A three-dimensional analysis of the sigmoid notch

Fractures of the distal radius are among the most common injuries of the upper extremity, though treatment has traditionally focused on restoration of the radiocarpal joint and late sequelae may persist. X-ray imaging underestimates sigmoid notch involvement following distal radius fractures. No classification system exists for disruption patterns of the sigmoid notch of the radius associated with distal radius fractures. This study quantifies the anatomy of the sigmoid notch and identifies the landmarks of the articular surface and proximal boundaries of the distal radioulnar joint (DRUJ) capsule. Computed tomography scans of freshly frozen cadaveric hands were used - followed by dissection, and three-dimensional reconstruction of the distal radius and sigmoid notch. The sigmoid notch surface was divided into two surfaces and measured. The Anterior Posterior (AP) and Proximal Distal (PD) widths of the articulating surface were reviewed, along with the radius of curvature, version angle and depth. The study showed that the sigmoid notch is flatter than previously believed - and only the distal 69% of its surface is covered by cartilage. On average, it has about nine degrees of retroversion, and its average inclination is almost parallel to the anatomical axis of the radius. Clinical implications exist for evaluation of the DRUJ involvement in distal radius fractures or degenerative diseases and for future development and evaluation of hemiarthroplasty replacement of the distal radius

Exploring innovation within low and medium technology SMEs: a qualitative study of Irish food companies

R&D is a key determinant of innovation and yet Low and Medium Technology (LMT) industries by their definition, do not invest heavily in this driver of innovation. Small and Medium-Sized Enterprises (SMEs) account for the majority of enterprises, contributing significantly to economic output, employment and the regional economy of developed countries. In fact, much of the SME population operate in LMT industries and have continued to survive and grow in the face of market turbulence. Given their economic importance and sustainability, the question of if and how these LMT SMEs innovate is an important one, especially given that they are disadvantaged relative to both the scale and R&D intensity of larger enterprises. This innovation research concentrates on the largely silent enterprise majority of LMT SMEs (Hirsch-Kreinsen et al., 2005; Dooley et al., 2017; Trott and Simms, 2017; Hullova et al, 2019) to gain better insights into the nature and management of innovation within such firms and the organisational capabilities that nurture their innovation output and continued survival. Encouragingly, numerous innovation researchers have begun to explore the innovation activity of the LMT sector and the SME’ within same (Bender and Laestadius, 2005; Kirner et al., 2009; Hansen, 2010; Som and Kirner, 2015; Hirsch-Kreinsen, 2015; Dooley and O’Sullivan, 2018; Flor et al., 2019). This research answers calls by Robertson et al. (2009), Hirsch-Kreinsen (2015), Som and Kirner (2015) and Hullova et al., (2019) for increased study of this largely ‘forgotten sector’ and how they innovate for survival and growth. In addressing this gap in innovation research, the research employs a qualitative case-based approach that studies seven cases of LMT SMEs within the food sector in Ireland. Cases were developed through multiple interviews of management team members (including the general manager/owner) across the seven cases that agreed to participate. The research findings highlight that LMT SMEs innovate for survival and growth and that this innovation activity is primarily incremental in nature. The predominant innovation undertaken by such firms is that of constant process innovation, ensuring continued enterprise efficiency and survival, followed in strategic importance by periodic product innovation that nurtures enterprise growth. The findings highlight that although management of the innovation process is often ad hoc in nature, the centralised decision power within key individuals (e.g. entrepreneurial Managing Director) permits an opportunistic yet focused trajectory to innovation activity. While acknowledging significant resource constraints and low investment in traditional R&D, the research highlights that LMT SME leverage capabilities, both internal within the venture and from external sources to support innovation. The research highlights the importance of the capabilities of collaboration, Managing Director entrepreneurial orientation, deep knowledge of and interaction with the customer base and a learning mode of doing, using and interacting (DUI) as core to their innovation for survival and growth. The main implications of the research are twofold. Firstly, our findings suggest that LMT SMEs innovate constantly and do so in the absence of traditional R&D and the Science, Technology and Innovation (STI) learning mode of innovation. Governments and policymakers need to give greater attention to their capability development through policies that enhance management capability and their exposure to a wider network of potential collaborators. Secondly, given the entrepreneurial Managing Director influence across the SME organisation, then education, training and mentoring support of key SME management will nurture innovation for the LMT SME firm survival and growth

Deformations in deep continuous reinforced concrete transfer girders

peer reviewedThis paper presents a three-parameter kinematic model for the deformation patterns of deep continuous transfer girders. The three degrees of freedom of the model are the average strains along the top and bottom longitudinal reinforcements within each shear span, as well as the transverse displacement in the critical loading zone. The model is validated with the help of a large test of a two-span continuous beam performed at the University of Toronto. It is shown that the apparently complex deformation patterns of the specimen are captured well by the kinematic model

PROBING THE ELECTRONIC PROPERTIES OF INTRAMOLECULAR PROTON TRANSFER, TRIPLE RYDBERG ANIONS, AND STABLE RADICALS VIA ANION PHOTOELECTRON SPECTROSCOPY

Negative ions were studied using gas-phase anion photoelectron spectroscopy. Combining these studies with theoretical calculations allowed for electronic properties, geometries, as well as chemical phenomena to be investigated. A system of triple Rydberg anions was discovered and studied. Intramolecular proton transfer was probed by extensive experimental and theoretical efforts, providing fundamental insights into the phenomena. Additionally, an electrospray ionization source was designed, constructed and integrated into the anion photoelectron spectrometer. This source creates a direct route for transferring species from the solution phase to the gas phase. This source was used to study stable radicals generated from radical scavengers

Budesonide Oral Suspension Improves Symptomatic, Endoscopic, and Histologic Parameters Compared With Placebo in Patients With Eosinophilic Esophagitis

Background & Aims Pharmacologic treatment of eosinophilic esophagitis (EoE) is limited to off-label use of corticosteroids not optimized for esophageal delivery. We performed a randomized, controlled phase 2 trial to assess the ability of budesonide oral suspension (BOS), a novel muco-adherent topical steroid formulation, to reduce symptoms and esophageal eosinophilia in adolescents and adults with EoE. Methods In this multicenter, randomized, double-blind, placebo-controlled, parallel-group trial, 93 EoE patients between the ages of 11 and 40 years with dysphagia and active esophageal eosinophilia were randomized to receive either BOS 2 mg or placebo twice daily for 12 weeks. Co-primary outcomes were change in Dysphagia Symptom Questionnaire (DSQ) score from baseline, and proportion of patients with a histologic response (≤6 eosinophils/high-power field) after treatment. Endoscopic severity scores and safety parameters were assessed. Results At baseline, mean DSQ scores were 29.3 and 29.0, and mean peak eosinophil counts were 156 and 130 per hpf in the BOS and placebo groups, respectively. After treatment, DSQ scores were 15.0 and 21.5, and mean peak eosinophil counts were 39 and 113 per high-power field, respectively (P < .05 for all). For BOS vs placebo, change in DSQ score was −14.3 vs −7.5 (P = .0096), histologic response rates were 39% vs 3% (P < .0001), and change in endoscopic severity score was −3.8 vs 0.4 (P < .0001). Adverse events were similar between groups. Conclusions Treatment with BOS was well tolerated in adolescent and young adult patients with EoE and resulted in improvement in symptomatic, endoscopic, and histologic parameters using validated outcome instruments

Developing a Brief Behavior Rating Scale for Progress Monitoring of Depression in School Settings

Frequent formative assessment of students’ functioning, or progress monitoring, is a critical component of multi-tiered systems of support as data inform data-driven decisions about response to treatment. Progress monitoring tools for students’ academic and behavioral functioning are readily available and widely researched; however, despite the documented prevalence of depressive disorders among youth and that schools have been put forth as an ideal location for the delivery of mental health services, there are currently no progress monitoring tools to examine students’ response to interventions that target depression. To address this gap, this study sought to develop a progress monitoring assessment of students’ depressive symptoms using an empirically informed model for creating Brief Behavior Rating Scales (BBRS). Using this model, a four-item BBRS of depressive symptoms (BBRS-D) was created from the item pools of the Beck Depression Inventory for Youth (BDI-Y) and Children’s Depression Inventory (CDI) administered during a treatment study of depression in female youth; the resulting short scale corresponds well to the full-length assessments (i.e., r = .65 and r = .59); however, the BBRS-D possessed lower than adequate internal consistency (α = .50

Randomized Controlled Trial of Physical Exercise in Diabetic Veterans With Length-Dependent Distal Symmetric Polyneuropathy

Rationale: Physical exercise is an essential adjunct to the management of patients with type 2 diabetes mellitus. Therapeutic interventions that improve blood flow to peripheral nerves, such as exercise, may slow the progression of neuropathy in the diabetic patient.Aims: This randomized clinical trial was conducted to determine whether a structured program of aerobic, isokinetic strength, or the combination of aerobic–isokinetic strength exercise intervention alters peripheral nerve function in glycemic-controlled diabetic patients with advanced length-dependent distal symmetric polyneuropathy.Methods: Forty-five patients with type 2 diabetes mellitus exhibiting tight glycemic control (HbA1c intergroup range 7.2–8.0%) were randomized by block design across four experimental groups: sedentary controls (n = 12), aerobic exercise (n = 11), isokinetic strength (n = 11), or the combination of aerobic–isokinetic strength training (n = 11). Patients randomized to training groups exercised 3× per week for 12 weeks, whereas patients randomized to the sedentary control group received standard of care. To minimize attention and educational bias, all patients attended a 12-session health promotion educational series. At baseline, immediately following intervention, and again at 12-week post-intervention, detailed nerve conduction studies were conducted as a primary outcome measure. At these same intervals, all patients completed as secondary measures quantitative sensory testing, symptom-limited treadmill stress tests, and a Short-Form 36-Veterans Questionnaire (SF-36V).Results: Of the 45 patients randomized into this study, 37 (82%) had absent sural nerve responses, 19 (42%) had absent median sensory nerve responses, and 17 (38%) had absent ulnar sensory nerve responses. By comparison, responses from tibial nerves were absent in only three (7%) subjects while responses from peroneal nerves were absent in five (11%) subjects. Eleven (92%) of 12 patients that had volunteered to be biopsied exhibited abnormal levels of epidermal nerve fiber densities. Exercise, regardless of type, did not alter sensory or motor nerve electrodiagnostic findings among those patients exhibiting measurable responses (ANOVA). There was, however, a modest (p = 0.01) beneficial effect of exercise on sensory nerve function (Fisher’s Exact Test). Importantly, the beneficial effect of exercise on sensory nerve function was enhanced (p = 0.03) during the post-intervention interval. In addition, three of six patients that had undergone exercise intervention exhibited a marked 1.9 ± 0.3-fold improvement in epidermal nerve fiber density. By comparison, none of three sedentary patients whom agreed to be biopsied a second time showed improvement in epidermal nerve fiber density. Compared to baseline values within groups, and compared with sedentary values across groups, neither aerobic, isokinetic strength, or the combination of aerobic–isokinetic strength exercise intervention altered peak oxygen uptake. Patients that underwent aerobic or the combined aerobic–isokinetic strength exercise intervention, however, demonstrated an increase in treadmill test duration that was sustained over the 12-week post-intervention period.Conclusion: A 12-week course of physical exercise, regardless of type, does not alter sensory or motor nerve electrodiagnostic findings. In a subset of patients, a short-term structured program of aerobic exercise may selectively improve sensory nerve fiber function. Large-scale exercise lifestyle intervention trials are warranted to further evaluate the impact of aerobic exercise on sensory nerve fiber function in diabetic neuropathic patients.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT00955201

The Hubble Space Telescope Survey of M31 Satellite Galaxies. III. Calibrating the Horizontal Branch as an Age Indicator for Nearby Galaxies

We present a new method for measuring the mean age of old/intermediate stellar populations in resolved, metal-poor ($\rm \langle[Fe/H]\rangle \lesssim -1.5$) galaxies using only the morphology of the horizontal branch (HB) and an estimate of the average metallicity. We calculate the ratio of blue-to-red HB stars and the mass-weighted mean ages of 27 M31 satellite galaxies that have star formation histories (SFHs) measured from Hubble Space Telescope-based color-magnitude diagrams (CMDs) that include the oldest Main Sequence Turn-off (MSTO) ages. We find a strong correlation between mean age, metallicity, and HB morphology, for stellar populations older than $\sim6$~Gyr. The correlation allows us to predict a galaxy's mean age from its HB morphology to a precision of $\lesssim 1$~Gyr. We validate our method by recovering the correct ages of Local Group galaxies that have robust MSTO-based ages and are not in our calibration sample. We also use our technique to measure the mean ages of isolated field galaxies KKR25 ($11.21^{+0.70}_{-0.65}$~Gyr) and VV124 ($11.03^{+0.73}_{-0.68}$~Gyr), which indicate that their main star formation episodes may have lasted several Gyr and support the picture that they achieved their early-type characteristics (e.g., low gas content, low star formation activity) in isolation and not through environment. Because the HB is $\sim80\times$ brighter than the oldest MSTO, our method can provide precise characteristic ages of predominantly old galaxies at distances $\sim 9$ times farther. We provide our calibrations in commonly used HST/ACS filters.Comment: 21 pages, 13 figures, 5 tables, submitted to Ap