14 research outputs found
Translational manipulation under anesthesia for patients with frozen shoulder: a case series study with five-year health care utilization and post-manipulative arthroscopic findings
No full textMuch work remains to reach consensus on musculoskeletal injury risk in military service members:A systematic review with meta-analysis
No full textMusculoskeletal injuries are the most common reason military service members cannot perform their military duties. Not only are they costly and associated with long-term disability, often long after completion of military service, but injuries also adversely affect the military readiness of a nation. This can be seen as a threat to national security and part of the impetus behind many efforts to better understand, predict, and mitigate injury risk in the military. A systematic review of literature published between 1995 and October 31, 2020 was conducted to identify significant risk factors of musculoskeletal injury in military populations across the world. 74 out of 170 eligible studies addressed comprehensive injuries, providing 994 unique risk factors. 46 of these studies provided data that could be included in a meta-analysis, which was possible for 15 predictor variables. Seven predictors were significant in meta-analysis: female sex(RR=1.46;95CI 1.30,1.64), high body mass index(RR=1.36;95CI 1.21,1.53), functional movement screen pain (RR=1.70;95CI 1.55,1.87) or scores ≤ 14(RR=1.42 95CI 1.29,1.56), prior injury(RR=1.54;95CI 1.32,1.80), slower running performance(RR=1.33;95CI 1.18,1.51), and poorer push-up performance(RR=1.15;95CI 1.04,1.27). Low BMI, height, weight, smoking, physical activity scores, and sit-up and jump performance were not significant risk factors in the meta-analysis. Most studies had a high risk of bias. Lack of raw data and large heterogeneity in definitions of predictors and injury outcomes limited comparison across many studies
A multicentre randomised, 1-year comparative effectiveness, parallel-group trial protocol of a physical therapy approach compared to corticosteroid injections
No full textCorticosteroid injections (CSIs) are commonly used as an initial or a primary intervention for knee osteoarthritis (OA). Consistent evidence indicates CSIs offer symptom relief with conflicting reports regarding long-term efficacy. Physical therapy (PT) offers a non-invasive alternative. There is moderate evidence suggesting short-term and long-term symptom relief and functional improvement with PT interventions. Patients with knee OA are more commonly prescribed CSI than PT prior to total joint replacement. UnitedHealthcare and Military Health System data show substantially more total knee replacement patients receive preoperative CSI than PT. There are no studies comparing CSI to a PT approach in individuals with knee OA. The primary objective of this study is to compare the effectiveness of CSI to PT in individuals with knee OA at 1, 2 and 12 months.We plan to recruit 156 participants meeting established knee OA criteria. Following informed consent, participants will be randomised to receive either CSI or PT. All participants will receive instruction on recommended exercise and weight control strategies plus usual medical care. The CSI intervention consisting of 3 injections and the PT intervention consisting of 8-12 sessions will be spaced over 12 months. Measures of the dependent variables (DVs) will occur at baseline, 4 weeks, 8 weeks, 6 months and 12 months post enrolment. This pragmatic, randomised clinical trial will be a mixed-model 2×5 factorial design. The independent variables are treatment (CSI and PT) and time with five levels from baseline to 1 year. The primary DV is the Western Ontario & McMaster Universities Arthritis Index (WOMAC). We will also compare healthcare utilisation between the 2 groups.The protocol was approved by the Madigan Army Medical Center Institutional Review Board. The authors intend to publish the results in a peer-reviewed source.NCT01427153
Minimal Data Elements for Surveillance and Reporting Of Musculoskeletal Injuries in the MILitary (ROMMIL) International Consensus Statement
No full textIntroduction A systematic approach to collecting and reporting injury data in military settings is necessary to maximize the impact of musculoskeletal injury-related research. An international consensus on recommended core data set of elements to capture and report is necessary. The purpose was to summarize the process and results from an international consensus study to establish recommended common minimum data elements for surveillance and Reporting Of Musculoskeletal injuries in the MILitary (ROMMIL).Methods A ten-step hybrid consensus process was performed. Knowledge users were embedded in the process for co-creation of pertinent questions, data elements, and voting. Evidence synthesis included a scoping review on the barriers and facilitators to implementing injury prevention programs, followed by a knowledge user survey. A sequential three round Delphi study refined and validated the final elements in the recommendation checklist. Consensus recommendations were presented to an international audience of stakeholders. Participants voted on each statement with 0 representing no importance, 5 somewhat important, and 10 maximum importance.Results The consensus recommendation includes one data principle of keeping continuous data continuous and 33 minimum data elements. Data elements include demographics, lifestyle, service branch, musculoskeletal/surgical history, exposure, and injury characteristics. The data principle endorsed by knowledge users recommends that continuous variables (e.g. age, weight, exposure) remain continuous and not categorized into groups. Dissenting viewpoints are detailed to provide fair and balanced consensus recommendations.Conclusions The ROMMIL checklist could be leveraged by clinicians, researchers and knowledge users working in miliary settings when comparing and harmonizing data across studies, service branches, and countries. The ROMMIL checklist will support improved data synthesis to better inform evidence-based practice in military medicine, and the ability to generate more useful prognostic models to quantify injury risk
Twin Pregnancy With Complete Hydatidiform Mole And Living Fetus [gestação Gemelar De Mola Hidatiforme Completa Com Feto Vivo]
No full textTwin pregnancy with a complete hydatidiform mole and a living fetus is a rare entity. According to the few cases described in the literature, this kind of gestation commonly has higher risks of miscarriage, preterm delivery, intrauterine fetal death, bleeding, preeclampsia and persistent trophoblastic disease. This study reports the case of a 20 years old primiparous patient with complete hydatidiform mole and living fetus, whose pregnancy was successfully carried to term. The differential diagnosis with placental degeneration was reached through anatomopathological investigation.472165170Abbi, M., Kriplani, A., Uppal, R., Takkar, D., Term twin pregnancy with hydatidiform mole and a normal fetus (1999) Archives of Gynecology and Obstetrics, 262 (3-4), pp. 189-191. , DOI 10.1007/s004040050248Anderson, C.K., Deiter, R.W., Motz, M.J., Goldstein, J.A., Complete hydatidiform mole with a coexistent healthy, viable fetus near term: A case report (1996) Journal of Reproductive Medicine for the Obstetrician and Gynecologist, 41 (1), pp. 55-58Arm, M.F., Triplet pregnancy with hydatidiform mole (2000) Int J Gynecol Cancer, 10, pp. 76-81Block, M.F., Merill, J.A., Hidatidiform mole with coexisting fetus (1982) Obstet Gynecol, 60 (1), pp. 129-134Bovicelli, L., Ghi, T., Pilu, G., Farina, A., Savelli, L., Simonazzi, G., Calzolari, E., Valeri, B., Prenatal diagnosis of a complete mole coexisting with a dichorionic twin pregnancy: Case report (2004) Human Reproduction, 19 (5), pp. 1231-1234. , DOI 10.1093/humrep/deh211Bristow, R.E., Shumway, J.B., Khouzami, A.N., Witter, F.R., Complete hydatidiform mole and surviving coexistent twin (1996) Obstetrical and Gynecological Survey, 51 (12), pp. 705-709. , DOI 10.1097/00006254-199612000-00002Bruchim, I., Kidron, D., Amiel, A., Altaras, M., Fejgin, M.D., Complete hydatidiform mole and a coexistent viable fetus: Report of two cases and review of the literature (2000) Gynecologic Oncology, 77 (1), pp. 197-202. , DOI 10.1006/gyno.2000.5733Chen, E.P., Molar pregnancy and living normal fetus coexistent until term: Prenatal biochemical and sonographic diagnosis (1997) Hum Reprod, 12 (4), pp. 853-856Dolapcioglu, K., Twin pregnancy with a complete hydatidiform mole and co-existent live fetus: Two cases reports and review of the literature (2009) Arch Gynecol Obstet, 279 (3), pp. 431-436Fishman, D.A., Padilla, L.A., Keh, P., Cohen, L., Frederiksen, M., Lurain, J.R., Management of twin pregnancies consisting of a complete hydatidiform mole and normal fetus (1998) Obstetrics and Gynecology, 91 (4), pp. 546-550. , DOI 10.1016/S0029-7844(97)00720-5, PII S0029784497007205Garbin, O., How to deal with a rare entity: The coexistence of a complete mole and healthy egg in a twin pregnancy? (1995) Fetal Diagn Ther, 10 (5), pp. 337-342Hamanoue, H., Umezu, N., Okuda, M., Harada, N., Ohata, T., Sakai, H., Mizuguchi, T., Matsumoto, N., Complete hydatidiform mole and normal live birth following intracytoplasmic sperm injection (2006) Journal of Human Genetics, 51 (5), pp. 477-479. , DOI 10.1007/s10038-006-0388-3Hyodo, M., Samura, O., Miharu, N., Ohama, K., Kudo, Y., Molar DNA in maternal serum in a case of 46,XY heterozygous complete hydatidiform mole coexisting with a 46,XX twin live fetus [5] (2005) Clinical Chemistry, 51 (3), pp. 676-677. , DOI 10.1373/clinchem.2004.043034Ishii, J., Iitsuka, Y., Takano, H., Matsui, H., Osada, H., Sekiya, S., Genetic differentiation of complete hydatidiform moles coexisting with normal fetuses by short tandem repeat-derived deoxyribonucleic acid polymorphism analysis (1998) American Journal of Obstetrics and Gynecology, 179 (I3), pp. 628-634. , DOI 10.1016/S0002-9378(98)70055-9Jinno, M., Ubukata, Y., Hanyu, I., Satou, M., Yoshimura, Y., Nakamura, Y., Hydatidiform mole with a surviving coexistent fetus following in-vitro fertilization (1994) Human Reproduction, 9 (9), pp. 1770-1772Klatt, T.E., Franciosi, R.A., Cruikshank, D.P., Normal fetus with a twin presenting as both a complete hydatidiform mole and placenta previa (2006) Obstetrics and Gynecology, 107 (II2), pp. 527-530. , PII 0000625020060200100037Koyama, S., A case of complete hydatidiform mole with coexistent fetus: Conclusive diagnosis of androgenesis of the molar placenta by variation of paternal acrocentric short arms (2010) Am J Perinatol, 27 (2), pp. 143-149Lambert-Messerlian, G., Pinar, H., Rubin, L.P., De Paepe, M.E., Tantravahi, U., Steinhoff, M.M., Russell, M., Canick, J.A., Second-trimester maternal serum markers in twin pregnancy with complete mole: Report of 2 cases (2005) Pediatric and Developmental Pathology, 8 (2), pp. 230-234. , DOI 10.1007/s10024-005-0121-9Lee, S.W., Clinical findings of multiple pregnancy with a complete hydatidiform mole and coexisting fetus (2010) J Ultrasound Med, 29 (2), pp. 271-280Lurian, J.R., Gestacional trophoblastic disease I: Epidemiology, pathology, clinical presentation and diagnosis of gestacional trophoblastic disease and managment of hydatidiform mole (2010) Am J Gynecol Obstet, pp. 1-9Makrydimas, G., Sebire, N.J., Thornton, S.E., Zagorianakou, N., Lolis, D., Fisher, R.A., Complete hydatidiform mole and normal live birth: A novel case of confined placental mosaicism (2002) Human Reproduction, 17 (9), pp. 2459-2463Malhtra, N., Hydatidiform mole with coexisting live fetus in dichorionic twin gestation (2001) Eur J Obstet Gynecol Reprod Biol, 94 (2), pp. 301-303Marcorelles, P., Audrezet, M.-P., Le Bris, M.-J., Laurent, Y., Chabaud, J.-J., Ferec, C., De Braekeleer, M., Lagarde, N., Diagnosis and outcome of complete hydatidiform mole coexisting with a live twin fetus (2005) European Journal of Obstetrics Gynecology and Reproductive Biology, 118 (1), pp. 21-27. , DOI 10.1016/j.ejogrb.2004.02.042, PII S0301211504001691Matsui, H., Sekiya, S., Hando, T., Wake, N., Tomoda, Y., Hydatidiform mole coexistent with a twin live fetus: A national collaborative study in Japan (2000) Human Reproduction, 15 (3), pp. 608-611Miller, D., Jackson, R., Ehlen, T., McMurtrie, E., Complete hydatidiform mole coexistent with a twin live fetus: Clinical course of four cases with complete cytogenetic analysis (1993) Gynecologic Oncology, 50 (1), pp. 119-123. , DOI 10.1006/gyno.1993.1175Moini, A., Riazi, K., Molar pregnancy with a coexisting fetus progressing to a viable infant (2003) International Journal of Gynecology and Obstetrics, 82 (1), pp. 63-64. , DOI 10.1016/S0020-7292(03)00039-0Montes-De-Oca-Valero, F., Macara, L., Shaker, A., Twin pregnancy with a complete hydatidiform mole and co-existing fetus following in-vitro fertilization (1999) Human Reproduction, 14 (11), pp. 2905-2907. , DOI 10.1093/humrep/14.11.2905Niemann, I., Sunde, L., Petersen, L.K., Evaluation of the risk of persistent trophoblastic disease after twin pregnancy with diploid hydatidiform mole and coexisting fetus (2007) Am J Obstet Gynecol, 197 (1), pp. 451-455Ogura, T., Katoh, H., Satoh, S., Tsukimori, K., Hirakawa, T., Wake, N., Nakano, H., Complete mole coexistent with a twin fetus (2006) Journal of Obstetrics and Gynaecology Research, 32 (6), pp. 593-601. , DOI 10.1111/j.1447-0756.2006.00463.xPiura, B., Twin pregnancy with complete hydatidiform mole and surviving co-existent fetus (2008) Arch Gynecol Obstet, 278 (4), pp. 377-382Sebire, N.L., Outcome of twin pregnancies with complete hydatidiform mole healthy co-twin (2002) The Lancet, 359 (9324), pp. 2165-2166Seckl, M.J., Sebire, N.J., Berkowitz, R.S., Gestational trophoblastic disease (2010) Lancet, 376, pp. 717-729Shahabi, S., Complete hytatidiform mole and coexisting fetus. A case report of two cases with contrasting outcomes (1977) J Reprod Med, 42 (11), pp. 756-760Steller, M.A., Genest, D.R., Bernstein, M.R., Lage, J.M., Goldstein, D.P., Berkowitz, R.S., Clinical features of multiple conception with partial or complete molar pregnancy and coexisting fetuses (1994) Journal of Reproductive Medicine for the Obstetrician and Gynecologist, 39 (3), pp. 147-154Sugigama, S., Genetically identified complete hydatiform mole coexisting with a live twin fetus: Comparison with conventional diagnosis (2007) Gynecol Obstet Invest, 64 (4), pp. 228-231Suri, S., Davies, M., Jauniaiss, X., Twin pregnangy presenting as a previa complete hydatiform mole and coexintig fetus complicated by a placental abscess (2009) Fetal Diagn Thear, 26, pp. 181-184Vaisbuch, E., Ben-Arie, A., Dgani, R., Perlman, S., Sokolovsky, N., Hagay, Z., Twin pregnancy consisting of a complete hydatidiform mole and co-existent fetus: Report of two cases and review of literature (2005) Gynecologic Oncology, 98 (1), pp. 19-23. , DOI 10.1016/j.ygyno.2005.02.002, PII S009082580500106XWax, J.R., Pinette, M.G., Chard, R., Blackstone, J., Cartin, A., Prenatal diagnosis by DNA polymorphism analysis of complete mole with coexisting twin (2003) American Journal of Obstetrics and Gynecology, 188 (4), pp. 1105-1106. , DOI 10.1067/mob.2003.15
Boundless Venus: the Crossover of the Conscious and Unconscious in the Works of Haruki Murakami
No full textThe objective of this thesis, Boundless Venus, is to examine consciousness in the
works of the contemporary Japanese writer Haruki Murakami. Principally the
discussion concerns itself with the unconscious, its conduits, its benefits upon the
conscious; which lead to the transformation of the self and structure of the literature.
Although the subject has been touched upon before, the conscious and unconscious
have previously been examined as exclusive concepts in Murakami. This research
will be looking at the recent change in the ‘crossover’ between these concepts,
which makes the concepts no longer two mutually exclusive concepts but ‘inclusive
concepts’. This is vital to understanding Murakami’s more recent works and the
nature of his influence on literature.
Boundless Venus explores the entire works of Haruki Murakami, principally his
most recent novel 1Q84 (2011) and his novels Hard-Boiled Wonderland and the
End of the World (1991) and The Wind-up Bird Chronicle (1997). It approaches the
work from a psychoanalytic and critical point of view and focuses on significant
narrative techniques, character development, and themes such as sex, music, and
dreams, used by Murakami to explore the relationship between the conscious and
unconscious and to narrate the crossover between the two
The production and characterisation of inorganic combinatorial libraries
No full textWith the increasing demand for research into new materials, techniques which are able to produce and characterise a large number of samples rapidly are becoming indispensable. Thin film technology has the potential to improve the amount of information contained on deposited samples by creating compositionally graded libraries. Conventionally, raster scan methods are used to interrogate such libraries. The production of combinatorial samples by methods not previously employed in this role has been carried out. Both solution based electrochemical deposition and electrostatic spray vaporisation production methods have been successfully modified to produce thin film continuous compositional spread (CCS) samples. Additional samples have been produced by off-axis direct current magnetron sputtering, a method already established in the combinatorial field. Presented here is a different approach to provide high-throughput data collection and analysis of combinatorial libraries using an X-ray diffraction (XRD) probe. An extended X-ray beam was used to illuminate the polycrystalline libraries and a large area detector used to collect the data. A new partitioning algorithm has been employed to analyze the collected data and extract the crystallographic information from the illuminated area. The results of the technique have been compared with the raster scans showing that the algorithm provides reliable data equivalent to multiple point data collections with significantly increased data acquisition speed. With the new chemical libraries and other simplified samples the partitioning method has been shown to be appropriate for the analysis of both distinct composition high density chemical libraries and also CCS samples. To achieve the validation of the new method the new libraries have been illumination with the extended beam X-ray source. The resultant superimposed diffraction patterns are partitioned with the novel software and compared with conventional XRD. The resolution of the partitioning method has been shown to be in the 1 mm range when applied to CCS libraries and 1.5 mm for high density chemical libraries. For randomly orientated polycrystalline samples the d-spacing change between the partitioned data and the corresponding raster scanned data is not statistically significant. This corresponds to d-spacing determination with a precession of < 0.01 Å when used with the Bruker D8 diffractometer and our geometry
Methodology used to develop the minimum common data elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement [version 2; peer review: 1 approved, 2 approved with reservations]
No full textBackground The objective was to summarize the methodology used to develop the international minimum data elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement. This is a recommended list of elements to be collected and reported when conducting injury surveillance research in military settings. Methods A Delphi methodology was employed to reach consensus. Preliminary steps included conducting a literature review and surveying a convenience sample of military stakeholders to 1) identify barriers and facilitators of military musculoskeletal injury (MSKI) prevention programs, 2) identify relevant knowledge gaps, and 3) establish future research priorities. A sequential three-round Delphi consensus survey followed, including relevant stakeholders from militaries around the world, using results to conduct an asynchronous knowledge user meeting (mixture of in-person and live video conference and recording) to explore the level of agreement among subject matter experts. Knowledge users, including former and current military service members, civilian practitioners working in military health networks, and international subject matter experts having experience with policy, execution, or clinical investigation of MSKI mitigation programs, MSKI diagnoses, and MSKI risk factors in military settings. For each round, participants scored questions on a Likert scale of 1-5. Scores ranged from No Importance (1) to Strong Importance (5). Results Literature review and surveys helped inform the scope of potential variables. Three rounds were necessary to reach minimum consensus. Ninety-five, 65, and 42 respondents participated in the first, second and third rounds, respectively. Conclusions Achieving consensus across relevant knowledge users representing military organizations globally can be challenging. This paper details the methodology employed to reach consensus for a core minimum data elements checklist for conducting MSKI research in military settings and improve data harmonization and scalability efforts. These methods can be used as a resource to assist in future consensus endeavors of similar nature
Minimal Data Elements for Surveillance and Reporting Of Musculoskeletal injuries in the MILitary (ROMMIL) International Consensus Statement
No full textINTRODUCTION: A systematic approach to collecting and reporting injury data in military settings is necessary to maximize the impact of musculoskeletal injury-related research. An international consensus on recommended core data set of elements to capture and report is necessary. The purpose was to summarize the process and results from an international consensus study to establish recommended common minimum data elements for surveillance and Reporting Of Musculoskeletal injuries in the MILitary (ROMMIL).METHODS: A 10-step hybrid consensus process was performed. Knowledge users were embedded in the process for co-creation of pertinent questions, data elements, and voting. Evidence synthesis included a scoping review on the barriers and facilitators to implementing injury prevention programs, followed by a knowledge user survey. A sequential three round Delphi study refined and validated the final elements in the recommendation checklist. Consensus recommendations were presented to an international audience of stakeholders. Participants voted on each statement with 0 representing no importance, 5 somewhat important, and 10 maximum importance.RESULTS: The consensus recommendation includes one data principle of keeping continuous data continuous and 33 minimum data elements. Data elements include demographics, lifestyle, service branch, musculoskeletal/surgical history, exposure, and injury characteristics. The data principle endorsed by knowledge users recommends that continuous variables (e.g., age, weight, exposure) remain continuous and not categorized into groups. Dissenting viewpoints are detailed to provide fair and balanced consensus recommendations.CONCLUSIONS: The ROMMIL checklist could be leveraged by clinicians, researchers, and knowledge users working in military settings when comparing and harmonizing data across studies, service branches, and countries. The ROMMIL checklist will support improved data synthesis to better inform evidence-based practice in military medicine, and the ability to generate more useful prognostic models to quantify injury risk.</p
Methodology used to develop the minimum common data elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement
No full textBackground: The objective was to summarize the methodology used to reach consensus for recommended minimum data elements that should be collected and reported when conducting injury surveillance research in military settings. This paper summarizes the methodology used to develop the international Minimum Data Elements for surveillance and Reporting of Musculoskeletal Injuries in the MILitary (ROMMIL) statement.Methods: A Delphi methodology was employed to reach consensus for minimum reporting elements. Preliminary steps included conducting a literature review and surveying a convenience sample of military stakeholders to 1) identify barriers and facilitators of military musculoskeletal injury (MSKI) prevention programs, 2) identify relevant knowledge/information gaps and 3) establish future research priorities. The team then led a sequential three-round Delphi consensus survey, including relevant stakeholders from militaries around the world, and then conducted asynchronous mixed knowledge user meeting to explore level of agreement among subject matter experts. Knowledge users, including former and current military service members, civil servant practitioners, and global-wide subject matter experts having experience with policy, execution, or clinical investigation of MSKI mitigation programs, MSKI diagnoses, and MSKI risk factors in military settings. For each round, participants scored each question on a Likert scale of 1-5. Scores ranged from No Importance (1) to Strong Importance (5).Results: Literature review and surveys helped informed the scope of potential variables to vote on. Three rounds were necessary to reach minimum consensus. Ninety-five, 65 and 42 respondents participated in the first, second and third rounds of the Delphi consensus, respectively. Ultimately, consensus recommendations emerged consisting of one data principle and 33 minimum data elements.Conclusions: Achieving consensus across relevant stakeholders representing military organizations globally can be challenging. This paper details the methodology employed to reach consensus for a core minimum data elements checklist for conducting MSKI research in military settings and improve data harmonization and scalability efforts. These methods can be used as a resource to assist in future consensus endeavors of similar nature
