bluuebunny/crossref_metadata_2025 huggingface dataset:
Generalized mixed linear modeling approach to analyze nodulation in common bean inbred lines
Authors: Rizzardi Diego Ary , Contreras-Soto Rodrigo Ivan , Figueiredo Alex Sandro Torre , Andrade Carlos Alberto de Bastos , Santana Rosangela Getirana , Scapim Carlos Alberto
Published: December 2017

Abstract: The objective of this work was to compare distributions for the modeling of the number and dry matter weight of nodules (DWN) of Rhizobium from different inoculants in common bean (Phaseolus vulgaris) inbred lines subjected to nitrogen doses, as well as to identify the best inoculant for those lines. The experiment was carried out in a randomized complete block design, arranged in split-split plots, with three factors - four inbred lines, five nitrogen doses (0, 20, 40, 60, and 80 kg ha-1), and three inoculants (CIAT 899, UFLA 02-100, and peat) - and four replicates. The number of nodules and their dry matter weight were analyzed with the generalized linear mixed modeling approach. The highest number of nodules was obtained with the CIAT 899 inoculant, at the dose of 20 kg ha-1 N (260 nodules), followed by UFLA 02-100, at 80 kg ha-1 (109 nodules), and peat alone at 20 kg ha-1 (98 nodules). The DWN with CIAT 899 exceeded in 0.66 g the DWN with UFLA 02-100, and in 0.95 g the DWN obtained without inoculation (inoculated with peat alone). The use of the negative binomial distribution and of the gamma distribution is a simple way to control data overdispersion of the nodule number and data underdispersion of DWN, respectively.
Remaining phosphorus content to determine phosphorus availability of the soils in Rio Grande do Sul
Authors: Rogeri Douglas Antonio , Bortolon Leandro , Gianello Clesio , Amorim Magno Batista
Published: December 2017

Abstract: The objective of this work was to evaluate remaining P compared with soil clay content as a P buffer index to classify P extracted by the Mehlich-1 (M1) and Mehlich-3 (M3) methods in soils from the state of Rio Grande do Sul, Brazil. The experiment was carried out in a completely randomized design with five P2O5 rates (0, 50, 100, 200, and 400 mg kg-1) and two sucessive corn crops, and three replicates, in 20 representative soils of the state. P extracted by M1 and M3 before crop planting was adjusted to P contents in biomass, considering soil buffer capacity. The division of soils into different buffering classes, based on soil clay or remaining P, improved the capacity of estimating soil available P of both methods. However, there was no difference among the correlation coefficients obtained by classifying soils according to the evaluated indexes (remaining P or soil clay) for both M1 and M3 methods. Remaining P is a viable alternative to replace soil clay content to classify soil P extracted with the M1 and M3 methods.
O centenário da Revolução Russa
Authors: Secco Lincoln
Published: December 2017

Resumo O propósito geral deste artigo é discutir alguns acontecimentos de 1917 na Rússia e mostrar um panorama das questões que os historiadores discutem hoje.
Análise do consumo alimentar em indivíduos com síndrome de Down da região metropolitana de Porto Alegre
Authors: Silva Franciéle Gomes da , Miraglia Fernanda
Published: December 2017

A síndrome de Down (SD), também conhecida como trissomia do cromossomo 21 é uma das principais causas de deficiência intelectual da população. Possuem características como protusão lingual, dificuldade de mastigação, diminuição da saliva e constipação, ainda apresentam uma grande prevalência de sobrepeso e obesidade. Objetivos: avaliar o consumo de alimentos industrializados, fontes de gorduras saturadas e trans, através de questionário de frequência alimentar (QFA) em pessoas com síndrome de Down. Método: foi realizado um estudo transversal, de caráter qualiquantitativo, com indivíduos portadores de SD, de ambos os sexos, de 0 a 52 anos que frequentam as Associações de Pais e Amigos dos Excepcionais (APAEs) de três cidades da região metropolitana de Porto Alegre. Os dados foram coletados através de um QFA elaborado pelas autoras e respondido pelos responsáveis. As análises foram processadas no programa estatístico SPSS versão 21.0. Resultados: foram entrevistados 33 indivíduos, sendo que 57,6% do total da amostra encontrava-se na faixa etária da primeira infância, dos zero aos 10 anos. O leite integral, sucos industrializados e frios e embutidos foram os alimentos com maior porcentagem de consumo diário. O consumo de refrigerantes foi de 42,4% entre uma e duas vezes por semana e 54,5% consomem carne de gado de três a quatro vezes por semana. Mais de 20% dos participantes relataram o consumo de frituras como frango frito e polenta ou aipim frito e ovo frito de uma a duas vezes na semana. Considerações finais: o consumo dos alimentos estudados é presente nessa população, apesar de poucos apresentarem frequência de consumo diária. Ainda assim os hábitos alimentares devem ser melhorados uma vez que já existe uma propensão para o aumento de peso na síndrome de Down.
El Periodo Cuaternario: La Historia Geológica de la Prehistoria
Authors: Silva Barroso Pablo Gabriel , Bardají Teresa , Roquero Elvira , Baena-Preysler Javier , Cearreta Alejandro , Rodríguez-Pascua Miguel A. , Rosas Antonio , Zazo Caridad , Goy José Luis
Published: December 2017

ResumenEste trabajo presenta una síntesis de la estratigrafía y geocronología del Periodo Cuaternario tras la actualización cronoestratigráfica aprobada por la Comisión Internacional de Estratigrafía (ICS-IUGS) y la Unión Internacional para el Estudio del Cuaternario (INQUA). Se aportan los datos más recientes sobre estratigrafía, cronología y paleoclimatología de este periodo en la Península Ibérica, así como los esquemas o fuentes bibliográficas más clásicas. Se da una visión general de la Prehistoria enmarcándola dentro de los episodios o eventos climáticos más característicos del Pleistoceno final, Holoceno y Antropoceno. Esta síntesis pretende ser una guía resumida de la cronología cuaternaria para todos aquellos investigadores que, trabajando en el Periodo Cuaternario, no poseen una formación científica adecuada al respecto.
Complementary feeding practices of children (6 months-23 months) in and around Lucknow, India
Authors: Srivastava Geetika , Bhatnagar Shrish , Khan Kabeer Ahmad
Published: December 2017

Background: According to infant and child mortality in India, levels trends and determinants the under 5 mortality rates (UFMR) of India is facing a steady decline but at this rate India could not meet its target of millennium development goal-4 (MDG-4), which aimed to reduced UFMR by 2/3rds between 1990 and 2015. Objective of the current study was to study the complementary feeding practices amongst children of age group 6 months to 23 months in Lucknow.Methods: In this prospective cross sectional study 256 mothers were interviewed over a period of 6 months at a referral care centre in Lucknow. Children of age groups   6-8 months, 9-11 months and 12-23 months attending the Paediatric OPD   were included in the study. WHO anthropometric   indices of nutritional status: weight-for-age, length-for-age and weight-for-length, expressed in standard deviation (SD) units (z-scores) were calculated. Information on feeding practices and various particulars of the study children were taken into account and the WHO Indicators for assessing infant and young child feeding practices were calculated. Complementary feeding index CFI was calculated using these WHO indicators.Results: In the study group 24% of the children were stunted, 38% were underweight and 35% were wasted. The CFI was seen to be low in 32%, medium in 61% and high only in 7% children. It was found that parental education had significant correlation with CFI. Weight for height was significantly associated with CFI (p=0.011).Conclusions: CFI is an important tool to target the lacunae in complementary feeding practices. The CFI scores directly correlate with the nutrition status of children thus targeting the determinants of CFI will bring a positive change in infant and young child feeding practices.
Parental obesity influence on body mass index of children: a cross sectional study
Authors: Patil Chaitanya R. , Thakre Sushama S. , Thakre Subhash B. , Petkar Prithvi B.
Published: December 2017

Background: Childhood obesity is a serious public health concern in both developed and developing countries. The children share food habits, physical activity habits etc. with their parents either in term of genetic or environmental influences, which affects the body mass index of the children. The objective of this study was to study the association of parental overweight/obesity with overweight/obesity in the children.Methods: A cross-sectional study was conducted in a government aided school in Nagpur during January 2016 to April 2016. Data was collected by a self-administered questionnaire which had information regarding the socio demographic characteristics like age, sex, socio economic status etc. Anthropometric measurements like height and weight of the children and their parents were measured. Necessary permissions were sought before the start of the study.Results: We found a significant association (p<0.01) between the obesity and overweight status of father and mother with the body mass index of their children with an odds ratio of 2.49 (1.69 to 3.66) and 2.90 (1.98 to 4.25) respectively. If both the parents are overweight/obese then the odds of their being overweight/obese is 3.00 (1.93-4.68). If either of parents is overweight/ obese, then the odds ratio is 3.10 (2.12-4.54).Conclusions: Stronger and significant associations were found between the overweight and obesity of the parents and their children. A significantly positive correlation was found between the body mass index of parents and body mass index of their children.
Effect of specific physiotherapy interventions in comparison with multisensory stimulation on neurobehavioral outcome and weight gain in preterm infants: a randomized control trial
Authors: Nadar Unis D. , Thakkar Pareshkumar A. , Shah Chaitali
Published: December 2017

Background: A premature infant is deprived of in-utero sensory experiences which are essential for normal brain development and rather is exposed to unusual sensory stimuli in the Neonatal Intensive Care Units (NICU) that pose risk to the developing brain in terms of adverse neurodevelopmental outcomes. The objective of this study was to study and compare the effect of specific physiotherapy intervention with multisensory stimulation on neurobehavioral outcome and weight gain in preterm infants. Inclusion criteria was preterm infants appropriate for gestational age more than 32 weeks, babies who were hemodynamically stable and babies receiving full enteral feeds. Exclusion criteria were major congenital anomalies, inability to undergo intervention (any fracture) or perinatal asphyxia. Methods: Eligible infants were randomly allocated into one of the two groups. Group A was offered multisensory stimulation: Auditory, Tactile, Visual and Vestibular (ATVV). Group B received Specific Physiotherapy Intervention (SPI) in form of kinesthetic exercises, oil massage and oral stimulation. The outcome was studied before and after intervention. Appropriate statistical tests were applied. Results: Both the groups had better suck co-ordination and improvement on neurobehavioral scale following intervention when compared to pre-intervention status (P<0.0001). When both groups were compared, SPI group had better sucking coordination than ATVV group, improvement in neurobehavioral scale was similar in either group.Conclusions: In preterm infants, Specific Physiotherapy Interventions are more effective in improving suck co-ordination, has better weight gain and are equally effective in improving neurobehavioral outcome compared to multisensory stimulation.
Clinical profile of immune thrombocytopenic purpua and outcome at 6 months: a South Indian observational study
Authors: Thiagarajan Srinivasan , S. Omana
Published: December 2017

Background: Immune thrombocytopenia studies in South India is very limited. This study was carried out with an aim to find the clinical spectrum of immune thrombocytopenia and outcome of this disorder affecting the children of central Kerala and to assess whether the clinical spectrum and outcome of this disorder differs from the western population.Methods: All newly diagnosed children of primary immune thrombocytopenia admitted in Paediatric ward from November 2012 to November 2013 were included in this study. Children with secondary causes of thrombocytopenia were excluded from the study population. Clinical profile and outcome at six months were studied. Children achieving complete response (platelet count >100 × 109/L and absence of bleeding) at six months was compared on the basis of severity of thrombocytopenia at presentation.Results: Thirty children were studied. The common age group affected was ranging from two to six years. The incidence of intracranial bleed was 6.6% and mortality 3.3%. 75.8 % of patients attained complete response and 17.2% of patients had response at six months. No patients ended up in hematological malignancy in follow up.Conclusions: Majority of patients with ITP does not require any intervention and only minor proportion of children progress to chronic immune thrombocytopenic purpura. Clinical spectrum and outcome of this condition does not differ from western studies. More research with larger sample size is required to study the incidence and outcome in Indian population.
Lead toxicity in a new-born due to in utero exposure
Authors: Laor Leanna , Sy Sharlene , Gupta Ruchi , Torres Joseph , Cohen Lourdes
Published: December 2017

Lead poisoning in a neonate is poorly defined, and limited data exists on appropriate follow-up and treatment of such infants. We are presenting the case of a newborn infant, who had a lead level of 63 mcg/dL. Treatment involved five days of intravenous chelation therapy. At discharge, no clinical sequelae of lead toxicity were found. However, due to the chronic nature of in utero exposure the infant requires close follow-up, in particular neurologic and developmental sequelae. Lead toxicity has many complications. Long-term complications include delays in growth and development. Furthermore, these complications may develop in children with minimal toxicity, let alone those with grossly abnormal values. Due to lack of data, perhaps it is worthwhile to screen those women of child-bearing age, who are of "high risk", for elevated blood lead levels to reduce the risk of in utero exposure.
A cross sectional study of polycystic ovarian syndrome among young women in Bhopal, Central India
Authors: Gupta Mahesh , Singh Daneshwar , Toppo Manju , Priya Angelin , Sethia Soumitra , Gupta Preeti
Published: December 2017

Background: Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder among women of reproductive age groups. It is one of the leading causes of poor fertility. Risk factors include obesity, not enough physical exercise, and a family history. Most studies in India report prevalence of PCOS as 9.13% to 36%. Behaviour and life style modifications are important part of treatment for PCOS. A number of cases in the community due to lack of awareness and proper guidance, it remains undiagnosed. Aim of this study was to find the prevalence of PCOS among the young females of Bhopal city. Thus, risk assessment in the form of a survey would be one of the strategies to identify this syndrome early so as to encourage young women to seek timely treatment and prevent its long term complications. Methods: Non comparative cross sectional study for duration of 8 month. Results: The prevalence of PCOS in this study was 8.20%. Among all the risk factors, BMI ≥25 (P value < 0.0001) and waist hip ratio ≥0.85 (<0.0001) were strongly associated with the presence of PCOS and Lack of awareness, there were in girls (78.4%). Conclusions: Women who were having BMI ≥25 and waist hip ratio ≥0.85 should be educated about its complications and should be advised weight loss. Girls who had irregularity of menses and signs of hyperandrogenism should be investigated and must be managed accordingly. Early diagnosis of PCOS and its prompt treatment will help the girls to improve quality of life.
Impact of smartphone use on quality of sleep among medical students
Authors: Kurugodiyavar Mahesh D. , H. R. Sushma , Godbole Maneesha , Nekar Manjunath S.
Published: December 2017

Background: Smartphone with its various functionalities has become an essential part of our daily activities and its use has been increasing. This has raised concern about its overuse and addiction especially in students. It is known that poor sleep is very common among medical students; there are many studies on sleep quality and its determinants in medical students but very few relating sleep quality and smartphone addiction. The main objective of this study was to investigate the relationship between smartphone use severity and sleep quality among medical students of KIMS, Hubballi. Methods: A cross‑sectional study on sample of 240 undergraduate medical students KIMS, Hubballi was conducted. Students were assessed using a self-administered questionnaire, Smart phone addiction scale (SAS) and Pittsburgh sleep quality inventory (PSQI). SAS score and PSQI scores were co-related. Hierarchical regression analyses were conducted to identify the variables independently associated with level of sleep quality. Results: Out of 240 subjects 117 (48.75%) were poor sleepers & 123 (51.25%) were good sleepers according to PSQI global sleep score. According to SAS score 123 (51.2%) were low users and 117 (48.75%) were high users of Smart phone. The mean (SD) PSQI global score was 4.8 (2.49) and mean (SD) SAS score was 102.93 (22.13). There was positive correlation between SAS score & PSQI score (r=0.343, p<0.001). Gender (β=0.141, p=0.021) & SAS score (β=0.292, p<0.001) were the significant predictors of global PSQI score. Conclusions: This study concludes that in medical students smartphone addiction affects sleep quality significantly and males are particularly more at risk of having poor sleep quality due to excessive smartphone use.
Estudo do efeito da tensão sobre a permeação por Hidrogênio em Aços API 5L X60 e API 5L X65
Authors: Araújo Bruno Araújo , De Paiva Filho Reginaldo Florêncio , Vilar Eudésio Oliveira , De Oliveira Misael Souto , Silva Antonio Almeida
Published: December 2017

Under operating conditions, the oil and gas transmission pipelines can be subjected to high pressures and, at the same time, suffer the effect of acidic substances in the transported hydrocarbons such as H2S, whose action alone or combined with stresses acting in the structure can cause degradation processes of the mechanical properties of the material. Given the importance of the phenomenon, this work has as main objective the realization of hydrogen electrochemical permeation tests in API 5L X60 and API 5L X65 steels under mechanical loading conditions. A device for performing electrochemical permeation tests of hydrogen in the specimens subjected to stress was used for the tests. Thus, it was possible to observe experimentally the influence of stress on the diffusion properties during the experiment. By applying stress on the order of 20% of the yield strength, it was possible to verify the increase of diffusivity of API 5L X60 steel. Furthermore, there was a strong influence of the stress level of permeability, because a large increase of permeability of API 5L X65 steel. The results indicate that the lattice deformation due to imposed mechanical stress has a great influence on the diffusion properties of materials
EQUILÍBRIO DE ADSORÇÃO DO CORANTE RODAMINA B EM CARVÃO ATIVADO OBTIDO DOS RESÍDUOS DO COCO VERDE
Authors: De Almeida e Silva Estela Souza Costa , Pinto Bruna Cristina , Lima Athos Silva , De Oliveira Magno André , Da Silva Bezerra Augusto Cesar , Souza Thainá Stefanie Ferreira , Rodrigues Christianne Garcia , Machado Alan Rodrigues Teixeira
Published: December 2017

Com o objetivo ao desenvolvimento de materiais alternativos para o tratamento de efluentes aquosos contendo contaminantes orgânicos, com este trabalho, foi produzido um carvão ativado utilizando como fonte de carbono os resíduos do coco verde. Ademais, o comportamento da adsorção do corante rodamina B, no material produzido, foi estudado em função da temperatura por meio das isotermas de adsorção e de seus parâmetros termodinâmicos. Os resultados obtidos mostraram que a adsorção da rodamina B em carvão ativado é um processo espontâneo e endotérmico, e  a quantidade de rodamina B adsorvida aumenta com a concentração a uma temperatura constante. Os resultados demonstraram, também, o potencial dos resíduos do coco verde como matéria-prima para obtenção de carvão ativado, bem como para o tratamento de efluentes contendo contaminantes orgânicos.
CORROSÃO DE AÇO GALVANIZADO EM SOLUÇÕES ÁCIDAS
Authors: Ruela Marcela São Paulo , Silveira Dalila Moreira da
Published: December 2017

Neste estudo, o comportamento corrosivo do aço galvanizado em soluções ácidas é analisado através dos ensaios de potencial de circuito aberto e polarização potenciodinâmica. Os corpos de prova foram imersos soluções de cloreto de sódio (NaCl) 3,5% p/v e sulfato de sódio (Na2SO4) 1% p/v com pH iguais a 2 e 4 para ambas. O meio reacional mais propenso a corrosão foi de NaCl 3,5% e pH 4, enquanto os menos corrosivos foram soluções de Na2SO4, independentemente do pH. Foi constatado que o fator que mais influenciou na corrosão foi a solução utilizada, sendo o pH pouco significante nas condições experimentais empregadas.
Expresiones jurídicas del ejercicio de la identidad personal y de la autodeterminación
Authors: Gete Alonso Maria Carmen
Published: December 2017

Resumen: La dignidad de la persona, su protección y respeto, es principio rector en el que se asientan los ordenamientos jurídicos positivos del área occidental, plasmado en textos universales, internacionales e internos (nacionales). La identidad comporta el reconocimiento de un nombre y apellidos – admitir el conocimiento de los propios orígenes – el respeto y protección en la fijación de las condiciones personales por sí misma, entre las manifestaciones más relevantes. La regulación positiva hecha en las leyes nacionales ni es uniforme, ni completa hasta el punto de que la ausencia de norma comporta una clara violación del derecho de autodeterminación.Palabras clave: Dignidad. Derechos personales. Autodeterminación. Identidad.
Risks and rewards of Externships: exploring goals and methods
Authors: Smith Linda F. , Giddings Jeff , Wortham Leah
Published: December 2017

Externships or field placement programs involve students placed away from the law school and supervised by a person who is not employed by the law school. Externships offer many potential rewards for students as well as other stakeholders, including especially community institutions. But there are also risks—risks that the externship will be expected to accomplish too much with too few resources or that the externship program will be held back in the potential for contribution due to inadequate imagination or planning. This article seeks to encourage externship teachers to put aside assumptions that are sometimes made about how externship programs “should be” and consider some alternative approaches to course design and possible goals for externship courses.
Enhancing Legal Aid through University law student engagement: a case study of the EBSU Law Clinic model
Authors: Nwedu Cosmos Nike
Published: December 2017

The provision of legal aid to underprivileged and vulnerable citizens who could not have ordinarily been able to provide for self legal representation and access to the court system is infrequent in many societies today, especially in most developing countries. There is also an observed non-inclusiveness in the delivery of legal aid. These have starkly resulted to a gap that impacts administration of justice negatively. However, the emergence of clinical legal education (CLE) at different law schools and universities around the world becomes a remedial approach both to increasing the consistency and breadth of legal aid activities, including promoting inclusiveness. CLE is gradually assuming a great height of unprecedented importance and progress in academic curriculum globally. Many universities and law schools have begun to incorporate law clinics into their educational curriculum not just as an essentially approved aspect of their legal education or a novel course of study that involves different pragmatic approaches of engaging law students on learning, but also as a practical mechanism for providing unmatched pedagogy that focuses on diverse lawyering skills successively maximized in providing free legal services to those citizens whose survival depends on the public mercy. This paper discusses how the engagement of university law students from CLE perspective helps to enhance the provision of legal aid to underprivileged and defenseless citizens. Consequently, Ebonyi State University (EBSU) Law Clinic model is used for a methodological case study analysis to that effect. EBSU is a State University in Nigeria and has effectively run its Law Clinic since inception till date, combining both empirical and theoretical approaches in providing pro bono oriented legal services to unprotected Nigerians. The paper further examines the modus operandi of the EBSU Law Clinic and highlights significant reasons why the Clinic stands to be a reference practice model.
Predicted Impact of the Food and Drug Administration’s Menu-Labeling Regulations on Restaurants in 4 New Jersey Cities
Authors: Gruner Jessie , DeWeese Robin S. , Lorts Cori , Yedidia Michael J. , Ohri-Vachaspati Punam
Published: December 2017

Objectives. To determine the proportion of restaurants that will be required to post calorie information under the Food and Drug Administration’s menu-labeling regulations in 4 New Jersey cities.

Methods. We classified geocoded 2014 data on 1753 restaurant outlets in accordance with the Food and Drug Administration’s guidelines, which will require restaurants with 20 or more locations nationwide to post calorie information. We used multivariate logistic regression analyses to assess the association between menu-labeling requirements and census tract characteristics.

Results. Only 17.6% of restaurants will be affected by menu labeling; restaurants in higher-income tracts have higher odds than do restaurants in lower-income tracts (odds ratio [OR] = 1.55; P = .02). Restaurants in non-Hispanic Black (OR = 1.62; P = .02) and mixed race/ethnicity (OR = 1.44; P = .05) tracts have higher odds than do restaurants in non-Hispanic White tracts of being affected.

Conclusions. Additional strategies are needed to help consumers make healthy choices at restaurants not affected by the menu-labeling law. These findings have implications for designing implementation strategies for the law and for evaluating its impact.
Hearing Aid Acquisition in Chinese Older Adults With Hearing Loss
Authors: He Ping , Wen Xu , Hu Xiangyang , Gong Rui , Luo Yanan , Guo Chao , Chen Gong , Zheng Xiaoying
Published: December 2017

Objectives. To investigate the prevalence and associated factors of hearing aid acquisition in Chinese older adults.

Methods. We obtained data from a population-based survey on ear and hearing disorders, which was conducted in 4 provinces of China in 2014 to 2015. Trained examiners conducted pure tone audiometry and audiologists further ascertained for hearing loss. We relied on hearing conditions and audiologists’ recommendations to identify 1503 participants who needed to wear hearing aids.

Results. Among those 1503 participants, the estimated prevalence of hearing aid acquisition was 6.5% (95% confidence interval = 5.3%, 7.8%). Urban residency, having severe hearing loss, understanding hearing aid function, and receiving a hearing test in the past 12 months were associated with elevated prevalence of hearing aid acquisition. The top-3 reported reasons for not acquiring a hearing aid were not understanding its function (25.4%), not needing it (22.3%), and not being able to afford it (21.3%).

Conclusions. Hearing aid use, as a widespread rehabilitation and treatment of hearing loss, remains a big challenge in China. Apart from providing low-cost hearing aids, more efforts should focus on improving hearing knowledge and disseminating information about hearing aid function among older adults.
Cost-Related Medication Nonadherence for Older Adults Participating in SNAP, 2013–2015
Authors: Srinivasan Mithuna , Pooler Jennifer A.
Published: December 2017

Objectives. To estimate the impact of Supplemental Nutrition Assistance Program (SNAP) participation on cost-related medication nonadherence (CRN) for older adults in the United States, with a particular focus on those who are food insecure and those threatened by hunger.

Methods. We used propensity score matching to create matched intervention and comparison groups of SNAP-eligible US adults aged 60 years and older with data from the 2013–2015 National Health Interview Survey. Intervention group participants were identified on the basis of self-reported SNAP participation in the past year.

Results. SNAP participants were 4.8 percentage points less likely to engage in CRN than eligible nonparticipants (P < .01). The effect of SNAP is about twice as large for older adults threatened by hunger (9.1 percentage points; P < .01), and considerable even for those who are food insecure (7.4 percentage points; P < .05).

Conclusions. Findings point to a spillover “income effect” as SNAP may help older adults better afford their medications, conceivably by reducing out-of-pocket food expenditures. When prescribing treatment plans, health systems and payers have a vested interest in connecting older patients to SNAP and other resources that may help address barriers to care.
Various Types of Arthritis in the United States: Prevalence and Age-Related Trends From 1999 to 2014
Authors: Park Juyoung , Mendy Angelico , Vieira Edgar R.
Published: December 2017

Objectives. To determine the prevalence trends of osteoarthritis (OA), rheumatoid arthritis (RA), and other types of arthritis in the United States from 1999 to 2014.

Methods. We analyzed data on 43 706 community-dwelling adults aged 20 years and older who participated in the 1999–2014 National Health and Nutrition Examination Surveys. We accounted for survey design and sampling weights so that estimates were nationally representative. We assessed temporal trends in age-standardized arthritis prevalence by using joinpoint regression.

Results. Age-adjusted prevalence of arthritis was 24.7% (OA = 9.7%; RA = 4.2%; other arthritis = 2.8%; “don’t know” type = 8.0%). Prevalence of OA increased from 6.6% to 14.3%, whereas RA prevalence decreased from 5.9% to 3.8%. Increase in OA prevalence was significant in both genders; in non-Hispanic Whites, non-Hispanic Blacks, and Hispanics; and in people with high socioeconomic status. Decrease in RA prevalence was more pronounced in men, non-Hispanic Blacks, and participants with low income or obesity.

Conclusions. Between 1999 and 2014, nearly one quarter of American adults reported arthritis. The prevalence of OA has more than doubled over time, whereas RA prevalence has declined.
Inequality in Utilization of Dental Services: A Systematic Review and Meta-analysis
Authors: Reda Sophie F. , Reda Seif M. , Thomson W. Murray , Schwendicke Falk
Published: December 2017

Background. Dental diseases are among the most prevalent conditions worldwide, with universal access to dental care being one key to tackling them. Systematic quantification of inequalities in dental service utilization is needed to identify where these are most pronounced, assess factors underlying the inequalities, and evaluate changes in inequalities with time.

Objectives. To evaluate the presence and extent of inequalities in dental services utilization.

Search Methods. We performed a systematic review and meta-analysis by searching 3 electronic databases (MEDLINE, Embase, Cochrane Central Database), covering the period from January 2005 to April 2017.

Selection Criteria. We included observational studies investigating the association between regular dental service utilization and sex, ethnicity, place of living, educational or income or occupational position, or insurance coverage status. Two reviewers undertook independent screening of studies and made decisions by consensus.

Data Collection and Analysis. Our primary outcome was the presence and extent of inequalities in dental service utilization, measured as relative estimates (usually odds ratios [ORs]) comparing different (high and low utilization) groups. We performed random effects meta-analysis and subgroup analyses by region, and we used meta-regression to assess whether and how associations changed with time.

Main Results. A total of 117 studies met the inclusion criteria. On the basis of 7 830 810 participants, dental services utilization was lower in male than female participants (OR = 0.85; 95% confidence interval [CI] = 0.74, 0.95; P < .001); ethnic minorities or immigrants than ethnic majorities or natives (OR = 0.71; 95% CI = 0.59, 0.82; P < .001); those living in rural than those living in urban places (OR = 0.87; 95% CI = 0.76, 0.97; P = .011); those with lower than higher educational position (OR = 0.61; 95% CI = 0.55, 0.68; P < .001) or income (OR = 0.66; 95% CI = 0.54, 0.79; P < .001); and among those without insurance coverage status than those with such status (OR = 0.58; 95% CI = 0.49, 0.68; P < .001). Occupational status (OR = 0.95; 95% CI = 0.81, 1.09; P = .356) had no significant impact on utilization. The observed inequalities did not significantly change over the assessed 12-year period and were universally present.

Authors’ Conclusions. Inequalities in dental service utilization are both considerable and globally consistent.

Public Health Implications. The observed inequalities in dental services utilization can be assumed to significantly cause or aggravate existing dental health inequalities. Policymakers should address the physical, socioeconomic, or psychological causes underlying the inequalities in utilization.
Mortality Among Confirmed Lassa Fever Cases During the 2015–2016 Outbreak in Nigeria
Authors: Buba Maryam Ibrahim , Dalhat Mahmood Muazu , Nguku Patrick Mboya , Waziri Ndadilnasiya , Mohammad Jibreel Omar , Bomoi Idriss Mohammed , Onyiah Amaka Pamela , Onwujei Jude , Balogun Muhammad Shakir , Bashorun Adebobola Toluwalashe , Nsubuga Peter , Nasidi Abdulsalami
Published: December 2017

Objectives. To determine factors associated with mortality among confirmed Lassa fever cases.

Methods. We reviewed line lists and clinical records of laboratory-confirmed cases of Lassa fever during the 2016 outbreak in Nigeria to determine factors associated with mortality. We activated an incident command system to coordinate response.

Results. We documented 47 cases, 28 of whom died (case fatality rate [CFR] = 59.6%; mean age 31.4 years; SD = ±18.4 years). The youngest and the oldest were the most likely to die, with 100% mortality in those aged 5 years or younger and those aged 55 years or older. Patients who commenced ribavirin were more likely to survive (odds ratio [OR] = 0.1; 95% confidence interval [CI] = 0.03, 0.50). Fatality rates went from 100% (wave 1) through 69% (wave 2) to 31% (wave 3; χ2 for linear trend: P < .01). Patients admitted to a health care center before incident command system activation were more likely to die (OR = 4.4; 95% CI = 1.1, 17.6). The only pregnant patient in the study died postpartum.

Conclusions. Effective, coordinated response reduces mortality from public health events. Attention to vulnerable groups during disasters is essential.

Public Health Implications. Activating an incident command system improves the outcome of disasters in resource-constrained settings.
Effects of Alcohol Interventions on Other Drug Use in the Cherokee Nation
Authors: Livingston Melvin D. , Komro Kelli A. , Wagenaar Alexander C. , Kominsky Terrence K. , Pettigrew Dallas W. , Garrett Brady A.
Published: December 2017

Objectives. To evaluate effects of 2 alcohol prevention interventions—Communities Mobilizing for Change on Alcohol (CMCA), a community organizing intervention designed to reduce youth alcohol access, and CONNECT, an individual-level screening and brief intervention approach—on other drug use outcomes.

Methods. We conducted a community intervention trial with quarterly surveys over 3 years (2012–2015) of high school students living within the jurisdictional service area of the Cherokee Nation in Oklahoma. We used generalized estimating equations and linear probability models to examine intervention spillover effects on other drug use.

Results. We found significant reductions in drug use other than alcohol attributable to CMCA and CONNECT. CMCA was associated with a 35% reduction in chewing tobacco use, a 39% reduction in marijuana use, and a 48% reduction in prescription drug misuse. CONNECT was associated with a 26% reduction in marijuana use and a 31% reduction in prescription drug misuse.

Conclusions. Nonalcohol drug use was consistently reduced as a result of 2 theoretically and operationally distinct alcohol prevention strategies. Evaluations of alcohol prevention efforts should continue to include other drug use to understand the broader effects of such interventions.
Advanced Imaging Adds Little Value in the Diagnosis of Femoroacetabular Impingement Syndrome
Authors: Cunningham Daniel J. , Paranjape Chinmay S. , Harris Joshua D. , Nho Shane J. , Olson Steven A. , Mather Richard C.
Published: December 2017

Background:

Femoroacetabular impingement (FAI) syndrome is an increasingly recognized source of hip pain and disability in young active adults. In order to confirm the diagnosis, providers often supplement physical examination maneuvers and radiographs with intra-articular hip injection, magnetic resonance imaging (MRI), or magnetic resonance arthrography (MRA). Since diagnostic imaging represents the fastest rising cost segment in U.S. health care, there is a need for value-driven diagnostic algorithms. The purpose of this study was to identify cost-effective diagnostic strategies for symptomatic FAI, comparing history and physical examination (H&P) alone (utilizing only radiographic imaging) with supplementation with injection, MRI, or MRA.

Methods:

A simple-chain decision model run as a cost-utility analysis was constructed to assess the diagnostic value of the MRI, MRA, and injection that are added to the H&P and radiographs in diagnosing symptomatic FAI. Strategies were compared using the incremental cost-utility ratio (ICUR) with a willingness to pay (WTP) of $100,000/QALY (quality-adjusted life year). Direct costs were measured using the Humana database (PearlDiver). Diagnostic test accuracy, treatment outcome probabilities, and utilities were extracted from the literature.

Results:

H&P with and without supplemental diagnostic injection was the most cost-effective. Adjunct injection was preferred in situations with a WTP of >$60,000/QALY, low examination sensitivity, and high FAI prevalence. With low disease prevalence and low examination sensitivity, as may occur in a general practitioner's office, H&P with injection was the most cost-effective strategy, whereas in the reciprocal scenario, H&P with injection was only favored at exceptionally high WTP (∼$990,000).

Conclusions:

H&P and radiographs with supplemental diagnostic injection are preferred over advanced imaging, even with reasonable deviations from published values of disease prevalence, test sensitivity, and test specificity. Providers with low examination sensitivity in situations with low disease prevalence may benefit most from including injection in their diagnostic strategy. Providers with high examination sensitivity in situations with high disease prevalence may not benefit from including injection in their diagnostic strategy. Providers should not routinely rely on advanced imaging to diagnose FAI syndrome, although advanced imaging may have a role in challenging clinical scenarios.

Level of Evidence:

Economic and Decision Analysis Level IV. See Instructions for Authors for a complete description of levels of evidence.
Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty
Authors: Huang ZeYu , Xie XiaoWei , Li LingLi , Huang Qiang , Ma Jun , Shen Bin , Kraus Virginia Byers , Pei FuXing
Published: December 2017

Background:

Tourniquet use during primary total knee arthroplasty is thought to reduce intraoperative blood loss and improve visibility. Our goal was to investigate whether tourniquet use is necessary for controlling intraoperative blood loss when alternatives such as tranexamic acid (TXA) are available.

Methods:

One hundred and fifty patients were equally randomized to 3 groups. Group A was treated with a tourniquet as well as multiple doses of intravenous TXA (20 mg/kg 5 to 10 minutes before the skin incision and 10 mg/kg 3, 6, 12, and 24 hours later) along with 1 g of topical TXA, Group B was treated the same as Group A but without the tourniquet, and Group C was treated with the tourniquet only.

Results:

The amount of intraoperative blood loss was similar for the 3 groups. Group B had significantly less hidden blood loss than Group A (p = 0.018) and Group C (p < 0.001). No significant differences (p > 0.05) were observed between Group A and Group B with regard to total blood loss, drainage volume, intraoperative blood loss, transfusion rate, or maximum change in the hemoglobin (Hb) level. We also found significantly more benefits for Group B compared with Groups A and C with regard to postoperative swelling ratio, levels of inflammatory biomarkers, visual analog scale (VAS) pain scores, range of motion at discharge, Hospital for Special Surgery (HSS) score, and patient satisfaction. There were no significant differences (p > 0.05) in the deep venous thrombosis or pulmonary embolus rates among the 3 groups. More wound secretion was observed in the groups in which a tourniquet was used.

Conclusions:

Patients treated with multiple doses of intravenous and topical TXA without a tourniquet had less hidden blood loss, a lower ratio of postoperative knee swelling, less postoperative knee pain, lower levels of inflammatory biomarkers, better early knee function, and even better early satisfaction than those treated with a tourniquet. Long-term follow-up should be performed to evaluate the effects on prosthetic fixation and long-term survival of total knee arthroplasty performed without a tourniquet.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Who Is Performing Hip Arthroscopy?
Authors: Duchman Kyle R. , Westermann Robert W. , Glass Natalie A. , Bedard Nicholas A. , Mather Richard C. , Amendola Annunziato
Published: December 2017

Background:

Hip arthroscopy utilization has increased dramatically over the last decade. However, the lack of a formal training curriculum raises concern that inconsistent technical performance may be an issue for early-career hip arthroscopists. The purpose of the present study was to investigate hip arthroscopy utilization by early-career orthopaedic surgeons while focusing on fellowship training status to better guide future development of a hip arthroscopy training curriculum.

Methods:

The American Board of Orthopaedic Surgery (ABOS) Part-II database was used to identify candidates who had performed ≥1 hip arthroscopy procedures between 2006 and 2015. Procedures were categorized using Common Procedural Terminology (CPT) codes, and candidates were categorized by fellowship training experience. Trends in hip arthroscopy utilization were evaluated using univariate and regression analyses while stratifying by fellowship training experience.

Results:

Overall, 9.2% (643) of 6,987 ABOS candidates had performed ≥1 hip arthroscopy procedures. Over the study period, both the proportion of candidates performing hip arthroscopy and the proportion of hip arthroscopy procedures performed (relative to all procedures performed, of any type) increased (p < 0.001). Candidates performing hip arthroscopy most frequently reported sports medicine fellowship training (74.5%; 479 of 643). Also, among the candidates who performed hip arthroscopy, the proportion who had sports medicine fellowship training increased over the study period (p = 0.001). The majority of candidates performing hip arthroscopy (67.2%; 432 of 643) performed ≤5 hip arthroscopy procedures, while a small number of high-volume hip arthroscopists (6.5%; 42 of 643) performed 34.6% (1,403 of 4,054) of all hip arthroscopy procedures.

Conclusions:

The increase in hip arthroscopy utilization in this cohort appears to have been driven primarily by the increased number of candidates performing hip arthroscopy and less by an increasing number of hip arthroscopy procedures being performed by individual candidates. The majority of candidates performing hip arthroscopy were sports-medicine-fellowship trained. This information is valuable for both trainees and educators interested in improving education and defining a curriculum for future hip arthroscopy training.
Pressure while Drilling Data Improves Reservoir Drilling Performance
Authors: Ward C. D. , Andreassen E.
Published: December 2017

A new down-hole annular Pressure-While-Drilling (PWD) tool has recently been applied to assist drilling of the reservoir section on the Statfjord Field, offshore Norway. In these highangle wells it is critical for drilling success to maintain the mud weight and Equivalent Circulating Density (ECD) within safe operating limits defined by the formation fluid, collapse, and fracture pressures. Operating outside these limits has historically led to expensive lost circulation, differential sticking, and pack-off incidents. Monitoring the actual down-hole pressure in real-time with a PWD tool, rather than relying on inferred pressures from predictive models, has allowed the Operator to stay within and better define these operating limits. The Operator used this improved hydraulics information to avoid pressure-related hole problems, optimise drilling practices, test hydraulics models, and obtain a greater understanding of the formation pressure limits.
Morphological and elemental analysis of alpaca hair (Vicugna pacos) using scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM – EDX)
Authors: MUCHA ALEKSANDRA , JANECZEK MACIEJ
Published: December 2017

The aim of studies was to evaluate the microstructure and elemental compositions of alpaca hair. The hair from eight alpacas, which came from different part of Poland, were analyzed by scanning electron microscopy with energy dispersive X-ray spectroscopy (SEM-EDX). The quantitive analysis was performed for nutritionally important elements (calcium and phosphorous), elements, which are part of building blocks of hair structure (silicon and sulfur) and trace elements (copper, zinc, selenium). Moreover, the elemental mapping was carried out. The SEM images showed that microstructure of hair is irregular and rough. The average diameter of hair is 32,27 ± 4,06 µm. The obtained results showed content of elements in hair and also their distribution in the structure of hair. This findings can be a good benchmark for further studies. .