Department of Radiology-Annual Report-July 1, 1997 to June 30, 1998

Department of Radiology Annual Executive Summary Report, July 1, 1997 to June 30, 1998. Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States. 103 pages

A scoping review to map evidence regarding key domains and questions in the management of non-traumatic wrist disorders

Introduction Non-traumatic wrist disorders (NTWD) are commonly encountered yet sparse resources exist to aid management. This study aimed to produce a literature map regarding diagnosis, management, pathways of care and outcome measures for NTWDs in the United Kingdom. Methods An interdisciplinary team of clinicians and academic researchers used Joanna Briggs Institute guidelines and the PRISMA ScR checklist in this scoping review. A mixed stakeholder group of patients and healthcare professionals identified 16 questions of importance to which the literature was mapped. An a-priori search strategy of both published and non-published material from five electronic databases and grey literature resources identified records. Two reviewers independently screened records for inclusion using explicit eligibility criteria with oversight from a third. Data extraction through narrative synthesis, charting and summary was performed independently by two reviewers. Results Of 185 studies meeting eligibility criteria, diagnoses of wrist pain, De Quervain’s syndrome and ulna-sided pain were encountered most frequently, with uncontrolled non-randomised trial or cohort study being the most frequently used methodology. Diagnostic methods used included subjective questioning, self-reported pain, palpation and special tests. Best practice guidelines were found from three sources for two NTWD conditions. Seventeen types of conservative management, and 20 different patient-reported outcome measures were suggested for NTWD. Conclusion Substantial gaps in evidence exist in all parts of the patient journey for NTWD when mapped against an analytic framework (AF). Opportunities exist for future rigorous primary studies to address these gaps and the preliminary concerns about the quality of the literature regarding NTWD

Examining Thai students' experiences of augmented reality technology in a university language education classroom

Descriptive mixed-methods were employed to investigate the experiences and perceptions of English as a Foreign Language (EFL) Thai students in higher education in integrating Augmented Reality technology (AR) in their reading classroom. Participants were queried on their habitual use of computers and the Internet, their perceptions of the advantages and disadvantages of AR, their experiences in using AR, and their reflective reports of self-efficacy in using AR in creating English vocabulary flashcards as supplemental learning resources. A questionnaire on their use of computers and the Internet was employed with 48 EFL, English-major undergraduates. Subsequently, the participants underwent the Classroom Activity Treatment which comprised 1) the Teacher Showcase, 2) the AR Computer Tutorial, and 3) the Student Showcase, respectively. Classroom observation notes were taken during the three phases. Besides, at the end of each of these three phases, a questionnaire on the acceptance and self-efficacy of AR was administered. Subsequently, 24 students participated in semi-structured interviews to elicit further insights into their perceptions of the effectiveness of AR in EFL instruction and learning. The Technology Acceptance Model 3 (Vankatesh & Bala, 2008) was employed for theoretical perspective on the data. Findings revealed most participants had no prior knowledge or understanding about AR before the study. Participants reported AR as advantageous for stimulating student engagement and motivation, and for enhancing memory and memorization. AR was reported to promote learning and practicing digital literacy skills. Participants reported relatively high levels of self-efficacy in using AR, which were primarily driven by their self-satisfaction, creativity and enthusiasm, peer and teacher assistance, as well as technological training and infrastructure. Participants also reported that they would continue using AR in the future when necessary resources, time, and access were secured, for the purposes of professional productivity and development. Analysis suggested that English education curricula be improved and re-designed to integrate the implementation of AR technology to tailor the learning experiences to the students’ needs and learning styles. Professional development and training should also be provided for teachers and students to educate them in using AR in language education teaching and learning

The performance of the World Rugby Head Injury Assessment Screening Tool: a diagnostic accuracy study

Abstract Background Off-field screening tools, such as the Sports Concussion Assessment Tool (SCAT), have been recommended to identify possible concussion following a head impact where the consequences are unclear. However, real-life performance, and diagnostic accuracy of constituent sub-tests, have not been well characterized. Methods A retrospective cohort study was performed in elite Rugby Union competitions between September 2015 and June 2018. The study population comprised consecutive players identified with a head impact event undergoing off-field assessments with the World Rugby Head Injury Assessment (HIA01) screening tool, an abridged version of the SCAT3. Off-field screening performance was investigated by evaluating real-life removal-from-play outcomes and determining the theoretical diagnostic accuracy of the HIA01 tool, and individual sub-tests, if player-specific baseline or normative sub-test thresholds were strictly applied. The reference standard was clinically diagnosed concussion determined by serial medical assessments. Results One thousand one hundred eighteen head impacts events requiring off-field assessments were identified, resulting in 448 concussions. Real-life removal-from-play decisions demonstrated a sensitivity of 76.8% (95% CI 72.6–80.6) and a specificity of 86.6% (95% CI 83.7–89.1) for concussion (AUROC 0.82, 95% CI 0.79–0.84). Theoretical HIA01 tool performance worsened if pre-season baseline values (sensitivity 89.6%, specificity 33.9%, AUROC 0.62, p < 0.01) or normative thresholds (sensitivity 80.4%, specificity 69.0%, AUROC 0.75, p < 0.01) were strictly applied. Symptoms and clinical signs were the HIA01 screening tool sub-tests most predictive for concussion; with immediate memory and tandem gait providing little additional diagnostic value. Conclusions These findings support expert recommendations that clinical judgement should be used in the assessment of athletes following head impact events. Substitution of the tandem gait and 5-word immediate memory sub-tests with alternative modes could potentially improve screening tool performance

상어에서의 기초 보조생식기술 연구

학위논문(박사) -- 서울대학교대학원 : 수의과대학 수의학과, 2022.2. 박세창.상어는 판새아강 상어상목에 속하는 어종들의 총칭으로, 초기 척추동물 중 현재까지 성공적으로 생존해 있는 대표적인 동물군이다. 척추동물 형성 초기에 나타나 진화의 역사를 고스란히 담고 있는 만큼, 상어는 면역체계, 번식 전략, 암 저항성 등 다양한 측면에서 중요한 진화생물학적 연구의 대상이다. 뿐만 아니라 상어는 생태학적으로도 중요한 역할을 하는데, 해양 생태계 먹이사슬의 최상위 포식자로서 해당 생태계가 균형 있고 안정적으로 유지될 수 있도록 기여하고 있기 때문이다. 상어 개체 수에 이상이 생기면 먹이사슬 전체가 무너질 수 있다는 점은 이미 여러 선행연구를 통해 밝혀진 바, 그 중요성이 높기 때문에 핵심종이라고도 불린다. 문제는 이들이 현재 심각한 멸종위기에 처해있다는 점이다. IUCN Red List에 따르면, 연골어류의 37%가량이 취약 (VU), 절멸 위기 (EN), 절멸 위급 (CR)군으로 분류되고 있어 심각한 멸종위기 상태를 마주하고 있다. 이러한 양상은 이미 1970년대부터 확인되어 왔으며, 그 가장 큰 요인으로는 샥스핀 산업을 필두로 하는 어업이 지적되어 왔다. 이에 전세계적으로 상어 어획량을 줄이고자 하는 환경운동이 수행되어 왔으나, 상어 특유의 느린 번식속도에 기인하여 이들의 멸종위기 상태가 쉽게 개선되지는 않고 있는 실정이다. 심각한 멸종위기 상태의 동물 종 보전을 위해서는 사람의 인위적인 개입이 필수불가결하다. 이미 재두루미, 몽고말, 코끼리, 북부흰코뿔소 등 다양한 멸종위기 동물종에서 종 구제 및 보호를 위하여 보조생식기술이 개발 적용되고 있다. 그러나 상어의 경우 동물 자체에 대한 접근이 쉽지 않아 사실상 연구 되어있는 바가 거의 없다. 이에 본 논문에서는 상어 종 보전에 기여하고자 일련의 연구들을 수행하였다. 우선적으로 기초적인 영상의학 아틀라스를 확립하였으며, 이후 보조생식기술 개발을 위하여 상어 정액 동결보존 프로토콜 및 호르몬 유도 배란 프로토콜, 호르몬 유도 정액 샘플링 프로토콜을 개발하였다. 1. 영상의학적 분석 기반 확립은 모든 수의학적 접근 방식의 기본이 되는 만큼, 본 연구는 최초로 컴퓨터 단층촬영 (CT) 및 자기공명영상진단 (MRI) 방식을 이용하여 상어에서의 세밀한 영상의학 아틀라스를 확립하였다. 체장 1 m 안팎의 어린 까치상어 (Triakis scyllium) 세 마리의 전신 CT 및 MRI 스캔을 수행했으며, 각 개체들을 냉동 후 transverse, sagittal, dorsal 단면으로 잘라 실제 단면 모습과 CT, MRI상의 단면을 비교분석 하였다. 다양한 장기 및 조직들을 세밀하게 구분하여 아틀라스를 확립하였다. 다만 미성숙 개체들을 대상으로 연구를 수행하였던 만큼 생식계통에 대한 확인은 불가하였다. 2. 까치상어 (Triakis scyllium) 수컷 다섯 마리를 대상으로 실험을 수행하였다. Ovaprim®을 0.2 mL/kg 투여 후 1시간 뒤, 상어의 복부를 부드럽게 마사지하여 urogenital papilla를 통해 나오는 정액의 secondary cloudy portion을 샘플링 하여 실험에 이용하였다. 정지상태 정자의 motility를 최대로 만들 수 있는 활성화 용액 조성을 확립하였으며 이를 SSAE-1로 명명하였다. 까치상어 정자에 최적화된 동결보존 프로토콜을 확립하기 위하여 총 8종의 extender solution, 3종류의 extension ratio, 15종의 cryoprotectants, 4종의 equilibration periods, 3종의 cooling rates, 3종의 thawing temperature를 테스트 하였다. 결과적으로 정립된 Kim’s protocol은 다음과 같다: extender, filtered seawater; extension ratio, 1:3; cryoprotectant, egg yolk 10% + ethylene glycol 10%; equilibration period, 10 min; cooling rate, 3 cm, 3 min; thawing temperature, 30℃, 10 s. 프로토콜을 이용했을 때 최종적으로 확인된 정자의 해동 후 운동능은 2.03%로 확인되었다. 3. 난태생 상어인 까치상어 (Triakis scyllium)와 태반성 태생 상어인 화이트팁 상어 (Triaenodon obesus)에서 실험을 수행하여 다양한 번식전략을 지닌 상어 종 전반에 걸쳐 연어 유래 gonadotropin-releasing hormone (GnRH, Ovaprim®) 적용 가능성을 확인하였다. 실험에 앞서 두 상어종에서 암컷과 수컷의 정상 혈중 성호르몬 농도를 각각 확인하여 추후 실험 분석의 base line으로 이용하였다. 두 종 모두에서 Ovaprim®이 혈중 에스트로겐, 프로게스테론, 테스토스테론의 농도 변화를 성공적으로 유도하였으며, 암컷에서는 난포 성숙 및 배란을, 수컷에서는 정액 사출을 유도함을 확인하였다. 추후 인공수정에 적용할 수 있도록 Ovaprim®의 농도 및 투여 주기를 최적화한 결과는 다음과 같았다: 까치상어 수컷: 0.2 mL/kg 투여 1시간 뒤 정액 샘플링; 까치상어 암컷: 0.2 mL/kg 투여 24시간 뒤 0.5 mL/kg 2차 투여; 화이트팁 상어 수컷: 0.2 mL/kg 투여 직후 정액 샘플링; 화이트팁 상어 암컷: 0.2 mL/kg 투여 24시간 뒤 0.2 mL/kg 또는 0.3 mL/kg 2차 투여.Shark is a generic term for fish species belonging to the Class Chondrichthyes Superorder Selachimorpha and is a representative animal group that has successfully survived to date among early vertebrates. As they appeared in the early stages of vertebrate formation and thus contain the history of evolution, sharks are important subject of evolutionary biological studies in various aspects such as immunology, reproductive biology, and cancer biology. In addition, sharks play an important role in ecological point of view because they are the apex predators of the marine food chain and are contributing to maintain a balanced and stable ecosystem. It has already been revealed through several previous studies that if the number of sharks become seriously reduced, the entire food chain of the relevant area can collapse. Sharks are thus also called as keystone species because of their high importance. The problem is that sharks are currently in critical danger of extinction. According to the IUCN Red List, about 37% of chondrocytes are classified into “vulnerable (VU),” “endangered (EN),” and “critically endangered (CR)” groups, facing serious extinction. Decline of population had been perceived since the 1970s, and the biggest contributing factor has been pointed out as fishing, led by the shark's fin industry. Accordingly, conservational efforts have been carried out worldwide to reduce shark fishing, but their endangered status has not been easily improved due to their uniquely slow breeding rate. Artificial intervention by human is indispensable for the conservation of critically endangered animal species. Assisted reproductive technology has already been developed and applied to conservational works for various endangered species such as white cranes, Przewalski’s horses, elephants, and northern white rhinos. However, in the case of sharks, access to the animals is not easy, so few studies have been conducted thus far. Therefore, in this paper, a series of studies on assisted reproductive technology were conducted to contribute to the shark conservation. First, basic imaging atlas was established, and then shark semen cryopreservation protocol, hormone induced ovulation protocol, and hormone induced semen sampling protocol were developed. 1. As imaging analysis techniques are the basis of veterinary approaches, this study established detailed imaging atlas in sharks using computed tomography (CT) and magnetic resonance imaging (MRI) methods for the first time. Whole-body CT and MRI scans were performed with three young banded houndsharks (Triakis scyllium) of around 1 m in total body length, and each individual was cryosectioned into transverse, sagittal, and dorsal planes to compare and analyze with the images from CT and MRI scans. Atlas was established by classifying various organs and tissues in detail. However, it was impossible to confirm the reproductive system as the study was conducted on immature individuals. 2. Experiments were conducted on five male banded houndsharks (Triakis scyllium). One hour after 0.2 mL/kg of Ovaprim® administration, the shark's abdomen was gently massaged and the secondary cloudy portion of semen was sampled through urogenital papilla. The composition of an activating extender capable of maximizing the motility of stationary spermatozoa was established, which was designated as SSAE-1. To establish a cryopreservation protocol optimized for banded houndshark semen, a total of 8 extender solutions, 3 extension ratios, 15 cryoprotectants, 4 equilibration periods, 3 cooling rates, and 3 thawing temperatures were tested. The optimized protocol (Kim’s protocol) was as follows: extender, filtered seawater; extension ratio, 1:3; cryoprotectant, egg yolk 10% + ethylene glycol 10%; equilibration period, 10 min; cooling rate, 3 cm, 3 min; thawing temperature, 30℃, 10 s. The resulting post-thaw spermatozoa motility was 2.03%. 3. Experiments were conducted on the ovoviviparous shark banded houndshark (Triakis scyllium) and the placental shark (Triaenodon obesus) to confirm the applicability of salmon-derived gonadotropin-releasing hormone analogue (sGnRHa, Ovaprim®) throughout shark species with various breeding strategies. Prior to the experiment, normal blood sex hormone concentrations of females and males were identified in each of the species, and used as the base line for further experimental analysis. In both species, it was confirmed that Ovaprim® successfully induced changes in concentration of estradiol, progesterone, and testosterone in the blood, follicular maturation and ovulation in females, and semen release in males. The optimized injection protocols of Ovaprim® for future application to artificial insemination were as follows: male banded houndshark: 0.2 mL/kg administration and semen sampling 1 hour after administration; female banded houndshark: 0.2 mL/kg first administration and 0.5 mL/kg second administration with 24 hours of gap time; male whitetip reef shark: 0.2 mL/kg administration and semen sampling right after administration; female whitetip reef shark: 0.2 mL/kg first administration and 0.2 mL/kg or 0.3 mL/kg second administration with 24 hours of gap time.ABSTRACT CONTENTS LIST OF FIGURES LIST OF TABLES ABBREVIATIONS CHAPTER I 1 Abstract 2 1. Introduction 3 2. Materials and Methods 5 3. Results 8 4. Discussion 9 5. Conclusion 13 References 39 CHAPTER II 47 Abstract 48 1. Introduction 49 2. Materials and Methods 52 3. Results 59 4. Discussion 63 5. Conclusion 73 References 88 CHAPTER Ⅲ 97 Abstract 98 1. Introduction 99 2. Materials and Methods 103 3. Results 112 4. Discussion 118 References 141 GENERAL CONCLUSION 151 국문 초록 153 PUBLISHED ARTICLES 158 CONFERENCE PROCEEDINGS 166 감사의 글 168박

The nature and consistency of exercise reporting in rehabilitation following rotator cuff repair

Abstract Purpose: Rotator cuff repair is conventional surgery, and postoperative rehabilitation programs are routine. Optimization and implementation of evidence-based exercise are dependent on comprehensive reporting of intervention content and dosage. The purpose of this study is to examine the content and consistency of reporting of postoperative exercise programs following arthroscopic rotator cuff repairs. Methods: Keyword search of PUBMED, EMBASE, Scopus, SPORTDiscuss, AMED, CINAHL, and Cochrane were performed from January 1950 to March 2019. All the studies that discussed rehabilitation following rotator cuff repairs of human adults were included. A Proforma Consensus on Exercise Reporting Template (CERT) assessment form was used to extract data. Results: Thirty-one studies were included in this report. Out of 19 items prescribed by the panel of exercise experts, only 1 study scored 63%. A mean score of 3.83 and a median of 3 with a range of 12 was registered. Out of these 31 studies, three studies scored 0 out of 19. Conclusion: Variation in content in rotator cuff post-operative regimens was evident, as was a lack of complete reporting of intervention specifics. Lack of exercise reporting is a clear barrier to implementation of best practice. Keywords: postoperative, rotator cuff, rehabilitation, exercise reporting guideline

Department of Radiology-Annual Executive Summary Report-July 1, 2011 to June 30, 2012

93 page Department of Radiology Annual Executive Summary Report, July 1, 2011 to June 30, 2012, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States. Table of Contents Chairman, Vice Chairmen 1 Divisions and Directors 1 Committees and Chairmen 1 Radiology Department Faculty Rank 2 Faculty with Secondary Appointments 3 Clinical Divisions 4 Radiology Residents and Fellows 5 Department Organizational Chart 6 Department Administration Chart 7 State of the Department 8 Appendix I: Publications Journal Articles 23 Books and Book Chapters 31 Abstracts 35 Appendix II: Formal Scientific Presentations 50 Appendix III: Honors, Editorial Activities, Service to Regional or National Organizations 68 Appendix IV: Active Grants 82 Appendix V: Pending Grants 8

Traumatic anterior shoulder dislocation:What is required to define optimal treatment strategies?

Traumatic anterior shoulder, or glenohumeral, dislocations are painful and functional shoulder instability limits patients in performing activities of daily living, sports and work. Up to 60% of patients experience redislocation following a first-time dislocation. If a patient experiences redislocation, it can increase damage to the joint, which in turn is associated with a higher redislocation risk. Selecting optimal treatment for patients can be a challenging process. There are effective operative interventions available, but it is unclear which patients should receive which intervention and in which stage. Risk factors associated with redislocation or worse outcomes can identify which treatment is suitable for the patient. These factors can guide the shared-decision making process when specific risk factors can be managed with the intervention of interest. This thesis demonstrates that (1) there are many inconsistencies in selection and definitions of risk factors; (2) the predictive value of risk factors can differ in specific patient groups; (3) it is important to evaluate the reliability and accuracy of quantifiable risk factors; (4) 3D position of the bony structures relative to each other can be a potential risk factor for redislocation; (5) there is insufficient awareness for standardization, timing and reporting of patient-reported outcome measures and (6) healthcare providers and patients can reach a consensus on which items are considered important to evaluate in shoulder instability research. Finally, taking these conclusions into account, it discusses what is required to define optimal treatment strategies following traumatic anterior shoulder dislocation

Acoustic Monitoring of Joint Health

The joints of the human body, especially the knees, are continually exposed to varying loads as a person goes about their day. These loads may contribute to damage to tissues including cartilage and the development of degenerative medical conditions such as osteoarthritis (OA). The most commonly used method currently for classifying the severity of knee OA is the Kellgren and Lawrence system, whereby a grade (a KL score) from 0 to 4 is determined based on the radiographic evidence. However, radiography cannot directly depict cartilage damage, and there is low inter-observer precision with this method. As such, there has been a significant activity to find non-invasive and radiation-free methods to quantify OA, in order to facilitate the diagnosis and the appropriate course of medical action and to validate the development of therapies in a research or clinical setting. A number of different teams have noted that variation in knee joint sounds during different loading conditions may be indicative of structural changes within the knee potentially linked to OA. Here we will review the use of acoustic methods, such as acoustic Emission (AE) and vibroarthrography (VAG), developed for the monitoring of knee OA, with a focus on the issues surrounding data collection and analysis