bluuebunny/crossref_metadata_2025 huggingface dataset:
Good Clinical Practice Guidance and Pragmatic Clinical Trials
Authors: Mentz Robert J. , Hernandez Adrian F. , Berdan Lisa G. , Rorick Tyrus , O’Brien Emily C. , Ibarra Jenny C. , Curtis Lesley H. , Peterson Eric D.
Published: February 2016

Randomized, clinical trials are commonly regarded as the highest level of evidence to support clinical decisions. Good Clinical Practice guidelines have been constructed to provide an ethical and scientific quality standard for trials that involve human subjects in a manner aligned with the Declaration of Helsinki. Originally designed to provide a unified standard of trial data to support submission to regulatory authorities, the principles may also be applied to other studies of human subjects. Although the application of Good Clinical Practice principles generally led to improvements in the quality and consistency of trial operations, these principles have also contributed to increasing trial complexity and costs. Alternatively, the growing availability of electronic health record data has facilitated the possibility for streamlined pragmatic clinical trials. The central tenets of Good Clinical Practice and pragmatic clinical trials represent potential tensions in trial design (stringent quality and highly efficient operations). In the present article, we highlight potential areas of discordance between Good Clinical Practice guidelines and the principles of pragmatic clinical trials and suggest strategies to streamline study conduct in an ethical manner to optimally perform clinical trials in the electronic age.
A Multivariate Quantile-Matching Bias Correction Approach with Auto- and Cross-Dependence across Multiple Time Scales: Implications for Downscaling
Authors: Mehrotra Rajeshwar , Sharma Ashish
Published: February 2016

A novel multivariate quantile-matching nesting bias correction approach is developed to remove systematic biases in general circulation model (GCM) outputs over multiple time scales. This is a significant advancement over typical quantile-matching alternatives available for bias correction, as they implicitly assume that correction of individual variable attributes will lead to correction of dependence biases between multiple variables. Furthermore, existing approaches perform bias correction at a given time scale (e.g., daily), whereas applications often require biases to be addressed at more than one time scale (such as annual in the case of most water resources planning projects). The proposed approach addresses all these issues, and additionally attempts to correct for lag-1 dependence (and cross-dependence) attributes across multiple time scales. The approach is called multivariate recursive quantile nesting bias correction (MRQNBC). The fidelity of the approach is demonstrated by applying it to a vector of CSIRO Mk3 GCM atmospheric variables and comparing the results with the commonly used quantile-matching approach. Following this, the implications of the approach in hydrology- and water resources–related applications are demonstrated by feeding the bias-corrected data to a rainfall downscaling model and comparing the downscaled rainfall attributes for current and future climate. The proposed approach is shown to represent the variability and persistence related attributes better and can thus be expected to have important consequences for the simulation of occurrence and intensity of extreme events such as floods and droughts in downscaled simulations, of importance in various climate impact assessment applications.
Response of the Baiu Rainband to Northwest Pacific SST Anomalies and Its Impact on Atmospheric Circulation
Authors: Matsumura Shinji , Horinouchi Takeshi , Sugimoto Shiori , Sato Tomonori
Published: February 2016

The Pacific–Japan (PJ) teleconnection pattern leads to a meridional precipitation dipole between the subtropics and East Asia in the summer of El Niño decaying years. However, observational analysis and model experiments indicate that increased sea surface temperature (SST) in the Kuroshio–Oyashio Extension (KOE) region, where a strong northward-decreasing SST gradient occurs, induces a northward shift of baiu rainfall with the subtropical jet, forming a tripolar precipitation anomaly pattern over the northwest Pacific. In July, the leading empirical orthogonal function (EOF) mode for precipitation represents the meridional dipole between subtropical and baiu rainfalls, while EOF-2 features the northward-shifted baiu rainband. The PJ atmospheric forcing increases KOE SST, which enhances northward shifts in the subtropical jet and baiu rainband, resulting in oceanic forcing over the KOE. In experiments using a regional climate model the subtropical jet response to KOE SST forcing explains about 20% of the anomalies in the control experiment. The northward-shifted baiu condensational heating also enhances the northward shift of the subtropical jet with a northeastward extension. In August when the baiu rainband disappears, the northward shift of the subtropical jet is enhanced mainly by KOE SST variability. During the summer, as a result of increased KOE SST and the northward-shifted baiu heating, cyclonic anomalies intensify over the Sea of Okhotsk and anticyclonic anomalies intensify over the northwest Pacific, affecting the western Pacific subtropical high. The results suggest that air–sea interaction over the KOE must be considered to better understand the summer northwest Pacific climate.
Evolution of the Diurnal Precipitation Cycle with the Passage of a Madden–Julian Oscillation Event through the Maritime Continent
Authors: Vincent Claire L. , Lane Todd P.
Published: February 2016

Changes in the diurnal precipitation cycle as the Madden–Julian oscillation (MJO) propagates through the Maritime Continent are investigated to explore the processes behind seaward-propagating precipitation northeast of New Guinea. Satellite rainfall estimates from TRMM 3B42 and the Climate Prediction Center morphing technique (CMORPH) are combined with simulations from the Weather Research and Forecasting (WRF) Model with a horizontal resolution of 4 km.

Comparison with 24-h rain gauge measurements indicates that both satellite estimates and the WRF Model exhibit systematic biases. Despite these biases, the changing patterns of offshore precipitation with the passage of the MJO show good consistency between satellite estimates and the WRF Model. In the few days prior to the main MJO envelope, light background wind, relatively clear skies, and an increasingly moist environment promote favorable conditions for the diurnal precipitation cycle.

Two distinct processes are identified: 100–200 km from the coast, precipitation moves offshore as a squall line with a propagation speed of 3–5 m s−1. Farther offshore, precipitation propagates with a speed close to 18 m s−1and is associated with an inertia–gravity wave generated by diurnally oscillating heating from radiative and moist convective processes over the land. A gravity wave signature is evident even after the MJO active period when there is little precipitation. By correcting for the background flow perpendicular to the coast, potential temperature anomalies for the lead-up, active, and follow-on MJO periods are shown to collapse to a remarkably invariant shape for a given time of day.
Integrative Performance Analysis of a Novel Bone Level Tapered Implant
Authors: Dard M. , Kuehne S. , Obrecht M. , Grandin M. , Helfenstein J. , Pippenger B.E.
Published: February 2016

Primary mechanical stability, as measured by maximum insertion torque and resonance frequency analysis, is generally considered to be positively associated with successful secondary stability and implant success. Primary implant stability can be affected by several factors, including the quality and quantity of available bone, the implant design, and the surgical procedure. The use of a tapered implant design, for instance, has been shown to result in good primary stability even in clinical scenarios where primary stability is otherwise difficult to achieve with traditional cylindrical implants—for example, in soft bone and for immediate placement in extraction sockets. In this study, bone-type specific drill procedures are presented for a novel Straumann bone level tapered implant that ensure maximum insertion torque values are kept within the range of 15 to 80 Ncm. The drill procedures are tested in vitro using polyurethane foam blocks of variable density, ex vivo on explanted porcine ribs (bone type 3), and finally in vivo on porcine mandibles (bone type 1). In each test site, adapted drill procedures are found to achieve a good primary stability. These results are further translated into a finite element analysis model capable of predicting primary stability of tapered implants. In conclusion, we have assessed the biomechanical behavior of a novel taper-walled implant in combination with a bone-type specific drill procedure in both synthetic and natural bone of various types, and we have developed an in silico model for predicting primary stability upon implantation.
Implant Surface Design Regulates Mesenchymal Stem Cell Differentiation and Maturation
Authors: Boyan B.D. , Cheng A. , Olivares-Navarrete R. , Schwartz Z.
Published: February 2016

Changes in dental implant materials, structural design, and surface properties can all affect biological response. While bulk properties are important for mechanical stability of the implant, surface design ultimately contributes to osseointegration. This article reviews the surface parameters of dental implant materials that contribute to improved cell response and osseointegration. In particular, we focus on how surface design affects mesenchymal cell response and differentiation into the osteoblast lineage. Surface roughness has been largely studied at the microscale, but recent studies have highlighted the importance of hierarchical micron/submicron/nanosurface roughness, as well as surface roughness in combination with surface wettability. Integrins are transmembrane receptors that recognize changes in the surface and mediate downstream signaling pathways. Specifically, the noncanonical Wnt5a pathway has been implicated in osteoblastic differentiation of cells on titanium implant surfaces. However, much remains to be elucidated. Only recently have studies been conducted on the differences in biological response to implants based on sex, age, and clinical factors; these all point toward differences that advocate for patient-specific implant design. Finally, challenges in implant surface characterization must be addressed to optimize and compare data across studies. An understanding of both the science and the biology of the materials is crucial for developing novel dental implant materials and surface modifications for improved osseointegration.
A Critical Perspective on Mechanical Testing of Implants and Prostheses
Authors: Bonfante E.A. , Coelho P.G.
Published: February 2016

The degree of interplay among variables in dental implant treatment presents a challenge to randomized clinical trials attempting to answer questions in a timely, unbiased, and economically feasible fashion. Further adding complexity to the different scenarios is the varied implant designs and related bone response, area of implantation, implant bulk material, restoration, abutments and related screws, fixation mode (screwed, fixed, or a combination), and horizontal implant-abutment matching geometry. This article critically appraises the most common mechanical testing methods used to characterize the implant-prostheses complex. It attempts to provide insight into the process of construction of an informed database of clinically relevant questions regarding preclinical evaluation of implant biomechanics and failure mechanisms. The use of single load to failure, fatigue life, fatigue limit, and step-stress accelerated life testing is discussed with emphasis on their deliverables, weaknesses, and strengths. Fractographic analysis and challenges in the correlation between laboratory- and in-service-produced failures of dental ceramics, resin composites, and titanium are introduced. In addition, examples are presented of mechanical characterization studies used in our laboratory to assess some implant-supported rehabilitation variables.
Effect of Osteotomy Preparation on Osseointegration of Immediately Loaded, Tapered Dental Implants
Authors: Stavropoulos A. , Cochran D. , Obrecht M. , Pippenger B.E. , Dard M.
Published: February 2016

The aim of the present preclinical in vivo study was to evaluate whether a modified “drill-only” protocol, involving slight underpreparation of the implant site, may have an effect on aspects of osseointegration of a novel bone-level tapered implant, compared with the “standard drilling” protocol involving taping and profiling of the marginal aspect of the implant socket. In each side of the edentulated and completely healed mandible of 11 minipigs, 2 tapered implants (8 mm long × 4.1 mm Ø, BLT; Institut Straumann AG, Basel, Switzerland) were installed either with the drill-only or the standard drilling protocol. Significantly lower average insertion torque values were recorded for the standard drilling protocol group (52 ± 29 Ncm) compared with the drill-only group (70 ± 27 Ncm) ( t test, P ≤ 0.05); no significant difference was observed between the 2 groups regarding implant stability, by means of resonance frequency analysis (75 ± 8 vs. 75 ± 6, respectively). Half of the implants were immediately loaded and the rest were submerged, providing observation times of 8 or 4 wk, respectively. Non-decalcified histological and histomorphometric analysis of the implants with surrounding tissues showed no significant differences between the 2 drilling protocols regarding the distance from the implant platform to the first coronal bone-to-implant contact (f-BIC), the total bone-to-implant contact (BIC) as a percentage of the total implant perimeter, and the bone density in an area extending 1 mm laterally from the implant (BATA) within 2 rectangular regions of interest (ROIs) 4 mm in height, representing the coronal (parallel-walled) and apical (tapered) aspect of the implant (ROI 1 and ROI 2, respectively) in non-submerged implants. In general, marginal peri-implant bone levels were at or slightly apical to the implant platform, and large amounts of bone-to-implant contact were observed. In contrast, immediately loaded implants placed with the drill-only protocol showed statistically significantly lower BIC values (66% ± 13.7%) compared with those installed with the standard drilling protocol (74.8% ± 11.2%) ( P = 0.018). In addition, although marginal bone levels were in most of the immediately loaded implants at or slightly apical to the implant platform, some of the implants installed with the drill-only protocol showed marginal bone loss and crater formation. Thus, in this model system, even slight underpreparation of the implant socket appeared to compromise osseointegration of immediately loaded bone-level tapered implants.
Tapered Implants in Dentistry
Authors: Wilson T.G. , Miller R.J. , Trushkowsky R. , Dard M.
Published: February 2016

The most common approach to lessen treatment times is by decreasing the healing period during which osseointegration is established. Implant design parameters such as implant surface, primary stability, thread configuration, body shape, and the type of bone have to be considered to obtain this objective. The relationship that exists between these components will define the initial stability of the implant. It is believed implant sites using a tapered design and surface modification can increase the primary stability in low-density bone. Furthermore, recent experimental preclinical work has shown the possibility of attaining primary stability of immediately loaded, tapered dental implants without compromising healing and rapid bone formation while minimizing the implant stability loss at compression sites. This may be of singular importance with immediate/early functional loading of single implants placed in poor-quality bone. The selection of an implant that will provide adequate stability in bone of poor quality is important. A tapered-screw implant design will provide adequate stability because it creates pressure on cortical bone in areas of reduced bone quality. Building on the success of traditional tapered implant therapy, newer tapered implant designs should aim to maximize the clinical outcome by implementing new technologies with adapted clinical workflows.
‘Like Skydiving without a Parachute’: How Class Origin Shapes Occupational Trajectories in British Acting
Authors: Friedman Sam , O’Brien Dave , Laurison Daniel
Published: February 2016

There is currently widespread concern that access to, and success within, the British acting profession is increasingly dominated by those from privileged class origins. This article seeks to empirically interrogate this claim using data on actors from the Great British Class Survey ( N = 404) and 47 qualitative interviews. First, survey data demonstrate that actors from working-class origins are significantly underrepresented within the profession. Second, they indicate that even when those from working-class origins do enter the profession they do not have access to the same economic, cultural and social capital as those from privileged backgrounds. Third, and most significantly, qualitative interviews reveal how these capitals shape the way actors can respond to shared occupational challenges. In particular we demonstrate the profound occupational advantages afforded to actors who can draw upon familial economic resources, legitimate embodied markers of class origin (such as Received Pronunciation) and a favourable typecasting.
Is delayed surgery related to worse outcomes in native left-sided endocarditis?
Authors: Tepsuwan Thitipong , Rimsukcharoenchai Chartaroon , Tantraworasin Apichat , Woragidpoonpol Surin , Schuarattanapong Suphachai , Nawarawong Weerachai
Published: February 2016

Background

Timing of surgery in the management of infective endocarditis is controversial, and there is still no definite conclusion on how early the surgery should be performed. This study focuses on the outcomes of surgery during the active period of infective endocarditis in consideration of the duration after diagnosis.

Methods

One hundred and thirty-four patients with active native valve infective endocarditis who underwent surgery from January 2006 to December 2013 were reviewed retrospectively. They were divided in 2 groups based on timing of surgery: early group (first week after diagnosis, n = 37) and delayed group (2 to 6 weeks after diagnosis, n = 97).

Results

Compared to the delayed group, the early group had significantly more patients in New York Heart Association class IV (81% vs. 43.3%), more mechanically ventilated (54.1% vs. 18.6%), more on inotropic support (62.2% vs. 38.1%), and hence a worse EuroSCORE II (14.8% vs. 8.8%). Operative mortality was comparable (5.4% vs. 10.3%) and 7-year survival was similar (77.4% vs. 74.6%). On multivariable regression analysis, delayed surgery did not impact on short- and long-term outcomes. Preoperative cardiac arrest and infection with Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, or Kingella were risk factors for higher operative mortality. Predictors of poor 7-year survival were diabetes mellitus and acute renal failure.

Conclusions

Delayed surgery is not associated with worse outcomes. Both early and delayed approaches are safe and provide acceptable results. Timing of surgery should be tailored to each patient’s clinical status, not based on duration of endocarditis alone.
State enrolment and energy-carbon transitions: Syndromic experimentation and atomisation in England
Authors: Eadson Will
Published: February 2016

This article analyses how national governments seek to enrol different subjects and objects in energy-carbon restructuring. It takes analysis beyond consideration of particular subjectivities and governmentalities to consider an expanded range of objects and subjects of governing at a distance. Developing an analytical model of ‘modes of enrolment’ focusing on power modalities, forms of policy integration and policy targets, the article explores five broad modes of enrolment employed in England. The article shows how policy across all modes of enrolment in England has increasingly tended towards disordered, syndromic experimentation and government by-project rather than any systematic programme of government.
The politics of construction: Towards a theory of material articulations
Authors: Minuchin Leandro
Published: February 2016

This paper seeks to position construction as a platform and practice for the articulation of a new type of urban politics. The argument is presented in four steps, and each supported by an analysis of the work of social movement Grupo Independiente Rosarino Organizado Solidariamente (GIROS) in Rosario. The first part describes how construction introduces prefiguration as a means of reconfiguring the spatialities and temporalities of urban politics. The second part presents an analysis of the processes of de-institutionalisation and de-commodification that emerge from the involvement of urban social movements with construction practices in peripheral settlements. I then illustrate how the politicisation of construction operates through a simultaneous recuperation of what is described as techno-popular knowledges and a disruption of hegemonic constructive epistemologies. Lastly, the paper introduces the notion of material articulation to examine how construction, as a prefigurative tactic, is used to formulate alternative urban political programmes. The part presents a brief conceptual history of the notion of articulation and argues for the need to deepen current trends that seek to expand its restrictive association with language and institutionalised politics. The paper concludes by addressing how material articulations are reconfiguring the content, agencies and spatialities of political action.
The classic saphenofemoral junction and its anatomical variations
Authors: Souroullas Panos , Barnes Rachel , Smith George , Nandhra Sandip , Carradice Dan , Chetter Ian
Published: February 2016

Background

The intraoperative anatomy of the saphenofemoral junction can vary from the ‘textbook’ description of six independent proximal tributaries: three medial – superficial external pudendal, deep external pudendal and the posteromedial thigh branch – and three lateral – superficial epigastric, superficial circumflex iliac and the anterolateral thigh branch. Varicose veins can recur following inadequate initial open surgery with failure to identify, ligate and divide these tributaries. An appreciation of common anatomical variations could minimise recurrence rates following surgery. This study aimed to identify common anatomical variations within our patient cohort.

Methods

This prospective observational study documented diagrammatically the anatomy of saphenofemoral junction in a consecutive series of 172 patients undergoing unilateral, primary saphenofemoral junction ligation for symptomatic superficial venous insufficiency. Diagrams recorded the number of tributaries and their relationship to the saphenofemoral junction, the existence of bifid systems and the relationship of the external pudendal artery to the saphenofemoral junction.

Results

In sum, 110 women and 62 men with a mean age of 47.2 (IQR 21–77) years were studied. The median number of saphenofemoral junction tributaries was 4 (IQR 0–7). In 74 cases (43.0%), at least one tributary drained directly into the common femoral vein (IQR 0–4), commonly the deep external pudendal (91.9%). The anterolateral thigh branch was identified in 62 cases (35.8%) and the posteromedial thigh branch in 93 cases (53.8%). The external pudendal artery was identified in 150 cases (87.2%) and was superficial to the great saphenous vein in 36 cases (20.9%).

Conclusions

Significant variations exist in the saphenofemoral junction anatomy. Familiarity with anatomical saphenofemoral junction variations is imperative to ensure operative success and reduce recurrence. Thorough dissection of the common femoral vein is necessary not only to ensure all proximal tributaries are identified and ligated but also as a safety mechanism in preventing avulsion trauma of direct common femoral vein tributaries.
Improvements to image quality using hybrid and model-based iterative reconstructions: a phantom study
Authors: Aurumskjöld Marie-Louise , Ydström Kristina , Tingberg Anders , Söderberg Marcus
Published: February 2016

Background

The number of computed tomography (CT) examinations is increasing and leading to an increase in total patient exposure. It is therefore important to optimize CT scan imaging conditions in order to reduce the radiation dose. The introduction of iterative reconstruction methods has enabled an improvement in image quality and a reduction in radiation dose.

Purpose

To investigate how image quality depends on reconstruction method and to discuss patient dose reduction resulting from the use of hybrid and model-based iterative reconstruction.

Material and Methods

An image quality phantom (Catphan® 600) and an anthropomorphic torso phantom were examined on a Philips Brilliance iCT. The image quality was evaluated in terms of CT numbers, noise, noise power spectra (NPS), contrast-to-noise ratio (CNR), low-contrast resolution, and spatial resolution for different scan parameters and dose levels. The images were reconstructed using filtered back projection (FBP) and different settings of hybrid (iDose4) and model-based (IMR) iterative reconstruction methods.

Results

iDose4 decreased the noise by 15–45% compared with FBP depending on the level of iDose4. The IMR reduced the noise even further, by 60–75% compared to FBP. The results are independent of dose. The NPS showed changes in the noise distribution for different reconstruction methods. The low-contrast resolution and CNR were improved with iDose4, and the improvement was even greater with IMR.

Conclusion

There is great potential to reduce noise and thereby improve image quality by using hybrid or, in particular, model-based iterative reconstruction methods, or to lower radiation dose and maintain image quality.
Application of Y-shaped, coated self-expandable metallic stents for anastomotic stenosis after gastrojejunostomy (Billroth II)
Authors: Li Teng-Fei , Wu Gang , Han Xin-Wei , Shui Shao-Feng , Ren Jian-Zhuang , Li Zhen , Ren Ke-Wei
Published: February 2016

Background

Anastomotic stenosis is an infrequent but life-threatening complication after gastrojejunostomy (Billroth II). Tubular or single tubular stents have limited efficacy due to the particular anatomy.

Purpose

To assess the feasibility of a Y-shaped, fully-coated, self-expandable, metallic stent (SEMS) for anastomotic stenosis after gastrojejunostomy (Billroth II).

Material and Methods

Between January 2008 and August 2014, 14 patients (10 with gastric carcinoma and four with duodenal ulcers) had anastomotic stenoses following Billroth II reconstructions. Eight patients with gastric cancer had tumor recurrence near the anastomosis; two had benign strictures. The four duodenal ulcer patients had benign stenoses. An integrated Y-shaped, fully coated SEMS was designed to accord with the anatomy of residual gastrojejunal anastomotic strictures. Fourteen stents were inserted under fluoroscopic control. Follow-up was at 1, 3, 9, and 12 months, and then annually.

Results

All 14 stents were inserted successfully at the first attempt with a technical success rate of 100%. After stenting, abdominal symptoms resolved in all patients. All patients were followed up for 4–27 months (mean, 13.9 months). One of the eight recurrent cases died of multiple tumor metastases and liver failure after 7 months, without obstruction symptoms. In all six patients with benign anastomotic stenosis, the stents were removed successfully without complication and with no evidence of restenosis based on clinical evaluation and imaging.

Conclusion

A Y-shaped, fully-coated SEMS proved to be a feasible and minimally invasive procedure for treating anastomotic stenosis after gastrojejunostomy (Billroth II).
Radiologist income, receipts, and academic performance: an analysis of many nations
Authors: Semelka Richard C , Busireddy KK , Burke Lauren MB , Ramalho Miguel , Martí-Bonmatí Luis , Morana Giovanni , AlObaidy Mamdoh , Elias Jorge
Published: February 2016

Background

Considerable interest exists in comparison between healthcare systems across multiple countries, especially where cost enters the discussion.

Purpose

To evaluate the relationship between radiologists’ income, receipts for studies, and academic performance across multiple countries.

Material and Methods

The annual income of radiologists and receipts for computed tomography (CT) and magnetic resonance imaging (MRI) were obtained based on a survey sent to expert radiologists practicing in 23 countries of varying developmental status. Articles published in generalist radiology journals determined the academic performance of each country.

Results

Among the developed countries, Canada has the highest estimated annual income for both private ($700,000/year) and university radiologists ($600,000/year) while Spain has the lowest income for private practice ($68,000/year) and Portugal has the lowest income for university practice ($57,300/year). Among the developing countries, Saudi Arabia has the highest incomes for both private ($210,000/year) and university ($140,000/year) radiologists and Vietnam has the lowest incomes for both private ($30,000/year) and university ($6,000/year) radiologists. Total receipts for CT and MRI studies ranged from $80/study (Portugal) to $1000/study (USA) in developed countries, and ranged from $30/study (Egypt) to $700/study (Saudi Arabia) in developing countries. A moderate correlation ( r = 0.482) was seen between radiologist’s income and the receipts for combined practice in all countries. The radiology journal academic quotient was highest in The Netherlands among developed countries, and Turkey among developing countries.

Conclusion

A relatively broad range of radiologists’ income is observed among developed and developing countries, which shows correlation with the receipts for advanced imaging studies. Countries with an acceptable compromise between income, receipts, and academic performance, may be the best models for other countries to emulate.
Tomographic evaluation of Hill–Sachs lesions: is there a correlation between different methods of measurement?
Authors: Assunção Jorge Henrique , Gracitelli Mauro Emilio Conforto , Borgo Gustavo Dias , Malavolta Eduardo Angeli , Bordalo-Rodrigues Marcelo , Ferreira Neto Arnaldo Amado
Published: February 2016

Background

Several methods are currently available to evaluate and quantify the glenoid or humeral bone loss; however, none is universally accepted, particularly in the case of Hill–Sachs (HS) lesions.

Purpose

To establish whether there is correlation among different methods of measuring HS lesions, and to investigate the correlation between glenoid bone loss and the various HS lesion measurements and to assess the inter-observer reliability of such measurements.

Material and Methods

We assessed computed tomography (CT) or arthro-CT scans taken from individuals with recurrent anterior glenohumeral dislocation. The scans were independently assessed by two examiners. The parameters assessed were as follows: HS lesion width and depth on the axial and coronal planes, articular arc loss on the axial plane, and percentage of glenoid bone loss on the sagittal plane.

Results

Scans from 50 shoulders were assessed. The percentage of articular arc loss and HS lesion width on the axial plane were the only measurements that exhibited strong correlation ( r = 0.83; P < 0.001). The values of the correlation coefficient corresponding to HS lesion depth on the coronal plane were the lowest. Most of the measurements exhibited moderate correlation. The inter-examiner reliability was good relative to all measurements except for HS lesion width and depth on the coronal plane, for which it was moderate.

Conclusion

The measurements of articular arc loss and HS lesion width on the axial plane exhibited strong correlation. The inter-examiner reliability relative to articular arc loss, HS lesion width and depth on the axial plane, and glenoid bone loss was good.
Digital margins: Social and digital exclusion of Gypsy-Travelers in the Netherlands
Authors: Salemink Koen
Published: February 2016

Research on digital inclusion increasingly focuses on vulnerable groups, with the prevailing idea that social exclusion leads to digital exclusion. The role of the socio-spatial context is often faded into the background due to user-centric (individual) approaches. This article explores how a vulnerable group, Gypsy-Travelers in the Netherlands, deals with digital developments within their socio-spatial context. Contrary to prevailing theories, the analysis shows that Gypsy-Travelers are digitally engaged, despite their social exclusion. An advantage of the Gypsy-Traveler culture is that extended families on the sites provide a large potential of proxy users for support. Many of the Gypsy-Travelers are digitally engaged, but they engage and participate on their own terms. Furthermore, the digital engagement of Gypsy-Travelers is not a panacea for their social exclusion. In fact, their problematic relation with the settled society is mirrored in online activities. This research shows that digitalization has added a new layer to the interaction between Gypsy-Travelers and settled society. It also demonstrates that more socially and spatially contextualized research approaches can add insights to the debate on social and digital exclusion.
Evaluating behavioral process similarity of mechanical products in redesign for functional adaptability
Authors: Yang Peng , Deng Yi-Min
Published: February 2016

Functional adaptability makes a product not only multifunctional but also compact in structure and flexible in application. An adaptable-function mechanical product generally demonstrates various degrees of similarity in its behavioral processes for different adaptable functions. Evaluation of this similarity is an important aspect of research for the design of such products, especially for redesigning existing products towards functional adaptability. Until present there lacks research on the design and development of this specific kind of products, including the work on the similarity evaluation of their behavioral processes. To address this problem, this paper investigates the functional and structural characteristics of adaptable-function products first. Based on this, by applying the function-behavior-structure design rationale, a redesign framework of mechanical product for functional adaptability was proposed, and the similarity characteristic of behavioral process was investigated, both on that of the behavior structure and that of behavior characteristics. Furthermore, the paper applied a fuzzy mathematics method for the evaluation of behavioral process similarity, for which a fuzzy comprehensive evaluation model was constructed and the corresponding evaluation method was proposed. Finally, a mini-combined machine tool with adaptable-functions was taken as an example to analyze the behavioral processes and to illustrate the proposed similarity evaluation procedure. The results demonstrated the feasibility and effectiveness of the proposed methodologies.
Classification of disc damage status by discovering knowledge from experimental data in marble cutting process
Authors: Akarslan Emre , Hocaoğlu Fatih O , Ucun Ismail
Published: February 2016

In marble industry, it is of vital importance to determine the damaged discs on time to prevent possible industrial injuries. Therefore, in this study, it is proposed to classify the status of the cutting discs that are used while cutting the natural stones. To classify the deflections of the discs, 673 different experiments are performed. Cutting discs corresponding to four different damage classes (undamaged disc, less damaged disc, much damaged disc, and broken disc) are employed in the tests. Eight different parameters (cutting forces (Fx, Fy, Fz), noise, peripheral speed of the disc, current, voltage, power consumption) are measured and recorded in the experiments. For each experiment, mean values of different measured data are studied. Artificial neural networks are employed as classifiers. In the first stage, all of these mean values corresponding to eight parameters are selected as the input vectors of the artificial neural networks, whereas in the second stage, the dimension of input vector is decreased by leaving out the parameters one by one. In this stage, it is aimed to determine the most important parameter that caries much more information about the cutting process.
HIV pre-test practices: an online survey examining perceptions of informed consent and pre-test information delivery in health care settings across the WHO European Region
Authors: Bell Stephen , Casabona Jordi , Tsereteli Nino , Raben Dorthe , de Wit John
Published: February 2016

The objective of this study was to gather health professionals’ perceptions about gaining informed consent and delivering HIV pre-test information. An online self-report survey was completed by 338 respondents involved in HIV testing in 55 countries in the WHO European Region. Nearly two thirds (61.5%) of respondents thought that HIV testing guidelines used in their country of work included recommendations about pre-test information; 83% thought they included recommendations regarding obtaining informed consent. One third (34%) of respondents thought that written informed consent was required; respondents from Eastern Europe and Central Asia were more likely to perceive this as required. Respondents from Western Europe thought pre-test information about the following aspects was significantly less likely to be addressed than respondents in other regions: the right to decline a test; services available after a positive test; laws/regulations impacting someone being tested and receiving a positive test result; potential risks for a client taking an HIV test; the possible need for partner notification after a positive test result. Results offer insight into perceived HIV pre-test practices in all but two national settings across the WHO European Region, and can be used in the development and evaluation of future HIV testing guidelines in the WHO European Region. Findings highlight that practices of obtaining written informed consent depart from current guidelines in some HIV testing settings. Furthermore, findings underscore that it is uncommon for pre-test information to address legal and social risks and harms that people testing HIV-positive may incur. This differs from the most recent global WHO guidelines emphasising the importance of such information, and raises important questions regarding the implications and appropriateness of the currently dominant focus of recommendations on streamlining the HIV testing process.
Decline in syphilis seroprevalence among females of reproductive age in Northern Cape Province, South Africa, 2003–2012: utility of laboratory-based information
Authors: Ballah Ngormbu J , Kuonza Lazarus R , De Gita Gloria , Musekiwa Alfred , Williams Seymour , Takuva Simbarashe
Published: February 2016

Strengthening current surveillance systems for syphilis is important to track and monitor disease burden. We used routinely collected laboratory information to generate surveillance estimates for syphilis trends among women of reproductive age (12–49 years) in the Northern Cape Province, a high syphilis burden region (2003 [8.6%] to 2011 [3.8%]) in South Africa. We extracted records meeting inclusion criteria from the National Health Laboratory Service electronic database for the period 2003–2012. A total of 286,024 women were included in the analysis. Syphilis seropositivity decreased between 2003 (5.7%) and 2012 (1.8%); p trend = 0.001, which was largely consistent with findings reported in the annual national syphilis and HIV survey from 2003 (8.6%) to 2011 (3.8%). Annually for the period from 2003 to 2012 there was an approximate 14% reduction in the prevalence ratio of syphilis seroprevalence (PR = 0.86, 95% CI = 0.85–0.87, p < 0.001). Three of five districts had significant decreases in syphilis seropositivity over this period. There were also declines in prevalence ratios for syphilis seropositivity for the various age groups for the period. This study shows that the national laboratory database in South Africa can be used as a complimentary surveillance tool to describe and understand trends in syphilis seroprevalence in South Africa.
Effect of ezetimibe plus pravastatin on endothelial dysfunction in patients with systemic lupus erythematosus
Authors: Vera-Lastra O , Méndez-Flores S , Cruz-Dominguez M P , Medina G , Calderón-Aranda E , Jara L J
Published: February 2016

Background

Patients with systemic lupus erythematosus (SLE) have a higher risk for cardiovascular disease (CVD), not fully explained by the conventional risk factors. These patients have endothelial dysfunction (ED) as an early process of atherosclerosis, which can be reversed with therapy.

Objective

To determine the effect of ezetimibe plus pravastatin on endothelial function in patients with SLE after 12 months of treatment.

Patients and methods

An open study, before and after, which assessed the effect of ezetimibe plus pravastatin treatment, was performed. Twenty two patients (21 women and one man) with diagnosis of SLE were studied, with a mean age 40 ± 5 years. Endothelial dysfunction was evaluated using vascular ultrasound of the brachial artery in order to measure the flow-mediated vasodilation (FMV) basal and after 12 months of treatment with pravastatin 40 mg/day plus ezetimibe 10 mg/day. In addition, a lipid profile: total cholesterol (TC), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), and serum C-reactive protein (CRP), was done.

Results

We found a basal FMV of 7.58% and 18.22% after 12 months of treatment, with an improvement of 10.64 points 95% CI (7.58–13.58), p < 0.001. TC decreased from 201.3 ± 58.9 mg/dL to 158.06 ± 50.13 mg/dL ( p < 0.01); LDL-C from 125.78 ± 44.4 mg/dL to 78.8 ± 32.9 mg/dL ( p < 0.001); HDL-C increased from 49.0 ± 16.8 mg/dL to 52.2 ± 13.8 mg/dL ( p = 0.077). The basal and final concentrations of CRP were 4.49 and 2.8, respectively, with a mean decrease of 2.11 mg/dL, 95% CI (0.908–3.32), p < 0.002. Both drugs were well tolerated.

Conclusion

Ezetimibe plus pravastatin significantly improved FMV in patients with SLE, decreasing ED and the lipid profile. This treatment ameliorated an early process of atherosclerosis and a risk factor for CVD.
Variations in the epidemiology of systemic lupus erythematosus in southern Sweden
Authors: Ingvarsson R F , Bengtsson A A , Jönsen A
Published: February 2016

Objective

The epidemiology of systemic lupus erythematosus (SLE) within a defined region in southern Sweden was studied during the time period 1981–2006. Furthermore, whether the phenotypic expression of SLE changed during the study period was investigated.

Methods

Patients with suspected SLE were retrieved from diagnosis registries, hospital records and central laboratory databases. All new cases of SLE in this region were identified using validated retrieval methods and observed prospectively in a structured follow-up program. SLE disease manifestations, including classification criteria, were followed over time.

Results

A total of 174 cases were diagnosed with SLE during 1981–2006. In the first period of the study, from 1981 to 1993, the incidence of SLE was 5.0/100,000 inhabitants and in the second period of the study, 1994–2006, the annual incidence decreased to 2.8/100,000. During the first period the highest incidence was among females between the ages of 45 and 54 years; 15.1/100,000 inhabitants, which was reduced in the second period to 3.8/100,000. During the second period the highest age and sex specific incidence was among women between 25 and 34 years (6.6/100,000 inhabitants). The point prevalence of SLE on 31 December 1993 was 55/100,000 inhabitants compared with 31 December 2006, when it was 65/100,000 inhabitants. The phenotype of the disease did not vary significantly during the study period.

Conclusion

The incidence rate of SLE in younger females remained stable from 1981 to 2006. However, in middle-aged women the incidence was substantially reduced in the latter half of the study period.
Musculoskeletal manifestations of the antiphospholipid syndrome
Authors: Noureldine M H A , Khamashta M A , Merashli M , Sabbouh T , Hughes G R V , Uthman I
Published: February 2016

The scope of clinical and laboratory manifestations of the antiphospholipid syndrome (APS) has increased dramatically since its discovery in 1983, where any organ system can be involved. Musculoskeletal complications are consistently reported in APS patients, not only causing morbidity and mortality, but also affecting their quality of life. We reviewed all English papers on APS involvement in the musculoskeletal system using Google Scholar and Pubmed; all reports are summarized in a table in this review. The spectrum of manifestations includes arthralgia/arthritis, avascular necrosis of bone, bone marrow necrosis, complex regional pain syndrome type-1, muscle infarction, non-traumatic fractures, and osteoporosis. Some of these manifestations were reported in good quality studies, some of which showed an association between aPL-positivity and the occurrence of these manifestations, while others were merely described in case reports.
Immunogenicity of pneumococcal polysaccharide vaccine in adult systemic lupus erythematosus patients undergoing immunosuppressive treatment
Authors: Rezende R P V , Ribeiro F M , Albuquerque E M N , Gayer C R , Andrade L E C , Klumb E M
Published: February 2016

Objective

To evaluate the immunogenicity of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) in adult systemic lupus erythematosus patients undergoing (IS group) and not undergoing (non-IS group) immunosuppressive treatment.

Methods

In this prospective open-label study from February 2013 to April 2014, 54 patients had blood samples collected immediately before PPSV23 immunization and 4–6 weeks thereafter for the ELISA measurement of IgG antibody levels against seven pneumococcal serotypes. Positive vaccine response for each serotype was defined as a four-fold or greater antibody response over baseline levels or as a post-vaccine anti-pneumococcal IgG level ≥1.3 µg/ml when baseline values were <1.3 µg/ml. Patients should have responded appropriately to ≥70% of the tested serotypes. We also calculated the mean ratio of post- to pre-vaccination anti-pneumococcal IgG levels.

Results

Twenty-eight patients were classified into the IS group and 26 into non-IS group. The median dose of prednisone at baseline was ≤5 mg/day in both groups. Serotype-specific vaccine response rates were not significantly different between the groups. Less than 40% of patients responded adequately by both vaccine response criteria, being numerically lower among IS patients. The mean ratio of increase in anti-pneumococcal levels was 6.4 versus 4.7 ( p = 0.001) in non-IS and IS groups, respectively.

Conclusion

The vaccine was poorly immunogenic, especially among adult systemic lupus erythematosus patients under immunosuppressive therapy.