Seasonal variation in adult hip disease secondary to osteoarthritis and developmental dysplasia of the hip

AIM: To determine if there was a seasonal variation in adults undergoing total hip arthroplasty for end stage hip disease due to osteoarthritis (OA) or sequelae of developmental dysplasia of the hip (DDH). METHODS: The total hip registry from the author's institution for the years 1969 to 2013 was reviewed. The month of birth, age, gender, and ethnicity was recorded. Differences between number of births observed and expected in the winter months (October through February) and non-winter mo (March through September) were analyzed with the χ2 test. Detailed temporal variation was mathematically assessed using cosinor analysis. RESULTS: There were 7792 OA patients and 60 DDH patients who underwent total hip arthroplasty. There were more births than expected in the winter months for both the DDH (P < 0.0001) and OA (P = 0.0052) groups. Cosinor analyses demonstrated a peak date of birth on 1st October. CONCLUSION: These data demonstrate an increased prevalence of DDH and OA in those patients born in winter

Quantification of lung perfusion blood volume by dual-energy CT in patients with and without chronic obstructive pulmonary disease

Purpose: In chronic obstructive pulmonary disease (COPD), pulmonary vascular alteration is one of the characteristic features. Recently, software has been used for the quantification of lung iodine perfusion blood volume (iPBV) using dual-energy CT, allowing objective evaluation. The purpose of this study was to evaluate the quantification of lung PBV with and without COPD. Materials and Methods: This study was approved by the Institutional Review Board. Sixty-two subjects who had undergone a respiratory function test within one month underwent dual-energy CT angiography. The subjects were divided into two groups: with (n=14) and without (n=48) COPD. We evaluated the quantification of lung iPBV in the early phase and late phase using Syngo softwarepost contrast. Associations between lung iPBV and respiratory function (forced expiratory volume in 1 second/forced vital capacity; FEV1/FVC) and the percentage area of emphysema (%LAA-950) were also evaluated. Results: In the early phase, lung iPBV values were 20.1±5.5 and 30.6±7.6 Hounsfield Unit (HU) in those with and without COPD, respectively, with a significant difference between them (Conclusions: Quantification of lung iPBV reflects reduced pulmonary perfusion in patients with COPD. It may be useful for objective evaluation of the pulmonary blood flow in patients with COPD

A cautionary note on methods of comparing programmatic efficiency between two or more groups of DMUs in data envelopment analysis

In some applications of data envelopment analysis (DEA) there may be doubt as to whether all the DMUs form a single group with a common efficiency distribution. The Mann-Whitney rank statistic has been used to evaluate if two groups of DMUs come from a common efficiency distribution under the assumption of them sharing a common frontier and to test if the two groups have a common frontier. These procedures have subsequently been extended using the Kruskal-Wallis rank statistic to consider more than two groups. This technical note identifies problems with the second of these applications of both the Mann-Whitney and Kruskal-Wallis rank statistics. It also considers possible alternative methods of testing if groups have a common frontier, and the difficulties of disaggregating managerial and programmatic efficiency within a non-parametric framework. © 2007 Springer Science+Business Media, LLC

Endovascular repair of aortic dissection and intramural hematoma: indications and serial changes

Thoracic aortic dissection (AD) is one of the most common aortic emergencies. It can be fatal if not promptly diagnosed and treated. Intramural hematoma (IMH) of the aorta is recognized as distinct from classic (double-barreled) AD. IMH also frequently leads to aortic emergency, which can be fatal unless rapidly diagnosed and treated.Recently, thoracic endovascular aortic repair (TEVAR) has been used for the treatment of complications caused by AD. TEVAR is also a viable option for the treatment of complicated IHM. In this article, we review the details of TEVAR as treatment options for AD and IMH, including the indications for TEVAR, imaging, and follow-up

Measuring Incineration Plants' Performance using Combined Data Envelopment Analysis, Goal Programming and Mixed Integer Linear Programming

Incineration plants produce heat and power from waste, reduce waste disposal to landfills, and discharge harmful emissions and bottom ash. The objective of the incineration plant is to maximize desirable outputs (heat and power) and minimize undesirable outputs (emissions and bottom ash). Therefore, studying the overall impact of incineration plants in a region so as to maximize the benefits and minimize the environmental impact is significant. Majority of prior works focus on plant specific decision making issues including performance analysis. This study proposes a hybrid Data Envelopment Analysis (DEA), Goal Programming (GP) and Mixed Integer Linear Programming (MILP) model to assess the performance of incineration plants, in a specific region, to enhance overall power production, consumption of waste and reduction of emissions. This model not only helps the plant operators to evaluate the effectiveness of incineration but also facilitates the policy makers to plan for overall waste management of the region through decision-making on adding and closing plants on the basis of their efficiency. Majority of prior studies on incineration plants emphasize on how to improve their performance on heat and power production and neglect the waste management aspects. Additionally, optimizing benefits and minimizing negative outputs through fixing targets in order to make decision on shutting down the suboptimal plants has not been modeled in prior research. This research combines both the aspects and addresses the overall performance enhancement of incineration plants within a region from both policy makers and plant operators’ perspectives. The proposed combined DEA, GP and MILP model enables to optimize incineration plants performance within a region by deriving efficiency of each plant and identifying plants to close down on the basis of their performance. The proposed model has been applied to a group of 22 incineration plants in the UK using secondary data in order to demonstrate the effectiveness of the model.

Relative Activation of Human Pregnane X Receptor versus Constitutive Androstane Receptor Defines Distinct Classes of CYP2B6 and CYP3A4 Inducers

Both the human pregnane X receptor (hPXR) and constitutive androstane receptor (hCAR) are capable of regulating CYP3A4 and CYP2B6 gene expression. However, the majority of currently identified CYP3A4 and CYP2B6 inducers are confirmed activators of hPXR but not hCAR. To compare these receptors with respect to their chemical selectivities, 16 drugs known to induce CYP3A4 and/or CYP2B expression were evaluated for relative activation of hPXR versus hCAR. Because of the high basal but low chemical-induced activation of hCAR in immortalized cells, alternative methods were used to evaluate hCAR activation potential. Thirteen of the 16 compounds were classified as moderate to strong hPXR activators. In contrast, carbamazepine (CMZ), efavirenz (EFV), and nevirapine (NVP) were classified as negligible or weak hPXR activators at concentrations associated with efficacious CYP2B6 reporter or endogenous gene induction in primary human hepatocytes, suggesting potential activation of hCAR. Subsequent experiments demonstrated that these three drugs efficiently induced nuclear accumulation of in vivo-transfected enhanced yellow fluorescent protein-hCAR and significantly increased expression of a CYP2B6 reporter gene when hCAR was expressed in CAR−/− mice. In addition, using a recently identified, chemically responsive splice variant of hCAR (hCAR3), the hCAR activation profiles of the 16 compounds were evaluated. By combining results from the hPXR- and hCAR3-based reporter gene assays, these inducers were classified as hPXR, hCAR, or hPXR/hCAR dual activators. Our results demonstrate that CMZ, EFV, and NVP induce CYP2B6 and CYP3A4 preferentially through hCAR and that hCAR3 represents a sensitive tool for in vitro prediction of chemical-mediated human CAR activation

Global Well-posedness of an Inviscid Three-dimensional Pseudo-Hasegawa-Mima Model

The three-dimensional inviscid Hasegawa-Mima model is one of the fundamental models that describe plasma turbulence. The model also appears as a simplified reduced Rayleigh-B\'enard convection model. The mathematical analysis the Hasegawa-Mima equation is challenging due to the absence of any smoothing viscous terms, as well as to the presence of an analogue of the vortex stretching terms. In this paper, we introduce and study a model which is inspired by the inviscid Hasegawa-Mima model, which we call a pseudo-Hasegawa-Mima model. The introduced model is easier to investigate analytically than the original inviscid Hasegawa-Mima model, as it has a nicer mathematical structure. The resemblance between this model and the Euler equations of inviscid incompressible fluids inspired us to adapt the techniques and ideas introduced for the two-dimensional and the three-dimensional Euler equations to prove the global existence and uniqueness of solutions for our model. Moreover, we prove the continuous dependence on initial data of solutions for the pseudo-Hasegawa-Mima model. These are the first results on existence and uniqueness of solutions for a model that is related to the three-dimensional inviscid Hasegawa-Mima equations

Public health insurance and entry into self-employment

We estimate the impact of a differential treatment of paid employees versus self-employed workers in a public health insurance system on the entry rate into entrepreneurship. In Germany, the public health insurance system is mandatory for most paid employees, but not for the selfemployed, who usually buy private health insurance. Private health insurance contributions are relatively low for the young and healthy, and until 2013 also for males, but less attractive at the other ends of these dimensions and if membership in the public health insurance allows other family members to be covered by contribution-free family insurance. Therefore, the health insurance system can create incentives or disincentives to starting up a business depending on the family’s situation and health. We estimate a discrete time hazard rate model of entrepreneurial entry based on representative household panel data for Germany, which include personal health information, and we account for non- random sample selection. We estimate that an increase in the health insurance cost differential between self-employed workers and paid employees by 100 euro per month decreases the annual probability of entry into selfemployment by 0.38 percentage points, i.e. about a third of the average annual entry rate. The results show that the phenomenon of entrepreneurship lock, which an emerging literature describes for the system of employer provided health insurance in the USA, can also occur in a public health insurance system. Therefore, entrepreneurial activity should be taken into account when discussing potential health care reforms, not only in the USA and in Germany