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Purpose: The objective of this study was to perform a cost-utility analysis comparing open carpal tunnel release (OCTR), endoscopic carpal tunnel release (ECTR), and carpal tunnel release with ultrasound (CTR-US) guidance. The aim of this study was to determine whether one of the three approaches was dominant from a societal perspective in terms of cost-utility, in order to help inform policy and treatment decision making going forward. Methods: This study was performed using a decision tree model, with three potential treatment decisions (OCTR, ECTR, and CTR-US). A cost-utility analysis was performed, using the incremental cost-effectiveness ratio. The willingness-to-pay threshold was set at $50,000/quality-adjusted life year (QALY) as per previous literature. Results: The total payer episode costs for OCTR, ECTR, and CTR-US were $4,324, $4,978, and $3,249, respectively. The cost of time off work for each procedure was $4,376.14, $3,650.24, and $622.20, respectively. The overall QALYs gained from each procedure were 0.42, 0.42, and 0.43, respectively (the maximum possible being 0.5 for a 6-month period). Compared with OCTR, ECTR and CTR-US were both less costly from a societal perspective (−$71.90 and −$4,828.94, respectively) and associated with greater QALYs gained (+0.0004 and +0.0143, respectively). Conclusions: Overall, the key finding of this study is that, from a societal perspective, CTR-US is less costly and provides greater QALY improvement when compared with OCTR and ECTR, and thus, CTR-US is considered a dominant intervention over both OCTR and ECTR. Type of study/level of evidence: Economic and decision analysis; IIb.

We present a uniform forward-modeling analysis of 90 late-M and L dwarfs in nearby young (∼10–200 Myr) moving groups, the Pleiades, and the Hyades using low-resolution ( R ≈ 150) near-infrared (0.9–2.4 μ m) spectra and the BT-Settl model atmospheres. We derive the objects’ effective temperatures, surface gravities, radii, and masses by comparing our spectra to the models using a Bayesian framework with nested sampling and calculate the same parameters using evolutionary models. Assuming the evolutionary-based parameters are more robust, our spectroscopically inferred parameters from BT-Settl exhibit two types of systematic behavior for objects near the M-L spectral type boundary. Several objects are clustered around T _eff ≈ 1800 K and $\mathrm{log}g\approx 5.5$ dex, implying impossibly large masses (150–1400 M _Jup ), while others are clustered around T _eff ≳ 3000 K and $\mathrm{log}g\lesssim 3.0$ dex, implying unphysically low masses and unreasonably young ages. We find the fitted BT-Settl model spectra tend to overpredict the peak J - and H -band flux for objects located near the M-L boundary, suggesting the dust content included in the model atmospheres is insufficient to match the observations. By adding an interstellar medium–like reddening law to the BT-Settl model spectra, we find the fits between models and observed spectra are greatly improved, with the largest reddening coefficients occurring at the M-L transition. This work delivers a systematic examination of the BT-Settl model atmospheres and constitutes the largest spectral analysis of benchmark late-M- and L-type brown dwarfs to date.

Evaluating cardiac dose during total body irradiation (TBI) is of increasing interest. A three-dimensional beam model for TBI was commissioned and lung shielding was simulated in a treatment planning system with the cardiac silhouette partially blocked and unblocked. When blocked, the median heart dose decreased by 6% (IQR = 6%) and the median cardiac V12Gy decreased by 27% (IQR = 17%). The median left anterior descending artery dose decreased 20% (IQR = 12%) for blocked cases. Because using partial heart shielding may result in considerable changes in dose to cardiac structures, TBI protocols should explicitly consider lung block design parameters and their potential effects.

Aims: The aims of this network meta-analysis (NMA) were to examine nonunion rates and functional outcomes following various operative and nonoperative treatments for displaced mid-shaft clavicle fractures. Methods: Initial search strategy incorporated MEDLINE, PubMed, Embase, and the Cochrane Library for relevant randomized controlled trials (RCTs). Four treatment arms were created: nonoperative (NO); intramedullary nailing (IMN); reconstruction plating (RP); and compression/pre-contoured plating (CP). A Bayesian NMA was conducted to compare all treatment options for outcomes of nonunion, malunion, and function using the Disabilities of the Arm Shoulder and Hand (DASH) and Constant-Murley Shoulder Outcome scores. Results: In all, 19 RCTs consisting of 1,783 clavicle fractures were included in the NMA. All surgical options demonstrated a significantly lower odds ratio (OR) of nonunion in comparison to nonoperative management: CP versus NO (OR 0.08; 95% confidence interval (CI) 0.04 to 0.17); IMN versus NO (OR 0.07; 95% CI 0.02 to 0.19); RP versus NO (OR 0.07; 95% CI: 0.01 to 0.24). Compression plating was the only treatment to demonstrate significantly lower DASH scores relative to NO at six weeks (mean difference -10.97; 95% CI -20.69 to 1.47). Conclusion: Surgical fixation demonstrated a lower risk of nonunion compared to nonoperative management. Compression plating resulted in significantly less disability early after surgery compared to nonoperative management. These results demonstrate possible early improved functional outcomes with compression plating compared to nonoperative treatment. Surgical fixation of mid-shaft clavicle fractures with compression plating may result in quicker return to activity by rendering patients less disabled early after surgery. Cite this article: Bone Jt Open 2021;2(8):646–654.

Abstract Background Non-union occurs in approximately 5 to 10% of fracture patients, with certain bones at greater risk of failing to heal. Non-unions have a significant impact on socioeconomic costs and the patients short and long-term quality of life. Low intensity pulsed ultrasound (LIPUS) is a non-invasive therapy for non-union treatment that can improve the long-term outcome. The purpose of this study is to summarize the available literature assessing LIPUS potential to improve the union rate in instrumented, infected, and fragility non-unions. Methods A literature search was conducted in the MEDLINE, EMBASE, and CINAHL databases for all relevant literature on the healing rates of LIPUS utilized in instrumented, infected, and fragility non-unions. Study characteristics were summarized for each of the included studies. The percentage of healed patients (healing rate), for instrumented, infected, and fragility fracture non-union patients were pooled from each included study. Results The literature search identified a total of 326 articles, while searching reference lists and grey literature identified an additional 3 articles. There was a total of 29 articles included in this review, with 20 articles included within the quantitative synthesis of healing rates. The most common design of included studies was case series (17 articles), followed by case reports (9 articles). Studies were primarily retrospective (18 studies), with an additional 10 prospective studies. Non-union healing rates were 82% (95% CI: 76 to 87%) in instrumented, 82% (95% CI: 70 to 95%) in infected, and 91% (95% CI: 87 to 95%) in fragility fracture patients with non-unions. Conclusion This study has provided a thorough overview of the current literature on LIPUS treatment for instrumented, infected, and fragility fracture non-unions. The healing rates for non-unions in these subgroups were comparable to healing rates observed with LIPUS use in general non-union literature. LIPUS treatment should be considered as a conservative non-surgical treatment option to potentially reduce the socioeconomic impact and improve the quality of life of these unfortunate patients. Level of evidence 4 (systematic review of primarily case series data)

Mapping out the populations of thick disk and halo brown dwarfs is important for understanding the metallicity dependence of low-temperature atmospheres and the substellar mass function. Recently, a new population of cold and metal-poor brown dwarfs has been discovered, with T _eff ≲ 1400 K and metallicity ≲−1 dex. This population includes what may be the first known “extreme T-type subdwarfs” and possibly the first Y-type subdwarf, WISEA J153429.75−104303.3. We have conducted a Gemini YJHK / Ks photometric follow-up campaign targeting potentially metal-poor T and Y dwarfs, utilizing the GNIRS and Flamingos-2 instruments. We present 14 near-infrared photometric detections of eight unique targets: six T subdwarf candidates, one moderately metal-poor Y dwarf candidate, and one Y subdwarf candidate. We have obtained the first-ever ground-based detection of the highly anomalous object WISEA J153429.75−104303.3. The F110W − J color of WISEA J153429.75−104303.3 is significantly bluer than that of other late T and Y dwarfs, indicating that WISEA J153429.75−104303.3 has an unusual spectrum in the 0.9–1.4 μ m wavelength range which encompasses the J -band peak. Our J -band detection of WISEA J153429.75−104303.3 and corresponding model comparisons suggest a subsolar metallicity and temperature of 400–550 K for this object. JWST spectroscopic follow-up at near-infrared and mid-infrared wavelengths would allow us to better understand the spectral peculiarities of WISEA J153429.75−104303.3, assess its physical properties, and conclusively determine whether or not it is the first Y-type subdwarf.

AbstractLittle is known about the genetic architecture of antifungal immunity in natural populations. Using two population genetic approaches, quantitative trait locus (QTL) mapping and evolve and resequence (E&R), we explored D. melanogasterBeauveria bassianaB. bassianaB. bassiana

Objective Calcium hydroxide (Ca(OH)2) has been used in endodontics as an intracanal medicament due to its antimicrobial effects and its ability to inactivate bacterial endotoxin. The inability to totally remove this intracanal medicament from the root canal system, however, may interfere with the setting of eugenol-based sealers or inhibit bonding of resin to dentin, thus presenting clinical challenges with endodontic treatment. This study used a chemical titration method to measure residual Ca(OH)2 left after different endodontic irrigation methods. Material and Methods Eighty-six human canine roots were prepared for obturation. Thirty teeth were filled with known but different amounts of Ca(OH)2 for 7 days, which were dissolved out and titrated to quantitate the residual Ca(OH)2 recovered from each root to produce a standard curve. Forty-eight of the remaining teeth were filled with equal amounts of Ca(OH)2 followed by gross Ca(OH)2 removal using hand files and randomized treatment of either: 1) Syringe irrigation; 2) Syringe irrigation with use of an apical file; 3) Syringe irrigation with added 30 s of passive ultrasonic irrigation (PUI), or 4) Syringe irrigation with apical file and PUI (n=12/group). Residual Ca(OH)2 was dissolved with glycerin and titrated to measure residual Ca(OH)2 left in the root. Results No method completely removed all residual Ca(OH)2. The addition of 30 s PUI with or without apical file use removed Ca(OH)2 significantly better than irrigation alone. Conclusions This technique allowed quantification of residual Ca(OH)2. The use of PUI (with or without apical file) resulted in significantly lower Ca(OH)2 residue compared to irrigation alone.

Knee osteoarthritis is a leading cause of disability around the world. Knee bracing provides a conservative management option for symptom relief. A variety of different bracing types, manufacturers and products are currently available on the market. The goal of this study is to examine the current state of the literature regarding the treatment of knee osteoarthritis with unloader bracing, specifically examining the representation of specific brace types, manufacturers and models within the literature. A scoping review technique was used because of its ability to evaluate research activity within an area of study and identify gaps within the literature. A thorough search of the MEDLINE database was conducted for articles where a knee brace model was identified, and we identified characteristics of the studies to evaluate important information about the body of literature related to knee bracing for the treatment of osteoarthritis. Fifty eligible studies were identified. The majority of studies have been published in the United States, and a large increase in the number of publications in this field was seen between 2010-2014. The most prominent study type was prospective comparative studies (44%), however there is a lack of randomized controlled trials (6%) within the literature. The most prominent hinge type within the literature is the dual hinge push brace, followed by the single hinge pull. While a large increase in the number of studies evaluating the treatment of knee osteoarthritis with bracing has occurred in the past 5 years, there is a lack of high quality studies evaluating the efficacy of the technique, as well as a lack of studies comparing bracing types and models.

Cediranib, an oral pan-vascular endothelial growth factor (VEGF) receptor tyrosine kinase inhibitor, failed to show benefit over lomustine in relapsed glioblastoma. One resistance mechanism for cediranib is up-regulation of epidermal growth factor receptor (EGFR). This study aimed to determine if dual therapy with cediranib and the oral EGFR inhibitor gefitinib improved outcome in recurrent glioblastoma.This was a multi-center randomized, two-armed, double-blinded phase II study comparing cediranib plus gefitinib versus cediranib plus placebo in subjects with first relapse/first progression of glioblastoma following surgery and chemoradiotherapy. The primary outcome measure was progression free survival (PFS). Secondary outcome measures included overall survival (OS) and radiologic response rate. Recruitment was terminated early following suspension of the cediranib program. 38 subjects (112 planned) were enrolled with 19 subjects in each treatment arm. Median PFS with cediranib plus gefitinib was 3.6 months compared to 2.8 months for cediranib plus placebo (HR; 0.72, 90% CI; 0.41 to 1.26). Median OS was 7.2 months with cediranib plus gefitinib and 5.5 months with cediranib plus placebo (HR; 0.68, 90% CI; 0.39 to 1.19). Eight subjects (42%) had a partial response in the cediranib plus gefitinib arm versus five patients (26%) in the cediranib plus placebo arm.Cediranib and gefitinib in combination is tolerated in patients with glioblastoma. Incomplete recruitment led to the study being underpowered. However, a trend towards improved survival and response rates with the addition of gefitinib to cediranib was observed. Further studies of the combination incorporating EGFR and VEGF inhibition are warranted.ClinicalTrials.gov NCT01310855.

This article describes how the University of North Texas Libraries' Digital Projects Unit used simple, freely-available APIs to add place names to metadata records for over 8,000 maps in two digital collections. These textual place names enable users to easily find maps by place name and to find other maps that feature the same place, thus increasing the accessibility and usage of the collections. This project demonstrates how targeted large-scale, automated metadata enhancement can have a significant impact with a relatively small commitment of time and staff resources.

The University of North Texas (UNT) and the Oklahoma Historical Society (OHS) are collaborating to digitize, process, and make publicly available more than one million photographs from the Oklahoma Publishing Company’s historic photo archive. The project, started in 2013, is expected to span a year and a half and will result in digitized photographs and metadata available through The Gateway to Oklahoma History. The project team developed the workflow described in this article to meet the specific criterion that all of the metadata work occurs in two locations simultaneously.

Over the past few years the University of North Texas Libraries' Digital Projects Unit (DPU) has developed a set of metadata analysis tools, processes, and methodologies aimed at helping to focus limited quality control resources on the areas of the collection where they might have the most benefit. The key to this work lies in its simplicity: records harvested from OAI-PMH-enabled digital repositories are transformed into a format that makes them easily parsable using traditional Unix/Linux-based command-line tools. This article describes the overall methodology, introduces two simple open-source tools developed to help with the aforementioned harvesting and breaking, and provides example commands to demonstrate some common metadata analysis requests. All software tools described in the article are available with an open-source license via the author's GitHub account.

To demonstrate a method of generating patient-specific, biologically-guided radiotherapy dose plans and compare them to the standard-of-care protocol.We integrated a patient-specific biomathematical model of glioma proliferation, invasion and radiotherapy with a multiobjective evolutionary algorithm for intensity-modulated radiation therapy optimization to construct individualized, biologically-guided plans for 11 glioblastoma patients. Patient-individualized, spherically-symmetric simulations of the standard-of-care and optimized plans were compared in terms of several biological metrics.The integrated model generated spatially non-uniform doses that, when compared to the standard-of-care protocol, resulted in a 67% to 93% decrease in equivalent uniform dose to normal tissue, while the therapeutic ratio, the ratio of tumor equivalent uniform dose to that of normal tissue, increased between 50% to 265%. Applying a novel metric of treatment response (Days Gained) to the patient-individualized simulation results predicted that the optimized plans would have a significant impact on delaying tumor progression, with increases from 21% to 105% for 9 of 11 patients.Patient-individualized simulations using the combination of a biomathematical model with an optimization algorithm for radiation therapy generated biologically-guided doses that decreased normal tissue EUD and increased therapeutic ratio with the potential to improve survival outcomes for treatment of glioblastoma.