BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation.Thus,patients with diabetes should be screened for this disorder according to local guidelines.An obstacle...BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation.Thus,patients with diabetes should be screened for this disorder according to local guidelines.An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment.AIM To validate both sections(A and B)of the Michigan Neuropathy Screening Instrument(MNSI)in Polish(PL)patients with diabetes.METHODS A cross-sectional study using a test(A1,B1)and re-test(A2,B2)formula was performed in 80 patients with diabetes.The gold standard used for neuropathy detection was a nerve conduction study(NCS)which was performed in all participants.Reliability of the MNSI-PL was assessed using the Cronbach’s alpha,Kuder-Richardson formula 20(KR-20),split-half reliability,the Gottman split-half tests,and correlation between first and second half was accessed.Stability was assessed using an intraclass correlation coefficient(ICC).For external validation,we used simple linear correlation,binomial regression,and agreement between two different tools using a Bland-Altman plot analysis.RESULTS The scale was internally consistent(Cronbach’s alpha for the full scale:0.81 for A and 0.87 for B).MNSI-PL scores in test/retest showed high stability(ICC=0.73 for A and ICC=0.97 for B).The statistically important correlations between MNSI-PL and NCS were found for B1,B2,and A1(P<0.005).The cut-off points of≥3 for section A(sensitivity of 90%-100%;specificity of 33%-40%)and≥2 for section B(sensitivity of 81%-84%;specificity of 60%-70%)were obtained during neuropathy detection.CONCLUSION The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.展开更多
背景与目的近年来,癌症患者导管相关性静脉血栓(catheter related thrombosis,CRT)发病率逐年增加,但尚缺乏专门针对CRT的预测工具。本研究比较Khorana评分、Michigan评分和COMPASS-CAT评分这三种工具对肺癌患者发生经外周置入中心静脉...背景与目的近年来,癌症患者导管相关性静脉血栓(catheter related thrombosis,CRT)发病率逐年增加,但尚缺乏专门针对CRT的预测工具。本研究比较Khorana评分、Michigan评分和COMPASS-CAT评分这三种工具对肺癌患者发生经外周置入中心静脉导管相关性上肢静脉血栓(peripherally inserted central catheter-related upper extremity venous thrombosis,PICC-UEVT)的预测效能。方法采用回顾性病例对照研究,收集344例经PICC的肺癌患者的临床资料,分为PICC-UEVT组(86例)和对照组(258例)。分别使用Khorana评分、Michigan评分和COMPASS-CAT评分对患者进行评分,绘制不同评分的受试者工作特征曲线(receiver operating characteristic,ROC),计算ROC下面积(area under curve,AUC),分析比较三种评分对肺癌患者发生PICC-UEVT的预测效能。结果Khorana评分、Michigan评分和COMPASS-CAT评分预测肺癌患者PICC-UEVT的AUC值分别为0.505(95%CI:0.435–0.575)、0.509(95%CI:0.438–0.580)和0.566(95%CI:0.498–0.633);最佳临界值分别为1、5和7分;灵敏度分别为0.302、0.035和0.884;特异度分别为0.717、0.996和0.248;阳性预测值分别为25.5%、75.0%和28.1%;阴性预测值分别为82.6%、75.6%和86.5%。结论COMPASS-CAT评分对肺癌患者发生PICC-UEVT的预测效能高于Khorana评分和Michigan评分,但三种评分的整体预测效能均不佳。展开更多
With all the improvement in wave and hydrodynamics numerical models, the question rises in our mind that how the accuracy of the forcing functions and their input can affect the results. In this paper, a commonly used...With all the improvement in wave and hydrodynamics numerical models, the question rises in our mind that how the accuracy of the forcing functions and their input can affect the results. In this paper, a commonly used numerical third-generation wave model, SWAN is applied to predict waves in Lake Michigan. Wind data are analyzed to determine wind variation frequency over Lake Michigan. Wave predictions uncertainty due to wind local effects are compared during a period where wind has a fairly constant speed and direction over the northern and southern basins. The study shows that despite model calibration in Lake Michigan area, the model deficiency arises from ignoring wind effects in small scales. Wave prediction also emphasizes that small scale turbulence in meteorological forces can increase prediction errors by 38%. Wave frequency and coherence analysis show that both models can predict the wave variation time scale with the same accuracy. Insufficient number of meteorological stations can result in neglecting local wind effects and discrepancies in current predictions. The uncertainty of wave numerical models due to input uncertainties and model principals should be taken into account for design risk factors.展开更多
The stability analysis of an abandoned underground gypsum mine requires the determination of the mine pillar’s strength.This is especially important for flooded abandoned mines where the gypsum pillars become saturat...The stability analysis of an abandoned underground gypsum mine requires the determination of the mine pillar’s strength.This is especially important for flooded abandoned mines where the gypsum pillars become saturated and are subjected to dissolution after flooding.Further,mine pillars are subjected to blast vibrations that generate some level of macro- and micro-fracturing.Testing samples of gypsum must,therefore,simulate these conditions as close as possible.In this research,the strength of gypsum is investigated in an as-received saturated condition using uniaxial compressive strength (UCS),Brazilian tensile strength (BTS) and point load index (PLI) tests.The scale effect was investigated and new correlations were derived to describe the effect of sample size on both UCS and BTS under dry and saturated conditions.Effects of blasting on these parameters were observed and the importance of choosing the proper samples was discussed.Finally,correlations were derived for both compressive and tensile strengths under dry and saturated conditions from the PLI test results,which are commonly used as a simple substitute for the indirect determination of UCS and BTS.展开更多
Lake Michigan, the sixth largest freshwater lake in the world by surface area, was utilized as a water body for assessment. Field data collected at sampling sites throughout the lake in an intensive monitoring effort ...Lake Michigan, the sixth largest freshwater lake in the world by surface area, was utilized as a water body for assessment. Field data collected at sampling sites throughout the lake in an intensive monitoring effort were utilized for evaluation of the distribution of sediment measurements. An assessment of sediment nutrient and carbon measurements within Lake Michigan was completed to recognize strata resulting from the hydrodynamics of the system. Nonparametric comparison tests revealed that significant differences exist between measurements of sediment nutrients and organic carbon in the lake using strata based upon water column depth (all results demon-strated a p < 0.05, α = 0.05). Cross-validation analysis was applied to the field-collected samples, revealing that large errors occur when estimating sediment flux of carbon or nutrients at a given location in the lake without considering stratification of the distributions of these measurements. Errors in estimating sediment concentrations of nutrients and carbon specific to a location in the lake demonstrated a statistically significant increase when stratification of sediment measurements wasn’t employed among sites. For example, distributions of errors in estimating all nutrients and organic carbon concentrations, whereby distance squared inverse interpolation methods were applied, demonstrated a statistically significant increase in absence of stratification (all p < 0.001, α = 0.05). These results have implications for characterization, monitoring, and modeling sediment and water interaction as related to eutrophication, as well as to contaminant exposure and bioaccumulation for chemicals within Lake Michigan and large water bodies where stratification of the sediment based upon physics of the system exists.展开更多
Water is one of the most essential resources required to sustain life. However, it could be detrimental to the health of those without access to water that is properly treated. Although the Safe Drinking Water Act of ...Water is one of the most essential resources required to sustain life. However, it could be detrimental to the health of those without access to water that is properly treated. Although the Safe Drinking Water Act of 1974 set regulations to protect citizens from naturally occurring and man-made contaminants, some people are still without clean and safe water, which is speculated to be because of their race. This research examines the disproportionality of available clean water provided by government sources in Michigan and its correlation with race and household income. In the study, it has been found that one of the leading causes of water contamination is industrial activity, with the automobile industry being responsible for approximately 300 million tons of lead contamination in water, and that the manufacturing company’s locations mostly centered in minority and low-income areas. Lower income cities, such as Hamtramck and Benton Harbor, have an average of 14.8 drinking water standard violations with the highest being 99 total violations, while higher income cities, like Novi and Bloomfield hills, have an average of 4 violations. Cities, like Flint and Detroit, which have a higher minority population, are 10 times more likely to have a water standard violation, and the minority population is proportionally related to the possibility of industrial manufacturing being located in those areas. These communities also face a higher risk of birth defects, developmental issues in children, and organ failure in adults, due to continuous exposure to water contaminants. Race as a direct causation could not be proven, but there are links to direct correlation through historical redlining and housing trends.展开更多
目的:探究桡动脉掌浅支腕横纹皮瓣游离移植修复手指软组织缺损的临床疗效。方法:选择2019年1月-2021年12月笔者医院收治的23例手指软组织缺损患者为研究对象,均给予桡动脉掌浅支腕横纹皮瓣游离移植修复治疗,术后随访6~12个月,评估疗效...目的:探究桡动脉掌浅支腕横纹皮瓣游离移植修复手指软组织缺损的临床疗效。方法:选择2019年1月-2021年12月笔者医院收治的23例手指软组织缺损患者为研究对象,均给予桡动脉掌浅支腕横纹皮瓣游离移植修复治疗,术后随访6~12个月,评估疗效、手指功能[Michigan手部功能问卷(Michigan hand outcomes quest ionnaire,MHQ)]及徒手肌力。结果:本组23例患者皮瓣均完全存活,手术优良率为100.00%,其中优14例,良9例;手术操作时间(3.16±0.21)h,术中出血量(83.27±6.59)ml,创面愈合时间(18.03±2.12)d;皮瓣两点分辨觉(7.41±0.43)mm。术后6个月MHQ评分:整体手功能(80.02±5.17)分,日常活动(78.94±6.13)分,工作情况(79.17±6.02)分,疼痛(77.02±6.13)分,外观(81.16±5.02)分,手功能满意程度(83.02±3.95)分。术后6个月肌力:4级5例,5级18例。随访期间出现术后创缘部分坏死1例,并发症发生率为4.35%。结论:桡动脉掌浅支腕横纹皮瓣游离移植修复手指软组织缺损疗效好,可有效恢复手指功能及徒手肌力,患者满意程度较高。展开更多
基金Supported by the Ministry of Health Subvention from the IT Simple System of the Wroclaw Medical University by Wroclaw Medical University,No.SUBZ.C310.22.075the MCDTR grant from the National Institute of Diabetes and Digestive and Kidney Diseases,No.P30DK092926.
文摘BACKGROUND Diabetic sensorimotor polyneuropathy is an important risk factor for foot ulceration and amputation.Thus,patients with diabetes should be screened for this disorder according to local guidelines.An obstacle to the diagnosis of this disease may be the lack of unified diagnostic criteria due to the lack of properly validated scales used for assessment.AIM To validate both sections(A and B)of the Michigan Neuropathy Screening Instrument(MNSI)in Polish(PL)patients with diabetes.METHODS A cross-sectional study using a test(A1,B1)and re-test(A2,B2)formula was performed in 80 patients with diabetes.The gold standard used for neuropathy detection was a nerve conduction study(NCS)which was performed in all participants.Reliability of the MNSI-PL was assessed using the Cronbach’s alpha,Kuder-Richardson formula 20(KR-20),split-half reliability,the Gottman split-half tests,and correlation between first and second half was accessed.Stability was assessed using an intraclass correlation coefficient(ICC).For external validation,we used simple linear correlation,binomial regression,and agreement between two different tools using a Bland-Altman plot analysis.RESULTS The scale was internally consistent(Cronbach’s alpha for the full scale:0.81 for A and 0.87 for B).MNSI-PL scores in test/retest showed high stability(ICC=0.73 for A and ICC=0.97 for B).The statistically important correlations between MNSI-PL and NCS were found for B1,B2,and A1(P<0.005).The cut-off points of≥3 for section A(sensitivity of 90%-100%;specificity of 33%-40%)and≥2 for section B(sensitivity of 81%-84%;specificity of 60%-70%)were obtained during neuropathy detection.CONCLUSION The MNSI-PL is a reliable and valid instrument in screening for diabetic neuropathy.
文摘背景与目的近年来,癌症患者导管相关性静脉血栓(catheter related thrombosis,CRT)发病率逐年增加,但尚缺乏专门针对CRT的预测工具。本研究比较Khorana评分、Michigan评分和COMPASS-CAT评分这三种工具对肺癌患者发生经外周置入中心静脉导管相关性上肢静脉血栓(peripherally inserted central catheter-related upper extremity venous thrombosis,PICC-UEVT)的预测效能。方法采用回顾性病例对照研究,收集344例经PICC的肺癌患者的临床资料,分为PICC-UEVT组(86例)和对照组(258例)。分别使用Khorana评分、Michigan评分和COMPASS-CAT评分对患者进行评分,绘制不同评分的受试者工作特征曲线(receiver operating characteristic,ROC),计算ROC下面积(area under curve,AUC),分析比较三种评分对肺癌患者发生PICC-UEVT的预测效能。结果Khorana评分、Michigan评分和COMPASS-CAT评分预测肺癌患者PICC-UEVT的AUC值分别为0.505(95%CI:0.435–0.575)、0.509(95%CI:0.438–0.580)和0.566(95%CI:0.498–0.633);最佳临界值分别为1、5和7分;灵敏度分别为0.302、0.035和0.884;特异度分别为0.717、0.996和0.248;阳性预测值分别为25.5%、75.0%和28.1%;阴性预测值分别为82.6%、75.6%和86.5%。结论COMPASS-CAT评分对肺癌患者发生PICC-UEVT的预测效能高于Khorana评分和Michigan评分,但三种评分的整体预测效能均不佳。
文摘With all the improvement in wave and hydrodynamics numerical models, the question rises in our mind that how the accuracy of the forcing functions and their input can affect the results. In this paper, a commonly used numerical third-generation wave model, SWAN is applied to predict waves in Lake Michigan. Wind data are analyzed to determine wind variation frequency over Lake Michigan. Wave predictions uncertainty due to wind local effects are compared during a period where wind has a fairly constant speed and direction over the northern and southern basins. The study shows that despite model calibration in Lake Michigan area, the model deficiency arises from ignoring wind effects in small scales. Wave prediction also emphasizes that small scale turbulence in meteorological forces can increase prediction errors by 38%. Wave frequency and coherence analysis show that both models can predict the wave variation time scale with the same accuracy. Insufficient number of meteorological stations can result in neglecting local wind effects and discrepancies in current predictions. The uncertainty of wave numerical models due to input uncertainties and model principals should be taken into account for design risk factors.
文摘The stability analysis of an abandoned underground gypsum mine requires the determination of the mine pillar’s strength.This is especially important for flooded abandoned mines where the gypsum pillars become saturated and are subjected to dissolution after flooding.Further,mine pillars are subjected to blast vibrations that generate some level of macro- and micro-fracturing.Testing samples of gypsum must,therefore,simulate these conditions as close as possible.In this research,the strength of gypsum is investigated in an as-received saturated condition using uniaxial compressive strength (UCS),Brazilian tensile strength (BTS) and point load index (PLI) tests.The scale effect was investigated and new correlations were derived to describe the effect of sample size on both UCS and BTS under dry and saturated conditions.Effects of blasting on these parameters were observed and the importance of choosing the proper samples was discussed.Finally,correlations were derived for both compressive and tensile strengths under dry and saturated conditions from the PLI test results,which are commonly used as a simple substitute for the indirect determination of UCS and BTS.
文摘Lake Michigan, the sixth largest freshwater lake in the world by surface area, was utilized as a water body for assessment. Field data collected at sampling sites throughout the lake in an intensive monitoring effort were utilized for evaluation of the distribution of sediment measurements. An assessment of sediment nutrient and carbon measurements within Lake Michigan was completed to recognize strata resulting from the hydrodynamics of the system. Nonparametric comparison tests revealed that significant differences exist between measurements of sediment nutrients and organic carbon in the lake using strata based upon water column depth (all results demon-strated a p < 0.05, α = 0.05). Cross-validation analysis was applied to the field-collected samples, revealing that large errors occur when estimating sediment flux of carbon or nutrients at a given location in the lake without considering stratification of the distributions of these measurements. Errors in estimating sediment concentrations of nutrients and carbon specific to a location in the lake demonstrated a statistically significant increase when stratification of sediment measurements wasn’t employed among sites. For example, distributions of errors in estimating all nutrients and organic carbon concentrations, whereby distance squared inverse interpolation methods were applied, demonstrated a statistically significant increase in absence of stratification (all p < 0.001, α = 0.05). These results have implications for characterization, monitoring, and modeling sediment and water interaction as related to eutrophication, as well as to contaminant exposure and bioaccumulation for chemicals within Lake Michigan and large water bodies where stratification of the sediment based upon physics of the system exists.
文摘Water is one of the most essential resources required to sustain life. However, it could be detrimental to the health of those without access to water that is properly treated. Although the Safe Drinking Water Act of 1974 set regulations to protect citizens from naturally occurring and man-made contaminants, some people are still without clean and safe water, which is speculated to be because of their race. This research examines the disproportionality of available clean water provided by government sources in Michigan and its correlation with race and household income. In the study, it has been found that one of the leading causes of water contamination is industrial activity, with the automobile industry being responsible for approximately 300 million tons of lead contamination in water, and that the manufacturing company’s locations mostly centered in minority and low-income areas. Lower income cities, such as Hamtramck and Benton Harbor, have an average of 14.8 drinking water standard violations with the highest being 99 total violations, while higher income cities, like Novi and Bloomfield hills, have an average of 4 violations. Cities, like Flint and Detroit, which have a higher minority population, are 10 times more likely to have a water standard violation, and the minority population is proportionally related to the possibility of industrial manufacturing being located in those areas. These communities also face a higher risk of birth defects, developmental issues in children, and organ failure in adults, due to continuous exposure to water contaminants. Race as a direct causation could not be proven, but there are links to direct correlation through historical redlining and housing trends.
文摘目的:探究桡动脉掌浅支腕横纹皮瓣游离移植修复手指软组织缺损的临床疗效。方法:选择2019年1月-2021年12月笔者医院收治的23例手指软组织缺损患者为研究对象,均给予桡动脉掌浅支腕横纹皮瓣游离移植修复治疗,术后随访6~12个月,评估疗效、手指功能[Michigan手部功能问卷(Michigan hand outcomes quest ionnaire,MHQ)]及徒手肌力。结果:本组23例患者皮瓣均完全存活,手术优良率为100.00%,其中优14例,良9例;手术操作时间(3.16±0.21)h,术中出血量(83.27±6.59)ml,创面愈合时间(18.03±2.12)d;皮瓣两点分辨觉(7.41±0.43)mm。术后6个月MHQ评分:整体手功能(80.02±5.17)分,日常活动(78.94±6.13)分,工作情况(79.17±6.02)分,疼痛(77.02±6.13)分,外观(81.16±5.02)分,手功能满意程度(83.02±3.95)分。术后6个月肌力:4级5例,5级18例。随访期间出现术后创缘部分坏死1例,并发症发生率为4.35%。结论:桡动脉掌浅支腕横纹皮瓣游离移植修复手指软组织缺损疗效好,可有效恢复手指功能及徒手肌力,患者满意程度较高。
