Surgical Treatment of the Upper Extremity in Rheumatoid Arthritis

All surgical procedures designed to preserve or improve function in the extremities, whether in rheumatoid arthritis or not, must consider the functional emphasis of the upper extremity as compared to the lower extremity. The upper extremity has, as its primary goal, mobility and prehension, whereas in the lower extremity, stability is the most important goal, mobility the next in order of importance, and prehension the least important. For example, the feet fulfill a need for stability with very little requirement for prehension, but the hand is more an instrument for prehension and there is less need to consider stability. I have divided surgery in the upper extremity of the rheumatoid patient into the surgery of prevention and the surgery of repair--that is, those procedures designed to prevent the loss of function and those designed to restore some measure of function

Cartilage Regeneration on a Large Articular Surface Facilitated by Stress Shielding

An animal model for the study of articular cartilage regeneration in-vivo facilitated by stress-shielding is introduced. The object of the model is to test the hypothesis that some form of cartilaginous tissue will grow upon a large joint surface in vivo with the joint in normal motion. The model utilizes the known capability of immature cells to differentiate. The source of cells is bleeding subchondral bone. In addition, the model provides a mechanically shielded environment in which cell differentiation and maturation can occur. The study showed that a substantial amount of tissue will grow in the animal model only when the new tissue is relieved of the normal joint stresses. The characteristics of the new tissue were observed after 12 weeks of growth. Gross observation showed that the new tissue grew to completely surround the shielding devices and covered the entire articular surface. The new tissue grew to the height of the shielded area (2 to 3mm.). Histologic evidence indicated the new growth was largely fibrous in nature but with some areas of newly differentiated chondrocytes. Biomechanical analyses quantified the tissue as being a soft, permeable neocartilage: biochemical evaluations dem­onstrated increased hydration with small amounts of proteoglycans. These characteristics are inferior to normal cartilage. Never the less, the tissue quality is as good or better than that obtained in other models and it grew to cover a significantly larger articulating surface than all other experimental models. Material obtained in this experiment provides a baseline of data for future experiments designed to manipulate the new tissue using tissue engi­neering methods and to learn how the new tissue will tolerate exposure to reintroduced normal stress

Federal Judicial Selection

“The First Two Centuries”: The first panel explored the provisions that the drafters made in the United States Constitution for federal judicial selection and traced the two-century history of the selection process following the constitution\u27s adoption. The panel consisted of Charles Cooper, Esq. of Cooper & Kirk PLLC; Gary L. McDowell, Haynes Professor of Leadership Studies and Political Science at the University of Richmond’s Jepson School of Leadership Studies; and Ms. Maeva Marcus, of the United States Supreme Court Historical Society. Rodney A. Smolla, the George E. Allen Chair in Law, served as program coordinator and moderator. “Modern Federal Judicial Selection”: The second panel explored modern federal judicial selection, tracing the selection process over the last two decades and analyzing how it has grown increasingly contentious. The panel consisted of Theresa M. Beiner, of the William H. Bowen School of Law at the University of Arkansas at Little Rock; Sheldon Goldman, Department of Political Science University of Massachusetts; Judge Edith Jones, U.S. Court of Appeals for the Fifth Circuit; and William P. Marshall, the Kenan Professor of Law University of North Carolina School of Law. Carl W. Tobias, Williams Professor of Law at the University of Richmond School of Law, served as moderator. “The Prospects of Reform”: The third panel explored numerous suggestions for remedying or ameliorating the difficulties that pervade modern federal judicial selection and the prospects for these measures\u27 success. The panel consisted of Terry Eastland, Publisher of The Weekly Standard; Michael Gerhardt, Hanson Professor of Law at the Marshall-Wythe School of Law, College of William and Mary; and Sanford V. Levinson, The W. St. John Garwood Centennial Chair in Law and Professor of Government at the University of Texas School of Law. Gary L. McDowell, the Haynes Professor of Leadership Studies and Political Science at the University of Richmond’s Jepson School of Leadership Studies, served as moderator

Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study)

Treatment of hyperphosphatemia in hemodialysis patients: The Calcium Acetate Renagel Evaluation (CARE Study).BackgroundHyperphosphatemia underlies development of hyperparathyroidism, osteodystrophy, extraosseous calcification, and is associated with increased mortality in hemodialysis patients.MethodsTo determine whether calcium acetate or sevelamer hydrochloride best achieves recently recommended treatment goals of phosphorus ≤5.5mg/dL and Ca × P product ≤55mg2/dL2, we conducted an 8-week randomized, double-blind study in 100 hemodialysis patients.ResultsComparisons of time-averaged concentrations (weeks 1 to 8) demonstrated that calcium acetate recipients had lower serum phosphorus (1.08mg/dL difference, P = 0.0006), higher serum calcium (0.63mg/dL difference, P < 0.0001), and lower Ca × P (6.1mg2/dL2 difference, P = 0.022) than sevelamer recipients. At each week, calcium acetate recipients were 20% to 24% more likely to attain goal phosphorus [odds ratio (OR) 2.37, 95% CI 1.28–4.37, P = 0.0058], and 15% to 20% more likely to attain goal Ca × P (OR 2.16, 95% CI 1.20–3.86, P = 0.0097). Transient hypercalcemia occurred in 8 of 48 (16.7%) calcium acetate recipients, all of whom received concomitant intravenous vitamin D. By regression analysis hypercalcemia was more likely with calcium acetate (OR 6.1, 95% CI 2.8–13.3, P < 0.0001). Week 8 intact PTH levels were not significantly different. Serum bicarbonate levels were significantly lower with sevelamer hydrochloride treatment (P < 0.0001).ConclusionCalcium acetate controls serum phosphorus and calcium-phosphate product more effectively than sevelamer hydrochloride. Cost-benefit analysis indicates that in the absence of hypercalcemia, calcium acetate should remain the treatment of choice for hyperphosphatemia in hemodialysis patients

On Secure Workflow Decentralisation on the Internet

Decentralised workflow management systems are a new research area, where most work to-date has focused on the system's overall architecture. As little attention has been given to the security aspects in such systems, we follow a security driven approach, and consider, from the perspective of available security building blocks, how security can be implemented and what new opportunities are presented when empowering the decentralised environment with modern distributed security protocols. Our research is motivated by a more general question of how to combine the positive enablers that email exchange enjoys, with the general benefits of workflow systems, and more specifically with the benefits that can be introduced in a decentralised environment. This aims to equip email users with a set of tools to manage the semantics of a message exchange, contents, participants and their roles in the exchange in an environment that provides inherent assurances of security and privacy. This work is based on a survey of contemporary distributed security protocols, and considers how these protocols could be used in implementing a distributed workflow management system with decentralised control . We review a set of these protocols, focusing on the required message sequences in reviewing the protocols, and discuss how these security protocols provide the foundations for implementing core control-flow, data, and resource patterns in a distributed workflow environment

Beyond Simple AGN Unification with Chandra-observed 3CRR Sources at 0.5 &lt; z &lt; 1

Low-frequency radio selection finds radio-bright galaxies regardless of the amount of obscuration by gas and dust. We report \chandra\ observations of a complete 178~MHz-selected, and so orientation unbiased, sample of 44 $0.5<z<1$ 3CRR sources. The sample is comprised of quasars and narrow-line radio galaxies (NLRGs) with similar radio luminosities, and the radio structure serves as both an age and an orientation indicator. Consistent with Unification, intrinsic obscuration (measured by \nh, X-ray hardness ratio, and X-ray luminosity) generally increases with inclination. However, the sample includes a population not seen in high-$z$ 3CRR sources: NLRGs viewed at intermediate inclination angles with \nh~$<10^{22}$~cm$^{-2}$. Multiwavelength analysis suggests these objects have lower $L/L_{\rm Edd}$ than typical NLRGs at similar orientation. Thus both orientation and $L/L_{\rm Edd}$ are important, and a "radiation-regulated Unification" provides a better explanation of the sample's observed properties. In comparison with the 3CRR sample at $1<z<2$, our lower-redshift sample shows a higher fraction of Compton-thin NLRGs (45\% vs.\ 29\%) but similar Compton-thick fraction (20\%), implying a larger covering factor of Compton-thin material at intermediate viewing angles and so a more "puffed-up" torus atmosphere. We posit that this is due to a range of $L/L_{\rm Edd}$ extending to lower values in this sample. In contrast, at high redshifts the narrower range and high $L/L_{\rm Edd}$ values allowed orientation (and so simple Unification) to dominate the sample's observed properties

Significance of Pelvic Fluid Observed during Ovarian Cancer Screening with Transvaginal Sonogram

The primary objective was to examine the role of pelvic fluid observed during transvaginal ultrasonography (TVS) in identifying ovarian malignancy. A single-institution, observational study was conducted within the University of Kentucky Ovarian Cancer Screening trial from January 1987 to September 2019. We analyzed true-positive (TP), false-positive (FP), true-negative (TN), and false-negative (FN) groups for the presence of pelvic fluid during screening encounters. Measured outcomes were the presence and duration of fluid over successive screening encounters. Of the 48,925 women surveyed, 2001 (4.1%) had pelvic fluid present during a TVS exam. The odds ratio (OR) of detecting fluid in the comparison group (TN screen; OR = 1) significantly differed from that of the FP cases (benign pathology; OR: 13.4; 95% confidence interval (CI): 9.1–19.8), the TP cases with a low malignant potential (LMP; OR: 28; 95% CI: 26.5–29.5), TP ovarian cancer cases (OR: 50.4; 95% CI: 27.2–93.2), and FN ovarian cancer cases (OR: 59.3; 95% CI: 19.7–178.1). The mean duration that pelvic fluid was present for women with TN screens was 2.2 ± 0.05 encounters, lasting 38.7 ± 1.3 months. In an asymptomatic screening population, free fluid identified in TVS exams was more associated with ovarian malignancy than in the control group or benign ovarian tumors. While pelvic free fluid may not solely discriminate malignancy from non-malignancy, it appears to be clinically relevant and warrants thoughtful consideration

Representing the function and sensitivity of coastal interfaces in earth system models

© The Author(s), 2020. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Ward, N. D., Megonigal, J. P., Bond-Lamberty, B., Bailey, V. L., Butman, D., Canuel, E. A., Diefenderfer, H., Ganju, N. K., Goni, M. A., Graham, E. B., Hopkinson, C. S., Khangaonkar, T., Langley, J. A., McDowell, N. G., Myers-Pigg, A. N., Neumann, R. B., Osburn, C. L., Price, R. M., Rowland, J., Sengupta, A., Simard, M., Thornton, P. E., Tzortziou, M., Vargas, R., Weisenhorn, P. B., & Windham-Myers, L. Representing the function and sensitivity of coastal interfaces in earth system models. Nature Communications, 11(1), (2020): 2458, doi:10.1038/s41467-020-16236-2.Between the land and ocean, diverse coastal ecosystems transform, store, and transport material. Across these interfaces, the dynamic exchange of energy and matter is driven by hydrological and hydrodynamic processes such as river and groundwater discharge, tides, waves, and storms. These dynamics regulate ecosystem functions and Earth’s climate, yet global models lack representation of coastal processes and related feedbacks, impeding their predictions of coastal and global responses to change. Here, we assess existing coastal monitoring networks and regional models, existing challenges in these efforts, and recommend a path towards development of global models that more robustly reflect the coastal interface.Funding for this work was provided by Pacific Northwest National Laboratory (PNNL) Laboratory Directed Research & Development (LDRD) as part of the Predicting Ecosystem Resilience through Multiscale Integrative Science (PREMIS) Initiative. PNNL is operated by Battelle for the U.S. Department of Energy under Contract DE-AC05-76RL01830. Additional support to J.P.M. was provided by the NSF-LTREB program (DEB-0950080, DEB-1457100, DEB-1557009), DOE-TES Program (DE-SC0008339), and the Smithsonian Institution. This manuscript was motivated by discussions held by co-authors during a three-day workshop at PNNL in Richland, WA: The System for Terrestrial Aquatic Research (STAR) Workshop: Terrestrial-Aquatic Research in Coastal Systems. The authors thank PNNL artist Nathan Johnson for preparing the figures in this manuscript and Terry Clark, Dr. Charlette Geffen, and Dr. Nancy Hess for their aid in organizing the STAR workshop. The authors thank all workshop participants not listed as authors for their valuable insight: Lihini Aluwihare (contributed to biogeochemistry discussions and development of concept for Fig. 3), Gautam Bisht (contributed to modeling discussion), Emmett Duffy (contributed to observational network discussions), Yilin Fang (contributed to modeling discussion), Jeremy Jones (contributed to biogeochemistry discussions), Roser Matamala (contributed to biogeochemistry discussions), James Morris (contributed to biogeochemistry discussions), Robert Twilley (contributed to biogeochemistry discussions), and Jesse Vance (contributed to observational network discussions). A full report on the workshop discussions can be found at https://www.pnnl.gov/publications/star-workshop-terrestrial-aquatic-research-coastal-systems