteosynthesis system, that, by low manufacturing costs and minimalized design, allows a minimalinvasive use

Resiliencia y felicidad en el personal asistencial del Hospital de Aplao en el Marco de la pandemia del COVID-19

El presente estudio tuvo por finalidad conocer el grado de relación entre las variables de Resiliencia y Felicidad en el marco de la pandemia del COVID-19, el tipo de estudio fue descriptivo correlacional, la muestra se constituyó con 97 participantes que estuvo conformada por el personal asistencial y administrativo del Hospital de Aplao, pertenecientes a la Región de Arequipa, para el procesamiento de los datos se utilizó la estadística descriptiva y la prueba estadística de Rho de Spearman. En los resultados se obtuvo p: 0.000 y Rho: 0.513, confirmándonos una correlación significativa entre ambas variables, es decir que a niveles altos de resiliencia le corresponden mayores niveles de felicidad y que la mayor parte de los participantes presentan niveles adecuados de resiliencia y felicidad, referido a las dimensiones de la resiliencia que más sobresalieron, fueron el sentirse bien solo y la perseverancia, en las dimensiones de la variable felicidad sobresalieron el sentido positivo de la vida, realización personal y satisfacción con la vida

Five Easy Pieces: The Dynamics of Quarks in Strongly Coupled Plasmas

We revisit the analysis of the drag a massive quark experiences and the wake it creates at a temperature T while moving through a plasma using a gravity dual that captures the renormalisation group runnings in the dual gauge theory. Our gravity dual has a black hole and seven branes embedded via Ouyang embedding, but the geometry is a deformation of the usual conifold metric. In particular the gravity dual has squashed two spheres, and a small resolution at the IR. Using this background we show that the drag of a massive quark receives corrections that are proportional to powers of log T when compared with the drag computed using AdS/QCD correspondence. We use the perturbation produced by the quark strings to compute the wake and compare with the results obtained using AdS/QCD correspondence. We also study the shear viscosity with running couplings, analyze the viscosity to entropy ratio and compare the result with the known bound. In the presence of higher order curvature square corrections from the back-reactions of the embedded D7 branes, we argue the possibility of the entropy to viscosity bound being violated. Finally, we show that our set-up could in-principle allow us to study a family of gauge theories at the boundary by cutting off the dual geometry respectively at various points in the radial direction. All these gauge theories can have well defined UV completions, and more interestingly, we demonstrate that any thermodynamical quantities derived from these theories would be completely independent of the cut-off scale and only depend on the temperature at which we define these theories. Such a result would justify the holographic renormalisabilities of these theories which we, in turn, also demonstrate. We give physical interpretations of these results and compare them with more realistic scenarios.Comment: 130 pages, 12 eps figures, LaTex; v4: final version with corrected typos, numerous additional references and enlargement of some sections. The published version, that appears in Nucl. Phys. B, differs slightly in section 3 where there is more emphasis on holographic renormalisabilty and less on the wake, compared to this versio

Neural correlates of cue‐induced changes in decision‐making distinguish subjects with gambling disorder from healthy controls

In addiction, there are few human studies on the neural basis of cue-induced changes in value-based decision making (Pavlovian-to-instrumental transfer, PIT). It is especially unclear whether neural alterations related to PIT are due to the physiological effects of substance abuse or rather related to learning processes and/or other etiological factors related to addiction. We have thus investigated whether neural activation patterns during a PIT task help to distinguish subjects with gambling disorder (GD), a nonsubstance-based addiction, from healthy controls (HCs). Thirty GD and 30 HC subjects completed an affective decision-making task in a functional magnetic resonance imaging (fMRI) scanner. Gambling-associated and other emotional cues were shown in the background during the task. Data collection and feature modeling focused on a network of nucleus accumbens (NAcc), amygdala, and orbitofrontal cortex (OFC) (derived from PIT and substance use disorder [SUD] studies). We built and tested a linear classifier based on these multivariate neural PIT signatures. GD subjects showed stronger PIT than HC subjects. Classification based on neural PIT signatures yielded a significant area under the receiver operating curve (AUC-ROC) (0.70,p= 0.013). GD subjects showed stronger PIT-related functional connectivity between NAcc and amygdala elicited by gambling cues, as well as between amygdala and OFC elicited by negative and positive cues. HC and GD subjects were thus distinguishable by PIT-related neural signatures including amygdala-NAcc-OFC functional connectivity. Neural PIT alterations in addictive disorders might not depend on the physiological effect of a substance of abuse but on related learning processes or even innate neural traits

New design challenges to widely implement 'Sustainable Product-Service Systems'

Sustainable Product-Service Systems (S.PSS) carry great potential to deliver social well-being and economic prosperity while operating within the limits of our planet. They can however be complex to design, test, implement and bring to the mainstream. To increase our understanding of the potential benefits, drivers and barriers in S.PSS design, the research community has been inspired to collect and analyse an extensive number of cases in diverse sectors and to develop and test several design methods and tools. This Special Volume on "New Design Challenges to Widely Implement 'Sustainable Product-Service Systems'" presents results of key studies in the following areas: user satisfaction and acceptance of S.PSS solutions, how industrial partnerships and stakeholder interactions can be designed for environmental and socio-ethical benefits, how knowledge of socio-technical change and transition management feeds S.PSS design processes, and the role of policy instruments to foster their implementation and scale-up. This Introduction reviews the current state of research and summarises the articles presented. The articles demonstrate increasing confidence in integrating approaches and theoretical frameworks from other arenas. These approaches include sociological practice theory, to shed new light on consumer practices in S.PSS configurations, and strategic niche management, to foster a suitable design and experimentation milieu. Experimentation, iteration and cyclical design processes were also seen by many authors as crucial to implementing and stabilising S.PSS solutions, but also their continuous sustainability evaluation. Several articles highlight the importance of local authorities, in developing S.PSS-enabling policies as well as supporting novel networks of stakeholders in the co-production of value. Finally this Introduction highlights key issues for a design research agenda, including but not limited to the development of new knowledge to support S.PSS designers (such as S.PSS design in low and middle-income contexts) and the role of Higher Educational Institutions (HEIs) in the diffusion of knowledge and know-how to companies. Together, the papers in this special volume provide insight into the promise of the S.PSS concept for understanding, advancing and accelerating sustainability

The importance of the primary reconstruction of the traumatized anterior maxillary sinus wall

This study evaluates the importance of specific posttraumatic reconstruction of the fractured anterior sinus wall. Several methods of different complexity of reconstruction are being compared by means of radiologic, rhinoscopic, and clinical data. Four groups of a total of 207 patients (age, 18-73 years; follow-up average, 4.2 years) with midfacial fractures, divided by operation technique and year, were evaluated. Control groups 1 to 3 received standard procedures without special regard on the reconstruction of the anterior sinus wall; the study group received specific reconstruction. The study group 4 showed a lower complication rate in nearly all measured parameters in comparison to groups 1 and 2. Study group 4 had the smallest incidences of posttraumatic sequelae in radiologic examinations; the clinical outcome was even to group 3. During open reduction and fixation procedures of midfacial fractures, attention should be given to the reconstruction of the anterior sinus wall to avoid postoperative discomfort

Propuesta de implementación de un edificio de estacionamientos en el centro histórico de la ciudad de cusco. Caso de estudio: Club Internacional Cusco

El presente trabajo de investigación, propone la implementación de un edificio de estacionamientos en el centro histórico de la ciudad de Cusco, en el local del Club Internacional Cusco, propuesta de solución al déficit de estacionamiento del centro histórico, analizando la viabilidad técnica y económica para un negocio de operación inmobiliaria de aparcamiento en un horizonte de 10 años, con una tasa de descuento k=8.16% anual, expresado en una edificación convencional destinada al estacionamiento vehicular implementado con un sistema automatizado, con una capacidad para 260 vehículos en un área de seis mil metros cuadrados (6,000 m2) construida en semisótano y la misma área en primer nivel, orientado a infraestructura para la práctica deportiva de socios del Club Internacional Cusco y público en general, ubicado en la intersección de la Av. Pardo con Av. San Miguel, diseñado bajo los conceptos de movilidad sostenible. Se plantea, una operación basada en la tarifa de S/. 4.00 por hora, con estos datos y con el porcentaje de ocupación determinado, se atenderían 2,587 vehículos por día, obteniendo ingresos anuales superiores S/. 4, 304,220 al año. Para iniciar operaciones se precisa de una inversión inicial de S/. 9, 652,427.91, con una participación del 30% por los socios inversionistas y el 70% restante por financiamiento bancario; el tiempo de recuperación de la inversión es al sexto año. El resultado de la evaluación financiera con un horizonte a 10 años se obtiene un VANe=9, 800,211.50 y un VANf= 5, 145,325.64; una TIRe= 23.5% y TIRf=49.61%.The present research work, proposes the implementation of a parking building in the historic center of the city of Cusco, in the premises of the Club Internacional Cusco, proposed solution to the parking deficit of the historic center, analyzing the technical and economic feasibility for a 10-year real-estate operation business with a discount rate of k = 8.16% per year, expressed in a conventional building intended for vehicular parking implemented with an automated system, with a capacity for 260 vehicles in an area of six thousand square meters (6,000 m2) built on a semi-basement and the same area on the first level, oriented to infrastructure for the sports practice of members of the Cusco International Club and the general public, located at the intersection of Av. Pardo and Av. San Miguel, designed under the concepts of sustainable mobility. It is proposed, an operation based on the rate of S /. 4.00 per hour, with these data and with the percentage of occupation determined, 2,587 vehicles per day would be attended, obtaining annual income above S /. 4, 304,220 a year. To start operations, an initial investment of S /. 9, 652, 427.91, with a 30% participation by the investment partners and the remaining 70% by bank financing; the time of recovery of the investment is to the sixth year. The result of the financial evaluation with a horizon of 10 years yields a VANe= 9, 800,211.50 and a VANf= 5, 145,325.64; a TIRe = 23.5% and TIRf = 49.61%.Tesi

BanBif: Banca Senior

El Banco Interamericano de Finanzas (BanBif) se encuentra en el 5to lugar como el banco comercial más grande del Perú, además de ser parte del Grupo “Fierro”, tiene 32 años en el mercado y es líder por su adecuado servicio, por lo que busca brindar las mejores soluciones financieras. El público objetivo identificado son las personas mayores de 65 años de un nivel socioeconómico A y B, conocidos como el segmento “Silver”. Asimismo, lo que BanBif pretende es crear una campaña de performance con la finalidad de rentabilizar a este grupo de clientes, además de buscar una oportunidad de colocación y captación de sus productos orientados a esta target, y por último de tener una propuesta de valor y comunicación cercana y de respeto dirigida a este tipo de segmento. Para lograr ello, se realizan entrevistas a profundidad, encuestas e investigación sobre sus hábitos de consumo, estilos de vida, y nivel económico. Todo ello, en base a la metodología “Boomerang”, bajo la herramienta UX (User Experience), procedimiento que se encuentra en función a testeos. De este modo, los hallazgos analizados mediante la investigación han permitido identificar el insight principal para plantear el desarrollo de la estrategia de campaña publicitaria para BanBif bajo el nombre “Experiencia Club”. Lo que se pretende es generar una interacción cercana gracias a la atención personalizada tanto en plataforma como a través de una línea directa hacia los clientes adultos mayores, siendo verdaderamente escuchados.Banco Interamericano de Finanzas (BanBif) is in 5th place as the largest commercial bank in Peru, besides being part of the "Fierro" Group, it has 32 years in the market and is a leader for its adequate service, so it seeks to provide the best financial solutions. The target public identified are people over 65 years of age of socioeconomic level A and B, known as the "Silver" segment. Likewise, BanBif intends to create a performance campaign with the purpose of making this group of clients profitable, in addition to seeking an opportunity to place and capture its products oriented to this target, and finally to have a value proposition and close and respectful communication directed to this type of segment. To achieve this, we conducted in-depth interviews, surveys and research on their consumption habits, lifestyles and economic level. All this, based on the "Boomerang" methodology, under the UX (User Experience) tool, a procedure that is based on tests. Thus, the findings analyzed through the research have allowed to identify the main insight to propose the development of the advertising campaign strategy for BanBif under the name "Club Experience". The aim is to generate a close interaction thanks to the personalized attention both on the platform and through a direct line to the elderly clients, being truly listened to