bluuebunny/crossref_metadata_2025 huggingface dataset:
Do single-use medical devices containing biopolymers reduce the environmental impacts of surgical procedures compared with their plastic equivalents?
Authors: Unger Scott R , Hottle Troy A , Hobbs Shakira R , Thiel Cassandra L , Campion Nicole , Bilec Melissa M , Landis Amy E
Published: May 2017

Background

While petroleum-based plastics are extensively used in health care, recent developments in biopolymer manufacturing have created new opportunities for increased integration of biopolymers into medical products, devices and services. This study compared the environmental impacts of single-use disposable devices with increased biopolymer content versus typically manufactured devices in hysterectomy.

Methods

A comparative life cycle assessment of single-use disposable medical products containing plastic(s) versus the same single-use medical devices with biopolymers substituted for plastic(s) at Magee-Women’s Hospital (Magee) in Pittsburgh, PA and the products used in four types of hysterectomies that contained plastics potentially suitable for biopolymer substitution. Magee is a 360-bed teaching hospital, which performs approximately 1400 hysterectomies annually.

Results

There are life cycle environmental impact tradeoffs when substituting biopolymers for petroplastics in procedures such as hysterectomies. The substitution of biopolymers for petroleum-based plastics increased smog-related impacts by approximately 900% for laparoscopic and robotic hysterectomies, and increased ozone depletion-related impacts by approximately 125% for laparoscopic and robotic hysterectomies. Conversely, biopolymers reduced life cycle human health impacts, acidification and cumulative energy demand for the four hysterectomy procedures. The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects. However, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts of products and devices made using biopolymers.

Conclusions

The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects; however, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts.
Strength-based differential tolerable settlement limits of bridges
Authors: Parks Shawn , Yang Mijia , Gajan Sivapalan , Pei Qiang
Published: May 2017

Based on realistic modeling of 44 bridges in national bridge inventory using its actual layout and dimensions, a theoretical framework is defined to calculate the tolerable differential settlement limits based on the over-bending moment or over-shear force generated by settlements and the moment or shear capacity of the bridge. First, the derived over-bending moment or over-shear force is validated through literature results. Second, the differential settlement limits of bridges are derived from the bridge strength capacities. Finally, based on the established differential settlement limits, the relationship of bridge differential settlement limits with its span length, number of spans, bridge skew, and the bridge type is discussed and compared with American Association of State Highway and Transportation Officials specification (2010). A statistics-based differential settlement limit criterion is also suggested for steel and pre-stressed concrete bridges and compared with the field survey results. From the research outcomes, it is concluded that extra caution is needed when implementing the 0.4% differential settlement limits of bridge foundations in American Association of State Highway and Transportation Officials.
Automating judgment? Algorithmic judgment, news knowledge, and journalistic professionalism
Authors: Carlson Matt
Published: May 2017

Journalistic judgment is both a central and fraught function of journalism. The privileging of objectivity norms and the externalization of newsworthiness in discourses about journalism leave little room for the legitimation of journalists’ subjective judgment. This tension has become more apparent in the digital news era due to the growing use of algorithms in automated news distribution and production. This article argues that algorithmic judgment should be considered distinct from journalists’ professional judgment. Algorithmic judgment presents a fundamental challenge to news judgment based on the twin beliefs that human subjectivity is inherently suspect and in need of replacement, while algorithms are inherently objective and in need of implementation. The supplanting of human judgment with algorithmic judgment has significant consequences for both the shape of news and its legitimating discourses.
An analytical study of the performance indices of articulated truck semi-trailer during three different cases to improve the driver comfort
Authors: Abdelkareem Mohamed AA , Makrahy Mostafa M , Abd-El-Tawwab Ali M , EL-Razaz ASA , Kamal Ahmed Ali Mohamed , Moheyeldein MM
Published: May 2017

Heavy trucks are mostly used for international transportations, with longer highways and long driving hours contributing to corresponding increases in the driver’s fatigue that is related to accidents. Therefore, this study aims to improve the truck ride performance using multistage leaf springs and semi-active suspension for the driver seat. This analytical study describes the influence of the truck main suspensions on the performance indices analytically using MATLAB Simulink for different loading conditions in three case studies: fully laden articulated truck (case A), unladen truck (case B), and empty semi-trailer and a multistage leaf springs is considered after designing the main leaf spring stiffness based on particle swarm optimization (case C). This study exhibits a contribution based on the fact that changing the trailer cargo weight has considerable effects on the natural frequency of the vibration modes of the vehicle system, particularly for articulated carriage. Subsequently, the influence of the dynamic interaction of an articulated vehicle between the semitrailer and the tractor on its ride behavior has been investigated. The model has also predicted the effect of total trailer cargo on performance indices for 13 degrees of freedom model of a 6-axle articulated truck semi-trailer vehicle with a random road excitation. Additionally, a semi-active driver seat suspension based on skyhook strategy and seat passive suspension are compared in terms of the power spectral density and root mean square values. The results showed that the truck ride performance is improved significantly, and all the acceleration responses are suppressed dramatically when a designed multistage leaf spring suspension is considered in case C. The current analysis demonstrated that using specific and adjustable suspension parameters can positively enhance the riding behavior of the unladen vehicle. The results showed that the cab, tractor, and trailer acceleration improved by 22%, 21%, and 28%, respectively, which provides a comfort driving trip essentially for long distance traveling.
Numerical analysis on the static–dynamic coupling influences of parallelism flaw in disc-rod rotor ball bearing system
Authors: Liu Yi , Liu Heng , Fan Bowen
Published: May 2017

The static–dynamic coupling influences of parallelism flaw are investigated in the disc-rod rotor ball bearing system. Three-dimensional finite element method and a contact solving method are combined to analyze the statics of flawed disc-rod rotor. This analysis shows that parallelism flaw causes mass eccentric and rotation-dependent rotor bow. When these dynamic factors are involved, parallelism flaw promotes the nonlinear complexity in high speed and reduces global stability areas for the flawed disc-rod rotor. Unstable motions are more likely to happen when rotating speed exceeds the critical speed when rotor has a parallelism flaw. The spectrums of flawed rotor are composed of rotating frequency, subharmonic frequency, and their linear combinations. Flawed rotor has a larger bow deformation and orbit size than the ideal rotor. Dynamic stress performs the same property with vibration curves which enables rotors to have the first-order bow deformation. Dynamic stress of flawed rotor is much higher than that of ideal rotor. This paper presents a numerical analysis method to study the static-dynamic features of disc-rod rotor ball bearing system with parallelism flaw.
“We are a Team”: Couple Identity and Memory Loss
Authors: Hernandez Elise , Spencer Beth , Ingersoll-Dayton Berit , Faber Alexandra , Ewert Allison
Published: May 2017

Couplehood can be an important source of resilience in the face of memory loss, but couple identity has only recently been explored and has rarely been measured. This paper examines older spouses’ descriptions of their couple identity and discusses salient themes. Data come from 19 couples from the Couples Life Story Project, a life review intervention where one partner has memory loss. Using baseline data, we analyzed how partners depicted their couple identity using a series of separate and overlapping circles. Almost half of the partners independently chose identical depictions of their relationships. An interpretative phenomenological approach revealed three major themes of couple identity: (1) doing things together and separately; (2) feelings, shared history, and closeness over time and; (3) essence of relationship. This study contributes to the small body of literature that focuses on couple identity and how partners mutually cope with aging-related challenges.
Understanding Public Perceptions of Growing Economic Inequality
Authors: Franko William W.
Published: May 2017

While most Americans appear to acknowledge the large gap between the rich and the poor in the United States, it is not clear whether the public is aware of recent changes in income inequality. Even though economic inequality has grown substantially in recent decades, studies have shown that the public's perception of growing income disparities has remained mostly unchanged since the 1980s. This research offers an alternative approach to evaluating how public perceptions of inequality are developed. Centrally, it conceptualizes the public's response to growing economic disparities by applying theories of macro-political behavior and place-based contextual effects to the formation of aggregate perceptions about income inequality. It is argued that most of the public relies on basic information about the economy to form attitudes about inequality and that geographic context—in this case, the American states—plays a role in how views of income disparities are produced. A new measure of state perceptions of growing economic inequality over a 25-year period is used to examine whether the public is responsive to objective changes in economic inequality. Time-series cross-sectional analyses suggest that the public's perceptions of growing inequality are largely influenced by objective state economic indicators and state political ideology. This research has implications for how knowledgeable the public is of disparities between the rich and the poor, whether state context influences attitudes about inequality, and what role the public will have in determining how expanding income differences are addressed through government policy.
Baseline Sleep Efficiency and Arousal Index Do Not Predict Who Will Benefit From Sedatives in Improving Positive Airway Pressure Adherence in Sleep Apnea to 90%
Authors: Sangal R. Bart
Published: May 2017

Positive airway pressure (PAP) is the preferred treatment for obstructive sleep apnea (OSA), but adherence is low. Educational or ongoing supportive intervention improves the number of PAP adherent patients from the 50% to the 70% range. A common side effect of PAP is increased awakenings. This prospective trial examined baseline polysomnographically derived sleep efficiency and arousal index in PAP adherent and nonadherent patients, and in patients needing sedating medicines to attain PAP adherence versus those who did not need such medicines. Patients with OSA were titrated on PAP during a polysomnography or treated with autotitrating PAP, followed by educational and supportive interventions. Patients with PAP related awakenings (patients describing waking up and taking PAP off in the middle of the night) or difficulty tolerating PAP were additionally treated with medicines that suppress arousals/awakenings (trazodone, mirtazapine, doxepin). A total of 120 of 151 (79%) new patients were ≥70% PAP adherent over a continuous 30-day period, typically within the first 90 days of starting PAP, without sedating medicines. Nineteen of the remaining patients were treated with medicines that suppress arousals and awakenings, and 16 became adherent, resulting in 136 (90%) of 151 new patients achieving adherence. There were no differences in baseline sleep efficiency or arousal index, between adherent and nonadherent patients, as well as between patients who needed sedating medicines for PAP adherence and those who did not. Adding medicines that suppress arousals and awakenings for patients having trouble tolerating PAP, increases the number of patients who are PAP adherent. The need for such medicines seems to be related to the PAP side effect of increased awakenings rather than baseline impaired sleep.
Eagle syndrome: A case report of stylocarotid syndrome with internal carotid artery dissection
Authors: Smoot Travis W , Taha Ammar , Tarlov Nicholas , Riebe Blake
Published: May 2017

Eagle syndrome is defined by an elongated styloid process or a calcified stylohyoid ligament that impinges on surrounding structures and causes a variety of symptoms. Classically, Eagle syndrome presents as neck, throat, or ear pain. The vascular variant, stylocarotid syndrome, can present as headache, transient ischemic attack, or stroke. Carotid artery dissection is a rare complication of stylocarotid syndrome. We report a case of stylocarotid syndrome in a 60-year-old man who presented with a right internal carotid artery (ICA) dissection and focal neurological deficits. Computed tomography with three-dimensional reformatting was used in the evaluation of his pathology. His dissecting right ICA was stented with subsequent symptom resolution. Improved recognition of the relationship between an elongated styloid or calcified stylohyoid ligament and symptomatology may lead to optimal etiology recognition and directed treatment.
Dual microcatheter coil embolization of acutely ruptured wide-necked intracranial aneurysms
Authors: Yoon Pyeong-Ho , Lee Jae-Wook , Lee Yun-Ho , Kwon Young-Sub , Yang Kook-Hee
Published: May 2017

The dual microcatheter technique is an alternative treatment for stent-assisted coiling in acutely ruptured wide-necked aneurysms because of no antiplatelet therapy. We assessed the safety and efficacy of this technique in ruptured wide-necked aneurysms. Between March 2008 and March 2016, 56 acutely ruptured aneurysms were treated with the dual microcatheter technique. The angiographic results, treatment-related complications, and clinical outcome were documented. Angiographic follow-up was available in 37 patients at a mean of 20.6 months (6 to 81 months). On the postembolization angiograms, 27 (48.2%) aneurysms showed complete occlusion (Raymond 1), 15 (26.8%) showed neck remnant (Raymond 2), and 14 (25.0%) showed body remnant (Raymond 3). Treatment-related complications occurred in seven patients (12.5%) and six patients remained asymptomatic. The permanent complication rate was 1.8% (1/56). A good outcome (modified Rankin Scale (mRS) score, 0–2) was observed in 64.3% of patients at the time of discharge. Five patients had died, all of the sequelae of subarachnoid hemorrhage. The overall mortality rate was 8.9% (5/56); however, the treatment-related mortality rate was 0%. Of the 37 aneurysms for which angiographic follow-up was available, 21 (56.8%) aneurysms demonstrated recanalization. Five aneurysms with recanalization were retreated endovascularly. There was one aneurysm re-rupture on follow-up and it rebled 21 months after the initial procedure. The dual microcatheter technique is a safe and effective treatment for acutely ruptured wide-necked aneurysms due to low treatment-related complication and mortality rate. However, the high rate of postembolization incomplete occlusion and recanalization remains as the main challenge.
Carotidynia in high-altitude travelers
Authors: Parra Andrea , Okada Tamuru , Lin Peter H
Published: May 2017

Background

Carotidynia is characterized by focal pain and tenderness of the carotid artery without associated hemodynamic or structural abnormalities. Carotid artery pathology has also been known to occur in high altitude due to aberrant baroreceptor response in the carotid bulb.

Case Presentation

We herein report two cases of high altitude-related idiopathic carotidynia. The first patient was a geologist who performed oil reserve survey in the Alaska Mountain, while the second patient was hiking in a mountain trail in Peru. Both patients developed acute onset of neck pain while traveling in high-altitude mountainous ranges. Carotid imaging showed transmural inflammation surrounding the carotid artery without intraluminal stenosis. Treatment with low-dose aspirin and nonsteroidal anti-inflammatory drug were initiated, which resulted in complete resolution of their symptom. Follow-up carotid ultrasound showed complete resolution of carotid inflammatory tissue density.

Discussion

This represents the first report linking carotidynia to high-altitude traveling.
Patients’ and healthcare professionals’ perceptions of self-management support interactions: Systematic review and qualitative synthesis
Authors: Franklin Marika , Lewis Sophie , Willis Karen , Bourke-Taylor Helen , Smith Lorraine
Published: May 2017

Objective

To review studies examining the experience of self-management support in patient–provider interactions and the shaping of goals through interactions.

Methods

We undertook a systematic review and thematic synthesis of the qualitative literature. We searched six databases (2004–2015) for published studies on the provision of self-management support in one-to-one, face-to-face, patient–provider interactions for obesity, type 2 diabetes mellitus and chronic obstructive pulmonary disease, with 14 articles meeting inclusion criteria.

Results

Themes identified from studies were (1) dominance of a traditional model of care, encompassing the provision of generic information, exclusion of the psychosocial and temporal nature of interactions and (2) a context of individual responsibility and accountability, encompassing self-management as patients’ responsibility and adherence, accountability and the attribution of blame. Interactions were constrained by consultation times, patient self-blame and guilt, desire for autonomy and beliefs about what constitutes ‘effective’ self-management.

Discussion

Encounters were oriented towards a traditional model of care delivery and this limited opportunity for collaboration. These findings suggest that healthcare professionals remain in a position of authority, limiting opportunities for control to be shared with patients and shared understandings of social context to be developed.
A university sport coach community of practice: Using a value creation framework to explore learning and social interactions
Authors: Bertram Rachael , Culver Diane M , Gilbert Wade
Published: May 2017

Coaches often identify social learning situations as the most valuable and influential to their learning. Thus, researchers have proposed implementing social learning initiatives, in particular, the community of practice approach. The purpose of the present study was to explore how an existing coach community of practice was created and sustained in a university setting, and to assess what value was created by participating in the community of practice. Participants included four National Collegiate Athletic Association Division 1 coaches from a university in the Southwestern United States. Data collection included an individual interview with each coach. Interviews were analysed using a value creation framework. The findings revealed that the coaches created value within all five cycles of Wenger et al.’s framework. In particular, the coaches learned a number of coaching strategies, some of which they were able to implement, and as a result, observe benefits in their coaching and athletes’ performance.
Noncirrhotic hepatocellular carcinoma: etiology and occult hepatitis B virus infection in a hepatitis B virus-endemic area
Authors: Shim Chang Woo , Park Joong-Won , Kim So Hee , Kim Jin Sook , Kim Bo Hyun , Kim Sung Hoon , Hong Eun Kyung
Published: May 2017

Background:

Although hepatocellular carcinoma (HCC) usually develops in cirrhotic livers, a minority of cases occur in noncirrhotic livers (NCLs). We investigated etiology, clinicopathological features, and occult hepatitis B virus (HBV) infection (OBI) in patients with NCL HCC in an HBV-endemic area.

Methods:

A total of 710 patients who underwent resection or transplantation for HCC at the National Cancer Center (NCC), Korea, were enrolled. HCC and fibrosis stage were diagnosed pathologically.

Results:

A total of 178 patients (25%) did not have cirrhosis (NCL group). The main cause of HCC was HBV infection (77.2%), followed by cryptogenic disease (11.0%). The prevalence of NCL was 19.2%, 32.5%, 50.0%, and 48.7% among patients with HBV, hepatitis C virus (HCV), alcoholic, and cryptogenic disease, respectively ( p < 0.05); corresponding nonfibrosis rates were 8.1%, 0%, 19.0%, and 24.3%, respectively. The NCL group was significantly older, with a larger tumor size, smaller tumor number, lower tumor stage, and more frequent non-HBV etiology. Among non-HBV HCC cases, 130 (80.2%) had antibodies against HBV core (HBc) and 55 (38.5%) had OBI. OBI-positive rates of 0%, 31.8%, and 52.6% were detected among HCV, alcoholic, and cryptogenic HCC cases, respectively. OBI did not correlate with advanced fibrosis. The NCL and liver cirrhosis (LC) groups did not differ in median overall survival.

Conclusion:

Regardless of etiology, a significant number of HCC patients, including half of nonviral cases, did not have LC. Half of cryptogenic HCC cases had OBI. This study promotes an understanding of fibrosis and OBI among patients with HCC in an HBV-endemic area.
Pressure-sensitive properties of carbon nanotubes/bismuth sulfide composite materials
Authors: Ali Asar , Khan Adam , Ali Amjad , Ahmad Mushtaq
Published: May 2017

In this work, the pressure-sensitive properties of pure multi-walled carbon nanotubes and multi-walled carbon nanotubes/bismuth sulfide composite are investigated and compared. Composite was prepared by 50 wt% of each ingredient. Sandwich-type pressure-sensitive pellets (Ag/CNT/Ag and Ag/CNT-Bi2S3/Ag) of 2 mm in thickness and 15 mm in diameter were fabricated at a pressure of 6894.8 kNm−2by Mortar and Pestle/Hydraulic Press technique. Both sides of the prepared samples were painted with silver paste to provide low resistance electrical contacts. Both the samples exhibited decrease in direct current resistance with the increase in the applied pressure (0–16.9 kNm−2). However, decrease in the resistance of multi-walled carbon nanotubes/bismuth sulfide composite was 1.2 times and sensitivity was 1.07 times higher than the pure carbon nanotubes. Experimental results were compared with simulated results that showed excellent agreement with each other.
Preparation and characterization of a novel bacterial cellulose/chitosan bio-hydrogel
Authors: Jia Yuanyuan , Wang Xiaohong , Huo Mingming , Zhai Xiaoli , Li Fei , Zhong Cheng
Published: May 2017

Composites of chitosan chloride and bacterial cellulose were successfully prepared by in situ method. Composites of bacterial cellulose/chitosan and pristine bacterial cellulose were investigated by means of scanning electron microscope, atomic force microscope, Fourier transform infrared spectroscopy, thermogravimetric analysis, X-ray diffraction, and bacteriostatic test. The crystallization of bacterial cellulose was interfered and weakened by the chitosan chloride included in the growth media, resulting in lower crystallinity index and thermal stability. And interaction between two polymers is verified by the thermal gravimetric analysis. The ultrafine nanofibril network structure of bacterial cellulose was retained by the composites, while the diameters were larger and the aperture inside were smaller than those of pristine bacterial cellulose, as shown through scanning electron microscope and atomic force microscope figures. The antimicrobial effects were enhanced by the increasing concentration of chitosan in composites. All the characteristics of the composites provide evidence for the miscibility of chitosan and cellulose. Their biocompatibility is proved through our published data. It is strongly indicated that bacterial cellulose–chitosan nanocomposites have great potential in tissue engineering or pharmaceutical applications in the near future.
Baseline Analysis: The Epistemology of Scenario Support
Authors: Bishop Peter C.
Published: May 2017

Foresight professionals have been developing and sharing scenarios about the future for a half century now. They argue that the only way to acknowledge the inherent uncertainties about the future is to offer multiple futures (scenarios) rather than single-valued predictions. Nevertheless, most forecasters still make predictions because the process of supporting them with evidence is well known and similar to supporting conclusions in history and science. This article presents an argument for supporting scenarios using evidence through a process of critically thinking about the assumptions required to support the most likely future. Using this more transparent approach allows other professionals to understand, discuss, and critique the support for scenarios as they do the conclusions in other disciplines. That ability to peer review futures work could build the foundation for a measure of credibility and legitimacy that those other disciplines enjoy.
Osteochondral Allograft Transplantation and Opening Wedge Tibial Osteotomy: Clinical Results of a Combined Single Procedure
Authors: Hsu Albert C. , Tirico Luis E. P. , Lin Abraham G. , Pulido Pamela A. , Bugbee William D.
Published: May 2017

Objective

To evaluate the outcome of patients who have undergone simultaneous osteotomy and osteochondral allograft (OCA) transplantation. Our hypothesis is that use of high tibial osteotomy and fresh OCA in a combined procedure is safe and effective without increasing morbidity in comparison to OCA alone.

Design

A case series of 17 patients underwent tibial osteotomy and simultaneous OCA during a single surgery. Osteotomy was indicated when axial alignment was within the affected compartment. Patients had a minimum of 2 years of follow-up after surgery. The mean graft size was 8.7 cm2, with 82% located on the medial femoral condyle alone and 18% involving the medial femoral condyle and one or more other sites. Data collection included demographics, osteotomy correction, graft site(s) and area, and clinical evaluation. Failure was defined as conversion to arthroplasty.

Results

Two of 17 patients (12%) failed at a mean of 9.3 years. The remaining 15 patients (88%) had intact allografts with mean survival of 8.1 years (SD 3.3). Five patients (29%) had an additional procedure, all undergoing osteotomy hardware removal. Of those with surviving allografts, mean pain and function scores improved significantly from the preoperative to postoperative assessment and International Knee Documentation Committee total scores improved significantly from 40.9 ± 15.4 preoperative to 75.5 ± 24.0 at latest follow-up ( P = 0.003); 92% of patients were satisfied with the results of the surgery. No postoperative complications occurred.

Conclusion

Combining high tibial osteotomy and OCA in properly selected patients is safe and effective.
What we see when we digitize pain: The risk of valorizing image-based representations of fibromyalgia over body and bodily experience
Authors: Manivannan Vyshali
Published: May 2017

Fibromyalgia is chronic pain of unknown etiology, attended by fatigue and affective dysfunction. Unapparent to the unpracticed eye or diagnostic image, it is denied the status of “real” suffering given to visually confirmable disorders. It is my customary mode of existence: a contingent landscape of swinging bridges that may or may not give way, everything a potential threat or deprivation. I don’t express it within the framework of acute pain, but I am evaluated by traditional biomedical standards anyway.

Ultimately, the diagnostic image of pain, and the medical and academic discourse used to interpret it, determines my functionality. Such a stance dismisses bodily senses and alternate ways of knowing in pursuit of the ocularcentric objectivity promised by digital health technologies, whose vision remains chained to the interpretive, discursive strategies of human operators and interpreters.

A new poetics of pain is critical not only for rewriting the dominant metaphors that construct and delimit our imaginings of pain but also for rewiring the use and reading of digital technologies, wherein the digital image becomes the new site of the hermeneutic exercise, even when the suffering body lies in plain view. This facilitates a failure to listen and touch in patient care, and the imposition of a narrative based on visual evidence, translated into sanitized language, at the cost of intercorporeality.

If pain strips sufferers of a voice, my body and its affects should be allowed to speak.
Exercise monitoring of young adults using a Facebook application
Authors: Pagkalos Ioannis , Kokkinopoulou A , Weal M , Petrou L , Hassapidou M
Published: May 2017

Facebook, with a record 1.7+ billion monthly active users, is increasingly the platform of choice for a multitude of e-health applications. This work presents our experience in exercise monitoring using a custom-built Facebook application for activity self-reporting. A group of young adults ( n = 49, age = 24 ± 7 years, body mass index (BMI) = 22.5 ± 3) took part in a 5-week pilot study, part of the NutriHeAl intervention project. Participants reported their daily exercise activities for an average of 33 ± 5 days and were also equipped with digital pedometers (Fibit Zips) for the full duration, allowing the evaluation of their activity reporting accuracy by comparing steps/min to a ‘truth ceiling’ value for two pre-defined exercise categories (2 + and 3+ metabolic equivalent of task (MET) intensity). We found that users not only reported their exercise consistently for an extended period of time but also achieved an average accuracy score of 71 ± 21% (82 ± 18% for 2+ MET exercises), making this novel exercise monitoring methodology a formidable tool for a modern physician’s digital arsenal. In addition, the developed tools and processes can also be re-used in other e-health applications.
Histopathological assessment of surgical margins of oral carcinomas and related shrinkage of tumour
Authors: Sarode Gargi , Sarode Sachin C , Shelke Pankaj , Patil Shankargouda
Published: May 2017

The UK Royal College of Pathologists has published widely recognized guidelines that are finding increasing acceptance in the histological assessment of surgical margins of oral squamous cell carcinoma (OSCC). These guidelines are based on the distance of surgical margins from tumour tissue. The results of various published articles indicate that overall shrinkage of OSCC specimens varies from 15% to 75% and depends upon many irrepressible intrinsic and extrinsic factors. In the present article, the intrinsic and extrinsic factors accountable for shrinkage are discussed in depth. A novel basal cell counting method for the assessment of margins and the calculation of shrinkage in OSCC specimens with flat epithelial connective tissue interfaces have also been put forward.
Induction Effect to Apoptosis by Maitake Polysaccharide: Synergistic Effect of Its Combination With Vitamin C in Neuroglioma Cell
Authors: Duan Lei , Wu Xiao-Lu , Zhao Fei , Zeng Rong , Yang Ke-Hu
Published: May 2017

Polysaccharide extracted from the Maitake mushroom (MP) is considered as a potential anticancer agent. The present study was performed to investigate the cytotoxic effects of MP and vitamin C (VC) alone and in combination on the viability of human neuroglioma M059 K cells in vitro. A combination of MP (1.0 mg/mL) and VC (0.4 mmol/L) led to a 53.10% reduction in cell viability and this treatment induced cell cycle arrest at the G2/M phase, and apoptosis occurred in 38.54% of the cells. Results of Hoechst 33258 staining and Western blot showed apoptotic cells appeared and changes in the expression of apoptosis-related proteins (upregulation of Bax and caspase-3, downregulation of Bcl-2, and activation of poly-(ADP-ribose)-polymerase). Moreover, the activities of caspase-3, caspase-8, and caspase-9 were enhanced in M059 K cells. The inhibiting effect of combined treatment with MP and VC on M059 K cells indicates the mechanism of anticancer activity involved induction of cell apoptosis.
Outcome of Expedited Rotator Cuff Surgery in Injured Workers: Determinants of Successful Recovery
Authors: Razmjou Helen , Boljanovic Dragana , Lincoln Sandra , Holtby Richard , Gallay Stephen , Henry Patrick , Macritchie Iona ,   WCP Consortium, Borthwick Cheryl , Mayer Lauren , Roknic Carolyn , Shore Deborah , Kamino Allison , Grossman Julie , Hill Joanne , Singh Gargi , Travers Niki , Yanofsky Loraine , Wilson Marni , Sumar Shellina , Savona Alicia , De Medeiros Filomena , Mann Helen , Champsi Aisha , Chau Stefanie , Medeiros Danielle , Richards Robin R.
Published: May 2017

Background:

Work-related rotator cuff injuries are a common cause of disability and employee time loss.

Purpose:

To examine the effectiveness of expedited rotator cuff surgery in injured workers who underwent rotator cuff decompression or repair and to explore the impact of demographic, clinical, and psychosocial factors in predicting the outcome of surgery.

Study Design:

Case series; Level of evidence, 4.

Methods:

Injured workers who were seen at a shoulder specialty program and who underwent expedited arthroscopic rotator cuff decompression or repair were observed for a period of 6 to 12 months based on their type of surgery and recovery trajectory. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form. The impact of surgery was assessed by whether the change in the ASES score exceeded the minimal clinically important difference (MCID) of 17 points. Secondary outcomes were range of motion (ROM), medication consumption, and work status.

Results:

One hundred forty-six patients (43 women [29%], 103 men [71%]; mean age, 52 years; SD, 8 years) completed the study. Sixty-seven (46%) patients underwent rotator cuff repair. The mean time between the date the patient consented to have surgery and the date of surgery was 82 (SD, 44) days. There was a statistically significant improvement in ASES score and ROM and work status (52 returned to regular duties and 59 to modified duties) ( P < .0001). Eighty-four percent (n = 122) of patients exceeded the MCID of 17 points. Individual factors that affected patient overall disability were preoperative ASES, work status prior to surgery, access to care, and autonomy at work. Achieving a minimal clinically meaningful change was influenced by perceived access to care, autonomy and stress at work, and overall satisfaction with the job.

Conclusion:

Expedited rotator cuff surgery improved disability, ROM, and work status in injured workers. Successful recovery after work-related shoulder injuries may further be facilitated by improving the psychosocial work environment and increasing access to care.
Three-Dimensional CT Evaluation of Tunnel Positioning in ACL Reconstruction Using the Single Anteromedial Bundle Biological Augmentation (SAMBBA) Technique
Authors: Buscayret Florent , Temponi Eduardo Frois , Saithna Adnan , Thaunat Mathieu , Sonnery-Cottet Bertrand
Published: May 2017

Background:

Remnant preservation may confer important advantages in the anterior cruciate ligament (ACL)–reconstructed knee. However, the presence of a large remnant may obscure visualization and impair the ability to correctly place tunnels during surgery.

Purpose:

To determine whether tunnel placement during anatomic ACL reconstruction using the single anteromedial bundle biological augmentation (SAMBBA) technique is consistent and precise when a large native remnant is preserved.

Study Design:

Case series; Level of evidence, 4.

Methods:

Included in this study were 99 patients undergoing an ACL reconstruction during which at least 50% of the native ACL was preserved. The femoral tunnel was created using an outside-in specific guide. The tibial tunnel was positioned in the anteromedial region of the ACL footprint, and the remnant was carefully preserved while drilling and passing the semitendinosus graft through it. Postoperatively, 3-dimensional computed tomography (3D CT) was used to evaluate tunnel placement. The mean tunnel locations were calculated and the standard deviation was used to evaluate precision of positioning. Inter- and intrareader agreement were determined to assess reliability of evaluation of tunnel position.

Results:

The center of the femoral tunnel was positioned at a mean 19.4% (SD, 2%) of the depth of the notch and a mean 23.1% (SD, 3.5%) of the lateral wall height. The center of the tibial tunnel was positioned at a mean 36.3% (SD, 3.8%) of the anteroposterior length of the tibial plateau and at a mean 47.0% (SD, 2.7%) of the mediolateral width. The small standard deviations demonstrate that this technique allows precise tunnel placement. The tunnel positions achieved were consistent with previous anatomic studies of femoral and tibial anteromedial bundle insertion. Intra- and interobserver reliability were high.

Conclusion:

Three-dimensional CT evaluation demonstrated that despite the presence of a large remnant, placement of femoral and tibial tunnels for anatomic ACL reconstruction using the SAMBBA technique is consistent and precise.
Flexion Posteroanterior Radiographs Affect Both Enrollment for and Outcomes After Injection Therapy for Knee Osteoarthritis
Authors: Meyer Maximilian A. , Leroux Timothy S. , Levy David M. , Tilton Annemarie K. , Lewis Paul B. , Yanke Adam B. , Cole Brian J.
Published: May 2017

Background:

Knee injection therapy is less effective for severe osteoarthritis (OA), specifically Kellgren-Lawrence (KL) grade 4. Patient selection for knee injection trials has historically been based on extension anteroposterior (AP) radiographic evaluation; however, emerging evidence suggests that KL grading using a flexion posteroanterior (PA) radiograph more accurately and reproducibly predicts disease severity. The impact of radiographic view on patient selection and outcome after knee injection therapy remains unknown.

Hypothesis:

A 45° flexion PA radiograph will reveal more advanced knee OA in certain patients. These patients will report worse pre- and postinjection outcomes.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Four raters independently graded extension AP and flexion PA radiographs from 91 patients previously enrolled in a knee injection trial. Patients determined to have KL grade 4 OA by any rater on extension AP radiographs were excluded. Among included patients, those upgraded to KL grade 4 on flexion PA radiographs by at least 2 raters constituted group 2, while all remaining patients constituted group 1. Demographic data and patient-reported outcome scores before injection and at 6 weeks, 3 months, 6 months, and 12 months postinjection were compared between groups.

Results:

Overall, 64 patients met the inclusion criteria, of which 19 patients (30%) constituted group 2. Compared with group 1, patients in group 2 were older (58.7 vs 52.3 years, P = .02), had worse visual analog scale pain scores before (6.6 vs 5.3, P = .03) and 6 months after injection (5.3 vs 3.5, P = .01), had less improvement in both Lysholm (8.5 vs 20.5, P = .02) and Short Form–12 physical component (–2.2 vs 1.7, P = .03) scores from preinjection to 6 months postinjection, and had less improvement in both Lysholm (1.6 vs 13.1, P = .03) and Knee injury and Osteoarthritis Outcome Score sport subscale (–2.1 vs 16, P = .01) scores from preinjection to 12 months postinjection.

Conclusion:

One in 3 patients considered to have mild to moderate knee OA on extension AP radiography is upgraded to severe knee OA (KL grade 4) on flexion PA radiography. These patients report worse preinjection outcomes, worse pain scores at short-term follow-up, and decreased improvement in knee function scores between 6 months and 1 year postinjection.
An evaluation of automated chest radiography reading software for tuberculosis screening among public- and private-sector patients
Authors: Rahman Md Toufiq , Codlin Andrew J. , Rahman Md Mahfuzur , Nahar Ayenun , Reja Mehdi , Islam Tariqul , Qin Zhi Zhen , Khan Md Abdus Shakur , Banu Sayera , Creswell Jacob
Published: May 2017

Computer-aided reading (CAR) of medical images is becoming increasingly common, but few studies exist for CAR in tuberculosis (TB). We designed a prospective study evaluating CAR for chest radiography (CXR) as a triage tool before Xpert MTB/RIF (Xpert).

Consecutively enrolled adults in Dhaka, Bangladesh, with TB symptoms received CXR and Xpert. Each image was scored by CAR and graded by a radiologist. We compared CAR with the radiologist for sensitivity and specificity, area under the receiver operating characteristic curve (AUC), and calculated the potential Xpert tests saved.

A total of 18 036 individuals were enrolled. TB prevalence by Xpert was 15%. The radiologist graded 49% of CXRs as abnormal, resulting in 91% sensitivity and 58% specificity. At a similar sensitivity, CAR had a lower specificity (41%), saving fewer (36%) Xpert tests. The AUC for CAR was 0.74 (95% CI 0.73–0.75). CAR performance declined with increasing age. The radiologist grading was superior across all sub-analyses.

Using CAR can save Xpert tests, but the radiologist's specificity was superior. Differentiated CAR thresholds may be required for different populations. Access to, and costs of, human readers must be considered when deciding to use CAR software. More studies are needed to evaluate CAR using different screening approaches.
The addition of vildagliptin to metformin prevents the elevation of interleukin 1ß in patients with type 2 diabetes and coronary artery disease: a prospective, randomized, open-label study
Authors: Younis Arwa , Eskenazi Dana , Goldkorn Ronen , Leor Jonathan , Naftali-Shani Nili , Fisman Enrique Z. , Tenenbaum Alexander , Goldenberg Ilan , Klempfner Robert
Published: May 2017

Background

Patients with type 2 diabetes present with an accelerated atherosclerotic process. Animal evidence indicates that dipeptidyl peptidase-4 inhibitors (gliptins) have anti-inflammatory and anti-atherosclerotic effects, yet clinical data are scarcely available.

Design and methods

A prospective, randomized, open-label study was performed in 60 patients with coronary artery disease (CAD) and type 2 diabetes, who participated in a cardiac rehabilitation program. After a washout period of 3 weeks, patients were randomized in a 2:1 ratio to receive combined vildagliptin/metformin therapy (intervention group: n = 40) vs. metformin alone (control group: n = 20) for a total of 12 weeks. Blinded assessment of interleukin-1ß (IL-1ß, the primary endpoint), hemoglobin A1c (HbA1c), and high sensitivity C reactive protein (hsCRP), were performed at baseline and after 12 weeks.

Results

Mean age of study patients was 67 ± 9 years, 75% were males, and baseline HbA1c and inflammatory markers levels were similar between the two groups. At 12 weeks of follow up, levels of IL-1ß, hsCRP, and HbA1c were significantly lower in the intervention group as compared with the control group. There was a continuous elevation of IL-1ß among the control group, which was not observed in the intervention group (49 vs. 4%, respectively; p < 0.001). The hsCRP was lowered by 60% in the vildagliptin/metformin group vs. 23% in the metformin group (p < 0.01). Moreover, a significant relative reduction of the HbA1c was seen in the intervention group (7% reduction, p < 0.03).

Conclusion

The addition of vildagliptin to metformin treatment in patients with type 2 diabetes and CAD led to a significant suppression of the IL-1ß elevation during follow up. A significant relative reduction of hsCRP and HbA1c in the intervention group was also observed.

Trial registrationNCT01604213
Developing an innovative entity extraction method for unstructured data
Authors: Zaghloul Waleed , Trimi Silvana
Published: May 2017

The main goal of this study is to build high-precision extractors for entities such as Person and Organization as a good initial seed that can be used for training and learning in machine-learning systems, for the same categories, other categories, and across domains, languages, and applications. The improvement of entities extraction precision also increases the relationships extraction precision, which is particularly important in certain domains (such as intelligence systems, social networking, genetic studies, healthcare, etc.). These increases in precision improve the end users’ experience quality in using the extraction system because it lowers the time that users spend for training the system and correcting outputs, focusing more on analyzing the information extracted to make better data-driven decisions.
Current progress in understanding the molecular pathogenesis of burn scar contracture
Authors: Tan Jianglin , Wu Jun
Published: May 2017

Abnormal wound healing is likely to induce scar formation, leading to dysfunction, deformity, and psychological trauma in burn patients. Despite the advancement of medical care treatment, scar contracture in burn patients remains a challenge. Myofibroblasts play a key role in scar contracture. It has been demonstrated that myofibroblasts, as well as inflammatory cells, fibroblasts, endothelial cells, and epithelial cells, secrete transforming growth factor-β1 (TGF-β1) and other cytokines, which can promote persistent myofibroblast activation via a positive regulation loop. In addition to the cellular contribution, the microenvironments, including the mechanical tension and integrin family, are also involved in scar contracture. Most recently, eukaryotic initiation factor 6 (eIF6), an upstream regulator of TGF-β1, has been demonstrated to be involved in myofibroblast differentiation and contraction in both in vitro fibroblast-populated collagen lattice (FPCL) and in vivo external mechanical stretch models. Moreover, the data showed that P311 could induce the transdifferentiation of epidermal stem cells to myofibroblasts by upregulating TGF-β1 expression, which mediated myofibroblast contraction. In this review, we briefly described the most current progress on the biological function of myofibroblasts in scar contracture and subsequently summarized the molecular events that initiated contracture. This would help us better understand the molecular basis of scar contracture as well as to find a comprehensive strategy for preventing/managing scar contracture.