Background The high hip center technique used for a deficient acetabulum is reconstruction of the hip at a high center of rotation. In the literature, there is no consensus regarding the value of this technique. Questions/purposes We investigated whether the newgeneration biconical threaded Zweymüller 1 cup fixed in a high nonanatomic position in patients with arthritis secondary to congenital hip disease experienced different rates of polyethylene wear and long-term survivorship when compared with anatomically positioned cups. Patients and Methods We studied the polyethylene wear rate and Kaplan-Meier survivorship of 104 titanium threaded Zweymüller 1 cups in 88 patients (81 females), placed in 70 hips at near-normal hip center and in 34 hips at a high hip center position at a distance of 31.1 to 60 mm (mean, 39.7 mm) from the interteardrop line. Minimum followup was 2 years (mean ± SD, 8.6 ± 3.5 years; range, 2-15 years). ResultsThe mean linear polyethylene wear rates in the near-normal and high hip center groups were not different (0.110 ± 0.050 mm and 0.113 ± 0.057 mm, respectively

BackgroundThe adoption in oncology of Clinical Decision Support (CDS) may help clinical users to efficiently deal with the high complexity of the domain, lead to improved patient outcomes, and reduce the current knowledge gap between clinical research and practice. While significant effort has been invested in the implementation of CDS, the uptake in the clinic has been limited. The barriers to adoption have been extensively discussed in the literature. In oncology, current CDS solutions are not able to support the complex decisions required for stratification and personalized treatment of patients and to keep up with the high rate of change in therapeutic options and knowledge.ResultsTo address these challenges, we propose a framework enabling efficient implementation of meaningful CDS that incorporates a large variety of clinical knowledge models to bring to the clinic comprehensive solutions leveraging the latest domain knowledge. We use both literature-based models and models built within the p-medicine project using the rich datasets from clinical trials and care provided by the clinical partners. The framework is open to the biomedical community, enabling reuse of deployed models by third-party CDS implementations and supporting collaboration among modelers, CDS implementers, biomedical researchers and clinicians. To increase adoption and cope with the complexity of patient management in oncology, we also support and leverage the clinical processes adhered to by healthcare organizations. We design an architecture that extends the CDS framework with workflow functionality. The clinical models are embedded in the workflow models and executed at the right time, when and where the recommendations are needed in the clinical process.ConclusionsIn this paper we present our CDS framework developed in p-medicine and the CDS implementation leveraging the framework. To support complex decisions, the framework relies on clinical models that encapsulate relevant clinical knowledge. Next to assisting the decisions, this solution supports by default (through modeling and implementation of workflows) the decision processes as well and exploits the knowledge embedded in those processes.

Based on neotectonic mapping, analysis of active deformation through tectonic data and the Coulomb stress changes caused by major earthquakes, the active faults in Lefkada Island were evaluated. Descriptions of historic and recent earthquakes were also taken into consideration as well as the seismotectonic data concerning the last strong seismic event of 2003. According to detailed field observations, among the active and neotectonic faults that have been identified, regarding seismic hazard, the most important can be considered the Athani fault. It is running parallel to and near the west coast and shows marked similarity with the northern branch of the offshore transform fault of Kefalonia-Lefkada. These two dextral strike-slip faults exhibit same structure and state of stress as well. Moreover, the Coulomb stress changes associated with the 2003 earthquake, well correlated with the spatial aftershock pattern, are positive in the area of the Athani fault. Attention has been also focused on the geologic hazard in relation to earthquake associated phenomena, such as surface rupturing, landslides and rockfalls, liquefaction and tsunamis. The fact that surface deformation is repeated in an identical way during past and recent earthquakes provides a great advantage for the seismic protection of the island.

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