Nina Hallowell was a medical sociologist, Professor of Social and Ethical Aspects of Genomics at the University of Oxford, and an active member of the editorial board of Health, Risk & Society. In ...this article I reflect on her contribution to the journal and to the interdisciplinary study of risk especially through her research on the risk of new genetic technologies, both its management and impact on those at-risk.
Introduction: A single-center, prospective randomized comparison of postoperative recovery between 23-gauge and 27-gauge surgical approaches in vitrectomy was performed. Methods: A single-center, ...prospective randomized comparison of postoperative recovery between 23-gauge and 27-gauge surgical approaches to evaluate efficiencies and postoperative outcomes of the two surgical gauges. Eighty patients who were scheduled to undergo pars plana vitrectomy (PPV) for floaters or macular surgery were treated with either 27-gauge or 23-gauge techniques and assessed for efficiency of the procedures as well as a variety of postop indicators of pain and inflammation. Results: 27-Gauge vitrectomy took 90 s more time compared to 23-gauge surgery. Wound closure was significantly easier in 27-gauge than 23-gauge. Less postoperative eye reddishness was seen in 27-gauge compared to 23-gauge. A trend towards less inflammation was seen in 27-gauge. Conclusion: Overall, the trial showed that 27-gauge has the better postoperative outcome compared to 23-gauge PPV. Combining vitrectomy with phaco-surgery did not influence the study outcome parameters.
Background. Due to an increasing stroke incidence, a lack of resources to implement effective rehabilitation and a significant proportion of patients with remaining impairments after treatment, there ...is a rise in demand for effective and prolonged rehabilitation. Development of self-rehabilitation programs provides an opportunity to meet these increasing demands.
Objective. The primary aim of this meta-analysis was to determine the effect of self-rehabilitation on motor outcomes, in comparison to conventional rehabilitation, among patients with stroke. The secondary aim was to assess the influence of trial location (continent), technology, time since stroke (acute/subacute vs chronic), dose (total training duration > vs ≤ 15 hours), and intervention design (self-rehabilitation in addition/substitution to conventional therapy) on effect of self-rehabilitation.
Methods. Studies were selected if participants were adults with stroke; the intervention consisted of a self-rehabilitation program defined as a tailored program where for most of the time, the patient performed rehabilitation exercises independently; the control group received conventional therapy; outcomes included motor function and activity; and the study was a randomized controlled trial with a PEDro score ≥5.
Results. Thirty-five trials were selected (2225 participants) and included in quantitative synthesis regarding motor outcomes. Trials had a median PEDro Score of 7 6–8. Self-rehabilitation programs were shown to be as effective as conventional therapy. Trial location, use of technology, stroke stage, and intervention design did not appear to have a significant influence on outcomes.
Conclusion. This meta-analysis showed low to moderate evidence that self-rehabilitation and conventional therapy efficacy was equally valuable for post-stroke motor function and activity.
Despite the interest in frugal innovation, both in research and in business practice, little is known about methods, approaches, or procedures that specifically support the systematic development of ...frugal innovations. In this article, we propose a novel approach that can be applied for developing frugal innovations, which also appears to be suitable for developing radical innovations. We present one in-depth case study that shows how the approach can be applied for successful concept development of a frugal and even radical innovation. The study follows an exploratory action research method conducted in a U.S. engineering company over 19 months. The action research resulted in a novel approach that we call objective-conflict-resolution (OCR). Applying this approach in the company led to the development of a frugal innovation-for which a patent application was submitted-that is significantly less expensive, requires fewer resources, and offers greater ease-of-use than previous solutions. The OCR approach has two main advantages over existing approaches. It can be applied for developing frugal and radical innovations when established approaches result in rather incremental solutions (such as value engineering) and is less complex and easier to implement than existing approaches that are deliberately used for developing radical solutions (such as TRIZ).
Abstract
Background
Post-thrombotic syndrome (PTS) is a common chronic consequence of deep vein thrombosis that affects the quality of life and is associated with substantial costs. In clinical ...practice, it is not possible to predict the individual patient risk. We develop and validate a practical two-step prediction tool for PTS in the acute and sub-acute phase of deep vein thrombosis.
Methods
Multivariable regression modelling with data from two prospective cohorts in which 479 (derivation) and 1,107 (validation) consecutive patients with objectively confirmed deep vein thrombosis of the leg, from thrombosis outpatient clinic of Maastricht University Medical Centre, the Netherlands (derivation) and Padua University hospital in Italy (validation), were included. PTS was defined as a Villalta score of ≥ 5 at least 6 months after acute thrombosis.
Results
Variables in the baseline model in the acute phase were: age, body mass index, sex, varicose veins, history of venous thrombosis, smoking status, provoked thrombosis and thrombus location. For the secondary model, the additional variable was residual vein obstruction. Optimism-corrected area under the receiver operating characteristic curves (AUCs) were 0.71 for the baseline model and 0.60 for the secondary model. Calibration plots showed well-calibrated predictions. External validation of the derived clinical risk scores was successful: AUC, 0.66 (95% confidence interval CI, 0.63–0.70) and 0.64 (95% CI, 0.60–0.69).
Conclusion
Individual risk for PTS in the acute phase of deep vein thrombosis can be predicted based on readily accessible baseline clinical and demographic characteristics. The individual risk in the sub-acute phase can be predicted with limited additional clinical characteristics.
The article examines the interplay between shop‐floor employees' educational levels, and firms' training strategies (expressed by the breadth of the training, the extent of the advanced IT training, ...and skills development in collaboration with local or national technical schools), leading to multinational companies' educational (mis)match in the context of the new model of manufacturing, known as ‘Industry 4.0.’ Following a survey of 26 senior managers from different companies operating in four advanced manufacturing industries (biotech, engineering, fashion and new materials) in five European countries (Germany, Italy, Spain, Sweden and the UK), a fuzzy‐set qualitative comparative analysis (fs/QCA) is applied. The results suggest several equifinal paths to corporate educational (mis)match. The findings reveal the need for a more hybridised coexistence between tertiary education and training activities, which can emerge from the cooperation of local actors (education/training institutions and businesses together). Tertiary education, training programmes focused on advanced IT skills, and collaborating with local knowledge providers can reinforce the effect; indeed, their presence (singly or in combination) intensifying the achievement of high levels of educational match. In the absence of these conditions (singly or in combination), a broad training programme can act as a counterbalance and vice versa. Policymakers should put in place tools to enable more inclusive access to collaborations between local businesses and knowledge providers, promoting an upgrade of educational programmes to develop shop‐floor workers who are more digitally aware, and better prepared to successfully undertake non‐routine cognitive tasks. This would foster the self‐sustainability and flourishing of advanced manufacturing in high‐income countries.
Use of oral contraceptives (OC) that combine a progestogen with synthetic ethinyl estradiol (EE) is associated with increased risk of venous thromboembolism. NOMAC/E2 is a new monophasic OC that ...combines nomegestrol acetate (NOMAC), a highly selective progestogen, with 17β-estradiol (E2). The study objective was to compare the effects on markers of haemostasis of NOMAC/E2 (2.5 mg/1.5 mg) versus the second-generation OC, levonorgestrel (LNG)/EE (100 μg/20 μg). Healthy women (age 18–38 years) received once-daily treatment for three consecutive 28-day cycles in a double-blind, randomised study: either NOMAC/E2 for 24 days with a four-day placebo interval (n=45) or LNG/EE for 21 days with a seven-day placebo interval (n=45) per cycle. Mean changes from baseline to end-of-treatment in coagulation markers, including prothrombin fragment 1+2 (primary endpoint), fibrinolysis markers and platelet functions were assessed. Mean prothrombin fragment 1+2 levels (primary endpoint) did not increase with NOMAC/E2 compared with LNG/EE ( –0.02 vs. +0.08 nM, p<0.01). Other significant differences between NOMAC/E2 and LNG/EE were mean changes in antithrombin (+0.3% vs. –4.4%, p<0.001), activated protein C resistance – normalised ratio (+0.20 vs. +0.46, p<0.01), D-dimer ( –53 vs. +43 ng/ml, p<0.001), plasminogen (+6% vs. +30%, p<0.0001) and plasminogen activator inhibitor-1 ( –3.1 vs. –8.0 ng/ml, p<0.001). There was no effect of either treatment on platelet aggregation. The NOMAC/E2 pill regimen has fewer adverse effects on blood biological coagulation and fibrinolysis markers than LNG/EE. This suggests that NOMAC/E2 could have a more favourable venous thromboembolism risk profile than LNG/EE; further epidemiological data are required to confirm this.
Pathological scars (PS), including hypertrophic scars (HTS) and keloids, are a common complication of poor wound healing that significantly affects patients' quality of life. Currently, there are ...several treatment options for PS, including surgery, drug therapy, radiation therapy, and biological therapy. However, these treatments still face major challenges such as low efficacy, high side effects, and a high risk of recurrence. Therefore, the search for safer and more effective treatments is particularly urgent. New materials often have less immune rejection, good histocompatibility, and can reduce secondary damage during treatment. New technology can also reduce the side effects of traditional treatments and the recurrence rate after treatment. Furthermore, derivative products of new materials and biomaterials can improve the therapeutic effect of new technologies on PS. Therefore, new technologies and innovative materials are considered better options for enhancing PS. This review concentrates on the use of two emerging technologies, microneedle (MN) and photodynamic therapy (PDT), and two novel materials, photosensitizers and exosomes (Exos), in the treatment of PS.
Digitalization of the economy is one of the priority tasks set in the development strategies of Kazakhstan. Currently, there is a rapid change in information and communication technologies (ICT). ...Emerging changes affect network technologies, computing and communication devices themselves, as well as data processing. As a result, information technologies are being used in an increasing number of spheres of human life and economic life. One of the relevant areas of scientific research is the sphere of the living environment, which is currently developing from the field of Smart Homes into the field of Smart City, Smart Transport system, etc.
Today, cities have become the main force of economic development and have taken a central place in production, consumption networks, the definition of social and economic relations and currently provide a significant share of the gross domestic product of many countries. Cities began to play a major role in national, regional, and global development. The quality of people's lives depends on them. Therefore, today, more than ever, special requirements are imposed on them, such as the availability of affordable urban infrastructure, high mobility, security of urban areas, environmental friendliness, and developed urban self-government. Governments and city government bodies are facing new challenges that should not only solve a whole range of emerging problems, but also carry out a radical transformation of cities. One of the key components of the transformation is intelligent electrical networks.
This article aims to identify and systematize technological, economic and other effects of the introduction of intelligent networks. The article analyzes current trends and approaches to urban planning with an emphasis on energy infrastructure. A comprehensive approach to the development of the power supply system is noted, the main directions of its intellectualization are highlighted. The general requirements for the "smart" power supply system of Astana are defined, a conceptual management model of the "smart" power system is developed, and the effects of its implementation are described.
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