Benefit In Certain Situations Research Articles

Tibial Lengthening along Submuscular Plate with Simultaneous Acute Tibial Deformity Correction by High-Energy Osteotomy: A Comparative Study.

Submuscular plating and osteotomy using power saw have shown the benefits in certain situations of limb lengthening. However, no previous studies combining both procedures have been conducted for acute tibial deformity correction and limb lengthening. Nineteen cases were enrolled in this study. Ten patients received tibial lengthening with acute knee angular deformity correction using high-energy osteotomy (Group 1), and nine patients received tibial lengthening only with osteotomy using multiple drills and osteotome (Group 2). Radiographic parameters retrieved before and after the operation included leg-length discrepancy, tibial length, length gained, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and mechanical axis deviation (MAD). There were significant differences between groups in terms of external fixator index (EFI) (p = 0.013) and healing index (HI) (p = 0.014), but no significance in the length gained (p = 0.356). The latest postoperative mLDFA (p = 0.315), MPTA (p = 0.497), and MAD (p = 0.211) of Group 1 were not distinguishable from Group 2. The functional outcomes were excellent, and there were no permanent complications. Despite showing a longer healing time, this alternative lengthening procedure which combines fixator-assisted plate lengthening in the tibia with simultaneous surgical intervention of acute tibial deformity correction using an oscillating saw is appropriate for patients with leg-length discrepancy and angular deformity of the tibia.

Clinically relevant infections in hematology and oncology: bacterial infections and the role of novel antibiotics in times of multidrug resistance

SummaryMultidrug resistance of bacterial pathogens is an increasing problem wordwide, especially treatment of multidrug resistant (MDR) gramnegative bacteria is challenging. In the recent past, several new antibiotics as well as new betalactamase inhibitors have been introduced. These novel drugs are valuable new tools for the therapy of infectious complications in cancer patients once there is a high risk for infections due to multidrug-resistant pathogens. While it is necessary to start empirical antibiotic therapy immediately, novel antibiotics only provide benefits in certain situations, depending on the underlying pathogens. Thus, these new antibiotics are best used guided by microbiological testing, since the exact mechanism of resistance determines susceptibility or resistance to certain antibiotics. For empirical therapy, previous culture results and/or colonization with MDR pathogens can help to choose from conventional antibiotics or novel drugs. In clinical practice, optimal antibiotic therapy can be achieved by close collaboration of specialists in hematooncology, infectious diseases and microbiology.

A Two-Tier Distributed Market Clearing Scheme for Peer-to-Peer Energy Sharing in Smart Grid

This article presents a novel two-tier peer-to-peer (P2P) market paradigm for energy sharing between multiregional proactive prosumers (producer+consumer) in transactive energy systems. In the proposed approach, interactions between prosumers can be achieved in inter-area markets as well as intra-area markets. A dual decomposition based and a consensus-based distributed market-clearing approaches are designed for the proposed double-layered hierarchical intra- and inter-area markets. The proposed approach preserves prosumers’ privacy by sharing only partial information with the fellow prosumers while settling the trade. Compared to the conventional P2P approaches, the proposed two-tier market-clearing scheme allows more prosumer participation in energy trading and significantly enhances their economic benefits in certain situations. The effectiveness of the proposed approach is validated through software simulations.

Assessing the potential to mitigate climate-related expansion of largemouth bass populations using angler harvest

Climate-related changes in fish communities can present new challenges for fishery managers who must address declines in cool- and cold-water sportfish while dealing with increased abundance of warm-water sportfish. We used largemouth bass (Micropterus salmoides) in Wisconsin lakes as model populations to determine whether angler harvest provides a realistic method for reducing abundance of a popular warm-water sportfish that has become more prevalent and has prompted management concerns around the globe. Model results indicate largemouth bass will be resilient to increased fishing mortality. Furthermore, high rates of voluntary catch-and-release occurring in most largemouth bass fisheries likely preclude fishing mortality rates required to reduce bass abundance at meaningful levels (≥25% reductions). Increasing fishing mortality in these scenarios may require more “stimulus” than merely providing anglers with greater harvest opportunities via less stringent harvest regulations. Angler harvest could result in populations dominated by small fish, a scenario that may be undesirable to anglers, but could provide ecological benefits in certain situations.

Adjustable versus non-adjustable sutures for strabismus.

Strabismus, or squint, can be defined as a deviation from perfect ocular alignment and can be classified in many ways according to its aetiology and presentation. Treatment can be broadly divided into medical and surgical options, with a variety of surgical techniques being available, including the use of adjustable or non-adjustable sutures for the extraocular muscles. There exists an uncertainty as to which of these techniques produces a better surgical outcome, and an opinion that the adjustable suture technique may be of greater benefit in certain situations. To determine if either an adjustable suture or non-adjustable suture technique is associated with a more accurate long-term ocular alignment and to identify specific situations in which it would be of benefit to use a particular method. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 5); Ovid MEDLINE; Ovid Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the ICTRP. The date of the search was 13 June 2017. We contacted experts in the field for further information. We included only randomised controlled trials (RCTs) comparing adjustable to non-adjustable sutures for strabismus surgery. We used standard procedures recommended by Cochrane. Two review authors independently screened search results and extracted data. We graded the certainty of the evidence using the GRADE approach. We identified one RCT comparing adjustable and non-adjustable sutures in primary horizontal strabismus surgeries in 60 children aged less than 12 years in Egypt. The study was not masked and we judged it at high risk of detection bias. Ocular alignment was defined as orthophoria or a horizontal tropia of 8 prism dioptres (PD) or less at near and far distances. At six months, there may be a small increased chance of ocular alignment with adjustable sutures compared with non-adjustable sutures clinically, however, the confidence intervals (CIs) were wide and were compatible with an increased chance of ocular alignment in the non-adjustable sutures group, so there was no statistical difference (risk ratio (RR) 1.18, 95% CI 0.91 to 1.53). We judged this to be low-certainty evidence, downgrading for imprecision and risk of bias. At six months, 730 per 1000 children in the non-adjustable sutures group had ocular alignment. The study authors reported that there were no complications during surgery. The trials did not assess patient satisfaction and resource use and costs. We could reach no reliable conclusions regarding which technique (adjustable or non-adjustable sutures) produced a more accurate long-term ocular alignment following strabismus surgery or in which specific situations one technique is of greater benefit than the other, given the low-certainty and chance with just the one study. More high-quality RCTs are needed to obtain clinically valid results and to clarify these issues. Such trials should ideally 1. recruit participants with any type of strabismus or specify the subgroup of participants to be studied, for example, thyroid, paralytic, non-paralytic, paediatric; 2. randomise all consenting participants to have either adjustable or non-adjustable surgery prospectively; 3. have at least six months of follow-up data; and 4. include reoperation rates as an outcome measure.

Foreword.

The usefulness of collaborative work between cerebral palsy (CP) registers is little recognized and is important to highlight. With the exciting presentation of data from the Australian CP registers, we can see the breadth of research possible through these efforts. Collaboration between CP registers affords an improvement in power provided by pooling data from different CP registers, which is of particular benefit in certain situations, for example analyzing trends in prevalence rates of CP among very tiny babies, quantifying the higher risk of CP among those born from multiple pregnancies, or studying the association between specific congenital anomalies and CP. It is important, of course, to have some caution when pooling data from different CP registers. It is necessary to have common descriptions of CP1, 2 and to ensure that the data points are sufficiently harmonized to allow accurate pooling. Decisions about the level of harmonization are a great challenge indeed, and can be addressed using repeated reliability studies between registers.3 Further, trends observed from different CP registers also generate new questions that require new investigations. And it is important as well to have some caution when analyzing these data, for example to use adequate statistical tools for multi-centric data to ensure accurate analysis. For example, what does it mean if trends in CP rates are decreasing in some geographical regions and not in others (all areas being population-based registers)? Are these true differences? Either in a single region, country, or continent, either from a single CP register or from a network of CP registers, we need to remember how powerful these data from CP registers can be when correctly analyzed. These data can be used for monitoring and surveillance of course, but are also an excellent resource for clinical epidemiological research in the CP field. Health professionals, policymakers, and persons with CP themselves should be aware of this and the potential benefits available through the excellent data resource that CP registers can provide. Professor Christine Cans Special Issue Associate Editor In the past few years there has been an increase both in the number and in the type of registries in medicine. Registries can be used to identify the medical needs and outcomes for people with specific diseases or conditions, can monitor newly registered medications for side effects, and evaluate the success of new treatments. In addition, the collection of such information, particularly if comprehensive, provides an invaluable resource for various types of research from health systems, health behaviour, and epidemiology, as well as providing baseline data for the design of clinical trials to improve treatment outcomes. This issue of papers uses data from the Australian Cerebral Palsy Register and demonstrates the wide range of research that is possible using population datasets. Some findings are clinically related, and concern correlations between prenatal conditions and birth outcomes, trends in congenital abnormalities over time, the variety of impairments across cohorts, and the social implications of specific impairments, and the possibilities for prevention. In addition, this issue contains three articles examining social–demographic findings from the registry, and policy-specific implications, including an article on the Australian National Disability Insurance Scheme. The supplement reports findings both from the long-standing cerebral palsy registries from Western Australia, Victoria, and South Australia and from data from the relatively new cerebral palsy registries from the remaining states and territories. Since the Australian Cerebral Palsy Register's inception in 2008, the Australian Cerebral Palsy Register Group have worked together to support the work of individual CP registers and to develop a minimum dataset to allow collaboration between them. This work has increased both the volume and the value of the data held, widening the possibility for conducting research to improve the quality of life of those with CP. This is clearly borne out in the following collection of papers and holds out the promise that this systematic collection of data will increase both our understanding of what it is like to live with CP and what can be done to improve the lives of those who do. Dr Nicole Gerrand Consumer Manager, Research Support and Development, Hunter New England Local Health District, Newcastle, Australia

The Appropriate Use of Percutaneous Coronary Intervention in Contemporary Clinical Practice

Percutaneous coronary intervention (PCI) is common and generally low risk. Although shown to be of significant benefit in certain clinical situations, especially in the context of acute coronary syndromes, there exist clinical scenarios where PCI has not been shown to be helpful. In these cases, the risk of periprocedural complications as well as longer term issues such as bleeding or stent thrombosis mean that PCI may potentially be harmful. To inform best clinical practice, we now have published recommendations with regards to the Appropriate Use Criteria (AUC) for coronary revascularisation. The goal of the AUC is to guide physician decision-making and future research as well as to label coronary revascularisation more clearly for patients and payors in regards to its expected benefits in certain situations. In this review, we summarise and discuss the more clinically relevant of these AUC, either because they are contentious or of particular relevance to the local context or practice. We conclude that there continue to be situations whereby inappropriate PCIs are performed, and these represent opportunities for quality improvement.

The role of a new contralateral routing of signal microphone in established unilateral cochlear implant recipients.

To investigate whether a contralateral routing of signal (CROS) microphone combined with a unilateral cochlear implant (CI) results in hearing improvement after a prolonged trial period. A prospective experimental trial was undertaken on a group of 10 postlingually deafened adults who are experienced CI users. Participants completed audiometric testing and validated questionnaires with their unilateral CI alone, followed by addition of a CROS microphone (CI-CROS). This was worn daily for the 2-week trial, after which hearing performance was reevaluated using the same measures. Objective tests included AzBio sentences in quiet and noise and consonant-vowel nucleus-consonant (CNC) words. Subjective measures included the Abbreviated Profile of Hearing Aid Benefit (APHAB); Speech, Spatial, Qualities of Hearing Index (SSQ); Hearing Implant Sound Quality Index; an institutional questionnaire; and a daily log sheet. There is statistically significant enhanced speech discrimination with the CI-CROS when speech is presented on the CROS side. However, scores are markedly diminished when background noise is introduced, particularly to the CROS side. Subjective results indicate lower satisfaction scores for the global and ease of communication subdomains of the APHAB with the CI-CROS, but increased scores on the spatial hearing subdomain of the SSQ (P < 0.05). The CI-CROS provides significant benefit in certain situations, particularly speech recognition in quiet. CI-CROS performance with background noise is poor, leading to low satisfaction scores. Further refinement of the device may yield a useful tool for unilateral CI users in the future.

When Amplification with Weak Values Fails to Suppress Technical Noise

The application of postselection to a weak quantum measurement leads to the phenomenon of weak values. Expressed in units of the measurement strength, the displacement of a quantum coherent measuring device is ordinarily bounded by the eigenspectrum of the measured observable. Postselection can enable an interference effect that moves the average displacement far outside this range, bringing practical benefits in certain situations. Employing the Fisher information metric, we argue that the amplified displacement offers no fundamental metrological advantage, due to the necessarily reduced probability of success. Our understanding of metrological advantage is the possibility of a lower uncertainty in the estimate of an unknown parameter with a large number of trials. We analyze a situation in which the detector is pixelated with a finite resolution, and in which the detector is afflicted by random displacements: imperfections which degrade the fundamental limits of parameter estimation. Surprisingly, weak-value amplification is no more robust to them than a technique making no use of the amplification effect brought about by a final, postselected measurement.

Adjustable versus non-adjustable sutures for strabismus

Strabismus, or squint, can be defined as a deviation from perfect ocular alignment and can be classified in many ways according to its aetiology and presentation. Treatment can be broadly divided into medical and surgical options, with a variety of surgical techniques being available, including the use of adjustable or non-adjustable sutures for the extraocular muscles. There exists an uncertainty as to which of these techniques produces a better surgical outcome, and also an opinion that the adjustable suture technique may be of greater benefit in certain situations. To examine whether adjustable or non-adjustable sutures are associated with a more accurate long-term ocular alignment following strabismus surgery and to identify any specific situations in which it would be of benefit to use a particular method. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 12), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE, (January 1950 to January 2013), EMBASE (January 1980 to January 2013), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (http://clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 17 January 2013. We also contacted experts in the field for further information. We planned to include only randomised controlled trials (RCTs) comparing adjustable to non-adjustable sutures for strabismus surgery. We did not find any studies that met the inclusion criteria for this review. We did not find any studies that met the inclusion criteria for this review, therefore none were included for analysis. Results of non-randomised studies that compared these techniques are reported. No reliable conclusions could be reached regarding which technique (adjustable or non-adjustable sutures) produces a more accurate long-term ocular alignment following strabismus surgery or in which specific situations one technique is of greater benefit than the other. High quality RCTs are needed to obtain clinically valid results and to clarify these issues. Such trials should ideally a) recruit participants with any type of strabismus or specify the subgroup of participants to be studied, for example, thyroid, paralytic, non-paralytic, paediatric; b) randomise all consenting participants to have either adjustable or non-adjustable surgery prospectively; c) have at least six months of follow-up data; and d) include re-operation rates as a primary outcome measure.

Appropriateness of Percutaneous Coronary Intervention: A Review

The appropriateness of coronary revascularization for various clinical scenarios has been reviewed formally by several specialty and subspecialty societies resulting in the formulation of scored appropriateness criteria. The goal of the appropriateness criteria is to guide physician decision-making and future research as well as to label coronary revascularization more clearly for patients and payors in regards to its expected benefits in certain situations. The appropriateness criteria were formulated from a standardized process and are intended to be updated at regular intervals as new data further elucidates the clinical roles of revascularization. Since its last iteration in early 2012, several studies have been published that may further expand scenarios or impact the appropriateness of revascularization in already-established scenarios. The differentiation of appropriateness with particular forms of revascularization has been reserved for specific clinical scenarios where revascularization is generally considered necessary and appropriate. The goals of this review are 1) to highlight aspects of the methodology and development of the coronary revascularization appropriateness criteria, and 2) to focus on the role established specifically for percutaneous coronary intervention within the criteria. Important data published in 2012 that further evaluates the role of percutaneous coronary intervention will also be reviewed with a focus on its potential impact on future iterations of the appropriateness criteria.

Influence of Material and Microtopography on the Development of Local Infection in vivo: Experimental Investigation in Rabbits

Polishing the surface of internal fracture fixation (IFF) implant materials can ease implant removal and reduce irritation to gliding tissues by reducing soft tissue adhesion and bony overgrowth. Thus, polishing the surface of these implants is expected to have significant clinical benefit in certain situations. The aim of the present study was to determine if polishing the surface of an IFF device influences susceptibility to infection. The local infection rate associated with 4-hole 2.0 mm Synthes locking compression plates (LCPs) composed of clinically available commercially pure titanium (cpTi) and titanium aluminium niobium (TAN) in their standard microrough form was compared with that of their test polished equivalents and also to clinically available electropolished stainless steel (EPSS). The LCPs were fixed in locking mode onto the tibia of mature, female New Zealand White rabbits and a clinical strain of Staphylococcus aureus was added to the implantation site. Twenty eight days after surgery the rabbits were euthanized and assessed for infection. The rank order based on descending ID50 was; polished TAN, standard TAN, standard cpTi, EPSS and finally polished cpTi, however, the ID50 values did not differ greatly between the groups with the same material. Using the LCP model in locking mode, polishing the surface of both cpTi and TAN was not found to influence the susceptibility to infection in our animal model.

Government failure versus market failure: microeconomics policy research and government performance

When should government intervene in market activity and when is it best to let market forces take their natural course? How does the existing empirical evidence about government performance guide our answers to these questions? In this clear, concise book, Clifford Winston offers his innovative analysis --shaped by thirty years of evidence --to assess the efficacy of government interventions. Markets fail when it is possible to make one person better off without making someone else worse off, thus indicating inefficiency. Governments fail when an intervention is unwarranted because markets are performing well or when the intervention fails to correct a market problem efficiently. Winston concludes from existing research that the cost of government failure may actually be considerably greater than the cost of market failure: My search of the evidence is not limited to policy failures. I will report success stories, but few of them emerged from my search. The prevalence of market failure is due to a lack of conviction in favor of markets, the inflexibility of intervening government agencies, and political forces that enable certain interest groups to benefit at the expense of society as a whole. Winston suggests that government policy can be improved by making greater use of market-oriented solutions that have already produced benefits in certain situations.

Long-acting bronchodilators in cystic fibrosis.

Over 80% of patients with cystic fibrosis (CF) have bronchodilator therapy prescribed, yet bronchodilator use in CF remains controversial. The development of long-acting beta-agonist drugs for clinical use has provided additional rationale for considering bronchodilator therapy in CF. This paper will review recent developments in bronchodilator use in CF patients, with emphasis on the long-acting beta agonists. It is reported that 50 to 60% of CF patients demonstrate significant intermittent airway hyperreactivity in response to bronchodilators or challenges. The beta-agonist drugs are the most commonly prescribed bronchodilators. Several mechanisms may be implicated in therapeutic response of CF patients to bronchodilators including direct smooth muscle relaxation, increased mucociliary clearance, direct effects on inflammatory cells and bacterial adherence, and possible direct effects on CF transmembrane conductance regulator (CFTR) function. Several recent studies have shown improved outcomes with long-acting bronchodilators. In spite of the widespread use of bronchodilators, there are very few long-term studies of their effects in CF patients. However, there are clearly clinical benefits in certain situations. Further research into the most appropriate utilization of these medications to improve outcomes in patients with CF would be helpful.

Detection of tick-borne encephalitis virus by sample transfer, plaque assay and strand-specific reverse transcriptase polymerase chain reaction: what do we detect?

Experimental inoculation of mice provides a well characterized model for studying infection with tick-borne encephalitis virus (TBEV), a flavivirus pathogenic for humans. Conflicting data on the kinetics of viremia and the development of virus titers in the brain, however, were only recently shown to have resulted from the use of assay systems with different levels of sensitivity in the titration of TBEV i.e. plaque assay or sample transfer into naive recipient mice. Theoretically, RT-PCR could extend further the detectability to antibody-neutralized virus and when undertaken strand-specifically discriminate active replication from the mere presence of TBEV. We have compared the conventional methods for detection of TBEV with a newly devised RT-PCR method. As expected, RT-PCR, in contrast to the infectivity assays, detected antibody-neutralized virus. Furthermore, the mere presence or active replication of the virus could be differentiated by strand-specific RT-PCR. Plaque assay and sample transfer, in contrast, both detected only infectious virus. However, whereas sample transfer provides higher sensitivity for detection of TBEV from solid organs, the plaque assay is less costly and considering animals welfare more convenient. Thus, the newly devised method may allow the resolution of unanswered questions, while both the traditional infectivity assays retain their benefits in certain situations.