bluuebunny/crossref_metadata_2025 huggingface dataset:
Limiting the Pitch Count in Youth Baseball Pitchers Decreases Elbow Pain
Authors: Matsuura Tetsuya , Takata Yuki , Iwame Toshiyuki , Iwase Jyoji , Yokoyama Kenji , Takao Shoichiro , Nishio Susumu , Arisawa Kokichi , Sairyo Koichi
Published: March 2021

Background:

Reducing the number of pitches thrown is regarded as the most effective way to prevent throwing injuries in youth baseball pitchers. However, few studies have compared the effectiveness of limiting the pitch count versus the limiting the number of innings pitched in terms of elbow injuries.

Hypothesis:

We hypothesized that, compared with inning limits, pitch count limits would lead to greater decreases in elbow pain, range of motion deficits, positive moving valgus stress test results, and the risk of capitellar osteochondritis dissecans (OCD).

Study Design:

Cohort study; Level of evidence, 3.

Methods:

This study retrospectively reviewed baseball pitchers aged 8 to 12 years in 2017 and 2018. Inning and pitch count limits in games were set to a daily maximum of 7 innings in 2017 and 70 pitches in 2018. Elbow pain, range of motion, and moving valgus stress test results were evaluated. The presence of capitellar OCD was assessed on ultrasonographic and radiographic images.

Results:

A total of 352 pitchers in 2017 and 367 pitchers in 2018 participated. The mean pitch count per game was lower in the pitch count limit (CL) group (52.5 ± 16.0) than in the inning limit (IL) group (98.2 ± 19.5) ( P < .001). Compared with the IL group, the CL group had significantly lower rates of elbow pain (40.9% vs 31.9%, respectively; P = .01) and reduced flexion (19.0% vs 10.6%, respectively; P = .001). Multivariate analysis revealed a significant association between elbow pain and age in both the IL and the CL groups ( P < .0001 and P = .02, respectively) and between OCD and elbow pain in the CL group ( P = .04).

Conclusion:

A pitch count limit of ≤70 pitches per day for baseball pitchers ≤12 years could be more protective against elbow pain and reduced flexion than a limit of ≤7 innings per day, but it may not be effective for reducing the risk of capitellar OCD.
Patellar Tendon Orientation and Strain Are Predictors of ACL Strain In Vivo During a Single-Leg Jump
Authors: Englander Zoë A. , Lau Brian C. , Wittstein Jocelyn R. , Goode Adam P. , DeFrate Louis E.
Published: March 2021

Background:

There is little in vivo data that describe the relationships between patellar tendon orientation, patellar tendon strain, and anterior cruciate ligament (ACL) strain during dynamic activities. Quantifying how the quadriceps load the ACL via the patellar tendon is important for understanding ACL injury mechanisms.

Hypothesis:

We hypothesized that flexion angle, patellar tendon orientation, and patellar tendon strain influence ACL strain during a single-leg jump. Specifically, we hypothesized that patellar tendon and ACL strains would increase concurrently when the knee is positioned near extension during the jump.

Study Design:

Descriptive laboratory study.

Methods:

Models of the femur, tibia, ACL, patellar tendon, and quadriceps tendon attachment sites of 8 male participants were generated from magnetic resonance imaging (MRI). High-speed biplanar radiographs during a single-leg jump were obtained. The bone models were registered to the radiographs, thereby reproducing the in vivo positions of the bones, ligament, and tendon attachment sites. Flexion angle, patellar tendon orientation, patellar tendon strain, and ACL strain were measured from the registered models. ACL and patellar tendon strains were approximated by normalizing their length at each knee position to their length at the time of MRI. Two separate bivariate linear regression models were used to assess relationships between flexion angle and patellar tendon orientation and between ACL strain and patellar tendon strain. A multivariate linear regression model was used to assess whether flexion angle and patellar tendon strain were significant predictors of ACL strain during the inflight and landing portions of the jump.

Results:

Both flexion angle and patellar tendon strain were significant predictors ( P < .05) of ACL strain. These results indicate that elevated ACL and patellar tendon strains were observed concurrently when the knee was positioned near extension.

Conclusion:

Concurrent increases in patellar tendon and ACL strains indicate that the quadriceps load the ACL via the patellar tendon when the knee is positioned near extension.

Clinical Relevance:

Increased ACL strain when the knee is positioned near extension before landing may be due to quadriceps contraction. Thus, landing with unanticipated timing on an extended knee may increase vulnerability to ACL injury as a taut ligament is more likely to fail.
Predictors of Pro-environmental Beliefs, Behaviors, and Policy Support among Climate Change Skeptics
Authors: Haltinner Kristin , Sarathchandra Dilshani
Published: March 2021

Previous research suggests that climate skeptics may hold a series of environmental concerns and support for environmental policy that, if engaged with, could serve to (in part) mitigate climate change. Using a unique data set from an online survey of 1,000 adults in the U.S. Pacific Northwest who are uncertain or skeptical of anthropogenic climate change, we explore the diversity of environmental concerns, environmental behaviors, and support for pro-environmental policy within and among those who do not accept climate science. Our results reveal statistically significant and consistent positive effects of (negative) environmental experiences on climate change skeptics’ environmental concerns, behaviors, and policy support. We also find that, among climate skeptics, religious ideation, conspiracy ideation, science distrust, political ideology (conservative), and gender (men) are negatively associated with certain pro-environmental attitudes, behaviors, and support for pro-environmental policy initiatives. We discuss the implications of these findings for climate change and science communication, environmental campaigns, and policy development.
A Cautionary Note on Estimating Effect Size
Authors: van den Bergh Don , Haaf Julia M. , Ly Alexander , Rouder Jeffrey N. , Wagenmakers Eric-Jan
Published: March 2021

An increasingly popular approach to statistical inference is to focus on the estimation of effect size. Yet this approach is implicitly based on the assumption that there is an effect while ignoring the null hypothesis that the effect is absent. We demonstrate how this common null-hypothesis neglect may result in effect size estimates that are overly optimistic. As an alternative to the current approach, a spike-and-slab model explicitly incorporates the plausibility of the null hypothesis into the estimation process. We illustrate the implications of this approach and provide an empirical example.
Varieties of Uberization: How technology and institutions change the organization(s) of late capitalism
Authors: Davis Gerald F. , Sinha Aseem
Published: March 2021

Organization theory faces challenges on all sides, yet it is uniquely suited to help understand and guide our current economic transition. In order to make good on this promise, however, organization theory needs to adopt a rigorously comparative approach and to jettison “America first.” Those who organize firms require ingredients that often include capital, labor, supplies, and a rule-bound market for selling. These ingredients in turn bear the imprint of national economies and the institutions that govern and support them. We argue that innovations in information and communication technologies (ICTs) combine with national institutions to guide what firms will look like by shaping what ingredients are available; ultimately, ICTs can fundamentally reorganize institutions such as capital and labor markets. We illustrate this argument with a comparison of how the ridehailing industry (such as Uber and Lyft in the United States) is organized in the US, Sweden, Germany, India, Indonesia, China, and Nigeria. The same basic innovation—a platform that allows riders and drivers to match via smartphone—produces substantially different organizational forms depending on domestic institutions. Moreover, in the US “Uberization” is challenging fundamental aspects of labor markets and the employment relation in industries well beyond ridehailing. The “varieties of Uberization” across national contexts exemplify the kinds of phenomena that organization theorists should be examining right now, if we aim to inform a more humane future.
Refining contextual inquiry to maximize generalizability and accelerate the implementation process
Authors: Davis Molly , Beidas Rinad S
Published: March 2021

Background:

While contextual inquiry, or in-depth mixed-methods work to study the implementation context, is critical for understanding the setting in which a behavioral health evidence-based practice (EBP) will be implemented, current methods to determine potential barriers and facilitators to implementation are often conducted in a single setting and/or for a single EBP per study, often taking 1–2 years to complete. To maximize generalizability and reduce the research-to-practice gap efficiently, it is important to move toward cross-sector and/or cross-EBP contextual inquiry.

Methods:

In this viewpoint, we argue for (a) collaborative research studies that seek to identify determinants of implementation that are similar and unique across different settings and EBPs, using rapid approaches when possible; (b) enhanced synthesis of existing research on implementation determinants to minimize duplication of contextual inquiry efforts; and (c) clear rationale for why additional in-depth or rapid contextual inquiry is needed before it is conducted. Throughout this viewpoint, the need to balance scientific rigor and speed are considered.

Conclusions:

Overall, this viewpoint seeks to encourage researchers to consolidate and share knowledge on barriers and facilitators to implementation to prepare for the scaling out of much needed implementation strategies and interventions for improving health.

Plain language summary:

Significant time and resources are often devoted to understanding what makes it easier or harder to use best practices for behavioral health concerns in health care settings. The goal of the current viewpoint is to offer ways to streamline this process so that high-quality behavioral health services can reach the patients that need them more quickly. In particular, we advocate for ways to share knowledge among researchers and learn from prior findings to more efficiently identify what makes it easier or harder to use best practices for addressing behavioral health problems in a given setting (e.g., primary care, schools, specialty mental health).
Reframing Systems Integration: A Process Perspective on Projects
Authors: Whyte Jennifer , Davies Andrew
Published: March 2021

The delivery of large-scale technical systems is achieved through project organizing. The concept of systems integration, with its distinct focus on the systems that projects deliver, is theoretically important as projects become more complex and face significant uncertainty. We reframe systems integration in interorganizational projects as a flexible and adaptive process of making constituent parts of systems work together. This process involves boundary-spanning structures and activities to address emergent complexity and uncertainty (that are both technological and organizational in nature). We discuss implications and highlight areas for further research on projects.
VE-cadherin cleavage in sleep apnoea: new insights into intermittent hypoxia-related endothelial permeability
Authors: Harki Olfa , Tamisier Renaud , Pépin Jean-Louis , Bailly Sébastien , Mahmani Anissa , Gonthier Brigitte , Salomon Aude , Vilgrain Isabelle , Faury Gilles , Briançon-Marjollet Anne
Published: March 2021

Background

Obstructive sleep apnoea (OSA) causes intermittent hypoxia that in turn induces endothelial dysfunction and atherosclerosis progression. We hypothesised that VE-cadherin cleavage, detected by its released extracellular fragment solubilised in the blood (sVE), may be an early indicator of emergent abnormal endothelial permeability. Our aim was to assess VE-cadherin cleavage in OSA patients and inin vivoandin vitrointermittent hypoxia models to decipher the cellular mechanisms and consequences.

Methods

Sera from seven healthy volunteers exposed to 14 nights of intermittent hypoxia, 43 OSA patients and 31 healthy control subjects were analysed for their sVE content. Human aortic endothelial cells (HAECs) were exposed to 6 h of intermittent hypoxiain vitro, with or without an antioxidant or inhibitors of hypoxia-inducible factor (HIF)-1, tyrosine kinases or vascular endothelial growth factor (VEGF) pathways. VE-cadherin cleavage and phosphorylation were evaluated, and endothelial permeability was assessed by measuring transendothelial electrical resistance (TEER) and fluorescein isothiocyanate (FITC)–dextran flux.

Results

sVE was significantly elevated in sera from healthy volunteers submitted to intermittent hypoxia and OSA patients before treatment, but conversely decreased in OSA patients after 6 months of continuous positive airway pressure treatment. OSA was the main factor accounting for sVE variations in a multivariate analysis. Inin vitroexperiments, cleavage and expression of VE-cadherin increased upon HAEC exposure to intermittent hypoxia. TEER decreased and FITC–dextran flux increased. These effects were reversed by all of the pharmacological inhibitors tested.

Conclusions

We suggest that in OSA, intermittent hypoxia increases endothelial permeability in OSA by inducing VE-cadherin cleavage through reactive oxygen species production, and activation of HIF-1, VEGF and tyrosine kinase pathways.
Reference equations for tidal breathing parameters using structured light plethysmography
Authors: Motamedi-Fakhr Shayan , Iles Richard , Barker Nicki , Alexander John , Cooper Brendan G.
Published: March 2021

Tidal breathing measurements can be used to identify changes in respiratory status. Structured light plethysmography (SLP) is a non-contact tidal breathing measurement technique. Lack of reference equations for SLP parameters makes clinical decision-making difficult. We have developed a set of growth-adjusted reference equations for seven clinically pertinent parameters of respiratory rate (fR), inspiratory time (tI), expiratory time (tE), duty cycle (tI/total breath time), phase (thoraco-abdominal asynchrony (TAA)), relative thoracic contribution (RTC) and tidal inspiratory/expiratory flow at 50% volume (IE50).

Reference equations were developed based on a cohort of 198 seated healthy subjects (age 2–75 years, height 82–194 cm, 108 males). We adopted the same methodological approach as the Global Lung Function Initiative (GLI) report on spirometric reference equations. 5 min of tidal breathing was recorded per subject. Parameters were summarised with their medians. The supplementary material provided is an integral part of this work and a reference range calculator is provided therein.

We found predictedfRto decrease with age and height rapidly in the first 20 years and slowly thereafter. ExpectedtI,tEand RTC followed the opposite trend. RTC was 6.7% higher in females. Duty cycle increased with age, peaked at 13 years and decreased thereafter. TAA was high and variable in early life and declined rapidly with age. Predicted IE50 was constant, as it did not correlate with growth.

These reference ranges for seven key measures ensure that clinicians and researchers can identify tidal breathing patterns in disease and better understand and interpret SLP and tidal breathing data.
Nailing femoral shaft fracture with postless distraction technique: a new technique enabled by shape-conforming pad
Authors: Aprato Alessandro , Secco Davide Carlo , D’Amelio Andrea , Grosso Elena , Massè Alessandro
Published: March 2021

Background

Femoral shaft fractures are usually treated with nailing using a traction table and a perineal post, but this may occasionally result in various groin-related complications, including pudendal nerve neurapraxia. Although most of them are transient, complication rates of up to 26% are reported. Recently, postless distraction technique has been described for elective hip arthroscopy. In this study we compared post and postless distraction technique in femoral shaft fracture nailing in terms of (1) quality of reduction, (2) outcome, and (3) complications.

Methods

We reviewed 50 patients treated with postless distraction nailing technique for femoral shaft fractures and compared them with our historical case series (95 patients). The following data were collected for all patients: age, gender, weight, height, diagnoses (fractures were classified according to the 2018 revision of AO classification), type and size of nail surgical timing, Trendelenburg angles during surgery, quality of reduction according to Baumgaertner and Thoresen classifications, Modified Harris Hip Scores at 6 months, and perineal complications.

Results

Median age was 53 years, and median weight was 70 kg (range 50–103 kg). We found no significant difference in terms of quality of reduction (72 versus 74% “excellent” reduction for subtrochanteric fractures, while 81 versus 79% “excellent” reduction for femoral shaft fractures) and functional outcomes (Modified Harris Hip Score 74 versus 79). One patient in the control group had a failure of the fixation, and one patient in the postless group had a deep infection. Two patients in the control group reported pudendal nerve neurapraxia for 4 months, while none reported complication linked to the postless technique.

Conclusions

Our results using the postless distraction technique show a sufficient distraction to allow reduction and internal fixation of the femoral fracture with a standard femoral nail.

Level of evidence:

IV
Statistical integration of two omics datasets using GO2PLS
Authors: Gu Zhujie , el Bouhaddani Said , Pei Jiayi , Houwing-Duistermaat Jeanine , Uh Hae-Won
Published: March 2021

Background

Nowadays, multiple omics data are measured on the same samples in the belief that these different omics datasets represent various aspects of the underlying biological systems. Integrating these omics datasets will facilitate the understanding of the systems. For this purpose, various methods have been proposed, such as Partial Least Squares (PLS), decomposing two datasets into joint and residual subspaces. Since omics data are heterogeneous, the joint components in PLS will contain variation specific to each dataset. To account for this, Two-way Orthogonal Partial Least Squares (O2PLS) captures the heterogeneity by introducing orthogonal subspaces and better estimates the joint subspaces. However, the latent components spanning the joint subspaces in O2PLS are linear combinations of all variables, while it might be of interest to identify a small subset relevant to the research question. To obtain sparsity, we extend O2PLS to Group Sparse O2PLS (GO2PLS) that utilizes biological information on group structures among variables and performs group selection in the joint subspace.

Results

The simulation study showed that introducing sparsity improved the feature selection performance. Furthermore, incorporating group structures increased robustness of the feature selection procedure. GO2PLS performed optimally in terms of accuracy of joint score estimation, joint loading estimation, and feature selection. We applied GO2PLS to datasets from two studies: TwinsUK (a population study) and CVON-DOSIS (a small case-control study). In the first, we incorporated biological information on the group structures of the methylation CpG sites when integrating the methylation dataset with the IgG glycomics data. The targeted genes of the selected methylation groups turned out to be relevant to the immune system, in which the IgG glycans play important roles. In the second, we selected regulatory regions and transcripts that explained the covariance between regulomics and transcriptomics data. The corresponding genes of the selected features appeared to be relevant to heart muscle disease.

Conclusions

GO2PLS integrates two omics datasets to help understand the underlying system that involves both omics levels. It incorporates external group information and performs group selection, resulting in a small subset of features that best explain the relationship between two omics datasets for better interpretability.
Social prescribing for people with complex needs: a realist evaluation
Authors: Wood Emily , Ohlsen Sally , Fenton Sarah-Jane , Connell Janice , Weich Scott
Published: March 2021

Background

Social Prescribing is increasingly popular, and several evaluations have shown positive results. However, Social Prescribing is an umbrella term that covers many different interventions. We aimed to test, develop and refine a programme theory explaining the underlying mechanisms operating in Social Prescribing to better enhance its effectiveness by allowing it to be targeted to those who will benefit most, when they will benefit most.

Methods

We conducted a realist evaluation of a large Social Prescribing organisation in the North of England. Thirty-five interviews were conducted with stakeholders (clients attending Social Prescribing, Social Prescribing staff and general practice staff). Through an iterative process of analysis, a series of context-mechanism-outcome configurations were developed, refined and retested at a workshop of 15 stakeholders. The initial programme theory was refined, retested and ‘applied’ to wider theory.

Results

Social Prescribing in this organisation was found to be only superficially similar to collaborative care. A complex web of contexts, mechanisms and outcomes for its clients are described. Key elements influencing outcomes described by stakeholders included social isolation and wider determinants of health; poor interagency communication for people with multiple needs. Successful Social Prescribing requires a non-stigmatising environment and person-centred care, and shares many features described by the asset-based theory of Salutogenesis.

Conclusions

The Social Prescribing model studied is holistic and person-centred and as such enables those with a weak sense of coherence to strengthen this, access resistance resources, and move in a health promoting or salutogenic direction.
Epidemiological survey to determine the prevalence of cholecystolithiasis in Uyghur, Kazakh, and Han Ethnic Groups in the Xinjiang Uyghur Autonomous Region of China: cross-sectional studies
Authors: Lv Fujun , Wang Guangjun , Ding Dandan , Shen Caifu , Liu Jiangwei , Ji Feng , Kang Yan
Published: March 2021

Background

This study was performed to understand the prevalence of and possible risk factors for cholecystolithiasis in Uyghur, Kazakh, Han, and other ethnic groups in the Xinjiang Uyghur autonomous region of China.

Methods

Subjects were enrolled using typical case sampling and multistage stratified random sampling. We collected epidemiological data regarding cholecystolithiasis using a standard questionnaire of risk factors for gallbladder disease in Xinjiang. The subjects completed the questionnaire and underwent an abdominal ultrasound examination of the liver and gallbladder.

Results

This study included 5454 Xinjiang residents aged ≥ 18 years. The prevalence of cholecystolithiasis was 15% (11.3% in men and 17.1% in women), and the sex difference was statistically significant (male-to-female odds ratio [OR] 1.867; p < 0.001). The cholecystolithiasis prevalence was also significantly different among the Han, Uyghur, Kazakh, and other ethnic groups (13.1%, 20.8%, 11.5%, and 16.8%, respectively; p < 0.001). The prevalence of cholecystolithiasis in northern Xinjiang was 13.5% and that in southern Xinjiang was 17.5%; this difference was also statistically significant (OR 1.599; p < 0.001). Across all ethnic groups, the cholecystolithiasis prevalence significantly increased with age (all p < 0.01) and body mass index (BMI) (all p < 0.01). A multivariate logistic regression analysis indicated that cholecystolithiasis prevalence was associated with sex, age, BMI, smoking, diabetes, fatty liver disease, and geographical differences between northern and southern Xinjiang.

Conclusions

The prevalence of cholecystolithiasis was significantly higher in the Uyghur ethnic group than in the Han, Kazakh, and other ethnic groups; in women than in men; in southern Xinjiang than in northern Xinjiang; in patients with fatty liver disease; and increased with age and BMI. Our findings could provide a theoretical basis for the formulation of control measures for cholecystolithiasis.
Associations of poor oral health with frailty and physical functioning in the oldest old: results from two studies in England and Japan
Authors: Albani Viviana , Nishio Kensuke , Ito Tomoka , Kotronia Eftychia , Moynihan Paula , Robinson Louise , Hanratty Barbara , Kingston Andrew , Abe Yukiko , Takayama Michiyo , Iinuma Toshimitsu , Arai Yasumichi , Ramsay Sheena E.
Published: March 2021

Background

Very few studies have examined the relationship of oral health with physical functioning and frailty in the oldest old (> 85 years). We examined the association of poor oral health with markers of disability, physical function and frailty in studies of oldest old in England and Japan.

Methods

The Newcastle 85+ Study in England (n = 853) and the Tokyo Oldest Old Survey on Total Health (TOOTH; n = 542) comprise random samples of people aged > 85 years. Oral health markers included tooth loss, dryness of mouth, difficulty swallowing and difficulty eating due to dental problems. Physical functioning was based on grip strength and gait speed; disability was assessed as mobility limitations. Frailty was ascertained using the Fried frailty phenotype. Cross-sectional analyses were undertaken using logistic regression.

Results

In the Newcastle 85+ Study, dry mouth symptoms, difficulty swallowing, difficulty eating, and tooth loss were associated with increased risks of mobility limitations after adjustment for sex, socioeconomic position, behavioural factors and co-morbidities [odds ratios (95%CIs) were 1.76 (1.26–2.46); 2.52 (1.56–4.08); 2.89 (1.52–5.50); 2.59 (1.44–4.65) respectively]. Similar results were observed for slow gait speed. Difficulty eating was associated with weak grip strength and frailty on full adjustment. In the TOOTH Study, difficulty eating was associated with increased risks of frailty, mobility limitations and slow gait speed; and complete tooth loss was associated with increased risk of frailty.

Conclusion

Different markers of poor oral health are independently associated with worse physical functioning and frailty in the oldest old age groups. Research to understand the underlying pathways is needed.
Frailty status as a potential factor in increased postoperative opioid use in older adults
Authors: Auckley Elizabeth D. , Bentov Nathalie , Zelber-Sagi Shira , Jeong Lily , Reed May J. , Bentov Itay
Published: March 2021

Background

Prescription opioids are commonly used for postoperative pain relief in older adults, but have the potential for misuse. Both opioid side effects and uncontrolled pain have detrimental impacts. Frailty syndrome (reduced reserve in response to stressors), pain, and chronic opioid consumption are all complex phenomena that impair function, nutrition, psychologic well-being, and increase mortality, but links among these conditions in the acute postoperative setting have not been described. This study seeks to understand the relationship between frailty and patterns of postoperative opioid consumption in older adults.

Methods

Patients ≥ 65 years undergoing elective surgery with a planned hospital stay of at least one postoperative day were recruited for this cohort study at pre-anesthesia clinic visits. Preoperatively, frailty was assessed by Edmonton Frailty and Clinical Frailty Scales, pain was assessed by Visual Analog and Pain Catastrophizing Scales, and opioid consumption was recorded. On the day of surgery and subsequent hospitalization days, average pain ratings and total opioid consumption were recorded daily. Seven days after hospital discharge, patients were interviewed using uniform questionnaires to measure opioid prescription use and pain rating.

Results

One hundred seventeen patients (age 73.0 (IQR 67.0, 77.0), 64 % male), were evaluated preoperatively and 90 completed one-week post discharge follow-up. Preoperatively, patients with frailty were more likely than patients without frailty to use opioids (46.2 % vs. 20.9 %, p = 0.01). Doses of opioids prescribed at hospital discharge and the prescribed morphine milligram equivalents (MME) at discharge did not differ between groups. Seven days after discharge, the cumulative MME used were similar between cohorts. However, patients with frailty used a larger fraction of opioids prescribed to them (96.7 % (31.3, 100.0) vs. 25.0 % (0.0, 83.3), p = 0.007) and were more likely (OR 3.7, 95 % CI 1.13–12.13) to use 50 % and greater of opioids prescribed to them. Patients with frailty had higher pain scores before surgery and seven days after discharge compared to patients without frailty.

Conclusions

Patterns of postoperative opioid use after discharge were different between patients with and without frailty. Patients with frailty tended to use almost all the opioids prescribed while patients without frailty tended to use almost none of the opioids prescribed.
Associations between antimicrobial susceptibility/resistance of Neisseria gonorrhoeae isolates in European Union/European Economic Area and patients’ gender, sexual orientation and anatomical site of infection, 2009–2016
Authors:   on behalf of The Euro-GASP Network, Jacobsson Susanne , Cole Michelle J. , Spiteri Gianfranco , Day Michaela , Unemo Magnus
Published: March 2021

Background

The emergence and spread of antimicrobial resistance (AMR) inNeisseria gonorrhoeae, nationally and internationally, is a serious threat to the management and control of gonorrhoea. Limited and conflicting data regarding the epidemiological drivers of gonococcal AMR internationally have been published. We examined the antimicrobial susceptibility/resistance of gonococcal isolates (n = 15,803) collected across 27 European Union/European Economic Area (EU/EEA) countries in 2009–2016, in conjunction to epidemiological and clinical data of the corresponding patients, to elucidate associations between antimicrobial susceptibility/resistance and patients’ gender, sexual orientation and anatomical site of infection.

Methods

In total, 15,803 N. gonorrhoeaeisolates from the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP), 2009–2016, were examined. Associations between gonococcal susceptibility/resistance and patients’ gender, sexual orientation and anatomical site of infection were investigated using univariate and multivariate logistic regression analysis. Statistical significance was determined by Pearson χ2-test or Fisher’s exact test with two-tailedp-values of < 0.05 indicating significance.

Results

The overall gonococcal resistance from 2009 to 2016 was 51.7% (range during the years: 46.5–63.5%), 7.1% (4.5–13.2%), 4.3% (1.8–8.7%), and 0.2% (0.0–0.5%) to ciprofloxacin, azithromycin, cefixime, and ceftriaxone, respectively. The level of resistance combined with decreased susceptibility to ceftriaxone was 10.2% (5.7–15.5%). Resistance to cefixime and ciprofloxacin, and resistance combined with decreased susceptibility to ceftriaxone were positively associated with urogenital infections and heterosexual males, males with sexual orientation not reported and females (except for ciprofloxacin), i.e. when compared to men-who-have-sex-with-men (MSM). Azithromycin resistance was positively associated with heterosexual males, but no association was significant regarding anatomical site of infection.

Conclusions

Overall, sexual orientation was the main variable associated with gonococcal AMR. Strongest positive associations were identified with heterosexual patients, particularly males, and not MSM. To provide evidence-based understanding and mitigate gonococcal AMR emergence and spread, associations between antimicrobial susceptibility/resistance and patients’ gender, sexual orientation and anatomical site of infection need to be further investigated in different geographic settings. In general, these insights will support identification of groups at increased risk and targeted public health actions such as intensified screening, 3-site testing using molecular diagnostics, sexual contact tracing, and surveillance of treatment failures.
Health care utilization for patients with stroke: a 3-year cross-sectional study of China’s two urban health insurance schemes across four cities
Authors: Yang Yong , Nicholas Stephen , Li Shuo , Huang Zhengwei , Chen Xiaoping , Ma Yong , Shi Xuefeng
Published: March 2021

Background

Stroke is a devastating disease and a major cause of death and disability in China. While existing studies focused mainly on differences in stroke patients’ health care utilization by insurance type, this study assesses whether health utilization and medical costs differed by insurance type across four cities in China.

Methods

A 5% random sample from the 2014–2016 China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) claims data were collected across four cities, Beijing, Shanghai, Tianjin, and Chongqing. Descriptive statistics and ordinary least squares regression were employed to analyze the data.

Results

We found that differences in healthcare utilization and inpatient and outpatient medical expenses varied more by city-specific insurance type than they did between the UEBMI and URBMI schemes. For example, the median UEBMI medical outpatient costs in Beijing (RMB500.2) were significantly higher than UEBMI patients in Shanghai (RMB260.8), Tianjin (RMB240.8), and Chongqing (RMB293.0), and Beijing URBMI patients had significantly higher outpatient medical costs (RMB356.9) than URBMI patients in Shanghai (RMB233.4) and Chongqing (RMB211.0), which were significantly higher than Tianjin (RMB156.2). Patients in Chongqing had 66.4% (95% CI: − 0.672, − 0.649) fewer outpatient visits, 13.0% (95% CI: − 0.144, − 0.115) fewer inpatient visits, and 34.2% (95% CI: − 0.366, − 0.318) shorter length of stay than patients in Beijing. The divergence of average length of stay and out-of-pocket (OOP) expenses by insurance type was also greater between cities than the UEMBI-URBMI mean difference.

Conclusions

Significant city-specific differences in stroke patients’ healthcare utilization and medical costs reflected inequalities in health care access. The fragmented social health insurance schemes in China should be consolidated to provide patients in different cities equal financial protection and benefit packages and to improve the equity of stroke patient access to health care.
Effect of periodontal therapy on COPD outcomes: a systematic review
Authors: Apessos Ioulianos , Voulgaris Athanasios , Agrafiotis Michalis , Andreadis Dimitrios , Steiropoulos Paschalis
Published: March 2021

Background

Latest evidence suggests that periodontitis is prevalent among patients with chronic obstructive pulmonary disease (COPD), while recent studies have also reported a potential benefit of periodontal treatment on several COPD outcomes. This systematic review aims to determine the impact of periodontal treatment on exacerbation rate, lung function and quality of life of COPD patients.

Methods

A systematic search of electronic databases of PubMed, Scopus, Virtual Health Library, ScienceDirect, Wiley Online Library, Web of Science, ProQuest Dissertation and Theses Global and Google Scholar was conducted. Search restricted to studies involving human subjects which were published from January 2000 to March 2020 in English language. Distiller Systematic Review software was used for data management. Risk of bias was assessed using Risk of Bias 2 (RoB2) and Risk of Bias for non-randomized studies of intervention (ROBINS-I) tools. Overall quality of evidence was judged based on Grading of Recommendations Assessment, Development and Evaluation working group methodology.

Results

Out of 1442 articles retrieved, 7 full text articles were included in the review. Limited evidence suggests that periodontal treatment in patients with COPD and periodontitis is associated with reduced exacerbation frequency and a slower lung function decline rate, while its effects on quality of life remain unclear. In addition, periodontal treatment in COPD is associated with lower hospitalization rates and reduced all-cause mortality. Significant methodological differences were noted amongst included studies, while very low-to-moderate overall quality of evidence was demonstrated.

Conclusions

Although it is reasonable to advise COPD patients not to neglect their dental health, further studies are warranted to determine the role of periodontal therapy on COPD clinical outcomes.

Trial Registration: PROSPERO 2020 (CRD42020158481). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020158481
A haptic laparoscopic trainer based on affine velocity analysis: engineering and preliminary results
Authors: De Witte Benjamin , Barnouin Charles , Moreau Richard , Lelevé Arnaud , Martin Xavier , Collet Christian , Hoyek Nady
Published: March 2021

Background

There is a general agreement upon the importance of acquiring laparoscopic skills outside the operation room through simulation-based training. However, high-fidelity simulators are cost-prohibitive and elicit a high cognitive load, while low-fidelity simulators lack effective feedback. This paper describes a low-fidelity simulator bridging the existing gaps with affine velocity as a new assessment variable. Primary validation results are also presented.

Methods

Psycho-motor skills and engineering key features have been considered e.g. haptic feedback and complementary assessment variables. Seventy-seven participants tested the simulator (17 expert surgeons, 12 intermediates, 28 inexperienced interns, and 20 novices). The content validity was tested with a 10-point Likert scale and the discriminative power by comparing the four groups’ performance over two sessions.

Results

Participants rated the simulator positively, from 7.25 to 7.72 out of 10 (mean, 7.57). Experts and intermediates performed faster with fewer errors (collisions) than inexperienced interns and novices. The affine velocity brought additional differentiations, especially between interns and novices.

Conclusion

This affordable haptic simulator makes it possible to learn and train laparoscopic techniques. Self-assessment of basic skills was easily performed with slight additional cost compared to low-fidelity simulators. It could be a good trade-off among the products currently used for surgeons' training.
Clinico-pathological study of malignant odontogenic tumours from a national referral centre
Authors: Sathasivam Hans Prakash , Saw Chee Lynn , Lau Shin Hin
Published: March 2021

Background

Malignant odontogenic tumours are extremely rare tumours occurring within the jaws. Our study was performed to determine the demographic and clinico-pathological features of malignant odontogenic tumours amongst a multi-ethnic Asian population.

Methods

This was a retrospective cross-sectional study of malignant odontogenic tumours diagnosed at the Institute for Medical Research, Malaysia, from 2009 to 2019. All cases were independently reviewed and reclassified following the criteria set out in the latest edition of the World Health Organization 2017 reference text. Demographic and clinico-pathological data were recorded for each case.

Results

Twenty-four cases of malignant odontogenic tumours were identified. The patients’ age ranged from 16 to 79 years with the mean age at diagnosis being 50.8 years (SD = 16.18). There was a male predominance (66.7%) in this cohort of patients. The ethnic distribution appeared to reflect the Malaysian population with most cases seen amongst the Malay ethnic group (66.7%). Ameloblastic carcinoma was the most frequently diagnosed malignant odontogenic tumour (45.8%) and was also predominantly seen in males (90.9%). All patients with clear cell odontogenic carcinoma were females. There was no obvious sex predilection in primary odontogenic carcinoma not otherwise specified (NOS). The mandible (79.2%) was more frequently involved compared to the maxilla.

Conclusions

Diagnosis and management of malignant odontogenic tumours are challenging due to the rarity of these tumours. Our study has elucidated the clinico-pathological features of malignant odontogenic tumours seen in a multi-ethnic Asian population.
Deep learning based prediction of necessity for orthognathic surgery of skeletal malocclusion using cephalogram in Korean individuals
Authors: Shin WooSang , Yeom Han-Gyeol , Lee Ga Hyung , Yun Jong Pil , Jeong Seung Hyun , Lee Jong Hyun , Kim Hwi Kang , Kim Bong Chul
Published: March 2021

Background

Posteroanterior and lateral cephalogram have been widely used for evaluating the necessity of orthognathic surgery. The purpose of this study was to develop a deep learning network to automatically predict the need for orthodontic surgery using cephalogram.

Methods

The cephalograms of 840 patients (Class ll: 244, Class lll: 447, Facial asymmetry: 149) complaining about dentofacial dysmorphosis and/or a malocclusion were included. Patients who did not require orthognathic surgery were classified as Group I (622 patients—Class ll: 221, Class lll: 312, Facial asymmetry: 89). Group II (218 patients—Class ll: 23, Class lll: 135, Facial asymmetry: 60) was set for cases requiring surgery. A dataset was extracted using random sampling and was composed of training, validation, and test sets. The ratio of the sets was 4:1:5. PyTorch was used as the framework for the experiment.

Results

Subsequently, 394 out of a total of 413 test data were properly classified. The accuracy, sensitivity, and specificity were 0.954, 0.844, and 0.993, respectively.

Conclusion

It was found that a convolutional neural network can determine the need for orthognathic surgery with relative accuracy when using cephalogram.
Clinical characteristics, treatment status and complications in women with tube ovarian abscess and endometriosis: a retrospective study
Authors: Li Hui , Zhao Yan , Chang Xiao-hong , Wang Yue , Zhu Hong-lan
Published: March 2021

Background

The aim of our present study was to investigate the clinical characteristics, treatment status and complications in women with endometriosis (EM) and tube ovarian abscess (TOA) to determine the possible association between TOA and EM.

Methods

Medical records were used to analyze the clinical characteristics, treatment and complications. Twenty women who were diagnosed with TOA with EM were compared with 93 women diagnosed as having TOA without EM between January, 2008 and December, 2018.

Results

In this study, TOA patients with EM were significantly more likely to have a lower age range (20–39 years) than the non-EM group [11/20 (55.0%) vs 27/93 (29.0%)]. In addition, TOA patients with EM were associated with a significantly lower rate of parity [11/20 (55.0%) vs 75/93 (80.6%)], higher rates of infertility [8/20(40%) vs 0/93(0%)] and a significantly lower incidence of elevated blood platelet counts [5/20 (25%) vs 43/93 (46.2%)]. Furthermore, women with EM had greater blood loss (347 ± 445.77 vs 204.67 ± 289.46) and an increased complication rate [3/20(15%) vs 0/93(0%)]. Among the 3 patients who had complications in the EM group, 2 patients had septic shock and 1 patient had intestinal obstruction. And 1 case who had septic shock followed by IVF treatment. There was no significance difference on other factors.

Conclusions

The present study indicated that EM did not increase the difficulty and time of treatment in patients with TOA, but increased bleeding during surgery and serious complications. It is suggested that doctors should pay more attention to postoperative treatment and nursing in women with TOA and EM, especially those who have a history of recent infertility treatment and related procedures.
Evaluation of e-health (Seha) application: a cross-sectional study in Saudi Arabia
Authors: Alharbi Abeer , Alzuwaed Joharah , Qasem Hind
Published: March 2021

Background

The Ministry of Health in Saudi Arabia is expanding the country’s telemedicine services by using advanced technology in health services. In doing so, an e-health application (app), Seha, was introduced in 2018 that allows individuals to have face-to-face visual medical consultations with their doctors on their smartphones.

Objective

This study evaluated the effectiveness of the app in improving healthcare delivery by ensuring patient satisfaction with the care given, increasing access to care, and improving efficiency in the healthcare system.

Methods

A cross-sectional study design was used to assess the perceptions of users of the Seha app and non-users who continued with traditional health services. The data were collected using an online survey via Google Forms between June 2020 and September 2020. Independent t tests and chi-square (χ2) tests were conducted to answer the research questions.

Results

There was a significant difference between users and non-users in terms of ease of access to health services (t =  − 9.38, p < 0.05), with app users having a higher mean score (4.19 ± 0.91) than non-users (3.41 ± 1.00); satisfaction with health services (t =  − 6.33, p < 0.05), with users having a higher mean score (3.96 ± 0.91) than non-users (3.45 ± 0.94); and efficiency (only one visit needed for treatment) (t =  − 3.20, p < 0.05), with users having a higher mean score (3.71 ± 0.93) than non-users (3.45 ± 0.93). There were significant associations between the use of the Seha app and age (χ2 = 8.79, p < 0.05), gender (χ2 = 22.19, p < 0.05), region (χ2 = 19.74, p < 0.05), and occupation (χ2 = 22.05, p < 0.05). There were significant relationships between the three items (on access, satisfaction, and efficiency) and experiencing technical issues (t = 4.47, t = 8.11, and t = 3.24, respectively, p < 0.05), with users who faced technical problems having significantly lower mean scores for all three items.

Conclusion

This study provided evidence that the Seha app improved the delivery of healthcare in Saudi Arabia. Users of the app had a better health experience in terms of their perceived ease of access to healthcare services; their satisfaction with healthcare services; and the efficiency of the system, measured by the number of required doctor visits. Other factors that appeared to influence the use of the app included age, gender, usual source of care, and technical difficulties.