Background: Current recommendations for osteoarthritis of the metacarpophalangeal joint (MCPJ) are confined to implant arthroplasty to preserve joint motion and provide pain relief. This study documents the median 2-year results of a novel soft tissue arthroplasty technique that interposes the dorsal capsule. Methods: A retrospective review of 10 MCPJ dorsal capsule interposition arthroplasties in 8 patients was conducted. Physical evaluation assessed MCPJ range of motion (ROM), grip strength, and pain. Outcome tests used were the Michigan Hand Outcome Score, Visual Analog Scale (VAS), and Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH). Kellgren and Lawrence Classification assessed severity of MCPJ osteoarthritis on preoperative radiographs. Results: The mean follow-up was 29 months from surgery. Average VAS was 2/10 postoperatively and average postoperative ROM improved 7 degrees. Average postoperative grip strength of the surgical hand was 30 kg. The QuickDASH average score was 24. Average Michigan Hand Questionnaire final score was 70. Patients with Kellgren Grades 2 or 3 osteoarthritis had the best QuickDASH and Michigan Hand Outcome scores. All patients working before surgery returned to work. No patient required a second surgery. Conclusion: This technique of dorsal capsule interposition arthroplasty provides a viable surgical option for isolated degenerative or traumatic arthritis of the MCPJ at an average follow-up of 2 years. Pain relief was most reliably provided in patients with less severe radiograph findings. The advantages of this procedure include preservation of bony anatomy, collateral ligaments, and volar plate to not preclude later implant arthroplasty.

Fatal occupational injury is a construction and management problem in the United States. Fatality rates among specialty trade contractors made up the largest percent of fatalities in construction at 62% per year. The purpose of this nonexperimental study was to examine the relationship between the quality of information in construction safety plans and construction safety among specialty trade contractors. The theoretical foundations for the study were Petersen'€™s accident/incident theory and work systems theory. The key research question was to examine the relationship between information quality and construction safety among specialty trade contractors. A survey with closed-ended questions was used to collect primary data from a self-selection sample of 134 specialty trade contractors in the United States. Spearman rank correlation coefficient (rs) was used to measure the strength of the relationship between information quality and construction safety. Results indicated that the quality of information in construction safety plans (measured by the relevance, accuracy, timeliness, and completeness of information) did not have any statistically significant relationships with construction safety among U.S. specialty trade contractors. Further research is needed to understand if the variables used in this study are relevant predictors for construction safety. This study connects with positive social change by bringing into focus quality information systems research required to improve safety among U.S. specialty trade contractors and provide safety professionals a direction for continuous safety improvement in the U.S. construction industry, thus benefitting construction stake holders.

The present study examined felony mental health court and mental health probation used in conjunction and whether those on mental health probation had a reduced rate of rearrest and psychiatric hospitalization as compared to participants on regular probation or not on either form of probation. The research explored whether specific variables predicted a reduced rate of hospitalization and arrest among the participants on mental health probation. Results found mental health probationers did not significantly differ from the probationers in their rate of rearrest, and were rearrested more frequently then participants not on probation. Mental health probationers did not differ significantly from regular probationers or those without probation in psychiatric hospitalization frequency. Within the mental health probationers type of crime, presence of a violent crime, age, gender, education level, history of substance abuse, prescription of psychiatric medication, diagnosis, mental retardation and prior psychiatric hospitalizations did not predict arrest. The above variables also did not predict psychiatric hospitalization, with the exception of a history of psychiatric hospitalization which predicted a higher rate of hospitalization while on mental health probation. Factors influencing these results and limitations of the present study were offered.

Labor intensive sectors such as the specialty crop sector have historically had strong reliance on foreign labor, constituting roughly oneifth of all U.S. farms while incurring roughly two-thirds of direct-hire expenses. It is estimated that more than half unauthorized of the foreign-born labor force in the specialty crop sector are unauthorized for US employment. Using data from the National Agricultural Workers Survey for 1989-2014, this study uses a treatment effects approach (via propensity score matching and minimum-biased estimation) to evaluate the farm wage implications of legalization of foreign-born specialty crop farm workers nationally, as well as specifically in California. Positive wage effects are estimated in nationally and in California, with higher magnitude effects observed in California.

As one of the most traded commodities worldwide and a staple in most Westerner’s diets, coffee has long suffered from a controversial reputation on the basis of unsustainable practices pertaining to flora, fauna, and humans. The new specialty coffee movement, which also purports itself to be actively engaging with and promoting more pro-environmental values, and the interlinkage with its unique customer base are the focus of this research. This thesis seeks to analyze whether said consumers represent a niche of ethical consumerism, which would reflect back on the movement as whole as an advocate of the human rights tradition. Through the use of attitude surveys, it was found that there is a significant part of the consumer base considerably involved with sustainability issues. This, however, does not apply to all of the sample group.

BACKGROUND: Colonoscopy performance by gastroenterologists has been shown to be associated with lower rates of developing interval colorectal cancer. However, it is unclear if this difference among specialists stems from a difference in meeting colonoscopy quality indicators. OBJECTIVE: The purpose of this study is to determine and compare the rates of colonoscopy quality indicators between different specialties. DESIGN: This is a cohort study of patients undergoing screening colonoscopy investigating quality metrics as compared by the proceduralist specialty. SETTING: All screening colonoscopies performed at the Cleveland Clinic between 2012 and 2014 were followed by manual chart review. PATIENTS: Average-risk patients, ≥50 years of age, who had a complete screening colonoscopy were included. MAIN OUTCOME MEASURES: Adenoma detection rate, cecal intubation rate, withdrawal time, and other nonestablished overall and segment-specific rates were calculated and compared using t tests. RESULTS: A total of 4151 patients were included in the analysis. Colonoscopies were performed by 54 (64.3%) gastroenterologists, 21 (25%) colorectal surgeons, and 9 (10.7%) general surgeons. Gastroenterologists had the highest overall adenoma detection rate (28.6 ± 1.2; p < 0.001), followed by colorectal surgeons (24.3 ± 1.5) and general surgeons (18.4 ± 2.3), as well as the highest adenoma detection rate in men (34.7 ± 1.3; p < 0.001), followed by colorectal surgeons (28.2 ± 1.6) and general surgeons (23.7 ± 2.6). Similarly, gastroenterologists had the highest adenoma detection rate in women (24.3 ± 1.1; p < 0.001), followed by colorectal surgeons (21.6 ± 1.4) and general surgeons (12.9 ± 2.0). Withdrawal time was the longest among general surgeons (11.1 ± 5.5; p = 0.041), followed by colorectal surgeons (10.94 ± 5.2) and gastroenterologists (10.16 ± 1.26). LIMITATIONS: We could not adjust for some procedure-related details such as retroflexion in the right colon and the use of end-of-scope devices. CONCLUSIONS: In this study, only gastroenterologists met the currently accepted overall and sex-specific adenoma detection rate benchmarks. They also outperformed nongastroenterologists in many other nonestablished quality metrics. See Video Abstract at http://links.lww.com/DCR/B232.

In anticipation of an expected national shortage of primary care physicians, 24 medical students from the East Tennessee State University Quillen College of Medicine were selected through a snowball sample and participated in in-depth interviews. A major aim of the study was to explore the social and economic factors influencing students’ specialty choice and career interests. Students’ perceptions of “rural” environments, student debt, professional obligations, specialties, and preceptorship experiences were analyzed. Students’ gender heavily influenced their feelings about choosing a medical specialty, as did their stereotypes of physicians in particular medical fields. The thesis concludes with recommendations for challenging negative stereotypes about primary care professions and addressing patterns of inequality within the medical profession.

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Although optical fibers and specialty waveguides are the base of majority of today's telecom and light delivery applications, fabrication deformation, nonlinearity and attenuation limit the bandwidth of the data being transmitted or the amount of power carried by these systems. One-way to overcome these limitations without changing the fibers design or fabrication is to engineer the input light in order to excite a certain mode or a group of modes with unique optical properties. Diffractive and micro optics are highly effective for selectively coupling light to specific modes. Using micro optics, mode selective coupling can be achieved through several matching schemes: phase only, phase and amplitude, or phase, amplitude and polarization. The main scope of this work is the design and fabrication of novel optical elements that overcome the limitations of these light delivery systems, as well as the characterization and analysis of their performance both experimentally and using numerical simulation

Non-timber forest products (NTFPs) are important in rural southwest Virginia as a source of household sustenance and supplemental income. The trade in NTFPs from this region is centuries old and now helps supply growing worldwide demands. Although marketing is a vital part of optimizing the value of these products, it has been ignored in rural natural resource development. This research analyzes marketing systems for selected NTFPs in southwest Virginia by describing marketing chains, interpreting data on important marketing elements, and comparing results within and between different groups of NTFPs. Product categories selected for emphasis are crafts (grapevine wreaths, baskets, furniture, and birdhouses), medicinal and herbal products, specialty wood products (musical instruments), and edible forest products. This qualitative, exploratory study utilizes direct interviews with fifty market players at various levels in marketing chains. Results provide information on NTFP products, value addition, market outlets, pricing, promotion, distribution, and marketing chains. Hundreds of people are involved with the NTFP trade in southwest Virginia and marketing can help ameliorate negative effects of job scarcity. The greatest opportunity for local level marketing exists for market players of crafts and specialty wood products. Medicinal and herbal products are the only category which very little local value addition takes place within the region and as a result, market players have minimal control over marketing. Edible forest products are not marketed but are collected only for consumption in the household. Several opportunities for marketing include improving market access for crafts and specialty wood products, increasing production through cultivation for medicinal and herbal products, and developing capacity for edible product cultivation. / Master of Science