7 research outputs found
Reliability of popliteal angle measurement: a study in cerebral palsy patients and healthy controls
No full textThe popliteal angle is a widely used clinical measure for hamstring contracture in cerebral palsy (CP) patients and in healthy individuals. The reliability of popliteal angle measurement is being questioned. The aim of this study is to determine the reliability of popliteal angle measurement by means of visual and goniometric assessment. METHODS: Three different observers measured the popliteal angle in 15 CP patients and 15 healthy volunteers. In each subject, popliteal angles were visually estimated and measured with a blinded goniometer twice by all observers with approximately 1 hour between measurement sessions. RESULTS: All intraclass correlation coefficients (ICCs) were lower in the CP group compared with healthy controls. The ICC for intraobserver differences was higher than 0.75 for both groups. The ICC for interobserver reliability of visual estimates and goniometric measurements was low for both groups. Intermethod ICC was higher than 0.75 for both groups. CONCLUSIONS: Measurements in the CP group seemed to be less reliable than measurements in the control group. Intraobserver reliability is reasonable for both groups, but lower in CP patients than in controls. Interobserver reliability of both visual estimates and goniometrical measurements is poor. No significant differences in reliability have been found between visual estimation and goniometric measurement. Because of poor interobserver reliability of popliteal angle measurement, this should not be the only variable in clinical decision making in CP patients
Long-term Results of the Posteromedial Release in the Treatment of Idiopathic Clubfoot
No full textBackground: Short-term follow-up studies show good results in foot function, after surgical treatment of idiopathic clubfeet. Long-term follow-up studies are rare and probably represent a mixture of experience of different treating orthopedic surgeons. The purpose of this study is to present the long-term results of the posteromedial release (PMR) in congenital clubfoot treatment of 1 treating surgeon. Materials and Methods: Thirty-eight patients with 58 clubfeet had an a la carte PMRe, performed by 1 experienced pediatric orthopedic surgeon before the age of 2 years. This group had a mean follow-up of 16 years (range 13 to 24 years). All patients were interviewed and examined. Thereafter, the standing anteroposterior and lateral radiographs of the feet were taken. The results of the treatment were graded according to the system of Laaveg and Ponseti, and with the radiographs the grade of osteoarthritis was determined. The results were compared with the controlateral normal feet. Results: In 53 feet, the mean rating was 80.6 points (range 43 to 97), according to the system of Laaveg and Ponseti. There were 15 excellent, 17 good, 13 fair, and 8 poor results. The majority of patients had the limitation of foot function with a significant decrease in dorsiflexion of 31% and a significant decrease of pronation-suppination of 24%. The grade of osteoarthritis was consistently higher in the clubfeet than in the controlateral normal feet. Five feet (9%) needed an additional bony procedure because of pain and overcorrection of the clubfeet. This was considered to be a failure of the surgical treatment. Conclusion: In our study population, PMR will lead to stiff, and therefore to clinical not fully functional, feet after a follow-up of 16 years. Level of Evidence: Therapeutic level III
Ten cold clubfeet
No full textBackground and purpose — Idiopathic clubfeet are commonly treated with serial manipulation and casting, known as the Ponseti method. The use of Plaster of Paris as casting material causes both exothermic and endothermic reactions. The resulting temperature changes can create discomfort for patients. Patients and methods — In 10 patients, we used a digital thermometer with a data logger to measure below-cast temperatures to create a thermal profile of the treatment process. Results — After the anticipated temperature peak, a surprisingly large dip was observed (Tmin = 26 °C) that lasted 12 hours. Interpretation — Evaporation of excess water from a cast might be a cause for discomfort for clubfoot patients and subsequently, their caregivers
Papel del factor de transcripción Kruppel-like factor 2 en la disfunción endotelial hepática asociada a la hipertensión portal y al daño por isquemia y reperfusión
No full textEl endotelio disfuncional presenta, entre otras caracteristicas, alteración en los mecanismos de vasodilatación, complicaciones trombóticas, disminución de la resistencia al estrés oxidativo, aumento de la expresión de moléculas de adhesión y de la secreción de moléculas proinflamatorias. El factor de transcripción endotelial KLF2 juega un importante papel en la regulación del fenotipo protector endotelial y su expresión depende de las fuerza hemodinámicas generadas por el flujo sanguíneo y de la administración exógena de estatinas.
La hipertensión portal y el daño hepático por I/R son dos condiciones patológicas asociadas a disfunción endotelial. Los trastornos estructurales característicos de la cirrosis hepática, la mayor causa prevalente de hipertensión portal en nuestro entorno, se acompañan de variaciones en las fuerzas hemodinámicas que pueden modificar la expresión de KLF2 y su programa transcripcional vasoprotector. Asímismo, durante la isquemia asociada a la preservación de injertos hepáticos para transplante, la interrupción de las fuerzas hemodinámicas generadas por el flujo sanguíneo podría resultar en la reducción de los programas endoteliales vasoprotectores, que se debería en parte a la pérdida de expresión de KLF2.
Los trabajos de investigación de la presente tesis doctoral amplian el conocimiento de los mecanismos moleculares responsables de la disfunción endotelial hepática, demostrando:
1. Que KLF2 está muy expresado en los hígados cirróticos y que su expresión se induce en las fases tempranas de la progresión de la enfermedad, representando un mecanismo compensador para mejorar los desórdenes vasculares característicos de los hígados cirróticos.
2. Que los hígados preservados en condiciones de transplante muestran un descenso tiempo-dependiente de KLF2, acompañado de daño hepático y aumentada resistencia vascular.
Además, demostran que la modulación farmacologica de la expresión de KLF2 puede ser beneficiosa tanto en el tratamiento de la hipertensión portal como en la preservación de los injertos hepáticos para transplante
Active monitoring versus an abduction device for treatment of infants with centered dysplastic hips: study protocol for a randomized controlled trial (TReatment with Active Monitoring (TRAM)-Trial)
No full textBackground: Developmental Dysplasia of the Hip (DDH) is one of the most common pediatric orthopedic disorders, affecting 1–3% of all newborns. The optimal treatment of centered DDH is currently under debate. This randomized controlled trial aims to study the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH. Methods: This is a multicenter, parallel-group, open-label, non-inferiority randomized controlled trial studying the (cost-)effectiveness of active monitoring versus abduction treatment for infants with centered DDH in fourteen hospitals in the Netherlands. In total, 800 infants with centered DDH (Graf IIa-/IIb/IIc), aged 10–16 weeks, will be randomly allocated to the active monitoring or abduction treatment group. Infants will be followed up until the age of 24 months. The primary outcome is the rate of normal hips, defined as an acetabular index lower than 25 degrees on an antero-posterior radiograph, at the age of 12 months. Secondary outcomes are the rate of normal hips at the age of 24 months, complications, time to hip normalization, the relation between baseline patient characteristics and the rate of normal hips, compliance, costs, cost-effectiveness, budget impact, health-related quality of life (HRQoL) of the infant, HRQoL of the parents/caregivers, and parent/caregiver satisfaction with the treatment protocol. Discussion: The outcomes of this randomized controlled trial will contribute to improving current care-as-usual for infants with centered DDH. Trial registration: Dutch Trial Register, NL9714, registered September 6, 2021. https://clinicaltrialregister.nl/en/trial/29596
The use of corporate reputation in the development of brand image strategy in the Taiwanese pharmaceutical industry
No full textThis thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This doctoral research aims to investigate the reputation building process of companies and to examine the applicability of western-developed theories about the uses of corporate reputation in a non-western context. It is the first study that synthesises three theories (value creation, strategic resources and corporate communication) to examine the strategic consequences of the uses of corporate reputation.
Corporate reputation is an attribute or a set of attributes ascribed to a firm and inferred from the firm’s past actions. It is the belief of market participants about a firm’s strategic character (Weigelt and Camerer, 1988). Also, corporate reputation is the public’s cumulative judgement of a firm over time (Roberts and Dowling, 2002).
The review of theoretical literature indicates the uses of corporate reputation by business organizations can be theorized along six dominant paradigmatic perspectives: 1-public relations; 2-marketing; 3-management, 4-economic; 5-sociological; 6-finance and accounting. The uses of corporate reputation in these six paradigms are comprehensively discussed. The objective of this study is to establish the use of corporate reputation in the development of brand image strategy. A review of the uses of the concept of corporate reputation is discussed in detail in chapter 2.
The review of the literature also identified a research gap by showing that scarce research has been conducted on how these three main functions (value creation, strategic resources and corporate communication) affect a company’s brand positioning strategy. The following research question thus is proposed: How do (Taiwanese pharmaceutical) companies use their corporate reputation to develop a brand image strategy?
The research hypotheses based on three theories (value-based theory, resource-based theory and integrated marketing communication theory) appear in Chapter 3. The research question is constructed theoretically, and then a conceptual model, which begins with three antecedents of corporate reputation and simultaneously illustrates the outcomes of their use, are discussed.
The construct of the uses of corporate reputation has three dimensions: value creation, strategic resources and corporate communication. Each of these three dimensions includes several items. The items were proposed based on the previous researchers’ summaries and the qualitative interview. The researcher will then depict the proposed research conceptual framework and a number of hypotheses that will be further investigated and tested.
Then the quantative study was completed by providing the data analysis and the results were explained. A multi-stage procedure was involved in this research. First, data examination and screening to prepare for subsequent quantitative analyses and then the descriptive statistics were presented. Second, a reliability test was performed on measurement scales to ensure that they achieve an acceptable level of reliability for further analysis. The resulting solutions were then re-assessed using confirmatory factor analysis. Finally, PLS (Partial Least Squares) was used to test the hypothesized relationships between the research constructs as postulated in the conceptual model, and to assess the overall goodness-of-fit between the proposed model and the collected data set.
The researcher then discusses the validation of the measurement model and the research findings. The findings are then further discussed in terms of the contribution to marketing theory and relevance to marketing managers. Then the items of adapted scales were subjected to several rounds of adjustments and were finally found to possess acceptable measurement properties. Reliability and construct validity tests indicated that all scales satisfied widely accepted criteria such as the minimum reliability of 0.7. The results of scale purification will be discussed. And an evaluation of the research hypotheses and their significance are summarized, the findings of all hypotheses testing will be reviewed and compared with previous research.
According to the research findings, the hypotheses that value creation, as one dimension of corporate reputation, has a positive impact on brand segmentation, brand differentiation and brand positioning are all accepted. The hypotheses that strategic resource, as one dimension of corporate reputation, has a positive impact on brand segmentation and brand differentiation are rejected. However, the hypothesis that strategic resource, as one dimension of corporate reputation, has a positive impact on brand positioning is accepted. The hypotheses that corporate communication, as one dimension of corporate reputation, has a positive impact on brand segmentation and brand differentiation are both accepted. The hypothesis that corporate communication, as one dimension of corporate reputation, has a positive impact on brand positioning is partially supported. Finally, the hypothesis that the (see in Table 5.18) moderating effect of price policy on corporate reputation has a positive impact on brand image strategy is partially but negatively supported.
This thesis makes a significant contribution to the study of corporate reputation of firms in the Taiwanese pharmaceutical industry from the robustness of the qualitative and quantitative data collection
