1,549 results on '"A. B. Adams"'
Search Results
2. Flexible and Modular Brain Network Dynamics Characterize Flow Experiences During Media Use: A Functional Magnetic Resonance Imaging Study
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Xuanjun (Jason) Gong, Shelby Wilcox, Christina Jimenez Najera, Justin Robert Keene, Richard Huskey, and Robyn B. Adams
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Brain network ,Linguistics and Language ,medicine.diagnostic_test ,Computer science ,business.industry ,Communication ,Dynamics (mechanics) ,Modular design ,Language and Linguistics ,Flow (mathematics) ,Media use ,medicine ,Functional magnetic resonance imaging ,Biological system ,business - Abstract
Flow is thought to occur when both task difficulty and individual ability are high. Flow experiences are highly rewarding and are associated with well-being. Importantly, media use can be a source of flow. Communication scholars have a long history of theoretical inquiry into how flow biases media selection, how different media content results in flow, and how flow influences media processing and effects. However, the neurobiological basis of flow during media use is not well understood, limiting our explanatory capacity to specify how media contribute to flow or well-being. Here, we show that flow is associated with a flexible and modular brain-network topology, which may offer an explanation for why flow is simultaneously perceived as high-control and effortless, even when the task difficulty is high. Our study tests core predictions derived from synchronization theory, and our results provide qualified support for the theory while also suggesting important theoretical updates.
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- 2021
3. Does Activity Level After Primary Total Hip Arthroplasty Affect Aseptic Survival?
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Gerald R. Hobbs, Joanne B. Adams, Michael J. Morris, David A. Crawford, Adolph V. Lombardi, and Keith R. Berend
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musculoskeletal diseases ,Orthopedic surgery ,medicine.medical_specialty ,business.industry ,Odds ratio ,Survivorship ,Confidence interval ,Surgery ,Activity ,Highly crosslinked polyethylene ,Harris Hip Score ,Polyethylene ,Survivorship curve ,medicine ,Orthopedics and Sports Medicine ,Total hip arthroplasty ,Aseptic processing ,business ,Body mass index ,RD701-811 ,Original Research ,Sports - Abstract
Background: The purpose of this study is to evaluate survivorship and outcomes of high-activity patients compared to low-activity patients after total hip arthroplasty. Methods: A retrospective review identified 2002 patients (2532 hip) that underwent a primary total hip arthroplasty with vitamin E–infused highly crosslinked polyethylene liner. Patients were divided into 2 groups based on their University of California Los Angeles (UCLA) activity level: low activity (LA) (UCLA ≤5) and high activity (HA) (UCLA ≥6). Outcomes included Harris Hip Score, UCLA activity score, and reoperations. A multivariate nominal regression analysis was performed to evaluate the significance of postoperative activity level on survivorship. Results: The mean follow-up duration was 4.5 years (range, 0.3 to 9.9 years). HA group had significantly higher improvements in Harris Hip Score (HHS) (P < .001) and UCLA activity score (P < .001). Aseptic revisions were performed in 2.1% of the LA group and in 0.4% hips of the HA group (P < .001). After controlling for age, gender, preoperative pain, HHS, and body mass index, a higher postoperative activity level remained a significant factor for improved aseptic survivorship with an odds ratio of 4.9 (95% confidence interval, 1.1 to 21.2, P = .03). The all-cause 5-year survivorship was 99% for the HA group and 96% to for the LA group (P < .001). The aseptic 5-year survivorship was 99.6% for the HA group and 98% for the LA group (P < .001). Conclusions: This study found that a higher activity level after primary THA was not deleterious to survivorship at short to midterm follow-up with modern implants.
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- 2021
4. Comparing downstream consequences of normal exercise stress echocardiograms and cardiac computed tomography angiography scans in patients suspected of having of obstructive coronary artery disease: a retrospective cohort study of Tricare beneficiaries
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Brandon L Walker, Kevin A Loudermilk, Samuel J Farrell, Andrew C Wyatt, Chu-Chiao Chu, Andrea N Keithler, Dustin M. Thomas, Susan G Williams, Jessica Rouse, Rosco S Gore, Cory G. Madigan, Michael B Adams, Laith R Dinkha, and Robert T Hoard
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medicine.medical_specialty ,Computed Tomography Angiography ,Coronary Artery Disease ,Coronary Angiography ,Medicare ,Coronary artery disease ,Predictive Value of Tests ,Cardiac computed tomography angiography ,Internal medicine ,Cardiac CT ,Stress Echocardiography ,medicine ,Humans ,Fee Schedule ,Downstream testing ,Radiology, Nuclear Medicine and imaging ,In patient ,Cardiac imaging ,Aged ,Retrospective Studies ,Original Paper ,business.industry ,Exercise stress ,Retrospective cohort study ,medicine.disease ,United States ,Stress echocardiography ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
To compare overall number of downstream tests and total costs between negative exercise stress echocardiograms (ESE) or cardiac computed tomography angiography scans (CCTA) in symptomatic Tricare beneficiaries suspected of having coronary artery disease (CAD). This is a retrospective cohort study examining 651 propensity-matched patients who underwent ESE or CCTA with normal results between 2008 and 2014 at the United States’ largest Department of Defense hospital. The total number of additional downstream tests over the next five years was determined. The total costs associated with each arm, inclusive of the initial test and all subsequent tests, were calculated using the 2018 Medicare Physician Fee Schedule. 18.5 percent of patients with a normal ESE result underwent some additional form of cardiac testing over the five years after initial testing compared to 12.8 percent of patients with a normal CCTA. The absolute difference in total number of downstream tests between both study groups was 5.7 percent (p = 0.03). When factoring the costs of the initial test as well as the downstream tests, the ESE group was associated with overall lower costs compared to the CCTA group, 351 United States Dollars (USD) versus 496 USD (p
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- 2021
5. Anti-C5 Antibody Tesidolumab Reduces Early Antibody-mediated Rejection and Prolongs Survival in Renal Xenotransplantation
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Cynthia P. Breeden, Jose L. Estrada, Andrew B. Adams, Alfred J. Tector, Luz M. Reyes, Christopher Burlak, Brendan P. Lovasik, Matthew Tector, David A. Faber, and Rodrigo M. Vianna
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Graft Rejection ,Swine ,Xenotransplantation ,medicine.medical_treatment ,Transplantation, Heterologous ,Antibodies, Monoclonal, Humanized ,Tacrolimus ,Article ,Mycophenolic acid ,Immune tolerance ,Animals, Genetically Modified ,Immune Tolerance ,medicine ,Animals ,Kidney transplantation ,biology ,business.industry ,Antibodies, Monoclonal ,Immunosuppression ,Antibiotic Prophylaxis ,medicine.disease ,Kidney Transplantation ,Macaca mulatta ,Transplantation ,Models, Animal ,Immunology ,biology.protein ,Surgery ,Antibody ,Rituximab ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
OBJECTIVE Pig-to-primate renal xenotransplantation is plagued by early antibody-mediated graft loss which precludes clinical application of renal xenotransplantation. We evaluated whether temporary complement inhibition with anti-C5 antibody Tesidolumab could minimize the impact of early antibody-mediated rejection in rhesus monkeys receiving pig kidneys receiving costimulatory blockade-based immunosuppression. METHODS Double (Gal and Sda) and triple xenoantigen (Gal, Sda, and SLA I) pigs were created using CRISPR/Cas. Kidneys from DKO and TKO pigs were transplanted into rhesus monkeys that had the least reactive crossmatches. Recipients received anti-C5 antibody weekly for 70 days, and T cell depletion, anti-CD154, mycophenolic acid, and steroids as baseline immunosuppression (n = 7). Control recipients did not receive anti-C5 therapy (n = 10). RESULTS Temporary anti-C5 therapy reduced early graft loss secondary to antibody-mediated rejection and improved graft survival (P < 0.01). Deleting class I MHC (SLA I) in donor pigs did not ameliorate early antibody-mediated rejection (table). Anti-C5 therapy did not allow for the use of tacrolimus instead of anti-CD154 (table), prolonging survival to a maximum of 62 days. CONCLUSION Inhibition of the C5 complement subunit prolongs renal xenotransplant survival in a pig to non-human primate model.
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- 2021
6. Impact of perivascular lymphocytic infiltration in aseptic total knee revision
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Joanne B. Adams, Keith R. Berend, Adolph V. Lombardi, David A. Crawford, and Braden J Passias
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Adult ,Male ,Reoperation ,Vasculitis ,medicine.medical_specialty ,Total knee arthroplasty ,Total knee ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Cell Movement ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Lymphocytes ,030212 general & internal medicine ,Arthroplasty, Replacement, Knee ,Aged ,Pain Measurement ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,Lymphocytic infiltration ,business.industry ,Middle Aged ,Prosthesis Failure ,Surgery ,Female ,Aseptic processing ,business ,Revision total knee arthroplasty - Abstract
AimsA limited number of investigations with conflicting results have described perivascular lymphocytic infiltration (PVLI) in the setting of total knee arthroplasty (TKA). The purpose of this study was to determine if PVLI found in TKAs at the time of aseptic revision surgery was associated with worse clinical outcomes and survivorship.MethodsA retrospective review was conducted on 617 patients who underwent aseptic TKA revision who had histological analysis for PVLI at the time of surgery. Clinical and radiological data were obtained pre- and postoperatively, six weeks postoperatively, and then every year thereafter.ResultsWithin this cohort, 118 patients (19.1%) were found to have PVLI on histological analysis. Re-revision was performed on 83 patients (13.4%) with no significant differences in all-cause or aseptic revisions between groups. A higher incidence of PVLI was noted in female patients (p = 0.037). There was no significant difference in improvement in the range of motion (p = 0.536), or improvement of KSC (p = 0.66), KSP (p = 0.61), or KSF (p = 0.3) clinical outcome scores between PVLI and no PVLI sub-groups. There was a higher incidence of a preoperative diagnosis of pain in the PVLI group compared with patients without PVLI (p = 0.002) present.ConclusionPVLI found on large-scale histological analysis in TKAs at aseptic revision surgery was not associated with worse clinical outcomes or rates of re-revision. Cite this article: Bone Joint J 2021;103-B(6 Supple A):145–149.
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- 2021
7. Refining Black men’s depression measurement using participatory approaches: a concept mapping study
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Leron C. Jackson, James Tabron, Wizdom Powell, Carol E. Golin, Leslie B. Adams, Nisha C. Gottfredson, Samuel L. K. Baxter, Giselle Corbie-Smith, and Alexandra F. Lightfoot
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Male ,medicine.medical_specialty ,Population ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,030212 general & internal medicine ,Black men ,education ,Internal conflict ,Depression (differential diagnoses) ,education.field_of_study ,Measurement ,030505 public health ,business.industry ,Depression ,Public health ,Research ,Public Health, Environmental and Occupational Health ,Stakeholder ,Men ,Mental health ,Black or African American ,Content analysis ,Female ,Concept mapping ,Biostatistics ,Public aspects of medicine ,RA1-1270 ,0305 other medical science ,business ,Men's Health ,Clinical psychology - Abstract
Background Despite cumulative socioeconomic disadvantage and risk factors, Black Americans have a lower prevalence of depression than whites. Given the emerging focus of depression as a public mental health crisis, culturally informed depression measures and scale development techniques are needed to better alleviate the mental health burden of socially marginalized populations. Yet, for Black men, race- and gender-related factors that position emotional vulnerability as a sign of weakness, may potentially mask the timely identification of mental health needs in this population. Thus, we address these gaps by employing a stakeholder-driven, community-engaged process for understanding Black men’s depression experience. Methods We use concept mapping, a structured mixed methods approach, to determine how stakeholders of Black men’s health conceptualize their depressive symptoms. Thirty-six stakeholders participated in a three-phase concept mapping study conducted in 2018. Three separate stakeholder groups were engaged for this study, including Black men, Black women, and primary care providers. Results Participants generated 68 characteristics of Black men’s depression which were reflected within five conceptual clusters: (1) physical states; (2) emotional states; (3) diminished drive; (4) internal conflicts; (5) communication with others; and (6) social pressures. Using a content analysis approach, we found that items comprising the “social pressures” cluster were not reflected in any common depression scales. Conclusions Findings from this study illustrate the similar and divergent pathways in which Black men express depressed mood. Furthermore, concept mapping results also yield a novel opportunity for culturally informed scale development in future research.
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- 2021
8. Optimization of de novo belatacept-based immunosuppression administered to renal transplant recipients
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Andrew B. Adams, David Wojciechowski, Allan D. Kirk, E. Steve Woodle, David A. Hildeman, Christian P. Larsen, Antoine Durrbach, Mandy L. Ford, and Flavio Vincenti
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Graft Rejection ,medicine.medical_specialty ,Personal Viewpoints ,medicine.medical_treatment ,Calcineurin Inhibitors ,Urology ,immunosuppressant ‐ fusion proteins and monoclonal antibodies ,Belatacept ,kidney transplantation: living donor ,Abatacept ,immunosuppression / immune modulation ,clinical research / practice ,medicine ,Humans ,Immunology and Allergy ,Pharmacology (medical) ,kidney transplantation / nephrology ,Prospective Studies ,Personal Viewpoint ,off‐label drug use ,Immunosuppression Therapy ,editorial / personal viewpoint ,Transplantation ,Everolimus ,business.industry ,Graft Survival ,Immunosuppression ,Kidney Transplantation ,Transplant Recipients ,Calcineurin ,Clinical trial ,Regimen ,rejection: acute ,Sirolimus ,Concomitant ,business ,Immunosuppressive Agents ,immunosuppressive regimens ‐ maintenance ,medicine.drug - Abstract
Kidney transplant recipients administered belatacept‐based maintenance immunosuppression present with a more favorable metabolic profile, reduced incidence of de novo donor‐specific antibodies (DSAs), and improved renal function and long‐term patient/graft survival relative to individuals receiving calcineurin inhibitor (CNI)‐based immunosuppression. However, the rates and severity of acute rejection (AR) are greater with the approved belatacept‐based regimen than with CNI‐based immunosuppression. Although these early co‐stimulation blockade‐resistant rejections are typically steroid sensitive, the higher rate of cellular AR has led many transplant centers to adopt immunosuppressive regimens that differ from the approved label. This article summarizes the available data on these alternative de novo belatacept‐based maintenance regimens. Steroid‐sparing, belatacept‐based immunosuppression (following T cell–depleting induction therapy) has been shown to yield AR rates comparable to those seen with CNI‐based regimens. Concomitant treatment with belatacept plus a mammalian target of rapamycin inhibitor (mTORi; sirolimus or everolimus) has yielded AR rates ranging from 0 to 4%. Because the optimal induction agent and number of induction doses; blood levels of mTORi; and dose, duration, and use of corticosteroids have yet to be determined, larger prospective clinical trials are needed to establish the optimal alternative belatacept‐based regimen for minimizing early cellular AR occurrence., Kirk et al. discuss available data on alternative de novo belatacept‐based immunosuppression regimens in place of the approved belatacept regimen to reduce acute rejection rates in kidney transplant recipients.
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- 2021
9. Talonavicular Joint-Sparing 3D Printed Navicular Replacement for Osteonecrosis of the Navicular
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Richard Danilkowicz and Samuel B. Adams
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Difficult problem ,medicine.medical_specialty ,3d printed ,business.industry ,Osteonecrosis ,Avascular necrosis ,Prostheses and Implants ,Tarsal Bones ,medicine.disease ,Tarsal Joints ,Surgery ,Printing, Three-Dimensional ,Talonavicular joint ,medicine ,Humans ,Orthopedics and Sports Medicine ,business - Abstract
Pathology of the navicular can be a difficult entity to treat, particularly when the injury has progressed to osteonecrosis. While various nonoperative and operative modalities have been described, the emerging field of additive manufacturing has become a potential solution to this difficult problem in certain scenarios. While these implants have largely been used for fusion in the past, the concept of joint sparing with 3D printed implants is also emerging, and this case highlights a patient treated with a talonavicular joint-sparing, patient-specific 3D printed total navicular replacement.
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- 2021
10. Increasing age and modifiable comorbidities are associated with short-term complications after open reduction and internal fixation of ankle fractures
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Nicholas B. Allen, Jaewhan Kim, Nathan L. Grimm, Samuel B. Adams, Jeffrey A. O’Donnell, and Richard Danilkowicz
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030222 orthopedics ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,medicine.medical_treatment ,Odds ratio ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Orthopedic surgery ,Medicine ,Current Procedural Terminology ,Internal fixation ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,Ankle ,business ,Complication ,Fixation (histology) - Abstract
Ankle fractures are common orthopedic injuries with complication rates fixation of up to 40%. Limited evidence exists in the literature regarding complications in the elderly population, and moreover, these studies frequently define elderly arbitrarily at 60–65 years old. The purpose of the present study was to utilize a large, validated database to evaluate whether there is an inflection point of age when postoperative complications after an ankle fracture significantly increase. A retrospective review of all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent fixation of an ankle fracture between 2012 and 2018 was performed. Patients were identified within the database using the Current Procedural Terminology codes. Appropriate statistical analysis was performed with p value less than 0.05 considered statistically significant. A total of 27,633 fractures were including and comprised of 221 posterior malleolar, 1567 medial malleolar, 8495 lateral malleolar, 10,175 bimalleolar, and 7175 trimalleolar. A total of 1545 complications were encountered (5.6%). There was a statistically significant association between increasing age and complications (OR = 1.03; p
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- 2021
11. Three-dimensional Printing in Orthopedic Surgery: Current Applications and Future Developments
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Jonathan R. Peterson, Samuel B. Adams, Bijan Abar, and Colleen M. Wixted
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medicine.medical_specialty ,business.industry ,Three dimensional printing ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,Medical physics ,Current (fluid) ,business - Published
- 2021
12. Incidence and Risk Factors for Flap Coverage After Total Ankle Arthroplasty
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Cierra S. Hong, Sean P. Ryan, Daniel J. Cunningham, Suhail K. Mithani, and Samuel B. Adams
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030203 arthritis & rheumatology ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,Incidence ,Incidence (epidemiology) ,Wound Breakdown ,Surgery ,Cohort Studies ,Arthroplasty, Replacement, Ankle ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Total ankle arthroplasty ,medicine ,Humans ,Orthopedics and Sports Medicine ,Ankle ,business ,Retrospective Studies - Abstract
Background: Wound complications following total ankle arthroplasty (TAA) can have a significant impact on patient morbidity, particularly when they require flap coverage. We sought to determine the risk factors associated with the need for flap coverage after TAA and hypothesized that medical and operative risk factors such as diabetes and additional procedures would be associated with the need for flap coverage after TAA. Methods: We performed a single-center retrospective review of TAAs from April 2007 to February 2019. Patient demographics and medical comorbidities were collected, in addition to other procedures performed at the time of TAA. Patients were stratified by the need for flap coverage, and unadjusted inferential statistics were performed to evaluate the risk factors associated with subsequent need for flap coverage. Results: Among 2065 patients undergoing TAA, 28 (1.4%) patients required flap coverage after the index arthroplasty. Patients requiring flap coverage were older ( P = .045), had higher Charlson comorbidity indices ( P = .017), and had higher rates of diabetes and pulmonary disease ( P = .038). Patients requiring flap coverage also had higher rates of additional procedures ( P = .043, P = .007). The most common flap was a radial forearm free flap, which was performed in 14 (50%) patients. Twenty-one patients (75%) requiring flap coverage had a stable, plantigrade foot at median 1.5-year follow-up. Conclusion: Patient and operative risk factors, including advanced age, increased comorbidity burden, diabetes, pulmonary disease, and increased number of simultaneous procedures, were significantly associated with need for subsequent flap coverage. This should be considered as the indications for TAA expand. Level of Evidence: Level III, retrospective, prognostic cohort study.
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- 2021
13. Physical therapy to address fall risk in an individual with neurofibromatosis
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Robert B Adams, Tamara S Struessel, and Justin T Dudley
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Male ,030506 rehabilitation ,medicine.medical_specialty ,Neurofibromatoses ,Psychological intervention ,Poison control ,Physical Therapy, Sports Therapy and Rehabilitation ,Suicide prevention ,Occupational safety and health ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Injury prevention ,Humans ,Medicine ,Neurofibromatosis ,Gait ,Postural Balance ,Physical Therapy Modalities ,business.industry ,Middle Aged ,medicine.disease ,Berg Balance Scale ,Quality of Life ,Physical therapy ,0305 other medical science ,business ,030217 neurology & neurosurgery - Abstract
Background: While physical therapy may help improve function and quality of life in patients with neurofibromatosis (NF), a standard of care remains to be established. This case report describes the physical therapy management of an individual with NF who was at high fall risk.Case Description: A 61-year-old male with NF and multiple comorbidities was determined to be at high fall risk by the Dynamic Gait Index, Berg Balance Scale, and Modified Falls Efficacy Scale. Deficits included coordination and strength which limited his ability to ascend and descend stairs or walk on uneven terrain. This reduced his independence at home and in his rural community. Interventions incorporated components of hip and trunk coordination, and addressed balance, strength, and functional mobility.Outcomes: The patient scored above the cutoff for high fall risk on all outcome assessments.Discussion: This case report describes physical therapy management to reduce fall risk for an individual with NF. Due to the limited research on NF, the treatment plan was developed using evidence-based practice for fall-risk reduction in other neurological disorders.
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- 2021
14. Preoperative ERCP has no impact on islet yield following total pancreatectomy and islet autotransplantation (TPIAT): Results from the Prospective Observational Study of TPIAT (POST) cohort
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Martin L. Freeman, Kerrington D. Smith, Syed A. Ahmad, Luis F. Lara, Martin Wijkstrom, David B. Adams, Rebecca Mitchell, B. Joseph Elmunzer, Leslie Long-Simpson, Guru Trikudanathan, Gregory J. Beilman, James S. Hodges, Piotr Witkowski, Timothy L. Pruett, Sarah Jane Schwarzenberg, Jaimie D. Nathan, Bashoo Naziruddin, Betul Hatipoglu, Yi Yang, Timothy B. Gardner, Andrew M. Posselt, Varvara A. Kirchner, Katherine A. Morgan, Appakalai N. Balamurugan, Vikesh K. Singh, Darwin L. Conwell, Srinath Chinnakotla, Melena D. Bellin, and Maisam Abu-El-Haija
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Islets of Langerhans Transplantation ,digestive system ,Article ,Cohort Studies ,Islets of Langerhans ,Young Adult ,03 medical and health sciences ,Pancreatectomy ,0302 clinical medicine ,Recurrence ,medicine ,Humans ,Prospective Studies ,Child ,Aged ,Cholangiopancreatography, Endoscopic Retrograde ,Pancreatic duct ,geography ,Pancreas divisum ,geography.geographical_feature_category ,Endoscopic retrograde cholangiopancreatography ,Hepatology ,medicine.diagnostic_test ,business.industry ,Confounding ,Gastroenterology ,Pancreatic Diseases ,Middle Aged ,Islet ,medicine.disease ,digestive system diseases ,Autotransplantation ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Pancreatitis ,030220 oncology & carcinogenesis ,Cohort ,Female ,030211 gastroenterology & hepatology ,business - Abstract
BACKGROUND AND AIMS: Many patients undergoing total pancreatectomy with islet autotransplant (TPIAT) for severe, refractory chronic pancreatitis or recurrent acute pancreatitis have a history of endoscopic retrograde cholangiopancreatography (ERCP). Using data from the multicenter POST (Prospective Observational Study of TPIAT) cohort, we aimed to determine clinical characteristics associated with ERCP and the effect of ERCP on islet yield. METHODS: Using data from 230 participants (11 centers), demographics, pancreatitis history, and imaging features were tested for association with ERCP procedures. Logistic and linear regression were used to assess association of islet yield measures with having any pre-operative ERCPs and with the number of ERCPs, adjusting for confounders. RESULTS: 175 (76%) underwent ERCPs [median number of ERCPs (IQR) 2 (1–4)]. ERCP was more common in those with obstructed pancreatic duct (p=0.0009), pancreas divisum (p=0.0009), prior pancreatic surgery (p=0.005), and longer disease duration (p=0.004). A greater number of ERCPs was associated with disease duration (p
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- 2021
15. Challenges of Diagnosing Hyponatremic Syndromes in Pulmonary and Extra Pulmonary Tuberculosis
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Kingsley C. Anachuna, Ernest Afu Ochang, Echeng J. Imoke, Emmanuel B. Adams, Keneth O. Inaku, Atana Uket Ewa, Antigha I. Cobham, and Ekaete S. Brown
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Pediatrics ,medicine.medical_specialty ,Tuberculosis ,Pleural effusion ,business.industry ,Urinary system ,030232 urology & nephrology ,nutritional and metabolic diseases ,Cerebral salt-wasting syndrome ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Extra pulmonary tuberculosis ,Pediatrics, Perinatology and Child Health ,medicine ,Adrenal insufficiency ,Surgery ,030212 general & internal medicine ,business ,Hyponatremia ,Antidiuretic - Abstract
Introduction Pulmonary tuberculosis (PTB) is one of the rare pulmonary infections causing hyponatremia (serum sodium ˂135 mmol/L) and severe hyponatremia (serum sodium ˂125 mmol/L). Although the major cause of hyponatremia in TB patients is syndrome of inappropriate antidiuretic hormone (SIADH) secretion, cerebral salt wasting syndrome (CSWS) can occur and requires evidence of inappropriate urinary salt losses and reduced arterial blood volume. Adrenal insufficiency (AI) is rare in TB with scanty literature describing it. The two reported cases highlight three possible causes of severe symptomatic hyponatremia in TB pleural effusion and disseminated TB, their treatment modalities, and the need to increase the index of suspicion to diagnose TB hyponatremia in children. Case Report Case 1: a 10-year-old girl with TB pleural effusion who developed recurrent hyponatremia in the first few weeks of anti-TB treatment which was responsive to sodium correction. Case 2: an 8-year-old girl presenting to our facility with presumptive TB. She deteriorated over several months and progressed to disseminated TB with AI. Discussion Early diagnosis and prompt and correct treatment of TB hyponatremia cannot be overemphasized, as AI, SIADH secretion, and CSWS, each require different therapeutic regimens, most especially AI on its own poses a huge clinical challenge. Conclusion A high index of suspicion, with intensified case finding at all levels of care, is necessary to identify and manage children with TB hyponatremia because early diagnosis and prompt treatment is lifesaving.
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- 2021
16. Comparison of bacterial diversity and distribution on the gills of Atlantic salmon ( Salmo salar L.): an evaluation of sampling techniques
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James W. Wynne, Joel Slinger, and Mark B. Adams
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Gills ,Gill ,endocrine system ,animal structures ,Salmo salar ,Beta diversity ,Zoology ,Aquaculture ,Applied Microbiology and Biotechnology ,Fish Diseases ,03 medical and health sciences ,Diversity index ,RNA, Ribosomal, 16S ,Animals ,Salmo ,030304 developmental biology ,0303 health sciences ,Amoebic gill disease ,Bacteria ,biology ,030306 microbiology ,business.industry ,Microbiota ,Amebiasis ,General Medicine ,biology.organism_classification ,Mucus ,Species richness ,business ,Biotechnology - Abstract
Aims Assess bacterial diversity and richness in mucus samples from the gills of Atlantic salmon in comparison to preserved or fixed gill filament tissues. Ascertain whether bacterial diversity and richness are homogeneous upon different arches of the gill basket. Methods and Results Bacterial communities contained within gill mucus were profiled using 16S rRNA gene sequencing. No significant difference in taxa richness, alpha (P > 0·05) or beta diversity indices (P > 0·05) were found between the bacterial communities of RNAlater preserved gill tissues and swab‐bound mucus. A trend of lower richness and diversity indices were observed in bacterial communities from posterior hemibranchs. Conclusions Non‐lethal swab sampling of gill mucus provides a robust representation of bacterial communities externally upon the gills. Bacterial communities from the fourth arch appeared to be the least representative overall. Significance and Impact of the Study The external mucosal barriers of teleost fish (e.g. gill surface) play a vital role as a primary defence line against infection. While research effort on the role of microbial communities on health and immunity of aquaculture species continues, the collection and sampling processes to obtain these data require evaluation so methodologies are consistently applied across future studies that aim to evaluate the composition of branchial microbiomes.
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- 2020
17. The Impact of Preoperative Mental Health and Depression on Outcomes After Total Ankle Arthroplasty
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Nicholas B. Allen, Daniel J. Cunningham, Samuel B. Adams, James A. Nunley, and John R. Steele
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Male ,medicine.medical_specialty ,Visual analogue scale ,medicine.medical_treatment ,MEDLINE ,Arthroplasty, Replacement, Ankle ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Orthopedics and Sports Medicine ,Patient Reported Outcome Measures ,Depression (differential diagnoses) ,Aged ,Retrospective Studies ,030203 arthritis & rheumatology ,030222 orthopedics ,Depression ,business.industry ,Mental Disorders ,Retrospective cohort study ,Recovery of Function ,General Medicine ,Evidence-based medicine ,Middle Aged ,Mental health ,Arthroplasty ,humanities ,Treatment Outcome ,Preoperative Period ,Cohort ,Physical therapy ,Female ,Surgery ,business ,Follow-Up Studies - Abstract
BACKGROUND Preoperative mental health and depression have been shown to negatively impact patient-reported outcome measures after a broad array of orthopaedic procedures including total ankle arthroplasty. The hypothesis for this study was that decreased Short Form (SF)-36 Mental Component Summary (MCS) scores will modulate the impact of depression on patient-reported outcome measures after total ankle arthroplasty. METHODS All patients undergoing primary total ankle arthroplasty between January 2007 and December 2016 who were enrolled into a prospective outcomes study and who had at least 1-year minimum study follow-up were retrospectively reviewed. Patients were separated into 4 groups based on the presence or absence of an SF-36 MCS score of
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- 2020
18. The Surgeon’s Role in Gastric Electrical Stimulation Therapy for Gastroparesis
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Abigail Stocker, David B. Adams, William P. Lancaster, and Thomas L. Abell
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Gastric electrical stimulation ,medicine.medical_specialty ,Abdominal pain ,Gastrointestinal tract ,business.industry ,Nausea ,Gastroenterology ,Stimulation ,medicine.disease ,Neuromodulation (medicine) ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Vomiting ,Medicine ,030211 gastroenterology & hepatology ,Surgery ,Gastroparesis ,medicine.symptom ,business ,Intensive care medicine - Abstract
Gastroparesis, which can be viewed as a syndrome featuring nausea, vomiting, and abdominal pain, and associated other symptoms and findings, is increasingly seen by surgeons. Gastroparesis is associated with a number of gastrointestinal anatomic and physiologic findings. This article reviews the use of bioelectric therapy of neuromodulation, via gastric electrical stimulation, for patients with drug refractory gastroparesis syndromes including surgical aspects of device placement and subsequent management. In addition to an overall approach to the placement and subsequent management of gastric electrical stimulation devices, several newer concepts are discussed. The role of pyloric dysfunction in gastroparesis is also discussed including how stimulation devices and pyloric therapies may be used in concert. The additions of full-thickness gastrointestinal biopsies along with other physiologic, including GI electrophysiology, as well as some serologic measures, are also discussed. In addition, evolving approaches and emerging technologies for bioelectric neuromodulation of the gastrointestinal tract are introduced. Gastroparesis syndromes can be approached in a systematic manner based on known pathophysiology and when indicated can be helped with surgical therapies including neuromodulation.
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- 2020
19. Early Patient Discharge in Selected Patients is Not Associated With Higher Readmission After Major Abdominal Operations
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Victor M. Zaydfudim, Florence E. Turrentine, Reid B. Adams, Timothy L. McMurry, and R. Scott Jones
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Patient discharge ,medicine.medical_specialty ,Proctectomy ,business.industry ,Open colectomy ,Patient Readmission ,Patient Discharge ,Laparoscopic colectomy ,Surgery ,Postoperative Complications ,Risk Factors ,Unplanned readmission ,Humans ,Medicine ,In patient ,Abdominal operations ,business ,Early discharge ,Colectomy ,Major hepatectomy ,Retrospective Studies - Abstract
Our objective was to examine the associations between early discharge and readmission after major abdominal operations.Advances in patient care resulted in earlier patient discharge after complex abdominal operations. Whether early discharge is associated with patient readmissions remains controversial.Patients who had colorectal, liver, and pancreas operations abstracted in 2011-2017 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files were included. Patient readmission was stratified by 6 operative groups. Patients who were discharged before median discharge date within each operative group were categorized as an early discharge. Analyses tested associations between early discharge and likelihood of 30-day postoperative unplanned readmission.A total of 364,609 patients with major abdominal operations were included. Individual patient groups and corresponding median day of discharge were: laparoscopic colectomy (n = 152,575; median = 4), open colectomy (n =137,462; median = 7), laparoscopic proctectomy (n = 12,238; median = 5), open proctectomy (n = 24,925; median = 6), major hepatectomy (n = 9,805; median = 6), pancreatoduodenectomy (n = 27,604; median = 8). Early discharge was not associated with an increase in proportion of readmissions in any operative group. Early discharge was associated with a decrease in average proportion of patient readmissions compared to patients discharged on median date in each of the operative groups: laparoscopic colectomy 6% versus 8%, open colectomy 11% versus 14%, laparoscopic proctectomy 13% versus 16%, open proctectomy 13% vs 17%, major hepatectomy 8% versus 12%, pancreatoduodenectomy 16% versus 20% (all P ≤ 0.02). Serious morbidity composite was significantly lower in patients who were discharged early than those who were not in each operative group (all P0.001).Early discharge in selected patients after major abdominal operations is associated with lower, and not higher, rate of 30-day unplanned readmission.
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- 2020
20. Total Ankle Total Talus Replacement Using a 3D Printed Talus Component: A Case Report
- Author
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Jie Chen, Craig C. Akoh, and Samuel B. Adams
- Subjects
musculoskeletal diseases ,030222 orthopedics ,3d printed ,medicine.medical_specialty ,business.industry ,Tibiotalar joint ,medicine.medical_treatment ,Ankle replacement ,Pain relief ,Avascular necrosis ,030229 sport sciences ,musculoskeletal system ,medicine.disease ,Tibial plafond ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,Orthopedics and Sports Medicine ,Functional status ,Ankle ,business ,human activities - Abstract
The 3D custom total talus replacement is a novel treatment for avascular necrosis of the talus. However, patients who require a total talus replacement often have concomitant degenerative changes to the tibiotalar, subtalar, or talonavicular joints. The combined 3D custom total ankle-total talus replacement (TATTR) is used for patients with an unreconstructable talus and adjacent tibial plafond involvement. The goal of performing a TATTR is to provide pain relief, retain motion at the tibiotalar joint, maintain or improve the patient's functional status, and minimize limb shortening. TATTR is made possible by 3D printing. The advent of 3D printing has allowed for the accurate recreation of the native talar anatomy with a talar dome that can be matched to a total ankle replacement polyethylene bearing. In this article, we will discuss a case of talar avascular necrosis treated with a combined TATTR and review the current literature for TATTR.
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- 2020
21. Ignition and Burn in a Hybrid Nuclear Fuel for a Pulsed Rocket Engine
- Author
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Jason Cassibry, Brian Taylor, and Robert B. Adams
- Subjects
Nuclear reaction ,020301 aerospace & aeronautics ,Work (thermodynamics) ,Materials science ,Nuclear fuel ,business.industry ,Nuclear engineering ,Aerospace Engineering ,Context (language use) ,02 engineering and technology ,Parameter space ,01 natural sciences ,law.invention ,Ignition system ,0203 mechanical engineering ,law ,0103 physical sciences ,Uranium-235 ,Rocket engine ,business ,010303 astronomy & astrophysics - Abstract
This work explores the parameter space of a cylindrical hybrid nuclear fuel in support of a z-pinch driven pulsed fission-fusion (PuFF) engine. 0D power balance and 1D burn wave calculations have been performed to explore the parameter space of hybrid cylindrical nuclear fuels. The boundary of minimal initial conditions needed to reach breakeven are found within the context of the model. The effects of initial conditions upon the yield at the end of burn wave expansion are also determined. The model is used to examine the minimum initial energies predicted to result in yields of a few MJ. The goal of this work is to guide fuel design, inform future models and experiments as well as look for the most efficient parameter space for ignition in a z-pinch driven hybrid nuclear reaction. The impact of initial parameters upon ignition, burn, and gain are discussed. It is found that a hybrid cylindrical target may breakeven with initial energy near the axis of approximately 4–6 MJ in lithium deuteride/uranium 235 fuel. It is also found that magnetic field can lower the threshold further of which the magnitude changes across the parameter space. The dual fusion/fission reactions are found to boost each other leading to lower initial driving energies needed to reach breakeven in the hybrid cylindrical nuclear fuel.
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- 2020
22. The Use of Bone Grafts, Bone Graft Substitutes, and Orthobiologics for Osseous Healing in Foot and Ankle Surgery
- Author
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Fangyu Chen, Samuel B. Adams, Jonathan R. Peterson, Eugene Nwankwo, and Travis J. Dekker
- Subjects
medicine.medical_specialty ,allograft ,autograft ,Grafts bone ,03 medical and health sciences ,0302 clinical medicine ,Bone marrow aspirate ,lcsh:Orthopedic surgery ,stem cells ,medicine ,BMP ,Orthopedics and Sports Medicine ,Topical Review ,orthobiologics ,030222 orthopedics ,bone marrow aspirate ,business.industry ,Foot and ankle surgery ,030229 sport sciences ,PDGF ,Surgery ,lcsh:RD701-811 ,medicine.anatomical_structure ,surgical procedures, operative ,Ankle ,business ,Foot (unit) - Abstract
Achieving fusion in osseous procedures about the foot and ankle presents unique challenges to the surgeon. Many patients have comorbidities that reduce osseous healing rates, and the limited space and high weightbearing demand placed on fusion sites makes the choice of bone graft, bone graft substitute, or orthobiologic agent of utmost importance. In this review, we discuss the essential characteristics of grafts, including their osteoconductive, osteoinductive, osteogenic, and angiogenic properties. Autologous bone graft remains the gold standard and contains all these properties. However, the convenience and lack of donor site morbidity of synthetic bone grafts, allografts, and orthobiologics, including growth factors and allogenic stem cells, has led to these being used commonly as augments.Level of Evidence:Level V, expert opinion.
- Published
- 2022
23. Time and State Legislation Have Decreased Opioid Prescribing in Elective Foot and Ankle Surgery in the United States
- Author
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Daniel J. Cunningham, Samuel B. Adams, Nicholas F. Kwon, Andrew M. Hanselman, and Nicholas B. Allen
- Subjects
Orthopedic surgery ,medicine.medical_specialty ,business.industry ,Foot and ankle surgery ,Legislation ,Perioperative ,Evidence-based medicine ,Article ,Opioid ,Emergency medicine ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Podiatry ,Medical prescription ,business ,Oxycodone ,RD701-811 ,Cohort study ,medicine.drug - Abstract
Category: Other; Ankle; Ankle Arthritis; Arthroscopy; Bunion; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports Introduction/Purpose: The opioid epidemic has focused attention on opioid overprescribing. State legislation has been enacted to reduce acute opioid prescribing. However, the impact of this legislation on elective foot and ankle surgery is largely unknown. The purpose of this study was to evaluate the impact of opioid limiting legislation on opioid prescribing in elective foot and ankle surgery. Methods: 90-day perioperative opioid prescription filling in oxycodone 5-mg equivalents was identified in all patients ages 18 and older undergoing non-trauma, non-arthroplasty foot and ankle surgery from 2010 - 2019 using a commercial database. States with and without legislation were identified and opioid prescription filling before and after legislation was tabulated. Unadjusted and adjusted analyses were performed to evaluate the impact of time and state legislation on perioperative opioid prescribing in this patient population. Results: Initial and cumulative opioid prescribing decreased significantly from 2010 to 2019 (39 vs 35.7 initial and 98.1 vs 55.7 cumulative oxycodone 5-mg equivalents, pConclusion: State legislation and time have been associated with large, clinically relevant reductions in 90-day perioperative cumulative opioid prescription filling although reductions in initial opioid prescription filing have remained low. These results encourage states without legislation to enact restraints to reduce the impact of the opioid epidemic.
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- 2022
24. State Regulation Positively Impacts Opioid Prescribing Patterns in Ankle Fracture Surgery: A National and State-Level Analysis
- Author
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Daniel J. Cunningham, Samuel B. Adams, Michael Blatter, and Mark J. Gage
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medicine.medical_specialty ,Adolescent ,Ankle Fractures ,Medicare ,Article ,Cohort Studies ,Humans ,Medicine ,Practice Patterns, Physicians' ,Medical prescription ,Aged ,Retrospective Studies ,General Environmental Science ,Orthopedic surgery ,Pain, Postoperative ,business.industry ,Perioperative ,United States ,Analgesics, Opioid ,Opioid ,Pill ,Emergency medicine ,General Earth and Planetary Sciences ,Current Procedural Terminology ,business ,Medicaid ,Oxycodone ,RD701-811 ,medicine.drug ,Cohort study - Abstract
Category: Ankle; Trauma Introduction/Purpose: The impact of time and state regulation on opioid prescribing in orthopaedic trauma is not well known. The purpose of this study is to evaluate the impact of time and state-level opioid legislation on 90-day perioperative opioid prescribing in ankle fracture surgery from 2010 - 2019. Methods: This is a retrospective, cohort study using a national insurance database including commercial insurance, Medicare, Medicaid, and cash pay patients to evaluate 90-day perioperative opioid prescription filling in 40,286 patients ages 18 and older undergoing Current Procedural Terminology codes 27766, 27769, 27792, 27814, 27822, and/or 27823 between 2010 and 2019 in all 50 United States. The primary study outcome was initial and cumulative 90-day perioperative opioid prescription filling and rates of filling and refills. Results: Mean first prescription volume has not changed dramatically from 2010 (37 oxycodone 5-mg pills) to 2019 (33.3 oxycodone 5-mg pills). However, cumulative prescriptions within the 90-day perioperative timeframe have decreased considerably from 2010 (128.5 oxycodone 5-mg pills) to 2019 (70.4 oxycodone 5-mg pills, pConclusion: In ankle fracture surgery, cumulative opioid prescribing has decreased dramatically over time. In addition, states with opioid prescribing legislation had larger reductions in perioperative opioid prescribing compared to states without opioid legislation. Legislation targeting duration or duration and volume had the largest impacts on opioid prescribing.
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- 2022
25. Performance and Characterization of a Neutral Beam Propulsion Technology Demonstrator
- Author
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Christine Hartzell, Anthony J. DeCicco, Kurt A. Polzin, Thomas Leps, and Robert B. Adams
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Materials science ,Ion beam ,business.industry ,Aerospace Engineering ,Faraday cup ,Thrust ,Plasma ,Propulsion ,Ion source ,symbols.namesake ,Electrically powered spacecraft propulsion ,Physics::Plasma Physics ,Space and Planetary Science ,Physics::Space Physics ,symbols ,Aerospace engineering ,business ,Beam (structure) - Abstract
A neutral beam propulsion technology demonstrator has been fabricated and tested. It uses gas diffusion neutralization to create a globally neutral plasma from an ion source. Thrust measurements fo...
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- 2020
26. Artificial Intelligence and Echocardiography: A Primer for Cardiac Sonographers
- Author
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Madeline Jankowski, Peg Knoll, Ashlee Davis, Richie Palma, Kristen Billick, David B. Adams, Kenneth Horton, Alan Paloma, and Jane E. Marshall
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CNN, Convolutional neural network ,Artificial intelligence ,business.industry ,AI, Artificial intelligence ,Deep learning ,030204 cardiovascular system & hematology ,Article ,Patient care ,030218 nuclear medicine & medical imaging ,Machine Learning ,03 medical and health sciences ,0302 clinical medicine ,Echocardiography ,EF, Ejection fraction ,Sonographer ,Medical imaging ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,business ,Neural networks ,Forecasting - Abstract
Artificial intelligence (AI) is emerging as a key component in diagnostic medical imaging, including echocardiography. AI with deep learning has already been used with automated view labeling, measurements, and interpretation. As the development and use of AI in echocardiography increase, potential concerns may be raised by cardiac sonographers and the profession. This report, from a sonographer's perspective, focuses on defining AI, the basics of the technology, identifying some current applications of AI, and how the use of AI may improve patient care in the future., Highlights • AI will have a strong role in echocardiography. • AI will guide image acquisition and optimization. • AI for image analysis may aid in interpretation. • AI is a tool that will not replace sonographers but will help them be more efficient.
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- 2020
27. Understanding the Role of Past Health Care Discrimination in Help-Seeking and Shared Decision-Making for Depression Treatment Preferences
- Author
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Sherry Shu Yeu Hou, Farah N. Shaikh, Jonathan Delman, Maria Jose Sanchez Roman, Leslie B. Adams, Timothy B. Creedon, Esther Y. Lee, Natasha A. Kaushal, Valeria Chambers, Ora Nakash, Ziva Mann, Frederick Lu, Adam C. Carle, Deborah Delman, Afsaneh Moradi, Tali Flomenhoft, Rajan A. Sonik, Nathaniel M. Tran, Dierdre Jordan, Danny McCormick, Dharma E. Cortés, Benjamin Lê Cook, Ruth Nabisere, Michael Flores, Caryn R.R. Rodgers, Heba Abolaban, Margo Moyer, Catherine Rodriguez Quinerly, Nicholas Carson, Ana M. Progovac, and Selma de Castro
- Subjects
Adult ,Semi-structured interview ,media_common.quotation_subject ,Ethnic group ,Social class ,Social issues ,Racism ,03 medical and health sciences ,0302 clinical medicine ,Health care ,Ethnicity ,Humans ,030212 general & internal medicine ,media_common ,Depression ,business.industry ,Public Health, Environmental and Occupational Health ,Hispanic or Latino ,Patient Acceptance of Health Care ,Mental health ,Help-seeking ,030227 psychiatry ,Black or African American ,business ,Psychology ,Delivery of Health Care ,Clinical psychology - Abstract
As a part of a larger, mixed-methods research study, we conducted semi-structured interviews with 21 adults with depressive symptoms to understand the role that past health care discrimination plays in shaping help-seeking for depression treatment and receiving preferred treatment modalities. We recruited to achieve heterogeneity of racial/ethnic backgrounds and history of health care discrimination in our participant sample. Participants were Hispanic/Latino ( n = 4), non-Hispanic/Latino Black ( n = 8), or non-Hispanic/Latino White ( n = 9). Twelve reported health care discrimination due to race/ethnicity, language, perceived social class, and/or mental health diagnosis. Health care discrimination exacerbated barriers to initiating and continuing depression treatment among patients from diverse backgrounds or with stigmatized mental health conditions. Treatment preferences emerged as fluid and shaped by shared decisions made within a trustworthy patient–provider relationship. However, patients who had experienced health care discrimination faced greater challenges to forming trusting relationships with providers and thus engaging in shared decision-making processes.
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- 2020
28. Standards for reporting on surgery for chronic pancreatitis: a report from the International Study Group for Pancreatic Surgery (ISGPS)
- Author
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Markus W. Büchler, Catherine Morgan, Kevin C. Conlon, Keith D. Lillemoe, John P. Neoptolemos, Massimo Falconi, Helmut Friess, Carlos Fernandez-del Castillo, Dejan Radenkovic, Nicholas J. Zyromski, Martin Smith, S. Burmeister, Claudio Bassi, Richard D. Schulick, Santhalingam Jegatheeswaran, Marc G. Besselink, Ajith K. Siriwardena, Hjalmar C. van Santvoort, Shailesh V. Shrikhande, John A. Windsor, Jakob R. Izbicki, Luca Gianotti, Christos Dervenis, Giovanni Marchegiani, Roland Andersson, Attila Oláh, Minas Baltatzis, J. Devar, Marco Del Chiaro, Mustapha Adham, Igor Khatkov, Olivier R. Busch, Thilo Hackert, David B. Adams, Giuseppe Garcea, Andrew Smith, Charles M. Vollmer, Ioannis Passas, Surgery, AGEM - Digestive immunity, AGEM - Endocrinology, metabolism and nutrition, AGEM - Re-generation and cancer of the digestive system, Siriwardena, A, Windsor, J, Zyromski, N, Marchegiani, G, Radenkovic, D, Morgan, C, Passas, I, Olah, A, Conlon, K, Smith, M, Busch, O, Baltatzis, M, Besselink, M, Vollmer, C, Castillo, C, Friess, H, Garcea, G, Burmeister, S, Hackert, T, Lillemoe, K, Schulick, R, Shrikhande, S, Smith, A, Gianotti, L, Falconi, M, Adams, D, Adham, M, Andersson, R, Del Chiaro, M, Devar, J, Jegatheeswaran, S, van Santvoort, H, Khatkov, I, Izbicki, J, Buchler, M, Neoptolemos, J, Bassi, C, and Dervenis, C
- Subjects
medicine.medical_specialty ,Outcome Assessment ,medicine.medical_treatment ,education ,MEDLINE ,Disease ,030230 surgery ,Outcome assessment ,Pancreatic surgery ,Pancreaticoduodenectomy ,03 medical and health sciences ,0302 clinical medicine ,Pancreatitis, Chronic ,Pancreaticojejunostomy ,Outcome Assessment, Health Care ,medicine ,Humans ,Chronic ,Pancreas ,Project group ,business.industry ,medicine.disease ,3. Good health ,Surgery ,Health Care ,medicine.anatomical_structure ,Pancreatitis ,030220 oncology & carcinogenesis ,business - Abstract
Background: The International Study Group for Pancreatic Surgery provides globally accepted definitions for reporting of complications after pancreatic surgery. This International Study Group for Pancreatic Surgery project aims to provide a standardized framework for reporting of the results of operative treatment for chronic pancreatitis. Methods: An International Study Group for Pancreatic Surgery project circulation list was created with pre-existing and new members and including gastroenterologists in addition to surgeons. A computerized search of the literature was undertaken for articles reporting the operative treatment of chronic pancreatitis. The results of the literature search were presented at the first face-to-face meeting of this International Study Group for Pancreatic Surgery project group. A document outlining proposed reporting standards was produced by discussion during an initial meeting of the International Study Group for Pancreatic Surgery. An electronic questionnaire was then sent to all current members of the International Study Group for Pancreatic Surgery. Responses were collated and further discussed at international meetings in North America, Europe, and at the International Association of Pancreatology World Congress in 2019. A final consensus document was produced by integration of multiple iterations. Results: The International Study Group for Pancreatic Surgery consensus standards for reporting of surgery in chronic pancreatitis recommends 4 core domains and the necessary variables needed for reporting of results: clinical baseline before operation; the morphology of the diseased gland; a new, standardized, operative terminology; and a minimum outcome dataset. The 4 domains combine to give a comprehensive framework for reports. Conclusion: Adoption of the 4 domains of the International Study Group for Pancreatic Surgery reporting standards for surgery for chronic pancreatitis will facilitate comparison of results between centers and help to improve the care for patients with this debilitating disease.
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- 2020
29. A Qualitative Evaluation of Tobacco Consumption in the Rural Context
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Ashley Sanders-Jackson, Robyn B. Adams, and Raymond A. Jussaume
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Consumption (economics) ,Health (social science) ,Public economics ,Health Policy ,Public Health, Environmental and Occupational Health ,Context (language use) ,Business - Abstract
Objectives: Understanding what rural adult tobacco users think about tobacco use, tobacco control policies and health may help create acceptable policies and interventions. Methods: We completed 8 focus groups in rural Michigan from winter 2016 through summer 2018. Interviews were transcribed and an iterative thematic analysis was completed during fall 2018. Results: Although our primary themes of Independence, Respect, Social Context, Economic Calculus, and Policy with an underlying theme of health were similar to themes that typically arise in tobacco control research, their application and social context appear to be unique in rural communities. Issues of respect for tobacco users, and well as third-party individuals affected by tobacco use, were paramount for participants. They viewed tobacco use as an individual choice and not a structural or policy-relevant issue, although they accepted restrictions on tobacco use in most settings where non-smokers are present. Conclusions: Participants understood that smoking is problematic and seem to be open to anti-smoking messaging and policies when correctly framed. Participants blame themselves for their smoking (ignoring industry responsibility) and used language that can be found in tobacco marketing. Framing tobacco control as a way to protect children while respecting smokers as people may be successful.
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- 2020
30. Dry Cleaner Releases and Forensic Considerations
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Joseph B. Adams, Adam H. Love, Bjorn Wespestad, and Chase A. Gerbig
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Forensic science ,Waste management ,Liability ,Business ,Management, Monitoring, Policy and Law ,Dry cleaner - Abstract
Upfront consideration of historical operations and potentially valuable forensic information/data helps to ensuring the cleanup liability at dry cleaner sites can be equitably divided. While each s...
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- 2020
31. Metal-on-Metal Total Hip Revisions: Pearls and Pitfalls
- Author
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Jesua I. Law, David A. Crawford, Adolph V. Lombardi, and Joanne B. Adams
- Subjects
Reoperation ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,Arthroplasty, Replacement, Hip ,General surgery ,Total hip replacement ,Metal debris ,Prosthesis Design ,Prosthesis Failure ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Risk stratification ,Metal-on-Metal Joint Prostheses ,medicine ,Humans ,Orthopedics and Sports Medicine ,Hip Prosthesis ,business ,Total hip arthroplasty - Abstract
Background At the turn of the 21st century, there was a re-emergence of metal-on-metal (MoM) articulation with 35% of all total hip arthroplasty implants having MoM articulation. Approximately 10 years after its peak use, MoM articulation began to decrease dramatically as revisions became more apparent because of adverse reaction to metal debris. Today, there are surveillance guidelines and reconstructive clinical pearls a surgeon should recognize. Methods This article gives a literature-based overview of clinical pearls and discusses how to avoid pitfalls when performing revision of a metal-on-metal total hip arthroplasty. Results Patients with MoM can be risk-stratified based on symptom, implant, and testing variables. Those patients who are symptomatic and/or develop adverse reaction to metal debris with local tissue destruction will require a revision. The revision of MoM can be challenging due to bone and soft tissue destruction. Constraint may be needed in cases of abductor deficiency. Conclusion Although MoM implants for THA have declined significantly, surgeons are still faced with the revision burden from a decade of high use. Risk stratification tools are available to aid in revision decision making, and the surgeon should be prepared to address the challenges these revisions present.
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- 2020
32. Three-Dimensional Printed Cage in Patients With Tibiotalocalcaneal Arthrodesis Using a Retrograde Intramedullary Nail: Early Outcomes
- Author
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Akhil Sharma, Selene G. Parekh, Lorena Bejarano-Pineda, and Samuel B. Adams
- Subjects
medicine.medical_specialty ,business.industry ,Nonunion ,Hindfoot arthrodesis ,Arthrodesis ,Bone Nails ,medicine.disease ,law.invention ,Surgery ,Radiography ,Intramedullary rod ,law ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Tibiotalocalcaneal arthrodesis ,In patient ,Ankle ,Podiatry ,business ,Ankle Joint - Abstract
Introduction. Segmental bone loss in the hindfoot hinders the chance of successful outcomes. Tibiotalocalcaneal arthrodesis is a reliable option; nevertheless, the risk of nonunion is high. Three-dimensional (3D) printed titanium implants offer a strong scaffold that can be customized and has demonstrated encouraging healing rates. In this study, we described the clinical outcomes and the radiologic union rate of a case series of patients with hindfoot arthrodesis, using a retrograde intramedullary nail associated to a 3D printed titanium cage. Methods. Seven patients undergoing hindfoot arthrodesis, using a retrograde intramedullary nail associated to a custom 3D printed titanium cage, were included. Demographic data were collected. Functional outcomes were assessed using the American Orthopedic Foot and Ankle Score and the Visual Analogue Scale for pain. Hindfoot alignment and radiographic union were evaluated using weight-bearing radiographs and computed tomography scan, respectively. Results. A total of 6 (85%) patients had more than 50% bony bridging. Only 1 patient underwent below knee amputation due to recurrence of chronic osteomyelitis. Two additional patients had minor complications. Conclusion. Tibiotalocalcaneal arthrodesis using customized titanium cages for patients with large bone defects has shown a high rate of union in those at risk of nonunion. However, further research with larger series is needed. Levels of Evidence: Level IV: Case series
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- 2020
33. Adoption of low tidal volume ventilation in the emergency department: A quality improvement intervention
- Author
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Brian E. Driver, Crystal Donelan, Alexander B. Adams, Alex O’Brien-Lambert, Sum Ambur, Matthew E. Prekker, and Daniel G. Hottinger
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Quality management ,medicine.medical_treatment ,Lung injury ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,Tidal Volume ,medicine ,Humans ,Tidal volume ,Aged ,Mechanical ventilation ,business.industry ,030208 emergency & critical care medicine ,General Medicine ,Emergency department ,Middle Aged ,Quality Improvement ,Respiration, Artificial ,Confidence interval ,Low tidal volume ,Ventilation (architecture) ,Emergency medicine ,Emergency Medicine ,Female ,Emergency Service, Hospital ,business - Abstract
Ventilator tidal volumes of8 mL/kg of predicted body weight (PBW) may increase the risk of lung injury. We sought to evaluate the impact of a quality improvement intervention among intubated Emergency Department (ED) patients to protocolize the prescription of low tidal volume ventilation.In this before-and-after study, the average tidal volume delivered to ED patients receiving volume assist-control ventilation was compared before (2007-2014) and after (2015-2016) implementation of a ventilator initiation protocol (the quality improvement intervention). The intervention emphasized 1) measurement of the patient's height to calculate PBW and therefore tailor the tidal volume to estimated lung size (8 mL/kg PBW), and 2) focused education and reference materials for ED physicians and respiratory therapists.Among ventilated ED patients meeting inclusion criteria in the before (N = 2185) and after (N = 774) cohorts, the mean (±SD) tidal volume decreased from 9.0 ± 1.4 mL/kg to 7.2 ± 0.9 mL/kg PBW following the intervention (absolute difference 1.8 mL/kg, 95% confidence interval 1.7 to 1.9 mL/kg, p 0.001). The proportion of patients receiving low tidal volume ventilation increased after the intervention (72%), as compared to before (23%). Low tidal volume ventilation continued to be utilized at 24 h after ICU admission in patients who remained intubated in the cohort following the intervention (mean tidal volume 7.3 mL/kg PBW).Pairing a ventilator initiation protocol with focused education and resources for emergency physicians and respiratory therapists was associated with a significant reduction in tidal volume delivered to ED patients.
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- 2020
34. Testicular Cancer Incidence and Mortality Within Rural and Urban Regions
- Author
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Wesley B Adams, Ryan Lockwood, Mike Craycraft, Skyler Taylor, and Michael J. Rovito
- Subjects
Adult ,Male ,Rural Population ,medicine.medical_specialty ,Adolescent ,Urban Population ,Ethnic group ,Context (language use) ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Testicular Neoplasms ,Health care ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Young adult ,business.industry ,Incidence ,Incidence (epidemiology) ,Public health ,Middle Aged ,Oncology ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,Pacific islanders ,business ,Demography - Abstract
Purpose: Testicular cancer (TCa) is among the most common cancers within adolescent and young adult (AYA) male populations. However, information is limited to variations in incidence and mortality outside of racial/ethnic subgroups. Rural regions historically have a greater overall cancer incidence than urban regions, although some key differences exist regarding site. TCa-specific incidence and mortality disparities are not commonly reported in this context. This study aims to help fill that gap by providing discovery evidence if there is an association between US rural/urban regions and TCa incidence and mortality. Methods: Secondary analysis of Surveillance, Epidemiology, and End Results incidence and mortality data were employed to determine if rural/urban TCa incidence and mortality disparities exist among U.S. males. Results: There was a 2.6% increased rate of TCa in U.S. urban as compared with rural geographic regions from 2011 to 2015. When geographic region is disaggregated, rural regions see higher rates than urban. When factoring in race/ethnicity, White/Caucasians and Hispanics had statistically higher urban rates whereas American Indian/Alaskan Natives and Asian/Pacific Islander groups had statistically higher rural rates. Conclusion: Geographic regional TCa variation research is virtually nonexistent for U.S. males, specifically AYAs of color. Determining preliminary trends in rural and urban regions can assist in the creation of more targeted services, particularly among underserved and vulnerable populations that have tenuous access to health care, to reduce disparate health outcomes. Exploring geographic differences in TCa incidence and mortality can have implications within service industry, health care accessibility, and public health justice areas of research and outreach.
- Published
- 2020
35. Inflammatory cytokines and matrix metalloproteinases in the synovial fluid after intra-articular elbow fracture
- Author
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Marc J. Richard, Angel Chen, Samuel B. Adams, Alexander J. Lampley, Elizabeth P. Wahl, and Dana L. Nettles
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Intra-Articular Fractures ,medicine.medical_treatment ,Elbow ,Type II collagen ,Proinflammatory cytokine ,03 medical and health sciences ,0302 clinical medicine ,Synovial Fluid ,medicine ,Humans ,Synovial fluid ,Orthopedics and Sports Medicine ,Prospective Studies ,Collagen Type II ,Aged ,Aged, 80 and over ,Inflammation ,Hematoma ,030222 orthopedics ,Elbow fracture ,business.industry ,Cartilage ,030229 sport sciences ,General Medicine ,Middle Aged ,Matrix Metalloproteinases ,Peptide Fragments ,Cytokine ,medicine.anatomical_structure ,Case-Control Studies ,Cytokines ,Female ,Surgery ,Contracture ,medicine.symptom ,Elbow Injuries ,business - Abstract
Background and hypothesis Post-traumatic elbow contracture remains a common and challenging complication with often unsatisfactory outcomes. Although the etiology is unknown, elevated or abnormal post-fracture synovial fluid cytokine levels may result in the migration of fibroblasts to the capsule and contribute to capsular pathology. Thus, the purpose of this study was to characterize the cytokine composition in the synovial fluid fracture hematoma of patients with intra-articular elbow fractures. Methods The elbow synovial fluid fracture hematoma of 11 patients with intra-articular elbow fractures was analyzed for CTXII (C-terminal telopeptides of type II collagen [a cartilage breakdown product]) as well as 15 cytokines and matrix metalloproteinases (MMPs) including interferon γ, interleukin (IL) 1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, tumor necrosis factor α, MMP-1, MMP-2, MMP-3, MMP-9, and MMP-10. The uninjured, contralateral elbow served as a matched control. Mean concentrations of each factor were compared between the fluid from fractured elbows and the fluid from control elbows. Results The levels of 14 of 15 measured cytokines and MMPs—interferon γ, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, tumor necrosis factor α, MMP-1, MMP-3, MMP-9, and MMP-10—were significantly higher in the fractured elbows. In addition, post hoc power analysis revealed that 10 of 14 significant differences were detected with greater than 90% power. The mean concentration of CTXII was not significantly different between groups. Conclusions These results demonstrate a proinflammatory environment after fracture that may be the catalyst to the development of post-traumatic elbow joint contracture. The cytokines with elevated levels were similar, although not identical, to the cytokines with elevated levels in studies of other weight-bearing joints, indicating the elbow responds uniquely to trauma.
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- 2020
36. Development of LepReact, a defined skin test for paucibacillary leprosy and low-level M. leprae infection
- Author
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Steven G. Reed, Richard W. Truman, Maria T. Pena, Alessandro Picone, Linda B. Adams, Malcolm S. Duthie, Amit P. Khandhar, and Zachary MacMillen
- Subjects
0303 health sciences ,medicine.medical_specialty ,biology ,030306 microbiology ,Transmission (medicine) ,business.industry ,General Medicine ,Skin test ,biology.organism_classification ,medicine.disease ,Applied Microbiology and Biotechnology ,03 medical and health sciences ,Immune system ,Antigen ,Chemoprophylaxis ,Immunology ,Epidemiology ,medicine ,Leprosy ,business ,Mycobacterium leprae ,030304 developmental biology ,Biotechnology - Abstract
The persistence of new leprosy cases in endemic areas such as India, Brazil, Bangladesh, and the Philippines has encouraged studies of chemoprophylaxis among contacts of patients. Epidemiological screening tools to enable early detection of infected individuals in endemic populations would be critical to target individuals most in need of intervention. Despite decades of attempts, however, there still are no tests available for the early detection of low-level infection with Mycobacterium leprae. In this report, we describe the development of a leprosy skin test using M. leprae-specific antigens. We selected the chimeric LID-1 fusion protein, formulated to achieve maximum performance at a minimal dose, as a skin test candidate based on its ability to elicit delayed-type hypersensitivity (DTH) reactions in M. leprae immune guinea pigs in a sensitive and specific manner, i.e., with no cross-reactivity observed with other mycobacterial species. Importantly, evaluations in armadillos indicated that intradermal inoculation of formulated LID-1 could distinguish uninfected from M. leprae-infected animals manifesting with symptoms distinctly similar to the PB presentation of patients. Together, our data provide strong proof-of-concept for developing an antigen-specific skin test to detect low-level M. leprae infection. Such a test could, when applied with appropriate use of chemo- and/or immunoprophylaxis, be instrumental in altering the evolution of clinical disease and M. leprae transmission, thus furthering the objective of zero leprosy.
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- 2020
37. From orchards to chips: Silicon Valley’s evolving entrepreneurial ecosystem
- Author
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Stephen B. Adams
- Subjects
Economics and Econometrics ,Entrepreneurship ,Silicon valley ,business.industry ,05 social sciences ,Environmental resource management ,0211 other engineering and technologies ,021107 urban & regional planning ,02 engineering and technology ,Development ,High tech ,Indigenous ,Geography ,0502 economics and business ,Ecosystem ,Business and International Management ,business ,050203 business & management ,Entrepreneurial ecosystem - Abstract
The initial development of Silicon Valley and its indigenous start-ups relied on various endowments, including abundant resources and a set of institutions and know-how inherited from previous indu...
- Published
- 2020
38. Particulated juvenile articular cartilage allograft transplantation for osteochondral lesions of the knee and ankle
- Author
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Travis J. Dekker, Samuel B. Adams, and Colleen M. Wixted
- Subjects
Cartilage, Articular ,Allograft transplantation ,medicine.medical_specialty ,Adolescent ,Knee Joint ,Biomedical Engineering ,Articular cartilage ,030204 cardiovascular system & hematology ,Talus ,No donors ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Transplantation, Homologous ,Medicine ,Limited evidence ,Surgical approach ,business.industry ,Hyaline cartilage ,Cartilage ,General Medicine ,Allografts ,Surgery ,medicine.anatomical_structure ,Ankle ,business ,030217 neurology & neurosurgery - Abstract
Introduction: Osteochondral lesions have been challenging to treat due to the limited regenerative capacity of native hyaline cartilage. Although surgical options are available, a newer technique, Particulated Juvenile Cartilage Allograft Transplantation (PJCAT) has shown promise for lesions of the knee and ankle. Short-term studies have been encouraging of its use, but there is still limited evidence of its long-term durability.Areas covered: This review will summarize the surgical options currently available for osteochondral lesions, outline the indications and contraindications of PJCAT, present the basic science and clinical evidence of the procedure, and describe the surgical approaches of this technique.Expert opinion: PJCAT is a promising method to treat osteochondral lesions. However, continued research is needed to document the efficacy of this technique and potential superiority over other techniques. Benefits include ease of application, potential for arthroscopic or minimally invasive delivery, no need for perpendicular access, no donor site morbidity, and delivery of viable chondrocytes in hyaline cartilage.
- Published
- 2020
39. Mid-Term Survivorship of a Novel Constrained Acetabular Device
- Author
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Joanne B. Adams, Adolph V. Lombardi, Michael J. Morris, Keith R. Berend, David A. Crawford, and Kenneth W. Brown
- Subjects
Reoperation ,musculoskeletal diseases ,medicine.medical_specialty ,Arthroplasty, Replacement, Hip ,Aseptic loosening ,Survivorship ,Prosthesis Design ,03 medical and health sciences ,0302 clinical medicine ,Survivorship curve ,medicine ,Humans ,Orthopedics and Sports Medicine ,Recurrent instability ,Stage (cooking) ,Survival rate ,Retrospective Studies ,030222 orthopedics ,business.industry ,Acetabulum ,Prosthesis Failure ,Surgery ,Treatment Outcome ,Cohort ,Hip Prosthesis ,Aseptic processing ,Complication ,business ,Follow-Up Studies - Abstract
Background Recurrent instability after total hip arthroplasty is a difficult complication. In certain cases, a constrained acetabular device is needed to address these issues. The purpose of this study is to report the midterm outcomes and survivorship of a single novel constrained liner device. Methods A retrospective review as performed on all procedures (except first stage exchange for infection) in which a Freedom Constrained (Zimmer Biomet, Warsaw, IN) liner was used between December 2003 and November 2016. Patients with 2-year minimum follow-up or failure were included, yielding a cohort of 177 patients. Procedures were 130 aseptic revisions, 40 reimplantations following infection eradication, and 7 complex primaries. The constrained mechanism was implanted in 46 hips (26%) to treat active instability and 131 hips (74%) for increased risk of instability and intraoperative instability. Patients had on average 3.4 previous surgeries. Results With an average 7.1-year follow-up, 11 hips dislocated (6.2%), and 13 hips (7.3%) were revised for acetabular aseptic loosening, resulting in an overall constrained aseptic or mechanical failure rate of 13.6%. Nineteen hips (10.7%) failed from infection with 58% of these having had a previous infection. Patients with active instability had significantly higher failure for dislocation than patients who were at risk (15.2% vs 3%, P = .01). All-cause survival rate at 7 years was 74.8%, aseptic survival was 83.6%, and survival for instability was 91.8%. Conclusion Revision for instability remains challenging as many patients have had numerous previous surgeries and at-risk anatomy. Constrained inserts are one option to manage instability, but a high rate of recurrence can still occur.
- Published
- 2020
40. Assessing the Social Validity of a Telepractice Training and Coaching Intervention
- Author
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Michelle M. Sands, Hedda Meadan, Nicole B. Adams, Melinda R. Snodgrass, Moon Y. Chung, Rebecca E. Hacker, and Susan S. Johnston
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Social communication skills ,business.industry ,education ,05 social sciences ,Applied psychology ,Psychological intervention ,050301 education ,Service provider ,Coaching ,Education ,Change agent ,Intervention (counseling) ,Social validity ,Developmental and Educational Psychology ,0501 psychology and cognitive sciences ,Communication skills ,business ,Psychology ,0503 education ,050104 developmental & child psychology - Abstract
Developing communication skills is critical for all young children, especially for those receiving early intervention (EI) services. Thus, many researchers have investigated evidence-based practices for teaching social communication skills. In an attempt to minimize the gap between research and practice, research investigating training caregivers to use communication teaching strategies has been conducted and replicated. In many studies, interventions have been delivered by researchers rather than natural change agents. The purpose of this study was to assess the social validity of a caregiver-implemented communication strategies intervention program in which the caregiver was trained and coached by a natural change agent, the family’s EI service provider, via telepractice. We analyzed multiple sources of data to investigate the social validity of the intervention program. We found that some aspects of the program had high levels of social validity (e.g., goals and outcomes). Other aspects of the program had lower levels of social validity (e.g., procedures and technology use). The findings, limitations, and implications for practice and research are discussed.
- Published
- 2020
41. A Novel Technique for Creating an Articulating Cement Spacer for Ankle Prosthetic Joint Infections
- Author
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Samuel B. Adams, Adam Short, and Colin T. Penrose
- Subjects
Reoperation ,Novel technique ,medicine.medical_specialty ,Prosthesis-Related Infections ,Prosthetic joint ,Joint Prosthesis ,Cement spacer ,Prosthesis Design ,Arthroplasty, Replacement, Ankle ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Muscle contracture ,030203 arthritis & rheumatology ,030222 orthopedics ,business.industry ,Bone Cements ,Soft tissue ,Anti-Bacterial Agents ,Surgery ,medicine.anatomical_structure ,Debridement ,Total ankle arthroplasty ,Anterior approach ,Ankle ,business ,Ankle Joint - Abstract
Total ankle arthroplasty has been increasing as a treatment for end-stage ankle arthritis. With this increase, the incidence of total ankle prosthetic infections will also increase. Treatment of these infections depends on the duration of symptoms and whether the infection is acute or chronic in presentation. The treatment of choice for chronic infections is a 2-stage procedure, the removal of implants and placement of a static cement spacer. We describe a technique for creating an articulating antibiotic cement spacer through an anterior approach in a patient with an infected total ankle arthroplasty. The articulating antibiotic cement spacer allows high doses of local antibiotics, decreases soft tissue contractures, and allows continued motion of the joint.
- Published
- 2020
42. Higher Activity Level Following Total Knee Arthroplasty Is Not Deleterious to Mid-Term Implant Survivorship
- Author
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David A. Crawford, Adolph V. Lombardi, Joanne B. Adams, Keith R. Berend, and Gerald R. Hobbs
- Subjects
Reoperation ,musculoskeletal diseases ,Activity level ,medicine.medical_specialty ,Knee Joint ,Total knee arthroplasty ,Aseptic loosening ,03 medical and health sciences ,0302 clinical medicine ,Survivorship curve ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Arthroplasty, Replacement, Knee ,Exercise ,Survival analysis ,Retrospective Studies ,030222 orthopedics ,business.industry ,musculoskeletal system ,Los Angeles ,Prosthesis Failure ,Surgery ,Treatment Outcome ,Female ,Implant ,Knee Prosthesis ,Range of motion ,business ,Body mass index ,Follow-Up Studies - Abstract
The impact of a patient's activity level following total knee arthroplasty (TKA) remains controversial, with some surgeons concerned about increased polyethylene wear, aseptic loosening, and revisions. The purpose of this study is to report on implant survivorship and outcomes of high activity patients compared to low activity patients after TKA.A retrospective review identified 1611 patients (2038 knees) that underwent TKA with 5-year minimum follow-up. Patients were divided in 2 groups based on their University of California Los Angeles (UCLA) activity level: low activity (LA) (UCLA ≤5) and high activity (HA) (UCLA ≥6). Outcomes included range of motion, Knee Society scores, complications, and reoperations. Parametric survival analysis was performed to evaluate the significance of activity level on survivorship while controlling for age, gender, preoperative pain, Knee Society clinical scores, Knee Society functional scores, and body mass index (BMI).Mean follow-up was 11.4 years (range 5.1-15.9). The LA group had significantly more female patients, were older, had higher BMI, and had lower functional scores preoperatively (all with P.001). The HA group had significantly higher improvements in Knee Society scores (P.001) and pain postoperatively (P.001). Revisions were performed in 4% of the LA group and 1.7% knees of the HA group (P = .003). After controlling for age, gender, preoperative pain, Knee Society clinical scores, Knee Society functional scores, and BMI, a higher postoperative activity level remained a significant factor for improved survivorship with an odds ratio of 2.4 (95% confidence interval 1.2-4.7, P = .011). The all-cause 12-year survivorship was 98% for the HA group and 95.3% for the LA group (P = .003). The aseptic 12-year survivorship was 98.4% for the HA group and 96.3% for the LA group (P = .02).Highly active patients had increased survivorship at 5-year minimum follow-up compared to lower activity patients after TKA. Patient activity level after TKA may not need to be limited with modern implants.
- Published
- 2020
43. The feasibility of outpatient conversion and revision hip arthroplasty in selected patients
- Author
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Joanne B. Adams, Michael J. Morris, Keith R. Berend, Adolph V. Lombardi, and David A. Crawford
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,business.industry ,Arthroplasty, Replacement, Hip ,General surgery ,Ambulatory surgery centre ,Middle Aged ,Postoperative Complications ,Outpatients ,medicine ,Feasibility Studies ,Humans ,Female ,Orthopedics and Sports Medicine ,Surgery ,business ,Revision hip arthroplasty ,Selection (genetic algorithm) ,Same day discharge ,Total hip arthroplasty - Abstract
Background: Total hip arthroplasty (THA) continues moving to the outpatient arena, and may be feasible for some conversion and revision scenarios. Controversy surrounds appropriate patient selection. The purpose of this study is to report complications associated with outpatient revision and conversion THA, and to determine if comorbidities are associated with complications or overnight stay. Methods: From June 2013 through August 2018, 46 patients (47 hips) underwent conversion ( n = 10) or revision ( n = 37) THA at a free-standing ambulatory surgery centre. This represented only 6.3% of revision THA cases at our institution during the study period that were selected for outpatient surgery. Mean patient age was 58.0 years, and 52% of patients were males. 1 or more major comorbidities were present in 15 patients (32%) including 1 valvular disease, 7 arrhythmia, 2 thromboembolism history, 3 obstructive sleep apnoea, 3 chronic obstructive pulmonary disease, 2 asthma, 4 frequent urination, and 1 renal disease. Results: 44 (94%) patients were discharged same day without incident, none required transfer to acute facility, and 3 stayed overnight (2 convenience, 1 for medical reasons - urinary retention). The patient kept overnight for medical reasons had no major comorbidities. 3 patients were placed on an extended course of antibiotics, including 2 with positive intraoperative cultures and 1 for cellulitis. There were no major complications, readmissions, or subsequent surgeries within 90 days. Conclusions: Outpatient revision hip arthroplasty is safe in selected patients undergoing minor or partial revisions. Presence of medical comorbidities was not associated with risk of complications. Medical optimisation and a multimodal programme to mitigate risk of blood loss and reduce narcotic need facilitate the safe performance of arthroplasty in an outpatient setting.
- Published
- 2019
44. Finite Element Analysis of Six Transcortical Pin Parameters and Their Effect on Bone–Pin Interface Stresses in the Equine Third Metacarpal Bone
- Author
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Gert J. Breur, Russell P. Main, Eric A. Nauman, Stephen B. Adams, and Timothy B. Lescun
- Subjects
External Fixators ,040301 veterinary sciences ,Finite Element Analysis ,0206 medical engineering ,Computed tomography ,02 engineering and technology ,Bone Nails ,Original research ,0403 veterinary science ,Stress (mechanics) ,Bone strength ,Cadaver ,Animals ,Medicine ,Horses ,Composite material ,Hole size ,General Veterinary ,medicine.diagnostic_test ,business.industry ,04 agricultural and veterinary sciences ,Metacarpal Bones ,020601 biomedical engineering ,Finite element method ,Biomechanical Phenomena ,Distal limb ,Third metacarpal bone ,Animal Science and Zoology ,Stress, Mechanical ,business - Abstract
Objective The objectives of this study were to validate a finite element model of the equine distal limb transfixation cast and to determine the effect of six transcortical pin parameters on bone–pin interface (BPI) stresses in the third metacarpal bone. Study Design A transfixation cast finite element model was developed from a computed tomography scan of the third metacarpal bone and modelled pin elements. The model was validated by comparing strain measured around a 6.3-mm transfixation pin in the third metacarpal bone with the finite element model. The pin parameters of diameter, number, location, spacing, orientation and material were evaluated by comparing a variety of pin configurations within the model. Results Pin diameter and number had the greatest impact on BPI stress. Increasing the diameter and number of pins resulted in lower BPI stresses. Diaphyseal pin location and stainless-steel pins had lower BPI stresses than metaphyseal location and titanium alloy pins, respectively. Offset pin orientation and pin spacing had minimal impact on BPI stresses during axial loading. Conclusion The results provide evidence that diameter and number are the main pin parameters affecting BPI stress in an equine distal limb transfixation cast. Configurations of various pin size and number may be proposed to reduce BPI stresses and minimize the risk of pin related complications. Further refinement of these models will be required to optimize pin configurations to account for pin hole size and its impact on overall bone strength.
- Published
- 2019
45. A method for assessing links between objectively measured food store scores and store & neighborhood favorability
- Author
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Josh Introne, Robyn B. Adams, Richard C. Sadler, and Ashley Sanders-Jackson
- Subjects
Michigan ,medicine.medical_specialty ,General Computer Science ,Health geography ,media_common.quotation_subject ,Psychological intervention ,Qualitative property ,Sample (statistics) ,lcsh:Computer applications to medicine. Medical informatics ,Health informatics ,Food Supply ,03 medical and health sciences ,0302 clinical medicine ,Residence Characteristics ,Perception ,medicine ,Humans ,030212 general & internal medicine ,Marketing ,media_common ,Spatial Analysis ,030505 public health ,business.industry ,Public health ,Methodology ,Public Health, Environmental and Occupational Health ,General Business, Management and Accounting ,Focus group ,Cross-Sectional Studies ,Socioeconomic Factors ,lcsh:R858-859.7 ,0305 other medical science ,Psychology ,business - Abstract
Worldwide, interest in research on methods to define access to healthy food at the local level has grown, given its central connection to carrying out a healthy lifestyle. Within this research domain, papers have examined the spatial element of food access, or individual perceptions about the food environment. To date, however, no studies have provided a method for linking a validated, objective measure of the food environment with qualitative data on how people access healthy food in their community. In this study, we present a methodology for linking scores from a modified Nutrition Environment Measures Survey in Stores (conducted at every store in our study site of Flint, Michigan) with perceptions of the acceptability of food stores and shopping locations drawn from seven focus groups (n = 53). Spatial analysis revealed distinct patterns in visiting and avoidance of certain store types. Chain stores tended to be rated more highly, while stores in neighborhoods with more African-American or poor residents were rated less favorably and avoided more frequently. Notably, many people avoided shopping in their own neighborhoods; participants traveled an average of 3.38 miles to shop for groceries, and 60% bypassed their nearest grocery store when shopping. The utility of our work is threefold. First, we provide a methodology for linking perceived and objective definitions of food access among a small sample that could be replicated in cities across the globe. Second, we show links between perceptions of food access and objectively measured food store scores to uncover inequalities in access in our sample to illustrate potential connections. Third, we advocate for the use of such data in informing the development of a platforms that aim to make the process of accessing healthy food easier via non-food retail based interventions. Future work can replicate our methods to both uncover patterns in distinct food environments and aid in advocacy around how to best intervene in the food environment in various locales.
- Published
- 2019
46. Partial 2-Stage Exchange for Infected Total Hip Arthroplasty: An Updated Report
- Author
-
Adolph V. Lombardi, Keith R. Berend, Joanne B. Adams, David A. Crawford, and Michael J. Morris
- Subjects
Adult ,Male ,Methicillin-Resistant Staphylococcus aureus ,Reoperation ,musculoskeletal diseases ,medicine.medical_specialty ,Prosthesis-Related Infections ,Arthroplasty, Replacement, Hip ,medicine.medical_treatment ,Cement spacer ,Periprosthetic ,Methicillin resistant Staphylococcus ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Postoperative Period ,Stage (cooking) ,Aged ,Retrospective Studies ,Aged, 80 and over ,Arthritis, Infectious ,030222 orthopedics ,Debridement ,business.industry ,Middle Aged ,Arthroplasty ,Anti-Bacterial Agents ,Surgery ,Harris Hip Score ,Female ,Hip Prosthesis ,business ,Total hip arthroplasty - Abstract
Purpose Management of an infected total hip arthroplasty (THA) is challenging. The eradication of infection as well as complications of component removal must all be considered. This study is an update on previous reports of treating periprosthetic infection (PJI) of the hip with a partial two-stage exchange with retention of the femoral component. Methods A retrospective review of our practice’s arthroplasty registry from 2000 to 2018 revealed 41 hips with 2-year minimum follow-up that were treated with a two-stage partial exchange for an infected THA. All first stage procedures allowed an articulating construct with one of three variations: Cemented constrained liner (13 hips), StageOne™ Hip Cement Spacer Mold (Zimmer Biomet, Warsaw, IN) (14 hips) or an antibiotic polymethylmethacrylate head molded from a bulb syringe (14 hips). 34/41 cases were culture positive, with 3 cases having methicillin resistant staphylococcus. Results Mean follow-up was 5.5 years (range, 1.5 to 18.5 years). The second stage reimplantation was accomplished in 39 of the 41 hips (95%) at a mean interval of 9.2 weeks (range, 5-9 weeks). Two patients underwent repeat radical debridement with removal of all components prior to reimplantation for persistent clinical evidence of infection. Thirty-three of the forty-one hips (81%) were infection-free at most recent follow-up. The mean postoperative Harris hip score at most recent evaluation was 63.6 (range, 24 to 100). Conclusion Eradication of periprosthetic joint infections, while minimizing patient morbidity, continues to be a challenge. Partial two-stage exchange may be considered in cases where removal of a well-fixed femoral component may result in significant bony destruction.
- Published
- 2019
47. New development: Public sector responses to complex socio-ecological issues—no silver bullets for rabbits
- Author
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Michael J. Reid, Andrew P. Woolnough, Lisa B. Adams, Theodore R. Alter, Lauren A. Hull, and Heidi M. Kleinert
- Subjects
Public Administration ,Sociology and Political Science ,business.industry ,media_common.quotation_subject ,05 social sciences ,Public sector ,ComputingMilieux_LEGALASPECTSOFCOMPUTING ,Citizen journalism ,050201 accounting ,Public administration ,General Business, Management and Accounting ,GeneralLiterature_MISCELLANEOUS ,Democracy ,0506 political science ,Socio ecological ,Action (philosophy) ,Accounting ,Political science ,0502 economics and business ,050602 political science & public administration ,business ,ComputingMilieux_MISCELLANEOUS ,Finance ,media_common - Abstract
This article reports on a United Nations-award winning initiative, the Victoria Rabbit Action Network (VRAN), which applied a systems approach, underpinned by a democratic and participatory engagem...
- Published
- 2019
48. Fractures of the Scapula
- Author
-
Alan J. Nixon and Stephen B. Adams
- Subjects
medicine.medical_specialty ,Scapula ,medicine.diagnostic_test ,business.industry ,Radiography ,medicine.medical_treatment ,Surgical removal ,Medicine ,Internal fixation ,Physical examination ,Computed tomography ,Radiology ,business - Published
- 2019
49. Growth enhancement of tropical abalone, Haliotis asinina L, through probiotic supplementation
- Author
-
Christopher J. S. Bolch, Muhamad Amin, Mark B. Adams, and Christopher M. Burke
- Subjects
0106 biological sciences ,biology ,Abalone ,Haliotis asinina ,Bacillus amyloliquefaciens ,business.industry ,010604 marine biology & hydrobiology ,Pediococcus acidilactici ,04 agricultural and veterinary sciences ,Aquatic Science ,biology.organism_classification ,01 natural sciences ,Feed conversion ratio ,law.invention ,Probiotic ,Aquaculture ,law ,040102 fisheries ,0401 agriculture, forestry, and fisheries ,Juvenile ,Food science ,business ,Agronomy and Crop Science - Abstract
The use of probionts has been considered to be an effective technology in enhancing growth performances and survival rate of aquaculture species. This study examined the effect of three probiotic candidates (Bacillus amyloliquefaciens MA228, Enterobacter ludwigii MA208, and Pediococcus acidilactici MA160) on the growth and survival rates of juvenile abalone, Haliotis asinina L). The three probionts were incorporated as a mixture of two or three onto Gracilaria sp. and fed to juvenile abalone for 62 days. Then, specific growth rate (SGR), feed conversion ratio (FCR), and survival rate (SR) were measured. The results showed that the increments in weight and length were significantly higher (P 72% among the treatments and control. Our study shows that the growth of juvenile abalone could be improved through probiotic supplementation. Thus, E. ludwigii MA208 and B. amyloliquefaciens MA228 are considered potential probionts which can be used to shorten culture period of abalone aquaculture.
- Published
- 2019
50. Optimizing cancer care for hepatocellular carcinoma at a safety‐net hospital: The value of a multidisciplinary disease management team
- Author
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Andrew B. Adams, Alexandra G. Lopez-Aguiar, Christina Wu, Rachel M. Lee, Grace Duininck, J.Y. Lin, Joel P. Wedd, Maria C. Russell, Lesley Miller, Sean R. Dariushnia, Shishir K. Maithel, and Olatunji B. Alese
- Subjects
Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Improved survival ,Disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Stage (cooking) ,Disease management (health) ,Referral and Consultation ,Early Detection of Cancer ,Patient Care Team ,Hepatology ,business.industry ,Liver Neoplasms ,Racial Groups ,Gastroenterology ,Disease Management ,Cancer ,General Medicine ,Hepatitis C ,Hepatitis C, Chronic ,Middle Aged ,medicine.disease ,Combined Modality Therapy ,United States ,digestive system diseases ,Oncology ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Etiology ,Female ,030211 gastroenterology & hepatology ,Surgery ,business ,Safety-net Providers - Abstract
BACKGROUND Hepatitis C (HCV) is the primary etiology of hepatocellular carcinoma (HCC) in the US multidisciplinary disease management teams (DMT) that optimize oncologic care. The impact of DMT for HCC in safety-net hospitals is unknown. METHODS Patients diagnosed with HCC from 2009 to 2016 at Grady Memorial Hospital (GMH) were included. The primary aim was to evaluate referrals to care, receipt of therapy, and overall survival (OS) after DMT formation. Screening patterns of HCV patients for HCC were also examined. RESULTS Of 204 HCC patients, median age was 58 years, with 81% male, 83% black. 46% presented with stage 4 disease, 53% had treatment with median OS 9.8 months. DMT formation was associated with increased referrals to surgery (49% vs 30%; P = .02), liver-directed therapy (58% vs 31%; P = .001), and radiation (13% vs 3%; P = .019). Patients were also more likely to get treatment (59% vs 41%; P = .026), with improved median OS (30.7 vs 4.9 months; P
- Published
- 2019
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