Actual Insertion Research Articles

An Extended DCT Domain Watermarking for Robot Vision against Geometric Image Attacks

With the rapid development of the Internet and the mobile service robot, the digital services are becoming important factors for robots to recognize things in the real world. Advances in computer technology and the risk of copyright infringement have increased in the way that anyone replicates and copies digital media easily. Therefore, ways to prevent and suppress copyright infringement, digital watermarking technologies that insert copyrights information into the work, are being researched. Digital watermark, depending on the actual insert domain, can be categorized into the spatial domain and transform domain. In this paper, we propose an extended DCT domain watermarking for robot vision. The suggested method is by distributing and duplicating watermark images that are including copyright information on the original images. By doing this, it can be strong on geometric image attacks such as partial cutting, resizing, rotating, and so forth. For the success of watermark extraction, invertible process can be used to recover a disfigured image. Experimental results are provided to support these methods, through the process of recombination by complete image pieces.

Measured Adaptive Matching Performance of a MIMO Terminal With User Effects

Absorption and impedance mismatch due to the proximity of a user as well as certain propagation channel characteristics can severely degrade the multiple-input-multiple-output (MIMO) performance of multiantenna terminals in real usage scenarios. In this context, we investigated the potential of adaptive impedance matching (AIM) to mitigate performance degradation from these effects based on channel measurements involving a terminal prototype in three user scenarios and two propagation environments. First, optimal AIM state for the terminal in a given user-channel setup was found by post-processing the measured channels. The optimal state was then experimentally verified with two Maury Microwave mechanical tuners. The results show that by employing AIM instead of 50- Ω termination, the average capacity is increased by up to 25%. Moreover, the observed capacity gains can be partly explained by physical mechanisms underlying the propagation conditions. Furthermore, the achieved gains with real tuners are only marginally affected by the tuners' actual insertion losses, estimated to be 0.1-0.7 dB. Therefore, we conclude that AIM can be a viable solution to enhance MIMO terminal performance.

Comparison of Accuracy of Various Positioning Guides used for Determination of Implant Placement Site using RVG

Objective of this study was to compare accuracy of placement of implant with three different positioning guides. Methods: Twenty-one patients were divided into three groups. In first group, implants were placed by using grid, second group (X-ray pin) and third group (wire eye). Preand postoperative radiographs were recorded by using radio visual graph (RVG). Planned insertion point (PIP) was marked and compared in all the three groups. Actual insertion point (AIP) was marked and compared, and the distance between AIP and nearest root of adjacent teeth was also measured. Results: Mean values of horizontal distance from GC to PIP by using grid guide, X-ray pin and wire eye was 0.1514 ± 0.1624, 0.2829 ± 0.1031 and 0.379 ± 0.069. Grid gives PIP that is more closer to GC. The mean values of distance from AIP to nearest root by using grid guide was 2.19 mm. There is less chances of root injury by using grid guide as compared to other guides under study. Conclusion: Grid guide stands out to be the most accurate in positioning of implants followed by X-ray pin and wire eye guide.

Le réel et ses signes : Brentano et Husserl sur l’engagement ontologique de l’intentionnalité

In spite of Brentano’s considerable influence on Husserl’s Logical Investigations, their analysis of intentionality is significatively different regarding some fundamental points, such as the status of reality, the nature of intentional acts, and their relation to the world. The core of the opposition between Brentano and Husserl is to be found in the ontological background of their theories, as a result of which they hold two different approaches of the existential import of intentionality. This paper investigates those differences in order to ask whether a relational understanding of intentionality is likely to give a satisfying account of reality. Both Brentano and Husserl’s analyses provide important clues regarding this issue and stress the main difficulties of the question, even if their theories fail to take into consideration the actual insertion of intentional acts within the world.

Psychosocial care Center for Alcohol and Drugs (CAPS ad): nursing insertion and practices in São Paulo City, Brazil

This exploratory study with a qualitative approach aimed to identify nurses' insertion and practices at Psychosocial Care Centers for alcohol and drugs in São Paulo City, Brazil. Sixteen nurses participated in the study. Data were recorded and were analyzed by dialectic hermeneutics and guided by Brazilian psychiatric reform premises. The results evidenced nurses' difficulties to take part in the care recommended at these services, as their practices are more linked up with the traditional mental health care model. Causes of this phenomenon include nurses' lack of preparation to act in psychoactive substance-related issues and lack of knowledge on specific contents that would favor their insertion into care practice in these scenarios. It is concluded that more attention should be paid to these contents in nursing education, as the legal requirement of nursing presence at these services is insufficient as a strategy to guarantee their actual insertion.

PTH-066 Specialist nurse-led percutaneous endoscopic gastrostomy insertion and patient assessment in modern-day practice

Introduction PEG feeding improves prognosis and general state of health when patients cannot maintain adequate nutrition. Some hospitals now have nutrition teams who review percutaneous endoscopic gastrostomy (PEG) requests. The PEG Clinical Nurse Specialist (CNS) can provide information/advice/counselling for patients and relatives on PEG feeding, aftercare and follow-up as well as being an integral part of the Upper GI multidisciplinary team. Methods Aims: To assess the role of the Specialist nurse lead PEG service in an associate teaching district general hospital (DGH). We retrospectively assessed 178 PEG referrals to the service over the period 2006–2008 in our DGH. All PEG referrals are assessed by a CNS who recommends appropriateness of PEG insertion or deflects inappropriate referrals. Data were obtained from the CNS records along with endoscopy software and from patient9s clinical data. Results 178 PEGs inserted in the period 2006–2008. Of these referrals, 44 (25%) were declined due to ill health and deemed as inappropriate (eg, advanced severe dementia). Of these 44 patients following assessment, 6 (13%) started eating and drinking within 48 h, 3 (6.8%) died within 24 h, 4 (9%) died within 72 h. 144 PEGs were inserted one failed due to difficulty in positioning. 38 (26.5%) were inserted by the CNS, and 105 (73.5%) were performed by 11 doctors in the same period. 11 (7.6%) of these were performed as day-case procedures. The nurse specialist requested a second opinion and consultant review for only six patients (3.3%). The CNS assessed and followed up all the 144 patients prior to PEG insertion and provided aftercare. PEG referrals required 60 min on average per patient assessment by the CNS, furthermore the actual PEG insertion average time was 30 min/patient. There were 2 (1%) complications due to minor bleeding from the skin incision. There were 14.6% (21 patients) deaths recorded at 30 days post insertion. Conclusion In our experience, specialist nurse led PEG service prevented inappropriate PEG insertion in 25% of all referrals and reduced significant clinical commitment for doctors with only requiring advice from consultant in 3%, saving 250 h of clinical assessment and review time. This service also helped reduce waiting times for patient assessment and improved the quality of the service offered by increasing continuity of care and closer liaison with dietician, ward nurses along with patients and their relatives. Our complication/mortality rates compared favourably at 1% and 15%, respectively, to the BSG announcement in 2006 suggesting that minor complications are around 15% and mortality up to 28%. For a modern day PEG service from our data, we recommend a Nurse Lead PEG assessment/insertion and follow-up service in all hospitals not offering this.

An Experimental Study on Initial Fixation Strength in Transpedicular Screwing Augmented With Calcium Phosphate Cement

An experimental study. To clarify the optimal insertion timing of transpedicular screws when the initial fixation strength reaches in maximum as calcium phosphate cement (CPC) hardens, in cases augmented by CPC to the vertebrae. CPC goes easily into the bone trabeculae and excels in the bone compatibility. However, it is still unknown as for differences of fixation effects by CPC hardening time at actual insertion of the pedicle screw. Fifty-seven vertebrae obtained from 11 human cadavers. The CPC and titanium pedicle screws were used. Experimental groups were decided as follows. (1) Control group (without CPC). (2) CPC group (augmented with CPC); the mixed CPC infused into the screw hole, afterwards the pedicle screw inserted at a set time (passage time from the initiation of powder and liquid agent mixing). The CPC group was further divided into 3 subgroups, with respect to insertion time of the pedicle screws: 2, 5, and 10 minute subgroups. Maximum pull-out strength was compared, and cross sectioned specimens of the 5 and 10 minute groups were prepared and observed. CPC group showed a pull-out strength of about 177% that of the control group. For inserting timing of the pedicle screw and pull-out strength, no apparent statistically significant difference was found between each subgroups, although the 10-minute group showed the lowest. Cross sectional observations revealed that the CPC diffused deeper into the bone trabeculae in the 5-minute group than in the 10 minutes. CPC augmentation enabled an average 77% increase of the maximum pull-out strength compared to the control group. The study of screw insertion timing augmented with CPC was indicative of the fact that an increase in the initial fixation of the pedicle screw can be achieved when the screw is inserted before initiation of CPC hardening.

Internal fixation of femoral neck fractures assisted by bi-planar navigation robot system: an experi-mental study

Objective To assess accuracy of inserting the cannulated screw guide pin and paral-lelism of implanting the screws with the assistance of an improved bi-planar navigation robot system. Methods In 12 synthetic proximal femoral bones, insertion of cannulated hip screws was simulated under navigation of an improved bi-planar robot system. After every 3 guide pins were inserted in each case, the accuracy of insertion was evaluated by direct measurement of the transverse section of femoral neck, and the parallelism was accessed by calculating an index from the angles measured on the AP and lateral views of X-ray film. A statistical comparison was made with the conventional surgeries. The frequency of intraoperative flu-oroscopy was also compared between the 2 operations. Results All guide pins were successfully inserted at one time. The measurement in the specimens revealed an error range of about 1 mm between the actual insertion site and the planned site. Statistical analysis of the screw parallelism index showed that the paral-lelism and operative stability in the computer-assisted navigation group were more satisfactory(P<0.05) than those in the conventional operation group. And the fluoroscopic frequency in the navigation group was also lower than that in the conventional operation group. Conclusion The improved bi-planar navigation robot system can effectively assist the fixation of the cannulated screws in the treatment of femoral neck fractures, because pin insertion can be more accurate, the parallelism of screws improved and the X-ray exposure reduced. Key words: Surgery, computer assisted; Femoral neck fractures; Fracture fixation, internal

A comparison of manufacturer-specific prescriptive procedures for infants

Early hearing detection and communication development (EHDCD) programs enable us to identify hearing loss in early infancy, making intervention by 6 months of age a reasonable goal. For infants and children fitted with hearing instruments, it is critical that the devices be adjusted appropriately so that the pre-lingual listener has full and consistent access to sound, without discomfort for loud sounds. Several published pediatric amplification guidelines are available to assist clinicians with the hearing aid fitting process for infants and children.1-5 While the guidelines were developed in different jurisdictions, similar recommendations are made for all stages of the hearing instrument fitting process. For example, the use of a systematic, evidence-based approach to hearing aid fitting that accounts for an infant’s external ear acoustics at the assessment, selection, and verification stages and that includes the measurement of hearing aid output limiting is a requirement of every current pediatric amplification protocol. While it is encouraging to see consensus in pediatric hearing aid fitting guidelines, there continue to be substantial differences among clinical practice behaviors. Surveys have indicated that the majority of pediatric audiologists use sound field-aided threshold measures to verify the electroacoustic performance of hearing instruments for young infants.6 Probe-microphone measures were used by roughly 20% of the audiologists fitting hearing aids to infants.6 It has been well-documented that behavioral measures (i.e., aided threshold measures) do not provide accurate estimates of the aided audibility of soft, average, and loud speech or the real-ear saturation response of the hearing aid and that infants 6 months of age and younger are not developmentally capable of performing this task.7,8 Failure to appropriately verify the electroacoustic performance of the hearing aid in terms of predicted speech audibility and maximum hearing instrument output can result in obstructing the language benefits an infant would have otherwise received from being identified at an early age and optimally fitted. It is also important to consider the prescriptive targets used to determine the recommended levels for amplified speech and target limits for hearing instrument output as a function of frequency. Prescriptive algorithms provide the foundation on which the hearing instrument performance characteristics are selected for the infant or child to be fitted. Recent survey data indicate that most audiologists fitting hearing aids to infants and young children use a published hearing aid prescriptive procedure.6,9 At present, prescriptive procedures can be divided into two classifications: (1) evidence-based generic prescriptive algorithms and (2) manufacturer-specific proprietary algorithms. Evidence-based generic prescriptive algorithms for children include the DSL m[i/o]10 and the NAL-NL1,11 both of which are intended for use with any hearing aid. Proprietary prescriptive methods incorporate prescriptive algorithms developed by manufacturers for use with their specific hearing instruments. The lack of published information regarding the development of pediatric manufacturer-specific proprietary algorithms makes it difficult for the audiologist to make an informed choice about which procedure will be best for their young patient.12 Some manufacturers have decided to forego the development of a proprietary pediatric algorithm and use either the NAL or DSL prescriptive algorithms for fitting children and have implemented these formulas in their fitting software. These generic prescriptive algorithms may have been adapted by the manufacturer to account for the unique characteristics (e.g., compression kneepoint) of their hearing aids. Several investigators have compared proprietary prescriptive algorithms for use with adults. Keidser and colleagues found a 10-dB variation in the amount of gain prescribed by NAL-NL1, DSL[i/o], and four proprietary algorithms for the same audiogram.12 A study by Hawkins and Cook compared simulated 2-cc versus actual 2-cc gain as well as simulated insertion versus actual insertion gain measures from the fitting software for 28 hearing aids of various styles from four major manufacturers.13 Results indicated a clear trend for the simulated values to overestimate what was actually provided by the hearing aids for both the 2-cc coupler and insertion gain comparisons.13 Differences of as much as 10 to 20 dB were noted for the various hearing aids and prescriptive algorithms in the study. “...an infant can end up with

On the use of the multivariate autoregressive and relative power contribution models for determination of transient root cause

The multivariate autoregressive (MAR) model and the relative power contribution (RPC) ratio are used in this work to determine the root causes of a power oscillation event and an apparent positive reactivity insertion transient occurred at the at the BWR/5 Units of the Laguna Verde Nuclear Power Plant (LVNPP) of México. The application of the MAR and PRC models leads to identify dominant frequencies and the contribution from other different signals to the dominant frequencies. The methodology firstly uses a linear model to estimate the response characteristics of the system and the spectra of the noise sources. The estimate of the process linear predictor is obtained by the ordinary least squares method. Then, the model performs a MAR analysis, and the RPC ratio is computed to determine the inter-relationship between the different reactor noise signals. The RPC ratio is an indication of how the fluctuation of one variable depends on other variables, at each frequency. Reactor signals acquired during the two transient operational events are used in the analysis. In the first event, a problem on the position controller of the flow control valve's stem induced the appearance of a power peak of 12% amplitude on the average power range monitors. Actual insertion of positive reactivity did not occur. The signals used for the analysis come from an average power range monitor, the position of the stem in the valve, controller of stem position, and controller of the recirculation flow. For the second transient, power oscillations of about 12% amplitude occurred. Signals from an average power range monitor, total flow through the core and flow through the 10 jet pump of each loop are analyzed. In both cases, some other signals were also used, but since they did not show appreciable influence on the RPC results, they were not considered for final analysis. The RPC results obtained in here confirmed previously known facts about the origin of the transients analyzed. Specifically, for the first transient, a dominant frequency of 1.7 Hz appeared on the power spectral densities of different signals from sensors on the recirculation loop B. At this 1.7 Hz frequency, the RPC ratio showed influence of such loop B spectra to the average reactor power spectrum, but no influence at all of the average reactor power to any of such loop B signals. The root cause, although not a real power transient event, therefore was not of neutronic nature, but related to recirculation flow. In the second transient, the prominent power oscillation frequency (0.54 Hz) was tracked within the spectral data of other signals. The RPC results for this case showed a strong influence of the average reactor power on the flow signals, but only a modest contribution from the flow signals to the average reactor power. The root cause therefore was of neutronic nature, due mainly to a combination of a particular core configuration and control rod pattern change at the moment of the event.

Performance of a noise barrier within an enclosed space

The present study involved experimental, theoretical, and numerical analyses of the insertion loss provided by rigid noise barriers in an enclosed space. The existing classical diffuse-field theory may be unable to predict the actual sound pressure level distribution and barrier insertion loss for indoor applications. Although predictions made by the ray tracing method at high frequencies are reasonably satisfactory, the method is computer-intensive and time-consuming. We propose a new formula that incorporates the effects of diffraction theory and the reflection of sound between room surfaces. Our results indicate that the present formula provides more realistic and practical predictions of the barrier insertion loss than existing approaches.

An Experimental Study of Insertion Effects of 2-D Microphone Array to Measured Sound Field

A two-dimensional microphone array is necessary to realize instantaneous measurements of sound fields. The array has a skeleton to hold many microphones, and the skeleton should be located near sound sources when the results of the measurements are applied to the method of nearfield acoustic holography. When spacings between the microphones would be small for a fine spatial resolution, bodies of microphones are approaching each other. In such a condition, sound waves reflected at the surfaces of the structure would become easier to reach to the microphones for measurements. As a result, measured distributions would be distorted by such disturbances. In this paper, an experimental procedure to investigate the effects of the array structure to the sound field is proposed. An actual array structure was constructed, and the effects added as deviations on the true values of complex sound pressures are measured experimentally with a scanning microphone. Then, relative complex deviations involved in the complex sound pressures are calculated and shown to evaluate the effects. Locations of reflecting surfaces that would cause the deviations are discussed with the values of lagged distances derived from the relative phase distributions. The methodology and results summarized in this paper would be worthy to develop the analysis to investigate the actual insertion effects of the array structure to the analytical applications such as the NAH.

Method for polymer hot embossing process development

Molding technologies associated with fabricating macro scale polymer components such as injection molding and hot embossing have been adapted with considerable success for fabrication of polymer microparts. While the basic principles of the process remain the same, the precision with which the processing parameters need to be controlled especially in the case of molding high aspect ratio (HAR) polymer microparts into polymer sheets is much greater than in the case of macro scale parts. It is seen that the bulk effects of the mold insert fixture and molding machine have a dominant influence on the molding parameters and that differences in material parameters such as the glass transition temperature (Tg) of polymer sheets are critical for the success and typically differ from sheet to sheet. This makes it very challenging to establish standard processing parameters for hot embossing of sheet polymers. In the course of this paper, a methodology for developing a hot embossing process for HAR microstructures based on known material properties and considering the cumulative behavior of mold, material, and machine will be presented. Using this method force–temperature–deflection curves were measured with the intent of fine tuning the hot embossing process. Tests were carried out for different materials using a dummy mold insert yielding information that could be directly transferred to the actual mold insert with minimum development time and no risk of damage to the actual microstructures.

Real-time, dynamic level-of-detail management for three-axis NC milling simulation

The Z-buffer based NC milling simulation approach has been widely used in a number of commercial application softwares. However, this approach is essentially based on image and hence it has many drawbacks. Some polygon-based approaches have been presented to overcome these drawbacks, but these approaches are mostly not optimal. In order to achieve real-time simulation, the total number of polygons has to be reduced in these approaches, which results in poor image quality. Using those proposed level-of-detail mesh algorithms can reduce the number of polygons, but the majority of those algorithms are not suitable for dynamic real-time NC milling simulation. Therefore, it is necessary to develop an approach to reduce the number of polygons without much loss in image quality. An adaptive regular mesh decimation algorithm is proposed in this paper. It uses a quadtree to represent the milling surface and enabled flags are used to perform the optimization of the mesh, actual insertion and deletion operations of triangles do not exist. This algorithm can automatically adjust the polygon density to approximate the milling surface according to its changes in real-time, and numerical inspections of any area of the machined surface can be performed with full resolution.

Identification of the distal insertion of the lateral collateral ligaments at the ankle joint: A cadaver study

Introduction The high interindividual variance of the angle between the calcaneo- and anterior talo-fibula ligaments (105° with range of 70–140°) is well known. Up to now, the respective anatomical knowledge of the surgeons has not been examined. Materials and method A lateral epifascial aspect, which corresponds to the operative conditions for a ligament reconstruction, was prepared at a foot fixed according to Thiel. With colored cannulas reference points were fixed and measured (spherical excess less than 5%). Thirty-three orthopedic surgeons experienced in foot and ankle surgery marked the distal insertion of the ligaments (calcaneo- and anterior talo-fibular) independently of each other and according to their operative procedure. The photographic documentation was performed at about 6 pixels/mm. After completion of the measurement, the anatomical insertions as a gold standard were dissected. Calibration was carried out according to a photographed scale on the images. The perspective distortions on each photo were interactively corrected by overlapping with the reference points and the anatomical structures. Results No candidate met the actual insertions revealed by the preparation. The mean distance between the points was about 75% of the actual distance. On average, the distance to the calcaneo-fibula insertion was lower than to the anterior talo-fibula insertion but, however, had a greater spreading width and was laid in 79% too far cranially, i.e., was assessed systematically wrong. Three surgeons looked for the insertion of the anterior talo-fibular ligament cranial of the lateral malleolus. Two candidates transferred the insertion of the calcaneo-fibular ligament ventrally (according to the lateral malleolus). The angle between the ligaments was underestimated 29 times and one candidate obtained it opened to dorso-cranial instead of ventro-caudal. With 23 surgeons the bisector deviated more than 10° of the anatomical direction, 17 times too much into the ventral. Clinical relevance The present study shows a wide variance in determining the distal insertion of the lateral ankle ligaments among different surgeons. This may explain different results after ligament reconstruction.

A method for the validation of a new calculus detection system

Recently, pilot studies from our laboratory have shown that dental surfaces may be discriminated by the analysis of tip oscillations of an ultrasonic instrument, which possesses computerized calculus-detection features. For the evaluation of this smart detection system, its surface recognition qualities are of crucial importance. For in vivo studies, however, it proved to be difficult to verify the subgingival detection results. Therefore, it was necessary to develop a method, which allowed a reliable validation of surface recognition results of this new device. This evaluation method is described here. Thirty extracted human teeth with subgingival calculus were embedded with plaster in a tray. To simulate subgingival pockets, dissected mucoperiostal porcine gingiva was sutured on the teeth. The thus-constructed dentition was mounted into a phantom head. A CCD-cam was attached with an intra-oral X-ray mount to the teeth. The dentist scanned the pockets with the ultrasonic instrument, simultaneously videotaping the scanning path of the supragingival portion of the insert. At the same time, the signals of the modified ultrasound scaler were recorded. After the tooth was removed from the phantom head, the tip of the ultrasound scaler could be repositioned using the video sequences. The actual insert location on calculus or cementum was assessed and compared with the computer signals. The whole procedure was repeated a second time and the reproducibility of the evaluation method was estimated. A kappa value of 0.95 was attained for the evaluation method. The present experimental design allows the in vitro repositioning of an automated dental instrument for the detection of subgingival surfaces on the tooth following an in vitro phantom-head video recording of its intra-oral scanning movements. This method will be used for the verification of in vivo results of a new ultrasound-based surface detection system.

Prediction of the distance from skin to epidural space for low-thoracic epidural catheter insertion by computed tomography

It may be clinically useful to predict the depth of the epidural space. To investigate the accuracy of preoperative abdominal computed tomography (CT) in prediction of the distance for low-thoracic epidural insertion, a single group observational study was conducted in 30 male patients undergoing elective major abdominal surgery requiring epidural analgesia for postoperative pain relief. Using the paramedian approach, low-thoracic epidural insertion at T10-11 interspace was performed with a standardized procedure to obtain an actual insertion length (AIL). According to the principles of trigonometry, an estimated insertion length (EIL) was calculated as 1.26 times the distance from skin to epidural space measured from the preoperative abdominal CT. The mean (SD) EIL and AIL were 5.5 (0.7) and 5.1 (0.6) cm, respectively, with a significant correlation (r=0.899, P<0.01). The EIL tended to have a higher value than the AIL (0.4 (0.3) cm). There were significant correlations of both EIL and AIL with weight (P<0.01), BMI (P<0.01), and body fat percentage (P<0.01), but not with height (P>0.05). We conclude that the preoperative abdominal CT is helpful in prediction of the distance for low-thoracic epidural insertion using the paramedian approach.

Interindividuelle Varianz unterschiedlicher Operateure bei der Festlegung der distalen Insertionsstellen der lateralen Kollateralbänder des OSG

Am lateralen Malleolus mit seiner gegenuber dem medialen Malleolus groseren Kapselflache fur die Sprunggelenke finden sich drei verstarkende Bander, deren Relationen zueinander sowie zu der Achse des subtalaren und des Sprunggelenkes bei allen rekonstruktiven Masnahmen sorgfaltige Beachtung finden mussen. Die grosen biomechanischen Relevanz dieser Ligamente fordert eine anatomische korrekte Wiederherstellung. Die Reproduzierbarkeit operativer ligamentarer Rekonstruktionen ist bislang jedoch nicht untersucht worden. An einem nach Thiel fixierten Fus-Praparat wurde lateral ein epifaszialer Aspekt hergestellt, der operativen Gegebenheiten fur eine Bandrekonstruktion entsprach. Mit Kanulen wurden Referenzpunkte festgelegt und vermessen (spharischer Exzess unter 5%). 33 operativ erfahrene Orthopaden markierten unabhangig voneinander die distalen Ansatze der Ligg. calcaneo-fibulare und talo-fibulare entsprechend ihrem operativen Vorgehen. Die photographische Dokumentation erfolgte bei 6 Pixel pro Millimeter. Nach Beendigung der Messreihe wurden die anatomischen Ansatze als Goldstandard freiprapariert. Die Kalibirierung erfolgte durch einen mitphotographierten Masstab. Die perspektivischen Verzerrungen der Einzelphotos wurden interaktiv anhand der Referenzpunkte und der anatomischen Strukturen durch Uberlagerung korrigiert. Kein Kandidat traf die tatsachlichen Ansatzpunkte entsprechend der Freipraparation. Der mittlere Abstand zwischen den Punkten lag bei ca 75% des tatsachlichen Abstandes. Der Abstand zum calcaneo-fibularen war im Mittel geringer als beim talo-fibularen Ansatz, hatte aber eine grosere Streubreite und lag in 79% zu weit cranial, d. h. wurden systematisch falsch eingeschatzt. 3 Operateure suchten den Ansatz des Lig. talo-fibulare cranial des Malleolus lateralis. 2 Kandidaten verlegten die Insertion des Lig. calcaneo-fibulare nach ventral (bezogen auf den Mallelolus lateralis). Der Winkel zwischen den Bandern wurde 29-mal zu klein eingeschatzt und 1 Kandidat erzielte einen nach dorsocranial statt nach ventrocaudal offenen Winkel. Bei 23 Operateuren wich die Winkelhalbierende um mehr als 10° von der anatomischen Richtung im Praparat ab, 17-mal davon zu sehr nach ventral. Die vorliegende Untersuchung zeigt, dass es eine grose Variabilitat zwischen unterschiedlichen Operateuren gibt. Alleine hierdurch ist mit einer grosen Streuung der klinischen Ergebnisse zu erwarten.

Is the actual in vivo insertion loss the sum of the individual insertion losses of each of the intervening tissue layers in obstetric patients?

Objective: The aim of this study was to test the hypothesis that the actual insertion loss in vivo during a routine third-trimester ultrasound examination is significantly greater than the sum of the individual insertion losses from each of the intervening tissue layers: (i) skin and subcutaneous fat, (ii) rectus muscle, investing fascia, and parietal peritoneum, and (iii) myometrium.

Randomised controlled trial assessing the acceptability of GyneFix® versus Gyne-T380S® for emergency contraception

ObjectiveTo assess insertion-linked pain and the short-term user-acceptability and safety of the GyneFix® as compared with T-framed intrauterine devices (IUDs).DesignA randomised controlled trial in an outpatient clinic setting.MethodWomen requesting an...