Effects of intervertebral disk behavior on the load distribution and fracture risk of the vertebral body

Osteoporosis is characterized by low bone mass and an increased fracture risk. Measurements of bone mass alone, however, will not provide adequate information about the fracture risk, because the trabecular architecture or spatial distribution of the bone density has an important effect on the strength. We have developed a method to estimate the tissue strength of trabecular bone directly from 3D reconstructed axial CT-scans in combination with a finite element model. The method provides the stress distribution throughout the structure which can be used as a measure for the strength and fracture risk of the bone. A matter of concern with this method are the external loading conditions placed on the vertebral body, which might be strongly affected by the behavior of the intervertebral disk. In this study we have tested the effects of various intervertebral disk models on the load distribution through the vertebral body. A 3D model of a vertebral body was developed based on serial axial CT-scans which were converted to a 3D finite element model. The model was augmented with intervertebral disks at the upper and lower endplates. The disks contained a nucleus and an annulus region. The properties of the nucleus were varied to study the effects of a healthy disk with a functional nucleus pulposus and a degenerated disk with virtually no load bearing of the nucleus pulposus. The methods introduced in this study can be used to estimate load transfer through the vertebral body directly from CT-scans and, thereby, assessing the fracture risk of the bone and thus the status of osteoporosi

Runoff and Sediment Losses from Annual and Unusual Storm Events from the Alto Experimental Watersheds, Texas: 23 Years After Silvicultural Treatments

Evaluating the potential impacts of intensive silvicultural practices on water quality is critical for establishing the long-term sustainability of contemporary forest management practices. From 1979 to 1985, a study involving nine small (~2.5 ha) forested watersheds was conducted near Alto, Texas in the upper western Gulf-Coastal Plain to evaluate the impacts then-current silvicultural practices on water quality. In the years following the study, silvicultural Best Management Practices (BMPs) including Streamside Management Zones (SMZs) and other erosion control practices evolved and questions arose about the applicability of earlier results to current practices. In 1999, these same watersheds were reinstrumented to evaluate the water quality effects of intensive silviculture using modern BMPs. Three years of pre-treatment data were collected to calibrate the watersheds. During the calibration phase, in June 2001, Tropical Storm Allison struck southeastern Texas, dumping almost 11.8 cm of rainfall on saturated soils in about 3 hours. This single storm event resulted in over 73% of the annual flow and over 95% of the annual sediment for 2001. In a little over three hours, the watersheds clearcut and chopped in 1980 generated over 2.5 times more sediment that the entire year following harvest and site-preparation. 1Comparisons of data from the 1979 Alto Watershed study with pretreatment data from the current study suggest that these watersheds have a high potential for geologic erosion even with mature forest cover. Large natural variation in runoff and sediment makes it difficult to detect treatment effects for these forested watersheds

Sensor fusion for intelligent process control.

An integrated system for the fusion of product and process sensors and controls for production of flat glass was envisioned, having as its objective the maximization of throughput and product quality subject to emission limits, furnace refractory wear, and other constraints. Although the project was prematurely terminated, stopping the work short of its goal, the tasks that were completed show the value of the approach and objectives. Though the demonstration was to have been done on a flat glass production line, the approach is applicable to control of production in the other sectors of the glass industry. Furthermore, the system architecture is also applicable in other industries utilizing processes in which product uniformity is determined by ability to control feed composition, mixing, heating and cooling, chemical reactions, and physical processes such as distillation, crystallization, drying, etc. The first phase of the project, with Visteon Automotive Systems as industrial partner, was focused on simulation and control of the glass annealing lehr. That work produced the analysis and computer code that provide the foundation for model-based control of annealing lehrs during steady state operation and through color and thickness changes. In the second phase of the work, with PPG Industries as the industrial partner, the emphasis was on control of temperature and combustion stoichiometry in the melting furnace, to provide a wider operating window, improve product yield, and increase energy efficiency. A program of experiments with the furnace, CFD modeling and simulation, flow measurements, and sensor fusion was undertaken to provide the experimental and theoretical basis for an integrated, model-based control system utilizing the new infrastructure installed at the demonstration site for the purpose. In spite of the fact that the project was terminated during the first year of the second phase of the work, the results of these first steps toward implementation of model-based control were sufficient to demonstrate the value of the approach to improving the productivity of glass manufacture

Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries

BACKGROUND: Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. METHODS: 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. FINDINGS: Of the 23 572 patients included from 56 countries, 18 305 were children (77·7%) and 5267 were neonates (22·3%). Access antibiotic use in children ranged from 7·8% (China) to 61·2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77·3%) and lowest in Finland (23·0%). In neonates, Access antibiotic use was highest in Singapore (100·0%) and lowest in China (24·2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. INTERPRETATION: There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. FUNDING: GARPEC was funded by the PENTA Foundation. GARPEC-China data collection was funded by the Sanming Project of Medicine in Shenzhen (SZSM2015120330). bioMérieux provided unrestricted funding support for the Global-PPS

A statistical method to minimize magnification errors in serial vertebral radiographs.

Incident vertebral deformities are commonly defined by observed changes in height between measurements on two consecutive radiographs. However, conventional radiographs are subject to magnification, and this magnification may differ between films, leading to artifactual changes in height. In order to minimize this effect, it is common practice to record the spine-film and film-focus distances, and from this to calculate a magnification factor for each film. We present a simple statistical method for correcting for differences in magnification between two films if the spine-film and film-focus distances are unknown. This method is shown to reduce the variance of the magnification differences in vertebral heights by 14%, considerably more than is possible using the spine-film distance. Using the statistical method, the number of vertebrae that showed not only a reduction in one or more height of 15%, but were also judged clinically to be free from any incident deformity by an expert radiologist, was reduced from 100 to 46. The number showing a reduction of 20% that were judged fracture-free was reduced from 15 to 9. In the subset of subjects for whom the spine-film distance was known, the reduction in false positives was similar, whichever method was used to correct for magnification. There was no difference in the number of confirmed incident fractures detected when magnification correction by either method was employed. It is concluded that correcting for magnification differences using the statistical method outlined here reduces the number of false positive deformities very substantially and by a similar extent as correcting the magnification using reliable, measured spine-film and film-focus distances. A further advantage of this method is that it can be used retrospectively

British and Polish general practitioners' opinions on the importance of preventive medicine

The delivery of preventive services in GPs' surgeries falls below recommended levels. Different attempts are performed to change the situation. The introduction in the UK in 2004 of a new GP contract based on a QOF fundamentally changed the way that primary practitioners are paid. Success of this intervention caused international interest in using financial incentives as a method of improving general practice. Polish primary care is still under development. In contemplating reform and the possible introduction of some of these British solutions in Poland, it would be valuable to compare what British and Polish GPs' think about prevention and see how their opinions can be affected by context in which they work. The aim of the survey involving 65 British and 65 Polish GPs was to compare what are their views of health promotion. The questionnaire solicited information on doctors' demographic characteristics, attitudes toward prevention, time they think they spend on preventive procedures and perceptions of the importance of 13 selected preventive procedures. Most British and Polish GPs answered that prevention is very important and they spend 10-30% of each consultation on it. Almost all doctors rated blood pressure measurement as important. For British GPs BMI, blood glucose, lipid profile, antialcohol and anti-smoking advice were important, in contrast to Polish doctors. In the presence of clear clinical guidelines, age and gender do not affect doctors' opinion on the importance of preventive procedures. Procedures in which GPs are directly involved are more important for them

Effects of intervertebral disk behavior on the load distribution and fracture risk of the vertebral body

Osteoporosis is characterized by low bone mass and an increased fracture risk. Measurements of bone mass alone, however, will not provide adequate information about the fracture risk, because the trabecular architecture or spatial distribution of the bone density has an important effect on the strength. We have developed a method to estimate the tissue strength of trabecular bone directly from 3D reconstructed axial CT-scans in combination with a finite element model. The method provides the stress distribution throughout the structure which can be used as a measure for the strength and fracture risk of the bone. A matter of concern with this method are the external loading conditions placed on the vertebral body, which might be strongly affected by the behavior of the intervertebral disk. In this study we have tested the effects of various intervertebral disk models on the load distribution through the vertebral body. A 3D model of a vertebral body was developed based on serial axial CT-scans which were converted to a 3D finite element model. The model was augmented with intervertebral disks at the upper and lower endplates. The disks contained a nucleus and an annulus region. The properties of the nucleus were varied to study the effects of a healthy disk with a functional nucleus pulposus and a degenerated disk with virtually no load bearing of the nucleus pulposus. The methods introduced in this study can be used to estimate load transfer through the vertebral body directly from CT-scans and, thereby, assessing the fracture risk of the bone and thus the status of osteoporosi