Laxity measurements of the Sacroiliac joints in women with pregnancy-related pelvic pain

The review of the origin, the diagnosis and treatment of pregnancy-related pelvic pain led to the conclusion that laxity of the S!Js may play a central role in the understanding of this syndrome. The department of Biomedical Physics and Technology and the department of Rehabilitation have studied the biomechanical properties of the pelvic joints, in particular the SUs for many years. Because no instrumented method was available, Snijders proposed a new vihration method for the in vivo assessment of SIJ laxity. This resulted in the method of Doppler imaginj\ of vibrations (DIV), which runs as a continuous thread throughout this thesis. 3·14 Chapter 2 describes the intra- and inter-tester reliability indexes of D!V in SIJ laxity measurements performed by several testers, including one experienced tester as well as inexperienced testers. The contribution of various sources of measurement enor associated with the measurement design is also addressed. Chapter 3 presents the pregnancy part of a longitudinal study on 163 subjects with and without PRPP. This study was designed to investigate the association between PRPP and S!J laxity at 36 weeks of pregnancy. Chapter 4 describes the postpartum part of the study presented in chapter 3. The aims of this study were to describe the association between PRPP and SIJ laxity 8 weeks after childbirth and to determine to what extent asymmetric laxity of the SUs during pregnancy has predictive power with regard to postpartum PRPP. Chapter 5 presents a study designed to establish the influence of a pelvic belt on S!J laxity. The belt was tested at two positions (low: at the level of the pubic symphysis, and high: just below the anterior superior iliac spines) and at two tensions (50 and 100 N) in ten healthy subjects. Finally, the study in chapter 6 investigates the influence of a pelvic belt at low and high position on SIJ laxity and its effect on the active straight leg raise (ASLR) test in 25 women with PRPP

Bypassing Health Centers in Tanzania: Revealed Preferences for Observable and Unobservable

When patients bypass on one health facility to seek health care at another, strong preference are revealed. This paper advances the view that the patterns of bypassing observed in Iringa Rural district in Tanzania show evidence of patients understanding of various measures of quality at the facilities that they visit and bypass. Importantly some of these measures are "unobservable", meaning that we do not expect patients to be able to evaluate whether or not these types of quality are present just from visiting a center. We use two data sets on various features of health facilities including consultation quality and prescription quality as evaluated by a team of clinicians. This is matched with data collected from health center registers that included the symptoms of patients and the village they traveled from. The register data is transformed into a patient-based sample and we use a multinomial/conditional logit regression on patient choice of provider to show the relationship between patient behavior and objective measure of technical quality in the health facilities. Patients seek facilities that provide high quality consultations, are staffed by more knowledgeable physicians, observe prescription practices and are polite. They avoid facilities that use injections too liberally or over-prescribe medicatio

Bypassing health centers in Tanzania: Revealed preferences for observable and unobservable quality

When patients bypass one health facility to seek health care at another, strong preferences are revealed. This paper advances the view that the patterns of bypassing observed in Iringa Rural district in Tanzania show evidence of patients' understanding of various measures of quality at the facilities that they visit and bypass. Importantly some of these measures are 'unobservable,' meaning that we do not expect patients to be able to evaluate whether or not these types of quality are present just from visiting a center. We use two data sets on various features of health facilities including consultation quality and prescription quality as evaluated by a team of clinicians. This is matched with data collected from health center registers that included the symptoms of patients and the village they traveled from. The register data is transformed into a patient-based sample and we use a multinomial/conditional logit regression on patient choice of provider to show the relationship between patient behavior and objective measure of technical quality in the health facilities. Patients seek facilities that provide high quality consultations, are staffed by more knowledgeable physicians, observe prescription practices, and are polite. They avoid facilities that use injections too liberally or over-prescribe medication

Long-term cortisol levels in hair of children and adolescents with Prader-Willi Syndrome

Context: Prader-Willi syndrome (PWS) is characterized by hypothalamic dysfunction. In children with PWS, stress-induced central adrenal insufficiency (CAI) has been described, however, daily life cortisol production may be normal. Hair cortisol concentration (HCC) is a marker of long-term systemic cortisol production. Cortisol awakening response (CAR) is the increase in cortisol level after awakening. A negative CAR might suggest hypothalamic-pituitary-adrenal (HPA)-axis reactivity problems. Little is known about HCC and CAR in children with PWS. Objective: To investigate long-term cortisol levels in hair and CAR in children with PWS. Design: Cross-sectional study. Patients: 41 children with PWS. Setting: Dutch PWS Reference Center. Main outcome measures: HCC and salivary cortisol measured by LCMS. Results: Median (IQR) HCC was 1.90 (1.02–3.30) pg/mg at a median (IQR) age of 14.5 (8.20–19.0) years, with median HCC in age-matched references being 2.63 pg/mg. Five patients (13.2%) had HCC &lt; 2.5th percentile for age and these patients had a repeatedly negative CAR. Median HCC was significantly lower in patients with negative CAR than in patients with normal CAR (1.00 (0.22–1.59) vs. 2.25 (1.47–3.26) pg/mg, p = 0.007). One patient had both HCC &lt; 2.5th percentile and repeatedly low morning salivary cortisol levels and negative CAR, and was diagnosed with adrenal insufficiency by overnight metyrapone test. Conclusions: HCC were normal in the majority of children with PWS. Our data suggest that children with HCC &lt; 2.5th percentile and (repeatedly) negative CAR might possibly have adrenal insufficiency or delayed HPA-axis responsiveness.</p

Taking Nothing for Granted in Management Education: A Systemic Perspective on the Role of Reflective Questioning

Questioning is one of the most critical behaviors in management education and learning. In this article we explore the antecedents, processes, and outcomes of reflective questioning, as a key element of management learning and education. Reflective questioning involves raising tentative, nonrhetorical questions. By reviewing and synthesizing the literature, we develop a model of reflective questioning in the form of a causal loop diagram. This model implies that reflective questioning can be taught through particular forms of management education, but is also contingent on the psychological safety of the group setting, the individual need for cognition, and challenging tasks and experiences

An unusual case of unilateral supernumerary extensor carpi radialis muscle

An uncommon anatomical variant of muscle that can be considered as a supernumerary extensor carpi radialis muscle was found during the dissection of the forearm region. The identified extensor carpi radialis muscle has origin on the lateral supraepicondylar ridge of the humerus, and an unusual insertion on the tubercle of the scaphoid bone. The presence of this supernumerary muscle may cause diagnostic errors in the forearm region, and can produce a debilitating pain syndrome by secondary compression of adjacent nerves, vessels or tendons due to its course along the anterior compartment of the forearm

Patterning of ultrathin YBCO nanowires using a new focused-ion-beam process

Manufacturing superconducting circuits out of ultrathin films is a challenging task when it comes to patterning complex compounds, which are likely to be deteriorated by the patterning process. With the purpose of developing high-T$_c$ superconducting photon detectors, we designed a novel route to pattern ultrathin YBCO films down to the nanometric scale. We believe that our method, based on a specific use of a focused-ion beam, consists in locally implanting Ga^{3+} ions and/or defects instead of etching the film. This protocol could be of interest to engineer high-T$_c$ superconducting devices (SQUIDS, SIS/SIN junctions and Josephson junctions), as well as to treat other sensitive compounds.Comment: 13 pages, 7 figure