The Role of Negative-Pressure Wound Therapy in Patients with Fracture-Related Infection:A Systematic Review and Critical Appraisal

INTRODUCTION: Fracture-related infection (FRI) is a severe musculoskeletal complication in orthopedic trauma surgery, causing challenges in bony and soft tissue management. Currently, negative-pressure wound therapy (NPWT) is often used as temporary coverage for traumatic and surgical wounds, also in cases of FRI. However, controversy exists about the impact of NPWT on the outcome in FRI, specifically on infection recurrence. Therefore, this systematic review qualitatively assesses the literature on the role of NPWT in the management of FRI. METHODS: A literature search of the PubMed, Embase, and Web of Science database was performed. Studies that reported on infection recurrence related to FRI management combined with NPWT were eligible for inclusion. Quality assessment was done using the PRISMA statement and the Newcastle-Ottawa Quality Assessment Scale. RESULTS: After screening and quality assessment of 775 unique identified records, eight articles could be included for qualitative synthesis. All eight studies reported on infection recurrence, which ranged from 2.8% to 34.9%. Six studies described wound healing time, varying from two to seven weeks. Four studies took repeated microbial swabs during subsequent vacuum dressing changes. One study reported newly detected pathogens in 23% of the included patients, and three studies did not find new pathogens. CONCLUSION: This review provides an assessment of current literature on the role of NPWT in the management of soft tissue defects in patients with FRI. Due to the lack of uniformity in included studies, conclusions should be drawn with caution. Currently, there is no clear scientific evidence to support the use of NPWT as definitive treatment in FRI. At this stage, we can only recommend early soft tissue coverage (within days) with a local or free flap. NPWT may be safe for a few days as temporarily soft tissue coverage until definitive soft tissue management could be performed. However, comparative studies between NPWT and early wound closure in FRI patients are needed

Parallel recovery in a trilingual speaker: the use of the Bilingual Aphasia Test as a diagnostic complement to the Comprehensive Aphasia Test

We illustrate the value of the Bilingual Aphasia Test in the diagnostic assessment of a trilingual speaker post-stroke living in England for whom English was a non-native language. The Comprehensive Aphasia Test is routinely used to assess patients in English, but only in combination with the Bilingual Aphasia Test is it possible and practical to provide a full picture of the language impairment. We describe our test selection and the assessment it allows us to make

Comparison of GC‐MS, HPLC‐MS and SIFT‐MS in conjunction with multivariate classification for the diagnosis of Crohn’s disease in urine

The developed world has seen an alarming increase in the incidence of gastrointestinal diseases, among the most common of which is Crohn’s disease (CD) in the young. The current “gold standard” techniques for diagnosis are often costly, time consuming, inefficient, invasive, and offer poor sensitivities and specificities. This paper compares the performances of three hyphenated instrumental techniques that have been suggested as rapid methods for the non‐invasive diagnosis of CD from urine. These techniques are gas chromatography‐mass spectrometry (GC‐MS), high performance liquid chromatography‐mass spectrometry (HPLC‐MS) and selected ion flow tube mass spectrometry (SIFT‐MS). Each of these techniques is followed by multivariate classification to provide a diagnosis based on the acquired data. The most promising results for potentially diagnosing CD was via HPLC‐MS. An overall classification accuracy of 73% (74% specificity; 73% sensitivity) was achieved for differentiating CD from healthy controls, statistically significant at 95% confidence

Investigation of Dyslexia and SLI Risk Variants in Reading- and Language-Impaired Subjects

Dyslexia (or reading disability) and specific language impairment (or SLI) are common childhood disorders that show considerable co-morbidity and diagnostic overlaps and have been suggested to share some genetic aetiology. Recently, genetic risk variants have been identified for SLI and dyslexia enabling the direct evaluation of possible shared genetic influences between these disorders. In this study we investigate the role of variants in these genes (namely MRPL19/C20RF3,ROBO1,DCDC2, KIAA0319, DYX1C1, CNTNAP2, ATP2C2 and CMIP) in the aetiology of SLI and dyslexia. We perform case–control and quantitative association analyses using measures of oral and written language skills in samples of SLI and dyslexic families and cases. We replicate association between KIAA0319 and DCDC2 and dyslexia and provide evidence to support a role for KIAA0319 in oral language ability. In addition, we find association between reading-related measures and variants in CNTNAP2 and CMIP in the SLI families

The exponential age distribution and the Pareto firm size distribution

firm size distribution, age distribution, firm growth, Gibrat’s law, Pareto distribution, Zipf Law, L20, L25,

Rakennusyrityksen tarjousvaiheen kustannuslaskenta

Opinnäytetyön tarkoituksena oli koota Rakennus K. Karhu Oy:lle toimintaohje tarjousvaiheen kustannuslaskentaan. Varsinaista tutkimustyötä tähän opinnäytetyöhön ei sisällytetty, vaan tarkoituksena oli useiden laajempia kokonaisuuksia käsittelevien eri lähteiden uumenista ja haastattelemalla aiheen parissa työskennelleitä henkilöitä koota pelkästään tarjousvaiheen kustannuslaskentaan keskittyvä ohje. Tarkoituksena ei ollut luoda uutta toimintatapaa yritykselle, vaan kehittää ja yhtenäistää jo käytössä olevia ja ajan saatossa muotoutuneita toimintaperiaatteita. Tämän tarjousvaiheen kustannuslaskentaan keskittyvän toimintamallin on tarkoitus päätyä osaksi mahdollisesti tulevaisuudessa koottavaa, koko yrityksen toiminnan kattavaa laatujärjestelmää. Tavoitteena oli luoda ohjeesta tiivis kokonaisuus, jota ei olisi liian raskas käyttää, jättäen jokaiselle projektinvetäjälle mahdollisuus toteuttaa omaa toimintatapaansa, kuitenkin yrityksen yhtenäistä linjaa noudattaen. Tässä ohjeen muotoon laaditussa opinnäytetyössä käsitellään rakennusyrityksen tarjousvaiheen kustannuslaskennan vaiheet, vaihe vaiheelta. Pääaihepiirit on jaoteltu projektin etenemisjärjestyksessä alusta loppuun. Tarkastellaan kohteen valinta, minkälainen ja mitkä kriteerit tulee kohteella olla, jotta siitä lähdetään tarjousta tekemään. Kun päätös tarjouskilpaan lähtemisestä on tehty, suoritetaan ennakkotarjouksien kysely alihankintana tehtävistä urakoista. Kun tämä on suoritettu, ja raaka-aineiden määrälaskenta on suoritettu, siirrytään hinnoitteluun ja varsinaiseen alihankintatarjousten kyselyyn. Ennen varsinaista tarjouskäsittelyä, käsiteltävää kohdetta verrataan vielä sopiviin viitekohteisiin ja näiden jälkilaskentatietoihin. Avainsanat (asiasanat) Kustannuslaskenta, tarjoaminen Muut tiedotThe purpose of this bachelor’s thesis was to collect instructions for tender-stage cost calculation in Rakennus K. Karhu Oy. No theoretical research was included in this bachelor’s thesis, but the purpose was to collect instructions just for tender-stage cost calculation, using several extensive sources and interviewing people working on the subject. The purpose was not to create a new kind of procedure for the company, but to develop and unify the principles already in use. The purpose is that this procedure, based on tender-stage cost calculation, is to be included as part of a quality system which will perhaps be created in the future. The main goal was to create a compact package that would not be too difficult to use, leaving each project leader the possibility to do things in his or her own way, still respecting the consistent? procedures of the company. In this bachelor’s thesis, compiled in a form of instruction, the stages of tender calculation in a construction company are dealt with step by step. The main topics are divided from start to finish in the order of the progress of the project. Choosing of the target is examined: what should it be like and what criteria should it have to lead to tendering. When the decision on participating in tendering is made,asking for preliminary bids from subcontractors follows. After this and the quantity calculations for raw-materials have been done, pricing and the actual asking for subcontractors’ tenders follow. Before the actual processing of the tender, the target is compared to similar reference targets and their post-calculation data