Influencia de la vía de abordaje y de posición de la cúpula acetabular en la luxación de la artroplastia total de cadera: estudio caso-control

Tanto la vía de acceso quirúrgica como la posición de los componentes se han relacionado con la presencia de una luxación en las artroplastias primarias de cadera. Hemos estudiado la presencia de esta complicación en una serie de 758 artroplastias no cementadas modelo Bihapro. Encontramos 21 luxaciones. Por otro lado se seleccionó de forma aleatoria un grupo de control de 42 pacientes que no habían presentado luxación. Se diseñó un estudio de casos y controles que englobaba por tanto a 63 pacientes que tenían implantada una artroplastia de este modelo. En el grupo de casos observamos que el porcentaje de luxación fue sensiblemente mayor en el sexo masculino con un 66,7%, en comparación con el sexo femenino que fue de un 42,8% aunque esta diferencia no fue estadísticamente significativa. No se observaron diferencias en la frecuencia de luxaciones en relación con la vía anterior o lateral, pero sin embargo en la vía posterior la luxación se produjo en un solo caso (4,8% de todas las luxaciones) con una incidencia claramente menor que en los abordajes anterior y lateral, siendo esta diferencia estadísticamente significativa (p=0,005). También observamos diferencias estadísticamente significativas en cuanto a un mayor porcentaje de luxaciones cuando la inclinación del componente acetabular era mayor de 50º (76,2%), o cuando la anteversión del cotilo era mayor o igual a 20º (54,4%). La vía de abordaje posterior con reconstrucción capsular y muscular presenta un menor porcentaje de luxación después de una artroplastia primaria en comparación con la anterior o lateral. Una inclinación mayor de 50º o una anteversión mayor de 20º favorecen la presencia de una luxación.The surgical approach and the cup position have been related with the dislocations of total hip arthroplasty. We have studied the presence of this complication in 758 Bihapro™ cementless arthroplasties. We got a case group of 21 dislocations; then we selected a control group of 42 patients without luxation to design a case-control study. The case group had a higher rate of dislocation in males (66.7 % versus 42.8 % in females) although this difference was not statistically significant. We didn’t observe any difference in the frequency of luxations relating to the anterior or lateral surgical approach, however in the posterior approach the dislocation appeared only in one case (4.8 % of the all dislocations) with statistically differences (p=0.005). We also observed statistically significant differences of luxations when the acetabular cup inclination was higher than 50º (76.2 %), or when the cup anteversion was equal or higher than 20º (52.4 %). The posterior surgical approach with capsular and muscular suture presented a lower rate of dislocation after a primary arthroplasty compared with the anterior or lateral approachs. An inclination bigger than 50º or an anteversion bigger than 20º seems to be a risk factor of luxation

Community-Oriented Development

Straipsnyje analizuojami tvarios plėtros principai ir uždaviniai Lietuvoje pereinant prie į bendruomenės tikslus orientuotos plėtros, paremtos profesionalų ir pilietinės visuomenės narių požiūrių integravimu. Tvarios, į bendruomenę orientuotos, plėtros procesas užtikrina, kad būtų gerbiamos kiekvieno asmens ir jų šeimų teisės, orumas, poreikiai ir pageidavimai bei sukurti įgalinimo mechanizmai, skatinantys aktyviai partnerystei ir kūrybiškoms inovacijoms. Lyginimo kriterijumi pasirinktas perėjimas nuo centralizuotos į bendruomenę orientuotos plėtros, arba darnios bendruomeninės plėtros, modelis, kuris galėtų užtikrinti, kad plėtros procesas būtų derinamas su konkrečioje vietovėje gyvenančių gyventojų poreikiais, įgalintų juos socialinei partnerystei, dalinimuisi, subsidiarumui ir klasterizavimui. Tyrimui taikomi sisteminės, statistinės ir atvejų analizės, grupių diskusijų metodai, leidžiantys įvertinti į bendruomenę orientuotos plėtros sėkmės atvejus ir trikdžius Lietuvoje, juos palyginti su pasaulyje identifikuotomis socialinėmis inovacijomis. Ieškoma trikdžių, priežasčių ir mechanizmų į bendruomenę orientuotai tvariai plėtrai įgalinti.The evaluation of modern trends, it can be said that Lithuanian cities can create a full quality of life. Success will depend on various factors: state policy and financial instruments, development strategies, investment and efficient management of public assets, urban centers, residential areas renewal, and most importantly – sustainable development of community participation. Sustainable development is an important community mobilization develops, positive leadership and community capacity in which it is necessary to validate the local government or other laws. Sustainable development communities necessary skills: understanding of sustainable development; ability to create a vision for the leadership, communication; teamwork; project management; process re-engineering; effective financial management; local economic development and understanding of democratic processes. Decisions about development, the future of local communities must be adopted in accordance with the principle of subsidiarity – the local community itself is able and willing to accept and implement certain decisions, decisions must be adopted and implemented in the higher authorities. Promoting partnerships and general cooperation, a key objective should be to improve quality of life. It is necessary to teach people, local communities, so that they understand that sustainable development is the responsibility of all, only their competence and contribution. With this goal, it is proposed: Promote public, private and NGO sector in the partnership and to validate solutions of inter-institutional and financial resources; Foster local culture and traditions, to create a safe and friendly neighborhood of the natural environment; Communitywide socioeducation and systemic sociocommunication; systemice development, multifunctional, multicriterian and multisectoral networks; communities to ensure the stability and continuity, independence from politicians and elections; building trust between the community, business, government, planners and designers; encourage multi-public (schools, cultural houses, libraries, etc.) and commercial (commercial, offices, etc.). These asuptions help for buildings welfare and smarth and creative communities. Public infrastructure development and the introduction of the infrastructure charge to ensure that the funds are used, from which comes in charge of infrastructure development and achieved the expected results based on the development and evaluation on the basis of science and knowledge. In urban areas land issues, the right to dispose of public land to municipalities

Cosmological Analogues of the Bartnik--McKinnon Solutions

We present a numerical classification of the spherically symmetric, static solutions to the Einstein--Yang--Mills equations with cosmological constant $\Lambda$. We find three qualitatively different classes of configurations, where the solutions in each class are characterized by the value of $\Lambda$ and the number of nodes, $n$, of the Yang--Mills amplitude. For sufficiently small, positive values of the cosmological constant, \Lambda < \Llow(n), the solutions generalize the Bartnik--McKinnon solitons, which are now surrounded by a cosmological horizon and approach the deSitter geometry in the asymptotic region. For a discrete set of values $\Lambda_{\rm reg}(n) > \Lambda_{\rm crit}(n)$, the solutions are topologically $3$--spheres, the ground state $(n=1)$ being the Einstein Universe. In the intermediate region, that is for \Llow(n) < \Lambda < \Lhig(n), there exists a discrete family of global solutions with horizon and ``finite size''.Comment: 16 pages, LaTeX, 9 Postscript figures, uses epsf.st

Paratransit: the need for a regulatory revolution in the light of institutional inertia

This chapter begins by defining what is traditionally meant by the term 'paratransit', before exploring why it has remained a relatively niche transport concern. Societal trends have shifted to a pattern of demand that is ill-suited to the system design for conventional public transport. Emerging IT applications offer the potential to introduce a new model of public transport appropriate to the travel needs of the 21st century. Paratransit modes are appealing because they could dynamically match the supply of a service with the level of demand required, unlike conventional models of public transport based on fading historical demand patterns. But the regulatory environment for the local passenger sector has been built incrementally over many years around the institutional frameworks for buses and taxis. Paratransit alternatives often do not fully fit under any of these categorisations with the result that they often do not have an institutional home and thus either upset the status quo (as with Uber currently) or else are still born. A redefinition of paratransit is proposed to facilitate a regulatory change to help address the institutional challenges of paratransit innovation

Shopping centre siting and modal choice in Belgium: a destination based analysis

Although modal split is only one of the elements considered in decision-making on new shopping malls, it remarkably often arises in arguments of both proponents and opponents. Today, this is also the case in the debate on the planned development of three major shopping malls in Belgium. Inspired by such debates, the present study focuses on the impact of the location of shopping centres on the travel mode choice of the customers. Our hypothesis is that destination-based variables such as embeddedness in the urban fabric, accessibility and mall size influence the travel mode choice of the visitors. Based on modal split data and location characteristics of seventeen existing shopping centres in Belgium, we develop a model for a more sustainable siting policy. The results show a major influence of the location of the shopping centre in relation to the urban form, and of the size of the mall. Shopping centres that are part of a dense urban fabric, measured through population density, are less car dependent. Smaller sites will attract more cyclists and pedestrians. Interestingly, our results deviate significantly from the figures that have been put forward in public debates on the shopping mall issue in Belgium