The Cost-Effectiveness of Platelet-Rich Plasma Compared With Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis.

PURPOSE: To examine the cost-effectiveness of a series (total of 3 injections) of intra-articular platelet-rich plasma (PRP) injections in comparison to that of hyaluronic acid (HA) viscosupplementation for the treatment of symptomatic knee osteoarthritis. METHODS: Outcome data regarding the use of PRP or HA injections for the treatment of symptomatic knee osteoarthritis were determined from the highest-quality data (Level I) available in the literature until 2015. Health utility values were then derived from these high-quality data. Costs were determined by examining typical charges for patients undergoing a series of either PRP or HA injections for the treatment of this condition at a large private orthopaedic practice. These health utility values and costs were used to create an expected-value decision analysis model. RESULTS: The results of the model revealed that the cost per quality-adjusted life-year (QALY) of a series of PRP injections was $8,635.23/QALY and that of a series of HA injections was $5,331.75/QALY. A series of PRP injections was associated with a higher initial cost than a series of HA injections (difference, $1,433.67); however, PRP was also more effective (higher utility value) than HA by 0.11 QALYs (0.69 vs 0.58, P = .0062) at 1 year. The incremental cost-effectiveness ratio of the use of PRP injections as opposed to HA was $12,628.15/QALY. CONCLUSIONS: Although a series of either PRP ($8,635.23/QALY) or HA ($5,331.75/QALY) injections for the treatment of symptomatic knee osteoarthritis would be considered cost-effective (cost per QALY < $50,000), PRP injections were not more cost-effective than HA injections. However, PRP was significantly more effective at 1 year, and being associated with an incremental cost-effectiveness ratio of $12,628.15/QALY when compared with HA, a series of PRP injections should be considered a reasonable and acceptable alternative to HA injections for the treatment of symptomatic knee osteoarthritis. LEVEL OF EVIDENCE: Level II, economic and decision analysis of Level I studies.

HWCVD a-Si:H interlayer slope waveguide coupler for multilayer silicon photonics platform.

We present interlayer slope waveguides, designed to guide light from one level to another in a multi-layer silicon photonics platform. The waveguide is fabricated from hydrogenated amorphous silicon (a-Si:H) film, deposited using hot-wire chemical vapor deposition (HWCVD) at a temperature of 230°C. The interlayer slope waveguide is comprises of a lower level input waveguide and an upper level output waveguide, connected by a waveguide on a slope, with vertical separation to isolate other crossing waveguides. Measured loss of 0.17 dB/slope was obtained for waveguide dimensions of 600 nm waveguide width (w) and 400 nm core thickness (h) at a wavelength of 1550 nm and for transverse electric (TE) mode polarization.

Hybrid Photon-Plasmon Coupling and Ultrafast Control of Nanoantennas on a Silicon Photonic Chip.

Hybrid integration of nanoplasmonic devices with silicon photonic circuits holds promise for a range of applications in on-chip sensing, field-enhanced and nonlinear spectroscopy, and integrated nanophotonic switches. Here, we demonstrate a new regime of photon-plasmon coupling by combining a silicon photonic resonator with plasmonic nanoantennas. Using principles from coherent perfect absorption, we make use of standing-wave light fields to maximize the photon-plasmon interaction strength. Precise placement of the broadband antennas with respect to the narrowband photonic racetrack modes results in controlled hybridization of only a subset of these modes. By combining antennas into groups of radiating dipoles with opposite phase, far-field scattering is effectively suppressed. We achieve ultrafast tuning of photon-plasmon hybridization including reconfigurable routing of the standing-wave input between two output ports. Hybrid photonic-plasmonic resonators provide conceptually new approaches for on-chip integrated nanophotonic devices.

Design Procedure and Fabrication of Reproducible Silicon Vernier Devices for High-Performance Refractive Index Sensing.

In this paper, we propose a generalized procedure for the design of integrated Vernier devices for high performance chemical and biochemical sensing. In particular, we demonstrate the accurate control of the most critical design and fabrication parameters of silicon-on-insulator cascade-coupled racetrack resonators operating in the second regime of the Vernier effect, around 1.55 µm. The experimental implementation of our design strategies has allowed a rigorous and reliable investigation of the influence of racetrack resonator and directional coupler dimensions as well as of waveguide process variability on the operation of Vernier devices. Figures of merit of our Vernier architectures have been measured experimentally, evidencing a high reproducibility and a very good agreement with the theoretical predictions, as also confirmed by relative errors even lower than 1%. Finally, a Vernier gain as high as 30.3, average insertion loss of 2.1 dB and extinction ratio up to 30 dB have been achieved.

Counterfactual and Factual Reflection: The Influence of Past Misdeeds on Future Immoral Behavior.

Though the decision to behave immorally is situated within the context of prior immoral behavior, research has provided contradictory insights into this process. In a series of experiments, we demonstrate that the effects of prior immoral behavior depend on how individuals think about, or reflect on, their immoral behavior. In Experiment 1, participants who reflected counterfactually on their prior moral lapses morally disengaged (i.e., rationalized) less than participants who reflected factually. In Experiment 2, participants who reflected counterfactually on their prior moral lapses experienced more guilt than those who reflected factually. Finally, in Experiments 3 and 4, participants who reflected counterfactually lied less on unrelated tasks with real monetary stakes than those who reflected factually. Our studies provide important insights into moral rationalization and moral compensation processes and demonstrate the profound influence of reflection in everyday moral life.

Canine scent detection and microbial source tracking of human waste contamination in storm drains.

Human fecal contamination of surface waters and drains is difficult to diagnose. DNA-based and chemical analyses of water samples can be used to specifically quantify human waste contamination, but their expense precludes routine use. We evaluated canine scent tracking, using two dogs trained to respond to the scent of municipal wastewater, as a field approach for surveying human fecal contamination. Fecal indicator bacteria, as well as DNA-based and chemical markers of human waste, were analyzed in waters sampled from canine scent-evaluated sites (urban storm drains and creeks). In the field, the dogs responded positively (70% and 100%) at sites for which sampled waters were then confirmed as contaminated with human waste. When both dogs indicated a negative response, human waste markers were absent. Overall, canine scent tracking appears useful for prioritizing sampling sites for which DNA-based and similarly expensive assays can confirm and quantify human waste contamination.

Expression of glycosaminoglycan epitopes during zebrafish skeletogenesis.

BACKGROUND: The zebrafish is an important developmental model. Surprisingly, there are few studies that describe the glycosaminoglycan composition of its extracellular matrix during skeletogenesis. Glycosaminoglycans on proteoglycans contribute to the material properties of musculo skeletal connective tissues, and are important in regulating signalling events during morphogenesis. Sulfation motifs within the chain structure of glycosaminoglycans on cell-associated and extracellular matrix proteoglycans allow them to bind and regulate the sequestration/presentation of bioactive signalling molecules important in musculo-skeletal development. RESULTS: We describe the spatio-temporal expression of different glycosaminoglycan moieties during zebrafish skeletogenesis with antibodies recognising (1) native sulfation motifs within chondroitin and keratan sulfate chains, and (2) enzyme-generated neoepitope sequences within the chain structure of chondroitin sulfate (i.e., 0-, 4-, and 6-sulfated isoforms) and heparan sulfate glycosaminoglycans. We show that all the glycosaminoglycan moieties investigated are expressed within the developing skeletal tissues of larval zebrafish. However, subtle changes in their patterns of spatio-temporal expression over the period examined suggest that their expression is tightly and dynamically controlled during development. CONCLUSIONS: The subtle differences observed in the domains of expression between different glycosaminoglycan moieties suggest differences in their functional roles during establishment of the primitive analogues of the skeleton.

The Evaluation of the Containment Efficacy of Semi-Rigid Isolators for Housing Cages of Laboratory Animals Infected With BSL-3 Agents.

Research animals models infected with Biosafety Level-3 (BSL-3) agents need to be housed in specialized biocontainment caging. Most of these specialized cages have input and exhaust that is high efficiency particulate air filtered and sealed to prevent escape of the BSL-3 agent. An alternative to the use of the above BSL-3 biocontainment caging is the use of a flexible film or modified semi-rigid plastic film isolator that has its own high efficiency particulate air-filtered input and exhaust and is sealed with respect to the animal room environment, thus preventing BSL-3 agent escape. Standard caging can be housed within such an isolator. Computational fluid dynamics was used to evaluate the integrity of modified semi-rigid isolators for containment of aerosolized BSL-3 agents. Three isolators were located inside an animal BSL-3 room to provide an extra tier of protection and to permit different infectious studies within the same room while reducing or eliminating the risk of cross-contamination. The isolators were sized to house caging for rabbits and smaller non-human primates such as marmosets, African greens, and macaques. Multiple case studies of failure scenarios were investigated, including isolator breaches through the plastic membrane seam separation and rips, and exhaust fan failure. Breaching the level of containment provided by the isolators required the improbable simultaneous event of a plastic membrane rip in addition to the rare malfunction of the back-up exhaust fans. Each isolator was equipped with 2 blower motors connected in parallel to a common exhaust plenum and a battery backup. Even with this rare double (simultaneous) event, the animal BSL-3 room air exhaust system was able to contain the few droplets released in the simulated computational fluid dynamics breach. The modified semi-rigid isolators with negative airflow proved safe and effective for aerosol studies using BSL-3 agents, even in the unlikely event of a breach in containment.

Comparative activity of telavancin and other antimicrobial agents against methicillin-resistant Staphylococcus aureus isolates collected from 1991 to 2006.

BACKGROUND: Increasingly frequent reports of vancomycin treatment failures for serious methicillin-resistant Staphylococcus aureus (MRSA) infections provide impetus for comparative in vitro studies to assess the activity of newer antimicrobial agents against a range of MRSA isolates. METHODS: A sample of 168 MRSA derived from a long-term MRSA collection was subjected to susceptibility testing to telavancin, daptomycin, linezolid, tigecycline and vancomycin by broth micro-dilution. Data were reviewed for sporadic occurrence of isolates with reduced susceptibility. Analyses were performed to test for temporal trends toward decreasing susceptibility and to compare susceptibility of isolates from different infection sites. RESULTS: No MRSA isolate from any time period was resistant to test antibiotics. For daptomycin, linezolid and tigecycline, there were no susceptibility differences between the pre- and postclinical availability periods. All newer agents were active against MRSA isolates with minimum inhibitory concentrations (MICs) of vancomycin >1 mg/l, but there were significant correlations in susceptibility among several pairs of antibiotics. CONCLUSIONS: Telavancin and other newer antistaphylococcal agents were fully active against MRSA from various infection sites including isolates with vancomycin MIC >1 mg/l.

Moral attentiveness: who pays attention to the moral aspects of life?

This research draws from social cognitive theory to develop a construct known as moral attentiveness, the extent to which an individual chronically perceives and considers morality and moral elements in his or her experiences, and proposes that moral attentiveness affects a variety of behaviors. A series of 5 studies with undergraduates, MBA students, and managers were conducted to create and validate a reliable multidimensional scale and to provide evidence that moral attentiveness is associated with (a) the recall and reporting of self- and others' morality-related behaviors, (b) moral awareness, and (c) moral behavior. Results of the studies suggest that moral attentiveness has a significant effect on how individuals understand and act in their moral worlds.

Ultrafast perturbation maps as a quantitative tool for testing of multi-port photonic devices.

Advanced photonic probing techniques are of great importance for the development of non-contact wafer-scale testing of photonic chips. Ultrafast photomodulation has been identified as a powerful new tool capable of remotely mapping photonic devices through a scanning perturbation. Here, we develop photomodulation maps into a quantitative technique through a general and rigorous method based on Lorentz reciprocity that allows the prediction of transmittance perturbation maps for arbitrary linear photonic systems with great accuracy and minimal computational cost. Excellent agreement is obtained between predicted and experimental maps of various optical multimode-interference devices, thereby allowing direct comparison of a device under test with a physical model of an ideal design structure. In addition to constituting a promising route for optical testing in photonics manufacturing, ultrafast perturbation mapping may be used for design optimization of photonic structures with reconfigurable functionalities.

The effects of moral judgment and moral identity on moral behavior: an empirical examination of the moral individual.

Recognizing limitations in classic cognitive moral development theory, several scholars have drawn from theories of identity to suggest that moral behavior results from both moral judgments and moral identity. The authors conducted 2 survey-based studies with more than 500 students and managers to test this argument. Results demonstrated that moral identity and moral judgments both independently influenced moral behavior. In addition, in situations in which social consensus regarding the moral behavior was not high, moral judgments and moral identity interacted to shape moral behavior. This interaction effect indicated that those who viewed themselves as moral individuals pursued the most extreme alternatives (e.g., never cheating, regularly cheating)--a finding that affirms the motivational power of a moral identity. The authors conclude by considering the implications of this research for both theory and practice.

A neurocognitive model of the ethical decision-making process: implications for study and practice.

The field of business ethics is entrenched in a cognitive approach that portrays the ethical decision-making process as a completely deliberate and reasoned exercise. In light of growing concerns about the veracity of this approach, I build upon current knowledge of how the brain functions to present a neurocognitive model of ethical decision making. The model suggests that ethical decision making involves 2 interrelated yet functionally distinct cycles, a reflexive pattern matching cycle and a higher order conscious reasoning cycle, and thereby describes not only reasoned analysis, but also the intuitive and retrospective aspects of ethical decision making. The model sparks research in new areas, holds significant implications for the study of ethical decision making, and provides suggestions for improving ethical behavior in organizations.

Moral awareness and ethical predispositions: investigating the role of individual differences in the recognition of moral issues.

The impact of the role of individual ethical predispositions, preferences for utilitarian and formalistic ideals, on managerial moral awareness was examined in 2 studies. Results suggested that a manager's ethical predispositions influence his or her responses to the characteristics of the moral issue. Both utilitarianism and formalism shaped moral awareness, but formalism demonstrated a greater capacity to do so in that formalists recognized both harm and the violation of a behavioral norm as indicators of the moral issue, whereas utilitarians responded only to harm. These findings provide support for the basic arguments underlying theories of moral development and offer several implications for the study and practice of moral awareness in organizations.

Out of control: A self-control perspective on the link between surface acting and abusive supervision.

In this study, we examined how leaders' customer interactions influence their tendency to abuse their followers. Specifically, we drew from ego-depletion theory to suggest that surface acting during customer interactions depletes leaders of their self-control resources, resulting in elevated levels of abusive supervision. Furthermore, we hypothesized that the effect of surface acting on abusive supervision is moderated by leaders' trait self-control, such that leaders with high trait self-control will be less affected by the depleting effects of surface acting than their peers. Results from a multiwave, multisource leader-follower dyad study in the service and sales industries provided support for our hypotheses. This research contributes to several literatures, particularly to an emerging area of study--the antecedents of leaders' abusive behaviors.

GM-CSF induction in human lung fibroblasts by IL-1beta, TNF-alpha, and macrophage contact.

Fibroblast-derived cytokines may play crucial roles in airway inflammation. In this study, we analyzed expression of the inflammatory cytokine, granulocyte-macrophage colony-stimulating factor (GM-CSF), a major eosinophilopoietin, by normal human lung fibroblast (NHLF) cells and its regulation by monokines and macrophage contact. NHLFs were stimulated with interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) and were cocultured with the U937 myelomonocytic cell line. The expression of GM-CSF transcripts was analyzed by reverse transcription-polymerase chain reaction (RT-PCR), and GM-CSF protein was detected by ELISA. Nuclear translocation of nuclear factor-kappaB (NF-kappaB), an important transcription factor for inflammatory gene expression, was assessed by electrophoretic mobility shift assay (EMSA). Both IL-1beta and TNF-alpha significantly enhanced the production of GM-CSF by NHLF. Coculturing of peripheral blood mononuclear cells (PBMC) with NHLF induced GM-CSF expression. This phenomenon was also seen on coculturing U937 cells or membranes derived from U937 with NHLF but was inhibited when the two types of cells were separated, suggesting a need for cell-cell contact. U937 membranes, as well as IL-1beta and TNF-alpha, induced nuclear translocation of NF-kappaB. These data support a prominent role for macrophage-fibroblast interactions in airway inflammation and fibrosis.

Assessment of Particulate Matter Levels in Vulnerable Communities in North Charleston, South Carolina prior to Port Expansion.

INTRODUCTION: The Port of Charleston, one of the busiest US ports, currently operates five terminals. The fifth terminal is being planned for expansion to accommodate container ships from the proposed Panama Canal expansion. Such expansion is expected to increase traffic within local vulnerable North Charleston neck communities by at least 7,000 diesel truck trips per day, more than a 70% increase from the present average rate of 10,000 trucks per day. Our objective was to measure the current particulate matter (PM) concentrations in North Charleston communities as a baseline to contrast against future air pollution after the proposed port expansion. METHODS: Saturation study was performed to determine spatial variability of PM in local Charleston neck communities. In addition, the temporal trends in particulate air pollution within the region were determined across several decades. With the BGI sampler, PM samples were collected for 24 hours comparable to the federal reference method protocol. Gravimetric analysis of the PM filter samples was conducted following EPA protocol. RESULTS: The range of the PM10 annual average across the region from 1982 to 2006 was 17.0-55.0 µg/m3. On only two occasions were the records of PM10 averaged above the 50.0 µg/m3 national standard. In the case of PM2.5, the annual average for 1999-2006 ranged from 11.0 to 13.5 µg/m3 and no annual average exceeded the 15.0 µg/m3 PM2.5 annual standard. CONCLUSIONS: Although ambient PM levels have fallen in the Charleston region since the 1960s due to aggressive monitoring by the stakeholders against air pollution, local air pollution sources within the North Charleston neck communities have consistently contributed to the PM levels in the region for several decades. This baseline assessment of ambient PM will allow for comparisons with future assessments to ascertain the impact of the increased truck and port traffic on PM concentrations.

Spinal deformity in aged zebrafish is accompanied by degenerative changes to their vertebrae that resemble osteoarthritis.

Age-related degenerative changes within the vertebral column are a significant cause of morbidity with considerable socio-economic impact worldwide. An improved understanding of these changes through the development of experimental models may lead to improvements in existing clinical treatment options. The zebrafish is a well-established model for the study of skeletogenesis with significant potential in gerontological research. With advancing age, zebrafish frequently develop gross deformities of their vertebral column, previously ascribed to reduced trunk muscle tone. In this study, we assess degenerative changes specifically within the bone and cartilage of the vertebral column of zebrafish at 1, 2 and 3-years of age. We show increased frequency and severity of spinal deformities/curvatures with age. Underlying the most severe phenotypes are partial or complete vertebral dislocations and focal thickening of the vertebral bone at the joint margins. MicroCT examination demonstrates small defects, fractures and morphological evidence suggestive of bone erosion and remodeling (i.e. osteophytes) within the vertebrae during aging, but no significant change in bone density. Light and electron microscopic examination reveal striking age-related changes in cell morphology, suggestive of chondroptosis, and tissue remodelling of the vertebral cartilage, particularly within the pericellular micro-environment. Glycosaminoglycan analysis of the vertebral column by HPLC demonstrates a consistent, age-related increase in the yield of total chondroitin sulfate disaccharide, but no change in sulfation pattern, supported by immunohistochemical analysis. Immunohistochemistry strongly identifies all three chondroitin/dermatan sulphate isoforms (C-0-S, C-4-S/DS and C-6-S) within the vertebral cartilage, particularly within the pericellular micro-environment. In contrast, keratan sulfate immunolocalises specifically with the notochordal tissue of the intervertebral disc, and its labelling diminishes with age. In summary, these observations raise the prospect that zebrafish, in addition to modelling skeletal development, may have utility in modelling age-related degenerative changes that affect the skeleton during senescence.

Automatic ethics: the effects of implicit assumptions and contextual cues on moral behavior.

We empirically examine the reflexive or automatic aspects of moral decision making. To begin, we develop and validate a measure of an individual's implicit assumption regarding the inherent morality of business. Then, using an in-basket exercise, we demonstrate that an implicit assumption that business is inherently moral impacts day-to-day business decisions and interacts with contextual cues to shape moral behavior. Ultimately, we offer evidence supporting a characterization of employees as reflexive interactionists: moral agents whose automatic decision-making processes interact with the environment to shape their moral behavior.