Functional Outcomes After Both Bone Forearm Fractures in Adults.

PubMed

Thayer, Mary K; Vaidya, Rahul; Langfitt, Maxwell; Carroll, Eben A; Cannada, Lisa K

2015-01-01

The purpose of this study was to evaluate midterm outcomes after both bone forearm fractures. A retrospective review of patients treated with open reduction and internal fixation (ORIF) at three level 1 trauma centers was completed. Eligible patients were sent three questionnaires: Disabilities of the Arm, Shoulder and Hand (DASH), Short Form-12 (SF-12), and questions about postinjury experience. Twenty-nine patients with an average age of 45 years returned the materials. The forms were completed an average of 60 months after ORIF. The mean DASH was 22 for all respondents. Twenty-one subjects participated in physical therapy (72%). Eight patients (28%) screened positive for posttraumatic stress disorder (PTSD). The mean SF-12 physical component score was 39 and the SF-12 mental component score was 40, both of which were lower than the non-PTSD group, indicating a lower subjective level of health (p < .05). The data suggest that, years after surgery, patients have decreased functional outcomes.

Influence of dominant- as compared with nondominant-side symptoms on Disabilities of the Arm, Shoulder and Hand and Western Ontario Rotator Cuff scores in patients with rotator cuff tendinopathy.

PubMed

Christiansen, David Høyrup; Michener, Lori; Roy, Jean-Sébastien

2018-02-13

The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Western Ontario Rotator Cuff (WORC) index are 2 widely used patient-reported questionnaires in individuals with rotator cuff (RC) tendinopathy. In contrast to the WORC index, for which the items are specific to the affected shoulder, the items of the DASH questionnaire assess the ability to perform activities regardless of the arm used. The objective of this study is to determine whether scores on the DASH questionnaire and WORC index are affected if the symptoms are on the dominant or nondominant side in individuals with RC tendinopathy. Given the number of items that can be influenced by dominance, the hypothesis is that DASH scores will be impacted by the side of the symptoms. Individuals with RC tendinopathy (N = 149) completed questions on symptomatology and hand dominance, the DASH questionnaire, and the WORC index. Differences in total scores (independent t test) and single items (Wilcoxon rank sum test) were compared between groups of participants with dominant-side symptoms and those without dominant-side symptoms. No significant differences were observed for WORC or DASH total scores when comparing participants with and without symptoms on their dominant side. Single-item comparison revealed more items being affected by symptom side on the DASH questionnaire (6 of 30 items) than on the WORC index (2 of 21 items). The side of the symptoms does not influence the DASH and WORC total scores, as there are no systematic differences between individuals with and without symptoms in their dominant shoulder. However, the presence of dominant symptoms does influence item scores more on the DASH questionnaire than on the WORC index. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Postoperative improvement in DASH score, clinical findings, and nerve conduction velocity in patients with cubital tunnel syndrome.

PubMed

Ido, Yoshikazu; Uchiyama, Shigeharu; Nakamura, Koichi; Itsubo, Toshiro; Hayashi, Masanori; Hata, Yukihiko; Imaeda, Toshihiko; Kato, Hiroyuki

2016-06-06

We investigated a recovery pattern in subjective and objective measures among 52 patients with cubital tunnel syndrome after anterior subcutaneous transposition of the ulnar nerve. Disabilities of the Arm, Shoulder and Hand (DASH) score (primary outcome), numbness score, grip and pinch strength, Semmes-Weinstein (SW) score, static 2-point discrimination (2PD) score, and motor conduction velocity (MCV) stage were examined preoperatively and 1, 3, 6, 12, and ≥24 months postoperatively. Statistical analyses were conducted to evaluate how each variable improved after surgery. A linear mixed-effects model was used for continuous variables (DASH score, numbness, grip and pinch strength), and a proportional odds model was used for categorical variables (SW and 2PD tests and MCV stages). DASH score significantly improved by 6 months. Significant recovery in numbness and SW test scores occurred at 1 month. Grip and pinch strength, 2PD test scores, and MCV stage improved by 3 months. DASH scores and numbness recovered regardless of age, sex, or disease severity. It was still unclear if both subjective and objective measures improved beyond 1-year postoperatively. These data are helpful for predicting postoperative recovery patterns and tend to be most important for patients prior to surgery.

Cross-cultural adaptation and clinical evaluation of a Korean version of the disabilities of arm, shoulder, and hand outcome questionnaire (K-DASH).

PubMed

Lee, Joo-Yup; Lim, Jae-Young; Oh, Joo Han; Ko, Young-Mi

2008-01-01

We developed a Korean version of the disabilities of arm, shoulder, and hand outcome questionnaire (K-DASH) by performing cross-cultural adaptation and evaluated the reliability and validity of the K-DASH. The K-DASH, SF-36, and Visual Analog Scale (VAS) for pain were administered to 161 patients with arm, shoulder, and hand problems. The internal consistency of the disability/symptom scores of the K-DASH was high (Cronbach's alpha 0.94). The retest assessed 131 of the 161 patients. The intraclass correlation coefficient was 0.91. The construct validity was evaluated using the correlations between the K-DASH and the SF-36 and VAS. The physical and mental component summary scales of the SF-36 and the VAS at rest and during activity were significantly correlated with the DASH disability/symptom scores. Despite the linguistic and cultural differences, the reliability and validity of the K-DASH were just as excellent as those of the original DASH.

Adherence to Dietary Approaches to Stop Hypertension (DASH) Dietary Pattern in Relation to Chronic Obstructive Pulmonary Disease (COPD): A Case-Control Study.

PubMed

Ardestani, Mohammad Emami; Onvani, Shokouh; Esmailzadeh, Ahmad; Feizi, Awat; Azadbakht, Leila

2017-01-01

This case-control study was designed to investigate the association between adherences to the Dietary Approaches to Stop Hypertension (DASH) diet in patients with chronic obstructive pulmonary disease (COPD) in comparison to subjects without COPD. This is a case-control study. Usual dietary intake was assessed using a validated food frequency questionnaire. Lung function was evaluated with spirometry testing, and one of the researchers inquired about other respiratory symptoms, including chronic cough, sputum, and breathlessness. Adherence to the DASH dietary pattern was assessed according to the Fung method. This study was conducted at Alzahra University Hospital of Isfahan, Iran, in 2015. Eight-four patients with COPD and 80 subjects without a history of COPD participated in study. The mean age of participants was 57 years. Average smoking in the case group was about 27.5 pack-years. Spirometry tests including forced expiratory volume in 1 second (FEV 1 ), forced vital capacity (FVC), and FEV 1 /FVC were significantly lower in patients with COPD (p = 0.0001). Among COPD symptoms, cough was significantly decreased across tertiles of DASH score (p = 0.03). Significant differences were found for DASH score between patients with COPD and control subjects (19.82 + 3.63 vs 21.13 + 3.82, p = 0.02). Vitamin C, vitamin E, and dietary fiber intake were lower in patients with COPD (144.32 + 70.51 vs 166.97 + 71.88, p = 0.04, 7.49 + 3.91 vs 8.72 + 3.21, p = 0.02 and 19.34 + 7.05 vs 22.19 + 7.87, p = 0.01, respectively). We observed that adherence to a DASH dietary pattern among patients with COPD was significantly lower compared to the control group. Cough was significantly decreased by increments in adherence to a DASH dietary pattern.

PROMIS Physical Function Computer Adaptive Test Compared With Other Upper Extremity Outcome Measures in the Evaluation of Proximal Humerus Fractures in Patients Older Than 60 Years.

PubMed

Morgan, Jordan H; Kallen, Michael A; Okike, Kanu; Lee, Olivia C; Vrahas, Mark S

2015-06-01

To compare the PROMIS Physical Function Computer Adaptive Test (PROMIS PF CAT) to commonly used traditional PF measures for the evaluation of patients with proximal humerus fractures. Prospective. Two Level I trauma centers. Forty-seven patients older than 60 years with displaced proximal humerus fractures treated between 2006 and 2009. Evaluation included completion of the PROMIS PF CAT, the Constant Shoulder Score, the Disabilities of the Arm, Shoulder, and Hand (DASH) and the Short Musculoskeletal Functional Assessment (SMFA). Observed correlations among the administered PF outcome measures. On average, patients responded to 86 outcome-related items for this study: 4 for the PROMIS PF CAT (range: 4-8 items), 6 for the Constant Shoulder Score, 30 for the DASH, and 46 for the SMFA. Time to complete the PROMIS PF CAT (median completion time = 98 seconds) was significantly less than that for the DASH (median completion time = 336 seconds, P < 0.001) and for the SMFA (median completion time = 482 seconds, P < 0.001). PROMIS PF CAT scores correlated statistically significantly and were of moderate-to-high magnitude with all other PF outcome measure scores administered. This study suggests using the PROMIS PF CAT as a sole PF outcome measure can yield an assessment of upper extremity function similar to those provided by traditional PF measures, while substantially reducing patient assessment time.

Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet in relation to obesity among Iranian female nurses.

PubMed

Barak, Farzaneh; Falahi, Ebrahim; Keshteli, Ammar Hassanzadeh; Yazdannik, Ahmadreza; Esmaillzadeh, Ahmad

2015-03-01

Limited observational studies have considered habitual consumption of the general population to examine the relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and obesity. The aim of the present study was to investigate adherence to the DASH diet in relation to general and central obesity among female nurses in Isfahan, Iran. Cross-sectional study carried out among 293 female nurses aged >30 years who were selected by a multistage, cluster random sampling method. Usual dietary intakes were assessed using a validated FFQ. We constructed the DASH score based on foods and nutrients emphasized or minimized in the DASH diet, focusing on eight components: high intake of fruits, vegetables, nuts and legumes, low-fat dairy products and whole grains and low intakes of sodium, sweetened beverages, and red and processed meats. General and abdominal obesity were defined as BMI ≥ 25 kg/m2 and waist circumference ≥ 88 cm, respectively. Isfahan, Iran. Female nurses (n 293) aged >30 years. Increased adherence to the DASH diet was associated with older age (P<0.01) and lower waist circumference (P=0.04). There was no statistically significant difference in the prevalence of general obesity between extreme quartiles of the DASH diet score. After adjustment for age, energy intake and other confounding factors, DASH diet score was not significantly associated with obesity. However, with further controlling for other dietary factors, those in the highest quartile of DASH diet score were 71 % less likely to have general obesity compared with those in the lowest quartile. In addition, following a DASH diet was inversely associated with central obesity after adjustment for potential confounders (OR=0.37; 95 % CI 0.14, 0.96). We found that adherence to the DASH diet was inversely related to central obesity among Iranian adult females. This association remained significant even after adjustment for potential confounders.

A Comparison of Ulnar Shortening Osteotomy Alone Versus Combined Arthroscopic Triangular Fibrocartilage Complex Debridement and Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

PubMed Central

Song, Hyun Seok

2011-01-01

Background This study compared the results of patients treated for ulnar impaction syndrome using an ulnar shortening osteotomy (USO) alone with those treated with combined arthroscopic debridement and USO. Methods The results of 27 wrists were reviewed retrospectively. They were divided into three groups: group A (USO alone, 10 cases), group B (combined arthroscopic debridement and USO, 9 cases), and group C (arthroscopic triangular fibrocartilage complex [TFCC] debridement alone, 8 cases). The wrist function was evaluated using the modified Mayo wrist score, disabilities of the arm, shoulder and hand (DASH) score and Chun and Palmer grading system. Results The modified Mayo wrist score in groups A, B, and C was 74.5 ± 8.9, 73.9 ± 11.6, and 61.3 ± 10.2, respectively (p < 0.05). The DASH score in groups A, B, and C was 15.6 ± 11.8, 19.3 ± 11.9, and 33.2 ± 8.5, respectively (p < 0.05). The average Chun and Palmer grading score in groups A and B was 85.7 ± 8.9 and 84.7 ± 6.7, respectively. The difference in the Mayo wrist score, DASH score and Chun and Palmer grading score between group A and B was not significant (p > 0.05). Conclusions Both USO alone and combined arthroscopic TFCC debridement with USO improved the wrist function and reduced the level of pain in the patients treated for ulnar impaction syndrome. USO alone may be the preferred method of treatment in patients if the torn flap of TFCC is not unstable. PMID:21909465

The use of Collagenase Clostridium Histolyticum in the management of Dupuytren's contracture-outcomes of a pilot study in a District General Hospital setting.

PubMed

Murphy, Lynn E; Murphy, Karen M; Kilpatrick, Shauneen M; Thompson, Neville W

2017-05-01

Collagenase Clostridium Histolyticum (CCH) is a recognised treatment option for adult patients presenting with Dupuytren's contracture (DC). Twenty male patients with established DC were treated using CCH. The average metacarpophalangeal (MCP) joint and proximal interphalangeal joint (PIP) contractures pre-treatment were 52 0 (range, 0 - 75 0 ) and 35 0 (range, 0 - 84 0 ) respectively. The average DASH score pre-treatment was 24.2 points (range, 0 - 68.2 points). Patients were reviewed at lmonth, 3months and at an average of 23 months (17 to 27 months). MCP joint contractures significantly improved compared to pre-treatment and the improvement was maintained at latest follow up. PIP joint contractures did significantly improve but to a lesser degree and there was no significant improvement compared to pre-treatment beyond 3months. A trend for MCP and PIP joint contracture recurrence was observed at latest follow up but did not reach statistical significance. DASH scores significantly improved from pre-treatment and the improvement was maintained at latest follow up. At 3months, the average patient satisfaction score was 9.5 (range, 6 - 10), which decreased to 8.6 (range, 6 - 10) at latest follow up. We estimated a potential cost saving of approximately £70,000 by treating 20 patients using CCH compared to inpatient operative fasciectomy. CCH is a useful option in the management of DC in appropriately selected patients. Cost-effectiveness in the treatment of DC should be carefully considered.

Degree of concordance with DASH diet guidelines and incidence of hypertension and fatal cardiovascular disease.

PubMed

Folsom, Aaron R; Parker, Emily D; Harnack, Lisa J

2007-03-01

Guidelines to prevent and treat hypertension advocate the Dietary Approaches to Stop Hypertension (DASH) diet. We studied whether a greater concordance with the DASH diet is associated with reduced incidence of hypertension (self-reported) and mortality from cardiovascular disease in 20,993 women initially aged 55 to 69 years. We created a DASH diet concordance score using food frequency data in 1986 and followed the women for events through 2002. No woman had perfect concordance with the DASH diet. Adjusted for age and energy intake, incidence of hypertension was inversely associated with the degree of concordance with the DASH diet, with hazard ratios across quintiles of 1.0, 0.91, 0.95, 0.99, and 0.87 (P trend = .02). There also were inverse, but not monotonic, associations between better DASH diet concordance and mortality from coronary heart disease, stroke, and all cardiovascular disease (CVD). However, after adjustment for other risk factors, there was little evidence that any end point was associated with the DASH diet score. Our results suggest that greater concordance with DASH guidelines did not have an independent long-term association with hypertension or cardiovascular mortality in this cohort. This implies that very high concordance, as achieved in the DASH trials, may be necessary to achieve any benefits of the DASH diet.

SURGICAL TREATMENT OF DISTAL RADIUS FRACTURES WITH A VOLAR LOCKED PLATE: CORRELATION OF CLINICAL AND RADIOGRAPHIC RESULTS

PubMed Central

Xavier, Claudio Roberto Martins; Dal Molin, Danilo Canesin; dos Santos, Rafael Mota Marins; dos Santos, Roberto Della Torre; Neto, Julio Cezar Ferreira

2015-01-01

Objectives: To analyze and correlate the clinical and radiographic results from patients with distal radius fractures who underwent surgical treatment with a fixed-angle volar locked plate. Methods: Sixty-four patients with distal radius fractures were evaluated. They all underwent surgical treatment with a volar locked plate for the distal radius, with a minimum of six months of postoperative follow-up. They underwent a physical examination that measured range of motion and grip strength, answered the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and underwent radiographic examination. Results: In the physical examination on the patients, all the range-of-motion measurements were reduced. Grip strength measured in kgf was on average 85.8% of the strength on the unaffected side. The mean DASH score was 15.99. A significant relationship was found between lower DASH scores and losses of extension and grip strength. On the radiographs, the mean values in relation to the unfractured side were 84.0% for radial inclination, 85.4% for radial length and 86.8% for volar deviation of the radius. Loss of radial length was correlated with losses of extension and grip strength. PMID:27027046

MIND diet slows cognitive decline with aging.

PubMed

Morris, Martha Clare; Tangney, Christy C; Wang, Yamin; Sacks, Frank M; Barnes, Lisa L; Bennett, David A; Aggarwal, Neelum T

2015-09-01

The Mediterranean and dash diets have been shown to slow cognitive decline; however, neither diet is specific to the nutrition literature on dementia prevention. We devised the Mediterranean-Dietary Approach to Systolic Hypertension (DASH) diet intervention for neurodegenerative delay (MIND) diet score that specifically captures dietary components shown to be neuroprotective and related it to change in cognition over an average 4.7 years among 960 participants of the Memory and Aging Project. In adjusted mixed models, the MIND score was positively associated with slower decline in global cognitive score (β = 0.0092; P < .0001) and with each of five cognitive domains. The difference in decline rates for being in the top tertile of MIND diet scores versus the lowest was equivalent to being 7.5 years younger in age. The study findings suggest that the MIND diet substantially slows cognitive decline with age. Replication of these findings in a dietary intervention trial would be required to verify its relevance to brain health. Copyright © 2015 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Clinical experience with arthroscopically-assisted repair of peripheral triangular fibrocartilage complex tears in adolescents--technique and results.

PubMed

Farr, Sebastian; Zechmann, Ulrike; Ganger, Rudolf; Girsch, Werner

2015-08-01

The purpose of this study was to report our preliminary results after arthroscopically-assisted repair of peripheral triangular fibrocartilage complex (TFCC) tears in adolescent patients. All children and adolescents who underwent arthroscopically-assisted repair of a Palmer 1B tear were identified and prospectively evaluated after a mean follow-up of 1.3 years. The postoperative assessment included documentation of clinical parameters, pain score (visual analogue scale, VAS), grip strength and completion of validated outcome scores (Modified Mayo Wrist Score, MMWS; Disabilities of the Arm, Shoulder and Hand Inventory, DASH). A total of 12 patients (four males, eight females) with a mean age of 16.3 years at the time of surgery were evaluated. The mean VAS decreased significantly from 7.0 to 1.7 after the procedure. We observed a significant increase of the MMWS after surgery; however, MMWS was still significantly lower at final follow-up when compared to the contralateral side. A mean postoperative DASH score of 16 indicated an excellent outcome after the procedure. DASH Sports and Work Modules showed fair and good overall outcomes in the short-term, respectively. Grip strength averaged 86 % of the contralateral side at final follow-up, with no significant difference being found between both sides. Arthroscopically-assisted repair of peripheral TFCC tears in adolescents provided predictable pain relief and markedly improved functional outcome scores. Concomitant pathologies may have to be addressed at the same time to eventually achieve a satisfactory outcome. Sports participation, however, may be compromised in the short-term and should therefore be resumed six months postoperatively.

The influence of education and income on responses to the QuickDASH questionnaire.

PubMed

Finsen, V

2015-05-01

We studied the influence of levels of income and education on QuickDASH scores. The scores were collected in a random sample of 1376 residents of Norway. The level of income was divided into four bands and level of education into five bands. The mean QuickDASH score for both men and women fell with every increase in education and income level. For women the mean score was 30 for those with the shortest education and 9 for those with the longest (p < 0.001). The corresponding figures for men were 19 and 7 (p < 0.01). The women with the lowest level of income had a mean score of 23, compared with 8 for women with the highest income level (p < 0.001). For men the corresponding mean scores were 20 and 5 (p < 0.001). Analysis of variance showed that age alone accounted for 16% of the variability of the scores among women and 7% among men. When levels of education and income were added to the analysis, these three factors accounted for 21% of the variability among women and 13% among men. We conclude that socioeconomic factors significantly influence QuickDASH scores. 3. © The Author(s) 2014.

The Association of Mediterranean and DASH Diets with Mortality in Adults on Hemodialysis: The DIET-HD Multinational Cohort Study.

PubMed

Saglimbene, Valeria M; Wong, Germaine; Craig, Jonathan C; Ruospo, Marinella; Palmer, Suetonia C; Campbell, Katrina; Garcia-Larsen, Vanessa; Natale, Patrizia; Teixeira-Pinto, Armando; Carrero, Juan-Jesus; Stenvinkel, Peter; Gargano, Letizia; Murgo, Angelo M; Johnson, David W; Tonelli, Marcello; Gelfman, Rubén; Celia, Eduardo; Ecder, Tevfik; Bernat, Amparo G; Del Castillo, Domingo; Timofte, Delia; Török, Marietta; Bednarek-Skublewska, Anna; Duława, Jan; Stroumza, Paul; Hoischen, Susanne; Hansis, Martin; Fabricius, Elisabeth; Felaco, Paolo; Wollheim, Charlotta; Hegbrant, Jörgen; Strippoli, Giovanni F M

2018-06-01

Background Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets associate with lower cardiovascular and all-cause mortality in the general population, but the benefits for patients on hemodialysis are uncertain. Methods Mediterranean and DASH diet scores were derived from the GA 2 LEN Food Frequency Questionnaire within the DIET-HD Study, a multinational cohort study of 9757 adults on hemodialysis. We conducted adjusted Cox regression analyses clustered by country to evaluate the association between diet score tertiles and all-cause and cardiovascular mortality (the lowest tertile was the reference category). Results During the median 2.7-year follow-up, 2087 deaths (829 cardiovascular deaths) occurred. The adjusted hazard ratios (95% confidence intervals) for the middle and highest Mediterranean diet score tertiles were 1.20 (1.01 to 1.41) and 1.14 (0.90 to 1.43), respectively, for cardiovascular mortality and 1.10 (0.99 to 1.22) and 1.01 (0.88 to 1.17), respectively, for all-cause mortality. Corresponding estimates for the same DASH diet score tertiles were 1.01 (0.85 to 1.21) and 1.19 (0.99 to 1.43), respectively, for cardiovascular mortality and 1.03 (0.92 to 1.15) and 1.00 (0.89 to 1.12), respectively, for all-cause mortality. The association between DASH diet score and all-cause death was modified by age ( P =0.03); adjusted hazard ratios for the middle and highest DASH diet score tertiles were 1.02 (0.81 to 1.29) and 0.70 (0.53 to 0.94), respectively, for younger patients (≤60 years old) and 1.05 (0.93 to 1.19) and 1.08 (0.95 to 1.23), respectively, for older patients. Conclusions Mediterranean and DASH diets did not associate with cardiovascular or total mortality in hemodialysis. Copyright © 2018 by the American Society of Nephrology.

Dietary Approaches to Stop Hypertension Diet, Weight Status, and Blood Pressure among Children and Adolescents: National Health and Nutrition Examination Surveys 2003-2012.

PubMed

Cohen, Juliana F W; Lehnerd, Megan E; Houser, Robert F; Rimm, Eric B

2017-09-01

The Dietary Approaches to Stop Hypertension (DASH) diet is associated with lower blood pressure and reduced risk of cardiovascular disease among adults, but little is known about accordance with this dietary pattern or health benefits among children and adolescents. The objectives were to evaluate accordance with the DASH diet, differences over time, and the association with health attributes among a nationally representative sample of US children and adolescents. Cross-sectional data from the 2003-2012 National Health and Nutrition Examination Surveys (NHANES) were analyzed. Data from 9,793 individuals aged 8 to 18 years were examined. DASH accordance was estimated based on nine nutrient targets: total fat, saturated fat, protein, cholesterol, fiber, calcium, magnesium, potassium, and sodium; possible score range is 0 to 9. Accordance with the DASH diet across time was examined comparing the 2011-2012 to 2003-2004 NHANES surveys. The association between DASH score and weight status was examined using multinomial logistic regression, and the associations with waist circumference, systolic blood pressure, and diastolic blood pressure were examined using multivariable linear regression. Accordance with the DASH diet was low across the age groups, with a range of mean DASH scores from 1.48 to 2.14. There were no significant changes across time. DASH score was inversely associated with systolic blood pressure (mm Hg) among 14- to 18-year-olds (β=-.46; 95% CI -.83 to -.09) among the larger sample of participants who completed at least one dietary recall, but no significant differences were seen in other age categories. In the subsample of participants with both dietary recalls, a significant inverse association was seen between DASH score and systolic blood pressure for 11- to 13-year-olds (β=-.57; 95% CI -1.02 to -.12). There were no significant associations between this dietary pattern and weight status, waist circumference, or diastolic blood pressure. Few US children and adolescents have diets that are in alignment with the DASH diet. Future research should explore strategies to encourage fruit, vegetable, and whole-grain consumption, as well as sodium reductions to help meet DASH nutrient targets in children and adolescents, as well as examine the potential benefits of this eating pattern on health in this population group. Copyright © 2017 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity.

PubMed

Armijo-Olivo, Susan; Woodhouse, Linda J; Steenstra, Ivan A; Gross, Douglas P

2016-12-01

To determine whether the Disabilities of the Arm, Shoulder, and Hand (DASH) tool added to the predictive ability of established prognostic factors, including patient demographic and clinical outcomes, to predict return to work (RTW) in injured workers with musculoskeletal (MSK) disorders of the upper extremity. A retrospective cohort study using a population-based database from the Workers' Compensation Board of Alberta (WCB-Alberta) that focused on claimants with upper extremity injuries was used. Besides the DASH, potential predictors included demographic, occupational, clinical and health usage variables. Outcome was receipt of compensation benefits after 3 months. To identify RTW predictors, a purposeful logistic modelling strategy was used. A series of receiver operating curve analyses were performed to determine which model provided the best discriminative ability. The sample included 3036 claimants with upper extremity injuries. The final model for predicting RTW included the total DASH score in addition to other established predictors. The area under the curve for this model was 0.77, which is interpreted as fair discrimination. This model was statistically significantly different than the model of established predictors alone (p<0.001). When comparing the DASH total score versus DASH item 23, a non-significant difference was obtained between the models (p=0.34). The DASH tool together with other established predictors significantly helped predict RTW after 3 months in participants with upper extremity MSK disorders. An appealing result for clinicians and busy researchers is that DASH item 23 has equal predictive ability to the total DASH score. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The anterolateral acromial approach for fractures of the proximal humerus.

PubMed

Gardner, Michael J; Boraiah, Sreevathsa; Helfet, David L; Lorich, Dean G

2008-02-01

Displaced and unstable fractures of the proximal humerus are notoriously difficult to manage. Successful surgical treatment requires finding the appropriate balance between adequate exposure for reduction and rigid fixation and minimizing soft tissue dissection. The anterolateral acromial approach was developed to allow less invasive treatment of proximal humerus fractures. The plane of the avascular anterior deltoid raphe is utilized, and the axillary nerve is identified and protected. Anterior dissection near the critical blood supply is avoided, substantial muscle retraction is minimized, and the lateral plating zone is directly accessed. Over a 4-year period, 52 patients with acute displaced fractures of the proximal humerus were treated with the anterolateral acromial approach and either a locking plate or an intramedullary nail. Twenty-three patients were evaluated clinically at a minimum follow-up of 1 year (average, 28 months) by clinical examination for range of motion and nerve function and a QuickDASH score. There were no axillary nerve deficits postoperatively related to the approach, and the average QuickDASH score was 25.2 (0, best; 100, worst). This approach allowed direct access to the lateral fracture planes for fracture reduction and plate placement or safe nail and interlocking screw placement.

Clinical outcomes after arthroscopic release for recalcitrant frozen shoulder.

PubMed

Ebrahimzadeh, Mohammad H; Moradi, Ali; Pour, Mostafa Khalili; Moghadam, Mohammad Hallaj; Kachooei, Amir Reza

2014-09-01

To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes.

Clinical Outcomes after Arthroscopic Release for Recalcitrant Frozen Shoulder

PubMed Central

Ebrahimzadeh, Mohammad H; Moradi, Ali; Pour, Mostafa Khalili; Moghadam, Mohammad Hallaj; Kachooei, Amir Reza

2014-01-01

Background: To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Methods: Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. Results: The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. Conclusions: According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes. PMID:25386586

Dietary habits, poverty, and chronic kidney disease in an urban population.

PubMed

Crews, Deidra C; Kuczmarski, Marie Fanelli; Miller, Edgar R; Zonderman, Alan B; Evans, Michele K; Powe, Neil R

2015-03-01

Poverty is associated with chronic kidney disease (CKD) in the United States and worldwide. Poor dietary habits may contribute to this disparity. Cross-sectional study. A total of 2,058 community-dwelling adults aged 30 to 64 years residing in Baltimore City, Maryland. Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet. DASH scoring based on 9 target nutrients (total fat, saturated fat, protein, fiber, cholesterol, calcium, magnesium, sodium, and potassium); adherence defined as score ≥4.5 of maximum possible score of 9. Poverty (self-reported household income <125% of 2004 Department of Health and Human Services guideline) and nonpoverty (≥125% of guideline). CKD defined as estimated glomerular filtration rate <60 mL/minute/1.73 m(2) (CKD epidemiology collaboration equation). Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) for relation of DASH score tertile and CKD, stratified by poverty status. Among 2,058 participants (mean age 48 years; 57% black; 44% male; 42% with poverty), median DASH score was low, 1.5 (interquartile range, 1-2.5). Only 5.4% were adherent. Poverty, male sex, black race, and smoking were more prevalent among the lower DASH score tertiles, whereas higher education and regular health care were more prevalent among the highest DASH score tertile (P < .05 for all). Fiber, calcium, magnesium, and potassium intake were lower, and cholesterol higher, among the poverty compared with nonpoverty group (P < .05 for all), with no difference in sodium intake. A total of 5.6% of the poverty and 3.8% of the nonpoverty group had CKD (P = .05). The lowest DASH tertile (compared with the highest) was associated with more CKD among the poverty (AOR 3.15, 95% confidence interval 1.51-6.56), but not among the nonpoverty group (AOR 0.73, 95% confidence interval 0.37-1.43; P interaction = .001). Poor dietary habits are strongly associated with CKD among the urban poor and may represent a target for interventions aimed at reducing disparities in CKD. Copyright © 2015 National Kidney Foundation, Inc. All rights reserved.

Dietary Habits, Poverty, and Chronic Kidney Disease in an Urban Population

PubMed Central

Crews, Deidra C.; Kuczmarski, Marie Fanelli; III, Edgar R. Miller; Zonderman, Alan B.; Evans, Michele K.; Powe, Neil R.

2014-01-01

Background Poverty is associated with chronic kidney disease (CKD) in the US and worldwide. Poor dietary habits may contribute to this disparity. Study Design Cross-sectional study. Setting & Participants 2,058 community-dwelling adults aged 30-64 years residing in Baltimore City, Maryland. Predictors Adherence to the Dietary Approaches to Stop Hypertension (DASH) diet. DASH scoring based on 9 target nutrients (total fat, saturated fat, protein, fiber, cholesterol, calcium, magnesium, sodium, and potassium); adherence defined as score ≥4.5 out of maximum possible score of 9. Poverty (self-reported household income <125% of 2004 Department of Health and Human Services guideline) and non-poverty (≥125% of guideline). Outcomes & Measurements CKD defined as estimated glomerular filtration rate <60mL/min/1.73m2 (CKD-EPI). Multivariable logistic regression used to calculate adjusted odds ratios (AORs) for relation of DASH score tertile and CKD, stratified by poverty status. Results Among 2,058 participants (mean age 48 years; 57% black; 44% male; 42% with poverty), median DASH score was low, 1.5 (IQR, 1-2.5). Only 5.4% were adherent. Poverty, male sex, black race, and smoking were more prevalent among the lower DASH score tertiles, while higher education and regular health care were more prevalent among the highest DASH score tertile (P<0.05 for all). Fiber, calcium, magnesium and potassium intake were lower, and cholesterol higher, among the poverty as compared to non-poverty group (P<0.05 for all), with no difference in sodium intake. A total of 5.6% of the poverty and 3.8% of the non-poverty group had CKD (P=0.05). The lowest DASH tertile (compared to the highest) was associated with more CKD among the poverty [AOR 3.15, 95% Confidence Interval (CI) 1.51-6.56], but not among the non-poverty group (AOR 0.73, 95% CI 0.37-1.43). P interaction 0.001. Conclusions Poor dietary habits are strongly associated with CKD among the urban poor and may represent a target for interventions aimed at reducing disparities in CKD. PMID:25238697

The association of the dietary approach to stop hypertension (DASH) diet with blood pressure, glucose and lipid profiles in Malaysian and Philippines populations.

PubMed

Tiong, X T; Nursara Shahirah, A; Pun, V C; Wong, K Y; Fong, A Y Y; Sy, R G; Castillo-Carandang, N T; Nang, E E K; Woodward, M; van Dam, R M; Tai, E S; Venkataraman, K

2018-05-07

Despite a growing body of evidence from Western populations on the health benefits of Dietary Approaches to Stop Hypertension (DASH) diets, their applicability in South East Asian settings is not clear. We examined cross-sectional associations between DASH diet and cardio-metabolic risk factors among 1837 Malaysian and 2898 Philippines participants in a multi-national cohort. Blood pressures, fasting lipid profile and fasting glucose were measured, and DASH score was computed based on a 22-item food frequency questionnaire. Older individuals, women, those not consuming alcohol and those undertaking regular physical activity were more likely to have higher DASH scores. In the Malaysian cohort, while total DASH score was not significantly associated with cardio-metabolic risk factors after adjusting for confounders, significant associations were observed for intake of green vegetable [0.011, standard error (SE): 0.004], and red and processed meat (-0.009, SE: 0.004) with total cholesterol. In the Philippines cohort, a 5-unit increase in total DASH score was significantly and inversely associated with systolic blood pressure (-1.41, SE: 0.40), diastolic blood pressure (-1.09, SE: 0.28), total cholesterol (-0.015, SE: 0.005), low-density lipoprotein cholesterol (-0.025, SE: 0.008), and triglyceride (-0.034, SE: 0.012) after adjusting for socio-demographic and lifestyle groups. Intake of milk and dairy products, red and processed meat, and sugared drinks were found to significantly associated with most risk factors. Differential associations of DASH diet and dietary components with cardio-metabolic risk factors by country suggest the need for country-specific tailoring of dietary interventions to improve cardio-metabolic risk profiles. Copyright © 2018 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Mediterranean and DASH Diet Scores and Mortality in Women with Heart Failure: The Women’s Health Initiative

PubMed Central

Levitan, Emily B.; Lewis, Cora E.; Tinker, Lesley F.; Eaton, Charles B.; Ahmed, Ali; Manson, JoAnn E.; Snetselaar, Linda G.; Martin, Lisa W.; Trevisan, Maurizio; Howard, Barbara V.; Shikany, James M.

2015-01-01

Background Current dietary recommendations for heart failure (HF) patients are largely based on data from non-HF populations; evidence regarding associations of dietary patterns with outcomes in HF is limited. We therefore evaluated associations of Mediterranean and DASH diet scores with mortality among postmenopausal women with HF. Methods and Results Women’s Health Initiative participants were followed from the date of HF hospitalization through the date of death or last participant contact prior to August 2009. Mediterranean and DASH diet scores were calculated from food-frequency questionnaires. Cox proportional hazards models adjusted for demographics, health behaviors, and health status were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). Over a median of 4.6 years of follow-up, 1,385 of 3,215 (43.1%) participants who experienced a HF hospitalization died. Multivariable-adjusted HRs were 1 (reference), 1.05 (95% CI 0.89–1.24), 0.97 (95% CI 0.81–1.17), and 0.85 (95% CI 0.70–1.02) across quartiles of the Mediterranean diet score (p-trend = 0.08) and 1 (reference), 1.04 (95% CI 0.89–1.21), 0.83 (95% CI 0.70–0.98), and 0.84 (95% CI 0.70–1.00) across quartiles of the DASH diet score (p-trend = 0.01). Diet score components vegetables, must, and whole grain intake were inversely associated with mortality. Conclusions Higher DASH diet scores were associated with modestly lower mortality in women with HF, and there was a non-significant trend towards an inverse association with Mediterranean diet scores. These data provide support for the concept that dietary recommendations developed for other cardiovascular conditions or general populations may also be appropriate in HF patients. PMID:24107587

Reliability, Validity, and Responsiveness of the QuickDASH in Patients With Upper Limb Amputation.

PubMed

Resnik, Linda; Borgia, Matthew

2015-09-01

To examine the internal consistency, test-retest reliability, validity, and responsiveness of the shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire in persons with upper limb amputation. Cross-sectional and longitudinal. Three sites participating in the U.S. Department of Veterans Affairs Home Study of the DEKA Arm. A convenience sample of upper limb amputees (N=44). Training with a multifunction upper limb prosthesis. Multiple outcome measures including the QuickDASH were administered twice within 1 week, and for a subset of 20 persons, after completion of in-laboratory training with the DEKA Arm. Scale alphas and intraclass correlation coefficient type 3,1 (ICC3,1) were used to examine reliability. Minimum detectable change (MDC) scores were calculated. Analyses of variance, comparing QuickDASH scores by the amount of prosthetic use and amputation level, were used for known-group validity analyses with alpha set at .05. Pairwise correlations between QuickDASH and other measures were used to examine concurrent validity. Responsiveness was measured by effect size (ES) and standardized response mean (SRM). QuickDASH alpha was .83, and ICC was .87 (95% confidence interval, .77-.93). MDC at the 95% confidence level (MDC95%) was 17.4. Full- or part-time prosthesis users had better QuickDASH scores compared with nonprosthesis users (P=.021), as did those with more distal amputations at both baseline (P=.042) and with the DEKA Arm (P=.024). The QuickDASH was correlated with concurrent measures of activity limitation as expected. The ES and SRM after training with the DEKA Arm were 0.6. This study provides evidence of reliability and validity of the QuickDASH in persons with upper limb amputation. Results provide preliminary evidence of responsiveness to prosthetic device type/training. Further research with a larger sample is needed to confirm results. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Functional incapacity related to rotator cuff syndrome in workers. Is it influenced by social characteristics and medical management?

PubMed

Champagne, Romain; Bodin, Julie; Fouquet, Natacha; Roquelaure, Yves; Petit, Audrey

2017-12-04

Survey. Rotator cuff syndrome (RCS) is one of the most common musculoskeletal disorders reported in workers. The functional incapacity related to RCS may vary according to the sociodemographic context and to the medical management. The purpose of this is to analyze the RCS-related functional incapacity assessed by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires in workers according to their sociodemographic characteristics and the use of care. A cross-sectional study was carried out on a French sample of workers diagnosed with RCS. The DASH and DASH-work scores were studied according to the sociodemographic factors, musculoskeletal symptoms, and RCS medical management during the preceding 12 months. Two hundred seven workers who suffered from RCS filled out the questionnaire of which 80% were still working. The DASH score was significantly higher in women (24.0 vs 17.4; P < .01; effect size (d) = 0.39), in patients over the age of 50 years (23.6 vs 11.3; P < .005) and in case of another upper limb musculoskeletal disorder (P < .0001; d ≥ 0.4). The DASH and DASH-work scores were significantly higher in case of use of care for RCS (P < .005; d > 0.6). The demographic factors and the RCS medical management influenced the overall incapacity assessed by the DASH questionnaire. Work incapacity was more especially related to the use of care for RCS. The sociodemographic and medical parameters added to other established predictors could help guide clinicians in managing their patients. Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Adherence to a healthy diet in relation to cardiovascular incidence and risk markers: evidence from the Caerphilly Prospective Study.

PubMed

Mertens, Elly; Markey, Oonagh; Geleijnse, Johanna M; Lovegrove, Julie A; Givens, D Ian

2018-04-01

Epidemiological findings indicate that higher adherence to a healthy diet may lower cardiovascular disease (CVD) risk. The present study aimed to investigate whether adherence to a healthy diet, assessed by the Healthy Diet Indicator (HDI), Dietary Approaches to Stop Hypertension (DASH) score, and Alternative Healthy Eating Index 2010 (AHEI-2010), was associated with CVD incidence and risk markers. Included in the present analyses were data from 1867 middle-aged men, aged 56.7 ± 4.5 years at baseline, recruited into the Caerphilly Prospective Study. Adherence to a healthy diet was examined in relation to CVD, coronary heart disease (CHD), and stroke incidence (Cox regression), and risk markers (linear regression) with adjustment for relevant confounders. The DASH score was inversely associated with CVD [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.66, 0.99], and stroke (HR 0.61; 95% CI 0.42, 0.88) incidence, but not with CHD after an average of 16.6 year follow-up, and with diastolic blood pressure, after 12 year follow-up. The AHEI-2010 was inversely associated with stroke (HR 0.66; 95% CI 0.42, 0.88) incidence, aortic pulse wave velocity, and C-reactive protein. The HDI was not associated with any single outcome. Higher DASH and AHEI-2010 scores were associated with lower CVD and stroke risk, and favourable cardiovascular health outcomes, suggesting that encouraging middle-aged men to comply with the dietary recommendations for a healthy diet may have important implications for future vascular disease and population health.

Standardized combined cryotherapy and compression using Cryo/Cuff after wrist arthroscopy.

PubMed

Meyer-Marcotty, M; Jungling, O; Vaske, B; Vogt, P M; Knobloch, Karsten

2011-02-01

cryotherapy and compression as integral part of the RICE regimen are thought to improve treatment outcome after sport injuries. Using standardized cryotherapy and compression perioperatively has been reported with conflicting clinical results. The impact of combined cryotherapy and compression is compared to standard care among patients undergoing wrist arthroscopy. fifty-six patients undergoing wrist arthroscopy were assessed, 54 patients were randomized to either Cryo/Cuff (3 × 10 min twice daily) or standard care over 3 weeks. Follow-up clinical visits were at postoperative days 1, 8, and 21. One patient in each group was lost during follow-up. Fifty-two patients were analyzed. Statistics were performed as Intention-to-treat analysis. Outcome parameters were pain, three-dimensional volume of the wrist, range of motion, and DASH score. the Cryo/Cuffgroup had a 49% reduction in pain level (VAS 3.5 ± 0.4 vs. VAS 1.8 ± 0.2 on the 21st postoperative day) when compared to a reduction of 41% in the control group (VAS 5.1 ± 0.6 preoperatively vs. VAS 3.0 ± 0.5 on the 21st postoperative day). Swelling and range of motion were not as significantly different between the two groups as were DASH scores (DASH-score Cryo/Cuff group preoperatively 37.3 ± 3.5 and postoperatively 36.9 ± 3.5; DASH-score control group preoperatively 42.8 ± 4.3 and postoperatively 41.9 ± 4.9). The CONSORT score reached 17 out of 22. there was no significant effect of additional home-based combined cryotherapy and compression using the Cryo/Cuff wrist bandage, following wrist arthroscopy regarding pain, swelling, range of motion, and subjective impairment assessed using the DASH score over 3 weeks in comparison with the control group.

The mini-incision technique for carpal tunnel release using nasal instruments in Chinese patients.

PubMed

Chen, Yanhua; Ji, Wei; Li, Tao; Cong, Xiaobin; Chen, Zhenbing

2017-08-01

Treatment of carpal tunnel syndrome (CTS) remains a challenge for hand surgeons. Carpal tunnel release (CTR) using nasal instruments has the advantages of both endoscopy and open surgery. In this study we aimed to explore the effectiveness of CTR using nasal instruments in Chinese patients.We present a case series of 49 cases of idiopathic CTS treated with the mini-incision technique using nasal instruments. The average recovery days before return to normal work and complications were recorded. The mean grip strength, pinch strength, and sensation were evaluated. Subjective results were evaluated using the visual analogue scale (VAS), Levine Carpal Tunnel Syndrome Questionnaire (LCTSQ), Disabilities of the Arm, Shoulder, and Hand (DASH), and Medical Outcomes Study (MOS) 36-item short-form health survey (SF-36).The mean follow-up was 13 months. No return of symptoms or blood vessel injury occurred. The incidence of scar tenderness was only 8.1%, later pillar pain (after 4 weeks) was 18.4%, and average recovery time to return to normal work was 23.7 days. The mean grip strength, pinch strength, and sensation were significantly improved (P < .001). The VAS, LCTSQ, and DASH survey postoperative mean scores were lower than the preoperative scores (P < .001). SF-36 scores were significantly increased following surgery (P < .001).We conclude that the mini-incision technique for CTR using nasal instruments in Chinese patients is safe, effective, and low cost. It is worthwhile for the technique to be promoted and used.

Predictors of return to work with upper limb disorders.

PubMed

Moshe, S; Izhaki, R; Chodick, G; Segal, N; Yagev, Y; Finestone, A S; Juven, Y

2015-10-01

Return to work (RTW) is a key goal in the proper management of upper limb disorders (ULDs). ULDs stem from diverse medical aetiologies and numerous variables can affect RTW. The abundance of factors, their complex interactions and the diversity of human behaviour make it difficult to pinpoint those at risk of not returning to work (NRTW) and to intervene effectively. To weigh various clinical, functional and occupational parameters that influence RTW in ULD sufferers and to identify significant predictors. A retrospective analysis of workers with ULD referred to an occupational health clinic and further examined by an occupational therapist. Functional assessment included objective and subject ive [Disability of the Arm, Shoulder and Hand (DASH) score] parameters. Quantification of work requirements was based on definitions from the Dictionary of Occupational Titles web site. RTW status was confirmed by a follow-up telephone questionnaire. Among the 52 subjects, the RTW rate was 42%. The DASH score for the RTW group was 27 compared with 56 in the NRTW group (P < 0.001). In multivariate analyses, only the DASH score was found to be a significant independent predictor of RTW (P < 0.05). Physicians and rehabilitation staff should regard a high DASH score as a warning sign when assessing RTW prospects in ULD cases. It may be advisable to focus on workers with a large discrepancy between high DASH scores and low objective disability and to concentrate efforts appropriately. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Dietary quality indices in relation to cardiometabolic risk among Finnish children aged 6-8 years - The PANIC study.

PubMed

Eloranta, A M; Schwab, U; Venäläinen, T; Kiiskinen, S; Lakka, H M; Laaksonen, D E; Lakka, T A; Lindi, V

2016-09-01

There are no studies on the relationships of dietary quality indices to the clustering of cardiometabolic risk factors in children. We therefore investigated the associations of four dietary quality indices with cardiometabolic risk score and cardiometabolic risk factors in Finnish children. Subjects were a population sample of 204 boys and 198 girls aged 6-8 years. We assessed diet by 4-day food records and calculated Dietary Approaches to Stop Hypertension (DASH) Score, Baltic Sea Diet Score (BSDS), Mediterranean Diet Score (MDS), and Finnish Children Healthy Eating Index (FCHEI). We calculated the age- and sex-adjusted cardiometabolic risk score summing up Z-scores for waist circumference, mean of systolic and diastolic blood pressure and concentrations of fasting serum insulin and fasting plasma glucose, triglycerides and HDL cholesterol, the last multiplying by -1. Higher FCHEI was associated with lower cardiometabolic risk score among boys (standardised regression coefficient β = -0.14, P = 0.044) adjusted for age, physical activity, electronic media time and household income. Higher DASH Score was related to a lower serum insulin in boys (β = -0.15, P = 0.028). Higher DASH Score (β = -0.16, P = 0.023) and FCHEI (β = -0.17, P = 0.014) were related to lower triglyceride concentration in boys. Higher FCHEI was associated with lower triglyceride concentration in girls (β = -0.16, P = 0.033). Higher DASH Score (β = -0.19, P = 0.011) and BSDS (β = -0.23, P = 0.001) were associated with lower plasma HDL cholesterol concentration in girls. Higher FCHEI was associated with lower cardiometabolic risk among boys, whereas DASH Score, BSDS or MDS were not associated with cardiometabolic risk in children. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Responsiveness of two Persian-versions of shoulder outcome measures following physiotherapy intervention in patients with shoulder disorders.

PubMed

Negahban, Hossein; Behtash, Zeinab; Sohani, Soheil Mansour; Salehi, Reza

2015-01-01

To identify the ability of the Persian-version of the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) to detect changes in shoulder function following physiotherapy intervention (i.e. responsiveness) and to determine the change score that indicates a meaningful change in functional ability of the patient (i.e. Minimally Clinically Important Difference (MCID)). A convenient sample of 200 Persian-speaking patients with shoulder disorders completed the SPADI and the DASH at baseline and then again 4 weeks after physiotherapy intervention. Furthermore, patients were asked to rate their global rating of shoulder function at follow-up. The responsiveness was evaluated using two methods: the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics extracted from the ROC method are the area under curve (AUC) and the optimal cutoff point called as MCID. Both the SPADI and the DASH showed the AUC of greater than 0.70 (AUC ranges = 0.77-0.82). The best cutoff points (or change scores) for the SPADI-total, SPADI-pain, SPADI-disability and the DASH were 14.88, 26.36, 23.86, and 25.41, respectively. Additionally, moderate to good correlations (Gamma = -0.51 to -0.58) were found between the changes in SPADI/DASH and changes in global rating scale. The Persian SPADI and DASH have adequate responsiveness to clinical changes in patients with shoulder disorders. Moreover, the MCIDs obtained in this study will help the clinicians and researchers to determine if a Persian-speaking patient with shoulder disorder has experienced a true change following a physiotherapy intervention. Implications for Rehabilitation Responsiveness was evaluated using two methods; the receiver operating characteristics (ROC) method and the correlation analysis. The Persian SPADI and DASH can be used as two responsive instruments in both clinical practice and research settings. The MCIDs of 14.88 and 25.41 points obtained for the SPADI-total and DASH indicated that the change scores of at least 14.88 points on the SPADI-total and 25.41 points on the DASH is necessary to certain that a true change has occurred following a physiotherapy intervention.

[Unidirectional versus multidirectional palmar locking osteosynthesis of unstable distal radius fractures: comparative analysis with LDR 2.4 mm versus 2.7 mm matrix-Smartlock].

PubMed

Hakimi, M; Jungbluth, P; Gehrmann, S; Nowak, J; Windolf, J; Wild, M

2010-03-01

Due to advances in the development of the unidirectional locking plates there is now an increased use of multidirectional palmar locking plates in the treatment of distal radius factures. The purpose of this study was to evaluate a possible improvement of the treatment and results. This prospective cohort study investigated 40 patients with C1 and C2 Colles' fractures who had been treated with unidirectional and multidirectional locking plates. The average time for the follow-up examinations was 12.3 months (range 12-15 months) after surgery. The intra-operative functional (neutral-zero method), radiological and subjective (DASH score, VAS) results were evaluated. The intra-operative fluoroscopy time of the unidirectional group was 58 s shorter compared to the multidirectional group. All fractures healed without any complication. The radiological, subjective (DASH score) and objective results for both groups were good and showed no differences. Unidirectional palmar locking plates are equally suited for the therapy of C1 and C2 fractures as multidirectional palmar locking plates but multidirectional plates require a longer fluoroscopy time.

The concurrent validity of the Amharic version of Screening of Activity Limitation and Safety Awareness (SALSA) in persons affected by leprosy.

PubMed

Wijk, Ulrika; Brandsma, J Wim; Dahlström, Orjan; Björk, Mathilda

2013-03-01

Leprosy is endemic in many countries and results in activity limitations. There is a need for assessment tools to guide professionals in their evaluation and choice of intervention in order to improve conditions for leprosy-affected people. The purpose of our study was to evaluate the concurrent validity of the Amharic version of Screening of Activity Limitation and Safety Awareness (SALSA-am) scale with Amharic version of Disability of the Arm, Shoulder and Hand (DASH-am) questionnaire. Thirty-eight individuals with nerve damage due to leprosy completed the SALSA-am and DASH-am questionnaires. Spearman's rank correlation was used to determine relationships between SALSA and DASH scores. Specificity, sensitivity and accuracy were calculated. There was a good correlation 0.87 (P < 0.001) between SALSA-am and DASH-am scores. Sensitivity, specificity and accuracy were calculated with acceptable results. SALSA-am is considered a useful questionnaire for determining activity limitations in persons affected by leprosy, and showed good correlation with DASH-am. The concurrent validity was considered good.

Construct validity of the canadian occupational performance measure in participants with tendon injury and Dupuytren disease.

PubMed

van de Ven-Stevens, Lucelle A W; Graff, Maud J L; Peters, Marlijn A M; van der Linde, Harmen; Geurts, Alexander C H

2015-05-01

In patient-centered practice, instruments need to assess outcomes that are meaningful to patients with hand conditions. It is unclear which assessment tools address these subjective perspectives best. The aim of this study was to establish the construct validity of the Canadian Occupational Performance Measure (COPM) in relation to the Disabilities of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes Questionnaire (MHQ) in people with hand conditions. It was hypothesized that COPM scores would correlate with DASH and MHQ total scores only to a moderate degree and that the COPM, DASH questionnaire, and MHQ would all correlate weakly with measures of hand impairments. This was a validation study. The COPM, DASH questionnaire, and MHQ were scored, and then hand impairments were measured (pain [numerical rating scale], active range of motion [goniometer], grip strength [dynamometer], and pinch grip strength [pinch meter]). People who had received postsurgery rehabilitation for flexor tendon injuries, extensor tendon injuries, or Dupuytren disease were eligible. Seventy-two participants were included. For all diagnosis groups, the Pearson coefficient of correlation between the DASH questionnaire and the MHQ was higher than .60, whereas the correlation between the performance scale of the COPM and either the DASH questionnaire or the MHQ was lower than .51. Correlations of these assessment tools with measures of hand impairments were lower than .46. The small sample sizes may limit the generalization of the results. The results supported the hypotheses and, thus, the construct validity of the COPM after surgery in people with hand conditions. © 2015 American Physical Therapy Association.

The mini-incision technique for carpal tunnel release using nasal instruments in Chinese patients

PubMed Central

Chen, Yanhua; Ji, Wei; Li, Tao; Cong, Xiaobin; Chen, Zhenbing

2017-01-01

Abstract Treatment of carpal tunnel syndrome (CTS) remains a challenge for hand surgeons. Carpal tunnel release (CTR) using nasal instruments has the advantages of both endoscopy and open surgery. In this study we aimed to explore the effectiveness of CTR using nasal instruments in Chinese patients. We present a case series of 49 cases of idiopathic CTS treated with the mini-incision technique using nasal instruments. The average recovery days before return to normal work and complications were recorded. The mean grip strength, pinch strength, and sensation were evaluated. Subjective results were evaluated using the visual analogue scale (VAS), Levine Carpal Tunnel Syndrome Questionnaire (LCTSQ), Disabilities of the Arm, Shoulder, and Hand (DASH), and Medical Outcomes Study (MOS) 36-item short-form health survey (SF-36). The mean follow-up was 13 months. No return of symptoms or blood vessel injury occurred. The incidence of scar tenderness was only 8.1%, later pillar pain (after 4 weeks) was 18.4%, and average recovery time to return to normal work was 23.7 days. The mean grip strength, pinch strength, and sensation were significantly improved (P < .001). The VAS, LCTSQ, and DASH survey postoperative mean scores were lower than the preoperative scores (P < .001). SF-36 scores were significantly increased following surgery (P < .001). We conclude that the mini-incision technique for CTR using nasal instruments in Chinese patients is safe, effective, and low cost. It is worthwhile for the technique to be promoted and used. PMID:28767593

Adherence to the DASH diet in relation to psychological profile of Iranian adults.

PubMed

Valipour, Ghazaleh; Esmaillzadeh, Ahmad; Azadbakht, Leila; Afshar, Hamid; Hassanzadeh, Ammar; Adibi, Peyman

2017-02-01

Although empirically derived dietary patterns have been examined in relation to depression, limited data are available linking theory-based dietary patterns and psychological health. We aimed to investigate the association between adherence to DASH-style diet and psychological health among Iranian adults. This cross-sectional study was done among 3846 general public adults in Isfahan, Iran. Dietary assessment was conducted using a validated 106-item dish-based semiquantitative food frequency questionnaire. To investigate participants' adherence to DASH-style diet, we created DASH score based on earlier publications focusing on eight components (fruits, vegetables, nuts and legumes, dairy products, grains, sweetened beverages and sweets, sodium, and red and processed meats). Participants were classified into three categories based on their DASH score [low (≤40), moderate (41-50), and high adherence (≥51)]. This categorization, instead of distribution-based classification, was used due to low adherence to the DASH dietary pattern in the study population. Psychological health was examined by means of validated Hospital Anxiety and Depression Scale and General Health Questionnaire. Depression, anxiety, and psychological distress were defined based on standard criteria. We found that moderate adherence to DASH-style diet was associated with lower odds of depression (OR 0.73; 95 % CI 0.59-0.90, P trend  = 0.63) compared with those with the lowest adherence. In our stratified analyses, these associations remained significant for women (0.70; 0.54-0.91) and for normal-weight participants (0.70; 0.52-0.92). Moreover, after controlling for potential confounders, an inverse association was observed between high adherence to DASH-style diet and anxiety in normal-weight participants (0.61; 0.37-0.98). Such associations were also seen between moderate adherence to DASH-eating style and anxiety in overweight or obese individuals (0.63; 0.42-0.95). We failed to find any significant association between consumption of DASH-style diet and psychological distress. We found an inverse association between moderate adherence to DASH dietary pattern and depression. Further prospective studies are required to confirm these findings.

Clinical rating systems in elbow research-a systematic review exploring trends and distributions of use.

PubMed

Evans, Jonathan P; Smith, Chris D; Fine, Nicola F; Porter, Ian; Gangannagaripalli, Jaheeda; Goodwin, Victoria A; Valderas, Jose M

2018-04-01

Clinical rating systems are used as outcome measures in clinical trials and attempt to gauge the patient's view of his or her own health. The choice of clinical rating system should be supported by its performance against established quality standards. A search strategy was developed to identify all studies that reported the use of clinical rating systems in the elbow literature. The strategy was run from inception in Medline Embase and CINHAL. Data extraction identified the date of publication, country of data collection, pathology assessed, and the outcome measure used. We identified 980 studies that reported clinical rating system use. Seventy-two separate rating systems were identified. Forty-one percent of studies used ≥2 separate measures. Overall, 54% of studies used the Mayo Elbow Performance Score (MEPS). For arthroplasty, 82% used MEPS, 17% used Disabilities of Arm, Shoulder and Hand (DASH), and 7% used QuickDASH. For trauma, 66.7% used MEPS, 32% used DASH, and 23% used the Morrey Score. For tendinopathy, 31% used DASH, 23% used Patient-Rated Tennis Elbow Evaluation (PRTEE), and 13% used MEPS. Over time, there was an increased proportional use of the MEPS, DASH, QuickDASH, PRTEE, and the Oxford Elbow Score. This study identified a wide choice and usage of clinical rating systems in the elbow literature. Numerous studies reported measures without a history of either a specific pathology or cross-cultural validation. Interpretability and comparison of outcomes is dependent on the unification of outcome measure choice. This was not demonstrated currently. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Distal biceps tendon rupture reconstruction using muscle-splitting double-incision approach

PubMed Central

Tarallo, Luigi; Mugnai, Raffaele; Zambianchi, Francesco; Adani, Roberto; Catani, Fabio

2014-01-01

AIM: To evaluate the clinical and functional results after repair of distal biceps tendon tears, following the Morrey’s modified double-incision approach. METHODS: We retrospectively reviewed 47 patients with distal rupture of biceps brachii treated between 2003 and 2012 in our Orthopedic Department with muscle-splitting double-incision technique. Outcome measures included the Mayo elbow performance, the DASH questionnaire, patient’s satisfaction, elbow and forearm motion, grip strength and complications occurrence. RESULTS: At an average 18 mo follow-up (range, 7 mo-10 years) the average Mayo elbow performance and DASH score were respectively 97.2 and 4.8. The elbow flexion range was 94%, extension was -2°, supination was 93% and pronation 96% compared with the uninjured limb. The mean grip strength, expressed as percentage of respective contralateral limb, was 83%. The average patient satisfaction rating on a Likert scale (from 0 to 10) was 9.4. The following complications were observed: 3 cases of heterotopic ossification (6.4%), one (2.1%) re-rupture of the tendon at the site of reattachment and 2 cases (4.3%) of posterior interosseous nerve palsy. No complication required further surgical treatment. CONCLUSION: This technique allows an anatomic reattachment of distal biceps tendon at the radial tuberosity providing full functional recovery with low complication rate. PMID:25133147

A priori-defined diet quality indices, biomarkers and risk for type 2 diabetes in five ethnic groups: the Multiethnic Cohort.

PubMed

Jacobs, Simone; Boushey, Carol J; Franke, Adrian A; Shvetsov, Yurii B; Monroe, Kristine R; Haiman, Christopher A; Kolonel, Laurence N; Le Marchand, Loic; Maskarinec, Gertraud

2017-08-01

Dietary indices have been related to risk for type 2 diabetes (T2D) predominantly in white populations. The present study evaluated this association in the ethnically diverse Multiethnic Cohort and examined four diet quality indices in relation to T2D risk, homoeostatic model assessment-estimated insulin resistance (HOMA-IR) and biomarkers of dyslipidaemia, inflammation and adipokines. The T2D analysis included 166 550 white, African American, Native Hawaiian, Japanese American and Latino participants (9200 incident T2D cases). Dietary intake was assessed at baseline using a quantitative FFQ and T2D status was based on three self-reports and confirmed by administrative data. Biomarkers were assessed about 10 years later in a biomarker subcohort (n 10 060). Sex- and ethnicity-specific hazard ratios were calculated for the Healthy Eating Index-2010 (HEI-2010), the alternative HEI-2010 (AHEI-2010), the alternate Mediterranean diet score (aMED) and the Dietary Approaches to Stop Hypertension (DASH). Multivariable-adjusted means of biomarkers were compared across dietary index tertiles in the biomarker subcohort. The AHEI-2010, aMED (in men only) and DASH scores were related to a 10-20 % lower T2D risk, with the strongest associations in whites and the direction of the relationships mostly consistent across ethnic groups. Higher scores on the four indices were related to lower HOMA-IR, TAG and C-reactive protein concentrations, not related to leptin, and the DASH score was directly associated with adiponectin. The AHEI-2010 and DASH were directly related to HDL-cholesterol in women. Potential underlying biological mechanisms linking diet quality and T2D risk are an improved lipid profile and reduced systemic inflammation and, with regards to DASH alone, an improved adiponectin profile.

Combat Casualty Hand Burns: Evaluating Impairment and Disability during Recovery

DTIC Science & Technology

2008-06-01

impairment guidelines would correlate with disability as mea- sured by the DASH. However, a study by Mink van der Molen et al. found only a weak correlation (r...Mink van der Molen AB, Ettema AM, Hovius SER. Outcome of hand trauma: the hand injury severity scoring system (HISS) and subsequent impairment and...0.38) between AMA and DASH scores at six months after hand trauma.16 In another study, van Oosterom et al. reported no statistically significant

Pilot randomised trial of a healthy eating behavioural intervention in uncontrolled asthma.

PubMed

Ma, Jun; Strub, Peg; Lv, Nan; Xiao, Lan; Camargo, Carlos A; Buist, A Sonia; Lavori, Philip W; Wilson, Sandra R; Nadeau, Kari C; Rosas, Lisa G

2016-01-01

Rigorous research on the benefit of healthy eating patterns for asthma control is lacking.We randomised 90 adults with objectively confirmed uncontrolled asthma and a low-quality diet (Dietary Approaches to Stop Hypertension (DASH) scores <6 out of 9) to a 6-month DASH behavioural intervention (n=46) or usual-care control (n=44). Intention-to-treat analyses used repeated-measures mixed models.Participants were middle-aged, 67% female and multiethnic. Compared with controls, intervention participants improved on DASH scores (mean change (95% CI) 0.6 (0, 1.1) versus -0.3 (-0.8, 0.2); difference 0.8 (0.2, 1.5)) and the primary outcome, Asthma Control Questionnaire scores (-0.2 (-0.5, 0) versus 0 (-0.3, 0.3); difference -0.2 (-0.5, 0.1)) at 6 months. The mean group differences in changes in Mini Asthma Quality of Life Questionnaire overall and subdomain scores consistently favoured the intervention over the control group: overall 0.4 (95% CI 0, 0.8), symptoms 0.5 (0, 0.9), environment 0.4 (-0.1, 1.0), emotions 0.4 (-0.2, 0.9) and activities 0.3 (0, 0.7). These differences were modest, but potentially clinical significant.The DASH behavioural intervention improved diet quality with promising clinical benefits for better asthma control and functional status among adults with uncontrolled asthma. A full-scale efficacy trial is warranted. Copyright ©ERS 2016.

Examination of the pronator quadratus muscle during hardware removal procedures after volar plating for distal radius fractures.

PubMed

Nho, Jae-Hwi; Gong, Hyun Sik; Song, Cheol Ho; Wi, Seung Myung; Lee, Young Ho; Baek, Goo Hyun

2014-09-01

It is not clear whether the pronator quadratus (PQ) muscle actually heals and provides a meaningful pronation force after volar plating for distal radius fractures (DRFs). We aimed to determine whether the length of the PQ muscle, which is dissected and then repaired during volar plating for a DRF, affects the forearm rotation strength and clinical outcomes. We examined 41 patients who requested hardware removal after volar plating. We measured the isokinetic forearm rotation strength and clinical outcomes including grip strength, wrist range of motion, and disabilities of the arm, shoulder and hand (DASH) scores at 6 months after fracture fixation. During the hardware removal surgery, which was performed at an average of 9 months (range, 8.3 to 11.5 months) after fracture fixation, we measured the PQ muscle length. The average PQ muscle length was 68% of the normal muscle length, and no significant relationship was found between the PQ muscle length and the outcomes including isokinetic forearm rotation strength, grip strength, wrist range of motion, and DASH scores. This study demonstrates that the length of the healed PQ muscle does not affect isokinetic forearm rotation strength and clinical outcomes after volar plating for DRFs. The results of this study support our current practice of loose repair of the PQ that is performed by most of the surgeons to prevent tendon irritation over the plate, and suggest that tight repair of the PQ is not necessary for achieving improved forearm function.

Long-Term Clinical Outcome After Titanium Lunate Arthroplasty for Kienböck Disease.

PubMed

Viljakka, Timo; Tallroth, Kaj; Vastamäki, Martti

2018-04-09

Titanium lunate arthroplasty (TLA) for Kienböck disease was introduced in 1984 to address the silicone-wear particle problem common to silicone lunate implants. We sought to study the outcome of TLA. We identified 11 patients from our hospital database who had undergone TLA between 2001 and 2010. We evaluated pain, range of motion (ROM), function, and radiological outcome at a mean 11 years after surgery. We compared preoperative ROM and radiological findings with final follow-up in the ipsilateral wrist and also made comparisons with the contralateral wrists. No implants were removed, and no wrist joints were fused. Pain on the visual analog scale averaged 0.5 at rest, 0.3 at night, and 2.7 during heavy exertion. Seven patients had no pain at rest and 9 had no pain at night. Range of motion reached 70% of that of the contralateral wrist, and strength reached 81%. The Disabilities of the Arm, Shoulder, and Hand (DASH) score averaged 9.6, optional DASH 9.7, and Mayo wrist score 67.7. Radiologically, only Ståhl and arthrosis indexes differed significantly between affected and unaffected wrists. Two patients had a dorsally dislocated implant, meaning that around 20% of our cases probably meet the criteria for failure. The longer-term results of TLA for stage III Kienböck disease are promising. Therapeutic IV. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Platelet-rich plasma (PRP) in chronic epicondylitis: study protocol for a randomized controlled trial.

PubMed

Martin, Jose I; Merino, Josu; Atilano, Leire; Areizaga, Luis M; Gomez-Fernandez, Maria C; Burgos-Alonso, Natalia; Andia, Isabel

2013-12-01

Tendinopathy is a difficult problem to manage and can result in significant patient morbidity. Currently, the clinical use of platelet-rich plasma (PRP) in painful tendons is widespread but its efficacy remains controversial. This study is a single-center, randomized double-blind controlled trial. Eighty patients will be allocated to have ultrasound (US)-guided needling combined with a leukocyte-depleted (that is, pure) PRP or lidocaine each alternate week for a total of two interventions. Outcome data will be collected before intervention, and at 6 weeks, 3, 6, and 12 months after intervention. Changes in pain and activity levels, as assessed by Disabilities of the Arm, Shoulder and Hand (DASH-E, Spanish version) score, at 6 months. We will compare the percentage of patients in each group that achieve a successful treatment defined as a reduction of at least 25% in the DASH-E score. Secondary outcome measures include changes in DASH-E at 3 and 12 months, changes in pain as assessed by the visual analogue scale (VAS) at the 6-week, 3-, 6-, and 12-month follow-up, changes in sonographic features and neovascularity, and percentage of patients in each group with adverse reactions at 3, 6, and 12 months. The results of this study will provide insights into the effect of pure PRP in tendon and may contribute to identifying the best protocol for PRP application in tendinopathies. ClinicalTrials.gov: NCT01945528.

A Multilevel Assessment of Barriers to Adoption of Dietary Approaches to Stop Hypertension (DASH) among African Americans of Low Socioeconomic Status

PubMed Central

Bertoni, Alain G.; Foy, Capri G.; Hunter, Jaimie C.; Quandt, Sara A.; Vitolins, Mara Z.; Whitt-Glover, Melicia C.

2013-01-01

Background We examined perceptions of Dietary Approaches to Stop Hypertension (DASH) and the food environment among African Americans (AA) with high blood pressure living in two low-income communities and objectively assessed local food outlets. Methods Focus groups were conducted with 30 AAs; participants discussed DASH and the availability of healthy foods in their community. Sessions were transcribed and themes identified. Fifty-four stores and 114 restaurants were assessed using the Nutrition Environment Measures Survey (NEMS). Results Common themes included poor availability, quality, and cost of healthy foods; tension between following DASH and feeding other family members; and lack of congruity between their preferred foods and DASH. Food outlets in majority AA census tracts had lower NEMS scores (stores: −11.7, p=.01, restaurants: −8.3, p=.001) compared with majority White areas. Conclusions Interventions promoting DASH among lower income AAs should reflect the food customs, economic concerns, and food available in communities. PMID:22080704

Clinical factors that affect perceived quality of life in arthroscopic reconstruction for acromioclavicular joint dislocation.

PubMed

Abat, F; Gich, I; Natera, L; Besalduch, M; Sarasquete, J

To analyse the results of arthroscopic repair of acromioclavicular dislocation in terms of health-related quality of life. Prospective study of patients with acromioclavicular dislocation Rockwood grade iii-v, treated arthroscopically with a mean follow up of 25.4 months. The demographics of the series were recorded and evaluations were performed preoperatively, at 3 months and 2 years with validated questionnaires as Short Form-36 Health Survey (SF-36), visual analogue scale (VAS), The Disabilities of the Arm, Shoulder and Hand (DASH), Constant-Murley Shoulder Outcome Score (Constant) and Walch-Duplay Score (WD). Twenty patients, 17 men and 3 women with a mean age of 36.1 years, were analysed. According to the classification of Rockwood, 3 patients were grade iii, 3 grade iv and 14 grade v. Functional and clinical improvement was detected in all clinical tests (SF-36, VAS and DASH) at 3 months and 2 years follow up (P<.001). The final Constant score was 95.3±2.4 and the WD was 1.8±0.62. It was not found that the health-related quality of life was affected by any variable studied except the evolution of DASH. The health-related quality of life (assessed by SF-36) in patients undergoing arthroscopic repair of acromioclavicular joint dislocation grades iii-v was not influenced by gender, age, grade, displacement, handedness, evolution of the VAS, scoring of the Constant or by the WD. However, it is correlated with the evolution in the DASH score. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Pilot randomised trial of a healthy eating behavioural intervention in uncontrolled asthma

PubMed Central

Ma, Jun; Strub, Peg; Lv, Nan; Xiao, Lan; Camargo, Carlos A.; Buist, A. Sonia; Lavori, Philip W.; Wilson, Sandra R.; Nadeau, Kari C.; Rosas, Lisa G.

2016-01-01

Rigorous research on the benefit of healthy eating patterns for asthma control is lacking. We randomised 90 adults with objectively confirmed uncontrolled asthma and a low-quality diet (Dietary Approaches to Stop Hypertension (DASH) scores <6 out of 9) to a 6-month DASH behavioural intervention (n=46) or usual-care control (n=44). Intention-to-treat analyses used repeated-measures mixed models. Participants were middle-aged, 67% female and multiethnic. Compared with controls, intervention participants improved on DASH scores (mean change (95% CI) 0.6 (0, 1.1) versus −0.3 (−0.8, 0.2); difference 0.8 (0.2, 1.5)) and the primary outcome, Asthma Control Questionnaire scores (−0.2 (−0.5, 0) versus 0 (−0.3, 0.3); difference −0.2 (−0.5, 0.1)) at 6 months. The mean group differences in changes in Mini Asthma Quality of Life Questionnaire overall and subdomain scores consistently favoured the intervention over the control group: overall 0.4 (95% CI 0, 0.8), symptoms 0.5 (0, 0.9), environment 0.4 (−0.1, 1.0), emotions 0.4 (−0.2, 0.9) and activities 0.3 (0, 0.7). These differences were modest, but potentially clinical significant. The DASH behavioural intervention improved diet quality with promising clinical benefits for better asthma control and functional status among adults with uncontrolled asthma. A full-scale efficacy trial is warranted. PMID:26493792

Dietary approaches to stop hypertension diet and obesity: A cross-sectional study of Iranian children and adolescents.

PubMed

Golpour-Hamedani, Sahar; Mohammadifard, Noushin; Khosravi, Alireza; Feizi, Awat; Safavi, Sayyed Morteza

2017-01-01

Few studies have investigated the effects of dietary approaches to stop hypertension (DASH) diet on obesity in children. The present study was conducted to examine adherence to the DASH diet in relation to obesity in children and adolescents, Isfahan, Iran. A cross-sectional study was carried out among 456 children aged 11-18 years who were selected by random cluster sampling method. Dietary intakes were assessed using a validated Food Frequency Questionnaire (FFQ). The DASH score was constructed based on food items emphasized or minimized in the DASH diet. Anthropometric measurements were conducted based on standard protocols. General and abdominal obesity were defined based on body mass index ≥ 95th percentiles and waist: height ratio of more than 0.5, respectively. Higher adherence to DASH diet was inversely associated with general obesity (odds ratioT1 vs. T3 3.34, 95% confidence interval 1.28-8.75); however, after controlling for confounding factors, this association disappeared. Furthermore, higher adherence to DASH diet was negatively associated with central obesity in children, but the relation was not statistically significant. We concluded that there was an inverse nonsignificant association between adherence to DASH diet and general obesity indices after adjustment for potential confounders. Further, well-designed randomized clinical trial studies are suggested to find out the effect of DASH diet on obesity obviously.

Assessing physical function in adult acquired major upper-limb amputees by combining the Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire and clinical examination.

PubMed

Ostlie, Kristin; Franklin, Rosemary J; Skjeldal, Ola H; Skrondal, Anders; Magnus, Per

2011-10-01

To describe physical function in adult acquired major upper-limb amputees (ULAs) by combining self-assessed arm function and physical measures obtained by clinical examinations; to estimate associations between background factors and self-assessed arm function in ULAs; and to assess whether clinical examination findings may be used to detect reduced arm function in unilateral ULAs. postal questionnaires and clinical examinations. Norwegian ULA population. Clinical examinations performed at 3 clinics. Questionnaires: population-based sample (n=224; 57.4% response rate). Clinical examinations: combined referred sample and convenience sample of questionnaire responders (n=70; 83.3% of those invited). SURVEY inclusion criteria: adult acquired major upper-limb amputation, resident in Norway, mastering of spoken and written Norwegian. Not applicable. The Disabilities of the Arm, Shoulder and Hand (DASH) Outcome Questionnaire, and clinical examination of joint motion and muscle strength with and without prostheses. Mean DASH score was 22.7 (95% confidence interval [CI], 20.3-25.0); in bilateral amputees, 35.7 (95% CI, 23.0-48.4); and in unilateral amputees, 22.1 (95% CI, 19.8-24.5). A lower unilateral DASH score (better function) was associated with paid employment (vs not in paid employment: adjusted regression coefficient [aB]=-5.40, P=.033; vs students: aB=-13.88, P=.022), increasing postamputation time (aB=-.27, P=.001), and Norwegian ethnicity (aB=-14.45, P<.001). At clinical examination, we found a high frequency of impaired neck mobility and varying frequencies of impaired joint motion and strength at the shoulder, elbow, and forearm level. Prosthesis wear was associated with impaired joint motion in all upper-limb joints (P<.006) and with reduced shoulder abduction strength (P=.002). Impaired without-prosthesis joint motion in shoulder flexion (ipsilateral: aB=12.19, P=.001) and shoulder abduction (ipsilateral: aB=12.01, P=.005; contralateral: aB=28.82, P=.004) was associated with increased DASH scores. Upper-limb loss clearly affects physical function. DASH score limitation profiles may be useful in individual clinical assessments. Targeted clinical examination may indicate patients with extra rehabilitational needs. Such examinations may be of special importance in relation to prosthesis function. Copyright © 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up.

PubMed

Peerbooms, Joost C; Sluimer, Jordi; Bruijn, Daniël J; Gosens, Taco

2010-02-01

Platelet-rich plasma (PRP) has shown to be a general stimulation for repair. Purpose To determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis. Randomized controlled trial; Level of evidence, 1. The trial was conducted in 2 teaching hospitals in the Netherlands. One hundred patients with chronic lateral epicondylitis were randomly assigned in the PRP group (n = 51) or the corticosteroid group (n = 49). A central computer system carried out randomization and allocation to the trial group. Patients were randomized to receive either a corticosteroid injection or an autologous platelet concentrate injection through a peppering technique. The primary analysis included visual analog scores and DASH Outcome Measure scores (DASH: Disabilities of the Arm, Shoulder, and Hand). Successful treatment was defined as more than a 25% reduction in visual analog score or DASH score without a reintervention after 1 year. The results showed that, according to the visual analog scores, 24 of the 49 patients (49%) in the corticosteroid group and 37 of the 51 patients (73%) in the PRP group were successful, which was significantly different (P <.001). Furthermore, according to the DASH scores, 25 of the 49 patients (51%) in the corticosteroid group and 37 of the 51 patients (73%) in the PRP group were successful, which was also significantly different (P = .005). The corticosteroid group was better initially and then declined, whereas the PRP group progressively improved. Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and significantly increases function, exceeding the effect of corticosteroid injection. Future decisions for application of the PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits.

Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up.

PubMed

Gosens, Taco; Peerbooms, Joost C; van Laar, Wilbert; den Oudsten, Brenda L

2011-06-01

Platelet-rich plasma (PRP) has been shown to be a general stimulation for repair and 1-year results showed promising success percentages. This trial was undertaken to determine the effectiveness of PRP compared with corticosteroid injections in patients with chronic lateral epicondylitis with a 2-year follow-up. Randomized controlled trial; Level of evidence, 1. The trial was conducted in 2 Dutch teaching hospitals. One hundred patients with chronic lateral epicondylitis were randomly assigned to a leukocyte-enriched PRP group (n = 51) or the corticosteroid group (n = 49). Randomization and allocation to the trial group were carried out by a central computer system. Patients received either a corticosteroid injection or an autologous platelet concentrate injection through a peppering needling technique. The primary analysis included visual analog scale (VAS) pain scores and Disabilities of the Arm, Shoulder and Hand (DASH) outcome scores. The PRP group was more often successfully treated than the corticosteroid group (P < .0001). Success was defined as a reduction of 25% on VAS or DASH scores without a reintervention after 2 years. When baseline VAS and DASH scores were compared with the scores at 2-year follow-up, both groups significantly improved across time (intention-to-treat principle). However, the DASH scores of the corticosteroid group returned to baseline levels, while those of the PRP group significantly improved (as-treated principle). There were no complications related to the use of PRP. Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and increases function significantly, exceeding the effect of corticosteroid injection even after a follow-up of 2 years. Future decisions for application of PRP for lateral epicondylitis should be confirmed by further follow-up from this trial and should take into account possible costs and harms as well as benefits.

Mobile Apps for the Dietary Approaches to Stop Hypertension (DASH): App Quality Evaluation.

PubMed

DiFilippo, Kristen Nicole; Huang, Wen-Hao David; Chapman-Novakofski, Karen M

2018-03-08

To identify the availability and quality of apps supporting Dietary Approaches to Stop Hypertension (DASH) education. The researchers identified DASH apps over 1 month in the Apple App Store. Five registered dietitians used the App Quality Evaluation (AQEL) to evaluate app quality on 7 domains. Interrater reliability was tested using intraclass correlations. One paid and 3 free DASH apps were evaluated. Interrater reliability (n = 5) was good for 3 apps and fair for 1 app. Only the paid app scored high (>8 of 10) on most AQEL quality domains. Based on lower quality found among the included free apps, further development of free apps is warranted. Whereas the paid app may be useful in supporting DASH education, future research should determine whether improvements in clinical outcomes are found and whether this app should be improved to address AQEL domains better. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis.

PubMed

Yi, Rosemary; Bratchenko, Walter W; Tan, Virak

2018-01-01

The aim of the study was to determine the efficacy of deep friction massage in the treatment of lateral epicondylitis by comparing outcomes with a control group treated with splinting and therapy and with an experimental group receiving a local steroid injection. A randomized clinical trial was conducted to compare outcomes after recruitment of consecutive patients presenting with lateral epicondylitis. Patients were randomized to receive one of 3 treatments: group 1: splinting and stretching, group 2: a cortisone injection, or group 3: a lidocaine injection with deep friction massage. Pretreatment and posttreatment parameters of visual analog scale (VAS) pain ratings, Disabilities of the Arm, Shoulder and Hand (DASH) scores, and grip strength were measured. Outcomes were measured at early follow-up (6-12 weeks) and at 6-month follow-up. There was a significant improvement in VAS pain score in all treatment groups at early follow-up. DASH score and grip strength improved in the cortisone injection group and the deep friction massage group at early follow-up; these parameters did not improve in the splinting and stretching group. At 6-month follow-up, only patients in the deep friction massage group demonstrated a significant improvement in all outcome measures, including VAS pain score, DASH score, and grip strength. Deep friction massage is an effective treatment for lateral epicondylitis and can be used in patients who have failed other nonoperative treatments, including cortisone injection.

Comparison of the Properties of the Handwriting Speed Test (HST) and Detailed Assessment of Speed of Handwriting (DASH): An Exploratory Study.

PubMed

Francis, Anna; Wallen, Margaret; Bundy, Anita

2017-05-01

Handwriting speed is an important component of students' ability to adequately express their ideas, knowledge and creativity in a timely and effective manner. Psychometric properties of the Handwriting Speed Test (HST) and Detailed Assessment of Speed of Handwriting (DASH) and accuracy of the norms for identifying current Australian students with handwriting speed difficulties were examined. An exploratory, cross-sectional study was conducted involving students, with and without handwriting difficulties, in Years 3-12 (mean age: 12.0 yrs, SD = 3.0 yrs; range = 7 to 18 yrs) in New South Wales (NSW; Australia). Participants were recruited through occupational therapists and schools. Students completed the HST and all DASH subtests. Thirty-two students with, and 139 students without, handwriting difficulties participated. Intra-rater and inter-rater reliability were found to be excellent; sensitivity was low and specificity high for the HST and DASH. No significant differences were found between test scores and normative data for students without handwriting difficulties (year/age groups with n > 10). The HST and DASH are reliable assessments of handwriting speed. Further research is required into discriminant validity of the HST and DASH and need for updated norms.

Disability in the upper extremity and quality of life in hand-arm vibration syndrome.

PubMed

Poole, Kerry; Mason, Howard

2005-11-30

To investigate whether hand-arm vibration syndrome (HAVS) leads to disability in the upper extremity or deficit in quality of life (QoL) using validated questionnaire tools, and to establish whether these effects are related to the Stockholm Workshop Staging (SWS). This was a postal cross-sectional questionnaire study with a 50% response rate. Four hundred and forty-four males, who had been diagnosed and staged according to the SWS were sent the Disability in the Arm, Shoulder and Hand (DASH) and the SF-36v2 QoL questionnaires. HAVS cases had significantly greater DASH disability scores and reduced QoL physical and mental component scores compared to published normal values. Those HAVS cases with a presumptive diagnosis of Carpal Tunnel Syndrome(CTS) had even higher disability scores. There was a clear, linear relationship between both the DASH disability score and the physical component of the QoL and sensorineural SWS, but not with the vascular SWS. HAVS has a significant effect on an individual's perceived ability to perform everyday tasks involving the upper extremity, and their quality of life. Physical capability may be further compromised in those individuals who have a presumptive diagnosis of CTS. These findings may have important implications regarding management of the affected worker.

Delivery of Patient-Reported Outcome Instruments by Automated Mobile Phone Text Messaging.

PubMed

Anthony, Christopher A; Lawler, Ericka A; Glass, Natalie A; McDonald, Katelyn; Shah, Apurva S

2017-11-01

Patient-reported outcome (PRO) instruments allow patients to interpret their health and are integral in evaluating orthopedic treatments and outcomes. The purpose of this study was to define: (1) correlation between PROs collected by automated delivery of text messages on mobile phones compared with paper delivery; and (2) patient use characteristics of a technology platform utilizing automated delivery of text messages on mobile phones. Paper versions of the 12-Item Short Form Health Survey (SF-12) and the short form of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) were completed by patients in orthopedic hand and upper extremity clinics. Over the next 48 hours, the same patients also completed the mobile phone portion of the study outside of the clinic which included text message delivery of the SF-12 and QuickDASH, assigned in a random order. Correlations between paper and text message delivery of the 2 PROs were assessed. Among 72 patients, the intraclass correlation coefficient (ICC) between the written and mobile phone delivery of QuickDASH was 0.91 (95% confidence interval [CI], 0.85-0.95). The ICC between the paper and mobile phone delivery of the SF-12 physical health composite score was 0.88 (95% CI, 0.79-0.93) and 0.86 (95% CI, 0.75-0.92) for the SF-12 mental health composite score. We find that text message delivery using mobile phones permits valid assessment of SF-12 and QuickDASH scores. The findings suggest that software-driven automated delivery of text communication to patients via mobile phones may be a valid method to obtain other PRO scores in orthopedic patients.

Relationship between distal radius fracture malunion and arm-related disability: A prospective population-based cohort study with 1-year follow-up

PubMed Central

2011-01-01

Background Distal radius fracture is a common injury and may result in substantial dysfunction and pain. The purpose was to investigate the relationship between distal radius fracture malunion and arm-related disability. Methods The prospective population-based cohort study included 143 consecutive patients above 18 years with an acute distal radius fracture treated with closed reduction and either cast (55 patients) or external and/or percutaneous pin fixation (88 patients). The patients were evaluated with the disabilities of the arm, shoulder and hand (DASH) questionnaire at baseline (concerning disabilities before fracture) and one year after fracture. The 1-year follow-up included the SF-12 health status questionnaire and clinical and radiographic examinations. Patients were classified into three hypothesized severity categories based on fracture malunion; no malunion, malunion involving either dorsal tilt (>10 degrees) or ulnar variance (≥1 mm), and combined malunion involving both dorsal tilt and ulnar variance. Multivariate regression analyses were performed to determine the relationship between the 1-year DASH score and malunion and the relative risk (RR) of obtaining DASH score ≥15 and the number needed to harm (NNH) were calculated. Results The mean DASH score at one year after fracture was significantly higher by a minimum of 10 points with each malunion severity category. The RR for persistent disability was 2.5 if the fracture healed with malunion involving either dorsal tilt or ulnar variance and 3.7 if the fracture healed with combined malunion. The NNH was 2.5 (95% CI 1.8-5.4). Malunion had a statistically significant relationship with worse SF-12 score (physical health) and grip strength. Conclusion Malunion after distal radius fracture was associated with higher arm-related disability regardless of age. PMID:21232088

Design and application of nickel-titanium olecranon memory connector in treatment of olecranon fractures: a prospective randomized controlled trial.

PubMed

Chen, Xiao; Liu, Peng; Zhu, Xiaofei; Cao, Liehu; Zhang, Chuncai; Su, Jiacan

2013-06-01

We carried out this study to test the efficacy of the olecranon memory connector (OMC) in olecranon fractures. We designed a prospective randomised controlled trial involving 40 cases of olecranon fractures. From May 2004 to December 2009, 40 patients with olecranon fractures were randomly assigned into two groups. Twenty patients were treated with OMC, while another 20 patients were fixed with locking plates in our hospital. The DASH score, MEP score, range of motion and radiographs were used to evaluate the postoperative elbow function and complications. For MEP score, OMC was better than the locking plate; for DASH score, complication rate, and range of elbow motion, the two methods presented no significant difference. The study showed that OMC could be an effective alternative to treat olecranon fractures.

Changes in Diet Quality Scores and Risk of Cardiovascular Disease Among US Men and Women

PubMed Central

Sotos-Prieto, Mercedes; Bhupathiraju, Shilpa N.; Mattei, Josiemer; Fung, Teresa T.; Li, Yanping; Pan, An; Willett, Walter C.; Rimm, Eric B.; Hu, Frank B.

2015-01-01

Background Adherence to several diet quality scores including the Alternative Healthy Eating Index (AHEI), Alternative Mediterranean diet score (AMED), and Dietary Approach to Stop Hypertension (DASH) has been associated with lower risk of cardiovascular disease (CVD), but little is known about how changes in these scores over time influence subsequent CVD risk. Methods and Results We analyzed the association between 4-year changes in three diet quality scores (AHEI, AMED, and DASH) and subsequent CVD risk among 29,343 men in the Health Professionals Follow-up Study and 51,195 women in the Nurses’ Health Study (1986–2010). During 1,394,702 person-years of follow up, we documented 11,793 CVD cases. Compared with participants whose diet quality remained relatively stable in each 4-year period, those with the greatest improvement in diet quality scores had a 7%–8% lower CVD risk in the subsequent 4-year period (pooled hazard ratio, 0.92 [95% confidence interval (CI): 0.87–0.99] for AHEI; 0.93 [95% CI: 0.85–1.02] for AMED; and 0.93 [95% CI: 0.87–0.99] for DASH; all P-trend<0.05). In the long term, increasing the diet scores from baseline to the first 4-year follow up was associated with lower CVD risk during the next 20 years (7% [95% CI: 1% to 12%] for AHEI and 9% [95% CI: 3% to 14%] for AMED). A decrease in diet quality scores was associated with significantly elevated risk of CVD in subsequent time periods. Conclusions Improving adherence to diet quality scores over time is associated with significantly lower CVD risk both in the short term and the long term. PMID:26644246

Relationship between self-reported upper limb disability and quantitative tests in hand-arm vibration syndrome.

PubMed

Poole, Kerry; Mason, Howard

2007-03-15

To establish the relationship between quantitative tests of hand function and upper limb disability, as measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, in hand-arm vibration syndrome (HAVS). A total of 228 individuals with HAVS were included in this study. Each had undergone a full HAVS assessment by an experienced physician, including quantitative tests of vibrotactile and thermal perception thresholds, maximal hand-grip strength (HG) and the Purdue pegboard (PP) test. Individuals were also asked to complete a DASH questionnaire. PP and HG of the quantitative tests gave the best and statistically significant individual correlations with the DASH disability score (r2 = 0.168 and 0.096). Stepwise linear regression analysis revealed that only PP and HG measurements were statistically significant predictors of upper limb disability (r2 = 0.178). Overall a combination of the PP and HG measurements, rather than each alone, gave slightly better discrimination, although not statistically significant, between normal and abnormal DASH scores with a sensitivity of 73.1% and specificity of 64.3%. Measurements of manual dexterity and hand-grip strength using PP and HG may be useful in helping to confirm lack of upper limb function and 'perceived' disability in HAVS.

Reliability, validity and responsiveness of the Arabic version of the Disability of Arm, Shoulder and Hand (DASH-Arabic).

PubMed

Alotaibi, Naser M; Aljadi, Sameera H; Alrowayeh, Hesham N

2016-12-01

To investigate the psychometric properties (reliability, validity and responsiveness) of the DASH-Arabic in a cohort of Arabic patients presenting with various upper extremity conditions. Participants were 139 patients with various upper extremity conditions, who completed the DASH-Arabic at the baseline, 2-5 days later and 30-36 days later. Participants completed demographic data forms, the SF-36 and VAS at baseline, and a Global Rating of Change scale at first and second follow-ups. Cronbach's alpha of the DASH-Arabic was 0.94. Test-retest reliability was excellent with an ICC of 0.97. The SEM was 3.50 and the MDC95 was 9.28. Construct validity of the DASH-Arabic with the SF-36 subscales and VAS scores ranged from r -0.32 to -0.57, all statistically significant (p < 0.001). The effect size (ES) for the DASH-Arabic was 1.39 and its standard response mean was 1.51. The area under the curve was 0.82 (95% CI = 0.72-0.92, p < 0.001). The optimally efficient cutoff for an improvement was found to be a difference of 15 DASH points. The DASH-Arabic is a reliable, valid and responsive upper extremity outcome measure for patients whose primary language is Arabic; it can be used to document patient status and outcomes and support evidence-based practice. Implications for Rehabilitation The DASH-Arabic demonstrated sound psychometric properties of reliability, validity and responsiveness. It is an effective patient status and outcome tool that will support evidence-based practice. This tool is recommended for evaluating upper extremity work-related injuries and tracking therapeutic outcomes.

Scalable privacy-preserving data sharing methodology for genome-wide association studies: an application to iDASH healthcare privacy protection challenge.

PubMed

Yu, Fei; Ji, Zhanglong

2014-01-01

In response to the growing interest in genome-wide association study (GWAS) data privacy, the Integrating Data for Analysis, Anonymization and SHaring (iDASH) center organized the iDASH Healthcare Privacy Protection Challenge, with the aim of investigating the effectiveness of applying privacy-preserving methodologies to human genetic data. This paper is based on a submission to the iDASH Healthcare Privacy Protection Challenge. We apply privacy-preserving methods that are adapted from Uhler et al. 2013 and Yu et al. 2014 to the challenge's data and analyze the data utility after the data are perturbed by the privacy-preserving methods. Major contributions of this paper include new interpretation of the χ2 statistic in a GWAS setting and new results about the Hamming distance score, a key component for one of the privacy-preserving methods.

Scalable privacy-preserving data sharing methodology for genome-wide association studies: an application to iDASH healthcare privacy protection challenge

PubMed Central

2014-01-01

In response to the growing interest in genome-wide association study (GWAS) data privacy, the Integrating Data for Analysis, Anonymization and SHaring (iDASH) center organized the iDASH Healthcare Privacy Protection Challenge, with the aim of investigating the effectiveness of applying privacy-preserving methodologies to human genetic data. This paper is based on a submission to the iDASH Healthcare Privacy Protection Challenge. We apply privacy-preserving methods that are adapted from Uhler et al. 2013 and Yu et al. 2014 to the challenge's data and analyze the data utility after the data are perturbed by the privacy-preserving methods. Major contributions of this paper include new interpretation of the χ2 statistic in a GWAS setting and new results about the Hamming distance score, a key component for one of the privacy-preserving methods. PMID:25521367

Percutaneous ultrasonic tenotomy for chronic elbow tendinosis: a prospective study.

PubMed

Barnes, Darryl E; Beckley, James M; Smith, Jay

2015-01-01

Elbow tendinopathy is the most common cause of elbow pain affecting active populations. Surgical excision is reserved for patients with refractory symptoms. Percutaneous ultrasonic tenotomy performed under local anesthesia also removes degenerated tissue and therefore provides an alternative treatment option to surgical excision. This investigation prospectively documented the safety and 1-year efficacy of ultrasonic percutaneous tenotomy performed by a single operator. Nineteen patients, aged 38 to 67 years, in whom >6 months of conservative management for medial (7) or lateral (12) elbow tendinopathy had failed were prospectively studied. All patients were treated with percutaneous ultrasonic tenotomy of the elbow by a single operator. Visual analog scale (VAS) for pain, the 11-item version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) index, and the Mayo Elbow Performance Score (MEPS) were assessed by an independent observer before treatment and at 6 weeks, 3 months, 6 months, and 12 months after treatment. No procedural complications occurred. Total treatment time was <15 minutes, and ultrasonic energy time averaged 38.6 ± 8.8 seconds per procedure. Average VAS scores were significantly improved from 6.4 to 2.6 at 6 weeks and were 0.7 at 12 months (P < .0001). Similar improvement occurred with the Quick DASH (pretreatment, 44.1; 12 months, 8.6, P < .0001) and MEPS (pretreatment, 59.1; 12 months, 83.4; P < .0001). Percutaneous ultrasonic tenotomy performed under local anesthesia appears to be a safe and effective treatment option for chronic, refractory lateral or medial elbow tendinopathy up to 1 year after the procedure. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Open Reduction and Internal Fixation versus Non-Surgical Treatment in Displaced Midshaft Clavicle Fractures: A Meta-Analysis.

PubMed

Ahmed, Abdulaziz F; Salameh, Motasem; AlKhatib, Nidal; Elmhiregh, Aissam; Ahmed, Ghalib O

2018-04-17

To compare open reduction and internal fixation (ORIF) and non-surgical treatment outcomes in displaced midshaft clavicle fractures. PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched in September 2017. Inclusion criteria were randomized controlled trials reporting nonunion, shoulder functional outcomes, and subsequent surgery rates or pain scores. We excluded studies with patients younger than 16 years, maximum follow-up less than nine months, and inaccessible full text. Extracted data included the first author, publication year, number of patients, number of nonunions, Constant scores, disabilities of the arm, shoulder and hand (DASH) scores, number of subsequent surgeries, and pain measured using the visual analogue analog scale. The risk ratio (RR) of nonunion was 0.15 (95% confidence interval [CI], 0.08, 0.31) in ORIF compared with that of non-surgical treatment. Constant and DASH scores were significantly better in ORIF up to 6 months. The mean difference (MD) in DASH scores at 12 months was statistically insignificant in both treatments (MD, -4.19; 95% CI, -9.34, 0.96). Constant scores remained significant in ORIF (MD, 4.39; 95% CI, 1.03, 7.75). Subsequent surgeries and pain scores were similar in both treatments. Significant reduction in nonunions and favorable early functional outcomes are associated with ORIF. Nevertheless, late functional outcomes, subsequent surgeries, and pain scores are similar to those of non-surgical treatment. Although patients treated with ORIF mainly had subsequent elective plate removals; non-surgically treated patients had more surgical fixations for nonunions. As a result, there remains inconsistent evidence regarding the best treatment for displaced midshaft clavicle fractures. Therapeutic Level I.

Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom12

PubMed Central

Monsivais, Pablo; Scarborough, Peter; Lloyd, Tina; Mizdrak, Anja; Luben, Robert; Mulligan, Angela A; Wareham, Nicholas J; Woodcock, James

2015-01-01

Background: The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease. Because the DASH diet emphasizes plant-based foods, including vegetables and grains, adhering to this diet might also bring about environmental benefits, including lower associated production of greenhouse gases (GHGs). Objective: The objective was to examine the interrelation between dietary accordance with the DASH diet and associated GHGs. A secondary aim was to examine the retail cost of diets by level of DASH accordance. Design: In this cross-sectional study of adults aged 39–79 y from the European Prospective Investigation into Cancer and Nutrition–Norfolk, United Kingdom cohort (n = 24,293), dietary intakes estimated from food-frequency questionnaires were analyzed for their accordance with the 8 DASH food and nutrient-based targets. Associations between DASH accordance, GHGs, and dietary costs were evaluated in regression analyses. Dietary GHGs were estimated with United Kingdom-specific data on carbon dioxide equivalents associated with commodities and foods. Dietary costs were estimated by using national food prices from a United Kingdom–based supermarket comparison website. Results: Greater accordance with the DASH dietary targets was associated with lower GHGs. Diets in the highest quintile of accordance had a GHG impact of 5.60 compared with 6.71 kg carbon dioxide equivalents/d for least-accordant diets (P < 0.0001). Among the DASH food groups, GHGs were most strongly and positively associated with meat consumption and negatively with whole-grain consumption. In addition, higher accordance with the DASH diet was associated with higher dietary costs, with the mean cost of diets in the top quintile of DASH scores 18% higher than that of diets in the lowest quintile (P < 0.0001). Conclusions: Promoting wider uptake of the DASH diet in the United Kingdom may improve population health and reduce diet-related GHGs. However, to make the DASH diet more accessible, food affordability, particularly for lower income groups, will have to be addressed. PMID:25926505

Greater accordance with the Dietary Approaches to Stop Hypertension dietary pattern is associated with lower diet-related greenhouse gas production but higher dietary costs in the United Kingdom.

PubMed

Monsivais, Pablo; Scarborough, Peter; Lloyd, Tina; Mizdrak, Anja; Luben, Robert; Mulligan, Angela A; Wareham, Nicholas J; Woodcock, James

2015-07-01

The Dietary Approaches to Stop Hypertension (DASH) diet is a proven way to prevent and control hypertension and other chronic disease. Because the DASH diet emphasizes plant-based foods, including vegetables and grains, adhering to this diet might also bring about environmental benefits, including lower associated production of greenhouse gases (GHGs). The objective was to examine the interrelation between dietary accordance with the DASH diet and associated GHGs. A secondary aim was to examine the retail cost of diets by level of DASH accordance. In this cross-sectional study of adults aged 39-79 y from the European Prospective Investigation into Cancer and Nutrition-Norfolk, United Kingdom cohort (n = 24,293), dietary intakes estimated from food-frequency questionnaires were analyzed for their accordance with the 8 DASH food and nutrient-based targets. Associations between DASH accordance, GHGs, and dietary costs were evaluated in regression analyses. Dietary GHGs were estimated with United Kingdom-specific data on carbon dioxide equivalents associated with commodities and foods. Dietary costs were estimated by using national food prices from a United Kingdom-based supermarket comparison website. Greater accordance with the DASH dietary targets was associated with lower GHGs. Diets in the highest quintile of accordance had a GHG impact of 5.60 compared with 6.71 kg carbon dioxide equivalents/d for least-accordant diets (P < 0.0001). Among the DASH food groups, GHGs were most strongly and positively associated with meat consumption and negatively with whole-grain consumption. In addition, higher accordance with the DASH diet was associated with higher dietary costs, with the mean cost of diets in the top quintile of DASH scores 18% higher than that of diets in the lowest quintile (P < 0.0001). Promoting wider uptake of the DASH diet in the United Kingdom may improve population health and reduce diet-related GHGs. However, to make the DASH diet more accessible, food affordability, particularly for lower income groups, will have to be addressed.

Outcomes of coronoid-first repair in terrible triad injuries of the elbow.

PubMed

Zhang, Junren; Tan, Mark; Kwek, Ernest Beng Kee

2017-09-01

Clinical outcomes of terrible triad injuries (TTIs) of the elbow are historically poor. To date, it is still debatable whether the coronoid needs to be fixed and if so, how and in which sequence. Between 2010 and 2013, 13 patients were treated surgically for acute TTIs of the elbow at a Tertiary Level 1 Trauma Centre by a single surgeon, using a standardized protocol, which included coronoid-brachialis complex fixation via pull-through trans-osseous sutures, radial head fixation or prosthetic replacement and a repair of the lateral ulnar collateral ligament. Repair of the medial collateral ligament (MCL) was done if valgus-stress test demonstrated persistent instability. Patients were then followed-up with clinical and radiological evaluation by the senior author until fracture union and elbow range of motion reached a plateau. Outcomes measured were range of motion, DASH scores and MEPS, as well as surgical complications. Intraoperative stability was achieved in all 13 cases, MCL repair was required in 3 cases and application of external fixation was not required in any case. Patients were followed-up for an average length of 27.7 months and the minimum follow-up period was 12 months. The average age of patients was 46.4 years (range 35-79 years old) at the time of trauma. This included eight Regan-Morrey Type I and five Regan-Morrey Type II coronoid fractures, with ten Mason Type I/II and three Mason Type III radial head fractures. The average arc of ulno-humeral motion was 105.0° (range 80°-135°). The average flexion contracture was 15.0° (range 0°-40°). The average supination-pronation arc was 114.9° (range 0°-180°). The average MEPS was 85 of 100 (range 45-100) and the average DASH score was 21.2 of 100 (range 1.7-61.2). A single case of radio-ulnar synostosis, heterotropic ossification and two cases of recurrent elbow instability were noted. The coronoid-first surgical approach, using a suture-lasso fixation method, has technical benefits for us and showed good clinical success in our series. This is important with postero-medial rotatory instability being common in our series of TTIs. We emphasize not to miss a TTI in an apparently isolated low Mason class radial head fracture.

Outcomes of nonoperatively treated displaced scapular body fractures.

PubMed

Dimitroulias, Apostolos; Molinero, Kenneth G; Krenk, Daniel E; Muffly, Matthew T; Altman, Daniel T; Altman, Gregory T

2011-05-01

Displaced scapular body fractures most commonly are treated conservatively. However there is conflicting evidence in the literature regarding the outcomes owing to retrospective design of studies, different classification systems, and diverse outcome tools. The functional outcome after nonoperative management of displaced scapular body fractures was assessed by change in the DASH (Disability of Arm, Shoulder and Hand) score; (2) the radiographic outcome was assessed by the change of the glenopolar angle (GPA); and (3) associated scapular and extrascapular injuries that may affect outcome were identified. Forty-nine consecutive patients were treated with early passive and active ROM exercises for a displaced scapular body fracture. We followed 32 of these patients (65.3%) for a minimum of 6 months (mean, 15 months; range, 6-33 months). Mean age of the patients was 46.9 years (range, 21-84 years) and the mean Injury Severity Score (ISS) was 21.5 (range, 5-50). Subjective functional results (DASH score) and radiographic assessment (fracture union, glenopolar angle) were measured. All fractures healed uneventfully. The mean change of glenopolar angle was 9° (range, 0°-20°). The mean change of the DASH score was 10.2, which is a change with minimal clinical importance. There was a correlation between the change in this score with the ISS and presence of rib fractures. Satisfactory outcomes are reported with nonoperative treatment of displaced scapular body fractures. We have shown that the severity of ISS and the presence of rib fractures adversely affect the clinical outcome.

Functional sequelae following bilateral mastectomy and immediate reconstruction with latissimus dorsi flap: medium-term follow-up.

PubMed

Paolini, Guido; Amoroso, Matteo; Pugliese, Pierfrancesco; Longo, Benedetto; Santanelli, Fabio

2014-04-01

Arm morbidity following unilateral Latissimus Dorsi (LD) flap harvest is controversial and bilateral harvest is considered potentially disabling. Arm and shoulder disability was investigated in patients undergoing bilateral mastectomy and immediate LD flap reconstruction. Thirty consecutive bilateral immediate reconstructions with denervated LD flaps, performed between 2005-2009, were retrospectively analyzed. Patients were assessed for arm function by conducting the Disability of Arm, Shoulder and Hand (DASH) test, between 12-51 months after surgery (mean 23 months). Disability scores ranged from 1-100%, with 1-25% being regarded as mild dysfunction, 26-50% as moderate dysfunction, 51-75% as severe dysfunction, and 76-100% as total dysfunction. A statistical analysis was performed using the Fisher exact test and the multivariate linear regression model for variables. The Global Mean Dash score was 14.8%. Twenty-four patients presented a mild functional deficit (< 25%), while six presented a moderate one (< 50%). Five of them presented a score < 40%, while only one patient presented a score of 49.1%. Higher scores were significantly associated (p < 0.001) with major postoperative complications and lower ones with re-innervated LD flaps (p < 0.01). An insignificant functional impairment was noted in most patients, while a moderate-to-severe one was noted only in the group with complications. Greater impairment is observed in the heavy activities. The DASH test is a useful tool in terms of informing patients and helping the surgeon to choose the best surgical option.

Translation, cross-cultural adaptation and validation of the Italian version of the Nottingham Clavicle Score (NCS).

PubMed

Vascellari, Alberto; Schiavetti, Stefano; Rebuzzi, Enrico; Coletti, Nicolò

2015-11-01

The Nottingham Clavicle Score (NCS) is a specific Patient Reported Outcome Measure of injuries to the clavicle, acromio-clavicular joint (ACJ) and sterno-clavicular joint. The purpose of this study was to translate the NCS into Italian and establish its cultural adaptiveness and validity. The original version of the NCS was translated into Italian in accordance with the cross-cultural adaptation guidelines described by Guillemin. Sixty-six patients [average age 45.7 years (SD 11.3)] who had received surgical treatment for injuries of the ACJ and the clavicle were included in the study. The study population completed the NCS twice within 5 days, the Oxford Shoulder Score (OSS), the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the short-form 36 (SF-36). Statistical tests assessed the construct validity, discriminant validity, internal consistency, reliability and feasibility of the NCS. The translation and adaptation of the NCS for an Italian context required no major cultural adaptation. Internal consistency was high (Cronbach's α, 0.86). Test-retest reproducibility was excellent (ρ = 0.981, p < 0.00001). Administration time was 45 s (range 1 min 32 s-8 min), and all items were answered. The Italian NCS showed strong correlation with the DASH (-0.87), the OSS (-0.84) and those subscales of the SF-36 (physical functioning, role physical and bodily pain) which aim to measure similar constructs. The Italian NCS scale is a reliable, valid, consistent shoulder assessment form that can be used to assess the functional limitations of patients with injuries of clavicle or ACJ. III.

Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fractures. A reliable system?

PubMed

Königshausen, M; Kübler, L; Godry, H; Citak, M; Schildhauer, T A; Seybold, D

2012-02-01

The surgical treatment of displaced proximal humeral fractures (ORIF) is a perpetual challenge to the surgeon. For this reason, the principle of polyaxiality was developed to provide an improved primary stability of the fracture through better anchorage of the screws, especially in osteoporotic bone. The aim of this study was to present clinical results with the polyaxial locking plate in the operative treatment of proximal humerus fractures in order to determine whether the technique of polyaxiality leads to better functional outcome and lower complication rates in comparison to monoaxial plates in the literature. Seventy-three patients with displaced proximal humeral fractures were treated surgically with the polyaxial locking Suture Plate™ (Arthrex(®)) between 03/2007 and 06/2009. Fifty-two of the patients (mean age, 69.9 ± 12.1) were included in a radiographical and clinical examination using the Constant score (CS) and the Disabilities of the Arm, Shoulder and Hand score (DASH). The follow-up examinations were on average 13.9 ± 4.5 months (10-27 months) after surgical treatment. The mean CS of the patients was 66.0 ± 13.7 points, the age- and gender-related CS was 90.9% ± 20.0% and the mean DASH score was 23.8 ± 19.8 points for the injured side. The patients with a nearly anatomical reduction of their fracture (n = 13) reached a significantly higher CS (75.1 ± 8.5; p = 0.004) and DASH-score (13.6 ± 11.6; p = 0.043) and none of these patients had a complication. The complications were identified in 12 (23.1%) cases, 5 of which involved loss of reduction. All of these 5 cases were lacking of initial medial column support and 4 of which were type C2.3 AO-Classification. The data show that the combination of angular stability with the possibility of variable polyaxial screw direction is a good concept for reduction and fixation of displaced proximal humeral fractures, but anatomical reduction and medial support remain important preconditions for a good outcome. However, a significantly lower rate of complications or better clinical outcome than that reported in the literature could not be found. Copyright © 2011 Elsevier Ltd. All rights reserved.

Is posterior synovial plica excision necessary for refractory lateral epicondylitis of the elbow?

PubMed

Rhyou, In Hyeok; Kim, Kang Wook

2013-01-01

Arthroscopic treatments for lateral epicondylitis including débridement of the extensor carpi radialis brevis (ECRB) origin (Baker technique) or resection of the radiocapitellar synovial plica reportedly improve symptoms. However the etiology of the disease and the role of the plica remain unclear. We asked if posterior radiocapitellar synovial plica excision made any additional improvement in pain or function after arthroscopic ECRB release. We retrospectively reviewed 38 patients who had arthroscopic treatment for refractory lateral epicondylitis between November 2003 and October 2009. Twenty patients (Group A) underwent the Baker technique and 18 patients (Group B) underwent a combination of the Baker technique and posterior synovial plica excision. The minimum followup was 36 months (mean, 46 months; range, 36-72 months) for Group A and 25 months (mean, 30 months; range, 25-36 months) for Group B. Postoperatively we obtained VAS pain and DASH scores for each group. Two years postoperatively, we found no differences in the VAS pain score or DASH: the mean VAS pain scores were 0.3 points in Group A and 0.4 points in Group B, and the DASH scores were 5.1 points and 6.1 points respectively. The addition of débridement of the posterior synovial fold did not appear to enhance either pain relief or function compared with the classic Baker technique without decortication.

The Brazilian version of the Constant-Murley Score (CMS-BR): convergent and construct validity, internal consistency, and unidimensionality.

PubMed

Barreto, Rodrigo Py Gonçalves; Barbosa, Marcus Levi Lopes; Balbinotti, Marcos Alencar Abaide; Mothes, Fernando Carlos; da Rosa, Luís Henrique Telles; Silva, Marcelo Faria

2016-01-01

To translate and culturally adapt the CMS and assess the validity of the Brazilian version (CMS-BR). The translation was carried out according to the back-translation method by four independent translators. The produced versions were synthesized through extensive analysis and by consensus of an expert committee, reaching a final version used for the cultural adaptation. A field test was conducted with 30 subjects in order to obtain semantic considerations. For the psychometric analyzes, the sample was increased to 110 participants who answered two instruments: CMS-BR and the Disabilities of the Arm, shoulder and Hand (DASH). The CMS-BR and DASH score range from 0 to 100 points. For the first, higher points reflect better function and for the latter, the inverse is true. The validity was verified by Pearson's correlation test, the unidimensionality by factorial analysis, and the internal consistency by Cronbach's alpha. The explained variance was 60.28% with factor loadings ranging from 0.60 to 0.91. The CMS-BR exhibited strong negative correlation with the DASH score (-0.82, p  < 0.05), Cronbach's alpha 0.85, and its total score was strongly correlated with the patient's range of motion (0.93, p  < 0.001). The CMS was satisfactorily adapted for Brazilian Portuguese and demonstrated evidence of validity that allows its use in this population.

The PROMIS physical function correlates with the QuickDASH in patients with upper extremity illness.

PubMed

Overbeek, Celeste L; Nota, Sjoerd P F T; Jayakumar, Prakash; Hageman, Michiel G; Ring, David

2015-01-01

To assess disability more efficiently with less burden on the patient, the National Institutes of Health has developed the Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function-an instrument based on item response theory and using computer adaptive testing (CAT). Initially, upper and lower extremity disabilities were not separated and we were curious if the PROMIS Physical Function CAT could measure upper extremity disability and the Quick Disability of Arm, Shoulder and Hand (QuickDASH). We aimed to find correlation between the PROMIS Physical Function and the QuickDASH questionnaires in patients with upper extremity illness. Secondarily, we addressed whether the PROMIS Physical Function and QuickDASH correlate with the PROMIS Depression CAT and PROMIS Pain Interference CAT instruments. Finally, we assessed factors associated with QuickDASH and PROMIS Physical Function in multivariable analysis. A cohort of 93 outpatients with upper extremity illnesses completed the QuickDASH and three PROMIS CAT questionnaires: Physical Function, Pain Interference, and Depression. Pain intensity was measured with an 11-point ordinal measure (0-10 numeric rating scale). Correlation between PROMIS Physical Function and the QuickDASH was assessed. Factors that correlated with the PROMIS Physical Function and QuickDASH were assessed in multivariable regression analysis after initial bivariate analysis. There was a moderate correlation between the PROMIS Physical Function and the QuickDASH questionnaire (r=-0.55, p<0.001). Greater disability as measured with the PROMIS and QuickDASH correlated most strongly with PROMIS Depression (r=-0.35, p<0.001 and r=0.34, p<0.001 respectively) and Pain Interference (r=-0.51, p<0.001 and r=0.74, p<0.001 respectively). The factors accounting for the variability in PROMIS scores are comparable to those for the QuickDASH except that the PROMIS Physical Function is influenced by other pain conditions while the QuickDASH is not. The PROMIS Physical Function instrument may be used as an upper extremity disability measure, as it correlates with the QuickDASH questionnaire, and both instruments are influenced most strongly by the degree to which pain interferes with achieving goals. Level III, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.

Diet quality and adherence to a healthy diet in Japanese male workers with untreated hypertension.

PubMed

Kanauchi, Masao; Kanauchi, Kimiko

2015-07-10

As Japanese societies rapidly undergo westernisation, the prevalence of hypertension is increasing. We investigated the association between dietary quality and the prevalence of untreated hypertension in Japanese male workers. We conducted a cross-sectional study of 433 male workers who completed a brief food frequency questionnaire. Adherence to the WHO-based Healthy Diet Indicator (HDI), the American Heart Association 2006 Diet and Lifestyle Recommendations, the Dietary Approaches to Stop Hypertension (DASH) diet, and Mediterranean-style diet was assessed using four adherence indexes (HDI score, AI-84 score, DASH score and MED score). Hypertension classes were classified into three categories: non-hypertension, untreated hypertension and treated hypertension (ie, taking antihypertensive medication). The prevalence of untreated hypertension and treated hypertension was 22.4% and 8.5%, respectively. Patients with untreated hypertension had significantly lower HDI and AI-84 scores compared with non-hypertension. DASH and MED scores across the three hypertension classes were comparable. After adjusting for age, energy intake, smoking habit, alcohol drinking, physical activity and salt intake, a low adherence to HDI and a lowest quartile of AI-84 score were associated with a significantly higher prevalence of untreated hypertension, with an OR of 3.33 (95% CI 1.39 to 7.94, p=0.007) and 2.23 (1.09 to 4.53, p=0.027), respectively. A lower dietary quality was associated with increased prevalence of untreated hypertension in Japanese male workers. Our findings support a potential beneficial impact of nutritional assessment using diet qualities. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Subjective evaluation of H.265/HEVC based dynamic adaptive video streaming over HTTP (HEVC-DASH)

NASA Astrophysics Data System (ADS)

Irondi, Iheanyi; Wang, Qi; Grecos, Christos

2015-02-01

The Dynamic Adaptive Streaming over HTTP (DASH) standard is becoming increasingly popular for real-time adaptive HTTP streaming of internet video in response to unstable network conditions. Integration of DASH streaming techniques with the new H.265/HEVC video coding standard is a promising area of research. The performance of HEVC-DASH systems has been previously evaluated by a few researchers using objective metrics, however subjective evaluation would provide a better measure of the user's Quality of Experience (QoE) and overall performance of the system. This paper presents a subjective evaluation of an HEVC-DASH system implemented in a hardware testbed. Previous studies in this area have focused on using the current H.264/AVC (Advanced Video Coding) or H.264/SVC (Scalable Video Coding) codecs and moreover, there has been no established standard test procedure for the subjective evaluation of DASH adaptive streaming. In this paper, we define a test plan for HEVC-DASH with a carefully justified data set employing longer video sequences that would be sufficient to demonstrate the bitrate switching operations in response to various network condition patterns. We evaluate the end user's real-time QoE online by investigating the perceived impact of delay, different packet loss rates, fluctuating bandwidth, and the perceived quality of using different DASH video stream segment sizes on a video streaming session using different video sequences. The Mean Opinion Score (MOS) results give an insight into the performance of the system and expectation of the users. The results from this study show the impact of different network impairments and different video segments on users' QoE and further analysis and study may help in optimizing system performance.

Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis.

PubMed

Arirachakaran, Alisara; Sukthuayat, Amnat; Sisayanarane, Thaworn; Laoratanavoraphong, Sorawut; Kanchanatawan, Wichan; Kongtharvonskul, Jatupon

2016-06-01

Clinical outcomes between the use of platelet-rich plasma (PRP), autologous blood (AB) and corticosteroid (CS) injection in lateral epicondylitis are still controversial. A systematic review and network meta-analysis of randomized controlled trials was conducted with the aim of comparing relevant clinical outcomes between the use of PRP, AB and CS injection. Medline and Scopus databases were searched from inception to January 2015. A network meta-analysis was performed by applying weight regression for continuous outcomes and a mixed-effect Poisson regression for dichotomous outcomes. Ten of 374 identified studies were eligible. When compared to CS, AB injection showed significantly improved effects with unstandardized mean differences (UMD) in pain visual analog scale (VAS), Disabilities of Arm Shoulder and Hand (DASH), Patient-Related Tennis Elbow Evaluation (PRTEE) score and pressure pain threshold (PPT) of -2.5 (95 % confidence interval, -3.5, -1.5), -25.5 (-33.8, -17.2), -5.3 (-9.1, -1.6) and 9.9 (5.6, 14.2), respectively. PRP injections also showed significantly improved VAS and DASH scores when compared with CS. PRP showed significantly better VAS with UMD when compared to AB injection. AB injection has a higher risk of adverse effects, with a relative risk of 1.78 (1.00, 3.17), when compared to CS. The network meta-analysis suggested no statistically significant difference in multiple active treatment comparisons of VAS, DASH and PRTEE when comparing PRP and AB injections. However, AB injection had improved DASH score and PPT when compared with PRP injection. In terms of adverse effects, AB injection had a higher risk than PRP injection. This network meta-analysis provided additional information that PRP injection can improve pain and lower the risk of complications, whereas AB injection can improve pain, disabilities scores and pressure pain threshold but has a higher risk of complications. Level I evidence.

Correlation of the degree of clavicle shortening after non-surgical treatment of midshaft fractures with upper limb function.

PubMed

Figueiredo, Gustavo Santiago de Lima; Tamaoki, Marcel Jun Sugawara; Dragone, Bruno; Utino, Artur Yudi; Netto, Nicola Archetti; Matsumoto, Marcelo Hide; Matsunaga, Fábio Teruo

2015-06-17

Despite the use of non-surgical methods to treat for the majority of midshaft fractures of the clavicle, it is remains controversial whether shortening of this bone following non-surgical treatment of a middle third fracture affects upper limb function. We conducted a cohort study by sequentially recruiting 59 patients with a fracture of the middle third of the clavicle. All patients were treated nonsurgically with a figure-of-eight bandage until clinical and radiological findings indicated healing of the fracture. Functional outcome was assessed using the Disability of Arm, Hand and Shoulder (DASH) score revalidated for the Portuguese language, other outcomes assessed included: pain measured by visual analogue scale (VAS); radiographies to measure the degree of shortening, fracture consolidation and fracture malunion. Information were also collected regarding the mechanism of injury, patient's daily activities level and epidemiological features of the patient cohort. The results of our findings are expressed as the comparison of the functional outcome with the degree of shortening. Patients were assessed six weeks and one year after injury. In the first evaluation, the mean DASH score was 28.84 and pain measured by VAS was 2.57. In the second evaluation (one year after injury) the mean DASH score was 8.18 and pain was 0.84. The mean clavicle shortening was 0.92 cm, ranging from 0 to 3 cm (SD = 0.64). There were no correlation between the degree of shortening and DASH score after six weeks and one year (p = 0.073 and 0.706, respectively). When only patients with of shortening greater than 2 cm were assessed for correlation, the result did not change. We conclude that clavicle shortening after nonsurgical treatment with a figure-of-eight bandage does not affect limb function, even when shortening exceeds 2 cm. ISRCTN85206617 . Registered 12 May 2014.

Uncemented three-dimensional-printed prosthetic replacement for giant cell tumor of distal radius: a new design of prosthesis and surgical techniques.

PubMed

Lu, Minxun; Min, Li; Xiao, Cong; Li, Yongjiang; Luo, Yi; Zhou, Yong; Zhang, Wenli; Tu, Chongqi

2018-01-01

Currently, it is challenging to treat giant cell tumor (GCT) of distal radius. For Campanacci grade III or recurrent GCTs, en bloc resection has been accepted as a better treatment option. Although numerous methods are available for reconstruction, all of them have some limitations in joint function and complications. In this study, our aims were to treat the GCT of distal radius with uncemented three-dimensional (3D)-printed prosthesis and to present and evaluate the surgical techniques and short-term outcomes. Between September 2015 and March 2017, 11 patients with distal radius GCTs were treated with personalized uncemented 3D-printed prosthesis. The preoperative/postoperative pain, range of motion, and grip strengths of all patients were evaluated. Oncological results, complications, and degenerative changes in the wrist joint were evaluated. Functional outcomes were assessed according to the disabilities of the arm, shoulder, and hand (DASH) questionnaire and Mayo wrist scoring systems. The average follow-up was 14.45 months (range, 8-18 months). There was a significant decrease in the mean postoperative visual analog scale score (2.33) compared with the preoperative score (5.22; p <0.001). The mean DASH score and Mayo wrist score of the wrist joint function were 18.7 and 72, respectively. There was no local recurrence or lung metastasis. No complication associated with prosthesis was observed, including aseptic loosening, subluxation, and breakage. Joint space narrowing, or disuse osteoporosis, was also not found in all cases. En bloc resection and reconstruction with a personalized uncemented 3D-printed prosthesis can be alternative options to treat Campanacci grade III or recurrent GCTs of distal radius and can result in short-term oncologic salvage, good postoperative function, and low complication rate. However, a long-term follow-up is required to determine the outcome.

Patient satisfaction and disability after brachial plexus surgery.

PubMed

Kretschmer, Thomas; Ihle, Sarah; Antoniadis, Gregor; Seidel, Julia A; Heinen, Christian; Börm, Wolfgang; Richter, Hans-Peter; König, Ralph

2009-10-01

Little is known about patient satisfaction and disability after brachial plexus surgery. Would patients undergo the procedure again, if they knew the current result beforehand? How do they rate their result and their disability? Of 319 plexus patients who had undergone surgery between 1995 and 2005, 199 received a 65-item questionnaire. Measurement instruments included a new plexus-specific outcome questionnaire (Ulm Questionnaire) with categories of satisfaction, functionality, pain, comorbidities, and work; and the disability of the arm, shoulder, and hand questionnaire (DASH; scale, 0-100). Of 99 returned questionnaires, 70 were returned in a useful form for evaluation. The results of patients with C5-C6 lesions (21 of 70) are as follows: 90% (19 of 21) would undergo surgery again, 95% (20 of 21) were satisfied with the result, and 86% (18 of 21) subjectively improved. The mean DASH score was 41 (standard deviation [SD], 24). The results of patients with C5-C7 lesions (6 of 70) are as follows: 50% (3 of 6) were satisfied and would undergo surgery again, and 67% (4 of 6) improved. The mean DASH score was 46 (SD, 13). The results of patients with C5-T1 lesions (43 of 70) are as follows: 67% (29 of 43) would undergo surgery again, 81% (35 of 42) were satisfied, and 74% (32 of 43) reported improvement. The mean DASH score was 58 (SD, 26). The overall mean DASH score was 52 (SD, 26). Pain since the injury was prevalent in 86% of patients (60 of 70), back pain in 53%, and depression/anxiety in 21%. Fifty-two percent of those who worked before their injury (27 of 53 patients) remained unemployed or incapacitated for work. Forty-five percent of previous workers (24 of 53) returned to their former occupation. Occupational retraining was successful for 70% of patients (16 of 23). The mean duration until return to work was 9 months overall and 5 months for those who returned to their previous occupation. Eighty-seven percent of patients were satisfied with the results and 83% would undergo the procedure again. Despite a high satisfaction rate, patients remained considerably disabled, and half of the previous workers did not return to work. Occupational retraining is effective.

Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial.

PubMed

D'Ambrosi, R; Palumbo, F; Paronzini, A; Ragone, V; Facchini, R M

2016-12-01

Results on the effectiveness of PRP supplementation in arthroscopic rotator cuff repair are conflicting, making it difficult to draw definitive conclusions. This was a prospective, randomized, and double-blind study with two groups of 20 patients each (PRP group and control group). Degenerative supraspinatus full-thickness tears grade C2-C3 were subjected to arthroscopic repair; PRP supplementation was given to patients in the PRP group. The outcomes were assessed by DASH, Constant scales, and ultrasound before and 6 months after surgery. Pain measured by VAS was evaluated preoperatively and 7 and 30 days after surgery. The two groups did not differ significantly by age, sex, and dominance of the affected side. In all surgical procedures, a long head of the biceps tenotomy and single-row repair were performed. The preoperative VAS was 5.6 ± 2.4 in PRP group and 6.4 ± 1.5 in the control group (p > 0.05). The group supplemented with PRP reported a VAS significantly better in the first week (2.5 ± 1.9 vs 5.3 ± 2.1, p < 0.05) and during the first month after surgery (1.5 ± 1.0 vs 3.2 ± 1.7, p < 0.05) compared to the control group. The preoperative Constant and DASH scores were 39.95 ± 12 and 51 ± 15.2, respectively, in the PRP group and 41 ± 11 (p > 0.05) and 45 ± 12.6 (p > 0.05) in the control group. The average Constant score improved significantly after 6 months to 81 ± 11.2 (p < 0.05) in the PRP group and 78.5 ± 9 (p < 0.05) in the control group. No differences were noted between the two groups (p > 0.05). The DASH score after 6 months was 17.4 ± 8 (p < 0.05) for the treatment group (the PRP group) and 21 ± 8.4 (p < 0.05) for the control group. No statistically significant differences were found as regards the DASH score in the two groups after 6 months (p > 0.05). The two groups showed no differences in the ultrasound evaluation after 6 months either. No re-ruptures occurred in either group. PRP leads to a reduction in pain during a short-term follow-up. Pain reduction allows for a more rapid recovery of mobilization and improvement in functionality. Randomized controlled trial, Level of evidence, 1.

Return to sports after arthroscopic capsulolabral repair using knotless suture anchors for anterior shoulder instability in soccer players: minimum 5-year follow-up study.

PubMed

Alentorn-Geli, Eduard; Álvarez-Díaz, Pedro; Doblas, Jesús; Steinbacher, Gilbert; Seijas, Roberto; Ares, Oscar; Boffa, Juan José; Cuscó, Xavier; Cugat, Ramón

2016-02-01

To report the return to sports and recurrence rates in competitive soccer players after arthroscopic capsulolabral repair using knotless suture anchors at a minimum of 5 years of follow-up. All competitive soccer players with anterior glenohumeral instability treated by arthroscopic capsulolabral repair using knotless suture anchors between 2002 and 2009 were retrospectively identified through the medical records. Inclusion criteria were: no previous surgical treatment of the involved shoulder, absence of glenoid or tuberosity fractures, absence of large Hill-Sachs or glenoid bone defect, minimum follow-up of 5 years, instability during soccer practice or games, and failure of non-surgical treatment. The charts of included players were reviewed, and a phone call was performed in a cross-sectional manner to obtain information on: current soccer, return to soccer, recurrence of instability, shoulder function (Rowe score), and disability [Quick-Disability of the Arm, Shoulder, and Hand (DASH) score and Quick-DASH Sports/Performing Arts Module]. Fifty-seven young male soccer players were finally included with a median (range) follow-up of 8 (5-10) years. Forty-nine (86 %) of the soccer players were able to return to soccer and 36 of them (73 %) at the same pre-injury level. There were 6 (10.5 %) re-dislocations in the 57 players, all of them of traumatic origin produced during soccer and other unrelated activities. The main reasons to not return to soccer were: knee injuries (two players), changes in personal life (two players), and job-related (three players). None of the players quit playing soccer because of their shoulder instability injury. The median (range) Rowe score, Quick-DASH score, and Quick-DASH sports score were 80 (25-100), 2.3 (0-12.5), and 0 (0-18.8), respectively. Competitive soccer players undergoing arthroscopic capsulolabral repair with knotless suture anchors for shoulder instability without significant bone loss demonstrate excellent return to play at mid-to-long-term follow-up, with a 10.5 % chances of re-dislocating. IV.

Minimally Invasive Osteosynthesis with a Bridge Plate Versus a Functional Brace for Humeral Shaft Fractures: A Randomized Controlled Trial.

PubMed

Matsunaga, Fabio Teruo; Tamaoki, Marcel Jun Sugawara; Matsumoto, Marcelo Hide; Netto, Nicola Archetti; Faloppa, Flavio; Belloti, Joao Carlos

2017-04-05

Nonoperative treatment has historically been considered the standard for fractures of the shaft of the humerus. Minimally invasive bridge-plate osteosynthesis for isolated humeral shaft fractures has been proven to be a safe technique, with good and reproducible results. This study was designed to compare clinical and radiographic outcomes between patients who had been treated with bridge plate osteosynthesis and those who had been managed nonoperatively with a functional brace. A prospective randomized trial was designed and included 110 patients allocated to 1 of 2 groups: surgery with a bridge plate or nonoperative treatment with a functional brace. The primary outcome was the Disabilities of the Arm, Shoulder and Hand (DASH) score at 6 months. The score on the Short Form-36 (SF-36) life-quality questionnaire, complications of treatment, Constant-Murley score for the shoulder, pain level, and radiographic results were assessed as secondary outcomes. Participants were assessed at 2 weeks; 1, 2, and 6 months; and 1 year after the interventions. The mean DASH score of the bridge plate group was statistically superior to that of the functional brace group (mean scores, 10.9 and 16.9, respectively; p = 0.046) only at 6 months. The bridge plate group also had a significantly more favorable nonunion rate (0% versus 15%) and less mean residual angular displacement seen on the anteroposterior radiograph (2.0° versus 10.5°) (both p < 0.05). No difference between the groups was detected with regard to the SF-36 score, pain level, Constant-Murley score, or angular displacement seen on the lateral radiograph. This trial demonstrates that, compared with functional bracing, surgical treatment with a bridge plate has a statistically significant advantage, of uncertain clinical benefit, with respect to self-reported outcome (DASH score) at 6 months, nonunion rate, and residual deformity in the coronal plane as seen on radiographs. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Psychometric Properties of the Persian Version of the Simple Shoulder Test (SST) Questionnaire.

PubMed

Ebrahimzadeh, Mohammad H; Vahedi, Ehsan; Baradaran, Aslan; Birjandinejad, Ali; Seyyed-Hoseinian, Seyyed-Hadi; Bagheri, Farshid; Kachooei, Amir Reza

2016-10-01

To validate the Persian version of the simple shoulder test in patients with shoulder joint problems. Following Beaton`s guideline, translation and back translation was conducted. We reached to a consensus on the Persian version of SST. To test the face validity in a pilot study, the Persian SST was administered to 20 individuals with shoulder joint conditions. We enrolled 148 consecutive patients with shoulder problem to fill the Persian SST, shoulder specific measure including Oxford shoulder score (OSS) and two general measures including DASH and SF-36. To measure the test-retest reliability, 42 patients were randomly asked to fill the Persian-SST for the second time after one week. Cronbach's alpha coefficient was used to demonstrate internal consistency over the 12 items of Persian-SST. ICC for the total questionnaire was 0.61 showing good and acceptable test-retest reliability. ICC for individual items ranged from 0.32 to 0.79. The total Cronbach's alpha was 0.84 showing good internal consistency over the 12 items of the Persian-SST. Validity testing showed strong correlation between SST and OSS and DASH. The correlation with OSS was positive while with DASH scores was negative. The correlation was also good to strong with all physical and most mental subscales of the SF-36. Correlation coefficient was higher with DASH and OSS in compare to SF-36. Persian version of SST found to be valid and reliable instrument for shoulder joint pain and function assessment in Iranian population.

Association of Changes in Diet Quality with Total and Cause-Specific Mortality

PubMed Central

Sotos-Prieto, Mercedes; Bhupathiraju, Shilpa N.; Mattei, Josiemer; Fung, Teresa T.; Li, Yanping; Pan, An; Willett, Walter C.; Rimm, Eric B.; Hu, Frank B.

2017-01-01

BACKGROUND Few studies have evaluated the relationship between changes in diet quality over time and the risk of death. METHODS We used Cox proportional-hazards models to calculate adjusted hazard ratios for total and cause-specific mortality among 47,994 women in the Nurses’ Health Study and 25,745 men in the Health Professionals Follow-up Study from 1998 through 2010. Changes in diet quality over the preceding 12 years (1986–1998) were assessed with the use of the Alternate Healthy Eating Index–2010 score, the Alternate Mediterranean Diet score, and the Dietary Approaches to Stop Hypertension (DASH) diet score. RESULTS The pooled hazard ratios for all-cause mortality among participants who had the greatest improvement in diet quality (13 to 33% improvement), as compared with those who had a relatively stable diet quality (0 to 3% improvement), in the 12-year period were the following: 0.91 (95% confidence interval [CI], 0.85 to 0.97) according to changes in the Alternate Healthy Eating Index score, 0.84 (95 CI%, 0.78 to 0.91) according to changes in the Alternate Mediterranean Diet score, and 0.89 (95% CI, 0.84 to 0.95) according to changes in the DASH score. A 20-percentile increase in diet scores (indicating an improved quality of diet) was significantly associated with a reduction in total mortality of 8 to 17% with the use of the three diet indexes and a 7 to 15% reduction in the risk of death from cardiovascular disease with the use of the Alternate Healthy Eating Index and Alternate Mediterranean Diet. Among participants who maintained a high-quality diet over a 12-year period, the risk of death from any cause was significantly lower — by 14% (95% CI, 8 to 19) when assessed with the Alternate Healthy Eating Index score, 11% (95% CI, 5 to 18) when assessed with the Alternate Mediterranean Diet score, and 9% (95% CI, 2 to 15) when assessed with the DASH score — than the risk among participants with consistently low diet scores over time. CONCLUSIONS Improved diet quality over 12 years was consistently associated with a decreased risk of death. PMID:28700845

Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health in U.S. adults.

PubMed

Park, Yong-Moon Mark; Steck, Susan E; Fung, Teresa T; Zhang, Jiajia; Hazlett, Linda J; Han, Kyungdo; Lee, Seung-Hwan; Kwon, Hyuk-Sang; Merchant, Anwar T

2017-10-01

There is sparse evidence on the relationship between the Mediterranean diet, Dietary Approaches to Stop Hypertension (DASH) style diet, and metabolic health, especially comparing cardiometabolic phenotypes among in normal weight and obese populations. We aimed to investigate the association of the Mediterranean diet scores (MDS) and DASH index with metabolically healthy obese (MHO) and metabolically obese normal weight (MONW) phenotypes in a representative U.S. MDS and DASH index were calculated using dietary data from 2767 adults aged 20-90 years without any prior diagnosis of cancer or cardiovascular disease from the National Health and Nutrition Examination Survey III, 1988-1994. MHO and MONW individuals were identified using fasting glucose, insulin resistance, blood pressure, triglycerides, C-reactive protein, and high-density lipoprotein-cholesterol. Higher MDS was associated with higher odds of MHO phenotype (odds ratio (OR) T3 vs T1 , 2.57 [95% confidence interval (CI), 1.04-6.35]; P trend = 0.04), and higher DASH index was associated with lower odds of MONW phenotype (OR T3 vs T1, 0.59 [95% CI, 0.38-0.93]; P trend = 0.03) only in the younger age group (<45 years for men or premenopausal women). No significant associations of MDS and DASH index with MHO and MONW phenotypes were observed in the older age group (≥45 years for men or postmenopausal women). Adherence to Mediterranean diet or DASH style diet was favorably associated with MHO and MONW phenotypes only in the younger age group, suggesting that potential dietary intervention to prevent cardiometabolic disease differ by age group. Published by Elsevier Ltd.

Accessibility and Affordability of Supermarkets: Associations With the DASH Diet.

PubMed

Mackenbach, Joreintje D; Burgoine, Thomas; Lakerveld, Jeroen; Forouhi, Nita G; Griffin, Simon J; Wareham, Nicholas J; Monsivais, Pablo

2017-07-01

It is unknown whether there is an interplay of affordability (economic accessibility) and proximity (geographic accessibility) of supermarkets in relation to having a Dietary Approaches to Stop Hypertension (DASH)-accordant diet. Data (collected: 2005-2015, analyzed: 2016) were from the cross-sectional, population-based Fenland Study cohort: 9,274 adults aged 29-64 years, living in Cambridgeshire, United Kingdom. Dietary quality was evaluated using an index of DASH dietary accordance, based on recorded consumption of foods and beverages in a validated 130-item, semi-quantitative food frequency questionnaire. DASH accordance was defined as a DASH score in the top quintile. Dietary costs (£/day) were estimated by attributing a food price variable to the foods consumed according to the questionnaire. Individuals were classified as having low-, medium-, or high-cost diets. Supermarket affordability was determined based on the cost of a 101-item market basket. Distances between home address to the nearest supermarket (geographic accessibility) and nearest economically-appropriate supermarket (economic accessibility) were divided into tertiles. Higher-cost diets were more likely to be DASH-accordant. After adjustment for key demographics and exposure to other food outlets, individuals with lowest economic accessibility to supermarkets had lower odds of being DASH-accordant (OR=0.59, 95% CI=0.52, 0.68) than individuals with greatest economic accessibility. This association was stronger than with geographic accessibility alone (OR=0.85, 95% CI=0.74, 0.98). Results suggest that geographic and economic access to food should be taken into account when considering approaches to promote adherence to healthy diets for the prevention of cardiovascular diseases and other chronic disease. Copyright © 2017 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Treatment strategy and long-term functional outcome of traumatic elbow dislocation in childhood: a single centre study.

PubMed

Nussberger, G; Schädelin, S; Mayr, J; Studer, D; Zimmermann, P

2018-04-01

Traumatic elbow dislocation (TED) is the most common injury of large joints in children. There is an ongoing debate on the optimal treatment for TED. We aimed to assess the functional outcome after operative and nonoperative treatment of TED. We analysed the medical records of patients with TED treated at the University Children's Hospital, Basel, between March 2006 and June 2015. Functional outcome was assessed using the Mayo Elbow Performance Score (MEPS) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) Sport and Music Module score. These scores were compared between nonoperatively and operatively treated patients. A total of 37 patients (mean age 10.2 years, 5.2 to 15.3) were included. Of these, 21 (56.8%) children had undergone nonoperative treatment, with 16 (43.2%) patients having had operative treatment. After a mean follow-up of 5.6 years (1.2 to 5.9), MEPS and QuickDASH Sport and Music Module scores in the nonoperative group and operative group were similar: MEPS: 97.1 points (SD 4.6) versus 97.2 points (SD 2.6); 95% confidence interval (CI)-2.56 to 2.03); p = 0.53; QuickDASH Sport and Music Module score: 3.9 points (SD 6.1) versus 3.1 points (SD 4.6); 95% CI 2.60 to 4.17; p = 0.94. We noted no significant differences regarding the long-term functional outcome between the subgroup of children treated operatively versus those treated nonoperatively for TED with accompanying fractures of the medial epicondyle and medial condyle. Functional outcome after TED was excellent, independent of the treatment strategy. If clear indications for surgery are absent, a nonoperative approach for TED should be considered. Level III - therapeutic, retrospective, comparative study.

Comparison of short- to medium-term results of Coonrad-Morrey elbow replacement in patients with rheumatoid arthritis versus patients after elbow injuries

PubMed Central

Szyluk, Karol; Widuchowski, Wojciech; Jasiński, Andrzej; Koczy, Bogdan; Widuchowski, Jerzy

2013-01-01

Background The aim of this study was to assess the utility of the Coonrad-Morrey elbow prosthesis in patients with severe elbow dysfunction secondary to rheumatoid arthritis (RA) or post-traumatic elbow dysfunction. Material/Methods The study involved 35 patients followed up for a mean of 36 months. The patients were divided into those with RA (Group I) and those with post-traumatic elbow dysfunction (Group II). Treatment outcomes were evaluated according to the Mayo Elbow Performance Score (MEPS) and the Disabilities of the Arm, Shoulder and Hand Score (Quick DASH). Results According to the MEPS, there were 20 (57.15%) excellent, 12 (34.3%) good, 1 (2.85%) fair, and 2 (5.7%) poor outcomes. The mean post-operative Quick-DASH score for the entire study group was 37.73 points. In subgroup analysis, the MEPS-based evaluation revealed: 14 (70%) excellent, 5 (25%) good, and 1 (5%) satisfactory outcome in Group I, versus 6 (40%) excellent, 7 (46.7%) good, and 2 (13.3%) poor outcomes in Group II. The mean Quick Dash scores were 78.64 points in Group I and 76.36 points in Group II. The final MEPS scores in Group I (p=0.000018) and Group II (p=0.00065) were most markedly influenced by reduction in elbow pain and improvement in the ability to perform activities of daily living (ADL): p=0.000018 in Group I and p=0.000713 in Group II. Conclusions The treatment outcomes confirm the utility of arthroplasty for severe elbow dysfunctions; they were most strongly influenced by pain reduction and improved ability to perform activities of daily living. PMID:23291737

Distal biceps reconstruction using an Achilles tendon allograft, transosseous EndoButton, and Pulvertaft weave with tendon wrap technique for retracted, irreparable distal biceps ruptures.

PubMed

Phadnis, Joideep; Flannery, Olivia; Watts, Adam C

2016-06-01

Distal biceps ruptures can result in ongoing pain and weakness when treated nonoperatively. If retraction of the tendon renders primary repair impossible, reconstruction using a graft is recommended. The current literature includes a variety of techniques with studies reporting small patient numbers. The aim of this study was to report the results of a larger cohort of patients using a technique modified from those previously described in the literature. Twenty-one consecutive male patients underwent distal biceps reconstruction through 2 small anterior incisions using an Achilles tendon allograft that was fixed distally using a transosseous EndoButton and secured proximally using a Pulvertaft weave and tendon wrap. The mean age was 44 years, and the mean time to surgery was 25 months (range, 2-96 months). Functional outcomes were collected prospectively. The mean preoperative Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score (11 patients) was 1.9 (range, 0-4.5). The mean postoperative Oxford Elbow Score, QuickDASH score, and Mayo Elbow Performance Score were 44.7 (range, 35-48), 4 (range, 0-20.5), and 92.9 (range, 70-100), respectively, at a mean follow up of 15 months (range, 6-35 months). The mean postoperative QuickDASH score was significantly improved compared with preoperatively (P < .001). All patients were satisfied and all returned to their previous level of activity. There were 2 transient lateral antebrachial cutaneous nerve paresthesias, and 2 patients had a 5° extension lag. There were no other complications. Achilles allograft reconstruction of retracted irreparable distal biceps ruptures provides consistently good results with few complications using this technique. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

DASH diet, insulin resistance, and serum hs-CRP in polycystic ovary syndrome: a randomized controlled clinical trial.

PubMed

Asemi, Z; Esmaillzadeh, A

2015-03-01

This study was designed to assess the effects of Dietary Approaches to Stop Hypertension (DASH) eating plan on insulin resistance and serum hs-CRP in overweight and obese women with PCOS. This randomized controlled clinical trial was done on 48 women diagnosed with PCOS. Subjects were randomly assigned to consume either the control (n=24) or the DASH eating pattern (n=24) for 8 weeks. The DASH diet consisted of 52% carbohydrates, 18% proteins, and 30% total fats. It was designed to be rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, cholesterol, refined grains, and sweets. Sodium content of the DASH diet was designed to be less than 2 400 mg/day. The control diet was also designed to contain 52% carbohydrates, 18% protein, and 30% total fat. Fasting blood samples were taken at baseline and after 8 weeks intervention to measure -insulin resistance and serum hs-CRP levels. -Adherence to the DASH eating pattern, compared to the -control diet, resulted in a significant reduction of serum insulin levels (-1.88 vs. 2.89 μIU/ml, p=0.03), HOMA-IR score (-0.45 vs. 0.80; p=0.01), and serum hs-CRP levels (-763.29 vs. 665.95 ng/ml, p=0.009). Additionally, a significant reduction in waist (-5.2 vs. -2.1 cm; p=0.003) and hip circumference (-5.9 vs. -1 cm; p<0.0001) was also seen in the DASH group compared with the control group. In conclusion, consumption of the DASH eating pattern for 8 weeks in overweight and obese women with PCOS resulted in the improvement of insulin resistance, serum hs-CRP levels, and abdominal fat accumulation. www.irct.ir: IRCT201304235623N6. © Georg Thieme Verlag KG Stuttgart · New York.

Incidence and Functional Outcomes of Scapholunate Diastases Associated Distal Radius Fractures: A 2-year Follow-Up Scapholunate Dissociation.

PubMed

Lans, Jonathan; Lasa, Alejandro; Chen, Neal C; Jupiter, Jesse B

2018-01-01

The Scapholunate Interosseous Ligament (SLIL) is the first intrinsic carpal ligament to be injured in wrist trauma, present in up to 64% of the distal radius fractures. However, it remains unclear what patients develop symptoms, making primary treatment of these injuries accompanying distal radius fractures remains questionable. The aim of this study was to evaluate the functional outcomes of patients with scapholunate diastasis associated with distal radius fractures. We evaluated 391 patients with a distal radius fracture. Using Computer Tomography (CT) scans the scapholunate interval was measured. We identified 14 patients with an SLD (>3mm) of the injured wrist, which underwent a CT-scan of the contralateral wrist. To evaluate the functional outcomes at a mean follow up of 136±90 weeks, we used the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) Score. There were 8 patients with bilateral SLD and 6 patients with unilateral SLD. Five patients had a qDASH score of 0 and one patient showed a qDASH score of 18.2. The patient with a poor score had bilateral preexisting osteoarthritis of the wrist. No patient had additional surgery of the SLIL. In patients with distal radius fractures, more than half of the 14 patients with an SL gap on CT had widening on the contralateral side. It is therefore worthwhile to image the contralateral wrist before diagnosing a SLD. The patients with unilateral SLD should not be surgically treated at initial presentation because they may have good functional outcomes after a follow up of 2 years.

Parent Diet Quality and Energy Intake Are Related to Child Diet Quality and Energy Intake

PubMed Central

Robson, Shannon M.; Couch, Sarah C.; Peugh, James L.; Glanz, Karen; Zhou, Chuan; Sallis, James F.; Saelens, Brian E.

2016-01-01

Background Parents' diets are believed to influence their children's diets. Previous studies have not adequately and simultaneously assessed the relation of parent and child total diet quality and energy intake. Objective To investigate if parent and child diet quality and energy intakes are related. Design A cross-sectional analysis using baseline dietary intake data from the Neighborhood Impact on Kids (NIK) study collected in 2007-2009. Participants/setting Parents and 6-12 year old children from households in King County (Seattle area), WA and San Diego County, CA, targeted by NIK were recruited. Eligible parent-child dyads (n=698) with two or three 24-hour dietary recalls were included in this secondary analysis. Main Outcome Measures Child diet quality (Healthy Eating Index-2010 [HEI-2010], Dietary Approaches to Stop Hypertension [DASH] score, and energy density (for food-only) and energy intake were derived from the dietary recalls using Nutrition Data Systems for Research. Statistical Analyses Performed Multiple linear regression models examined the relationship between parent diet quality and child diet quality, and the relationship between parent energy intake and child energy intake. In both analyses, we controlled for parent characteristics, child characteristics, household education and neighborhood type. Results Parent diet quality measures were significantly related to corresponding child diet quality measures: HEI-2010 (standardized beta [β] = 0.39, p<0.001); DASH score (β = 0.33, p<0.001); energy density (β = 0.32, p<0.001). Parent daily average energy intake (1763 ± 524 kilocalories) also was significantly related (β = 0.30, p<0.001) to child daily average energy intake (1751 ± 431 kilocalories). Conclusion Parent and child intakes were closely related across various metrics of diet quality and for energy intake. Mechanisms of influence are likely to be shared food environments, shared meals, and parent modeling. PMID:27050725

Increased wound complication with intramedullary screw fixation of clavicle fractures: Is it thermal necrosis?

PubMed

Domos, Peter; Tytherleigh-Strong, Graham; Van Rensburg, Lee

2017-01-01

Adult mid-shaft clavicle fractures are common injuries. For displaced fractures, open reduction with plate or intramedullary (IM) fixation is the widely used techniques. All methods have their own potential drawbacks, especially related to local soft tissue complications. There is little information about outcome and management of local wound complications after clavicle fracture fixations. Ninety-seven patients underwent open reduction and internal fixation, 17 were treated with IM screw fixation and 80 with plate fixation. Wound complication occurred in eight patients (8.2%) and rates differed significantly between IM and plate fixations (29.4% vs. 3.8%). Patients were assessed on average 58.3 months with visual analogue pain scores (VASs), Oxford Shoulder Score (OSS), and QuickDash (QD) score. Five patients had wound breakdown and three patients had wound erythema. In seven patients with stable fixation, it was possible to "dress and suppress" with average 3 weeks of oral antibiotics. One patient had unstable fixation and required longer antibiotic treatment with early screw removal. One patient developed a chronic discharging wound, requiring debridement and later plate removal. At final follow-up, all wounds remained healed, bony union was achieved in all. The average scores were: VAS 1, OSS 46, and QD 4.5. Good function with dry healed wound and united clavicle can be achieved. Further studies are required to investigate the difference in soft tissue complication rates, which may be due to the IM technique of retrograde drilling with a guide wire and due to aseptic thermal bone necrosis, rather than true infection.

Association Between Blood Pressure and Adherence to French Dietary Guidelines.

PubMed

Lelong, Helene; Blacher, Jacques; Menai, Mehdi; Galan, Pilar; Fezeu, Leopold; Hercberg, Serge; Kesse-Guyot, Emmanuelle

2016-08-01

Adopting a healthy diet like the Dietary Approach to Stop Hypertension (DASH) or Mediterranean diet (MD) represents a major lifestyle for blood pressure (BP) control in general population. Nutritional policies, such as the French Nutrition and Health Program (Programme National Nutrition Santé or PNNS), have been implemented in several countries with the aims of preventing chronic diseases. The objective of our study was to investigate association between BP and adherence to PNNS guidelines compared with adherence to DASH or MD. We conducted a cross-sectional study in 11,302 untreated participants from the NutriNet-Santé study, a French web-based cohort study. Three validated scores reflecting adherence to PNNS guidelines, DASH diet, and MD were calculated from repeated 24-hour records. Three BP measurements using a standardized protocol were collected. Multivariate linear models were used to assess the associations between the dietary scores and BP. In women, independent of age, socioeconomic status, body mass index, tobacco use, alcohol consumption, and physical activity, adherence to PNNS guidelines was inversely significantly associated with systolic BP (β = -0.63, P < 0.0001). This association was of similar amplitude that between BP and adherence to DASH-style diet (β = -0.66, P < 0.0001) or MD (β = -0.63, P = 0.0002). No significant association was found in men. Adherence to French nutritional recommendations was found negatively associated with BP at the same magnitude as adherence to well-known dietary pattern in the prevention and treatment of hypertension. © American Journal of Hypertension, Ltd 2016. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Adherence to dietary guidelines and cardiovascular disease risk in the EPIC-NL cohort.

PubMed

Struijk, Ellen A; May, Anne M; Wezenbeek, Nick L W; Fransen, Heidi P; Soedamah-Muthu, Sabita S; Geelen, Anouk; Boer, Jolanda M A; van der Schouw, Yvonne T; Bueno-de-Mesquita, H Bas; Beulens, Joline W J

2014-09-20

Global and national dietary guidelines have been created to lower chronic disease risk. The aim of this study was to assess whether greater adherence to the WHO guidelines (Healthy Diet Indicator (HDI)); the Dutch guidelines for a healthy diet (Dutch Healthy Diet-index (DHD-index)); and the Dietary Approaches to Stop Hypertension (DASH) diet was associated with a lower risk of cardiovascular disease (CVD), coronary heart disease (CHD) or stroke. A prospective cohort study was conducted among 33,671 healthy Dutch men and women aged 20-70 years recruited into the EPIC-NL study during 1993-1997. We used Cox regression adjusted for relevant confounders to estimate the hazard ratios per standard deviation increase in score and 95% confidence intervals (CI) of the associations between the dietary guidelines and CVD, CHD and stroke risk. After an average follow-up of 12.2 years, 2752 CVD cases were documented, including 1630 CHD cases and 527 stroke cases. We found no association between the HDI (0.98, 95% CI 0.94; 1.02) or DHD-index (0.96, 95% CI 0.92; 1.00) and CVD incidence. Similar results were found for these guidelines and CHD or stroke incidence. Higher adherence to the DASH diet was significantly associated with a lower CVD (0.92, 95% CI 0.89; 0.96), CHD (0.91, 95% CI 0.86; 0.95), and stroke (0.90, 95% CI 0.82; 0.99) risk. The HDI and the DHD-index were not associated with CVD risk, while the DASH diet was significantly associated with a lower risk of developing CVD, CHD and stroke. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Cross-cultural adaptation and validation of the Korean version of the Oxford shoulder score.

PubMed

Roh, Young Hak; Noh, Jung Ho; Kim, Woo; Oh, Joo Han; Gong, Hyun Sik; Baek, Goo Hyun

2012-01-01

The Oxford shoulder score (OSS) is being used increasingly and has been adapted cross-culturally in some Western countries. On the other hand, there are few validated translations of the OSS in Asian countries. This study translated and adapted cross-culturally the original OSS to produce a Korean version, and assessed the validity and reliability of the Korean version of the OSS (Korean OSS). One hundred and five patients with shoulder pain caused by degenerative or inflammatory disorders completed the Korean OSS and Korean disability of arm, shoulder and hand (DASH). In addition, the pain score by a visual analog scale (VAS) during activity and at rest, subjective assessment of activities of daily living (ADL), the active range of motion (ROM), and measurements of the abduction strength (strength) were included in the validation process. There were no major linguistic or cultural problems during the forward and backward translations of the MHQ, except for a minor change due to cultural discrepancies in eating such as using a spoon and chopsticks by one dominant hand instead of a knife and fork by two hands. The internal consistency was high (Cronbach's alpha 0.91). The reproducibility test showed no significant difference (Intra-class coefficient 0.95). The construct validity, which was tested by the Pearson correlation coefficient revealed a strong correlation (r > 0.6) between the Korean OSS against subscale of DASH disability/symptom, DASH work and ADL, as well as a moderate correlation (0.3 < r < 0.6) with the DASH sports/music, strength, ROM, pain during activity and pain at rest. The Korean OSS proved to be valid by demonstrating a significant correlation with the patient-based upper extremity questionnaire and clinical assessment. The application and evaluation of the instrument is feasible and understandable among patients in Korea.

Dietary Patterns Over Time and Microalbuminuria in Youth and Young Adults With Type 1 Diabetes: The SEARCH Nutrition Ancillary Study.

PubMed

Costacou, Tina; Crandell, Jamie; Kahkoska, Anna R; Liese, Angela D; Dabelea, Dana; Lawrence, Jean M; Pettitt, David J; Reynolds, Kristi; Mayer-Davis, Elizabeth J; Mottl, Amy K

2018-06-14

We assessed the association between diet quality and microalbuminuria in youth-onset type 1 diabetes using three indices: a modified Mediterranean diet score for children and adolescents (mKIDMED), the Dietary Approaches to Stop Hypertension (DASH), and the Healthy Eating Index-2010 (HEI). Youth and young adults from the SEARCH (Search for Diabetes in Youth) Nutrition Ancillary Study diagnosed with type 1 diabetes in 2002-2008, who had repeated dietary assessments at baseline and follow-up visits and urine albumin-to-creatinine ratio (UACR) measured at the outcome visit (2012-2015) ( n = 461), were selected for study. Regression models estimated the association between each longitudinally assessed diet score and UACR and microalbuminuria (UACR ≥30 μg/mg). The cohort was 43% female, and at follow-up, mean age was 20 years, disease duration was 108 months, and 7% had microalbuminuria. Adherence to a higher-quality diet was low for the mKIDMED (mean 3.7 of a possible range of -3 to 12) and the DASH (mean 42 of 80) and better, for the HEI (mean 56.3 of 100). A borderline inverse association was observed between the HEI score and microalbuminuria after adjustment for caloric and protein intake and demographic and disease factors (odds ratio [OR] HEI 0.83, P = 0.07), which lost significance with further adjustment for HbA 1c and systolic blood pressure (OR HEI 0.86, P = 0.19). Results were similar for continuous UACR. No significant associations were observed for diet quality characterized by the mKIDMED or DASH indices. Greater adherence to the HEI may be beneficial for kidney health in youth and young adults with type 1 diabetes. Low adherence to the mKIDMED and DASH diets may explain the lack of association with microalbuminuria. © 2018 by the American Diabetes Association.

Return to competitive sports after medial epicondyle fractures in adolescent athletes: results of operative and nonoperative treatment.

PubMed

Lawrence, J Todd R; Patel, Neeraj M; Macknin, Jonathan; Flynn, John M; Cameron, Danielle; Wolfgruber, Hayley C; Ganley, Theodore J

2013-05-01

The optimal treatment of medial epicondyle fractures in pediatric athletes remains unclear. To evaluate the outcomes of operative and nonoperative management of medial epicondyle fractures in young athletes. Case series; Level of evidence, 4. The records of all children with fractures of the medial epicondyle over a 5-year period, with a minimum 2 years of follow-up at a pediatric tertiary referral center, were reviewed. Patients with intra-articular entrapment of the fracture fragment or ulnar nerve entrapment were excluded. Treatment decisions were made primarily based on injury mechanism and elbow laxity or instability. Patients were contacted and asked to complete a modified Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. Complete data with 2-year follow-up were available for 20 athletes: 6 treated nonoperatively and 14 treated operatively. At the latest follow-up, both groups achieved excellent DASH scores. Half of each cohort required physical therapy, and 6 of 14 patients who received operative treatment reported numbness. All patients were either very or completely satisfied with their treatment. Fourteen patients were overhead athletes (8 treated operatively, 6 nonoperatively). Excellent DASH scores were achieved in both groups, and all overhead athletes were able to return to their sport at the next appropriate level. Seven patients were baseball pitchers and sustained a fracture while throwing (4 treated operatively, 3 nonoperatively). None felt their performance was limited after treatment, and excellent DASH scores were achieved in both groups. These data demonstrate that nonoperative treatment can be successful in young athletes with low-energy medial epicondyle avulsions, a stable elbow, and minimal fracture displacement. Surgical management can be successful in athletes who sustain more significant trauma, who have elbow laxity or instability, or who have significant fracture fragment displacement after a fracture of the medial epicondyle.

Multiple Off-Ice Performance Variables Predict On-Ice Skating Performance in Male and Female Division III Ice Hockey Players.

PubMed

Janot, Jeffrey M; Beltz, Nicholas M; Dalleck, Lance D

2015-09-01

The purpose of this study was to determine if off-ice performance variables could predict on-ice skating performance in Division III collegiate hockey players. Both men (n = 15) and women (n = 11) hockey players (age = 20.5 ± 1.4 years) participated in the study. The skating tests were agility cornering S-turn, 6.10 m acceleration, 44.80 m speed, modified repeat skate, and 15.20 m full speed. Off-ice variables assessed were years of playing experience, height, weight and percent body fat and off-ice performance variables included vertical jump (VJ), 40-yd dash (36.58m), 1-RM squat, pro-agility, Wingate peak power and peak power percentage drop (% drop), and 1.5 mile (2.4km) run. Results indicated that 40-yd dash (36.58m), VJ, 1.5 mile (2.4km) run, and % drop were significant predictors of skating performance for repeat skate (slowest, fastest, and average time) and 44.80 m speed time, respectively. Four predictive equations were derived from multiple regression analyses: 1) slowest repeat skate time = 2.362 + (1.68 x 40-yd dash time) + (0.005 x 1.5 mile run), 2) fastest repeat skate time = 9.762 - (0.089 x VJ) - (0.998 x 40-yd dash time), 3) average repeat skate time = 7.770 + (1.041 x 40-yd dash time) - (0.63 x VJ) + (0.003 x 1.5 mile time), and 4) 47.85 m speed test = 7.707 - (0.050 x VJ) - (0.01 x % drop). It was concluded that selected off-ice tests could be used to predict on-ice performance regarding speed and recovery ability in Division III male and female hockey players. Key pointsThe 40-yd dash (36.58m) and vertical jump tests are significant predictors of on-ice skating performance specific to speed.In addition to 40-yd dash and vertical jump, the 1.5 mile (2.4km) run for time and percent power drop from the Wingate anaerobic power test were also significant predictors of skating performance that incorporates the aspect of recovery from skating activity.Due to the specificity of selected off-ice variables as predictors of on-ice performance, coaches can elect to assess player performance off-ice and focus on other uses of valuable ice time for their individual teams.

Arthroscopic-assisted repair of triangular fibrocartilage complex foveal avulsion in distal radioulnar joint injury

PubMed Central

Woo, Sung Jong; Jegal, Midum; Park, Min Jong

2016-01-01

Background: Disruption of the triangular fibrocartilage complex (TFCC) foveal insertion can lead to distal radioulnar joint (DRUJ) instability accompanied by ulnar-sided pain, weakness, snapping, and limited forearm rotation. We investigated the clinical outcomes of patients with TFCC foveal tears treated with arthroscopic-assisted repair. Materials and Methods: Twelve patients underwent foveal repair of avulsed TFCC with the assistance of arthroscopy between 2011 and 2013. These patients were followed up for an average of 19 months (range 14–25 months). The avulsed TFCC were reattached to the fovea using a transosseous pull-out suture or a knotless suture anchor. At the final followup, the range of motion, grip strength and DRUJ stability were measured as objective outcomes. Subjective outcomes were assessed using the Visual Analog Scale (VAS) for pain, patient rated wrist evaluation (PRWE), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score) and return to work. Results: Based on the DRUJ stress test, 5 patients had normal stability and 7 patients showed mild laxity as compared with the contralateral side. Postoperatively, the mean range of pronation supination increased from 141° to 166°, and the mean VAS score for pain decreased from 5.3 to 1.7 significantly. The PRWE and DASH questionnaires also showed significant functional improvement. All patients were able to return to their jobs. However, two patients complained of persistent pain. Conclusions: Arthroscopically assisted repair of TFCC foveal injury can provide significant pain relief, functional improvement and restoration of DRUJ stability. PMID:27293286

Functional and oncological outcome after surgical resection of the scapula and clavicle for primary chondrosarcoma.

PubMed

Nota, S P F T; Russchen, M J A M; Raskin, K A; Mankin, H J; Hornicek, F J; Schwab, J H

2017-04-01

The scapula is a relatively common site for chondrosarcoma to develop in contrary to the clavicle, which is rarely affected by these tumors. The aim of this study is to determine the functional and oncological outcome for patients treated operatively for scapular or clavicular chondrosarcoma. In this single-center retrospective study, we included a sample of 20 patients that received the diagnosis of a primary chondrosarcoma of the scapula or clavicle. Of the surviving patients, the functional function was assessed using the DASH and the PROMIS Physical Function-Upper Extremity. Patients were longitudinally tracked for their oncological outcome. All patients were followed for at least 2 years or until death. The mean age of the cohort was 47 years. Eighteen patients suffered from a chondrosarcoma of the scapula, and in 2 patients, the tumor was located in the clavicle. Metastasis, local recurrence and a higher tumor grade were all associated with a decreased overall survival. For the patients with a chondrosarcoma of the scapula, the average DASH score was 16 ± 16 and the mean PROMIS Physical Function-Upper Extremity score was 48 ± 10. Patients with both an intact rotator cuff and glenoid had a better physical function. Upper extremity function after (partial) scapulectomy varied depending on whether the glenoid was spared and whether a functioning shoulder abductor remained. When the resection spared these structures, then excellent functional outcomes were reported. Oncologic outcomes depended upon the grade of the tumor and whether local recurrence and metastases occurred.

Does a better adherence to dietary guidelines reduce mortality risk and environmental impact in the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition?

PubMed

Biesbroek, Sander; Verschuren, W M Monique; Boer, Jolanda M A; van de Kamp, Mirjam E; van der Schouw, Yvonne T; Geelen, Anouk; Looman, Moniek; Temme, Elisabeth H M

2017-07-01

Guidelines for a healthy diet aim to decrease the risk of chronic diseases. It is unclear as to what extent a healthy diet is also an environmentally friendly diet. In the Dutch sub-cohort of the European Prospective Investigation into Cancer and Nutrition, the diet was assessed with a 178-item FFQ of 40 011 participants aged 20-70 years between 1993 and 1997. The WHO's Healthy Diet Indicator (HDI), the Dietary Approaches to Stop Hypertension (DASH) score and the Dutch Healthy Diet index 2015 (DHD15-index) were investigated in relation to greenhouse gas (GHG) emissions, land use and all-cause mortality risk. GHG emissions were associated with HDI scores (-3·7 % per sd increase (95 % CI -3·4, -4·0) for men and -1·9 % (95 % CI -0·4, -3·4) for women), with DASH scores in women only (1·1 % per sd increase, 95 % CI 0·9, 1·3) and with DHD15-index scores (-2·5 % per sd increase (95 % CI -2·2, -2·8) for men and -2·0 % (95 % CI -1·9, -2·2) for women). For all indices, higher scores were associated with less land use (ranging from -1·3 to -3·1 %). Mortality risk decreased with increasing scores for all indices. Per sd increase of the indices, hazard ratios for mortality ranged from 0·88 (95 % CI 0·82, 0·95) to 0·96 (95 % CI 0·92, 0·99). Our results showed that adhering to the WHO and Dutch dietary guidelines will lower the risk of all-cause mortality and moderately lower the environmental impact. The DASH diet was associated with lower mortality and land use, but because of high dairy product consumption in the Netherlands it was also associated with higher GHG emissions.

The incidence of upper extremity injuries in endoscopy nurses working in the United States.

PubMed

Drysdale, Susan A

2013-01-01

Numerous studies have addressed musculoskeletal disorders in the international working population. The literature indicates that injuries exist at astounding rates with significant economic impact. Attempts have been made by government, private industry, and special interest groups to address the issues related to the occurrence and prevention of musculoskeletal injuries. Because of the limited research on the gastrointestinal (GI) endoscopy nursing sector, this descriptive, correlational study explored the incidence of upper extremity injuries in GI endoscopy nurses and technicians in the United States. A total of 215 subjects were included in the study. Findings show that upper extremity injuries exist among nurses working in GI endoscopy. Twenty-two percent of respondents missed work for upper extremity injuries. The findings also show that the severity of disability is related to the type of work done, type of assistive aids available at work, and whether or not ergonomic or physiotherapy assessments were provided at the place of employment. In reference to rate of injury and the availability of ergonomics and physiotherapy assessments, those who had ergonomic assessments available to them had scores on the Disabilities of the Arm, Shoulder, and Hand (DASH) inventory (indicating upper extremity disability) that were significantly lower (DASH score, 9.96) than those who did not have the assessments available (DASH score, 14.66). The results suggest that there are a significant number of subjects who are disabled to varying degrees and the majority of these are employed in full-time jobs.

Healthy Dietary Patterns and Oxidative Stress as Measured by Fluorescent Oxidation Products in Nurses' Health Study.

PubMed

Jung, Seungyoun; Smith-Warner, Stephanie A; Willett, Walter C; Wang, Molin; Wu, Tianying; Jensen, Majken; Hankinson, Susan E; Eliassen, A Heather

2016-09-21

Healthy diets may lower oxidative stress and risk of chronic diseases. However, no previous studies examined associations between diet and fluorescent oxidation products (FlOP), a global marker of oxidative stress. We evaluated associations between healthy eating patterns (Alternative Healthy Eating Index (AHEI), Dietary Approach to Stop Hypertension (DASH), and Alternate Mediterranean Diet (aMED)) and FlOP, measured at three excitation/emission wavelengths (FlOP_360, FlOP_320, FlOP_400) from 2021 blood samples collected from 1688 women within the Nurses' Health Study. AHEI, DASH, and aMED scores were significantly positively associated with FlOP_360 and FlOP_320 concentrations ( p -trend ≤ 0.04), but not associated with FlOP_400. Among specific food groups that contribute to these diet scores, significantly positive associations were observed with legumes and vegetables for FlOP_360, vegetables and fruits for FlOP_320, and legumes and alcohol for FlOP_400. Inverse associations were observed with nuts, sweets or desserts, and olive oil for FlOP_360, nuts for FlOP_320 and sweets or desserts for FlOP_400 (all p -trend ≤ 0.05). However, FlOP variation due to diet was small compared to overall FlOP variation. In conclusion, AHEI, DASH, and aMED scores were unexpectedly positively, but weakly, associated with FlOP_360 and FlOP_320. However, these findings should be interpreted cautiously as the determinants of FlOP concentrations are not fully understood.

Patient-Reported Outcome Measures for Hand and Wrist Trauma

PubMed Central

Dacombe, Peter Jonathan; Amirfeyz, Rouin; Davis, Tim

2016-01-01

Background: Patient-reported outcome measures (PROMs) are important tools for assessing outcomes following injuries to the hand and wrist. Many commonly used PROMs have no evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. This systematic review examines the PROMs used in the assessment of hand and wrist trauma patients, and the evidence for reliability, validity, and responsiveness of each measure in this population. Methods: A systematic review of Pubmed, Medline, and CINAHL searching for randomized controlled trials of patients with traumatic injuries to the hand and wrist was carried out to identify the PROMs. For each identified PROM, evidence of reliability, validity, and responsiveness was identified using a further systematic review of the Pubmed, Medline, CINAHL, and reverse citation trail audit procedure. Results: The PROM used most often was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; the Patient-Rated Wrist Evaluation (PRWE), Gartland and Werley score, Michigan Hand Outcomes score, Mayo Wrist Score, and Short Form 36 were also commonly used. Only the DASH and PRWE have evidence of reliability, validity, and responsiveness in patients with traumatic injuries to the hand and wrist; other measures either have incomplete evidence or evidence gathered in a nontraumatic population. Conclusions: The DASH and PRWE both have evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. Other PROMs used to assess hand and wrist trauma patients do not. This should be considered when selecting a PROM for patients with traumatic hand and wrist pathology. PMID:27418884

[Functional and aesthetic results of orthopaedic treatment of midshaft fractures of the clavicle. A 22 years follow-up study].

PubMed

Sirvent-Díaz, E; Calmet-García, J; Capdevila-Baulenes, J

2014-01-01

To evaluate the functional results of the orthopaedic treatment of midshaft clavicle fractures with a minimum follow-up of 15 years. A retrospective study was conducted on 40 patients, mean age 35 years (18-64) with a non-surgically treated clavicle fracture. The mean follow-up was more than 22 years (15-32). The clinical evaluation was performed with the Disability of Arm, Shoulder and Hand score (DASH), Constant Shoulder Score test (CSS), EVA score, and a subjective assessment of the final result. Fractures were classified according to Neer's criteria. The radiological evaluation was performed with an anteroposterior and 45° cefalic anteroposterior oblique X-Ray. A mean DASH score 2.17 points (0-20.82), the mean CSS score was 98.2 (79-100), the mean EVA score was 0.42 (0-6), and 100% patients were satisfied, with good or excellent results. The control X-Ray showed 39 healed fractures (97.5%) with a mean shortening of 6.4mm (0-20). The presence of comminution and/or shortening of 15 mm or more had the worst functional and radiographic results. Despite this, non-surgical treatment showed excellent functional and radiographic results, and a high personal satisfaction. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

Mid-term functional outcome after the internal fixation of distal radius fractures

PubMed Central

2012-01-01

Background Distal radius fracture is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Despite the popularity of volar locking plate fixation, there are few large cohort or long term follow up studies to justify this modality. Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate. Methods 180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation = 10.4). Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) and modified MAYO wrist scores. Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union. Results The median DASH score was 2.3 and median MAYO score was 90 for the whole group. Overall, 133 patients (74%) had a good or excellent DASH and MAYO score. Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome. Complications occurred in 27 patients (15%) and in 11 patients were major (6%). Conclusion This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other non-operative and operative treatment modalities. On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention. PMID:22280557

Mid-term functional outcome after the internal fixation of distal radius fractures.

PubMed

Phadnis, Joideep; Trompeter, Alex; Gallagher, Kieran; Bradshaw, Lucy; Elliott, David S; Newman, Kevin J

2012-01-26

Distal radius fracture is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Despite the popularity of volar locking plate fixation, there are few large cohort or long term follow up studies to justify this modality. Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate. 180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation=10.4). Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) and modified MAYO wrist scores. Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union. The median DASH score was 2.3 and median MAYO score was 90 for the whole group. Overall, 133 patients (74%) had a good or excellent DASH and MAYO score. Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome. Complications occurred in 27 patients (15%) and in 11 patients were major (6%). This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other non-operative and operative treatment modalities. On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention.

Incidence and Functional Outcomes of Scapholunate Diastases Associated Distal Radius Fractures: A 2-year Follow-Up Scapholunate Dissociation

PubMed Central

Lans, Jonathan; Lasa, Alejandro; Chen, Neal C.; Jupiter, Jesse B.

2018-01-01

Background: The Scapholunate Interosseous Ligament (SLIL) is the first intrinsic carpal ligament to be injured in wrist trauma, present in up to 64% of the distal radius fractures. However, it remains unclear what patients develop symptoms, making primary treatment of these injuries accompanying distal radius fractures remains questionable. Objective: The aim of this study was to evaluate the functional outcomes of patients with scapholunate diastasis associated with distal radius fractures. Methods: We evaluated 391 patients with a distal radius fracture. Using Computer Tomography (CT) scans the scapholunate interval was measured. We identified 14 patients with an SLD (>3mm) of the injured wrist, which underwent a CT-scan of the contralateral wrist. To evaluate the functional outcomes at a mean follow up of 136±90 weeks, we used the Quick Disabilities of the Arm, Shoulder and Hand (qDASH) Score. Results: There were 8 patients with bilateral SLD and 6 patients with unilateral SLD. Five patients had a qDASH score of 0 and one patient showed a qDASH score of 18.2. The patient with a poor score had bilateral preexisting osteoarthritis of the wrist. No patient had additional surgery of the SLIL. Conclusion: In patients with distal radius fractures, more than half of the 14 patients with an SL gap on CT had widening on the contralateral side. It is therefore worthwhile to image the contralateral wrist before diagnosing a SLD. The patients with unilateral SLD should not be surgically treated at initial presentation because they may have good functional outcomes after a follow up of 2 years. PMID:29456778

Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage.

PubMed

Humada Álvarez, G; Simón Pérez, C; García Medrano, B; Faour Martín, O; Marcos Rodríguez, J J; Vega Castrillo, A; Martín Ferrero, M A

The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results. Copyright © 2017. Publicado por Elsevier España, S.L.U.

A Non-surgical Intervention for Triangular Fibrocartilage Complex Tears.

PubMed

Barlow, Susan J

2016-12-01

The current literature contains no reports of treatment options other than surgery following failed conservative management of a triangular fibrocartilage complex (TFCC) tear. The purpose of this study is to describe the use of a novel brace as a non-surgical intervention for TFCC tears. This paper is a case study of a subject with a magnetic resonance imaging-confirmed TFCC tear. As an alternative to surgery, he consented to wear a novel brace for 12 weeks after conservative management of his injury had failed. His recovery from injury was monitored with a weight-bearing tolerance test and the disabilities of the arm, shoulder and hand (DASH) outcome measure. An increase in weight-bearing tolerance and upper extremity use was evident immediately after donning the brace. After 12 weeks, the subject demonstrated a return to normal weight-bearing tolerance and normal DASH outcome measure scores. These improvements were still evident at a 1-year follow-up appointment. Utilizing this novel brace resulted in functional status improvement in a subject with a TFCC tear as demonstrated by significant changes in his DASH outcome measure scores. This case study demonstrates the first non-surgical alternative treatment for a TFCC tear after conservative management has failed. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Accuracy of a disability instrument to identify workers likely to develop upper extremity musculoskeletal disorders.

PubMed

Stover, Bert; Silverstein, Barbara; Wickizer, Thomas; Martin, Diane P; Kaufman, Joel

2007-06-01

Work related upper extremity musculoskeletal disorders (MSD) result in substantial disability, and expense. Identifying workers or jobs with high risk can trigger intervention before workers are injured or the condition worsens. We investigated a disability instrument, the QuickDASH, as a workplace screening tool to identify workers at high risk of developing upper extremity MSDs. Subjects included workers reporting recurring upper extremity MSD symptoms in the past 7 days (n = 559). The QuickDASH was reasonably accurate at baseline with sensitivity of 73% for MSD diagnosis, and 96% for symptom severity. Specificity was 56% for diagnosis, and 53% for symptom severity. At 1-year follow-up sensitivity and specificity for MSD diagnosis was 72% and 54%, respectively, as predicted by the baseline QuickDASH score. For symptom severity, sensitivity and specificity were 86% and 52%. An a priori target sensitivity of 70% and specificity of 50% was met by symptom severity, work pace and quality, and MSD diagnosis. The QuickDASH may be useful for identifying jobs or workers with increased risk for upper extremity MSDs. It may provide an efficient health surveillance screening tool useful for targeting early workplace intervention for prevention of upper extremity MSD problems.

Rasch Model Analysis Gives New Insights Into the Structural Validity of the QuickDASH in Patients With Musculoskeletal Shoulder Pain.

PubMed

Jerosch-Herold, Christina; Chester, Rachel; Shepstone, Lee

2017-09-01

Study Design Cross-sectional secondary analysis of a prospective cohort study. Background The shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) is a widely used outcome measure that has been extensively evaluated using classical test theory. Rasch model analysis can identify strengths and weaknesses of rating scales and goes beyond classical test theory approaches. It uses a mathematical model to test the fit between the observed data and expected responses and converts ordinal-level scores into interval-level measurement. Objective To test the structural validity of the QuickDASH using Rasch analysis. Methods A prospective cohort study of 1030 patients with shoulder pain provided baseline data. Rasch analysis was conducted to (1) assess how the QuickDASH fits the Rasch model, (2) identify sources of misfit, and (3) explore potential solutions to these. Results There was evidence of multidimensionality and significant misfit to the Rasch model (χ 2 = 331.09, P<.001). Two items had disordered threshold responses with strong floor effects. Response bias was detected in most items for age and sex. Rescoring resulted in ordered thresholds; however, the 11-item scale still did not meet the expectations of the Rasch model. Conclusion Rasch model analysis on the QuickDASH has identified a number of problems that cannot be easily detected using traditional analyses. While revisions to the QuickDASH resulted in better fit, a "shoulder-specific" version is not advocated at present. Caution needs to be exercised when interpreting results of the QuickDASH outcome measure, as it does not meet the criteria for interval-level measurement and shows significant response bias by age and sex. J Orthop Sports Phys Ther 2017;47(9):664-672. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7288.

Association between individual DASH tasks and restricted wrist flexion and extension after volar plate fixation of a fracture of the distal radius.

PubMed

Bot, Arjan G J; Souer, J Sebastiaan; van Dijk, C Niek; Ring, David

2012-12-01

Symptoms and psychosocial factors are suggested to account for more of the variation in disability than physical impairment, but perhaps less so at the level of specific tasks. This study assessed the influence of impaired wrist motion on specific tasks on the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Sixty-three patients with an operatively treated fracture of the distal radius completed the Pain Catastrophizing Scale (PCS), Pain Anxiety Symptoms Scale, and Center for Epidemiologic Studies Depression Scale (CES-D) just before surgery and the DASH questionnaire 3 months after surgery. Nine questions on the DASH were selected as potentially sensitive to changes in wrist motion and evaluated in bivariate and multivariable analyses. In multivariable models of factors associated with specific tasks, only "Open a tight or new jar" was affected by wrist flexion and PCS accounting for 33 % of the variation. Motion, pain, and PCS were significant predictors of the DASH score. Among the eight tasks not related to wrist motion, 33 % of the variation in disability with writing was accounted for by PCS and limb dominance; 20 % of disability preparing a meal by pain, CES-D, and PCS; 14 % of disability with making a bed by pain and CES-D; and 23 % of changing a light bulb overhead by age, pain, and fracture type. After volar plate fixation of a fracture of the distal radius, upper extremity disability based on select items from the DASH questionnaire correlated minimally with impairment of wrist motion, even at the level of specific tasks. Prognostic Level II.

Association between adherence to the Dietary Approaches to Stop Hypertension diet with food security and weight status in adult women.

PubMed

Tabibian, Saeideh; Daneshzad, Elnaz; Bellissimo, Nick; Brett, Neil R; Dorosty-Motlagh, Ahmad R; Azadbakht, Leila

2018-06-10

To investigate the association between adherence to the Dietary Approaches to Stop Hypertension (DASH) diet with food security and weight status in adult women. This cross-sectional study was carried out in 227 women-20-50 years of age-who were referred from 10 health centres. Dietary intakes were assessed using validated food frequency questionnaires. The DASH score was calculated using the Fung method based on eight food and nutrient components (high intake of fruits, vegetables, whole grains, nuts and legumes, low-fat dairy, low intakes of red and processed meats, sweetened beverages and sodium). The United States Department of Agriculture (USDA) household food security questionnaire was used to assess food security status. The prevalence of food insecurity was 33.9%. A greater percentage of overweight and obese people were in the food insecure group (P = 0.006). In addition, the prevalence of overweight and obese people was lower with greater adherence to the DASH dietary pattern (P = 0.017). After controlling for age and energy intake, participants in the highest tertile of adherence to DASH diet had 66% lower odds of overweight and obesity than those in the lowest tertile (odds ratio (OR): 0.34; 95% confidence interval (CI): 0.15; 0.79). This relationship of DASH diet tertile and overweight and obesity was significant for both food secure women (OR: 0.54, 95% CI: 0.23; 0.97) and food insecure women (OR: 0.35, 95% CI: 0.06; 0.42). Adherence to the DASH diet is associated with a reduced risk of overweight and obesity, based on body mass index, in both food secure and insecure Iranian women. © 2018 Dietitians Association of Australia.

Long-term functional, subjective and psychological results after single digit replantation.

PubMed

Chen, Jing; Zhang, Ai Xian; Chen, Qing Zhong; Mu, Shuai; Tan, Jun

2018-03-01

The aim of this study was to analyse the long-term functional, subjective, and psychological results after single-digit replantation. Thirty cases of digital replantation (14 thumbs, 12 index fingers, 2 middle fingers, 1 ring finger, and 1 little finger) in 30 patients (7 females and 23 males) with a mean age of 44.2 years (20-65 years) were evaluated at the end of a mean follow-up time of 36 months (19-50 months). The active range of motion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction were determined using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes questionnaire (MHQ). Psychological sequelae, including depression, anxiety, and posttraumatic stress disorder (PTSD), were assessed. A correlation analysis among variables was also performed. The mean score for the DASH questionnaire was 6.6 (range: 0-39.2). The symptom of cold intolerance occurred in 53% of the patients. Two patients were diagnosed with depression, and only one patient exhibited PTSD. The DASH score had a good statistical correlation with total grip strength, pinch grip strength, and static two-point discrimination (S-2PD) (P < 0.05). Several aspects of the MHQ were also statistically relevant to some or all of the three objective results. Furthermore, the grip strength showed significant correlation with DASH and most aspects of the MHQ in multivariate logistic regression analysis (P < 0.05). Total grip strength is the most important factor positively related to subjective outcomes. The incidence rates of psychological symptoms after digit replantation are very low at long-term follow-up. Level IV, therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Proximal humeral fractures: the role of calcium sulphate augmentation and extended deltoid splitting approach in internal fixation using locking plates.

PubMed

Somasundaram, K; Huber, C P; Babu, V; Zadeh, H

2013-04-01

The aim of our study is to analyse the results of our surgical technique for the treatment of proximal humeral fractures and fracture dislocations using locking plates in conjunction with calcium sulphate bone-substitute augmentation and tuberosity repair using high-strength sutures. We used the extended deltoid-splitting approach for fracture patterns involving displacement of both lesser and greater tuberosities and for fracture-dislocations. Optimal surgical management of proximal humeral fractures remains controversial. Locking plates have become a popular method of fixation. However, failure of fixation may occur if they are used as the sole method of fixation in comminuted fractures, especially in osteopenic bone. We retrospectively analysed 22 proximal humeral fractures in 21 patients; 10 were male and 11 female with an average age of 64.6 years (range 37-77). Average follow-up was 24 months. Eleven of these fractures were exposed by the extended deltoid-splitting approach. Fractures were classified according to Neer and Hertel systems. Preoperative radiographs and computed tomography (CT) scans in three- and four-part fractures were done to assess the displacement and medial calcar length for predicting the humeral head vascularity. According to the Neer classification, there were five two-part, six three-part, five four-part fractures and six fracture-dislocations (two anterior and four posterior). Results were assessed clinically with disabilities of the arm, shoulder and hand (DASH) scores, modified Constant and Murley scores and serial postoperative radiographs. The mean DASH score was 16.18 and the modified Constant and Murley score was 64.04 at the last follow-up. Eighteen out of twenty-two cases achieved good clinical outcome. All the fractures united with no evidence of infection, failure of fixation, malunion, tuberosity failure, avascular necrosis or adverse reaction to calcium sulphate bone substitute. There was no evidence of axillary nerve injury. Four patients had a longer recovery period due to stiffness, associated wrist fracture and elbow dislocation. The CaSO4 bone substitute was replaced by normal appearing trabecular bone texture at an average of 6 months in all patients. In our experience, we have found the use of locking plates, calcium sulphate bone substitute and tuberosity repair with high-strength sutures to be a safe and reliable method of internal fixation for complex proximal humeral fractures and fracture-dislocations. Furthermore, we have also found the use of the extended deltoid-splitting approach to be safe and to provide excellent exposure facilitating accurate reduction for fixation of the fracture patterns involving displacement of both lesser and greater tuberosities and for fracture-dislocations. Copyright © 2012 Elsevier Ltd. All rights reserved.

Global Characterization of Protein-Altering Mutations in Prostate Cancer

DTIC Science & Technology

2013-08-01

abnormal signals are marked as horizontal dashed lines on each plot. (A) Average number of AR per nucleus. (B) Average PTEN/CEP10 ratio. doi:10.1371...1060. 20. Hankinson SE, Manson JE, Spiegelman D, Willett WC, Longcope C, et al. (1995) Reproducibility of plasma hormone levels in postmenopausal

Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study.

PubMed

Koorevaar, Rinco C T; Van't Riet, Esther; Ipskamp, Marcel; Bulstra, Sjoerd K

2017-03-01

Frozen shoulder is a potential complication after shoulder surgery. It is a clinical condition that is often associated with marked disability and can have a profound effect on the patient's quality of life. The incidence, etiology, pathology and prognostic factors of postoperative frozen shoulder after shoulder surgery are not known. The purpose of this explorative study was to determine the incidence of postoperative frozen shoulder after various operative shoulder procedures. A second aim was to identify prognostic factors for postoperative frozen shoulder after shoulder surgery. 505 consecutive patients undergoing elective shoulder surgery were included in this prospective cohort study. Follow-up was 6 months after surgery. A prediction model was developed to identify prognostic factors for postoperative frozen shoulder after shoulder surgery using the TRIPOD guidelines. We nominated five potential predictors: gender, diabetes mellitus, type of physiotherapy, arthroscopic surgery and DASH score. Frozen shoulder was identified in 11% of the patients after shoulder surgery and was more common in females (15%) than in males (8%). Frozen shoulder was encountered after all types of operative procedures. A prediction model based on four variables (diabetes mellitus, specialized shoulder physiotherapy, arthroscopic surgery and DASH score) discriminated reasonably well with an AUC of 0.712. Postoperative frozen shoulder is a serious complication after shoulder surgery, with an incidence of 11%. Four prognostic factors were identified for postoperative frozen shoulder: diabetes mellitus, arthroscopic surgery, specialized shoulder physiotherapy and DASH score. The combination of these four variables provided a prediction rule for postoperative frozen shoulder with reasonable fit. Level II, prospective cohort study.

Patient-Reported Outcome Measures for Hand and Wrist Trauma: Is There Sufficient Evidence of Reliability, Validity, and Responsiveness?

PubMed

Dacombe, Peter Jonathan; Amirfeyz, Rouin; Davis, Tim

2016-03-01

Patient-reported outcome measures (PROMs) are important tools for assessing outcomes following injuries to the hand and wrist. Many commonly used PROMs have no evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. This systematic review examines the PROMs used in the assessment of hand and wrist trauma patients, and the evidence for reliability, validity, and responsiveness of each measure in this population. A systematic review of Pubmed, Medline, and CINAHL searching for randomized controlled trials of patients with traumatic injuries to the hand and wrist was carried out to identify the PROMs. For each identified PROM, evidence of reliability, validity, and responsiveness was identified using a further systematic review of the Pubmed, Medline, CINAHL, and reverse citation trail audit procedure. The PROM used most often was the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; the Patient-Rated Wrist Evaluation (PRWE), Gartland and Werley score, Michigan Hand Outcomes score, Mayo Wrist Score, and Short Form 36 were also commonly used. Only the DASH and PRWE have evidence of reliability, validity, and responsiveness in patients with traumatic injuries to the hand and wrist; other measures either have incomplete evidence or evidence gathered in a nontraumatic population. The DASH and PRWE both have evidence of reliability, validity, and responsiveness in a hand and wrist trauma population. Other PROMs used to assess hand and wrist trauma patients do not. This should be considered when selecting a PROM for patients with traumatic hand and wrist pathology.

[EFFECTIVENESS OF SHARP TEETH HOOK PLATE FOR TREATMENT OF OLECRANON FRACTURES].

PubMed

Yin, Qudong; Gu, Sanjun; Liu, Jun; Wu, Yongwei; Lu, Yao; Ma, Yunhong; Sheng, Youyin

2016-09-08

To investigate the effectiveness of sharp teeth hook plate by cutting for the treatment of olecranon fractures by comparison with Kirschner wire tension belt and locking plate. Between January 2011 and April 2015, 32 cases of olecranon fractures were treated. Fracture was fixed with sharp teeth hook plate by cutting in 12 cases (trial group) and with Kirschner wire tension belt or locking plate in 20 cases (control group). There was no significant difference in gender, age, side and type of fracture, and time from injury to operation between 2 groups ( P >0.05). The healing time of fractures and complications were recorded. At 1 year after operation, the subjective function results were evaluated according to Disability of Arm, Shoulder, and Hand (DASH) score, and objective function results by Mayo Elbow Score (MEPS); visual analogue scale (VAS) was used for elbow joint pain, and range of motion of flexion and extension of elbow joint was measured. All incisions healed by first intention, with no vascular and nerve injuries. All patients were followed up 12-36 months with an average of 18 months. All fractures healed, and there was no significant difference in the healing time between 2 groups ( P >0.05). Loosening of Kirschner wire occurred in 2 cases of control group, but no loosening of internal fixation was observed in trial group after operation. There was no significant difference in the incidence of complications between 2 groups ( P >0.05). The DASH, MEPS, VAS score, and range of motion of flexion in trial group were superior to those in control group, showing significant differences ( P <0.05) at 1 year after operation. There was no significant difference in range of motion of extension between 2 groups ( P >0.05). Sharp teeth hook plate for treatment of olecranon fractures overcomes the shortcomings that Kirschner wire tension is easy to slide and locking plate has a compression effect on triceps tendon, so it has good effectiveness.

Multiple Off-Ice Performance Variables Predict On-Ice Skating Performance in Male and Female Division III Ice Hockey Players

PubMed Central

Janot, Jeffrey M.; Beltz, Nicholas M.; Dalleck, Lance D.

2015-01-01

The purpose of this study was to determine if off-ice performance variables could predict on-ice skating performance in Division III collegiate hockey players. Both men (n = 15) and women (n = 11) hockey players (age = 20.5 ± 1.4 years) participated in the study. The skating tests were agility cornering S-turn, 6.10 m acceleration, 44.80 m speed, modified repeat skate, and 15.20 m full speed. Off-ice variables assessed were years of playing experience, height, weight and percent body fat and off-ice performance variables included vertical jump (VJ), 40-yd dash (36.58m), 1-RM squat, pro-agility, Wingate peak power and peak power percentage drop (% drop), and 1.5 mile (2.4km) run. Results indicated that 40-yd dash (36.58m), VJ, 1.5 mile (2.4km) run, and % drop were significant predictors of skating performance for repeat skate (slowest, fastest, and average time) and 44.80 m speed time, respectively. Four predictive equations were derived from multiple regression analyses: 1) slowest repeat skate time = 2.362 + (1.68 x 40-yd dash time) + (0.005 x 1.5 mile run), 2) fastest repeat skate time = 9.762 - (0.089 x VJ) - (0.998 x 40-yd dash time), 3) average repeat skate time = 7.770 + (1.041 x 40-yd dash time) - (0.63 x VJ) + (0.003 x 1.5 mile time), and 4) 47.85 m speed test = 7.707 - (0.050 x VJ) - (0.01 x % drop). It was concluded that selected off-ice tests could be used to predict on-ice performance regarding speed and recovery ability in Division III male and female hockey players. Key points The 40-yd dash (36.58m) and vertical jump tests are significant predictors of on-ice skating performance specific to speed. In addition to 40-yd dash and vertical jump, the 1.5 mile (2.4km) run for time and percent power drop from the Wingate anaerobic power test were also significant predictors of skating performance that incorporates the aspect of recovery from skating activity. Due to the specificity of selected off-ice variables as predictors of on-ice performance, coaches can elect to assess player performance off-ice and focus on other uses of valuable ice time for their individual teams. PMID:26336338

Dietary quality and markers of inflammation: No association in youth with type 1 diabetes.

PubMed

Liese, Angela D; Ma, Xiaonan; Ma, Xiaoguang; Mittleman, Murray A; The, Natalie S; Standiford, Debra A; Lawrence, Jean M; Pihoker, Catherine; Marcovina, Santica M; Mayer-Davis, Elizabeth J; Puett, Robin C

2018-02-01

Systemic inflammation is a key process underlying cardiovascular disease (CVD) development, and CVD risk is significantly elevated in persons with type 1 diabetes (T1D). Youth with T1D exhibit increased levels of inflammation. Studies in persons without diabetes suggest that dietary quality influences inflammation, yet little is known about dietary influences on inflammation in youth with T1D. This study evaluated the association of four distinct dietary quality indices (Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index 2010 (HEI2010), modified KIDMED and Total Antioxidant Capacity (TAC)) with biomarkers of inflammation (C-reactive protein (CRP), fibrinogen and interleukin-6 (IL-6)) in a sample of 2520 youth with T1D participating in the SEARCH for Diabetes in Youth Study. Average diet quality was moderate to poor, with mean scores of 43 (DASH, range 0-80), 55 (HEI2010, range 0-100), 3.7 (mKIDMED, range 3-12) and 7237 (TAC). None of the four diet quality scores was associated with the selected biomarkers of inflammation in any analyses. Evaluation of a non-linear relationship or interactions with BMI or levels of glycemic control did not alter the findings. Replication of analyses using longitudinal data yielded consistent findings with our cross-sectional results. Biomarkers of inflammation in youth with T1D may not be directly influenced by dietary intake, at least at the levels of dietary quality observed here. More work is needed to understand what physiologic mechanisms specific to persons with T1D might inhibit the generally beneficial influence of high dietary quality on systemic inflammation observed in populations without diabetes. Copyright © 2017 Elsevier Inc. All rights reserved.

Characteristics of stereotypic movement disorder and self-injurious behavior assessed with the Diagnostic Assessment for the Severely Handicapped (DASH-II).

PubMed

Matson, J L; Hamilton, M; Duncan, D; Bamburg, J; Smiroldo, B; Anderson, S; Baglio, C

1997-01-01

The first experiment involved 143 individuals with severe and profound mental retardation. Individuals with Stereotypic Movement Disorder, Self-Injurious Behavior (SIB), and Stereotypic movement disorder with self-injurious behavior as assessed by the Diagnostic Assessment for the Severely Handicapped-II DASH-II were validated against Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) criteria. In a second study DASH-II scores for 1480 individuals with severe and profound mental retardation were compared on demographic variables, core and associated features of each disorder. Characteristics of persons in each group were reviewed. Persons with profound mental retardation were more likely to evince stereotypies or self-injury compared to their severely impaired counterparts. Also, those with stereotypies were more likely to present with Pervasive Developmental Disorder (PDD)/autism, organicity, and eating disorders, while persons with SIB were more likely to evince sleep, sexual, and eating disorders.

Return-to-activity after anatomical reconstruction of acute high-grade acromioclavicular separation.

PubMed

Saier, T; Plath, J E; Beitzel, K; Minzlaff, P; Feucht, J M; Reuter, S; Martetschläger, F; Imhoff, Andreas B; Aboalata, M; Braun, S

2016-04-02

To evaluate return-to-activity (RtA) after anatomical reconstruction of acute high-grade acromioclavicular joint (ACJ) separation. A total of 42 patients with anatomical reconstruction of acute high-grade ACJ-separation (Rockwood Type V) were surveyed to determine RtA at a mean 31 months follow-up (f-u). Sports disciplines, intensity, level of competition, participation in overhead and/or contact sports, as well as activity scales (DASH-Sport-Module, Tegner Activity Scale) were evaluated. Functional outcome evaluation included Constant score and QuickDASH. All patients (42/42) participated in sporting activities at f-u. Neither participation in overhead/contact sports, nor level of activity declined significantly (n.s.). 62 % (n = 26) of patients reported subjective sports specific ACJ integrity to be at least the same as prior to the trauma. Sporting intensity (hours/week: 7.3 h to 5.4 h, p = .004) and level of competition (p = .02) were reduced. If activity changed, in 50 % other reasons but clinical symptoms/impairment were named for modified behavior. QuickDASH (mean 6, range 0-54, SD 11) and DASH-Sport-Module (mean 6, range 0-56, SD 13) revealed only minor disabilities at f-u. Over time Constant score improved significant to an excellent score (mean 94, range 86-100, SD 4; p < .001). Functional outcome was not correlated with RtA (n.s.). All patients participated in sporting activities after anatomical reconstruction of high-grade (Rockwood Type V) ACJ-separation. With a high functional outcome there was no significant change in activity level (Tegner) and participation in overhead and/or contact sports observed. There was no correlation between functional outcome and RtA. Limiting, there were alterations in time spent for sporting activities and level of competition observed. But in 50 % those were not related to ACJ symptoms/impairment. Unrelated to successful re-established integrity and function of the ACJ it should be considered that patients decided not return-to-activity but are very content with the procedure.

A Comprehensive Study of Internal Distraction Plating, an Alternative Method for Distal Radius Fractures.

PubMed

Jain, Mohit J; Mavani, Kinjal J

2016-12-01

The management of highly comminuted distal radius fractures still remains a major treatment challenge. Articular comminution and compromised bone quality are the culprits. One novel approach is the technique of Internal Distraction Plating which involves "bridging" the fracture with the use of a standard 3.5mm plate applied dorsally in distraction from the radius, proximal to the fracture, to the long finger metacarpal distally, bypassing the comminuted segment. The plate is removed once fracture union has been achieved. The present study was conducted with the aim to evaluate the role of internal dorsal distraction plating as an alternative method in the treatment of fracture distal radius in terms of special indications, technique and outcome. This study was a prospective longitudinal study on 20 patients (mean age 62 years) treated with internal distraction plating for comminuted distal radius fractures with specific indications. Regular follow-ups with standard radiographs and analysis were done upto 24 months. Functional outcome were assessed by DASH Score and the Gartland and Werley demerit score. At final follow-up, all fractures had united and X-rays showed mean palmar tilt of 7°, positive ulnar variance of 0.5mm, radial inclination of 18° and average loss of 2mm of radial height. Mean range of motion values for wrist flexion 46°, extension 50°, pronation 79° and supination 77° At final follow-up, the mean DASH score was 32. 85% patient had excellent to good result as per Gartland and Werley demerit score. This construct has yield satisfactory clinical and radiographic results with these very challenging injuries. The purpose of this study was to report the radiographic and the functional outcomes of treatment with this technique. External fixator and volar plating in communited distal end radius fractures are not always satisfactory in old age with osteoporotic bone because of complications associated with them. The current technique represents an alternative that provides union of the comminuted distal radius fracture with anatomical alignment, optimal range of motion and with minimal clinical disability.

Early Rehabilitation of Distal Radius Fractures Stabilized by Volar Locking Plate: A Prospective Randomized Pilot Study

PubMed Central

Quadlbauer, Stefan; Pezzei, Christoph; Jurkowitsch, Josef; Kolmayr, Brigitta; Keuchel, Tina; Simon, Daniel; Hausner, Thomas; Leixnering, Martin

2016-01-01

Background Distal radius fractures are very common and an increased incidence of 50% is estimated by 2030. Therefore, both operative and postsurgical treatment remains pertinent. Main aim in treating intra-articular fractures is to restore the articular surface by internal fixation and early mobilization (EM). Questions/Purposes The purpose of this study was to compare functional results between EM immediately after surgery and 5 weeks of immobilization (IM). Patients and Methods In a randomized prospective study, 30 patients with an isolated distal radius fracture were treated by open reduction and internal fixation using a single volar locking plate excluding bone graft. Fifteen patients were randomized in the EM group and 15 in the IM group. At 6 weeks, 9 weeks, 3 months, 6 months, and 1 year postsurgery, range of motion, grip strength and X-rays were evaluated. Additionally, Quick Disability of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Patient-Rated Wrist Evaluation (PRWE), modified Green O'Brien (Mayo) score, and pain according to the Visual Analog Scale score were analyzed. Results Patients in the EM group had a significantly better range of motion in the sagittal plane, in grip strength up to 6 months, in the frontal plane up to 9 weeks, and in forearm rotation up to 6 weeks. Also QuickDASH and PRWE scores were better up to 6 weeks postsurgery. The Green O'Brien score differed significantly up to 1 year. At 1 year, 93% “excellent” and “good” results in the Green O'Brien score with a mean QuickDASH of 5.98 ± 10.94 and PRWE score of 4.27 ± 9.23 were observed in the EM group. No differences regarding loss of reduction, pain, duration of physiotherapy, and sick leave were noted. Conclusion EM of surgically treated distal radius fractures (without bone graft) is a safe method for postoperative aftercare and leads to an improved range of motion and grip strength at 6 months postsurgery compared with an IM of 5 weeks. Level of Evidence This is a level Ib clinical study. PMID:28428911

A web-based nutrition program reduces health care costs in employees with cardiac risk factors: before and after cost analysis.

PubMed

Sacks, Naomi; Cabral, Howard; Kazis, Lewis E; Jarrett, Kelli M; Vetter, Delia; Richmond, Russell; Moore, Thomas J

2009-10-23

Rising health insurance premiums represent a rapidly increasing burden on employer-sponsors of health insurance and their employees. Some employers have become proactive in managing health care costs by providing tools to encourage employees to directly manage their health and prevent disease. One example of such a tool is DASH for Health, an Internet-based nutrition and exercise behavior modification program. This program was offered as a free, opt-in benefit to US-based employees of the EMC Corporation. The aim was to determine whether an employer-sponsored, Internet-based diet and exercise program has an effect on health care costs. There were 15,237 total employees and spouses who were included in our analyses, of whom 1967 enrolled in the DASH for Health program (DASH participants). Using a retrospective, quasi-experimental design, study year health care costs among DASH participants and non-participants were compared, controlling for baseline year costs, risk, and demographic variables. The relationship between how often a subject visited the DASH website and health care costs also was examined. These relationships were examined among all study subjects and among a subgroup of 735 subjects with cardiovascular conditions (diabetes, hypertension, hyperlipidemia). Multiple linear regression analysis examined the relationship of program use to health care costs, comparing study year costs among DASH participants and non-participants and then examining the effects of increased website use on health care costs. Analyses were repeated among the cardiovascular condition subgroups. Overall, program use was not associated with changes in health care costs. However, among the cardiovascular risk study subjects, health care costs were US$827 lower, on average, during the study year (P= .05; t(729) = 1.95). Among 1028 program users, increased website use was significantly associated with lower health care costs among those who visited the website at least nine times during the study year (US$14 decrease per visit; P = .04; t(1022) = 2.05), with annual savings highest among 80 program users with targeted conditions (US$55 decrease per visit; P < .001; t(74) = 2.71). An employer-sponsored, Internet-based diet and exercise program shows promise as a low-cost benefit that contributes to lower health care costs among persons at higher risk for above-average health care costs and utilization.

A Web-Based Nutrition Program Reduces Health Care Costs in Employees With Cardiac Risk Factors: Before and After Cost Analysis

PubMed Central

Cabral, Howard; Kazis, Lewis E; Jarrett, Kelli M; Vetter, Delia; Richmond, Russell; Moore, Thomas J

2009-01-01

Background Rising health insurance premiums represent a rapidly increasing burden on employer-sponsors of health insurance and their employees. Some employers have become proactive in managing health care costs by providing tools to encourage employees to directly manage their health and prevent disease. One example of such a tool is DASH for Health, an Internet-based nutrition and exercise behavior modification program. This program was offered as a free, opt-in benefit to US-based employees of the EMC Corporation. Objective The aim was to determine whether an employer-sponsored, Internet-based diet and exercise program has an effect on health care costs. Methods There were 15,237 total employees and spouses who were included in our analyses, of whom 1967 enrolled in the DASH for Health program (DASH participants). Using a retrospective, quasi-experimental design, study year health care costs among DASH participants and non-participants were compared, controlling for baseline year costs, risk, and demographic variables. The relationship between how often a subject visited the DASH website and health care costs also was examined. These relationships were examined among all study subjects and among a subgroup of 735 subjects with cardiovascular conditions (diabetes, hypertension, hyperlipidemia). Multiple linear regression analysis examined the relationship of program use to health care costs, comparing study year costs among DASH participants and non-participants and then examining the effects of increased website use on health care costs. Analyses were repeated among the cardiovascular condition subgroups. Results Overall, program use was not associated with changes in health care costs. However, among the cardiovascular risk study subjects, health care costs were US$827 lower, on average, during the study year (P = .05; t 729 = 1.95). Among 1028 program users, increased website use was significantly associated with lower health care costs among those who visited the website at least nine times during the study year (US$14 decrease per visit; P = .04; t 1022 = 2.05), with annual savings highest among 80 program users with targeted conditions (US$55 decrease per visit; P < .001; t 74 = 2.71). Conclusions An employer-sponsored, Internet-based diet and exercise program shows promise as a low-cost benefit that contributes to lower health care costs among persons at higher risk for above-average health care costs and utilization. PMID:19861297

[Shortening deformities of the clavicle after diaphyseal clavicular fractures : Influence on patient-oriented assessment of shoulder function].

PubMed

Jubel, A; Schiffer, G; Andermahr, J; Ries, C; Faymonville, C

2016-06-01

The aim of this study was the evaluation of patient-oriented outcome scores for shoulder function and residual complaints after diaphyseal clavicular fractures with respect to shortening deformities. The analysis was based on data of 172 adult patients (mean age 39 ± 14 years) with healed clavicular fractures treated operatively (n = 104) or conservatively (n = 67). The control population consisted of 35 healthy adults without shoulder problems and 25 patients with nonunion after conservative treatment. The subjective estimation of the level of pain was collated on a visual analog scale (VAS 1-100 points), together with the relative Constant and Murley score, the Cologne clavicle score, the disabilities of the arm, shoulder and hand (DASH) score and a bilateral comparison of the length difference of the clavicles. Patients with a clavicular length difference of > 2 cm had significantly (p < 0.001) more pain, a greater loss of mobility and significantly lower values in the scoring system of Constant and Murley, the DASH and Cologne clavicle scores compared to patients with clavicular length differences < 0.5 cm and healthy controls (p < 0.001). The results of this study showed that shortening deformities after clavicular fractures in adults have a large impact on the functional result and patient-oriented outcome scores. The aim of the therapy of diaphyseal clavicular fractures should therefore concentrate on reconstruction of the anatomical length of the clavicle.

Factors Influencing Outcomes after Ulnar Nerve Stability-Based Surgery for Cubital Tunnel Syndrome: A Prospective Cohort Study

PubMed Central

Kang, Ho Jung; Oh, Won Taek; Koh, Il Hyun; Kim, Sungmin

2016-01-01

Purpose Simple decompression of the ulnar nerve has outcomes similar to anterior transposition for cubital tunnel syndrome; however, there is no consensus on the proper technique for patients with an unstable ulnar nerve. We hypothesized that 1) simple decompression or anterior ulnar nerve transposition, depending on nerve stability, would be effective for cubital tunnel syndrome and that 2) there would be determining factors of the clinical outcome at two years. Materials and Methods Forty-one patients with cubital tunnel syndrome underwent simple decompression (n=30) or anterior transposition (n=11) according to an assessment of intra-operative ulnar nerve stability. Clinical outcome was assessed using grip and pinch strength, two-point discrimination, the mean of the disabilities of arm, shoulder, and hand (DASH) survey, and the modified Bishop Scale. Results Preoperatively, two patients were rated as mild, another 20 as moderate, and the remaining 19 as severe according to the Dellon Scale. At 2 years after operation, mean grip/pinch strength increased significantly from 19.4/3.2 kg to 31.1/4.1 kg, respectively. Two-point discrimination improved from 6.0 mm to 3.2 mm. The DASH score improved from 31.0 to 14.5. All but one patient scored good or excellent according to the modified Bishop Scale. Correlations were found between the DASH score at two years and age, pre-operative grip strength, and two-point discrimination. Conclusion An ulnar nerve stability-based approach to surgery selection for cubital tunnel syndrome was effective based on 2-year follow-up data. Older age, worse preoperative grip strength, and worse two-point discrimination were associated with worse outcomes at 2 years. PMID:26847300

The outcome of scapulothoracic arthrodesis using cerclage wires, plates, and allograft for facioscapulohumeral dystrophy.

PubMed

Cooney, Alan D; Gill, Inder; Stuart, Paul R

2014-01-01

Scapulothoracic arthrodesis is a recognized treatment for impaired shoulder function in patients with facioscapulohumeral dystrophy (FSHD) and is traditionally performed with autograft. The purpose of the study was to report our experience with scapulothoracic arthrodesis in patients with FSHD using allograft, rather than autograft, with particular respect to the effect of fusion on preoperative and postoperative Disabilities of the Arm, Shoulder and Hand (DASH) scores; forced vital capacity (FVC); and complications. The early results of 14 consecutive scapulothoracic arthrodeses in FSHD patients with cerclage wires, plates, and allograft (fresh-frozen femoral heads) are reported. DASH scores were recorded preoperatively and 6 months postoperatively. Preoperative and 6-month FVCs were compared. The surgical technique is described. Eleven patients underwent 14 fusions. The mean follow-up period was 29 months (range, 6-50 months). Forward flexion improved from 70° to 115° (P = .001) and abduction from 68° to 109° (P = .007). The DASH score improved from 48 points to 34 points (P = .005). FVC decreased from 98% to 92% of predicted (P = .021), although this was not clinically significant. One patient required revision for nonunion, and metalwork was removed in 5 scapulae. A postoperative chest infection developed in 1 patient and a pleural effusion in another. One brachial plexus palsy occurred, which had almost completely resolved by 27 months postoperatively. Scapulothoracic arthrodesis can be performed successfully with allograft. The nonunion and complication rates are similar to those in the existing literature. A small decrease in FVC does occur but not to a clinically significant level. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

The Dietary Approaches to Stop Hypertension Diet and New and Recurrent Root Caries Events in Men.

PubMed

Kaye, Elizabeth K; Heaton, Brenda; Sohn, Woosung; Rich, Sharron E; Spiro, Avron; Garcia, Raul I

2015-09-01

To examine the effect of overall dietary quality on number of teeth with new or recurrent root caries events during follow-up (root caries increment). Prospective study with dental examinations approximately every 3 years over 20 years. Veterans Affairs Dental Longitudinal Study in greater Boston, Massachusetts, area. Men aged 47 to 90 (N = 533). A single calibrated examiner assessed root caries and restorations, calculus, probing pocket depth, and attachment loss on each tooth at each examination. The adjusted root caries increment (root-ADJCI) was computed from new and recurrent root caries events on teeth with recession of 2 mm or more. Dietary information was obtained from food frequency questionnaires. An adherence score was computed by comparing consumption frequency of 10 food groups (fruits, vegetables, total dairy, low-fat dairy, meat, total grains, high-fiber grains, legumes, fats, sweets) from the Dietary Approaches to Stop Hypertension (DASH) diet guidelines. Mean root-ADJCIs were compared according to DASH adherence score quartile using generalized linear negative binomial regression models, controlling for age, number of teeth at risk of root caries, time at risk of root caries, calculus, presence of removable denture, history of dental prophylaxis, body mass index, and smoking status. Men with DASH adherence scores in the highest quartile had a 30% lower mean root-ADJCI (1.86 teeth) than those in the lowest quartile (2.68 teeth) (P = .03). Root-ADJCI was lower with greater adherence to recommendations for vegetables and total grains and greater with greater sugar-sweetened carbonated beverage consumption. Root caries incidence rate did not vary significantly between quartiles. A higher-quality diet may reduce root caries risk in older men. © 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.

Outcomes and Disability After Massive Proximal Upper Extremity Reconstruction in a Resource-Limited Setting.

PubMed

Giladi, Aviram M; Shanmugakrishnan, R Raja; Venkatramani, Hari; Raja Sekaran, S; Chung, Kevin C; Sabapathy, S Raja

2017-06-01

At Ganga Hospital in Coimbatore, India, a unique approach is applied to treat massive upper limb injuries. However, long-term outcomes of complex reconstruction performed in the resource-limited setting are not known. This hinders understanding of outcomes and disability from these injuries and prevents systematically addressing care delivery around upper extremity trauma in the developing world. This project aims to analyze the details of the unique Ganga Hospital reconstruction experience and use patient-reported outcome measures for the first time in this patient population to evaluate post-injury recovery and disability . Forty-six patients were evaluated 6 months or more after massive proximal upper extremity reconstruction at Ganga Hospital. Patients completed functional tests, Jebsen-Taylor test (JTT), and patient-reported outcomes (PROs)-Michigan Hand Questionnaire (MHQ), Disability of Arm, Shoulder, and Hand questionnaire (DASH), and Short-Form 36 (SF-36). Correlations between metrics were assessed with Pearson's correlation coefficients. Linear regression modeling evaluated associations between severity, reconstruction, and outcomes. MHQ and DASH results correlated with functional test performance, JTT performance, and SF-36 scores (Pearson's coefficients all ≥0.33, p ≤ 0.05). In this cohort, mean MHQ score was 79 ± 15 and mean DASH score was 13 ± 15, which are not significantly different than scores for long-term outcomes after other complex upper extremity procedures. The following factors predicted PROs and functional performance after reconstruction: extent of soft tissue reconstruction, multi-segmental ulna fractures, median nerve injury, and ability for patients to return to work and maintain their job after injury. Complex proximal upper extremity salvage can be performed in the resource-limited setting with excellent long-term functional and patient-reported outcomes. PRO questionnaires are useful for reporting outcomes that correlate to functional and sensory testing and may be used to assess post-traumatic disability.

Early return to work following open carpal tunnel decompression in lamb freezing workers.

PubMed

Wyatt, M C; Veale, G A

2008-08-01

Carpal tunnel syndrome is common at the largest lamb processing plant in the world, especially in new lamb boners. The purpose of this study was to establish the incidence and whether expeditious return to work following open carpal tunnel decompression was possible. Two hundred patients with a neurophysiologically confirmed diagnosis underwent surgery between 2002 and 2006. One hundred and eighty-seven patients were assessed retrospectively and 13 prospectively. The incidence in new lamb boners was 10% in their first season. On average, workers commenced rehabilitation at 11 days post-operatively and full duties at 29 days post-operatively with minimal further time off taken. Ninety percent returned to their previous role. By 8 weeks in the prospective group visual analogue pain scores had improved from 8.75 to 2.0 (P<0.01) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores had improved from 140 points to 68 (P<0.01). Grip/pinch testing, static two-point discrimination scores and complication rates were comparable with previous studies. This study provides good evidence that coordinated, early rehabilitation and return to work is effective in a high-demand population.

Oxford Shoulder Score: A Cross-Cultural Adaptation and Validation Study of the Persian Version in Iran.

PubMed

Ebrahimzadeh, Mohammad H; Birjandinejad, Ali; Razi, Shiva; Mardani-Kivi, Mohsen; Reza Kachooei, Amir

2015-09-01

Oxford shoulder score is a specific 12-item patient-reported tool for evaluation of patients with inflammatory and degenerative disorders of the shoulder. Since its introduction, it has been translated and culturally adapted in some Western and Eastern countries. The aim of this study was to translate the Oxford Shoulder Score (OSS) in Persian and to test its validity and reliability in Persian speaking population in Iran. One hundred patients with degenerative or inflammatory shoulder problem participated in the survey in 2012. All patients completed the Persian version of OSS, Persian DASH and the SF-36 for testing validity. Randomly, 37 patients filled out the Persian OSS again three days after the initial visit to assess the reliability of the questionnaire. Cronbach's alpha coefficient was 0.93. The intraclass correlation coefficient was 0.93. In terms of validity, there was a significant correlation between the Persian OSS and DASH and SF-36 scores (P < 0.001). The Persian version of the OSS proved to be a valid, reliable, and reproducible tool as demonstrated by high Cronbach's alpha and Pearson's correlation coefficients. The Persian transcript of OSS is administrable to Persian speaking patients with shoulder condition and it is understandable by them.

Focal Muscle Vibration and Physical Exercise in Postmastectomy Recovery: An Explorative Study

PubMed Central

Fara, Maria Antonietta; Filippi, Guido Maria; La Torre, Giuseppe; Tozzi, Roberto; Vanacore, Nicola

2017-01-01

Background. Physical activity initiation and maintenance are particular challenges in the postmastectomy recovery and in particular Dragon Boat racing seems to be a useful sport activity. The aim of this study was to evaluate the role of focal muscle vibration as a proprioceptive input to improve upper limb functioning in a group of “paddlers” patients. Methods. A group of paddlers has been evaluated before vibratory treatment (T0), immediately after therapy (T1), after one week (T2), and after one month (T3) with DASH questionnaire, Body Image Scale, McGill pain questionnaire, Constant Scale, and Short Form 36 questionnaire. Results. Fourteen patients showed a significant reduction in disability score (p = 0,001) using DASH scale, an improvement of upper limb function (p = 0,001) using the Constant scale, and a reduction of pain (p = 0,007) at the McGill pain questionnaire. The Mental Composite Score of the Short Form 36 questionnaire showed significant results (p = 0,04) while no significant results had been found regarding the physical mental score (p = 0,08). Conclusion. Focal muscle vibration may be a useful treatment in a postmastectomy recovery of upper limb functionality. PMID:28459068

The exploded hand syndrome: a report of five industrial injury cases.

PubMed

Al-Qattan, M M

2013-10-01

The term 'exploded hand syndrome' refers to a specific type of crush injury to the hand in which a high compressive force excessively flattens the hand leading to thenar muscle extrusion through burst lacerations. Out of 89 crushed hands seen over a period of seven years, only five had exploded hand syndrome. They were all male industrial workers ranging in age between 24 and 55 years. All patients had thenar muscle extrusion. Other concurrent injuries included fractures/dislocations, compartment syndrome, and ischaemia. All patients were treated by excision of the extruded intrinsic muscles, as well as primary management of concurrent injuries. All patients had functional assessment including: motor power and sensory testing, range of motion of hand joints, and the quick DASH score. Objective testing showed reduced sensibility in the thumb, reduced grip strength (mean 52% of contralateral hand), reduced pinch strength (mean of 27% of contralateral hand), reduced thumb opposition (the mean Kapandji Score was 5 out of 10), and deficits in the range of motion of the metacarpophalangeal and interphalangeal joints of the thumb. The quick DASH score ranged from 11 to 49 and only two patients were able to go back to regular manual work.

CHRONIC UCL INJURY: A MULTIMODAL APPROACH TO CORRECTING ALTERED MECHANICS AND IMPROVING HEALING IN A COLLEGE ATHLETE— A CASE REPORT

PubMed Central

Patrick, Rachel; McGinty, Josh; Lucado, Ann; Collier, Beth

2016-01-01

ABSTRACT Background Ulnar collateral ligament (UCL) tears and associated Tommy Johns surgical intervention from excessive and poor quality pitching has increased immensely—with more college and professional pitchers undergoing the surgery in 2014 alone than in the 1990s as a whole.1 Faulty mechanics developed at young ages are often well-engrained by the late adolescent years and the minimal healing ability of the largely avascular UCL often leads to delayed safe return to sport.2 Purpose The purpose of this case study was to describe an innovative, multimodal approach to conservative management of a chronic UCL injury in a college-aged baseball pitcher. This innovative approach utilizes both contractile and non-contractile dry needling to enhance soft tissue healing combined with standard conservative treatment to decrease pain and improve sport performance as measured by the Disabilities of Arm, Shoulder and Hand (DASH), Numeric Pain Report Scale (NPRS), and return to sport. Study Design Retrospective Case Report Case Description A collegiate athlete presented to an outpatient orthopedic physical therapy clinic for treatment of UCL sprain approximately six weeks post-injury and platelet-rich plasma injection. Diagnostic testing revealed chronic ligamentous microtrauma. Impairments at evaluation included proximal stabilizing strength deficits, myofascial trigger points throughout the dominant upper extremity, improper pitching form, and inability to pitch in game conditions due to severe pain. Interventions included addressing strength deficits throughout the body, dry needling, and sport-specific biomechanical training with pitching form analysis and correction. Outcomes Conventional DASH and Sport-Specific scale on the DASH and the numeric pain rating scale improved beyond both the minimally clinically important difference and minimal detectable change over the 12 week treatment3,4 At 24-week follow up, conventional DASH scores decreased from 34.20% disability to 3.33% disability while sport-specific DASH scores decreased from 100% disability to 31.25% disability. Although initially unable to compete due to high pain levels, the subject is currently completing his pitching role full-time with 1/10 max pain. Discussion The approach used in this case study provides an innovative approach to conservative UCL partial tear treatment. Dry needling of both contractile and non-contractile tissue in combination with retraining of faulty mechanics may encourage chronically injured ligamentous tissue healing and encourage safe return to sport. Level of evidence Level 4 PMID:27525185

Plate fixation versus conservative treatment of displaced midshaft clavicle fractures: Functional outcome and patients' satisfaction during a mean follow-up of 5 years.

PubMed

van der Ven Denise, J C; Timmers, T K; Flikweert, P E; Van Ijseldijk, A L A; van Olden, G D J

2015-11-01

The aim of the present prospective clinical trial was to compare patient-oriented and surgeon-based outcomes after non-operative care with operative treatment of displaced midshaft clavicle fractures. Between January 2009 and July 2011, 97 consecutive patients presenting with a midshaft clavicle fracture were prospectively recorded and included in this study. The patients were placed in either of the treatment groups on their own preference. They were then seen in outpatient clinic at two, six and 24 weeks were all endpoints were investigated and motivation of choice of treatment was noted. Study follow-up was continued until Augustus 2014, being the time point that long-term functional outcome was measured through a DASH score by letter. 97 patients were included in the functional outcome analysis. The mean DASH and Constant scores were significant better in the operative (90.9±14.2 and 15.7±17.2) than in the conservative treatment group at six weeks (78.7±17.0 and 24.8±16.7). There was a significant improvement in the Constant (95.9±10.5 versus 94.5±5.9) and DASH scores (8.8±12.0 versus 7.1±10.7) for both groups at 24 weeks but there was no significant difference in functional scores between the groups. Four patients developed a non-union, one patient in the operative and three patients in the conservative group. Overall complications were significantly higher in the operative group (31%) compared to the conservative group (9%) (p<0.001). There was no significant difference in long-term functional outcome between the two treatment groups (5.2±9.8 versus 2.5±4.9 p=0.12). Patient's satisfaction was higher in the operative than in the conservative group (p<0.04). Significant superior outcome scores were seen at six weeks for the operative group. However, at 24 weeks and 5-year follow-up no difference was seen in functional outcome scores for both treatment groups. Therefore, the challenge for the future is to better identify the subgroup of patients who might benefit from primary surgical intervention. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cross-cultural adaptation and validation of the Italian version of the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score.

PubMed

Merolla, Giovanni; Corona, Katia; Zanoli, Gustavo; Cerciello, Simone; Giannotti, Stefano; Porcellini, Giuseppe

2017-12-01

The Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score is a reliable and sensitive tool to measure the performance of overhead athletes. The purpose of this study was to carry out a cross-cultural adaptation and validation of the KJOC questionnaire in Italian and to assess its reliability, validity, and responsiveness. Ninety professional athletes with a painful shoulder were included in this study and were assigned to the "injury group" (n = 32) or the "overuse group" (n = 58); 65 were managed conservatively and 25 were treated by arthroscopic surgery. To assess the reliability of the KJOC score, patients were asked to fill in the questionnaire at baseline and after 2 weeks. To test the construct validity, KJOC scores were compared to those obtained with the Italian version of the Disabilities of the Arm, Shoulder, and Hand (DASH) scale, and with the DASH sports/performing arts module. To test KJOC score responsiveness, the follow-up KJOC scores of the participants treated conservatively were compared to those of the patients treated by arthroscopic surgery. Statistical analysis demonstrated that the KJOC questionnaire is reliable in terms of the single items and the overall score (ICC 0.95-0.99); that it has high construct validity (r s  = -0.697; p < 0.01); and that it is responsive to clinical differences in shoulder function (p < 0.0001). The Italian version of the KJOC Shoulder and Elbow score performed in a similar way to the English version and demonstrated good validity, reliability, and responsiveness after conservative and surgical treatment. II.

Protein Arms in the Kinetochore-Microtubule Interface of the Yeast DASH Complex

PubMed Central

Miranda, JJ L.; King, David S.

2007-01-01

The yeast DASH complex is a heterodecameric component of the kinetochore necessary for accurate chromosome segregation. DASH forms closed rings around microtubules with a large gap between the DASH ring and the microtubule cylinder. We characterized the microtubule-binding properties of limited proteolysis products and subcomplexes of DASH, thus identifying candidate polypeptide extensions involved in establishing the DASH-microtubule interface. The acidic C-terminal extensions of tubulin subunits are not essential for DASH binding. We also measured the molecular mass of DASH rings on microtubules with scanning transmission electron microscopy and found that approximately 25 DASH heterodecamers assemble to form each ring. Dynamic association and relocation of multiple flexible appendages of DASH may allow the kinetochore to translate along the microtubule surface. PMID:17460120

[Characteristics of Dupuytren's disease in women. A study of 67 cases].

PubMed

Ferry, N; Lasserre, G; Pauchot, J; Lepage, D; Tropet, Y

2013-12-01

The aim of this study was to identify the clinical differences of the Dupuytren's disease in gender. Testosterone induces an increase of the Dupuytren's fibroblast proliferation via androgen's receptors. Testosterone rate increases during pregnancy and menopausis. We also reached a link between this factors and the clinical aspects of Dupuytren' disease in the women of our study. This retrospective, comparative study was about all women and a randomized number of men, who underwent surgery for Dupuytren' disease between 1980 and 2010. We analysed all the epidemiologic and clinical data, the surgery procedures and the complications. Pre- and postoperative measurements of the extension lack of all the joints were performed with a manual goniometer. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate the patients function. This specific data of women were reached. Sixty-seven women and 69 men were compared. The complex regional pain syndrome was significantly more common in women and the correction of the proximal interphalangeal joint was significantly lower in women. Recurrence rate and mean follow up were not statistically different. Mean DASH score was higher in women. We have not found any association between menopausis, pregnancy and the average age at presentation of the disease, the recurrence rate or the extension rate. The prognosis of the Dupuytren's disease is worse in women than in men. Other studies are necessary to reach the link between the testosterone and the clinical history of the disease in women. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Intercondylar humerus fracture- parallel plating and its results.

PubMed

Kumar, Sanjiv; Singh, Sudhir; Kumar, Dharmender; Kumar, Neeraj; Verma, Reetu

2015-01-01

Intercondylar fracture of humerus is one of the commonest fractures of young adult and counts for about 30% of all elbow fractures. The treatment of these fractures continues to present challenges despite advances in internal fixation. Although orthogonal plating use to provid adequate functional results in these fractures, parallel plating is said to be mechanically more stable construct thus allowing early mobilization and better range of motion. AIM of the study is to assess the clinical as well functional results of these fractures treated with parallel plating. Prospective study in a tertiary care hospital. A total of 23 fresh patients of intercondylar fracture of humerus from Jan 2013 to May 2014 were included in the study and were treated with parallel plating. These patients were followed at 3, 6, 12, 24 weeks and at 1year of follow up and assessed in terms of time for union, range of motion, MAYO score, DASH score and complication rate. At final follow up Mayo score was 96.32±04.96 from 5.00±01.26 and DASH SCORE was 31.42±2.04 which dropped from 150±05.34, Range of motion improved from 21.38±05.70 to 116.1±07.92 with 100% union rate and complications less than 19%. Parallel plating for intercondylar fracture of humerus is excellent method of fixation and results are similar to those treated with orthogonal plating.

Open reduction and internal fixation of Ideberg IV and V glenoid intra-articular fractures through a Judet approach: a retrospective analysis of 11 cases.

PubMed

Hu, Chuanzhen; Zhang, Weibin; Qin, Hui; Shen, Yuhui; Xue, Zichao; Ding, Haoliang; An, Zhiquan

2015-02-01

To evaluate the methods and the outcomes of complex intra-articular glenoid fractures, treated by open reduction and internal fixations. The outcomes of 11 cases of complex intra-articular glenoid scapular fractures were retrospectively analyzed. The fractures were classified as type IV in five cases, type Va in two and Vb in four cases, according to Ideberg classification system. The mean step or gap between the main articular fragments was 6.3 ± 6.2 (4-25) mm. The fractures were openly reduced through a Judet approach and fixed with reconstructive plates or bands placed on the lateral and medial side of affected scapula, respectively. The main articular fragments were strengthened with a 4.0-mm cannulated screw in five cases. The bone union, the anterior flexion, the external and internal rotation of the shoulders were checked and recorded. The functional outcomes were evaluated using DASH questionnaire, Constant and UCLA shoulder score systems, respectively. 11 patients were followed up with an average of 28.2 ± 12.6 (12-50) months. All the fractures were united smoothly without second intervention. At the latest visiting, the mean anterior flexion of affected shoulder was 157.3 ± 7.37° (range 150°-170°), the mean external rotation of the affected shoulder was 58.2 ± 7.5° (range 50°-70°). When the shoulder in the internal rotation, the extended thumb reached to L4 or L1 or T10 or T7 in one case, to T12 in two cases and to T8 in four cases, respectively, the mean Constant score was 91.7 ± 2.8 (86-96) points. The mean UCLA score was 32.7 ± 1.7 (30-35) points, leading to four cases of excellent and seven cases of good results. The mean DASH score was 7.4 ± 3.3 (3.4-13) points. Good outcomes could be obtained when Ideberg IV and V glenoid fractures were treated by open reduction and internal fixation through a Judet approach.

Platelet-Rich Plasma Treatment With Physical Therapy in Chronic Partial Supraspinatus Tears.

PubMed

Ilhanli, Ilker; Guder, Necip; Gul, Murat

2015-09-01

Despite the insufficient evidence, due to potential contribution to the improvement, platelet-rich plasma (PRP) is emerging as a promising method. The aim of this study was to assess the effectiveness of PRP injection in partial supraspinatus tears by comparing with physical therapy (PT). Seventy patients with chronic partial supraspinatus tears in magnetic resonance imaging were randomized into two groups; PRP (n = 35) and PT (n = 35). Before the treatment, at the end of the treatment and at the 12th month after the end of the treatment, range of motion (ROM), visual analog scale (VAS) for pain, Disabilities of Arm, Shoulder and Hand questionnaire (DASH), Neer's, Hawkins' and drop arm tests and Beck Depression Inventory were investigated. Statistical analysis was made for 62 subjects (PRP group, n = 30; PT group, n = 32). There were no differences between the groups according to demographic data. At the 12th month after the end of the treatment, significant improvement in ROM was detected in both groups, pain was reduced significantly in both groups and improvement of the DASH score was observed in both groups. At all the evaluation steps, increases in ROM degrees were significantly higher in the PT group than the PRP group. For VAS in activity and in rest, after the treatment, improvement was higher in the PT group than the PRP group. However, improvement of the DASH score of the PRP group was significantly better than the PT group. When we compared with PT, PRP seemed to be a well-tolerated application which showed promising results in patients with chronic partial supraspinatus tears.

Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation.

PubMed

Gautam, V K; Verma, Saurabh; Batra, Sahil; Bhatnagar, Nidhi; Arora, Sumit

2015-04-01

To evaluate the clinical and ultrasonographic changes in the morphology and vascularity of the common extensor tendon after injecting platelet-rich plasma (PRP) or corticosteroid (CS) for recalcitrant lateral epicondylitis (LE). 30 patients aged 18 to 60 years with recalcitrant (>6 months) LE not responsive to oral medication or non-invasive treatment were randomised to receive PRP (n=15) or CS (n=15) injection. Patients were assessed using the visual analogue scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand Scale (DASH) score, Oxford Elbow Score, modified Mayo Clinic performance index for the elbow (modified Mayo score), and hand grip strength. Ultrasonography was performed by a musculoskeletal ultrasonologist to evaluate for tear at the common extensor origin, oedema at the common extensor origin, cortical erosion, probe-induced tenderness, and thickness of the tendon. The VAS for pain, DASH score, Oxford Elbow Score, modified Mayo score, and hand grip strength all improved significantly from pre-injection to the 6-month follow-up in the PRP and CS groups. However, in the CS group, the scores generally peaked at 3 months and then deteriorated slightly at 6 months indicating recurrence of symptoms, which involved 46.7% of the CS patients. At 6 months, the number of patients positive for various ulrasonographic findings generally decreased. However, in the CS group, the number of patients with reduced thickness of the common extensor tendon increased from 2 to 12, and the number of patients with cortical erosion at the lateral epicondyle increased from 9 to 11. PRP appeared to enable biological healing of the lesion, whereas CS appeared to provide short-term, symptomatic relief but resulted in tendon degeneration.

The effect of chair massage on muscular discomfort in cardiac sonographers: a pilot study

PubMed Central

2010-01-01

Background Cardiac sonographers frequently have work-related muscular discomfort. We aimed to assess the feasibility of having sonographers receive massages during working hours in an area adjacent to an echocardiography laboratory and to assess relief of discomfort with use of the massages with or without stretching exercises. Methods A group of 45 full-time sonographers was randomly assigned to receive weekly 30-minute massage sessions, massages plus stretching exercises to be performed twice a day, or no intervention. Outcome measures were scores of the QuickDASH instrument and its associated work module at baseline and at 10 weeks of intervention. Data were analyzed with standard descriptive statistics and the separation test for early-phase comparative trials. Results Forty-four participants completed the study: 15 in the control group, 14 in the massage group, and 15 in the massage plus stretches group. Some improvement was seen in work-related discomfort by the QuickDASH scores and work module scores in the 2 intervention groups. The separation test showed separation in favor of the 2 interventions. Conclusion On the basis of the results of this pilot study, larger trials are warranted to evaluate the effect of massages with or without stretching on work-related discomfort in cardiac sonographers. Trial Registration NCT00975026 ClinicalTrials.gov PMID:20846441

Bilateral simultaneous endoscopic carpal tunnel release: Mean time to resume activities of daily living and return to work.

PubMed

Degeorge, B; Coulomb, R; Kouyoumdjian, P; Mares, O

2018-06-01

The purpose of this study was to determine the time needed to return to personal and professional activities after bilateral simultaneous endoscopic carpal tunnel release. During a retrospective, single-center study, we included a cohort of 30 patients (60 wrists). Patients were evaluated clinically (pain, paresthesia) and functionally (QuickDASH score) pre- and postoperatively. At the last follow-up, patients completed a questionnaire regarding the time needed to resume personal activities using the ADL scale (feeding, personal hygiene and dressing) and return to work. We also evaluated procedure satisfaction and willingness to undergo the surgery again. The average patient age was 60.5 years (range 39-86). At the last follow-up, average time to resume personal activities was 2.2 days (0-14) for feeding, 4.4 days (0-15) for personal hygiene and 3.9 days (0-14) for dressing. Average time to return to recreational activities was 11.7 days (1-60). Average time to return to work was 36.6 days (15-60). Overall, 97% of patients were satisfied or very satisfied with the outcome. All patients would have the bilateral simultaneous surgery again. Bilateral simultaneous endoscopic carpal tunnel release is rarely performed. For mild conditions, contralateral symptom improvement is common after unilateral surgery. Bilateral simultaneous endoscopic carpal tunnel release appears to be disabling right after surgery, but clinical and functional scores are similar after the third postoperative day. These data can be used for patient education and decision making when considering surgery bilateral carpal tunnel syndrome. Bilateral simultaneous endoscopic carpal tunnel release is a feasible and safe procedure. Level IV, case series. Copyright © 2018 SFCM. Published by Elsevier Masson SAS. All rights reserved.

Long-term Outcomes After Ulnar Collateral Ligament Reconstruction in Competitive Baseball Players: Minimum 10-Year Follow-up.

PubMed

Osbahr, Daryl C; Cain, E Lyle; Raines, B Todd; Fortenbaugh, Dave; Dugas, Jeffrey R; Andrews, James R

2014-06-01

Ulnar collateral ligament reconstruction (UCLR) has afforded baseball players with excellent results; however, previous studies have described only short-term outcomes. To evaluate long-term outcomes after UCLR in baseball players. Case series; Level of evidence, 4. All UCLRs performed on competitive baseball players with a minimum 10-year follow-up were identified. Surgical data were collected prospectively and patients were surveyed by telephone follow-up, during which scoring systems were used to assess baseball career and post-baseball career outcomes. Of 313 patients, 256 (82%) were contacted at an average of 12.6 years; 83% of these baseball players (90% pitchers) were able to return to the same or higher level of competition in less than 1 year, but results varied according to preoperative level of play. Baseball career longevity was 3.6 years in general and 2.9 years at the same or higher level of play, but major and minor league players returned for longer than did collegiate and high school players after surgery (P < .001). Baseball retirement typically occurred for reasons other than elbow problems (86%). Many players had shoulder problems (34%) or surgery (25%) during their baseball career, and these occurrences most often resulted in retirement attributable to shoulder problems (P < .001). For post-baseball career outcomes, 92% of patients were able to throw without pain, and 98% were still able to participate in throwing at least on a recreational level. The 10-year minimum follow-up scores (mean ± standard deviation) for the Disabilities of the Arm, Shoulder and Hand (DASH), DASH work module, and DASH sports module were 0.80 ± 4.43, 1.10 ± 6.90, and 2.88 ± 11.91, respectively. Overall, 93% of patients were satisfied, with few reports of persistent elbow pain (3%) or limitation of function (5%). Long-term follow-up of UCLRs in baseball players indicates that most patients were satisfied, with few reports of persistent elbow pain or limitation of function. During their baseball career, most of these athletes were able to return to the same or higher level of competition in less than 1 year, with acceptable career longevity and retirement typically for reasons other than the elbow. According to a standardized disability and outcome scale, patients also had excellent results after UCLR during daily, work, and sporting activities. © 2014 The Author(s).

No association between dietary patterns and risk for cognitive decline in older women with nine-year follow-up: data from the Women’s Health Initiative Memory Study

PubMed Central

Haring, Bernhard; Wu, Chunyuan; Mossavar-Rahmani, Yasmin; Snetselaar, Linda; Brunner, Robert; Wallace, Robert B.; Neuhouser, Marian L.; Wassertheil-Smoller, Sylvia

2015-01-01

Background Data on the association between dietary patterns and age-related cognitive decline are inconsistent. Objective To determine whether dietary patterns assessed by the alternate Mediterranean diet score (aMED), the Healthy Eating Index (HEI) 2010, the Alternate Healthy Eating Index (AHEI) 2010 or the Dietary Approach to Stop Hypertension (DASH) diet score are associated with cognitive decline in older women. To examine if dietary patterns modify the risk for cognitive decline in hypertensive women. Design Prospective, longitudinal cohort study. Food frequency questionnaires (FFQs) were used to derive dietary patterns at baseline. Hypertension was defined as self-report of current drug therapy for hypertension or clinic measurement of SBP ≥ 140mmHg or DBP ≥ 90mmHg. Participants/setting Postmenopausal women (N=6,425) aged 65 to 79 years who participated in the Women’s Health Initiative Memory Study (WHIMS) and were cognitively intact at baseline. Main Outcome Measures Cognitive decline was defined as cases of mild cognitive impairment (MCI) or probable dementia (PD). Cases were identified through rigorous screening and expert adjudication. Statistical Analyses performed Cox proportional hazards models with multivariable adjustment were used to estimate the relative risk for developing MCI or PD. Results During a median follow-up of 9.11 years, we documented 499 cases of MCI and 390 of PD. In multivariable analyses we did not detect any statistically significant relationships across quintiles of aMED, HEI-2010, DASH and AHEI-2010 scores and MCI or PD (ptrend=0.30, 0.44, 0.23 and 0.45). In hypertensive women we found no significant association between dietary patterns and cognitive decline (ptrend=0.19, 0.08, 0.07 and 0.60). Conclusions Dietary patterns characterized by the aMED, HEI-2010, AHEI-2010 or DASH dietary score were not associated with cognitive decline in older women. Adherence to a healthy dietary pattern did not modify the risk for cognitive decline in hypertensive women. PMID:27050728

Endoscopic repair of tears of the superficial layer of the distal triceps tendon.

PubMed

Heikenfeld, Roderich; Listringhaus, Rico; Godolias, Georgios

2014-07-01

The purpose of this study was to evaluate the results after endoscopic repair of partial superficial layer triceps tendon tears. Fourteen patients treated surgically between July 2005 and December 2012 were studied prospectively for 12 months. Indication for surgery was a partial detachment of the triceps tendon from the olecranon that was proved by magnetic resonance imaging (MRI) in all cases. Ten of these patients had chronic olecranon bursitis. All patients were treated with endoscopic surgery including bursectomy and repair of the distal triceps tendon with double-loaded suture anchors. Clinical examination of the patients as well as functional and subjective scores (Mayo Elbow Performance Index [MEPI], Disabilities of the Arm, Shoulder and Hand Score [Quick DASH]) were obtained preoperatively and postoperatively at 6 and 12 months. An isokinetic strength measurement and MRI were performed preoperatively and 12 months after surgery. All 14 patients were completely evaluated. The MEPI and Quick DASH Score improved significantly after the repair at all postoperative examinations. The MEPI gained 29 points, up to 96 points at last follow-up (P < .05), and the Quick DASH Score went down 15.6 points after 12 months to 4.5 points (P < .05). Maximum extension power improved 55.8%, up to 94.7% at last follow-up compared with the contralateral side. Using MRI, we found one reruptured partial tear of the triceps tendon that did not require revision surgery. Although triceps tendon ruptures are generally uncommon, partial superficial tears might be more common than previously described. Once the diagnosis is made, endoscopic repair is a method leading to good clinical results with improved function of the affected elbow. Endoscopic repair of superficial tears of the triceps tendon is able to restore function and strength and leads to excellent clinical results after 1 year. Strength recovers to nearly that of the contralateral side, and serious complications appear to be infrequent. Level IV, therapeutic case series. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Diet quality as assessed by the Healthy Eating Index, the Alternate Healthy Eating Index, the Dietary Approaches to Stop Hypertension score, and health outcomes: a systematic review and meta-analysis of cohort studies.

PubMed

Schwingshackl, Lukas; Hoffmann, Georg

2015-05-01

Dietary patterns consider synergistic effects compared with isolated foods or nutrients on health outcomes. The aim of this systematic review and meta-analysis was to examine the associations of diet quality as assessed by the Healthy Eating Index (HEI), the Alternate Healthy Eating Index (AHEI), and the Dietary Approaches to Stop Hypertension (DASH) score and the risk of all-cause mortality, cardiovascular mortality or incidence, cancer mortality or incidence, type 2 diabetes mellitus, and neurodegenerative diseases. A literature search was performed using the electronic databases MEDLINE, SCOPUS, and EMBASE with an end date of May 10, 2014. Study-specific risk ratios were pooled using a random effect model by the Cochrane software package Review Manager 5.2. Fifteen cohort studies (34 reports), including 1,020,642 subjects, met the criteria and were included in the meta-analysis. Diets of the highest quality, as assessed by the HEI, AHEI, and DASH score, resulted in a significant risk reduction (RR) for all-cause mortality (RR 0.78, 95% CI 0.76 to 0.80; P<0.00001; I²=61%, 95% CI 20% to 81%), cardiovascular disease (incidence or mortality) (RR 0.78, 95% CI 0.75 to 0.81; P<0.00001; I²=45%, 95% CI 13% to 66%), cancer (incidence or mortality) (RR 0.85, 95% CI 0.82 to 0.88; P<0.00001; I²=77%, 95% CI 68% to 84%), and type 2 diabetes mellitus (RR 0.78, 95% CI 0.72 to 0.85; P<0.00001; I²=74%, 95% CI 52% to 86%). Differences observed for neurodegenerative diseases were not significant. Egger regression tests provided no evidence of publication bias. Diets that score highly on the HEI, AHEI, and DASH are associated with a significant reduction in the risk of all-cause mortality, cardiovascular disease, cancer, and type 2 diabetes mellitus by 22%, 22%, 15%, and 22%, respectively, and therefore is of high public health relevance. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Novel use of a flowable collagen-glycosaminoglycan matrix (Integra™ Flowable Wound Matrix) combined with percutaneous cannula scar tissue release in treatment of post-burn malfunction of the hand--A preliminary 6 month follow-up.

PubMed

Hirche, C; Senghaas, A; Fischer, S; Hollenbeck, S T; Kremer, T; Kneser, U

2016-02-01

Long-term function following severe burns to the hand may be poor secondary to scar adhesions to the underlying tendons, webspaces, and joints. In this pilot study, we report the feasibility of applying a pasty dermal matrix combined with percutaneous cannula teno- and adhesiolysis. In this 6 month follow-up pilot study, we included eight hands in five patients with hand burns undergoing minimal-invasive, percutaneous cannula adhesiolysis and injection of INTEGRA™ Flowable Wound Matrix for a pilot study of this new concept. The flowable collagen-glycosaminoglycan wound matrix (FCGWM) was applied with a buttoned 2mm cannula to induce formation of a neo-gliding plane. Post treatment follow-up was performed to assess active range of motion (AROM), grip strength, Disabilities of the Arm, Shoulder and Hand (DASH) score, Vancouver Scar Scale (VSS) and quality of life Short-Form (SF)-36 questionnaire. No complications were detected associated with the treatment of FCGWM injection. The mean improvement (AROM) at 6 months was 30.6° for digits 2-5. The improvement in the DASH score was a mean of 9 points out of 100. The VSS improved by a mean of 2 points out of 14. The study demonstrates the feasibility and safety of percutaneous FCGWM for dermal augmentation after burn. Results from this pilot study show improvements in AROM for digits 2-5, functional scores from the patient's perspective (DASH) and scar quality (VSS). The flowable form of established INTEGRA™ wound matrix offers the advantage of minimal-invasive injection after scar release in the post-burned hand with a reduction in the risk of postsurgical re-scarring. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

Radiological and functional outcomes 2.7 years following conservatively treated completely displaced midshaft clavicle fractures.

PubMed

Fuglesang, Hendrik F S; Flugsrud, Gunnar B; Randsborg, Per-Henrik; Stavem, Knut; Utvåg, Stein E

2016-01-01

It is unclear whether all completely displaced midshaft clavicle fractures require primary surgical intervention. The aim of this study was to elucidate the radiological and clinical outcomes after conservative treatment, and to identify subgroups at risk of an inferior outcome. Retrospective case series. Level II trauma center. Between 2005 and 2008, 122 patients were conservatively treated for a completely displaced midshaft clavicle fracture of whom 92 were eligible for inclusion in this study. Of these, 59 completed the study after a median of 2.7 years after the fracture (min-max, 1.1-4.9). The patients received the standard treatment administered at our institution at the time: nonsurgically with a sling without physiotherapy. Patients with painful nonunions were subsequently offered surgery. At follow-up, the patients' Disabilities of Arm, Shoulder, and Hand (DASH) and the Constant scores were evaluated. Radiographs were taken at follow-up and compared to those taken acutely. Nonunion was found in 9 of the 59 (15.3%) patients. Twenty-four (24%) patients reported a fair-to-poor DASH score (i.e. >20). Patients with fractures that were vertically displaced by more than 100% (one bone width) were significantly less satisfied than those with fractures vertically displaced at 100% (p = 0.04). Initial shortening of more than 15 mm was not associated with a worse outcome or nonunion. The odds ratio of developing a nonunion increased with age (p = 0.04). By treating completely displaced midshaft clavicle fractures conservatively with a sling and offering plate fixation for eventual painful nonunions, we found a 24% risk of a fair or poor clinical result with a DASH score over 20. A vertical displacement of more than 100 % between the main fragments on the initial radiograph was associated with an inferior clinical outcome in this study. IV.

Very High Prevalence of Frozen Shoulder in Patients With Type 1 Diabetes of ≥45 Years' Duration: The Dialong Shoulder Study.

PubMed

Juel, Niels Gunnar; Brox, Jens Ivar; Brunborg, Cathrine; Holte, Kristine Bech; Berg, Tore Julsrud

2017-08-01

To compare the prevalence of shoulder disorders and self-reported shoulder disability in patients with long-term type 1 diabetes mellitus and diabetes-free subjects; and to explore the association between the long-term glycemic burden and shoulder disability in the diabetes group. Cross-sectional study of shoulder diagnoses with 30 years' historical data on glycemic burden in patients with diabetes. Diabetics center and a university hospital. Subjects attending the Norwegian Diabetics Center in 2015 with type 1 diabetes since 1970 or earlier were eligible (N=136). One hundred and five patients were included, and 102 (50% women; mean age, 61.9y) completed the study together with 73 diabetes-free subjects (55% women; mean age, 62.5y). Not applicable. Shoulder diagnoses decided through clinical examination according to scientific diagnostic criteria. Frozen shoulder was diagnosed in 60 (59%) patients with diabetes and 0 diabetes-free subjects, with a lifetime prevalence of 76% in the diabetes group versus 14% in the diabetes-free subjects. Patients with diabetes had higher disability and higher mean QuickDASH scores (23.0±19.9) than diabetes-free subjects (8.9±12.0), with a mean difference of -14.2 (95% confidence interval, -19.3 to -9.0) points (P<.001). We found an association between chronic hyperglycemia and QuickDASH scores, with a 6.16-point increase in QuickDASH scores per unit increase in glycated hemoglobin A 1c (HbA 1c ) (P=.014). The point prevalence of frozen shoulder in patients with long-lasting type 1 diabetes was 59%, and the lifetime prevalence was 76%. The diabetes group had more shoulder disability than diabetes-free subjects. The historical HbA 1c level was associated with increased shoulder disability. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Cross-cultural adaptation and reliability and validity of the Dutch Patient-Rated Tennis Elbow Evaluation (PRTEE-D).

PubMed

van Ark, Mathijs; Zwerver, Johannes; Diercks, Ronald L; van den Akker-Scheek, Inge

2014-08-11

Lateral Epicondylalgia (LE) is a common injury for which no reliable and valid measure exists to determine severity in the Dutch language. The Patient-Rated Tennis Elbow Evaluation (PRTEE) is the first questionnaire specifically designed for LE but in English. The aim of this study was to translate into Dutch and cross-culturally adapt the PRTEE and determine reliability and validity of the PRTEE-D (Dutch version). The PRTEE was cross-culturally adapted according to international guidelines. Participants (n = 122) were asked to fill out the PRTEE-D twice with a one week interval to assess test-retest reliability. Internal consistency of the PRTEE-D was determined by calculating Crohnbach's alphas for the questionnaire and subscales. Intraclass Correlation Coefficients (ICC) were calculated for the overall PRTEE-D score, pain and function subscale and individual questions to determine test-retest reliability. Additionally, the Disabilities for the Arm, Shoulder and Hand questionnaire (DASH) and Visual Analogue Scale (VAS) pain scores were obtained from 30 patients to assess construct validity; Spearman's correlation coefficients were calculated between the PRTEE-D (subscales) and DASH and VAS-pain scores. The PRTEE was successfully cross-culturally adapted into Dutch (PRTEE-D). Crohnbach's alpha for the first assessment of the PRTEE-D was 0.98; Crohnbach's alpha was 0.93 for the pain subscale and 0.97 for the function subscale. ICC for the PRTEE-D was 0.98; subscales also showed excellent ICC values (pain scale 0.97 and function scale 0.97). A significant moderate correlation exists between PRTEE-D and DASH (0.65) and PRTEE-D and VAS pain (0.68). The PRTEE was successfully cross-culturally adapted and this study showed that the PRTEE-D is reliable and valid to obtain an indication of severity of LE. An easy-to-use instrument for practitioners is now available and this facilitates comparing Dutch and international research data.

Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial.

PubMed

Palacio, Evandro Pereira; Schiavetti, Rafael Ramos; Kanematsu, Maiara; Ikeda, Tiago Moreno; Mizobuchi, Roberto Ryuiti; Galbiatti, José Antônio

2016-01-01

To evaluate the effects of platelet-rich plasma (PRP) infiltration in patients with lateral epicondylitis of the elbow, through analysis of the Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaires. Sixty patients with lateral epicondylitis of the elbow were prospectively randomized and evaluated after receiving infiltration of three milliliters of PRP, or 0.5% neocaine, or dexamethasone. For the scoring process, the patients were asked to fill out the DASH and PRTEE questionnaires on three occasions: on the day of infiltration and 90 and 180 days afterwards. Around 81.7% of the patients who underwent the treatment presented some improvement of the symptoms. The statistical tests showed that there was evidence that the cure rate was unrelated to the substance applied (p = 0.62). There was also intersection between the confidence intervals of each group, thus demonstrating that the proportions of patients whose symptoms improved were similar in all the groups. At a significance level of 5%, there was no evidence that one treatment was more effective than another, when assessed using the DASH and PRTEE questionnaires.

Perioperative risks associated with the operative treatment of clavicle fractures.

PubMed

d'Heurle, Albert; Le, Toan; Grawe, Brian; Casstevens, E Christopher; Edgington, Jon; Archdeacon, Michael T; Wyrick, John

2013-11-01

Clavicle fractures are a common injury among young adults who were historically treated non-operatively with satisfactory outcomes. However, more recent studies have shown a higher nonunion rate for displaced clavicle fractures treated conservatively. The purpose of this study is to investigate the midterm complications, clinical outcomes and overall patient satisfaction after osteosynthesis of midshaft clavicular fractures. A total of 37 patients treated for a clavicle fracture from January 2007 to December 2008 with at least 12 months' follow-up were identified from a billing code search. At the latest follow-up appointment, the patients completed the Constant Shoulder, the Disabilities of the Arm, Shoulder and Hand scale (DASH) and the Medical Outcomes Study 36-Item Short-Form Health Survey version 2.0 (SF36v2) functional outcome surveys as well as a custom questionnaire to assess hand dominance, employment status, the amount of time taken before returning to work, the presence of numbness around the incision site (a surrogate marker of a supraclavicular nerve palsy), whether the patient desired the plate removed and/or if it was worth another surgery. With regard to the functional outcome surveys, the average DASH score was 11.8 ± 16.4, the Constant score was 93.3 ± 7.2, the SF36v2 physical component summary (PCS) was 50.7 ± 10.1 and the SF36v2 mental component summary (MCS) 50.6 ± 11.2. From the custom questionnaire, 27 patients (73%) found their cosmetic appearance acceptable while the remaining 10 patients (27%) were bothered by the appearance of the plate. The average time to return to work was 82.1 ± 77.4 days. There were no infections, refractures or nonunions of the clavicle. As the relative indications for open reduction and internal fixation of clavicle fractures become more popular, such as cosmetic concerns or faster recovery, we wish to demonstrate that the procedure is not without risks, including implant discomfort requiring a subsequent operation for removal, numbness around the incision site and infection. Despite these risks, patients tend to be satisfied with the procedure and are able to function at levels equal to that of the general population. The purpose of this study is not to recommend for or against operative treatment of clavicle fractures but merely to demonstrate risks associated with the procedure. Copyright © 2013 Elsevier Ltd. All rights reserved.

Arthroscopic Removal and Rotator Cuff Repair Without Acromioplasty for the Treatment of Symptomatic Calcifying Tendinitis of the Supraspinatus Tendon.

PubMed

Ranalletta, Maximiliano; Rossi, Luciano Andrés; Bongiovanni, Santiago Luis; Tanoira, Ignacio; Piuzzi, Nicolas; Maignon, Gastón

2015-04-01

Calcified rotator cuff tendinitis is a common cause of chronic shoulder pain that leads to significant pain and functional limitations. Although most patients respond well to conservative treatment, some eventually require surgical treatment. To evaluate the clinical outcome with arthroscopic removal of calcific deposit and rotator cuff repair without acromioplasty for the treatment of calcific tendinitis of the supraspinatus tendon. Case series; Level of evidence, 4. This study retrospectively evaluated 30 consecutive patients with a mean age of 49.2 years. The mean follow-up was 35 months (range, 24-88 months). Pre- and postoperative functional assessment was performed using the Constant score, University of California Los Angeles (UCLA) score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH). Pain was assessed by visual analog scale (VAS). Radiographs and magnetic resonance imaging (MRI) were performed to evaluate the recurrence of calcifications and the indemnity of the supraspinatus tendon repair. Significant improvement was obtained for pain (mean VAS, 8.7 before surgery to 0.8 after; P < .001). The mean Constant score increased from 23.9 preoperatively to 85.3 postoperatively (P < .001), the mean Quick DASH score decreased from 47.3 preoperatively to 8.97 postoperatively (P < .001), and the UCLA score increased from 15.8 preoperatively to 32.2 postoperatively (P < .001). MRI examination at last follow-up (70% of patients) showed no tendon tears, and 96.2% of patients were satisfied with their results. Arthroscopic removal and rotator cuff repair without acromioplasty can lead to good results in patients with symptomatic calcifying tendonitis of the supraspinatus tendon.

The covalently bound diazo group as an infrared probe for hydrogen bonding environments.

PubMed

You, Min; Liu, Liyuan; Zhang, Wenkai

2017-07-26

Covalently bound diazo groups are frequently found in biomolecular substrates. The C[double bond, length as m-dash]N[double bond, length as m-dash]N asymmetric stretching vibration (ν as ) of the diazo group has a large extinction coefficient and appears in an uncongested spectral region. To evaluate the solvatochromism of the C[double bond, length as m-dash]N[double bond, length as m-dash]N ν as band for studying biomolecules, we recorded the infrared (IR) spectra of a diazo model compound, 2-diazo-3-oxo-butyric acid ethyl ester, in different solvents. The width of the C[double bond, length as m-dash]N[double bond, length as m-dash]N ν as band was linearly dependent on the Kamlet-Taft solvent parameter, which reflects the polarizability and hydrogen bond accepting ability of the solvent. Therefore, the width of the C[double bond, length as m-dash]N[double bond, length as m-dash]N ν as band could be used to probe these properties for a solvent. We found that the position of the C[double bond, length as m-dash]N[double bond, length as m-dash]N ν as band was linearly correlated with the density of hydrogen bond donor groups in the solvent. We studied the relaxation dynamics and spectral diffusion of the C[double bond, length as m-dash]N[double bond, length as m-dash]N ν as band of a natural amino acid, 6-diazo-5-oxo-l-norleucine, in water using nonlinear IR spectroscopy. The relaxation and spectral diffusion time constants of the C[double bond, length as m-dash]N[double bond, length as m-dash]N ν as band were similar to those of the N[double bond, length as m-dash]N[double bond, length as m-dash]N ν as band. We concluded that the position and width of the C[double bond, length as m-dash]N[double bond, length as m-dash]N ν as band of the diazo group could be used to probe the hydrogen bond donating and accepting ability of a solvent, respectively. These results suggest that the diazo group could be used as a site-specific IR probe for the local hydration environments.

Functional measures developed for clinical populations identified impairment among active workers with upper extremity disorders

PubMed Central

Gardner, Bethany T.; Dale, Ann Marie; Buckner-Petty, Skye; Rachford, Robert; Strickland, Jaime; Kaskutas, Vicki; Evanoff, Bradley

2017-01-01

Purpose Few studies have explored measures of function across a range of health outcomes in a general working population. Using four upper extremity (UE) case definitions from the scientific literature, we described the performance of functional measures of work, activities of daily living, and overall health. Methods A sample of 573 workers completed several functional measures: modified recall versions of the QuickDASH, Levine Functional Status Scale (FSS), DASH Work module (DASH-W), and standard SF-8 physical component score. We determined case status based on four UE case definitions: 1) UE symptoms, 2) UE musculoskeletal disorders (MSD), 3) carpal tunnel syndrome (CTS), and 4) work limitations due to UE symptoms. We calculated effect sizes for each case definition to show the magnitude of the differences that were detected between cases and non-cases for each case definition on each functional measure. Sensitivity and specificity analyses showed how well each measure identified functional impairments across the UE case definitions. Results All measures discriminated between cases and non-cases for each case definition with the largest effect sizes for CTS and work limitations, particularly for the modified FSS and DASH-W measures. Specificity was high and sensitivity was low for outcomes of UE symptoms and UE MSD in all measures. Sensitivity was high for CTS and work limitations. Conclusions Functional measures developed specifically for use in clinical, treatment-seeking populations may identify mild levels of impairment in relatively healthy, active working populations, but measures performed better among workers with CTS or those reporting limitations at work. PMID:26091980

Musculoskeletal Complications in Type 1 Diabetes

PubMed Central

Larkin, Mary E.; Barnie, Annette; Braffett, Barbara H.; Cleary, Patricia A.; Diminick, Lisa; Harth, Judy; Gatcomb, Patricia; Golden, Ellen; Lipps, Janie; Lorenzi, Gayle; Mahony, Carol; Nathan, David M.

2014-01-01

OBJECTIVE The development of periarticular thickening of skin on the hands and limited joint mobility (cheiroarthropathy) is associated with diabetes and can lead to significant disability. The objective of this study was to describe the prevalence of cheiroarthropathy in the well-characterized Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort and examine associated risk factors, microvascular complications, and the effect of former DCCT therapy (intensive [INT] vs. conventional [CONV]) on its development. RESEARCH DESIGN AND METHODS This cross-sectional analysis was performed in 1,217 participants (95% of the active cohort) in EDIC years 18/19 after an average of 24 years of follow-up. Cheiroarthropathy—defined as the presence of any one of the following: adhesive capsulitis, carpal tunnel syndrome, flexor tenosynovitis, Dupuytren's contracture, or a positive prayer sign—was assessed using a targeted medical history and standardized physical examination. A self-administered questionnaire (Disabilities of the Arm, Shoulder and Hand [DASH]) assessed functional disability. RESULTS Cheiroarthropathy was present in 66% of subjects (64% of the INT group and 68% of the CONV group; P = 0.1640) and was associated with age, sex, diabetes duration, skin intrinsic fluorescence, HbA1c, neuropathy, and retinopathy (P < 0.005 for each). DASH functional disability scores were worse among subjects with cheiroarthropathy (P < 0.0001). CONCLUSIONS Cheiroarthropathy is common in people with type 1 diabetes of long duration (∼30 years) and is related to longer duration and higher levels of glycemia. Clinicians should include cheiroarthropathy in their routine history and physical examination of patients with type 1 diabetes because it causes clinically significant functional disability. PMID:24722493

Modifying soul food for the Dietary Approaches to Stop Hypertension diet (DASH) plan: implications for metabolic syndrome (DASH of Soul).

PubMed

Rankins, Jenice; Wortham, Jaleena; Brown, Linda L

2007-01-01

This article presents results of a community-based participatory study (DASH of Soul) designed to produce soul food that meets the nutrient criteria of the DASH diet plan. DASH of Soul was tested during a 10-month period with two sub-groups of low-income African American women: (1) a focus group cooking club recruited from among "early adopters" of a previous intervention; and (2) a broader peer group dinner club recruited through a health center serving the neighborhood of the focus group. Methods for the cooking club included 10 filmed cooking labs to: (a) modify traditional soul food (MSF) to reduce food energy, total fat, saturated fat, sugar, and sodium; (b) evaluate and improve upon sensory acceptability; (c) integrate acceptable MSF into the DASH diet plan (MS-DASH); (d) produce VHS- and DVD-formatted MS-DASH cooking shows. Methods for the dinner club included monthly participation in weekly promotional dinner meetings that featured the cooking show and a different DASH food group each month for 8 months. Based on computer software analysis, the nutrient composition of a sample MS-DASH menu developed by the cooking club was consistent with nutrient levels for the DASH diet plan. The authors concluded from the focus group interviews and intercept surveys that, with continued motivation, the potential is good for the study population to make MS-DASH a lifestyle choice, reducing their risks for diet-related diseases that cluster to comprise metabolic syndrome.

Platelet-Rich Plasma Treatment With Physical Therapy in Chronic Partial Supraspinatus Tears

PubMed Central

Ilhanli, Ilker; Guder, Necip; Gul, Murat

2015-01-01

Background: Despite the insufficient evidence, due to potential contribution to the improvement, platelet-rich plasma (PRP) is emerging as a promising method. Objectives: The aim of this study was to assess the effectiveness of PRP injection in partial supraspinatus tears by comparing with physical therapy (PT). Patients and Methods: Seventy patients with chronic partial supraspinatus tears in magnetic resonance imaging were randomized into two groups; PRP (n = 35) and PT (n = 35). Before the treatment, at the end of the treatment and at the 12th month after the end of the treatment, range of motion (ROM), visual analog scale (VAS) for pain, Disabilities of Arm, Shoulder and Hand questionnaire (DASH), Neer’s, Hawkins’ and drop arm tests and Beck Depression Inventory were investigated. Results: Statistical analysis was made for 62 subjects (PRP group, n = 30; PT group, n = 32). There were no differences between the groups according to demographic data. At the 12th month after the end of the treatment, significant improvement in ROM was detected in both groups, pain was reduced significantly in both groups and improvement of the DASH score was observed in both groups. At all the evaluation steps, increases in ROM degrees were significantly higher in the PT group than the PRP group. For VAS in activity and in rest, after the treatment, improvement was higher in the PT group than the PRP group. However, improvement of the DASH score of the PRP group was significantly better than the PT group. Conclusions: When we compared with PT, PRP seemed to be a well-tolerated application which showed promising results in patients with chronic partial supraspinatus tears. PMID:26473076

[Midcarpal arthrodesis with cortical bolting chip for treatment of grade II/III scaphoid non-union and scapholunate advanced collapse].

PubMed

Zeplin, P H; Kuhfuss, I

2009-06-01

These case reports describe a mediocarpal arthrodesis with excision of the scaphoid using a cortical bolting chip and screw fixation instead of the use of Kirschner wires or Spider plates. Four patients with a symptomatic SLAC/SLAC-wrist >or= grade II were treated. The evaluation occurred six months later. For the evaluation the Cooney and Bussey as well as DASH scores were used (pain, strength, range of motion, functional status, possible limitations of quality of life, subjective perception of the patient). The radiological evaluation was performed by conventional wrist X-ray in two projections. All patients were pain-free after the operation. From the radiological point of view a complete osseous consolidation has set in. The mean strength six months after surgical intervention was 53 % (preoperative 52 %) and the total range of motion 47 % (preoperative 59 %) compared to the opposite side. The Cooney and Bussey scores were at 69 (+ 25 %) and the DASH score at 44 (- 28 %) points. In case of an SNAC/SLAC-wrist a motion-preserving operation should always be given preference to a wrist stiffening procedure. The modified mid-carpal partial arthrodesis is an alternative operating procedure for the treatment of SNAC/SLAC-wrists in stage II/III. However, a higher number of cases and comparative studies are needed to confirm this concept.

Osteosynthesis using plates and screws after removing a limited area of the periosteum in order to reduce misclassified during radiological assessment metacarpal shaft fractures

PubMed Central

Neagu, TP; Popescu, SA; Cobilinschi, C; Tincu, R; Tiglis, M; Lascar, I

2016-01-01

Hand fractures are one of the most common causes for presenting to the emergency room. Metacarpal fractures count about 18 to 44% of all hand fractures, and are most often standalone closed injuries, without misplacement, not needing operative treatment. We present a case in which osteosynthesis with plates and screws was used to reduce two metacarpal fractures in order to allow an early motion recovery, despite the fact that a small portion of the periosteum needed to be removed. The type of fractures were misclassified according to the radiological findings, therefore the correct diagnosis was established during surgery. The results according to the radiological aspects and to the DASH score were excellent with 95% function recovery at twelve months. In this case, the use of osteosynthesis with plates and screws led to a good fracture healing without any major complications. However, there are a series of complications related to this method that should be taken into consideration. Being misled by the radiological aspects of the fractures, the most certain way to classify a metacarpal shaft fracture is through exploratory surgery, even if in most of the cases the three radiological views are enough to establish the diagnosis. Abbreviations: DASH score = Disability of Arm, Shoulder and Hand score, TAM = Total Active Motion, MCP = metacarpal phalangeal joint, PIP = proximal inter phalangeal joint PMID:27974942

Poor Physical Performance is Associated with Obesity Among University Students in China.

PubMed

Du, Tianhua; Zhu, Ergang; Jiao, Suhua

2017-05-05

BACKGROUND The aim of this study was to explore the relationship between physical performance and BMI (body mass index) of university students in China. MATERIAL AND METHODS We conducted a cross-sectional study evaluating the physical performance and BMI of university students. BMI was calculated based on height and weight. Overweight and obesity were defined by the Working Group on Obesity references in China. RESULTS A total of 2313 participants (978 males and 1335 females) were recruited in our study. The mean value of the 50-meter dash and standing long jump in male students was higher than in female students (P<0.05). The overall prevalences of overweight (including obesity) and obesity for male students were 17.9% and 4.2%, respectively, and 5.1% and 0.5%, respectively, for female university students. BMI was weakly positively associated with the 50-meter dash score, but was negatively associated with the score for standing long jump and pull-ups. CONCLUSIONS Our study suggested that overweight and obesity are associated with physical performance of university students, especially in male students. University students should exercise more to improve physical health.

PubMed

Walder, P; Paša, L; Pavliska, L

2017-01-01

PURPOSE OF THE STUDY The aim of the study was to evaluate the safety and efficacy of the application of platelet- and leukocyte-rich plasma (L-PRP) in the treatment of lateral humeral epicondyle (ERH) as compared to the administration of corticosteroid therapy. MATERIAL AND METHODS It was a prospective, double-blind and randomized clinical trial. It included a total of 25 cases of ERH in 23 patients aged 18 to 60 years. They were divided into two arms: L-PRP arm with 10 cases and corticosteroid arm with 15 cases. The therapy of L-PRP group: first application: 3 ml of native L-PRP without activation, second application: after 6 weeks, 3 ml of thawed L-PRP. Therapy of the corticosteroid arm patients: first and second application (both after 6 weeks) of 3.5 mg of Betamethasonum. The follow-up period was 12 months. The safety evaluation was carried out based on the number of adverse events. The efficacy was evaluated using the DASH score and the Visual Analogue Scale (VAS). The time series outcomes were analysed statistically by percentile graphs and repeated measures ANOVA. RESULTS The ascertained values of blood elements in the received L-PRP as against the original blood were the following: platelets around 400%, white blood cells around 200%, red blood cells around 30%. The differences in individual subpopulations of white blood cells: neutrophils 74%, lymphocytes 424%, monocytes 385%, eosinophils 43%, basophils 337%. The product was classified as L-PRP group based on the POSEIDO classification. Safety evaluation: both the groups reported no adverse and also no serious adverse events. One patient withdrew from the corticosteroid group on the grounds of a subjective feeling of treatment failure. Efficacy evaluation: for both the general DASH score and Work Module a statistically better effect of L-PRP was proven in the first 6 months at p < 0.05. For the general DASH score, the L-PRP group reported a decrease of difficulties from approximately 50% to 20% on DASH score and in the corticosteroid group the difficulties returned to more or less the initial value. In the Work Module, the L-PRP group showed a decline in difficulties from approximately 46% to 18% and the corticosteroid group from approximately 43% only to 38%. The Sports and Music Module was evaluated by percentile graphs only. The VAS assessment proved that an effect was achieved only after the administration of the first dose of L-PRP and corticosteroid, with a more significant effect reported in L-PRP. The overall statistical evaluation using the VAS showed no difference between these two therapies at the level of significance of p<0.05 (p = 0.08). DISCUSSION The product used by us was classified as a L-PRP subcategory. The application of the native and subsequently frozen L-PRP is rare as compared to the corticosteroid therapy. CONCLUSIONS According to our results, the application of L-PRP is suitable to treat lateral humeral epicondyle. The benefits can be foreseen in the form of a better functional score, whereas the analgesic effect equals the effect of corticosteroid. A slightly additive effect was seen in the thawed second dose. Key words: platelet- and leucocyte-rich plasma, epicondylitis radialis humeri.

Adherence to predefined dietary patterns and incident type 2 diabetes in European populations: EPIC-InterAct Study.

PubMed

2014-02-01

Few studies have investigated the relationship between predefined dietary patterns and type 2 diabetes incidence; little is known about the generalisability of these associations. We aimed to assess the association between predefined dietary patterns and type 2 diabetes risk in European populations. From among a case-cohort of 12,403 incident diabetes cases and 16,154 subcohort members nested within the prospective European Prospective Investigation into Cancer and Nutrition study, we used data on 9,682 cases and 12,595 subcohort participants from seven countries. Habitual dietary intake was assessed at baseline with country-specific dietary questionnaires. Two diet-quality scores (alternative Healthy Eating Index [aHEI], Dietary Approaches to Stop Hypertension [DASH] score) and three reduced rank regression (RRR)-derived dietary-pattern scores were constructed. Country-specific HRs were calculated and combined using a random-effects meta-analysis. After multivariable adjustment, including body size, the aHEI and DASH scores were not significantly associated with diabetes, although for the aHEI there was a tendency towards an inverse association in countries with higher mean age. We observed inverse associations of the three RRR-derived dietary-pattern scores with diabetes: HRs (95% CIs) for a 1-SD difference were 0.91 (0.86, 0.96), 0.92 (0.84, 1.01) and 0.87 (0.82, 0.92). Random-effects meta-analyses revealed heterogeneity between countries that was explainable by differences in the age of participants or the distribution of dietary intake. Adherence to specific RRR-derived dietary patterns, commonly characterised by high intake of fruits or vegetables and low intake of processed meat, sugar-sweetened beverages and refined grains, may lower type 2 diabetes risk.

Functional Outcomes 18 Months After Total and Midarm Transplantation: A Case Report.

PubMed

Iglesias, M; Ramírez-Berumen, M; Butrón, P; Alberú-Gómez, J; Salazar-Hernández, F; Macias-Gallardo, J; Leal-Villalpando, R P; Zamudio-Bautista, J; Acosta, V; Jauregui, L; Hernández-Campos, A; Espinosa-Cruz, V; Vázquez-Lamadrid, J; González-Sánchez, J; Cuellar-Rodriguez, J; Sierra-Madero, J G; Gaytan-Cervantes, R; Contreras-Barbosa, S; Navarro-Lara, A; Guzman-Gonzalez, J; Domínguez-Cherit, J; Vilatoba, M; Toussaint-Caire, S; Vega-Boada, F; Gómez-Pérez, F J; Mayorquin-Ruiz, M

2018-04-01

The function reported after arm transplantation is deemed beneficial relative to the marked disability that upper arm amputation causes. We report a 51-year-old man with a Disabilities of the Arm, Shoulder and Hand (DASH) score of 75.83 who underwent bilateral arm transplantation in October 2015. The right arm was transplanted at the glenohumeral joint level, including transplantation of the humeral head, joint capsule, and rotator cuff ligaments and tendons. Additionally, neurorrhaphies were performed at the origin of the terminal branches of the brachial plexus, including the axillary and musculocutaneous nerves. Therefore, this was considered a total arm transplantation. The left arm was transplanted at the transhumeral level, with complete transplantation of the biceps and triceps brachii, and terminolateral neurorrhaphy of the donor musculocutaneous nerve to the receptor radial nerve. A maintenance triple immunosuppression scheme was administered, with tacrolimus levels kept at 10 ng/mL. At 18 months post-transplantation, the intrinsic musculature in the left hand showed electrical registry, DASH score was 67.5, Carroll test score was 28 in both extremities, Hand Transplant Score System was 67.5 in the right extremity and 77.5 in the left extremity, and Short Form-36 score was 96.1. The patient was healthy, with restored body integrity. He could lift medium-sized weightless objects, eat and go to the bathroom by himself, drink liquids with bimanual grasp, swim, dress almost independently, and drive. The functional evolution of the patient was similar to previously reported transplanted arms, even though the right arm transplant involved the glenohumeral joint and axillary and musculocutaneous nerve repair. Copyright © 2017 Elsevier Inc. All rights reserved.

Diagnosis and management of hook of hamate fractures.

PubMed

Kadar, Assaf; Bishop, Allen T; Suchyta, Marissa A; Moran, Steven L

2018-06-01

The purpose of this study was to evaluate the time to diagnosis and management of hook of hamate fractures in an era of advanced imaging. We performed a retrospective study of 51 patients treated for hook of hamate fractures. Patients were sent a quickDASH questionnaire regarding the outcomes of their treatment. Hook of hamate fractures were diagnosed with advanced imaging at a median of 27 days. Clinical findings of hook of hamate tenderness had better sensitivity than carpal tunnel-view radiographs. Nonunion occurred in 24% of patients with non-operative treatment and did not occur in the operative group. Both treatment groups achieved good clinical results, with a grip strength of 80% compared with the non-injured hand and a median quickDASH score of 2. Advanced imaging improved the time to diagnosis and treatment compared to historical case series. Nonunion is common in patients treated non-operatively. IV.

Functionality after arthroscopic debridement of central triangular fibrocartilage tears with central perforations.

PubMed

Möldner, Meike; Unglaub, Frank; Hahn, Peter; Müller, Lars P; Bruckner, Thomas; Spies, Christian K

2015-02-01

To investigate functional and subjective outcome parameters after arthroscopic debridement of central articular disc lesions (Palmer type 2C) and to correlate these findings with ulna length. Fifty patients (15 men; 35 women; mean age, 47 y) with Palmer type 2C lesions underwent arthroscopic debridement. Nine of these patients (3 men; 6 women; mean static ulnar variance, 2.4 mm; SD, 0.5 mm) later underwent ulnar shortening osteotomy because of persistent pain and had a mean follow-up of 36 months. Mean follow-up was 38 months for patients with debridement only (mean static ulnar variance, 0.5 mm; SD, 1.2 mm). Examination parameters included range of motion, grip and pinch strengths, pain (visual analog scale), and functional outcome scores (Modified Mayo Wrist score [MMWS] and Disabilities of the Arm, Shoulder, and Hand [DASH] questionnaire). Patients who had debridement only reached a DASH questionnaire score of 18 and an MMWS of 89 with significant pain reduction from 7.6 to 2.0 on the visual analog scale. Patients with additional ulnar shortening reached a DASH questionnaire score of 18 and an MMWS of 88, with significant pain reduction from 7.4 to 2.5. Neither surgical treatment compromised grip and pinch strength in comparison with the contralateral side. We identified 1.8 mm or more of positive ulnar variance as an indication for early ulnar shortening in the case of persistent ulnar-sided wrist pain after arthroscopic debridement. Arthroscopic debridement was a sufficient and reliable treatment option for the majority of patients with Palmer type 2C lesions. Because reliable predictors of the necessity for ulnar shortening are lacking, we recommend arthroscopic debridement as a first-line treatment for all triangular fibrocartilage 2C lesions, and, in the presence of persistent ulnar-sided wrist pain, ulnar shortening osteotomy after an interval of 6 months. Ulnar shortening proved to be sufficient and safe for these patients. Patients with persistent ulnar-sided wrist pain after debridement who had preoperative static positive ulnar variance of 1.8 mm or more may be treated by ulnar shortening earlier in order to spare them prolonged symptoms. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Significance of a Pronator Quadratus–Sparing Approach for Volar Locking Plate Fixation of Comminuted Intra-articular Fractures of the Distal Radius

PubMed Central

Itoh, Soichiro; Yumoto, Myu; Kanai, Misa; Yoshida, Wataru; Yoshioka, Taro

2016-01-01

Background: The preservation of the integrity of the pronator quadratus (PQ) muscle is expected to have many benefits, particularly in cases of highly comminuted intra-articular fractures of the distal radius. Therefore, we examined the significance of a PQ muscle–sparing approach for volar locking plate (VLP) fixation of these types of fractures. Methods: Sixty-five patients who sustained AO Foundation and Orthopaedic Trauma Association (AO/OTA) type C2 and C3 distal radius fractures were treated with VLP fixation using either a PQ muscle release and repair (PQ-releasing group, n = 30) or a PQ muscle–sparing approach (PQ-sparing group, n = 35). Radiographic parameters, active range of motion (ROM), percentage of the grip power of the injured hand compared with that of the opposite hand, wrist pain visual analog scale (VAS) score, and Quick Disability of the Arm, Shoulder, and Hand (DASH) score (disability/symptom) were evaluated monthly up to 12 months after surgery. Results: The mean VAS score was significantly lower in the PQ-sparing group at 2, 3, and 4 months postoperatively than in the PQ-releasing group. Furthermore, the mean Quick DASH score in the PQ-sparing group was significantly lower than that in the PQ-releasing group at 1 and 2 months postoperatively. There were no significant differences, however, in the other functional parameters in the groups through the observation period. Conclusions: The PQ muscle–sparing approach appears to achieve satisfactory results in patients undergoing VLP fixation of comminuted intra-articular fractures of the distal radius. PMID:27418895

Comparative outcome of bomb explosion injuries versus high-powered gunshot injuries of the upper extremity in a civilian setting.

PubMed

Luria, Shai; Rivkin, Gurion; Avitzour, Malka; Liebergall, Meir; Mintz, Yoav; Mosheiff, Ram

2013-03-01

Explosion injuries to the upper extremity have specific clinical characteristics that differ from injuries due to other mechanisms. To evaluate the upper extremity injury pattern of attacks on civilian targets, comparing bomb explosion injuries to gunshot injuries and their functional recovery using standard outcome measures. Of 157 patients admitted to the hospital between 2000 and 2004, 72 (46%) sustained explosion injuries and 85 (54%) gunshot injuries. The trauma registry files were reviewed and the patients completed the DASH Questionnaire (Disabilities of Arm, Shoulder and Hand) and SF-12 (Short Form-12) after a minimum period of 1 year. Of the 157 patients, 72 (46%) had blast injuries and 85 (54%) had shooting injuries. The blast casualties had higher Injury Severity Scores (47% vs. 22% with a score of > 16, P = 0.02) and higher percent of patients treated in intensive care units (47% vs. 28%, P = 0.02). Although the Abbreviated Injury Scale score of the upper extremity injury was similar in the two groups, the blast casualties were found to have more bilateral and complex soft tissue injuries and were treated surgically more often. No difference was found in the SF-12 or DASH scores between the groups at follow up. The casualties with upper extremity blast injuries were more severely injured and sustained more bilateral and complex soft tissue injuries to the upper extremity. However, the rating of the local injury to the isolated limb is similar, as was the subjective functional recovery.

Intramedullary nailing of clavicular midshaft fractures in adults using titanium elastic nail.

PubMed

Chen, Qing-Yu; Kou, Dong-Quan; Cheng, Xiao-Jie; Zhang, Wei; Wang, Wei; Lin, Zhang-Qin; Cheng, Shao-Wen; Shen, Yue; Ying, Xiao-Zhou; Peng, Lei; Lv, Chuan-Zhu

2011-01-01

Studies showed elastic stable intramedullary nailing (ESIN) of displaced midclavicular fractures has excellent outcomes, as well as high complication rates and specific problems. The aim was to discuss ESIN of midshaft clavicular fractures. Totally 60 eligible patients (aged 18-63 years) were randomized to either ESIN group or non-operative group between January 2007 and May 2008. Clavicular shortening was measured after trauma and osseous consolidation. Radiographic union and complications were assessed. Function analysis including Constant shoulder scores and disabilities of the arm, shoulder and hand (DASH) scores were performed after a 15-month follow-up. ESIN led to a signifcantly shorter time to union, especially for simple fractures. In ESIN group, all patients got fracture union, of which 5 cases had medial skin irritation and 1 patient needed revision surgery because of implant failure. In the nonoperative group, there were 3 nonunion cases and 2 symptomatic malunions developed requiring corrective osteotomy. At 15 months after intramedullary stabilization, patients in the ESIN group were more satisfied with the appearance of the shoulder and overall outcome, and they benefited a lot from the great improvement of post-traumatic clavicular shortening. Furthermore, DASH scores were lower and Constant scores were significantly higher in contrast to the non-operative group. ESIN is a safe minimally invasive surgical technique with lower complication rate, faster return to daily activities, excellent cosmetic and better functional results, restoration of clavicular length for treating mid-shaft clavicular fractures, resulting in high overall satisfaction, which can be regard as an alternative to plate fixation or nonoperative treatment of mid-shaft clavicular fractures.

Proximal fractures of the humerus in patients older than 75 years of age: should we consider operative treatment?

PubMed

de Kruijf, Marjolein; Vroemen, J P A M; de Leur, K; van der Voort, E A M; Vos, D I; Van der Laan, L

2014-06-01

Over 75 % of patients presenting with a proximal humerus fracture are 70 years or older. Very little is known about the outcome after operative treatment of these fractures in very old patients. This study was performed to gain more insight in safety and functional outcome of surgical treatment of proximal humerus fractures in the elderly. In this observational study, we analyzed all operatively treated patients, aged 75 or older, with a proximal humerus fracture between January 2003 and December 2008 in our center. Patient selection was on clinical grounds, based on physical, mental, and social criteria. Complications were evaluated. We used the DASH Questionnaire to investigate functional outcome, pain, and ADL limitations. Sixty-four patients were treated surgically for a displaced proximal fracture of the humerus: 15 two-part, 32 three-part, and 17 four-part fractures. Mean DASH scores were 37.5, 36.9, and 48.6, respectively. Regarding the operative methods, overall good results were obtained with the modern locked plate osteosynthesis (mean DASH 34.4). Prosthetic treatment, mostly used in highly comminuted fractures, often resulted in poor function (mean DASH 72.9). Persistent pain and ADL limitations were more present in more comminuted fractures (64 and 50 % in patients with 4-part fractures vs. 14 % in 2-part fractures). There were no postoperative deaths within 3 months of surgery, and fracture-related and non-fracture-related complication rates were low (non-union 3 %; 1 myocardial infarction). This study shows that it is safe and justifiable to consider surgical treatment of a severely dislocated proximal humerus fracture in selected patients aged 75 and older. According to OCEBM Working Group,Level IV.

[Results of flexor tendon sutures of the fingers with 2-strand (40 tendons) and 4-strand (64 tendons) core sutures].

PubMed

Winkel, R; Kalbhenn, O; Hoffmann, R

2012-06-01

This retrospective examination compares the results of finger flexor tendon sutures with 2 strands and 4 strands. It was checked, whether and how 2 more strands influenced the rupture rate, the movement of the finger and the contentment of the patients. From 1996 to 2000 for the core suture of the flexor tendon of fingers we used 2 strands. 35 patients with 40 tendon sutures of 73 patients were examined. From 2001 to 2005 we used for the core suture 2 loop threads. 53 patients with 64 tendon sutures from a total of 111 patients were examined. At least 12 months had passed between operation and the examination. The rupture rate and the range of movement of each finger joint and the total mobility of the affected fingers were evaluated. Each case was compared to the uninjured opposite hand. The functional result was judged according to the score of Buck-Gramcko. The patient's contentment was recorded by the DASH (disability of arm, shoulder and hand) score. Effects of gender, age, accompanying injuries, zone of the injury and their influence on the results were analysed. The Buck-Gramcko score showed in the 2-strand group a distribution from summarised 70% "excellent" and "good" and 30% "fair" and "poor". In the 4-strand-group the relation was 93.7% "excellent" and "good", 6.3% "fair", one "poor". In the 2-strand group 2/40 (5%) of the tendon sutures ruptured, in the 4-strand group 1/64 (1.6%) ruptured. The average DASH value in the 2-strands-group was 16.6/100, in the 4-strands-group 18.1/100 when 0 is the best possible result and 100 the worst. The patient judgement in the 2-strand group was summarised to 70% for "excellent" and "good" and 30% "fair" and "poor". In the 4-strand group the patient's judgment was summarised in 75% "excellent" and "good" and in 25% "fair". The results of flexor tendon sutures with 4-strand core sutures have been superior to the results with 2-strand core suture according to range of motion of the fingers (P <0.005). © Georg Thieme Verlag KG Stuttgart · New York.

Calcific tendinitis of the rotator cuff: a randomized controlled trial of ultrasound-guided needling and lavage versus subacromial corticosteroids.

PubMed

de Witte, Pieter Bas; Selten, Jasmijn W; Navas, Ana; Nagels, Jochem; Visser, Cornelis P J; Nelissen, Rob G H H; Reijnierse, Monique

2013-07-01

Calcific tendinitis of the rotator cuff (RCCT) is frequently diagnosed in patients with shoulder pain, but there is no consensus on its treatment. To compare 2 regularly applied RCCT treatments: ultrasound (US)-guided needling and lavage (barbotage) combined with a US-guided corticosteroid injection in the subacromial bursa (subacromial bursa injection [SAI]) (group 1) versus an isolated SAI (group 2). Randomized controlled trial; Level of evidence, 1. Patients were randomly assigned to the 2 groups. Shoulder function was assessed before treatment and at regular follow-up intervals (6 weeks and 3, 6, and 12 months) using the Constant shoulder score (CS, primary outcome), the Western Ontario Rotator Cuff Index (WORC), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Additionally, calcification location, size, and Gärtner classification were assessed on radiographs. Results were analyzed using the t test, linear regression, and a mixed model for repeated measures. This study included 48 patients (25 female, 52.1%; mean age, 52.0 ± 7.3 years; 23 patients in group 1) with a mean baseline CS of 68.7 ± 11.9. No patients were lost to follow-up. Four patients in group 1 and 11 in group 2 (P = .06) had an additional barbotage procedure or surgery during the follow-up period because of persisting symptoms and no resorption. At 1-year follow-up, the mean CS in group 1 was 86.0 (95% CI, 80.3-91.6) versus 73.9 (95% CI, 67.7-80.1) in group 2 (P = .005). The mean calcification size decreased by 11.6 ± 6.4 mm in group 1 and 5.1 ± 5.7 mm in group 2 (P = .001). There was total resorption in 13 patients in group 1 and 6 patients in group 2 (P = .07). With regression analyses, correcting for baseline CS and Gärtner type, the mean treatment effect was 20.5 points (P = .05) in favor of barbotage. Follow-up scores were significantly influenced by baseline scores. Results for the DASH and WORC were similar. On average, there was improvement at 1-year follow-up in both treatment groups, but clinical and radiographic results were significantly better in the barbotage group.

A user's survey of the clinical application and content validity of the DASH (Disabilities of the Arm, Shoulder and Hand) outcome measure.

PubMed

Kennedy, Carol A; Beaton, Dorcas E

Survey. To elicit feedback on the clinical use and content validity of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure from frontline users of the instrument. A cross-sectional survey was administered to registered DASH users and inquired about how the DASH was being used and to identify the informational value of items of the DASH (content validity). About 172 completed the survey. One or both of the DASH and/or QuickDASH were consistently (89.5%) being used. About 90% were using it in adults (21-65 years), and at least 70% were using it across the entire extremity, and to a lesser extent, 10% reported using it in isolated neck injuries. Most respondents (66.9%-75.8%) were using the DASH in musculoskeletal (MSK) disorders, with some applying it for other more unique or non-MSK conditions (2.5%-16.6%). All but 1 of the 30 DASH items had at least 10% endorsement as being informative, and 4 items were identified as being problematic by greater than 20%. The DASH is being used as intended (whole extremity and MSK conditions), and in addition, it is being used in different body regions and diverse conditions. Not applicable (descriptive survey). Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Prevalence of Symptoms of Depression, Anxiety, and Posttraumatic Stress Disorder in Workers With Upper Extremity Complaints.

PubMed

Degen, Ryan M; MacDermid, Joy C; Grewal, Ruby; Drosdowech, Darren S; Faber, Kenneth J; Athwal, George S

2016-07-01

Study Design Cross-sectional cohort study. Background Symptoms of depression, panic disorder (PD), and posttraumatic stress disorder (PTSD) have been associated with musculoskeletal complaints and could represent barriers to recovery in injured workers. Objectives To determine the prevalence of symptoms of depression, PD, and PTSD utilizing the Patient Health Questionnaire (PHQ) in a cohort of patients presenting to an upper extremity injured-worker clinic; secondarily, to identify any relationships between patients screening positive and patient-reported outcome measures. Methods In 2010, 418 patients completed the PHQ during their initial evaluation. Patients with PHQ scores exceeding threshold values for symptoms of depression, PD, or PTSD were compared based on patient-reported outcome scores, including the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH) and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The prevalence of symptoms, and their relationship with presenting complaints and patient-reported outcomes, were calculated. Results Thirty-one percent of patients scored above thresholds for symptoms of at least 1 mental health disorder. Of those who screened positive, 67% screened positive for depression, 44% for PTSD, and 50% for PD, with 43% of patients positive for multiple symptoms. Patients experiencing neck pain had significantly higher screening rates of depressive symptoms (62.5% versus 20.1%, P = .004) and PD (37.5% versus 12.9%, P = .044) compared with other presenting complaints. Similarly, patients with chronic pain had higher rates of depression (54.5% versus 20.1%, P = .006), PD (63.6% versus 12%, P<.001), and PTSD (36.4% versus 14.8%, P = .05) compared with other presenting complaints. Patients endorsing depressive symptoms had significantly lower SF-36 mental component summary scores (26.3 ± 10.7 versus 37.6 ± 9.9, P<.001) and higher shortened-version DASH (72.3 ± 16.7 versus 61.5 ± 11.1, P = .003) and DASH work scores (86.5 ± 19.2 versus 82.1 ± 20.1, P = .007) compared to patients endorsing other items on the PHQ. Conclusion In this prospective cohort study of injured workers, we identified a relatively high prevalence of symptoms of psychological disorders utilizing the PHQ, with one third of injured workers screening positive for symptoms of depression, PD, or PTSD. Further longitudinal follow-up is necessary to determine the impact on treatment outcomes. Level of Evidence Symptom prevalence, level 1b. J Orthop Sports Phys Ther 2016;46(7):590-595. Epub 12 May 2016. doi:10.2519/jospt.2016.6265.

Medical subdomain classification of clinical notes using a machine learning-based natural language processing approach.

PubMed

Weng, Wei-Hung; Wagholikar, Kavishwar B; McCray, Alexa T; Szolovits, Peter; Chueh, Henry C

2017-12-01

The medical subdomain of a clinical note, such as cardiology or neurology, is useful content-derived metadata for developing machine learning downstream applications. To classify the medical subdomain of a note accurately, we have constructed a machine learning-based natural language processing (NLP) pipeline and developed medical subdomain classifiers based on the content of the note. We constructed the pipeline using the clinical NLP system, clinical Text Analysis and Knowledge Extraction System (cTAKES), the Unified Medical Language System (UMLS) Metathesaurus, Semantic Network, and learning algorithms to extract features from two datasets - clinical notes from Integrating Data for Analysis, Anonymization, and Sharing (iDASH) data repository (n = 431) and Massachusetts General Hospital (MGH) (n = 91,237), and built medical subdomain classifiers with different combinations of data representation methods and supervised learning algorithms. We evaluated the performance of classifiers and their portability across the two datasets. The convolutional recurrent neural network with neural word embeddings trained-medical subdomain classifier yielded the best performance measurement on iDASH and MGH datasets with area under receiver operating characteristic curve (AUC) of 0.975 and 0.991, and F1 scores of 0.845 and 0.870, respectively. Considering better clinical interpretability, linear support vector machine-trained medical subdomain classifier using hybrid bag-of-words and clinically relevant UMLS concepts as the feature representation, with term frequency-inverse document frequency (tf-idf)-weighting, outperformed other shallow learning classifiers on iDASH and MGH datasets with AUC of 0.957 and 0.964, and F1 scores of 0.932 and 0.934 respectively. We trained classifiers on one dataset, applied to the other dataset and yielded the threshold of F1 score of 0.7 in classifiers for half of the medical subdomains we studied. Our study shows that a supervised learning-based NLP approach is useful to develop medical subdomain classifiers. The deep learning algorithm with distributed word representation yields better performance yet shallow learning algorithms with the word and concept representation achieves comparable performance with better clinical interpretability. Portable classifiers may also be used across datasets from different institutions.

The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study

PubMed Central

Koorevaar, Rinco C. T.; van ‘t Riet, Esther; Gerritsen, Marleen J. J.; Madden, Kim; Bulstra, Sjoerd K.

2016-01-01

Background Psychological symptoms are highly prevalent in patients with shoulder complaints. Psychological symptoms in patients with shoulder complaints might play a role in the aetiology, perceived disability and pain and clinical outcome of treatment. The aim of this study was to assess whether preoperative symptoms of distress, depression, anxiety and somatisation were associated with a change in function after shoulder surgery and postoperative patient perceived improvement of pain and function. In addition, the change of psychological symptoms after shoulder surgery was analyzed and the influence of postoperative symptoms of psychological disorders after surgery on the change in function after shoulder surgery and perceived postoperative improvement of pain and function. Methods and Findings A prospective longitudinal cohort study was performed in a general teaching hospital. 315 consecutive patients planned for elective shoulder surgery were included. Outcome measures included change of Disabilities of the Arm, Shoulder and Hand (DASH) score and anchor questions about improvement in pain and function after surgery. Psychological symptoms were identified before and 12 months after surgery with the validated Four-Dimensional Symptom Questionnaire (4DSQ). Psychological symptoms were encountered in all the various shoulder diagnoses. Preoperative symptoms of psychological disorders persisted after surgery in 56% of patients, 10% of patients with no symptoms of psychological disorders before surgery developed new psychological symptoms. Preoperative symptoms of psychological disorders were not associated with the change of DASH score and perceived improvement of pain and function after shoulder surgery. Patients with symptoms of psychological disorders after surgery were less likely to improve on the DASH score. Postoperative symptoms of distress and depression were associated with worse perceived improvement of pain. Postoperative symptoms of distress, depression and somatisation were associated with worse perceived improvement of function. Conclusions Preoperative symptoms of distress, depression, anxiety and somatisation were not associated with worse clinical outcome 12 months after shoulder surgery. Symptoms of psychological disorders before shoulder surgery persisted in 56% of patients after surgery. Postoperative symptoms of psychological disorders 12 months after shoulder surgery were strongly associated with worse clinical outcome. PMID:27846296

The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study.

PubMed

Koorevaar, Rinco C T; van 't Riet, Esther; Gerritsen, Marleen J J; Madden, Kim; Bulstra, Sjoerd K

2016-01-01

Psychological symptoms are highly prevalent in patients with shoulder complaints. Psychological symptoms in patients with shoulder complaints might play a role in the aetiology, perceived disability and pain and clinical outcome of treatment. The aim of this study was to assess whether preoperative symptoms of distress, depression, anxiety and somatisation were associated with a change in function after shoulder surgery and postoperative patient perceived improvement of pain and function. In addition, the change of psychological symptoms after shoulder surgery was analyzed and the influence of postoperative symptoms of psychological disorders after surgery on the change in function after shoulder surgery and perceived postoperative improvement of pain and function. A prospective longitudinal cohort study was performed in a general teaching hospital. 315 consecutive patients planned for elective shoulder surgery were included. Outcome measures included change of Disabilities of the Arm, Shoulder and Hand (DASH) score and anchor questions about improvement in pain and function after surgery. Psychological symptoms were identified before and 12 months after surgery with the validated Four-Dimensional Symptom Questionnaire (4DSQ). Psychological symptoms were encountered in all the various shoulder diagnoses. Preoperative symptoms of psychological disorders persisted after surgery in 56% of patients, 10% of patients with no symptoms of psychological disorders before surgery developed new psychological symptoms. Preoperative symptoms of psychological disorders were not associated with the change of DASH score and perceived improvement of pain and function after shoulder surgery. Patients with symptoms of psychological disorders after surgery were less likely to improve on the DASH score. Postoperative symptoms of distress and depression were associated with worse perceived improvement of pain. Postoperative symptoms of distress, depression and somatisation were associated with worse perceived improvement of function. Preoperative symptoms of distress, depression, anxiety and somatisation were not associated with worse clinical outcome 12 months after shoulder surgery. Symptoms of psychological disorders before shoulder surgery persisted in 56% of patients after surgery. Postoperative symptoms of psychological disorders 12 months after shoulder surgery were strongly associated with worse clinical outcome.

Data analysis environment (DASH2000) for the Subaru telescope

NASA Astrophysics Data System (ADS)

Mizumoto, Yoshihiko; Yagi, Masafumi; Chikada, Yoshihiro; Ogasawara, Ryusuke; Kosugi, George; Takata, Tadafumi; Yoshida, Michitoshi; Ishihara, Yasuhide; Yanaka, Hiroshi; Yamamoto, Tadahiro; Morita, Yasuhiro; Nakamoto, Hiroyuki

2000-06-01

New framework of data analysis system (DASH) has been developed for the SUBARU Telescope. It is designed using object-oriented methodology and adopted a restaurant model. DASH shares the load of CPU and I/O among distributed heterogeneous computers. The distributed object environment of the system is implemented with JAVA and CORBA. DASH has been evaluated by several prototypings. DASH2000 is the latest version, which will be released as the beta version of data analysis system for the SUBARU Telescope.

Electronic communication in phosphine substituted bridged dirhenium complexes - clarifying ambiguities raised by the redox non-innocence of the C4H2- and C4-bridges.

PubMed

Li, Yan; Blacque, Olivier; Fox, Thomas; Luber, Sandra; Polit, Walther; Winter, Rainer F; Venkatesan, Koushik; Berke, Heinz

2016-04-07

The mononuclear rhenium carbyne complex trans-[Re(C[triple bond, length as m-dash]CSiMe3)([triple bond, length as m-dash]C-Me)(PMe3)4][PF6] (2) was prepared in 90% yield by heating a mixture of the dinitrogen complex trans-[ReCl(N2)(PMe3)4] (1), TlPF6, and an excess of HC[triple bond, length as m-dash]CSiMe3. 2 could be deprotonated with KOtBu to the vinylidene complex trans-[Re(C[triple bond, length as m-dash]CSiMe3)([double bond, length as m-dash]C[double bond, length as m-dash]CH2)(PMe3)4] (3) in 98% yield. Oxidation of 3 with 1.2 equiv. of [Cp2Fe][PF6] at -78 °C gave the Cβ-C'β coupled dinuclear rhenium biscarbyne complex trans-[(Me3SiC[triple bond, length as m-dash]C)(PMe3)4Re[triple bond, length as m-dash]C-CH2-CH2-C[triple bond, length as m-dash]Re(PMe3)4(C[triple bond, length as m-dash]CSiMe3)][PF6]2 (5) in 92% yield. Deprotonation of 5 with an excess of KOtBu in THF produced the diamagnetic trans-[(Me3SiC[triple bond, length as m-dash]C)(PMe3)4Re[double bond, length as m-dash]C[double bond, length as m-dash]CH-CH[double bond, length as m-dash]C[double bond, length as m-dash]Re(PMe3)4(C[triple bond, length as m-dash]CSiMe3)] complex (E-6(S)) in 87% yield with an E-butadienediylidene bridge. Density functional theory (DFT) calculations of E-6(S) confirmed its singlet ground state. The Z-form of 6 (Z-6(S)) could not be observed, which is in accord with its DFT calculated 17.8 kJ mol(-1) higher energy. Oxidation of E-6 with 2 equiv. of [Cp2Fe][PF6] resulted in the stable diamagnetic dicationic trans-[(Me3SiC[triple bond, length as m-dash]C)(PMe3)4Re[triple bond, length as m-dash]C-CH[double bond, length as m-dash]CH-C[triple bond, length as m-dash]Re(PMe3)4(C[triple bond, length as m-dash]CSiMe3)][PF6]2 complex (E-6[PF6]2) with an ethylenylidene dicarbyne structure of the bridge. The paramagnetic mixed-valence (MV) complex E-6[PF6] was obtained by comproportionation of E-6(S) and E-6[PF6]2 or by oxidation of E-6(S) with 1 equiv. of [Cp2Fe][PF6]. The dicationic trans-[(Me3SiC[triple bond, length as m-dash]C)(PMe3)4Re[triple bond, length as m-dash]C-C[triple bond, length as m-dash]C-C[triple bond, length as m-dash]Re(PMe3)4(C[triple bond, length as m-dash]CSiMe3)][PF6]2 (7[PF6]2) complex, attributed a butynedi(triyl) bridge structure, was obtained by deprotonation of E-6[PF6]2 with KOtBu followed by oxidation with 2 equiv. of [Cp2Fe][PF6]. The neutral complex 7 could be accessed best by reduction of 7[PF6]2 with KH in the presence of 18-crown-6. According to DFT calculations 7 possesses two equilibrating electronic states: diamagnetic 7(S) and triplet 7(F) with ferromagnetically coupled spins. The latter is calculated to be 5.2 kcal mol(-1) lower in energy than 7(S). There is experimental evidence that 7(S) prevails in solution. 7 could not be isolated in the crystalline state and is unstable transforming mainly by H-abstraction to give E-6(S). UV-Vis-NIR spectroscopy for the dinuclear rhenium complexes E-6(S), E-6[PF6] and E-6[PF6]2, as well as EPR spectroscopic and variable-temperature magnetization measurements for the MV complex E-6[PF6] were also conducted. Spectro-electrochemical reduction studies on 7[PF6]2 allowed the characterization of the mono- and direduced forms of 7(+) and 7 by means of IR- and UV-Vis-NIR-spectroscopy and revealed the chemical fate of the higher reduced form.

[Intramedullary stabilisation of displaced midshaft clavicular fractures: does the fracture pattern (simple vs. complex) influence the anatomic and functional result].

PubMed

Langenhan, R; Reimers, N; Probst, A

2014-12-01

Displaced midshaft clavicular fractures are often treated operatively. The most common way of treatment is plating. Elastic stable intramedullary nailing (ESIN) is an alternative, but seldom used. Studies showed comparable or even better results for intramedullary nailing than for plating in simple 2- or 3-fragment midshaft fractures. The indication of ESIN for multifragmentary clavicular fractures is discussed critically in the literature because of reduced primary stability and danger of secondary shortening. Until now only few studies report functional results after fracture healing depending on the fracture type. To the best of our knowledge there is no study showing significantly worse functional scores for ESIN in complex displaced midshaft fractures. The objective of this study was to examine anatomic and functional results of simple (2 or 3 fragments, OTA type 15B1 and 15B2) and complex (multifragmentary, OTA type 15B3) displaced midshaft clavicula fractures after internal fixation. Between 2009 and 2012, 40 patients (female/male 10/30; mean age 33 [16-60] years) with closed displaced midshaft clavicular fractures were treated by open reduction and ESIN (Titanium Elastic Nail [TEN], Synthes, Umkirch, Germany). Thirty-seven patients were retrospectively analysed after a mean of 27 (12-43) months. Twenty patients (group A) had simple fractures (OTA type 15B1 and 15B2), 17 patients (group B) had complex fractures (OTA type 15B3). All shoulder joints were postoperatively treated functionally for six weeks without weight limited to 90° abduction/flexion. Both groups were comparable in gender, age, body mass index, months until metal removal, number of physiotherapy sessions and time until follow-up examination. Joint function (neutral zero method) and strength (standing patient with arm in 90° abduction, holding 1-12 kg for 5 sec) in both shoulders were documented. The distance between the centre of the jugulum and the lateral acromial border was measured for both sides. The DASH, Constant-Murley, Oxford shoulder and clavicular scores (Jubel) were calculated. Patients documented contentedness of outcome by VAS between 0 (absolute discontented) and 10 (very contented). Complications were recorded. Operatively treated displaced midshaft clavicular fractures. in comparison to the healthy side in group A had an average shortening of 5 (0-20) mm and in group B of 10 (3-25) mm, with a statistical significance between both groups. Patients of both groups were very contented with the results (VAS group A: 9.6; B: 9.5). DASH score (group A: 28; B: 3.1), Constant-Murley score (group A: 95.0; B: 93.8), Oxford shoulder score (group A: 46.2; B: 45.9) and the clavicula score (Jubel) (group A: 1.2; B: 2.1) were comparable between both groups without significance. In 4 patients (11%) complications occurred. Once (group B) an infection was seen, three times (group B) the ESIN had to be shortened on the medial side because of telescoping. Open ESIN of simple and complex displaced midshaft clavicular fractures leads after an average of 27 months to good or even excellent results. Healing of the clavicle in a modestly shortened position does not impair the patient. Georg Thieme Verlag KG Stuttgart · New York.

The Dash

ERIC Educational Resources Information Center

Buck, Marilyn

2008-01-01

Important events in our lives have a beginning and ending date with a dash in between. What is important is not the dates on either end but what the dash represents. The "dashes" of Amy Morris Homans and Barbara E. Forker are examined. Each touched the lives of their students and the profession that was their lives. Homans understood the…

The Nutritional Characteristics of the Hypotensive WASHOKU-modified DASH Diet: A Sub-analysis of the DASH-JUMP Study.

PubMed

Kawamura, Atsuko; Kajiya, Katsuko; Kishi, Hiroko; Inagaki, Junko; Mitarai, Makoto; Oda, Hiroshi; Umemoto, Seiji; Kobayashi, Sei

2018-01-01

We developed a WASHOKU-modified DASH diet named DASH-JUMP. We previously reported the hypotensive effect of the DASH-JUMP diet in Japanese participants with untreated high-normal Blood Pressure (BP) or stage 1 hypertension. We aim to introduce the DASH-JUMP diet worldwide as a new lifestyle medicine. Accordingly, we prospectively assessed the nutritional characteristics of the DASH-JUMP diet. Participants were treated with the DASH-JUMP diet for 2 months. Then, for 4 months after the intervention, they consumed their usual diets. We conducted a nutritional survey using the FFQg nutrient questionnaire at baseline and after 1, 2, 3, and 6 months. We received completed questionnaires from 55 participants (28 men and 27 women; mean age 54.2 ± 8.0 years) and analyzed them. The DASH-JUMP diet is rich in green-yellow vegetables, seaweed, milk, and mushrooms, while it has low contents of meat, eggs, confectionery, oils and fats, pickles, shellfish boiled in sweetened soy sauce, and fruits. Nutrients significantly associated with the observed change in systolic BP were niacin (P = 0.005) and carbohydrate (P = 0.033). The results of the FFQg questionnaire revealed that participants who had an increased BP at 1 month after ceasing the intervention had eating habits that broadly imitated the DASH-JUMP diet at 4 months after ceasing the intervention. Therefore, the systolic and diastolic BP values at 4 months after ceasing the intervention decreased significantly compared to those at baseline. The DASH-JUMP diet may represent a new lifestyle medicine for reducing hypertension. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Evaluating the safety and efficacy of sodium-restricted/Dietary Approaches to Stop Hypertension diet after acute decompensated heart failure hospitalization: design and rationale for the Geriatric OUt of hospital Randomized MEal Trial in Heart Failure (GOURMET-HF).

PubMed

Wessler, Jeffrey D; Maurer, Mathew S; Hummel, Scott L

2015-03-01

Heart failure (HF) is a major public health problem affecting predominantly older adults. Nonadherence to diet remains a significant contributor to acute decompensated HF (ADHF). The sodium-restricted Dietary Approaches to Stop Hypertension (DASH/SRD) eating plan reduces cardiovascular dysfunction that can lead to ADHF and is consistent with current HF guidelines. We propose that an intervention that promotes adherence to the DASH/SRD by home-delivering meals will be safe and improve health-related quality of life (QOL) in older adults after hospitalization for ADHF. This is a 3-center, randomized, single-blind, controlled trial of 12-week duration designed to determine the safety and efficacy of home-delivered DASH/SRD-compliant meals in older adults after discharge from ADHF hospitalization. Sixty-six subjects will be randomized in a 1:1 stratified fashion by gender and left ventricular ejection fraction (<50% vs ≥50%). Study subjects will receive either preprepared, home-delivered DASH/SRD-compliant meals or usual dietary advice for 4weeks after hospital discharge. Investigators will be blinded to group assignment, food diaries, and urinary electrolyte measurements until study completion. The primary efficacy end point is the change in the Kansas City Cardiomyopathy Questionnaire summary scores for health-related QOL from study enrollment to 4weeks postdischarge. Safety evaluation will focus on hypotension, renal insufficiency, and hyperkalemia. Exploratory end points include echocardiography, noninvasive vascular testing, markers of oxidative stress, and salt taste sensitivity. This randomized controlled trial will test the efficacy, feasibility, and safety of 4weeks of DASH/SRD after ADHF hospitalization. By testing a novel dietary intervention supported by multiple levels of evidence including preliminary data in outpatients with stable HF, we will address a critical evidence gap in the care of older patients with ADHF. If effective and safe, this intervention could be scaled to assess effects on readmission and healthcare costs in older adults after ADHF. Published by Elsevier Inc.

Shallow Water Propagation

DTIC Science & Technology

2010-02-26

bottom waveguide. The lower contour plot demonstrates that this method, unlike other parabolic equations, can treat seismic sources. 20100308162...solitons. One illustration in Figure 8 shows depth-averaged data at the Naval Research Laboratory vertical line array (VLA) [dashed blue curves...vertical line array about 15 km from the source. The right panel [blue curves] compares corresponding simulations from a three-dimensional adiabatic mode

The NCAR Digital Asset Services Hub (DASH): Implementing Unified Data Discovery and Access

NASA Astrophysics Data System (ADS)

Stott, D.; Worley, S. J.; Hou, C. Y.; Nienhouse, E.

2017-12-01

The National Center for Atmospheric Research (NCAR) Directorate created the Data Stewardship Engineering Team (DSET) to plan and implement an integrated single entry point for uniform digital asset discovery and access across the organization in order to improve the efficiency of access, reduce the costs, and establish the foundation for interoperability with other federated systems. This effort supports new policies included in federal funding mandates, NSF data management requirements, and journal citation recommendations. An inventory during the early planning stage identified diverse asset types across the organization that included publications, datasets, metadata, models, images, and software tools and code. The NCAR Digital Asset Services Hub (DASH) is being developed and phased in this year to improve the quality of users' experiences in finding and using these assets. DASH serves to provide engagement, training, search, and support through the following four nodes (see figure). DASH MetadataDASH provides resources for creating and cataloging metadata to the NCAR Dialect, a subset of ISO 19115. NMDEdit, an editor based on a European open source application, has been configured for manual entry of NCAR metadata. CKAN, an open source data portal platform, harvests these XML records (along with records output directly from databases) from a Web Accessible Folder (WAF) on GitHub for validation. DASH SearchThe NCAR Dialect metadata drives cross-organization search and discovery through CKAN, which provides the display interface of search results. DASH search will establish interoperability by facilitating metadata sharing with other federated systems. DASH ConsultingThe DASH Data Curation & Stewardship Coordinator assists with Data Management (DM) Plan preparation and advises on Digital Object Identifiers. The coordinator arranges training sessions on the DASH metadata tools and DM planning, and provides one-on-one assistance as requested. DASH RepositoryA repository is under development for NCAR datasets currently not in existing lab-managed archives. The DASH repository will be under NCAR governance and meet Trustworthy Repositories Audit & Certification (TRAC) requirements. This poster will highlight the processes, lessons learned, and current status of the DASH effort at NCAR.

Prevention of Thumb Web Space Contracture With Multiplanar External Fixation.

PubMed

Harper, Carl M; Iorio, Matthew L

2016-09-01

Thumb web space contracture following hand trauma can be disabling with numerous reconstructive procedures existing to correct the resultant deformity. Following marked soft tissue injury to the hand we utilized the Stryker Hoffmann II Micro External Fixator System to link the first and second metacarpals by a multiplanar system using 1.6 or 2.0 mm self-drilling half-pins and 3 mm carbon fiber connecting rods. This facilitated placement of the thumb in maximal palmar abduction as well as allowed adjustment of thumb position throughout the postoperative period. This technique was performed on 5 patients. Two patients were treated with a first web space external fixator for table saw injuries to the radial aspect of the hand. An additional 2 patients were treated with a first web space external fixator following metacarpophalangeal joint capsular release in the setting of thermal burns. A fifth patient underwent second ray amputation, trapeziectomy and trapezoidectomy for squamous cell carcinoma with subsequent stabilization with the external fixator. The external fixator was left in place until soft tissues were healed (average 5.5 wk). The patients were allowed to mobilize their hand in as much as the external fixator allowed, and no device-associated complications were noted. Thumb web space was preserved with passive and supple thumb circumduction and web space abduction/adduction in all patients at an average follow-up of 5 months. The average Quick Dash Score was 35±5 and the average Modern Activity Subjective Survey of 2007 was 30±8.

Minimally Displaced, Isolated Radial Head and Neck Fractures Do Not Require Formal Physical Therapy: Results of a Prospective Randomized Trial.

PubMed

Egol, Kenneth A; Haglin, Jack M; Lott, Ariana; Fisher, Nina; Konda, Sanjit R

2018-04-18

Nondisplaced and minimally displaced fractures of the radial head and neck are common injuries, yet the role of physical therapy (PT) in their treatment is unclear. The aim of this trial was to assess the need for formal PT following a simple fracture of the radial head or neck. Patients who had a nondisplaced or minimally displaced fracture of the radial head or neck and presented to 1 of 2 providers were enrolled prospectively between January 2014 and August 2016. Patients were randomized to receive outpatient PT or perform self-directed home exercise. The follow-up intervals were 6 weeks, 3 months, 6 months, and at least 1 year. The outcome measures were Disabilities of the Arm, Shoulder and Hand (DASH) scores; pain; time to clinical healing; and range of motion. Demographic data were analyzed using the Mann-Whitney U test and Fisher exact test. Independent-samples t tests were utilized to compare outcome measures. Fifty-one patients were enrolled in the study. The average follow-up was 16.6 months. Twenty-five patients were randomized to a home-exercise cohort, and 26 patients were randomized to a formal-outpatient-PT cohort. There were no significant differences in demographics between cohorts. At 6 weeks, the home-exercise cohort had better function as indicated by a significantly lower mean DASH score compared with the PT cohort (p = 0.021). At 3 months, 6 months, and final follow-up, there were no significant differences between cohorts for any outcome measure. Patients who performed home exercises after sustaining a nondisplaced or minimally displaced fracture of the radial head or neck demonstrated better early function at 6 weeks compared with patients who received formal PT. After 6 weeks, there were no significant differences in outcomes. These data suggest that prescribing PT for patients who have an isolated nondisplaced or minimally displaced fracture of the radial head or neck is not cost-effective and that instructing the patient to perform self-directed exercises will be followed by a similar outcome. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Healthful dietary patterns and long-term weight change among women with a history of gestational diabetes mellitus.

PubMed

Tobias, D K; Zhang, C; Chavarro, J; Olsen, S; Bao, W; Bjerregaard, A A; Fung, T T; Manson, J E; Hu, F B

2016-11-01

Diet represents a key strategy for the prevention of obesity and type 2 diabetes among women with a history of gestational diabetes mellitus (GDM), although effective dietary patterns to prevent weight gain in the long term are largely unknown. We sought to evaluate whether improvement in overall diet quality is associated with less long-term weight gain among high-risk women with prior GDM. Women with a history of GDM (N=3397) were followed from 1991 to 2011, or until diagnosis of type 2 diabetes or other chronic disease. Usual diet was assessed via food frequency questionnaire every 4 years from which we calculated the Alternative Healthy Eating Index (aHEI-2010), Alternate Mediterranean Diet (AMED) and Dietary Approaches to Stop Hypertension (DASH) dietary pattern scores. Weight, lifestyle and health-related outcomes were self-reported every 2 years. We estimated the change in dietary score with change in body weight using linear regression models adjusting for age, baseline body mass index (BMI), baseline and simultaneous change in physical activity and smoking status and other risk factors. Women were followed up to 20 years, gaining an average 1.9 kg (s.d.=7.0) per 4-year period. Women in the highest quintile (Q5) of diet change (most improvement in quality) gained significantly less weight per 4-year period than the lowest quintile (Q1; decrease in quality), independent of other risk factors (4-year weight change, aHEI-2010: Q5=1.30 kg vs Q1=3.27 kg; AMED: Q5=0.94 kg vs Q1=2.56 kg, DASH: Q5=0.64 kg vs Q1=2.75 kg). Significant effect modification by BMI (p-interactions <0.001) indicated a greater magnitude of weight change among women with a higher baseline BMI for all three patterns. Increased diet quality was associated with less weight gain, independent of other lifestyle factors. Post-partum recommendations on diet quality may provide one strategy to prevent long-term weight gain in this high-risk group.

Measurement properties of the QuickDASH (disabilities of the arm, shoulder and hand) outcome measure and cross-cultural adaptations of the QuickDASH: a systematic review.

PubMed

Kennedy, Carol A; Beaton, Dorcas E; Smith, Peter; Van Eerd, Dwayne; Tang, Kenneth; Inrig, Taucha; Hogg-Johnson, Sheilah; Linton, Denise; Couban, Rachel

2013-11-01

To identify and synthesize evidence for the measurement properties of the QuickDASH, a shortened version of the 30-item DASH (Disabilities of the Arm, Shoulder and Hand) instrument. This systematic review used a best evidence synthesis approach to critically appraise the measurement properties [using COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN)] of the QuickDASH and cross-cultural adaptations. A standard search strategy was conducted between 2005 (year of first publication of QuickDASH) and March 2011 in MEDLINE, EMBASE and CINAHL. The search identified 14 studies to include in the best evidence synthesis of the QuickDASH. A further 11 studies were identified on eight cross-cultural adaptation versions. Many measurement properties of the QuickDASH have been evaluated in multiple studies and across most of the measurement properties. The best evidence synthesis of the QuickDASH English version suggests that this tool is performing well with strong positive evidence for reliability and validity (hypothesis testing), and moderate positive evidence for structural validity testing. Strong negative evidence was found for responsiveness due to lower correlations with global estimates of change. Information about the measurement properties of the cross-cultural adaptation versions is still lacking, or the available information is of poor overall methodological quality.

Validity and cross-cultural adaptation of the persian version of the oxford elbow score.

PubMed

Ebrahimzadeh, Mohammad H; Kachooei, Amir Reza; Vahedi, Ehsan; Moradi, Ali; Mashayekhi, Zeinab; Hallaj-Moghaddam, Mohammad; Azami, Mehran; Birjandinejad, Ali

2014-01-01

Oxford Elbow Score (OES) is a patient-reported questionnaire used to assess outcomes after elbow surgery. The aim of this study was to validate and adapt the OES into Persian language. After forward-backward translation of the OES into Persian, a total number of 92 patients after elbow surgeries completed the Persian OES along with the Persian DASH and SF-36. To assess test-retest reliability, 31 randomly selected patients (34%) completed the Persian OES again after three days while abstaining from all forms of therapeutic regimens. Reliability of the Persian OES was assessed by measuring intraclass correlation coefficient (ICC) for test-retest reliability and Cronbach's alpha for internal consistency. Spearman's correlation coefficient was used to test the construct validity. Cronbach's alpha coefficient was 0.92 showing excellent reliability. Cronbach's alpha for function, pain, and social-psychological subscales was 0.95, 0.86, and 0.85, respectively. Intraclass correlation coefficient (ICC) was 0.85 for the overall questionnaire and 0.90, 0.76, and 0.75 for function, pain, and social-psychological subscales, respectively. Construct validity was confirmed as the Spearman correlation between OES and DASH was 0.80. Persian OES is a valid and reliable patient-reported outcome measure to assess postsurgical elbow status in Persian speaking population.

Functional outcomes after shoulder resection: the patient's perspective.

PubMed

Stevens, Nicole M; Kim, H Mike; Armstrong, April D

2015-09-01

Resection arthroplasty is a salvage procedure used for the treatment of deep-seated infections after total shoulder arthroplasty, hemiarthroplasty, and reverse total shoulder arthroplasty. Previous studies have reported a 50% to 66% rate of pain relief after resection arthroplasty but with significant functional limitations. Our study aimed to qualify the perspective of the patients on their limitations and satisfaction with resection arthroplasty. A retrospective record review of resection arthroplasties performed between September 2003 and December 2012 yielded 14 patients, and 7 completed the survey. The patients completed surveys with the focus on the "patient perspective." Functional scores, including American Shoulder and Elbow Surgeons, Simple Shoulder Test, Disabilities of the Arm, Shoulder, and Hand (DASH), DASH work, and DASH sports, were determined. Pain reduction and functional outcomes were similar to past reports of resection arthroplasty. Five of the 7 patients (71%) reported satisfaction with their resection arthroplasty, and 6 of the 7 patients (86%) would undergo the procedure again if given the choice. Five of the 7 patients (71%) were able to most of activities of daily living. Patients in our study were generally satisfied with their resection arthroplasty. Resection arthroplasty is a reasonable option for treatment of deep-seated periprosthetic infections or for patients with multiple previous failed procedures for total shoulder arthroplasty, hemiarthroplasty. and reverse shoulder arthroplasty. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Clinimetric evaluation of shoulder disability questionnaires: a systematic review of the literature

PubMed Central

Bot, S; Terwee, C; van der Windt, D A W M; Bouter, L; Dekker, J; de Vet, H C W

2004-01-01

Methods: Systematic literature searches were performed to identify self administered shoulder disability questionnaires. A checklist was developed to evaluate and compare the clinimetric quality of the instruments. Results: Two reviewers identified and evaluated 16 questionnaires by our checklist. Most studies were found for the Disability of the Arm, Shoulder, and Hand scale (DASH), the Shoulder Pain and Disability Index (SPADI), and the American Shoulder and Elbow Surgeons Standardised Shoulder Assessment Form (ASES). None of the questionnaires demonstrated satisfactory results for all properties. Most questionnaires claim to measure several domains (for example, pain, physical, emotional, and social functioning), yet dimensionality was studied in only three instruments. The internal consistency was calculated for seven questionnaires and only one received an adequate rating. Twelve questionnaires received positive ratings for construct validity, although depending on the population studied, four of these questionnaires received poor ratings too. Seven questionnaires were shown to have adequate test-retest reliability (ICC >0.70), but five questionnaires were tested inadequately. In most clinimetric studies only small sample sizes (n<43) were used. Nearly all publications lacked information on the interpretation of scores. Conclusion: The DASH, SPADI, and ASES have been studied most extensively, and yet even published validation studies of these instruments have limitations in study design, sample sizes, or evidence for dimensionality. Overall, the DASH received the best ratings for its clinimetric properties. PMID:15020324

CONICAL, RADIOGRAPHIC, AND PATIENT-REPORTED RESULTS OF SURFACE REPLACING PROXIMAL INTERPHALANGEAL JOINT ARTHROPLASTY OF THE HAND

PubMed Central

Amirtharajah, Mohana; Fufa, Duretti; Lightdale, Nina; Weiland, Andew

2011-01-01

The purpose of this study was to evaluate the one-year clinical, radiologic and patient-reported results of surface-replacing proximal interphalangeal joint arthroplasty (SR-PIP) of the hand. Fifteen patients with 18 joints underwent the procedure, and nine patients with 11 joints had follow-up of at least one year's duration. Of these joints, six had a diagnosis of osteoarthritis with no history of trauma, three had post-traumatic arthritis, one had psoriatic arthritis, and one had erosive arthritis. The mean clinical follow-up was at 3.3 years, and the mean radiographic follow-up was at 3.1 years. The average post-operative gain in range of motion at the PIP joint was 28 degrees and was statistically significant. Six patients completed self-reported questionnaires at a mean of 4.8 years post-operatively. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score post-operatively was 17, and the Michigan Hand Questionnaire (MHQ) score for overall satisfaction was 70. There were three complications but only one reoperation. Seven of 11 joints showed some evidence of subsidence on follow-up radiographic examination. However, no joints were revised sec-ondary to loosening. Longer follow-up is needed to determine if this observable radiologic subsidence leads to symptomatic loosening of the implant PMID:22096433

Some transition metal complexes derived from mono- and di-ethynyl perfluorobenzenes.

PubMed

Armitt, David J; Bruce, Michael I; Gaudio, Maryka; Zaitseva, Natasha N; Skelton, Brian W; White, Allan H; Le Guennic, Boris; Halet, Jean-François; Fox, Mark A; Roberts, Rachel L; Hartl, Frantisek; Low, Paul J

2008-12-21

Transition metal alkynyl complexes containing perfluoroaryl groups have been prepared directly from trimethylsilyl-protected mono- and di-ethynyl perfluoroarenes by simple desilylation/metallation reaction sequences. Reactions between Me(3)SiC[triple bond, length as m-dash]CC(6)F(5) and RuCl(dppe)Cp' [Cp' = Cp, Cp*] in the presence of KF in MeOH give the monoruthenium complexes Ru(C[triple bond, length as m-dash]CC(6)F(5))(dppe)Cp' [Cp' = Cp (); Cp* ()], which are related to the known compound Ru(C[triple bond, length as m-dash]CC(6)F(5))(PPh(3))(2)Cp (). Treatment of Me(3)SiC[triple bond, length as m-dash]CC(6)F(5) with Pt(2)(mu-dppm)(2)Cl(2) in the presence of NaOMe in MeOH gave the bis(alkynyl) complex Pt(2)(mu-dppm)(2)(C[triple bond, length as m-dash]CC(6)F(5))(2) (). The Pd(0)/Cu(i)-catalysed reactions between Au(C[triple bond, length as m-dash]CC(6)F(5))(PPh(3)) and Mo( identical withCBr)(CO)(2)Tp* [Tp* = hydridotris(3.5-dimethylpyrazoyl)borate], Co(3)(mu(3)-CBr)(mu-dppm)(CO)(7) or IC[triple bond, length as m-dash]CFc [Fc = (eta(5)-C(5)H(4))FeCp] afford Mo( identical withCC[triple bond, length as m-dash]CC(6)F(5))(CO)(2)Tp* (), Co(3)(mu(3)-CC[triple bond, length as m-dash]CC(6)F(5))(mu-dppm)(CO)(7) () and FcC[triple bond, length as m-dash]CC[triple bond, length as m-dash]CC(6)F(5) (), respectively. The diruthenium complexes 1,4-{Cp'(PP)RuC[triple bond, length as m-dash]C}(2)C(6)F(4) [(PP)Cp' = (PPh(3))(2)Cp (); (dppe)Cp (); (dppe)Cp* ()] are prepared from 1,4-(Me(3)SiC[triple bond, length as m-dash]C)(2)C(6)F(4) in a manner similar to that described for the monoruthenium complexes -. The non-fluorinated complexes 1,4-{Cp'(PP)RuC[triple bond, length as m-dash]C}(2)C(6)H(4) [(PP)Cp' = (PPh(3))(2)Cp (); (dppe)Cp (); (dppe)Cp* ()], prepared for comparison, are obtained from 1,4-(Me(3)SiC[triple bond, length as m-dash]C)(2)C(6)H(4). Spectro-electrochemical studies of the ruthenium aryl and arylene alkynyl complexes - and -, together with DFT-based computational studies on suitable model systems, indicate that perfluorination of the aromatic ring has little effect on the electronic structures of these compounds, and that the frontier orbitals have appreciable diethynylphenylene character. Molecular structure determinations are reported for the fluoroaromatic complexes , , , and .

Floating shoulders: Clinical and radiographic analysis at a mean follow-up of 11 years

PubMed Central

Pailhes, ReÌ gis; Bonnevialle, Nicolas; Laffosse, JeanMichel; Tricoire, JeanLouis; Cavaignac, Etienne; Chiron, Philippe

2013-01-01

Context: The floating shoulder (FS) is an uncommon injury, which can be managed conservatively or surgically. The therapeutic option remains controversial. Aims: The goal of our study was to evaluate the long-term results and to identify predictive factors of functional outcomes. Settings and Design: Retrospective monocentric study. Materials and Methods: Forty consecutive FS were included (24 nonoperated and 16 operated) from 1984 to 2009. Clinical results were assessed with Simple Shoulder Test (SST), Oxford Shoulder Score (OSS), Single Assessment Numeric Evaluation (SANE), Short Form-12 (SF12), Disabilities of the Arm Shoulder and Hand score (DASH), and Constant score (CST). Plain radiographs were reviewed to evaluate secondary displacement, fracture healing, and modification of the lateral offset of the gleno-humeral joint (chest X-rays). New radiographs were made to evaluate osteoarthritis during follow-up. Statistical Analysis Used: T-test, Mann-Whitney test, and the Pearson's correlation coefficient were used. The significance level was set at 0.05. Results: At mean follow-up of 135 months (range 12-312), clinical results were satisfactory regarding different mean scores: SST 10.5 points, OSS 14 points, SANE 81%, SF12 (50 points and 60 points), DASH 14.5 points and CST 84 points. There were no significant differences between operative and non-operative groups. However, the loss of lateral offset influenced the results negatively. Osteoarthritis was diagnosed in five patients (12.5%) without correlation to fracture patterns and type of treatment. Conclusions: This study advocates that floating shoulder may be treated conservatively and surgically with satisfactory clinical long-term outcomes. However, the loss of gleno-humeral lateral offset should be evaluated carefully before taking a therapeutic option. PMID:23960364

Treatment of distal-third clavicular fractures (Neer type ii-b) with a triple button device.

PubMed

Cano-Martínez, J A; Nicolás-Serrano, G; Andrés-Grau, J; Bento-Gerard, J

The purpose of this study is to describe the outcomes of using a triple button device for the treatment of displaced distal-third clavicle fractures (Neer, type ii-b). A retrospective review was conducted on a series of patients between November 2011 and December 2014. Fourteen patients initially met the inclusion criteria, but 2 were excluded, leaving 12 patients (83.3% male; mean age 32.2 years) for the final analysis at a mean follow-up of 26±11.24 months (range, 12-48). Post-operative follow-up was performed at 2 weeks (two first months), and monthly thereafter, until was achieving clinically and radiological healing. The functional outcome was evaluated using the Constant score, and DASH score in the last follow-up. The mean Constant Score was 95.5±5.2 points (range, 85-100), with a mean DASH score of 3.3±4.4 points (range, 0-12.5). The mean time to clinical healing was10.3±3.1 weeks (range, 8-16), and the mean time to radiological healing was 13.6±2.6 weeks (range, 12-20). There were no major complications. There were 5 minor complications without clinical impact: 2 coracoclavicular calcifications, 1 hypertrophic scar, 1 patient with discomfort due to the device, and 1 superficial wound infection. All patients returned their previous activity. Good clinical results can be achieved with the triple button device in unstable distal fractures of the clavicle, without the need to remove the hardware. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Short-term evaluation of arthroscopic management of tennis elbow; including resection of radio-capitellar capsular complex.

PubMed

Babaqi, AbdulRahman A; Kotb, Mohammed M; Said, Hatem G; AbdelHamid, Mohamed M; ElKady, Hesham A; ElAssal, Maher A

2014-06-01

There has been controversy regarding the pathogenesis and treatment of lateral epicondylitis. Different surgical techniques for the treatment of lateral epicondylitis prescribed. The purpose of this study was to evaluate the short-term outcomes of arthroscopic management including resection of the radio-capitellar capsular complex, using different validated scores. In this study, arthroscopic resection of a capsular fringe complex was done beside debridement of the undersurface of Extensor Carpi Radialis Brevis (ECRB). Thirty-one patients with recalcitrant lateral epicondylitis for a minimum of 6 months had surgery. In all patients, a collar-like band of radio-capitellar capsular complex was found to impinge on the radial head and subluxate into the radio-capitellar joint with manipulation under direct vision. Outcomes were assessed using Mayo Elbow Performance Index (MEPI), the Patient-Rated Tennis Elbow Evaluation (PRTEE), and the Disability of the Arm, Shoulder, and Hand (DASH), beside visual analog scale (VAS) for pain and satisfaction criteria. After arthroscopic surgery, overall satisfaction was extremely positive, over the 31 patients, 93.5% of the patients are satisfied. The mean score for pain improved from 8.64 to 1.48 points. The total PRTEE improved from 55.53 to 10.39 points. The mean MEPI score was improved from 61.82 to 94.10 points. DASH score also improved from 24.46 to 4.81 points. All improvements are statistically significant (P < 0.05). Arthroscopic release of ECRB in patients with chronic lateral epicondylitis is a reproducible method with a marked improvement in function within a short period, with special consideration for resection of radio-capitellar capsular complex.

Hertel 7 fracture of the humeral head. Can two different fixation systems (Diphos/PHP) lead to different outcomes? A retrospective study.

PubMed

Gumina, S; Baudi, P; Candela, V; Campochiaro, G

2016-10-01

To compare clinical outcomes and complication rates in the medium-to-long-term follow-up of Hertel 7 humeral head fractures treated with two different locking plates. A total of 52 patients with type 7 humeral head fracture (in accordance with Hertel classification) were enrolled retrospectively: 24 patients [4 male, 20 female; mean age (standard deviation [SD]): 68.9 (5.8) years] were treated with Diphos H plate (Group A) and 28 patients [6 male, 22 female; mean age (SD): 61.0 (7.5) years] with Proximal Humeral Plate (PHP; Group B). The mean follow-up periods were 25.6 and 18.9 months, respectively. Functional outcomes were assessed using the Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score; X-ray evaluation was also performed and complications were recorded. The mean Constant score in the Diphos and PHP groups at follow-up were 75.6 (SD 13.4) and 78.9 (SD 12.8), respectively (p>0.05). The DASH score was similar in both groups (Diphos: 18.6, range 0-51.5; PHP: 16.8, range 0-47.8) (p>0.05). In our series, 9.6% of patients had complications; these included a case of aseptic non-union and a case of avascular necrosis of the humeral head in each group, and a secondary screw perforation in a patient treated with Diphos. In patients with Hertel 7 proximal humeral fractures, Diphos and PHP lead to similar satisfactory functional outcomes and are associated with low complication rates; this confirms that both are useful implants for the treatment of this pattern of fracture. Copyright © 2016. Published by Elsevier Ltd.

Beta2-adrenergic receptor genotype affects the renin-angiotensin-aldosterone system response to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern.

PubMed

Sun, Bei; Williams, Jonathan S; Svetkey, Laura P; Kolatkar, Nikheel S; Conlin, Paul R

2010-08-01

Beta(2)-adrenergic receptor (beta2-AR) is a susceptibility locus for hypertension, and polymorphisms at this site relate to salt sensitivity and low plasma renin activity (PRA). The Dietary Approaches to Stop Hypertension (DASH) dietary pattern lowers blood pressure and appears to interact with the renin-angiotensin-aldosterone system (RAAS). We hypothesized that the DASH diet associates with increased RAAS activity, and genotype status at beta2-AR G46A modifies this response. We genotyped participants in the DASH-Sodium study (n = 372) at beta2-AR G46A to determine the association with blood pressure, RAAS components, and consumption of the DASH diet. We used 2-way mixed linear regression and an additive model for all primary analyses. Mean (+/-SEM) PRA was significantly higher in participants in the DASH group than in participants in the control group (0.68 +/- 0.03 compared with 0.54 +/- 0.03 ng x mL(-1) x h(-1), P = 0.002). Serum aldosterone, urinary aldosterone, and urinary potassium concentrations were also significantly higher in the DASH group (P < 0.01 for all). We observed significant gene-diet interactions for changes in systolic blood pressure (SBP) and concentrations of aldosterone and urinary potassium (P for interaction = 0.048, 0.017, and 0.001 for SBP and aldosterone and urinary potassium concentrations, respectively). There was an association between the A allele of beta2-AR G46A and greater blood pressure reduction and blunted aldosterone and PRA responses to the DASH diet. Our results indicate that the DASH diet lowers blood pressure and increases PRA and aldosterone concentrations. There is an association between the G46A polymorphism of beta2-AR and blood pressure and RAAS responses to the DASH diet, which suggests that beta2-AR may be a genetic modifier of DASH-diet responsiveness. This trial was registered at clinicaltrials.gov as NCT00000608.

Dynamic Fixation of Humeral Shaft Fractures Using Active Locking Plates: A Prospective Observational Study.

PubMed

Madey, Steven M; Tsai, Stanley; Fitzpatrick, Daniel C; Earley, Kathleen; Lutsch, Michael; Bottlang, Michael

2017-01-01

Rigid locked plating constructs can suppress fracture healing by inhibiting interfragmentary motion required to stimulate natural bone healing by callus formation. Dynamic fixation with active locking plates reduces construct stiffness, enables controlled interfragmentary motion, and has been shown to induce faster and stronger bone healing in vivo compared to rigid locking plates. This prospective observational study represents the first clinical use of active locking plates. It documents our early clinical experience with active plates for stabilization of humeral shaft fractures to assess their durability and understand potential complications. Eleven consecutive patients with humeral shaft fractures (AO/OTA types 12 A-C) were prospectively enrolled at a level I and a level II trauma center. Fractures were stabilized by using active locking plates without supplemental bone graft or bone morphogenic proteins. The screw holes of active locking plates are elastically suspended in elastomer envelopes inside the plate, enabling up to 1.5 mm of controlled interfragmentary motion. Progression of fracture healing and integrity of implant fixation was assessed radiographically at 3, 6, 12, and 24 weeks post surgery. Patient-reported functional outcome measures were obtained at 6, 12, and 24 weeks post surgery. The primary endpoint of this study was plate durability in absence of plate bending or breakage, or failure of the elastically suspended locking hole mechanism. Secondary endpoints included fracture healing, complications requiring revision surgery, and functional outcome scores. The eleven patients had six simple AO/ OTA type 12A fractures, three wedge type 12B fractures, and two comminuted type 12C fracture, including one open fracture. All active locking plates endured the 6-month loading period without any signs of fatigue or failure. Ten of eleven fractures healed at 10.9 ± 5.2 weeks, as evident by bridging callus and pain-free function. One fracture required revision surgery 37 weeks post surgery due to late fixation failure at the screwbone interface in the presence of a atrophic delayed union. The average Disability of the Arm, Shoulder and Hand (DASH) score improved from 31 ± 22 at week 6 to 13 ± 15 by week 24, approaching that of the normal, healthy population (DASH = 10.1). By week 12, the difference between Constant shoulder scores, expressed as the difference between the affected and contralateral arm (8 ± 8), was considered excellent. By week 24, the SF-12 physical health score (44 ± 9) and mental health score (48 ± 11) approached the mean value of 50 that represents the norm for the general U.S. population. Absence of failure of the plate and locking holes suggests that dynamic fixation of humeral shaft fractures with active plates provides safe and effective fixation. Moreover, early callus bridging and excellent functional outcome scores suggest that dynamic fixation with active locking plates may promote increased fracture healing over standard locked plating.

OHS Provides Easy Heart Health Tips at “DASH and Dine” Event | Poster

Cancer.gov

The lunchtime dash to a nearby eatery is a daily ritual at NCI at Frederick, but Occupational Health Services (OHS) recently showed employees a different, healthy kind of DASH—Dietary Approaches to Stop Hypertension. Employees who visited the educational lunch-hour event, called “DASH and Dine,” had the chance to speak with OHS staff about the benefits of the DASH Eating Plan,

Plate fixation and bone grafting of distal clavicle nonunions: radiologic and functional outcomes.

PubMed

Villa, Jordan C; van der List, Jelle P; Gausden, Elizabeth B; Lorich, Dean G; Helfet, David L; Kloen, Peter; Wellman, David S

2016-11-01

The optimal treatment for distal clavicle nonunions remains unknown. Small series have reported outcomes following distal fragment excision and various fixation techniques. We present the clinical, radiographic and functional outcomes after superior plating or double (superior and anteroinferior) plating in combination with bone grafting as treatment for distal clavicle nonunions. We collected demographic and radiographic data from a consecutive series of ten patients with symptomatic nonunion of the distal clavicle treated since 1998. Functional outcomes were assessed, as well as the visual analogue scale (VAS) score. The mean clinical follow-up was 41.4 months (range of 12-158 months). The mean radiological follow-up was 30.6 months (range of 3-158 months). All nonunions healed as demonstrated by subsidence of clinical symptoms and radiographic criteria. The average time to union was 3.7 months (range of 2-8 months). The mean The Disabilities of the Arm, Shoulder and Hand (DASH) score was 11.9 (range of 0-62.5) and mean VAS score was 0.9 at follow-up. This study illustrates good clinical, radiologic and functional outcomes in ten patients with distal clavicle nonunion treated with superior or double (superior and anteroinferior) plating in combination with bone grafting. Double-plating can be considered an alternative to superior plating offering better resistance against the pulling effect of the arm with the use of smaller fixation plates.

DASH Diet: Reducing Hypertension through Diet and Lifestyle

MedlinePlus

... and Cardiovascular Health DASH Diet DASH Diet: Reducing Hypertension through Diet and Lifestyle Reviewed by Taylor Wolfram, ... vkusidey/iStock/Thinkstock Think you can't stop hypertension, or high blood pressure? You might be able ...

Effect of magnetic therapy on selected physical performances.

PubMed

Schall, David M; Ishee, Jimmy H; Titlow, Larry W

2003-05-01

The purpose of this study was to investigate the effects of magnetic therapy in the form of shoe insoles on vertical jump, bench squat, 40-yd dash, and a soccer-specific fitness test performance. Subjects were 14 collegiate male soccer players who were pretested, retested 3 weeks later, and then placed into a double-blind control or treatment group using a matching procedure. The control group received magnetic shoe insoles with a rating of 125 gauss, and the treatment group received insoles with a rating of 600 gauss. Subjects wore the insoles during practice and games for 7 weeks and were then retested. Results indicated significant differences among test scores during the 3 time periods but not between the treatment and control groups. There was a decline in 40-yd dash performance from the initial evaluation (5.10 seconds) to the final evaluation (5.08 seconds). There were no other significant differences. Within the limitations of the study, magnetic therapy did not improve physical performance.

Diet Quality as Assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and Health Outcomes: An Updated Systematic Review and Meta-Analysis of Cohort Studies.

PubMed

Schwingshackl, Lukas; Bogensberger, Berit; Hoffmann, Georg

2018-01-01

Diets of the highest quality have been associated with a significantly lower risk of noncommunicable diseases. It was the aim of this study to update a previous systematic review investigating the associations of diet quality as assessed by the Healthy Eating Index (HEI), Alternate Healthy Eating Index (AHEI), and Dietary Approaches to Stop Hypertension (DASH) score and multiple health outcomes. As an additional topic, the associations of these diet quality indices with all-cause mortality and cancer mortality among cancer survivors were also investigated. A literature search for prospective cohort studies that were published up to May 15, 2017 was performed using the electronic databases PubMed, Scopus, and Embase. Summary risk ratios (RRs) and 95% CIs were estimated using a random effects model for high vs low adherence categories. The updated review process showed 34 new reports (total number of reports evaluated=68; including 1,670,179 participants). Diets of the highest quality, as assessed by the HEI, AHEI, and DASH score, resulted in a significant risk reduction for all-cause mortality (RR 0.78, 95% CI 0.77 to 0.80; I 2 =59%; n=13), cardiovascular disease (incidence or mortality) (RR 0.78, 95% CI 0.76 to 0.80; I 2 =49%; n=28), cancer (incidence or mortality) (RR 0.84, 95% CI 0.82 to 0.87; I 2 =66%; n=31), type 2 diabetes (RR 0.82, 95% CI 0.78 to 0.85; I 2 =72%; n=10), and neurodegenerative diseases (RR 0.85, 95% CI 0.74 to 0.98; I 2 =51%; n=5). Among cancer survivors, the association between diets for the highest quality resulted in a significant reduction in all-cause mortality (RR 0.88, 95% CI 0.81 to 0.95; I 2 =38%; n=7) and cancer mortality (RR 0.90, 95% CI 0.83 to 0.98; I 2 =0%; n=7). In the updated meta-analyses, diets that score highly on the HEI, AHEI, and DASH were associated with a significant reduction in the risk of all-cause mortality, cardiovascular disease, cancer, type 2 diabetes, and neurodegenerative disease by 22%, 22%, 16%, 18%, and 15%, respectively. Moreover, high-quality diets were inversely associated with overall mortality and cancer mortality among cancer survivors. Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Safe corridors for K-wiring in phalangeal fractures.

PubMed

Rex, C; Vignesh, R; Javed, M; Balaji, Subba Chandra; Premanand, C; Zakki, Syed Ashfaque

2015-01-01

Unstable phalangeal fractures are commonly treated with K-wire fixation. Operative fixation must be used judiciously and with the expectation that the ultimate outcome should be better than the outcome after nonoperative management. It is necessary to achieve a stable fracture fixation and early mobilization. In order to achieve this goal, one should closely understand the safe portals/corridors in hand for K-wire entry for fractures of the phalanges. Safe corridors were defined and tested using a pilot cadaveric and a clinical case study by assessing the outcome. In our prospective case series, 50 patients with 64 phalangeal fractures were treated with closed reduction and K-wires were inserted through safe portals identified by a pilot cadaveric study. On table active finger movement test was done and the results were analyed using radiology, disabilities of the arm, shoulder, and hand (DASH) score and total active motion (TAM). In our study, little finger (n = 28) was the most commonly involved digit. In fracture pattern, transverse (n = 20) and spiral (n = 20) types were common. Proximal phalanx (n = 38) was commonly involved and the common site being the base of the phalanx (n = 28). 47 (95%) patients had excellent TAM and the mean postoperative DASH score was 58.05. All patients achieved excellent and good scores proving the importance of the safe corridor concept. K-wiring through the safe corridor has proved to yield the best clinical results because of least tethering of soft tissues as evidenced by performing "on-table active finger movement test" at the time of surgery. We strongly recommend K-wiring through safe portals in all phalangeal fractures.

Prepregnancy adherence to dietary patterns and lower risk of gestational diabetes mellitus123

PubMed Central

Tobias, Deirdre K; Zhang, Cuilin; Chavarro, Jorge; Bowers, Katherine; Rich-Edwards, Janet; Rosner, Bernard; Mozaffarian, Dariush; Hu, Frank B

2012-01-01

Background: Previous studies observed inverse associations of adherence to the alternate Mediterranean (aMED), Dietary Approaches to Stop Hypertension (DASH), and alternate Healthy Eating Index (aHEI) dietary patterns with risk of type 2 diabetes; however, their associations with gestational diabetes mellitus (GDM) risk are unknown. Objective: This study aimed to assess usual prepregnancy adherence to well-known dietary patterns and GDM risk. Design: Our study included 21,376 singleton live births reported from 15,254 participants of the Nurses’ Health Study II cohort between 1991 and 2001. Pregnancies were free of prepregnancy chronic disease or previous GDM. Prepregnancy dietary pattern adherence scores were computed based on participants’ usual intake of the patterns’ components, assessed with a validated food-frequency questionnaire. Multivariable logistic regressions with generalized estimating equations were used to estimate the RRs and 95% CIs. Results: Incident first-time GDM was reported in 872 pregnancies. All 3 scores were inversely associated with GDM risk after adjustment for several covariables. In a comparison of the multivariable risk of GDM in participants in the fourth and first quartiles of dietary pattern adherence scores, aMED was associated with a 24% lower risk (RR: 0.76; 95% CI: 0.60, 0.95; P-trend = 0.004), DASH with a 34% lower risk (RR: 0.66; 95% CI: 0.53, 0.82; P-trend = 0.0005), and aHEI with a 46% lower risk (RR: 0.54; 95% CI: 0.43, 0.68; P-trend < 0.0001). Conclusion: Prepregnancy adherence to healthful dietary patterns is significantly associated with a lower risk of GDM. PMID:22760563

Clinical and Radiographic Outcomes of Unipolar and Bipolar Radial Head Prosthesis in Patients with Radial Head Fracture: A Systemic Review and Meta-Analysis.

PubMed

Chen, Hongwei; Wang, Ziyang; Shang, Yongjun

2018-06-01

To compare clinical outcomes of unipolar and bipolar radial head prosthesis in the treatment of patients with radial head fracture. Medline, Cochrane, EMBASE, Google Scholar databases were searched until April 18, 2016 using the following search terms: radial head fracture, elbow fracture, radial head arthroplasty, implants, prosthesis, unipolar, bipolar, cemented, and press-fit. Randomized controlled trials, retrospective, and cohort studies were included. The Mayo elbow performance score (MEPS), disabilities of the arm, shoulder, and hand (DASH) score, radiologic assessment, ROM, and grip strength following elbow replacement were similar between prosthetic devices. The pooled mean excellent/good ranking of MEPS was 0.78 for unipolar and 0.73 for bipolar radial head arthroplasty, and the pooled mean MEPS was 86.9 and 79.9, respectively. DASH scores for unipolar and bipolar prosthesis were 19.0 and 16.3, respectively. Range of motion outcomes were similar between groups, with both groups have comparable risk of flexion arc, flexion, extension deficit, rotation arc, pronation, and supination (p values <0.001 for both unipolar and bipolar prosthesis). However, bipolar radial head prosthesis was associated with an increased chance of heterotopic ossification and lucency (p values ≤0.049) while unipolar prosthesis was not (p values ≥0.088). Both groups had risk for development of capitellar osteopenia or erosion/wear (p values ≤0.039). Unipolar and bipolar radial head prostheses were similar with respect to clinical outcomes. Additional comparative studies are necessary to further compare different radial head prostheses used to treat radial head fracture.

Spectral Detection of Acute Mental Stress with VIS-SWIR Hyperspectral Imagery

DTIC Science & Technology

2013-03-01

collected with a contact probe. The variance of “stress” (red solid lines) is lower on average than “non-stress” (blue dashed lines) because the HRV ...6 ROC Receiver Operating Characteristic . . . . . . . . . . . . . . . . . . . . . 6 HRV Heart Rate Variability...systems. A stressor involving the cognitive system manifests 7 in the form of anxiety , for example, the reaction to a quiz or speech, whereas a

Effects of the dietary approaches to stop hypertension diet alone and in combination with exercise and caloric restriction on insulin sensitivity and lipids.

PubMed

Blumenthal, James A; Babyak, Michael A; Sherwood, Andrew; Craighead, Linda; Lin, Pao-Hwa; Johnson, Julie; Watkins, Lana L; Wang, Jenny T; Kuhn, Cynthia; Feinglos, Mark; Hinderliter, Alan

2010-05-01

This study examined the effects of the Dietary Approaches to Stop Hypertension (DASH) diet on insulin sensitivity and lipids. In a randomized control trial, 144 overweight (body mass index: 25 to 40) men (n=47) and women (n=97) with high blood pressure (130 to 159/85 to 99 mm Hg) were randomly assigned to one of the following groups: (1) DASH diet alone; (2) DASH diet with aerobic exercise and caloric restriction; or (3) usual diet controls (UC). Body composition, fitness, insulin sensitivity, and fasting lipids were measured before and after 4 months of treatment. Insulin sensitivity was estimated on the basis of glucose and insulin levels in the fasting state and after an oral glucose load. Participants in the DASH diet with aerobic exercise and caloric restriction condition lost weight (-8.7 kg [95% CI: -2.0 to -9.7 kg]) and exhibited a significant increase in aerobic capacity, whereas the DASH diet alone and UC participants maintained their weight (-0.3 kg [95% CI: -1.2 to 0.5 kg] and +0.9 kg [95% CI: 0.0 to 1.7 kg], respectively) and had no improvement in exercise capacity. DASH diet with aerobic exercise and caloric restriction demonstrated lower glucose levels after the oral glucose load, improved insulin sensitivity, and lower total cholesterol and triglycerides compared with both DASH diet alone and UC, as well as lower fasting glucose and low-density lipoprotein cholesterol compared with UC. DASH diet alone participants generally did not differ from UC in these measures. Combining the DASH diet with exercise and weight loss resulted in significant improvements in insulin sensitivity and lipids. Despite clinically significant reductions in blood pressure, the DASH diet alone, without caloric restriction or exercise, resulted in minimal improvements in insulin sensitivity or lipids.

The PROMIS Global Health Questionnaire Correlates With the QuickDASH in Patients With Upper Extremity Illness.

PubMed

Stoop, Nicky; Menendez, Mariano E; Mellema, Jos J; Ring, David

2018-01-01

The objective of this study is to evaluate the construct validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health instrument by establishing its correlation to the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire in patients with upper extremity illness. A cohort of 112 patients completed a sociodemographic survey and the PROMIS Global Health and QuickDASH questionnaires. Pearson correlation coefficients were used to evaluate the association of the QuickDASH with the PROMIS Global Health items and subscales. Six of the 10 PROMIS Global Health items were associated with the QuickDASH. The PROMIS Global Physical Health subscale showed moderate correlation with QuickDASH and the Mental Health subscale. There was no significant relationship between the PROMIS Global Mental Health subscale and QuickDASH. The consistent finding that general patient-reported outcomes correlate moderately with regional patient-reported outcomes suggests that a small number of relatively nonspecific patient-reported outcome measures might be used to assess a variety of illnesses. In our opinion, the blending of physical and mental health questions in the PROMIS Global Health makes this instrument less useful for research or patient care.

Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Sustainability and Sonographic Progression at 3 Years.

PubMed

Seng, Chusheng; Mohan, P Chandra; Koh, Suang Bee Joyce; Howe, Tet Sen; Lim, Yee Gen; Lee, Brian P; Morrey, Bernard F

2016-02-01

A previously published study found positive outcomes for a novel technique for ultrasound-guided percutaneous ultrasonic tenotomy, showing good tolerability, safety, and early efficacy within an office setting. In this follow-up study, all 20 members of the original cohort were contacted after 3 years to explore the sustainability of symptomatic relief, functional improvement, and sonographic soft tissue response for percutaneous ultrasonic tenotomy. Case series; Level of evidence, 4. All 20 subjects of the clinical trial that was performed from June to November 2011 were further assessed at 36 months after the procedure in terms of visual analog scale for pain, Disabilities of the Arm, Shoulder and Hand (DASH)-Compulsory/Work scores, need for adjunct procedures, and overall satisfaction. Importantly, all 20 were reassessed with ultrasound imaging at 36 months, and evidence of the common extensor tendon response was assessed in terms of tendon hypervascularity, tendon thickness, and the progress of the hypoechoic scar tissue. A 100% clinical follow-up was achieved, inclusive of ultrasonographic assessment. None of the subjects required further treatment procedures, and 100% expressed satisfaction. Previous improvements in visual analog scale (current median ± SD, 0 ± 0.9; range, 0-3) and DASH-Work scores (current median, 0 ± 0) were sustained with conformity to a linear pattern on polynomial measures. There was further reduction in DASH-Compulsory scores to a median of 0 ± 0.644 (range, 0-2) with a significant decrease on repeated measures (P = .008). Tendon hypervascularity was resolved in 94% of patients, and 100% had reduction in tendon thickness. Overall reduction in the hypoechoic scar tissue was observed in all subjects, with a 90% response achieved by 6 months. Between 6 and 36 months, further reduction in the scar was observed in around 60% of patients, with 20% of patients having complete resolution of the hypoechoic scar. Minimally invasive percutaneous ultrasonic tenotomy provided sustained pain relief and functional improvement for recalcitrant tennis elbow at 3-year follow-up. It is one of the few procedures to demonstrate positive sonographic evidence of tissue-healing response and is an attractive alternative to surgical intervention for definitive treatment of recalcitrant elbow tendinopathy. © 2015 The Author(s).

Brazilian dietary patterns and the dietary approaches to stop hypertension (DASH) diet-relationship with metabolic syndrome and newly diagnosed diabetes in the ELSA-Brasil study.

PubMed

Drehmer, Michele; Odegaard, Andrew O; Schmidt, Maria Inês; Duncan, Bruce B; Cardoso, Letícia de Oliveira; Matos, Sheila M Alvim; Molina, Maria Del Carmen B; Barreto, Sandhi M; Pereira, Mark A

2017-01-01

Studies evaluating dietary patterns, including the DASH diet, and their relationship with the metabolic syndrome and diabetes may help to understand the role of dairy products (low fat or full fat) in these conditions. Our aim is to identify dietary patterns in Brazilian adults and compare them with the (DASH) diet quality score in terms of their associations with metabolic syndrome and newly diagnosed diabetes in the Brazilian Longitudinal Study of Adult Health-the ELSA-Brasil study. The ELSA-Brasil is a multicenter cohort study comprising 15,105 civil servants, aged 35-74 years at baseline (2008-2010). Standardized interviews and exams were carried out, including an OGTT. We analyzed baseline data for 10,010 subjects. Dietary patterns were derived by principal component analysis. Multivariable logistic regression investigated associations of dietary patterns with metabolic syndrome and newly diagnosed diabetes and multivariable linear regression with components of metabolic syndrome. After controlling for potential confounders, we observed that greater adherence to the Common Brazilian meal pattern (white rice, beans, beer, processed and fresh meats), was associated with higher frequencies of newly diagnosed diabetes, metabolic syndrome and all of its components, except HDL-C. Participants with greater intake of a Common Brazilian fast foods/full fat dairy/milk based desserts pattern presented less newly diagnosed diabetes. An inverse association was also seen between the DASH Diet pattern and the metabolic syndrome, blood pressure and waist circumference. Diet, light foods and beverages/low fat dairy pattern was associated with more prevalence of both outcomes, and higher fasting glucose, HDL-C, waist circumference (among men) and lower blood pressure. Vegetables/fruit dietary pattern did not protect against metabolic syndrome and newly diagnosed diabetes but was associated with lower waist circumference. The inverse associations found for the dietary pattern characterizing Brazilian fast foods and desserts, typically containing dairy products, with newly diagnosed diabetes, and for the DASH diet with metabolic syndrome, support previously demonstrated beneficial effects of dairy products in metabolism. The positive association with metabolic syndrome and newly diagnosed diabetes found for the pattern characterizing a typical Brazilian meal deserves further investigation, particularly since it is frequently accompanied by processed meat. Trial registration NCT02320461. Registered 18 December 2014.

OHS Provides Easy Heart Health Tips at “DASH and Dine” Event | Poster

Cancer.gov

The lunchtime dash to a nearby eatery is a daily ritual at NCI at Frederick, but Occupational Health Services (OHS) recently showed employees a different, healthy kind of DASH—Dietary Approaches to Stop Hypertension. Employees who visited the educational lunch-hour event, called “DASH and Dine,” had the chance to speak with OHS staff about the benefits of the DASH Eating Plan, a diet developed by the National Heart, Lung, and Blood Institute (NHLBI).

Empirical evaluation of H.265/HEVC-based dynamic adaptive video streaming over HTTP (HEVC-DASH)

NASA Astrophysics Data System (ADS)

Irondi, Iheanyi; Wang, Qi; Grecos, Christos

2014-05-01

Real-time HTTP streaming has gained global popularity for delivering video content over Internet. In particular, the recent MPEG-DASH (Dynamic Adaptive Streaming over HTTP) standard enables on-demand, live, and adaptive Internet streaming in response to network bandwidth fluctuations. Meanwhile, emerging is the new-generation video coding standard, H.265/HEVC (High Efficiency Video Coding) promises to reduce the bandwidth requirement by 50% at the same video quality when compared with the current H.264/AVC standard. However, little existing work has addressed the integration of the DASH and HEVC standards, let alone empirical performance evaluation of such systems. This paper presents an experimental HEVC-DASH system, which is a pull-based adaptive streaming solution that delivers HEVC-coded video content through conventional HTTP servers where the client switches to its desired quality, resolution or bitrate based on the available network bandwidth. Previous studies in DASH have focused on H.264/AVC, whereas we present an empirical evaluation of the HEVC-DASH system by implementing a real-world test bed, which consists of an Apache HTTP Server with GPAC, an MP4Client (GPAC) with open HEVC-based DASH client and a NETEM box in the middle emulating different network conditions. We investigate and analyze the performance of HEVC-DASH by exploring the impact of various network conditions such as packet loss, bandwidth and delay on video quality. Furthermore, we compare the Intra and Random Access profiles of HEVC coding with the Intra profile of H.264/AVC when the correspondingly encoded video is streamed with DASH. Finally, we explore the correlation among the quality metrics and network conditions, and empirically establish under which conditions the different codecs can provide satisfactory performance.

One-Dimensional Nature of InAs/InP Quantum Dashes Revealed by Scanning Tunneling Spectroscopy.

PubMed

Papatryfonos, Konstantinos; Rodary, Guillemin; David, Christophe; Lelarge, François; Ramdane, Abderrahim; Girard, Jean-Christophe

2015-07-08

We report on low-temperature cross-sectional scanning tunneling microscopy and spectroscopy on InAs(P)/InGaAsP/InP(001) quantum dashes, embedded in a diode-laser structure. The laser active region consists of nine InAs(P) quantum dash layers separated by the InGaAsP quaternary alloy barriers. The effect of the p-i-n junction built-in potential on the band structure has been evidenced and quantified on large-scale tunneling spectroscopic measurements across the whole active region. By comparing the tunneling current onset channels, a consistent energy shift has been measured in successive quantum dash or barrier layers, either for the ground state energy of similar-sized quantum dashes or for the conduction band edge of the barriers, corresponding to the band-bending slope. The extracted values are in good quantitative agreement with the theoretical band structure calculations, demonstrating the high sensitivity of this spectroscopic measurement to probe the electronic structure of individual nanostructures, relative to local potential variations. Furthermore, by taking advantage of the potential gradient, we compared the local density of states over successive quantum dash layers. We observed that it does not vanish while increasing energy, for any of the investigated quantum dashes, in contrast to what would be expected for discrete level zero-dimensional (0D) structures. In order to acquire further proof and fully address the open question concerning the quantum dash dimensionality nature, we focused on individual quantum dashes obtaining high-energy-resolution measurements. The study of the local density of states clearly indicates a 1D quantum-wirelike nature for these nanostructures whose electronic squared wave functions were subsequently imaged by differential conductivity mapping.

Effects of local microwave diathermy on shoulder pain and function in patients with rotator cuff tendinopathy in comparison to subacromial corticosteroid injections: a single-blind randomized trial.

PubMed

Rabini, Alessia; Piazzini, Diana B; Bertolini, Carlo; Deriu, Laura; Saccomanno, Maristella F; Santagada, Domenico A; Sgadari, Antonio; Bernabei, Roberto; Fabbriciani, Carlo; Marzetti, Emanuele; Milano, Giuseppe

2012-04-01

Single-blind randomized clinical trial, with a follow-up of 24 weeks. To determine the effects of hyperthermia via localized microwave diathermy on pain and disability in comparison to subacromial corticosteroid injections in patients with rotator cuff tendinopathy. Hyperthermia improves symptoms and function in several painful musculoskeletal disorders. However, the effects of microwave diathermy in rotator cuff tendinopathy have not yet been established. Ninety-two patients with rotator cuff tendinopathy and pain lasting for at least 3 months were recruited from the outpatient clinic of the Department of Orthopaedics and Traumatology, University Hospital, Rome, Italy. Participants were randomly allocated to either local microwave diathermy or subacromial corticosteroids. The primary outcome measure was the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). Secondary outcome measures were the Constant-Murley shoulder outcome score and a visual analog scale for pain assessment. At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcome measures relative to baseline values. Changes over time in QuickDASH, Constant-Murley, and visual analog scale scores were not different between treatment arms. In patients with rotator cuff tendinopathy, the effects of localized microwave diathermy on disability, shoulder function, and pain are equivalent to those elicited by subacromial corticosteroid injections.

Measures of upper limb function for people with neck pain. A systematic review of measurement and practical properties.

PubMed

Alreni, Ahmad Salah Eldin; Harrop, Deborah; Lowe, Anna; Tanzila Potia; Kilner, Karen; McLean, Sionnadh Mairi

2017-06-01

There is a strong relationship between neck pain (NP) and upper limb disability (ULD). Optimal management of NP should incorporate upper limb rehabilitation and therefore include the use of an ULD measure in the assessment and management process. Clear guidance regarding the suitability of available measures does not exist. The aim of this study was to identify all available measures of ULD for populations with NP, critically evaluate their measurement properties and finally recommend a list of suitable measures. This two-phase systematic review is reported in accordance with the PRISMA statement. Phase one identified clearly reproducible measures of ULD for patients with NP. Phase two identified evidence of their measurement properties. In total, 11 papers evaluating the measurement properties of five instruments were included in this review. The instruments identified were the DASH questionnaire, the QuickDASH questionnaire, the NULI questionnaire, the SFA and the SAMP test. There was limited positive evidence of validity of the DASH, QuickDASH, NULI, SFA and SAMP. There was limited positive evidence of reliability of the NULI, SFA and SAMP. There was unknown evidence of responsiveness of the DASH and QuickDASH. Although all measures are supported by a limited amount of low quality evidence, the DASH, QuickDASH, NULI questionnaires, and the SAMP test are promising measures, but they require further robust evaluation. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

The Mediterranean Diet Score Is More Strongly Associated with Favorable Cardiometabolic Risk Factors over 2 Years Than Other Diet Quality Indexes in Puerto Rican Adults.

PubMed

Mattei, Josiemer; Sotos-Prieto, Mercedes; Bigornia, Sherman J; Noel, Sabrina E; Tucker, Katherine L

2017-04-01

Background: Multiple diet quality scores have been used to evaluate adherence to specific dietary recommendations or to consumption of healthful foods and nutrients. It remains unknown which score can more strongly predict longitudinal changes in cardiometabolic risk factors. Objective: We aimed to determine associations of 5 diet quality scores [AHA diet score (AHA-DS), Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index (HEI)-2005, Mediterranean diet score (MeDS), and Alternative Healthy Eating Index (AHEI)] with 2-y changes in cardiometabolic risk factors in adults 45-75 y old. Methods: Data from the Boston Puerto Rican Health Study were analyzed ( n = 1194). Diet quality scores were calculated from a baseline-validated food-frequency questionnaire. Multivariable-adjusted, repeated-subjects, mixed-effects models, adjusted for baseline measures, estimated associations between each z score and 14 individual cardiometabolic factors measured at 2 y. Results: MeDS was significantly associated with lower 2-y waist circumference (β coefficient ± SE: -0.52 ± 0.26, P = 0.048); body mass index (BMI; -0.23 ± 0.08, P = 0.005); log-insulin (-0.06 ± 0.02, P = 0.005); log-homeostasis model assessment of insulin resistance (HOMA-IR; -0.05 ± 0.02, P = 0.030), and log-C-reactive protein (-0.13 ± 0.03, P = 0.0002). Similar but weaker associations were observed for the AHEI with BMI, insulin, and HOMA-IR. The AHA-DS was inversely associated with BMI (-0.17 ± 0.08, P = 0.033). Neither the HEI-2005 nor DASH was significantly associated with any variable. Traditional Puerto Rican foods consumed by individuals with high MeDSs included vegetables and meats in homemade soups, orange juice, oatmeal, beans and legumes, fish, whole milk, corn oil, and beer. Conclusions: The MeDS comprises food components and scores associated with a favorable cardiometabolic profile over 2 y in Puerto Rican adults. An overall healthy diet may be particularly beneficial for maintaining a lower BMI. These results can help identify suitable measures of diet quality in epidemiologic studies and craft meaningful nutritional messages and dietary recommendations for the intended population. This study was registered at clinicaltrials.gov as NCT01231958. © 2017 American Society for Nutrition.

FMCSA’s advanced system testing utilizing a data acquisition system on the highways (FAST DASH) safety technology evaluation project #2 : technology brief.

DOT National Transportation Integrated Search

2016-11-01

The Federal Motor Carrier Safety Administration (FMCSA) established the FAST DASH program to perform efficient independent evaluations of promising safety technologies aimed at commercial vehicle operations. In this second FAST DASH safety technology...

Space Storms and Space Weather Hazards

DTIC Science & Technology

2001-06-12

dashed curve is a run where the IMF was switched to northward again at t=50 min. Dipolarization at synchronous orbit sets in about 1 hour after the...years. The Modified Atmospheric Density Model revolutionized orbit tracking by applying intelligent feedback from empirical drag data for satellites in...coefficients for a set of operationally relevant satellites was improved, on average, by 200% and computational variability was greatly dampened. The orbit

FMCSA’s advanced system testing utilizing a data acquisition system on the highways (FAST DASH) safety technology evaluation project #3 : novel convex mirrors : technology brief.

DOT National Transportation Integrated Search

2016-11-01

The Federal Motor Carrier Safety Administration (FMCSA) established the FAST DASH program to perform efficient independent evaluations of promising safety technologies aimed at commercial vehicle operations. In this third FAST DASH safety technology ...

High-voltage electrical burn injuries: functional upper extremity assessment.

PubMed

Mazzetto-Betti, K C; Amâncio, A C G; Farina, J A; Barros, M E P M; Fonseca, M C R

2009-08-01

High-voltage electric injuries have many manifestations, and an important complication is the damage of the central/peripheral nervous system. The purpose of this work was to assess the upper limb dysfunction in patients injured by high-voltage current. The evaluation consisted of analysis of patients' records, cutaneous-sensibility threshold, handgrip and pinch strength and a specific questionnaire about upper limb dysfunctions (DASH) in 18 subjects. All subjects were men; the average age at the time of the injury was 38 years. Of these, 72% changed job/retired after the injury. The current entrance was the hand in 94% and grounding in the lower limb in 78%. The average burned surface area (BSA) was 8.6%. The handgrip strength of the injured limb was reduced (p<0.05) and so also that of the three pinch types. The relationship between the handgrip strength and the DASH was statistically significant (p<0.001) as well as the relationship between the three pinch types (p

Formation of unexpected silicon- and disiloxane-bridged multiferrocenyl derivatives bearing Si-O-CH[double bond, length as m-dash]CH2 and Si-(CH2)2C(CH3)3 substituents via cleavage of tetrahydrofuran and trapping of its ring fragments.

PubMed

Bruña, Sonia; González-Vadillo, Ana Mª; Ferrández, Marta; Perles, Josefina; Montero-Campillo, M Merced; Mó, Otilia; Cuadrado, Isabel

2017-09-12

The formation of a family of silicon- and siloxane-bridged multiferrocenyl derivatives carrying different functional groups attached to silicon, including Fc 2 (CH 3 ) 3 C(CH 2 ) 2 SiCH[double bond, length as m-dash]CH 2 (5), Fc 2 (CH 2 [double bond, length as m-dash]CH-O)SiCH[double bond, length as m-dash]CH 2 (6), Fc 2 (OH)SiCH[double bond, length as m-dash]CH 2 (7), Fc 2 (CH 2 [double bond, length as m-dash]CH-O)Si-O-Si(O-CH[double bond, length as m-dash]CH 2 )Fc 2 (8) and Fc 2 (CH 2 [double bond, length as m-dash]CH-O)Si-O-SiFc 3 (9) is described. Silyl vinyl ether molecules 6, 8 and 9 and the heteroleptic vinylsilane 5 resulted from the competing metathesis reaction of lithioferrocene (FcLi), CH 2 [double bond, length as m-dash]CH-OLi or (CH 3 ) 3 C(CH 2 ) 2 Li with the corresponding multifunctional chlorosilane, Cl 3 SiCH[double bond, length as m-dash]CH 2 or Cl 3 Si-O-SiCl 3 . The last two organolithium species have been likely formed in situ by fragmentation of the tetrahydrofuran solvent. Diferrocenylvinyloxyvinylsilane 6 is noteworthy since it represents a rare example of a redox-active silyl mononomer in which two different C[double bond, length as m-dash]C polymerisable groups are directly connected to silicon. The molecular structures of the silicon-containing multiferrocenyl species 5, 6, 8 and 9 have been investigated by single-crystal X-ray diffraction studies, demonstrating the capture and storage processes of two ring fragments resulting from the cleavage of cyclic THF in redox-active and stable crystalline organometallic compounds. From electrochemical studies we found that by changing the anion of the supporting electrolyte from [PF 6 ] - to [B(C 6 F 5 ) 4 ] - , the redox behaviour of tetrametallic disiloxane 8 can be switched from a poorly resolved multistep redox process to four consecutive well-separated one-electron oxidations, corresponding to the sequential oxidation of the four ferrocenyl moieties.

[Arthroscopically assisted transcapsular refixation of the triangular fibrocartilage complex of the wrist].

PubMed

Pillukat, T; Fuhrmann, R A; Windolf, J; van Schoonhoven, J

2016-08-01

Refixation of the triangular fibrocartilage complex (TFCC) to the ulnar capsule of the wrist. Distal TFCC tears without instability, proximal TFCC intact. Loose ulnar TFCC attachment without tear or instability. Peripheral TFCC tears with instability of the distal radioulnar joint (DRUJ). Complex or proximal tears of the TFCC. Isolated, central degenerative tears without healing potential. Arthroscopically guided, minimally invasive suture of the TFCC to the base of the sixth extensor compartment. Above elbow plaster splint, 70° flexion of the elbow joint, 45° supination for 6 weeks. Skin suture removal after 2 weeks. No physiotherapy to extend pronation and supination during the first 3 months. In an ongoing long-term study, 7 of 31 patients who underwent transcapsular refixation of the TFCC between 1 January 2003 and 31 December 2010 were evaluated after an average follow-up interval of 116 ± 34 months (range 68-152 months). All patients demonstrated an almost nearly unrestricted range of wrist motion and grip strength compared to the unaffected side. All distal radioulnar joints were stable. On the visual analogue scale (VAS 0-10), pain at rest was 1 ± 1 (range 0-2) and pain during exercise 2 ± 2 (range 0-5); the DASH score averaged 10 ± 14 points (range 0-39 points). All patients were satisfied. The modified Mayo wrist score showed four excellent, two good, and one fair result. These results correspond to the results of other series. Transcapsular refixation is a reliable, technically simple procedure in cases with ulnar-sided TFCC tears without instability leading to good results.

Changes in Depression, Health Anxiety, and Pain Catastrophizing Between Enrollment and 1 Month After a Radius Fracture.

PubMed

Golkari, Sina; Teunis, Teun; Ring, David; Vranceanu, Ana-Maria

2015-01-01

To test the difference in symptoms of (1) depression, (2) health anxiety, and (3) catastrophic thinking between 1 and 6 weeks after injury to the radius. In total, 69 adult patients with a minimally displaced radial head or distal radius fracture were prospectively enrolled. After diagnosis, we recorded demographic variables, 11-point ordinal numerical pain score, and agreement with "no pain, no gain"; Disabilities of the Arms, Shoulder, and Hand (DASH) questionnaire; Center for Epidemiologic Studies Depression Scale; the Whiteley Index; and the Pain Catastrophizing Scale. In total, 55 patients (80%) returned after 1 month to reevaluate pain, Disabilities of the Arms, Shoulder, and Hand, Center for Epidemiologic Studies Depression, Whiteley Index, and Pain Catastrophizing Scale scores. Center for Epidemiologic Studies Depression scores decreased by an average of 5 ± 9 points (p < 0.001), and Pain Catastrophizing Scale scores decreased by 2 ± 6 points (p = 0.0041). In multivariable analysis, decrease in Center for Epidemiologic Studies Depression was associated with not having an additional pain condition, more days elapsed between injury and final evaluation, and stronger agreement with "no pain, no gain" (adjusted R(2) = 0.26, p = 0.0006). An increase in Whiteley scores was associated with fewer years of education (R = -0.34, p = 0.012). Changes in Pain Catastrophizing Scale scores were associated with marital status (single -1.7 ± 4.3 vs married -4.6 ± 6.0 vs separated 0.55 ± 6.2, p = 0.040). Symptoms of depression and catastrophic thinking, but not health anxiety, improved during recovery after injury. If psychologic measures are used as a screening tool to predict outcome after treatment, one should account for a patient's disease phase. Prognostic level I. Copyright © 2015 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

The challenge of Monteggia-like lesions of the elbow: mid-term results of 46 cases.

PubMed

Jungbluth, P; Tanner, S; Schneppendahl, J; Grassmann, J-P; Wild, M; Hakimi, M; Windolf, J; Laun, R

2018-02-01

The aim of this retrospective multicentre study was to evaluate mid-term results of the operative treatment of Monteggia-like lesions and to determine the prognostic factors that influence the clinical and radiological outcome. A total of 46 patients (27 women and 19 men), with a mean age of 57.7 years (18 to 84) who had sustained a Monteggia-like lesion were followed up clinically and radiologically after surgical treatment. The Mayo Modified Wrist Score (MMWS), Mayo Elbow Performance Score (MEPS), Broberg and Morrey Score, and Disabilities of the Arm, Shoulder and Hand (DASH) score were used for evaluation at a mean of 65 months (27 to 111) postoperatively. All ulnar fractures were stabilized using a proximally contoured or precontoured locking compression plate. Mason type I fractures of the radial head were treated conservatively, type II fractures were treated with reconstruction, and type III fractures with arthroplasty. All Morrey type II and III fractures of the coronoid process was stabilized using lag screws. Good results were found for the MMWS, with a mean of 88.4 (40 to 100). There were 29 excellent results (63%), nine good (20%), seven satisfactory (15%), and one poor (2%). Excellent results were obtained for the MEPS, with a mean of 90.7 (70 to 100): 31 excellent results (68%), 13 good (28%), and two fair (4%). Good results were also found for the functional rating index of Broberg and Morrey, with a mean score of 86.6 (57 to 100). There were 16 excellent results (35%), 22 good (48%), six fair (13%), and two poor (4%). The mean DASH score was 15.1 (0 to 55.8). Two patients had delayed wound healing; four patients had nonunion requiring bone grafting. One patient had asymptomatic loosening of the radial head prosthesis. Monteggia-like lesions are rare. With correct identification, classification, and understanding using CT scans followed by appropriate surgical treatment that addresses all components of the injury, good to excellent mid-term results can be achieved. Cite this article: Bone Joint J 2018;100-B:212-18. ©2018 The British Editorial Society of Bone & Joint Surgery.

A P-H functionalized Al/P-based frustrated Lewis pair - hydrophosphination of nitriles, ring opening with cyclopropenones and evidence of P[double bond, length as m-dash]C double bond formation.

PubMed

Keweloh, Lukas; Aders, Niklas; Hepp, Alexander; Pleschka, Damian; Würthwein, Ernst-Ulrich; Uhl, Werner

2018-06-12

Hydroalumination of R-P(H)-C[triple bond, length as m-dash]C-tBu with bulky H-Al[CH(SiMe3)2]2 afforded the new P-H functionalized Al/P-based frustrated Lewis pair R-P(H)-C[[double bond, length as m-dash]C(H)-tBu]-AlR2 [R = CH(SiMe3)2; FLP 7]. A weak adduct of 7 with benzonitrile (8) was detected by NMR spectroscopy, but could not be isolated. tert-Butyl isocyanide afforded a similar, but isolable adduct (9), in which the isocyanide C atom was coordinated to aluminium. The unique reactivity of 7 became evident from its reactions with the heteroatom substituted nitriles PhO-C[triple bond, length as m-dash]N, PhCH2S-C[triple bond, length as m-dash]N and H8C4N-C[triple bond, length as m-dash]N. Hydrophosphination of the C[triple bond, length as m-dash]N triple bonds afforded imines at room temperature which were coordinated to the FLP by Al-N and P-C bonds to yield AlCPCN heterocycles (10 to 12). These processes depend on substrate activation by the FLP. Diphenylcyclopropenone and its sulphur derivative reacted with 7 by addition of the P-H bond to a C-C bond of the strained C3 ring and ring opening to afford the fragment (Z)-Ph-C(H)[double bond, length as m-dash]C(Ph)-C-X-Al (X = O, S). The C-O or C-S groups were coordinated to the FLP to yield AlCPCX heterocycles (13 and 14). The thiocarbonyl derived compound 14 contains an internally stabilized phosphenium cation with a localized P[double bond, length as m-dash]C bond, a trigonal planar coordinated P atom and a short P[double bond, length as m-dash]C distance (168.9 pm). Insight into formation mechanisms, the structural and energetic properties of FLP 7 and compounds 13 and 14 was gained by quantum chemical DFT calculations.

Role of autologous non-vascularised intramedullary fibular strut graft in humeral shaft nonunions following failed plating.

PubMed

Kashayi-Chowdojirao, Sreekanth; Vallurupalli, Aashish; Chilakamarri, Vijay Krishna; Patnala, Chandrasekhar; Chodavarapu, Lalith Mohan; Kancherla, Nageswara Rao; Khazi Syed, Asif Hussain

2017-11-01

Non-union humeral shaft fractures are seen frequently in clinical practice at about 2-10% in conservative management and 30% in surgically operated patients. Osteosynthesis using dynamic compression plate (DCP), intramedullary nailing, locking compression plate (LCP), Ilizarov technique along with bone grafting have been reported previously. In cases of prior failed plate-screw osteosynthesis the resultant osteopenia, cortical defect, bone loss, scalloping around screws and metallosis, make the management of non-union more complicated. Fibular graft as an intramedullary strut is useful in these conditions by increasing screw purchase, union and mechanical stability. This study is a retrospective and prospective follow up of revision plating along with autologous non-vascularised intramedullary fibular strut graft (ANVFG) for humeral non-unions following failed plate osteosynthesis. Seventy eight cases of nonunion humeral shaft fractures were managed in our institute between 2008 and 2015. Of these, 57 cases were failed plate osteosynthesis, in which 15 cases were infected and 42 cases were noninfected. Out of the 78 cases, bone grafting was done in 55 cases. Fibular strut graft was used in 22 patients, of which 4 cases were of primary nonunion with osteoporotic bone. Applying the exclusion criteria of infection and inclusion criteria of failed plate osteosynthesis managed with revision plating using either LCP or DCP and ANVFG, 17 cases were studied. The mean age of the patients was 40.11 yrs (range: 26-57 yrs). The mean duration of non-union was 4.43 yrs (range: 0.5-14 yrs). The mean follow-up period was 33.41 months (range: 12-94 months). The average length of fibula was 10.7 cm (range: 6-15 cm). Main outcome measurements included bony union by radiographic assessment and pre- and postoperative functional evaluation using the DASH (Disabilities of the Arm, Shoulder and Hand) score. Results: Sixteen out of 17 fractures united following revision plating and fibular strut grafting. Average time taken for union was 3.5 months (range: 3-5 months). Complications included one each of implant failure with bending, transient radial nerve palsy and transient ulnar nerve palsy. No case had infection, graft site morbidity or peroneal nerve palsy. Functional assessment by DASH score improved from 59.14 (range: 43.6-73.21) preoperatively to 23.39 (range: 8.03-34.2) postoperatively (p = 0.0003). Conclusion: The results of our study indicate that revision plating along with ANVFG is a reliable option in humeral diaphyseal non-unions with failed plate-screw osteosynthesis providing adequate screw purchase, mechanical stability and high chances of union with good functional outcome.

[Hand replantation: differences in functional outcome considering patient age and sociomedical aspects].

PubMed

Reichl, H; Schütz, T; Gabl, M; Angermann, P; Russe, E; Wechselberger, G

2013-12-01

By presenting 2 cases of successful hand replantation with similar trauma mechanism, level of amputation and ischaemia time of an 18-year-old female patient and a 48-year-old depressive male patient, the influence of age and sociomedical status on the postoperative outcome is discussed. DASH- (disabilities of the arm, shoulder and hand) score and Biometrics E-LINK power and sensitivity measurement were used to evaluate the outcomes. © Georg Thieme Verlag KG Stuttgart · New York.

Clinical and radiological outcome following treatment of displaced lateral clavicle fractures using a locking compression plate with lateral extension: a prospective study.

PubMed

Beirer, Marc; Siebenlist, Sebastian; Crönlein, Moritz; Postl, Lukas; Huber-Wagner, Stefan; Biberthaler, Peter; Kirchhoff, Chlodwig

2014-11-19

Treatment of lateral fractures of the clavicle is challenging and has been controversially discussed for a long time due to high non-union rates in non-operative treatment and high complication rates in surgical treatment. Acromioclavicular joint instability due to the injury of the closely neighbored coraco-clavicular ligaments can result in a cranialization of the medial clavicle shaft. A recently developed implant showed a promising functional outcome in a small collective of patients. In this prospective study, 20 patients with a mean age of 40.7 ± 11.3 years with a dislocated fracture of the lateral clavicle (Jäger&Breitner I-III, Neer I-III) were enrolled. All patients were surgically treated using the locking compression plate (LCP) for the superior anterior clavicle (Synthes®). Functional outcome was recorded using the Munich Shoulder Questionnaire (MSQ) allowing for qualitative self-assessment of the Shoulder Pain and Disability Index (SPADI), of the Disability of the Arm, Shoulder and Hand (DASH) score and of the Constant Score. Acromioclavicular joint stability was evaluated using the Taft-Score. The mean follow-up was 14.2 ± 4.0 months. The mean MSQ was 87.0 ± 7.4 points, the mean SPADI 91.1 ± 11.3 points, the mean DASH score 7.6 ± 7.3 points and the mean normative age- and sex-specific Constant Score 85.6 ± 8.0 points. The mean Taft Score resulted in 10.7 ± 1.0 points. The mean Taft Score in lateral clavicular fractures with fracture gap between the coracoclavicular ligaments in combination with a rupture of the conoid ligament (J&B II a, Neer II B; n =11) was with 10.3 ± 0.9 points significantly lower than the mean Taft Score of all other types of lateral clavicle fractures (J&B I, II b, III; n =9) which resulted in 11.3 ± 0.9 points (p<0.05). The Synthes® LCP superior anterior clavicle plate allows for a safe stabilization and good functional outcome with high patient satisfaction in fractures of the lateral clavicle. However, in fractures type Jäger&Breitner II a, Neer II B a significant acromioclavicular joint instability was observed and additional reconstruction of the coracoclavicular ligaments should be performed. ClinicalTrials.gov NCT02256059. Registered 02 October 2014.

Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty

PubMed Central

Booker, Simon; Alfahad, Nawaf; Scott, Martin; Gooding, Ben; Wallace, W Angus

2015-01-01

To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score (CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score. PMID:25793164

Association of Long-Term Adherence to the MIND Diet with Cognitive Function and Cognitive Decline in American Women.

PubMed

Berendsen, A M; Kang, J H; Feskens, E J M; de Groot, C P G M; Grodstein, F; van de Rest, O

2018-01-01

There is increasing attention for dietary patterns as a potential strategy to prevent cognitive decline. We examined the association between adherence to a recently developed Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet with cognitive function and cognitive decline, taking into account the interaction between the apolipoprotein E ε4 genotype and the MIND diet. Population-based prospective cohort study. A total of 16,058 older women aged 70 and over from the Nurses' Health Study. Dietary intake was assessed five times between 1984 and 1998 with a 116-item Food Frequency Questionnaire. The MIND score includes ten brain-healthy foods and five unhealthy foods. Cognition was assessed four times by telephone from 1995 to 2001 (baseline) with the Telephone Interview for Cognitive Status (TICS) and by calculating composite scores of verbal memory and global cognition. Linear regression modelling and linear mixed modelling were used to examine the associations of adherence to the MIND diet with average cognitive function and cognitive change over six years, respectively. Greater long-term adherence to the MIND diet was associated with a better verbal memory score (multivariable-adjusted mean differences between extreme MIND quintiles=0.04 (95%CI 0.01-0.07), p-trend=0.006), but not with cognitive decline over 6 years in global cognition, verbal memory or TICS. Long-term adherence to the MIND diet was moderately associated with better verbal memory in later life. Future studies should address this association within populations at greater risk of cognitive decline.

Cementless anatomical prosthesis for the treatment of 3-part and 4-part proximal humerus fractures: cadaver study and prospective clinical study with minimum 2 years followup

PubMed Central

Obert, Laurent; Saadnia, Rachid; Loisel, François; Uhring, Julien; Adam, Antoine; Rochet, Séverin; Clappaz, Pascal; Lascar, Tristan

2016-01-01

Introduction: The purpose of this study was to evaluate the functional and radiological outcomes of a cementless, trauma-specific locked stem for 3- and 4-part proximal humeral fractures. Materials and methods: This study consisted of two parts: a cadaver study with 22 shoulders and a multicenter prospective clinical study of 23 fracture patients evaluated at least 2 years after treatment. In the cadaver study, the locked stem (HumelockTM, FX Solutions) and its instrumentation were evaluated. In the clinical study, five senior surgeons at four different hospitals performed the surgical procedures. An independent surgeon evaluated the patients using clinical (Constant score, QuickDASH) and radiological (X-rays, CT scans) outcome measures. Results: The cadaver study allowed us to validate the height landmarks relative to the pectoralis major tendon. In the clinical study, at the review, abduction was 95° (60–160), forward flexion was 108° (70–160), external rotation (elbow at body) was 34° (0–55), the QuickDASH was 31 (4.5–59), the overall Constant score was 54 (27–75), and the weighted Constant score was 76 (31.5–109). Discussion: This preliminary study of hemiarthroplasty (HA) with a locked stem found results that were at least equivalent to published series. As all patients had at least a 2-year follow-up, integration of the locked stem did not cause any specific complications. These results suggest that it is possible to avoid using cement when hemiarthroplasty is performed for the humeral stem. This implant makes height adjustment and transosseous suturing of the tuberosities more reproducible. PMID:27194107

Anthropometric and Athletic Performance Combine Test Results Among Positions Within Grade Levels of High School-Aged American Football Players.

PubMed

Leutzinger, Todd J; Gillen, Zachary M; Miramonti, Amelia M; McKay, Brianna D; Mendez, Alegra I; Cramer, Joel T

2018-05-01

Leutzinger, TJ, Gillen, ZM, Miramonti, AM, McKay, BD, Mendez, AI, and Cramer, JT. Anthropometric and athletic performance combine test results among positions within grade levels of high school-aged American football players. J Strength Cond Res 32(5): 1288-1296, 2018-The purpose of this study was to investigate differences among player positions at 3 grade levels in elite, collegiate-prospective American football players. Participants' data (n = 7,160) were analyzed for this study (mean height [Ht] ± SD = 178 ± 7 cm, mass [Bm] = 86 ± 19 kg). Data were obtained from 12 different high school American football recruiting combines hosted by Zybek Sports (Boulder, Colorado). Eight 2-way (9 × 3) mixed factorial analysis of variances {position (defensive back [DB], defensive end, defensive lineman, linebacker, offensive lineman [OL], quarterback, running back, tight end, and wide receiver [WR]) × grade (freshmen, sophomores, and juniors)} were used to test for differences among the mean test scores for each combine measure (Ht, Bm, 40-yard [40 yd] dash, proagility [PA] drill, L-cone [LC] drill, vertical jump [VJ], and broad jump [BJ]). There were position-related differences (p ≤ 0.05) for Ht, 40 yd dash, and BJ, within each grade level and for Bm, PA, LC, and VJ independent of grade level. Generally, the results showed that OL were the tallest, weighed the most, and exhibited the lowest performance scores among positions. Running backs were the shortest, whereas DBs and WRs weighed the least and exhibited the highest performance scores among positions. These results demonstrate the value of classifying high school-aged American football players according to their specific position rather than categorical groupings such as "line" vs. "skill" vs. "big skill" when evaluating anthropometric and athletic performance combine test results.

Single-arm open-label study of Durolane (NASHA nonanimal hyaluronic acid) for the treatment of osteoarthritis of the thumb.

PubMed

Velasco, Eloisa; Ribera, Mª Victoria; Pi, Joan

2017-01-01

Osteoarthritis of the trapeziometacarpal (TMC) joint of the thumb - also known as rhizarthrosis - is painful and has a significant impact on quality of life. Intra-articular injection of hyaluronic acid may potentially meet the need for effective, minimally invasive intervention in patients not responding adequately to initial treatment. We aimed to confirm the safety and effectiveness of viscosupplementation with Durolane (NASHA nonanimal hyaluronic acid) in rhizarthrosis. This was a prospective, single-arm, multicenter, open-label study with a 6-month follow-up period. Eligible patients had Eaton-Littler grade II-III rhizarthrosis in one TMC joint with pain and visual analog scale (VAS) pain score ≥4 (scale: 0-10). A single injection of NASHA was administered to the affected TMC joint. The primary effectiveness variable was change from baseline in VAS pain score. Thirty-five patients (mean age 60.8 years; 85.7% female) received NASHA and completed the study. The least-squares mean change from baseline in VAS pain score over 6 months was -2.00, a reduction of 27.8% ( p <0.001). The reduction in pain exceeded 25% as early as month 1 (26.5%), and gradual improvement was observed throughout the 6-month follow-up period. Secondary effectiveness parameters included QuickDASH (shortened version of Disabilities of the Arm, Shoulder, and Hand [DASH]), Kapandji thumb opposition test, radial abduction, metacarpophalangeal (MCP) joint flexion, and pinch (clamp) strength. Most of these measurements showed statistically significant improvements from baseline over 6 months. Five adverse events (injection site reactions) were reported in four patients (11.4%), and there were no serious or allergic reactions. This study suggests that viscosupplementation using NASHA is effective and well tolerated in treating the symptoms of rhizarthrosis.

Eating with others and meal location are differentially associated with nutrient intake by sex: The Diabetes Study of Northern California (DISTANCE).

PubMed

Pachucki, Mark C; Karter, Andrew J; Adler, Nancy E; Moffet, Howard H; Warton, E Margaret; Schillinger, Dean; O'Connell, Bethany Hendrickson; Laraia, Barbara

2018-08-01

Though eating with others is often a social behavior, relationships between social contexts of eating and nutrient intake have been underexplored. This study evaluates how social aspects of eating - frequencies of eating meals with others, meals prepared at home, and meals outside the home - are associated with nutrient intake. Because diet improvement can reduce complications of diabetes mellitus, we surveyed a multi-ethnic cohort of persons with type 2 diabetes (n = 770) about social aspects of diet (based on 24-hour recalls). Sex-stratified multiple regression analyses adjusted for confounders assessed the relationship between frequency of eating with others and nutrient intake (total energy, energy from fat, energy from carbohydrates, Healthy Eating Index/HEI, Dietary Approaches to Stop Hypertension/DASH score). Although there was slight variation in men's versus women's propensity to share meals, after adjustment for confounders, there was no consistently significant association between meals with others and the 5 nutrient intake measures for either men or women. The directions of association between categories of eating with others and diet quality (HEI and DASH scores) - albeit not significant - were different for men (positive) and women (mostly negative), which warrants further investigation. The next analyses estimated nutrient intake associated with meals prepared at home, and meals consumed outside the home. Analyses indicated that greater meal frequency at home was associated with significantly better scores on diet quality indices for men (but not women), while meal frequency outside the home was associated with poorer diet quality and energy intake for women (but not men). Better measurement of social dimensions of eating may inform ways to improve nutrition, especially for persons with diabetes for whom diet improvement can result in better disease outcomes. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Clavicle Trial: A Multicenter Randomized Controlled Trial Comparing Operative with Nonoperative Treatment of Displaced Midshaft Clavicle Fractures.

PubMed

Ahrens, Philip M; Garlick, Nicholas I; Barber, Julie; Tims, Emily M

2017-08-16

The treatment of displaced midshaft clavicle fractures remains controversial. We undertook a multicenter randomized controlled trial to compare effectiveness and safety between nonoperative management and ORIF (open reduction and internal fixation) for displaced midshaft clavicle fractures in adults. Three hundred and one eligible adult patients were randomized to 1 of the 2 treatment groups and followed at 6 weeks, 3 months, and 9 months after recruitment. The primary outcome was the rate of radiographically evident nonunion at 3 months following treatment. Secondary outcomes were the rate of radiographically evident nonunion at 9 months, limb function measured using the Constant-Murley Score and DASH (Disabilities of the Arm, Shoulder and Hand) score, and patient satisfaction. There was no difference in the proportion of patients with radiographic evidence of nonunion at 3 months between the operative (28%) and nonoperative (27%) groups, whereas at 9 months the proportion with nonunion was significantly lower (p < 0.001) in the operative group (0.8%) than in the nonoperative group (11%). The DASH and Constant-Murley scores and patient satisfaction were all significantly better in the operative group than in the nonoperative group at 6 weeks and 3 months. Although at 3 months there was no evidence that surgery had reduced the rate of nonunion of displaced midshaft clavicle fractures, at 9 months nonoperative treatment had led to a significantly higher nonunion rate (11% compared with <1%). The rate of secondary surgical intervention during the trial period was 12 (11%) of the 147 patients in the nonoperative group. ORIF is a safe and reliable intervention with superior early functional outcomes and should be considered for patients who sustain this common injury. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty

PubMed Central

von Engelhardt, Lars V; Manzke, Michael; Breil-Wirth, Andreas; Filler, Timm J; Jerosch, Joerg

2017-01-01

AIM To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system. METHODS Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation (CoR) was assessed and compared to the CoR of the prosthesis by using the MediCAD® software. Additionally, the pre- and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score. RESULTS Both, the Constant and DASH scores improved significantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc. (P > 0.05). The pre- and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neck-shaft angle showed no significant changes (P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring. CONCLUSION TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut. PMID:29094010

Mirror therapy for distal radial fractures: A pilot randomized controlled study.

PubMed

Bayon-Calatayud, Manuel; Benavente-Valdepeñas, Ana Maria; Del Prado Vazquez-Muñoz, Maria

2016-10-12

To investigate the efficacy of mirror therapy in reducing pain and disability in patients with distal radial fractures. Pilot randomized controlled study. Twenty-two patients with closed distal radial fracture. Patients were randomly assigned to experimental (= 11) or control (= 11) groups. Researchers were blinded to group allocation. Both groups received conventional physiotherapy. In addition, the experimental group had 15 sessions of mirror therapy (a daily session, 30 min). The control group received the same amount of conventional occupational therapy. Assessment was made from baseline to post-treatment. Pain was measured on a visual analogue scale (VAS). Active wrist extension and Quick-DASH (Disabilities of Arm, Shoulder and Hand) were used to assess functional recovery. Pain, disability, and range of motion improved for both groups after intervention. No significant post-treatment differences were found between groups in Quick-DASH (= 0.409), active wrist extension (= 0.191) and VAS scores (= 0.807). There was no significant difference in active wrist extension between groups. Mirror therapy was not superior to conventional occupational therapy in reducing pain and disability.

Biceps muscle fatty infiltration and atrophy. A midterm review after arthroscopic tenotomy of the long head of the biceps.

PubMed

The, Bertram; Brutty, Mike; Wang, Allan; Wambeek, Nicholas D K; Campbell, Peter; Halliday, Michael J C; Ackland, Timothy R

2015-03-01

Pathology of the long head of the biceps (LHB) tendon is commonly treated by tenotomy. High levels of clinical function and patient satisfaction are reported in the short-term. The purpose of this study was to investigate the midterm effects of tenotomy on biceps fatty infiltration and atrophy in active working-age male patients. Twenty-five men (mean age, 57 years) were evaluated at a mean follow-up of 6.7 years after tenotomy. Bilateral magnetic resonance imaging (MRI) was performed, and fatty infiltration of the biceps was assessed relative to the ipsilateral triceps. Seventeen participants had an intact contralateral LHB tendon. To assess atrophy, anterior muscle compartment volume was measured by serial cross-sectional area measurements on MRI. The tenotomized side was then compared to the healthy side in these 17 participants. Clinical scores were obtained using the QuickDASH and Oxford Elbow Score, and the occurrence of a Popeye sign and residual pain were recorded. Good clinical function was maintained at a mean follow-up time of 6.7 years (range, 4 to 10 years) (QuickDASH score of 7.1; standard error [SE], 1.8) and Oxford Elbow Score of 97.9 [SE 1.2]). Eleven of the 25 participants had a Popeye deformity. Four participants showed signs of fatty infiltration, and all were minor (grade 1). The mean decrease in total volume of the anterior musculature was 3.6%. In participants without a Popeye deformity, it was 3.3%, whereas it was 4.1% in participants with a Popeye sign (P = .8). In the midterm, LHB tenotomy in active men of working age does not result in fatty degeneration or substantial atrophy in the anterior musculature of the arm. Clinical function remains good. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Home food environment in relation to children's diet quality and weight status.

PubMed

Couch, Sarah C; Glanz, Karen; Zhou, Chuan; Sallis, James F; Saelens, Brian E

2014-10-01

The objective of this cohort study was to explore relationships among the home food environment (HFE), child/parent characteristics, diet quality, and measured weight status among 699 child-parent pairs from King County, WA, and San Diego County, CA. HFE variables included parenting style/feeding practices, food rules, frequency of eating out, home food availability, and parents' perceptions of food costs. Child dietary intake was measured by 3-day recall and diet quality indicators included fruits and vegetables, sweet/savory snacks, high-calorie beverages, and Dietary Approaches to Stop Hypertension (DASH) score. Individual linear regression models were run in which child BMI z score and child diet quality indicators were dependent variables and HFE variables and child/parent characteristics were independent variables of interest. Fruit and vegetable consumption was associated with parental encouragement/modeling (β=.68, P<0.001) and unhealthful food availability (-0.27, P<0.05); DASH score with food availability (healthful: 1.3, P<0.01; unhealthful: -2.25, P<0.001), food rules (0.45, P<0.01), and permissive feeding style (-1.04, P<0.05); high-calorie beverages with permissive feeding style (0.14, P<0.01) and unhealthful food availability (0.21, P<0.001); and sweet/savory snacks with healthful food availability (0.26, P<0.05; unexpectedly positive). Children's BMI z score was positively associated with parent's use of food restriction (0.21, P<0.001), permissive feeding style (0.16, P<0.05), and concern for healthy food costs (0.10, P<0.01), but negatively with verbal encouragement/modeling (-0.17, P<0.05), and pressure to eat (-0.34, P<0.001). Various HFE factors associated with parenting around eating and food availability are related to child diet quality and weight status. These factors should be considered when designing interventions for improving child health. Copyright © 2014 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Healthful dietary patterns and type 2 diabetes mellitus risk among women with a history of gestational diabetes mellitus.

PubMed

Tobias, Deirdre K; Hu, Frank B; Chavarro, Jorge; Rosner, Bernard; Mozaffarian, Dariush; Zhang, Cuilin

2012-11-12

Type 2 diabetes mellitus (T2DM) has reached epidemic proportions. Women with gestational diabetes mellitus (GDM) are at high risk for T2DM after pregnancy. Adherence to healthful dietary patterns has been inversely associated with T2DM in the general population; however, whether these dietary patterns are associated with progression to T2DM among a susceptible population is unknown. Four thousand four hundred thirteen participants from the Nurses' Health Study II cohort with prior GDM were followed up from 1991 to 2005. We derived the alternate Mediterranean diet (aMED), Dietary Approaches to Stop Hypertension (DASH), and alternate Healthy Eating Index (aHEI) dietary pattern adherence scores from a post-GDM validated food-frequency questionnaire, with cumulative average updating every 4 years. Multivariable Cox proportional hazards models estimated the relative risk (hazard ratios) and 95% confidence intervals. We observed 491 cases of incident T2DM during 52 743 person-years. All 3 patterns were inversely associated with T2DM risk with adjustment for age, total calorie intake, age at first birth, parity, ethnicity, parental diabetes, oral contraceptive use, menopause, and smoking. When we compared participants with the highest adherence (quartile 4) vs lowest (quartile 1), the aMED pattern was associated with 40% lower risk of T2DM (hazard ratio, 0.60 [95% CI, 0.44-0.82; P=.002]); the DASH pattern, with 46% lower risk (0.54 [0.39-0.73; P.001]); and the aHEI pattern, with 57% lower risk (0.43 [0.31-0.59; P.001]). Adjustment for body mass index moderately attenuated these findings. Adherence to healthful dietary patterns is associated with lower T2DM risk among women with a history of GDM. The inverse associations are partly mediated by body mass index.

Persistent non-union of the humeral shaft treated by plating and autologous bone grafting.

PubMed

Pollon, Tristan; Reina, Nicolas; Delclaux, Stéphanie; Bonnevialle, Paul; Mansat, Pierre; Bonnevialle, Nicolas

2017-02-01

Surgical treatment of persistent non-union of the humeral shaft is a complex situation because of the risk of failure and surgery-related complications. The primary objective of this study was to evaluate clinical and radiological results of a continuous series of persistent non-union treated with plating and bone grafting. The secondary objective was to expose factors contributing to the failure of prior bone union attempts. Sixteen patients (average age of 52 years) were treated for persistent non-union of the humeral shaft in our department; six of these patients had predisposing comorbidities or addictions. The persistent non-union was treated by plating with autologous bone graft from the iliac crest in a single-stage procedure in 12 cases and a two-stage procedure in three cases; one case was treated with plating and vascularized fibula graft. At a minimum follow-up of 12 months (average 78 months), four (25 %) failed to heal. The 12 other patients had bone union after an average of eight months. The average QuickDASH score was 48 points (18-72). A retrospective analysis of the prior attempts to treat the non-union revealed three cases of unstable fixation, four cases with no osteogenic supply and seven cases of positive microbiological cultures at the non-union site. Plating and autologous bone grafting resulted in union in only 75 % of persistent non-union of the humeral shaft. The persistent nature of the humeral shaft non-union could be attributed to deviating from validated rules for surgical treatment and/or the presence of a surgical site infection.

Outcomes After Dermal Allograft Reconstruction of Chronic or Subacute Pectoralis Major Tendon Ruptures.

PubMed

Neumann, Julie A; Klein, Christopher M; van Eck, Carola F; Rahmi, Hithem; Itamura, John M

2018-01-01

Avoiding delay in the surgical management of pectoralis major (PM) ruptures optimizes outcomes. However, this is not always possible, and when a tear becomes chronic or when a subacute tear has poor tissue quality, a graft can facilitate reconstruction. The primary aim was to evaluate the clinical outcomes of PM reconstruction with dermal allograft augmentation for chronic tears or for subacute tears with poor tissue quality. A second aim was to determine patient and surgical factors affecting outcome. Case series; Level of evidence, 4. Nineteen consecutive patients (19 PM ruptures) with a mean ± SD age of 39.1 ± 8.4 years were retrospectively reviewed at 26.4 ± 16.0 months following PM tendon reconstruction with dermal allograft. Surgery was performed at 19.2 ± 41.2 months after injury (median, 7.6 months; range, 1.1-185.4 months). Several outcome scores were recorded pre- and postoperatively, including Disabilities of the Arm, Shoulder, and Hand (DASH), as well as visual analog scale (VAS) (range, 0-10; 0 = no pain) and Single Assessment Numeric Evaluation (SANE). Range of motion, Constant score, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test score, and complications/reoperations were recorded postoperatively. Scores improved significantly for the DASH (preoperative, 34.9; postoperative, 8.0; P < .001) and VAS (preoperative, 5.0; postoperative, 1.5; P = .011). There was a trend toward improved SANE scores (preoperative, 15.0; postoperative, 80.0; P = .097), but the difference was not statistically significant, likely because of the small number of patients having preoperative SANE scores for review. Increased age was associated with higher VAS scores ( r = 0.628, P = .016) and less forward flexion ( r = -0.502, P = .048) and external rotation ( r = -0.654, P = .006). Patients with workers' compensation had lower scores for 3 measures: SANE (75.8 vs 88.4, P = .040), Constant (86.7 vs 93.4, P = .019), and ASES (81.9 vs 97.4, P = .016). Operating on the dominant extremity resulted in lower Constant scores (87.8 vs 95.4, P = .012). A 2-head tendon tear (107.5° vs 123.3°, P = .033) and the use of >1 graft (105.0° vs 121.3°, P = .040) resulted in decreased abduction. This was the first large series to observe patients with chronic or subacute PM tendon tears treated with dermal allograft reconstruction. PM tendon reconstruction with dermal allografts resulted in good objective and subjective patient-reported outcomes.

The effect of redox-active cyanomanganese(I) ligands on intramolecular electron transfer to, and alkyne alignment in, M(CO)(RC[triple bond, length as m-dash]CR)Tp' (M = Mo or W) units.

PubMed

Adams, Christopher J; Connelly, Neil G; Onganusorn, Sriwipha

2009-04-28

The complexes [(eta-C(5)Me(5))(ON)LMn(micro-CN)M(CO)(RC[triple bond, length as m-dash]CR)Tp'](+) (L = CNXyl, M = Mo; L = CNBu(t), M = Mo or W, R = Ph or Me) and trans- or cis-[(dppm){(EtO)(3)P}(OC)(2)Mn(micro-CN)M(CO)(PhC[triple bond, length as m-dash]CPh)Tp'](+), and their linkage isomers [(eta-C(5)Me(5))(ON)LMn(micro-NC)M(CO)(PhC[triple bond, length as m-dash]CPh)Tp'](+) and trans- or cis-[(dppm){(EtO)(3)P}(OC)(2)Mn(micro-NC)M(CO)(PhC[triple bond, length as m-dash]CPh)Tp'](+), undergo two one-electron oxidations. The complexes [(eta-C(5)Me(5))(ON)LMn(micro-XY)M(CO)(RC[triple bond, length as m-dash]CR)Tp'](+) (XY = CN or NC) are oxidised first at the N-bound metal centre and then at the C-bound centre. For [(dppm){(EtO)(3)P}(OC)(2)Mn(micro-XY)M(CO)(PhC[triple bond, length as m-dash]CPh)Tp'](+), the trans isomers are first oxidised at manganese whereas the cis isomers are first oxidised at M. Thus, the order of one-electron oxidation of the two series of binuclear monocations is influenced by linkage isomerisation of the cyanide bridge and cis-trans isomerisation of the Mn(CO)(2) group. IR spectroscopic changes on reaction of Ag(+) with [(eta-C(5)Me(5))(ON)(Bu(t)NC)Mn(micro-CN)W(CO)(MeC[triple bond, length as m-dash]CMe)Tp'](+) are consistent with one-electron at the N-bound tungsten centre. Likewise, trans-[(dppm){(EtO)(3)P}(OC)(2)Mn(micro-NC)M(CO)(PhC[triple bond, length as m-dash]CPh)Tp'](+) (M = Mo or W) give the stable dications [(dppm){(EtO)(3)P}(OC)(2)Mn(micro-NC)M(CO)(PhC[triple bond, length as m-dash]CPh)Tp'](2+). Significantly longer Mn-P bond distances in trans-[(dppm){(EtO)(3)P}(OC)(2)Mn(micro-NC)Mo(CO)(PhC[triple bond, length as m-dash]CPh)Tp'](2+) than in trans-[(dppm){(EtO)(3)P}(OC)(2)Mn(micro-NC)Mo(CO)(PhC[triple bond, length as m-dash]CPh)Tp'](+) are consistent with one-electron oxidation first at Mn(I); the alignment of the (CN)Mn(CO)(2){P(OEt)(3)}(dppm) fragment relative to the alkyne in trans-[(dppm){(EtO)(3)P}(OC)(2)Mn(micro-NC)Mo(CO)(PhC[triple bond, length as m-dash]CPh)Tp'](+) suggests it acts as a pi-acceptor, in contrast to related species such as trans-(NC)Mn(CO)(2){P(OEt)(3)}(dppm) and (NC)Mn(NO){P(OPh)(3)}(pi-C(5)H(4)Me) which behave as simple N-donors.

An unusual alkylidyne homologation.

PubMed

Han, Yong-Shen; Hill, Anthony F; Kong, Richard Y

2018-02-27

The reaction of [W([triple bond, length as m-dash]CH)Br(CO) 2 (dcpe)] (dcpe = 1,2-bis(dicyclohexylphosphino)ethane) with t BuLi and SiCl 4 affords the trichlorosilyl ligated neopentylidyne complex [W([triple bond, length as m-dash]C t Bu)(SiCl 3 )(CO) 2 (dcpe)]. This slowly reacts with H 2 O to afford [W([triple bond, length as m-dash]CCH 2 t Bu)Cl 3 (dcpe)] and ultimately H 2 C[double bond, length as m-dash]CH t Bu via an unprecedented alkylidyne homologation in which coordinated CO is the source of the additional carbon atom with potential relevance to the Fischer-Tropsch process.

Construct validity, test-retest reliability and internal consistency of the Thai version of the disabilities of the arm, shoulder and hand questionnaire (DASH-TH) in patients with carpal tunnel syndrome.

PubMed

Buntragulpoontawee, Montana; Phutrit, Suphatha; Tongprasert, Siam; Wongpakaran, Tinakon; Khunachiva, Jeeranan

2018-03-27

This study evaluated additional psychometric properties of the Thai version of the disabilities of the arm, shoulder and hand questionnaire (DASH-TH) which included, test-retest reliability, construct validity, internal consistency of in patients with carpal tunnel syndrome. As for determining construct validity, the Thai EuroQOL questionnaire (EQ-5D-5L) was also administered in order to examine convergent and divergent validity. Fifty patients completed both questionnaires. The DASH-TH showed excellent test-retest reliability (intraclass correlation coefficient = 0.811) and internal consistency (Cronbach's alpha = 0.911). The exploratory factor analysis yielded a six-factor solution while the confirmatory factor analysis denoted that the hypothesized model adequately fit the data with a comparative fit index of 0.967 and a Tucker-Lewis index of 0.964. The related subscales between the DASH-TH and the Thai EQ-5D-5L were significantly correlated, indicating the DASH-TH's convergent and discriminant validity. The DASH-TH demonstrated good reliability, internal consistency construct validity, and multidimensionality, in assessing the upper extremity function in carpal tunnel syndrome patients.

Initial varus displacement of proximal humerus fractures results in similar function but higher complication rates.

PubMed

Capriccioso, Christina E; Zuckerman, Joseph D; Egol, Kenneth A

2016-04-01

To investigate the effect of initial varus or valgus surgical neck alignment on outcomes of patients who sustained proximal humerus fractures treated with open reduction and internal fixation (ORIF). An institutional review board approved database of proximal humerus fractures treated with locked plates was reviewed. Of 185 fractures in the database, 101 fractures were identified and met inclusion criteria. Initial varus displacement was seen in 47 fractures (OTA types 11.A2.2, A3.1, A3.3, B1.2, B2.2, C1.2, C2.2, or C2.3) and initial valgus displacement was observed in 54 fractures (OTA types 11.A2.3, B1.1, C1.1, or C2.1). All patients were treated in a similar manner and examined by the treating physician at standard intervals. Functional outcomes were quantified via the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and physical examination data at 12 months. Radiographs were reviewed for complications of healing. Additionally, complication rate and reoperation rate were investigated. Patients who presented with initial varus displacement had an average age of 59.3 years, while patients in the valgus group had an average age of 62.4 years. Overall, there was no statistically significant difference in age, sex distribution, BMI, fracture parts, screws used, or implant plate type between the two groups. At a minimum 12 months follow up, there was no significant difference in DASH scores between those presenting with varus versus valgus fracture patterns. In addition, no significant differences were seen in final shoulder range of motion in any plane. Overall, 30 patients included in this study developed a complication. A significantly greater number of patients in the initial varus cohort developed complications (40.4%), as compared to 20.3% of patients in the initial valgus cohort (P=0.03). Fourteen patients in this study underwent reoperation. Nine of these patients were in the varus cohort, while 5 were in the valgus cohort (P=0.15). In this study, initial surgical neck displacement in varus or valgus was found to not significantly affect functional outcome. Based upon our findings, patients with varus displaced proximal humerus fractures are at a greater risk of developing postoperative complications than those who present with initial valgus displaced fracture patterns. Copyright © 2016 Elsevier Ltd. All rights reserved.

Outcome after brachial plexus injury surgery and impact on quality of life.

PubMed

Rasulić, Lukas; Savić, Andrija; Živković, Bojana; Vitošević, Filip; Mićović, Mirko; Baščarević, Vladimir; Puzović, Vladimir; Novaković, Nenad; Lepić, Milan; Samardžić, Miroslav; Mandić-Rajčević, Stefan

2017-07-01

The aim of this study was to investigate outcomes after surgery for brachial plexus injury (BPI), not only motor outcomes but also the quality of life of the patients. We operated on 128 consecutive patients with BPI from 1992 to 2012. We documented the information on the injured nerve, level of injury, type of treatment used, timing of surgery, patient age, and preoperative and postoperative motor deficits. In 69 patients who agreed to participate in a quality of life study, additional assessments included functionality, pain, quality of life, patient satisfaction, and psychosocial health. Of patients who underwent only exploration and neurolysis, 35.3% showed a good quality of recovery. Patients who underwent nerve reconstruction using nerve grafting showed a better rate of good quality recovery (56.7%), and the results following nerve transfer depended on the type of transfer used. After surgery, 82.6% of patients showed significant improvement, 82.6% were satisfied, and 81.2% responded positively when asked if they would undergo surgery again if they knew the current result beforehand. Overall, 69.6% patients continued working after surgery. The mean DASH disability score was high (58.7) in the study group. Patients who had early surgery showed a consistently higher DASH score. About 76% of patients reported having pain regularly, and 18.8% reported depression or anxiety. We consider that it is important to report not only muscle recovery, but also other aspects of recovery.

Dietary Patterns Associated with Lower 10-Year Atherosclerotic Cardiovascular Disease Risk among Urban African-American and White Adults Consuming Western Diets

PubMed Central

Bodt, Barry A.; Stave Shupe, Emily; Zonderman, Alan B.; Evans, Michele K.

2018-01-01

The study’s objective was to determine whether variations in the 2013 American College of Cardiology/American Heart Association 10-year risk for atherosclerotic cardiovascular disease (ASCVD) were associated with differences in food consumption and diet quality. Findings from the baseline wave of Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study 2004–2009, revealed participants consumed a Western diet. Diet quality measures, specifically the Healthy Eating Index (HEI)-2010, Dietary Approaches to Stop Hypertension (DASH) diet and the Mean Adequacy Ratio (MAR), based on two 24-h recalls collected during follow-up HANDLS studies from 2009–2013, were used. Reported foods were assigned to 27 groups. In this cross-sectional analysis, the participants (n = 2140) were categorized into tertiles based on their 10-year ASCVD risk. Lower and upper tertiles were used to determine significantly different consumption rates among the food groups. Ten groups were used in hierarchical case clustering to generate four dietary patterns (DPs) based on group energy contribution. The DP with the highest HEI-2010 score included sandwiches along with vegetables and cheese/yogurt. This DP, along with the pizza/sandwiches DP, had significantly higher DASH and MAR scores and a lower 10-year ASCVD risk, compared to the remaining two DPs–meats/sandwiches and sandwiches/bakery products; thus, Western dietary patterns were associated with different levels of ASCVD 10-year risk. PMID:29385036

Systematic diagnosis and therapy of lateral elbow pain with emphasis on elbow instability.

PubMed

Kniesel, Bettina; Huth, Jochen; Bauer, Gerhard; Mauch, Frieder

2014-12-01

In recalcitrant epicondylitis innumerable operative techniques have been published, nevertheless a certain percentage of patients remains symptomatic after operative treatment. We developed an individual, systematic diagnostic pathway including arthroscopic assessment of elbow stability to identify the optimal and respectively less invasive therapy. We so far included 40 patients with recalcitrant lateral epicondylitis (mean age 46 ± 11). 5 patients had previous surgery. In all patients, we did an elbow arthroscopy and a systematic arthroscopic stability testing. 25 patients were treated exclusively arthroscopically once instability was excluded. In 13 patients with slight instability, we did an open debridement of the lateral tendon complex and local refixation. Two patients with severe instability were treated with open debridement and additional stabilization of the LUCL with a trizeps graft. With a minimum follow-up of 1 year, we assessed the DASH score and subjective patient satisfaction. Mean follow-up was 24 ± 12 months, mean duration of symptoms before surgery was 19 ± 18 months. The mean DASH score at follow-up was 22 ± 19.36 patients reported symptoms improvement, 34 patients would repeat surgery given the same situation; in 30 cases, patients expectations had been fulfilled. We did not observe any intraoperative complications or infections. One patient developed joint stiffness requiring reoperation. Using a systematic diagnostic pathway including assessment of elbow stability and consecutive individualized, respectively, less invasive surgical procedure we acquired high patients satisfaction and good clinical outcome with a low complication rate. Level III.

Cross-cultural adaptation of Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score: Reliability and validity in Turkish-speaking overhead athletes.

PubMed

Turgut, Elif; Tunay, Volga Bayrakci

2018-03-09

Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC-SES) is a subjective assessment tool to measure functional status of the upper extremities in overhead athletes. The aim was to translate and culturally adapt the KJOC-SES and to evaluate the psychometric properties of the Turkish version (KJOC-SES-Tr) in overhead athletes. The forward and back-translation method was followed. One hundred and twenty-three overhead athletes completed the KJOC-SES-Tr, the Disabilities of the Arm, Shoulder, and Hand (DASH), and the American Shoulder and Elbow Surgeons Evaluation Form (ASES). Participants were assigned to one of the following subgroups: asymptomatic (playing without pain) or symptomatic (playing with pain, or not playing due to pain). Internal consistency, reliability, construct validity, discriminant validity, and content validity of the KJOC-SES-Tr were tested. The test-retest reliability of the KJOC-SES-Tr was excellent with an interclass coefficient of 0.93. There was a strong correlation between the KJOC-SES-Tr and the DASH and the ASES, indicating that the construct validity was good for all participants. Results of the KJOC-SES-Tr significantly differed between different subgroups and categories of athletes. The floor and ceiling effects were acceptable for symptomatic athletes. The KJOC-SES-Tr was shown to be valid, reliable tool to monitor the return to sports following injuries in athletes. Copyright © 2018 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

[Validation of the German version of the Oxford Elbow Score : A cross-sectional study].

PubMed

Marquardt, J; Schöttker-Königer, T; Schäfer, A

2016-08-01

Elbow complaints are complex problems leading to severe consequences for affected people and the healthcare system. The German version of the Oxford Elbow Score (OES) is the first German-speaking instrument that specifically measures elbow complaints from the patient's perspective and changes of their health status. The aim of this study is the validation of the German version of the OES. In this context the internal consistency and the construct validity were investigated. 59 patients with elbow complaints completed the German version of the OES, the DASH and the SF-36 in a cross-sectional study. The internal consistency was calculated with Cronbach's alpha coefficients. Spearman's correlation coefficients were used to confirm construct validity. Cronbach's alpha for pain, function and psychological subscales was 0.88, 0.81 and 0.90, respectively. The whole questionnaire presents a Cronbach's alpha value of 0.93. Convergent construct validity was confirmed with correlation coefficients containing values of -0.84, -0.77 and -0.82 compared to DASH and values ranging from 0.41 to 0.80 compared with the physical domains of the SF-36. The divergent construct validity presented values ranging from 0.07 to 0.20 with the SF-36 domains of "general health perception" and "mental health". The German OES is an internal consistent instrument with good convergent and divergent construct validity. Other aspects of the validity, the reliability and the responsiveness should be confirmed through further studies.

Among 4 Diet Quality Indexes, Only the Alternate Mediterranean Diet Score Is Associated with Better Colorectal Cancer Survival and Only in African American Women in the Multiethnic Cohort.

PubMed

Jacobs, Simone; Harmon, Brook E; Ollberding, Nicholas J; Wilkens, Lynne R; Monroe, Kristine R; Kolonel, Laurence N; Le Marchand, Loic; Boushey, Carol J; Maskarinec, Gertraud

2016-09-01

Colorectal cancer (CRC) is the second leading cause of cancer-related death in the United States, with a 5-y survival rate of ∼65%. Therefore, the identification of modifiable health factors to improve CRC survival is crucial. We investigated the association of 4 prediagnostic a priori diet quality indexes with CRC-specific and all-cause mortality in the Multiethnic Cohort (MEC). The MEC included >215,000 African-American, Native Hawaiian, Japanese-American, Latino, and white adults living in Hawaii and California who completed a validated quantitative food-frequency questionnaire in 1993-1996. CRC cases and deaths were identified through linkages to cancer registries and to state and national vital registries. Sex-specific HRs and 95% CIs were estimated for the Healthy Eating Index (HEI) 2010, the Alternative HEI (AHEI) 2010, the alternate Mediterranean Diet (aMED) score, and the Dietary Approaches to Stop Hypertension (DASH) index with CRC-specific and overall mortality as the primary outcomes. Ethnicity-specific analyses were the secondary outcomes. Among 4204 MEC participants diagnosed with invasive CRC through 2010, 1976 all-cause and 1095 CRC-specific deaths were identified. A higher aMED score was associated with lower CRC-specific mortality in women [HR continuous pattern score divided by its respective SD (HR1SD): 0.86; 95% CI: 0.77, 0.96] but not in men (HR1SD: 1.01; 95% CI: 0.92, 1.11). A higher aMED score was also associated with lower all-cause mortality in women (HR1SD: 0.88; 95% CI: 0.81, 0.96) but not in men (HR1SD: 1.00; 95% CI: 0.93, 1.07). The HEI-2010, AHEI-2010, and DASH index were not significantly associated with CRC-specific or with all-cause mortality. The inverse relation for the aMED score was limited to African Americans and to colon (compared with rectal) cancer. The aMED score was related to lower mortality only in African-American women (1 of 5 ethnic groups studied). The results should be interpreted with caution due to the small numbers of cases within ethnic groups and the issue of multiple testing. © 2016 American Society for Nutrition.

The Functional Arm Scale for Throwers (FAST)-Part II: Reliability and Validity of an Upper Extremity Region-Specific and Population-Specific Patient-Reported Outcome Scale for Throwing Athletes.

PubMed

Huxel Bliven, Kellie C; Snyder Valier, Alison R; Bay, R Curtis; Sauers, Eric L

2017-04-01

The Functional Arm Scale for Throwers (FAST) is an upper extremity (UE) region-specific and population-specific patient-reported outcome (PRO) scale developed to measure health-related quality of life in throwers with UE injuries. Stages I and II, described in a companion paper, of FAST development produced a 22-item scale and a 9-item pitcher module. Stage III of scale development, establishing reliability and validity of the FAST, is reported herein. To describe stage III of scale development: reliability and validity of the FAST. Cohort study (diagnosis); Level of evidence, 2. Data from throwing athletes collected over 5 studies were pooled to assess reliability and validity of the FAST. Reliability was estimated using FAST scores from 162 throwing athletes who were injured (n = 23) and uninjured (n = 139). Concurrent validity was estimated using FAST scores and Disabilities of the Arm, Shoulder, and Hand (DASH) and Kerlan-Jobe Orthopaedic Clinic (KJOC) scores from 106 healthy, uninjured throwing athletes. Known-groups validity was estimated using FAST scores from 557 throwing athletes who were injured (n = 142) and uninjured (n = 415). Reliability and validity were assessed using intraclass correlation coefficients (ICCs), and measurement error was assessed using standard error of measurement (SEM) and minimum detectable change (MDC). Receiver operating characteristic curves and sensitivity/specificity values were estimated for known-groups validity. Data from a separate group (n = 18) of postsurgical and nonoperative/conservative rehabilitation patients were analyzed to report responsiveness of the FAST. The FAST total, subscales, and pitcher module scores demonstrated excellent test-retest reliability (ICC, 0.91-0.98). The SEM 95 and MDC 95 for the FAST total score were 3.8 and 10.5 points, respectively. The SEM 95 and MDC 95 for the pitcher module score were 5.7 and 15.7 points, respectively. The FAST scores showed acceptable correlation with DASH (ICC, 0.49-0.82) and KJOC (ICC, 0.62-0.81) scores. The FAST total score classified 85.1% of players into the correct injury group. For predicting UE injury status, a FAST total cutoff score of 10.0 out of 100.0 was 91% sensitive and 75% specific, and a pitcher module score of 10.0 out of 100.0 was 87% sensitive and 78% specific. The FAST total score demonstrated responsiveness on several indices between intake and discharge time points. The FAST is a reliable, valid, and responsive UE region-specific and population-specific PRO scale for measuring patient-reported health care outcomes in throwing athletes with injury.

The Functional Arm Scale for Throwers (FAST)—Part II: Reliability and Validity of an Upper Extremity Region-Specific and Population-Specific Patient-Reported Outcome Scale for Throwing Athletes

PubMed Central

Huxel Bliven, Kellie C.; Snyder Valier, Alison R.; Bay, R. Curtis; Sauers, Eric L.

2017-01-01

Background: The Functional Arm Scale for Throwers (FAST) is an upper extremity (UE) region-specific and population-specific patient-reported outcome (PRO) scale developed to measure health-related quality of life in throwers with UE injuries. Stages I and II, described in a companion paper, of FAST development produced a 22-item scale and a 9-item pitcher module. Stage III of scale development, establishing reliability and validity of the FAST, is reported herein. Purpose: To describe stage III of scale development: reliability and validity of the FAST. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Data from throwing athletes collected over 5 studies were pooled to assess reliability and validity of the FAST. Reliability was estimated using FAST scores from 162 throwing athletes who were injured (n = 23) and uninjured (n = 139). Concurrent validity was estimated using FAST scores and Disabilities of the Arm, Shoulder, and Hand (DASH) and Kerlan-Jobe Orthopaedic Clinic (KJOC) scores from 106 healthy, uninjured throwing athletes. Known-groups validity was estimated using FAST scores from 557 throwing athletes who were injured (n = 142) and uninjured (n = 415). Reliability and validity were assessed using intraclass correlation coefficients (ICCs), and measurement error was assessed using standard error of measurement (SEM) and minimum detectable change (MDC). Receiver operating characteristic curves and sensitivity/specificity values were estimated for known-groups validity. Data from a separate group (n = 18) of postsurgical and nonoperative/conservative rehabilitation patients were analyzed to report responsiveness of the FAST. Results: The FAST total, subscales, and pitcher module scores demonstrated excellent test-retest reliability (ICC, 0.91-0.98). The SEM95 and MDC95 for the FAST total score were 3.8 and 10.5 points, respectively. The SEM95 and MDC95 for the pitcher module score were 5.7 and 15.7 points, respectively. The FAST scores showed acceptable correlation with DASH (ICC, 0.49-0.82) and KJOC (ICC, 0.62-0.81) scores. The FAST total score classified 85.1% of players into the correct injury group. For predicting UE injury status, a FAST total cutoff score of 10.0 out of 100.0 was 91% sensitive and 75% specific, and a pitcher module score of 10.0 out of 100.0 was 87% sensitive and 78% specific. The FAST total score demonstrated responsiveness on several indices between intake and discharge time points. Conclusion: The FAST is a reliable, valid, and responsive UE region-specific and population-specific PRO scale for measuring patient-reported health care outcomes in throwing athletes with injury. PMID:28451614

Cross-cultural adaptation of the Disability of Arm, Shoulder, and Hand questionnaire: Spanish for Puerto Rico Version

PubMed Central

Mulero-Portela, Ana L.; Colón-Santaella, Carmen L.; Cruz-Gomez, Cynthia

2010-01-01

The purpose of this study was to perform a cross-cultural adaptation of the Disability of Arm, Shoulder, and Hand (DASH) questionnaire to Spanish for Puerto Rico. Five steps were followed for the cross-cultural adaptation: forward translations into Spanish for Puerto Rico, synthesis of the translations, back translations into English, revision by an expert committee, and field test of the prefinal version. Psychometric characteristics of reliability and construct validity were evaluated for the final version. Internal consistency of the final version was high (Cronbach's α = 0.97) and item-to-total correlations were moderate (range from 0.44 to 0.85). Construct validity was evaluated by correlating the DASH with the scales of the Functional Assessment of Cancer Therapy - Breast. Fair to moderate correlations found in this study between the DASH and most scales of the Functional Assessment of Cancer Therapy - Breast support the construct validity of the Puerto Rico-Spanish DASH. The final version of the questionnaire was revised and approved by the Institute for Work and Health of Canada. Revisions to the original DASH English version are recommended. This version of the DASH is valid and reliable, and it can be used to evaluate outcomes in both clinical and research settings. PMID:19901616

The use of a tablet computer to complete the DASH questionnaire.

PubMed

Dy, Christopher J; Schmicker, Thomas; Tran, Quynh; Chadwick, Brian; Daluiski, Aaron

2012-12-01

To determine whether electronic self-administration of the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire using a tablet computer increased completion rate compared with paper self-administration. We gave the DASH in self-administered paper form to 222 new patients in a single hand surgeon's practice. After a washout period of 5 weeks, we gave the DASH in self-administered tablet computer form to 264 new patients. A maximum of 3 questions could be omitted before the questionnaire was considered unscorable. We reviewed the submitted surveys to determine the number of scorable questionnaires and the number of omitted questions in each survey. We completed univariate analysis and regression modeling to determine the influence of survey administration type on respondent error while controlling for patient age and sex. Of the 486 total surveys, 60 (12%) were not scorable. A significantly higher proportion of the paper surveys (24%) were unscorable compared with electronic surveys (2%), with significantly more questions omitted in each paper survey (2.6 ± 4.4 questions) than in each electronic survey (0.1 ± 0.8 questions). Logistic regression analysis revealed survey administration mode to be significantly associated with DASH scorability while controlling for age and sex, with electronic survey administration being 14 times more likely than paper administration to yield a scorable DASH. In our retrospective series, electronic self-administration of the DASH decreased the number of omitted questions and yielded a higher number of scorable questionnaires. Prospective, randomized evaluation is needed to better delineate the effect of survey administration on respondent error. Administration of the DASH with a tablet computer may be beneficial for both clinical and research endeavors to increase completion rate and to gain other benefits from electronic data capture. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Time Course of Change in Blood Pressure From Sodium Reduction and the DASH Diet.

PubMed

Juraschek, Stephen P; Woodward, Mark; Sacks, Frank M; Carey, Vincent J; Miller, Edgar R; Appel, Lawrence J

2017-11-01

Both sodium reduction and the Dietary Approaches to Stop Hypertension (DASH) diet lower blood pressure (BP); however, the patterns of their effects on BP over time are unknown. In the DASH-Sodium trial, adults with pre-/stage 1 hypertension, not using antihypertensive medications, were randomly assigned to either a typical American diet (control) or DASH. Within their assigned diet, participants randomly ate each of 3 sodium levels (50, 100, and 150 mmol/d, at 2100 kcal) over 4-week periods. BP was measured weekly for 12 weeks; 412 participants enrolled (57% women; 57% black; mean age, 48 years; mean systolic BP [SBP]/diastolic BP [DBP], 135/86 mm Hg). For those assigned control, there was no change in SBP/DBP between weeks 1 and 4 on the high-sodium diet (weekly change, -0.04/0.06 mm Hg/week) versus a progressive decline in BP on the low-sodium diet (-0.94/-0.70 mm Hg/week; P interactions between time and sodium <0.001 for SBP and DBP). For those assigned DASH, SBP/DBP changed -0.60/-0.16 mm Hg/week on the high- versus -0.42/-0.54 mm Hg/week on the low-sodium diet ( P interactions between time and sodium=0.56 for SBP and 0.10 for DBP). When comparing DASH to control, DASH changed SBP/DBP by -4.36/-1.07 mm Hg after 1 week, which accounted for most of the effect observed, with no significant difference in weekly rates of change for either SBP ( P interaction=0.97) or DBP ( P interaction=0.70). In the context of a typical American diet, a low-sodium diet reduced BP without plateau, suggesting that the full effects of sodium reduction are not completely achieved by 4 weeks. In contrast, compared with control, DASH lowers BP within a week without further effect thereafter. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000608. © 2017 American Heart Association, Inc.

Rapid resolution of chronic shoulder pain classified as derangement using the McKenzie method: a case series

PubMed Central

Aytona, Maria Corazon; Dudley, Karlene

2013-01-01

The McKenzie method, also known as Mechanical Diagnosis and Therapy (MDT), is primarily recognized as an evaluation and treatment method for the spine. However, McKenzie suggested that this method could also be applied to the extremities. Derangement is an MDT classification defined as an anatomical disturbance in the normal resting position of the joint, and McKenzie proposed that repeated movements could be applied to reduce internal joint displacement and rapidly reduce derangement symptoms. However, the current literature on MDT application to shoulder disorders is limited. Here, we present a case series involving four patients with chronic shoulder pain from a duration of 2–18 months classified as derangement and treated using MDT principles. Each patient underwent mechanical assessment and was treated with repeated movements based on their directional preference. All patients demonstrated rapid and clinically significant improvement in baseline measures and the disabilities of the arm, shoulder, and hand (QuickDASH) scores from an average of 38% at initial evaluation to 5% at discharge within 3–5 visits. Our findings suggest that MDT may be an effective treatment approach for shoulder pain. PMID:24421633

A new brain-computer interface design using fuzzy ARTMAP.

PubMed

Palaniappan, Ramaswamy; Paramesran, Raveendran; Nishida, Shogo; Saiwaki, Naoki

2002-09-01

This paper proposes a new brain-computer interface (BCI) design using fuzzy ARTMAP (FA) neural network, as well as an application of the design. The objective of this BCI-FA design is to classify the best three of the five available mental tasks for each subject using power spectral density (PSD) values of electroencephalogram (EEG) signals. These PSD values are extracted using the Wiener-Khinchine and autoregressive methods. Ten experiments employing different triplets of mental tasks are studied for each subject. The findings show that the average BCI-FA outputs for four subjects gave less than 6% of error using the best triplets of mental tasks identified from the classification performances of FA. This implies that the BCI-FA can be successfully used with a tri-state switching device. As an application, a proposed tri-state Morse code scheme could be utilized to translate the outputs of this BCI-FA design into English letters. In this scheme, the three BCI-FA outputs correspond to a dot and a dash, which are the two basic Morse code alphabets and a space to denote the end (or beginning) of a dot or a dash. The construction of English letters using this tri-state Morse code scheme is determined only by the sequence of mental tasks and is independent of the time duration of each mental task. This is especially useful for constructing letters that are represented as multiple dots or dashes. This combination of BCI-FA design and the tri-state Morse code scheme could be developed as a communication system for paralyzed patients.

Dietary patterns and risk of advanced colorectal neoplasms: A large population based screening study in Germany.

PubMed

Erben, Vanessa; Carr, Prudence R; Holleczek, Bernd; Stegmaier, Christa; Hoffmeister, Michael; Brenner, Hermann

2018-06-01

Specific components of the diet such as red and processed meat have been associated with the risk of developing colorectal cancer. However, evidence on the association of dietary patterns with colorectal neoplasms is sparse. The aim of this study was to analyze the association of dietary patterns with prevalence of advanced colorectal neoplasms among older adults in Germany. A cross-sectional study was conducted among participants of screening colonoscopy in Saarland, Germany, who were enrolled in the KolosSal study (Effektivität der Früherkennungs-Koloskopie: eine Saarland-weite Studie) from 2005 to 2013. Information on diet and lifestyle factors was obtained through questionnaires and colonoscopy results were extracted from physicians' reports. Associations of a priori defined dietary patterns (vegetarian or adapted versions of the Healthy Eating Index [HEI] and the Dietary Approaches to Stop Hypertension [DASH] index) with the risk of advanced colorectal neoplasms were assessed by multiple logistic regression analyses with comprehensive adjustment for potential confounders. A total of 14,309 participants were included (1561 with advanced colorectal neoplasms). Healthier eating behavior was associated with lower prevalence of advanced colorectal neoplasms in a dose-response manner. Adjusted odds ratios (95% confidence intervals) comparing the highest with the lowest categories of adapted HEI and DASH were 0.61 (0.50, 0.76) and 0.70 (0.55, 0.89), respectively. No significant associations were observed for a vegetarian eating pattern (adjusted OR 0.80 (0.55, 1.17)). Healthy dietary patterns, as described by a high HEI or DASH score, but not a vegetarian diet alone, are associated with reduced risk of advanced colorectal neoplasms. Copyright © 2018 Elsevier Inc. All rights reserved.

Bridging Graft in Irreparable Massive Rotator Cuff Tears: Autogenic Biceps Graft versus Allogenic Dermal Patch Graft.

PubMed

Rhee, Sung Min; Oh, Joo Han

2017-12-01

Few comparative studies have reported on the use of biologic grafts for irreparable massive rotator cuff tears. The purpose of this study was to assess the results of arthroscopic bridging graft in irreparable massive rotator cuff tears using an autogenic long head of biceps tendon (LHBT) or an allogenic dermal patch (ADP). We retrospectively reviewed 24 patients treated using the LHBT (group I) and eight patients with complete rupture of the LHBT treated using an ADP (group II) since 2011. Preoperative Goutallier's fatty degeneration, range of motion (ROM), visual analogue scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score were assessed and healing failure was evaluated at 1 year after surgery by ultrasonography or magnetic resonance imaging. The mean fatty degeneration in groups I and II was 3.9 and 3.6 for the supraspinatus ( p = 0.288), 2.7 and 2.9 for the infraspinatus ( p = 0.685), 0.9 and 1.3 for the subscapularis ( p = 0.314), and 1.3 and 3.0 for the teres minor ( p = 0.005), respectively. Subscapularis tears were found in 8 patients (33.3%) in group I and in 7 patients (87.5%) in group II ( p = 0.023). Mean ROMs and functional scores improved significantly in group I (forward flexion: 121.7° to 153.3°, p = 0.010; external rotation: 32.7° to 52.7°, p = 0.001; external rotation at 90°: 63.3° to 74.5°, p = 0.031; internal rotation: T10.5 to T9.3, p = 0.045; VAS: 7.0 to 1.1, p < 0.001; ASES score: 45.4 to 81.6, p = 0.028; and Quick DASH score: 50.0 to 14.2, p = 0.017), whereas only VAS showed significant improvement in group II (from 5.9 to 2.0, p = 0.025) and ROMs and other functional scores increased without statistical significance in the group. Healing failure was found in 13 patients (54.2%) in group I and in 6 patients (75.0%) in group II ( p = 0.404). The surgeon should prudently choose surgical options for irreparable massive rotator cuff tears, especially in patients with severe fatty degeneration in the teres minor or combined biceps and subscapularis tears.

Simulation of Thermal Signature of Tires and Tracks

DTIC Science & Technology

2012-08-01

the body-ply is a linear elastic material. To facilitate the analysis, the tire was divided into Tread and Sidewall by the dash line as shown in...only one element is assigned through the thickness of the tire . Therefore, the thickness of the element is the same as the thickness of the tire ...to the whole part of the 3D full tire in the thermal analysis. The average strain energy density for each part ( tread or sidewall) in the cross

Pacific kids DASH for health (PacDASH) randomized, controlled trial with DASH eating plan plus physical activity improves fruit and vegetable intake and diastolic blood pressure in children.

PubMed

Novotny, Rachel; Nigg, Claudio R; Li, Fenfang; Wilkens, Lynne R

2015-04-01

Pacific Kids DASH for Health (PacDASH) aimed to improve child diet and physical activity (PA) level and prevent excess weight gain and elevation in blood pressure (BP) at 9 months. PacDASH was a two-arm, randomized, controlled trial (ClinicalTrials.gov: NCT00905411). Eighty-five 5- to 8-year-olds in the 50th-99th percentile for BMI were randomly assigned to treatment (n=41) or control (n=44) groups; 62 completed the 9-month trial. Sixty-two percent were female. Mean age was 7.1±0.95 years. Race/ethnicity was Asian (44%), Native Hawaiian or Other Pacific Islander (28%), white (21%), or other race/ethnicity (7%). Intervention was provided at baseline and 3, 6 and 9 months, with monthly supportive mailings between intervention visits, and a follow-up visit at 15 months to observe maintenance. Diet and PA were assessed by 2-day log. Body size, composition, and BP were measured. The intervention effect on diet and PA, body size and composition, and BP by the end of the intervention was tested using an F test from a mixed regression model, after adjustment for sex, age, and ethnic group. Fruit and vegetable (FV) intake decreased less in the treatment than control group (p=0.04). Diastolic BP (DBP) was 12 percentile units lower in the treatment than control group after 9 months of intervention (p=0.01). There were no group differences in systolic BP (SBP) or body size/composition. The PacDASH trial enhanced FV intake and DBP, but not SBP or body size/composition.

Development of a QSAR model for predicting aqueous reaction rate constants of organic chemicals with hydroxyl radicals.

PubMed

Luo, Xiang; Yang, Xianhai; Qiao, Xianliang; Wang, Ya; Chen, Jingwen; Wei, Xiaoxuan; Peijnenburg, Willie J G M

2017-03-22

Reaction with hydroxyl radicals (˙OH) is an important removal pathway for organic pollutants in the aquatic environment. The aqueous reaction rate constant (k OH ) is therefore an important parameter for fate assessment of aquatic pollutants. Since experimental determination fails to meet the requirement of being able to efficiently handle numerous organic chemicals at limited cost and within a relatively short period of time, in silico methods such as quantitative structure-activity relationship (QSAR) models are needed to predict k OH . In this study, a QSAR model with a larger and wider applicability domain as compared with existing models was developed. Following the guidelines for the development and validation of QSAR models proposed by the Organization for Economic Co-operation and Development (OECD), the model shows satisfactory performance. The applicability domain of the model has been extended and contained chemicals that have rarely been covered in most previous studies. The chemicals covered in the current model contain functional groups including [double bond splayed left]C[double bond, length as m-dash]C[double bond splayed right], -C[triple bond, length as m-dash]C-, -C 6 H 5 , -OH, -CHO, -O-, [double bond splayed left]C[double bond, length as m-dash]O, -C[double bond, length as m-dash]O(O)-, -COOH, -C[triple bond, length as m-dash]N, [double bond splayed left]N-, -NH 2 , -NH-C(O)-, -NO 2 , -N[double bond, length as m-dash]C-N[double bond splayed right], [double bond splayed left]N-N[double bond splayed right], -N[double bond, length as m-dash]N-, -S-, -S-S-, -SH, -SO 3 , -SO 4 , -PO 4 , and -X (F, Cl, Br, and I).

High performance mode locking characteristics of single section quantum dash lasers.

PubMed

Rosales, Ricardo; Murdoch, S G; Watts, R T; Merghem, K; Martinez, Anthony; Lelarge, Francois; Accard, Alain; Barry, L P; Ramdane, Abderrahim

2012-04-09

Mode locking features of single section quantum dash based lasers are investigated. Particular interest is given to the static spectral phase profile determining the shape of the mode locked pulses. The phase profile dependence on cavity length and injection current is experimentally evaluated, demonstrating the possibility of efficiently using the wide spectral bandwidth exhibited by these quantum dash structures for the generation of high peak power sub-picosecond pulses with low radio frequency linewidths.

Validation of Ocean Color Sensors Using a Profiling Hyperspectral Radiometer

DTIC Science & Technology

2014-01-01

shadows. The HyperOCRs are all thermally characterized for temperature corrections and spectrally characterized to account for stray light corrections...August 24,2010 is shown in Figure 4A along with the mean percent difference between the NOAA Hyperpro ( Black /Dash) and the other two identical Hyperpro...difference (n=24) between the NOAA Hyperpro ( Black /Dash, Fig. 4A) and the other two Hyperpro systems. The dotted line for the red (bottom) and dash line for

An alternative treatment option for scaphoid nonunion advanced collapse (SNAC) and radioscaphoid osteoarthritis: early results of a prospective study on the pyrocarbon adaptive proximal scaphoid implant (APSI).

PubMed

Daruwalla, Zubin J; Davies, Kirstenlee; Shafighian, Ali; Gillham, Nicholas R

2013-06-01

Scaphoid nonunion advanced collapse (SNAC) and radioscaphoid osteoarthritis are difficult to treat. Options include proximal row carpectomy (PRC), four corner fusion (4CF) and wrist arthroplasty or arthrodesis. However, with inevitable disease progression, a significant proportion of patients undergo total wrist fusion. This reduces function by abolishing wrist movement. We review the preliminary results of a pyrocarbon interpositional radiocarpal implant in a small cohort of patients from our prospective study and challenge the assumption that there are no surgical alternatives. This study prospectively studied 12 consecutive pyrocarbon Interpositional arthroplasty day cases over 3 years. Patients were assessed using level of pain, ranges of motion, grip strength, key pinch, type of and time to return to work and the disabilities of the arm, shoulder and hand (DASH) score, both preoperatively and postoperatively. Radiographs were also taken and patient satisfaction recorded. All 12 patients could be contacted and were satisfied with their surgery. There were no immediate, early or late postoperative complications associated with the procedure. Promising results were noted in terms of pain, ranges of motion, grip strength, key pinch, type of and time to return to work, DASH scores, photographs and radiographs. The mean follow-up was 18 months, range between 11 months and 3 years. Our early results are encouraging, warrant further and longer studies and support the use of pyrocarbon implants as a primary procedure in what is a generally young and active subgroup of patients.

Surgical and functional outcomes after operative management of complex and displaced intra-articular glenoid fractures.

PubMed

Anavian, Jack; Gauger, Erich M; Schroder, Lisa K; Wijdicks, Coen A; Cole, Peter A

2012-04-04

Operative treatment is indicated for displaced fractures of the glenoid fossa. However, little is known regarding functional outcomes in these patients. This study assesses surgical and functional results after treatment of displaced, high-energy, complex, intra-articular glenoid fractures. Thirty-three patients with displaced intra-articular fractures of the glenoid were treated surgically between 2002 and 2009. The indications for operative treatment included articular fracture gap or step-off of ≥ 4 mm. Twenty-five patients also had extra-articular scapular involvement. A posterior approach was utilized in twenty-one patients, an anterior approach in seven, and a combined approach in five. Functional outcomes, including Disabilities of the Arm, Shoulder and Hand (DASH) and Short Form-36 (SF-36) scores, shoulder motion and strength, and return to work and/or activities, were obtained for thirty patients (91%). At a mean follow-up of twenty-seven months (range, twelve to seventy-three months), all patients had radiographic union of the fracture. The mean DASH score was 10.8 (range, 0 to 42). All mean SF-36 subscores were comparable with those of the normal population. Twenty-six patients (87%) were pain-free at the time of follow-up, and four had mild pain with prolonged activity. Twenty-seven (90%) of thirty patients returned to their preinjury level of work and/or activities. Our data suggest that surgical treatment for complex, displaced intra-articular glenoid fractures with or without involvement of the scapular neck and body can be associated with good functional outcomes and a low complication rate.

Psychometric properties of the Mayo Elbow Performance Score.

PubMed

Celik, Derya

2015-06-01

To translate and culturally adapt the Mayo Elbow Performance Score (MEPS), a widely used instrument for evaluating disability associated with elbow injuries, into Turkish (MEPS-T) and to determine psychometric properties of the translated version. The MEPS was translated into Turkish using published methodological guidelines. The measurement properties of the MEPS-T (construct validity and floor and ceiling effects) were tested in 91 patients with elbow pathology. The reproducibility of the MEPS-T was tested in 59 patients over 7-14 days. The responsiveness of the MEPS-T was tested in a subgroup of 46 patients diagnosed with lateral epicondylitis and who received conservative treatment for 6 weeks. The interclass correlation coefficient (ICC) was used to estimate the test-retest reliability. The construct validity was analyzed with the disabilities of the arm, shoulder and hand (DASH), Visual Analog Scale (VAS) and the Short Form 36 (SF-36). Effect size (ES) was used to assess the responsiveness. The distribution of floor and ceiling effects was determined. The MEPS-T showed very good test-retest reliability (ICC 0.89). The correlation coefficients between the MEPS-T and DASH and VAS were -0.61 and -0.53, respectively (p < 0.001). The highest correlations were between the MEPS-T and the mental component summary (r = 0.47, p = 0.001) and role emotional (r = 0.45, p = 0.001). The MEPS-T ES, 0.50, was moderate (95% CI 0.33-0.62). We observed no ceiling or floor effects. The MEPS-T represents a valid, reliable and moderately responsive instrument for evaluating patients with elbow disease.

Improving hand sensibility in vibration induced neuropathy: A case-series.

PubMed

Rosén, Birgitta; Björkman, Anders; Lundborg, Göran

2011-04-27

We report a long-term series of nine workers suffering from vibration-induced neuropathy, after many years of exposure to hand-held vibrating tools at high or low frequency. They were treated with temporary selective cutaneous anaesthesia (EMLA® cream) of the forearm repeatedly for a period up to one year (in two cases four years). The aim was to improve their capacity to perceive touch and thereby improve hand function and diminish disability. The treatment principle is based on current concepts of brain plasticity, where a deafferentation of a skin area results in improved sensory function in adjacent skin areas. All participants had sensory hand problems in terms of numbness (median touch thresholds > 70 mg) and impaired hand function influencing ADL (mean DASH score 22).After an initial identical self-administered treatment period of 8 weeks (12-15 treatments with increasing intervals) they did one treatment every 2-3 month. After one year sensibility (touch thresholds and tactile discrimination) as well as hand function (mean DASH score 13) were improved in a majority of the cases. Seven of the participants choose to continue the treatment after the first year and two of them have continued at a regular basis for up to four years. A surprising, secondary finding was diminishing nocturnal numbness of the hand and arm in eight of the nine subjects from "frequently" to "hardly ever or never". Our observations open new perspectives for treatment of impaired sensibility and hand function in a group of patients with vibration induced hand problems where we have no treatment to offer today.

Improving hand sensibility in vibration induced neuropathy: A case-series

PubMed Central

2011-01-01

Objectives We report a long-term series of nine workers suffering from vibration-induced neuropathy, after many years of exposure to hand-held vibrating tools at high or low frequency. They were treated with temporary selective cutaneous anaesthesia (EMLA® cream) of the forearm repeatedly for a period up to one year (in two cases four years). The aim was to improve their capacity to perceive touch and thereby improve hand function and diminish disability. The treatment principle is based on current concepts of brain plasticity, where a deafferentation of a skin area results in improved sensory function in adjacent skin areas. Methods All participants had sensory hand problems in terms of numbness (median touch thresholds > 70 mg) and impaired hand function influencing ADL (mean DASH score 22). After an initial identical self-administered treatment period of 8 weeks (12-15 treatments with increasing intervals) they did one treatment every 2-3 month. Results After one year sensibility (touch thresholds and tactile discrimination) as well as hand function (mean DASH score 13) were improved in a majority of the cases. Seven of the participants choose to continue the treatment after the first year and two of them have continued at a regular basis for up to four years. A surprising, secondary finding was diminishing nocturnal numbness of the hand and arm in eight of the nine subjects from "frequently" to "hardly ever or never". Conclusions Our observations open new perspectives for treatment of impaired sensibility and hand function in a group of patients with vibration induced hand problems where we have no treatment to offer today. PMID:21524297

Plate fixation versus intramedullary nailing of completely displaced midshaft fractures of the clavicle: a prospective randomised controlled trial.

PubMed

Fuglesang, H F S; Flugsrud, G B; Randsborg, P H; Oord, P; Benth, J Š; Utvåg, S E

2017-08-01

This is a prospective randomised controlled trial comparing the functional outcomes of plate fixation and elastic stable intramedullary nailing (ESIN) of completely displaced mid-shaft fractures of the clavicle in the active adult population. We prospectively recruited 123 patients and randomised them to either plate fixation or ESIN. Patients completed the Quick Disabilities of the Arm, Shoulder and Hand (DASH) score at one to six weeks post-operatively. They were followed up at six weeks, three and six months and one year with radiographs, and their clinical outcome was assessed using both the DASH and the Constant Score. Plate fixation provided a faster functional recovery during the first six months compared with ESIN, but there was no difference after one year. The duration of surgery was shorter for ESIN (mean 53.4 minutes, 22 to 120) than for plate fixation (mean 69.7 minutes, 35 to 106, p < 0.001). The recovery after ESIN was slower with increasing fracture comminution and with open reduction (p < 0.05). Both methods return the patients to their pre-injury functional levels, but plate fixation has a faster recovery period in comminuted fractures than ESIN. ESIN has a shorter operative time and lower infection and implant rates of failure when using 2.5 mm nails or wider, suggesting that this is the preferred method in mid-shaft fractures with no comminution, whereas plate fixation is the superior method in comminuted fractures. Cite this article: Bone Joint J 2017;99-B:1095-1101. ©2017 The British Editorial Society of Bone & Joint Surgery.

Midterm results after modified Epping procedure for trapeziometacarpal osteoarthritis.

PubMed

Klein, Silvan M; Breindl, Gisela; Koller, Michael; Mielenz, Melanie; Roll, Christina; Kinner, Bernd; Prantl, Lukas

2013-08-01

Various surgical procedures have been proposed for the treatment of trapeziometacarpal joint (TMJ) osteoarthritis. Despite an overall satisfactory outcome in most cases, some patients complain about inadequate performance at work, due to instability of the TMJ. We present a cross-sectional study of patients with TMJ arthritis who underwent a modified Epping procedure for increased TMJ stability. 71 patients underwent a modified Epping procedure with a flexor carpi radialis tendon sling stabilizer. 59 patients were followed up after a mean time of 38 months. Residual pain was evaluated by visual analog scale. Functional outcome was quantified by pinch and grip strength, static two-point discrimination test, as well as DASH outcome scoring. Quality of life measures included patients' perceived satisfaction, activities of daily living (ADL), grip/pinch force and manual performance at work. 85 % of the patients regained full or partial manual performance during labor. Strength and ADL improved or remained the same in 81 %. In cases of a unilateral treatment, no difference in grip between the operated and nonoperated hand was observed. Mean tip pinch strength was 2.8 kg for the operated and 3.6 kg for the nonoperated hand. Mean pain level during rest was 0.98, 0.95 during mild activity, and 3.70 during strenuous activity. Mean DASH score was 26.6. The great majority of patients who underwent this novel procedure benefited from an unaffected or improved work performance, due to good TMJ stability combined with adequate motion for ADL. Less favorable results were seen in patients with accompanying hand pathologies.

Humeral lengthening and proximal deformity correction with monorail external fixator in young adults.

PubMed

Ruan, Hongjiang; Zhu, Yi; Liu, Shen; Kang, Qinglin

2018-05-01

Several humeral lengthening or simultaneous deformity corrections through one osteotomy using various external fixators were reported, while literature regarding correction of shortening and proximal varus deformity is scarce. This retrospective clinical study evaluated the results of preforming an acute correction and delayed lengthening in young adults through two osteotomies using monorail external fixator. We report seven patients with various pathologies who underwent humeral proximal deformity correction and lengthening between 2009 and 2015. Pre-operative and post-operative clinical and radiographic data were collected. The mean follow-up time was 33.4 months (25-46 months). The humeral neck-shaft angle improved from 97.9° (85-110°) to 138.6° (135-145°). The magnitude of lengthening achieved was average 7.6 cm (range, 6-10 cm) at an average healing index of lengthening of 30.2 days/cm (range, 27.7-35.4 days/cm). There was a significant increase in range of shoulder abduction, and active abduction improved from pre-operative 136.4° (range, 95-160°) to post-operative 166.4° (range, 150-180°). The DASH score improved significance from 23.29 ± 8.36 to 6.57 ± 3.65 (t = 4.848; p < 0.001). Acute deformity correction and gradual lengthening with the monorail external fixator can be used for humeral shortening and proximal varus angular deformity. Functional improvement is expected after surgery and post-operative therapy.

High performance dash on warning air mobile, missile system. [intercontinental ballistic missiles - systems analysis

NASA Technical Reports Server (NTRS)

Levin, A. D.; Castellano, C. R.; Hague, D. S.

1975-01-01

An aircraft-missile system which performs a high acceleration takeoff followed by a supersonic dash to a 'safe' distance from the launch site is presented. Topics considered are: (1) technological feasibility to the dash on warning concept; (2) aircraft and boost trajectory requirements; and (3) partial cost estimates for a fleet of aircraft which provide 200 missiles on airborne alert. Various aircraft boost propulsion systems were studied such as an unstaged cryogenic rocket, an unstaged storable liquid, and a solid rocket staged system. Various wing planforms were also studied. Vehicle gross weights are given. The results indicate that the dash on warning concept will meet expected performance criteria, and can be implemented using existing technology, such as all-aluminum aircraft and existing high-bypass-ratio turbofan engines.

DASH Eating Plan

MedlinePlus

... Approaches to Stop Hypertension. It is an eating plan that is based on research studies sponsored by ... risk of getting heart disease. The DASH eating plan Emphasizes vegetables, fruits, and whole-grains Includes fat- ...

Facile synthesis of -C[double bond, length as m-dash]N- linked covalent organic frameworks under ambient conditions.

PubMed

Ding, San-Yuan; Cui, Xiao-Hui; Feng, Jie; Lu, Gongxuan; Wang, Wei

2017-10-31

We reported herein a facile approach for the synthesis of -C[double bond, length as m-dash]N- linked covalent organic frameworks under ambient conditions. Three known (COF-42, COF-43, and COF-LZU1) and one new (Pr-COF-42) COF materials were successfully synthesized using this method. Furthermore, this simple synthetic approach makes the large-scale synthesis of -C[double bond, length as m-dash]N- linked COFs feasible.

Materials and Modulators for 3D Displays

DTIC Science & Technology

2002-08-01

1243 nm. 0, 180 and 360 deg. in this plot correspond to parallel polarization. The dashed curve is a cos2(θ) fit to the data with a constant value...dwell time (solid bold curve ), 10 µs dwell time (dashed bold curve ) and static case (thin dashed curve ). 26 Figure. 20. Schematics of free-space...photon. The two peaks in the two photon spectrum can be fit by two Lorentzian curves . These spectra indicate that in the rhodamine B molecule the

Identification of the formation of metal-vinylidene interfacial bonds of alkyne-capped platinum nanoparticles by isotopic labeling.

PubMed

Hu, Peiguang; Chen, Limei; Deming, Christopher P; Bonny, Lewis W; Lee, Hsiau-Wei; Chen, Shaowei

2016-10-07

Stable platinum nanoparticles were prepared by the self-assembly of 1-dodecyne and dodec-1-deuteroyne onto bare platinum colloid surfaces. The nanoparticles exhibited consistent core size and optical properties. FTIR and NMR measurements confirmed the formation of Pt-vinylidene (Pt[double bond, length as m-dash]C[double bond, length as m-dash]CH-) interfacial linkages rather than Pt-acetylide (Pt-C[triple bond, length as m-dash]C-) and platinum-hydride (Pt-H) bonds.

Dual mini-fragment plating for midshaft clavicle fractures: a clinical and biomechanical investigation.

PubMed

Prasarn, Mark L; Meyers, Kathleen N; Wilkin, Geoffrey; Wellman, David S; Chan, Daniel B; Ahn, Jaimo; Lorich, Dean G; Helfet, David L

2015-12-01

We sought to evaluate clinical and biomechanical outcomes of dual mini-fragment plate fixation for clavicle fractures. We hypothesized that this technique would produce an anatomical reduction with good clinical outcomes, be well tolerated by patients, and demonstrate equivalent biomechanics to single plating. Dual mini-fragment plating was performed for 17 isolated, displaced midshaft clavicle fractures. Functional outcomes and complications were retrospectively reviewed. A sawbones model compared dual plating biomechanics to a (1) superior 3.5-mm locking reconstruction plate, or (2) antero-inferior 3.5-mm locking reconstruction plate. On biomechanical testing, with anterior loading, dual plating was significantly more rigid than single locked anterior-plating (p = 0.02) but less rigid than single locked superior-plating (p = 0.001). With superior loading, dual plating trended toward higher rigidity versus single locked superior-plating (p = 0.07) but was less rigid than single locked anterior-plating (p = 0.03). No statistically significant differences in axial loading (p = 0.27) or torsion (p = 0.23) were detected. Average patient follow-up was 16.1 months (12-38). Anatomic reduction was achieved and maintained through final healing (average 14.7 weeks). No patient underwent hardware removal. Average 1-year DASH score was 4.0 (completed in 88 %). Displaced midshaft clavicle fractures can be effectively managed with dual mini-fragment plating. This technique results in high union rates and excellent clinical outcomes. Compared to single plating, dual plating is biomechanically equivalent in axial loading and torsion, yet offers better multi-planar bending stiffness despite the use of smaller plates. This technique may decrease the need for secondary surgery due to implant prominence and may aid in fracture reduction by buttressing butterfly fragments in two planes.

[Reconstruction of the extensor pollicis longus tendon by transposition of the extensor indicis tendon].

PubMed

Loos, A; Kalb, K; Van Schoonhoven, J; Landsleitner Dagger, B

2003-12-01

Rupture of the extensor pollicis longus-tendon (EPL) is a frequent complication after distal radius fractures. Other traumatic and non-traumatic reasons for this tendon lesion are known, including a theory about a disorder in the blood supply to the tendon itself. We examined 40 patients after reconstruction of the EPL-tendon in a mean follow-up time of 30 months. All patients were clinically examined and a DASH questionnaire was answered by all patients. The method to reconstruct the EPL-tendon was the transposition of the extensor indicis-tendon. After the operations the thumb was put in a splint for four weeks in a "hitch-hiker's-position". 31 ruptures of the tendon (77.5 %) were a result of trauma. In 20 of them (50 %) a distal radius fracture had occurred. Clinical examination included measurements of the movement of the thumb- and index-finger joints, the grip strength and the maximal span of the hand. Significant differences were not found. The isolated extension of the index finger was possible in all patients. But it was reduced in ten cases which represent 25 %. Our results were evaluated by the Geldmacher score to evaluate the reconstruction of the EPL-tendon. 20 % excellent, 65 % good, 12.5 % fair and 2.5 % poor results were reached. The Geldmacher score was used critically. We suggest its modification for the evaluation of thumb abduction. The DASH score reached a functional value of ten points which represents a very good result. In conclusion the extensor indicis-transposition is a safe method to reconstruct the EPL-tendon. Its substantial advantage is taking a healthy muscle as the motor, thereby avoiding the risk of using a degenerated muscle in late tendon reconstruction. A powerful extension of the index finger will be maintained by physical education. Generally, the loss of the extension of the index finger is negligible. It does not disturb the patients. But it has to be discussed with the patient before the operation.

Index-based dietary patterns and risk of lung cancer in the NIH-AARP diet and health study.

PubMed

Anic, G M; Park, Y; Subar, A F; Schap, T E; Reedy, J

2016-01-01

Dietary pattern analysis considers combinations of food intake and may offer a better measure to assess diet-cancer associations than examining individual foods or nutrients. Although tobacco exposure is the major risk factor for lung cancer, few studies have examined whether dietary patterns, based on preexisting dietary guidelines, influence lung cancer risk. After controlling for smoking, we examined associations between four diet quality indices-Healthy Eating Index-2010 (HEI-2010), Alternate Healthy Eating Index-2010 (AHEI-2010), alternate Mediterranean Diet score (aMED) and Dietary Approaches to Stop Hypertension (DASH)-and lung cancer risk in the NIH-AARP (National Institutes of Health-American Association of Retired Persons) Diet and Health study. Baseline dietary intake was assessed in 460 770 participants. Over a median of 10.5 years of follow-up, 9272 incident lung cancer cases occurred. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and confidence intervals (CIs). Comparing highest to lowest quintiles, HRs (95% CIs) for lung cancer were as follows: HEI-2010=0.83 (0.77-0.89), AHEI-2010=0.86 (0.80-0.92), aMED=0.85 (0.79-0.91) and DASH=0.84 (0.78-0.90). Among the individual components of the dietary indices, higher consumption of whole grains and fruits was significantly inversely associated with lung cancer risk for several of the diet indices. Total index score analyses stratified by smoking status showed inverse associations with lung cancer for former smokers; however, only HEI-2010 was inversely associated in current smokers and no index score was inversely associated among never smokers. Although smoking is the factor most strongly associated with lung cancer, this study adds to a growing body of evidence that diet may have a modest role in reducing lung cancer risk, especially among former smokers.

Single-arm open-label study of Durolane (NASHA nonanimal hyaluronic acid) for the treatment of osteoarthritis of the thumb

PubMed Central

Velasco, Eloisa; Ribera, Mª Victoria; Pi, Joan

2017-01-01

Introduction Osteoarthritis of the trapeziometacarpal (TMC) joint of the thumb – also known as rhizarthrosis – is painful and has a significant impact on quality of life. Intra-articular injection of hyaluronic acid may potentially meet the need for effective, minimally invasive intervention in patients not responding adequately to initial treatment. We aimed to confirm the safety and effectiveness of viscosupplementation with Durolane (NASHA nonanimal hyaluronic acid) in rhizarthrosis. Patients and methods This was a prospective, single-arm, multicenter, open-label study with a 6-month follow-up period. Eligible patients had Eaton–Littler grade II–III rhizarthrosis in one TMC joint with pain and visual analog scale (VAS) pain score ≥4 (scale: 0–10). A single injection of NASHA was administered to the affected TMC joint. The primary effectiveness variable was change from baseline in VAS pain score. Results Thirty-five patients (mean age 60.8 years; 85.7% female) received NASHA and completed the study. The least-squares mean change from baseline in VAS pain score over 6 months was −2.00, a reduction of 27.8% (p<0.001). The reduction in pain exceeded 25% as early as month 1 (26.5%), and gradual improvement was observed throughout the 6-month follow-up period. Secondary effectiveness parameters included QuickDASH (shortened version of Disabilities of the Arm, Shoulder, and Hand [DASH]), Kapandji thumb opposition test, radial abduction, metacarpophalangeal (MCP) joint flexion, and pinch (clamp) strength. Most of these measurements showed statistically significant improvements from baseline over 6 months. Five adverse events (injection site reactions) were reported in four patients (11.4%), and there were no serious or allergic reactions. Conclusion This study suggests that viscosupplementation using NASHA is effective and well tolerated in treating the symptoms of rhizarthrosis. PMID:28392718

Higher Mediterranean Diet Quality Scores and Lower Body Mass Index Are Associated with a Less-Oxidized Plasma Glutathione and Cysteine Redox Status in Adults.

PubMed

Bettermann, Erika L; Hartman, Terryl J; Easley, Kirk A; Ferranti, Erin P; Jones, Dean P; Quyyumi, Arshed A; Vaccarino, Viola; Ziegler, Thomas R; Alvarez, Jessica A

2018-02-01

Both systemic redox status and diet quality are associated with risk outcomes in chronic disease. It is not known, however, the extent to which diet quality influences plasma thiol/disulfide redox status. The purpose of this study was to investigate the influence of diet, as measured by diet quality scores and other dietary factors, on systemic thiol/disulfide redox status. We performed a cross-sectional study of 685 working men and women (ages ≥18 y) in Atlanta, GA. Diet was assessed by 3 diet quality scores: the Alternative Healthy Eating Index (AHEI), Dietary Approaches to Stop Hypertension (DASH), and the Mediterranean Diet Score (MDS). We measured concentrations of plasma glutathione (GSH), cysteine, their associated oxidized forms [glutathione disulfide (GSSG) and cystine (CySS), respectively], and their redox potentials (EhGSSG and EhCySS) to determine thiol/disulfide redox status. Linear regression modeling was performed to assess relations between diet and plasma redox after adjustment for age, body mass index (BMI), sex, race, and history of chronic disease. MDS was positively associated with plasma GSH (β = 0.02; 95% CI: 0.003, 0.03) and total GSH (GSH + GSSG) (β = 0.02; 95% CI: 0.003, 0.03), and inversely associated with the CySS:GSH ratio (β = -0.02; 95% CI: -0.04, -0.004). There were significant independent associations between individual MDS components (dairy, vegetables, fish, and monounsaturated fat intake) and varying plasma redox indexes (P < 0.05). AHEI and DASH diet quality indexes and other diet factors of interest were not significantly correlated with plasma thiol and disulfide redox measures. Adherence to the Mediterranean diet was significantly associated with a favorable plasma thiol/disulfide redox profile, independent of BMI, in a generally healthy working adult population. Although longitudinal studies are warranted, these findings contribute to the feasibility of targeting a Mediterranean diet to improve plasma redox status.

Associations of key diet-quality indexes with mortality in the Multiethnic Cohort: the Dietary Patterns Methods Project.

PubMed

Harmon, Brook E; Boushey, Carol J; Shvetsov, Yurii B; Ettienne, Reynolette; Reedy, Jill; Wilkens, Lynne R; Le Marchand, Loic; Henderson, Brian E; Kolonel, Laurence N

2015-03-01

Healthy dietary patterns have been linked positively with health and longevity. However, prospective studies in diverse populations in the United States addressing dietary patterns and mortality are limited. We assessed the ability of the following 4 diet-quality indexes [the Healthy Eating Index-2010 (HEI-2010), the Alternative HEI-2010 (AHEI-2010), the alternate Mediterranean diet score (aMED), and the Dietary Approaches to Stop Hypertension (DASH)] to predict the reduction in risk of mortality from all causes, cardiovascular disease (CVD), and cancer. White, African American, Native Hawaiian, Japanese American, and Latino adults (n = 215,782) from the Multiethnic Cohort completed a quantitative food-frequency questionnaire. Scores for each dietary index were computed and divided into quintiles for men and women. Mortality was documented over 13-18 y of follow-up. HRs and 95% CIs were computed by using adjusted Cox models. High HEI-2010, AHEI-2010, aMED, and DASH scores were all inversely associated with risk of mortality from all causes, CVD, and cancer in both men and women (P-trend < 0.0001 for all models). For men, the HEI-2010 was consistently associated with a reduction in risk of mortality for all causes (HR: 0.75; 95% CI: 0.71, 0.79), CVD (HR: 0.74; 95% CI: 0.69, 0.81), and cancer (HR: 0.76; 95% CI: 0.70, 0.83) when lowest and highest quintiles were compared. In women, the AHEI and aMED showed large reductions for all-cause mortality (HR: 0.78; 95% CI: 0.74, 0.82), the AHEI showed large reductions for CVD (HR: 0.76; 95% CI: 0.69, 0.83), and the aMED showed large reductions for cancer (HR: 0.84; 95% CI: 0.76, 0. 92). These results, in a US multiethnic population, suggest that consuming a dietary pattern that achieves a high diet-quality index score is associated with lower risk of mortality from all causes, CVD, and cancer in adult men and women. © 2015 American Society for Nutrition.

Biomarker-calibrated nutrient intake and healthy diet index associations with mortality risks among older and frail women from the Women's Health Initiative.

PubMed

Zaslavsky, Oleg; Zelber-Sagi, Shira; Hebert, James R; Steck, Susan E; Shivappa, Nitin; Tabung, Fred K; Wirth, Michael D; Bu, Yunqi; Shikany, James M; Orchard, Tonya; Wallace, Robert B; Snetselaar, Linda; Tinker, Lesley F

2017-06-01

Background: Although studies to date have confirmed the association between nutrition and frailty, the impact of dietary intake and dietary patterns on survivorship in those with frailty is yet to be examined in a well-powered cohort with validated frailty status. Moreover, previous studies were limited by measurement error from dietary self-reports. Objective: We derived biomarker-calibrated dietary energy and protein intakes to address dietary self-report error. Using these data, we then evaluated the association of mortality in older women with frailty and dietary intake and healthy diet indexes, such as the alternate Mediterranean Diet (aMED), the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII). Design: The analytic sample included 10,034 women aged 65-84 y with frailty and complete dietary data from the Women's Health Initiative Observational Study. Frailty was assessed with modified Fried's criteria. Dietary data were collected by food-frequency questionnaire. Results: Over a mean follow-up period of 12.4 y, 3259 (31%) deaths occurred. The HRs showed progressively decreased rates of mortality in women with higher calibrated dietary energy intakes ( P- trend = 0.003), higher calibrated dietary protein intakes ( P- trend = 0.03), higher aMED scores ( P- trend = 0.006), and higher DASH scores ( P- trend = 0.02). Although the adjusted point estimates of HRs (95% CIs) for frail women scoring in the second, third, and fourth quartiles on DII measures were 1.15 (1.03, 1.27), 1.28 (1.15, 1.42), and 1.24 (1.12, 1.38), respectively, compared with women in the first quartile, no overall effect was observed across quartiles ( P- trend = 0.35). Subgroup analyses by chronic morbidity or smoking status or by excluding women with early death did not substantially change these findings. Conclusions: The current study highlights the importance of nutrition in older, frail women. Diet quality and quantity should be considered in managing persons with frailty. © 2017 American Society for Nutrition.

Return to sports after plate fixation of displaced midshaft clavicular fractures in athletes.

PubMed

Ranalletta, Maximiliano; Rossi, Luciano A; Piuzzi, Nicolás S; Bertona, Agustin; Bongiovanni, Santiago L; Maignon, Gaston

2015-03-01

Recent prospective randomized trials support primary plate fixation of displaced midshaft clavicle fractures. However, the safety and efficacy of this practice have not been well documented in athletes, nor has the time to return-to-sport. To analyze the time to return-to-sport, functional outcomes, and complications in a group of athletes with displaced midshaft clavicle fractures treated using precontoured locking plates. Case series; Level of evidence, 4. A total of 54 athletes with displaced midshaft clavicle fractures were treated with plate fixation between November 1, 2008, and December 31, 2012. The mean follow-up time was 22.4 months. Patients completed a questionnaire focused on the time to return-to-sport and treatment course. Functional outcomes were assessed with the Constant score and short version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Pain was evaluated with the visual analog scale (VAS). Radiographs were reviewed to identify radiographic union time, malunion, and nonunion. Of the 54 patients, 53 returned to sports after open reduction and internal fixation of their fracture; 94% returned to the same level. The mean time to return-to-sport was 68 days (range, 5-180 days). Nine (16.6%) of the cases returned to sports before 6 weeks after surgery, 40 (74%) returned between 6 and 12 weeks, and 5 patients (9.2%) returned 12 weeks after surgery. The mean Constant score was 94.1 ± 5.2 (range, 78-100), and the mean QuickDASH score was 0.4 ± 4.7 (range, 0-7.1). The mean VAS pain score during follow-up was 0.29 ± 1.0 (range, 0-5). Three major complications occurred: 1 extrinsic compression of the subclavian vein, 1 nonunion, and 1 hardware loosening. Hardware removal was necessary in 5 patients (9.3%). Plate fixation of displaced clavicle fractures in athletes is a safe procedure resulting in excellent functional outcomes, with an early return to the same level of sports in the majority of patients. © 2014 The Author(s).

Arthroscopic treatment of acute acromioclavicular dislocations using a double button device: Clinical and MRI results.

PubMed

Loriaut, P; Casabianca, L; Alkhaili, J; Dallaudière, B; Desportes, E; Rousseau, R; Massin, P; Boyer, P

2015-12-01

Arthroscopic treatment of acute grade 3 and 4 acromioclavicular dislocation is controversial, due to the risk of recurrence and of postoperative reduction defect. The purpose of the present study was to investigate whether the healing of the acromioclavicular (AC) and coracoclavicular (CC) ligaments and the accurate 3D positioning parameters of the AC joint using MRI were correlated with satisfactory functional outcome. Thirty-nine patients were enrolled from 2009 to 2011 and managed arthroscopically by CC lacing using a double-button device. Clinical assessment included the Shoulder and Hand (QuickDash) score, Constant-Murley score and visual analog scale (VAS) for residual pain. Time and rate to return to work and return to sport were assessed according to type of sport and work. Postoperative complications were recorded. Radiological examination consisted of anteroposterior clavicle and lateral axillary radiographs. AC ligament healing and 3D joint congruency were assessed on MRI and correlated to the clinical results. Mean patient age was 35.7 years (range, 20-55). Mean follow-up was 42.3±10.6 months (range, 24-60). At final follow-up, mean QuickDash score, Constant score and VAS were respectively 1.7±4 (range, 0-11), 94.7±7.3 (range, 82-100) and 0.5±1.4 (range, 0-2). Thirty-five (90%) patients were able to resume work, including heavy manual labor, and sport. Radiology found accurate 3D joint congruency in 34 patients (87%) and CC and AC ligament healing in 36 (93%). Complications included reduction loss at 6 weeks in 3 patients, requiring surgical stabilization. Satisfactory functional results were associated with accurate AC joint congruency in the coronal and axial planes (P<0.05) and good AC and CC ligament healing (P<0.04). An initial 25% reduction defect in the coronal plane was not associated with poor functional results (P=0.07). Arthroscopic treatment by CC lacing satisfactorily restored ligament and joint anatomy in the present series. These satisfactory anatomic results correlated with good clinical outcome encourage continuing with this technique. Level IV, therapeutic case series. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Improving adherence to healthy dietary patterns, genetic risk, and long term weight gain: gene-diet interaction analysis in two prospective cohort studies

PubMed Central

Wang, Tiange; Heianza, Yoriko; Sun, Dianjianyi; Huang, Tao; Ma, Wenjie; Rimm, Eric B; Manson, JoAnn E; Hu, Frank B; Willett, Walter C

2018-01-01

Abstract Objective To investigate whether improving adherence to healthy dietary patterns interacts with the genetic predisposition to obesity in relation to long term changes in body mass index and body weight. Design Prospective cohort study. Setting Health professionals in the United States. Participants 8828 women from the Nurses’ Health Study and 5218 men from the Health Professionals Follow-up Study. Exposure Genetic predisposition score was calculated on the basis of 77 variants associated with body mass index. Dietary patterns were assessed by the Alternate Healthy Eating Index 2010 (AHEI-2010), Dietary Approach to Stop Hypertension (DASH), and Alternate Mediterranean Diet (AMED). Main outcome measures Five repeated measurements of four year changes in body mass index and body weight over follow-up (1986 to 2006). Results During a 20 year follow-up, genetic association with change in body mass index was significantly attenuated with increasing adherence to the AHEI-2010 in the Nurses’ Health Study (P=0.001 for interaction) and Health Professionals Follow-up Study (P=0.005 for interaction). In the combined cohorts, four year changes in body mass index per 10 risk allele increment were 0.07 (SE 0.02) among participants with decreased AHEI-2010 score and −0.01 (0.02) among those with increased AHEI-2010 score, corresponding to 0.16 (0.05) kg versus −0.02 (0.05) kg weight change every four years (P<0.001 for interaction). Viewed differently, changes in body mass index per 1 SD increment of AHEI-2010 score were −0.12 (0.01), −0.14 (0.01), and −0.18 (0.01) (weight change: −0.35 (0.03), −0.36 (0.04), and −0.50 (0.04) kg) among participants with low, intermediate, and high genetic risk, respectively. Similar interaction was also found for DASH but not for AMED. Conclusions These data indicate that improving adherence to healthy dietary patterns could attenuate the genetic association with weight gain. Moreover, the beneficial effect of improved diet quality on weight management was particularly pronounced in people at high genetic risk for obesity. PMID:29321156

A comparison between two double-button endoscopically assisted surgical techniques for the treatment acute acromioclavicular dislocations.

PubMed

Vulliet, P; Le Hanneur, M; Cladiere, V; Loriaut, P; Boyer, P

2018-04-01

To compare clinical and radiological outcomes between two endoscopically assisted double-button techniques in high-grade acute acromioclavicular separations. A retrospective single-center study was conducted in patients with acute acromioclavicular joint dislocation Rockwood types III and V, from 2009 to 2014. All were treated endoscopically, with a 1-year minimum follow-up. Two consecutive series were conducted; the first (TR group) received the TightRope ® system, whereas last series (DB group) was treated with the Dog Bone ® button technology (Arthrex, Naples, FL, USA). Primary endpoints were last follow-up values of Constant score (CS) and Quick-DASH (QD) score. Moreover, the posttraumatic displacement and its evolution were assessed on bilateral Zanca radiographs. A displacement of 5 mm or greater the day after surgery was considered as a lack of reduction; the same difference on last follow-up X-rays was considered as a loss of reduction. Forty patients were reviewed: 22 in the TR group and 18 in the DB group. After a mean follow-up of 27.7 ± 8.3 months, CS and QD averaged, respectively, 94.3 ± 4.4 and 2.0 ± 2.6 in the TR series, whereas they averaged, respectively, 95 ± 6.1 and 3.4 ± 3.3 in the DB series after a mean follow-up of 24.1 ± 5 months (PCS = 0.16, PQDS = 0.08). Lack of reduction and loss of reduction rates were significantly higher in the DB group, with P = 0.0005 and P < 0.0001, respectively. Both techniques provided good to excellent functional outcomes. However, considering inferior radiological results using the Dog Bone ® device, we would prefer the TightRope ® device in acute acromioclavicular dislocations. IV: Therapeutic study-cases series.

The Effects of Cold Whirlpool on Power, Speed, Agility, and Range of Motion

PubMed Central

Patterson, Stephen M.; Udermann, Brian E.; Doberstein, Scott T.; Reineke, David M.

2008-01-01

The purpose was to determine if cold whirlpool treatment decreases functional performance equally regardless of gender. A secondary aim was to determine if there is a gradual increase in functional performance across time. Twenty-one college-aged subjects volunteered to participate in this study and were required to perform four measures of functional performance including: counter movement vertical jump, T-test, 36.58-meter dash (40-yard), and active range of motion of the ankle. Participants were treated with a 20 minute, 10 degree Celsius cold whirlpool following the pre-test of a given functional performance measure. Participants demonstrated significant decreases in counter movement vertical jump, T-test, and 40-yard dash performance immediately following treatment. Vertical jump performance remained impaired for at least 32 minutes. While both the T-test and 40-yard dash were affected for 7 and 22 minutes post- treatment, respectively. Participants also demonstrated significant decreases in peak power and average power immediately after and for 32 minutes post-treatment. Dorsiflexion was significantly decreased 7 and 12 minutes following treatment. There were no differences for plantar flexion, inversion, or eversion. These data suggest functional performance was affected immediately following and for up to 32 minutes after cold whirlpool treatment. It was also evident that there is a gradual performance increase for each measure of functional performance across time. Therefore, the consequences should be carefully considered before returning athletes to activity following cold whirlpool treatment. Key pointsCryotherapy is a common and highly effective modality in treating acute and chronic athletic injuries.The results indicated that cold whirlpool does have an immediate and subsequent effect on functional performance.Understanding how cold whirlpool adversely affects functional performance allows clinicians to continue using this modality before vigorous athletic activity. PMID:24149907

Performance changes and relationship between vertical jump measures and actual sprint performance in elite sprinters with visual impairment throughout a Parapan American games training season

PubMed Central

Loturco, Irineu; Winckler, Ciro; Kobal, Ronaldo; Cal Abad, Cesar C.; Kitamura, Katia; Veríssimo, Amaury W.; Pereira, Lucas A.; Nakamura, Fábio Y.

2015-01-01

The aims of this study were to estimate the magnitude of variability and progression in actual competitive and field vertical jump test performances in elite Paralympic sprinters with visual impairment in the year leading up to the 2015 Parapan American Games, and to investigate the relationships between loaded and unloaded vertical jumping test results and actual competitive sprinting performance. Fifteen Brazilian Paralympic sprinters with visual impairment attended seven official competitions (four national, two international and the Parapan American Games 2015) between April 2014 and August 2015, in the 100- and 200-m dash. In addition, they were tested in five different periods using loaded (mean propulsive power [MPP] in jump squat [JS] exercise) and unloaded (squat jump [SJ] height) vertical jumps within the 3 weeks immediately prior to the main competitions. The smallest important effect on performances was calculated as half of the within-athlete race-to-race (or test-to-test) variability and a multiple regression analysis was performed to predict the 100- and 200-m dash performances using the vertical jump test results. Competitive performance was enhanced during the Parapan American Games in comparison to the previous competition averages, overcoming the smallest worthwhile enhancement in both the 100- (0.9%) and 200-m dash (1.43%). In addition, The SJ and JS explained 66% of the performance variance in the competitive results. This study showed that vertical jump tests, in loaded and unloaded conditions, could be good predictors of the athletes' sprinting performance, and that during the Parapan American Games the Brazilian team reached its peak competitive performance. PMID:26594181

DASH Eating Plan

MedlinePlus

... Card Other Resources ChooseMyPlate.gov (U.S. Department of Agriculture, U.S. Department of Health and Human Services) DASH ( ... Dietary Guidelines for Americans, 2010 (U.S. Department of Agriculture, U.S. Department of Health and Human Services) High ...

Utilisation of an eta(3)-allyl hydride complex, formed by UV irradiation, as a controlled source of 16-electron (eta(5)-C(5)Me(5))Rh(CH(2)[double bond, length as m-dash]CHMe).

PubMed

Sexton, Catherine J; López-Serrano, Joaquín; Lledós, Agustí; Duckett, Simon B

2008-10-21

Low temperature UV irradiation of solutions of (eta(5)-C(5)Me(5))Rh(CH(2)[double bond, length as m-dash]CHMe)(2) yields (eta(5)-C(5)Me(5))Rh(eta(3)-CH(2)CHCH(2))(H), which provides controlled access to the 16-electron fragment (eta(5)-C(5)Me(5))Rh(CH(2)[double bond, length as m-dash]CHMe).

Dispersion and Attenuation Due to Scattering from Heterogeneities of the Frame Bulk Modulus of a Poroelastic Medium

DTIC Science & Technology

2010-02-19

attenuation is a function of the Hurst exponent which characterizes the fractal het- erogeneity. Muller and Gurevich15,16 used statistical smoothing of...modified Bessel function of the third kind, Γ denotes the gamma function, and ν is the Hurst coefficient which is assumed to be 0 < ν ≤ 1. The three...The Hurst coefficient, ν, is ν = 0.1 (long-dashed line), ν = 0.5 (short-dashed line), and ν = 0.9 (long-short dashed line). In (a) the sound speed

Autologous tenocyte injection for the treatment of severe, chronic resistant lateral epicondylitis: a pilot study.

PubMed

Wang, Allan; Breidahl, William; Mackie, Katherine E; Lin, Zhen; Qin, An; Chen, Jimin; Zheng, Ming H

2013-12-01

Severe chronic lateral epicondylitis (LE) is associated with degenerative tendon changes, extracellular matrix breakdown, and tendon cell loss. On the basis of positive outcomes from preclinical studies, this study is the first clinical trial of autologous tenocyte injection (ATI) on severe tendinopathy associated with chronic LE. Autologous tenocyte injection is a safe and effective procedure that enables a reduction in pain and improvement in function in resistant LE. Case series; Level of evidence, 4. Patients with severe refractory LE underwent clinical evaluation and magnetic resonance imaging (MRI) before intervention. A patellar tendon needle biopsy was performed under local anesthetic, and tendon cells were expanded by in vitro culture. Tenocytes used for the injection were characterized by flow cytometry and real-time polymerase chain reaction. Autologous tenocytes were injected into the site of tendinopathy identified at the origin of the extensor carpi radialis brevis tendon under ultrasound guidance on a single occasion. Patients underwent serial clinical evaluations and repeat MRI at 12 months after intervention. A total of 20 consecutive patients were included in the study. Three patients withdrew consent after enrollment and before ATI. No adverse event was reported at either biopsy or injection sites. Furthermore, no infection or excessive fibroblastic reaction was found in any patient at the injection site. Clinical evaluation revealed an improvement in mean visual analog scale scores, for a maximum pain score from 5.94 at the initial assessment to 0.76 at 12 months (P < .001). Mean quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and grip strength scores also significantly improved over the 12-month follow-up (QuickDASH score, 45.88 [baseline] to 3.84; grip strength, 20.17 kg [baseline] to 37.38 kg; P < .001). With use of a validated MRI scoring system, the grade of tendinopathy at the common extensor origin improved significantly by 12 months (P < .001). One patient elected to proceed to surgery 3 months after ATI following a reinjury at work. In this study, patients with chronic LE who had previously undergone an unsuccessful full course of nonoperative treatment showed significantly improved clinical function and structural repair at the origin of the common extensor tendon after ATI. This novel treatment is encouraging for the treatment of tendinopathy and warrants further evaluation.

Effects of Sodium Reduction and the DASH Diet in Relation to Baseline Blood Pressure.

PubMed

Juraschek, Stephen P; Miller, Edgar R; Weaver, Connie M; Appel, Lawrence J

2017-12-12

Both sodium reduction and the DASH (Dietary Approaches to Stop Hypertension) diet, a diet rich in fruits, vegetables, and low-fat dairy products, and reduced in saturated fat and cholesterol, lower blood pressure. The separate and combined effects of these dietary interventions by baseline blood pressure (BP) has not been reported. The authors compared the effects of low versus high sodium, DASH versus control, and both (low sodium-DASH vs. high sodium-control diets) on systolic blood pressure (SBP) by baseline BP. In the DASH-Sodium (Dietary Patterns, Sodium Intake and Blood Pressure) trial, adults with pre- or stage 1 hypertension and not using antihypertensive medications, were randomized to either DASH or a control diet. On either diet, participants were fed each of 3 sodium levels (50, 100, and 150 mmol/day at 2,100 kcal) in random order over 4 weeks separated by 5-day breaks. Strata of baseline SBP were <130, 130 to 139, 140 to 149, and ≥150 mm Hg. Of 412 participants, 57% were women, and 57% were black; mean age was 48 years, and mean SBP/diastolic BP was 135/86 mm Hg. In the context of the control diet, reducing sodium (from high to low) was associated with mean SBP differences of -3.20, -8.56, -8.99, and -7.04 mm Hg across the respective baseline SBP strata listed (p for trend = 0.004). In the context of high sodium, consuming the DASH compared with the control diet was associated with mean SBP differences of -4.5, -4.3, -4.7, and -10.6 mm Hg, respectively (p for trend = 0.66). The combined effects of the low sodium-DASH diet versus the high sodium-control diet on SBP were -5.3, -7.5, -9.7, and -20.8 mm Hg, respectively (p for trend <0.001). The combination of reduced sodium intake and the DASH diet lowered SBP throughout the range of pre- and stage 1 hypertension, with progressively greater reductions at higher levels of baseline SBP. SBP reductions in adults with the highest levels of SBP (≥150 mm Hg) were striking and reinforce the importance of both sodium reduction and the DASH diet in this high-risk group. Further research is needed to determine the effects of these interventions among adults with SBP ≥160 mm Hg. (Dietary Patterns, Sodium Intake and Blood Pressure [DASH-Sodium]; NCT00000608). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Effects of dietary sodium and the DASH diet on the occurrence of headaches: results from randomised multicentre DASH-Sodium clinical trial.

PubMed

Amer, Muhammad; Woodward, Mark; Appel, Lawrence J

2014-12-11

Headaches are a common medical problem, yet few studies, particularly trials, have evaluated therapies that might prevent or control headaches. We, thus, investigated the effects on the occurrence of headaches of three levels of dietary sodium intake and two diet patterns (the Dietary Approaches to Stop Hypertension (DASH) diet (rich in fruits, vegetables and low-fat dairy products with reduced saturated and total fat) and a control diet (typical of Western consumption patterns)). Randomised multicentre clinical trial. Post hoc analyses of the DASH-Sodium trial in the USA. In a multicentre feeding study with three 30 day periods, 390 participants were randomised to the DASH or control diet. On their assigned diet, participants ate food with high sodium during one period, intermediate sodium during another period and low sodium during another period, in random order. Occurrence and severity of headache were ascertained from self-administered questionnaires, completed at the end of each feeding period. The occurrence of headaches was similar in DASH versus control, at high (OR (95% CI)=0.65 (0.37 to 1.12); p=0.12), intermediate (0.57 (0.29 to 1.12); p=0.10) and low (0.64 (0.36 to 1.13); p=0.12) sodium levels. By contrast, there was a lower risk of headache on the low, compared with high, sodium level, both on the control (0.69 (0.49 to 0.99); p=0.05) and DASH (0.69 (0.49 to 0.98); p=0.04) diets. A reduced sodium intake was associated with a significantly lower risk of headache, while dietary patterns had no effect on the risk of headaches in adults. Reduced dietary sodium intake offers a novel approach to prevent headaches. NCT00000608. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effects of dietary sodium and the DASH diet on the occurrence of headaches: results from randomised multicentre DASH-Sodium clinical trial

PubMed Central

Amer, Muhammad; Woodward, Mark; Appel, Lawrence J

2014-01-01

Objectives Headaches are a common medical problem, yet few studies, particularly trials, have evaluated therapies that might prevent or control headaches. We, thus, investigated the effects on the occurrence of headaches of three levels of dietary sodium intake and two diet patterns (the Dietary Approaches to Stop Hypertension (DASH) diet (rich in fruits, vegetables and low-fat dairy products with reduced saturated and total fat) and a control diet (typical of Western consumption patterns)). Design Randomised multicentre clinical trial. Setting Post hoc analyses of the DASH-Sodium trial in the USA. Participants In a multicentre feeding study with three 30 day periods, 390 participants were randomised to the DASH or control diet. On their assigned diet, participants ate food with high sodium during one period, intermediate sodium during another period and low sodium during another period, in random order. Outcome measures Occurrence and severity of headache were ascertained from self-administered questionnaires, completed at the end of each feeding period. Results The occurrence of headaches was similar in DASH versus control, at high (OR (95% CI)=0.65 (0.37 to 1.12); p=0.12), intermediate (0.57 (0.29 to 1.12); p=0.10) and low (0.64 (0.36 to 1.13); p=0.12) sodium levels. By contrast, there was a lower risk of headache on the low, compared with high, sodium level, both on the control (0.69 (0.49 to 0.99); p=0.05) and DASH (0.69 (0.49 to 0.98); p=0.04) diets. Conclusions A reduced sodium intake was associated with a significantly lower risk of headache, while dietary patterns had no effect on the risk of headaches in adults. Reduced dietary sodium intake offers a novel approach to prevent headaches. Trial registration number NCT00000608. PMID:25500372

Capture of SO3 isomers in the oxidation of sulfur monoxide with molecular oxygen.

PubMed

Wu, Zhuang; Lu, Bo; Feng, Ruijuan; Xu, Jian; Lu, Yan; Wan, Huabin; Eckhardt, André K; Schreiner, Peter R; Xie, Changjian; Guo, Hua; Zeng, Xiaoqing

2018-02-13

When mixing SO with O 2 in N 2 , Ne, or Ar, an end-on complex OS-OO forms in the gas phase and can subsequently be trapped at cryogenic temperatures (2.8-15.0 K). Upon infrared light irradiation, OS-OO converts to SO 3 and SO 2 + O with the concomitant formation of a rare 1,2,3-dioxathiirane 2-oxide, i.e., cyclic OS([double bond, length as m-dash]O)O. Unexpectedly, the ring-closure of 16 OS- 18 O 18 O yields a ca. 2 : 1 mixture of cyclic 18 OS([double bond, length as m-dash] 16 O) 18 O and 16 OS([double bond, length as m-dash] 18 O) 18 O. The characterization of OS-OO and OS([double bond, length as m-dash]O)O with IR and UV/Vis spectroscopy is supported by high-level ab initio computations.

Tailoring the photoluminescence polarization anisotropy of a single InAs quantum dash by a post-growth modification of its dielectric environment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mrowiński, P.; Misiewicz, J.; Sęk, G.

Excitonic emission from single InAs/InGaAlAs/InP quantum dashes has been investigated in terms of controlling the polarization anisotropy by altering the shape of the processed sub-micrometer mesa structures. Photoluminescence has been measured from exemplary single quantum dashes emitting around 1.3 and 1.55 μm and placed inside rectangular mesas of various orientation, asymmetry, and sizes. The detected degree of linear polarization of bright exciton emission ranges from −0.1 to ca. 0.55, compared to 0.25 for dashes in unaltered or isotropic in-plane dielectric surrounding. These results are interpreted by numerical simulations using an emitter coupled with a single optical mode in such a mesamore » and outgoing in the direction normal to the sample surface.« less

Compilation of Local Fallout Data from Test Detonations 1945-1962 Extracted from DASA 1251. Volume I. Continental U.S. Tests

DTIC Science & Technology

1979-05-01

fallout patterns by "dot-dash" lines. The time lines are intended to give only a rough average arrival time in hours as estimated from the wind reports and...by interpolation between the H-lI and H+11 hour values. 4. The surface air pressure was 13.10 psi, the temperature -2.O°C and the relative humidity...surface air pressure was 13.04 psi, the temperature -2.8 0 C, and the relative humidity 87%. 17 i’ 17 I

Effects of Molecular Adsorption on the Electronic Structure of Single-Layer Graphene

DTIC Science & Technology

2011-08-03

HgxCd1xTe ( MCT -A) detector at a resolution of 4 cm1. 1000 scans were averaged in about 8 min, and 2-fold zero-filling and triangle apodization were...range was∼10007500 cm1, limited on the low end by the Si transmission and on the high end by the detector response. Note that the spectrometer low-pass...reflections) and without any arbitrary vertical displacement. The dashed line shows the position of δR/R = 0. The increased noise at the high-energy end is

Effects of Different Dietary Interventions on Calcitriol, Parathyroid Hormone, Calcium, and Phosphorus: Results from the DASH Trial

PubMed Central

Michos, Erin D.; Miller, Edgar R.; Crisp, Zeni

2018-01-01

The “Dietary Approaches to Stop Hypertension” (DASH) diet, rich in fiber and low-fat dairy, effectively lowers blood pressure. DASH’s effect on calcitriol and other markers of bone-mineral metabolism is unknown. This secondary analysis of the DASH trial aimed to determine the effect of dietary patterns on blood concentrations of calcitriol, parathyroid hormone (PTH), ionized calcium, and urinary excretion of calcium and phosphorus. Outcomes were available in 334 participants in the trial. After a 3-week run-in on the control diet, participants were randomized to control, fruits and vegetables (F&V), or DASH diets. Outcomes were assessed at the end of run-in, and during the last week of the intervention period. Mean age of participants was 45.7 ± 10.7 years, 46% female, and 57% African-American. Mean ± Standard Deviation(SD) baseline serum concentrations of calcitriol, PTH, and ionized calcium were 37.8 ± 9.2 pg/mL, 46.1 ± 18.5 pg/mL and 5.2 ± 0.23 mg/dL, respectively. Mean (±SD) urinary calcium and phosphorus excretions were 150.1 ± 77.8 and 708.0 ± 251.8 mg/24 h, respectively. Compared with control, DASH reduced calcitriol −3.32 pg/mL (p = 0.004). Otherwise, there was no significant effect on other biomarkers. DASH lowered serum calcitriol perhaps more among African-Americans. These results raise important questions about the interpretation and clinical significance of low calcitriol concentrations in the setting of recommended diets. PMID:29562597

Dots & dashes : piecing together transit's future.

DOT National Transportation Integrated Search

2008-11-01

Dots & Dashes is an interactive board game that is used at public planning meetings to engage stakeholders in long range transit planning. Groups of three to six people use game pieces with monetary values to choose the priorities of transit projects...

FleetDASH

DOE Office of Scientific and Technical Information (OSTI.GOV)

Singer, Mark R

2017-09-06

FleetDASH helps federal fleet managers maximize their use of alternative fuel. This presentation explains how the dashboard works and demonstrates the newest capabilities added to the tool. It also reviews complementary online tools available to fleet managers on the Alternative Fuel Data Center.

Equally good fixation of cemented and uncemented cups in total trapeziometacarpal joint prostheses. A randomized clinical RSA study with 2-year follow-up.

PubMed

Hansen, Torben Baek; Stilling, Maiken

2013-02-01

Cup failure is a recognized problem in total trapeziometacarpal (TM) joint prostheses; it may be related to poor fixation, which can be revealed by radiostereometric analysis (RSA). We compared the early implant migration of cemented trapezium cups to that of uncemented screw cups. In a prospective, parallel-group, randomized patient-blinded clinical trial, we included 32 hands in 28 patients (5 males) with a mean age of 58 (40-77) years and with Eaton stage-2 or -3 osteoarthritis of the trapeziometacarpal joint. Patients were randomized to surgery with a cemented DLC all-polyethylene cup (C) (n = 16) or an uncemented hydroxyapatite-coated chrome-cobalt Elektra screw cup (UC) (n = 16). Uncemented cups were inserted without threading of the bone. Stereoradiographs for evaluation of cup migration (primary effect size) and DASH and pain scores were obtained during 2 years of follow-up. The 2-year total translation (TT) was similar (p = 0.2): 0.24 mm (SD 0.10) for the C (n = 11) and 0.19 mm (SD 0.16) for the UC (n = 11). Variances were similar (p = 0.4). Judged by RSA, 2 UC cups and 1 C cup became loose (TT > 1 mm). Both UC cups were found to be loose at revision. Grip strength, pain, and DASH scores were similar between groups at all measurement points. Early implant fixation and clinical outcome were equally good with both cup designs. This is the first clinical RSA study on trapezium cups, and the method appears to be clinically useful for detection of loose implants.

Platelet-rich plasma for chronic lateral epicondylitis: is one injection sufficient?

PubMed

Glanzmann, Michael C; Audigé, Laurent

2015-12-01

Chronic lateral epicondylitis is generally treated using nonsurgical methods including physiotherapy and infiltrations of cortisone or platelet-rich plasma (PRP). The latter is known for its simple application as well as associated low risk of adverse events, which lend to its widespread use in treating various musculoskeletal conditions. There is limited evidence on the effectiveness of PRP injections to optimally treat chronic lateral epicondylitis. This study explored the effectiveness of single or repeated injections for patients with symptoms that spanned 6 months or more and were unresponsive to alternate conservative measures. Patients with chronic lateral epicondylitis received PRP injections in 4-week intervals that were complemented with standardized physical therapy. Patient-reported outcomes based on the patient-rated elbow evaluation (PREE), quick disabilities of the arm, shoulder and hand (qDASH), and EuroQol (five dimensions) 3-level version (EQ5D3L) questionnaires were documented at each visit including 6 months after the first injection. These outcomes were compared between patients receiving 1 vs. 2 or 3 PRP injections. Sixty-two patients received one (n = 36) or more (n = 26) PRP injections. The mean baseline to 6-month follow-up scores of the PREE and qDASH questionnaires improved significantly from 54.0 to 23.0 and 50.3 to 20.7, respectively. The mean baseline EQ5D3L-visual analogue scale score improved from 62.5 to 82.9 by 6 months post-injection. These outcomes did not significantly differ between the patients who received varying numbers of injections. Patients with chronic lateral epicondylitis reported significant pain relief and gain in function as well as quality of life 6 months after localized PRP treatment. A single PRP injection may be sufficient.

Intramedullary fixation of forearm fractures with new locked nail.

PubMed

Bansal, Himanshu

2011-09-01

Lack of availability of interlocked nails made plate osteosynthesis the first choice of treatment of forearm fractures inspite of more surgical exposure, periosteal stripping and big skin incision subsequent scar along with higher risk of refracture on implant removal. We hereby report the first 12 cases with 19 forearm bone fractures internally fixed by indegenous interlocked nail. Existing square nails were modified to have a broad proximal end of 5.5 mm with a hole for locking screw of 2.5 mm. The nail has a distal hole of 1/1.2/1.5 mm in 2.5/3/3.5 mm diameter nail, respectively. A new method of distal locking with a clip made of k wire is designed. The clip after insertion into the bone and hole in nail and opposite cortex snuggly fits the bone providing a secure locking system. Twelve skeletally mature patients, mean age 32 years (range 24-45 years) with 19 diaphyseal fractures of the forearm were treated with this indigenously made new nail. The patient were evaluated for fracture union, functional recovery and complications. The functional outcome was assessed by disabilities of arm, shoulder and hand questionnaire (DASH score). Time to radiographic union ranged between 12 and 28 weeks, with a 100% union rate. Complications were minimal, with mild infection in open fracture (n=1) and delayed union (n=1) in patient with comminuted fracture of the ulna only. The clinical results were excellent. The DASH score ranged between 0 and 36 points. This new interlocking nail may be considered as an alternative to plate osteosynthesis for fractures of the forearm in adults. The advantages are benefit of closed reduction, smaller residual scar, reduced cost and early union with allowance of immediate movements.

Costs and outcome for serious hand and arm injuries during the first year after trauma - a prospective study.

PubMed

Rosberg, Hans-Eric; Carlsson, Katarina Steen; Cederlund, Ragnhild I; Ramel, Eva; Dahlin, Lars B

2013-05-24

To study costs and outcome for serious hand and arm injuries during the first year after the trauma. In patients with a Hand Injury Severity Score (HISS) > 50, DASH and EQ-5D scores as well as factors related to costs within the health care sector, costs due to lost production and total costs were evaluated. Cox-regression analysis stratifying for mechanism of injury was used to analyse return to work. The majority of the 45 included patients (median 42 years 16-64) were men with severe (n = 9) or major (n = 36) injuries with different type of injuries (amputations n = 13; complex injuries n = 18; major nerve injuries/full house n = 13; burn injury n = 1). DASH and EQ-5D decreased and increased, respectively, significantly over time during one year. Total costs (+34%) and costs of lost production were highest for persons injured at work. Factors associated with higher health care costs were age >50 years (+52%), injury at work (+40%) and partial labour market activity (+66%). Costs of lost production had a significant role in total costs of injury. Patients with major injuries had longer duration of sick leave. Patients with severe injuries were more likely to return to work [(RR 3.76 (95% CI 1.38-10.22) from Cox regression, controlling for age, gender and presence of nerve injury]. Despite the fact that work environments have constantly improved over the last decades, we found that hand injuries at work were most costly both in terms of health care and costs of lost production, although the severity, i.e. HISS, did not differ from injuries occurring at home or during leisure.

The Radial Bow following Square Nailing in Radius and Ulna Shaft Fractures in Adults and its Relation to Disability and Function.

PubMed

Dave, M B; Parmar, K D; Sachde, B A

2016-07-01

One of the points made against nailing in radius and ulna shaft fractures has been the loss of radial bow and its impact on function. The aims of the study were to assess the change in magnitude and location of the radial bow in radius and ulna shaft fractures treated with intramedullary square nails and to assess the impact of this change on functional outcome, patient reported disability and the range of motion of the forearm. We measured the magnitude of radial bow and its location in the operated extremity and compared it to the uninjured side in 32 adult patients treated with intramedullary square nailing for radius and ulna shaft fractures at our institute. The mean loss of magnitude of maximum radial bow was 2.18 mm which was statistically significant by both student-T test and Mann-Whitney U test with p value less than 0.01. The location of maximum radial bow shifted distally but was statistically insignificant. The magnitude of maximum radial bow had a negative correlation with DASH score that was statistically insignificant (R=- 0.22, p=0.21). It had a positive, statistically significant correlation to the extent of supination in the operated extremity (R = 0.66, p = 0.0004). A loss of up to 2mm of radial bow did not influence the functional outcome as assessed by criteria reported by Anderson et al. The magnitude of radial bow influenced the supination of the forearm but not the final disability as measured by DASH score. Intramedullary nailing did decrease the magnitude of radial bow but a reduction of up to 2mm did not influence the functional outcome.

The contributions of unhealthy lifestyle factors to apparent resistant hypertension: findings from the Reasons for Geographic And Racial Differences in Stroke (REGARDS) study.

PubMed

Shimbo, Daichi; Levitan, Emily B; Booth, John N; Calhoun, David A; Judd, Suzanne E; Lackland, Daniel T; Safford, Monika M; Oparil, Suzanne; Muntner, Paul

2013-02-01

Unhealthy lifestyle factors may contribute to apparent treatment resistant hypertension (aTRH). We examined associations of unhealthy lifestyle factors with aTRH in individuals taking antihypertensive medications from three or more classes. Participants (n = 2602) taking three or more antihypertensive medication classes were identified from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study. aTRH was defined as having SBP/DBP at least 140/90 mmHg despite the use of three or more antihypertensive medication classes or the use of four or more classes to achieve blood pressure control. Lifestyle factors included obesity, physical inactivity, current smoking, heavy alcohol consumption, a low Dietary Approaches to Stop Hypertension (DASH) diet score and high sodium-to-potassium (Na/K) intake. Among participants taking three or more antihypertensive medication classes, 1293 (49.7%) participants had aTRH. The prevalence of unhealthy lifestyle factors in participants with and without aTRH was 55.2 and 51.7%, respectively, for obesity, 42.2 and 40.5% for physical inactivity, 11.3 and 11.5% for current smoking, 3.1 and 4.0% for heavy alcohol consumption, 23.1 and 21.5% for low-DASH diet score, and 25.4 and 24.4% for high Na/K intake. After adjustment for age, sex, race, and geographic region of residence, none of the unhealthy lifestyle factors were associated with aTRH. The associations between each unhealthy lifestyle factor and aTRH remained nonsignificant after additional adjustment for education, income, depressive symptoms, total calorie intake, and comorbidities. Unhealthy lifestyle factors did not have independent associations with aTRH among individuals taking three or more antihypertensive medication classes.

The Contributions of Unhealthy Lifestyle Factors to Apparent Resistant Hypertension: Findings from the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

PubMed Central

Shimbo, Daichi; Levitan, Emily B.; Booth, John N.; Calhoun, David A.; Judd, Suzanne E.; Lackland, Daniel T.; Safford, Monika M.; Oparil, Suzanne; Muntner, Paul

2013-01-01

Objectives Unhealthy lifestyle factors may contribute to apparent treatment resistant hypertension (aTRH). We examined associations of unhealthy lifestyle factors with aTRH in individuals taking antihypertensive medications from three or more classes. Methods Participants (n=2,602) taking three or more antihypertensive medication classes were identified from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study. aTRH was defined as having systolic/diastolic blood pressure ≥140/90 mmHg despite the use of three or more antihypertensive medication classes or the use of four or more classes to achieve blood pressure control. Lifestyle factors included obesity, physical inactivity, current smoking, heavy alcohol consumption, a low DASH diet score and high sodium-to-potassium (Na/K) intake. Results Among participants taking three or more antihypertensive medication classes, 1,293 (49.7%) participants had aTRH. The prevalence of unhealthy lifestyle factors in participants with and without aTRH was 55.2% and 51.7% respectively for obesity, 42.2% and 40.5% for physical inactivity, 11.3% and 11.5% for current smoking, 3.1% and 4.0% for heavy alcohol consumption, 23.1% and 21.5% for low DASH diet score, and 25.4% and 24.4% for high Na/K intake. After adjustment for age, sex, race, and geographic region of residence, none of the unhealthy lifestyle factors was associated with aTRH. The associations between each unhealthy lifestyle factor and aTRH remained non-significant after additional adjustment for education, income, depressive symptoms, total calorie intake, and co-morbidities. Conclusions Unhealthy lifestyle factors did not have independent associations with aTRH among individuals taking three or more antihypertensive medication classes. PMID:23303356

Treatment options and outcome after bony avulsion of the flexor digitorum profundus tendon: a review of 29 cases.

PubMed

Halát, Gabriel; Negrin, Lukas; Erhart, Jochen; Ristl, Robin; Hajdu, Stefan; Platzer, Patrick

2017-02-01

The objective of this retrospective review was to evaluate the functional and esthetic outcomes in patients with non- or minimally (<2 mm), and severely (>2 mm) displaced bony avulsions of the flexor digitorum profundus (FDP) tendon. Between 1996 and 2010, 29 patients with a bony avulsion of the FDP tendon were treated. The displacement magnitude of the avulsed fragment determined, whether conservative or surgical treatment was performed. Persisting functional deficit, radiological findings, remaining disabilities using the Disability of the Arm, Shoulder, and Hand (DASH) score, as well as treatment-related deformities and complications were evaluated retrospectively and at a mean follow-up of 7 years. In 16 patients, conservative therapy by initial static splinting due to a fragment displacement of <2 mm was conducted. These patients reported no functional impairment at follow-up. In 13 cases, major displacement (>2 mm) of the bony fragment led to an open reconstruction of the avulsion injury either by screw fixation or a Lengemann pull-out wire. In a majority, an extension deficit in the DIP joint and a decrease of tip pinch strength by 25% was present at follow-up. In five patients, peri- or short-term postoperative complications occurred and in five, a nail deformity remained. DASH score revealed satisfying results after both therapeutic approaches. Conservative treatment in non- or minimally displaced avulsions leads to satisfying functional results. Patients receiving surgery after major fragment displacement need to be aware of a possible impaired ROM at the DIP joint. The use of the Lengemann pull-out wire may place patients at an increased complication risk and frequently induces nail deformities. Therapeutic, level IV.

Outcome Assessment after Aptis Distal Radioulnar Joint (DRUJ) Implant Arthroplasty

PubMed Central

Kachooei, Amir Reza; Chase, Samantha M; Jupiter, Jesse B

2014-01-01

Background: Conventional treatments after complicated injuries of the distal radioulnar joint (DRUJ) such as Darrach and Kapandji-Sauvé procedures have many drawbacks, which may eventually lead to a painful unstable distal ulna. The development of DRUJ prosthesis has significantly evolved over the past years. In this study, we assessed the outcome results of patients after DRUJ implant arthroplasty using the Aptis (Scheker) prosthesis. Methods: We identified 13 patients with 14 prosthesis during the past 10 years. Patients underwent DRUJ arthroplasty due to persistent symptoms of instability, chronic pain, and stiffness. Records and follow-up visits were reviewed to find the final post-operative symptoms, pain, range of motion, and grip strength with a mean follow-up of 12 months (range: 2-25 months). Also, patients were contacted prospectively by phone in order to administer the disabilities of the arm shoulder and hand (DASH), patient rated wrist evaluation (PRWE), and visual analogue scale (VAS), and to interview regarding satisfaction and progress in daily activities. Eleven patients out of 13 could be reached with a median follow-up time of 60 months (range: 2 to 102 months). Results: No patient required removal of the prosthesis. Only two patients underwent secondary surgeries in which both required debridement of the screw tip over the radius. The median DASH score, PRWE score, VAS, and satisfaction were 1.3, 2.5, 0, and 10, respectively. The mean range of flexion, extension, supination, and pronation was 62, 54, 51, and 64, respectively. Conclusions: Distal radioulnar joint injuries are disabling and patients usually undergo one or more salvage surgeries prior to receiving an arthroplasty. The Scheker prosthesis has shown satisfactory results with 100% survival rate in all reports. The constrained design of this prosthesis gives enough stability to prevent painful subluxation. PMID:25386579

A Collection of Technical Studies Completed for the Computer-Aided Acquisition and Logistic Support (CALS) Program Fiscal Year 1988. Volume 3. CGM Registration

DTIC Science & Technology

1991-03-01

the array are used cyclically, that is when the end of the array is reached, the pattern starts over at the beginning. Dashed lines wrap around curves...the dash pattern relative to the start of the path. It is interpreted as a .distance into the dash pattern at which the pattern should be started ...cubic seldom Is drawn using the four points specified. The curve starts at the first point and ends at the fourth point; the second and third point are

Bridging Graft in Irreparable Massive Rotator Cuff Tears: Autogenic Biceps Graft versus Allogenic Dermal Patch Graft

PubMed Central

Rhee, Sung Min

2017-01-01

Background Few comparative studies have reported on the use of biologic grafts for irreparable massive rotator cuff tears. The purpose of this study was to assess the results of arthroscopic bridging graft in irreparable massive rotator cuff tears using an autogenic long head of biceps tendon (LHBT) or an allogenic dermal patch (ADP). Methods We retrospectively reviewed 24 patients treated using the LHBT (group I) and eight patients with complete rupture of the LHBT treated using an ADP (group II) since 2011. Preoperative Goutallier's fatty degeneration, range of motion (ROM), visual analogue scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, and Quick Disabilities of the Arm, Shoulder, and Hand (DASH) score were assessed and healing failure was evaluated at 1 year after surgery by ultrasonography or magnetic resonance imaging. Results The mean fatty degeneration in groups I and II was 3.9 and 3.6 for the supraspinatus (p = 0.288), 2.7 and 2.9 for the infraspinatus (p = 0.685), 0.9 and 1.3 for the subscapularis (p = 0.314), and 1.3 and 3.0 for the teres minor (p = 0.005), respectively. Subscapularis tears were found in 8 patients (33.3%) in group I and in 7 patients (87.5%) in group II (p = 0.023). Mean ROMs and functional scores improved significantly in group I (forward flexion: 121.7° to 153.3°, p = 0.010; external rotation: 32.7° to 52.7°, p = 0.001; external rotation at 90°: 63.3° to 74.5°, p = 0.031; internal rotation: T10.5 to T9.3, p = 0.045; VAS: 7.0 to 1.1, p < 0.001; ASES score: 45.4 to 81.6, p = 0.028; and Quick DASH score: 50.0 to 14.2, p = 0.017), whereas only VAS showed significant improvement in group II (from 5.9 to 2.0, p = 0.025) and ROMs and other functional scores increased without statistical significance in the group. Healing failure was found in 13 patients (54.2%) in group I and in 6 patients (75.0%) in group II (p = 0.404). Conclusions The surgeon should prudently choose surgical options for irreparable massive rotator cuff tears, especially in patients with severe fatty degeneration in the teres minor or combined biceps and subscapularis tears. PMID:29201303

Correlation between physical anomaly and behavioral abnormalities in Down syndrome

PubMed Central

Bhattacharyya, Ranjan; Sanyal, Debasish; Roy, Krishna; Bhattacharyya, Sumita

2010-01-01

Objective: The minor physical anomaly (MPA) is believed to reflect abnormal development of the CNS. The aim is to find incidence of MPA and its behavioral correlates in Down syndrome and to compare these findings with the other causes of intellectual disability and normal population. Materials and Methods: One-hundred and forty intellectually disabled people attending a tertiary care set-up and from various NGOs are included in the study. The age-matched group from normal population was also studied for comparison. MPA are assessed by using Modified Waldrop scale and behavioral abnormality by Diagnostic assessment scale for severely handicapped (DASH II scale). Results: The Down syndrome group had significantly more MPA than other two groups and most of the MPA is situated in the global head region. There is strong correlation (P < 0.001) between the various grouped items of Modified Waldrop scale. Depression subscale is correlated with anomalies in the hands (P < 0.001), feet and Waldrop total items (P < 0.005). Mania item of DASH II scale is related with anomalies around the eyes (P < 0.001). Self-injurious behavior and total Waldrop score is negatively correlated with global head. Conclusion: Down syndrome group has significantly more MPA and a pattern of correlation between MPA and behavioral abnormalities exists which necessitates a large-scale study. PMID:21559153

Musculoskeletal system problems and quality of life of mothers of children with cerebral palsy with different levels of disability.

PubMed

Kavlak, Erdoğan; Altuğ, Filiz; Büker, Nihal; Şenol, Hande

2015-01-01

The objective of this study is to investigate musculoskeletal system problems and quality of life of mothers of children with cerebral palsy with different levels of disability. 100 children (37 girls and 63 boys) with cerebral palsy (CP) and their mothers were included in this study. Functional levels of children with CP were assessed by using the Gross Motor Function Classification System (GMFCS) and the Pediatric Functional Independence Measure (WeeFIM). Quality of life of mothers regarding health was assessed by using the Nottingham Health Profile (NHP). Musculoskeletal system problems of mothers were assessed by using the Neck Disability Index (NDI) and the Roland-Morris Disability Questionnaire (RMDQ). No statistical significance was found when GMFCS levels of children with CP and the NHP, DASH-T, RMDQ, NDI and the BAE values of mothers were compared in an inter-group way (p> 0.05). When the NHP parameters and the existence of lower and arm pains of mothers were compared with their BAI, NDI, RMDQ and DASH-T scores, a statistically significant relationship was found among them (p< 0.05). As functional levels of children with CP get worse, upper extremity, lower back and neck problems and anxiety levels of mothers increase and this situation negatively affects mothers' quality of life.

Effects of the dietary approaches to stop hypertension diet, exercise, and caloric restriction on neurocognition in overweight adults with high blood pressure.

PubMed

Smith, Patrick J; Blumenthal, James A; Babyak, Michael A; Craighead, Linda; Welsh-Bohmer, Kathleen A; Browndyke, Jeffrey N; Strauman, Timothy A; Sherwood, Andrew

2010-06-01

High blood pressure increases the risks of stroke, dementia, and neurocognitive dysfunction. Although aerobic exercise and dietary modifications have been shown to reduce blood pressure, no randomized trials have examined the effects of aerobic exercise combined with dietary modification on neurocognitive functioning in individuals with high blood pressure (ie, prehypertension and stage 1 hypertension). As part of a larger investigation, 124 participants with elevated blood pressure (systolic blood pressure 130 to 159 mm Hg or diastolic blood pressure 85 to 99 mm Hg) who were sedentary and overweight or obese (body mass index: 25 to 40 kg/m(2)) were randomized to the Dietary Approaches to Stop Hypertension (DASH) diet alone, DASH combined with a behavioral weight management program including exercise and caloric restriction, or a usual diet control group. Participants completed a battery of neurocognitive tests of executive function-memory-learning and psychomotor speed at baseline and again after the 4-month intervention. Participants on the DASH diet combined with a behavioral weight management program exhibited greater improvements in executive function-memory-learning (Cohen's D=0.562; P=0.008) and psychomotor speed (Cohen's D=0.480; P=0.023), and DASH diet alone participants exhibited better psychomotor speed (Cohen's D=0.440; P=0.036) compared with the usual diet control. Neurocognitive improvements appeared to be mediated by increased aerobic fitness and weight loss. Also, participants with greater intima-medial thickness and higher systolic blood pressure showed greater improvements in executive function-memory-learning in the group on the DASH diet combined with a behavioral weight management program. In conclusion, combining aerobic exercise with the DASH diet and caloric restriction improves neurocognitive function among sedentary and overweight/obese individuals with prehypertension and hypertension.

Cross-cultural adaptation and validation of the Patient-Rated Tennis Elbow Evaluation Questionnaire on lateral elbow tendinopathy for French-speaking patients.

PubMed

Kaux, Jean-François; Delvaux, François; Schaus, Jean; Demoulin, Christophe; Locquet, Médéa; Buckinx, Fanny; Beaudart, Charlotte; Dardenne, Nadia; Van Beveren, Julien; Croisier, Jean-Louis; Forthomme, Bénédicte; Bruyère, Olivier

Translation and validation of algo-functional questionnaire. The lateral elbow tendinopathy is a common injury in tennis players and physical workers. The Patient-Rated Tennis Elbow Evaluation (PRTEE) Questionnaire was specifically designed to measure pain and functional limitations in patients with lateral epicondylitis (tennis elbow). First developed in English, this questionnaire has since been translated into several languages. The aims of the study were to translate and cross-culturally adapt the PRTEE questionnaire into French and to evaluate the reliability and validity of this translated version of the questionnaire (PRTEE-F). The PRTEE was translated and cross-culturally adapted into French according to international guidelines. To assess the reliability and validity of the PRTEE-F, 115 participants were asked twice to fill in the PRTEE-F, and once the Disabilities of Arm, Shoulder and Hand Questionnaire (DASH) and the Short Form Health Survey (SF-36). Internal consistency (using Cronbach's alpha), test-retest reliability (using intraclass correlation coefficient (ICC), standard error of measurement and minimal detectable change), and convergent and divergent validity (using the Spearman's correlation coefficients respectively with the DASH and with some subscales of the SF-36) were assessed. The PRTEE was translated into French without any problems. PRTEE-F showed a good test-retest reliability for the overall score (ICC 0.86) and for each item (ICC 0.8-0.96) and a high internal consistency (Cronbach's alpha = 0.98). The correlation analyses revealed high correlation coefficients between PRTEE-F and DASH (convergent validity) and, as expected, a low or moderate correlation with the divergent subscales of the SF-36 (discriminant validity). There was no floor or ceiling effect. The PRTEE questionnaire was successfully cross-culturally adapted into French. The PRTEE-F is reliable and valid for evaluating French-speaking patients with lateral elbow tendinopathy. Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

47 CFR 2.926 - FCC identifier.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Arabic numerals, capital letters, or combination thereof. A prospective grantee or his authorized... shall consist of a series of Arabic numerals, capital letters or a combination thereof, and may include the dash or hyphen (-). The total of Arabic numerals, capital letters and dashes or hyphens shall not...

47 CFR 2.926 - FCC identifier.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Arabic numerals, capital letters, or combination thereof. A prospective grantee or his authorized... shall consist of a series of Arabic numerals, capital letters or a combination thereof, and may include the dash or hyphen (-). The total of Arabic numerals, capital letters and dashes or hyphens shall not...

DASH-2: Flexible, Low-Cost, and High-Throughput SNP Genotyping by Dynamic Allele-Specific Hybridization on Membrane Arrays

PubMed Central

Jobs, Magnus; Howell, W. Mathias; Strömqvist, Linda; Mayr, Torsten; Brookes, Anthony J.

2003-01-01

Genotyping technologies need to be continually improved in terms of their flexibility, cost-efficiency, and throughput, to push forward genome variation analysis. To this end, we have leveraged the inherent simplicity of dynamic allele-specific hybridization (DASH) and coupled it to recent innovations of centrifugal arrays and iFRET. We have thereby created a new genotyping platform we term DASH-2, which we demonstrate and evaluate in this report. The system is highly flexible in many ways (any plate format, PCR multiplexing, serial and parallel array processing, spectral-multiplexing of hybridization probes), thus supporting a wide range of application scales and objectives. Precision is demonstrated to be in the range 99.8–100%, and assay costs are 0.05 USD or less per genotype assignment. DASH-2 thus provides a powerful new alternative for genotyping practice, which can be used without the need for expensive robotics support. PMID:12727908

iDASH: integrating data for analysis, anonymization, and sharing

PubMed Central

Bafna, Vineet; Boxwala, Aziz A; Chapman, Brian E; Chapman, Wendy W; Chaudhuri, Kamalika; Day, Michele E; Farcas, Claudiu; Heintzman, Nathaniel D; Jiang, Xiaoqian; Kim, Hyeoneui; Kim, Jihoon; Matheny, Michael E; Resnic, Frederic S; Vinterbo, Staal A

2011-01-01

iDASH (integrating data for analysis, anonymization, and sharing) is the newest National Center for Biomedical Computing funded by the NIH. It focuses on algorithms and tools for sharing data in a privacy-preserving manner. Foundational privacy technology research performed within iDASH is coupled with innovative engineering for collaborative tool development and data-sharing capabilities in a private Health Insurance Portability and Accountability Act (HIPAA)-certified cloud. Driving Biological Projects, which span different biological levels (from molecules to individuals to populations) and focus on various health conditions, help guide research and development within this Center. Furthermore, training and dissemination efforts connect the Center with its stakeholders and educate data owners and data consumers on how to share and use clinical and biological data. Through these various mechanisms, iDASH implements its goal of providing biomedical and behavioral researchers with access to data, software, and a high-performance computing environment, thus enabling them to generate and test new hypotheses. PMID:22081224

iDASH: integrating data for analysis, anonymization, and sharing.

PubMed

Ohno-Machado, Lucila; Bafna, Vineet; Boxwala, Aziz A; Chapman, Brian E; Chapman, Wendy W; Chaudhuri, Kamalika; Day, Michele E; Farcas, Claudiu; Heintzman, Nathaniel D; Jiang, Xiaoqian; Kim, Hyeoneui; Kim, Jihoon; Matheny, Michael E; Resnic, Frederic S; Vinterbo, Staal A

2012-01-01

iDASH (integrating data for analysis, anonymization, and sharing) is the newest National Center for Biomedical Computing funded by the NIH. It focuses on algorithms and tools for sharing data in a privacy-preserving manner. Foundational privacy technology research performed within iDASH is coupled with innovative engineering for collaborative tool development and data-sharing capabilities in a private Health Insurance Portability and Accountability Act (HIPAA)-certified cloud. Driving Biological Projects, which span different biological levels (from molecules to individuals to populations) and focus on various health conditions, help guide research and development within this Center. Furthermore, training and dissemination efforts connect the Center with its stakeholders and educate data owners and data consumers on how to share and use clinical and biological data. Through these various mechanisms, iDASH implements its goal of providing biomedical and behavioral researchers with access to data, software, and a high-performance computing environment, thus enabling them to generate and test new hypotheses.

Effects of Dietary Approach to Stop Hypertension diet on androgens, antioxidant status and body composition in overweight and obese women with polycystic ovary syndrome: a randomised controlled trial.

PubMed

Azadi-Yazdi, M; Karimi-Zarchi, M; Salehi-Abargouei, A; Fallahzadeh, H; Nadjarzadeh, A

2017-06-01

Polycystic ovary syndrome (PCOS) is the most common endocrine disease in reproductive age women. The present study aimed to determine the effects of Dietary Approaches to Stop Hypertension (DASH) diet on reproductive hormones, plasma total antioxidant status and anthropometric indices in overweight and obese PCOS women. In this randomised controlled clinical trial, 60 women with PCOS were randomly assigned to one of two diets with energy restriction: the DASH diet and a control diet. The DASH and control diets consisted of 50-55% carbohydrate, 15-20% protein and 25-30% total fat. The DASH diet was designed to be rich in vegetables, fruits, whole grains and low-fat dairy products, as well as low in saturated fats, cholesterol, refined grains and sweets. In the present study, the anthropometric indices, body composition, total testosterone, androstenedione, sex hormone binding globulin (SHBG), free androgen index and 2,2'-diphenyl-1-picryylhydrazyl (DPPH) scavenging activity were measured before and after 3 months. The consumption of DASH diet compared to the control diet was associated with a significant reduction in weight [-5.78 (1.91) kg versus -4.34 (2.87) kg, P = 0.032], body mass index (BMI) [-2.29 (0.15) kg m -2 versus -1.69 (0.20) kg m -2 , P = 0.02], fat mass [-3.23(1.66) kg versus -2.13 (1.26) kg, P = 0.008] and serum androstenedione [-1.75 (1.39) ng mL -1 versus -1.02 (0.72) ng mL -1 , P-value = 0.019]. Increased concentrations of SHBG [28.80 (21.71) versus 11.66(18.82) nmol L -1 , P = 0.003) and DPPH scavenging activity [30.23% (19.09) versus 12.97% (25.12) were also found in the DASH group. The DASH diet could improve weight loss, BMI and fat mass. Furthermore, it could result in a significant reduction in serum androstenedione and a significant increase in antioxidant status and SHBG. © 2016 The British Dietetic Association Ltd.

[Triple fracture of the shoulder suspensory complex].

PubMed

Tamimi Mariño, I; Martin Rodríguez, I; Mora Villadeamigo, J

2013-01-01

The superior suspensory complex of the shoulder (SSCS) is a ring shaped structure composed of bones and soft tissues that play a fundamental role in the stability of the shoulder joint. Isolated injuries of the SSCS are relatively common, but injuries that affect 3 components are extremely unusual. We present a triple injury of the SSCS in a 26 year old patient with a Neer type ii clavicular fracture, a Kuhn type iii acromion fracture and an Ogawa type i coracoid fracture. An open reduction and stabilization of the clavicle was performed with 2 Kirschner nails. The acromial fracture was synthesized with 2 cannulated screws, and the coracoid fracture was treated conservatively. After 24 months of follow up the patient had an excellent functional outcome according to the Constat-Murley shoulder score and QuickDASH scoring system, and all the fractures healed correctly. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

Effects of Different Conditioning Activities on 100-m Dash Performance in High School Track and Field Athletes.

PubMed

Ferreira-Júnior, João B; Guttierres, Ana P M; Encarnação, Irismar G A; Lima, Jorge R P; Borba, Diego A; Freitas, Eduardo D S; Bemben, Michael G; Vieira, Carlos A; Bottaro, Martim

2018-06-01

This study compared the effects of different conditioning activities on the 100-m dash performance of 11 male, high school track and field athletes (mean age = 16.3; SD = 1.2 years). Participants performed a 100-m dash seven minutes after each of four randomized conditioning protocols, with each condition and 100-m dash separated by 3-10 days. The conditioning protocols were (a) control, no conditioning activity; (b) weighted plyometric, three sets of 10 repetitions of alternate leg bounding with additional load of 10% of the body mass; (c) free sprint, two 20-m sprints; and (d) resisted sprint (RS), two 20-m resisted sprints using an elastic tubing tool. We obtained session ratings of perceived exertion (SRPE) immediately after each conditioning protocol. There were no significant differences between any of the three experimental conditioning activities on 100-m sprint time, but the RS protocol improved 100-m sprint time compared with the control (no conditioning) protocol ( p < .001). The RS also led to greater sprint velocity and higher SRPE compared with the control condition ( p < .01). There was no significant association between SRPE and 100-m performance ( p = .77, r = .05). These results suggest a benefit for young male track and field athletes to the elastic tubing warm-up activities prior to the 100-m dash.

78 FR 21573 - Airworthiness Directives; Bombardier, Inc. Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-11

.... For service information identified in this proposed AD, contact Bombardier, Inc., Q-Series Technical... following service information: de Havilland Dash 8 Series 100 Maintenance Task Card 531X1, Revision 25, in... Havilland Dash 8 Series 100 Maintenance Task Card 631X1, Revision 25, in Section 8, Electrical Wiring...

75 FR 45496 - Amendment of the Commission's Rules to Accommodate 30 Megahertz Channels in the 6525-6875 MHz...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-03

... to Provide for Conditional Authorization on Additional Channels in the 21.8[dash]22.0 GHz and 23.0[dash]23.2 GHz Band Correction In rule document 2010-17205 beginning on page 41767 in the issue of...

Juxta-articular Plate Fixation in Distal Radius Intra-articular Fractures with Accompanying Volar Free Fragments beyond the Watershed Line

PubMed Central

Lee, Jun-Ku; Lee, Soo-Hyun; Sim, Young-Suk; Kim, Tae-Ho; Baek, Eugene

2018-01-01

Background Although distal radius fractures (DRF) are common fractures, intra-articular comminuted DRF with volar free fragments are uncommon. There is considerable difficulty in the fixation of free fragments beyond the watershed line using the existing volar locking plate. We aimed to examine the efficacy and potential complications associated with the use of juxta-articular volar plates in intra-articular DRF accompanied by free fragments beyond the watershed line. Methods The patients were enrolled in a consecutive manner between 2007 and 2016. In cases of DRF with free fragments beyond the watershed line, we employed a 2.4-mm small fragment juxta-articular volar locking compression plate using a volar Henry approach. A total of 32 patients were included in this study. There were 15 males and 17 females with a mean age of 52.3 years (range, 33 to 69 years). The mean follow-up period was 14.5 months (range, 10 to 24 months). Preoperative radiographs and three-dimensional computed tomography images were used to analyze fracture patterns and assess the free fragments beyond the watershed line. The mean number of free fracture fragments beyond the watershed line was 2.33. Plain radiographs of immediate postoperative and last follow-up were used to confirm fracture union, incongruence, radial height, volar tilt, radial inclination, and arthritic changes. For functional assessment, we measured grip strength, range of motion (ROM), modified Mayo wrist score (MMWS) and determined Disabilities of Arm, Shoulder and Hand (DASH) scores at the last follow-up. Postoperative complications were monitored during the follow-up period. Results All patients obtained sound union without significant complications. At the last follow-up, 16 cases presented with an articular step-off of more than 1 mm (mean, 1.10 mm). The mean MMWS was 76.3 (range, 55 to 90), mean DASH score was 15.38 (range, 9 to 22), mean visual analogue scale score for pain was 1.2 and mean grip strength was 75.5% of the opposite side. The mean ROM was 74.3° for volar flexion and 71.5° for dorsiflexion. Conclusions In cases of intra-articular DRF with free fragments beyond the watershed line, a volar approach with use of a juxtaarticular plate provided favorable outcomes without significant complications. PMID:29854335

Management of unstable distal third clavicle fractures: clinical and radiological outcomes of the arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures.

PubMed

Cisneros, Luis Natera; Reiriz, Juan Sarasquete

2017-04-01

Surgical treatment is indicated for the management of Neer type IIB fractures of the distal third of the clavicle. The aim of this study was to assess the clinical and radiological outcomes, in cases of unstable distal third clavicle fractures managed by means of an arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures. Nine patients with unstable distal third clavicle fractures (Neer type IIB) managed arthroscopically by means of a conoid ligament reconstruction and fracture cerclage with sutures, between 2008 and 2012, were included. The QoL was evaluated at the last follow-up visit, by means of the Health Survey questionnaire (SF36), the visual analogue scale (VAS) for pain, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the constant score, and a Global Satisfaction scale (from 0 to 10). The mean time from fracture fixation until radiological union, the development of hardware loosening, nonunion, infections, and hardware skin discomfort were evaluated. The mean age was 36 [21-48] years old. The mean [range] time from surgery until the last follow-up visit was 49 [46-52] months. Values of the questionnaires assessed at the last follow-up visit were: (1) physical SF36 score (50.72 ± 6.88); (2) mental SF36 score (50.92 ± 11.65); (3) VAS for pain (1.86 ± 1.35); (4) DASH questionnaire (11.97 ± 7.03); (5) constant score (89.67 ± 8.55), and (6) Global Satisfaction (8.17 ± 0.98). The mean time elapsed from fracture fixation to radiological union was 8.41 ± 3.26 months. Hardware loosening was observed in none of the patients. Nonunion was observed in 11.11% (1/9) of the patients. Hardware skin discomfort was observed in 11.11% (1/9) of the patients. Patients with unstable distal third clavicle fractures managed by means of an arthroscopy-assisted conoid ligament reconstruction and fracture cerclage with sutures may have good clinical and radiological outcomes, with no need for a second surgical procedure to remove any metal hardware. Therapeutic; case series, Level IV.

Improving adherence to healthy dietary patterns, genetic risk, and long term weight gain: gene-diet interaction analysis in two prospective cohort studies.

PubMed

Wang, Tiange; Heianza, Yoriko; Sun, Dianjianyi; Huang, Tao; Ma, Wenjie; Rimm, Eric B; Manson, JoAnn E; Hu, Frank B; Willett, Walter C; Qi, Lu

2018-01-10

To investigate whether improving adherence to healthy dietary patterns interacts with the genetic predisposition to obesity in relation to long term changes in body mass index and body weight. Prospective cohort study. Health professionals in the United States. 8828 women from the Nurses' Health Study and 5218 men from the Health Professionals Follow-up Study. Genetic predisposition score was calculated on the basis of 77 variants associated with body mass index. Dietary patterns were assessed by the Alternate Healthy Eating Index 2010 (AHEI-2010), Dietary Approach to Stop Hypertension (DASH), and Alternate Mediterranean Diet (AMED). Five repeated measurements of four year changes in body mass index and body weight over follow-up (1986 to 2006). During a 20 year follow-up, genetic association with change in body mass index was significantly attenuated with increasing adherence to the AHEI-2010 in the Nurses' Health Study (P=0.001 for interaction) and Health Professionals Follow-up Study (P=0.005 for interaction). In the combined cohorts, four year changes in body mass index per 10 risk allele increment were 0.07 (SE 0.02) among participants with decreased AHEI-2010 score and -0.01 (0.02) among those with increased AHEI-2010 score, corresponding to 0.16 (0.05) kg versus -0.02 (0.05) kg weight change every four years (P<0.001 for interaction). Viewed differently, changes in body mass index per 1 SD increment of AHEI-2010 score were -0.12 (0.01), -0.14 (0.01), and -0.18 (0.01) (weight change: -0.35 (0.03), -0.36 (0.04), and -0.50 (0.04) kg) among participants with low, intermediate, and high genetic risk, respectively. Similar interaction was also found for DASH but not for AMED. These data indicate that improving adherence to healthy dietary patterns could attenuate the genetic association with weight gain. Moreover, the beneficial effect of improved diet quality on weight management was particularly pronounced in people at high genetic risk for obesity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

[Clinical characteristics and surgical management of Eyres type V coracoid fracture combined with superior shoulder suspensory complex injury].

PubMed

Liu, Hongzhi; Qiu, Changmao; Liu, Zhaojie; Zhang, Yinguang; Tian, Wei; Jia, Jian

2014-12-01

To investigate the clinical characteristics of Eyres type V coracoid fracture combined with superior shoulder suspensory complex (SSSC) injuries, and the effectiveness of open reduction and fixation. Between March 2004 and July 2012, 13 patients with Eyres type V coracoid fracture and SSSC injuries were treated. There were 10 males and 3 females with an average age of 41 years (range, 23-59 years). Injury was caused by falling from height in 4 cases, by traffic accident in 6 cases, and by impact of the heavy weight in 3 cases. The interval from injury to operation was 3-10 days (mean, 5.2 days). SSSC injuries included 9 cases of acromioclavicular joint dislocation, 5 cases of clavicular fractures, and 4 cases of acromion fractures. The coracoid fractures were fixed with cannulated screws; the acromioclavicular joint dislocations were fixed with hook plate (6 cases) or Kirschner wires (2 case) except 1 untreated case; the clavicular fractures were fixed with anatomical locking plate (3 cases) and hook plate (2 cases); the acromion fractures were fixed with cannulated screws (1 case), Kirschner wires (2 cases), or both of them (1 case). The mean operation time was 158.0 minutes (range, 100-270 minutes), and the mean intraoperative blood loss was 207.7 mL (range, 150-300 mL). The other patients obtained primary healing of incision except 1 patient who had inflammation around incision, which was cured after change dressing. All patients were followed up for 22.6 months on average (range, 17-35 months). All fractures achieved union at a mean time of 3.6 months (range, 2-6 months). No nerve injury and implant fixation failure complications were observed. At last follow-up, the Constant score and the disability of the arm, shoulder, and hand (DASH) score had a significant improvement when compared with scores at pre-operation (P < 0.05). The shoulder range of motion in flexion, abduction, and external rotation at last follow-up were significantly higher than those at pre-operation (P < 0.05). Eyres type V coracoid fracture associated with SSSC injuries usually results in the instability of the shoulder. With individual surgical treatment, the satisfactory function and good effectiveness can be obtained.

Nanostructured Quantum Dots or Dashes in Photovoltaic Devices and Methods Thereof

NASA Technical Reports Server (NTRS)

Raffaele, Ryne P. (Inventor); Wilt, David M. (Inventor)

2015-01-01

A photovoltaic device includes one or more structures, an array of at least one of quantum dots and quantum dashes, at least one groove, and at least one conductor. Each of the structures comprises an intrinsic layer on one of an n type layer and a p type layer and the other one of the n type layer and the p type layer on the intrinsic layer. The array of at least one of quantum dots and quantum dashes is located in the intrinsic layer in at least one of the structures. The groove extends into at least one of the structures and the conductor is located along at least a portion of the groove.

Korean Type Distal Radius Anatomical Volar Plate System: A Preliminary Report

PubMed Central

Kim, Jeong Hwan; Kim, Jihyeung; Kim, Min Bom; Rhee, Seung Hwan; Gong, Hyun Sik; Lee, Young Ho

2014-01-01

Background Distal radius fracture is the most common fracture of the upper extremity, and approximately 60,000 distal radius fractures occur annually in Korea. Internal fixation with an anatomical volar locking plate is widely used in the treatment of unstable distal radius fractures. However, most of the currently used distal radius anatomical plate systems were designed based on the anatomical characteristics of Western populations. Recently, the Korean-type distal radius anatomical volar plate (K-DRAVP) system was designed and developed based on the anatomical characteristics of the distal radius of Koreans. The purpose of this study was to evaluate the preliminary results of the new K-DRAVP system, and to compare its radiologic and functional results with those of the other systems. Methods From March 2012 to October 2012, 46 patients with acute distal radius fractures who were treated with the K-DRAVP system at three hospitals were enrolled in this study. Standard posteroanterior and lateral radiographs were obtained to assess fracture healing, and three radiographic parameters (volar tilt, radial inclination, and radial length) were assessed to evaluate radiographic outcomes. The range of motion and grip strength, the Gartland and Werley scoring system, and the disabilities of the arm, shoulder and hand (DASH) questionnaire were used to assess clinical and functional outcomes. Results All radiologic parameters were restored to normal values, and maintained without any loosening or collapse until the time of final follow-up. Grip strength was restored to 84% of the value for the unaffected side. The mean range of motion of the wrist at final follow-up was restored to 77%-95% of the value for the unaffected side. According to the Gartland and Werley scoring system, there were 16 excellent, 26 good, and 4 fair results. The mean DASH score was 8.4 points. There were no complications after surgery. Conclusions The newly developed K-DRAVP system could be used to restore and maintain good anatomical parameters, and provide good clinical outcomes with low complication rates. This system is a promising surgical option for the treatment of distal radius fractures in the Korean population. PMID:25177449

77 FR 63215 - Airworthiness Directives; Bombardier, Inc. Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-16

... can be found in the Bombardier Q400 Dash 8 Aircraft Maintenance Manual. (h) Retained Actions for... operational check fails, guidance on doing the repair can be found in the Bombardier Q400 Dash 8 Aircraft... which the reidentification is done, an operational check of the alternate extension system of the main...

77 FR 67763 - Airworthiness Directives; Pratt & Whitney Division Turbofan Engines

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-14

... Airworthiness Directives; Pratt & Whitney Division Turbofan Engines AGENCY: Federal Aviation Administration (FAA..., PW4156A, PW4158, PW4160, PW4460, PW4462, and PW4650 turbofan engines, including models with any dash... PW4650 turbofan engines, including models with any dash number suffix, with 3rd stage low-pressure...

Validity of the Sleep Subscale of the Diagnostic Assessment for the Severely Handicapped-II (DASH-II)

ERIC Educational Resources Information Center

Matson, Johnny L.; Malone, Carrie J.

2006-01-01

Currently there are no available sleep disorder measures for individuals with severe and profound intellectual disability. We, therefore, attempted to establish the external validity of the "Diagnostic Assessment for the Severely Handicapped-II" (DASH-II) sleep subscale by comparing daily observational sleep data with the responses of…

Hermaphroditism in the dash-and-dot goatfish Parupeneus barberinus.

PubMed

Longenecker, K; Langston, R; Crane, M

2017-03-01

Presence of bisexual individuals and a sex-specific bimodal size distribution are suggestive of protogyny in the dash-and-dot goatfish Parupeneus barberinus, but the most parsimonious interpretation of histological analysis is juvenile hermaphroditism. This is the first report of hermaphroditism in the Mullidae. © 2017 The Fisheries Society of the British Isles.

Development of DASH Mobile: a mHealth lifestyle change intervention for the management of hypertension.

PubMed

Mann, Devin M; Kudesia, Valmeek; Reddy, Shivani; Weng, Michael; Imler, Daniel; Quintiliani, Lisa

2013-01-01

Several landmark studies based on the DASH diet have established the effectiveness of a lifestyle approach to blood pressure control that emphasizes a diet rich in fruits and vegetables with moderate portions of low-fat dairy and lean protein along with increased physical activity and reduced sodium intake. However, this evidence base remains underused due feasibility limitations of implementing these intense in-person interventions and poor engagement with desktop computer based versions. Mobile technologies such as smartphones and wireless sensors have the ability to deliver behavioral interventions in-the-moment and with reduced user burden. DASH Mobile is a new mHealth system being developed to deliver this evidence-based lifestyle intervention to hypertensive patients. The system consists of an Android based "app" that facilitates easy tracking of DASH food portions, integrated Bluetooth blood pressure, weight and pedometer monitoring, goal setting, simple data visualizations and multimedia video clips to train patients in the basic concepts of the lifestyle change plan. At present, the system is undergoing usability testing with a pilot clinical trial planned for Spring 2013.

Hydridosilylamido complexes of Ta and Mo isolobal with Berry's zirconocenes: syntheses, β-Si-H agostic interactions, catalytic hydrosilylation, and insight into mechanism.

PubMed

McLeod, Nicolas A; Kuzmina, Lyudmila G; Korobkov, Ilia; Howard, Judith A K; Nikonov, Georgii I

2016-02-14

The syntheses of novel Group 5 and Group 6 hydrosilylamido complexes of the type R(ArN[double bond, length as m-dash])M{N((t)Bu)SiMe2-H}X (M = Ta, R = Cp; M = Mo, R = ArN; X = Cl, H, OBn, Me) are described. The various substituents in the X position seem to play the key role in determining the extent of β-agostic interaction with the Si-H bond. The Mo agostic hydrido complex (ArN[double bond, length as m-dash])2Mo{η(3)-N((t)Bu)SiMe2-H}H is a pre-catalyst for the hydrosilylation of carbonyls. The stoichiometric reaction between benzaldehyde and (ArN[double bond, length as m-dash])2Mo{η(3)-N((t)Bu)SiMe2-H}H gives the benzoxy complex (ArN[double bond, length as m-dash])2Mo{N((t)Bu)SiMe2-H}(OBn), which showed a similar catalytic reactivity compared to the parent hydride. Mechanistic studies suggest that a non-hydride mechanism is operative.

Highly efficient non-degenerate four-wave mixing under dual-mode injection in InP/InAs quantum-dash and quantum-dot lasers at 1.55 μm

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sadeev, T., E-mail: tagir@mailbox.tu-berlin.de; Arsenijević, D.; Huang, H.

2015-11-09

This work reports on non-degenerate four-wave mixing under dual-mode injection in metalorganic vapor phase epitaxy grown InP/InAs quantum-dash and quantum dot Fabry-Perot laser operating at 1550 nm. High values of normalized conversion efficiency of −18.6 dB, optical signal-to-noise ratio of 37 dB, and third order optical susceptibility normalized to material gain χ{sup (3)}/g{sub 0} of ∼4 × 10{sup −19} m{sup 3}/V{sup 3} are measured for 1490 μm long quantum-dash lasers. These values are similar to those obtained with distributed-feedback lasers and semiconductor optical amplifiers, which are much more complicated to fabricate. On the other hand, due to the faster gain saturation and enhanced modulation of carriermore » populations, quantum-dot lasers demonstrate 12 dB lower conversion efficiency and 4 times lower χ{sup (3)}/g{sub 0} compared to quantum dash lasers.« less

Data Access System for Hydrology

NASA Astrophysics Data System (ADS)

Whitenack, T.; Zaslavsky, I.; Valentine, D.; Djokic, D.

2007-12-01

As part of the CUAHSI HIS (Consortium of Universities for the Advancement of Hydrologic Science, Inc., Hydrologic Information System), the CUAHSI HIS team has developed Data Access System for Hydrology or DASH. DASH is based on commercial off the shelf technology, which has been developed in conjunction with a commercial partner, ESRI. DASH is a web-based user interface, developed in ASP.NET developed using ESRI ArcGIS Server 9.2 that represents a mapping, querying and data retrieval interface over observation and GIS databases, and web services. This is the front end application for the CUAHSI Hydrologic Information System Server. The HIS Server is a software stack that organizes observation databases, geographic data layers, data importing and management tools, and online user interfaces such as the DASH application, into a flexible multi- tier application for serving both national-level and locally-maintained observation data. The user interface of the DASH web application allows online users to query observation networks by location and attributes, selecting stations in a user-specified area where a particular variable was measured during a given time interval. Once one or more stations and variables are selected, the user can retrieve and download the observation data for further off-line analysis. The DASH application is highly configurable. The mapping interface can be configured to display map services from multiple sources in multiple formats, including ArcGIS Server, ArcIMS, and WMS. The observation network data is configured in an XML file where you specify the network's web service location and its corresponding map layer. Upon initial deployment, two national level observation networks (USGS NWIS daily values and USGS NWIS Instantaneous values) are already pre-configured. There is also an optional login page which can be used to restrict access as well as providing a alternative to immediate downloads. For large request, users would be notified via email with a link to their data when it is ready.

Unravelling the immunological roles of dipeptidyl peptidase 4 (DPP4) activity and/or structure homologue (DASH) proteins

PubMed Central

Klemann, C.; Stephan, M.

2016-01-01

Summary Dipeptidyl peptidase (DPP) 4 (CD26, DPP4) is a multi‐functional protein involved in T cell activation by co‐stimulation via its association with adenosine deaminase (ADA), caveolin‐1, CARMA‐1, CD45, mannose‐6‐phosphate/insulin growth factor‐II receptor (M6P/IGFII‐R) and C‐X‐C motif receptor 4 (CXC‐R4). The proline‐specific dipeptidyl peptidase also modulates the bioactivity of several chemokines. However, a number of enzymes displaying either DPP4‐like activities or representing structural homologues have been discovered in the past two decades and are referred to as DPP4 activity and/or structure homologue (DASH) proteins. Apart from DPP4, DASH proteins include fibroblast activation protein alpha (FAP), DPP8, DPP9, DPP4‐like protein 1 (DPL1, DPP6, DPPX L, DPPX S), DPP4‐like protein 2 (DPL2, DPP10) from the DPP4‐gene family S9b and structurally unrelated enzyme DPP2, displaying DPP4‐like activity. In contrast, DPP6 and DPP10 lack enzymatic DPP4‐like activity. These DASH proteins play important roles in the immune system involving quiescence (DPP2), proliferation (DPP8/DPP9), antigen‐presenting (DPP9), co‐stimulation (DPP4), T cell activation (DPP4), signal transduction (DPP4, DPP8 and DPP9), differentiation (DPP4, DPP8) and tissue remodelling (DPP4, FAP). Thus, they are involved in many pathophysiological processes and have therefore been proposed for potential biomarkers or even drug targets in various cancers (DPP4 and FAP) and inflammatory diseases (DPP4, DPP8/DPP9). However, they also pose the challenge of drug selectivity concerning other DASH members for better efficacy and/or avoidance of unwanted side effects. Therefore, this review unravels the complex roles of DASH proteins in immunology. PMID:26671446

The effects of dietary approaches to stop hypertension diet on weight loss, anti-Müllerian hormone and metabolic profiles in women with polycystic ovary syndrome: A randomized clinical trial.

PubMed

Foroozanfard, Fatemeh; Rafiei, Hamideh; Samimi, Mansooreh; Gilasi, Hamid Reza; Gorjizadeh, Roohangiz; Heidar, Zahra; Asemi, Zatollah

2017-07-01

This study was designed to evaluate the effects of the dietary approaches to stop hypertension (DASH diet) on weight loss, anti-Müllerian hormone (AMH) and metabolic profiles in women with polycystic ovary syndrome (PCOS). A randomized controlled clinical trial was conducted among 60 overweight or obese patients with PCOS. Patients were randomly assigned to receive either low-calorie DASH (N=30) or control diet (N=30) for 12 weeks. The DASH and control diets were consisted of 52%-55% carbohydrates, 16%-18% proteins and 30% total fats; however, the DASH diet was designed to be rich in fruits, vegetables, whole grains, low-fat dairy products, cholesterol and refined grains. Both diets were equicaloric. Adherence to the DASH diet, compared to the control diet, resulted in a significant decrease in BMI (-1.6±0.5 vs -1.2±0.7 kg/m 2 , P=.02). Significant decreases in AMH (-1.1±3.1 vs +0.3±0.7 ng/mL, P=.01), insulin (-25.2±51.0 vs -1.2±28.8 pmol/L, P=.02), homoeostasis model of assessment-estimated insulin resistance (-0.9±2.0 vs -0.1±1.0, P=.02), free androgen index (FAI; -0.03±0.09 vs +0.06±0.21, P=.02) and malondialdehyde (MDA) levels (-0.5±0.4 vs +0.2±0.3 μmol/L, P<.001), and significant increases in quantitative insulin sensitivity check index (+0.01±0.03 vs -0.004±0.01, P=.02), sex hormone-binding globulin (SHBG; +3.7±8.5 vs -1.5±7.2 nmol/L, P=.01) and nitric oxide (NO; +9.0±4.9 vs +0.6±2.3 μmol/L, P<.001) were also seen in the DASH group compared with the control group. Adherence to the DASH diet for 12 weeks among PCOS women had beneficial effects on BMI, AMH, insulin metabolism, SHBG, FAI, NO and MDA levels. © 2017 John Wiley & Sons Ltd.

Analysis of factors related to arm weakness in patients with breast cancer-related lymphedema.

PubMed

Lee, Daegu; Hwang, Ji Hye; Chu, Inho; Chang, Hyun Ju; Shim, Young Hun; Kim, Jung Hyun

2015-08-01

The aim of this study was to evaluate the ratio of significant weakness in the affected arm of breast cancer-related lymphedema patients to their unaffected side. Another purpose was to identify factors related to arm weakness and physical function in patients with breast cancer-related lymphedema. Consecutive patients (n = 80) attended a single evaluation session following their outpatient lymphedema clinic visit. Possible independent factors (i.e., lymphedema, pain, psychological, educational, and behavioral) were evaluated. Handgrip strength was used to assess upper extremity muscle strength and the disabilities of arm, shoulder, and hand (DASH) questionnaire was used to assess upper extremity physical function. Multivariate logistic regression was performed using factors that had significant differences between the handgrip weakness and non-weakness groups. Out of the 80 patients with breast cancer-related lymphedema, 29 patients (36.3 %) had significant weakness in the affected arm. Weakness of the arm with lymphedema was not related to lymphedema itself, but was related to the fear of using the affected limb (odds ratio = 1.76, 95 % confidence interval = 1.30-2.37). Fears of using the affected limb and depression significantly contributed to the variance in DASH scores. Appropriate physical and psychological interventions, including providing accurate information and reassurance of physical activity safety, are necessary to prevent arm weakness and physical dysfunction in patients with breast cancer-related lymphedema.

Results of surgical treatment of acromioclavicular dislocations type III using modified Weaver Dunn technique.

PubMed

López-Alameda, S; Fernández-Santás, T; García-Villanueva, A; Varillas-Delgado, D; Garcia de Lucas, F

To evaluate the clinical and radiological results of the surgical treatment of type III acromioclavicular dislocations using the Weaver-Dunn technique in the delayed phase. A non-randomised controlled retrospective observational study of 38 patients operated between January 2006 and December 2014. We excluded 10 patients due to death or non-localisation. We collected demographic data, time to intervention, complications, analysing the Visual Analog Scale, DASH and Oxford Shoulder Score and the updated radiological result. mean age of patients with right-dominant shoulder affected in 71% of cases predominantly by non-level falls was 35. 70% of the cases had subjective perception of both recovery of strength and disappearance of deformity. Full radiological reduction was observed in 95% of the cases with the appearance of mild osteoarthritis in 44% and moderate osteoarthritis in 5.6%. The results of the DASH presented values of 12,939 (±16,851) and the OSS of 42,736 (±7,794), indicating satisfactory articular function. The data from this study shows similar results to previous studies regarding subjective recovery of strength, maintenance of anatomical reduction, functional test results and efficacy of the Weaver-Dunn technique. The modified Weaver-Dunn technique provided good clinical and radiological results with patient reincorporation to their usual activities and maintenance over time. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

The selective activation of a C-F bond with an auxiliary strong Lewis acid: a method to change the activation preference of C-F and C-H bonds.

PubMed

Wang, Lin; Sun, Hongjian; Li, Xiaoyan; Fuhr, Olaf; Fenske, Dieter

2016-11-15

The selective activation of the C-F bonds in substituted (2,6-difluorophenyl)phenylimines (2,6-F 2 H 3 C 6 -(C[double bond, length as m-dash]NH)-n'-R-C 6 H 4 (n' = 2, R = H (1); n' = 2, R = Me (2); n' = 4, R = tBu (3))) by Fe(PMe 3 ) 4 with an auxiliary strong Lewis acid (LiBr, LiI, or ZnCl 2 ) was explored. As a result, iron(ii) halides ((H 5 C 6 -(C[double bond, length as m-dash]NH)-2-FH 3 C 6 )FeX(PMe 3 ) 3 (X = Br (8); Cl (9)) and (n-RH 4 C 6 -(C[double bond, length as m-dash]NH)-2'-FH 3 C 6 )FeX(PMe 3 ) 3 (n = 2, R = Me, X = Br (11); n = 4, R = tBu, X = I (12))) were obtained. Under similar reaction conditions, using LiBF 4 instead of LiBr or ZnCl 2 , the reaction of (2,6-difluorophenyl)phenylimine with Fe(PMe 3 ) 4 afforded an ionic complex [(2,6-F 2 H 3 C 6 -(C[double bond, length as m-dash]NH)-H 4 C 6 )Fe(PMe 3 ) 4 ](BF 4 ) (10) via the activation of a C-H bond. The method of C-F bond activation with an auxiliary strong Lewis acid is appropriate for monofluoroarylmethanimines. Without the Lewis acid, iron(ii) hydrides ((2-RH 4 C 6 -(C[double bond, length as m-dash]NH)-2'-FH 3 C 6 )FeH(PMe 3 ) 3 (R = H (13); Me (14))) were generated from the reactions of Fe(PMe 3 ) 4 with the monofluoroarylmethanimines (2-FH 4 C 6 -(C[double bond, length as m-dash]NH)-2'-RC 6 H 4 (R = H (4); Me (5))); however, in the presence of ZnCl 2 or LiBr, iron(ii) halides ((2-RH 4 C 6 -(C[double bond, length as m-dash]NH)-H 4 C 6 )FeX(PMe 3 ) 3 (R = H, X = Cl (15); R = Me, X = Br (16))) could be obtained through the activation of a C-F bond. Furthermore, a C-F bond activation with good regioselectivity in (pentafluorophenyl)arylmethanimines (F 5 C 6 -(C[double bond, length as m-dash]NH)-2,6-Y 2 C 6 H 3 (Y = F (6); H (7))) could be realized in the presence of ZnCl 2 to produce iron(ii) chlorides ((2,6-Y 2 H 3 C 6 -(C[double bond, length as m-dash]NH)-F 4 C 6 )FeCl(PMe 3 ) 3 (Y = F (17); H (18))). This series of iron(ii) halides could be used to catalyze the hydrosilylation reaction of aldehydes. Due to the stability of iron(ii) halides to high temperature, the reaction mixture was allowed to be heated to 100 °C and the reaction could finish within 0.5 h.

Dietary Fat, Eicosanoids and Breast Cancer Risk

DTIC Science & Technology

2005-04-01

Celery log 1Og log Peas 15g 15g 15g Garlic Powder/Salt/Pepper Dash Dash Dash Lemon Juice 2g 2g 2g Mayonnaise 25g 9g 0 Fat Free Miracle Whip 0 20g 30g...Sugar 0 4g 4g Oatmeal Walnut Cookie 30g 30g 30g Dinner: Beef Tenderloin 65g 60g 75g Mashed Potatoes 10Og 140g 140g w/Butter/Olive Oil 5g/4g 0 0 Corn 80g...Fat Free Gravy 40g 40g 40g w/ Safflower Oil/Flax Oil 7g (Safflower) 3g (Safflower) 3g (Flax) Mashed Potato 100g 140g 140g Green Beans 100g 100g �g

Neglected post burns contracture of hand in children: Analysis of contributory socio-cultural factors and the impact of neglect on outcome.

PubMed

Gupta, Ravi Kumar; Jindal, Nipun; Kamboj, Kulbhushan

2014-12-01

No study has ever evaluated the causes and effect of neglect on the outcome of post burns contractures of hand in children. 66 hands in 61 children (mean age 12.22 years) with a mean neglect of 11.6 years (range 5-17 years) were assessed for the causes of neglect and the outcome of surgery. Average follow up was 6.6 years. The results were assessed in two groups of 5-10 years neglect as group I and >10 years neglect as group II. In a total number of 134 contracted rays in 66 hands, the surgical procedures included local Z/V-Y flap (51 rays), cross finger flap (48 rays), full thickness graft (35 rays). Additional external fixator with a distracter was used in 3 patients treated at a delay of 14, 16 and 17 years. 50 (81.96%) patients belonged to rural and slum areas. The reasons for delayed treatment included poverty - 33 patients, lack of awareness of surgical treatment - 16 patients; and indifference of parents - 12 patients. 44 (72.13%) children were illiterates. With treatment the average DASH score improved from 65.10 to 36.90 (p < .000) and from 68.14 to 45.93 (p < .000) in group I and II respectively. The results were significantly superior in group I (p < .000). The main factors for neglect in treatment of post burns contracture include poverty, lack of awareness and illiteracy. All the patients showed significant improvement in function after the surgery. Contractures with higher neglect had significantly inferior outcome.

[The effects of hook plates on the subacromial space--a clinical and MRT study].

PubMed

Hackenberger, J; Schmidt, J; Altmann, T

2004-01-01

The analysis of middle- and long-term results after treatment of acromioclavicular joint injuries with a hook plate as a temporary implant and a comparison of the results with those described in literature have been made. In a retrospective study we were able to conduct follow-up examinations on 28 out of 39 Tossy III patients (72 %) who received surgical treatment using a hook plate according to Dreithaler. Examinations took place on average 3.0 (1.2-5.6) years after surgery. A special focus of attention was the effect of the hook plate on the subacromial space. Accordingly, physical examination was supplemented by sonography of the shoulder as well as comparative bilateral shoulder MRI. 86 % of our patients expressed satisfaction with the functional outcome of surgery as opposed to 54 % concerning its cosmetic result. In shoulder sonography no patient turned out to have suffered a higher grade rotator cuff lesion, whereas age-related degenerative alterations were found in 46 % of the patients. Instability under load was found in 7 patients (25 %). Among these were 3 with severe instability (11 %). 2 patients (7 %) were found to have a permanent subluxation of the acromioclavicular joint with partial range of motion impairment. All scores monitored (DASH, Taft, Constant-Murley) on average returned good to excellent results. MRI scans displayed no case of higher grade rotator cuff lesion. In accordance with the findings of ultrasound imaging a higher incidence of extraarticular ossification was found as well as, in some cases, arthrosis of the acromioclavicular joint. In our opinion, the hook plate designed by Dreithaler is easy to handle and serves as a qualified implant for temporary stabilisation of the acromioclavicular joint with middle- and long-term good to excellent results.

Patterns of Emotional and Behavioural Disturbance Associated with Autistic Traits in Young People with Severe Intellectual Disabilities and Challenging Behaviours

ERIC Educational Resources Information Center

Hill, Jennie; Furniss, Frederick

2006-01-01

Emotional and behavioural disturbance was assessed in 82 individuals with severe intellectual disabilities and challenging behaviour using the Diagnostic Assessment for the Severely Handicapped-II (DASH-II). Levels of disturbance were compared firstly in individuals with and without features of autism as assessed by the DASH-II, and secondly in…

75 FR 9756 - Airworthiness Directives; Bombardier, Inc. Model DHC-8-100 and DHC-8-200 Series Airplanes, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-04

... defined in Part 1 of the Bombardier (de Havilland) DHC-6 Twin Otter, Dash 7 & Dash 8 Corrosion Prevention... Corrosion Prevention and Control Manual PSM 1-GEN- 5, Part 1, Revision 3, contains the revision level of... more likely to exhibit indications of corrosion. We are issuing this AD to prevent structural failure...

Validation of Core Temperature Estimation Algorithm

DTIC Science & Technology

2016-01-29

plot of observed versus estimated core temperature with the line of identity (dashed) and the least squares regression line (solid) and line equation...estimated PSI with the line of identity (dashed) and the least squares regression line (solid) and line equation in the top left corner. (b) Bland...for comparison. The root mean squared error (RMSE) was also computed, as given by Equation 2.

System for line drawings interpretation

NASA Astrophysics Data System (ADS)

Boatto, L.; Consorti, Vincenzo; Del Buono, Monica; Eramo, Vincenzo; Esposito, Alessandra; Melcarne, F.; Meucci, Mario; Mosciatti, M.; Tucci, M.; Morelli, Arturo

1992-08-01

This paper describes an automatic system that extracts information from line drawings, in order to feed CAD or GIS systems. The line drawings that we analyze contain interconnected thin lines, dashed lines, text, and symbols. Characters and symbols may overlap with lines. Our approach is based on the properties of the run representation of a binary image that allow giving the image a graph structure. Using this graph structure, several algorithms have been designed to identify, directly in the raster image, straight segments, dashed lines, text, symbols, hatching lines, etc. Straight segments and dashed lines are converted into vectors, with high accuracy and good noise immunity. Characters and symbols are recognized by means of a recognizer, specifically developed for this application, designed to be insensitive to rotation and scaling. Subsequent processing steps include an `intelligent'' search through the graph in order to detect closed polygons, dashed lines, text strings, and other higher-level logical entities, followed by the identification of relationships (adjacency, inclusion, etc.) between them. Relationships are further translated into a formal description of the drawing. The output of the system can be used as input to a Geographic Information System package. The system is currently used by the Italian Land Register Authority to process cadastral maps.

[Long-term efficacy of open reduction and internal fixation versus external fixation for unstable distal radius fractures: a meta-analysis].

PubMed

Yang, Z; Yuan, Z Z; Ma, J X; Ma, X L

2017-11-07

Objective: To make a systematic assessment of the Long-term efficacy of open reduction and internal fixation versus external fixation for unstable distal radius fractures. Methods: A computer-based online search of PubMed, ScienceDirect, EMBASE, BIOSIS, Springer and Cochrane Library were performed. The randomized and controlled trials of open reduction and internal fixation versus external fixation for unstable distal radius fractures were collected. The included trials were screened out strictly based on the criterion of inclusion and exclusion. The quality of included trials was evaluated. RevMan 5.0 was used for data analysis. Results: Sixteen studies involving 1 268 patients were included. There were 618 patients with open reduction and internal fixation and 650 with external fixation. The results of meta-analysis indicated that there were statistically significant differences with regard to the complications postoperatively (infection( I (2)=0%, RR =0.27, 95% CI 0.16-0.45, Z =4.92, P <0.000 01) and total complications( I (2)=0%, RR =0.71, 95% CI 0.59-0.85, Z =3.65, P =0.000 3) ), DASH scores( I (2)=37%, MD =-5.67, 95% CI -8.31--3.04, Z =4.22, P <0.000 1) and volar tilt( I (2)=78%, MD =2.29, 95% CI 0.33-4.24, Z =2.30, P =0.02)( P <0.05) at the end of follow-up period were noted. There were no statistically significant differences observed between two approaches with respect to the clinical outcomes (grip strength, flexion, extension, pronation, supination, radial deviation and ulnar deviation) and radiographic outcome(radial length) at the end of follow-up period( P <0.05). Conclusion: Both open reduction and internal fixation and external fixation are effective treatment for unstable distal radius fractures. Compared with external fixation, open reduction and internal fixation provides reduced complications postoperatively, lower DASH scores and better restoration of volar tilt for treatment of distal radius fractures.

A Double-Blinded Placebo Randomized Controlled Trial Evaluating Short-term Efficacy of Platelet-Rich Plasma in Reducing Postoperative Pain After Arthroscopic Rotator Cuff Repair: A Pilot Study.

PubMed

Hak, Alisha; Rajaratnam, Krishan; Ayeni, Olufemi R; Moro, Jaydeep; Peterson, Devin; Sprague, Sheila; Bhandari, Mohit

2015-01-01

We aimed to determine whether patients with arthroscopically repaired rotator cuff (RC) tears would have reduced pain and improved function after ultrasound-guided platelet-rich plasma (PRP) injections compared with placebo injection. PRP compared with placebo (saline) was more effective in reducing pain at the site of an RC injury that has undergone arthroscopic repair. Randomized controlled trial. Level 2. We conducted a 2-centered, blinded, randomized controlled trial comparing the level of pain in patients undergoing arthroscopic repair. Patients were randomized to either PRP or saline (placebo). They received 2 ultrasound-guided injections of the randomized product: 1 intraoperatively and 1 at 4 weeks postoperatively. The primary outcome measure was shoulder pain demonstrated using a visual analog scale (VAS) at 6 weeks postoperatively. Secondary outcomes included the EuroQol-5 Dimensions (EQ-5D); the Western Ontario Rotator Cuff Index (WORC); and the Disabilities of the Arm, Shoulder, and Hand Score (DASH), as well as adverse events and revision surgeries. Patients were assessed clinically preoperatively and at 2, 4, and 6 weeks postsurgery. A prespecified interim analysis was conducted after 50% of patients were recruited and followed. We recruited 25 patients when interim power analysis led to an early trial termination. Follow-up was 96%. The mean difference between groups was not statistically significant (-1.81; 95% CI, -4.3 to 1.2; P = 0.16). The EQ-5D, WORC, and DASH scores also did not show significant differences between groups at week 6 (P = 0.5, 0.99, and 0.9, respectively). There were no revision surgeries, and 4 adverse events (3 PRP, 1 saline). There was no statistical difference in outcome measures when augmenting arthroscopically repaired RC tears with PRP. Identifying therapies that improve outcomes in patients with RC tears remains a challenge and deserves ongoing investigation.

A Double-Blinded Placebo Randomized Controlled Trial Evaluating Short-term Efficacy of Platelet-Rich Plasma in Reducing Postoperative Pain After Arthroscopic Rotator Cuff Repair

PubMed Central

Hak, Alisha; Rajaratnam, Krishan; Ayeni, Olufemi R.; Moro, Jaydeep; Peterson, Devin; Sprague, Sheila; Bhandari, Mohit

2015-01-01

Background: We aimed to determine whether patients with arthroscopically repaired rotator cuff (RC) tears would have reduced pain and improved function after ultrasound-guided platelet-rich plasma (PRP) injections compared with placebo injection. Hypothesis: PRP compared with placebo (saline) was more effective in reducing pain at the site of an RC injury that has undergone arthroscopic repair. Study Design: Randomized controlled trial. Level of Evidence: Level 2. Methods: We conducted a 2-centered, blinded, randomized controlled trial comparing the level of pain in patients undergoing arthroscopic repair. Patients were randomized to either PRP or saline (placebo). They received 2 ultrasound-guided injections of the randomized product: 1 intraoperatively and 1 at 4 weeks postoperatively. The primary outcome measure was shoulder pain demonstrated using a visual analog scale (VAS) at 6 weeks postoperatively. Secondary outcomes included the EuroQol-5 Dimensions (EQ-5D); the Western Ontario Rotator Cuff Index (WORC); and the Disabilities of the Arm, Shoulder, and Hand Score (DASH), as well as adverse events and revision surgeries. Patients were assessed clinically preoperatively and at 2, 4, and 6 weeks postsurgery. A prespecified interim analysis was conducted after 50% of patients were recruited and followed. Results: We recruited 25 patients when interim power analysis led to an early trial termination. Follow-up was 96%. The mean difference between groups was not statistically significant (–1.81; 95% CI, –4.3 to 1.2; P = 0.16). The EQ-5D, WORC, and DASH scores also did not show significant differences between groups at week 6 (P = 0.5, 0.99, and 0.9, respectively). There were no revision surgeries, and 4 adverse events (3 PRP, 1 saline). Conclusion: There was no statistical difference in outcome measures when augmenting arthroscopically repaired RC tears with PRP. Clinical Relevance: Identifying therapies that improve outcomes in patients with RC tears remains a challenge and deserves ongoing investigation. PMID:25553214

Musculoskeletal Ultrasonography in CRPS: Assessment of Muscles Before and After Motor Function Recovery with Dry Needling as the Sole Treatment.

PubMed

Vas, Lakshmi Champak; Pai, Renuka; Pattnaik, Manorama

2016-01-01

Motor impairment is an important criterion in the Clinical Diagnostic Criteria (CDC) of Complex Regional Pain Syndrome type-1 (CRPS-1) as defined by International Association for Study of Pain (IASP). To describe the changes in musculoskeletal ultrasonography (MSKUSG) in CRPS-1 before and after treatment with ultrasound-guided dry needling (USGDN) in retrospective data from 44 patients. Patients irrespective of age, gender, or cause of CRPS were included in this retrospective data analysis; the Budapest criteria for the diagnosis of CRPS were stringently adhered to. The analysis was done at Ashirvad Institute for Pain Management and Research with the database of CRPS patients who were treated between December 2005 and December 2014. The CDC, range of motion at upper extremity joints, dynamometry, Disability of arm, shoulder and hand score (DASH) and ultrasonography were documented on days one, 15, and 45. MSKUSG demonstrated loss of myoarchitecture and reduced bulk. All 44 patients received USGDN as the sole intervention with medications and physiotherapy. MSKUSG at 15 and 45 days after starting USGDN showed a return of normalcy to the myoarchitecture and muscle bulk increase that coincided with the disappearance of CDC and a progressive and predictable improvement of the DASH scores in all the 44 patients. The analysis focuses on only 2 parameters: the musculoskeletal changes of the forearm flexors and extensors on ultrasound guidance and the efficacy of the dry needling treatment. It is not a comparative study with another accepted form of treatment or intervention. We have not looked into the age and gender predilection of the condition owing to the small sample size of the study. Analysis of long term maintenance of relief and rehabilitation of the disability were limited to one year. Myofascial pathology of co-contraction appears to cause CDC of CRPS and probable ischemic loss of myoarchitecture. Relief of co-contraction with USGDN allowed resolution of tenosynovitis causing the CDC and return of normal myoarchitecture.

Treatment of unstable distal radius fractures: non-invasive dynamic external fixator versus volar locking plate – functional and radiological outcome in a prospective case-controlled series

PubMed Central

Bajwa, Ali S.; Rammappa, Manju; Lee, Ling; Nanda, Rajesh

2015-01-01

Introduction: Distal radius fracture (DRF) is a common injury and various treatment modalities including open reduction and internal fixation (ORIF) with volar locking plate are available. More recently, a non-invasive external fixator has been used. Aims: To prospectively compare the use of a non-invasive external fixator with early dynamisation for DRF against ORIF with volar locking plate control group. Methods: Consecutive patients with closed DRF were included in a prospective case-controlled study. Patients were assigned to non-invasive external fixator or ORIF. Minimum follow-up was two years. Follow-up was at weeks 2, 4, 6, 8, 12, 26 and at one and two-year post-operatively. The outcome measures included demographic details, injury mechanism, AO fracture type, risk factors, body mass index (BMI), ulnar styloid fracture and dorsal comminution, radiographs, grip strength and DASH score. Results: Consecutive 50 patients were treated either with non-invasive external fixator (25/50) or with ORIF (25/50) and the mean age of the two groups was 53 years (SD 17.1) and 49 years (SD 19.5), respectively. Demographics were matched in two groups. In the non-invasive external fixator group, there were 10 AO Type-A, 5 Type-B and 10 Type-C fractures. The ORIF group included 8 Type-A, 6 Type-B and 11 Type-C fractures. The mean DASH score at three-months and one-year post-injury in non-invasive fixator group was 12.2 (SD 3.1) and 3.5 (SD 0.7), respectively, significantly greater than those of ORIF group 14.5 (SD 5.6) and 11.2 (SD 4.4), respectively (p < 0.05). Conclusion: DRF treated with non-invasive external fixator can give functional results superior to ORIF at three-months and the trend is maintained at one and two-year post-operatively. PMID:27163089

Advantages of Arthroscopic Rotator Cuff Repair With a Transosseous Suture Technique: A Prospective Randomized Controlled Trial.

PubMed

Randelli, Pietro; Stoppani, Carlo Alberto; Zaolino, Carlo; Menon, Alessandra; Randelli, Filippo; Cabitza, Paolo

2017-07-01

Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic. To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair. Randomized controlled trial; Level of evidence, 1. Sixty-nine patients with rotator cuff tears were enrolled: 35 patients were operated with metal anchors and 34 with standardized transosseous repair. The patients were clinically evaluated before surgery, during the 28 days after surgery, and at least 1 year after the operation by the use of validated rating scores (Constant score, QuickDASH, and numerical rating scale [NRS]). Final follow-up was obtained at more than 3 years by a QuickDASH evaluation to detect any difference from the previous follow-up. During the follow-up, rotator cuff integrity was determined through magnetic resonance imaging and was classified according to the 5 Sugaya categories. Patients operated with the transosseous technique had significantly less pain, especially from the 15th postoperative day: In the third week, the mean NRS value for the anchor group was 3.00 while that for transosseous group was 2.46 ( P = .02); in the fourth week, the values were 2.44 and 1.76, respectively ( P < .01). No differences in functional outcome were noted between the 2 groups at the final evaluation. In the evaluation of rotator cuff repair integrity, based on Sugaya magnetic resonance imaging classification, no significant difference was found between the 2 techniques in terms of retear rate ( P = .81). No significant differences were found between the 2 arthroscopic repair techniques in terms of functional and radiological results. However, postoperative pain decreased more quickly after the transosseous procedure, which therefore emerges as a possible improvement in the surgical repair of the rotator cuff. Registration: NCT01815177 ( ClinicalTrials.gov identifier).

Outcomes of Pin and Plaster Versus Locking Plate in Distal Radius Intraarticular Fractures

PubMed Central

Bahari-Kashani, Mahmoud; Taraz-Jamshidy, Mohammad Hosein; Rahimi, Hassan; Ashraf, Hami; Mirkazemy, Masoud; Fatehi, Amirreza; Asadian, Mariam; Rezazade, Jafar

2013-01-01

Background Distal radius fractures are among the most prevalent fractures predictive of probable occurrence of other osteoporotic fractures. They are treated via a variety of methods, but the best treatment has not been defined yet. Objectives This study was performed to compare the results of open reduction and internal fixation with locking plates versus the pin and plaster method. Materials and Methods In this prospective study, 114 patients aged 40 to 60 years with Fernandez type III fracture referring to Imam-Reza and Mehr hospitals of Mashhad from 2009 to 2011, were selected randomly; after obtaining informed consent, they were treated with pin and plaster fixation (n = 57) or internal fixation with the volar locking plate (n = 57). They were compared at the one year follow up. Demographic features and standard radiographic indices were recorded and MAYO, DASH and SF - 36 tests were performed. Data was analyzed by SPSS software version 13, with descriptive indices, Mann-Whitney and Chi-square tests. Results SF-36 test demonstrated a better general health (P < 0.001), mental health (P = 0.006), physical functioning (P < 0.001), social functioning (P < 0.001) and energy/fatigue (P < 0.001) in LCP group. However, pain (P = 0.647) was not significantly different between the groups. Physical limitation (P < 0.001) and emotional limitation (P < 0.001) were greater in the pin and plaster group. Also, in the LCP group mean MAYO score (P < 0.001) was more than pin and plaster group. Mean DASH score was not different between the groups (P = 0.218). The rate of acceptable results of radiographic indices (P < 0.001), grip strength (P < 0.001) and range of motion in supination-pronation (P < 0.001) in LCP method were better than the pin and plaster method. Conclusions In treatment of intra-articular distal radius fractures in middle-aged patients internal fixation with locking plates may be prefered to pin and plaster as the treatment of choice. PMID:24350132

Arthroscopically assisted reduction of acute acromioclavicular joint dislocation using a single double-button device: Medium-term clinical and radiological outcomes.

PubMed

Issa, S-P; Payan, C; Le Hanneur, M; Loriaut, P; Boyer, P

2018-02-01

Double-button devices for endoscopic management of acute acromioclavicular joint dislocation (ACJD) provide satisfactory short-term functional and radiological results. However, little exists in the literature regarding the long- and medium-term results of these implants, especially regarding the evolution of the acromioclavicular joint (ACJ). Satisfactory and steady long- and medium-term outcomes can be achieved in patients with acute ACJD undergoing endoscopically assisted ACJ repair using a single double-button device. A retrospective single-center study was conducted in patients with acute Rockwood III and IV ACJD treated endoscopically with a single double-button device from October 2008 to October 2010, allowing a minimum 5-year follow-up. Functional evaluation used Constant and Quick-DASH scores. Clinical evidence of dislocation recurrence was combined with bilateral Zanca views to assess coracoclavicular distance. Acromioclavicular osteoarthritis was evaluated on the Paxinos test and Zanca views. Nineteen of the 25 operated patients were seen at a mean 76.9±8.5 months' follow-up. Mean age was 34.4±8.3 years. Mean Constant and Quick-DASH scores were 96.2±5.1 and 0.9±1.6 points, respectively. Four patients had a recurrence of their initial dislocation, 3 of whom had positive Paxinos test, whereas the 15 patients without recurrence had a negative test (p=0.004). Five patients had radiological evidence of ACJ osteoarthritis: all 4 patients with recurrence and 1 without (p=0.001). Long- and medium-term radioclinical outcome of endoscopically assisted management of acute ACJD using a single double-button device seems to be satisfactory and steady over time. Recurrence of the initial dislocation appears to be related to onset of degenerative ACJ arthropathy. Therapeutic type IV-Retrospective case series. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Optimal symmetric flight studies

NASA Technical Reports Server (NTRS)

Weston, A. R.; Menon, P. K. A.; Bilimoria, K. D.; Cliff, E. M.; Kelley, H. J.

1985-01-01

Several topics in optimal symmetric flight of airbreathing vehicles are examined. In one study, an approximation scheme designed for onboard real-time energy management of climb-dash is developed and calculations for a high-performance aircraft presented. In another, a vehicle model intermediate in complexity between energy and point-mass models is explored and some quirks in optimal flight characteristics peculiar to the model uncovered. In yet another study, energy-modelling procedures are re-examined with a view to stretching the range of validity of zeroth-order approximation by special choice of state variables. In a final study, time-fuel tradeoffs in cruise-dash are examined for the consequences of nonconvexities appearing in the classical steady cruise-dash model. Two appendices provide retrospective looks at two early publications on energy modelling and related optimal control theory.

Successfully recruiting a multicultural population: the DASH-Sodium experience.

PubMed

Kennedy, Betty M; Conlin, Paul R; Ernst, Denise; Reams, Patrice; Charleston, Jeanne B; Appel, Lawrence J

2005-01-01

Recruiting practices employed by the four clinical centers participating in the Dietary Approaches to Stop Hypertension (DASH)-Sodium trial were examined to assess the most successful method of obtaining participants and to describe pertinent learning experiences gained as a result of the trial. The primary recruitment strategies employed by each center were mass mailing brochures (direct, coupon packs, or other) and mass media (advertisements in newspapers, radio, and television spots). Of 412 randomized participants, 265 (64%) were from mass distribution of brochures, 62 (15%) mass media, and 85 (21%) were prior study participants, referred by word-of-mouth, or reported coming from screening events and presentations. Although the most successful method of recruitment was mass mailing brochures, three times as many brochures were distributed to obtain similar success as in the initial DASH trial.

An on-board near-optimal climb-dash energy management

NASA Technical Reports Server (NTRS)

Weston, A. R.; Cliff, E. M.; Kelley, H. J.

1982-01-01

On-board real time flight control is studied in order to develop algorithms which are simple enough to be used in practice, for a variety of missions involving three dimensional flight. The intercept mission in symmetric flight is emphasized. Extensive computation is required on the ground prior to the mission but the ensuing on-board exploitation is extremely simple. The scheme takes advantage of the boundary layer structure common in singular perturbations, arising with the multiple time scales appropriate to aircraft dynamics. Energy modelling of aircraft is used as the starting point for the analysis. In the symmetric case, a nominal path is generated which fairs into the dash or cruise state. Feedback coefficients are found as functions of the remaining energy to go (dash energy less current energy) along the nominal path.

Midterm Follow-up of Treating Volar Marginal Rim Fractures with Variable Angle Lcp Volar Rim Distal Radius Plates.

PubMed

Goorens, Chul Ki; Geeurickx, Stijn; Wernaers, Pascal; Staelens, Barbara; Scheerlinck, Thierry; Goubau, Jean

2017-06-01

Specific treatment of the volar marginal rim fragment of distal radius fractures avoids occurance of volar radiocarpal dislocation. Although several fixation systems are available to capture this fragment, adequately maintaining internal fixation is difficult. We present our experience of the first 10 cases using the 2.4 mm variable angle LCP volar rim distal radius plate (Depuy Synthes®, West Chester, US), a low-profile volar rim-contouring plate designed for distal plate positioning and stable buttressing of the volar marginal fragment. Follow-up patient satisfaction, range of motion, grips strength, functional scoring with the QuickDASH and residual pain with a numeric rating scale were assessed. Radiological evaluation consisted in evaluating fracture consolidation, ulnar variance, volar angulation and maintenance of the volar rim fixation. The female to male ratio was 5:5 and the mean age was 52.2 (range, 17-80) years. The mean follow-up period was 11 (range, 5-19) months postoperatively. Patient satisfaction was high. The mean total flexion/extension range was 144° (range, 100-180°) compared to the contralateral uninjured side 160° (range, 95-180°). The mean total pronation/supination range was 153° (range, 140-180°) compared to the contralateral uninjured side 170° (range, 155-180°). Mean grip strength was 14 kg (range, 9-22), compared to the contralateral uninjured side 20 kg (range, 12-25 kg). Mean pre-injury level activity QuickDASH was 23 (range, 0-34.1), while post-recovery QuickDASH was 25 (range 0-43.2). Residual pain was 1.5 on the visual numerical pain rating scale. Radiological evaluation revealed in all cases fracture consolidation, satisfactory reconstruction of ulnar variance, volar angulation and volar rim. We encountered no flexor tendon complications, although plate removal was systematically performed after fracture consolidation. The 2.4 mm variable angle LCP volar rim distal radius plates is a valid treatment option for treating the volar marginal fragment in distal radius fractures.

The Strategic Nature of the Tactical Satellite. Part 2

DTIC Science & Technology

2006-08-13

hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and...constellation orbiting at 100 NM. The curves represent data for three mission types: SIGINT (solid), comm/BFT (dashed), and imagery (dotted). Two panes...persistent constellation orbiting at 500 km. The curves represent data for three mission types: SIGINT (solid), comm/BFT (dashed), and imagery (dotted

Synergistic oxygen atom transfer by ruthenium complexes with non-redox metal ions.

PubMed

Lv, Zhanao; Zheng, Wenrui; Chen, Zhuqi; Tang, Zhiming; Mo, Wanling; Yin, Guochuan

2016-07-28

Non-redox metal ions can affect the reactivity of active redox metal ions in versatile biological and heterogeneous oxidation processes; however, the intrinsic roles of these non-redox ions still remain elusive. This work demonstrates the first example of the use of non-redox metal ions as Lewis acids to sharply improve the catalytic oxygen atom transfer efficiency of a ruthenium complex bearing the classic 2,2'-bipyridine ligand. In the absence of Lewis acid, the oxidation of ruthenium(ii) complex by PhI(OAc)2 generates the Ru(iv)[double bond, length as m-dash]O species, which is very sluggish for olefin epoxidation. When Ru(bpy)2Cl2 was tested as a catalyst alone, only 21.2% of cyclooctene was converted, and the yield of 1,2-epoxycyclooctane was only 6.7%. As evidenced by electronic absorption spectra and EPR studies, both the oxidation of Ru(ii) by PhI(OAc)2 and the reduction of Ru(iv)[double bond, length as m-dash]O by olefin are kinetically slow. However, adding non-redox metal ions such as Al(iii) can sharply improve the oxygen transfer efficiency of the catalyst to 100% conversion with 89.9% yield of epoxide under identical conditions. Through various spectroscopic characterizations, an adduct of Ru(iv)[double bond, length as m-dash]O with Al(iii), Ru(iv)[double bond, length as m-dash]O/Al(iii), was proposed to serve as the active species for epoxidation, which in turn generated a Ru(iii)-O-Ru(iii) dimer as the reduced form. In particular, both the oxygen transfer from Ru(iv)[double bond, length as m-dash]O/Al(iii) to olefin and the oxidation of Ru(iii)-O-Ru(iii) back to the active Ru(iv)[double bond, length as m-dash]O/Al(iii) species in the catalytic cycle can be remarkably accelerated by adding a non-redox metal, such as Al(iii). These results have important implications for the role played by non-redox metal ions in catalytic oxidation at redox metal centers as well as for the understanding of the redox mechanism of ruthenium catalysts in the oxygen atom transfer reaction.

Astym treatment vs. eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial

PubMed Central

Stegink-Jansen, Caroline W.

2015-01-01

Introduction. Patients with chronic lateral elbow (LE) tendinopathy, commonly known as tennis elbow, often experience prolonged symptoms and frequent relapses. Astym treatment, evidenced in animal studies to promote the healing and regeneration of soft tissues, is hypothesized to improve outcomes in LE tendinopathy patients. This study had two objectives: (1) to compare the efficacy of Astym treatment to an evidence-based eccentric exercise program (EE) for patients with chronic LE tendinopathy, and (2) to quantify outcomes of subjects non-responsive to EE who were subsequently treated with Astym treatment. Study Design. Prospective, two group, parallel, randomized controlled trial completed at a large orthopedic center in Indiana. Inclusion criteria: age range of 18–65 years old, with clinical indications of LE tendinopathy greater than 12 weeks, with no recent corticosteriod injection or disease altering comorbidities. Methods. Subjects with chronic LE tendinopathy (107 subjects with 113 affected elbows) were randomly assigned using computer-generated random number tables to 4 weeks of Astym treatment (57 elbows) or EE treatment (56 elbows). Data collected at baseline, 4, 8, 12 weeks, 6 and 12 months. Primary outcome measure: DASH; secondary outcome measures: pain with activity, maximum grip strength and function. The treating physicians and the rater were blinded; subjects and treating clinicians could not be blinded due to the nature of the treatments. Results. Resolution response rates were 78.3% for the Astym group and 40.9% for the EE group. Astym subjects showed greater gains in DASH scores (p = 0.047) and in maximum grip strength (p = 0.008) than EE subjects. Astym therapy also resolved 20/21 (95.7%) of the EE non-responders, who showed improvements in DASH scores (p < 0.005), pain with activity (p = 0.002), and function (p = 0.004) following Astym treatment. Gains continued at 6 and 12 months. No adverse effects were reported. Conclusion. This study suggests Astym therapy is an effective treatment option for patients with LE tendinopathy, as an initial treatment, and after an eccentric exercise program has failed. Registration/Funding. Ball Memorial Hospital provided limited funding. Trial registration was not required by FDAAA 801. Known about the Subject. Under the new paradigm of degenerative tendinopathy, eccentric exercise (EE) is emerging as a first line conservative treatment for LE tendinopathy. EE and Astym treatment are among the few treatment options aiming to improve the degenerative pathophysiology of the tendon. In this trial, Astym therapy, which has shown success in the treatment of tendinopathy, is compared to EE, which has also shown success in the treatment of tendinopathy. Clinical Relevance. There is a need for more effective, conservative treatment options. Based on the current efficacy study, Astym therapy appears to be a promising, non-invasive treatment option. PMID:26038722

Functional Results in Arthroscopic Treatment in Patients with Chronic Lateral Elbow Pain.

PubMed

Phorkhar, Termphong; Chanlalit, Cholawish

2015-11-01

Modern surgery as elbow arthroscopic surgery is an accepted operation due to benefit in precise intra-articular lesion detection and minimally invasive surgery. To report the functional results when using arthroscopic surgery to treat chronic lateral elbow pain. The data was collected from 25 patients with chronic lateral elbow pain that failed in non-operative treatment and treated with elbow arthroscopic surgery. Five patients were excluded from this study due to diagnosed as instability that needed the ligament reconstruction. The etiology of pain were grouped in to tennis elbow (4 pts), plica (9 pts), tennis elbow combined with plica (4 pts) and cartilage lesion (3 pts). Thai quick DASH questionnaire was used to evaluate the functional results by comparing pre and post operation score and calculated statistic results with paired t-test by level of significance p < 0.05. The mean follow-up after surgery was 22 months by mean disability module pre and post-operative score is 68 and 18 respectively. In the occupation module was 74 and 25 respectively and in sports module was 81 and 17 respectively. All modules, scores was significant improved with p-value = 0.000, 0.000 and 0.004 respectively. The disability mean score in pre and post-operative along the diagnosis, tennis elbow mean score was 74 and 33, in plica lesion mean score was 65 and 11, combined lesions mean score was 60 and 18 and cartilage lesion mean score was 60 and 20. Approaching chronic lateral elbow pain with arthroscopy can maintain the signficant improvement of functional result in midterm follow-up.

The challenging surgical treatment of closed distal humerus fractures in elderly and octogenarian patients: radiographic and functional outcomes with a minimum follow-up of 24 months.

PubMed

Biz, Carlo; Sperotto, Silvano Pierluigi; Maschio, Nicola; Borella, Matteo; Iacobellis, Claudio; Ruggieri, Pietro

2017-10-01

The main purpose of this retrospective, non-randomized, case series study was to evaluate the clinical and radiographic outcomes of distal humerus fractures (DHFs) in a consecutive series of elderly patients operatively treated by two surgeons, and second, to identify proper indications for two elderly age ranges and two fracture pattern groups. From January 2009 to June 2014, 51 patients (pts) underwent open reduction and internal fixation (ORIF) using the locking compression plate (LCP) distal humerus plate (DHP) system at our institution. Medical records and radiographs were retrospectively assessed. Patients were divided into 3 groups according to gender, age (pts <85 years, pts ≥85 years) and AO classification (13-B1-B2-C1-C2 or 13-C3). All subjects completed MEPS, Quick-DASH and SF-36 PCS/MCS scores at final follow-up, and statistical analysis was performed. 36 patients (20 women, 16 men), mean age 80.3 years, with AO type 13-B and 13-C DHFs were included with a mean follow-up of 56 months (range 24-92). The most common mechanism of trauma was a fall from ground level (55.6%). The mean MEPS was 78.9 points, Quick-DASH 28.4, SF-36 PCS 48.3 and MCS 48.9. There was statistically significant evidence that having a 13-C3 fracture leads to worse results in MEPS, Quick-DASH and SF-36. The female gender correlates with worse results in SF-36. The patients ≥85 years had a worse prognosis according to Quick-DASH and SF-36, while the AO 13-C3 pattern obtained the worst ROM outcomes versus AO 13 B1-B2-C1-C2 (normal ROM 0°-140°): mean ROM 24°-114° vs 10°-130°, mean flexion deficit 26° vs 10°, mean extension deficit 24° vs 10°, respectively). Complications were presents in 36.1% of patients, overall belonging to the AO type 13-C fracture pattern and to the group ≥85 years. These study data seem to confirm our hypothesis that plate fixation for DHFs guarantees adequate fracture osteosynthesis and satisfactory functional outcomes at medium to long-term follow-up, not only in elderly patients, but also in octogenarian osteoporotic patients (≥85 years) with 13-C1 and 13-C2 fracture patterns, while an alternative solution should be considered for type C3 fractures, even in a primary trauma setting.

DASH for asthma: A pilot study of the DASH diet in not-well-controlled adult asthma⋆

PubMed Central

Ma, Jun; Strub, Peg; Lavori, Phillip W.; Buist, A. Sonia; Camargo, Carlos A.; Nadeau, Kari C.; Wilson, Sandra R.; Xiao, Lan

2014-01-01

This pilot study aims to provide effect size confidence intervals, clinical trial and intervention feasibility data, and procedural materials for a full-scale randomized controlled trial that will determine the efficacy of Dietary Approaches to Stop Hypertension (DASH) as adjunct therapy to standard care for adults with uncontrolled asthma. The DASH diet encompasses foods (e.g., fresh fruit, vegetables, and nuts) and antioxidant nutrients (e.g., vitamins A, C, E, and zinc) with potential benefits for persons with asthma, but it is unknown whether the whole diet is beneficial. Participants (n = 90) will be randomized to receive usual care alone or combined with a DASH intervention consisting of 8 group and 3 individual sessions during the first 3 months, followed by at least monthly phone consultations for another 3 months. Follow-up assessments will occur at 3 and 6 months. The primary outcome measure is the 7-item Juniper Asthma Control Questionnaire, a validated composite measure of daytime and nocturnal symptoms, activity limitations, rescue medication use, and percentage predicted forced expiratory volume in 1 second. We will explore changes in inflammatory markers important to asthma pathophysiology (e.g., fractional exhaled nitric oxide) and their potential to mediate the intervention effect on disease control. We will also conduct pre-specified subgroup analyses by genotype (e.g., polymorphisms on the glutathione S transferase gene) and phenotype (e.g., atopy, obesity). By evaluating a dietary pattern approach to improving asthma control, this study could advance the evidence base for refining clinical guidelines and public health recommendations regarding the role of dietary modifications in asthma management. PMID:23648395

cl-dash: rapid configuration and deployment of Hadoop clusters for bioinformatics research in the cloud.

PubMed

Hodor, Paul; Chawla, Amandeep; Clark, Andrew; Neal, Lauren

2016-01-15

: One of the solutions proposed for addressing the challenge of the overwhelming abundance of genomic sequence and other biological data is the use of the Hadoop computing framework. Appropriate tools are needed to set up computational environments that facilitate research of novel bioinformatics methodology using Hadoop. Here, we present cl-dash, a complete starter kit for setting up such an environment. Configuring and deploying new Hadoop clusters can be done in minutes. Use of Amazon Web Services ensures no initial investment and minimal operation costs. Two sample bioinformatics applications help the researcher understand and learn the principles of implementing an algorithm using the MapReduce programming pattern. Source code is available at https://bitbucket.org/booz-allen-sci-comp-team/cl-dash.git. hodor_paul@bah.com. © The Author 2015. Published by Oxford University Press.

Road Lane Detection by Discriminating Dashed and Solid Road Lanes Using a Visible Light Camera Sensor.

PubMed

Hoang, Toan Minh; Hong, Hyung Gil; Vokhidov, Husan; Park, Kang Ryoung

2016-08-18

With the increasing need for road lane detection used in lane departure warning systems and autonomous vehicles, many studies have been conducted to turn road lane detection into a virtual assistant to improve driving safety and reduce car accidents. Most of the previous research approaches detect the central line of a road lane and not the accurate left and right boundaries of the lane. In addition, they do not discriminate between dashed and solid lanes when detecting the road lanes. However, this discrimination is necessary for the safety of autonomous vehicles and the safety of vehicles driven by human drivers. To overcome these problems, we propose a method for road lane detection that distinguishes between dashed and solid lanes. Experimental results with the Caltech open database showed that our method outperforms conventional methods.

Road Lane Detection by Discriminating Dashed and Solid Road Lanes Using a Visible Light Camera Sensor

PubMed Central

Hoang, Toan Minh; Hong, Hyung Gil; Vokhidov, Husan; Park, Kang Ryoung

2016-01-01

With the increasing need for road lane detection used in lane departure warning systems and autonomous vehicles, many studies have been conducted to turn road lane detection into a virtual assistant to improve driving safety and reduce car accidents. Most of the previous research approaches detect the central line of a road lane and not the accurate left and right boundaries of the lane. In addition, they do not discriminate between dashed and solid lanes when detecting the road lanes. However, this discrimination is necessary for the safety of autonomous vehicles and the safety of vehicles driven by human drivers. To overcome these problems, we propose a method for road lane detection that distinguishes between dashed and solid lanes. Experimental results with the Caltech open database showed that our method outperforms conventional methods. PMID:27548176

cl-dash: rapid configuration and deployment of Hadoop clusters for bioinformatics research in the cloud

PubMed Central

Hodor, Paul; Chawla, Amandeep; Clark, Andrew; Neal, Lauren

2016-01-01

Summary: One of the solutions proposed for addressing the challenge of the overwhelming abundance of genomic sequence and other biological data is the use of the Hadoop computing framework. Appropriate tools are needed to set up computational environments that facilitate research of novel bioinformatics methodology using Hadoop. Here, we present cl-dash, a complete starter kit for setting up such an environment. Configuring and deploying new Hadoop clusters can be done in minutes. Use of Amazon Web Services ensures no initial investment and minimal operation costs. Two sample bioinformatics applications help the researcher understand and learn the principles of implementing an algorithm using the MapReduce programming pattern. Availability and implementation: Source code is available at https://bitbucket.org/booz-allen-sci-comp-team/cl-dash.git. Contact: hodor_paul@bah.com PMID:26428290

Prevalence of remaining horizontal instability in high-grade acromioclavicular joint injuries surgically managed.

PubMed

Cisneros, Luis Natera; Reiriz, Juan Sarasquete

2017-04-01

To determine the prevalence of remaining horizontal instability in high-grade acromioclavicular joint (ACJ) injuries surgically managed by means of four different surgical strategies and to assess its relation to the clinical outcomes and the quality of life. In this multicentric non-randomized retrospective study, 53 patients with high-grade ACJ injuries surgically managed (by means of open or arthroscopic surgery) were clinically and radiographically assessed at 24 months or more after shoulder surgery. The presence of post-surgical remaining horizontal instability was evaluated by means of Alexander or axillary X-ray views. The study population was divided into two groups: patients with evidence of post-surgical remaining horizontal instability and patients without evidence of post-surgical remaining horizontal instability at the last follow-up visit. The relationship between remaining horizontal instability and the quality-of-life questionnaires was analyzed. 18.87% (10/53) of the Alexander or axillary X-rays views showed post-surgical remaining horizontal instability at the last follow-up visit (INSTAB-group). Results of the questionnaires were: (1) physical SF36 score (INSTAB-group 57.02 ± 3.17  and NO-INSTAB-group 57.66 ± 3.30, p = 0.583); (2) mental SF36 score (INSTAB-group 53.95 ± 3.98  and NO-INSTAB-group 55.71 ± 3.30, p = 0.150); (3) NRS for pain (INSTAB-group 1.30 ± 1.49 and NO-INSTAB-group 0.83  ± 1.08, p = 0.260); (4) DASH questionnaire (INSTAB-group 5.27 ± 5.42 and NO-INSTAB-group 3.06 ± 2.30, p = 0.049); (5) Constant score (INSTAB-group 93.4 ± 3.5 and NO-INSTAB-group 94.83  ± 4.3, p = 0.333); and Global satisfaction (INSTAB-group 8.7  ± 0.95 and NO-INSTAB-group 8.64 ± 1.03, p = 0.874). Independently of the type of procedure, post-surgical remaining horizontal instability was present in almost one-fifth of the patients, and this group of patients showed a significantly worse DASH score. The addition of an acromioclavicular augmentation might have to be considered, taking into account that its absence may have a negative impact in terms of shoulder disabilities. Level IV, prognostic case series.

Arthroscopic R-LCL plication for symptomatic minor instability of the lateral elbow (SMILE).

PubMed

Arrigoni, Paolo; Cucchi, Davide; D'Ambrosi, Riccardo; Menon, Alessandra; Aliprandi, Alberto; Randelli, Pietro

2017-07-01

Minor instability has been proposed as a possible aetiology of lateral elbow pain. This study presents the results of the arthroscopic plication of the radial component of the lateral collateral ligament (R-LCL) to reduce minor instability of the lateral elbow. Twenty-seven patients with recalcitrant lateral epicondylitis who had failed conservative therapy and who had no previous trauma or overt instability, were included. R-LCL plication was performed in the presence of at least one sign of lateral ligamentous patholaxity and one intra-articular abnormal finding. Single-assessment numeric evaluation (SANE), Oxford Elbow Score (OES), quickDASH (Disabilities of the Arm, Shoulder, Hand), patient satisfaction and post-operative range of motion were evaluated. SANE improved from a median of 30 [2-40] points pre-operatively to 90 [80-100] at final follow-up (p < 0.0001), and 96.3% patients obtained good or excellent subjective results. Post-operative median quickDASH was 9.1 [0-25] points and OES 42 [34-48]. Median post-operative flexion was 145°, and extension was 0°. Post-operative flexion was restrained in seven patients and extension in eight patients; 59% of patients reached full ROM at final follow-up. R-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with a symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up. A slight limitation in range of motion is a possible undesired consequence of this intervention. Retrospective case series, Level IV.

Metacarpophalangeal joint stiffness. Still a challenge for the hand surgeon?

PubMed

Jiménez, I; Muratore-Moreno, G; Marcos-García, A; Medina, J

2016-01-01

The aim of this study is to analyse the outcomes of the surgical treatment of metacarpophalangeal stiffness by dorsal teno-arthrolysis in our centre, and present a review the literature. This is a retrospective study of 21 cases of metacarpophalangeal stiffness treated surgically. Dorsal teno-arthrolysis was carried out on all patients. A rehabilitation programme was started ten days after surgery. An evaluation was performed on the aetiology, variation in pre- and post-operative active mobility, complications, DASH questionnaire, and a subjective satisfaction questionnaire. The mean age of the patients was 36.5 years and the mean follow-up was 6.5 years. Of the 21 cases, the most common cause was a metacarpal fracture (52.4%), followed by complex trauma of the forearm (19%). Improvement in active mobility was 30.5°, despite obtaining an intra-operative mobility 0-90° in 80% of cases. Mean DASH questionnaire score was 36.9 points. The outcome was described as excellent in 10% of our patients, good in 30%, poor in 40%, and bad in the remaining 20%. There was a complex regional pain syndrome in 9.5% of cases, and intrinsic muscle injury in 14.3%. Because of its difficult management and poor outcomes, surgical treatment of metacarpophalangeal stiffness in extension is highly complex, with dorsal teno-arthrolysis being a reproducible technique according to our results, and the results reported in the literature. Copyright © 2016 SECOT. Published by Elsevier Espana. All rights reserved.

Modeling of Women's 100-M Dash World Record: Wind-Aided or Not?

ERIC Educational Resources Information Center

Hazelrigg, Conner; Waibel, Bryson; Baker, Blane

2015-01-01

On July 16, 1988, Florence Griffith Joyner (FGJ) shattered the women's 100-m dash world record (WR) with a time of 10.49 s, breaking the previous mark by an astonishing 0.27 s. By all accounts FGJ dominated the race that day, securing her place as the premiere female sprinter of that era, and possibly all time. In the aftermath of such an…

75 FR 45076 - Approval and Promulgation of Air Quality Implementation Plans; New York, New Jersey, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-02

... the 2007-2009 design value for the NY-NJ-CT PM 2.5 nonattainment area would be 14.0 [micro]g/m\\3\\. VI... the New York-N. New Jersey-Long Island, NY-NJ-CT fine particle (PM 2.5 ) nonattainment area has... determine that the New York-N. New Jersey-Long Island, NY[dash]NJ[dash]CT PM 2.5 nonattainment area...

Wave Evolution in River Mouths and Tidal Inlets

DTIC Science & Technology

2014-06-01

Monterey Bay by a Datawell Buoy (blue) and three collocated WRD buoys (red). Also shown is the f −4 spectral roll off (black dashed). .............. 48...f −4 spectral roll off (black dashed) and the blocking frequency in regions B-E. .................................................... 53   Figure...Significant Wave Height Hz hertz IMU Inertial measurement unit JONSWAP Joint North Sea Wave Program km kilometer MCR Mouth of the Columbia River MEMS

Mediterranean Diet and Other Dietary Patterns in Primary Prevention of Heart Failure and Changes in Cardiac Function Markers: A Systematic Review.

PubMed

Sanches Machado d'Almeida, Karina; Ronchi Spillere, Stefanny; Zuchinali, Priccila; Corrêa Souza, Gabriela

2018-01-10

Heart failure (HF) is a complex syndrome and is recognized as the ultimate pathway of cardiovascular disease (CVD). Studies using nutritional strategies based on dietary patterns have proved to be effective for the prevention and treatment of CVD. Although there are studies that support the protective effect of these diets, their effects on the prevention of HF are not clear yet. We searched the Medline, Embase, and Cochrane databases for studies that examined dietary patterns, such as dietary approaches to stop hypertension (DASH diet), paleolithic, vegetarian, low-carb and low-fat diets and prevention of HF. No limitations were used during the search in the databases. A total of 1119 studies were identified, 14 met the inclusion criteria. Studies regarding the Mediterranean, DASH, vegetarian, and Paleolithic diets were found. The Mediterranean and DASH diets showed a protective effect on the incidence of HF and/or worsening of cardiac function parameters, with a significant difference in relation to patients who did not adhere to these dietary patterns. It is observed that the adoption of Mediterranean or DASH-type dietary patterns may contribute to the prevention of HF, but these results need to be analyzed with caution due to the low quality of evidence.

Mediterranean Diet and Other Dietary Patterns in Primary Prevention of Heart Failure and Changes in Cardiac Function Markers: A Systematic Review

PubMed Central

Sanches Machado d’Almeida, Karina; Ronchi Spillere, Stefanny; Zuchinali, Priccila; Corrêa Souza, Gabriela

2018-01-01

Background: Heart failure (HF) is a complex syndrome and is recognized as the ultimate pathway of cardiovascular disease (CVD). Studies using nutritional strategies based on dietary patterns have proved to be effective for the prevention and treatment of CVD. Although there are studies that support the protective effect of these diets, their effects on the prevention of HF are not clear yet. Methods: We searched the Medline, Embase, and Cochrane databases for studies that examined dietary patterns, such as dietary approaches to stop hypertension (DASH diet), paleolithic, vegetarian, low-carb and low-fat diets and prevention of HF. No limitations were used during the search in the databases. Results: A total of 1119 studies were identified, 14 met the inclusion criteria. Studies regarding the Mediterranean, DASH, vegetarian, and Paleolithic diets were found. The Mediterranean and DASH diets showed a protective effect on the incidence of HF and/or worsening of cardiac function parameters, with a significant difference in relation to patients who did not adhere to these dietary patterns. Conclusions: It is observed that the adoption of Mediterranean or DASH-type dietary patterns may contribute to the prevention of HF, but these results need to be analyzed with caution due to the low quality of evidence. PMID:29320401

Kinematic Characteristics of Meteor Showers by Results of the Combined Radio-Television Observations

NASA Astrophysics Data System (ADS)

Narziev, Mirhusen

2016-07-01

One of the most important tasks of meteor astronomy is the study of the distribution of meteoroid matter in the solar system. The most important component to address this issue presents the results of measurements of the velocities, radiants, and orbits of both showers and sporadic meteors. Radiant's and orbits of meteors for different sets of data obtained as a result of photographic, television, electro-optical, video, Fireball Network and radar observations have been measured repeatedly. However, radiants, velocities and orbits of shower meteors based on the results of combined radar-optical observations have not been sufficiently studied. In this paper, we present a methods for computing the radiants, velocities, and orbits of the combined radar-TV meteor observations carried out at HisAO in 1978-1980. As a result of the two-year cycle of simultaneous TV-radar observations 57 simultaneous meteors have been identified. Analysis of the TV images has shown that some meteor trails appeared as dashed lines. Among the simultaneous meteors of d-Aquariids 10 produced such dashed images, and among the Perseids there were only 7. Using a known method, for such fragmented images of simultaneous meteors - together with the measured radar distance, trace length, and time interval between the segments - allowed to determine meteor velocity using combined method. In addition, velocity of the same meteors was measured using diffraction and radar range-time methods based on the results of radar observation. It has been determined that the mean values of meteoroid velocity based on the combined radar-TV observations are greater in 1 ÷ 3 km / c than the averaged velocity values measured using only radar methods. Orbits of the simultaneously observed meteors with segmented photographic images were calculated on the basis of the average velocity observed using the combined radar-TV method. The measured results of radiants velocities and orbital elements of individual meteors allowed us to calculate the average value for stream meteors. The data for the radiants, velocities and orbits of the meteor showers obtained by combined radar-TV observations to compared with data obtained by other authors.

Arthroscopic Bankart repair and capsular shift for recurrent anterior shoulder instability: functional outcomes and identification of risk factors for recurrence.

PubMed

Ahmed, Issaq; Ashton, Fiona; Robinson, Christopher Michael

2012-07-18

Arthroscopic Bankart repair and capsular shift is a well-established technique for the treatment of anterior shoulder instability. The purpose of this study was to evaluate the outcomes following arthroscopic Bankart repair and capsular shift and to identify risk factors that are predictive of recurrence of glenohumeral instability. We performed a retrospective review of a prospectively collected database consisting of 302 patients who had undergone arthroscopic Bankart repair and capsular shift for the treatment of recurrent anterior glenohumeral instability. The prevalence of patient and injury-related risk factors for recurrence was assessed. Cox proportional hazards models were used to estimate the predicted probability of recurrence within two years. The chief outcome measures were the risk of recurrence and the two-year functional outcomes assessed with the Western Ontario shoulder instability index (WOSI) and disabilities of the arm, shoulder and hand (DASH) scores. The rate of recurrent glenohumeral instability after arthroscopic Bankart repair and capsular shift was 13.2%. The median time to recurrence was twelve months, and this complication developed within one year in 55% of these patients. The risk of recurrence was independently predicted by the patient's age at surgery, the severity of glenoid bone loss, and the presence of an engaging Hill-Sachs lesion (all p < 0.001). These variables were incorporated into a model to provide an estimate of the risk of recurrence after surgery. Varying the cutoff level for the predicted probability of recurrence in the model from 50% to lower values increased the sensitivity of the model to detect recurrences but decreased the positive predictive value of the model to correctly predict failed repairs. There was a significant improvement in the mean WOSI and DASH scores at two years postoperatively (both p < 0.001), but the mean scores in the group with recurrence were significantly lower than those in the group without recurrence (both p < 0.001). Our study identified factors that are independently associated with a higher risk of recurrence following arthroscopic Bankart repair and capsular shift. These data can be useful for counseling patients undergoing this procedure for the treatment of recurrent glenohumeral instability and individualizing treatment options for particular groups of patients. Prognostic level I. See Instructions for authors for a complete description of levels of evidence.

Greenhouse gas emissions of self-selected diets in the UK and their association with diet quality: is energy under-reporting a problem?

PubMed

Murakami, Kentaro; Livingstone, M Barbara E

2018-02-21

While the admittedly limited number of epidemiological findings on the association between diet-related greenhouse gas emissions (GHGE) and diet quality are not always consistent, potential influence of bias in the estimation of diet-related GHGE caused by misreporting of energy intake (EI) has not been investigated. This cross-sectional study evaluated diet-related GHGE in the UK and their association with diet quality, taking account of EI under-reporting. Dietary data used were from the National Diet and Nutrition Survey rolling programme 2008/2009-2013/2014, in which 4-day food diaries were collected from 3502 adults aged ≥19 years. Diet-related GHGE were estimated based on 133 food groups, using GHGE values from various secondary sources. Diet quality was assessed by the healthy diet indicator (HDI), Mediterranean diet score (MDS) and Dietary Approaches to Stop Hypertension (DASH) score. EI misreporting was assessed as reported EI divided by estimated energy requirement (EI:EER). Mean value of daily GHGE was 5.7 kg carbon dioxide equivalents (CO 2 eq), which is consistent with those reported from a number of national representative samples in other European countries. Mean EI:EER was 0.74. Assuming that all the dietary variables were misreported in proportion to the misreporting of EI, the mean value of the misreporting-adjusted diet-related GHGE was 8.2 kg CO 2 eq/d. In the entire population, after adjustment for potential confounders (i.e., age, sex, ethnicity, socioeconomic classification, smoking status and physical activity), diet-related GHGE were inversely associated with HDI and DASH score but not with MDS. However, with further adjustment for EI:EER, diet-related GHGE showed inverse associations with all three measures of diet quality. Similar associations were observed when only under-reporters (EI:EER < 0.70; n = 1578) were analysed. Conversely, in the analysis including only plausible reporters (EI:EER 0.70-1.43; n = 1895), diet-related GHGE showed inverse associations with all diet quality measures irrespective of adjustment. With taking account of EI under-reporting, this study showed inverse associations between diet-related GHGE and diet quality not only in the entire sample but also in the separate analyses of plausible reporters and under-reporters, as well as potential underreporting of diet-related GHGE.

Prognostic factors to succeed in surgical treatment of chronic acromioclavicular dislocations.

PubMed

Barth, J; Duparc, F; Baverel, L; Bahurel, J; Toussaint, B; Bertiaux, S; Clavert, P; Gastaud, O; Brassart, N; Beaudouin, E; De Mourgues, P; Berne, D; Duport, M; Najihi, N; Boyer, P; Faivre, B; Meyer, A; Nourissat, G; Poulain, S; Bruchou, F; Ménard, J F

2015-12-01

Treatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable. This article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays. Based on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients' mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10(-3)) and the horizontal plane (p=0.022). In this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result. Level II prospective non-randomized comparative study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Nanothermodynamics Applied to Thermal Processes in Heterogeneous Materials

DTIC Science & Technology

2012-08-03

models agree favorably with a wide range of measurements of local thermal and dynamic properties. Progress in understanding basic thermodynamic...Monte- Carlo (MC) simulations of the Ising model .7 The solid black lines in Fig. 4 show results using the uncorrected (Metropolis) algorithm on the...parameter g=0.5 (green, dash-dot), g=1 (black, solid ), and g=2 (blue, dash-dot-dot). Note the failure of the standard Ising model (g=0) to match

User’s Manual for the Modular Analysis-Package Libraries ANAPAC and TRANL

DTIC Science & Technology

1977-09-01

number) Computer software Fourier transforms Computer software library Interpolation software Digitized data...disregarded to give the user a simplified plot. (b) The last digit of ISPACE determines the type of line to be drawn, provided KODE is not...negative. If the last digit of ISPACE is 0 a solid line is drawn 1 a dashed line is drawn - - - 2 a dotted line is drawn .... 3 a dash-dot line is

Transient Simulation of Ram Accelerator Flowfields

DTIC Science & Technology

1993-01-01

PROPULSIVE FLOWS WITH COMIBUSTION CHEMISTRY, ADVANCED TURBULENCE MODELS - 1񕚑ŕ. Reference: Dash, "Advanced Computational Models for Analyzing High - Speed...coupled, implicit manner. Near-wall effects have been dealt with via the low Reynolds number formulation of Chien: and the recent model of Rodi.3 High ...July 1989. 19 Dash, S.M., ’Advanced Computational Models for Analyzing High -Speed Propulsive Flowficlds,’ 199M J&ý,NAF Propulsion Meeting, CPIA Pub. 550

Valve and dash-pot assembly

DOEpatents

Chang, Shih-Chih

1986-01-01

A dash-pot valve comprising a cylinder submerged in the fluid of a housing and having a piston attached to a plunger projecting into the path of closing movement of a pivotal valve member. A vortex chamber in said cylinder is provided with tangentially directed inlets to generate vortex flow upon retraction of said plunger and effect increasing resistance against said piston to progressively retard the closing rate of said valve member toward its seat.

Improved valve and dash-pot assembly

DOEpatents

Chang, S.C.

1985-04-23

A dash-pot valve comprises a cylinder submerged in the fluid of a housing and have a piston attached to a plunger projecting into the path of closing movement of a pivotal valve member. A vortex chamber in said cylinder is provided with targentially directed inlets to generate vortex flow upon retraction of said plunger and effect increasing resistance against said piston to progressively retard the closing rate of said valve member toward its seat.

Modular Electronics for Flash Memory Production

DTIC Science & Technology

2011-12-28

DEFENSE TECHNICAL INFORMATION CENTER ImuM ktkUmlimäj DTICfhas determined on oc öf^H AJI that this Technical Document has the Distribution...the second harmonic (8I2/8V2), and a normalization to remove the scale of the measured current. The red dashed lines represent notable vibrational...superimposed as red dashed lines. The agreement between the two spectroscopies is conclusive that we have successfully put our OPE derivative into the gap

Mission Connect Mild TBI Translational Research Consortium

DTIC Science & Technology

2010-08-01

Grill RJ, Parsley MA, Unabia G, Hulsebosch CE. Anti- inflammatory treatment of traumatic brain injury (TBI). Society for Neuroscience, 2009...Hulsebosch, CD, DeWitt DS, Dash PK, Grill RJ, Parsley MA, Unabia, BC, Rea HC, & Perez-Polo, JR Role of IL-1 and TNF receptor activation in neurological...deficits at TBI. Military health Research Forum, 2009. Hulsebosch, CD, DeWitt DS, Dash PK, Grill RJ, Parsley MA, Unabia, BC, Rea HC, & Perez-Polo, JR

Organic Electronic Devices Using Crosslinked Polyelectrolyte Multilayers as an Ultra-Thin Dielectric Material

DTIC Science & Technology

2006-09-01

energy band diagram illustrating the allowed energies for valence and conducting electrons. The dashes within the band gap (Eg) represent localized ...allowed energies for valence and conducting electrons. The dashes within the band gap (Eg) represent localized electron energy states, or traps, that...been observed with the formation of alternating bond lengths along the backbone.43 The localization of the π-electrons while forming the shorter double

Engaging Students via Innovative Military Useful Technologies

DTIC Science & Technology

2013-07-01

projects involved four additional M.Eng. students who are all finishing their degrees during the spring of 2013: Aniket Dash, Sunil Channapatna...Ravindrachar, Herat Gandhi, and Heesung Sohn. Aniket Dash and Sunil Channapatna Ravindrachar have worked with us on creating a way for unmanaged C++, C...16 and was able to get some simple Isis2 system calls working. In the spring semester, Aniket and Sunil have made very strong progress and are

Single-photon emission of InAs/InP quantum dashes at 1.55 μm and temperatures up to 80 K

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dusanowski, Ł., E-mail: lukasz.dusanowski@pwr.edu.pl; Syperek, M.; Misiewicz, J.

2016-04-18

We report on single photon emission from a self-assembled InAs/InGaAlAs/InP quantum dash emitting at 1.55 μm at the elevated temperatures. The photon auto-correlation histograms of the emission from a charged exciton indicate clear antibunching dips with as-measured g{sup (2)}(0) values significantly below 0.5 recorded at temperatures up to 80 K. It proves that the charged exciton complex in a single quantum dash of the mature InP-based material system can act as a true single photon source up to at least liquid nitrogen temperature. This demonstrates the huge potential of InAs on InP nanostructures as the non-classical light emitters for long-distance fiber-based securemore » communication technologies.« less

Reductive transformation of V(iii) precursors into vanadium(ii) oxide nanowires.

PubMed

Ojelere, Olusola; Graf, David; Ludwig, Tim; Vogt, Nicholas; Klein, Axel; Mathur, Sanjay

2018-05-15

Vanadium(ii) oxide nanostructures are promising materials for supercapacitors and electrocatalysis because of their excellent electrochemical properties and high surface area. In this study, new homoleptic vanadium(iii) complexes with bi-dentate O,N-chelating heteroarylalkenol ligands (DmoxCH[double bond, length as m-dash]COCF3, PyCH[double bond, length as m-dash]COCF3 and PyN[double bond, length as m-dash]COCF3) were synthesized and successfully transformed by reductive conversion into VO nanowires. The chemical identity of V(iii) complexes and their redox behaviour were unambiguously established by single crystal X-ray diffraction studies, cyclic voltammetry, spectrometric studies and DFT calculations. Transformation into the metastable VO phase was verified by powder X-ray diffraction and thermo-gravimetry. Transmission electron microscopy and X-ray photoelectron spectroscopy data confirmed the morphology and chemical composition of VO nanostructures, respectively.

Radiological and clinical predictors of long-term outcome in rotator cuff calcific tendinitis.

PubMed

de Witte, Pieter Bas; van Adrichem, Raymond A; Selten, Jasmijn W; Nagels, Jochem; Reijnierse, M; Nelissen, Rob G H H

2016-10-01

Knowledge on the epidemiology and long-term course of rotator cuff calcific tendinitis (RCCT) is scarce. We assessed demographics, radiological characteristics, and their association with long-term outcomes in a large patient group. Baseline demographics, radiological characteristics and treatment were recorded in 342 patients. Interobserver agreement of radiological measures was analyzed. Long-term outcome was evaluated with questionnaires (WORC, DASH). The association of baseline characteristics with outcome was assessed. Mean age was 49.0 (SD = 10.0), and 59.5 % were female. The dominant arm was affected in 66.0 %, and 21.3 % had bilateral disease. Calcifications were on average 18.7 mm (SD = 10.1, ICC = 0.84 (p < 0.001)) and located 10.1 mm (SD = 11.8) medially to the acromion (ICC = 0.77 (p < 0.001)). Gärtner type I calcifications were found in 32.1 % (Kappa = 0.47 (p < 0.001)). After 14 years (SD = 7.1) of follow-up, median WORC was 72.5 (range, 3.0-100.0; WORC < 60 in 42 %) and median DASH 17.0 (range, 0.0-82.0). Female gender, dominant arm involvement, bilateral disease, longer duration of symptoms, and multiple calcifications were associated with inferior WORC. DASH results were similar. Many subjects have persisting shoulder complaints years after diagnosis, regardless of treatment. Female gender, dominant arm involvement, bilateral disease, longer duration of symptoms, and multiple calcifications were associated with inferior outcome. Radiological measures had moderate-to-good reliability and no prognostic value. • Most RCCT studies report on short-term outcome and/or small patients groups. • In this large, long-term observational study, RCCT appeared to not be self-limiting in many subjects. • Negative prognostic factors included female gender, more calcifications, dominant arm affected, and longer duration of symptoms. • Interobserver agreement of general radiological RCCT measures is moderate to good. • More rigorous diagnostics and treatment might be needed in specific RCCT cases.

DASH Eating Plan: An Eating Pattern for Diabetes Management

PubMed Central

2017-01-01

IN BRIEF The DASH (Dietary Approaches to Stop Hypertension) eating plan is an acceptable eating pattern for people who have diabetes. In addition to promoting blood pressure control, this eating pattern has been shown to improve insulin resistance, hyperlipidemia, and even overweight/obesity. This balanced approach promotes consumption of a variety of foods (whole grains, fat-free or low-fat dairy products, fruits, vegetables, poultry, fish, and nuts) and is appropriate for the entire family. PMID:28588372

Mission Connect Mild TBI Translational Research Consortium

DTIC Science & Technology

2009-08-01

modalities. We recruited to the project Margaret A. Parsley to carry out the Mild Traumatic Brain Injuries (MTBIs) under the supervision of Doug DeWitt...abstracts: Hulsebosch CE, Johnson KM, Dewitt DS, Dash PK, Grill R, Parsley MA, Unabia G, Rea H, Perez-Polo JR. Role of IL-1 and TNF receptor activation in...neurological deficits after TBI National Neurotrauma Society, 2010 Johnson KM, Dewitt DS, Dash PK, Grill R, Parsley MA, Unabia G, Rea H, Perez-Polo

Dynamic Testing of Laterally Confined Concrete

DTIC Science & Technology

1990-09-01

for Intermediate Confining pressure (Dashed Curve). 31 23. Example of Regression Fit by Equation (6) for Highest Pressure Group (Dashed Curve... pressure group , loaded by a moderate striker-bar impact speed of 420 in/sec. (10.7 m/s). The peak stress of 124 MPa (18 ksi) occurs at a strain of...survived at one end. This was for the highest speed impact in the lowest confining pressure group . Curves are given in the Appendix Figure A-15. The

Ammonolysis of ketene as a potential source of acetamide in the troposphere: a quantum chemical investigation.

PubMed

Sarkar, Saptarshi; Mallick, Subhasish; Kumar, Pradeep; Bandyopadhyay, Biman

2018-05-16

Quantum chemical calculations at the CCSD(T)/CBS//MP2/aug-cc-pVTZ levels of theory have been carried out to investigate a potential new source of acetamide in Earth's atmosphere through the ammonolysis of the simplest ketene. It was found that the reaction can occur via the addition of ammonia at either the C[double bond, length as m-dash]C or C[double bond, length as m-dash]O bond of ketene. The potential energy surface as well as calculated rate coefficients indicate that under tropospheric conditions, ammonolysis would occur almost exclusively via ammonia addition at the C[double bond, length as m-dash]O bond with negligible contribution from addition at the C[double bond, length as m-dash]C bond. The reaction of ketene with water has also been investigated in order to compare between hydrolysis and ammonolysis, as the former is known to be responsible for the formation of acetic acid. The rate coefficient for the formation of acetamide was found to be ∼106 to 109 times higher than that for the formation of acetic acid from the same ketene source in the troposphere. By means of the relative rate of ammonolysis with respect to hydrolysis, it was shown that acetamide formation would dominate over acetic acid formation at various altitudes in the troposphere.

Pressure-induced emission band separation of the hybridized local and charge transfer excited state in a TPE-based crystal.

PubMed

Liu, Xuedan; Li, Aisen; Xu, Weiqing; Ma, Zhiyong; Jia, Xinru

2018-05-08

We herein report a newly synthesized simple molecule, named TPE[double bond, length as m-dash]C4, with twisted D-A structure. TPE[double bond, length as m-dash]C4 showed two intrinsic emission bands ascribed to the locally excited (LE) state and the intramolecular charge transfer (ICT) state, respectively. In the crystal state, the LE emission band is usually observed. However, by applying hydrostatic pressure to the powder sample and the single crystal sample of TPE[double bond, length as m-dash]C4, dual-fluorescence (445 nm and 532 nm) was emerged under high pressure, owing to the pressure-induced emission band separation of the hybridized local and charge transfer excited state (HLCT). It is found that the emission of TPE[double bond, length as m-dash]C4 is generally determined by the ratio of the LE state to the ICT state. The ICT emission band is much more sensitive to the external pressure than the LE emission band. The HLCT state leads to a sample with different responsiveness to grinding and hydrostatic pressure. This study is of significance in the molecular design of such D-A type molecules and in the control of photoluminescence features by molecular structure. Such results are expected to pave a new way to further understand the relationship between the D-A molecular structure and stimuli-responsive properties.

Nucleation-dependant chemical bonding paradigm: the effect of rare earth ions on the nucleation of urea in aqueous solution.

PubMed

Chen, Xiaoyan; Sun, Congting; Wu, Sixin; Xue, Dongfeng

2017-03-29

Rare earth ions can be used to construct a variety of novel structures and are favorable to chemical bonding regulation and design. In this study, the chemical bonding paradigm between rare earth ions (Ln 3+ ) and urea molecules in an aqueous solution can be tracked by the evolution of C[double bond, length as m-dash]O, NH 2 , and CN vibration bands during the urea nucleation stage. Rare earth ions such as La 3+ , Gd 3+ , and Lu 3+ can manipulate the nucleation time of urea via regulating the nucleation-dependant N-C[double bond, length as m-dash]OH-N hydrogen-bonding between urea molecules. Two types of chemical bondings between Ln 3+ and urea molecules have been confirmed, which are Ln 3+ O[double bond, length as m-dash]C-N and Ln 3+ NH 2 -C. Compared with Ln 3+ NH 2 -C, Ln 3+ prefers to coordinate with the O[double bond, length as m-dash]C bond in urea. With a higher concentration of rare earth ions in the solution, some N-C[double bond, length as m-dash]OH-N hydrogen bonds are broken as a consequence of the incorporation of Ln 3+ into the lattice, resulting in the decreased symmetry of local urea molecules in the crystalline nuclei and the consequent Ln 3+ concentration-dependent nucleation time of urea. Moreover, using the ionic electronegativity scale of Ln 3+ , the different effects of La 3+ , Gd 3+ , and Lu 3+ on urea nucleation can be further distinguished. The present study provides basic data for unrevealing the chemical bonding regulation role of rare earth ions in the formation of hydrogen bonded materials, which may give insight into the design and fabrication of novel materials utilizing rare earth ions to adjust the chemical bonding process.

Low-Intensity Sprint Training With Blood Flow Restriction Improves 100-m Dash.

PubMed

Behringer, Michael; Behlau, Daniel; Montag, Johannes C K; McCourt, Molly L; Mester, Joachim

2017-09-01

Behringer, M, Behlau, D, Montag, JCK, McCourt, ML, and Mester, J. Low-intensity sprint training with blood flow restriction improves 100-m dash. J Strength Cond Res 31(9): 2462-2472, 2017-We investigated the effects of practical blood flow restriction (pBFR) of leg muscles during sprint training on the 100-m dash time in well-trained sport students. Participants performed 6 × 100-m sprints at 60-70% of their maximal 100-m sprinting speed twice a week for 6 weeks, either with (intervention group [IG]; n = 12) or without pBFR (control group [CG]; n = 12). The 100-m dash time significantly decreased more in the IG (-0.38 ± 0.24 seconds) than in the CG (-0.16 ± 0.17 seconds). The muscle thickness of the rectus femoris increased only in the IG, whereas no group-by-time interactions were found for the muscle thickness of the biceps femoris and the biceps brachii. The maximal isometric force, measured using a leg press, did not change in either group. However, the rate of force development improved in the IG. Growth hormone, testosterone, insulin-like growth factor 1, and cortisol concentrations did not significantly differ between both groups at any measurement time point (pre, 1 minute, 20 minutes, 120 minutes, and 24 hours after the 6 all-out sprints of the first training session). The muscle damage marker h-FABP increased significantly more in the CG than in the IG. The pBFR improved the 100-m dash time significantly more than low-intensity sprint interval training alone. Other noted benefits of training with pBFR were a decreased level of muscle damage, a greater increase of the rectus femoris muscle thickness, and a higher rate of force development. However, the tested hormones were unable to explain the additional beneficial effects.

A Quantitative Analysis of Solar Flare Characteristics as Observed in the Solar Observing Optical Network and the Global Oscillation Network Group

DTIC Science & Technology

2012-03-01

due to their possible threat to operations. Because of their importance, event-level flares are given extra consideration in this report. (AFWA...In the impulsive phase (3 to 10 minutes), as this reconnection takes place, electrons and ions with large energies are accelerated and released...right, correspond to the horizontal lines with large red dashes. The flash and gradual phases are bound by the vertical dashed lines. 13 variable in

Enhancing Sparsity by Reweighted l(1) Minimization

DTIC Science & Technology

2008-07-01

recovery depends on the sparsity level k. The dashed curves represent a reweighted ℓ1 algorithm that outperforms the traditional unweighted ℓ1...approach (solid curve ). (a) Performance after 4 reweighting iterations as a function of ǫ. (b) Performance with fixed ǫ = 0.1 as a function of the number of...signal recovery (declared when ‖x0 − x‖ℓ∞ ≤ 10−3) for the unweighted ℓ1 algorithm as a function of the sparsity level k. The dashed curves represent the

Synthesis and SMM behaviour of trinuclear versus dinuclear 3d-5f uranyl(v)-cobalt(ii) cation-cation complexes.

PubMed

Chatelain, Lucile; Tuna, Floriana; Pécaut, Jacques; Mazzanti, Marinella

2017-05-02

Trinuclear versus dinuclear heterodimetallic U V O 2 + Co 2+ complexes were selectively assembled via a cation-cation interaction by tuning the ligand. The trimeric complex 2, with a linear [Co-O[double bond, length as m-dash]U[double bond, length as m-dash]O-Co] core, exhibits magnetic exchange and slow relaxation with a reversal barrier of 30.5 ± 0.9 K providing the first example of a U-Co exchange-coupled SMM.

47 CFR 15.122 - Closed caption decoder requirements for digital television receivers and converter boxes.

Code of Federal Regulations, 2011 CFR

2011-10-01

... code 0×2D Lower-left border (⌊), G2 char code 0×7C G0 dash (-), char code 0×2D Horizontal border... (-), char code 0×2D Upper-left border (⌈), G2 char code 0×7F G0 dash (-), char code 0×2D (4) Support for..., if the character to the left of the embedded return is a hyphen, the embedded return should be...

47 CFR 15.122 - Closed caption decoder requirements for digital television receivers and converter boxes.

Code of Federal Regulations, 2010 CFR

2010-10-01

... code 0×2D Lower-left border (⌊), G2 char code 0×7C G0 dash (-), char code 0×2D Horizontal border... (-), char code 0×2D Upper-left border (⌈), G2 char code 0×7F G0 dash (-), char code 0×2D (4) Support for..., if the character to the left of the embedded return is a hyphen, the embedded return should be...

Economic consequences of accidents to hands and forearms by log splitters and circular saws: cost of illness study.

PubMed

Eriksson, Martin; Karlsson, Johan; Carlsson, Katarina Steen; Dahlin, Lars B; Rosberg, Hans-Eric

2011-02-01

We estimated costs associated with injuries to hands from log splitters and circular saws used to cut up firewood and assessed the value of prevention. The study was carried out as a cost of illness study with an incidence approach based on 57 consecutive patients (median age 51; range 8-81) with injuries to the hand or forearm. Twenty-six of the 57 had an amputation which required microsurgery and 31/57 had various injuries. Median Hand Injury Severity Score (HISS) reflecting the severity of all injuries was 67 (range 6-332). Median DASH score after 2-7 years was 12.5 (0-73.3). Total cost (direct costs, costs of lost productivity, and lost quality of life) was estimated to roughly EUR 14 million (EUR 2.8 million/year), where the cost of lost quality of life is 82% of the total cost and loss of productivity and direct costs are 9% each. Injuries sustained from log splitters and circular saws account for considerable costs, but first and foremost human suffering.

Does Wrist Arthrodesis With Structural Iliac Crest Bone Graft After Wide Resection of Distal Radius Giant Cell Tumor Result in Satisfactory Function and Local Control?

PubMed

Wang, Tao; Chan, Chung Ming; Yu, Feng; Li, Yuan; Niu, Xiaohui

2017-03-01

Many techniques have been described for reconstruction after distal radius resection for giant cell tumor with none being clearly superior. The favored technique at our institution is total wrist fusion with autogenous nonvascularized structural iliac crest bone graft because it is structurally robust, avoids the complications associated with obtaining autologous fibula graft, and is useful in areas where bone banks are not available. However, the success of arthrodesis and the functional outcomes with this approach, to our knowledge, have only been limitedly reported. (1) What is the success of union of these grafts and how long does it take? (2) How effective is the technique in achieving tumor control? (3) What complications occur with this type of arthrodesis? (4) What are the functional results of wrist arthrodesis by this technique for treating giant cell tumor of the distal radius? Between 2005 and 2013, 48 patients were treated for biopsy-confirmed Campanacci Grade III giant cell tumor of the distal radius. Of those, 39 (81% [39 of 48]) were treated with wrist arthrodesis using autogenous nonvascularized iliac crest bone graft. Of those, 27 (69% [27 of 39]) were available for followup at a minimum of 24 months (mean, 45 months; range, 24-103 months). During that period, the general indications for this approach were Campanacci Grade III and estimated resection length of 8 cm or less. Followup included clinical and radiographic assessment and functional assessment using the Disabilities of the Arm, Shoulder and Hand (DASH) score, the Musculoskeletal Tumor Society (MSTS) score, grip strength, and range of motion at every followup by the treating surgeon and his team. All functional results were from the latest followup of each patient. Union of the distal junction occurred at a mean of 4 months (± 2 months) and union of the proximal junction occurred at a mean of 9 months (± 5 months). Accounting for competing events, at 12 months, the rate of proximal junction union was 56% (95% confidence interval [CI], 35%-72%), whereas it was 67% (95% CI, 45%-82%) at 18 months. In total, 11 of the 27 patients (41%) underwent repeat surgery on the distal radius, including eight patients (30%) who had complications and three (11%) who had local recurrence. The mean DASH score was 9 (± 7) (value range, 0-100, with lower scores representing better function), and the mean MSTS 1987 score was 29 (± 1) (value range, 0-30, with higher scores representing better function) as well as 96% (± 4%) of mean MSTS 1993 score (value range, 0%-100%, with higher scores representing better function). The mean grip strength was 51% (± 23%) of the uninvolved side, whereas the mean arc of forearm rotation was 113° (± 49°). Reconstruction of defects after resection of giant cell tumor of the distal radius with autogenous structural iliac crest bone graft is a facile technique that can be used to achieve favorable functional results with complications and recurrences comparable to those of other reported techniques. We cannot show that this technique is superior to other options, but it seems to be a reasonable option to consider when other reconstruction options such as allografts are not available. Level IV, therapeutic study.

Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures

PubMed Central

Kopylov, Philippe; Geijer, Mats; Tägil, Magnus

2009-01-01

Background and purpose In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position, the treatment of choice is operation. The type of operation and the choice of implant, however, is a matter of discussion. Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation. Methods 50 patients with an unstable or comminute distal radius fracture were randomized to either closed reduction and bridging external fixation, or open reduction and internal fixation using the TriMed system. The primary outcome parameter was grip strength, but the patients were followed for 1 year with objective clinical assessment, subjective outcome using DASH, and radiographic examination. Results At 1 year postoperatively, grip strength was 90% (SD 16) of the uninjured side in the internal fixation group and 78% (17) in the external fixation group. Pronation/supination was 150° (15) in the internal fixation group and 136° (20) in the external fixation group at 1 year. There were no differences in DASH scores or in radiographic parameters. 5 patients in the external fixation group were reoperated due to malunion, as compared to 1 in the internal fixation group. 7 other cases were classified as radiographic malunion: 5 in the external fixation group and 2 in the internal fixation group. Interpretation Internal fixation gave better grip strength and a better range of motion at 1 year, and tended to have less malunions than external fixation. No difference could be found regarding subjective outcome. PMID:19857180

Evaluation of the reliability and validity of the Persian version of Patient-Rated Elbow Evaluation questionnaire.

PubMed

Farazdaghi, Mohammad Reza; Mansoori, Ali; Vosoughi, Omid; Kordi Yoosefinejad, Amin

2017-05-01

Elbow joint pathologies are highly prevalent in Persian-speaking countries. A reliable low-cost method like an appropriate questionnaire is mandatory for the early diagnosis of elbow joint disorders. Among designed questionnaires, Patient-Rated Elbow Evaluation (PREE) is an accepted commonly used scale evaluating pain and dysfunction of the patients. The aims of the study were to cross-culturally adapt and also to identify the psychometric properties of the Persian PREE. The original version of the PREE was translated and cross-culturally adapted to Persian according to the guidelines by Beaton et al. Seventy-three patients and thirty-nine healthy people were enrolled in the study. Test-retest reliability and internal consistency were evaluated using ICC, Cronbach's alpha, and item-total correlation, respectively. Construct validity was investigated using Disability of Arm, Shoulder, and Hand (DASH) questionnaire and physical component scale of SF-36 (PCS). To determine a cutoff point for discriminating patients from non-patients, receiver operating characteristic curve was plotted. The Persian PREE displayed high internal consistency (Cronbach's alpha = 0.91) and had acceptable ICC values in the subscales and total score (ICC > 0.90). A positive moderate correlation with DASH (r = 0.66, P < 0.001) and a negative moderate correlation with PCS of SF-36 (r = -0.44, P < 0.001) were observed. The cutoff point equal to 13.16 was determined for Persian PREE. The Persian PREE exhibited promising validity and reliability. The findings supported its applicability in clinical situations that were consistent with the original version.

Motion deficit in nodal interphalangeal joint osteoarthritis by digital goniometer in housewives.

PubMed

Ventura-Ríos, L; Hayes-Salinas, M; Ferrusquia-Toriz, D; Cariño-Escobar, R I; Cruz-Arenas, E; Gutiérrez-Martínez, J; González-Ramírez, L; Hernández-Díaz, C

2018-06-01

Range of motion (ROM) measured objectively in nodal hand osteoarthritis (NHOA) is missing. Evaluation of collateral ligaments by ultrasound (US) is unknown in NHOA also. To compare ROM in interphalangeal joints in housewives with nodal OA, with a control group by a digital system using angle to voltage (Multielgon). The second objective was to assess correlation between collateral radial and ulnar ligaments thickness and ROM. For this cross-sectional observational study, we assessed 60 hands with symptomatic NHOA and 30 hands of healthy housewives matched for age. We obtained clinical and demographic characteristics (a complete standardized physical examination of hand joints, DASH questionnaire, pain surveys, gross grasp hand goniometer, and ROM measurements by Multielgon. Presence of synovitis, power Doppler signal, osteophytes, and collateral ligaments thickness was evaluated by US. We used descriptive statistics, Spearman correlation, X 2 test, t test and odds ratio. Significant less gross grasp and ROM in the right hand were observed in NHOA (p = 0.01 for both). Presence of OA, painful joints, disease duration, and score DASH were significant correlated with reduced ROM (OR 4.12, 4.12, 1.04 and 1.09, respectively). Reduced ROM was statistical significant in thumb MCP and IP joints, second and third DIP in dominant hand. There was no association between collateral radial and ulnar ligaments and reduced ROM. Synovitis and osteophytes were more prevalent in OA group. Multielgon demonstrated the pattern of reduced ROM in nodal OA of housewives particularly in MCP and IP thumb joints, second and third distal interphalangeal joints.

Four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate.

PubMed

Hernekamp, J F; Reinecke, A; Neubrech, F; Bickert, B; Kneser, U; Kremer, T

2016-04-01

Four-corner fusion is a standard procedure for advanced carpal collapse. Several operative techniques and numerous implants for osseous fixation have been described. Recently, a specially designed locking plate (Aptus©, Medartis, Basel, Switzerland) was introduced. The purpose of this study was to compare functional results after osseous fixation using K-wires (standard of care, SOC) with four-corner fusion and locking plate fixation. 21 patients who underwent four-corner fusion in our institution between 2008 and 2013 were included in a retrospective analysis. In 11 patients, osseous fixation was performed using locking plates whereas ten patients underwent bone fixation with conventional K-wires. Outcome parameters were functional outcome, osseous consolidation, patient satisfaction (DASH- and Krimmer Score), pain and perioperative morbidity and the time until patients returned to daily work. Patients were divided in two groups and paired t-tests were performed for statistical analysis. No implant related complications were observed. Osseous consolidation was achieved in all cases. Differences between groups were not significant regarding active range of motion (AROM), pain and function. Overall patient satisfaction was acceptable in all cases; differences in the DASH questionnaire and the Krimmer questionnaire were not significant. One patient of the plate group required conversion to total wrist arthrodesis without implant-related complications. Both techniques for four-corner fusion have similar healing rates. Using the more expensive locking implant avoids a second operation for K-wire removal, but no statistical differences were detected in functional outcome as well as in patient satisfaction when compared to SOC.

Validity and Responsiveness of the Short Version of the Western Ontario Rotator Cuff Index (Short-WORC) in Patients With Rotator Cuff Repair.

PubMed

Dewan, Neha; MacDermid, Joy C; MacIntyre, Norma

2018-05-01

Study Design Clinical measurement. Background Recently, the Western Ontario Rotator Cuff Index (WORC) was shortened, but few studies have reported its measurement properties. Objective To compare the validity and responsiveness of the short version of the Western Ontario Rotator Cuff Index (Short-WORC) and the WORC (disease-specific measures) with those of the Shoulder Pain and Disability Index (SPADI) and the simple shoulder test (SST) (joint-specific measures); the Disabilities of the Arm, Shoulder and Hand (DASH) (a region-specific measure); and the Medical Outcomes Study 12-Item Short-Form Health Survey version 2 (SF-12v2) (a general health status measure) in patients undergoing rotator cuff repair (RCR). Methods A cohort of patients (n = 223) completed the WORC, SPADI, SST, DASH, and SF-12v2 preoperatively and at 3 and 6 months after RCR. Short-WORC scores were extracted from the WORC questionnaire. The construct validity (Pearson correlations) and internal responsiveness (effect size [ES], standardized response mean [SRM], relative efficiency [RE]) of the Short-WORC were calculated. Results The Short-WORC was strongly correlated with the WORC (r = 0.89-0.96) and moderately to strongly correlated with non-disease-specific measures at preoperative and postoperative assessments (r = 0.51-0.92). The Short-WORC and WORC were equally responsive (RE Short-WORC/WORC = 1) at 0 to 6 months and highly responsive overall at 0 to 3 months (ES Short-WORC , 0.72; ES WORC , 0.92; SRM Short-WORC , 0.75; SRM WORC , 0.81) and 0 to 6 months (ES Short-WORC , 1.05; ES WORC , 1.12; SRM Short-WORC , 0.89; SRM WORC , 0.89). The responsiveness of the comparator measures (SPADI, SST, DASH, SF-12v2) was poor to moderate at 0 to 3 months (ES, 0.07-0.55; SRM, 0.09-0.49) and 0 to 6 months (ES, 0.05-0.78; SRM, 0.07-0.78). Conclusion The Short-WORC and WORC have similar responsiveness in patients undergoing RCR, and are more responsive than non-disease-specific measures. Future studies should focus on validation of the Short-WORC in samples representing the spectrum of rotator cuff disorders. J Orthop Sports Phys Ther 2018;48(5):409-418. doi:10.2519/jospt.2018.7928.

Reliability of the detailed assessment of speed of handwriting on Flemish children.

PubMed

Simons, Johan; Probst, Michel

2014-01-01

This study evaluates the reliability of the Detailed Assessment of Speed of Handwriting (DASH) in a Dutch-speaking sample of children. The sample included 650 boys and 513 girls (age range = 9-16 years). Handwriting speed measurements were obtained using the DASH. Interrater agreement, test-retest reliability, and internal consistency were calculated; gender and age effects were analyzed. Interrater agreement shows excellent reliability with intraclass correlation coefficients of at least 0.94. Test-retest correlations ranged from r = 0.65 to r = 0.81. The internal consistency measures, calculated with Cronbach's alpha, were between 0.88 and 0.94. Both gender and age have a significant effect on handwriting speed, with F (7.1144) = 17.43 (P < .001) for gender and F (7.1144) = 21.8 (P < .001) for age. The DASH is a reliable assessment tool to evaluate handwriting speed of Dutch-speaking children. There is a tendency of girls to write faster than boys.

Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease.

PubMed

Engstrand, Christina; Krevers, Barbro; Kvist, Joanna

2015-01-01

Prospective cohort study. The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytren's disease. Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. Safety and social issues of hand function and quality of life had an evident association with functional recovery. IV. Copyright © 2015 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

Dots and dashes: art, virtual reality, and the telegraph

NASA Astrophysics Data System (ADS)

Ruzanka, Silvia; Chang, Ben

2009-02-01

Dots and Dashes is a virtual reality artwork that explores online romance over the telegraph, based on Ella Cheever Thayer's novel Wired Love - a Romance in Dots and Dashes (an Old Story Told in a New Way)1. The uncanny similarities between this story and the world of today's virtual environments provides the springboard for an exploration of a wealth of anxieties and dreams, including the construction of identities in an electronically mediated environment, the shifting boundaries between the natural and machine worlds, and the spiritual dimensions of science and technology. In this paper we examine the parallels between the telegraph networks and our current conceptions of cyberspace, as well as unique social and cultural impacts specific to the telegraph. These include the new opportunities and roles available to women in the telegraph industry and the connection between the telegraph and the Spiritualist movement. We discuss the development of the artwork, its structure and aesthetics, and the technical development of the work.

[Soft tissue sarcoma of the upper extremities. Analysis of factors relevant for prognosis in 160 patients].

PubMed

Lehnhardt, M; Hirche, C; Daigeler, A; Goertz, O; Ring, A; Hirsch, T; Drücke, D; Hauser, J; Steinau, H U

2012-02-01

Soft tissue sarcomas (STS) are a rare entity with reduced prognosis due to their aggressive biology. For an optimal treatment of STS identification of independent prognostic factors is crucial in order to reduce tumor-related mortality and recurrence rates. The surgical oncological concept includes wide excisions with resection safety margins >1 cm which enables acceptable functional results and reduced rates of amputation of the lower extremities. In contrast, individual anatomy of the upper extremities, in particular of the hand, leads to an intentional reduction of resection margins in order to preserve the extremity and its function with the main intention of tumor-free resection margins. In this study, the oncological safety and outcome as well as functional results were validated by a retrospective analysis of survival rate, recurrence rate and potential prognostic factors. A total of 160 patients who had been treated for STS of the upper extremities were retrospectively included. Independent prognostic factors were analyzed (primary versus recurrent tumor, tumor size, resection status, grade of malignancy, additional therapy, localization in the upper extremity). Kaplan-Meier analyses for survival rate and local control were calculated. Further outcome measures were functional results validated by the DASH score and rate of amputation. In 130 patients (81%) wide tumor excision (R0) was performed and in 19 patients (12%) an amputation was necessary. The 5-year overall survival rate was 70% and the 5-year survival rate in primary tumors was 81% whereas in recurrences 55% relapsed locally. The 10-year overall survival rate was 45% and the 5-year recurrence rate was 18% for primary STS and 43% for recurrent STS. Variance analysis revealed primary versus recurrent tumor, tumor size, resection status and grade of malignancy as independent prognostic factors. Analysis of functional results showed a median DASH score of 37 (0-100; 0=contralateral extremity). The 5-year survival and local recurrence rates are comparable to STS wide resections with safety margins >1 cm for the lower extremities and the trunk. Analysis of prognostic factors revealed resection status and the tumor-free resection margins to be the main goals in STS resection of upper extremity.

Tendon transfer options about the shoulder in patients with brachial plexus injury.

PubMed

Elhassan, Bassem; Bishop, Allen T; Hartzler, Robert U; Shin, Alexander Y; Spinner, Robert J

2012-08-01

The purpose of this study was to evaluate the early outcome of shoulder tendon transfer in patients with brachial plexus injury and to determine the factors associated with favorable outcomes. Fifty-two patients with traumatic brachial plexus injury and a paralytic shoulder were included in the study. All patients were evaluated at a mean of nineteen months (range, twelve to twenty-eight months) postoperatively. Twelve patients had a C5-6 injury, twenty-two had a C5-7 injury, five had a C5-8 injury, and thirteen had a C5-T1 injury. Transfer of the lower portion of the trapezius muscle was performed either in isolation or as part of multiple tendon transfers to improve shoulder function. Additional muscles transferred included the middle and upper portions of the trapezius, levator scapulae, upper portion of the serratus anterior, teres major, latissimus dorsi, and pectoralis major. All patients had a stable shoulder postoperatively. Shoulder external rotation improved substantially in all patients from no external rotation (hand-on-belly position) to a mean of 20° (p = 0.001). Patients who underwent additional transfers had marginal improvement of shoulder flexion, from a mean of 10° preoperatively to 60° postoperatively, and of shoulder abduction, from a mean of 10° to 50° (p = 0.01 for each). Mean pain on a visual analog scale improved from 6 points preoperatively to 2 points postoperatively. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score improved from 59 to 47 points (p = 0.001). The mean Subjective Shoulder Value improved from 5% to 40% (p = 0.001). Greater age, higher body mass index, and more extensive nerve injury were associated with a poorer DASH score in a multivariate analysis (p = 0.003). Tendon transfers about the shoulder can improve shoulder function in patients with brachial plexus injury resulting in a paralytic shoulder. Significant improvement of shoulder external rotation but only marginal improvements of shoulder abduction and flexion can be achieved. The outcome can be expected to be better in patients with less severe nerve injury.

Accelerated rehabilitation compared with a standard protocol after distal radial fractures treated with volar open reduction and internal fixation: a prospective, randomized, controlled study.

PubMed

Brehmer, Jess L; Husband, Jeffrey B

2014-10-01

There are relatively few studies in the literature that specifically evaluate accelerated rehabilitation protocols for distal radial fractures treated with open reduction and internal fixation (ORIF). The purpose of this study was to compare the early postoperative outcomes (at zero to twelve weeks postoperatively) of patients enrolled in an accelerated rehabilitation protocol with those of patients enrolled in a standard rehabilitation protocol following ORIF for a distal radial fracture. We hypothesized that patients with accelerated rehabilitation after volar ORIF for a distal radial fracture would have an earlier return to function compared with patients who followed a standard protocol. From November 2007 to November 2010, eighty-one patients with an unstable distal radial fracture were prospectively randomized to follow either an accelerated or a standard rehabilitation protocol after undergoing ORIF with a volar plate for a distal radial fracture. Both groups began with gentle active range of motion at three to five days postoperatively. At two weeks, the accelerated group initiated wrist/forearm passive range of motion and strengthening exercises, whereas the standard group initiated passive range of motion and strengthening at six weeks postoperatively. Patients were assessed at three to five days, two weeks, three weeks, four weeks, six weeks, eight weeks, twelve weeks, and six months postoperatively. Outcomes included Disabilities of the Arm, Shoulder and Hand (DASH) scores (primary outcome) and measurements of wrist flexion/extension, supination, pronation, grip strength, and palmar pinch. The patients in the accelerated group had better mobility, strength, and DASH scores at the early postoperative time points (zero to eight weeks postoperatively) compared with the patients in the standard rehabilitation group. The difference between the groups was both clinically relevant and statistically significant. Patients who follow an accelerated rehabilitation protocol that emphasizes motion immediately postoperatively and initiates strengthening at two weeks after volar ORIF of a distal radial fracture have an earlier return to function than patients who follow a more standard rehabilitation protocol. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Figure-of-eight bandage versus arm sling for treating middle-third clavicle fractures in adults: study protocol for a randomised controlled trial.

PubMed

Lenza, Mario; Taniguchi, Luiz Fabiano Presente; Ferretti, Mario

2016-05-04

Fracture of the clavicle is common, accounting for 2.6 to 4.0 % of all fractures, with an overall incidence of 36.5 to 64 per 100,000 per year. Around 80 % of clavicle fractures occur in the middle third of the clavicle. Randomised controlled trials comparing treatment interventions have failed to indicate the best therapeutic practices for these fractures. The objective of this study is to evaluate the effects (benefits and harms) of two commonly-used conservative interventions: the figure-of-eight bandage versus the arm sling as treatments of middle-third clavicle fractures. This project has been designed as a single-centre, two-arm randomised controlled trial that will compare two interventions: figure-of-eight bandage versus the arm sling. We propose to recruit 110 adults, aged 18 years or older, with an acute (less than 10 days since injury) middle-third clavicle fracture. The primary outcomes to be evaluated will be function and/or disability measured by the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire. In order to assess the secondary outcomes, the Modified University of California at Los Angeles (modified - UCLA) Shoulder Rating Scale will be used. The occurrence of pain (Visual Analogue Scale for pain (VAS)), treatment failure, adverse events and the ability to return to previous activities will also be recorded and evaluated as secondary outcomes. the primary outcome DASH score and the secondary outcomes - modified UCLA and VAS scores - will be analysed graphically. We will apply generalised mixed models with the intervention groups (two levels), and time-point assessments (seven levels) as fixed effects and patients as a random effect. According to the current literature there is very limited evidence from two small trials regarding the effectiveness of different methods of conservative interventions for treating clavicle fractures. This is the first randomised controlled trial comparing the figure-of-eight bandage versus the arm sling for treating clavicle fractures that follows the CONSORT Statement guidelines. ClinicalTrials.gov NCT02398006 .

Effekt einer ad libitum verzehrten fettreduzierten Kost, reich an Obst, Gemüse und Milchprodukten auf den Blutdruck bei Borderline-Hypertonikern

NASA Astrophysics Data System (ADS)

Möseneder, Jutta M.

2002-01-01

In der randomisierten, multizentrischen DASH-Studie (Dietary Approaches to Stop Hy-pertension), die unter kontrollierten Bedingungen stattfand, führte eine fettreduzierte Mischkost, reich an Obst, Gemüse und Milchprodukten, bei Borderline-Hypertonikern zu einer signifikanten Blutdrucksenkung. Während der Studienphase wurden Körpermasse, Natrium-Aufnahme sowie Alkoholzufuhr aufgrund der bekannten Einflussnahme auf den Blutdruck konstant gehalten. In der eigenen Pilot-Studie sollte untersucht werden, ob das Ergebnis der DASH-Studie (i) mit deutschen Hypertonikern und (ii) unter habituellen Ernährungs- und Lebensbedingungen mit regelmäßig durchgeführter Ernährungsberatung und ad libitum Verzehr anstelle des streng kontrollierten Studienansatzes bestätigt werden kann. Eine Konstanz der Körpermasse, der Natrium-Urinausscheidung (unter diesem Studienansatz valider als die Aufnahme) und des Alkoholkonsums wurde vorausgesetzt. Die Studienpopulation setzte sich aus 53 übergewichtigen Probanden mit einer nicht medikamentös therapierten Borderline-Hypertonie und ohne Stoffwechselerkrankungen zusammen. Die Studienteilnehmer wurden randomisiert entweder der Idealgruppe mit einer fettarmen Kost reich an Milchprodukten, Obst und Gemüse (ähnlich der DASH-Idealgruppe) oder der Kontrollgruppe mit habitueller Ernährungsweise zugeteilt. Über einen Zeitraum von fünf Wochen wurde den Probanden etwa 50% ihres täglichen Lebensmittelbedarfes entsprechend ihrer Gruppenzugehörigkeit kostenfrei zur Verfügung gestellt. Gelegenheitsblutdruckmessungen und 24h-Blutdruckmessungen, Ernährungs- und Aktivitätsprotokolle, Blut- und Urinproben sowie anthropometrische Messungen wurden vor, während und fünf Wochen nach der Interventionsphase durchgeführt. Die Ergebnisse zeigen, dass in der Idealgruppe keine signifikante Blutdrucksenkung beobachtet werden konnte. Dies lässt sich durch die Tatsache erklären, dass die Lebens-mittel- und Nährstoffaufnahme der deutschen Kontrollgruppe eher der amerikanischen Idealgruppe entsprach. In der Pilot-Studie waren die Unterschiede in der Nährstoffzufuhr zwischen den beiden Gruppen viel geringer als in der DASH-Studie; für eine blutdrucksenkende Ernährungsumstellung bestand somit nur ein geringer Spielraum. Eine weitere Erklärung besteht in der unterschiedlichen Zusammensetzung der Studienpopulation. Bei DASH wurden vorwiegend farbige Probanden (40% höhere Hypertonieprävalenz) untersucht. Die Studienergebnisse lassen also den Schluss zu, dass Ernährungs- und Lebensstilgewohnheiten sowie der genetische Hintergrund der entsprechenden Bevölkerungsgruppe bei der Formulierung von nährstoff- oder lebensmittelbezogenen Empfehlungen zur Senkung des Bluthochdruckes Berücksichtigung finden müssen. The Dietary Approaches to Stop Hypertension trial (DASH), a randomized well-controlled feeding study conducted at 4 medical centers, demonstrated that a low-fat diet, rich in fruits, vegetables and dairy products is able to lower blood pressure of borderline-hypertensive people significantly. Body weight, sodium intake and alcohol consumption were kept constant during the whole study period, due to the known influence on hypertension. Aim of our study project was to investigate whether the results of the DASH study can be confirmed by (i) using a German hypertensive population and (ii) replacing the well-controlled feeding design by allowing ad libitum intake according to dietary ad-vice. The participants were asked to keep their body weight, sodium urine excretion (un-der this study design more valid than sodium intake) and their alcohol consumption con-stant. Our pilot study population consisted of 53 mainly overweight participants with borderline hypertension and without medication or any metabolic disorders. They were randomly assigned to either an ideal diet low in fat and rich in dairy products, fruits and vegetables (similar to the DASH I-group) or a habitual diet as control (C-group). During five weeks the subjects were provided 50 % of their daily intake for free according to their dietary pattern. Single and 24h-blood pressure measurements, dietary weighed and physical activity records, blood and urine samples and anthropometric measurements were collected before, during and five weeks after the intervention period. The study results indicated that no significantly reduction of blood pressure could be observed for both methods in the I-group of our trial. This is due to the fact that the baseline intake of foods and nutrients of the German subjects was nearly corresponding to the intake targeted for the DASH I-group. Therefore, it was impossible to increase the intake of these nutrients in our I-group by the same percentage as in the DASH study. Another explanation may be the different consistency of the study population. About 60% of the DASH study population were African Americans with a known higher prevalence of hy-pertension (about 40%) than Caucasians. The conclusion is that even convincing results of a controlled trial cannot be simply transferred into dietary advice for the general public. For addressing food-based dietary guidelines to reduce the risk of hypertension it is necessary to consider the genetic background as well as the dietary and the lifestyle situation of the target population carefully.

The National Football League Combine: performance differences between drafted and nondrafted players entering the 2004 and 2005 drafts.

PubMed

Sierer, S Patrick; Battaglini, Claudio L; Mihalik, Jason P; Shields, Edgar W; Tomasini, Nathan T

2008-01-01

The purpose of this study was to examine performance differences between drafted and nondrafted athletes (N = 321) during the 2004 and 2005 National Football League (NFL) Combines. We categorized players into one of 3 groups: Skill, Big skill, and Linemen. Skill players (SP) consisted of wide receivers, cornerbacks, free safeties, strong safeties, and running backs. Big skill players (BSP) included fullbacks, linebackers, tight ends, and defensive ends. Linemen (LM) consisted of centers, offensive guards, offensive tackles, and defensive tackles. We analyzed player height and mass, as well as performance on the following combine drills: 40-yard dash, 225-lb bench press test, vertical jump, broad jump, pro-agility shuttle, and the 3-cone drill. Student t-tests compared performance on each of these measures between drafted and nondrafted players. Statistical significance was found between drafted and nondrafted SP for the 40-yard dash (P < 0.001), vertical jump (P = 0.003), pro-agility shuttle (P < 0.001), and 3-cone drill (P < 0.001). Drafted and nondrafted BSP performed differently on the 40-yard dash (P = 0.002) and 3-cone drill (P = 0.005). Finally, drafted LM performed significantly better than nondrafted LM on the 40-yard dash (P = 0.016), 225-lb bench press (P = 0.003), and 3-cone drill (P = 0.005). Certified strength and conditioning specialists will be able to utilize the significant findings to help better prepare athletes as they ready themselves for the NFL Combine.

Can HN[double bond, length as m-dash]NH, FN[double bond, length as m-dash]NH, or HN[double bond, length as m-dash]CHOH bridge the σ-hole and the lone pair at P in binary complexes with H2XP, for X = F, Cl, NC, OH, CN, CCH, CH3, and H?

PubMed

Del Bene, Janet E; Alkorta, Ibon; Elguero, José

2015-11-11

Ab initio MP2/aug'-cc-pVTZ calculations have been carried out to investigate the properties of complexes formed between H2XP, for X = F, Cl, NC, OH, CN, CCH, CH3, and H, and the possible bridging molecules HN[double bond, length as m-dash]NH, FN[double bond, length as m-dash]NH, and HN[double bond, length as m-dash]CHOH. H2XP:HNNH and H2XP:FNNH complexes are stabilized by PN pnicogen bonds, except for H2(CH3)P:FNNH and H3P:FNNH which are stabilized by N-HP hydrogen bonds. H2XP:HNCHOH complexes are stabilized by PN pnicogen bonds and nonlinear O-HP hydrogen bonds. For a fixed H2XP molecule, binding energies decrease in the order HNCHOH > HNNH > FNNH, except for the binding energies of H2(CH3)P and H3P with HNNH and FNNH. Binding energies of complexes with HNCHOH and HNNH increase as the P-N1 distance decreases, but binding energies of complexes with FNNH show little dependence on this distance. The large binding energies of H2XP:HNCHOH complexes arise from a cooperative effect involving electron-pair acceptance by P to form a pnicogen bond, and electron-pair donation by P to form a hydrogen bond. The dominant charge-transfer interaction in these complexes involves electron-pair donation by N across the pnicogen bond, except for complexes in which X is one of the more electropositive substituents, CCH, CH3, and H. For these, lone-pair donation by P across the hydrogen bond dominates. AIM and NBO data for these complexes are consistent with their bonding characteristics, showing molecular graphs with bond critical points and charge-transfer interactions associated with hydrogen and pnicogen bonds. EOM-CCSD spin-spin coupling constants (1p)J(P-N) across the pnicogen bond for each series of complexes correlate with the P-N distance. In contrast, (2h)J(O-P) values for complexes H2XP:HNCHOH do not correlate with the O-P distance, a consequence of the nonlinearity of these hydrogen bonds.

Terahertz-bandwidth coherence measurements of a quantum dash laser in passive and active mode-locking operation.

PubMed

Martin, Eamonn; Watts, Regan; Bramerie, Laurent; Shen, Alexandre; Gariah, Harry; Blache, Fabrice; Lelarge, Francois; Barry, Liam

2012-12-01

This research carries out coherence measurements of a 42.7 GHz quantum dash (QDash) semiconductor laser when passively, electrically, and optically mode-locked. Coherence of the spectral lines from the mode-locked laser is determined by examining the radio frequency beat-tone linewidth as the mode spacing is increased up to 1.1 THz. Electric-field measurements of the QDash laser are also presented, from which a comparison between experimental results and accepted theory for coherence in passively mode-locked lasers has been performed.

Acceptability of the Current and Proposed Items in the Meal, Ready-to-Eat

DTIC Science & Technology

2002-05-01

Cayenne pepper and Mrs. Dash), and dessert items (Peanut Butter M&Ms, Crispy M&Ms, Pumpkin Pound cake, Almond Poppy Pound cake, and a Chocolate Mint...Almost Every Entree 16.34 Every Entree 22.18 Because the Cayenne pepper and Mrs. Dash are not included in the current MREs, the soldiers were asked... pepper . Half(54.47%) wish to have Hot sauce in ’·every/almost every’· entree (Table 3). Forty percent (43.29%) would like to have Cayenne pepper "never

Clinical Results of Platelet-Rich Plasma for Partial Thickness Rotator Cuff Tears: A Case Series.

PubMed

Zafarani, Zohreh; Mirzaee, Fateme; Guity, Mohamadreza; Aslani, Hamidreza

2017-09-01

Partial thickness rotator cuff tears (PTRCTs) are a common pathology among shoulder disorders in people over 50 years. Treatment of PTRCTs remains controversial. Most studies on the treatment of PTRCTs have explained surgical techniques or outcomes; few studies have centralized on the conservative and new management of PTRCTs, like treatment with Platelet-rich plasma (PRP). These case series study have been conducted on Platelet-rich plasma (PRP) injection, as a concentrated source of cytokines that can stimulate healing of soft tissue. PRP injection showed positive effect on improving PTRCTs complains. This method improved pain, function, DASH score and shoulder joint range motion in. Because of PRP products are safe and easy to prepare and apply, and also according to improving patient's condition, this method can be used to treat PTRCTs.

Outcome of distal end clavicle fractures treated with locking plates.

PubMed

Vaishya, Raju; Vijay, Vipul; Khanna, Vikram

2017-02-01

Fractures of the lateral end of the clavicle are relatively uncommon. These fractures are unstable due to the various deforming forces which act on the fragments as well as the small distal fracture fragment. At most times the deforming forces are not taken into consideration, and the fracture is not fixed securely. In this study, we assessed a fixation technique using the precontoured locking plates to find out whether it provided a stable fixation with good functional outcome. Totally, 32 patients with lateral end clavicle fracture (Neer's Type II) were included in the study. After the informed consent and preoperative investigations were obtained, open reduction and internal fixation was done using a 3.5 mm precontoured superior locking plate with lateral extension under general anesthesia. Postoperative X-rays were done on day 1 and every 6 weeks after operation, until radiological union was achieved. The postoperative pain was assessed using Visual Analogue Scale (VAS) on postoperative days 1, 2 and 10. Postoperatively arm pouch sling was given for 2 weeks followed by active mobilization. Patients were asked to do their daily routine work and avoid lifting heavy weights. The functional outcome was assessed at the end of 2nd and 6th months with the help of Disabilities of the Arm, Shoulder and Hand (DASH) scoring. There were no intraoperative complications in the procedure. The mean VAS score on postoperative day 1 was found to be 5 which decreased to 3 on day 2 and 0 on day 10. The mean DASH score was calculated as 11.63 at the end of postoperative month 2 and then 4.6 at the end of month 6. There was one case of malunion in whom the overhead abduction was restricted but was not painful and was managed conservatively. The precontoured locking plates with lateral extension may be a good method to fix the fractures of the lateral end clavicle, which provide a stable fixation with good functional outcome with very few instances of stiffness and decreased range of motion of the shoulder with the hook plates and failure of fixation in screw and K-wire fixations. It may well be the answer to the fixation questions of the lateral clavicle fractures, although larger comparative studies between the surgical treatment methods are required to confirm the same. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

Effects of sodium intake and diet on racial differences in urinary potassium excretion: results from the Dietary Approaches to Stop Hypertension (DASH)-Sodium trial.

PubMed

Turban, Sharon; Thompson, Carol B; Parekh, Rulan S; Appel, Lawrence J

2013-01-01

We previously showed that African Americans excreted less urinary potassium than whites, even while consuming similar diets in the Dietary Approaches to Stop Hypertension (DASH) trial. We hypothesized that a low-sodium diet may eliminate these differences. Data from the DASH-Sodium randomized controlled feeding trial were analyzed. 412 adults with prehypertension or stage 1 hypertension. Random assignment to either a typical American "control" diet (1.7 g [43 mEq] potassium/2,100 kcal/d) or the DASH diet (4.1 g [105 mEq] potassium/2,100 kcal/d). Within each diet, participants received 3 levels of sodium intake in random order for 30 days. 24-hour urine samples were analyzed at the end of each period. The primary outcome was urinary potassium excretion. On the DASH diet, African Americans consistently excreted significantly less urinary potassium (mean 24-hour urinary potassium excretion, 2,594 ± 961 mg [66 ± 25 mEq]) than whites (3,412 ± 1,016 mg [87 ± 26 mEq]) at the highest sodium level; adjusted (P < 0.001); this difference was not altered by sodium level (P = 0.6 comparing white to African American difference in urinary potassium excretion on high- vs low-sodium diet). In contrast, there was a smaller but significant white-African American difference in mean daily urinary potassium excretion in participants fed the control/high-sodium diet that was not present in the control/low-sodium diet (adjusted differences of 281 mg [7 mEq]/d vs 20 mg [0.5 mEq]/d, respectively; P = 0.007). Significant interactions were found between race and diet (P < 0.001) and between race and sodium (P = 0.02). Single rather than multiple urine collections were available at each time. Lack of stool potassium and sweat potassium values. Racial differences in urinary potassium excretion depend on sodium intake and diet. Our results may help explain the previously documented large variability in urinary potassium excretion. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

Comparative effects of different dietary approaches on blood pressure in hypertensive and pre-hypertensive patients: A systematic review and network meta-analysis.

PubMed

Schwingshackl, Lukas; Chaimani, Anna; Schwedhelm, Carolina; Toledo, Estefania; Pünsch, Marina; Hoffmann, Georg; Boeing, Heiner

2018-05-02

Pairwise meta-analyses have shown beneficial effects of individual dietary approaches on blood pressure but their comparative effects have not been established. Therefore we performed a systematic review of different dietary intervention trials and estimated the aggregate blood pressure effects through network meta-analysis including hypertensive and pre-hypertensive patients. PubMed, Cochrane CENTRAL, and Google Scholar were searched until June 2017. The inclusion criteria were defined as follows: i) Randomized trial with a dietary approach; ii) hypertensive and pre-hypertensive adult patients; and iii) minimum intervention period of 12 weeks. In order to determine the pooled effect of each intervention relative to each of the other intervention for both diastolic and systolic blood pressure (SBP and DBP), random effects network meta-analysis was performed. A total of 67 trials comparing 13 dietary approaches (DASH, low-fat, moderate-carbohydrate, high-protein, low-carbohydrate, Mediterranean, Palaeolithic, vegetarian, low-GI/GL, low-sodium, Nordic, Tibetan, and control) enrolling 17,230 participants were included. In the network meta-analysis, the DASH, Mediterranean, low-carbohydrate, Palaeolithic, high-protein, low-glycaemic index, low-sodium, and low-fat dietary approaches were significantly more effective in reducing SBP (-8.73 to -2.32 mmHg) and DBP (-4.85 to -1.27 mmHg) compared to a control diet. According to the SUCRAs, the DASH diet was ranked the most effective dietary approach in reducing SBP (90%) and DBP (91%), followed by the Palaeolithic, and the low-carbohydrate diet (ranked 3rd for SBP) or the Mediterranean diet (ranked 3rd for DBP). For most comparisons, the credibility of evidence was rated very low to moderate, with the exception for the DASH vs. the low-fat dietary approach for which the quality of evidence was rated high. The present network meta-analysis suggests that the DASH dietary approach might be the most effective dietary measure to reduce blood pressure among hypertensive and pre-hypertensive patients based on high quality evidence.

Predictors of performance in an ophthalmology residency program.

PubMed

Alfawaz, Abdullah M; Al-Dahmash, Saad A

2016-06-01

To assess the value of current selection criteria and additional factors as predictors of performance in an ophthalmology residency training program. A retrospective study. Data were collected from the files of 166 residents who were collectively trained in an ophthalmology residency program from 2000 to 2013. The program's selection criteria included medical school grade point average (GPA), Saudi licensing examination (SLE) score, multiple-choice question ophthalmology selection (MCQ) examination score, and interview mark. Indicators of performance included average scores in the promotion examination for 4 years of training (average R), King Saud University fellowship examination (KSU) score, and Saudi Board in Ophthalmology examination (SBO) score. An average of KSU and SBO scores was also used as a performance indicator. Times of program completion and average performance score across all years in the residency program were used as second-level indicators of performance. There were strong correlations between the MCQ examination score and each training performance indicator (average R, KSU score, SBO score, and average of KSU and SBO scores; p = 0.002, 0.008, 0.05, and 0.002, respectively). The interview mark correlated well with average R (p = 0.001) but not with other indicators. The MCQ examination score and the interview mark were the only predictors of second-level indicators of performance (p = 0.009 and 0.029, respectively). The MCQ examination score and interview mark were the 2 best predictors of performance as an ophthalmology resident. GPA and SLE score were poor predictors of performance. Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.

Reaction of the thermo-labile triazenide Na[tBu3SiNNNSiMe3] with CO2: formation of the imido carbonate (tBu3SiO)(Me3SiO)C[double bond, length as m-dash]N-SitBu3 and carbamine acid (tBu3SiO)CONH2.

PubMed

Lerner, H-W; Bolte, M; Wagner, M

2017-07-11

The thermo-labile triazenide Na[tBu 3 SiNNNSiMe 3 ] was prepared by the reaction of Me 3 SiN 3 with Na(thf) 2 [SitBu 3 ] in pentane at -78 °C. Treatment of Na[tBu 3 SiNNNSiMe 3 ] with an excess of carbon dioxide in pentane at -78 °C yielded the imido carbonate (tBu 3 SiO)(Me 3 SiO)C[double bond, length as m-dash]N-SitBu 3 and the carbamine acid (tBu 3 SiO)CONH 2 along with other products. From the reaction solution we could isolate the imido carbonate (tBu 3 SiO)(Me 3 SiO)C[double bond, length as m-dash]N-SitBu 3 and carbamine acid (tBu 3 SiO)CONH 2 . At first single crystals of the carbamine acid (tBu 3 SiO)CONH 2 (triclinic, space group P1[combining macron]) were grown from this solution at room temperature. A second crop of crystals were obtained by concentrating the solution. The second charge consisted of the imido carbonate (tBu 3 SiO)(Me 3 SiO)C[double bond, length as m-dash]N-SitBu 3 (monoclinic, space group P2 1 /n).

Acceptability and feasibility of the 'DASH for Asthma' intervention in a randomized controlled trial pilot study.

PubMed

Blonstein, Andrea C; Lv, Nan; Camargo, Carlos A; Wilson, Sandra R; Buist, A Sonia; Rosas, Lisa G; Strub, Peg; Ma, Jun

2016-08-01

'DASH for Asthma' (n 90) was a 6-month randomized controlled trial that demonstrated potential benefits of a DASH (Dietary Approaches to Stop Hypertension) behavioural intervention for improving diet quality and asthma control by comparing intervention to usual care in adults with uncontrolled asthma. The present study examined acceptability and feasibility of the intervention from the perspective of intervention participants and lifestyle coaches. Grounded in Social Cognitive Theory, the 3-month intensive stage, including three individual and eight group sessions, focused on diet modifications and behavioural self-regulation. The 3-month maintenance stage contained telephone consultations. Participants and lifestyle coaches completed surveys including 5-point Likert scales and open-ended questions. We analysed data using descriptive and inductive content analyses. Forty-six intervention participants (survey response rate was 65-72 %) and two lifestyle coaches. Participants and lifestyle coaches were highly satisfied (all mean ratings >4) with individual and group sessions. Participants identified mastery of knowledge and skills (awareness, goal setting, self-monitoring, problem solving), social learning (class members sharing experiences and ideas) and good coaching skills (reflective listening, empathy, motivational counselling) as important contributors to self-efficacy and programme satisfaction. Participants also valued personalized feedback received in individual sessions. Lifestyle coaches viewed participant engagement as a facilitator to effective sessions. Finally, participants and lifestyle coaches identified food tasting as beneficial for observational learning and facilitation of participant engagement. High class attendance and self-monitoring rate also reflected the high engagement among participants. The DASH behavioural intervention was feasible and highly acceptable to participants with uncontrolled asthma and lifestyle coaches.

Insertion of terminal alkyne into Pt-N bond of the square planar [PtI2(Me2phen)] complex.

PubMed

Benedetti, Michele; De Castro, Federica; Lamacchia, Vincenza; Pacifico, Concetta; Natile, Giovanni; Fanizzi, Francesco P

2017-11-21

The reactivity of [PtX 2 (Me 2 phen)] complexes (X = Cl, Br, I; Me 2 phen = 2,9-dimethyl-1,10-phenanthroline) with terminal alkynes has been investigated. Although the dichlorido species [PtCl 2 (Me 2 phen)] exhibits negligible reactivity, the bromido and iodido derivatives lead in short time to the formation of five-coordinate Pt(ii) complexes of the type [PtX 2 (Me 2 phen)(η 2 -CH[triple bond, length as m-dash]CR)] (X = Br, I; R = Ph, n-Bu), in equilibrium with the starting reagents. Similar to analogous complexes with simple acetylene, the five coordinate species can also undergo dissociation of an halido ligand and formation of the transient square-planar cationic species [PtX(Me 2 phen)(η 2 -CH[triple bond, length as m-dash]CR)] + . This latter can further evolve to give an unusual, sparingly soluble square planar product where the former terminal alkyne is converted into a :C[double bond, length as m-dash]C(H)(R) moiety with the α-carbon bridging the Pt(ii) core with one of the two N-donors of coordinated Me 2 phen. The final product [PtX 2 {κ 2 -N,C-(Z)-N[combining low line]1-N10-C[combining low line][double bond, length as m-dash]C(H)(R)}] (N1-N10 = 2,9-dimethyl-1,10-phenanthroline; X = Br, I) contains a Pt-N-C-C-N-C six-membered chelate ring in a square planar Pt(ii) coordination environment.

Secure distributed genome analysis for GWAS and sequence comparison computation.

PubMed

Zhang, Yihua; Blanton, Marina; Almashaqbeh, Ghada

2015-01-01

The rapid increase in the availability and volume of genomic data makes significant advances in biomedical research possible, but sharing of genomic data poses challenges due to the highly sensitive nature of such data. To address the challenges, a competition for secure distributed processing of genomic data was organized by the iDASH research center. In this work we propose techniques for securing computation with real-life genomic data for minor allele frequency and chi-squared statistics computation, as well as distance computation between two genomic sequences, as specified by the iDASH competition tasks. We put forward novel optimizations, including a generalization of a version of mergesort, which might be of independent interest. We provide implementation results of our techniques based on secret sharing that demonstrate practicality of the suggested protocols and also report on performance improvements due to our optimization techniques. This work describes our techniques, findings, and experimental results developed and obtained as part of iDASH 2015 research competition to secure real-life genomic computations and shows feasibility of securely computing with genomic data in practice.

Secure distributed genome analysis for GWAS and sequence comparison computation

PubMed Central

2015-01-01

Background The rapid increase in the availability and volume of genomic data makes significant advances in biomedical research possible, but sharing of genomic data poses challenges due to the highly sensitive nature of such data. To address the challenges, a competition for secure distributed processing of genomic data was organized by the iDASH research center. Methods In this work we propose techniques for securing computation with real-life genomic data for minor allele frequency and chi-squared statistics computation, as well as distance computation between two genomic sequences, as specified by the iDASH competition tasks. We put forward novel optimizations, including a generalization of a version of mergesort, which might be of independent interest. Results We provide implementation results of our techniques based on secret sharing that demonstrate practicality of the suggested protocols and also report on performance improvements due to our optimization techniques. Conclusions This work describes our techniques, findings, and experimental results developed and obtained as part of iDASH 2015 research competition to secure real-life genomic computations and shows feasibility of securely computing with genomic data in practice. PMID:26733307

DASH, the data and specimen hub of the National Institute of Child Health and Human Development

PubMed Central

Hazra, Rohan; Tenney, Susan; Shlionskaya, Alexandra; Samavedam, Rajni; Baxter, Kristin; Ilekis, John; Weck, Jennifer; Willinger, Marian; Grave, Gilman; Tsilou, Katerina; Songco, David

2018-01-01

The benefits of data sharing are well-established and an increasing number of policies require that data be shared upon publication of the main study findings. As data sharing becomes the new norm, there is a heightened need for additional resources to drive efficient data reuse. This article describes the development and implementation of the Data and Specimen Hub (DASH) by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) to promote data sharing from NICHD-funded studies and enable researchers to comply with NIH data sharing policies. DASH’s flexible architecture is designed to archive diverse data types and formats from NICHD’s broad scientific portfolio in a manner that promotes FAIR data sharing principles. Performance of DASH over two years since launch is promising: the number of available studies and data requests are growing; three manuscripts have been published from data reanalysis, all within two years of access. Critical success factors included NICHD leadership commitment, stakeholder engagement and close coordination between the governance body and technical team. PMID:29557977

A 12-week weight reduction intervention for overweight individuals taking antipsychotic medications.

PubMed

Green, Carla A; Janoff, Shannon L; Yarborough, Bobbi Jo H; Yarborough, Micah T

2014-11-01

People taking antipsychotic medications are at increased risk for obesity, diabetes, and early mortality. Few weight loss interventions have targeted this population. Thirty-six individuals were randomized to an evidence-based 12-week weight loss intervention (PREMIER with DASH diet, n = 18) or to usual care (n = 18) in this feasibility trial. Average attendance was 8.6 of 12 sessions. Intent-to-treat analyses of covariance, adjusted for baseline weight, showed significant changes in weight: Mean weight in intervention participants declined from 213.3 to 206.6 pounds, while control participants' weight was unchanged. It is possible to recruit, assess, intervene with, and retain participants taking antipsychotic medications in a dietary and exercise lifestyle change trial. Participants reported high levels of satisfaction with the intervention.

Cross-cultural adaptation and validation of the Italian version of the Western Ontario Osteoarthritis of the Shoulder index (WOOS).

PubMed

Corona, Katia; Cerciello, Simone; Morris, Brent Joseph; Visonà, Enrico; Merolla, Giovanni; Porcellini, Giuseppe

2016-12-01

The Western Ontario Osteoarthritis of the Shoulder index (WOOS) has been introduced as a disease-specific quality of life measurement in patients with glenohumeral arthritis. The aim of the present study was to perform a cross-cultural adaptation of the English version of the WOOS to Italian and to assess its validity, reliability and responsiveness in patients with glenohumeral joint osteoarthritis treated conservatively. The adaptation process was carried out following the simplified Guillemin criteria. The English version was translated into Italian by two bilingual orthopaedic surgeons and then translated back into English by two different bilingual orthopaedic surgeons. The original version was compared with the back-translation. The questionnaire was prospectively administered to 30 patients with glenohumeral osteoarthritis at baseline and again after 5 days for retest reliability. After 6 months of conservative treatment, the responsiveness of the questionnaire was assessed in a subsample of 20 patients. The level of statistical significance was set at 0.05. The interclass correlation coefficient between test and retest of the WOOS was 0.99 (P < 0.001). Pearson's correlation coefficient between the WOOS and disability of the arm, shoulder and hand (DASH) preoperatively was 0.73 (P < 0.01) and the correlation between the changes of score for the WOOS and DASH was 0.75 (P < 0.01). There were no floor or ceiling effects. Responsiveness, calculated by standardized response mean, was 1.1 and effect size was 1.3. The Italian version of the WOOS questionnaire has shown to be equivalent to its English version and demonstrated good validity, reliability and responsiveness to conservative treatment of glenohumeral osteoarthritis. Level II.

A Retrospective Evaluation of Anatomical Reinsertion of the Distal Biceps Brachii Tendon Using an ACL TightRope® RT with a Titanium Cortical Button and Ultra High Molecular Weight Polyethylene Suture: A Preliminary Report.

PubMed

Witkowski, Jarosław; Kentel, Maciej; Królikowska, Aleksandra; Reichert, Paweł

2016-01-01

Various surgical techniques for treating distal biceps brachii tendon injury have been described, and to date there is no consensus regarding the preferred fixation method for the anatomic reinsertion of the ruptured tendon. The aim of the study was to clinically and functionally evaluate the upper limb after surgical anatomic reinsertion of the distal biceps brachii tendon using an ACL TightRope® RT with a titanium cortical button and ultra high molecular weight polyethylene (UHMWPE) suture, and to assess postoperative complications. The sample comprised 3 patients. Clinical examination (history, measurements of the active range of forearm motion, arm circumference, the maximum isometric forearm supination and flexion muscle torque), pain evaluation (on a visual analogue scale [VAS]) and functional assessment (the Mayo Elbow Performance Index [MEPI] and Quick Disabilities of the Arm, Shoulder and Hand [DASH]) were carried out. Complications were documented. The results of the range of motion measurements, arm circumferences and normalized isometric torque values of the muscle groups being studied were comparable in the involved and uninvolved limbs. The MEPI (x = 95.00 ± 10.42) and Quick DASH (x = 8.66 ± 18.04) scores revealed very good results. The VAS results were close to no pain (x = 3.33 ± 5.77 mm). No complications were noted. The preliminary comprehensive clinical and functional assessment of the upper limb justify the clinical use of the ACL TightRope® RT with a titanium cortical button and UHMWPE suture in surgical anatomic reinsertion of the distal biceps brachii tendon. The early results with a small sample were encouraging, but studies with a larger number of cases and longer follow-up are needed.

Transverse pinning versus intramedullary pinning in fifth metacarpal's neck fractures: A randomized controlled study with patient-reported outcome.

PubMed

Galal, Sherif; Safwat, Wael

2017-01-01

The 5th metacarpal fractures accounts for 38% of all hand fractures given that the neck is the weakest point in metacarpals, so neck fracture is the most common metacarpal fracture. Surgical fixation is also advocated for such fractures to prevent mal-rotation of the little finger which will lead to fingers overlap in a clenched fist. Various methods are available for fixation of such fractures, like intramedullary & transverse pinning. There are very few reports in the literature comparing both techniques. Authors wanted to compare outcomes and complications of transverse pinning versus intramedullary pinning in fifth metacarpal's neck fractures. A single-center, parallel group, prospective, randomized study was conducted at an academic Level 1 Trauma Center from October 2014 to December 2016. A total of 80 patients with 5th metacarpal's neck fractures were randomized to pinning using either transverse pinning (group A) or intramedullary pinning (group B). Patients were assessed clinically on range of motion, patient-reported outcome using the Quick-DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire & radiographically. Two blinded observers assessed outcomes. At final follow up for each patient (12 months) the statistically significant differences were observed in operative time, the transverse pinning group showed shorter operative time, as well as complication rate as complications were observed only in intramedullary pinning group. No differences were found in range of motion or the Quick -DASH score. Both techniques are equally safe and effective treatment option for 5th metacarpal's neck fractures. The only difference was shorter operative time & less incidence of complications in transverse pinning group. Level II, Therapeutic study.

[Surgical treatment of midshaft clavicular fractures using intramedullary nail].

PubMed

Vlček, M; Niedoba, M; Jakubička, J; Pech, J; Kalvach, J

2018-01-01

The aim of our study was to assess treatment outcomes in fractures of the middle part of the clavicle using an intramedullary nail. We have evaluated a total of 58 patients with a clavicle bone fracture stabilized by the Hofer Clavicula Pin implant (HCP, Hofer GmbH & Co KG, Fürstenfeld, Germany). A static implant was used in 43 cases, and a dynamic implant was used in the remaining 15. The mean age of patients was 39.1 years (range 1871, SD 4.4), the male-to-female ratio being 43:15. The right collarbone was broken in 26 patients, the left one in 32. The average time between accident and surgery was 10.2 days (range 2-19, SD 4.4). The set included 24 two-, 14 three- and 20 four-fragment fractures of the clavicle midshaft. Open reduction was used in all the cases. The implant was introduced by the indirect method: first, insertion of the pin from the fracture antegrade into the lateral fragment took place, then it was inserted retrogradely into the medial fragment. The average patient follow-up was 7.1 months (range 623, SD 5.5). X-ray signs of healing were evident in all cases, with healing occurring at 8.4 weeks on average (range 620, SD 4.1). In one case (1.7%), however, healing did not occur - refracture was diagnosed 18 days following pin extraction with no clear mechanism of injury; two more refractures were caused by a new accident. The apex of the pin was broken in four cases (6.9%). In two cases (3.4%), angulation of the pin occurred; however, full fracture healing was satisfactorily achieved. Pin prominence was observed in a total of 23 cases (39.7%), requiring premature extraction of the implant due to perforation or irritation of skin and pain in 13 (22.4%) cases. 10 cases (17.2%) of prominence were asymptomatic. Six cases with skin perforation by the implant developed clinical signs of infection, wound healing was always achieved after extraction of the pin and application of antibiotics. A very good functional finding in the shoulder joint was observed in 57 patients (98.2%). The DASH score reached an average of 8.1 points (range 0.8-30.8, SD 4.4). Constant score was 93.1 (range 42.8-98.1, SD 3.2). Intramedullary stabilization of two-, three- and four-fragment fractures of the middle part of the clavicle using the Hofer Clavicula Pin provides very good stability during healing and leads to good healing of fractures. The complications of the method are soft tissue irritation or even skin perforation in the region of the lateral end of the implant. Preventive insertion of the pin closer to the bone may prevent such complications, but also result in difficult pin extraction.Key words: fractures - clavicle - osteosynthesis - intramedullary complications.

Gain and refractive index dynamics in p-doped InAs quantum dash semiconductor optical amplifiers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Komolibus, Katarzyna; Tyndall National Institute, University College Cork, Cork T12 R5CP; Piwonski, Tomasz, E-mail: tomasz.piwonski@tyndall.ie

The ultrafast carrier dynamics in a p-doped dash-in-a-well structure at 1.5 μm is experimentally investigated. An analysis of the timescales related to carrier relaxation and escape processes as well as the “dynamical” linewidth enhancement factor is presented and compared with results obtained from similar un-doped materials. Intentional p-doping of the active region results in an enhancement of the intermediate timescale of the gain dynamics associated with phonon-assisted electron capture and a reduction of the α-factor due to increased differential gain.

Sonar Based Navigation of an Autonomous Underwater Vehicle

DTIC Science & Technology

1994-06-01

3.1.4 Obstacles that are not on the map are marked, known initial position. 35 Eommd Trejecay of AUV 25 Elied -Solid ine Actual :Dashed line 20, 15 I...actual trajectory. Efifets of Camn*= in do Pai~on of AUV. 20 15- 5- 0 S 10 15 20 25 30 35 Figure 3.16 The effects of currents in the trajectory of the...vehicle. 38 E~med T~MjMMa~ ofAUV 20Eadalmd 3affid one Actual :Dashed hMe 15- 0- 0 5 10 15 20 25 30 35 X (irn faet) Figure 3.17 Position estimation

Comparison of the efficacy of lidocaine and betamethasone dipropionate in carpal tunnel syndrome injection.

PubMed

Dernek, Bahar; Aydin, Tugba; Koseoglu, Pinar Kursuz; Kesiktas, Fatma Nur; Yesilyurt, Tugba; Diracoglu, Demirhan; Aksoy, Cihan

2017-01-01

Carpal tunnel syndrome (CTS) is a commonly seen peripheral nerve mononeuropathy. Corticosteroid injection within the carpal tunnel is among the conservative treatment options. The exact mechanism of action of steroids is not fully clear; decreased inflammation surrounding nerves or tendons is thought to be the main effect. Lidocaine has been shown to have anti-inflammatory effects on certain cells (monocytes, macrophages, neutrophils etc.). The aim of this study is to evaulate the efficacy of lidocaine treatment as a alternative to corticosteroid treatment in carpal tunnel syndrome. A total of 67 carpal tunnel syndrome patients who were diagnosed with physical examination and EMG were evaluated. Twenty-nine patients received a mixture of normal saline solution and lidocaine (0.5 cc of normal saline solution and 0.5 cc of lidocaine) while 38 patients were administered betamethasone dipropionate (1 cc). Quick DASH (Disabilities of the Arm, Shoulder and Hand) and Visual Analog Scale (VAS) scores were noted in 1st, 3rd and 6th month follow-ups. There were no significant difference between saline solution + Lidocaine group and betamethasone dipropionate groups; initial, 1st, 3rd and 6th month VAS scores and QDASH scores (p > 0.05). Considering the potential side effects of corticosteroid, lidocaine injection is a good alternative treatment of carpal tunnel syndrome instead of corticosteroids.

Abductor Digiti Minimi Flap for Vascularized Coverage in the Surgical Management of Complex Regional Pain Syndrome Following Carpal Tunnel Release.

PubMed

Cheung, Kevin; Klausmeyer, Melissa A; Jupiter, Jesse B

2017-11-01

The development of Complex Regional Pain Syndrome (CRPS) represents a potentially devastating complication following carpal tunnel release. In the presence of a suspected incomplete release of the transverse carpal ligament or direct injury to the median nerve, neurolysis as well as nerve coverage to prevent recurrent scar has been shown to be effective. Retrospective chart review and telephone interview was conducted for patients who underwent abductor digiti minimi flap coverage and neurolysis of the median nerve for CRPS following carpal tunnel release. Fourteen wrists in 12 patients were reviewed. Mean patient age was 64 years (range, 49-83 years), and the mean follow-up was 44 months. Carpal tunnel outcome instrument scores were 47.4 ± 6.8 preoperatively and 27.1 ± 10.6 at follow-up ( P < .001). Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores at follow-up were 29.4 ± 26. No significant postoperative complications were identified. The abductor digiti minimi flap is a reliable option with minimal donor site morbidity. It provides predictable coverage when treating CRPS following carpal tunnel syndrome.

A new surgical technique for the treatment of scaphotrapezial arthritis associated with trapeziometacarpal arthritis: the narrow pseudoarthrosis.

PubMed

Rubino, M; Cavagnaro, L; Sansone, V

2016-09-01

We describe a technique for treating Eaton stage IV osteoarthritis of the first ray, which is a development of our previously published technique for treating trapeziometacarpal arthritis. This simple technique is based on a limited resection arthroplasty of the first trapeziometacarpal and the scaphotrapezial joints, with the aim of inducing the formation of a narrow pseudoarthrosis at both sites. A total of 26 consecutive patients were treated for Eaton stage IV arthritis at a mean follow-up of 4.7 years (range 3.2-6.6). There were statistically significant improvements in all clinical parameters: mean appositional and oppositional pinch strength, mean DASH score (65 points pre-operatively to 8.7 points at final follow-up), and in mean visual analogue scale score (8.6 to 0.2 points). Although a larger cohort and a longer follow-up will be necessary to evaluate this new technique fully, these results encourage us to believe that the limited excision arthroplasty of the trapeziometacarpal and scaphotrapezial joints is a viable alternative to the existing surgical treatments for stage IV thumb arthritis. 4. © The Author(s) 2015.

Predicting and adapting to the agricultural impacts of large-scale drought (Invited)

NASA Astrophysics Data System (ADS)

Elliott, J. W.; Glotter, M.; Best, N.; Ruane, A. C.; Boote, K.; Hatfield, J.; Jones, J.; Rosenzweig, C.; Smith, L. A.; Foster, I.

2013-12-01

The impact of drought on agriculture is an important socioeconomic consequence of climate extremes. Drought affects millions of people globally each year, causing an average of 6-8 billion of damage annually in the U.S. alone. The 1988 U.S. drought is estimated to have cost 79 billion in 2013 dollars, behind only Hurricane Katrina as the most costly U.S. climate-related disaster in recent decades. The 2012 U.S. drought is expected to cost about 30 billion. Droughts and heat waves accounted for 12% of all billion-dollar disaster events in the U.S. from 1980-2011 but almost one quarter of total monetary damages. To make matters worse, the frequency and severity of large-scale droughts in important agricultural regions is expected to increase as temperatures rise and precipitation patterns shift, leading some researchers to suggest that extended drought will harm more people than any other climate-related impact, specifically in the area of food security. Improved understanding and forecasts of drought would have both immediate and long-term implications for the global economy and food security. We show that mechanistic agricultural models, applied in novel ways, can reproduce historical crop yield anomalies, especially in seasons for which drought is the overriding factor. With more accurate observations and forecasts for temperature and precipitation, the accuracy and lead times of drought impact predictions could be improved further. We provide evidence that changes in agricultural technologies and management have reduced system-level drought sensitivity in US maize production in recent decades, adaptations that could be applied elsewhere. This work suggests a new approach to modeling, monitoring, and forecasting drought impacts on agriculture. Simulated (dashed line), observed (solid line), and observed linear trend (dashed straight green line) of national average maize yield in tonnes per hectare from 1979-2012. The red dot indicates the USDA estimate for 2012 released in November 2012. We use shading to show the central 95% (lighter bands) and 75% (darker bands) of the resampled forecast error distribution. The June-August Palmer Z-Index (by US climate division) for b) 1988 and c) 2012.

GeoDash: Assisting Visual Image Interpretation in Collect Earth Online by Leveraging Big Data on Google Earth Engine

NASA Technical Reports Server (NTRS)

Markert, Kel; Ashmall, William; Johnson, Gary; Saah, David; Mollicone, Danilo; Diaz, Alfonso Sanchez-Paus; Anderson, Eric; Flores, Africa; Griffin, Robert

2017-01-01

Collect Earth Online (CEO) is a free and open online implementation of the FAO Collect Earth system for collaboratively collecting environmental data through the visual interpretation of Earth observation imagery. The primary collection mechanism in CEO is human interpretation of land surface characteristics in imagery served via Web Map Services (WMS). However, interpreters may not have enough contextual information to classify samples by only viewing the imagery served via WMS, be they high resolution or otherwise. To assist in the interpretation and collection processes in CEO, SERVIR, a joint NASA-USAID initiative that brings Earth observations to improve environmental decision making in developing countries, developed the GeoDash system, an embedded and critical component of CEO. GeoDash leverages Google Earth Engine (GEE) by allowing users to set up custom browser-based widgets that pull from GEE's massive public data catalog. These widgets can be quick looks of other satellite imagery, time series graphs of environmental variables, and statistics panels of the same. Users can customize widgets with any of GEE's image collections, such as the historical Landsat collection with data available since the 1970s, select date ranges, image stretch parameters, graph characteristics, and create custom layouts, all on-the-fly to support plot interpretation in CEO. This presentation focuses on the implementation and potential applications, including the back-end links to GEE and the user interface with custom widget building. GeoDash takes large data volumes and condenses them into meaningful, relevant information for interpreters. While designed initially with national and global forest resource assessments in mind, the system will complement disaster assessments, agriculture management, project monitoring and evaluation, and more.

Dash Cam videos on YouTube™ offer insights into factors related to moose-vehicle collisions.

PubMed

Rea, Roy V; Johnson, Chris J; Aitken, Daniel A; Child, Kenneth N; Hesse, Gayle

2018-03-26

To gain a better understanding of the dynamics of moose-vehicle collisions, we analyzed 96 videos of moose-vehicle interactions recorded by vehicle dash-mounted cameras (Dash Cams) that had been posted to the video-sharing website YouTube™. Our objective was to determine the effects of road conditions, season and weather, moose behavior, and driver response to actual collisions compared to near misses when the collision was avoided. We identified 11 variables that were consistently observable in each video and that we hypothesized would help to explain a collision or near miss. The most parsimonious logistic regression model contained variables for number of moose, sight time, vehicle slows, and vehicle swerves (AIC c w = 0.529). This model had good predictive accuracy (AUC = 0.860, SE = 0.041). The only statistically significant variable from this model that explained the difference between moose-vehicle collisions and near misses was 'Vehicle slows'. Our results provide no evidence that road surface conditions (dry, wet, ice or snow), roadside habitat type (forested or cleared), the extent to which roadside vegetation was cleared, natural light conditions (overcast, clear, twilight, dark), season (winter, spring and summer, fall), the presence of oncoming traffic, or the direction from which the moose entered the roadway had any influence on whether a motorist collided with a moose. Dash Cam videos posted to YouTube™ provide a unique source of data for road safety planners trying to understand what happens in the moments just before a moose-vehicle collision and how those factors may differ from moose-vehicle encounters that do not result in a collision. Copyright © 2018 Elsevier Ltd. All rights reserved.

A QM/MM study of the initial excited state dynamics of green-absorbing proteorhodopsin.

PubMed

Borin, Veniamin A; Wiebeler, Christian; Schapiro, Igor

2018-04-17

The primary photochemical reaction of the green-absorbing proteorhodopsin is studied by means of a hybrid quantum mechanics/molecular mechanics (QM/MM) approach. The simulations are based on a homology model derived from the blue-absorbing proteorhodopsin crystal structure. The geometry of retinal and the surrounding sidechains in the protein binding pocket were optimized using the QM/MM method. Starting from this geometry the isomerization was studied with a relaxed scan along the C13[double bond, length as m-dash]C14 dihedral. It revealed an "aborted bicycle pedal" mechanism of isomerization that was originally proposed by Warshel for bovine rhodopsin and bacteriorhodopsin. However, the isomerization involved the concerted rotation about C13[double bond, length as m-dash]C14 and C15[double bond, length as m-dash]N, with the latter being highly twisted but not isomerized. Further, the simulation showed an increased steric interaction between the hydrogen at the C14 of the isomerizing bond and the hydroxyl group at the neighbouring tyrosine 200. In addition, we have simulated a nonadiabatic trajectory which showed the timing of the isomerization. In the first 20 fs upon excitation the order of the conjugated double and single bonds is inverted, consecutively the C13[double bond, length as m-dash]C14 rotation is activated for 200 fs until the S1-S0 transition is detected. However, the isomerization is reverted due to the specific interaction with the tyrosine as observed along the relaxed scan calculation. Our simulations indicate that the retinal - tyrosine 200 interaction plays an important role in the outcome of the photoisomerization.

GeoDash: Assisting Visual Image Interpretation in Collect Earth Online by Leveraging Big Data on Google Earth Engine

NASA Astrophysics Data System (ADS)

Markert, K. N.; Ashmall, W.; Johnson, G.; Saah, D. S.; Anderson, E.; Flores Cordova, A. I.; Díaz, A. S. P.; Mollicone, D.; Griffin, R.

2017-12-01

Collect Earth Online (CEO) is a free and open online implementation of the FAO Collect Earth system for collaboratively collecting environmental data through the visual interpretation of Earth observation imagery. The primary collection mechanism in CEO is human interpretation of land surface characteristics in imagery served via Web Map Services (WMS). However, interpreters may not have enough contextual information to classify samples by only viewing the imagery served via WMS, be they high resolution or otherwise. To assist in the interpretation and collection processes in CEO, SERVIR, a joint NASA-USAID initiative that brings Earth observations to improve environmental decision making in developing countries, developed the GeoDash system, an embedded and critical component of CEO. GeoDash leverages Google Earth Engine (GEE) by allowing users to set up custom browser-based widgets that pull from GEE's massive public data catalog. These widgets can be quick looks of other satellite imagery, time series graphs of environmental variables, and statistics panels of the same. Users can customize widgets with any of GEE's image collections, such as the historical Landsat collection with data available since the 1970s, select date ranges, image stretch parameters, graph characteristics, and create custom layouts, all on-the-fly to support plot interpretation in CEO. This presentation focuses on the implementation and potential applications, including the back-end links to GEE and the user interface with custom widget building. GeoDash takes large data volumes and condenses them into meaningful, relevant information for interpreters. While designed initially with national and global forest resource assessments in mind, the system will complement disaster assessments, agriculture management, project monitoring and evaluation, and more.

Rilonacept in the treatment of subacromial bursitis: A randomized, non-inferiority, unblinded study versus triamcinolone acetonide.

PubMed

Carroll, Matthew B; Motley, Spencer A; Wohlford, Susanna; Ramsey, Bryan C

2015-12-01

Subacromial bursitis is caused by inflammation of the bursa that separates the superior surface of the supraspinatus tendon from the overlying coraco-acromial ligament and acromion. While multiple cytokines are implicated, interleukin-1 beta appears to play a prominent role. Rilonacept, an interleukin-1 trap, may be an alternative to corticosteroid injection for the management of this condition. This single center, randomized, non-inferiority, unblinded study recruited 33 subjects over 9 months. Twenty subjects received 160mg intrabursal injection of rilonacept and 13 received a 6mL mixture of lidocaine, bupivacaine, and 80mg triamcinolone acetonide. QuickDASH, subject reported pain, and adverse events were recorded at time of injection, 2 days later, 2 weeks later, and 4 weeks later. Primary outcome was improvement in QuickDASH 4 weeks post-injection. Secondary outcomes were improvement in subject reported pain and occurrence of adverse events at 4 weeks. Both study groups were equally matched for age, gender, ethnicity, and site of bursa injection. Both medications demonstrated a statistically significant improvement in QuickDASH 4 weeks post-injection, but triamcinolone acetonide injection offered greater improvement (P=0.004). Both medications demonstrated improvement in subject reported pain but between group comparison at 4 weeks showed that triamcinolone was superior (P=0.044). No statistically significant differences in adverse events were noted between groups, but subjects who received rilonacept experienced more episodes of diarrhea and headache. While improvement in QuickDASH and pain was noted with a single intrabursal injection of rilonacept at 4 weeks, injection with triamcinolone acetonide was more efficacious. This trial was registered with www.clinicaltrials.gov (NCT01830699). Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Does platelet-rich plasma accelerate recovery after rotator cuff repair? A prospective cohort study.

PubMed

Jo, Chris Hyunchul; Kim, Ji Eun; Yoon, Kang Sup; Lee, Ji Ho; Kang, Seung Baik; Lee, Jae Hyup; Han, Hyuk Soo; Rhee, Seung Hwan; Shin, Sue

2011-10-01

Platelet-rich plasma (PRP) has been recently used to enhance and accelerate the healing of musculoskeletal injuries and diseases, but evidence is still lacking, especially on its effects after rotator cuff repair. Platelet-rich plasma accelerates recovery after arthroscopic rotator cuff repair in pain relief, functional outcome, overall satisfaction, and enhanced structural integrity of repaired tendon. Cohort study; Level of evidence, 2. Forty-two patients with full-thickness rotator cuff tears were included. Patients were informed about the use of PRP before surgery and decided themselves whether to have PRP placed at the time of surgery. Nineteen patients underwent arthroscopic rotator cuff repair with PRP and 23 without. Platelet-rich plasma was prepared via plateletpheresis and applied in the form of a gel threaded to a suture and placed at the interface between tendon and bone. Outcomes were assessed preoperatively and at 3, 6, 12, and finally at a minimum of 16 months after surgery (at an average of 19.7 ± 1.9 months) with respect to pain, range of motion, strength, and overall satisfaction, and with respect to functional scores as determined using the following scoring systems: the American Shoulder and Elbow Surgeon (ASES) system, the Constant system, the University of California at Los Angeles (UCLA) system, the Disabilities of the Arm, Shoulder and Hand (DASH) system, the Simple Shoulder Test (SST) system, and the Shoulder Pain and Disability Index (SPADI) system. At a minimum of 9 months after surgery, repaired tendon structural integrities were assessed by magnetic resonance imaging. Platelet-rich plasma gel application to arthroscopic rotator cuff repairs did not accelerate recovery with respect to pain, range of motion, strength, functional scores, or overall satisfaction as compared with conventional repair at any time point. Whereas magnetic resonance imaging demonstrated a retear rate of 26.7% in the PRP group and 41.2% in the conventional group, there was no statistical significance between the groups (P = .388). The results suggest that PRP application during arthroscopic rotator cuff repair did not clearly demonstrate accelerated recovery clinically or anatomically except for an improvement in internal rotation. Nevertheless, as the study may have been underpowered to detect clinically important differences in the structural integrity, additional investigations, including the optimization of PRP preparation and a larger randomized study powered for healing rate, are necessary to further determine the effect of PRP.

Bilateral humeral lengthening in achondroplasia with unilateral external fixators: is it safe and does it improve daily life?

PubMed

Balci, H I; Kocaoglu, M; Sen, C; Eralp, L; Batibay, S G; Bilsel, K

2015-11-01

A retrospective study was performed in 18 patients with achondroplasia, who underwent bilateral humeral lengthening between 2001 and 2013, using monorail external fixators. The mean age was ten years (six to 15) and the mean follow-up was 40 months (12 to 104). The mean disabilities of the arm, shoulder and hand (DASH) score fell from 32.3 (20 to 40) pre-operatively to 9.4 (6 to 14) post-operatively (p = 0.037). A mean lengthening of 60% (40% to 95%) was required to reach the goal of independent perineal hygiene. One patient developed early consolidation, and fractures occurred in the regenerate bone of four humeri in three patients. There were three transient radial nerve palsies. Humeral lengthening increases the independence of people with achondroplasia and is not just a cosmetic procedure. ©2015 The British Editorial Society of Bone & Joint Surgery.

Early results of a prospective study on the pyrolytic carbon (pyrocarbon) Amandys® for osteoarthritis of the wrist

PubMed Central

Daruwalla, ZJ; Davies, KL; Shafighian, A; Gillham, NR

2012-01-01

INTRODUCTION The preliminary results of a pyrocarbon interpositional radiocarpal implant in a small cohort of patients were reviewed. As it is currently only a limited release product, we describe to potential users early complications and negative outcomes. METHODS Patients were assessed using pain levels, ranges of motion, grip strength, type of and time to return to work as well as pre-operative and post-operative DASH (Disabilities of the Arm, Shoulder and Hand) scores. Radiographs were taken and patient satisfaction was recorded. RESULTS All six patients were contacted. One was not satisfied. Three had reduced motion. None experienced squeaking. There were no immediate or late post-operative complications. There was one early volar displacement of an implant. CONCLUSIONS Although our early results are somewhat encouraging, further and longer studies are warranted before supporting the use of this particular pyrocarbon implant as a primary procedure. PMID:23031769

Is coracoclavicular stabilisation alone sufficient for the endoscopic treatment of severe acromioclavicular joint dislocation (Rockwood types III, IV, and V)?

PubMed

Barth, J; Duparc, F; Andrieu, K; Duport, M; Toussaint, B; Bertiaux, S; Clavert, P; Gastaud, O; Brassart, N; Beaudouin, E; De Mourgues, P; Berne, D; Bahurel, J; Najihi, N; Boyer, P; Faivre, B; Meyer, A; Nourissat, G; Poulain, S; Bruchou, F; Ménard, J F

2015-12-01

The primary objective was to evaluate correlations linking anatomical to functional outcomes after endoscopically assisted repair of acute acromioclavicular joint dislocation (ACJD). Combined acromioclavicular and coracoclavicular stabilisation improves radiological outcomes compared to coracoclavicular stabilisation alone. A prospective multicentre study was performed. Clinical outcome measures were pain intensity on a visual analogue scale (VAS), subjective functional impairment (QuickDASH score), and Constant's score. Anatomical outcomes were assessed on standard radiographs (anteroposterior view of the acromioclavicular girdle and bilateral axillary views) obtained preoperatively and postoperatively and on postoperative dynamic radiographs taken as described by Tauber et al. Of 116 patients with acute ACJD included in the study, 48% had type III, 30% type IV, and 22% type V ACJD according to the Rockwood classification. Coracoclavicular stabilisation was achieved using a double endobutton in 93% of patients, and concomitant acromioclavicular stabilisation was performed in 50% of patients. The objective functional outcome was good, with an unweighted Constant's score ≥ 85/100 and a subjective QuickDASH functional disability score ≤ 10 in 75% of patients. The radiographic analysis showed significant improvements from the preoperative to the 1-year postoperative values in the vertical plane (decrease in the coracoclavicular ratio from 214 to 128%, p=10(-6)) and in the horizontal plane (decrease in posterior displacement from 4 to 0mm, p=5×10(-5)). The anatomical outcome correlated significantly with the functional outcome (absolute R value=0.19 and p=0.045). We found no statistically significant differences across the various types of constructs used. Intra-operative control of the acromioclavicular joint did not improve the result. Implantation of a biological graft significantly improved both the anatomical outcome in the vertical plane (p=0.04) and acromioclavicular stabilisation in the horizontal plane (p=0.02). The coracoclavicular ratio on the anteroposterior radiograph was adversely affected by a longer time from injury to surgery (p=0.02) and by a higher body mass index (BMI) (p=0.006). High BMI also had a negative effect on the difference in the distance separating the anterior edge of the acromion from the anterior edge of the clavicle between the injured and uninjured sides, as assessed on the axillary views (p=0.009). This study demonstrates that acute ACJD requires stabilisation in both planes, i.e., at the coracoclavicular junction and at the acromioclavicular joint. Coracoclavicular stabilisation alone is not sufficient, regardless of the type of implant used. Implantation of a biological graft should be considered when the time from injury to surgery is longer than 10days. The weight of the upper limb should be taken into account, with 6weeks of immobilisation to unload the construct in patients who have high BMI values. II, prospective non-randomised comparative study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Spelling Endings Added to e: Level III, Unit 5, Lesson 1; Capitalization: Lesson 2; Question Marks and Exclamation Points: Lesson 3; Quotation Marks: Lesson 4; Spelling Double Letter Demons: Lesson 5; Colons and Dashes: Lesson 6; Punctuating Series with Commas and Semicolons: Lesson 7; More Confusing Word Pairs: Lesson 8; Separating Sentence Parts with Punctuation: Lesson 9; Other Uses for Commas and Semicolons.

ERIC Educational Resources Information Center

Manpower Administration (DOL), Washington, DC. Job Corps.

This self-study program for the high-school level contains lessons in the following subjects: Spelling Endings Added to e; Capitalization; Question Marks and Exclamation Points; Quotation Marks; Spelling Double Letter Demons; Colons and Dashes; Punctuating Series with Commas and Semicolons; More Confusing Word Pairs; Separating Sentence Parts with…

146-GHz millimeter-wave radio-over-fiber photonic wireless transmission system.

PubMed

Fice, M J; Rouvalis, E; van Dijk, F; Accard, A; Lelarge, F; Renaud, C C; Carpintero, G; Seeds, A J

2012-01-16

We report the experimental implementation of a wireless transmission system with a 146-GHz carrier frequency which is generated by optical heterodyning the two modes from a monolithically integrated quantum dash dual-DFB source. The monolithic structure of the device and the inherent low noise characteristics of quantum dash gain material allow us to demonstrate the transmission of a 1 Gbps ON-OFF keyed data signal with the two wavelengths in a free-running state at 146-GHz carrier wave frequency. The tuning range of the device fully covers the W-band (75 - 110 GHz) and the F-band (90 - 140 GHz).