Classification of degenerative segment disease in adults with deformity of the lumbar or thoracolumbar spine

Lumbar and thoracolumbar deformity in the adult is a condition with impairment of health status that can need surgical treatment. In contrast with adolescent deformity, where magnitude of the curve plays a significant role in surgical indication, the aspects relevant in adult deformity are pain and dysfunction that correlate with segment degeneration and imbalance. Previous classifications of adult deformity have been of little use for surgical planning.Chart review and classification of radiographic and clinical findings. A classification of degenerative disc disease based on distribution of diseased segments and balance status of the spine is presented.Four main categories are presented: Type I (limited nonapical segment disease), Type II (limited apical segment disease), Type III (extended segment disease--apical and nonapical), Type IV (imbalanced spine: IVa, sagittally imbalanced; IVb, sagittally and coronally imbalanced).Types I and II can be treated by fusion of a selective area of the curve. Type III needs fusion of all the extension of the coronal curve. Type IV usually needs aggressive corrective procedures, frequently including posterior tricolumnar osteotomies. This classification permits interpreting the extension and magnitude of the disease and can help establish a surgical plan regarding selective fusion and methods of sagittal correction. Future research is needed to validate the classification

Patrimonio, tecnología e inmigración

Antonio Bonet, arquitecto catalán que emigró al cono sur americano, desarrolló una importante y significativa obra de arquitectura moderna tanto en Argentina como en Uruguay, tierras que lo acogieron y en las que dejó su huella artística y creativa como parte de un patrimonio sudamericano. Articulándose con profesionales nativos logró una producción regional en el uso espacial, lenguaje y materialidad experimentando con las nuevas tecnologías y procesos de racionalización industrial, reproponiendo la vanguardia moderna y efectuando una efectiva interpretación del modo local del habitar. Su visión integradora de la arquitectura de innovación que hace y comparte ciudad es otro testimonio de su inserción como inmigrante, el reconocimiento del entorno, su historia y la propia que se hace presente sin renunciar a la contemporaneidad construyendo comunidad. En estos términos se propone estudiar algunos casos que por sus relevantes características arquitectónicas, urbanas e históricas entienden al sitio y sus usuarios, dando cuenta de la calidad de este profesional

Classification of sagittal imbalance based on spinal alignment and compensatory mechanisms

Sagittal balance is an independent predictor of clinical outcomes in spinal care. Surgical treatment is challenging and jeopardized by frequent complications. Guidelines for surgical treatment are currently not based on a classification of the disease. A comprehensive classification of sagittal balance based on regional deformities and compensatory mechanisms combined in deformity patterns is proposed. Though the sagittal shape of the spine can change due to degeneration or trauma, correlations between sagittal shape parameters and pelvic incidence (PI) have been described. Pelvic incidence is not changed by degeneration, thus representing a permanent source of information on the original sagittal shape of the spine.One hundred and twenty-eight full-spine lateral standing radiographs of patients with different spinal conditions were evaluated and classified by one rater. One random subseries of 35 patients was evaluated by two raters for calculation of inter-rater agreement. Spinopelvic parameters were measured in all the radiographs. Internal validity of the classification system was evaluated comparing the values of regional sagittal parameters that distinguish one category from the others.Eight different patterns were identified regarding the site of the deformity and the presence of compensatory mechanisms: cervical, thoracic, thoracolumbar junction, lumbar, lower lumbar, global and pelvic kyphosis and normal sagittal alignment. Inter-rater agreement was almost perfect (κ = 0.963). Statistically significant differences were found comparing the means of selected sagittal spinopelvic parameters that conceptually divide pairs or groups of categories: C2-C7 SVA for cervical kyphosis vs all other patients, TK-PI mismatch for thoracic kyphosis vs all other patients, T11-L2 kyphosis for thoracolumbar kyphosis vs all other patients, global alignment (LL+TK-PI) and SVA for lumbar kyphosis vs global kyphosis and pelvic tilt for pelvic kyphosis vs lumbar, lower lumbar and global kyphosis.A comprehensive classification of sagittal imbalance is presented. This classification permits a better interpretation of the deformity and muscle forces acting on the spine, and helps surgical planning. Preliminary validation has been provided

Rivette’s The Nun: Religion between Sadism and Masochism

This article was delivered as a paper at the 2015 International Conference on Religion and Film in Istanbul, Turkey

Abuses, resilience, behavioural problems and post-traumatic stress symptoms among unaccompanied migrant minors: An Italian cross-sectional exploratory study

The aims of this study were to explore the type and prevalence of pre-/peri-migratory trauma experiences in unaccompanied minors and the prevalence of mental health problems and resilience. The study included 19 unaccompanied migrant minors aged 16–17 years coming from Egypt, Albania, Senegal, Bangladesh, Gambia, Morocco and Mali. The participants completed self-report questionnaires on emotional and behavioural problems, post-traumatic stress symptoms, abuse and resilience. All the unaccompanied migrant minors in our study were physically and psychologically abused at least once in their life and more than half were sexually abused before or during their migration. The most frequent abuses were: being hit with an object, being punished at school and at home with torture and infliction of pain, being forced to do something dangerous, being insulted, undergoing theft or damage of personal objects, being forced to look at sexual photos or videos and being sexually abused. The scores on post-traumatic stress, depression, anxiety and dissociation are above the clinical cut-off point. Mean scores in the scales of resilience are generally in line with normative data. These scores show that despite their traumatic pre-migratory and peri-migratory experiences of abuse and the clinical psychopathological effects, the minors interviewed proved to have good sources of resilience. Immigration policies however should be based not only on admittance to emergency refuge centres but also on assessing the subjects and providing them with psychological support for the traumas experienced in order to achieve a successful integration process in the host societ

Jean-Jacques Rousseau: between autonomy and authenticity

This thesis reconsiders some of the major works and themes of Jean-Jacques Rousseau in the light of recent debates centering on forms of subjectivity in liberal modernity. Rousseau is not a liberal thinker in the sense that he invests full political agency in the individual. However, he shares common ground with the liberal tradition in his promotion of the self to the exclusion of the social in a number of works. On the other hand, Rousseau's strictly political framework is communitarian in its recognition of the purely public nature of legitimacy - the General Will which all individual citizens are expected to express and conform to.It is argued that the dichotomy identified in Rousseau's work between the positions of subject and citizen fail to fully realise the potential for a reconstructive view of subjectivity. This reconstructive view is based on the potential for reconciling individuation and socialisation. This reconciliation has two branches. In the first place, the subject loses any idealist or transcendental status, consciousness, cognition, knowledge and other vital parameters of selfdefinition are decentered. Secondly, subjectivity is reconstructed along relational lines as intersubjectivity. In the process truth is demoted from the plane certainty to a more humble life in the transactional milieu of the social sphere organising and coordinating daily actions, forms and practices.Rousseau's works do not expressly recognise the intersubjective reorganisation of subjectivity. They do however traverse the field of tensions in the process of attempting to define the subject or social life in terms either of the idealist category of selfhood, or the practical category of community. The reference points of authenticity and autonomy are juxtaposed to suggest that those reconstructive theories guiding some current thinking can be useful in reconsidering Rousseau's notion of subjectivity in a more complete sense. This greater completeness adds a dimension of inconclusiveness since it is achieved by bringing Rousseau's narrative and autobiographical works and his systematic and philosophical works into direct confrontation.The Confessions is reconsidered as a work in which the attempt to describe authenticity is immediately frustrated by the position of the real in language. However, the real cannot appear otherwise than in language. For Rousseau self-identity has the wholeness of substance and is grasped immediately. This immediacy is what language obscures, but it is not recoverable through the reconstruction of the self's presence to self. Rather, the subject must acknowledge its indebtedness to its recognition by the other for its sense of identity. This indebtedness must further be expressed as a recognition of the other, which recognition is identifiable at the core of language and inseparable from intentional consciousness, including self-consciousnessThe Dialogues is the product of a crisis of the subject held to ransom and objectified by its complete entrapment in the webs of a conspiracy. The subject makes a virtue of its unique status as the sole object of this universal representational system. It is the reality which the conspiracy regards but can never fully capture. The constructive power of the conspiracy can nevertheless not dissolve the authentic self which attempts to define itself non-derivatively as the truth misrepresented by lies. The text promises to deliver the subject as presence - as truth - but fails. This failure is productive insofar as it advances a model of understanding more finely tuned both to its own experience of the conspired against subject unable to ultimately identify either the conspirators or the subject which that discourse has constructed. The subject's attempts to test the conspiracy and to present themselves as the only fully examined subject can never be exhausted. What follows is endless examination, revelation and interpretation, the relocation of truth away from ontology, and the decentering of the subject from presence to time, or multiple temporal frameworks.For Rousseau autonomy under the law means the freedom to bind oneself to the norms of the social formation by participating in the formation of those norms. What is not considered in this idealism of the freely negotiated contract and the novel social agreement is the sense in which subjects clash with the given nature of norms, their existence as conditions which one enters involuntarily. At best, simple reconciliation with those norms represents the acceptance of the social role as the authentic self. However, this neglects the fact that the cause is not objective in the sense that it exists prior to discourse but only in the sense in which it assumes priority in discourse. Clearly, under the law, oedipal narratives structure self-understanding and the range and nature of lawful positions available to the self. However, autobiography, insofar as it is a narrative of the representation of guiding imperatives, or a confession of pathos laden distortions of authenticity offers the opportunity to produce self-interpretations which actively reinscribe the cause with agency of some type.Emile broaches but contains the framework for intersubjective selfhood. The ecuation is driven by a model of autonomy which view relatedness in terms of compromise and sacrifice. The form of selfhood is modelled on the real as object world, on the assumption that a scientific understanding of nature is disenchanted and referential rather than semantic and merely another, competing fable amongst others. However, the education resolves the tensions it itself produces by disguising the subject's relation to forms of otherness as the potential crisis against which its own theory guided genesis of the individual guards

Opening the Black Box: Explaining the Process of Basing a Health Recommender System on the I-Change Behavioral Change Model

Recommender systems are gaining traction in healthcare because they can tailor recommendations based on users' feedback concerning their appreciation of previous health-related messages. However, recommender systems are often not grounded in behavioral change theories, which may further increase the effectiveness of their recommendations. This paper's objective is to describe principles for designing and developing a health recommender system grounded in the I-Change behavioral change model that shall be implemented through a mobile app for a smoking cessation support clinical trial. We built upon an existing smoking cessation health recommender system that delivered motivational messages through a mobile app. A group of experts assessed how the system may be improved to address the behavioral change determinants of the I-Change behavioral change model. The resulting system features a hybrid recommender algorithm for computer tailoring smoking cessation messages. A total of 331 different motivational messages were designed using 10 health communication methods. The algorithm was designed to match 58 message characteristics to each user pro le by following the principles of the I-Change model and maintaining the bene ts of the recommender system algorithms. The mobile app resulted in a streamlined version that aimed to improve the user experience, and this system's design bridges the gap between health recommender systems and the use of behavioral change theories. This article presents a novel approach integrating recommender system technology, health behavior technology, and computer-tailored technology. Future researchers will be able to build upon the principles applied in this case study.European Union's Horizon 2020 Research and Innovation Programme under Grant 68112