Category:
Hindfoot
Introduction/Purpose:
The number of calcaneus fractures per year continues to increase in the United States, resulting in an increased number of open reduction and internal ...fixation (ORIF)procedures to repair these injuries. These surgeries are notorious for post-operative complications, including post-surgical wound healing problems that occur in 16 to 43% of patients. Umbilical cord (UC) allograft has anti-inflammatory and anti-scarring properties and has been shown to promote healing of cutaneous wounds. The objective of this study was to evaluate the clinical and economic outcomes related to wound complications after ORIF management of calcaneal fractures with and without adjunctive UC.
Methods:
A clinical and economic evaluation was performed based on information pertaining to ORIF management obtained from the published literature and our previous clinical data of ORIF for calcaneal fractures with (n=20) and without adjunctive UC (n=20).
Results:
After ORIF for calcaneal fractures, 10% of patients that received adjunctive UC required wound care compared to 35% of patients didn't receive the adjunctive treatment. Similarly, the readmission and reoperation rate were higher in the control group compared to the UC treatment group (30% vs 10%, respectively). Available cost-effectiveness data demonstrated that treatment with UC results in an average cost-savings of $2,775.50 per person over a five-year period (total cost of $330, 500 vs. $386,010 in the UC and control group, respectively). Using available data that includes costs incurred from time off work, adjunctive UC allograft treatment resulted in an average cost-savings of $14,377.50 per patient over a four-year period (total cost of $704,260 vs. $991,810 in the UC and control group, respectively).
Conclusion:
Wound complications remain a significant burden to patient recovery and an economic burden to payors and providers. Based on our observed complications rates, adjunctive use of UC during ORIF management of calcaneal fractures may not only decrease wound complications but also reduce socioeconomic costs.
Land subsidence in urban environments is an increasingly prominent aspect in the monitoring and maintenance of urban infrastructures. In this study we update the subsidence information over Rome and ...its surroundings (already the subject of past research with other sensors) for the first time using Copernicus Sentinel-1 data and open source tools. With this aim, we have developed a fully automatic processing chain for land deformation monitoring using the European Space Agency (ESA) SentiNel Application Platform (SNAP) and Stanford Method for Persistent Scatterers (StaMPS). We have applied this automatic processing chain to more than 160 Sentinel-1A images over ascending and descending orbits to depict primarily the Line-Of-Sight ground deformation rates. Results of both geometries were then combined to compute the actual vertical motion component, which resulted in more than 2 million point targets, over their common area. Deformation measurements are in agreement with past studies over the city of Rome, identifying main subsidence areas in: (i) Fiumicino; (ii) along the Tiber River; (iii) Ostia and coastal area; (iv) Ostiense quarter; and (v) Tivoli area. Finally, post-processing of Persistent Scatterer Inteferometry (PSI) results, in a Geographical Information System (GIS) environment, for the extraction of ground displacements on urban infrastructures (including road networks, buildings and bridges) is considered.
Species with short life spans frequently show a close relationship between population abundance and environmental variation making these organisms potential indicator species of climatic variability. ...White (Penaeus setiferus), brown (P. aztecus), and pink (P. duorarum) penaeid shrimp typically have an annual life history and are of enormous ecological, cultural, and economic value to the southeastern United States and Gulf of Mexico. Within North Carolina, all three species rely on the Pamlico Sound, a large estuarine system that straddles Cape Hatteras, one of the most significant climate and biogeographic breaks in the world, as a nursery area. These characteristics make penaeid species within the Pamlico Sound a critical species-habitat complex for assessing climate impacts on fisheries. However, a comprehensive analysis of the influence of the environmental conditions that influence penaeid shrimp populations has been lacking in North Carolina. In this study, we used more than 30 years of data from two fishery-independent trawl surveys in the Pamlico Sound to examine the spatial distribution and abundance of adult brown, white, and pink shrimp and the environmental drivers associated with adult shrimp abundance and juvenile brown shrimp recruitment using numerical models. Brown shrimp recruitment models demonstrate that years with higher temperature, salinity, offshore windstress, and North Atlantic Oscillation phase predict increased abundance of juveniles. Additionally, models predicting adult brown, white, and pink shrimp abundance illustrate the importance of winter temperatures, windstress, salinity, the North Atlantic Oscillation index, and the abundance of spawning adult populations from the previous year on shrimp abundance. Our findings show a high degree of variability in shrimp abundance is explained by climate and environmental variation and indicate the importance of understanding these relationships in order to predict the impact of climate variability within ecosystems and develop climate-based adaptive management strategies for marine populations.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background:
Hip dysplasia is a common condition in active adults with hip pain that can lead to joint degeneration. Periacetabular osteotomy (PAO) is a common surgical treatment for hip dysplasia. ...The effect of this surgery on pain, function and quality of life (QOL) has not been systematically analysed.
Purpose:
In adults with hip dysplasia: (1) evaluate differences in pain, function and QOL in those undergoing PAO and healthy controls; (2) evaluate pre- to post-PAO changes in pain, function and QOL; (3) evaluate differences in pain, function and QOL in those with mild versus severe dysplasia, undergoing PAO; and (4) evaluate differences in pain, function and QOL in those having primary PAO versus those with previous hip arthroscopy.
Methods:
A comprehensive, reproducible search strategy was performed on 5 different databases. We included studies that assessed pain, function and QOL in adults undergoing PAO for hip dysplasia, using hip-specific patient reported outcomes measures.
Results:
From 5017 titles and abstracts screened, 62 studies were included. Meta-analysis showed PAO patients had worse outcomes pre- and post-PAO compared to healthy participants. Specifically, pain (standardised mean difference SMD 95% confidence interval CI): −4.05; −4.78 to −3.32), function (−2.81; −3.89 to −1.74), and QOL (−4.10; −4.43 to −3.77) were significantly poorer preoperatively.
Meta-analysis found patients experienced improvements following PAO. Pain improved from pre-surgery to 1-year (standardised paired difference SPD 1.35; 95% CI, 1.02–1.67) and 2 years postoperatively (1.35; 1.16–1.54). For function, the activities of daily living scores at 1 year (1.22; 1.09–1.35) and 2 years (1.06; 0.9–1.22) and QOL at 1 year (1.36; 1.22–1.5) and 2 years (1.3; 1.1–1.5) all improved. No difference was found between patients undergoing PAO with mild versus severe dysplasia.
Conclusions:
Before undergoing PAO surgery, adults with hip dysplasia have worse levels of pain, function and QOL compared to healthy participants. These levels improve following PAO, but do not reach the same level as their healthy participants.
Registration:
PROSPERO (CRD42020144748)
Summary Lactoferrin is a highly conserved protein from an evolutionary perspective, with a wide range of roles related to protection from infection and promotion of nutritional status. Infection, ...malnutrition and intestinal pathologies are key inter-related problems, represent important threats to survival and are associated with adverse long-term health outcomes after preterm birth. Lactoferrin is available as a commercial extract from bovine milk and offers potential as a therapeutic intervention for preterm infants modulating infections and intestinal pathologies. In this review we explore the structure, direct antimicrobial effects, modification of host immune function and gastrointestinal effects of lactoferrin. Current trial data are reviewed, and research priorities and challenges identified and discussed.
Developmental dysplasia of the hip (DDH) is a condition associated with hip pain and impairments. Periacetabular osteotomy (PAO) is a common surgical treatment for DDH. Outcomes following PAO have ...historically been based on radiology or patient reported outcomes, and not physical impairments.
To investigate differences in physical impairments in adults with DDH undergoing PAO compared with asymptomatic participants, and to investigate pre- to post-PAO changes in physical impairments.
Systematic review with meta-analysis.
A literature search was performed in five databases (MEDLINE, CINAHL, EMBASE, Sports Discuss, and PsychINFO), using the PRISMA checklist. Studies were considered eligible if patients were aged 15 years and older, treated with PAO for DDH and if they included a physical impairment outcome measure. Two independent reviewers performed data extraction and assessed methodological quality, using a modified version of the Downs and Black checklist.
Of 5,017 studies, 24 studies were included with 2190 patients. The methodological quality scores ranged from 39% to 88%. With low level of evidence, meta-analysis showed 58% of patients had a positive anterior impingement test (95%CI: 39-76%), prior to PAO and one to three years after PAO. Five years after PAO, the proportion fell to 17% (95%CI: 11-24%). Prior to PAO, patients with DDH walked with a lower peak hip extension angle, compared to asymptomatic participants (SMD 0.65 (95%CI 0.21-1.10). Best evidence synthesis of non-pooled data showed limited evidence of increased walking velocity, stride length and improved hip flexion and extension moment 18-months post-PAO compared to pre-op. Cadence, hip abduction and hip flexion strength did not change.
Most patients with DDH have a positive hip impingement test, pre-PAO. Compared to asymptomatic participants, patients with DDH demonstrate physical impairments during walking which appear to improve after surgery. Hip abduction and flexion strength did not change pre- to post-PAO.
1b.
Neglect poses a significant risk for children throughout their development and is often linked with serious consequences that reach into adulthood. The Child Neglect Questionnaire (CNQ) fills ...existing gaps by incorporating multiple perspectives from both parents and the child, as well as measuring the complex phenomenon of neglect multidimensionally. Furthermore, this measure addresses the need for an instrument specifically developed for late childhood (ages 10-12), as much of the extant evidence and corresponding measures focus on young children and their mothers. A panel of three psychologists, using Cicchetti’s model of child neglect as a theoretical guide, began by selecting items from an existing database. Results of exploratory and confirmatory factor analyses and item response theory demonstrated the unidimensionality of physical, emotional, educational, and supervision neglect as well as a second-order construct of child neglect. Analyses controlling for risk status due to father’s substance use disorder, socioeconomic status, and child’s ethnicity demonstrated that father’s and mother’s (parental) neglect, particularly in the child’s versions, had sound concurrent and predictive validity. Concurrently, at age 10-12, the child’s version of both parents’ neglect correlated with their parenting behaviors evaluated by other available measures. Prospectively, from 10-12 years of age to 11-13 years of age, parental neglect predicted child’s drug use frequency with coexisting psychological dysregulation, psychiatric symptoms, antisocial behavior, non-normative sexual behavior, involvement with deviant peers and leisure activities thus demonstrating sound predictive validity. Also, internal consistency and inter-rater reliability were excellent. The CNQ, particularly the child’s version, may thus be useful for detecting children at high risk for parental neglect.
Delay in care secondary to socioeconomic status (SES) and demographic factors represents an area for potential improvement. Reducing time to surgery in distal radius fracture (DRF) fixation may ...improve outcomes while reducing cost. The purpose of this study is to investigate the effect of SES on time to surgery in our study population.
Patients undergoing outpatient DRF surgery within an academic healthcare system during a 4-year period were reviewed. Time to surgery and demographic factors were analyzed. The US Census Bureau was used to determine median household income (MHI) for a patient's ZIP code; patients were stratified into three groups based on MHI.
A total of 413 patients met inclusion criteria. SES (14.7 d in the low-SES group, 14.0 d in the mid-SES group, and 11.1 d in the high-SES group,
= 0.00063), insurance (11.7 d for insured versus 16.3 d for Medicaid/uninsured,
< 0.0001), race (non-White group: 15.2 d versus White group: 10.9 d,
< 0.0001), and treatment facility (16.2 d at county hospital versus 10.9 d at university hospital,
< 0.0001) were associated with time to surgery in univariate analysis. Multivariate analysis found that only treatment facility was associated with time to surgery.
Non-White, uninsured/Medicaid individuals residing in low-SES areas may be more likely to receive care at a safety-net facility and are at greatest risk for delay in time to surgery. Measures aimed to reduce barriers to care, increase healthcare coverage, and improve patient education should be initiated to mitigate these disparities.
A “Dobsonian” telescope is a Newtonian optical tube assembly mounted on a very simple but largely effective alt-az mount, typically made from plywood or particle board. This style of mount was ...popularised in the USA by one John Dobson, an eccentric sometime monk, who saw simplicity as a way to proliferate affordable telescopes. In this he was successful to the point that he has been immortalised through the adoption of his name for this style of telescope. Telescope manufacturers embraced the notion as a cost-cutting measure that could help boost sales, while the ranks of Amateur Telescope Makers swelled as the viability of producing a telescope without the need for expensive machining was recognised. This step-change in approach could rightfully be termed a revolution.
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