An Unternehmenswerten und politischem Rahmen ansetzen

Die Sustainable Balanced Scorecard verspricht mehr Nachhaltigkeit in der Un­ternehmensführung. Für ihre maximale Wirkung muss die gesamte Strategie eines Unternehmens mit Hilfe der Scorecard optimiert werden. Ein ebenso wichtiger Erfolgsfaktor sind besonders für kleine und mittlere Unternehmen langfristig stabile Rahmenbedingungen

Web-based audiovisual patient information system—a study of preoperative patient information in a neurosurgical department

Background: In the current climate of increasing awareness, patients are demanding more knowledge about forthcoming operations. The patient information accounts for a considerable part of the physician's daily clinical routine. Unfortunately, only a small percentage of the information is understood by the patient after solely verbal elucidation. To optimise information delivery, different auxiliary materials are used. Methods: In a prospective study, 52 consecutive stationary patients, scheduled for an elective lumbar disc operation were asked to use a web-based audiovisual patient information system. A combination of pictures, text, tone and video about the planned surgical intervention is installed on a tablet personal computer presented the day before surgery. All patients were asked to complete a questionnaire. Results: Eighty-four percent of all participants found that the audiovisual patient information system lead to a better understanding of the forthcoming operation. Eighty-two percent found that the information system was a very helpful preparation before the pre-surgical interview with the surgeon. Ninety percent of all participants considered it meaningful to provide this kind of preoperative education also to patients planned to undergo other surgical interventions. Eighty-four percent were altogether "very content” with the audiovisual patient information system and 86% would recommend the system to others. Conclusions: This new approach of patient information had a positive impact on patient education as is evident from high satisfaction scores. Because patient satisfaction with the informed consent process and understanding of the presented information improved substantially, the audiovisual patient information system clearly benefits both surgeons and patient

Manifestations electro-cliniques du syndrome de Lennox–Gastaut

Introduction : Le syndrome de Lennox-Gastaut (SLG) est une encéphalopathie épileptique rare. Notre étude consiste à déterminer les caractéristiques électro-cliniques du SLG au centre hospitalier national universitaire de Fann à DAKAR. Méthodologie: Il s’agit d’une étude rétrospective portant sur les dossiers médicaux de juillet 2004 à mai 2015, réalisée à la clinique neurologique et à l’hôpital des enfants Albert Royer. L’âge des enfants, l’âge de début des crises, les antécédents pathologiques, le type de crise, les troubles cognitifs et les tracés EEG ont été recueillis. Ont été inclus dans cette étude, tous les patients présentant de multiples types de crises, partielles ou généralisées ; un retard mental et à l’EEG, des pointes ondes lentes généralisées à la veille et/ou pointes rapides rythmiques pendant le sommeil.Résultats: Nous rapportons cinq cas de SLG de différents âges avec comme antécédents, une épilepsie familiale chez trois enfants et un syndrome de west chez un enfant. Le sex ratio était de 3/2 en faveur du sexe masculin. L’âge de début du SLG se situait typiquement entre 1 et 7 ans chez 4 patients. Les types de crises retrouvées étaient les crises toniques (100%), les absences atypiques (80%), les crises partielles motrices (60%), les crises atoniques (40%) et crises généralisées tonico-cloniques (40%). Aussi, tous les enfants avaient des troubles cognitifs. Les patterns EEG les plus fréquemment retrouvés étaient des décharges de Pointes ondes lentes Conclusion : Le SLG est une encéphalopathie épileptique infantile rare caractérisée par de multiples types de crise, un tracé EEG spécifique et un retard psychomoteur. Les résultats de notre étude concernant le profil électro-clinique se rapprochent de ceux de la littérature. Electro-clinical manifestations of Lennox–Gastaut SyndromeIntroduction: Lennox–Gastaut syndrome (LGS) is an uncommon epileptic encephalopathy. In this study, we tried to determine the clinical and EEG characteristics of patients with LGS in DAKAR Fann teaching hospital. Methods: It is a retrospective study concerning medical folders during July 2004 to May 2015 realized in neurological clinic and Albert Royer children’s hospital. Age, gender, age at seizure onset, seizure type(s), epilepsy risk factors, cognitive disorders and EEG of all patients were registered. We included for this study all patients presenting multiple seizure types, mental retardation and an interictal EEG showing bursts of slow spike-wave complexes during awake and/or generalized paroxysmal fast activity during sleep. Results: We report different age five LGS cases with familial epilepsia in three cases and west syndrome in one case. The sex ratio was 3/2 for male. The age at seizure onset was typically between 1 and 7 years in four patients. The most common seizure type was tonic (100%), followed by atypic absence (80%), partial motor seizures (60%), and atonic seizures (40%) and generalized tonic–clonic seizures (40%). All the five childrens had cognitive disorders. The most common EEG finding was slow spike-wave complexes. Conclusion: LGS is an uncommon epileptic encephalopathy characterized by multiple seizure types, a specific electroencephalographic pattern and psychomotor retardation, beginning in childhood. Our results are  comparable with literature.

L’atrophie multisystematisee a la clinique neurologique Ibrahima Pierre Ndiaye de Dakar, Senegal

Introduction:  L’atrophie multisystématisée (AMS) est une affection neurodégénérative d’évolution progressive et fatale. De cause inconnue, elle est classée en deux formes cliniques (AMS-P et AMS-C). Patients et Méthode: Nous avons réalisé une étude transversale portant sur neuf patients, membres de sept familles, répondant aux critères diagnostiques consensuels de l’AMS. Résultats: L’âge moyen de survenue était de 43,7 ans. Les syndromes parkinsonien et cérébelleux ont été retrouvés dans 5 cas, un syndrome pyramidal dans 4 cas et une dysautonomie dans 3 cas. Une dysarthrie était présente dans 5 cas, des troubles cognitifs et une dysphagie dans 4 cas, des mouvements anormaux dans 2 cas, des troubles du sommeil et une hypoacousie chez 1 cas. La forme AMS-P était prédominante dans 5 cas, la forme AMS-C a été retrouvée chez 4 cas. L’imagerie cérébrale a objectivé dans 100% des cas une atrophie cérébelleuse et une atrophie du tronc cérébral. L’ENMG était en faveur d’une polyneuropathie chez trois patients et une atteinte du VIII a été objectivée chez un patient. Les pedigrees des quatre familles ont mis en évidence un mode de transmission autosomique récessive. Conclusion: L’AMS considérée comme sporadique, peut aussi revêtir une caractéristique génétique. Nous avons rapporté des cas d’AMS chez des personnes issues de mariages consanguins, dont certaines ont des cas similaires dans la famille avec une prédominance de la forme AMS-P. Une cause génétique avec un mode de transmission autosomique récessive est fortement suspectée. Une étude génétique s’impose afin d’isoler les gènes. English title: Multiple system atrophy at the Ibrahima Pierre Ndiaye neurological clinic, Dakar, Senegal Background Multiple system atrophy (MSA) is a progressive and fatal neurodegenerative disease. Of unknown cause, it is classified into two clinical forms (AMS-P and AMS-C). Patients and Method We carried out a cross-sectional study of nine patients, members of seven families, meeting the consensus  diagnostic criteria of the AMS. Results The mean age of onset was 43.7 years. Parkinsonian and cerebellar syndromes were found in 5 cases, pyramidal syndrome in 4 cases and dysautonomia in 3 cases. Dysarthria was present in 5 cases, cognitive impairment and dysphagia in 4 cases, abnormal movements in 2 cases, sleep disturbances and hearing loss in 1 case. The AMS-P form was predominant in 5 cases, the AMS-C form was found in 4 cases. Brain imaging demonstrated cerebellar atrophy and brainstem atrophy in 100% of cases. The ENMG was in favor of polyneuropathy in three patients and VIII involvement was demonstrated in one patient. The pedigrees of the four families showed an autosomal recessive mode of inheritance. Conclusion: AMS, considered to be sporadic, can also have a genetic characteristic. We have reported cases of AMS in people from  consanguineous marriages, some of whom have similar cases in the family with a predominance of the AMS-P form. A genetic cause with an autosomal recessive mode of inheritance is strongly suspected. Genetic study is needed in order to isolate the genes

Architecture and Advanced Electronics Pathways Toward Highly Adaptive Energy- Efficient Computing

With the explosion of the number of compute nodes, the bottleneck of future computing systems lies in the network architecture connecting the nodes. Addressing the bottleneck requires replacing current backplane-based network topologies. We propose to revolutionize computing electronics by realizing embedded optical waveguides for onboard networking and wireless chip-to-chip links at 200-GHz carrier frequency connecting neighboring boards in a rack. The control of novel rate-adaptive optical and mm-wave transceivers needs tight interlinking with the system software for runtime resource management

Gender differences in patients with dizziness and unsteadiness regarding self-perceived disability, anxiety, depression, and its associations

BACKGROUND: It is known that anxiety and depression influence the level of disability experienced by persons with vertigo, dizziness or unsteadiness. Because higher prevalence rates of disabling dizziness have been found in women and some studies reported a higher level of psychiatric distress in female patients our primary aim was to explore whether women and men with vertigo, dizziness or unsteadiness differ regarding self-perceived disability, anxiety and depression. Secondly we planned to investigate the associations between disabling dizziness and anxiety and depression. METHOD: Patients were recruited from a tertiary centre for vertigo and balance disorders. Participants rated their global disability as mild, moderate or severe. They filled out the Dizziness Handicap Inventory and the two subscales of the Hospital Anxiety Depression Scale (HADS). The HADS was analysed 1) by calculating the median values, 2) by estimating the prevalence rates of abnormal anxiety/depression based on recommended cut-off criteria. Mann-Whitney U-tests, Chi-square statistics and odds ratios (OR) were calculated to compare the observations in both genders. Significance values were adjusted with respect to multiple comparisons. RESULTS: Two-hundred and two patients (124 women) mean age (standard deviation) of 49.7 (13.5) years participated. Both genders did not differ significantly in the mean level of self-perceived disability, anxiety, depression and symptom severity. There was a tendency of a higher prevalence of abnormal anxiety and depression in men (23.7%; 28.9%) compared to women (14.5%; 15.3%). Patients with abnormal depression felt themselves 2.75 (95% CI: 1.31-5.78) times more severely disabled by dizziness and unsteadiness than patients without depression. In men the OR was 8.2 (2.35-28.4). In women chi-square statistic was not significant. The ORs (95% CI) of abnormal anxiety and severe disability were 4.2 (1.9-8.9) in the whole sample, 8.7 (2.5-30.3) in men, and not significant in women. CONCLUSIONS: In men with vertigo, dizziness or unsteadiness emotional distress and its association with self-perceived disability should not be underestimated. Longitudinal surveys with specific pre-defined co-variables of self-perceived disability, anxiety and depression are needed to clarify the influence of gender on disability, anxiety and depression in patients with vertigo, dizziness or unsteadiness

The Orchestration Stack: The Impossible Task of Designing Software for Unknown Future Post-CMOS Hardware

Future systems based on post-CMOS technologies will be wildly heterogeneous, with properties largely unknown today. This paper presents our design of a new hardware/software stack to address the challenge of preparing software development for such systems. It combines well-understood technologies from different areas, e.g., network-on-chips, capability operating systems, flexible programming models and model checking. We describe our approach and provide details on key technologies

The genomic and transcriptional landscape of primary central nervous system lymphoma

Primary lymphomas of the central nervous system (PCNSL) are mainly diffuse large B-cell lymphomas (DLBCLs) confined to the central nervous system (CNS). Molecular drivers of PCNSL have not been fully elucidated. Here, we profile and compare the whole-genome and transcriptome landscape of 51 CNS lymphomas (CNSL) to 39 follicular lymphoma and 36 DLBCL cases outside the CNS. We find recurrent mutations in JAK-STAT, NFkB, and B-cell receptor signaling pathways, including hallmark mutations in MYD88 L265P (67%) and CD79B (63%), and CDKN2A deletions (83%). PCNSLs exhibit significantly more focal deletions of HLA-D (6p21) locus as a potential mechanism of immune evasion. Mutational signatures correlating with DNA replication and mitosis are significantly enriched in PCNSL. TERT gene expression is significantly higher in PCNSL compared to activated B-cell (ABC)-DLBCL. Transcriptome analysis clearly distinguishes PCNSL and systemic DLBCL into distinct molecular subtypes. Epstein-Barr virus (EBV)+ CNSL cases lack recurrent mutational hotspots apart from IG and HLA-DRB loci. We show that PCNSL can be clearly distinguished from DLBCL, having distinct expression profiles, IG expression and translocation patterns, as well as specific combinations of genetic alterations