bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of Concurrent Peroneal Nerve Injury in Multiligament Knee Injuries and Outcomes after Knee Reconstruction
Authors: Worley John R. , Brimmo Olubusola , Nuelle Clayton W. , Cook James L. , Stannard James P.
Published: June 2018

The purpose of this study was to determine incidence of concurrent peroneal nerve injury and to compare outcomes in patients with and without peroneal nerve injury after surgical treatment for multiligament knee injuries (MLKIs). A retrospective study of 357 MLKIs was conducted. Patients with two or more knee ligaments requiring surgical reconstruction were included. Mean follow-up was 35 months (0–117). Incidence of concurrent peroneal nerve injury was noted and patients with and without nerve injury were evaluated for outcomes. Concurrent peroneal nerve injury occurred in 68 patients (19%). In patients with nerve injury, 45 (73%) returned to full duty at work; 193 (81%) patients without nerve injury returned to full duty (p = 0.06). In patients with nerve injury, 37 (60%) returned to their previous level of activity; 148 (62%) patients without nerve injury returned to their previous level of activity (p = 0.41). At final follow-up, there were no significant differences in level of pain (mean visual analog scale 1.6 vs. 2; p = 0.17), Lysholm score (mean 88.6 vs. 88.8; p = 0.94), or International Knee Documentation Committee score (mean 46.2 vs. 47.8; p = 0.67) for patients with or without peroneal nerve injury, respectively. Postoperative range of motion (ROM) (mean 121 degrees) was significantly lower (p = 0.02) for patients with nerve injury compared with patients without nerve injury (mean 127 degrees). Concurrent peroneal nerve injury occurred in 19% of patients in this large cohort suffering MLKIs. After knee reconstruction surgery, patients with concurrent peroneal nerve injuries had significantly lower knee ROM and trended toward a lower rate of return to work. However, outcomes with respect to activity level, pain, and function were not significantly different between the two groups. This study contributes to our understanding of patient outcomes in patients with concurrent MLKI and peroneal nerve injury, with a focus on the patient's ability to return to work and sporting activity.
The Effect of Remnant Tissue Preservation in Anatomic Double-Bundle ACL Reconstruction on Knee Stability and Graft Maturation
Authors: Takahashi Tsuneari , Kimura Masashi , Hagiwara Keiichi , Ohsawa Takashi , Takeshita Katsushi
Published: June 2018

Several investigators have developed anterior cruciate ligament reconstructions (ACLR) with remnant tissue preservation (RTP) and have reported better clinical outcomes. However, the effects of RTP remain controversial. To date, no reports have compared both clinical and radiological outcomes of anatomic double-bundle ACLR using the hamstring tendon and outside-in technique with/without RTP. This article evaluates the effectiveness of RTP in ACLR on knee stability and graft maturation. In total, 75 patients with unilateral ACL injury who had undergone anatomic double-bundle ACLR using autografted hamstring tendon either with RTP (Group P, n = 43) or without (Group N, n = 32) were enrolled. Clinical scores, pre- and postoperative side-to-side differences (SSDs) obtained using Telos, radiological evaluations of the grafted tendon using the signal/noise quotient (SNQ) measured using magnetic resonance imaging, and arthroscopic evaluations of the grafted tendon were retrospectively compared between the groups. Postoperative SSDs were smaller in the Group P (0.78 ± 1.90 mm) than in the Group N (1.29 ± 2.18 mm); however, this difference was not significant. Comparing two subgroups of the Group P, the SSD was significantly smaller in those with sufficient remnant coverage (−0.56 ± 1.38 mm) than in those without (1.48 ± 1.77 mm) (p = 0.019), as well as in the Group N patients (p = 0.019). The degree of synovial coverage of the anteromedial (p = 0.0064) and posterolateral (p = 0.032) bundle grafted tendon at the time of second-look arthroscopy was significantly better in the Group P than in the Group N. SNQ values of ACL grafted tendon at proximal (p = 0.049), middle, and distal (p = 0.039) one-third in Group P were better than those in Group N. RTP may enhance synovial coverage and maturation of the grafted tendon. Sufficient remnant tissue coverage may contribute to better knee stability. This is a Level III, retrospective comparative study.
Mucoid Degeneration of the Anterior Cruciate Ligament: Characterization of Natural History, Femoral Notch Width Index, and Patient Reported Outcome Measures
Authors: Hotchen Andrew J. , Demetriou Charis , Edwards Dennis , Melton Joel T. K.
Published: June 2018

The presentation and clinical course of mucoid degeneration of the anterior cruciate ligament (MD-ACL) are poorly documented within the literature. Subsequently, it is under-diagnosed and the optimal management strategy remains ill-defined. Here, we characterize the syndrome associated with MD-ACL and compare the natural clinical course with the outcomes of arthroscopic management. Thirty-one patients with radiological features of MD-ACL over a 2-year period had their clinical notes retrospectively reviewed. Seven patients underwent arthroscopic debridement of the ACL for MD. These were followed up for a minimum of 2 years and an average of 2.8 years from surgery. The remainder were managed conservatively (n = 24) and were followed up for a minimum of 2 years and an average of 4.0 years. The notch width index (NWI) and associated pathology was noted. Primary outcome measures were presence of knee pain and use of analgesia. Secondary outcome measures were the Oxford and Lysholm knee scores. The most commonly reported symptoms were posterior knee pain (77.4%) and limitation of terminal flexion (58.1%). All patients who underwent arthroscopic debridement were pain and analgesia free at follow-up. Of the patients who did not undergo arthroscopic surgery, three patients had knee replacement surgery and three were lost to follow-up. The remaining patients, 14/18 (77.8%), reported knee pain and regular analgesia use at follow-up, which was significantly more than the arthroscopic debridement group (p < 0.01). The knee scores were significantly better in the arthroscopic debridement group at follow-up (Oxford knee score: 45 vs 34; Lysholm: 92 vs 67; p < 0.01). Furthermore, the postoperative improvement in the Oxford knee and Lysholm scores compared with preoperatively was 12.1 and 31.8 points, respectively (p < 0.01). The NWI was increased in patients with mild-to-severe osteoarthritis (0.266 vs 0.273; p < 0.05). MD-ACL should be considered in patients who report posterior knee pain, limitation of terminal flexion, and it can be associated with other knee pathologies. MD-ACL can be successfully managed with arthroscopic radio frequency debulking with improvement in quality of life at follow-up.
Arthroscopic and 3D CT Scan Evaluation of Femoral Footprint of the Anterior Cruciate Ligament in Chronic ACL Deficient Knees
Authors: Das Anupam , Yadav C. S. , Gamanagatti Shivanand , Pandey R. M. , Mittal Ravi
Published: June 2018

The outcome of single-bundle anterior cruciate ligament (ACL) reconstruction depends largely on the anatomic placement of bone tunnel. The lateral intercondylar ridge (LIR) and bifurcate ridge (BR) are useful bony landmarks for femoral tunnel placement. The purpose of our study was to compare the bony landmarks of ACL footprint on femur by three-dimensional computed tomography (3D CT) scan and arthroscopy in chronic ACL-deficient knees. Fifty patients above 18 years of age who were diagnosed of having ACL tear were selected for the study. All the cases were more than 6 months old since the injury. Preoperative 3D CT scan of the affected knee was obtained for each of them. They underwent single-bundle anatomic ACL reconstruction. Measurements were done on the preoperative 3D CT and arthroscopy to quantify the position of the LIR and BR. The proximodistal distance of lateral femoral condyle was 21.41+/−2.5 mm on CT scan and 22.02+/−2.02 mm on arthroscopy. On preoperative 3D CT scan, the midpoint of the LIR was found to be located at a mean distance of 11.17±2.11 mm from the proximal margin of the lateral femoral condyle. On arthroscopy, it was at 10.18+/−1.52 mm from the proximal margin the lateral femoral condyle. The “bifurcate ridge”(BR) was not visible in any of the cases during arthroscopy or CT scan. We concluded that LIR is an easily identifiable bony landmark on arthroscopy in all cases. It can also be identified on CT scans. BR is not identified both on arthroscopy and CT scans in chronic ACL tears. The arthroscopic measurements of bony landmarks are quite close to those of CT scan. Midpoint of LIR is at 52.185% of the proximodistal distance on CT scan evaluation and it is at 46.21% on arthroscopic evaluation.
A Clinical Study of Patients with Acute Epiglottitis
Authors: Kono Michihisa , Goto Takashi , Bandoh Nobuyuki , Harabuchi Yasuaki
Published: June 2018

Acute epiglottitis is an acute inflammation of the upper respiratory airway that rarely causes airway obstruction. A retrospective study was conducted on 115 patients with acute epiglottitis from April 2007 to December 2017 (65 males and 50 females; aged 12–85 years old, median age of 45 years). When counting the number of patients according to the month, from April to September more than 10 patients were treated. Median duration from symptom onset to first visit was 3 days (1–14 days). Eight (7%) of 115 patients had diabetes, and 16 (13.9%) had epiglottic cyst. We divided all the patients into six groups by laryngeal findings according to the classification of Katori and Tsukuda. Number of patients classified as IA, IB, IIA, IIB, IIIA, and IIIB was 41 (35.7%), 21 (18.3%), 22 (19.1%), 15 (13%), 8 (7%), and 8 (7%), respectively. Median duration of hospitalization was 5 days (2–26 days). In the blood test on the first day of hospitalization, the number of white blood cells (WBC) ranged from 3,400 to 25,350/μL (median 10,350/μL) and the C-reactive protein (CRP) ranged from 0.01 to 23.3 mg/dL (median, 2.5 mg/dL). The number of WBC and CRP at the fourth day after the hospitalization was significantly lower than those at the first day. Eight (7%) patients required the airway management such as tracheotomy or cricothyroidotomy. Age, laryngeal finding (severe epiglottis swelling and arytenoid edema; Katori and Tsukuda's classification IIIB), and high inflammatory reaction in blood test (WBC ≥ 20,000/μL and CRP ≥ 20 mg/dL) were the factors that significantly correlated with the airway management.
Functional Effects of the Adams Procedure: A Retrospective Intervention Study
Authors: Kootstra Thomas , van Doesburg Margriet , Schuurman Arnold
Published: June 2018

Background Injury to the distal radioulnar joint (DRUJ) causes swelling and ulnar-sided wrist pain. The Adams procedure stabilizes the DRUJ and shows promising short-term results.

Purpose We studied the long-term functional outcome in patients who underwent the Adams procedure. We also tested the null hypothesis that there would be no difference in range of motion (ROM) and grip strength between the operated wrist compared to the unaffected side.

Patients and Methods We identified 74 consecutive patients that were operated from March 2005 to February 2014. Twenty-three patients responded to our invitation and underwent clinical follow-up. Three patients had a re-do of the Adams procedure after presenting with postoperative DRUJ instability, one was excluded due to additional wrist surgery not related to the initial procedure. Wrist functionality in the remaining 22 patients was examined by measuring ROM in all planes and grip strength of the operated and non-operated hand. Functional outcome was measured by asking patients to complete the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure and the Patient-Rated Wrist and Hand Evaluation (PRWHE).

Results After a mean follow-up time of 5.0 years (standard deviation [SD] 2.0), we found that supination, pronation, and grip strength were significantly decreased in the operated wrist. Postoperative DASH and PRWHE-scores averaged 13.1 (SD 18.6) and 20.3 (SD 15.1), respectively.

Conclusion The Adams procedure affects, but largely restores pronation and supination, and clinical examination, DASH, and PRWHE scores indicate that the Adams procedure leaves patients with upper extremity functionality comparable to a healthy population.

Level of Evidence Level IV.
Passagerer Herzschrittmacher
Authors: Graf Matthias , Stiller Patrick , Karch Martin
Published: June 2018

Symptomatic bradycardia is usually caused by abnormalities of atrioventricular conduction or sinus node dysfunction. Reversible and irreversible causes must be considered.

Temporary pacemakers are used in the emergency treatment in case of severe bradyarrhythmia.

They help to bridge the acute phase until spontaneous restoration of atrioventricular or sinus node function or –if spontaneous restoration fails- until a permanent pacemaker system was implanted.

In the following article we discuss the commonly used temporary pacemaker systems. We demonstrate their use and correct programming by an illustrated step by step explanation. For troubleshooting a flow chart was added.
Screening ist durchaus sinnvoll
Authors: Mittag Jonas
Published: June 2018

Von Müdigkeit und Konzentrationsschwäche bis hin zu einer makrozytären Anämie oder einer Demenz reichen die potenziellen Symptome bzw. Manifestationen eines bestehenden Vitamin-B12-Mangels. Dass eine Medikation mit Metformin das Risiko für eine Vitam-B12-Malabsorption erhöht, ist zwar in klinischen Studien gut belegt, wirklich in der Praxis angekommen ist das Wissen ob dieser unerwünschten Metforminwirkung allerdings nicht. Um frühzeitig potenziellen irreversiblen neurologischen Manifestationen entgegenwirken zu können, wird empfohlen, Patienten mit Typ-2-Diabetes, die länger als 1 Jahr mehr als 1000 mg Metformin täglich einnehmen, zu screenen – und zwar insbesondere solche, die noch weitere Risikofaktoren aufweisen. Auch eine kalziumreiche Ernährung mit Milch und Milchprodukten oder kalziumreichem Gemüse (z. B. Grünkohl, Spinat, Brokkoli, Porree) ist sinnvoll, da die Studienlage nahelegt, dass sich damit die Vitamin-B12-resorptionssenkenden Effekte von Metformin reduzieren lassen.
Research on unit commitment optimization of high permeability wind power generation and P2G
Authors: Ge Shaoyun , Liu Xiaoou , Liu Hong , Gu Chenghong , Ge Lukun
Published: June 2018

As an important form of future energy utilization, the operation of combined electricity-gas energy systems is also threatened by high-level penetration intermittent renewable energy. The application of power to gas (P2G) technology has deepened the coupling between the concerned power system and the natural gas system, and hence, bidirectional energy flow between the power system and the natural gas system can be implemented. P2G technology provides an alternative solution for the optimal operation of the combined electricity-gas energy systems to accommodate intermittent renewable energy, particularly, wind power. In this new environment, the unit commitment optimization of high permeability wind power and P2G is addressed, where the objective is to minimize the total operating cost of combined electricity-gas energy systems. First, the P2G technology and the application and supportive policies are introduced. Second, considering the characteristics of P2G devices and the combined system, a two-level economic dispatch model of the combined system with security constraints is proposed. Third, based on the Karush Kuhn Tucker optimality condition, the two-level optimization model is transformed into a mixed integer linear programming. Finally, the case study shows that the proposed unit commitment model is effective and accurate in optimizing the combined energy systems with high penetration level wind power.
Experimental investigation of near anode phenomenon in inverted cylindrical magnetron discharge
Authors: Rane R. , Bandyopadhyay P. , Bandyopadhyay M. , Mukherjee S.
Published: June 2018

The experimental investigation of the plasma properties near the anode of an inverted cylindrical DC magnetron discharge is carried out in the background of argon gas. These experiments are mainly performed at the low transverse magnetic field in the range of 0–100 G and at an argon pressure of 0.3–2 × 10−2 mbar. It is observed that the anode fall becomes prominent in the presence of a magnetic field. In addition, the plasma potential profile near the anode shows two distinct regions with potential difference of 10–15 V at the boundary of anode glow. It is also noticed that the anode glow expands radially as a function of magnetic field. The size of the anode glow increases with magnetic field in order to collect more electron current. The plasma density and electron temperature as measured by the double Langmuir probe near the anode are observed to be higher as compared to the background plasma. The stable electron sheath near the anode transforms into oscillating anode glow with the application of magnetic field beyond 4–5 G. The oscillation frequency as observed in floating potential and discharge current lies in the range of 1–10 kHz. The frequency increases linearly with discharge power and argon pressure while it decreases with magnetic field. Furthermore, a qualitative interpretation of the inverted cylindrical magnetron discharge is provided based on the theoretical analysis performed by Golubovskii et al.
Direct numerical simulation of quasi-equilibrium turbulent puffs in pipe flow
Authors: Priymak V. G.
Published: June 2018

The flow of an incompressible fluid in a straight circular pipe driven by a pressure gradient is a canonical shear flow undergoing subcritical transition. It is well established that at transitional Reynolds numbers 1760 ≲ Re ≲ 2700 (based on the mean axial flow speed  U¯ and pipe diameter D), flow in the pipe becomes spatially intermittent with irregular alternation of laminar flow and the turbulent coherent structures commonly referred to as puffs and slugs. In the present study, we describe quasi-equilibrium turbulent puffs at 2000 ⩽ Re⩽ 2200 by solving unsteady Navier-Stokes equations with periodic velocity along the pipe for very long times up to 8×104D/U¯. We present results with both constant mass flux and constant pressure gradient driving. We show that one can obtain different values of mean pressure gradient for different initial conditions, i.e., that multiple numerical Navier-Stokes solutions exist at a given Re. These solutions have an extensive statistically stationary stage and describe localized puffs surrounded by laminar flow or clusters of interacting puffs. A detailed pattern of entrainment of fluid at the laminar turbulent interfaces is provided by computing trajectories of fluid tracers. Specific backstreaming regions are exposed for both the trailing and leading fronts of the puff.
Genetic algorithms shape laser pulses to optimize plasma X-ray production
Authors: Cesare Chris
Published: June 2018

Fine-tuning the temporal profile of a high-intensity laser pulse doubles the energy in secondary radiation from a clustered gas.
Relaxation times measured for singlet and triplet electron spin states between two donor qubits
Authors: De Jarnette Drew
Published: June 2018

Two single-electron spin qubits based on single and double donor quantum dots controllably produce singlet and triplet states transitions in the combined system of two electron spins. The lifetimes were measured using single spin readout.
Development of a new smog chamber for studying the impact of different UV lamps on SAPRC chemical mechanism predictions and aerosol formation
Authors: White Stephen , Angove Dennys , Li Kangwei , Campbell Ian , Element Adrian , Halliburton Brendan , Lavrencic Steve , Cameron Donald , Jamie Ian , Azzi Merched
Published: June 2018

Environmental contextChemical mechanisms are an important component of predictive air quality models that are developed using smog chambers. In smog chamber experiments, UV lamps are often used to simulate sunlight, and the choice of lamp can influence the obtained data, leading to differences in model predictions. We investigate the effect of various UV lamps on the prediction accuracy of a key mechanism in atmospheric chemistry.
AbstractA new smog chamber was constructed at CSIRO following the decommissioning of the previous facility. The new chamber has updated instrumentation, is 35 % larger, and has been designed for chemical mechanism and aerosol formation studies. To validate its performance, characterisation experiments were conducted to determine wall loss and radical formation under irradiation by UV lamps. Two different types of blacklights commonly used in indoor chambers are used as light sources, and the results using these different lamps are investigated. Gas-phase results were compared against predictions from the latest version of the SAPRC chemical mechanism. The SAPRC mechanism gave accurate results for hydrocarbon reaction and oxidation formation for propene and o-xylene experiments, regardless of the light source used, with variations in ozone concentrations between experiment and modelled results typically less than 10 % over 6-h irradiation. The SAPRC predictions for p-xylene photooxidation showed overprediction in the rate of oxidation, although no major variations were determined in mechanism results for different blacklight sources. Additionally, no significant differences in the yields of aerosol arising from new particle formation were discernible regardless of the light source used under these conditions.
Estimating pseudocounts and fold changes for digital expression measurements
Authors: Erhard Florian
Published: June 2018

Motivation

Fold changes from count based high-throughput experiments such as RNA-seq suffer from a zero-frequency problem. To circumvent division by zero, so-called pseudocounts are added to make all observed counts strictly positive. The magnitude of pseudocounts for digital expression measurements and on which stage of the analysis they are introduced remained an arbitrary choice. Moreover, in the strict sense, fold changes are not quantities that can be computed. Instead, due to the stochasticity involved in the experiments, they must be estimated by statistical inference.

Results

Here, we build on a statistical framework for fold changes, where pseudocounts correspond to the parameters of the prior distribution used for Bayesian inference of the fold change. We show that arbitrary and widely used choices for applying pseudocounts can lead to biased results. As a statistical rigorous alternative, we propose and test an empirical Bayes procedure to choose appropriate pseudocounts. Moreover, we introduce the novel estimator Ψ LFC for fold changes showing favorable properties with small counts and smaller deviations from the truth in simulations and real data compared to existing methods. Our results have direct implications for entities with few reads in sequencing experiments, and indirectly also affect results for entities with many reads.

Availability and implementation

Ψ LFC is available as an R package under https://github.com/erhard-lab/lfc (Apache 2.0 license); R scripts to generate all figures are available at zenodo (doi: 10.5281/zenodo.1163029).

Supplementary information

Supplementary data are available at Bioinformatics online.
SONiCS: PCR stutter noise correction in genome-scale microsatellites
Authors: Kedzierska Katarzyna Z , Gerber Livia , Cagnazzi Daniele , Krützen Michael , Ratan Aakrosh , Kistler Logan
Published: June 2018

Motivation

Massively parallel capture of short tandem repeats (STRs, or microsatellites) provides a strategy for population genomic and demographic analyses at high resolution with or without a reference genome. However, the high Polymerase Chain Reaction (PCR) cycle numbers needed for target capture experiments create genotyping noise through polymerase slippage known as PCR stutter.

Results

We developed SONiCS—Stutter mONte Carlo Simulation—a solution for stutter correction based on dense forward simulations of PCR and capture experimental conditions. To test SONiCS, we genotyped a 2499-marker STR panel in 22 humpback dolphins (Sousa sahulensis) using target capture, and generated capillary-based genotypes to validate five of these markers. In these 110 comparisons, SONiCS showed a 99.1% accuracy rate and a 98.2% genotyping success rate, miscalling a single allele in a marker with low sequence coverage and rejecting another as un-callable.

Availability and implementation

Source code and documentation for SONiCS is freely available at https://github.com/kzkedzierska/sonics. Raw read data used in experimental validation of SONiCS have been deposited in the Sequence Read Archive under accession number SRP135756.

Supplementary information

Supplementary data are available at Bioinformatics online.
Nuclear factor E2-related factor 2 deficiency impairs atherosclerotic lesion development but promotes features of plaque instability in hypercholesterolaemic mice
Authors: Ruotsalainen Anna-Kaisa , Lappalainen Jari P , Heiskanen Emmi , Merentie Mari , Sihvola Virve , Näpänkangas Juha , Lottonen-Raikaslehto Line , Kansanen Emilia , Adinolfi Simone , Kaarniranta Kai , Ylä-Herttuala Seppo , Jauhiainen Matti , Pirinen Eija , Levonen Anna-Liisa
Published: June 2018

Aims

Oxidative stress and inflammation play an important role in the progression of atherosclerosis. Transcription factor NF-E2-related factor 2 (Nrf2) has antioxidant and anti-inflammatory effects in the vessel wall, but paradoxically, global loss of Nrf2 in apoE deficient mice alleviates atherosclerosis. In this study, we investigated the effect of global Nrf2 deficiency on early and advanced atherogenesis in alternative models of atherosclerosis, LDL receptor deficient mice (LDLR−/−), and LDLR−/− mice expressing apoB-100 only (LDLR−/− ApoB100/100) having a humanized lipoprotein profile.

Methods and results

LDLR−/− mice were fed a high-fat diet (HFD) for 6 or 12 weeks and LDLR−/−ApoB100/100 mice a regular chow diet for 6 or 12 months. Nrf2 deficiency significantly reduced early and more advanced atherosclerosis assessed by lesion size and coverage in the aorta in both models. Nrf2 deficiency in LDLR−/− mice reduced total plasma cholesterol after 6 weeks of HFD and triglycerides in LDLR−/−ApoB100/100 mice on a chow diet. Nrf2 deficiency aggravated aortic plaque maturation in aged LDLR−/−ApoB100/100 mice as it increased plaque calcification. Moreover, ∼36% of Nrf2−/−LDLR−/−ApoB100/100 females developed spontaneous myocardial infarction (MI) or sudden death at 5 to 12 months of age. Interestingly, Nrf2 deficiency increased plaque instability index, enhanced plaque inflammation and calcification, and reduced fibrous cap thickness in brachiocephalic arteries of LDLR−/−ApoB100/100 female mice at age of 12 months.

Conclusions

Absence of Nrf2 reduced atherosclerotic lesion size in both atherosclerosis models, likely via systemic effects on lipid metabolism. However, Nrf2 deficiency in aged LDLR−/−ApoB100/100 mice led to an enhanced atherosclerotic plaque instability likely via increased plaque inflammation and oxidative stress, which possibly predisposed to MI and sudden death.
Uber, the Taylor Review, Mutuality and the Duty Not to Misrepresent Employment Status
Authors: McGaughey Ewan
Published: June 2018

Do employing entities have a responsibility to not misrepresent the employment status of their staff? This article suggests that recent jurisprudence does create this responsibility. The article starts, first, by discussing the much-awaited Taylor Review, released in July 2017. This purported to address the problems of employment rights and tax in the software-driven ‘gig’ economy. Four main groups of Taylor’s recommendations were to relabel employment statuses and write more secondary legislation, reform tax, cut paid holidays and introduce new ‘soft’ labour rights. These proposals do not address the real issues. Second, this article explains why a test for employment status highlighted by Taylor—‘mutuality of obligation’—has not formed part of binding UK Supreme Court jurisprudence since Autoclenz Ltd v Belcher. Third, it discusses what the Taylor Review did not: the problem of misrepresentation of employment status, which has become closely associated with the gig economy. In October 2017, the Supreme Court issued a path-breaking judgment that changed the requirements for fraud cases, aligning the tests for civil and criminal fraud and therefore making fraud claims easier. This is relevant because of the very serious finding, in Aslam v Uber BV [2017] IRLR 4, [96] by the Employment Tribunal that Uber provided an ‘excellent illustration … of “armies of lawyers” contriving documents in their clients’ interests which simply misrepresent the true rights and obligations on both sides’. This raises the question of whether ‘contriving’ to ‘misrepresent’ something enables fraud claims, either by staff who seek employment rights or by public authorities for tax receipts or social security contributions.
Informal employees in the European Union: working conditions, employment precariousness and health
Authors: Julià Mireia , Belvis Francesc , Vives Alejandra , Tarafa Gemma , Benach Joan
Published: June 2018

Background

The aim of this study is to estimate the prevalence of informal workers and their working conditions and employment precariousness in the EU-27; and to explore the association of different contract arrangements with health outcomes and how they are influenced by working and employment conditions.

Methods

A sample of 27 245 working-age employees from the fifth European Working Condition Survey of 2010 was analysed. Logistic regression models were fitted to estimate the contribution of different contract arrangement (permanent, temporary and informal) and working and employment precariousness variables on health outcomes (psychosocial well-being and self-rated health).

Results

Prevalence of informal employees in the EU-27 is 4.1% among men and 5.1% among women. Although informal employees have the poorest working conditions and employment precariousness, they did not seem to reflect poorer health. Precariousness employment variables have a greater impact than working conditions variables in reducing the association between health outcomes and type of contract arrangement, especially in the case of informal employees.

Conclusions

Informal employment in the EU-27 is characterized by worse working conditions and employment precariousness than the conditions for formal employees. There is no evidence at all that being in informal employment implies better health outcomes compared to permanent employees.
PKCδ inhibition as a novel medical countermeasure for radiation‐induced vascular damage
Authors: Soroush Fariborz , Tang Yuan , Zaidi Hasan M. , Sheffield Joel B. , Kilpatrick Laurie E. , Kiani Mohammad F.
Published: June 2018

In the event of a radiologic catastrophe, endothelial cell and neutrophil dysfunction play important roles in tissue injury. Clinically available therapeutics for radiation‐induced vascular injury are largely supportive. PKCδ was identified as a critical regulator of the inflammatory response, and its inhibition was shown to protect critical organs during sepsis. We used a novel biomimetic microfluidic assay (bMFA) to interrogate the role of PKCδ in radiation‐induced neutrophil‐endothelial cell interaction and endothelial cell function. HUVECs formed a complete lumen in bMFA and were treated with 0.5, 2, or 5 Gy ionizing radiation (IR). At 24 h post‐IR, the cells were treated with a PKCδ inhibitor for an additional 24 h. Under physiologic shear flow, the role of PKCδ on endothelium function and neutrophil adherence/migration was determined. PKCδ inhibition dramatically attenuated IR‐induced endothelium permeability increase and significantly decreased neutrophil migration across IR‐treated endothelial cells. Moreover, neutrophil adhesion to irradiated endothelial cells was significantly decreased after PKCδ inhibition in a flow‐dependent manner. PKCδ inhibition downregulated IR‐induced P‐selectin, intercellular adhesion molecule 1, and VCAM‐1 but not E‐selectin overexpression. PKCδ is an important regulator of neutrophil‐endothelial cell interaction post‐IR, and its inhibition can serve as a potential radiation medical countermeasure.—Soroush, F., Tang, Y., Zaidi, H. M., Sheffield, J. B., Kilpatrick, L. E., Kiani, M. F. PKCδ inhibition as a novel medical countermeasure for radiation‐induced vascular damage. FASEB J. 32, 6436–6444 (2018). www.fasebj.org
Sex differences in NSAID‐induced perturbation of human intestinal barrier function and microbiota
Authors: Edogawa Shoko , Peters Stephanie A. , Jenkins Gregory D. , Gurunathan Sakteesh V. , Sundt Wendy J. , Johnson Stephen , Lennon Ryan J. , Dyer Roy B. , Camilleri Michael , Kashyap Purna C. , Farrugia Gianrico , Chen Jun , Singh Ravinder J. , Grover Madhusudan
Published: June 2018

Intestinal barrier function and microbiota are integrally related and play critical roles in maintenance of host physiology. Sex is a key biologic variable for several disorders. Our aim was to determine sex‐based differences in response to perturbation and subsequent recovery of intestinal barrier function and microbiota in healthy humans. Twenty‐three volunteers underwent duodenal biopsies, mucosal impedance, and in vivo permeability measurement. Permeability testing was repeated after administration of indomethacin, then 4 to 6 wk after its discontinuation. Duodenal and fecal microbiota composition was determined using 16S rRNA amplicon sequencing. Healthy women had lower intestinal permeability and higher duodenal and fecal microbial diversity than healthy men. Intestinal permeability increases after indomethacin administration in both sexes. However, only women demonstrated decreased fecal microbial diversity, including an increase in Prevotella abundance, after indomethacin administration. Duodenal microbiota composition did not show sex‐specific changes. The increase in permeability and microbiota changes normalized after discontinuation of indomethacin. In summary, women have lower intestinal permeability and higher microbial diversity. Intestinal permeability is sensitive to perturbation but recovers to baseline. Gut microbiota in women is sensitive to perturbation but appears to be more stable in men. Sex‐based differences in intestinal barrier function and microbiome should be considered in future studies.—Edogawa, S., Peters, S. A., Jenkins, G. D., Gurunathan, S. V., Sundt, W. J., Johnson, S., Lennon, R. J., Dyer, R. B., Camilleri, M., Kashyap, P. C., Farrugia, G., Chen, J., Singh, R. J., Grover, M. Sex differences in NSAID‐induced perturbation of human intestinal barrier function and microbiota. FASEB J. 32, 6615–6625 (2018). www.fasebj.org
Untying the Interprofessional Gordian Knot: The National Collaborative for Improving the Clinical Learning Environment
Authors: Brandt Barbara F. , Kitto Simon , Cervero Ronald M.
Published: June 2018

The National Collaborative for Improving the Clinical Learning Environment (NCICLE) is a growing group of over 40 organizations representing a variety of health professions. NCICLE is beginning a discussion of issues related to culture in health care, specifically how the current culture inhibits optimal outcomes, and the discordance between current early interprofessional education (IPE) curricula in health professions schools and traditional practice models in health care. In October 2017, the Accreditation Council for Graduate Medical Education and the Josiah Macy Jr. Foundation sponsored an NCICLE symposium on optimizing interprofessional clinical learning environments. In this Invited Commentary, the authors observe that interprofessional practice and education is a decades-long field that has presented a “Gordian knot” of intractable, complex problems to solve because medicine has often not been at the table for conversations about IPE. The NCICLE symposium represented an important opportunity for medicine to signal that finding new solutions for unraveling the interprofessional Gordian knot and creating optimal clinical learning environments requires meaningful participation from all health professions. Those solutions need to build on the long history of experience and research in IPE and collaborative practice. After the NCICLE symposium provided a promising beginning, the authors propose three essential issues and one key practical step forward to move the interprofessional agenda forward.
Blockchain Technology: A Data Framework to Improve Validity, Trust, and Accountability of Information Exchange in Health Professions Education
Authors: Funk Eric , Riddell Jeff , Ankel Felix , Cabrera Daniel
Published: June 2018

Health professions educators face multiple challenges, among them the need to adapt educational methods to new technologies. In the last decades, multiple new digital platforms have appeared in the learning arena, including massive open online courses and social-media-based education. The major critique of these novel methods is the lack of the ability to ascertain the origin, validity, and accountability of the knowledge that is created, shared, and acquired. Recently, a novel technology based on secured data storage and transmission, called blockchain, has emerged as a way to generate networks where validity, trust, and accountability can be created. Conceptually, blockchain is an open, public, distributed, and secure digital registry where information transactions are secured and have a clear origin, explicit pathways, and concrete value. Health professions education based on blockchain will potentially allow improved tracking of content and the individuals who create it, quantify educational impact on multiple generations of learners, and build a relative value of educational interventions. Furthermore, institutions adopting blockchain technology would be able to provide certification and credentialing of health care professionals with no intermediaries. There is potential for blockchain to significantly change the future of health professions education and radically transform how patients, professionals, educators, and learners interact around safe, valid, and accountable information.
Knowledge Accrual Following Participation in Pediatric Fundamental Critical Care Support Course in Gaborone, Botswana*
Authors: Cox Megan , Afonso Natasha , Mazhani Loeto , Kloeck David , Mysore Mohan , Roy Kevin , Setlhare Segolame , Daman Tlamelo , Meaney Peter A.
Published: June 2018

Objectives:

To describe provider characteristics, knowledge acquisition, perceived relevance, and instruction quality of the Society of Critical Care Medicine’s Pediatric Fundamentals of Critical Care Support course pilot implementation in Botswana.

Design:

Observational, single center.

Setting:

Academic, upper middle-income country.

Subjects:

Healthcare providers in Botswana.

Interventions:

A cohort of healthcare providers completed the standard 2-day Pediatric Fundamentals of Critical Care Support course and qualitative survey during the course. Cognitive knowledge was assessed prior to and immediately following training using standard Pediatric Fundamentals of Critical Care Support multiple choice questionnaires. Data analysis used Fisher exact, chi-square, paired t test, and Wilcoxon rank-sum where appropriate.

Main Results:

There was a significant increase in overall multiple choice questionnaires scores after training (mean 67% vs 77%; p < 0.001). Early career providers had significantly lower mean baseline scores (56% vs 71%; p < 0.01), greater knowledge acquisition (17% vs 7%; p < 0.02), but no difference in posttraining scores (73% vs 78%; p = 0.13) compared with more senior providers. Recent pediatric resuscitation or emergency training did not significantly impact baseline scores, posttraining scores, or decrease knowledge acquisition. Eighty-eight percent of providers perceived the course was highly relevant to their clinical practice, but only 71% reported the course equipment was similar to their current workplace.

Conclusions:

Pediatric Fundamentals of Critical Care Support training significantly increased provider knowledge to care for hospitalized seriously ill or injured children in Botswana. Knowledge accrual is most significant among early career providers and is not limited by previous pediatric resuscitation or emergency training. Further contextualization of the course to use equipment relevant to providers work environment may increase the value of training.
Magnetic Resonance Spectroscopy for Evaluating the Effect of Pulsed Electromagnetic Fields on Marrow Adiposity in Postmenopausal Women With Osteopenia
Authors: Li Shaojun , Jiang Hongning , Wang Bo , Gu Mingjun , Bi Xia , Yin Ying , Wang Yu
Published: June 2018

Objective

Pulsed electromagnetic fields (PEMFs) could promote osteogenic differentiation and suppress adipogenic differentiation in bone mesenchymal stem cells ex vivo. However, data on the effect of PEMF on marrow adiposity in humans remain elusive. We aimed to determine the in vivo effect of PEMF on marrow adiposity in postmenopausal women using magnetic resonance spectroscopy.

Methods

Sixty-one postmenopausal women with osteopenia, aged 53 to 85 years, were randomly assigned to receive either PEMF treatment or placebo. The session was performed 3 times per week for 6 months. All women received adequate dietary calcium and vitamin D. Bone mineral density (BMD) by dual-energy x-ray absorptiometry, vertebral marrow fat content by magnetic resonance spectroscopy, and serum biomarkers were evaluated before and after 6 months of treatment.

Results

A total of 27 (87.1%) and 25 (83.3%) women completed the treatment schedule in the PEMF and placebo groups, respectively. After the 6-month treatment, lumbar spine and hip BMD increased by 1.46% to 2.04%, serum bone-specific alkaline phosphatase increased by 3.23%, and C-terminal telopeptides of type 1 collagen decreased by 9.12% in the PEMF group (P < 0.05), whereas the mean percentage changes in BMD and serum biomarkers were not significant in the placebo group. Pulsed electromagnetic field treatment significantly reduced marrow fat fraction by 4.81%. The treatment difference between the 2 groups was −4.43% (95% confidence interval, −3.70% to −5.65%; P = 0.009).

Conclusions

Pulsed electromagnetic field is an effective physiotherapy in postmenopausal women, and this effect may, at least in part, regulate the amount of fat within the bone marrow. Magnetic resonance spectroscopy may serve as a complementary imaging biomarker for monitoring response to therapy in osteoporosis.
Carotid Artery Tortuosity Index Is Associated With the Need for Early Aortic Root Replacement in Patients With Loeys-Dietz Syndrome
Authors: Chu Linda C. , Haroun Reham R. , Beaulieu Robert J. , Black James H. , Dietz Harry C. , Fishman Elliot K.
Published: June 2018

Objective

This study aimed to determine if carotid arterial tortuosity represents a marker of disease severity in Loeys-Dietz syndrome (LDS).

Methods

Fifty-four 54 LDS patients (mean age, 17.0 years) who underwent computed tomogram angiography from January 2004 to December 2013 were retrospectively identified. Carotid artery tortuosity index (CATI) was calculated from computed tomogram angiography. Clinical variables were obtained from the medical records. Relationship between CATI and need for aortic root replacement was evaluated with Cox proportional hazard model and Kaplan-Meier analysis.

Results

Higher CATI was associated with the need for aortic root replacement (P < 0.001) in the univariate Cox proportional hazard model. Patients were stratified based on both CATI and aortic root size in Kaplan-Meier analysis, and patients with higher CATI were more likely to require aortic root replacement (P < 0.001) in both aortic root size strata.

Conclusion

Increased carotid artery tortuosity is associated with the need for early aortic root replacement in patients with LDS.
Magnetic Resonance Imaging Features of Endometrial Polyps: Frequency of Occurrence and Interobserver Reliability
Authors: Balcacer Patricia , Cooper Kirsten A. , Huber Steffen , Spektor Michael , Pahade Jay K. , Israel Gary M.
Published: June 2018

Objective

This study aimed to evaluate magnetic resonance imaging (MRI) features and interobserver agreement of endometrial polyps.

Methods

After institutional review board approval, our database was searched for women older than 18 years who underwent MRI pelvis and pelvic surgical intervention from 2012 to 2016. Seventy-two patients with polyps and 75 controls composed the study cohort. Two radiologists evaluated the MRIs retrospectively for polyps. Polyp characteristics and enhancement were assessed.

Results

Sensitivity and specificity of readers 1 and 2 were 59.7% and 88.0%, and 44.4 and 96.0%, respectively. There was moderate agreement for presence of polyps (κ = 0.556,P≤ 0001), T2 fibrous core, and intratumoral cysts, with slight agreement for T2 signal and enhancement. Polyp size moderately correlated with pathology (κ = 0.465 [P= 0.025] for reader 1, κ = 0.562 [P= 0.029] for reader 2). The most common enhancement was same as myometrium.

Conclusion

Magnetic resonance imaging is moderately sensitive for detecting endometrial polyps, demonstrating features that are not sensitive but can be specific, with moderate interobserver agreement.
Early arterial access for resuscitative endovascular balloon occlusion of the aorta is related to survival outcome in trauma
Authors: Matsumura Yosuke , Matsumoto Junichi , Kondo Hiroshi , Idoguchi Koji , Ishida Tokiya , Okada Yohei , Kon Yuri , Oka Kazuyuki , Ishida Kenichiro , Toyoda Yukitoshi , Funabiki Tomohiro
Published: June 2018

BACKGROUND

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used in refractory hemorrhagic shock patients. Since the optimal timing of arterial access remains unclear, we evaluated the preocclusion status of patients, and elapsed time from the arrival to the hospital is associated with the survival outcomes in the REBOA patients.

METHODS

From August 2011 to December 2016, The Diagnostic and Interventional Radiology in Emergency, Critical care and Trauma-Intra-Aortic Balloon Occlusion (DIRECT-IABO) investigators registered refractory hemorrhagic shock patients undergoing REBOA from 23 hospitals in Japan. Patient characteristics, mechanism of injury, Injury Severity Score (ISS), preocclusion and postocclusion systolic blood pressure, duration of aortic occlusion, clinical time course, and survival outcome were recorded and analyzed. Binary logistic regression analysis was used with mortality and Kaplan-Meier survival analysis was conducted to demonstrate the difference between early and delayed access groups.

RESULTS

Among the enrolled 207 cases, the following patients were excluded from the analysis: five since they were younger than 18 years, nine due to failed attempts at REBOA, 51 nontrauma patients, and 33 who received resuscitative thoracotomy plus REBOA. Thus, the remaining 109 cases were analyzed (30-day survivors, n = 60; nonsurvivors, n = 49). The preocclusion systolic blood pressure was higher, and both hospital arrival to initial arterial access and duration of occlusion were shorter in the survivors. Lower ISS (odds ratio, 0.944; 95% confidence interval, 0.907–0.982; p = 0.0039) and shorter arrival to access (odds ratio, 0.989; 95% confidence interval, 0.979–0.999; p = 0.034) were significantly associated with 30-day survival in the logistic regression analysis. The cutoff point of 21.5 minutes was used in the receiver operating characteristic analysis. The early access group showed a significantly shorter time of arrival to definitive hemostasis and also demonstrated a significantly higher survival in the Kaplan-Meier survival analysis (p = 0.014, Log-rank test).

CONCLUSION

The arrival to access time and ISS were significantly associated with mortality in the REBOA patients in Japan. The early access group demonstrated better survival. The proactive early access in the resuscitation phase might be related to better patient outcomes.

LEVEL OF EVIDENCE

Therapeutic/care management, level V.