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As value-based care grows in popularity across the United States, more payers have turned toward bundled payment models for surgical procedures. Though episode costs in spine are highly variable, physical therapy (PT) has been identified as a driver of 90-day cost. The goal of this study is to assess the impact of postoperative PT on patient-reported outcomes and cost after lumbar fusion surgery using bundled insurance data. Bundled payment information of lumbar fusion episodes-of-care (EOC) from 2019 to 2021 was reviewed at a single, urban, tertiary care center. EOC comprised a 210-day period surrounding the date of the procedure, beginning 30 days preoperatively and ending 180 days postoperatively. Patients were grouped into physical therapy (PT) and no physical therapy (no PT) groups based on the presence of PT claims. Bivariate analysis of surgical outcomes revealed similar overall complication rates (P = 0.413), 30-day readmissions (P = 0.366), and 90-day readmissions (P = 0.774). Patients who did not participate in postoperative PT had significantly better preoperative physical component score (PCS) (P = 0.003), 6-month postoperative PCS (P = 0.001), and 6-month ΔPCS (P = 0.026) compared with patients who participated in postoperative PT. At 1-year follow-up, patients who did not participate in PT had less leg pain (P = 0.041) than those who did participate in PT. Our study finds that PT after lumbar fusion is not associated with significant improvement in Oswestry Disability Index, PCS, mental component score, or visual analog scale pain scores. Additionally, the number of PT sessions a patient attends has no correlation with improvement in these outcomes. [ABSTRACT FROM AUTHOR]

To study the changes in dynamic compliance (C dyn), ventilation/perfusion (V ˙ / Q ˙) mismatch and haemodynamic variables in hypoxaemic anaesthetized horses whose PaO 2 increased following salbutamol inhalation. Retrospective, clinical, cohort study. A group of 73 client-owned horses treated with salbutamol when PaO 2 <100 mmHg (13.3 kPa) during anaesthesia. Horses were divided into two groups: responders (R), where PaO 2 after salbutamol ≥1.2 PaO 2 before treatment (i.e. ≥20% increase), and non-responders (NR), where PaO 2 after salbutamol <1.2 PaO 2 before treatment. Demographic data and intraoperative variables before treatment were compared between R and NR. C dyn , arterial to end-tidal carbon dioxide difference [P(a-E´)CO 2 ], estimated ratio of dead space to tidal volume (est.V D /V T), estimated shunt fraction (F-shunt), heart rate, systolic, mean and diastolic arterial pressure and dobutamine requirements were compared before and after treatment within R and NR. For each variable, the difference (Δ) between values pre- and posttreatment was calculated and compared between groups R and NR. Numerical data were compared using univariate or bivariate analysis and categorical data were compared using chi-square test; p < 0.05. Of the 73 horses 50 were classified as R while 23 horses were classified as NR. There was no statistical difference between R and NR for demographic data or initial intraoperative variables except for body weight [R: 531 (170–715) kg, NR: 540 (420–914) kg]. While salbutamol did not alter C dyn in either group, it significantly decreased P(a-E´)CO 2 , est.V D /V T and F-shunt in R only. ΔP(a-E´)CO 2 , Δest.V D /V T and ΔF-shunt were significantly greater in R (−17.8%, −19.0% and −24.1%, respectively) than in NR (11.5%, 6.6% and −0.3%, respectively). In hypoxaemic anaesthetized horses responding to inhaled salbutamol by a ≥1.2 increase in PaO 2 no change in C dyn was detected, but indicators of V ˙ / Q ˙ mismatch improved. [ABSTRACT FROM AUTHOR]

This study investigates the association between inflammatory myopathies (IM), and their correlation with cancer. There are several potential causes behind the association of cancer and inflammatory myopathies. The positivity of specific antibodies for myositis plays a significant role. Our objective is to describe cancer and inflammatory myopathies in Colombia, focusing on demographics, clinical characteristics, and laboratory data. We retrospectively analyzed 112 IM patients diagnosed at Fundación Valle del Lili in Cali, Colombia, the cases met the EULAR/ACR criteria. Data included demographics, clinical signs, laboratory findings, and malignancy. Malignancy associations were explored using logistic regression. The survival analysis was assessed using Kaplan–Meier curves and the Log-Rank test. Dermatomyositis was the most common subtype (45.5%), with a female predominance (66.1%). Cancer diagnosis occurred in 11.6% of cases, predominantly thyroid cancer. The median time from myopathy onset to cancer diagnosis was 11 months, with 75% of cases within the first year. Bivariate analysis indicated associations between cancer and age, Gottron's papules, digital ulcers, and heliotrope rash. However, multivariate analysis identified age as the only significant malignancy risk factor. Survival analysis showed better rates in younger patients. This study provides into the link between IM and cancer in the Colombian population. Thyroid cancer predominated, with a slightly higher proportion of female cancer diagnoses. Age emerged as a significant risk factor for malignancy. Understanding this association is crucial for early detection and improving patient outcomes related to IM-associated malignancies. [ABSTRACT FROM AUTHOR]

It is essential to use compound families in statistical modeling for asymmetric-positive-skewed reliability and relief in real-life data for a number of reasons, including the capacity to capture underlying patterns and characteristics in the data more accurately. The current work introduces a novel compound and continuous G family of probability distributions characterized by two parameters, denoted as the compounded two-parameters general Rayleigh geometric family of probabilistic distributions. The research involves rigorous calculations to ascertain and analyze the relevant mathematical properties of this newly proposed family. We present aging notions under the new family, providing corresponding density, hazard, and survival functions. Notably, a specific emphasis is placed on the examination of the reciprocal-Weibull baseline model, both from a mathematical and statistical perspective, in a dedicated section of the study. To generate various multivariate and bivariate type distributions, the copula method is employed. These newly derived models hold significant utility for effectively modeling the multivariate and bivariate data. The study showcases the wide applicability in different sides under real-life datasets. The presented applications serve as concrete demonstrations of the family's effectiveness and versatility in addressing real-world scenarios. [ABSTRACT FROM AUTHOR]

The objective of the study is to understand the characteristics of people who died by different suicide methods in Toronto, Canada. Suicide cases were identified by the Office of the Chief Coroner of Ontario (1998–2020). Demographic and clinical variables were retrieved. All suicide deaths were classified into different groups based on suicide method. Bivariate analyses and multinomial logistic regressions were performed to compare their demographic and clinical characteristics. Hanging (N = 1721), jumping from height (N = 1280), and poisoning (N = 955) were the most common suicide methods in Toronto. Those who died by hanging were more likely to be married or in common law relationships, live with others, experience employment/financial/academic-related stressors and die at home. People who died by jumping from height had a higher likelihood of having a psychiatric and/or emergency department visit in the past week and having schizophrenia or related disorders/symptoms. People who died by poisoning had higher odds of being female and leaving suicide notes. They were also more likely to have previous suicide attempts, experience depression and/or bipolar disorder and have physical conditions. Specific suicide prevention strategies should be designed and implemented to account both for commonalities and differences among people who die by different suicide methods. [ABSTRACT FROM AUTHOR]

To determine if perioperative administration of dexmedetomidine affects postoperative fluid intake in tonsillectomy patients. A retrospective chart review was performed at University Medical Center, Texas Tech Health Science Center, Lubbock, Texas. The study identified 534 patients within the last five years who met the criteria. Common indications for the surgeries included recurrent tonsillitis, obstructive sleep apnea, and sleep disordered breathing. Patients with concurrent peritonsillar abscess drainage, microlaryngoscopy, bronchoscopy, supraglottoplasty, and other procedures that may impact fluid intake were excluded. The relationship between dexmedetomidine and fluid intake was evaluated using bivariate analysis as well as multivariable regression to account for possible confounders such as age, concurrent medication, surgery type, and method of surgery using STATA statistical software, version 17.0 (StataCorp LLC, College Station, TX). Administration of dexmedetomidine did not significantly impact the amount of fluid intake, fluid intake per kilogram per hour, or average postoperative pain levels in patients who underwent tonsillectomy or adenotonsillectomy in the bivariate analysis (p = 0.217, 0.489, 0.512 respectively) and multiple regression model (p = 0.156, 0.802, 0.795) Dexmedetomidine does not negatively influence postoperative fluid intake levels in patients and should continue to be utilized in appropriately selected patients experiencing anxiety or agitation prior to surgery. [ABSTRACT FROM AUTHOR]

Large-scale clinical studies on the incidence of middle mesial canals (MMCs) in nonsurgical root canal treatment (RCT) and retreatment of mandibular molars are lacking. The primary aim of this observational study was to determine the incidence of MMCs in mandibular first and second molars that received RCT or nonsurgical retreatment (NSRetx). The secondary aim was to determine factors associated with incidence of MMCs. Included were 3018 mandibular molars that received RCT (n = 1624) or NSRetx (n = 1394) by 3 endodontists in a private practice. Demographic and procedural data were collected. Bivariate and multivariable (Poisson regression model) analyses were performed. Incidence of MMCs was 8.8% (n = 267). Although the bivariate analysis showed that NSRetx was significantly associated with incidence of MMCs, this association did not reach the threshold for statistical significance after controlling for all covariates (P =.07). Multivariable analysis on the entire cohort showed that incidence of MMCs was significantly associated with younger age (risk ratio [RR] = 1.62; 95% confidence interval [CI], 1.28–2.06), male gender (RR = 1.48; 95% CI, 1.18–1.85), preoperative cone-beam computed tomography (CBCT) (RR = 1.48; 95% CI, 1.17–1.89), and first molar (RR = 2.30; 95% CI:1.74–3.05). Subgroup multivariable analyses revealed that incidence of MMCs was associated with male gender only in the RCT group (RR = 2.26; 95% CI, 1.55–3.30) but not in the NSRetx group (RR = 1.11; 95% CI, 0.82, 1.50); and with preoperative CBCT only in the NSRetx group (RR = 1.78; 95% CI, 1.28, 2.50) but not in the RCT group (RR = 1.10; 95% CI, 0.71, 1.69). Associations with younger age and first molar remained unchanged. Overall incidence of MMCs was 8.8%. Incidence of MMCs was significantly higher in younger patients and in mandibular first molars but was not associated with the type of treatment. [ABSTRACT FROM AUTHOR]

• 32% of the sample was zero dose(ZD) or under-immunized(UI) in selected geo-pockets. • The prevalence of ZD/UI were high in urban slums (59%) and ' haors ' (wetland) (32%) • Having proper health documents of child emerged as a key driver of ZD/UI. In the era of Gavi's 5.0 vision of "leaving no one behind with immunization", childhood routine vaccination in missed communities is considered as a priority concern. Despite having a success story at the national level, low uptake of immunization is still persistent in selected pocket areas of Bangladesh. However, prevalence and the associated factors of zero-dose (ZD) and under-immunization (UI) are still unknown at those geo-pockets of Bangladesh. Thus, the study aims to report and identify the factors associated with ZD and UI in selected geographical locations. This study used data from a Lot Quality Assurance Sampling (LQAS) survey where 504 households from 18 clusters of four hard to reach (HTR) and one urban slum were included. Caregivers of children aged 4.5 to 23 months were interviewed. Three outcome variables- ZD, UI and ZD/UI were considered and several related attributes were considered as independent variables. Data were analyzed through bivariate analysis, binary logistic regression and dominance analysis. Overall, 32% of the children were either ZD (8%) or UI (26%) in the selected areas. The adjusted odds of ZD/UI for urban slum and haor (wetlands) areas were 5.62 and 3.61 respectively considering coastal areas as reference. However, distance of nearest EPI center, availability of EPI card, age of caregivers, education and occupation of mother and number of earning members in household were influential factors for ZD/UI. According to dominance analysis, availability of EPI card can explain the most of the variation of ZD/UI in this study. The study findings highlight the high prevalence ZD/UI in certain geo-pockets of the country. It provided a powerful insight of current situation and associated factors in regards to ZD/UI in the country which will help policy-makers and programme managers in designing programmes to reduce missed communities in Bangladesh. [ABSTRACT FROM AUTHOR]

The Spinal Instability Neoplastic Score (SINS) classification system is a validated and the most widely accepted instrument for defining instability in vertebral metastasis (VM), in which lesions scoring between 7 and 12 are defined as indeterminate and the treatment is controversial. This study aimed to determine which variables more frequently are considered by spine surgeons for choosing between the conservative and the surgical treatment of VMs among patients with an indeterminate SINS. A single-round online survey was conducted with 10 spine surgeons with expertise in the management of VMs from our AO Spine Region. In this survey, each surgeon independently reviewed demographic and cancer-related variables of 36 real-life cases of patients with vertebral metastases scored between 7 and 12 in the SINS. Bivariate and multivariate analyses were performed to identify significant SINS and non-SINS variables influencing the decision-making on surgical treatment. The most commonly variables considered important were the SINS element "mechanical pain", rated important for 44.4% of the cases, "lesion type" for 36.1%, and "degree of vertebral collapse" and the non-SINS factor "tumor histology" rated for 13.9% of cases. By far the factor most commonly rated unimportant was "posterior element compromise" (in 72.2% of cases). Surgeons relied on mechanical pain and type of metastatic lesion for treatment choices. Vertebral collapse, spinal malalignment, and mobility were less influential. Spinal mobility was a predictor of surgical versus non-surgical treatment. The only variables not identified either by surgeons themselves or as a predictor of surgery selection was the presence/degree of posterolateral/posterior element involvement. [ABSTRACT FROM AUTHOR]

Obesity is associated with lower socioeconomic status. To date, however, scarce research has examined the prevalence, comorbidity, and incremental burden of obesity in relation to medical, psychiatric, functional, and homelessness measures among low-income veterans. A nationally representative sample of 1004 low-income U.S. veterans was examined. Bivariate and multivariable analyses were conducted to assess relationships between obesity and medical and psychiatric comorbidities, functioning, and homelessness measures. The prevalence estimate of obesity among low-income U.S. veterans was 38.2% (confidence interval (CI): 34.2; 42.2), which is higher than previously reported for the general U.S. veteran population. It was particularly high among young, females with children. Obesity was associated with co-occurring medical (chronic pain, diabetes, sleep disorders, high blood pressure, heart disease) and psychiatric (trauma- and anxiety-related) conditions, poor functioning, and current psychiatric medication use. Veterans with obesity were less likely to have current savings and more likely to have current debt. They also were more likely to have experienced evictions and foreclosures and less likely to use active coping or positive reframing as a means of dealing with stressful situations. The prevalence of obesity among U.S. veterans is high. Specific demographic groups particularly vulnerable to developing obesity warrant targeted interventions. Modifying weight management programs, understanding coping styles, and assessing, monitoring, and treating obesity in low-income veterans may help improve overall health and quality of life in multiple domains. • Of U.S. low-income veterans, 38.2% met criteria for obesity. • Veterans with obesity had higher odds of foreclosures and evictions. • Veterans with obesity were less likely to use active coping to manage stress. [ABSTRACT FROM AUTHOR]

Reducing animal product consumption has benefits for population health and the environment. The relationship between vegetarianism and mental health, however, remains poorly understood. This study explores this relationship in a nationally representative cohort in Great Britain. We use data from the 1970 British Cohort Study, which collected information on vegetarianism at age 30 in 2000 (n = 11,204) and psychological distress (PD) at ages 26, 30, 34, 42, and 46–48 in 2016/18. We first developed a statistical adjustment strategy by regressing PD at age 30 on vegetarianism and 14 confounders measured at ages 10 and 26. We then ran multilevel growth curve models, testing whether within-person changes in PD between ages 30 and 46–48 differed by vegetarianism, before and after statistical adjustment. At age 30, 4.5 % of participants reported being vegetarian. In the cross-sectional models at age 30, vegetarians reported more distress compared with non-vegetarians in bivariate analysis (b = 0.30, 95%CI 0.09, 0.52), but this difference disappeared in the fully-adjusted model (b = 0.02, 95%CI −0.17, 0.21). In the longitudinal models between ages 30 and 46/48, there were no differences in within-person changes in psychological distress between vegetarians and non-vegetarians (p =.723). Sensitivity analyses using red meat consumption yielded similar findings. In this British cohort, vegetarianism at age 30 was not associated with changes in psychological distress during mid-adulthood. Since psychological distress in early adulthood predicted vegetarianism at age 30, more studies are needed to disentangle the progression of this relationship over the life-course. • Most studies on vegetarianism and mental health are methodologically weak. • Vegetarianism at age 30 was not associated with subsequent changes in psychological distress in the 1970 British Cohort Study. • Vegetarianism and mental health may still be related during the transition to aduthood. [ABSTRACT FROM AUTHOR]

Despite the endorsement of intrauterine device (IUD) use in adolescents and young adults (AYAs) by leading professional organizations and demonstrated acceptance and desirability by AYAs, clinicians may worry about the procedural difficulty of IUD device placement in younger patients. The aim of this study was to evaluate the clinical outcomes of first-attempt IUD placement in an AYA population by vaginal delivery (VD) history. We performed a retrospective cohort study of patients under 25 years old at reproductive health clinics with an IUD placement attempt between January 1 and August 31, 2017. We abstracted sociodemographic characteristics, pregnancy history, and procedural characteristics including complications. Bivariate analyses compared successful first-attempt IUD placement by VD history. We also assessed the frequency of secondary clinical outcomes including ancillary measures used, provider type, symptoms reported during the procedure, and complications. We included 1325 participants (median age = 21.3 years), including 42 (3.2%) with a previous VD. Nearly all IUD placements were successful on the first attempt (n = 1301, 98.2%) and performed by advanced practice clinicians (n = 1314, 99.2%). First-attempt IUD placement success was similar in those participants with and without VD (P >.999). Ancillary measures other than nonsteroidal anti-inflammatory drugs were used infrequently (n = 16, 3.6%). Among participants with an unsuccessful placement, 66.7% returned, and all had a successful IUD placement on the second attempt. Documented complications within 6 months of placement were rare (n = 29) and mostly comprised expulsions (n = 27, 93.1%). IUD placement success among AYAs at community-based reproductive health clinics is high and is not associated with a history of VD. [ABSTRACT FROM AUTHOR]

To evaluate the prevalence of and risk factors for urinary fecal incontinence (UI, FI) during sexual activity (UIS, FIS) among adults with spina bifida (SB). An international online survey of adults with SB was administered through SB clinics and SB organizations via social media. Adults with a history of masturbation or partnered sexual activity were included. The primary outcome was ever experiencing UIS/FIS. Nonparametric tests and logistic regression were used for analysis. A total of 341 adults met inclusion criteria (median age: 36 years, 59% female, 52% shunted, 48% community ambulators). Baseline UI in the last 4 weeks was reported by 50% and FI by 41%. Nineteen (5%) had a urostomy. Eight (2%) had a colostomy. Overall, 93% had a history of partnered genital contact. Among adults without a diversion, UIS was more common than FIS (70% vs 45%, P <.001). Among adults without a urostomy, UIS was more common among women (76% vs 62%, P =.01) and those with baseline UI (84% vs 50%, P <.001). UIS was not associated with age, shunt, ambulatory, or catheterization status (P >=.32). On bivariate analysis, female sex and baseline UI were independent predictors of UIS (P <=.001). Among adults without a colostomy, FIS was associated with female sex (50% vs 39%, P =.046), baseline FI (59% vs 32%, P <.001), community ambulation (52% vs 40%, P =.04), but not age, shunt, or MACE status (P >=.27). On multivariate analysis, baseline FI was independently associated with FIS (P <.001). Among adults with UIS/FIS, 29% experienced UIS "almost always" to "always," compared to 5% for FIS (P <.001). Virtually all adults found UIS/FIS bothersome (>=96% for each), even when incontinence occurred "almost never." UIS/FIS mostly occurred before and/or during orgasm than afterward (P <.001). UIS was reported by 53% of adults with a urostomy (100% bothersome). FIS was reported by 38% of adults with a colostomy (100% bothersome). Incontinence during sexual activity is a common problem for men and women with SB. Baseline incontinence is an independent, but not absolute, predictor of both. While FIS is less frequent than UIS, both are virtually always bothersome. [ABSTRACT FROM AUTHOR]

There is some evidence that in twin reversed arterial perfusion sequence, intervention at early gestational age could prevent a spontaneous death of the pump twin, achieving a better global survival. To review the perinatal outcomes of early intervention in pregnancies complicated by twin reversed arterial perfusion (TRAP) sequence. A comprehensive search from inception to December 2022 was conducted on databases including MEDLINE, EMBASE, Cochrane Library and LILACS. All studies that reported intervention in twin or triplet pregnancy complicated with TRAP sequence at 12 + 0 to 16 + 6 weeks of gestation were eligible. A descriptive and bivariate analysis was performed. Out of the 222 full-text articles, 44 studies reporting 108 cases of early intervention in TRAP sequence were included. A successful procedure was achieved in 105 (95.5 %) interventions: 89 (94.7 %) among twin pregnancies and 16(100 %) among triplet pregnancies. An overall livebirth rate was achieved in 75 patients (70.8 %): intrafetal laser group 55 (73.3 %), radiofrequency 10 (76.9 %) and endoscopic laser 3 (75.0 %). The median gestational age at delivery was 38 + 0 (37 + 4 – 39 + 4) weeks. The median treatment–delivery interval was 23 + 2 (IQR, 21 + 0–25 + 6) weeks. The most frequent adverse outcomes reported were preterm labor in 7 (13.7 %) patients. There were no severe adverse maternal outcomes. Early intervention with intrafetal laser and radiofrequency in TRAP sequence achieves a livebirth rate of the pump twin of about 75 %. [ABSTRACT FROM AUTHOR]

Background: Obesity prevalence is significantly higher among Latino boys than girls. Weight status at 12 mo, a significant predictor of childhood obesity, is associated with feeding practices during infancy. Objectives: The objectives were to examine breastfeeding and formula-feeding practices overall and by infant gender and to examine relations among infant gender, milk-feeding practices, and obesity risk among Latino infants over the first year of life. Methods: Latino mother-infant dyads (n = 90) were recruited from a pediatric clinic. Mothers were interviewed at regular intervals (infants aged 2, 4, 6, and 9 mo), and 24-h feeding recalls were conducted when infants were aged 6 and 9 mo. Infants' lengths and weights were retrieved from clinic records to calculate weight-for-length percentiles. A bivariate analysis was conducted to compare feeding practices by gender and mediation analysis to test whether feeding practices mediated the relation between gender and obesity risk. Results: The majority (80%) of mothers were born outside the United States. In early infancy, mixed feeding of formula and breastfeeding was common. At 6 and 9 mo of age, milk-feeding practices differed, with formula feeding more common for boys than girls. At 12 mo, 38% of infants experienced obesity risk (-85th weight-for-length percentile). Infants' obesity risk increased by 18% per 1 oz increase in powdered formula intake. Formula intake among boys was on average 1.42 oz (in dry weight) higher than that among girls, which, in turn, mediated their increased obesity risk (IERR = 1.27, 95% confidence interval: 1.02, 1.90). Conclusions: The increased obesity risk among Latino boys compared with girls at 12 mo was explained by higher rates of formula feeding at 6 and 9 mo of age. Future investigations of cultural values and beliefs in gender-related feeding practices are warranted to understand the differences in obesity risk between Latino boys and girls. [ABSTRACT FROM AUTHOR]

To identify the prognostic factors of surgical resection for meningioma and their relationship with patient outcomes. This retrospective study included 53 patients (≥16 years), who underwent surgical resection for intracranial meningioma at the King Abdulaziz University Hospital from 2012 to 2022. Data regarding tumor location and size, histopathological type, chief complaint, chief complaint duration, admission date, diagnosis, operation, and discharge date were collected. These data were subjected to univariate and bivariate analyses to investigate the relationship between the postsurgical outcomes of the patients with meningioma and the variables of age at surgery, sex, length of hospitalization, chief complaint, Glasgow outcome score, World Health Organization histopathological classification, body mass index, tumor size, and nature of surgical resection. The mean age of our study cohort was 49.09 ± 12.64 years, with a female preponderance (75.5%) and mean body mass index of 29.31 ± 5.52 kg/m2. length of hospitalization (mean: 26.92 ± 54.88 days) demonstrated a significant (P = 0.012) impact on prognosis after surgery. In addition, convexity meningiomas (21.2%), which were observed in the maximum number of cases, and mean tumor volume (28.67 ± 48.85 mm) were significantly (P = 0.049) associated with the outcome. Most patients (78.8%) underwent total surgical resection, and histopathological examinations revealed a higher frequency of grade 1 than grade 2 tumors. Short duration of hospitalization and superficial location of the tumor are associated with optimal outcomes after surgical resection for patients with meningioma. [ABSTRACT FROM AUTHOR]

Perfluoroalkylated carboxylic acids (PFCAs) are a subclass of man-made chemicals that have been widely used in industrial production and consumer products. As a result, PFCAs have been found to accumulate in the environment and bioaccumulate in organisms, leading to potential health and environmental impacts. This study investigated the inhibition of 11 PFCAs on gonadal 3β-hydroxysteroid dehydrogenases in humans, rats, and mice. We observed a V-shaped inhibition pattern against human granulosa (KGN) cell 3β-HSD2 starting from C9 (half-maximal inhibitory concentration, IC 50 , 100.8 μM) to C11 (8.92 μM), with a V-shaped turn. The same V-shaped inhibition pattern was also observed for PFCAs against rat testicular 3β-HSD1 from C9 (IC 50 , 50.43 μM) to C11 (6.60 μM). Mouse gonadal 3β-HSD6 was insensitive to the inhibition of PFCAs, with an IC 50 of 50.43 μM for C11. All of these PFCAs were mixed inhibitors of gonadal 3β-HSDs. Docking analysis showed that PFCAs bind to the nicotinamide adenine dinucleotide (NAD+)/steroid binding sites of these enzymes and bivariate correlation analysis showed that molecular length determines the inhibitory pattern of PFCAs on these enzymes. In conclusion, the carbon chain length determines the inhibitory strength of PFCAs on human, rat, and mouse gonadal 3β-HSDs, and the inhibitory strength of PFCAs against human and rat 3β-HSD enzymes shows V-shaped turn. [Display omitted] • PFAS inhibit human and rat 3β-HSDs. • The potency of perfluoroalkyl carbonic acids is increased from C9 to C11 and then is declined. • Carbon chain length determines the potency of PFAS with a V-shaped pattern. [ABSTRACT FROM AUTHOR]

• In the unadjusted bivariate analysis there was a tendency for QoL to deteriorate from pre to peri to menopause and then increase slightly post menopause. • Regular exercise resulted in better QoL scores. • Being very overweight and having more menopause symptoms resulted in worse QoL. To determine if quality of life (QoL) changes before, during and after menopause and whether these changes are linked to symptoms, demographics, and/or lifestyle factors. We undertook a cross-sectional online survey. We invited women aged between 35 and 60 years to complete the survey which included the Short-Form 36 (SF-36) generic quality of life measure, the menopause specific Utian-Quality of life (UQOL) measure, and questions about health and wellbeing, menopause symptoms and hormonal stage. The data were analysed with one-way ANOVA analysis and multivariate regression modelling. 279 women completed the survey. Most were aged between 51 and 55 years. In the unadjusted analysis there was a tendency for QoL to deteriorate from pre to peri to menopause and then increase slightly post menopause. This was however not significant in multivariate analysis. Multivariate analysis identified that lifestyle factors significantly influenced QoL. Regular exercise resulted in better QoL scores across a number of the UQol and SF-36 sub-scales. Being very overweight and having more menopause symptoms resulted in worse QoL. Although there was a trend towards worse quality of life in the peri and menopause stages this was not significantly different in adjusted multivariate analyses. Those experiencing more symptoms had significantly worse QoL. Lifestyle factors may affect QoL, but the picture is not straightforward. It is promising that there was a trend toward improved QoL in the post-menopausal stage. These findings should inform education material and promote awareness of the menopause and its impact on QoL. (245) [ABSTRACT FROM AUTHOR]

Gliosarcoma (GSM) is a variant of glioblastoma, 1 of the most common and aggressive primary brain tumors in adults. Our study seeks to analyze a large cohort of patients with GSM in the National Cancer Database (NCDB) to elucidate clinical predictors of overall survival (OS). Data was collected on patients diagnosed with histologically-confirmed GSM using the NCDB (2004–2016). OS was determined via univariate Kaplan-Meier analysis. Bivariate and multivariate Cox proportional-hazards analyses were also utilized. Our cohort of 1015 patients had a median age at diagnosis of 61 years. Six hundred thirty-one (62.2%) were male, 896 (89.0%) were Caucasian, and 698 (68.8%) lacked any comorbidities. Median OS was 11.5 months. Regarding treatment, 264 (26.5%) patients underwent surgery (S) only (OS = 5.19 months), 61 (6.1%) underwent surgery and radiotherapy (S + RT) (OS = 6.87 months), 20 (2.0%) underwent surgery and chemotherapy (S + CT); (OS = 15.51 months), and 653 (65.4%) underwent S + CT + RT (triple) combination therapy (OS = 13.8 months). Notably, on bivariate analysis, S + CT (Hazard ratio [HR] = 0.59, P -value = 0.04) and triple therapy (HR = 0.57, P < 0.01) were associated with increased OS. S + RT was not significantly associated with OS. Similarly, on multivariate Cox proportional-hazards analyses, gross total resection (HR = 0.76, P = 0.02), S + CT (HR = 0.46, P < 0.01), and triple therapy (HR = 0.52, P < 0.01) predicted significantly increased OS. Furthermore, age >60 years old (HR = 1.03, P < 0.01) and the presence of comorbidities (HR = 1.43, P < 0.01) predicted significantly decreased OS. Despite maximal multimodal treatment, GSMs have poor median OS. NCDB data suggest age, comorbidities, extent of resection, and adjuvant treatment each minimally delays poor outcomes. [ABSTRACT FROM AUTHOR]

A considerable body of earlier literature has analysed the determinants of road safety outcomes at the aggregate level. A sub-set of that literature has sought to assess the effect of road expenditure, both investment and maintenance spending, on road safety. The results have been inconclusive and, in part, counterintuitive. To clarify that relationship, this paper undertakes a bivariate analysis using European panel data. Three main results emerge. First, there is only limited evidence of longer-term relationships (common stochastic trends) among different measures of the variables. Second, causality tests on stationary variables suggest that the direction of causality depends on how the variables are measured. Third, unrestricted Vector Autoregression (VAR) analyses suggest that there is a positive relationship from some measures of road safety outcomes to road infrastructure investment, and that an increase in one real measure of road infrastructure investment reduces fatalities permanently, if with a lag. While not modelling the true and complex data generating processes, these bivariate analyses help address the salient empirical issues emerging from earlier literature, and the results provide a detailed description of the relationship between road safety and infrastructure expenditure. • Road safety is a major public policy issue and priority. • Earlier analyses of road expenditure and road safety have been inconclusive. • Variable measurement, causality and time series properties require attention. • Some measures of road expenditure boost road safety and vice versa. [ABSTRACT FROM AUTHOR]

The VS-5 index was recently proposed to predict complications, nonroutine discharge, length of stay (LOS), and cost after vestibular schwannoma (VS) resection. The VS-5 ranges from 0–17.86, and a score ≥2 was proposed as being predictive of postoperative adverse events. We sought to determine whether the VS-5 is predictive of nonroutine discharge and length of stay in an institutional cohort. This is a retrospective study of 100 patients undergoing VS resection. For each patient, a VS-5 score was calculated. Bivariate analyses were conducted to determine differences in postoperative outcomes between high- and low-risk subgroups. Area under the receiver operating characteristic curve sensitivity/specificity analysis using Youden's Index was conducted to evaluate the optimal cutoff. Fifty-one (51%) patients were classified as high risk (VS-5 ≥ 2). Patients with VS-5 ≥ 2 had higher frequency of nonroutine discharge (22% vs. 4%, P = 0.0150) and no significant difference in postoperative LOS. The area under the receiver operating characteristic curve for predicting nonroutine discharge was 0.78 ± 0.15 (P < 0.0001). The optimal cutoff for nonroutine discharge was ≥6, higher than the published cutoff of ≥ 2. The new cutoff was predictive of nonroutine discharge (47% vs. 6%, P = 0 < 0.0001) and LOS (6 [3–11] days vs. 3 [1–28] days, P = 0.0001). The VS-5 frailty index predicted nonroutine discharge but not LOS. Youden's index indicates that a cutoff of 6, not 2, is optimal for predicting nonroutine discharge and LOS. [ABSTRACT FROM AUTHOR]

Tourette syndrome (TS) is associated with learning disabilities and educational impairment. Teacher knowledge about TS may have a positive impact on students with TS, but factors associated with teacher knowledge of TS are not known. In this cross-sectional study, teachers of youth with TS and of a community control group completed a Teacher Understanding of Tourette Syndrome Survey (TUTS), a pilot questionnaire enquiring about self-perceived understanding, teacher knowledge, and sources of information. We compared TUTS scores between TS and control groups and between those who did and did not use specific sources of information about TS using Wilcoxon rank-sum tests. Bivariate correlation analyses were used to evaluate associations between teacher knowledge and potential contributing factors. Data from 114 teachers of children with TS and 78 teachers of control subjects were included. Teachers of youth with TS had significantly more knowledge, had higher self-perceived understanding, and used more sources of information than teachers of the control group. Teachers who knew of the Tourette Association of America and who gathered information themselves had higher knowledge about TS than those who did not. Teachers of children with TS know more about TS and use more sources to learn about TS than teachers of children without TS. [ABSTRACT FROM AUTHOR]

The Lomax model, also known as Pareto Type-II, has broad feasibility, especially in financing. This work introduces a new generalization of the Lomax model called the arc-sine exponentiation Lomax, which helps consider economic phenomena. The arc-sine exponentiation Lomax distribution captures a variety of shapes of density and hazard functions. The estimators of the proposed model's parameters are derived using the maximum likelihood method. In a simulation study, the accuracy and efficacy of estimators are evaluated by computing their mean square errors and biases. Furthermore, a bivariate extension of the arc-sine exponentiation Lomax model is also introduced. The bivariate extension is introduced using Farlie–Gumble–Morgenstern copula approach. The new bivariate model is called Farlie–Gumble–Morgenstern arc-sine exponentiation Lomax distribution. Finally, a data set of thirty-two observations representing the export of goods demonstrates the arc-sine exponentiation Lomax model. The best-fitting results of the arc-sine exponentiatial Lomax are compared with some prominent extensions of the Lomax distribution. [ABSTRACT FROM AUTHOR]

Describir el compromiso cutáneo (CC) en pacientes con lupus eritematoso sistémico (LES) al inicio de la enfermedad y durante el seguimiento. Determinar factores asociados a dicho compromiso al comienzo de la enfermedad. Estudio retrospectivo, observacional y descriptivo, de centro único, en pacientes con diagnóstico de LES (ACR 97 o SLICC 2012). Se utilizó la clasificación de Gilliam modificada para el CC. Se realizó estadística descriptiva y análisis bivariado y multivariado para evaluar los factores asociados al compromiso cutáneo. Se incluyeron 149 pacientes (91,3% mujeres) con una mediana de edad al diagnóstico de 33 años. El CC al inicio de la enfermedad ocurrió en 125 pacientes (83,9%), seguido por compromiso articular en 120 (80,5%). Las lesiones no específicas fueron más frecuentes que las específicas: 92,8% versus 66,4%, respectivamente. En el análisis bivariado, la mayor demora al diagnóstico, la presencia de compromiso articular, la menor presencia de trombocitopenia y la mayor puntuación de SLEDAI-2K se asociaron con la presencia de CC al inicio de la enfermedad. En el análisis multivariado, la variable que se mantuvo asociada de manera independiente fue el compromiso articular (OR: 2,8; IC 95%: 1,1-7,5; p = 0,04). Durante el seguimiento, 4/24 pacientes que no habían presentado CC al diagnóstico y 51/125 pacientes que sí lo presentaron tuvieron al menos un nuevo episodio cutáneo (rango: 1-5 brotes). Nuestro estudio demuestra la alta frecuencia de pacientes que presentan compromiso cutáneo en el LES, tanto en el diagnóstico como evolutivamente, y confirma los datos reportados previamente en cuanto a la existencia de un fenotipo cutáneo-articular. To describe skin involvement (SI) in patients with systemic lupus erythematosus (SLE) at onset and during follow-up of the disease and to determine factors associated with SI at lupus diagnosis. Retrospective, observational, and descriptive study, from a single centre in patients diagnosed with SLE (ACR 1982-97 or SLICC 2012 criteria). The modified Gilliam classification for SI was used. Descriptive statistics and bivariate and multivariate analysis were performed to evaluate the factors associated with SI at diagnosis of the disease. A total of 149 patients were included, 91.3% women, with a median age at diagnosis of 33 years. SI at onset of the disease occurred in 125 patients (83.9%), followed by joint involvement in 120 cases (80.5%). Non-specific skin lesions were more frequent than specific lesions, 92.8% versus 66.4%, respectively. In the bivariate analysis, a longer delay to diagnosis, the presence of joint involvement, a lower presence of thrombocytopenia, and a higher SLEDAI-2K score were associated with the presence of SI at onset of the disease. In the multivariate analysis, the variable that remained independently associated was joint involvement (OR: 2.8: 95% CI: 1.1-7.5; P =.04). During follow-up, 4/24 patients who had not presented SI at diagnosis and 51/125 patients who had, had at least one new skin flare (range: 1-5 outbreaks). Our study demonstrates the high frequency of skin involvement in SLE, both diagnostically and evolutionarily, and confirms previously reported data regarding the existence of a skin-articular phenotype. [ABSTRACT FROM AUTHOR]

Construction and demolition waste (CDW) is produced in conjunction with construction projects at various phases. In Egypt's situation, the disposal of CDW issue has grown to be a major problem, and there is an urgent need to discover a safe disposal method. Based on the exploration of the literature, three main factors that affect the safe disposal of CDW (SDCDW) were found as follows: (1) management of route, collection and transportation; (2) determination of illegal waste dumping sites; and (3) construction waste tracking and scheduling. In this paper, a wide sample of construction industry academics and practitioners were approached by an online survey questionnaire for (1) investigating the applicability and effectiveness of SDCDW factors in the Egyptian construction industry; and (2) examining the relationship between these factors and SDCDW. Different statistical methods were used such as Relative Importance Index (RII) to rank the framework items. In addition, Bi-variate correlation analysis was conducted to test the effectiveness of automation techniques included in the framework with respect to the level of agreement upon reaching safe disposal of CDW. The findings showed that (1) among the various factors, "selection of the shortest path transport route" has the highest applicability, while "detection of CDW illegal disposal sites" is the most effective factor; and (2) there exist positive statistical relationships between SDCDW and all of the various factors. The findings show that creating a conceptual framework for SDCDW in Egypt, which includes these various elements, is necessary as the next research initiative. [ABSTRACT FROM AUTHOR]

Beavers and muskrats are semi-aquatic, generalist herbivorous rodents regarded as invasive in southern South America, with high impacts on the ecosystem. They share some morphological characters of the skull, but different body sizes and phylogenetic history, showing evident shape differences in young and adult skulls during the development in both species. Considering their similar ecological specializations, skull shape could be achieved through different or similar patterns of allometric growth during ontogeny. We analyzed quantitatively the ontogenetic series including 94 specimens of beavers and muskrats and performed multivariate and bivariate analyses considering 20 linear measurements. Our main results from the different approaches suggest high differences in the ontogenetic trajectories of beavers and muskrats, implying disparity in the muscular, functional, and structural conditions of the skull of both species. These differences reflect that although skulls might undergo similar mechanical stress, it is possible to reach a cranial morphology compatible with the similar behavioral and ecological specializations between both species from patterns of skull development that are markedly different. [Display omitted] [ABSTRACT FROM AUTHOR]

Pineoblastomas (PBLs) are rare high-grade tumors treated variably with surgery and/or radiation. The role of surgical extent of resection and radiotherapy (RT) in adult PBL remains unclear. We queried the Surveillance, Epidemiology, and End Results (SEER) database to assess these variables' effects on overall survival (OS) in adult PBL. The SEER (1975–2016) database was queried for adult patients with diagnosis of PBL (ICD-0-3: 9362/3). Variables extracted included age, sex, race, geographical region, extent of tumor resection, RT, chemotherapy (CT), and OS data. Comparisons were performed with the χ2 test for categorical variables, Cox proportional hazards models to assess the association of clinical variables on OS, and Kaplan-Meier curves were generated. A total of 201 patients with PBL were identified with mean age 40.0 years (interquartile range 27.0–51.0) and most patients being male (53%) and Caucasian (77%). 101 (50%) patients received RT, and gross total resection was achieved in 83 (41%). Age stratification by decade revealed statistically significant poorer OS in patients aged ≥70 years. In bivariate analysis, RT with or without surgery was associated with improved 5-year OS compared with no RT (77.3% vs. 63.2%, P = 0.020). In multivariate analysis, age was a poor prognostic factor for OS (P < 0.001) and RT did appear to improve survival (P = 0.020). Extent of surgical resection was not significantly associated with improved survival. In adult patients with PBL, RT may offer an OS benefit irrespective of surgery or extent of surgical resection. Patients ≥70 years of age are associated with poorer OS. [ABSTRACT FROM AUTHOR]

Streptococcus pneumoniae is a leading cause of bacterial meningitis worldwide. Conventional microbiological assays take several days and require the use of various drugs for empirical treatment. Rapid antigen tests in cerebrospinal fluid (CSF) may be useful to triage pneumococcal meningitis immediately. To elucidate whether rapid antigen tests in CSF are useful in the triage of pneumococcal meningitis. Data sources Cochrane CENTRAL, MEDLINE, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov databases were searched. Study eligibility criteria All types of cohort studies except multiple-group studies, where the sensitivity and specificity of rapid antigen tests in CSF compared with CSF culture can be extracted. Participants Patients with suspected meningitis. Tests Rapid antigen tests in CSF. Reference standards One or more of the following: blood culture, CSF culture, and polymerase chain reaction in CSF. Assessment of risk of bias The methodological quality of the included studies was assessed using QUADAS-2. Methods of data synthesis We used a random-effects bivariate model for the meta-analysis. We conducted a subgroup analysis by dividing studies into types of antigen tests, adults and children, low-income and high-income countries, and with or without exposure to antibiotics before lumbar puncture. Forty-four studies involving 14 791 participants were included. Most studies had a moderate-to-low methodological quality. Summary sensitivity and specificity were 99.5% (95% confidence interval (CI), 92.4–100%) and 98.2% (95% CI, 96.9–98.9%), respectively. Positive predictive values and negative predictive values at the median prevalence (4.2%) in the included studies were 70.8% (95% CI, 56.6–79.9%) and 100% (95% CI, 99.7–100%), respectively. The diagnostic accuracy was consistent across the various subgroups, except for slightly reduced sensitivity in high-income countries. Rapid antigen tests in CSF would be useful in triaging pneumococcal meningitis. Further studies are warranted to investigate the clinical benefit of ruling out pneumococcal meningitis based on the results of rapid antigen tests. [ABSTRACT FROM AUTHOR]

Background: Fatal drug overdoses, now primarily driven by illicit opioids like fentanyl, continue to increase in the United States, reflecting a growing need for prevention and treatment strategies. Preventive interventions have primarily focused on curbing opioid prescribing, and treatment strategies target individuals. However, little is known about the broader social context surrounding these individuals.Objective: This study examines the association between drug overdose mortality and social determinants of health (SDOH) across different levels of influence in the social-ecological model.Methods: Data on drug overdose death and SDOH were collected at the county level for most mid-Atlantic states in 2019. Association between each characteristic and drug overdose mortality was measured through a bivariate analysis. Furthermore, a multivariate analysis was performed to detect risk factors of drug overdose death while adjusting for multiple comparisons. All statistical analyses were performed with SAS version 9.4.Results: SDOH, including violent crime (P < 0.001), access to the Internet (P < 0.001), per capita income (P < 0.001), social vulnerability index (P = 0.001), and access to health care (P < 0.001), demonstrated a statistically significant positive association with drug overdose death. In contrast, vacancy rate was negatively associated with drug overdose mortality (P < 0.001). The association between drug overdose deaths and opioid prescription rates was not statistically significant (P = 0.412).Conclusion: Factors such as violent crime and social vulnerability demonstrated a statistically significant impact on drug overdose mortality. To address drug overdose crisis, health care system, community leaders, and policy makers' strategies should focus on socially vulnerable populations. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare disparities linked to patient rurality and socioeconomic status are known to exist, but few studies have examined the effect of urban versus rural status on outcomes after orthopedic trauma surgery. The aim of this study was to examine the correlation between patient rurality, socioeconomic status, and outcomes after orthopedic trauma.Materials and Methods: This is a retrospective cohort study of patients diagnosed with a hip or long bone fracture between January 2016 and December 2017. Data were collected from the Nationwide Inpatient Sample (NIS), a 20% weighted sample of 95% of the U.S. inpatient population. Patients were stratified into 3 groups: isolated hip fracture, isolated long bone fracture, and polytrauma. Bivariate analysis was completed using chi-squared tests for categorical variables and t-tests for continuous variables. Multivariable analysis was completed using population-weighted logistic regression models, based on a conceptual model derived selection of covariates.Results: We included 235,393 patients diagnosed with a hip or extremity fracture. These were weighted to represent 1,176,965 patients nationally. In the hip fracture group, rural patient status was associated with higher odds of mortality (OR 1.32, P < 0.001) but not complications (OR 0.95, P = 0.082). In the extremity fracture and polytrauma groups, rural patient status was not associated with significantly higher odds of mortality or complications. In the urban polytrauma group, zip code with below-median income was associated with increased odds of mortality (OR 1.23, P = 0.002) but not complications. In the rural polytrauma group, zip code with below-median income was not associated with significantly increased odds of mortality or complications. In the hip fracture and extremity fracture groups, below-median income was not associated with significantly higher odds of mortality.Conclusion: We found that rural patients with hip fracture have higher mortality compared to urban patients and that socioeconomic disparities in mortality after a polytrauma exist in urban settings. These results speak to the ongoing need to develop objective measures of disparity-sensitive healthcare and optimize trauma systems to better serve low-income patients and patients in rural areas. [ABSTRACT FROM AUTHOR]

This systematic review analyses the potential of cocoa residues for energy conversion using anaerobic digestion and evaluates strategies for optimizing methane production yields, retrieving information from papers published on anaerobic digestion of cocoa residues in journals indexed in Scopus, Web of Science, and PubMed databases. The articles were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The effects of operational and compositional variables were evaluated by multivariate (PCA) and bivariate (correlation) statistics. A total of twenty-two studies were selected for this systematic review, and five of them were considered for meta-analysis. This search evidenced a lack of studies on the anaerobic digestion of cocoa residues, leading to, for example, high heterogeneity in methane yields between studies (163 to 382 mL CH4 gVS−1). Operational and compositional conditions in the anaerobic digestion were comparable (statistically significant correlations), and anaerobic digestion was considered efficient in the treatment of cocoa residues. In the meta-analysis, optimizing strategies did not significantly affect methane yields. Nonetheless, pretreatment using organic solvents can lead to inhibitory effects on the process. Anaerobic co-digestion can be considered a satisfactory strategy depending on the origin of the co-substrate. In conclusion, this review has worldwide relevance for the waste treatment sector and regarding the search for sustainable energy alternatives. To the best of our knowledge, this study was the first one that used quantitative methods such as multivariate bivariate statistical approaches and meta-analysis to answer questions related to the energy conversion of cocoa residues using anaerobic digestion. • Anaerobic digestion is poorly studied using cocoa residues as biomass. • Cocoa residues are potential biomass for biogas production. • Optimization strategies did not show statistical significance in the meta-analysis. • Co-digestion can increase methane yields. [ABSTRACT FROM AUTHOR]

This article focuses on the estimation and design aspects of a bivariate collocated cokriging experiment. For a large class of covariance matrices, a linear dependency criterion is identified, which allows the best linear unbiased estimator of the primary variable in a bivariate collocated cokriging setup to reduce to a univariate kriging estimator. Exact optimal designs for efficient prediction for such simple and ordinary reduced cokriging models with one-dimensional inputs are determined. Designs are found by minimizing the maximum and the integrated prediction variance, where the primary variable is an Ornstein–Uhlenbeck process. For simple and ordinary cokriging models with known covariance parameters, the equispaced design is shown to be optimal for both criterion functions. The more realistic scenario of unknown covariance parameters is addressed by assuming prior distributions on the parameter vector, thus adopting a Bayesian approach to the design problem. The equispaced design is proved to be the Bayesian optimal design for both criteria. The work is motivated by designing an optimal water monitoring system for an Indian river. • A linear dependency condition for reduction of simple and ordinary cokriging model to kriging model • Introduction of the generalized Markov-type covariance • G-optimal designs for reduced bivariate cokriging models under a frequentist setup • G-optimal and I-optimal designs for reduced bivariate cokriging models under a Bayesian setup [ABSTRACT FROM AUTHOR]

• Prevalence of work-related injuries was estimated at 361 per 10,000 people in our study population. • Work-related injuries decreased with increasing age. • Work-related injuries increased utilization of some types of healthcare. • Workplace injuries can be associated with ongoing health problems. Introduction: Prior studies examining the relationship between work- related injuries and healthcare use among middle-aged and older workers were mainly cross-sectional and reported inconsistent results. Objective: The objective of this study was to examine the associations between work-related injuries and 10 types of healthcare service use for any cause among middle-aged and older Canadian workers using longitudinal data. Methods: Our study involved longitudinal analysis of baseline and 18-month follow-up Maintaining Contact Questionnaire data from the Canadian Longitudinal Survey on Aging (CLSA) for a national sample of Canadian males and females aged 45–85 years who worked or were recently retired (N = 24,748). Results: Among CLSA participants who worked or were recently retired, 361 per 10,000 reported a work-related injury within the year prior to the survey. Work-related injuries decreased with increasing age. Work-related injury was associated with emergency department visits, overnight hospitalization, visits to dentists, and visits to physiotherapists, occupational therapists, or chiropractors at follow-up in bivariate analyses. Compared to those with no work-related injuries, Canadians with work-related injuries had used, on average, a significantly higher number of health services within the last 12 months prior their survey. When controlling for the contribution of various socio-demographic, work-related, and health-related characteristics, work-related injuries remained a significant predictor of emergency department visits and visits to physiotherapists, occupational therapists, or chiropractors. Conclusions: The relationship between work-related injuries, emergency department visits, and visits to physiotherapists, occupational therapists, or chiropractors in middle-aged and older workers in Canada suggests that workplace injuries can be associated with ongoing health problems. Practical Applications: Healthcare services used by injured employees must be considered priorities for employment insurance coverage, if not already covered. Future research should more fully examine whether pre-existing health conditions predict both work-related injury and subsequent health problems. Injury-specific healthcare use following work-related injuries in middle-aged and older workers, as well as economic costs, should also be examined. [ABSTRACT FROM AUTHOR]

Cranioplasty is a common neurosurgical procedure and autologous grafts are preferred due to their aesthetic and biocompatibility benefits. Multiple risk factors are implicated as predictors for neurologic outcome. This study focuses on risk factors that may be associated with complications and analyzes the predictors of neurologic outcomes after autologous cranioplasty. This is a retrospective observational study conducted at a tertiary care center between 2015 and 2021. Adults with autologous cranioplasty (n = 132) were recruited from procedure logs and the hospital electronic health record. Clinicodemographic parameters, risk factors, and complications were recorded. Neurologic outcomes were measured using the dichotomized Glasgow Outcome Scale (GOS). Primary outcome measure was pre- and post-cranioplasty GOS at the last follow up. Secondary outcome measures were the predicting factors that contributed to enhanced neurologic outcome post-cranioplasty. Mean age was 41.4 (standard deviation ± 13.5) years with male predominance (12.2:1). Complications developed in 12.9% (n = 17), with infections in 3.8% (n = 5) and hydrocephalus in 2.3% (n = 3). In bivariate analysis, pre-cranioplasty GOS good grades 4 and 5 (P < 0.001), trauma as an indication for decompressive craniectomy (DC) (P < 0.001), and early cranioplasty ≤12 weeks (P = 0.023) were statistically significant predictors for post-cranioplasty neurologic recovery at follow-up. In a multiple logistic regression model, adjusted odds ratio for pre-cranioplasty GOS was 28.77 (95% confidence interval [CI] 7.21–114.74, P < 0.001), for trauma as indication for DC was 5.15 (95% CI 1.65–16.05, P = 0.003), and for early cranioplasty ≤12 weeks was 3.04 (95% CI 1.12–8.27 P = 0.029). Autologous cranioplasty contributes to a quantifiable neurologic outcome. Pre-cranioplasty neurologic status, cranioplasty done for traumatic DC and early cranioplasty may have potential for enhanced neurologic recovery. Further clinical studies with better evidence may expound upon these findings. [ABSTRACT FROM AUTHOR]

Introduction: People with disabilities report a higher prevalence of cigarette use than people without disabilities. However, evidence is limited on the relationships between disability type, degree of functional difficulty, and other tobacco product use.Methods: Data from the 2019 U.S. National Health Interview Survey were used to estimate the prevalence and odds of tobacco product use for 6 disability types and degree of functional difficulty. Bivariate and multivariable analyses conducted in 2021 examined the associations between tobacco product use and disability type.Results: Compared to adults who reported no difficulty, current cigarette use prevalence was higher for adults who reported a lot of difficulty/cannot do at all to vision (21.5% vs 13.1%), hearing (19.6% vs 13.6%), mobility (20.0% vs 12.9%), and cognitive (25.4% vs 12.9%) disability questions. The odds of current cigarette (AOR=1.32), pipe (AOR=1.85), and smokeless tobacco (AOR=1.57) use were significantly higher for adults who reported a lot of difficulty/cannot do at all to any disability question and significantly higher for current cigarette (AOR=1.24), e-cigarette (AOR=1.33), pipe (AOR=1.45), and smokeless tobacco (AOR=1.29) use for adults who reported some difficulty to any disability question than those who reported no difficulty. Pipe use was correlated with mobility difficulty (AOR=1.68), and smokeless tobacco use was correlated with hearing difficulty (AOR=1.95).Conclusions: People who reported difficulty with vision, hearing, mobility, or cognition had a higher cigarette use prevalence than people without disabilities. Other tobacco use differed by disability type. Future research should tailor tobacco interventions to reduce these disparities. [ABSTRACT FROM AUTHOR]

This study aims to compare low socioeconomic status, urban early adolescents' (EAs) attitudes toward gender, gender diversity and sexual diversity in two contexts with similar progressive legal frameworks for gender equality and nondiscrimination, South Africa and Belgium, to understand the ways in which adolescents modify or conform to prevailing attitudes. The study used a cross-sectional design and sampled 1,102 and 569 EAs (between 11 and 15 years old) in Belgium and South Africa respectively. Quantitative data were collected using tablets. Sample characteristics and gender attitude scales are described and compared in the two countries, and between boys and girls within each country. Comparisons are conducted on the mean score for the 5-point Likert scale items on the gender attitude scales. Girls in both countries expressed more tolerant attitudes toward same-sex romantic relationships and experienced more gender diverse emotional attraction and physical attraction to same-sex individuals than boys. Generally, boys endorsed more heteronormative relationship norms and other stereotypical attitudes than girls. Conversely, girls tended to embrace sexual double standards more than boys. South African EAs exhibited more sexual diversity but less tolerant attitudes toward gender and gender diversity. Belgian EAs, especially girls, tended to exhibit more tolerant attitudes toward diversity in gender identity. There were important differences in attitudes toward gender, gender diversity, and sexual diversity among EAs, despite the countries' similar progressive legislative frameworks. In the future, sociocultural and other determinants of EAs' attitudes should be further explored at different levels from the individual to the societal. [ABSTRACT FROM AUTHOR]

Proximal junctional kyphosis (PJK) is a radiographic complication following adult spinal deformity (ASD) surgery. The decision-making process for PJK revision surgery is multi-faceted, involving the evaluation of clinical symptoms, radiographic findings, and patient-specific factors. To compare characteristics between ASD patients who received PJK revision at various time points and who did not receive PJK revision at all. Prospective, multicenter cohort of ASD patients with PJK. A total of 113 ASD patients who underwent surgery for complex spinal correction and developed PJK postoperatively. Spinopelvic parameters associated with the timing for revision surgery in patients who develop PJK following ASD surgery. Data was obtained from a multicenter database. Patients with ASD diagnosed with PJK were identified; those who had a revision within 6W were excluded due to the lack of postoperative films before 6W. The remaining patients were separated into groups: received revision surgery within two years, between two and four years, or no revision surgery within four years. Demographic variables were included. The SRS-22 questionnaire was used to assess health-related quality-of-life (HRQOL) at baseline. Spinopelvic parameters at 6W were collected, including C2-pelvic angle (C2PA), T4-pelvic angle (T4PA), L1-pelvic angle (L1PA), and T4PA-L1PA mismatch. Additionally, the incidence of preceding neurologic complications (within one year of PJK diagnosis) was determined. Hart-PJK severity score (PJKSS) was calculated without instrumentation or fracture components due to a lack of specific data. Bivariate analysis was performed with the Kruskal-Wallis and chi-squared tests. A total of 113 patients diagnosed with PJK were included. Six patients who had revision before six weeks postoperatively were excluded. Forty-seven patients (41.6%) had a revision surgery between 6 weeks and 2 years, 18 had a revision between 2 and 4 years (15.9%), and 48 patients (42.5%) had no revision surgery within 4 years. There were no significant differences between C2PA (p = 0.719), T4PA (p = 0.701), L1PA (p = 0.934), and T4PA-L1PA mismatch (p = 0.613) at 6W between the three groups. Likewise, the incidence of neurologic complications was not significantly different (p = 0.797). Early 6W postoperative spinopelvic parameters and the incidence of neurologic complications do not explain the timing of revision surgery. Additionally, demographics and HRQOL are similar among patients who received revision surgery for PJK and those who did not. Surgeons may be utilizing different variables for early risk stratification of PJK revision. This abstract does not discuss or include any applicable devices or drugs. [ABSTRACT FROM AUTHOR]

A new model for general cyclical long memory is introduced, by means of random modulation of certain bivariate long memory time series. This construction essentially decouples the two key features of cyclical long memory: quasi-periodicity and long-term persistence. It further allows for a general cyclical phase in cyclical long memory time series. Several choices for suitable bivariate long memory series are discussed, including a parametric fractionally integrated vector ARMA model. The parametric models introduced in this work have explicit autocovariance functions that can be readily used in simulation, estimation, and other tasks. [ABSTRACT FROM AUTHOR]

The four-factor model of emotional intelligence (EI) abilities has faced challenges in the inconsistency of the facilitation branch leading Mayer et al. (2024) to propose a provisional factor- Connecting Emotions- that consists of relating emotions to sensations. The Aesthetic Descriptors of Emotion Measure (ADEM) has emerging potential as a measure of this new EI ability factor. The ADEM is a performance measure based on the Aesthetic Approach to Emotions (AAE) that matches descriptive aesthetic-sensory language to emotional states providing a non-evaluative representation of emotions. The ADEM presents six emotions and found distinct aesthetic profiles for each. Cronbach Alpha and factor analyses respectively found consistency and validity with the internal structure of the ADEM. Bivariate and partial bivariate analyses (controlling for cognitive reasoning) indicated that the ADEM corresponds with self-perceived measures of emotional clarity and a similar performance-based EI measure (MEIS-Synesthesia subtest). The ADEM has potential as a method for developing EI in educational and clinical settings. [ABSTRACT FROM AUTHOR]

The multiple-probability decision-making method for earthquake hazards considers multiple performance indicators and can be used to effectively estimate the seismic risk of structures. The seismic vulnerability model directly affects the development of the earthquake risk distribution in regional structures. This paper innovatively developed a bivariate intensity measurement method based on macroscopic and instrumental seismic intensities. An optimized instrument intensity calculation model was established considering the actual monitoring data of historical earthquakes in China. A hybrid seismic vulnerability quantification method based on empirical, expert judgement and analysis has been proposed and applied to evaluate the vulnerability levels of three types of building clusters in two typical earthquakes in Qinghai Province, China (the 2008 Dachaidan (DCD) earthquake and the 2009 Haixi (HX) earthquake). A structural hybrid vulnerability matrix and surface for nine zones based on bivariate intensity measures were developed. A synthetic vulnerability membership index considering fuzzy failure criteria and decision theory was proposed, and vulnerability membership curves for different vulnerability levels were established. An improved earthquake economic loss prediction function is proposed, and synthetic economic vulnerability index prediction models for three typical buildings in different regions are established. The estimated and calculated results of the developed multiscale variable parameter synthetic vulnerability model are highly consistent with the actual earthquake loss observations. • This paper proposes a bivariate intensity measure to estimate the seismic fragility of buildings. • An optimized hybrid vulnerability matrix and surface of typical buildings were established. • The 2008 and 2009 Dachaidan and Haixi earthquakes in Qinghai Province, China, were reported. [ABSTRACT FROM AUTHOR]

Parabens are commonly used preservatives in cosmetics, food, and pharmaceutical products. The objective of this study was to examine the effect of nine parabens on human and rat 17β-hydroxysteroid dehydrogenase 1 (17β-HSD1) in human placental and rat ovarian cytosols, as well as on estradiol synthesis in BeWo cells. The results showed that the IC 50 values for these compounds varied from methylparaben with the weakest inhibition (106.42 μM) to hexylparaben with the strongest inhibition (2.05 μM) on human 17β-HSD1. Mode action analysis revealed that these compounds acted as mixed inhibitors. For rats, the IC 50 values ranged from the weakest inhibition for methylparaben (no inhibition at 100 μM) to the most potent inhibition for hexylparaben (0.87 μM), and they functioned as mixed inhibitors. Docking analysis indicated that parabens bind to the region bridging the NADPH and steroid binding sites of human 17β-HSD1 and the NADPH binding site of rat 17β-HSD1. Bivariate correlation analysis demonstrated negative correlations between LogP, molecular weight, heavy atoms, and apolar desolvation energy, and the IC 50 values of these compounds. In conclusion, this study identified the inhibitory effects of parabens and their binding mechanisms on human and rat 17β-HSD1, as well as their impact on hormone synthesis. [Display omitted] [ABSTRACT FROM AUTHOR]

Patients undergoing orthodontic treatment (OT) face an increased risk of developing external apical root resorption (EARR). A prognostic risk assessment prior to OT can potentially be conducted through anatomical features in panoramic radiography. This retrospective study aimed to assess the significance of Kjær's morphological characteristics in analyzing the risk of EARR. Panoramic radiographs of 1,156 patients (624 females, 532 males) were retrospectively analyzed. Anamnestic and treatment-related data were extracted from patient records. The mean age at the start of OT was 12.8 ± 2.2 years (min. 6.4 years, max. 22.3 years) and at the end of OT 15.9 years (min. 8.5 years, max. 24.1 years). The mean treatment duration was 3.1 ± 1.6 years. Panoramic radiographs with a minimum of two per patient were examined for the presence of Kjær's characteristics. The degree of EARR was registered defining resorption in four degrees of severity. Bivariate analysis and multivariate Poisson regression were performed to assess the association between Kjær's characteristics and EARR patient- and tooth- related (α = 0.05). In total, 72.8% of the patients showed EARR at the end of OT with lateral maxillary incisors most frequently affected. Short roots (p < 0.001) were significantly associated with EARR in patients. Tooth-related microdontia (#12, #22, lower second premolars), narrow crowns (#11, #21, lower incisors), short roots (upper incisors, lower first molars) and ectopia (#11, #21, #13), such as shorter distal roots of the mandibular first molar showed a significant association with EARR depending on severity degree. The type of orthodontic appliance (fixed: p < 0.001, fixed and removeable: p = 0.008), as well as treatment duration (p < 0.001) were also identified as risk factors for EARR. Although the risk assessment for EARR development through panoramic radiography analysis is limited, predisposition appears to be present in specific dental characteristics and treatment-related factors. [ABSTRACT FROM AUTHOR]

To facilitate breeding for improved resistance to the reproductive disorder of retained placenta (RP), genetic parameters were estimated for RP and its genetic correlation with other reproductive disorders as well as with production and fertility traits of Iranian Holstein dairy cows. Data were 154,048 lactation records collected between 2011 and 2018 from 59,610 Holstein dairy cows in 9 Iranian herds. Other reproductive disorders included dystocia, stillbirth, and twinning. Fertility records were available for days from calving to first service (DFS), days open (DO), number of inseminations per conception (NIC), and success of first insemination (SFI). Genetic parameters for RP were estimated using univariate linear and logistic animal models with ASREML software. The univariate linear animal model was used to implement bivariate analysis to investigate potential genetic correlations of RP with other reproductive disorders and with production and fertility traits. Heritability estimates for RP were low from both linear (0.031) and logistic (0.092) animal models. Estimated genetic correlations with RP were −0.04 for twinning, 0.32 for stillbirth, and 0.34 for dystocia, which indicates that selection against RP could indirectly select against dystocia and stillbirth. Estimated genetic correlations between RP and production traits (milk, fat, and protein yields) at 100, 200, and 305 d in milk ranged from −0.12 to −0.29; the greatest correlation (−0.29) was for the first 100 d in milk. A moderate positive genetic correlation (0.25) was found for RP and DO, DFS, and NIC, whereas a low negative genetic correlation (−0.09) was found between RP and SFI. The pedigree-based genetic analysis of RP showed that this trait has a low heritability, is linked to other reproductive disorders, and generally has an unfavorable relationship with production and fertility traits. Selection against RP can reduce the incidence of reproductive disorders and improve fertility and production traits. • Heritability estimates for retained placenta (RP) was less than 0.1. Although in the logistics model it was three times as much as the linear model. • The estimated genetic correlation between RP and dystocia and stillbirth were moderately positive. • The genetic correlations between RP with milk components in different days in milk were moderately negative. • Days open, days from calving to first service had a moderately positive genetic correlation with RP. • Selection against dystocia and stillbirth can reduce the incidence of RP in dairy cows and improve reproductive performance. • The estimated genetic correlation between RP and success in first service was negative and less than 0.1. [ABSTRACT FROM AUTHOR]

Objectives: The EuroQoL 3-level version of EQ-5D and 5-level version of EQ-5D questionnaires are often used to quantify health states. They include ordinal responses across 5 health dimensions (EQ-5D index) and an EQ-visual analog scale (EQ-VAS) overall health rating. We investigated the value of incorporating the EQ-VAS to update health utility estimates using a Bayesian framework.Methods: We created a joint bivariate normal EQ-VAS and EQ-5D index utility model and compared this to a univariate normal EQ-5D index utility model. We tested these models for 1026 Sri Lankan patients with chronic kidney disease and 94 Australian patients with wounds. We validated our approach by simulating EQ-VAS and EQ-5D index responses and applying our Bayesian model and then comparing the modeled estimates to our observed data.Results: The combined model showed a reduction in estimate uncertainty for all respondents. Compared with the EQ-5D index-only model, the mean utility for Sri Lankan respondents dropped from 0.556 (0.534-0.579) to 0.540 (0.521-0.559) in men and increased from 0.489 (0.461-0.518) to 0.528 (0.506-0.550) in women, with reduced credible interval width by 13% and 23%, respectively. The mean utility in Australian respondents moved from 0.715 (0.633-0.800) to 0.716 (0.652-0.782) in men, and 0.652 (0.581-0.723) to 0.652 (0.593-0.711) in women, with reduced credible interval width by 23% and 17%, respectively. The credible interval width for simulated data also narrowed, ranging from 8.3 to 8.5%.Conclusions: Including the EQ-VAS through Bayesian methods can add value by reducing requisite sample sizes and decision uncertainty using small amounts of additional data that is often collected but rarely used. [ABSTRACT FROM AUTHOR]

In order to evaluate the accuracy of commercially available handheld fundus cameras for a variety of ophthalmic diagnoses, we conducted a systematic review, searching PubMed and PubMed Central and performing a bivariate analysis to determine the pooled sensitivity and specificity of handheld fundus cameras. Eleven studies validating handheld fundus cameras against a gold-standard method for disease diagnosis were included. For nonmydriatic images, pooled sensitivity was 83% (95% confidence interval (CI): 77-88%) and specificity was 92% (95% CI: 79-97%). For mydriatic images, pooled sensitivity was 87% (95% CI: 79-92%) and specificity was 90% (95% CI: 78-96%). Overall pooled sensitivity was 85% (95% CI: 80-89%) and specificity was 91% (95% CI: 83-95%). Of the 11 studies included, 5 assessed the diagnosis of diabetic retinopathy, for which sensitivity was 87% (95% CI: 80-92%) and specificity was 95% (95% CI: 85-98%). For all other diagnoses combined, sensitivity was 81% (95% CI: 74-87%) and specificity was 83% (95% CI: 76-89%). These findings suggest that handheld fundus cameras are capable of achieving acceptable sensitivity and specificity values for eye disease, with mydriatic images being more sensitive for disease. Diabetic retinopathy was the single diagnosis with the strongest data to support the use of handheld fundus cameras for disease screening. [ABSTRACT FROM AUTHOR]

Describir si las enfermedades inflamatorias reumáticas (EIR) se asocian con mayor riesgo de hospitalización y/o mortalidad por COVID-19 e identificar los factores asociados a la hospitalización y mortalidad en EIR y COVID-19 en diferentes hospitales de Andalucía. Diseño: Estudio multicéntrico observacional de casos y controles. Pacientes Casos: EIR y COVID-19 de diferentes centros de Andalucía. Controles: pacientes sin EIR pareados por sexo, edad y PCR-COVID. Protocolo Se solicitó al Servicio de Microbiología un listado de pacientes con PCR para COVID-19 desde 14 de marzo al 14 de abril de 2020. Se identificaron los pacientes que tuvieran EIR y luego consecutivamente un control pareado para cada caso. Variables La variable de desenlace principal fue ingreso hospitalario y mortalidad por COVID-19. Análisis estadístico Bivariante seguida de modelos de regresión logística binaria (variable dependiente: mortalidad/ingreso hospitalario). Se incluyeron 156 pacientes con COVID-19, 78 con EIR y 78 sin EIR. Los pacientes con EIR no presentaron características de la enfermedad COVID-19 diferentes a la población general, tampoco mayor ingreso hospitalario ni mortalidad. El factor asociado con mortalidad en los pacientes con EIR fue edad (OR [IC 95%], 1,1 [1,0-1,2]; p = 0,025), mientras que los factores asociados con ingreso hospitalario fueron edad (OR [IC 95%], 1,1 [1,1-1,2]; p = 0,007) e hipertensión arterial (OR [IC 95%], 3,9 [1,5-6,7]; p = 0,003). La mortalidad y el ingreso hospitalario por COVID-19 no parecen aumentados en las EIR. La edad se asoció con mortalidad en EIR y, además, la hipertensión arterial se asoció con ingreso hospitalario. To describe whether rheumatic inflammatory diseases (RID) are associated with a higher risk of hospitalization and/or mortality from COVID-19 and identify the factors associated with hospitalization and mortality in RID and COVID-19 in different Hospitals in Andalusia. Design: Multicentre observational case-control study. Patients: RID and COVID-19 from different centres in Andalusia. Controls: patients without RIS matched by sex, age and CRP-COVID. Protocol A list of patients with PCR for COVID-19 was requested from the microbiology service from March 14 to April 14, 2020. The patients who had RID were identified and then consecutively a paired control for each case. Variables The main outcome variable was hospital admission and mortality from COVID-19. Statistical analysis Bivariate followed by binary logistic regression models (DV: mortality/hospital admission). One hundred and fifty-six patients were included, 78 with RID and COVID-19 and 78 without RID with COVID-19. The patients did not present characteristics of COVID-19 disease different from the general population, nor did they present higher hospital admission or mortality. The factor associated with mortality in patients with RID was advanced age (OR [95% CI], 1.1 [1.0-1.2]; p = 0.025), while the factors associated with hospitalization were advanced age (OR [95% CI], 1.1 [1.0-1.1]; p = 0.007) and hypertension (OR [95% CI], 3.9 [1.5-6.7]; p = 0.003). Mortality and hospital admission due to COVID-19 do not seem to increase in RID. Advanced age was associated with mortality in RID and, in addition, HTN was associated with hospital admission. [ABSTRACT FROM AUTHOR]

Surgical site infections (SSIs) after spine surgery are a significant cause of morbidity. Surgeons often prescribe oral antibiotics in the postoperative setting for infected-appearing wounds to prevent reoperation for infection; however, the efficacy of this practice has not been well studied. Neurosurgical spine patients with clinical concerns for SSI at the University of Pennsylvania were retrospectively studied from 2014 to 2018. Clinical predictors of 90-day reoperation for infection despite antibiotic treatment and variables that influenced antibiotic prescription were analyzed. Three hundred and ninety-two patients were included in the study. Preoperative albumin level, days elapsed to antibiotic prescription from index surgery, preoperative hemoglobin level, surgical location, gender, discharge disposition, and level of wound concern were significant predictors of reoperation for infection on bivariate analysis. Days elapsed to antibiotic prescription, surgical location, and level of wound concern remained significant after multivariable logistic regression. Variables that significantly predicted prescription of an antibiotic include length of stay, cerebrospinal fluid leak, race, and level of wound concern. Length of stay, race, and level of wound concern remained significant after multivariable analysis. Wound infection remains a challenging problem in spine surgery and it is reasonable to perform early reoperation in patients with high clinical concerns for infection, because bacterial isolates are often resistant to common oral antibiotics. Patients with wounds with low clinical concerns for infection may undergo a trial of oral antibiotics; however, duration of treatment should not be prolonged. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the patterns of head and neck injuries secondary to boxing. We conducted a 20-year retrospective cross-sectional study using the National Electronic Injury Submission System (NEISS). We derived the predictor variables from both patient and injury characteristics. The principal outcome variable was the probability of hospital admission from the ED. We used bivariate analysis to determine if an association existed between two variables of interest. We created a multiple logistic regression model to model the probability of admission using all significant univariate predictors. The final sample consisted of 1,919 patients. Children were most likely to injure their heads (p < 0.01). Young adults were also most likely to injure their heads (p < 0.05). Adults were most likely to injure their faces (p < 0.01). Children were most likely to incur facial contusions (p < 0.01) and internal organ injuries (p < 0.01). Young adults were most likely to suffer concussions (p < 0.01). Adults were most likely to suffer lacerations (p < 0.01). Certain age groups were more/less likely to injure a particular anatomical site and more/less likely to incur a particular type of injury. Relative to young adults, seniors had an increased odd of admission. Head injuries had an increased odds of admission relative to mouth injuries. Fractures and internal organ injuries proved to be the most dangerous injuries. [ABSTRACT FROM AUTHOR]

The goal of this resident survey study was to investigate preparedness among orthodontic residents in providing orthodontic treatment with clear aligners and manage the digital workflow for in-house fabrication of clear aligners. A survey questionnaire was emailed to all active AAO resident members which included recent graduates of 2021 (n=1,124) to evaluate didactic education, clinical experience, confidence levels and the residents' future practice plans with regards to clear aligner therapy. Inferential statistics were restricted to bivariate analysis employing Pearson's chi-square tests, CMH tests, and unpaired Student's t-test (p=0.05). A total of 277 Orthodontic residents responded to the survey, with an overall response rate of 25%. Nearly 50% of the residents did not receive didactic classes on clear aligner therapy or fabrication. About 13-17% of the respondents did not have access to CBCT, digital teeth alignment software or 3D printed models. A significant decrease in confidence was found among residents who did not receive this training in their residency programs. Based on the findings of our survey, thorough training and education of the technology used in clear aligner therapy has the potential to improve residents' confidence and competence in utilizing 3D technology and clear aligners in their future practice. [ABSTRACT FROM AUTHOR]

Treating patients with glioblastoma (GBM) requires extensive medical infrastructure. Individualized risk assessment for extended length of stay (LOS), nonroutine discharge disposition, and increased total hospital charges is critical to optimize delivery of care. Our study sought to develop predictive models identifying independent risk factors for these outcomes. We retrospectively reviewed patients undergoing GBM resection at our institution between January 2017 and September 2020. Extended LOS and elevated hospital charges were defined as values in the upper quartile of the cohort. Nonroutine discharge was defined as any disposition other than to home. Multivariate models for each outcome included covariates demonstrating P ≤ 0.10 on bivariate analysis. We identified 265 patients undergoing GBM resection, with an average age of 58.2 years. 24.5% of patients experienced extended LOS, 22.6% underwent nonroutine discharge, and 24.9% incurred elevated total hospital charges. Decreasing Karnofsky Performance Status (KPS) (P = 0.004), increasing modified 5-factor frailty (mFI-5) index (P = 0.012), lower surgeon experience (P = 0.005), emergent surgery (P < 0.0001), and larger tumor volume (P < 0.0001) predicted extended LOS. Independent predictors of nonroutine discharge included older age (P = 0.02), decreasing KPS (P < 0.0001), and emergent surgery (P = 0.048). Nonprivate insurance (P = 0.011), decreasing KPS (P = 0.029), emergent surgery (P < 0.0001), and larger tumor volume (P = 0.004) predicted elevated hospital charges. These models were incorporated into an open-access online calculator (https://neurooncsurgery3.shinyapps.io/gbm%5fcalculator/). Several factors were independent predictors for at least 1 high-value care outcome, with lower KPS and emergent admission associated with each outcome. These models and our calculator may help clinicians provide individualized postoperative risk assessment to glioblastoma patients. [ABSTRACT FROM AUTHOR]