L’impact de l’instrumentation du rachis sur les efforts intervertébraux et articulaires aux membres inférieurs au cours de la marche chez les patients ayant une scoliose idiopathique adolescente

RESUMÉ La scoliose est une pathologie musclo-squelettique. Cette maladie peut affecter la mobilité du corps humain et causer des problématiques liées aux mouvements. L’évaluation des pathologies musculaires, tel que la scoliose, demeure problématique en clinique de réadaptation. En lien avec cette problématique, une méthode de quantification des efforts articulaires aux membres inférieurs pour le corps humain en mouvement a été développée. Cette quantification sera utile dans le domaine de réadaptation, elle pourrait aider dans la sélection d’un programme efficace et spécifique des exercices de rééducation pour chacune des articulations aux membres inférieurs et dans le développement d’un indicateur pour évaluer le confort ainsi que la qualité de la marche des patients scoliotiques. Dans ce contexte, ce mémoire présente le développement d’un modèle dynamique multi-corps du corps humain pour la quantification des efforts intervertébraux ainsi que des efforts articulaires à la hanche, au genou et à la cheville afin de comparer le comportement dynamique au cours de la marche entre des patients ayant une Scoliose Idiopathique Adolescente (SIA) en condition pré-post opératoire et des sujets sains. Ensuite, pour chaque articulation, les valeurs maximales, minimales ainsi que les amplitudes des couples et des forces latéraux, verticaux et antéro-postérieurs ont été analysés à l’aide d’un test ANOVA à un facteur. De plus, un test Tukey post-hoc a été utilisé pour analyser les différences entre les trois groupes de sujets. Au niveau des efforts intervertébraux, l’étude montre que les valeurs minimales du couple antéro-postérieur ont diminué après l'instrumentation du rachis de 31%, 27%, 28%, et 31% au niveau de L5-L4, L4-L3, L3-L2, et L2-L1 respectivement. Le couple médio-latérale a significativement augmenté après l'instrumentation du rachis de 52%, 54%, 52%, 52%, 47% et 50% au niveau de L4 L5, L4-L3, L3-L2, L2-L1, L1-T12 et T11- T12 respectivement. Les forces médio-latérale, verticale et antéro-postérieur étaient significativement différentes après la chirurgie au niveau lombaire et thoraco-lombaire. Ces résultats montrent que l'asymétrie de la balance gauche-droite de la scoliose lors de la marche a été partiellement corrigée après la chirurgie. Les résultats du couple antéro-postérieur ont montré une similitude entre les patients sains et post-opératoire au niveau lombaire. Cependant, le comportement des autres composantes n’est pas globalement similaire aux sujets sains, ce qui implique le besoin du suivi en réadaptation après l’instrumentation du rachis.----------ABSTRACT Scoliosis is a musculoskeletal pathology. This disease can affect the mobility of human body and cause problems related to movements. The evaluation of muscle diseases, such as scoliosis, remains problematic in rehabilitation clinic. To respond to this problem, a quantification method of the lower limbs joint efforts during gait has been developed. This quantification will be useful in rehabilitation; it could help to select specific postural rehabilitation exercises around each lower limb joint to develop indicators of quality and comfort during gait. In this context, this study presents the development of a dynamics multi-body model of the human body for the quantification of intervertebral, hip, knee and ankle joint efforts in order to compare the dynamic behavior during gait between patients with Adolescent Idiopathic Scoliosis with (AIS) before and after spine instrumentation and healthy subjects. Then, One-way ANOVA was performed for the maximum, the minimum and the range of medio-lateral, vertical and anteroposterior torques and forces at each joint of the lower limbs. When appropriate, a Tukey's post hoc was performed to determine the differences. Amongst the intervertebral efforts results, the minimal values of the normalized antero-posterior intervertebral torques significantly decreased after surgery by 31%, 27%, 28%, and 31% at the L5-L4, L4-L3, L3-L2, and L2-L1 joints, respectively. The magnitude of the normalized medio-lateral intervertebral torques significantly increased after surgery by 52%, 54%, 52%, 52%, 47%, and 50% at the L5-L4, L4-L3, L3-L2, L2-L1, L1-T12, and T12-T11 joints, respectively. The antero-posterior, medio-lateral and vertical forces were significantly different after surgery at lumbar and thoraco-lumbar level. These results show that the asymmetry in the left-right balance of the scoliotic patient during gait was partially rectified after surgery. The results of antero-posterior torques showed a similarity between healthy and post-op patients at the lumbar level. However, the behaviours were globally still not similar to healthy patients for the other components, supporting the need for physiotherapy follow-up using a tool quantifying the intervertebral efforts during gait. For the lower limbs joint efforts, the results show that the scoliotic patients have the same dynamic behavior as healthy subjects for medio-lateral and antero-posterior torques. However, these patients have a reduced medio-lateral force compared to healthy subjects at the hip, knee and ankle. The study showed no significant difference between the two groups of scoliotic subjects

Corporate Governance and Risk Management in Healthcare Institutions: Application in the National Health Service

ABSTRACT: The quality of health care is a global issue of concern in recent years, as number of patients has significantly, higher costs, and technological development all led to an increase in malpractice and a reduction in quality of care particularly in the United Kingdom‟s National Health Service (NHS). In the early 1990s the NHS depended on an indemnity system under which NHS trusts were obliged to pay insurance premiums to the NHS Litigation Authority (NHSLA), which managed and dealt with clinical negligence claims on behalf on NHS trusts. However, this system developed into a system of risk management standards in 2002 as part of the governance reforms implemented by the NHS. The new governance reforms and risk management system were introduced for the purpose of improving the quality of care, better financial status, and reducing the numbers of clinical negligence claims. This study is interested in the connection between governance and risk management particularly in NHS trusts. Particular interest will be on the Foundation Trust Status (FT) as part of the governance structure of trusts. Under FTs the board of directors became responsible for making financial and strategic decision when compared with normal NHS Trusts. This research will investigate the impact of FTs on NHS trusts risk management levels, financial position, and the number of clinical negligence claims. In order to conduct such investigation and empirical analysis will be conducted on a set of panel database over the period of (2002-2009). The empirical analysis consisted of three stages, the first analysis examined the correlation between FTs and risk management levels and established that the governance reforms are positively related to risk management levels. The second analysis studied the connection between financial health represented by total net assets of trusts and FTs found that better financial health is achieved by implementing FT status. The final analysis evaluated the impact of FT on the number of new clinical negligence claims and discovered that they are negatively related; hence FTs are associated with lower numbers of new claims. In summary, this research supports the notion that corporate governance and risks management are significantly related and improved governance structure of NHS trusts helped improved many aspects of quality of care in the United Kingdom. Furthermore, this study helped understand the overall impact of FT status on NHS trusts and provides the basis for future studies related to this subject

Chronic inflammatory demyelinating polyneuropathy as a paraneoplastic manifestation of colorectal carcinoma: What do we know?

The pathogenesis of chronic inflammatory demyelinating polyneuropathy (CIDP) remains highly debated among experts. In recent times, literature has divulged a riveting yet plausible association between colorectal carcinoma and CIDP as its paraneoplastic ramification. Initially, research suggested that chronic inflammatory demyelinating polyneuropathy (CIDP) was caused solely by macrophages. However, recent studies have insinuated towards an alternative pathogenesis, one involving autoantibodies against paranodal junction proteins. These two distinct mechanisms are the primary contenders responsible for the development of CIDP, rendering it an elusive paraneoplastic manifestation of colorectal carcinoma.</p

Phase III study of nilotinib versus best supportive care with or without a TKI in patients with gastrointestinal stromal tumors resistant to or intolerant of imatinib and sunitinib

Background This phase III open-label trial investigated the efficacy of nilotinib in patients with advanced gastrointestinal stromal tumors following prior imatinib and sunitinib failure. Patients and methods Patients were randomized 2:1 to nilotinib 400 mg b.i.d. or best supportive care (BSC; BSC without tyrosine kinase inhibitor, BSC+imatinib, or BSC+sunitinib). Primary efficacy end point was progression-free survival (PFS) based on blinded central radiology review (CRR). Patients progressing on BSC could cross over to nilotinib. Results Two hundred and forty-eight patients enrolled. Median PFS was similar between arms (nilotinib 109 days, BSC 111 days; P=0.56). Local investigator-based intent-to-treat (ITT) analysis showed a significantly longer median PFS with nilotinib (119 versus 70 days; P=0.0007). A trend in longer median overall survival (OS) was noted with nilotinib (332 versus 280 days; P=0.29). Post hoc subset analyses in patients with progression and only one prior regimen each of imatinib and sunitinib revealed a significant difference in median OS of >4 months in favor of nilotinib (405 versus 280 days; P=0.02). Nilotinib was well tolerated. Conclusion In the ITT analysis, no significant difference in PFS was observed between treatment arms based on CRR. In the post hoc subset analyses, nilotinib provided significantly longer median O

Local modification of GaAs nanowires induced by laser heating

GaAs nanowires were heated locally under ambient air conditions by a focused laser beam which led to oxidation and formation of crystalline arsenic on the nanowire surface. Atomic force microscopy, photoluminescence and Raman spectroscopy experiments were performed on the same single GaAs nanowires in order to correlate their structural and optical properties. We show that the local changes of the nanowires act as a barrier for thermal transport which is of interest for thermoelectric applications

Are the medio-lateral joint forces in the lower limbs different between scoliotic and healthy subjects during gait?

INTRODUCTION: The quantification of internal joint efforts could be essential in the development of rehabilitation tools for patients with musculo-skeletal pathologies, such as scoliosis. In this context, the aim of this study was to compare the hips joint mediolateral forces during gait, between healthy subjects and adolescents with left lumbar or thoracolumbar scoliosis (AIS), categorized by their Cobb angle (CA). MATERIAL AND METHODS: Twelve healthy subjects, 12 AIS with CA between 20° and 40° and 16 AIS in pre-operative condition (CA : > 40°) walked at 4 km/h on an instrumented treadmill. The experimental set-up include six infrared cameras allow the computation of the tridimensional (3D) angular displacement and strain gauges located under the motor-driven treadmill allow the computation of ground reaction forces (GRF). The hips joint mediolateral forces were calculated using a 3D inverse dynamic of human body. One-way ANOVA was performed for the maximum, the minimum and the range of medio-lateral forces at each joint of the lower limbs. When appropriate, a Tukey's post hoc was performed to determine the differences. RESULTS: The mediolateral forces were significantly lower at the right hip for AIS with CA between 20° and 40° compared to healthy subject. CONCLUSION: The spinal deformation leads to a reduced medio-lateral force at the right hip, which could gradually change the scheme of postural adjustments for AIS during gait. Further research on the quantification of the joint lower limb efforts should include the knee and ankle joints to evaluate the impact of spinal deformation on the lower limb dynamic behaviour in AIS patients

Continuous and transparent multimodal authentication: reviewing the state of the art

Individuals, businesses and governments undertake an ever-growing range of activities online and via various Internet-enabled digital devices. Unfortunately, these activities, services, information and devices are the targets of cybercrimes. Verifying the user legitimacy to use/access a digital device or service has become of the utmost importance. Authentication is the frontline countermeasure of ensuring only the authorized user is granted access; however, it has historically suffered from a range of issues related to the security and usability of the approaches. They are also still mostly functioning at the point of entry and those performing sort of re-authentication executing it in an intrusive manner. Thus, it is apparent that a more innovative, convenient and secure user authentication solution is vital. This paper reviews the authentication methods along with the current use of authentication technologies, aiming at developing a current state-of-the-art and identifying the open problems to be tackled and available solutions to be adopted. It also investigates whether these authentication technologies have the capability to fill the gap between high security and user satisfaction. This is followed by a literature review of the existing research on continuous and transparent multimodal authentication. It concludes that providing users with adequate protection and convenience requires innovative robust authentication mechanisms to be utilized in a universal level. Ultimately, a potential federated biometric authentication solution is presented; however it needs to be developed and extensively evaluated, thus operating in a transparent, continuous and user-friendly manner