BACKGROUND: Capsule endoscopy (CE) allows for a non-invasive small bowel evaluation for a wide range of gastrointestinal (GI) symptoms and diseases. Capsule technology has been rapidly advancing over recent years, often improving image frequency and quality. The Pillcam SB3 (SB3) capsule is one such technology that offers an adaptive frame rate advantage over the previous versions of the capsule the Pillcam SB2 (SB2). Some have proposed that this improvement in capsule technology may lead to increased diagnostic yields; however, real world clinical data is currently lacking. AIM: To evaluate the clinically relevant findings of SB3 and SB2 capsules in a population of United States veterans. METHODS: A retrospective analysis of 260 consecutive CE studies was performed including 130 SB3 and 130 SB2 capsule studies. Recorded variables included: age, gender, type of capsule, body mass index, exam completion, inpatient status, opioid use, diabetes, quality of preparation, gastric transit time, small bowel transit time, indication, finding, and if the exam resulted in a change in clinical management. The primary outcome measured was the detection of clinically relevant findings between SB3 and SB2 capsules. RESULTS: Mean age of the study population was 67.1 ± 10.4 years and 94.2% of patients were male. Of these 28.1% were on opioid users. The most common indications for capsule procedure were occult GI bleeding (74.6%) and overt GI bleeding (14.6%). Rates of incomplete exam were similar between SB3 and SB2 groups (16.9% 9.2%, = 0.066). The overall rate of clinically relevant finding was 48.9% in our study. No significant difference was observed in SB3 SB2 capsules for clinically relevant findings (46.2% 51.5%, = 0.385) or change in clinical management (40.8% 50.0%, = 0.135). CONCLUSION: Our study found no significant difference in clinically relevant findings between SB3 and SB2 capsules.

Introduction: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an endovascular technique for temporarily stabilizing hemodynamically unstable patients until permanent interventions can be performed. The benefits of in-hospital REBOA to control hemorrhage in different areas is now well studied, yet little is known about its use and indications in the pre-hospital setting. Aim: The aim of this study is to analyze if mortality amongst trauma patients who receive in-hospital REBOA is affected by total pre-hospital time (TPT) and if earlier prehospital REBOA intervention could be beneficial. Methods: A retrospective analysis using the ABOtrauma registry, an international registry for trauma patients that receive REBOA. There were 314 patients in the registry, 168 patients excluded because of missing data, wrong input, TPT < 15minuts or TPT > 120 minutes. The remaining 146 included were divided into 4 groups. Statistically analyzed using chi-square test for association or binomial logistic regression. Results: We found no significant correlation between TPT and mortality amongst the time groups that received in-hospital REBOA, at the emergency department (p=0.293), at 24 hours (p=0.209) or at 30 days (p=0.385), nor between time of injury and ABO insertion at 24 hours (p=0.917), or 30 days (p=0.840). Conclusion: Our findings suggests that pre-hospital time may not be a good indicator for survival amongst patients that receive in-hospital REBOA and that these patients might possibly have had a similar outcome even if earlier intervention of pre-hospital REBOA was performed. Future prospective randomized controlled trails on the subject is needed to draw certain conclusions.

Background: Multiple studies have shown that people who have experienced a serious health problem such as an injury tend to overrate the quality of health they had before that event. The main objective of this study was to test whether the phenomenon of respondents overrating their past health can also be observed in people from the general population. A second aim was to test whether habitual optimism is indeed focused on events in the future. Method: A representatively selected community sample from Leipzig, Germany (n = 2282, age range: 40–75 years) was examined. Respondents were asked to assess their current health, their past health (5 years before), and their expected future health (in 5 years) on a 0–100 scale. In addition, the study participants completed several questionnaires on specific aspects of physical and mental health. Results: Respondents of all age groups assessed their health as having been better in the past than it was at present. Moreover, they also assessed their earlier state of health more positively than people 5 years younger did their current state. Habitual optimism was associated with respondents having more positive expectations of how healthy they will be in 5 years time (r = 0.37), but the correlation with their assessments of their current health was nearly as high (r = 0.36). Conclusion: Highly positive scores of retrospectively assessed health among people who have experienced a health problem cannot totally be accounted for by a response to that health problem.

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京都大学 / 新制・課程博士 / 博士(医学) / 甲第23773号 / 医博第4819号 / 新制||医||1057(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 金子 新, 教授 杉田 昌彦, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

This exploratory study aims to elucidate the mental processes of wayfinding in an outdoor area and the effects of map contour representations, map color, individual differences of users (gender, brain dominance, experience level, and cultural differences), and environmental cues using a field study in an established trail network in Jefferson National Forest. Six maps with three different contour representations (contour lines, shaded relief, and schematic) and two color codes (color and black-and-white) were tested for wayfinding performance. Thirty-six participants of different nationalities (Locals versus Internationals), experience in map usage (experienced versus novice), handedness, and gender took part in the study. Three out of ten junctions on the test route had directional signs while the rest had no sign. The participants performed wayfinding tasks in a national forest trail park, using the think aloud and retrospective protocols to obtain the information processes used by the participants during wayfinding. Subjective feedback was also obtained to find out users' map preferences and opinions on their experience during the experiment. Multiple regression analyses were used to predict the relationship of the predictor variables to wayfinding performance. It was found that cultural differences and signage presence were significant predictors of decision-making accuracy at trail junctions. The rest of the predictors were not significant in predicting total time of completion, time for decision-making at junction, accuracy of decision-making, and time deviated from route due to choosing a wrong path at junction. Cultural differences were also significant in the prediction of the time deviated from route. It was also found that the participants were using maps to derived route information for wayfinding. They utilized structural matching of the map with the terrain, by orientation principle, to continuously check the current position on the map. There was some evidence of participants gaining survey knowledge from the map during wayfinding but this could not be confirmed by the study. A set of design guidelines were given for map and trail design to improve the wayfinding performance of recreational users. / Master of Science

AIM: To evaluate marginal bone loss around dental implants at the 2nd stage abutment surgery and retrospectively evaluate the association of pre-surgical variables. MATERIAL AND METHODS: Eighty-seven subjects (41 Males and 46 females) were enrolled in this cohort. The subjects' ages ranged from 23 to 80 years. Two endosseous implant brands were utilized: Nobel Biocare and Straumann Bone Level . Clinical measurements (mesial, distal, buccal, and lingual) were recorded from the coronal margin of the implant platform to the bone margin with a periodontal probe (Williams periodontal probe, Hu-Friedy) at the time of implant placement and at the 2nd stage abutment surgery. The pre-surgical variables (medication intake, implant site, bone graft volume, membrane type, and smoking) were evaluated using Chi-square test. RESULTS: The marginal bone loss (MBL) difference was calculated. The Mean clinical MBL: Mesial = 0.71 mm, Distal = 0.56mm, Buccal/Labial = 0.65 mm, and Lingual/Palatal = 0.56 mm. The test showed no statistically significant difference between test and control subjects in each of the variables, with the exception of thyroid medication. A statistically significant (P value = 0.011) association was found between levothyroxine and MBL at the mesial measurement. CONCLUSION: This limited cohort study suggests that medication-controlled hypothyroidism patients may experience an increased risk of marginal alveolar bone loss around dental implants at the 2nd stage abutment surgery. The final determination will be recalculated when the study population reaches the estimated requirement of 200 subjects.