bluuebunny/crossref_metadata_2025 huggingface dataset:
Cancer and Complementary Therapies: Current Trends in Survivors’ Interest and Use
Authors: Qureshi Maryam , Zelinski Erin , Carlson Linda E.
Published: April 2018

Background. Cancer survivors use complementary therapies (CTs) for a variety of reasons; however, with interest and use reportedly on the rise and a widening range of products and practices available, there is a need to establish trends in and drivers of interest. We aimed to determine (1) frequencies of use, level of interest, and barriers for 30 specific CTs and (2) whether physical symptoms, perceived stress (PS), or spiritual well-being were related to interest levels. Method. A total of 212 cancer outpatients were surveyed at the Tom Baker Cancer Centre in Calgary, Canada. Results. Overall, up to 75% of survivors already used some form of CTs since their diagnosis. The most highly used were the following: vitamins B12 and D, multivitamins, calcium, and breathing and relaxation exercises. Those who had not used CTs indicated highest interest in massage, vitamin B12, breathing and relaxation, mindfulness-based stress reduction, and antioxidants. The most frequently reported barriers for all CTs were not knowing enough about what a therapy was and not having enough evidence on whether it worked. High PS predicted higher interest for all CTs, but spirituality was not significantly related to any. Physical symptoms, anxiety, and depression were significant predictors of interest for some CTs. Conclusion. These findings provide a blueprint for future clinical efficacy trials and highlight the need for clinical practice guidelines.
Structure singular value theory based robust motion control of live maintenance robot with reconfigurable terminal function for high voltage transmission line
Authors: Jiang Wei , Wu Gongping , Fan Fei , Yan Yu , Liu Xiaqing , Li Hongjun , Chen Wei
Published: April 2018

In a complex rigid–flexible coupling environment of overhead high-voltage transmission line, the manipulator robust trajectory tracking motion control of live maintenance robot is the premise of fulfilling the entire maintenance operations. In the process of manipulator’s different function reconfigurable (drainage board bolt tightening and insulator strings replacement), in response to the shortage of excessive pursuit of robust stability for robot manipulator when using H∞ control, as it ignores the influence of structure changes caused by terminal reconfigurable on the system stability to a certain extent, the structured singular value theory–based robot robust μ synthesis control method was proposed in this article. The intrinsic relationship between structured singular value control ( μ method) and H∞ control was elaborated, a general control model of the multi-arms and multi-actions robot system was established, the multifunction terminal reconfigurable live maintenance robot with its two kinds of operations was set as a research object, and the corresponding robot μ controller was designed. In the MATLAB development environment, simulation results have shown that on the premise of maintaining the robust stability, compared to the H∞ control method, μ control can obtain better performance robustness for the perturbation of its own structural changes in the process of different operation functions switch. Finally, the validity and engineering practicability of this method is verified by actual 220 kV live operation experiments.
Are civics teachers different from teachers of other disciplines in their handling of controversial issues?
Authors: Erlich Rakefet Ron , Gindi Shahar
Published: April 2018

Conducting discussions on controversial political issues is an important vehicle to promote students’ democratic values and critical thinking in schools. This schoolwide task cuts across all disciplines and different subject matter. Israeli civics and social studies teachers are often required to touch upon such issues and manage the situations that follow. This study examined whether civics and social studies teachers are different from teachers of other disciplines in their attitudes toward controversial political issues and in their reported behaviors. Civics and social studies teachers scored higher in all the variables related to discussions of controversial political issue and reported more relevant behaviors. In examining the variables that predict teachers’ self-efficacy to conduct controversial political issue discussions, variables that related to professional identity were the strongest predictors alongside pluralistic attitudes. We concluded that teacher training should emphasize the importance of discussions of controversial political issue and develop teachers’ ability to conduct such discussions as part of their professional role.
Exclusionary visual depiction of disabled persons in Malaysian news photographs
Authors: Soo Ang Pei , Lee Yeo Siang
Published: April 2018

Disability has been perceived as a social conditioning phenomenon and a sign system marking the body and mind. Accordingly, photographs of disability could shape our cultural perceptions about disability and disabled persons. In response to this position, we engage in a critical semiotic inquiry into press photographs of disability ( N = 1002) from The Star, a Malaysian mainstream English newspaper. We adapted Van Leeuwen’s (2008) social and visual actor networks to understand the visual techniques employed in depicting disabled actors in these images. The depiction is examined in relation to their absence and/or presence in these published photographs. If absent, the inclusion of non-disabled is analyzed. When present, the social categorizations of roles, grouping and specific/generic depictions are investigated. Findings reveal disabled persons have been symbolically excluded and thus, socially othered. These exclusionary strategies imply disabling journalistic practices which should be cautioned as they could could potentially undermine the advocacy for an inclusive society.
iNakba, mobile media and society’s memory
Authors: Tirosh Noam
Published: April 2018

The iNakba is a new mobile application that allows users to locate, and learn about, Palestinian villages that were destroyed during and after the Nakba, the consequences of the war between Jewish forces and local and external Arab forces following the withdrawal of British Mandate from the colony of Palestine in 1948. As such, the iNakba, as a new mobile application, is a mnemonic device utilized in a heated memory contestation that exemplifies how contemporary technological capabilities operate as a reminder for a society that seeks to forget. This study reveals that when marginalized groups struggle for recognition in society’s memory sphere, while capitalizing on contemporary media’s unique characteristics, they benefit from the blurring of the familiar distinction between communicative and cultural memory (Assmann & Czaplicka, 1995). The unique characteristics of new media create a new opportunity to make many more narratives and group memories known, officially organized, and mediated for mass audiences. These new memory affordances may contribute to establishing a culture of just memory that takes into consideration memory ethics and promotes the “duty to remember” the stories of the oppressed and marginalized.
Coexistence of systemic lupus erythematosus and multiple sclerosis. A case report and literature review
Authors: Jácome Sánchez Elisa Carolina , García Castillo María Ariana , González Victor Paredes , Guillén López Fernando , Correa Díaz Edgar Patricio
Published: April 2018

Multiple sclerosis (MS) and systemic lupus erythematous (SLE) are autoimmune diseases, the coexistence of which is uncommon in patients. Owing to the rarity of this condition, the distinction between MS and SLE is a diagnostic challenge for neurologists. We present a case report in which MS and SLE were present in the same patient. There are few case reports in the world on the association between MS and SLE. The following case report is the first of its kind in which both MS and SLE are present in a patient from a country with low prevalence of MS such as Ecuador.
Moving beyond the risk paradigm: Using the Good Lives Model with offenders in denial of sexual offending
Authors: Dealey Jill
Published: April 2018

Denial of sexual offending is complex, and can hinder the development of a positive working relationship between an offender and the probation officer managing their case; it can also impact on the offender’s wider life experience as they are stranded between their past offending and creating a new offence-free life. The theory of the Good Lives Model can be used as a tool to reduce both the tensions in this professional relationship and enable the offender to move forward, both in addressing their behaviour and establishing a non-offending life.
From ‘nothing works’ to ‘post-truth’: The rise and fall of evidence in British probation
Authors: Raynor Peter
Published: April 2018

Since its origins over half a century ago, evaluative research on probation services has swung between optimism and pessimism. This article, based largely on England and Wales, describes and reviews the long journey from over-optimism, via ‘nothing works’ in the 1970s, to programmes based on Risk-Need-Responsivity principles, introduced on a large scale from the late 1990s but limited in their impact owing largely to problems in implementation. After this, evaluation researchers developed greater interest in implementation, in organisational culture and, in particular, in practitioners’ skills. In the process, researchers have developed a better understanding of the necessary social science methods for evaluation and have begun to learn from new sources such as desisting former offenders. In the meantime, in spite of encouraging research, the political context in some countries has become hostile, and research has to survive in a new context of ‘post-truth’ and politically motivated denigration of expertise.
Hidden Abuse Within the Home: Recognizing and Responding to Sibling Abuse
Authors: Stutey Diane , Clemens Elysia V.
Published: April 2018

Sibling abuse is a serious phenomenon in our society that often goes unaddressed. Victims of sibling abuse experience psychological effects similar to those of child abuse (Caspi, 2012; Wiehe, 2002). The purpose of this article is to provide school counselors with a definition of sibling abuse and a five-step model to recognize and respond. A decision-making tree for working with students and families serves as a framework for preventative and comprehensive services.
School Counselors’ Roles in Developing Partnerships with Families and Communities for Student Success
Authors: Epstein Joyce L. , Van Voorhis Frances L.
Published: April 2018

This article discusses a theoretical perspective, research results, and practical examples that support new roles for school counselors in strengthening school programs of family and community involvement. A modest proposal is offered for school counselors to spend 20% of their time on strengthening teamwork for partnerships by working with other educators, parents, and community partners to plan, implement, and evaluate goal-linked partnership programs for their schools. This investment of school counselors’ time and talent should improve the quality of outreach and involvement activities, the number of parents who remain knowledgeable partners in their children's education across the grades, and results for students. The new direction also should reduce the number of students with serious academic and behavioral problems that school counselors presently try to solve alone.
Noninvasive ventilation in stable hypercapnic COPD: what is the evidence?
Authors: Duiverman Marieke L.
Published: April 2018

Long-term noninvasive ventilation (NIV) to treat chronic hypercapnic respiratory failure is still controversial in severe chronic obstructive pulmonary disease (COPD) patients. However, with the introduction of high-intensity NIV, important benefits from this therapy have also been shown in COPD. In this review, the focus will be on the arguments for long-term NIV at home in patients with COPD. The rise of (high-intensity) NIV in COPD and the randomised controlled trials showing positive effects with this mode of ventilation will be discussed. Finally, the challenges that might be encountered (both in clinical practice and in research) in further optimising this therapy, monitoring and following patients, and selecting the patients who might benefit most will be reviewed.
Immunogenicity and safety of subunit influenza vaccines in pregnant women
Authors: Kostinov Mikhail P. , Cherdantsev Alexander P. , Akhmatova Nelli K. , Praulova Daria A. , Kostinova Aristitsa M. , Akhmatova Elina A. , Demina Evgeniia O.
Published: April 2018

Pregnancy is a condition of modulated immune suppression, so this group of patients has increased risk of infectious diseases.

Trivalent subunit vaccines, unadjusted Agrippal S1 (group I) and immunoadjuvant Grippol Plus (group II), containing 5 μg of actual influenza virus strains, were administered respectively to 37 and 42 women in the second and third trimester of physiological pregnancy.

The administration of subunit influenza vaccines was accompanied by the development of local reactions in no more than 10% of patients, compared with 4.9% of the 41 pregnant women in the placebo group (group III). Systemic reactions were of a general somatic nature, did not differ between vaccinated and placebo groups, and were not associated with vaccination. Physiological births in groups I, II and III were 94.6%, 92.9% and 85.4%, respectively, and the birth rates of children without pathologies were 91.9%, 90.5% and 80.5%, respectively, and were comparable between groups. Vaccination stimulated the production of protective antibodies against influenza virus strains in 64.8–94.5% of patients after immunisation with an unadjusted vaccine and in 72.5–90.0% of patients after the administration of an immunoadjuvant vaccine. After 9 months, antibody levels were recorded in 51.3–72.9% in group I and 54.2–74.2% in group II. Immunisation against influenza in pregnant women provided a high level of seroprotection and seroconversion. Nevertheless, the level of seroprotection against the influenza strain A(H3N2, Victoria) was slightly lower in the group immunised with an unadjusted vaccine compared to those vaccinated with the immunoadjuvant vaccine.
Aspergillus-induced superoxide production by cystic fibrosis phagocytes is associated with disease severity
Authors: Brunel Shan F. , Willment Janet A. , Brown Gordon D. , Devereux Graham , Warris Adilia
Published: April 2018

Aspergillus fumigatusinfects up to 50% of cystic fibrosis (CF) patients and may play a role in progressive lung disease. As cystic fibrosis transmembrane conductance regulator is expressed in cells of the innate immune system, we hypothesised that impaired antifungal immune responses play a role in CF-relatedAspergilluslung disease.

Peripheral blood mononuclear cells, polymorphonuclear cells (PMN) and monocytes were isolated from blood samples taken from CF patients and healthy volunteers. Live-cell imaging and colorimetric assays were used to assess antifungal activityin vitro. Production of reactive oxygen species (ROS) was measured using luminol-induced chemiluminescence and was related to clinical metrics as collected by case report forms.

CF phagocytes are as effective as those from healthy controls with regards to phagocytosis, killing and restricting germination ofA. fumigatusconidia. ROS production by CF phagocytes was up to four-fold greater than healthy controls (p<0.05). This effect could not be replicated in healthy phagocytes by priming with lipopolysaccharide or serum from CF donors. Increased production of ROS againstA. fumigatusby CF PMN was associated with an increased number of clinical exacerbations in the previous year (p=0.007) and reduced lung function (by forced expiratory volume in 1 s) (p=0.014).

CF phagocytes mount an intrinsic exaggerated release of ROS uponA. fumigatusstimulation which is associated with clinical disease severity.
Mask pressure effects on the nasal bridge during short-term noninvasive ventilation
Authors: Brill Anne-Kathrin , Pickersgill Rachel , Moghal Mohammad , Morrell Mary J. , Simonds Anita K.
Published: April 2018

The aim of this study was to assess the influence of different masks, ventilator settings and body positions on the pressure exerted on the nasal bridge by the mask and subjective comfort during noninvasive ventilation (NIV).

We measured the pressure over the nasal bridge in 20 healthy participants receiving NIVviafour different NIV masks (three oronasal masks, one nasal mask) at three different ventilator settings and in the seated or supine position. Objective pressure measurements were obtained with an I-Scan pressure-mapping system. Subjective comfort of the mask fit was assessed with a visual analogue scale.

The masks exerted mean pressures between 47.6±29 mmHg and 91.9±42.4 mmHg on the nasal bridge. In the supine position, the pressure was lower in all masks (57.1±31.9 mmHg supine, 63.9±37.3 mmHg seated; p<0.001). With oronasal masks, a change of inspiratory positive airway pressure (IPAP) did not influence the objective pressure over the nasal bridge. Subjective discomfort was associated with higher IPAP and positively correlated with the pressure on the skin.

Objective measurement of pressure on the skin during mask fitting might be helpful for mask selection. Mask fitting in the supine position should be considered in the clinical routine.
Outcome of advanced lung cancer with central airway obstructionversuswithout central airway obstruction
Authors: Verma Akash , Goh Soon Keng , Tai Dessmon Y.H. , Kor Ai Ching , Soo Chun Ian , Seow Debra G.F. , Sein Zin Nge Nge , Samol Jens , Chopra Akhil , Abisheganaden John
Published: April 2018

Patients with central airway obstruction (CAO) from advanced lung cancer present with significant morbidity and are assumed to have lower survival. Hence, they are offered only palliative support. We asked if patients who have advanced lung cancer with CAO (recanalised and treated) will behave similarly to those with advanced lung cancer without CAO.

This study was a retrospective review of the medical records of the patients managed for advanced lung cancer during 2010 and 2015 at our institution.

85 patients were studied. Median survival and 1-, 2- and 5-year survival were 5.8 months, 30.3%, 11.7% and 2.3%versus9.3 months, 35.7%, 9.6% and 4.7%, respectively, in the CAO and no CAO groups (p=0.30). More patients presented with respiratory failure (15 (35%)versusnone; p=0.0001) and required assisted mechanical ventilation (10 (23.3%)versusnone; p=0.001) in the CAO group compared with the no CAO group. Fewer patients received chemotherapy in the CAO group (11 (25.5%)) compared with the no CAO group (23 (54.7%); p=0.008).

There was no difference in survival among patients with advanced lung cancer whether they presented with CAO or without CAO. Survival was similar to those without CAO in patients with recanalised CAO despite greater morbidity and lesser use of chemotherapy, strongly advocating bronchoscopic recanalisation of CAO. These findings dispel the nihilism associated with such cases.
Cost Savings of Implementing Site-Specific Ground Motion Response Analysis in the Design of Short-Period Mississippi Embayment Bridges
Authors: Wood Clinton M. , Baker Ethan R. B.
Published: April 2018

Deep dynamic site characterization and a site-specific ground motion response analysis (SSGMRA) were conducted for a bridge site in Monette, Arkansas. The SSGMRA indicated the design acceleration response spectrum determined using the American Association of State Highway and Transportation Officials (AASHTO) general seismic procedure could be reduced by one third for the short-period range due to attenuation of the short-period ground motions. The steel girder pile-bent bridge, originally designed using the AASHTO general seismic design procedure, was redesigned using the updated seismic demands estimated from SSGMRA. A cost-savings analysis was then conducted to determine the potential savings associated with conducting the SSGMRA. By designing based on the results of the SSGMRA, a potential gross savings of $205,000, or 7% of the original bridge construction cost, could be achieved for the study bridge. Items that contributed most to the cost savings were the pile and embankment construction.
Slow calcium waves mediate furrow microtubule reorganization and germ plasm compaction in the early zebrafish embryo
Authors: Eno Celeste , Gomez Timothy , Slusarski Diane C. , Pelegri Francisco
Published: April 2018

Zebrafish germ plasm ribonucleoparticles (RNPs) become recruited to furrows of early zebrafish embryos through their association with astral microtubules ends. During the initiation of cytokinesis, microtubules are remodeled into a furrow microtubule array (FMA), which is thought to be analogous to the mammalian midbody involved in membrane abscission. During furrow maturation, RNPs and FMA tubules transition from their original distribution along the furrow to enrichments at the furrow distal ends, which facilitates germ plasm mass compaction. We show that nebel mutants exhibit reduced furrow-associated slow calcium waves (SCWs), caused at least in part by defective enrichment of calcium stores. RNP and FMA distal enrichment mirrors the medial-to-distal polarity of SCWs, and inhibition of calcium release or downstream mediators such as Calmodulin affects RNP and FMA distal enrichment. Blastomeres with reduced or lacking SCWs, such as early blastomeres in nebel mutants and wild-type blastomeres at later stages, exhibit medially bundling microtubules similar to midbodies in other cell types. Our data indicate that SCWs provide medial-to-distal directionality along the furrow to facilitate germ plasm RNP enrichment at the furrow ends.
The triple helix of collagens – an ancient protein structure that enabled animal multicellularity and tissue evolution
Authors: Fidler Aaron L. , Boudko Sergei P. , Rokas Antonis , Hudson Billy G.
Published: April 2018

The cellular microenvironment, characterized by an extracellular matrix (ECM), played an essential role in the transition from unicellularity to multicellularity in animals (metazoans), and in the subsequent evolution of diverse animal tissues and organs. A major ECM component are members of the collagen superfamily –comprising 28 types in vertebrates – that exist in diverse supramolecular assemblies ranging from networks to fibrils. Each assembly is characterized by a hallmark feature, a protein structure called a triple helix. A current gap in knowledge is understanding the mechanisms of how the triple helix encodes and utilizes information in building scaffolds on the outside of cells. Type IV collagen, recently revealed as the evolutionarily most ancient member of the collagen superfamily, serves as an archetype for a fresh view of fundamental structural features of a triple helix that underlie the diversity of biological activities of collagens. In this Opinion, we argue that the triple helix is a protein structure of fundamental importance in building the extracellular matrix, which enabled animal multicellularity and tissue evolution.
The cytoskeleton regulates symmetry transitions in moving amoeboid cells
Authors: van Haastert Peter J. M. , Keizer-Gunnink Ineke , Kortholt Arjan
Published: April 2018

Symmetry and symmetry breaking are essential in biology. Symmetry comes in different forms: rotational symmetry, mirror symmetry and alternating right–left symmetry (for example, gliding reflection symmetry). Especially the transitions between the different symmetry forms are important because they specify crucial points in cell biology, including gastrulation in development, formation of the cleavage furrow in cell division, or the front in cell polarity. However, the mechanisms of these symmetry transitions are not well understood. Here, we have investigated the fundamental properties of symmetry and symmetry transitions of the cytoskeleton during cell movement. Our data show that the dynamic shape changes of amoeboid cells are far from random, but are the consequence of refined symmetries and symmetry changes that are orchestrated by small G-proteins and the cytoskeleton, with local stimulation by F-actin and Scar, and local inhibition by IQGAP2 and myosin.
A fragment of adhesion molecule L1 is imported into mitochondria, and regulates mitochondrial metabolism and trafficking
Authors: Kraus Kristina , Kleene Ralf , Braren Ingke , Loers Gabriele , Lutz David , Schachner Melitta
Published: April 2018

The cell adhesion molecule L1 (also known as L1CAM) plays important roles in the mammalian nervous system under physiological and pathological conditions. We have previously reported that proteolytic cleavage of L1 by myelin basic protein leads to the generation of a 70 kDa transmembrane L1 fragment (L1-70) that promotes neuronal migration and neuritogenesis. Here, we provide evidence that L1-70 is imported from the cytoplasm into mitochondria. Genetic ablation of L1, inhibition of mitochondrial import of L1-70 or prevention of myelin basic protein-mediated generation of L1-70 all lead to reduced mitochondrial complex I activity, and impaired mitochondrial membrane potential, fusion, fission and motility, as well as increased retrograde transport. We identified NADH dehydrogenase ubiquinone flavoprotein 2 as a binding partner for L1, suggesting that L1-70 interacts with this complex I subunit to regulate complex I activity. The results of our study provide insights into novel functions of L1 in mitochondrial metabolism and cellular dynamics. These functions are likely to ameliorate the consequences of acute nervous system injuries and chronic neurodegenerative diseases.
Radiation dose optimisation for conventional imaging in infants and newborns using automatic dose management software: an application of the new 2013/59 EURATOM directive
Authors: Alejo L , Corredoira E , Sánchez-Muñoz F , Huerga C , Aza Z , Plaza-Núñez R , Serrada A , Bret-Zurita M , Parrón M , Prieto-Areyano C , Garzón-Moll G , Madero R , Guibelalde E
Published: April 2018

﻿Objective:

The new 2013/59 EURATOM Directive (ED) demands dosimetric optimisation procedures without undue delay. The aim of this study was to optimise paediatric conventional radiology examinations applying the ED without compromising the clinical diagnosis.

Methods:

Automatic dose management software (ADMS) was used to analyse 2678 studies of children from birth to 5 years of age, obtaining local diagnostic reference levels (DRLs) in terms of entrance surface air kerma. Given local DRL for infants and chest examinations exceeded the European Commission (EC) DRL, an optimisation was performed decreasing the kVp and applying the automatic control exposure. To assess the image quality, an analysis of high-contrast resolution (HCSR), signal-to-noise ratio (SNR) and figure of merit (FOM) was performed, as well as a blind test based on the generalised estimating equations method.

Results:

For newborns and chest examinations, the local DRL exceeded the EC DRL by 113%. After the optimisation, a reduction of 54% was obtained. No significant differences were found in the image quality blind test. A decrease in SNR (−37%) and HCSR (−68%), and an increase in FOM (42%), was observed.

Conclusion:

ADMS allows the fast calculation of local DRLs and the performance of optimisation procedures in babies without delay. However, physical and clinical analyses of image quality remain to be needed to ensure the diagnostic integrity after the optimisation process.

Advances in knowledge:

ADMS are useful to detect radiation protection problems and to perform optimisation procedures in paediatric conventional imaging without undue delay, as ED requires.
Inferring Commitment from Rates of Organizational Transition
Authors: Jago Arthur S. , Laurin Kristin
Published: April 2018

Organizations often implement changes that can signal their values. However, the most objectively efficient changes do not necessarily serve as the best signals. Across seven experiments, we investigate how different rates of transition influence people’s perceptions of how committed organizations are to the values underlying changes or improvements. We find that slower, less efficient transitions signal greater commitment compared with faster, more efficient transitions that reach otherwise identical endpoints (Experiment 1). Using mediation and moderation strategies, we demonstrate that this discontinuity occurs because people assume slower transitions require relatively more effort to enact (Experiments 2 and 3). Moreover, these commitment inferences persist beyond the point at which changes end (Experiment 4), when further improvement along the same dimension is no longer possible (Experiment 5), and regardless of whether the organization decided to transition either quickly or slowly (Experiment 6). This effect reverses, however, when people can directly compare slower and faster transitions that ultimately reach identical endpoints (Experiment 7). Taken together, these findings suggest that people often infer greater commitment from slower transitions that unfold over time, even when those transitions are objectively inferior to faster alternatives.

Data are available at https://doi.org/10.1287/mnsc.2017.2980 .

This paper was accepted by Yuval Rottenstreich, judgment and decision making.
A Multi-Compartment Vehicle Routing Problem with Loading and Unloading Costs
Authors: Hübner Alexander , Ostermeier Manuel
Published: April 2018

This paper discusses a multi-compartment vehicle routing problem (MCVRP) that occurs in the context of grocery distribution. Different temperature-specific product segments (e.g., frozen or ambient) are transported from a retail warehouse to outlets. Different temperature-specific product segments can be transported together using multi-compartment vehicles. These trucks are technically able to have different temperature zones on the same truck by separating the capacity of a vehicle flexibly into a limited number of compartments. On one hand, this leads to a cost saving as different product segments ordered by one outlet can be delivered jointly using only one truck. This impacts the routing and the number of stops—i.e., the transportation costs and unloading costs. On the other hand, more than one shipping gate has to be approached at the warehouse to collect and load different product segments. As a consequence, the number of segments on each truck and therefore the number of compartments impact loading, transportation, and unloading costs.

An extended MCVRP with flexible compartments is presented to account for these loading and unloading costs. To solve the problem that arises, a large neighborhood search (LNS) tailored to the extended model is defined. The LNS includes problem-specific extensions in terms of the removal and reinsert operators as well as the termination criteria. It is tested using a case study with a retailer, benchmark data, and randomly generated data. Results are also compared to existing approaches. In line with the analyses performed for the model introduced, it is shown that the integration of loading and unloading costs into the model impacts routing considerably, and ultimately results in significant savings potential for retailers.
Anatomical total shoulder arthroplasty in young patients with osteoarthritis
Authors: Gauci M. O. , Bonnevialle N. , Moineau G. , Baba M. , Walch G. , Boileau P.
Published: April 2018

Aims

Controversy about the use of an anatomical total shoulder arthroplasty (aTSA) in young arthritic patients relates to which is the ideal form of fixation for the glenoid component: cemented or cementless. This study aimed to evaluate implant survival of aTSA when used in patients aged < 60 years with primary glenohumeral osteoarthritis (OA), and to compare the survival of cemented all-polyethylene and cementless metal-backed glenoid components.

Materials and Methods

A total of 69 consecutive aTSAs were performed in 67 patients aged < 60 years with primary glenohumeral OA. Their mean age at the time of surgery was 54 years (35 to 60). Of these aTSAs, 46 were undertaken using a cemented polyethylene component and 23 were undertaken using a cementless metal-backed component. The age, gender, preoperative function, mobility, premorbid glenoid erosion, and length of follow-up were comparable in the two groups. The patients were reviewed clinically and radiographically at a mean of 10.3 years (5 to 12, sd 26) postoperatively. Kaplan–Meier survivorship analysis was performed with revision as the endpoint.

Results

A total of 26 shoulders (38%) underwent revision surgery: ten (22%) in the polyethylene group and 16 (70%) in the metal-backed group (p < 0.0001). At 12 years’ follow-up, the rate of implant survival was 74% (sd 0.09) for polyethylene components and 24% (sd 0.10) for metal-backed components (p < 0.0002). Glenoid loosening or failure was the indication for revision in the polyethylene group, whereas polyethylene wear with metal-on-metal contact, instability, and insufficiency of the rotator cuff were the indications for revision in the metal-backed group. Preoperative posterior subluxation of the humeral head with a biconcave/retroverted glenoid (Walch B2) had an adverse effect on the survival of a metal-backed component.

Conclusion

The survival of a cemented polyethylene glenoid component is three times higher than that of a cementless metal-backed glenoid component ten years after aTSA in patients aged < 60 years with primary glenohumeral OA. Patients with a biconcave (B2) glenoid have the highest risk of failure. Cite this article: Bone Joint J 2018;100-B:485–92.
Additive manufacturing
Authors: Mumith A. , Thomas M. , Shah Z. , Coathup M. , Blunn G.
Published: April 2018

Increasing innovation in rapid prototyping (RP) and additive manufacturing (AM), also known as 3D printing, is bringing about major changes in translational surgical research.

This review describes the current position in the use of additive manufacturing in orthopaedic surgery.

Cite this article: Bone Joint J 2018;100-B:455-60.
An NIHR-approved two-year observational study on magnetically controlled growth rods in the treatment of early onset scoliosis
Authors: Nnadi C. , Thakar C. , Wilson-MacDonald J. , Milner P. , Rao A. , Mayers D. , Fairbank J. , Subramanian T.
Published: April 2018

Aims

The primary aim of this study was to evaluate the performance and safety of magnetically controlled growth rods in the treatment of early onset scoliosis. Secondary aims were to evaluate the clinical outcome, the rate of further surgery, the rate of complications, and the durability of correction.

Patients and Methods

We undertook an observational prospective cohort study of children with early onset scoliosis, who were recruited over a one-year period and followed up for a minimum of two years. Magnetically controlled rods were introduced in a standardized manner with distractions performed three-monthly thereafter. Adverse events which were both related and unrelated to the device were recorded. Ten children, for whom relevant key data points (such as demographic information, growth parameters, Cobb angles, and functional outcomes) were available, were recruited and followed up over the period of the study. There were five boys and five girls. Their mean age was 6.2 years (2.5 to 10).

Results

The mean coronal Cobb angle improved from 57.6° (40° to 81°) preoperatively, 32.8° (28° to 46°) postoperatively, and 41° (19° to 57°) at two years. Five children had an adverse event, with four requiring return to theatre, but none were related to the device. There were no neurological complications or infections. No devices failed. One child developed a proximal junctional kyphosis. The mean gain in spinal column height from T1 to S1 was 45.4 mm (24 to 81) over the period of the study.

Conclusion

Magnetically controlled growth rods provide an alternative solution to traditional growing rods in the surgical management of children with early onset scoliosis, supporting growth of the spine while controlling curve progression. Their use has clear psychosocial and economic benefits, with the reduction of the need for repeat surgery as required with traditional growing rods. Cite this article: Bone Joint J 2018;100-B:507–15.
Vascularized fibular epiphyseal transfer for proximal humeral reconstruction in children with a primary sarcoma of bone
Authors: Stevenson J. D. , Doxey R. , Abudu A. , Parry M. , Evans S. , Peart F. , Jeys L.
Published: April 2018

Aims

Preserving growth following limb-salvage surgery of the upper limb in children remains a challenge. Vascularized autografts may provide rapid biological incorporation with the potential for growth and longevity. In this study, we aimed to describe the outcomes following proximal humeral reconstruction with a vascularized fibular epiphyseal transfer in children with a primary sarcoma of bone. We also aimed to quantify the hypertrophy of the graft and the annual growth, and to determine the functional outcomes of the neoglenofibular joint.

Patients and Methods

We retrospectively analyzed 11 patients who underwent this procedure for a primary bone tumour of the proximal humerus between 2004 and 2015. Six had Ewing’s sarcoma and five had osteosarcoma. Their mean age at the time of surgery was five years (two to eight). The mean follow-up was 5.2 years (1 to 12.2).

Results

The overall survival at five and ten years was 91% (confidence interval (CI) 95% 75% to 100%). At the time of the final review, ten patients were alive. One with local recurrence and metastasis died one-year post-operatively. Complications included seven fractures, four transient nerve palsies, and two patients developed avascular necrosis of the graft. All the fractures presented within the first postoperative year and united with conservative management. One patient had two further operations for a slipped fibular epiphysis of the autograft, and a hemi-epiphysiodesis for lateral tibial physeal arrest. Hypertrophy and axial growth were evident in nine patients who did not have avascular necrosis of the graft. The mean hypertrophy index was 65% (55% to 82%), and the mean growth was 4.6 mm per annum (2.4 to 7.6) in these nine grafts. At final follow-up, the mean modified functional Musculoskeletal Tumour Society score was 77% (63% to 83%) and the mean Toronto Extremity Salvage Score (TESS) was 84% (65% to 94%).

Conclusion

Vascularized fibular epiphyseal transfer preserves function and growth in young children following excision of the proximal humerus for a malignant bone tumour. Function compares favourably to other limb-salvage procedures in children. Longer term analysis is required to determine if this technique proves to be durable into adulthood. Cite this article: Bone Joint J 2018;100-B:535–41.
A qualitative study of patient experience of an open fracture of the lower limb during acute care
Authors: Tutton E. , Achten J. , Lamb S. E. , Willett K. , Costa M. L.
Published: April 2018

Aims

The aim of this study was to explore the patients’ experience of recovery from open fracture of the lower limb in acute care.

Patients and Methods

A purposeful sample of 20 participants with a mean age of 40 years (20 to 82) (16 males, four females) were interviewed a mean of 12 days (five to 35) after their first surgical intervention took place between July 2012 and July 2013 in two National Health Service (NHS) trusts in England, United Kingdom. The qualitative interviews drew on phenomenology and analysis identified codes, which were drawn together into categories and themes.

Results

The findings identify the vulnerability of the patients expressed through three themes; being emotionally fragile, being injured and living with injury. The participants felt a closeness to death and continued uncertainty regarding loss of their limb. They experienced strong emotions while also trying to contain their emotions for the benefit of others. Their sense of self changed as they became a person with visible wounds, needed intimate help, and endured pain. When ready, they imagined what it would be like to live with injury.

Conclusion

Recovery activities require an increased focus on emotional wellbeing. Surgeons are aware of the need for clinical expertise and for adequate pain relief but may not be as aware that their patients require support regarding their body image and help to imagine their future life. Cite this article: Bone Joint J 2018;100-B:522–6.
Dorsal bridge plating or transarticular screws for Lisfranc fracture dislocations
Authors: Kirzner N. , Zotov P. , Goldbloom D. , Curry H. , Bedi H.
Published: April 2018

Aims

The aim of this retrospective study was to compare the functional and radiological outcomes of bridge plating, screw fixation, and a combination of both methods for the treatment of Lisfranc fracture dislocations.

Patients and Methods

A total of 108 patients were treated for a Lisfranc fracture dislocation over a period of nine years. Of these, 38 underwent transarticular screw fixation, 45 dorsal bridge plating, and 25 a combination technique. Injuries were assessed preoperatively according to the Myerson classification system. The outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) score, the validated Manchester Oxford Foot Questionnaire (MOXFQ) functional tool, and the radiological Wilppula classification of anatomical reduction.

Results

Significantly better functional outcomes were seen in the bridge plate group. These patients had a mean AOFAS score of 82.5 points, compared with 71.0 for the screw group and 63.3 for the combination group (p < 0.001). Similarly, the mean Manchester Oxford Foot Questionnaire score was 25.6 points in the bridge plate group, 38.1 in the screw group, and 45.5 in the combination group (p < 0.001). Functional outcome was dependent on the quality of reduction (p < 0.001). A trend was noted which indicated that plate fixation is associated with a better anatomical reduction (p = 0.06). Myerson types A and C2 significantly predicted a poorer functional outcome, suggesting that total incongruity in either a homolateral or divergent pattern leads to worse outcomes. The greater the number of columns fixed the worse the outcome (p < 0.001).

Conclusion

Patients treated with dorsal bridge plating have better functional and radiological outcomes than those treated with transarticular screws or a combination technique. Cite this article: Bone Joint J 2018;100-B:468–74.
Patients with unilateral transfemoral amputation treated with a percutaneous osseointegrated prosthesis
Authors: Hansson E. , Hagberg K. , Cawson M. , Brodtkorb T. H.
Published: April 2018

Aims

The aim of this study was to compare the cost-effectiveness of treatment with an osseointegrated percutaneous (OI-) prosthesis and a socket-suspended (S-) prosthesis for patients with a transfemoral amputation.

Patients and Methods

A Markov model was developed to estimate the medical costs and changes in quality-adjusted life-years (QALYs) attributable to treatment of unilateral transfemoral amputation over a projected period of 20 years from a healthcare perspective. Data were collected alongside a prospective clinical study of 51 patients followed for two years.

Results

OI-prostheses had an incremental cost per QALY gained of €83 374 compared with S-prostheses. The clinical improvement seen with OI-prostheses was reflected in QALYs gained. Results were most sensitive to the utility value for both treatment arms. The impact of an annual decline in utility values of 1%, 2%, and 3%, for patients with S-prostheses resulted in a cost per QALY gained of €37 020, €24 662, and €18 952, respectively, over 20 years.

Conclusion

From a healthcare perspective, treatment with an OI-prosthesis results in improved quality of life at a relatively high cost compared with that for S-prosthesis. When patients treated with S-prostheses had a decline in quality of life over time, the cost per QALY gained by OI-prosthesis treatment was considerably reduced. Cite this article: Bone Joint J 2018;100-B:527–34.
Higher preoperative sensitivity to pain and pain at rest are associated with worse functional outcome after stemless total shoulder arthroplasty
Authors: Kadum B. , Inngul C. , Ihrman R. , Sjödén G. O. , Sayed-Noor A. S.
Published: April 2018

Aims

The aims of this study were to investigate any possible relationship between a preoperative sensitivity to pain and the degree of pain at rest and on exertion with postoperative function in patients who underwent stemless total shoulder arthroplasty (TSA).

Patients and Methods

In this prospective study, we included 63 patients who underwent stemless TSA and were available for evaluation one year postoperatively. There were 31 women and 32 men; their mean age was 71 years (53 to 89). The pain threshold, which was measured using a Pain Matcher (PM) unit, the degree of pain (visual analogue scale at rest and on exertion, and function using the short version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), were recorded preoperatively, as well as three and 12 months postoperatively.

Results

We found an inverse relationship between both the preoperative PM threshold and pain (VAS) at rest and the 12-month postoperative QuickDASH score (Pearson correlation coefficient (r) ≥ 0.4, p < 0.05). A linear regression analysis showed that the preoperative PM threshold on the affected side and preoperative pain (VAS) at rest were the only factors associated with the QuickDASH score at 12 months.

Conclusion

These findings indicate the importance of central sensitization in the restoration of function after TSA. Further studies are required to investigate whether extra analgesia and rehabilitation could influence the outcome in at risk patients. Cite this article: Bone Joint J 2018;100-B:480–4.
Spinal tuberculosis
Authors: Dunn R. N. , Ben Husien M.
Published: April 2018

Tuberculosis (TB) remains endemic in many parts of the developing world and is increasingly seen in the developed world due to migration. A total of 1.3 million people die annually from the disease. Spinal TB is the most common musculoskeletal manifestation, affecting about 1 to 2% of all cases of TB. The coexistence of HIV, which is endemic in some regions, adds to the burden and the complexity of management.

This review discusses the epidemiology, clinical presentation, diagnosis, impact of HIV and both the medical and surgical options in the management of spinal TB.

Cite this article: Bone Joint J 2018;100-B:425–31.