Disease Severity and Quality of Life Measurements in Contact Dermatitis: A Systematic Review 2005-2015.

BACKGROUND: Contact dermatitis (CD) has been assessed by numerous disease severity indices resulting in heterogeneity across published research. OBJECTIVE: This study aims to evaluate published CD severity scales and identify a criterion standard for assessment. METHODS: Scopus and Ovid MEDLINE were searched for human randomized controlled trials (RCTs) on CD severity measures published during a 10-year period. Eligible studies were English-language RCTs reporting disease severity outcome measures for CD in humans. Studies were excluded if they were duplicates, not available in English, not related to CD, not RCTs, not conducted on human subjects, or did not report relevant outcome measures. RESULTS: A total of 22 disease outcome measures were used in 81 included RCTs. Instrument-based measures were used in 40 (49.4%) studies, and visual assessments were used in 66 (81.5%) RCTs. Only 5 (6.2%) studies reported quality of life (QoL) outcomes. Two (2.5%) studies used a clinical severity scale, which combined both QoL and visual assessments. LIMITATIONS: This study was limited by the exclusion of non-RCTs and gray literature. CONCLUSIONS: Wide variation in CD outcome measures exists including instrument-based measures, visual assessments, and QoL outcomes. A standardized outcome measure must be generated to reduce heterogeneity.

Surgical Hip Dislocation for the Treatment of Intra-Articular Injuries and Hip Instability Following Traumatic Posterior Dislocation in Children and Adolescents.

BACKGROUND: Traumatic posterior hip dislocation in children is a rare injury that typically is treated with closed reduction. Surgical treatment is typically recommended for nonconcentric reduction with joint space asymmetry with entrapped labrum or an osteochondral fragment. The surgical hip dislocation (SHD) approach allows for full assessment of the acetabulum and femoral head and has been our preferred surgical strategy. The purpose of this study was to (1) describe the intra-articular pathologic findings seen at the time of SHD; and (2) to investigate hip pain, function, and activity level of a cohort of children and adolescents after open treatment of a posterior hip dislocation using the SHD approach. METHODS: Following IRB approval, 23 patients who sustained a traumatic posterior hip dislocation between January 2009 and December 2013 were identified. In 8/23 (34.8%) patients there was evidence of nonconcentric reduction after closed treatment and surgical treatment was performed using the SHD approach. Seven male and 1 female (mean age, 11.2 y; range, 6 to 14.6 y) were followed for an average of 28 months (range, 13 to 67 mo). The modified Harris Hip Score (mHHS) and the University of California Los Angeles activity score assessed clinical hip outcome and activity level at minimum of 1 year after surgery. RESULTS: Six patients were treated after an acute trauma, whereas 2 were treated after recurrent dislocations. Five patients were involved in motor vehicle accidents and 3 in sports-related injuries. Intraoperative findings include posterior labral avulsion in all patients, fracture of the cartilaginous posterior wall (n=3), and femoral head chondral injuries (n=5) and fracture (n=1). The labral root was repaired using suture anchor technique in 7/8 patients and resected in 1. In 2 patients, labral repair was complemented by screw fixation of the posterior wall. All but one patient (mHHS=94) reported maximum mHHS. The University of California Los Angeles activity score was 10 for 5/8 patients and 7 in 3 patients. No case of femoral head osteonecrosis was noted. One patient developed an asymptomatic heterotopic ossification. CONCLUSIONS: When open reduction is recommended for the treatment of intra-articular pathologies and hip instability following traumatic dislocation of the hip in children and adolescents, the SHD is an excellent approach that allows surgical correction of the damaged bony and soft-tissue structures including repair of the capsule-labral complex, and reduction and internal fixation of the cartilaginous posterior wall and femoral head fractures. LEVEL OF EVIDENCE: Level IV.

Practical Use of Computationally Frugal Model Analysis Methods.

Three challenges compromise the utility of mathematical models of groundwater and other environmental systems: (1) a dizzying array of model analysis methods and metrics make it difficult to compare evaluations of model adequacy, sensitivity, and uncertainty; (2) the high computational demands of many popular model analysis methods (requiring 1000's, 10,000 s, or more model runs) make them difficult to apply to complex models; and (3) many models are plagued by unrealistic nonlinearities arising from the numerical model formulation and implementation. This study proposes a strategy to address these challenges through a careful combination of model analysis and implementation methods. In this strategy, computationally frugal model analysis methods (often requiring a few dozen parallelizable model runs) play a major role, and computationally demanding methods are used for problems where (relatively) inexpensive diagnostics suggest the frugal methods are unreliable. We also argue in favor of detecting and, where possible, eliminating unrealistic model nonlinearities-this increases the realism of the model itself and facilitates the application of frugal methods. Literature examples are used to demonstrate the use of frugal methods and associated diagnostics. We suggest that the strategy proposed in this paper would allow the environmental sciences community to achieve greater transparency and falsifiability of environmental models, and obtain greater scientific insight from ongoing and future modeling efforts.

High frequency of genotype D and spontaneous hepatitis B virus genomic mutations among Haitians in a multiethnic North American population.

GOALS/BACKGROUND: The importance of hepatitis B virus (HBV) genotype and mutations has been increasingly recognized. We aimed to determine HBV genotype, precore (PC), and basal core promoter region (BCP) mutations in a HBV multiethnic South Florida population. STUDY: Samples from 213 patients were tested for HBV-DNA using Abbott RealTime HBV IUO assay, and for mutations using INNO-LiPA assay. RESULTS: Patients were predominantly male (67%); 61 (31%) were African American, 60 (28%) Hispanic, 37 (17%) Haitian, 27 (19%) white non-Hispanic, and 14 (6.6%) Asian. Genotype A was found in 101 (69%), D in 25 (17%), F in 9 (6%), G in 7 (5%), C and E in 6 (4%) each, B in 4 (3%), and H in 2 (1%) patients. Mixed genotypes were detected in 11 patients. Genotype A was more prevalent in all ethnicities except for Asian. Among hepatitis B e antigen (HBeAg)-negative patients (59%), BCP, PC, and combined BCP/PC mutations were found in 30 (37.5%), 13 (16.3%), and 14 (17.5%), respectively. Genotype D was associated with higher frequency of HBeAg-negative status [18/24 (75%) vs. 62/121 (51%) P=0.03] and mutations [16/19 (84%) vs. 40/67 (60%) P=0.04] compared with others. Genotype A was negatively associated with mutations [26/31 (84%) vs. 30/55 (55%), P=0.009]. PC mutations were more common in genotype D (14/19, 73%) compared with genotype A (7/54, 13%, P<0.0001). One-hundred percent and 79% of Asians and Haitians had spontaneous mutations, respectively. All Haitians with genotype D had PC mutations and 3 (50%) had BCP/PC. CONCLUSIONS: The present study shows that HBeAg-negative status and spontaneous mutations were more common with genotype D; the presence of genotype D in Haitians was always associated with spontaneous mutations.

Genotipos y serotipos del virus de la hepatitis C en sueros de pacientes de Caracas: determinación de serotipos mediante una prueba inmunoblot en tira / Hepatitis C genotype and serotype in serum of infected patients from Caracas-Venezuela: serotype determination using a strip immunoblot assay

Se estudiaron genotipos y serotipos en 30 sueros anti-VHC positivos, de pacientes atendidos en un Hospital General de Caracas. Los genotipos fueron determinados mediante sonda tipo específica (INNO LiPA HCV II), los serotipos por prueba inmunoblot en tira (CHIRON RIBA HCV SEROTYPING SIA). El ARN VHC por PCR fue detectado en 18 sueros (60 por ciento) en 12 de ellos (67 por ciento) un solo genotipo, infección mixta (2 o más subtipos del mismo genotipo) en 2 (11 por ciento), coinfección (dos o más genotipos) en 3 (17 por ciento) y 1 (6 por ciento) indeterminado. El genotipo detectado con mayor frecuencia fue el 1 (44 por ciento) siguiendole en frecuencia el 2 (22 por ciento). Los tipos y subtipos detectados fueron: 1a en 17 por ciento, 1b en 22 por ciento, 2 en 6 por ciento, 1a/1b en 6 por ciento, 2a/2c en 17 por ciento, 3a/3b en 6 por ciento, 4c/4d en 16 por ciento, se detectó coinfección en 3 sueros con los siguientes genotipos: 1b+2a (6 por ciento), 2a/2b + 4a (6 por ciento) y 1b + 2 + 4 (6 por ciento). Al analizar los 30 sueros en que se practicó el serotipiaje se aprecia que el serotipo 1 se detectó en 30 por ciento, el serotipo 2 en 13 por ciento, el serotipo 3 en 7 por ciento, coinfección con serotipos 1 + 3 en 6 por ciento e indeterminados 47 por ciento. Se logró determinar la presencia de genotipos o serotipos en un número aproximadamente similar de muestras, la concordancia fue del 33 por ciento