Objectives: The incidence of pectoralis major tendon tears is rising, and repair is generally considered, but there is a paucity of comparative data to demonstrate the superiority of operative treatment. We sought to compare the outcomes of operative and nonoperative treatment of pectoralis major tendon tears. We hypothesized that repair would result in superior outcomes compared to nonoperative treatment. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was completed using MEDLINE, SPORTDiscus, CINAHL, Cochrane, Embase and Web of Science databases. English-language studies were included with a minimum of 6 months average follow-up and 5 cases per study. Methodological Index for Nonrandomized Studies was utilized to assess the quality of the existing literature. Meta-analysis of pooled mechanisms of injury and outcomes was completed. Pooled effect-sizes were calculated from random effects models. Continuous variables were assessed using mixed model analysis with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data was transformed using the Freeman-Tukey log-linear transformation for variance stabilization and then assessed using a mixed model with a study-level random effect and subsequently back-transformed. Significance was set at P<.05. Results: Twenty-three articles with 664 injuries met the inclusion criteria for comparison (Figure 1). All patients were male with 63.2% of injuries occurring during weight training, with an average age of 31.48 years and follow-up of 37.02 months. Included studies had moderately high methodological quality. Operative treatment was significantly superior to nonoperative treatment with a relative improvement of functional outcome by 0.70 (P=.027), full isometric strength by 77.07% (P<.001), isokinetic strength by 28.86% (P<.001) compared to the uninjured arm, cosmesis satisfaction by 13.79% (P=.037), and resting deformity by 98.85% (P<.001) (Table 1). There was an overall complication rate of 14.21%, including a 3.08% rate of rerupture, for operative treatment. Conclusion: Pectoralis major tendon repair resulted in significantly superior outcomes as compared to nonoperative treatment with an associated 14.21% complication rate. There was a statistically significant improvement in functional outcome, isokinetic strength, isometric strength, cosmesis, and resting deformity. [Figure: see text][Table: see text]
Simulation studies of outpatient clinics often involve significant data collection challenges. We describe an approach for data collection using sensor networks which facilitates the collection of a large volume of very detailed patient flow data through healthcare clinics. Such data requires extensive preprocessing before it is ready for analysis. We present a general data preparation framework for sensor network generated data with particular emphasis on the creation and analysis of patient path strings. Several examples of the analysis of sensor network data are also presented. Our approach has been used in two large outpatient clinics in the United States.
In efforts to combat eutrophication, the U.S. Environmental Protection Agency has established aggressive nitrogen, phosphorus, and sediment reduction goals for states and regulated dischargers within the Chesapeake Bay watershed. Chesapeake Bay jurisdictions are struggling to meet the nutrient (N, P) reduction goals. This paper evaluates the efficacy of removing legacy N from groundwater as a compliance strategy for three potential classes of “buyers” of N reductions in the Chesapeake Bay watershed: permitted point sources, permitted municipal stormwater systems (called MS4s), and state nonpoint source (NPS) managers. We compare denitrifying spring bioreactors with conventional agricultural and urban NPS removal technologies using evaluative criteria important to each of these buyers. Results indicate that spring bioreactors compare favorably to other N removal technologies based on cost effectiveness, administrative costs, and certainty of N removal performance. Most conventional NPS technologies provide greater ancillary benefits. On balance, denitrifying spring bioreactors add a valuable compliance option to those tasked with achieving Bay N reduction goals.
his paper presents a pilot plant process dcvclopnicnt of a T typical esterification process. ?'he first phase consisted of the design and construction of a small versatile pilot plant system for the study of low pressure, moderate temperature liquid phase organic reactions. The second phase consisted of a specific development study of the esterification reaction of methyl alcohol and acetic acid. Supplerncntary work involved the development of a gas chromatographic analysis for a methyl alcohol, nicthyl acetate, acetic acid, and water system. Design and ConstructionThe basic pieces of equipment were a ten gallon, jacketed, glass-lined reactor, a ten gallon glass-lined receiving or feed tank, three sections of Oldershaw sieve tray column, reflux splitter, feed tray, condenser, and a flexopulse tinier.The equipment diagram (Figure 1) shows the layout and actual position of the pilot plant equipment. The ten gallon feed tank is lined with Pfaudler Glasteel 59 and designed for 150
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