The effect of manual therapy on ankle dorsiflexion range of motion: A pilot crossover randomized trial.

INTRODUCTION: Restricted ankle dorsiflexion is common after lower limb injury. The aim of this pilot study was to investigate the effect of passive ankle joint mobilization and calf muscle massage on ankle dorsiflexion range of motion in adults with residual restricted dorsiflexion. The secondary aim was to assess the methodology of the pilot study to inform a larger clinical trial. METHOD: The study design was a randomized crossover trial with assessor blinding. Twenty-five healthy participants with a history of lower limb injury were included in the study. Ankle joint mobilization and calf muscle massage were applied for 5 min in a random order, one to two weeks apart. Ankle dorsiflexion was measured by using the weight-bearing lunge pre- and post-intervention (cm). Paired t-tests were used to analyze the effect of the manual therapy interventions on restricted ankles. A minimal detectable difference 95% (MMD95) was calculated. The pilot study was analyzed for suitability of inclusion criteria, blinding of assessors and the manual therapist, and the washout period. RESULTS: A significant increase in dorsiflexion was demonstrated for ankle joint mobilization (change score = 0.51 ± 0.76, p = 0.003) and calf muscle soft tissue massage (change score = 0.91 ± 1.07, p < 0.001). There was no difference in change scores between manual therapy techniques (mobilization 0.51 ± 0.76, massage 0.91 ± 1.07, p = 0.12). Evaluation of the pilot study revealed limitations to be modified in future studies. CONCLUSION: These preliminary data indicate ankle joint mobilization and calf muscle soft tissue massage had similar effects on increasing ankle dorsiflexion range of motion in ankles with residual dorsiflexion restriction.

Development of a calcium alginate-cellulose nanocrystal-based coating to reduce the impact of oil spills on shorelines.

It is well known that oil stranded on shoreline substrates can be difficult to remove and cause serious environmental effects. To address this issue, a calcium alginate-cellulose nanocrystal (CA-CNC)-based coating with a unique surface structure and superhydrophobic properties was developed to reduce the extent of shoreline oiling. The results of batch washing test showed that not only did the introduction of CNC not reduce the oil removal efficiency; it also improved the environmental stability of the coating to resist the effects associated with seawater immersion and erosion (especially in the case of 0.4 wt% of CNC). The oil-repellent performance of the coated gravels implied that both oscillation time and oil concentration had almost no effects on the amount of adhered oil. Assessment of oiling prevention based on the laboratory shoreline tank simulator proved the coated gravel performed very well as more oil floated and less oil remained on substrates and penetrated into the subsurface. Biotoxicity analysis showed that the coating powders reduced impacts on the toxicity of the oil to algae at low doses. There is a good potential for the use of this CA-CNC based coating technique to improve shoreline oil spill response.

Exploring the effects of substrate mineral fines on oil translocation in the shoreline environment: Experimental analysis, numerical simulation, and implications for spill response.

Mineral fines act a pivotal part in determining the fate and behavior of oil. In this study, the infiltrations of oil emulsion in simulated sediments and natural shoreline sediments were investigated using a fixed bed experiment. Oil infiltration process was simulated based on fixed-bed dispersion model. The role of mineral fines in oil release was explored using simulated and natural sediments. Although mineral fines exhibited a higher affinity for oil, it was found that increasing fines fractions decreased the flow rate of oil emulsion, thereby decreasing the oil retention in the sediment column. In terms of oil release from the sediment, the highest level of oil mass was observed in the oil-mineral flocculation phase compared to the water column and the water surface compartments. Compared to light crude oil, the release of engine oil from sediment was less. The effects of mineral fines on oil infiltration and release were also confirmed by using natural shoreline sediments. Results of our detailed field studies also showed that current shoreline classification datasets do not characterize the presence and fraction of mineral fines at a level of detail required to accurately predict the significance of oil translocation following spill incidents.

Adult-Onset Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-Like Episodes (MELAS) in a Patient Without Significant Family History.

This case reports a 53-year-old Caucasian female previously diagnosed with viral encephalitis and Fahr's Syndrome who presented with altered mental status. Shortly after arrival, she displayed severe lactic acidosis and was transferred to the intensive care unit (ICU), where she had a brief seizure. Neurological workup was performed including carotid ultrasound, magnetic resonance angiography (MRA) brain, and computed tomography (CT) angiogram of the neck, all of which were unremarkable. Initial magnetic resonance imaging (MRI) performed showed small, acute ischemic foci in the bilateral occipital lobes and medial left thalamus. Subsequent diffusion-weighted imaging (DWI) MRI of the bilateral occipital lobes showed vasogenic edema, a common finding in Mitochondrial Encephalopathy, Lactic Acid, and Stroke-like episodes (MELAS). The patient was given Levetiracetam and managed supportively. She was progressively extubated and her seizure symptoms and lactic acidosis resolved. Our case represents a unique case in which a patient with non-contributory family history is first diagnosed with MELAS after age 40 after her symptoms were initially attributed to other pathologies.

Traumatic Brain Injury-Related Pediatric Mortality and Morbidity in Low- and Middle-Income Countries: A Systematic Review.

BACKGROUND: The burden of pediatric traumatic brain injury (pTBI) in low- and middle-income countries (LMICs) is unknown. To fill this gap, we conducted a review that aimed to characterize the causes of pTBI in LMICs, and their reported associated mortality and morbidity. METHODS: A systematic review was conducted. MEDLINE, Embase, Global Health, and Global Index Medicus were searched from January 2000 to May 2020. Observational or experimental studies on pTBI of individuals aged between 0 and 16 years in LMICs were included. The causes of pTBI and morbidity data were descriptively analyzed, and case fatality rates were calculated. PROSPERO ID: CRD42020171276. RESULTS: A total of 136 studies were included. Fifty-seven studies were at high risk of bias. Of the remaining studies, 170,224 cases of pTBI were reported in 32 LMICs. The odds of having a pTBI were 1.8 times higher (95% confidence interval, 1.6-2.0) in males. The odds of a pTBI being mild were 4.4 times higher (95% confidence interval, 1.9-6.8) than a pTBI being moderate or severe. Road traffic accidents were the most common cause (n = 16,275/41,979; 39%) of pTBIs. On discharge, 24% of patients (n = 4385/17,930) had a reduction in their normal mental or physical function. The median case fatality rate was 7.3 (interquartile range, 2.1-7.7). CONCLUSIONS: Less than a quarter (n = 32) of all LMICs have published high-quality data on the volume and burden of pTBI. From the limited data available, young male children are at a high risk of pTBIs in LMICs, particularly after road traffic accidents.

Decision support tools for oil spill response (OSR-DSTs): Approaches, challenges, and future research perspectives.

Marine oil spills pose a significant threat to ocean and coastal ecosystems. In addition to costs incurred by response activities, an economic burden could be experienced by stakeholders dependent on coastal resources. Decision support tools for oil spill response (OSR-DSTs) have been playing an important role during oil spill response operations. This paper aims to provide an insight into the status of research on OSR-DSTs and identify future directions. Specifically, a systematic review is conducted including an examination of the advantages and limitations of currently applied and emerging decision support techniques for oil spill response. In response to elevated environmental concerns for protecting the polar ecosystem, the review includes a discussion on the use of OSR-DSTs in cold regions. Based on the analysis of information acquired, recommendations for future work on the development of OSR-DSTs to support the selection and implementation of spill response options are presented.

A framework for the evaluation and selection of shoreline surface washing agents in oil spill response.

The shorelines frequently suffer adverse impacts from oil spill accidents. As one important technique of shoreline cleanup, the application of surface washing agents (SWAs) can help achieve high oil removal from shoreline substrates with less damage to affected zone. In this study, a framework for evaluation and selection of SWAs in oil spill incidents was constructed to better understand and apply this technique. A decision tree was firstly developed to illustrate all possible scenarios which are appropriate to use SWAs in consideration of oil collectability, shoreline character, types and amount of stranded oil, and cleanup requirement. Based on literature review, theoretical modeling, and experts' suggestions, an integrated multi-criteria decision analysis (MCDA) method was then come up to select the most preferred SWA from five aspects of toxicity, effectiveness, minimal dispersion, demonstrated field test, and cost. Its suitability and rationality were proved by a hypothetical case. In addition, sensitivity analysis was performed by changing the weight of each criterion independently to check the priority rank of alternatives, and it also verified the robustness and stability of this model. The presented framework has significant implications for future research and application of SWAs in the shoreline cleanup.

Association of Clinician Diagnostic Performance With Machine Learning-Based Decision Support Systems: A Systematic Review.

Importance: An increasing number of machine learning (ML)-based clinical decision support systems (CDSSs) are described in the medical literature, but this research focuses almost entirely on comparing CDSS directly with clinicians (human vs computer). Little is known about the outcomes of these systems when used as adjuncts to human decision-making (human vs human with computer). Objectives: To conduct a systematic review to investigate the association between the interactive use of ML-based diagnostic CDSSs and clinician performance and to examine the extent of the CDSSs' human factors evaluation. Evidence Review: A search of MEDLINE, Embase, PsycINFO, and grey literature was conducted for the period between January 1, 2010, and May 31, 2019. Peer-reviewed studies published in English comparing human clinician performance with and without interactive use of an ML-based diagnostic CDSSs were included. All metrics used to assess human performance were considered as outcomes. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) and Risk of Bias in Non-Randomised Studies-Intervention (ROBINS-I). Narrative summaries were produced for the main outcomes. Given the heterogeneity of medical conditions, outcomes of interest, and evaluation metrics, no meta-analysis was performed. Findings: A total of 8112 studies were initially retrieved and 5154 abstracts were screened; of these, 37 studies met the inclusion criteria. The median number of participating clinicians was 4 (interquartile range, 3-8). Of the 107 results that reported statistical significance, 54 (50%) were increased by the use of CDSSs, 4 (4%) were decreased, and 49 (46%) showed no change or an unclear change. In the subgroup of studies carried out in representative clinical settings, no association between the use of ML-based diagnostic CDSSs and improved clinician performance could be observed. Interobserver agreement was the commonly reported outcome whose change was the most strongly associated with CDSS use. Four studies (11%) reported on user feedback, and, in all but 1 case, clinicians decided to override at least some of the algorithms' recommendations. Twenty-eight studies (76%) were rated as having a high risk of bias in at least 1 of the 4 QUADAS-2 core domains, and 6 studies (16%) were considered to be at serious or critical risk of bias using ROBINS-I. Conclusions and Relevance: This systematic review found only sparse evidence that the use of ML-based CDSSs is associated with improved clinician diagnostic performance. Most studies had a low number of participants, were at high or unclear risk of bias, and showed little or no consideration for human factors. Caution should be exercised when estimating the current potential of ML to improve human diagnostic performance, and more comprehensive evaluation should be conducted before deploying ML-based CDSSs in clinical settings. The results highlight the importance of considering supported human decisions as end points rather than merely the stand-alone CDSSs outputs.

Inexact inventory-theory-based optimization of oily waste management system in shoreline spill response.

The oily waste generated from the cleanup operations during shoreline spill response can result in challenging environmental and socioeconomic problems. In this study, an inexact inventory-theory-based optimization model (ITOM) for oily waste management during shoreline spill response was developed to support the spill management team. The most appropriate facilities and optimal waste allocation scheme under uncertainty can be selected to achieve minimum total system cost. To satisfy the demand of oily waste treatment, these oily waste management facilities can be selectively opened depending on the situation. In the combination with the economic order quantity model of inventory theory, the developed model can provide the optimal solutions of batch size and order cycle for treatment facilities to minimize the inventory cost. A case study was used to demonstrate the application of ITOM. The obtained solutions include the facilities selection and waste allocation for waste collection and destocking stages under different risk levels. These solutions can provide a good guideline with managers to analyze the trade-offs between system cost and constraint-violation risks. The developed model has high application potential as a job-aid tool to manage the oily waste generated from oiled shoreline cleanup operations.

A review of Gulf of Mexico coastal marsh erosion studies following the 2010 Deepwater Horizon oil spill and comparison to over 4 years of shoreline loss data from Fall 2010 to 2015.

The 2010 Deepwater Horizon (DWH) oil spill affected nearly 1105 km of coastal marsh. Long-term shoreline loss in the northern Gulf of Mexico is an important question with far-reaching ecological and human-use implications. Numerous studies have examined potential exacerbated marsh shoreline retreat after the DWH using ground-level sampling and/or aerial/satellite imagery interpretation. This paper reviews previous DWH erosion studies, discusses their limitations and sometimes conflicting results, and provides a comprehensive analysis of a larger data set. Shoreline retreat measurements from multiple studies following the DWH incident were combined for 131 herbaceous marsh sample sites for the period from Fall 2010 to Summer 2015. Significant increases in shoreline loss were found only in the period from Fall 2010 to Fall 2011 for heavily oiled shorelines relative to other periods. The evidence does not suggest widespread long-term coastal marsh erosion from the DWH.

Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review.

OBJECTIVES: To estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective during the early phases of the pandemic. DESIGN: Systematic review. METHODS: Two parallel searches of academic bibliographic databases and grey literature were undertaken until 8 May 2020. Governments were also contacted for further information where possible. There were no restrictions on language, information sources used, publication status and types of sources of evidence. The AACODS checklist or the National Institutes of Health study quality assessment tools were used to appraise each source of evidence. OUTCOME MEASURES: Publication characteristics, country-specific data points, COVID-19-specific data, demographics of affected HCWs and public health measures employed. RESULTS: A total of 152 888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%, n=14 058) and nurses (38.6%, n=10 706), but deaths were mainly in men (70.8%, n=550) and doctors (51.4%, n=525). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.2 deaths reported per 100 infections for HCWs aged over 70 years. Europe had the highest absolute numbers of reported infections (119 628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7). CONCLUSIONS: COVID-19 infections and deaths among HCWs follow that of the general population around the world. The reasons for gender and specialty differences require further exploration, as do the low rates reported in Africa and India. Although physicians working in certain specialities may be considered high risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs.

Prevalence of and Characteristics Associated With Self-reported Good Hearing in a Population With Elevated Audiometric Thresholds.

Importance: Audiometric evidence of hearing loss does not always relate to self-reported hearing loss. Objective: To determine the prevalence of self-reported good hearing in a population with audiometrically defined hearing loss and identify associated factors. Design, Setting, and Participants: We analyzed audiometric data from adults aged 20 to 69 years from the 1999 to 2002 cycles of the US National Health and Nutrition Examination Survey, a cross-sectional, nationally representative interview and examination survey of the civilian, noninstitutionalized population. Logistic regression was used to examine unadjusted and multivariable-adjusted relationships between demographic, hearing health, and general health factors related to self-perceived hearing status. Analysis was conducted between September 4, 2018, and November 30, 2018. Interventions: Audiometry and questionnaires. Main Outcomes and Measure: The prevalence of persons reporting good hearing among those with audiometrically defined hearing loss and the variables associated with this population. Results: The mean (SD) age was 47.0 (0.4) years for hearing loss defined by any frequency >25 dB HL and 52.5 (1.1) years for hearing loss defined by PTA >25 dB HL. For the sample with hearing loss defined by any frequency >25 dB HL, 744 (56.1%) were men and 629 (43.9%) were women. For the sample with hearing loss defined by PTA >25 dB HL 251 (68.5%) were men and 114 (31.5%) were women. Of the 1373 participants who were found to have hearing loss (at least 1 individual frequency >25 dB HL in either ear) 993 (68.5%) reported good hearing. Younger age, nonwhite race, and women were all more likely to report good hearing. When the definition of hearing loss was made more stringent (pure-tone average >25 dB HL), 365 participants had audiometric hearing loss, but 174 (43%) continued to report good hearing. We observed that better self-perceived general health status (OR, 1.90; 95% CI, 1.25-2.90) and higher dietary quality (OR, 1.01; 95% CI, 1.00-1.02) were significantly associated with increased self-report of good hearing, whereas tinnitus (OR, 0.25; 95% CI, 0.14-0.44), noise exposure (OR, 0.39; 95% CI, 0.26-0.58), and several comorbid conditions were associated with decreased self-report of good hearing. Conclusions and Relevance: A significant proportion of the study population reported good hearing despite having audiometric evidence of hearing loss; the prevalence was related to how hearing loss was defined. The report of good hearing was significantly associated with demographics and general health status. The high prevalence of mild hearing loss and self-reported good hearing was associated with the low reported use of hearing aids.

Extent and degree of shoreline oiling: Deepwater Horizon oil spill, Gulf of Mexico, USA.

The oil from the 2010 Deepwater Horizon spill in the Gulf of Mexico was documented by shoreline assessment teams as stranding on 1,773 km of shoreline. Beaches comprised 50.8%, marshes 44.9%, and other shoreline types 4.3% of the oiled shoreline. Shoreline cleanup activities were authorized on 660 km, or 73.3% of oiled beaches and up to 71 km, or 8.9% of oiled marshes and associated habitats. One year after the spill began, oil remained on 847 km; two years later, oil remained on 687 km, though at much lesser degrees of oiling. For example, shorelines characterized as heavily oiled went from a maximum of 360 km, to 22.4 km one year later, and to 6.4 km two years later. Shoreline cleanup has been conducted to meet habitat-specific cleanup endpoints and will continue until all oiled shoreline segments meet endpoints. The entire shoreline cleanup program has been managed under the Shoreline Cleanup Assessment Technique (SCAT) Program, which is a systematic, objective, and inclusive process to collect data on shoreline oiling conditions and support decision making on appropriate cleanup methods and endpoints. It was a particularly valuable and effective process during such a complex spill.

Oil persistence on beaches in Prince William Sound - a review of SCAT surveys conducted from 1989 to 2002.

In 2002, 13 years after the Exxon Valdez oil spill (EVOS), 39 selected sites in Prince William Sound (PWS) were re-surveyed following established shoreline cleanup assessment team (SCAT) field observation procedures to document surface and sub-surface oiling conditions in shoreline sediments and to compare results with those from previous Shoreline Cleanup Assessment Team (SCAT) surveys and other surveys in PWS. The selected sites are locations where EVOS oil persisted in 1992, at the time the Federal and State On-Scene Coordinators determined that the cleanup was complete and that further cleanup activities would provide no net environmental benefit. These sites had been included in a 2001 NOAA survey of shoreline oiling conditions and account for 88% of the sub-surface oil residues (SSO) oil documented by that study. The 2002 field survey found isolated occurrences of residual EVOS surface oil residues (SO) in the form of weathered asphalt pavement at 15 of the 39 sites. This residual SO typically consisted of asphalt in mixed sand/gravel substrate, located within a wave shadow effect created by boulders or bedrock in the upper intertidal to supratidal zone. Residual SO, expressed as a continuous oil cover, was less than 200 m(2) within the approximately 111,120 m(2) surveyed. A total of 1182 pits were dug at locations where SSO residues were present in 1992. Six of the 39 sites and 815 (68%) of the pits contained no residual SSO. Eighty-three percent of pits with SSO residues were found primarily in middle to upper intertidal locations. SSO residues commonly occurred in a discontinuous approximately 3 cm thick band 5-10 cm below the boulder/cobble or pebble/gravel veneer. The SO and SSO occurrences in the 2002 survey closely match the locations where they were found in 1992 and earlier surveys; however, in 2002 residual SSO patches are more discontinuous and thinner than they were in the earlier surveys. These sites are biased toward SSO persistence; those that have SSO residues represent less than 0.5% of the originally oiled shorelines in PWS. Despite evidence of continued oil weathering, both at the surface and in the sub-surface, it is clear that the natural cleaning processes at these particular locations are slow. The slow weathering rates are a consequence of the oil residue being incorporated in finer sediments (fine sand, silt, mix) and isolated from active weathering processes as boulders and outcrops, shallow bedrock asperities, or boulder-armoring create wave shadows and limit effective physical action on shorelines.

The persistence and character of stranded oil on coarse-sediment beaches.

Small amounts of oil that can persist for decades in the intertidal zone of coarse-sediment beaches have been documented in a few well-studied cases. Oil that survives attenuation over the short-term (weeks to months) will persist until there is a change in the environmental conditions, as might occur where there is a seasonal storm-wave climate or as a beach undergoes long-term (erosional) changes. Oil residues can persist on the beach surface as tar mats, asphalt-like pavements, or as veneers on sediment particles or hard surfaces. Subsurface oil residues can persist in similar forms or as fill or partial fill of the pore spaces between coarse-sediment particles. Oil penetrates until it reaches fine-grained sediment, the water table, bedrock, or other penetration-limiting layers. Amounts of persistent oil are very small fractions of the volumes that were originally stranded and these protected residues can continue to biodegrade as they become thinner and more discontinuous.