bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Gastrocnemius Turn Flap and Hamstring Graft for the Treatment of Kuwada Type 3 Chronic Ruptures of the Achilles Tendon: A Retrospective Study
Authors: Bai Lu , Guan Siyao , You Tian , Zhang Wentao , Chen Peng
Published: December 2019

Background:

Chronic Achilles tendon rupture is challenging to repair, and many procedures have been suggested to fill the gap that separates the distal and proximal ends of the ruptured tendon.

Purpose:

To compare clinical outcomes between the free hamstring graft (HG) and gastrocnemius turn flap (GTF) procedures in the treatment of chronic Achilles tendon rupture.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This retrospective study included 26 patients (25 males, 1 female; mean age, 36.7 years; range, 22-53 years) with Kuwada type 3 chronic rupture of the Achilles tendon. A total of 11 patients underwent GTF surgery, whereas 15 patients underwent HG surgery. Follow-up assessments were conducted at 3, 6, and 12 months postoperatively.

Results:

The complication rate was significantly higher in the GTF group compared with the HG group (27.2% vs 6.6%, respectively; χ2 = 12.462; P = .001). At the 3-month follow-up, the degree of ankle dorsiflexion was significantly higher in the HG group than in the GTF group ( t = 3.144; P = .004). At 6-month and 1-year follow-up, no significant differences in ankle function were seen between the 2 groups.

Conclusion:

Hamstring tendon graft is associated with better early recovery of dorsiflexion compared with GTF. The long-term clinical outcomes of these 2 procedures are similar.
Complex Acoustic Environments: Review, Framework, and Subjective Model
Authors: Weisser Adam , Buchholz Jörg M. , Keidser Gitte
Published: December 2019

The concept of complex acoustic environments has appeared in several unrelated research areas within acoustics in different variations. Based on a review of the usage and evolution of this concept in the literature, a relevant framework was developed, which includes nine broad characteristics that are thought to drive the complexity of acoustic scenes. The framework was then used to study the most relevant characteristics for stimuli of realistic, everyday, acoustic scenes: multiple sources, source diversity, reverberation, and the listener’s task. The effect of these characteristics on perceived scene complexity was then evaluated in an exploratory study that reproduced the same stimuli with a three-dimensional loudspeaker array inside an anechoic chamber. Sixty-five subjects listened to the scenes and for each one had to rate 29 attributes, including complexity, both with and without target speech in the scenes. The data were analyzed using three-way principal component analysis with a (2 3 2) Tucker3 model in the dimensions of scales (or ratings), scenes, and subjects, explaining 42% of variation in the data. “Comfort” and “variability” were the dominant scale components, which span the perceived complexity. Interaction effects were observed, including the additional task of attending to target speech that shifted the complexity rating closer to the comfort scale. Also, speech contained in the background scenes introduced a second subject component, which suggests that some subjects are more distracted than others by background speech when listening to target speech. The results are interpreted in light of the proposed framework.
There Is No Place Like Home: A Survey on Satisfaction and Reported Outcomes of a Home-Based Rehabilitation Program Among Orthopedic Surgery Patients
Authors: Gagin Roni , HaGani Neta , Levy Itay , Norman Doron
Published: December 2019

Background:

Home-based rehabilitation (HBR) was previously found to be associated with positive outcomes that are equal to inpatient rehabilitation. Few studies have examined the challenges patients are facing during rehabilitation and recovery and their satisfaction from HBR.

Objective:

The purpose of this study was to examine the overall satisfaction and reported outcomes of HBR.

Methods:

A telephone survey was conducted among 146 orthopedic surgery patients who participated in an HBR program, at the end of the HBR and 6 months after. The questionnaire included information about level of independence, satisfaction from HBR, and difficulties during HBR.

Findings:

The overall satisfaction was high (73.1%). Patients reported on improvements in level of independence between the time of hospital discharge, the end of the program ( P = .0001), and the 6 months follow-up ( P = .004). Long wait for beginning of HBR, being a widower, and residing in a facility or with a nonfamilial caregiver were associated significantly with less general well-being and independence. The repeated measures analysis showed age lower than 71 and private health insurance ownership were associated with a better recovery. The most common difficulties reported were physical difficulties, lack of function, and caregivers’ burden.

Conclusions:

Patients and families need more emotional, social, and physical support during HBR. The increase in health services delivered in community settings requires a more clear-cut policy and supervision for HBR and the follow-up services.
When Religious Faith Mutilates Gender Equality: Women Entry in Sabarimala Temple in Kerala
Authors: Bijukumar V.
Published: December 2019

The brewing controversy over allowing entry of women of all age groups into the hill shrine of Ayyappa in Kerala polarized public opinion on women’s equal access to sacred spaces and the perpetuation of tradition in places of worship. Protagonists of gender equality claim that the restriction is as an attack on women’s right to access sacred places and a violation of Article 14 (right to equality) and Article 25(2) of the Indian Constitution which guarantees the right to religious freedom to all, thereby allowing irrationality to creep into the most literate society in the country. Critics protesting against the entry argue that it is against the centuries-old-practices-defined customs. According to them, women’s entry would pollute the temple and the celibate nature of Ayyappa should be protected.
Max India Group: How to Create a Culture of Maxism?
Authors: Kumar Rohit , Dutta Swarup Kumar
Published: December 2019

Max India is a multi-business entity and is the holding company for Max Healthcare, Max Bupa Health Insurance, Antara Senior Living, Life Insurance and Max Speciality Films. The case describes how an enterprise-wide quality management system can help achieve the vision of the Max Group, which is to build one of the most admired corporates for service excellence, and how can quality and service excellence become a boardroom subject? The case lists down the details of different businesses and the perspective of different stakeholders in the implementation of the Max Performance Excellence Framework and building the culture of Maxism. The case was written based on both primary research (interview research) and secondary research.
Gene therapy for hemophilia
Authors: Nathwani Amit C.
Published: December 2019

Gene therapy offers the potential for a cure for patients with hemophilia by establishing continuous endogenous expression of factor VIII or factor IX (FIX) following transfer of a functional gene to replace the hemophilic patient’s own defective gene. The hemophilias are ideally suited for gene therapy because a small increment in blood factor levels (≥5% of normal) is associated with significant amelioration of bleeding phenotype in severely affected patients. In 2011, the St. Jude/UCL phase 1/2 trial was the first to provide clear evidence of a stable dose-dependent increase in FIX levels in patients with severe hemophilia B following a single administration of adeno-associated viral (AAV) vectors. Transgenic FIX expression has remained stable at ∼5% of normal in the high-dose cohort over a 7-year follow-up period, resulting in a substantial reduction in spontaneous bleeding and FIX protein usage without toxicity. This study has been followed by unparalleled advances in gene therapy for hemophilia A and B, leading to clotting factor activity approaching normal or near-normal levels associated with a “zero bleed rates” in previously severely affected patients following a single administration of AAV vectors. Thus, AAV gene therapies are likely to alter the treatment paradigm for hemophilia A and B. This review explores recent progress and the remaining limitations that need to be overcome for wider availability of this novel treatment of inherited bleeding disorders.
Monitoring and treatment of MDS in genetically susceptible persons
Authors: Davies Stella M.
Published: December 2019

Genetic susceptibility to myelodysplastic syndrome (MDS) occurs in children with inherited bone marrow failure syndromes, including Fanconi anemia, Shwachman Diamond syndrome, and dyskeratosis congenita. Available evidence (although not perfect) supports annual surveillance of the blood count and bone marrow in affected persons. Optimal treatment of MDS in these persons is most commonly transplantation. Careful consideration must be given to host susceptibility to DNA damage when selecting a transplant strategy, because significant dose reductions and avoidance of radiation are necessary. Transplantation before evolution to acute myeloid leukemia (AML) is optimal, because outcomes of AML are extremely poor. Children and adults can present with germline mutations in GATA2 and RUNX1, both of which are associated with a 30% to 40% chance of evolution to MDS. GATA2 deficiency may be associated with a clinically important degree of immune suppression, which can cause severe infections that can complicate transplant strategies. GATA2 and RUNX1 deficiency is not associated with host susceptibility to DNA damage, and therefore, conventional treatment strategies for MDS and AML can be used. RUNX1 deficiency has a highly variable phenotype, and MDS can occur in childhood and later in adulthood within the same families, making annual surveillance with marrow examination burdensome; however, such strategies should be discussed with affected persons, allowing an informed choice.
Update from the clinic: what’s new in the diagnosis of cancer-associated thrombosis?
Authors: Peterson Erica A. , Lee Agnes Y. Y.
Published: December 2019

Malignancy is associated with a high risk of venous thromboembolism (VTE), and treatment with anticoagulant therapy is associated with a high risk of bleeding. Thus, accurate and timely VTE diagnosis in cancer patients is essential for identifying individuals who would benefit from anticoagulant therapy and for avoiding unnecessary treatment that can cause anticoagulant-related bleeding. The approach to the diagnosis of VTE in non-cancer patients involves a stepwise process beginning with an assessment of the pretest probability (PTP) of VTE using a validated clinical prediction rule (CPR) followed by D-dimer testing and/or diagnostic imaging. In patients with a low PTP and a negative D-dimer result, VTE can be excluded without additional imaging. However, published data suggest that CPRs and D-dimer testing may not be as accurate or as useful in patients with cancer. Studies have shown that the combination of a low PTP and negative D-dimer result is not efficient for exclusion of deep vein thrombosis (DVT) or pulmonary embolism (PE) in the cancer patient population because the vast majority of patients still require radiologic imaging. We propose that cancer patients with suspected VTE should proceed directly to radiologic imaging to confirm or exclude a diagnosis of DVT or PE.
Beyond JAK-STAT: novel therapeutic targets in Ph-negative MPN
Authors: Gerds Aaron T.
Published: December 2019

The Philadelphia chromosome-negative myeloproliferative neoplasms (MPNs) share a common pathobiology of constitutive activation of the JAK and STAT pathway, despite having the 3 distinct phenotypes of essential thrombocythemia, polycythemia vera, and primary myelofibrosis. Targeting the JAK-STAT pathway has led to remarkable clinical benefit, including reduction in splenomegaly, amelioration of cytokine-driven symptoms, improvement in quality of life, and even some improvement in survival. However, targeting this pathway has not resulted in consistent disease modification by current metrics, including a reduction in mutant allele burden or reversal of fibrosis. Moreover, targeting JAK-STAT can lead to limiting treatment-emergent side effects, such as anemia and thrombocytopenia. Continued discovery points to a complex system of pathogenesis beyond JAK-STAT driving the formation and evolution of MPNs. This article reviews the successes and limitations of JAK-STAT inhibition, surveys the strategies behind emerging therapies, and discusses the challenges that are present in moving beyond JAK-STAT.
Meeting the needs of CML patients in resource-poor countries
Authors: Malhotra Hemant , Radich Jerald , Garcia-Gonzalez Pat
Published: December 2019

Subsequent to the development and global availability of BCR/ABL–targeted tyrosine kinase inhibitors (TKIs), the prognosis of patients with chronic myeloid leukemia (CML), at least those in the chronic phase, has markedly improved, and in the developed world, the average lifespan of these patients is now close to that of age- and sex-matched subjects without the disease. However, the situation in low- and middle-income countries (LMICs) may not be so rosy. Many important differences in hematological cancers, including CML, have been highlighted in various publications in LMICs vs developed countries. These include differences in incidence and prevalence rates, age and stage of disease at diagnosis, response rates, and survival. Some of the possible reasons proposed for these are varying socioeconomic milieu (impacting availability of effective drugs and essential monitoring), environmental factors (mainly exposure to viral infections and pesticides), nutritional factors with interplay of malnutrition and diet on drug absorption and blood levels, and possible unknown genetic factors. Although generic first-generation TKIs (imatinib) are available in many parts of the world, several challenges remain in providing optimal treatment to patients with CML in resource-poor countries. Some of these include availability of optimal and high-quality BCR/ABL testing, availability and expense related to use of second- and third-generation TKIs (nilotinib, dasatinib, bosutinib, and ponatinib) and hematopoietic stem cell transplantation, issues with compliance and toxicities of drugs, and ensuring a minimal standard-of-care treatment and monitoring for every patient diagnosed with CML. For the purpose of this article, the more objective country label—LMIC—coined by the World Bank will be used (gross national income per capita between $1026 and $3995; World Bank, June 2019). Some of these issues will be discussed in this article in greater detail by experts in the field in 3 different but interconnected sections.
Primary immunodeficiencies: novel genes and unusual presentations
Authors: Notarangelo Luigi D. , Uzel Gulbu , Rao V. Koneti
Published: December 2019

Recent advances in genomics have greatly expanded the spectrum of primary immune deficiencies (PIDs). Along with the identification of pathogenic variants in novel genes, distinct phenotypes have been associated with different variants in the same gene. Although PIDs have been historically defined based on increased susceptibility to infections, immune dysregulation has emerged as a frequent and in some cases, predominant phenotype. Autoimmune cytopenias with onset in childhood, lasting longer than 12 months, and affecting multiple lineages should raise the suspicion of a possible PID with monogenic origin. Characterization of the various molecular and cellular mechanisms responsible for these unusual manifestations of PIDs, although at times resource intensive, may allow for targeted intervention in many of them.
A program of transition to adult care for sickle cell disease
Authors: Saulsberry Anjelica C. , Porter Jerlym S. , Hankins Jane S.
Published: December 2019

Most children with sickle cell disease (SCD) today survive into adulthood. Among emerging adults, there is a marked increase in acute care utilization and a rise in mortality, which can be exacerbated by not establishing or remaining in adult care. Health care transition programs are therefore essential to prepare, transfer, and integrate emerging adults in the adult care setting. The Six Core Elements of Health Care Transition, created by the Center for Health Care Transition Improvement, define the basic components of health care transition support as follows: (1) transition policy, (2) tracking and monitoring progress, (3) assessing transition readiness, (4) planning for adult care, (5) transferring to adult care, and (6) integrating into adult care. Programs that implement the Six Core Elements have experienced significant declines in care abandonment during adolescence and young adulthood and higher early adult care engagement. Most of the core transition activities are not currently reimbursable, however, posing a challenge to sustain transition programs. Ongoing studies are investigating interventions in comparative effectiveness trials to improve health-related quality of life and reduce acute care utilization among emerging adults with SCD. Although these studies will identify best practices for health care transition, it is also important to define how the transition outcomes will be measured, as no consensus definition exists for successful health care transition in SCD. Future research is needed to define best practices for health care transition, systematically assess transition outcomes, and revise payment models to promote sustainability of health care transition programs.
Management of rare acquired bleeding disorders
Authors: Menegatti Marzia , Biguzzi Eugenia , Peyvandi Flora
Published: December 2019

Autoantibodies toward clotting factors may develop in people suffering from autoimmune or neoplastic diseases, after drug intake or even in subjects without apparent conditions. They are more commonly directed against factor VIII (FVIII) or von Willebrand factor leading to acquired hemophilia A or acquired von Willebrand syndrome, respectively. Rarely, autoantibodies develop against other clotting factors, such as fibrinogen, FII, FV, FVII, FX, FXI, and FXIII. The clinical picture of an acquired bleeding disorder includes a wide spectrum of clinical manifestations ranging from minimal or no bleeding to life-threatening events. Patients with no previous personal or family history of bleeding may have sudden-onset hemorrhagic manifestations, sometimes fatal, especially if an early diagnosis is not made. On the other hand, some patients may not have hemorrhagic symptoms at onset, and their diagnosis can therefore be delayed. The laboratory diagnostic assessment is performed by screening coagulation tests followed by specific factor-level measurement and inhibitor-titrating assays. An early diagnosis of acquired coagulopathies is mandatory for starting the appropriate treatment aimed at both controlling the acute bleeding episode mainly using the bypassing agents, and eradicating the anticlotting factor autoantibody, using immunosuppressive treatment. Therefore, prompt intervention by an expert and a specialized center is needed for immediate recognition and treatment of the disease.
Case-based discussion on the implications of exogenous estrogens in hemostasis and thrombosis: the obstetrician’s view
Authors: James Andra H.
Published: December 2019

This is the obstetrician’s view on 3 different clinical scenarios involving bleeding and thrombotic disorders. In the first scenario, an 18 year old with a history of heavy menstrual bleeding since menarche presents with abdominal pain and ultrasound findings suggestive of a hemorrhagic ovarian cyst. The association with an underlying bleeding disorder is recognized. The goals of management, which are controlling hemorrhage and preserving fertility, are stated. Ovarian suppression, the most effective method to prevent recurrent hemorrhagic ovarian cysts, is outlined. Long-term management of heavy menstrual bleeding with hormonal contraception is described. In the second scenario, the same patient returns 5 years later for a preconception visit. The potential risks to an unborn baby with von Willebrand disease (VWD) are addressed. The natural rise in von Willebrand factor (VWF) during pregnancy is discussed, but the fact that women with VWD do not achieve the same VWF levels as women without VWD is emphasized and the implications are presented. In anticipation of pregnancy, the need for nonhormonal management of heavy menstrual bleeding and hemorrhagic ovarian cysts is mentioned. In the third and final scenario, the patient’s cousin with factor V Leiden seeks consultation regarding the risks of thrombosis with in vitro fertilization. The steps of assisted reproductive technology are described. The strategies to prevent venous thromboembolism by preventing ovarian hyperstimulation and reducing the likelihood of multiple gestation are detailed.
Evidence-Based Minireview: Longitudinal geriatric assessment in quality care for older patients with hematologic malignancies
Authors: Lin Richard J. , Klepin Heidi D.
Published: December 2019

A 65-year-old women was diagnosed with acute myeloid leukemia (AML; normal cytogenetics, NPM1 mutated, FLT3-ITD wild type). Preinduction screening geriatric assessment (GA) did not reveal any significant deficit, because she was independent of basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs), had normal cognition, and scored 10 (range 0-12) on the short physical performance battery (SPPB). She underwent standard 7 + 3 induction and achieved a complete remission, although her course was complicated by neutropenic sepsis and bacteremia. She is being evaluated for postremission therapy. Would you recommend a follow-up GA at this time?
New therapies for von Willebrand disease
Authors: Mannucci Pier Mannuccio
Published: December 2019

The management of von Willebrand disease (VWD) is based upon the dual correction of the primary hemostasis defect, due to the inherited deficiency of von Willebrand factor (VWF), and of the secondary defect of factor VIII coagulant activity (FVIII:C), due to the loss of binding and stabilization by VWF of this intrinsic coagulation factor in flowing blood. The traditional therapeutic weapons (the synthetic derivative of the antidiuretic hormone desmopressin and plasma-derived VWF/FVIII concentrates) are able to transiently correct both the defects. With the goal of tackling the primary deficiency in the disease, that is, VWF, but at the same time exploiting the normal capacity of patients to produce FVIII, the novel approach of replacing only VWF was implemented in the last 10 years. Following the manufacturing of a concentrate fractionated from human plasma and of one obtained by recombinant DNA technology, clinical studies have shown that VWF-only products correct not only the primary VWF deficiency but also the secondary FVIII:C deficiency. The demonstrated efficacy of these products in various clinical situations and, ultimately, in such a hemostasis-challenging context as surgery testifies to the effectiveness and safety of this approach. It remains to be seen whether VWF-only products are efficacious and safe in still-unexplored situations, such as use in children; the long-term use for prophylaxis; and in recurrent gastrointestinal (GI) bleeding due to angiodysplasia, a major therapeutic problem in VWD.
Ready for prime time: role for geriatric assessment to improve quality of care in hematology practice
Authors: Klepin Heidi D.
Published: December 2019

Older adults represent the growing majority of patients diagnosed with hematologic disorders, yet they remain underrepresented on clinical trials. Older patients of the same chronologic age differ from one another with varying comorbidity and functional reserve. The concepts of frailty and resilience are important to patient-centered care and are patient and setting specific. The use of geriatric assessment to inform tailored decision making and management can personalize care for older adults with hematologic malignancies. This article will highlight available evidence to support the role of geriatric assessment measures to enhance quality of care for older adults diagnosed with hematologic malignancies.
Economic feasibility of gasoline production from lignocellulosic wastes in Hong Kong
Authors: Guan Weixiang , Chua Sim-Ying , Tsang Chi-Wing , Chen Xiao , Lin Carol Sze Ki , Fu Raymond Sze Wai , Hu Haoquan , Liang Changhai
Published: December 2019

In this study, the conceptual process flowsheet was developed and the economic feasibility of woody biomass conversion to biofuel as feedstock was analysed by considering several promising experimental processes for lignin depolymerization, such as hydrodeoxygenation and hydrogenolysis, along with lignocellulosic biomass fractionation processes. The engineering simulation process toward the commercial production of bio-gasoline from lignocellulosic biomass using SuperPro Designer® was modeled. The compatibility of the end products with the current gasoline specifications was evaluated and various blending options were investigated to meet the octane number and Reid vapor pressure requirement of the product. The economic potential of the simulated engineering process was then evaluated from an economic perspective. The operating costs and capital investment of three scenario using three different catalytic systems were estimated and discussed to assess of the potential of commercializing of woody biomass valorization process. The main potential market segments were identified, including the process by-products such as xylose and cellulose pulp. From the economic evaluation study, it was found that selling the biomass fractionation products alone does have a greater profit than valorization of lignin to produce bio-gasoline, with net present value of RMB 22,653,000 and RMB 177,000, respectively at the same return on investment if the plant is set up in Hong Kong. It was also found that catalysts play a pivotal role in determination of the profitability in the valorization process, not only because of the price of the catalyst, but also the product distributions obtained with various types of it. To obtain the same gross profit, the sale price of bio-gasoline has to be set higher with platinum catalysts than with ruthenium catalysts (nearly 10 folds). Thus, catalyst development and process improvement are crucial in the establishment of bio-based circular economy.
Will artificial intelligence eventually replace psychiatrists?
Authors: Brown Christian , Story Giles William , Mourão-Miranda Janaina , Baker Justin Taylor
Published: December 2019

The dystopian scenario of an ‘artificial intelligence takeover’ imagines artificial intelligence (AI) becoming the dominant form of intelligence on Earth, rendering humans redundant. As a society we have become increasingly familiar with AI and robots replacing humans in many tasks, certain jobs and even some areas of medicine, but surely this is not the fate of psychiatry?

Here a computational neuroscientist (Janaina Mourão-Miranda) and psychiatrist (Justin Taylor Baker) suggest that psychiatry as a profession is relatively safe, whereas psychiatrists Christian Brown and Giles William Story predict that robots will be taking over the asylum.
Prognostic Impact of the 21-Gene Recurrence Score Assay Among Young Women With Node-Negative and Node-Positive ER-Positive/HER2-Negative Breast Cancer
Authors: Poorvu Philip D. , Gelber Shari I. , Rosenberg Shoshana M. , Ruddy Kathryn J. , Tamimi Rulla M. , Collins Laura C. , Peppercorn Jeffrey , Schapira Lidia , Borges Virginia F. , Come Steven E. , Warner Ellen , Jakubowski Debbie M. , Russell Christy , Winer Eric P. , Partridge Ann H.
Published: December 2019

PURPOSE

The 21-gene recurrence score (RS) assay is prognostic among women with early-stage estrogen receptor–positive (ER+) and human epidermal growth factor receptor 2–negative (HER2−) breast cancer and is used to inform recommendations for chemotherapy. Women ≤ 40 years of age represent a minority of patients studied using gene expression profiles.

METHODS

The Young Women's Breast Cancer Study is a prospective cohort of women diagnosed with breast cancer at age ≤ 40 years and enrolled patients between 2006 and 2016 (N = 1,302). We identified patients with stage I-III ER+/HER2− breast cancer. The RS assay was performed on banked specimens for patients who had not been tested clinically. Distant recurrence-free survival (DRFS) was assessed by TAILORx and traditional RS risk groups among patients with axillary node–negative (N0) and limited node–positive (N1) breast cancer.

RESULTS

Among eligible women (N = 577), 189 (33%) had undergone RS testing, and 320 (56%) had banked specimens sufficient for testing. Median follow-up was 6.0 years. Median age at diagnosis was 37.2 years; 300 of 509 patients (59%) had N0 breast cancer, of whom 195 (65%) had an RS of 11-25 and fewer than half (86 of 195; 44%) received chemotherapy. Six-year DRFS rates were 94.4% and 92.3% (RS < 11), 96.9% and 85.2% (RS 11-25), and 85.1% and 71.3% (RS ≥ 26) among women with N0 and N1 disease, respectively.

CONCLUSION

The RS assay is prognostic among young women with node-negative and limited node-positive breast cancer, representing a valuable tool for risk stratification. Disease outcomes with a median follow-up of 6 years among young women with N0 disease and an RS of 0-25, a minority of whom received chemotherapy, and node-positive disease with an RS < 11 were very good, whereas those with N0 disease and an RS ≥ 26 or N1 disease with an RS ≥ 11 experienced substantial risk of early distant recurrence.
Why Policies Fail: The Illusion of Services in the Opioid Epidemic
Authors: Strach Patricia , Zuber Katie , Pérez-Chiqués Elizabeth
Published: December 2019

Context: Although New York State is a generous provider of substance-use treatment, people who ask for help have difficulty accessing services. If the laws are on the books, the agency is there to act, and the options are available, why is treatment so hard to get?

Methods: The authors conducted 87 open-ended interviews and observed local task force meetings in Sullivan County, New York. They open coded data, identifying key topics and themes.

Findings: Even though New York is a best-case scenario for treatment, people who seek help cannot always access it. The state sees the problem as a lack of beds or information about beds, but people on the ground face real barriers that make it difficult to get treatment, including the medical model of detoxification, admissions criteria, staff shortages, and other life complications.

Conclusions: Contrary to the policy literature, this article shows that policies may fail not because they are poorly designed or implemented but because the policy itself does not address the actual underlying problem. Furthermore, in the case of opioids, it shows how misplaced solutions can hide evidence of the underlying problem, exacerbating the very issue that policy makers want to fix.
Bilateral Gait 6 and 12 Months Post–Anterior Cruciate Ligament Reconstruction Compared with Controls
Authors: DAVIS-WILSON HOPE C. , PFEIFFER STEVEN J. , JOHNSTON CHRISTOPHER D. , SEELEY MATTHEW K. , HARKEY MATTHEW S. , BLACKBURN J. TROY , FOCKLER RYAN P. , SPANG JEFFREY T. , PIETROSIMONE BRIAN
Published: December 2019

Purpose

To compare gait biomechanics throughout stance phase 6 and 12 months after unilateral anterior cruciate ligament reconstruction (ACLR) between ACLR and contralateral limbs and compared with controls.

Methods

Vertical ground reaction force (vGRF), knee flexion angle (KFA), and internal knee extension moment (KEM) were collected bilaterally 6 and 12 months post-ACLR in 30 individuals (50% female, 22 ± 3 yr, body mass index = 23.8 ± 2.2 kg·m−2) and at a single time point in 30 matched uninjured controls (50% female, 22 ± 4 yr, body mass index = 23.6 ± 2.1 kg·m−2). Functional analyses of variance were used to evaluate the effects of limb (ACLR, contralateral, and control) and time (6 and 12 months) on biomechanical outcomes throughout stance.

Results

Compared with the uninjured controls, the ACLR group demonstrated bilaterally lesser vGRF (ACLR, 9% body weight [BW]; contralateral, 4%BW) during early stance and greater vGRF during midstance (ACLR, 5%BW; contralateral, 4%BW) 6 months post-ACLR. Compared to the uninjured controls, the ACLR group demonstrated bilaterally lesser vGRF (ACLR, 10%BW; contralateral, 8%BW) during early stance and greater vGRF during midstance (ACLR, 5%BW; contralateral, 5%BW) 12 months post-ACLR. Compared with controls, the ACLR limb demonstrated lesser KFA during early stance at 6 (2.3°) and 12 months post-ACLR (2.0°), and the contralateral limb demonstrated lesser KFA during early stance at 12 months post-ACLR (2.8°). Compared with controls, the ACLR limb demonstrated lesser KEM during early stance at both 6 months (0.011BW × height) and 12 months (0.007BW × height) post-ACLR, and the contralateral limb demonstrated lesser KEM during early stance only at 12 months (0.006BW × height).

Conclusions

Walking biomechanics are altered bilaterally after ACLR. During the first 12 months post-ACLR, both the ACLR and contralateral limbs demonstrate biomechanical differences compared with control limbs. Differences between the contralateral and control limbs increase from 6 to 12 months post-ACLR.
Energy Deficit Required for Exercise-induced Improvements in Glycemia the Next Day
Authors: SCHLEH MICHAEL W. , PITCHFORD LISA M. , GILLEN JENNA B. , HOROWITZ JEFFREY F.
Published: December 2019

Purpose

This study determined the impact of an exercise-induced energy deficit on postprandial and 24 h glycemic control the day after a session of exercise.

Methods

Fifteen healthy participants (m/f = 5/10, 27 ± 6 yr, body mass index = 24 ± 3 kg·m−2, peak oxygen consumption [V˙O2peak] = 36 ± 9 mL·kg−1·min−1) completed two separate 5-d experimental trials performed under “free-living” conditions. On day 1 of each trial, participants were fitted with a continuous glucose monitor and abstained from exercise. Day 2 served as a nonexercise control (NoEx). On day 3, participants exercised at 3:00 pm (65% V˙O2peak) until they expended 350 kcals (~45 min). The diet during both experimental trials was identical with the exception of meals after this exercise session. During one trial, the dinner after exercise did not replenish the 350 kcal expended during exercise, thereby establishing an exercise energy deficit (ExDEF). During the other experimental trial, the dinner after exercise contained an additional 350 kcal to compensate for the energy expended during exercise, and thereby maintained energy balance after exercise (ExBAL). Free-living glycemia was measured the day before exercise (NoEx) and the day after exercise under ExDEF and ExBAL conditions.

Results

The day after exercise, 3 h postprandial area under the curve was lower after breakfast in ExDEF compared with ExBAL (16.0 ± 1.8 vs 17.0 ± 1.6 mmol·L−1·h−1 per 3 h, P = 0.01), but did not differ between groups after lunch (P = 0.24), dinner (P = 0.39), or evening snack (P = 0.45). Despite differences in the glycemic response to breakfast, 24 h glycemia did not differ between ExDEF and ExBAL (area under the curve = 128 ± 10 vs 131 ± 10 mmol·L−1·h−1 per 24 h, respectively; P = 0.54).

Conclusions

An exercise-induced energy deficit lowered the glycemic response to breakfast the next day—but this energy deficit did not impact total 24 h glycemia, the day after exercise in metabolically healthy adults.
Smoking and Biochemical, Performance, and Muscle Adaptation to Military Training
Authors: SIDDALL ANDREW , BILZON JAMES , THOMPSON DYLAN , TAULER PEDRO , GREEVES JULIE , IZARD RACHEL , STOKES KEITH
Published: December 2019

Purpose

To determine whether physical performance adaptation is impaired in smokers during early stages of military training and to examine some of the putative mechanistic candidates that could explain any impairment.

Methods

We examined measures of oxidative stress (malondialdehyde [MDA], lipid hydroperoxides), inflammation (C-reactive protein, interleukin-6), antioxidants (vitamins A and E and carotenes) and hormones (cortisol, testosterone, insulin-like growth factor-1) in 65 male British Army Infantry recruits (mean ± SD age, 21 ± 3 yr; mass, 75.5 ± 8.4 kg; height, 1.78 ± 0.07 m) at week 1, week 5, and week 10 of basic training. Physical performance (static lift, grip strength, jump height, 2.4 km run time, and 2-min press up and sit up scores) was examined and lower-leg muscle and adipose cross-sectional area and density measured by peripheral Quantitative Computed Tomography.

Results

Basic military training, irrespective of smoking status, elicited improvement in all physical performance parameters (main time effect; P < 0.05) except grip strength and jump height, and resulted in increased muscle area and decreased fat area in the lower leg (P < 0.05). MDA was higher in smokers at baseline, and both MDA and C-reactive protein were greater in smokers during training (main group effect; P < 0.05) than nonsmokers. Absolute performance measures, muscle characteristics of the lower leg and other oxidative stress, antioxidant, endocrine, and inflammatory markers were similar in the two groups.

Conclusions

Oxidative stress and inflammation were elevated in habitual smokers during basic military training, but there was no clear evidence that this was detrimental to physical adaptation in this population over the timescale studied.
Distinct Coordination Strategies Associated with the Drop Vertical Jump Task
Authors: DICESARE CHRISTOPHER ANDREW , MINAI ALI A. , RILEY MICHAEL A. , FORD KEVIN R. , HEWETT TIMOTHY E. , MYER GREGORY D.
Published: December 2019

Introduction

Coordination of multiple degrees of freedom in the performance of dynamic and complex motor tasks presents a challenging neuromuscular control problem. Experiments have inferred that humans exhibit self-organized, preferred coordination patterns, which emerge due to actor and task constraints on performance. The purpose of this study was to determine if the set of effective coordination strategies that exist for a task centers on a small number of robust, invariant patterns of behavior.

Methods

Kinetic movement patterns computed from a cohort of 780 primarily female adolescent athletes performing a drop vertical jump (DVJ) task were analyzed to discover distinct groups into which individuals could be classified based on the similarity of movement coordination solutions.

Results

Clustering of reduced-dimension joint moment of force time series revealed three very distinct, precisely delineated movement profiles that persisted across trials, and which exhibited different functional performance outcomes, despite no other apparent group differences. The same analysis was also performed on a different task—a single-leg drop landing—which also produced distinct movement profiles; however, the three DVJ profiles did not translate to this task as group assignment was inconsistent between these two tasks.

Conclusion

The task demands of the DVJ and single-leg drop—successful landing, reversal of downward momentum, and, in the case of the DVJ, vertical propulsion toward a maximally positioned target—constrain movement performance such that only a few successful outcomes emerge. Discovery of the observed strategies in the context of associated task constraints may help our understanding of how injury risk movement patterns emerge during specific tasks, as well as how the natural dynamics of the system may be exploited to improve these patterns.
NA FEIRA TAMBÉM TEM INOVAÇÃO? UMA ANÁLISE DA CRIAÇÃO E CONFECÇÃO DE “MODINHA” NA FEIRA DA RUA JOSÉ AVELINO
Authors: Calíope Thalita Silva , Silva Filho José Carlos Lázaro da
Published: December 2019

O objetivo deste artigo foi identificar o processo de inovação nas empresas de confecção de modinha na Feira da José Avelino. Para alcançá-lo, realizou-se um estudo de caso na Feira da José Avelino. Os dados foram coletados por meio de entrevista em profundidade com 11 feirantes e analisados com a análise de conteúdo. Encontrou-se que, embora a Feira seja reconhecida como polo de moda e seja capaz de criar moda, há uma grande influência externa, especialmente de novelas, sendo um mercado de massa. Constatou-se que a estratégia inovativa predominante é a imitativa. Existe um ciclo incessante em que, quando surge uma inovação, os feirantes imitam uns aos outros, levando à saturação, com produtos sem diferenciação e com preços baixos que fazem com que haja concorrência acirrada entre as empresas, induzindo-as a buscarem inovações para se destacarem. Assim, a imitação leva à inovação.
GESTÃO SUSTENTÁVEL – MOTIVADORES, BARREIRAS E PERCEPÇÃO DE MICRO E PEQUENOS EMPRESÁRIOS
Authors: Rocha Rafael Toniolo da , Introvini Rodrigo Faria , Caldana Adriana Cristina Ferreira , Krauter Elizabeth , Liboni Lara Bartocci
Published: December 2019

A demanda por uma administração mais sustentável das organizações é crescente. No entanto, poucos estudos direcionam a tomada de decisão sobre gestão sustentável em empresas de pequeno porte. Este estudo se propôs identificar principais motivadores e barreiras para adoção da gestão sustentável segundo percepção de micro e pequenos empresários. A coleta de dados foi realizada por meio de questionário que foi respondido por 72 empresas dos estados de São Paulo, Paraná e Mato Grosso. Para a análise dos dados foram utilizadas as técnicas de análise fatorial e análise de conglomerados.  Por meio deste estudo foi possível estabelecer um conjunto de oito fatores que influenciam na gestão sustentável de empresas de pequeno porte e traçar três perfis de empresas no quesito gestão sustentável. Verificou-se que a maioria das empresas se enquadraram numa abordagem preventiva em relação a gestão sustentável. Estudos em profundidade são recomendados para explicar os resultados.
A UTILIZAÇÃO DE EQUIPAMENTOS DE PROTEÇÃO INDIVIDUAL E COLETIVA POR PROFISSIONAIS DE SAÚDE: REVISÃO INTEGRATIVA
Authors: DE SOUSA FERNANDA FERREIRA , De Sousa Isabele Alves , De Oliveira Luciane Marta Neiva
Published: December 2019

A transmissão de agentes infecciosos é um crítico agravante à saúde pública. As medidas de precaução-padrão são consideradas um conjunto de medidas adotadas como forma eficiente de redução dos riscos de infecção, incluindo a lavagem de mãos, o uso de equipamentos de proteção individual (EPI) e de proteção coletiva (EPC), manuseio apropriado de resíduos dos serviços de saúde e imunização. Objetivo: investigar através de uma revisão de literatura a utilização de EPI e EPC por profissionais de saúde, e o reconhecimento da importância desta pratica pelos mesmos, dentro do âmbito das medidas de precaução padrão para controle de infecções hospitalares. Metodologia: Esta pesquisa trata-se de uma revisão integrativa realizada nos meses de outubro e novembro de 2017, através das bases eletrônicas, LILACS, MEDLINE e SciELO, por meio do portal regional da biblioteca virtual em saúde (BVS). Resultados: foram selecionados 5 artigos de caráter transversal com base nos critérios de inclusão e exclusão, os  quais serviram de base para a coleta de informações relevantes para os resultados,e foram tabelados e expostos. Conclusão: o presente estudo estabelece que o uso de equipamentos de proteção individual e equipamentos de proteção coletiva por trabalhadores da área de saúde não é adotada de maneira eficaz, sugerindo à falta de adesão e conhecimento sobre as medidas de proteção padrão.
MULHERES EM TRATAMENTO HEMODIALÍTICO: QUALIDADE DE VIDA E ASSISTÊNCIA DE ENFERMAGEM
Authors: Martins Lágila Cristina Nogueira , Magnabosco Patrícia , Pereira Maria Elizabeth Roza
Published: December 2019

Introdução: A Doença Renal Crônica (DRC) é um problema de saúde pública e sua evolução relaciona-se a altas taxas de morbimortalidade no Brasil e no mundo, sendo necessário, muitas vezes, Terapia Renal Substitutiva. O trabalho visa avaliar a qualidade de vida (QV) e a assistência de enfermagem de mulheres portadoras de DRC submetidas ao tratamento hemodialítico. Materiais e métodos: pesquisa descritiva, transversal com abordagem quantitativa realizada no setor de hemodiálise de um Hospital Universitário do Triângulo Mineiro. Para a coleta de dados foi utilizado um instrumento sociodemográfico semi-estruturado, SF-36 acrescido de questões referentes à assistência de enfermagem e para análise dos dados foi utilizado o programa SPSS. Resultados: das mulheres entrevistadas, 26,31% apresentaram entre 51 e 60 anos e 57,89% apresentaram hipertensão como doença de base da DRC.  Em relação ao instrumento SF-36, os domínios aspectos físicos, aspectos emocionais e dor foram os que receberam menores escores. Quanto a assistência de enfermagem, 94,74% das mulheres avaliaram a assistência recebida no referido local como satisfatória. Discussão: A DRC afeta principalmente pessoas em idade economicamente ativa e o tratamento debilitante interfere no desenvolvimento de atividades diárias e de lazer, gerando prejuízo psicológico, entretanto percebe-se que os escores referentes à saúde física do SF-36 afetaram mais a QV dessas mulheres do que os escores de saúde mental. Conclusão: A QV é prejudicada nesses pacientes, sendo agravada por algumas variáveis sociodemográficas, clínicas e hábitos de vida. Já a assistência de enfermagem é indispensável para o enfrentamento das dificuldades e adesão ao tratamento.
SAÚDE E ATIVIDADES DE LAZER DE JOVENS NO ENSINO MÉDIO
Authors: Tolocka Rute Estanislava , RAMOS Eduardo Pereira , PERUCHI Luis  Paulo Liberato
Published: December 2019

A literatura indica que atividades de lazer auxiliam na prevenção de patologias,porém, esta relação entre  jovens ainda não está bem estudada. Pouco se sabe sobre o nível de saúde de jovens que participam de programas de esporte e lazer e o sedentarismo tem aumentado entre os jovens. O objetivo deste estudo foi verificar a  participação de jovens secundaristas em um Programa de  Esporte e Lazer (PEL) e doenças relatadas; 350 estudantes de uma escola técnica de segundo grau participaram do estudo, respondendo a um questionário; entre os jovens participantes do PEL 35.5% relataram ter   doenças e este índice chegou a 50.9%.  entre os que não participam do PEL. Foi encontrada correlação estatistica significante entre a participação  no programa e não declarar ter  doenças. Mais estudos são necessários para diminuir a barreira para as práticas de lazer  físico desportivo entre os jovens, especialmente os que estão acometidos por doenças.
AVALIAÇÃO DA SATISFAÇÃO DO ATENDIMENTO FISIOTERAPÊUTICO EM AMBIENTE HOSPITALAR
Authors: Camargo André , Gonçalves Jamila Gabrielle , Mazzo Débora Melo , Schleder Juliana Carvalho
Published: December 2019

Esta pesquisa teve por objetivo avaliar o grau de satisfação em relação ao atendimento fisioterapêutico dos pacientes hospitalizados nas enfermarias do Hospital Universitário Regional dos Campos Gerais (HURCG). Participaram da pesquisa 55 pacientes, os quais responderam a um questionário brasileiro de satisfação validado para pacientes ambulatoriais, sendo este adaptado para o perfil da pesquisa. As questões versavam sobre: interação fisioterapeuta-paciente, estrutura física e satisfação geral. A hipótese inicial de encontrar nos dados boa satisfação dos pacientes com atendimento fisioterapêutico prestado, pôde ser comprovada na pergunta referente ao nível de satisfação geral, na qual demonstrou que 90,90% (n=50) apontaram essa questão como “excelente” ou “ótima”. O resultado obtido, de modo geral, foi satisfatório, porém, ressalta-se a necessidade da otimização da assistência fisioterapêutica através de capacitações sistemáticas de toda a equipe para a manutenção da qualidade técnica do atendimento, sempre incentivando a humanização e a importância da interação fisioterapeuta-paciente.