Clavicular fracture treatment: choices and challenges

Midschacht claviculafracturen komen veel voor en zijn meestal verplaatst. Het is niet bekend welke behandeling het beste is. In dit proefschrift worden onderzoeken beschreven naar alle facetten van de twee meest toegepaste behandelopties voor sleutelbeenbreuken: operatieve fixatie met een plaat, en conservatieve behandeling met een sling/mitella. Zowel behandelresultaten, als het proces van besluitvorming komen aan bod, met als doel de keus voor de beste behandeling te vergemakkelijken. De belangrijkste resultaten van een gerandomiseerd, gecontroleerd onderzoek (RCT) en een meta-analyse laten zien dat niet één van die twee behandelingen duidelijk beter is. Conservatieve behandeling heeft met name risico op niet genezen van de breuk (nonunion), en plaatfixatie heeft risico op wondinfectie, breken of buigen van de plaat, of klachten waardoor de plaat verwijderd moet worden. Ook blijkt na ongeveer 4.5 jaar de helft van alle patiënten nog steeds klachten te hebben, zoals pijn. Het tweede deel van het proefschrift onderzoekt de besluitvorming over de behandeling van sleutelbeenbreuken. Er blijkt ruimte voor verbetering in de toepassing van gedeelde besluitvorming. Daarnaast blijken de meeste orthopedisch- en traumachirurgen vóór samen beslissen te zijn, maar weet een kwart niet wat het inhoudt en is het lastig om gedeelde besluitvorming te bereiken.LUMC / Geneeskunde Repositoriu

Evaluation of the TruNarc Handheld Narcotics Analyzer as a Pre-Analysis Screening Device for the Orange County Crime Lab

Forensic analysis of suspected narcotics is often dangerous as the substances’ composition is unknown. Many techniques for drug identification require handling of the substance outside of its packaging, which can expose the analyst to potentially harmful chemicals. The TruNarc Handheld Narcotics Analyzer is a portable Raman spectroscopy device that is non-destructive of evidence and can be used to screen drugs through simple packaging to minimize the risk of exposure. The Orange County Crime Lab (OCCL) is testing the limits of this device to determine if it can be used to screen new evidence within the Seized Drugs Lab. The OCCL has used this device on over 85 pieces of individual casework, which were then confirmed using gas chromatography and mass spectrometry (GC/MS). Methamphetamine, cocaine, and fentanyl in various forms such as powders, crystalline substances, and tablets, are all drugs we are optimistic that the TruNarc will be able to accurately identify in casework. We found that the three drugs of interest could be identified in most cases where substances were light in color, in powder or crystalline form, and in translucent plastic packaging. However, mixtures and tablets were difficult for the TruNarc to accurately identify. Further testing will be done to determine the lower limits of detection for drugs of interest before making a decision on implementing the device as a pre-analysis screening method in the laboratory and field settings

Does clavicular shortening after nonoperative treatment of midshaft fractures affect shoulder function? A systematic review

Trauma Surger

Shared decision-making in trauma and emergency surgery settings. A literature review

Emergency teams are made up of professionals of different specialities, including emergency physicians, surgeons, anesthesiologists, and nurses. Such units are characterized by the need to face unexpected situations with little time to make clinical decisions. In trauma and emergency settings, clinicians must act in a coordinated way, ensuring, at the same time, proper knowledge transfer and sharing to reach the best possible result for the patient. While such dynamics must be explicit and clear within the team, involving the patient in the decision-making process may require additional tools and procedures. Indeed, the time to engage with the patient and the family to understand the patient’s wishes and treatment preferences may be limited or absent at all. While the so-called shared decision-making (SDM) stands as one of the pillars of the modern patient-centric healthcare scenario, knowledge translation and transfer dynamics may appear particularly challenging in emergency settings. Starting from an investigation of the recent literature on SDM, the paper presents a literature review of the barriers, facilitators, and knowledge translation dynamics of SDM in trauma and emergency surgery. Results assess the importance, tools, and dynamics of SDM processes

Further evidence that not all executive functions are equal

The current study presents a comparison of 2 structural equation models describing the relationship between the executive functions of updating and inhibiting. Although it has been argued that working memory capacity is defined by one’s ability to control the focus of attention, the findings of the current study support a view of the executive control of attention that reflects updating and inhibiting as not entirely dependent on the same resources

Humidity affects populations of Drosophila suzukii (Diptera: Drosophilidae) in blueberry

Temperature and humidity affect insect physiology, survival, fecundity, reproductive status and behaviour. Complementing previous work investigating the effects of temperature on adult survival and fecundity of the invasive frugivorous pest, Drosophila suzukii (Matsumura), this study was conducted to determine the effect of humidity on D. suzukii larval development, adult survival, fecundity and reproductive status using blueberry as a host substrate. The five constant humidity levels in laboratory bioassays were 20, 33, 71, 82 and 94% RH at 20.6 ± 0.2°C. As RH increased, fecundity and longevity increased. At the higher humidity levels, RH had limited impact on mean generation times (T), larval development and eclosion times. The highest net reproductive rate (R[subcript]o = 68) and highest intrinsic rate of population increase (r[subscript]m = 0.17) were both recorded at 94% RH. The reproductive status of females, as indicated by the number of mature oocytes per female, was significantly greater at 82 and 94% RH, compared to 71% RH. In addition to the laboratory procedures, we correlated field trap captures over an 81-day summer period to relative humidity (RH) levels in close proximity to those traps. In the field, low ambient humidity levels resulted in decreased trap captures. A humidity-dependent population model predicted lower densities of D. suzukii relative to populations at higher humidity. This study supports the hypothesis that cultural practices that minimize lower humidity levels in crops can contribute to the management of D. suzukii. Such methods may include open pruning, drip irrigation and field floor management.This is the publisher’s final pdf. The article is copyrighted by Blackwell Verlag and published by John Wiley & Sons, Inc. It can be found at: http://onlinelibrary.wiley.com/journal/10.1111/%28ISSN%291439-0418Keywords: ovarian maturation, longevity, relative humidity, fecundity, spotted wing drosophilaKeywords: ovarian maturation, longevity, relative humidity, fecundity, spotted wing drosophil

Increasing Seed Viability of Maize Haploid Inducing Lines by Genetic and Non-Genetic Approaches

Some haploid inducing lines used in the production of maize doubled haploids (DHs), express germination problems and reduced vigor. In this study, haploid inducing lines RWS, RWK-76 and their reciprocal hybrids RWS/RWK-76 and RWK-76/RWS were examined for viability by Tetrazolium (TZ) and germination ability by standard germination tests. Evaluation based on TZ tests showed that 59% of the seed of RWK-76/RWS were not viable, compared with only 12% dead seed in RWS/RWK-76. Similarly, the percentage and speed of germination in RWK- 76/RWS (25%, 1.53) was lower than for RWS/RWK-76 (74%, 4.30). In an effort to develop a quick method for assessing seed viability in these lines, the TZ test was repeated in a different way. Seed from each genotype was placed in beakers containing distilled water.Seed would either float or sink. Subsequent TZ testing confirmed that seed that floated was dead, and seed that sank was alive, although some of them had defective embryos. The dead seed in both genotypes failed to develop an embryo, leaving an empty cavity that would fill with air and cause seed to float on water. This feature can be exploited for a simple and practical method to separate living from dead seed. In addition, we surveyed theig1 (indeterminate gametophyte) gene as a candidate for germination problems in inducer lines.Sequencing data from theig1 region showed that RWS and RWK-76 differed in one nucleotide and amino acidin the firstexon of ig1.Segregation of ig1 alleles from RWS and RWK-76 wassignificantly (P=0.01) distortedin the respectiveF2 population relative to the expected Mendelian segregation ratio (1:2:1). Thus, either ig1 or a linked gene in the ig1 region affect seed viability

Covert Reorganization of Implicit Task Representations by Slow Wave Sleep

There is evidence that slow wave sleep (SWS) promotes the consolidation of memories that are subserved by mediotemporal- and hippocampo-cortical neural networks. In contrast to implicit memories, explicit memories are accompanied by conscious (attentive and controlled) processing. Awareness at pre-sleep encoding has been recognized as critical for the off-line memory consolidation. The present study elucidated the role of task-dependent cortical activation guided by attentional control at pre-sleep encoding for the consolidation of hippocampus-dependent memories during sleep.A task with a hidden regularity was used (Number Reduction Task, NRT), in which the responses that can be implicitly predicted by the hidden regularity activate hippocampo-cortical networks more strongly than responses that cannot be predicted. Task performance was evaluated before and after early-night sleep, rich in SWS, and late-night sleep, rich in rapid eye movement (REM) sleep. In implicit conditions, slow cortical potentials (SPs) were analyzed to reflect the amount of controlled processing and the localization of activated neural task representations.During implicit learning before sleep, the amount of controlled processing did not differ between unpredictable and predictable responses, nor between early- and late-night sleep groups. A topographic re-distribution of SPs indicating a spatial reorganization occurred only after early, not after late sleep, and only for predictable responses. These SP changes correlated with the amount of SWS and were covert because off-line RT decrease did not differentiate response types or sleep groups.It is concluded that SWS promotes the neural reorganization of task representations that rely on the hippocampal system despite absence of conscious access to these representations.Original neurophysiologic evidence is provided for the role of SWS in the consolidation of memories encoded with hippocampo-cortical interaction before sleep. It is demonstrated that this SWS-mediated mechanism does not depend critically on explicitness at learning nor on the amount of controlled executive processing during pre-sleep encoding

Assessing Order Effects in Online Community-based Health Forums

Measuring the quality of health content in online health forums is a challenging task. The majority of the existing measures are based on evaluations of forum users and may not be reliable. We employed machine learning techniques, text mining methods, and Big Data platforms to construct four measures of textual quality to automatically determine the similarity of a given answer to professional answers. We then used them to assess the quality of 66,888 answers posted on Yahoo! Answers Health section. All four measures of textual quality revealed a higher quality for asker-selected best answers indicating that askers, to some extent, have a proper judgment to select the best answers. We also studied the presence of order effects in online health forums. Our results suggest that the textual quality of the first answer positively influences the mean textual quality of the subsequent answers and negatively influences the quantity of subsequent answers