bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis
Authors: Lin Xianfeng , Huang Kangmao , Zhu Guiqi , Huang Zhaobo , Qin An , Fan Shunwu 
Published: September 2016

Background:
Acupuncture reportedly relieves chronic knee pain and improves physical function in patients diagnosed with osteoarthritis, but the duration of these effects is controversial. The aim of this study was to evaluate the temporal effects of acupuncture on chronic knee pain due to knee osteoarthritis by means of a meta-analysis.

Methods:
The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for studies published through March 2015. Ten randomized controlled trials of acupuncture compared with sham acupuncture, usual care, or no intervention for chronic knee pain in patients with clinically diagnosed or radiographically confirmed knee osteoarthritis were included. All of the studies were available in English. Weighted mean differences (WMDs), 95% confidence intervals (CIs), publication bias, and heterogeneity were calculated.

Results:
The acupuncture groups showed superior pain improvement (p < 0.001; WMD = −1.24 [95% CI, −1.92 to −0.56]; I2 > 50%) and physical function (p < 0.001; WMD = 4.61 [95% CI, 2.24 to 6.97]; I2 > 50%) in the short term (up to 13 weeks). The acupuncture groups showed superior physical function (p = 0.016; WMD = 2.73 [95% CI, 0.51 to 4.94]; I2 > 50%) but not superior pain improvement (p = 0.199; WMD = −0.55 [95% CI, −1.39 to 0.29]; I2 > 50%) in the long term (up to 26 weeks). Subgroup analysis revealed that the acupuncture groups tended to have better outcomes compared with the controls. Significant publication bias was not detected (p > 0.05), but the heterogeneity of the studies was substantial.

Conclusions:
This meta-analysis demonstrates that acupuncture can improve short and long-term physical function, but it appears to provide only short-term pain relief in patients with chronic knee pain due to osteoarthritis.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Distribution of High-Volume Shoulder Arthroplasty Surgeons in the United States
Authors: Somerson Jeremy S. , Stein Brandon A. , Wirth Michael A. 
Published: September 2016

Background:
Access to total shoulder arthroplasty (TSA) may become a concern in the United States because of an aging and active population resulting in increased demand. As high-volume TSA surgeons have demonstrated superior outcomes, access to these surgeons is a matter of patient and public health policy interest. The release of the 2012 Medicare Provider Utilization and Payment Data Public Use File (MPUPD-PUF) in 2014 provided volume and reimbursement data for procedures performed by individual physicians participating in Medicare. This study analyzed surgeon prevalence, surgeon distribution, and factors associated with higher or lower surgeon prevalence in metropolitan areas.

Methods:
The MPUPD-PUF was reviewed for the 2012 calendar year, and data were extracted for all physicians who performed a minimum of 11 TSA procedures for Medicare beneficiaries. Physicians in each major metropolitan area (population of >1 million) were grouped together. Average reimbursement, number of high-volume TSA surgeons, and number of total procedures were calculated per major metropolitan area. The presence of an American Shoulder and Elbow Surgeons (ASES) fellowship program and mean geographic reimbursement were analyzed for association with the number of high-volume TSA surgeons.

Results:
The MPUPD-PUF included 774 surgeons across the United States who performed an annual minimum of 11 TSA procedures covered by Medicare, with a combined total of 19,505 TSA procedures. Of these surgeons, 45% practiced within major metropolitan areas with a population of >1 million. Surgeons who had completed an ASES fellowship had a higher volume of procedural claims (median, 26; range, 11 to 120) compared with other surgeons (median, 17; range, 11 to 163; p < 0.001). The distribution among major metropolitan areas was highly unequal, and more surgeons were present in cities with an ASES fellowship program.

Conclusions:
Access to high-volume shoulder arthroplasty surgeons by the Medicare population is lacking in multiple major metropolitan areas in the United States because of the uneven distribution of these surgeons. The method of analysis in this study allows for opportunities to target training programs as well as placement of physicians to ensure access to high-volume shoulder arthroplasty surgeons.
The Science of Health-Care Delivery
Authors: Sharan Alok D. , Weinstein James 
Published: September 2016

Abstract:
As the health-care system evolves toward delivering greater value for the patient, orthopaedic surgeons are continually being challenged to manage the health of a population. The traditional focus of scientific inquiry within orthopaedics has been at the individual patient level. The science of health-care delivery is an evolving field that is aimed at bringing rigorous inquiry into determining the proper organizational design that can deliver high-quality and low-cost care for a population. This article provides an overview of basic concepts involved in systems and organizational theory relevant to orthopaedic surgery.
Development and Validation of a Preoperative Surgical Site Infection Risk Score for Primary or Revision Knee and Hip Arthroplasty
Authors: Everhart Joshua S. , Andridge Rebecca R. , Scharschmidt Thomas J. , Mayerson Joel L. , Glassman Andrew H. , Lemeshow Stanley 
Published: September 2016

Background:
Surgical site infection (SSI) is a major complication following total joint arthroplasty. Host susceptibility to infection has emerged as an important predictor of SSI. The purpose of this study was to develop and validate a preoperative SSI risk-assessment tool for primary or revision knee and hip arthroplasty.

Methods:
Data for 6,789 patients who underwent total joint arthroplasty (from the years 2000 to 2011) were obtained from a single hospital system. SSI was defined as a superficial infection within 30 days or deep infection within 1 year. Logistic regression modeling was utilized to create a risk scoring system for a derivation sample (n = 5,789; 199 SSIs), with validation performed on a hold-out sample (a subset of observations chosen randomly from the initial sample to form a testing set; n = 1,000; 41 SSIs).

Results:
On the basis of logistic regression modeling, we created a scoring system to assess SSI risk (range, 0 to 35 points) that is the point sum of the following: primary hip arthroplasty (0 points); primary knee (1); revision hip (3); revision knee (3); non-insulin-dependent diabetes (1); insulin-dependent diabetes (1.5); chronic obstructive pulmonary disease (COPD) (1); inflammatory arthropathy (1.5); tobacco use (1.5); lower-extremity osteomyelitis or pyogenic arthritis (2); pelvis, thigh, or leg traumatic fracture (2); lower-extremity pathologic fracture (2.5); morbid obesity (2.5); primary bone cancer (4); reaction to prosthesis in the last 3 years (4); and history of staphylococcal septicemia (4.5). The risk score had good discriminatory capability (area under the ROC [receiver operating characteristic] curve = 0.77) and calibration (Hosmer-Lemeshow chi-square test, p = 0.34) and was validated using the independent sample (area under the ROC curve = 0.72). A small subset of patients (5.9%) had a >10% estimated infection risk.

Conclusions:
The patient comorbidities composing the risk score heavily influenced SSI risk for primary or revision knee and hip arthroplasty. We believe that infection risk can be objectively determined in a preoperative setting with the proposed SSI risk score.
Postoperative Limb-Offset Discrepancy Notably Affects Soft-Tissue Tension in Total Hip Arthroplasty
Authors: Takao Masaki , Nishii Takashi , Sakai Takashi , Sugano Nobuhiko 
Published: September 2016

Background:
Inadequate soft-tissue tension in total hip arthroplasty is regarded as one cause of dislocation or abductor muscle weakness. The purpose of the present study was to assess how the postoperative discrepancy in limb offset (consisting of both femoral offset and acetabular offset) affects soft-tissue tension compared with other factors among patients with unilateral hip disease undergoing total hip arthroplasty.

Methods:
A total of 89 consecutive patients underwent mini-incision total hip arthroplasty involving an anterolateral or posterior approach and with use of a computer navigation system. Soft-tissue tension was measured by applying traction amounting to 40% of body weight with the joint positioned at 0°, 15°, 30°, and 45° of flexion. The separation between the cup and the prosthetic head was measured using the navigation system.

Results:
The cup-head separation differed significantly for varying angles of flexion (p < 0.001), with the greatest distance noted at 15° of flexion (mean and standard deviation, 11 ± 5 mm). Stepwise multiple regression analysis showed that postoperative limb-offset discrepancy, an anterolateral approach, and preoperative abduction range of motion were correlated with the cup-head separation at 15° of flexion. Postoperative limb-offset discrepancy was negatively correlated with the cup-head separation at 0°, 15°, and 30° of flexion.

Conclusions:
Postoperative limb-offset discrepancy significantly affected the soft-tissue tension in total hip arthroplasty at varying degrees of flexion. This indicated that it is important to restore normal limb offset without overlengthening to obtain adequate soft-tissue tension in total hip arthroplasty.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Are We Prescribing Our Patients Too Much Pain Medication?
Authors: Grant Daniel R. , Schoenleber Scott J. , McCarthy Alicia M. , Neiss Geraldine I. , Yorgova Petya K. , Rogers Kenneth J. , Gabos Peter G. , Shah Suken A. 
Published: September 2016

Background:
Physicians play a role in the current prescription drug-abuse epidemic. Surgeons often prescribe more postoperative narcotic pain medication than patients routinely need. Although narcotics are effective for severe, acute, postoperative pain, few evidence-based guidelines exist regarding the routinely required amount and duration of use post-hospital discharge.

Methods:
Patients in a prospective cohort undergoing posterior spinal fusion for idiopathic scoliosis were asked preoperatively to rate their pain level, the level of pain expected each week postoperatively, and their pain tolerance. Post-discharge pain scores and narcotic use were reported at weekly intervals for 4 weeks postoperatively. Demographic data, preoperative Scoliosis Research Society (SRS)-22 scores, operative details, perioperative data, and self-reported pain levels were analyzed with respect to their association with total medication use and refills received. Disposal plans were also assessed.

Results:
Seventy-two patients were enrolled, and 85% completed the surveys. The mean patient age was 14.9 years; 69% of the patients were female. The cohort was divided into 3 groups on the basis of total medication usage. The mean number of pills used in the middle (average-use) group was 49 pills. In postoperative week 4, narcotic usage was minimal (a mean of 2.9 pills by the highest-use group). Also by this time point, pain scores had, on average, returned to preoperative levels. Older age, male sex, a higher body mass index, and a higher preoperative pain score were associated with increased narcotic use. Sixty-seven percent of the patients planned to dispose of their unused medication, although only 59% of those patients planned on doing so in a manner recommended by the U.S. Food and Drug Administration.

Conclusions:
Postoperative narcotic dosing may be improved by considering patient age, weight, sex, and preoperative pain score. The precise estimation of individual narcotic needs is complex. Patient and family education on the importance and proper method of narcotic disposal is an essential component of minimizing the availability of unused postoperative medication.

Level of Evidence:
Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Big Data Analytics Workflow to Safeguard ESP Operations in Real-Time
Authors: Gupta Supriya , Saputelli Luigi , Nikolaou Michael 
Published: September 2016

Abstract
The electrical submersible pump (ESP) is one of the most common forms of artificial lift pumping techniques used in the industry. ESP lift method helps maximize the production of recoverable oil by achieving higher drawdowns and larger fluid volume handling (Ratcliff, Gomez et al. 2013). Unpredictable and repeated ESP shutdowns often occur due to changes in well conditions, improper system design, and dynamic and changing operating environments (Takács 2009). Excessive shutdowns and trips greatly reduce the run-life of the ESP (El Gindy, Abdelmotaal et al. 2015). The associated equipment replacement or repair costs and related downtime and production losses are huge. E&P companies nowadays are deploying web-based monitoring platforms for real-time surveillance of essential ESP and well data. Acquiring and innovatively processing ESP operational data in real time using hybrid methods employing engineering principles and statistical methods can reveal patterns in data to distinguish between safe and unsafe operations, diagnostic measures to identify the issue and remedial actions to address the issue and take corrective action. In this manner, analytics based health monitoring platform can improve the way operators avoid ESP shutdowns which are commonly observed in remote well operations and help advance from supervised approach towards failure mitigation to a more practical approach by leveraging real time data.
This paper presents a big data analytics workflow that would allow field personnel and production engineering teams to quickly interpret trends and patterns in ESP operations, diagnose problems and take remedial actions to monitor and safeguard ESP operations. Adoption and integration of this ESP health management workflow with the real-time monitoring system can maximize equipment availability and save millions of dollars in replacement, maintenance and deferred or lost production.
Enhance Production in Tight-Casing with ESP in Artificial Sump
Authors: Bridges Jeffrey , Sikes Matthew , Kirk Jordan , Savela Danette 
Published: September 2016

AbstractEagle Ford Shale (EFS) wells are comprised of a combination of challenges that can quickly limit production potential. This paper will review a case history of a well where conventional lift methods were crippled by these challenges, so an electrical submersible pump (ESP) was tested after previous installations were uneconomical.Utilizing artificial sumps in gassy wells has proven valuable in larger casing sizes, but this well included an additional set of unique challenges. The challenges for the ESP system for this specific test included: (i) deviated wellbore; (ii) scale and corrosion issues; (iii) tight casing; (iv) high gas-to-liquid ratio; (v) gas slugging. To overcome these challenges, a slimline ESP system was installed inside an artificial sump to separate gas and operate smoothly during gas slug events. The system was equipped with a recirculation system to maintain cooling for the motor and a capillary line for continuous chemical treatment.This paper presents comparisons between different forms of artificial lift producing separately in the same well, as well as different forms operating concurrently in offset wells. Uncommon design and operation methods are presented with production results. The test concluded that a comprehensive design for downhole ESP equipment, including a chemical treatment plan, can increase production in an EFS well. Results included an improved drawdown rate, improved production, and no evidence of scale buildup. Additional benefits would include significantly increased time between well work overs and reduced number of system failures due to corrosion, resulting in a substantial reduction in non-productive time.The positive results of the test demonstrate how to achieve the beneficial economic impacts of a properly designed ESP system in the Eagle Ford Shale as compared to traditional artificial lift designs.
Improving Artificial Lift Design Through Dynamic Simulation
Authors: Nguyen H. T. , Mundo F. C. 
Published: September 2016

Abstract
In a low commodity price environment, the quickest and most cost efficient way to increase production is by optimizing the existing well stock. The objective of this paper is to describe the successful use of transient flow and dynamic simulation to optimize artificial lift systems in tight gas wells.
The most economical way to produce natural gas wells for the field in this study (Field A) is on a plunger lift system. However, optimal plunger lift relies heavily on certain wellbore conditions (e.g. liquid to gas ratio, differential pressure between the sand face and flow line, and annular and fracture volume). Dynamic simulation helped understand the optimal wellbore conditions for maximum plunger performance, optimized plunger lift cycles, and allowed engineers to develop a consistent plunger lift strategy across the field. Improved knowledge of the dynamics of the plunger lift system resulted in a few million dollars in cost savings by refining the selection criteria for candidate wells and reducing risks in well intervention execution.
Dynamic simulation was also utilized for rod pump optimization for a 40 well rod pump pilot program. Preliminary results of the pilot program suggested that the initial rod pump design performed below expectations. The pilot well produced at a low gas rate with a high annulus liquid level. Dynamic simulation was used to test and improve the existing rod pump design and best practices. Understanding the downhole dynamics of the system allowed the engineers to identify a choke in the system resulting in a false-high fluid level reading while simultaneously causing the pump to gas lock. An optimized rod pump design was created from the learnings and the design was executed in the field. As a result, the rod pump was able to fully pump off the annulus volume and the gas production was increased by 50%.
This paper discusses the methodology to match actual field data and investigate the downhole dynamics for plunger and rod pump operation using a commercial transient flow application. The learnings and observations from this study allowed engineers to answer key technical questions, to reduce project execution risks, and to increase gas production. In the end, dynamic simulation provided a quick way to improve existing designs, test new ideas, and refine operational procedures without the time and cost of field implementation.
Досвід лікування Ноліпрелом пацієнтів з артеріальною гіпертензією та цукровим діабетом 2-го типу в Україні (огляд досліджень)
Authors: Sirenko Yu.N. , Rekovets O.L. 
Published: September 2016

Дана стаття присвячена оцінці результатів 7 досліджень з Ноліпрелом у пацієнтів з артеріальною гіпертензією й цукровим діабетом 2-го типу, проведених в Україні: ПРАКТИК, ВЕКТОР ЖИЗНИ, СКИФ, СКИФ-2, ДИАГНОЗ, СТАТУС, UNIA. Усього в дослідження було включено 17 265 пацієнтів. У 94 % пацієнтів із цукровим діабетом була виявлена артеріальна гіпертензія. Середнє зниження офісного артеріального тиску (АТ) за всіма дослідженнями становило 36,7/17,6 мм рт.ст. Досягнення цільового рівня АТ відзначено в 77 % пацієнтів. Альбумінурія у пацієнтів із цукровим діабетом 2-го типу й артеріальною гіпертензією визначалася в 3 із 7 досліджень: СТАТУС (88,8 %), ПРАКТИК (30,8 %) і СКИФ (71 %). У середньому частота виявлення альбумінурії в дослідженнях становила 63,53 %. Швидкість клубочкової фільтрації (ШКФ) менше від 60 мл/хв визначалася в дослідженнях ПРАКТИК (31,3 % пацієнтів), СКИФ-2 (18,4 % пацієнтів). У середньому частота зниження ШКФ менше від 60 мл/хв у пацієнтів із цукровим діабетом 2-го типу й артеріальною гіпертензією становила 24,7 %. Гіпертрофія лівого шлуночка виявлена у 87,1 % пацієнтів. В Україні серед хворих на цукровий діабет 2-го типу спостерігається поганий контроль АТ у пацієнтів з високим ризиком серцево-судинних ускладнень. Основні причини поганого контролю АТ: лікарська інерція з недостатнім призначенням раціональних фіксованих комбінацій і адекватних доз препаратів. Усього в 7 дослідженнях у 25 пацієнтів з 17 265, включених в дослідження, спостерігалися побічні реакції, їх частота становила 0,13 %. Відміна препарату була в 0,02 % випадків.
Антигіпертензивна ефективність препарату Хітен (периндоприл) у хворих із м’якою та помірною артеріальною гіпертензією
Authors: Rekovets O.L. 
Published: September 2016

Мета: вивчити антигіпертензивну ефективність і переносимість препарату Хітен (периндоприл) виробництва компанії «Ауробіндо Фарма Лімітед», Індія, у хворих з м’якою й помірною артеріальною гіпертензією. Методи. У дослідження були включені 53 пацієнти. Здійснювався контроль офісного артеріального тиску (АТ) і частоти серцевих скорочень, ефективності проведеної терапії, реєструвалися випадки розвитку побічних реакцій, проводилися амбулаторне моніторування АТ, контроль біохімічних показників сироватки крові, загальний аналіз крові. Хітен у дозі 4–8 мг 1 раз на день призначався протягом 30 днів. У випадках, коли не було досягнуто цільового рівня офісного АТ, при необхідності додавався гідрохлортіазид у дозі 12,5 мг 1 раз на день. Загальний курс лікування для одного пацієнта становив 6 місяців. Середній вік хворих становив 51,38 ± 1,40 року, індекс маси тіла — 29,50 ± 0,59 кг/м2. Вихідний рівень офісного середнього систолічного АТ (САТ) і діастолічного АТ (ДАТ) у цілому по групі становив 156,77 ± 0,66 мм рт.ст. і 95,19 ± 0,98 мм рт.ст. Результати. Встановлено, що у хворих із м’якою і помірною артеріальною гіпертензією лікування Хітеном (периндоприлом) у дозі 4–8 мг (одним або в комбінації з гідрохлортіазидом) забезпечує достовірне зниження як офісного САТ — на 28,67 мм рт.ст. і ДАТ — на 14,57 мм рт.ст., так і середньодобового САТ — на 14,14 мм рт.ст. і ДАТ — на 7,55 мм рт.ст., а також зниження індексів часу й тиску. Цільовий АТ за даними офісного вимірювання (< 140/90 мм рт.ст.) було досягнуто у 88 %, за даними добового моніторування АТ (< 130/80 мм рт.ст.) — у 78 % випадків. Відміна препарату була в 3 пацієнтів (5,6 %). Висновок. Результати проведеного дослідження свідчать про високу антигіпертензивну ефективність і добру переносимість лікування Хітеном (периндоприлом) як монотерапії, так і в комбінації з гідрохлортіазидом у хворих з м’якою та помірною АГ.
Does the Ability of Operating Cash Flows to Measure Firm Performance Improve during Periods of Financial Distress?
Authors: Lee Jong Eun , Glasscock Robson , Park Myung Seok 
Published: September 2016

SYNOPSIS
This study examines whether the associations between stock returns and earnings, and stock returns and cash flows from operations (OCF), vary during periods of firm-specific financial distress. We find that a firm's stock returns are more strongly associated with its OCF than its earnings when the firm is in financial distress. In a regression of stock returns on both OCF and earnings, and interactions of these two variables with an indicator for financial distress, the Shapley value, which measures contribution to the regression R2, is higher for the interaction of OCF with distress than for the interaction of earnings with distress. We also find that the strength of the observed return-OCF relation increases in a market-wide crisis. These findings support the view that investors, in times of firm distress, place significantly more weight on OCF information than on earnings information.
JEL Classifications: G01; G10; M41.
Data Availability: Data used in this study are available from public sources identified in the study.