A Uniform Method for Proving Lower Bounds of the Computational Complexity of Logical Theories

https://deepblue.lib.umich.edu/bitstream/2027.42/154178/1/39015100081655.pd

Nonconvergence, Undecidability, and Intractability in Asymptotic Problems

https://deepblue.lib.umich.edu/bitstream/2027.42/154144/1/39015099114582.pd

Patient Satisfaction with Sutures Used in Knee Arthroscopy Portal Closure: Randomized Control Trial

Abstract: Introduction Both absorbable and non-absorbable sutures are routinely used for closure of arthroscopic portal incisions. However, current literature assessing patient satisfaction using either suture type in knee arthroscopic portal closure is limited. Purpose/Hypothesis The purpose of this study is to evaluate patient outcomes and satisfaction following wound closure with absorbable (Monocryl) versus non-absorbable (Nylon) sutures during knee arthroscopy. Study Design Randomized Controlled Trial (Level I) Methods Patients over 18 years undergoing primary knee arthroscopy were identified during procedure scheduling. Exclusion criteria included revision procedures, concomitant ligament reconstruction or meniscal repair surgery. Before surgery, enrolled patients were randomly assigned to undergo closure with either 3-0 Monocryl or 3-0 nylon sutures. Postoperative evaluation was performed at 2-, 6- and 12-weeks and included a Visual Analogue Cosmesis scale, a 10-point visual analogue scale (VAS) for pain, patient scar assessment, and customized questionnaire assessing scar satisfaction. Results Two hundred seventy-four patients were included for analysis: 145 in the absorbable group and 129 in the non-absorbable group. There was no significant difference between groups in terms of age, sex, BMI, race, smoking status, or laterality of procedure. Patients in the non- absorbable group reported higher overall satisfaction ratings at week 6 follow-up (9.12 ± 1.85 vs. 8.44 ± 2.49, p=0.019) and week 12 follow-up (9.13 ± 1.76 vs. 8.54 ± 2.50, p=0.048). There was no difference in pain, swelling, itching, numbness, incisional pain, or burning at any time point. Patients in the non-absorbable group observed more skin discoloration at 2-week (3.00 ± 2.33 vs. 2.41 ± 1.80, p=0.026) and 6-week (3.74 ± 2.82 vs. 2.98 ± 2.45, p=0.032) follow-up with no significant difference at 12 weeks. Conclusion Despite reporting worse skin discoloration at early follow up, patients receiving non-absorbable sutures reported higher overall satisfaction than patients receiving absorbable sutures. Given that there was no difference in pain, swelling, itching, numbness, incisional pain, or burning, it is possible that non-queried variables such as time spent with patients (possibly increased in the non-absorbable group due to the time spent removing sutures) or frustration with the delayed resorption of absorbable sutures led to this difference

Determining Accuracy of Chondral Lesion Sizing Methods Prior to Surgery

Background: Osteochondral lesions of the knee may require cartilage restoration such as osteochondral allograft (OCA) transplantation or autologous chondrocyte implantation (ACI). Although MRI and arthroscopy can offer valuable information regarding lesion characteristics prior to these procedures, no study has compared the use of each in estimating the sizes of grafts used at the time of surgical correction. Hypothesis/Purpose: To compare osteochondral defect size measurements and characteristics across MRI, arthroscopy, and at the time of implantation with OCA or ACI. Study Design: Retrospective Cohort Study (Level III) Methods: Patients who underwent ACI and OCA transplantation at a single institution between 2015 and 2019 were retrospectively identified. Osteochondral lesion characteristics including size were collected preoperatively from MRI and arthroscopy and at the time of definitive open surgical intervention. Subgroup analysis was performed comparing measurement techniques depending on the corrective surgical approach used as well as depending on the mechanism of chondral injury to determine if these had any effect on the ability of arthroscopy or MRI to predict graft size. Results: Overall, 136 chondral lesions were addressed with restoration procedures in 117 patients (mean age 32.5 years). Average difference between final graft size and lesion area measured with index arthroscopy was 116 mm2, while average difference between final graft size and lesion size measured with preoperative MRI was 182 mm2 (P \u3c .001). Depending on surgical technique, measurements with MRI were more similar to final graft size when a patient underwent OCA transplantation versus ACI (P = .007). Depending on mechanism of injury, MRI measurements of lesions were closer to graft area when lesions resulted from trauma (P = .047). Conclusion: Chondral lesion size determined by preoperative MRI imaging is less accurate than arthroscopic measurements. The mechanism injury leading to chondral damage and degree of damage may influence the ability of MRI and arthroscopy to accurately measure chondral lesions and predict the final graft size used in surgical correction. Future studies may be warranted to further investigate influencing factors that alter the reliability of arthroscopy and MRI in measuring chondral lesions. Magnetic Resonanc

Whose Land Is It Anyway? Navigating Ghana\u27s Complex Land System

This Article dives into Ghana’s complex land-registration system, which is influenced by both statutory and customary law. Section II discusses Ghana’s statutory land laws. Section III provides a brief overview of Ghana’s customary land laws. Section IV discusses several obstacles within Ghana’s land-administration system

Psychological Resilience and Cognitive Function Among Older Military Veterans.

The purpose of this study was to explore the association between psychological resilience and cognitive function in military veterans. We obtained public-use data from the Health and Retirement Study (HRS) for this cross-sectional study of military veterans aged 52 to 101 years (n = 150). We estimated a multivariable linear regression model in which cognitive function served as the dependent variable and psychological resilience served as the independent variable. After controlling for demographics, health conditions, and health behaviors, veterans who had higher psychological resilience scores had better cognitive function (b = 0.22, p = 0.03). Our findings suggest that psychological resilience may be associated with cognitive function among veterans. These findings highlight the importance of assessing psychological resilience in gerontological social work practice

Seasonal Phytoplankton Blooms in the North Atlantic Linked to the Overwintering Strategies of Copepods

The North Atlantic Ocean contains diverse patterns of seasonal phytoplankton blooms with distinct internal dynamics. We analyzed blooms using remotely-sensed chlorophyll a concentration data and change point statistics. The first bloom of the year began during spring at low latitudes and later in summer at higher latitudes. In regions where spring blooms occurred at high frequency (i. e., proportion of years that a bloom was detected), there was a negative correlation between bloom timing and duration, indicating that early blooms last longer. In much of the Northeast Atlantic, bloom development extended over multiple seasons resulting in peak chlorophyll concentrations in summer. Spring bloom start day was found to be positively correlated with a spring phenology index and showed both positive and negative correlations to sea surface temperature and the North Atlantic Oscillation in different regions. Based on the characteristics of spring and summer blooms, the North Atlantic can be classified into two regions: a seasonal bloom region, with a well-defined bloom limited to a single season; and a multi-seasonal bloom region, with blooms extending over multiple seasons. These regions differed in the correlation between bloom start and duration with only the seasonal bloom region showing a significant, negative correlation. We tested the hypothesis that the near-surface springtime distribution of copepods that undergo diapause (Calanus finmarchicus, C. helgolandicus, C. glacialis, and C. hyperboreus) may contribute to the contrast in bloom development between the two regions. Peak near-surface spring abundance of the late stages of these Calanoid copepods was generally associated with areas having a well-defined seasonal bloom, implying a link between bloom shape and their abundance. We suggest that either grazing is a factor in shaping the seasonal bloom or bloom shape determines whether a habitat is conducive to diapause, while recognizing that both factors can re-enforce each other

Seasonal Phytoplankton Blooms in the North Atlantic Linked to the Overwintering Strategies of Copepods

The North Atlantic Ocean contains diverse patterns of seasonal phytoplankton blooms with distinct internal dynamics. We analyzed blooms using remotely-sensed chlorophyll a concentration data and change point statistics. The first bloom of the year began during spring at low latitudes and later in summer at higher latitudes. In regions where spring blooms occurred at high frequency (i. e., proportion of years that a bloom was detected), there was a negative correlation between bloom timing and duration, indicating that early blooms last longer. In much of the Northeast Atlantic, bloom development extended over multiple seasons resulting in peak chlorophyll concentrations in summer. Spring bloom start day was found to be positively correlated with a spring phenology index and showed both positive and negative correlations to sea surface temperature and the North Atlantic Oscillation in different regions. Based on the characteristics of spring and summer blooms, the North Atlantic can be classified into two regions: a seasonal bloom region, with a well-defined bloom limited to a single season; and a multi-seasonal bloom region, with blooms extending over multiple seasons. These regions differed in the correlation between bloom start and duration with only the seasonal bloom region showing a significant, negative correlation. We tested the hypothesis that the near-surface springtime distribution of copepods that undergo diapause (Calanus finmarchicus, C. helgolandicus, C. glacialis, and C. hyperboreus) may contribute to the contrast in bloom development between the two regions. Peak near-surface spring abundance of the late stages of these Calanoid copepods was generally associated with areas having a well-defined seasonal bloom, implying a link between bloom shape and their abundance. We suggest that either grazing is a factor in shaping the seasonal bloom or bloom shape determines whether a habitat is conducive to diapause, while recognizing that both factors can re-enforce each other