Frequency of cast-related complications and influencing factors in patients with casts.

BACKGROUND: Casting is a common procedure in the treatment of extremity fractures, but it can lead to serious complications if applied improperly. However, there are few studies on the prevalence of cast-related complications. PURPOSE: To assess the frequency of cast-related complications and influencing factors in patients referred to medical centers affiliated with a University of Medical Sciences. METHODS: A descriptive study was conducted on 120 patients with limb fractures in need of casting. The study was conducted from November 1, 2020, to June 1, 2021. A checklist was used to assess complications, and complications were monitored by regular telephone contact. Each patient was followed up for 3 months. Descriptive and inferential statistics were used to analyze the data. RESULTS: Pain, impaired mobility, numbness, swelling, and a burning sensation inside the cast were the most common complications in the first week after cast application and occurred in 94.2%, 72.5%, 60.8%, 60%, and 54.2% of patients, respectively. Patients whose casts were applied by a nurse experienced more pain (p = 0.002), numbness (p = 0.02), and swelling (p = 0.05). The incidence of numbness was significantly higher in patients who were more active during convalescence (p = 0.04). CONCLUSIONS: Due to the importance of cast-related complications, in-service training programs for casting staff are needed. Furthermore, patient education and follow-up should be taken more seriously.

Application of particle swarm optimization to water management: an introduction and overview.

Particle swarm optimization (PSO) is a stochastic population-based optimization algorithm inspired by the interactions of individuals in a social world. This algorithm is widely applied in different fields of water resources problems. This paper presents a comprehensive overview of the basic PSO algorithm search strategy and PSO's applications and performance analysis in water resources engineering optimization problems. Our literature review revealed 22 different varieties of the PSO algorithm. The characteristics of each PSO variety together with their applications in different fields of water resources engineering (e.g., reservoir operation, rainfall-runoff modeling, water quality modeling, and groundwater modeling) are highlighted. The performances of different PSO variants were compared with other evolutionary algorithms (EAs) and mathematical optimization methods. The review evaluates the capability and comparative performance of PSO variants over conventional EAs (e.g., simulated annealing, differential evolution, genetic algorithm, and shark algorithm) and mathematical methods (e.g., support vector machine and differential dynamic programming) in terms of proper convergence to optimal Pareto fronts, faster convergence rate, and diversity of computed solutions.

Hydrodynamic modelling of a flood-prone tidal river using the 1D model MIKE HYDRO River: calibration and sensitivity analysis.

Hydrodynamic modelling is a powerful tool to gain understanding of river conditions. However, as widely known, models vary in terms of how they respond to changes and uncertainty in their input parameters. A hydrodynamic river model (MIKE HYDRO River) was developed and calibrated for a flood-prone tidal river located in South East Queensland, Australia. The model was calibrated using Manning's roughness coefficient for the normal dry and flood periods. The model performance was assessed by comparing observed and simulated water level, and estimating performance indices. Results indicated a satisfactory agreement between the observed and simulated results. The hydrodynamic modelling results revealed that the calibrated Manning's roughness coefficient ranged between 0.011 and 0.013. The impacts of tidal variation at the river mouth and the river discharge from upstream are the major driving force for the hydrodynamic process. To investigate the impacts of the boundary conditions, a new sensitivity analysis approach, based on adding stochastic terms (random noise) to the time series of boundary conditions, was conducted. The main purpose of such new sensitivity analysis was to impose changes in magnitude and time of boundary conditions randomly, which is more similar to the real and natural water level variations compared to impose constant changes of water level. In this new approach, the possible number of variations in simulated results was separately evaluated for both downstream and upstream boundaries under 5%, 10%, and 15% perturbation. The sensitivity analysis results revealed that in the river under study, the middle parts of the river were shown to be more sensitive to downstream boundary condition as maximum water level variations can reach 8%, 12%, and 15% under 5%, 10%, and 15% changes in the downstream boundary, respectively. The outcomes of the present paper will benefit future modelling efforts through provision of a robust tool to enable prediction of water levels at ungauged points of the river under various scenarios of flooding and climate change for the purpose of city planning and decision-making.

Review of climate change impacts on predicted river streamflow in tropical rivers.

Tropical regions are characterized by hydrological extreme events, which are likely to be exacerbated by climate change. Therefore, quantifying the extent to which climate change may damage a hydrological system becomes crucial. This paper aims to evaluate the findings from previous research on projected impacts of climate change on hydrological systems located in regions bounded by the Tropic of Cancer and the Tropic of Capricorn. It intends to provide an in-depth understanding of the climatic conditions, applied approaches, climate change impacts on future streamflow, and measures to reduce prediction uncertainty in the tropics. The review revealed that there is a significant variation in the magnitude of climate change impacts on streamflow in the tropics. The reason for the inconsistent trend prediction is that projections are heavily dependent on the trajectory of greenhouse gas emissions, climate model structural differences, and uncertainty of downscaling methods and hydrological models. Therefore, to minimize the uncertainty and maximize confidence in streamflow projections, it is essential to apply multi-member model ensembles and to clarify the adaptation strategy (coping, adjusting, or transforming).

Application of non-animal-inspired evolutionary algorithms to reservoir operation: an overview.

Evolutionary algorithms (EAs) have been widely used to search for optimal strategies for the planning and management of water resources systems, particularly reservoir operation. This study provides a comprehensive diagnostic assessment of state of the art of the non-animal-inspired EA applications to reservoir optimization. This type of EAs does not mimic biologic traits and group strategies of animal (wild) species. A search of pertinent papers was applied to the journal citation reports (JCRs). A bibliometric survey identified 14 pertinent non-animal-inspired EAs, such as the genetic algorithm (GA), simulated annealing (SA), and differential evolution (DE) algorithms, most of which have a number of modified versions. The characteristics of non-animal-inspired EAs and their modified versions were discussed to identify the difference between EAs and how each EA was improved. Additionally, the type of application of non-animal-inspired EAs to different case studies was investigated, and comparisons were made between the performance of the applied EAs in the studied literature. The survey revealed that the GA is the most frequently applied algorithm, followed by the DE algorithm. Non-animal-inspired EAs are superior to the classical methods of reservoir optimization (e.g., the non-linear programming and dynamic programming) due to faster convergence, diverse solution space, and efficient objective function evaluation. Several non-animal-inspired EAs of recent vintage have been shown to outperform the classic GA, which was the first evolutionary algorithm applied to reservoir operation.

Narcotics in rheumatology.

Patients with rheumatic conditions often suffer from related chronic pain. When first-line traditional medications such as acetaminophen and anti-inflammatory medications do not suffice, then other options are needed. The traditional medications may ultimately not provide sufficient pain relief, or alternatively, they can pose as a contraindication due to underlying hypertension, renal, and/or hepatic disease. Therefore, narcotics are an alluring alternative, which if used in a multidisciplinary and systematic approach to the patient, can prove to be quite beneficial in the lives of these patients.

Cardiopulmonary manifestations of ankylosing spondylitis.

Ankylosing spondylitis is a chronic inflammatory condition that usually affects young men. Cardiac dysfunction and pulmonary disease are well-known and commonly reported extra-articular manifestation, associated with ankylosing spondylitis (AS). AS has also been reported to be specifically associated with aortitis, aortic valve diseases, conduction disturbances, cardiomyopathy and ischemic heart disease. The pulmonary manifestations of the disease include fibrosis of the upper lobes, interstitial lung disease, ventilatory impairment due to chest wall restriction, sleep apnea, and spontaneous pneumothorax. They are many reports detailing pathophysiology, hypothesized mechanisms leading to these derangements, and estimated prevalence of such findings in the AS populations. At this time, there are no clear guidelines regarding a stepwise approach to screen these patients for cardiovascular and pulmonary complications.

Communication outcomes in audiologic reporting.

BACKGROUND: Audiologists often work collaboratively with other health professionals-particularly otolaryngology providers. Some form of written reporting of audiologic outcomes is typically the vehicle by which communication among providers occurs. Quality patient care is dependent on both accurate interpretation of outcomes and effectiveness of communication between providers. Audiologic reporting protocols tend to vary among clinics and providers, with most methods being based on preference rather than standardized definitions. PURPOSE: As part of an ongoing quality-improvement program, audiologic communication was reviewed by comparing written audiometric reports to descriptions of the audiometric results dictated by otolaryngology providers to evaluate the agreement of communication between provider groups. RESEARCH DESIGN: Retrospective chart review. STUDY SAMPLE: The study sample consisted of 6000 randomly selected charts from a total of 15,625 for the years 2004 and 2008 in the electronic medical record system of a large academic health-care system. DATA COLLECTION AND ANALYSIS: Audiogram reports and associated otolaryngology reports were reviewed by an audiologist and two audiology doctoral students. Communication occurred among 37 audiology providers and 39 otolaryngology providers. Data collected included rating of congruence or incongruence between reports, normal versus abnormal audiologic outcomes, and the nature of communication disparities. Data also included provider type (audiologist, audiology doctoral student, or trainee in clinical fellowship year [CFY]; otolaryngologist, otolaryngology resident, physician assistant, or nurse practitioner). RESULTS: Incongruent results were higher among the sample of audiologic evaluations with abnormal outcomes (29.2%) compared with normal outcomes (9.5%). Of those cases rated as incongruent, differences in reporting audiometric results stemmed largely from variance in reporting of numerical values from the audiogram (20%), apparent dictation errors (10.1%), and communication of the ear tested (8.6%). Of those cases in which the interpretations of audiology providers differed from those of otolaryngology providers, incongruent results occurred in the interpretation of degree (29.4%), tympanometric results (28.2%), type of hearing loss (12.8%), acoustic reflex results (4.0%), symmetry (3.3%), and other domains (4.2%). Rates of incongruent results were similar regardless of experience level of the audiology provider (audiologist or audiology doctoral student/CFY) but differed depending on the educational background and experience of the otolaryngology provider. The highest incongruent interpretations were found among residents (32.5%), followed by otolaryngologists (25.2%) and physician assistants and nurse practitioners (21%). CONCLUSIONS: This study highlights the need for audiologists to critically evaluate the effectiveness of their communication with other health-care providers and demonstrates the need for evidence-based approaches for interpreting audiologic information and reporting audiologic information to others.

Point mutations and genomic deletions in CCND1 create stable truncated cyclin D1 mRNAs that are associated with increased proliferation rate and shorter survival.

A gene expression signature of tumor proliferation rate in mantle cell lymphoma (MCL) is an overriding molecular predictor of the length of survival following diagnosis. Many strongly proliferative MCL tumors have exceptionally high cyclin D1 mRNA levels and preferentially express short cyclin D1 mRNA isoforms. We demonstrate here that these short mRNAs are cyclin D1a isoforms with truncated 3'UTRs, not alternatively spliced cyclin D1b mRNA isoforms. Among 15 MCL tumors with truncated cyclin D1 mRNAs, 7 had genomic deletions in the CCND1 3'UTR region. In 3 others, CCND1 contained point mutations that created premature polyadenylation signals, giving rise to 1.5-kb mRNAs lacking most of the 3'UTR. Both types of genomic alteration created transcripts lacking mRNA destabilization elements present in the wild-type cyclin D1a mRNA. Premature polyadenylation due to a 3'UTR mutation also was present in the Z-138 MCL cell line, which expressed both truncated and full-length cyclin D1a mRNAs. In these cells, the half-life of the short cyclin D1a mRNA was much longer than that of the full-length mRNA. We conclude that alterations of CCND1 3'UTR structure can significantly increase its oncogenic effect and worsen the clinical course of MCL patients.

Treatment of cellulite with optical devices: an overview with practical considerations.

Cellulite is a common condition in women for which treatment is frequently requested. Its etiology is unknown, but a myriad of factors including genetics, hormones, and inflammation appear to contribute to its formation. Despite the popularity of therapies touting their effectiveness for this pervasive condition, few have proven long-lasting benefits. Lasers and light sources are the latest devices to have entered the cellulite therapeutic market. This paper describes these optical devices and provides an overview of their published effectiveness.