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To determine the utilization rate of a home-based rehabilitation program after an inpatient rehabilitation stay, and to investigate the profile of users. Observational study. Inpatient rehabilitation facility in a tertiary hospital. Older patients (N=1913) discharged home between June 2018 and May 2021, after an inpatient rehabilitation stay. Not applicable. Discharge to home-based rehabilitation. Over the study period, 296 (15.5%) patients were discharged to home-based rehabilitation. Compared with the others, home-based rehabilitation patients were more frequently women (69.6% vs 61.5%; P =.008), and admitted after orthopedic surgery (elective or for fracture) (30.1% vs 16.1%; P <.001). They had worse functional performance at admission (mean Functional Independence Measure self-care score: 27.8±7.3 vs 30.8±6.7; P <.001), but greater gain in self-care during their inpatient stay (5.0±4.8 vs 4.4±4.7; P =.038). In multivariable analysis, being a woman (adjusted odds ratio [adjOR], 1.36; 95% confidence interval [CI], 1.01-1.82; P =.040), being admitted after orthopedic surgery (adjOR, 2.32; 95% CI, 1.64-3.27; P <.001), being admitted for gait disorders or falls (adjOR, 1.38; 95% CI, 1.01-1.88; P =.039), and showing greater gain in mobility during the inpatient stay (adjOR, 1.12; 95% CI, 1.07-1.17; P <.001) remained associated with discharge to home-based rehabilitation. In contrast, higher mobility at discharge decreased the odds of discharge to home-based rehabilitation (adjOR, 0.87; 95% CI, 0.83-0.91; P <.001). One in 6 patients benefited from home-based rehabilitation after their inpatient stay. Although these patients had poorer functional performance at admission and discharge, they showed greater mobility improvement during their inpatient stay, suggesting that their good recovery potential was a key determinant of their orientation toward home-based rehabilitation. [ABSTRACT FROM AUTHOR]

Objectives: This study describes the utilization of a pediatric emergency department (ED) during the early months of the COVID-19 pandemic in the initial U.S. epicenter, including the impact on visit acuity and incidences of common diagnoses.Study Design: We performed an observational retrospective review of patients younger than 18 years old seen in a New York City pediatric ED from March 7th to May 6th 2020, and during the same time period in 2018 and 2019. Demographics, visit details, diagnoses, and dispositions were compared. Validated algorithms were utilized to create practical diagnosis groupings and to determine the probability of a visit requiring emergent evaluation.Results: ED visits during the pandemic decreased by 56% to an average daily census of 67 patients, from an anticipated 152. Admission rates rose from 13.3% to 17.4% (p<0.001), and the proportion of triage Emergency Severity Index level 1 and 2 patients increased by 23.7% (p<0.001). Non-emergent visits dropped from 32.3% to 27.5% (p<0.001). Several common, often low-acuity diagnoses saw disproportionate reductions in visits including headache, chest pain, and minor injuries. Concerningly, visits for suicidal ideation, suicide attempt, or self-harm increased by 100% (p<0.001) and visits for evaluating abuse or neglect decreased by 89% (p=0.01).Conclusions: Pediatric ED utilization substantially deceased during the early months of the COVID-19 pandemic in New York City, but left relatively higher patient acuity. Healthcare systems in early epicenters must also prepare for the disproportionate impact a pandemic has on the most vulnerable pediatric patients, particularly those at risk for self-harm or abuse. [ABSTRACT FROM AUTHOR]

To examine the relationship between falls efficacy and the change in gait speed and functional status in older patients undergoing postacute rehabilitation. Prospective cohort study. Postacute rehabilitation facility. Patients (N=180) aged 65 years and older (mean age ± SD, 81.3±7.1y). Not applicable. Data on demographics; functional, cognitive, and affective status; and falls efficacy using a 10-item version of the Falls Efficacy Scale (FES; range, 0-100) were collected upon admission. Data about gait speed and functional status (Barthel Index and Basic Activities of Daily Living [BADL]) were measured at admission and discharge. In addition, BADL performance was self-reported 1 month after discharge. Compared with admission, all rehabilitation outcomes improved at discharge: gait speed (0.41±0.15 m/s vs 0.50±0.16 m/s; P <.001), Barthel Index score (68.4±16.3 vs 82.5±13.6; P <.001), and BADL (3.5±1.6 vs 4.7±1.3; P <.001). Adjusting for baseline status and other potential confounders, baseline FES independently predicted gait speed (adjusted coefficient: 0.002; 95% confidence interval [CI], 0.000-0.004; P =.025) and Barthel index (adjusted coefficient: 0.225; 95% CI, 0.014-0.435; P =.037) at discharge, with higher confidence at baseline predicting greater improvement. Baseline FES was also independently associated with self-reported BADL performance at the 1-month follow-up (adjusted coefficient: 0.020; 95% CI, 0.010-0.031; P <.001). In older patients, higher falls efficacy predicted better gait and functional rehabilitation outcomes, independently of baseline performance. These results suggest that interventions aiming at falls efficacy improvement during rehabilitation might also contribute to enhancing gait speed and functional status in patients admitted to this setting. • Falls efficacy (FE) represents the confidence in performing daily activities without falling. • This study examined FE as a determinant of successful inpatient geriatric rehabilitation. • Higher FE predicted better gait speed and functional status at discharge from rehabilitation. • Interventions in rehabilitation aimed at enhancing FE may contribute to patient progress. [ABSTRACT FROM AUTHOR]

Pesticides are used worldwide with potential harmful effects on both fauna and flora. The Kibale National Park in Uganda, a site renowned for its biodiversity is surrounded by tea, banana and eucalyptus plantations as well as maize fields and small farms. We previously showed presence of pesticides with potential endocrine disruptive effects in the vicinity. To further investigate the water pollution linked to agricultural pressure in this protected area, we implemented a complementary monitoring strategy based on: analytical chemistry, effects based methods and the deployment of Polar Organic Chemical Integrative Samplers (POCIS). Chemical analysis of the POCIS extracts revealed the presence of 13 pesticides: carbofuran, DEET, 2.4-D amine, carbaryl, ametryn, isoproturon, metolachlor, terbutryn, dimethoate, imidacloprid, picaridin, thiamethoxam, carbendazim, with the first three being present in the largest quantities. Water samples collected at the POCIS sampling sites exhibited thyroid and estrogen axis disrupting activities in vivo , in addition to developmental and behaviour effects on Xenopus laevis tadpoles model. Based on our observations, for the health of local human and wildlife populations, further monitoring as well as actions to reduce agrochemical use should be considered in the Kibale National Park and in regions exposed to similar conditions. Image 1 • The Kibale national park (KNP) in Uganda is a hotspot of biodiversity. • Wildlife in the northern part of KNP is threatened by the presence of phytochemicals. • Chemical analysis of local river water revealed the presence of 13 pesticides. • Local river water exhibited thyroid and estrogen disrupting activities in vivo. • Further monitoring and pesticide usage reduction should be considered in KNP. Water collected in Kibale national park in Uganda contains 13 pesticides and exhibits thyroid and estrogen axis disruption in aquatic larvae. [ABSTRACT FROM AUTHOR]

To prevent worsening of ankle valgus and functional repercussions, a distal inter-tibiofibular osteochondroma can be removed using a transfibular approach. We evaluated the difference between the preoperative and postoperative tibiotalar tilt at the last follow-up examination and the clinical and radiologic outcomes. We included 10 consecutive ankles that had undergone removal of an osteochondroma using a transfibular approach. The mean patient age was 10.6 years. One ankle was lost to follow-up. The mean postoperative follow-up duration was 5.9 years. The mean preoperative and postoperative tibiotalar tilt was 7.2° and 7.1°, respectively, with no significant difference. The mean postoperative American Orthopaedic Foot and Ankle Society score was 92.4. Tibiofibular synostosis developed in 7 cases. Osteochondroma recurred in 1 case. The transfibular approach stabilizes ankle valgus and is associated with good functional outcomes. However, it is an extensive procedure associated with postoperative synostosis and, thus, should be considered primarily when surgical access for an anterior approach is limited. [ABSTRACT FROM AUTHOR]

Symptomatic tarsal coalitions that begin in early adolescence are usually treated by resection and interposition (fat, muscle, or bone wax) to prevent recurrence. The purpose of the present retrospective study was to describe our operative technique and report our clinical and radiologic outcomes with sterile silicone sheet interposition after resection of painful tarsal coalitions in 4 children (4 feet). The present series included 1 case of talocalcaneal synchondrosis and 3 of synostosis (2 talocalcaneal and 1 cuboid-navicular). Two validated functional scales were used to assess the patients' overall outcome and satisfaction with the procedure: the American Orthopaedic Foot and Ankle Society ankle-hindfoot score and the Foot Function Index. Conventional radiography, computed tomography with 3-dimensional reconstruction, and magnetic resonance imaging were performed at the final follow-up visit. The mean follow-up period was 40 (range 12 to 80) months. The mean age at surgery was 10.5 (range 8 to 13) years. All patients had achieved their desired activity level at 6 months postoperatively. The mean American Orthopaedic Foot and Ankle Society ankle-hindfoot score was 93.5 (range 74 to 100), and the mean Foot Function Index was 3.25% (range 0% to 13%). No recurrence of the coalition on imaging at the final follow-up visit was observed in this patient series. Sterile silicone sheet interposition can be used to prevent recurrence of tarsal coalition in symptomatic tarsal coalitions after failure of conservative management. [ABSTRACT FROM AUTHOR]

Generalized analytical expressions for the two-electron relativistic Unresolved-Transition-Array (UTA) energy variance and shift for electric and magnetic transitions of general multipole order are presented. The revised expressions are shown to agree with the exact moments calculated directly from the energy levels of two-electron configurations. We show that for electric transitions of even multipole order and for magnetic transitions, the available expressions in the literature, which are implemented in widely used atomic codes, are incorrect. We suggest an alternative method for the calculation of the UTA energy variance and shift by using the analytical expressions for the two-electron energy levels and line-strengths. The method is much more efficient and simple than the use of the traditional lengthy analytic expressions. Finally, the effect of UTA widths on Super-Transition-Array (STA) spectral opacity is shown for several examples. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the long-term clinical, functional, and radiological outcomes in 30 patients with at least 15 years of follow-up. Methods We performed a retrospective study that identified 73 patients. Thirty patients agreed to participate and were included. The mean follow-up was 18 years (range, 15–24 years). There were 14 cases of perilunate dislocation and 16 cases of perilunate fracture-dislocation (including 13 transscaphoid perilunate fracture-dislocations). At the last follow-up, the clinical and functional evaluation was based on the range of motion, grip strength, the Mayo wrist score, the Quick Disabilities of the Arm Shoulder and Hand score, and the Patient-Rated Wrist Evaluation score. Radiological abnormalities, according to the Herzberg classification, were 5 type A1 cases, 7 type B, 16 type B1, and 2 type C. Results The mean flexion–extension arc, radial–ulnar abduction arc, and pronation–supination arc were, respectively, 68%, 67%, and 80%, relative to the contralateral side. The mean grip strength was 70%, relative to the contralateral side. The mean Mayo wrist score was 70, and the mean Quick Disabilities of the Arm Shoulder and Hand and Patient-Rated Wrist Evaluation scores were, respectively, 20 and 21. Five patients had secondary procedure. Six patients had a complex regional pain syndrome type 1. Conclusions Although arthritis occurred in 70% of cases, its clinical and functional impact appeared to be low. However, the 2 lowest Mayo wrist scores corresponded to the patients with the most advanced arthritis. Complex regional pain syndrome appeared to have an impact on long-term outcomes. Type of study/level of evidence Therapeutic IV. [ABSTRACT FROM AUTHOR]

We have recently completed developing a new super transition array (STA) code for calculating absorption and emission spectra of LTE plasmas. The code follows the theory of Bar-Shalom et al. with various improvements. In this work we focus on the first order correction for the Boltzmann populations for which traditional calculations can be very costly. We present here a method faster by an order of magnitude than the traditional method. We then investigate the effect of this correction on the opacity spectra of several elements. Finally we interpret results of a recent opacity experiment on gold plasma. A good agreement is reached. [ABSTRACT FROM AUTHOR]

Summary: Background: Guidelines issued by the WHO call for immunization against yellow fever (YF) at least 10 days before entering an endemic area. We assessed the extent at which travelers complied with these guidelines. Methods: A two-phase study at one travel center in Israel. Phase I—travelers planning to visit YF-endemic areas (n=295) were evaluated in regard to the timing of administration of YF vaccine before travel. Phase II—the specific causes of arriving late were studied prospectively in another group of 132 travelers. Results: Phase I—one-half of the travelers (n=148) headed to South America (SA), and 147 to Africa. The mean age (±SD) of this cohort was 30.9 (±14.9) years (range 6–75 years). Overall, 64 (21.7%; 95% confidence interval, 17.4–26.8) received the vaccine less then 10 days before departure. However, only 10.8% of those heading to SA arrived late, as compared to 32.7% of those heading to Africa (p<0.0001). Phase II—a last minute''s decision was the commonest reason given for arriving late (43.2%). Conclusion: One-fifth of travelers fail to comply with the WHO guidelines concerning YF vaccination. Travelers and travel agents alike need to be reminded of the importance of timely vaccination against YF. [Copyright &y& Elsevier]

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Switzerland's maternity protection legislation aims to protect the health of pregnant employees and their unborn children by regulating their potential occupational exposure to hazards and strenuous activities. This legislation provides a role for obstetricians, but not for midwives. Identify the practices of Switzerland's French-speaking midwives that favour the implementation of maternity protection legislation and reflect on the profession's role in supporting pregnant employees. 356 midwives answered an online questionnaire. The analysis focuses on the 205 midwives who perform pregnancy consultations in their practice. Data were analysed in two stages using STATA software: 1) simple descriptive and correlational statistics and 2) hierarchical cluster analysis to identify typologies of practices by grouping similar responses. Despite having no officially defined role in Switzerland's maternity protection legislation, its midwives actively participate in protecting pregnant employees , especially those with more knowledge of the legislation, those with more years of experience and those practicing independently. The barriers that midwives face when trying to provide greater support for pregnant employees are linked significantly to their lack of knowledge about the legislation, a lack of recognition for their role in the current legislation and a lack of continuing education about the occupational health risks associated with pregnancy at work. Their profession and specific practices give midwives privileged access to pregnant employees. Midwives' knowledge of the legislation, their awareness of the occupational risks and hazards facing pregnant employees and the conviction that their profession has the potential to make a difference could all be improved. The role of midwives should be—and deserves to be—formally and legally recognised and integrated into Switzerland's maternity protection legislation. [ABSTRACT FROM AUTHOR]

Whether recommendations for the use of occlusal devices are made uniformly in terms of indications, designs, and wearing time is unclear. Different recommendations may lead to different clinical outcomes. The purpose of this survey was to assess the professional practice of dental surgeons in France regarding the use of occlusal devices. A 26-question cross-sectional survey was sent to a panel of French dentists via the County Councils of the Dental Order. The questionnaire concerned the amount of occlusion-related treatment, the use of an anterior deprogramming device, stabilization splint, and anterior repositioning appliance, and the patient follow-up as well as the drawbacks of using an occlusal device as a therapeutic solution. The statistical tests used in the study were the chi-square test and the Yate correction for continuity. A total of 771 responses were received. Invasive options were still reported as being used as a first-line treatment for temporomandibular disorder, although a statistical difference was found between experienced and recently graduated practitioners, with recent graduates preferring noninvasive options as first-line treatment. Also, the results showed that anterior deprogramming devices were not used or that their application, particularly the length of treatment, was unfamiliar to practitioners. The anterior repositioning appliance seems to be used, but only a few practitioners integrate it into their practice. In general, about one-third of dentists appear to have a good knowledge of occlusion-related treatments, in particular, the use of occlusal devices. The results indicated that only 20% to 30% of practitioners have good knowledge of contemporary occlusion-related practice. There is a need for the standardization of practice and improved education for practitioners in the use of occlusal devices. [ABSTRACT FROM AUTHOR]

Objective: To determine features that distinguish febrile young infants with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Study Design: Retrospective single-center study included febrile infants <57 days of age evaluated in the emergency department of Cohen Children's Medical Center of Northwell Health, New Hyde Park, New York, from March 1 to April 30 of 2018, 2019, and 2020. Sociodemographic and clinical features were compared between those seen during the 2020 coronavirus disease-2019 pandemic and previous years, as well as between infants with SARS-CoV-2 infection and infants without SARS-CoV-2 infection (SARS-CoV-2 negative or evaluated during 2018 and 2019).Results: In all, 124 febrile infants <57 days of age were identified; 38 during the 2-month study period in 2018, 33 in 2019, and 53 in 2020. During 2020, fewer febrile infants had a serious bacterial infection or a positive respiratory viral panel than in prior years (6% vs 21% [P = .02]; 15% vs 53% [P < .001], respectively). SARS-CoV-2 was the most frequent pathogen detected in 2020; of 30 infants tested, 20 tested positive. Infants with SARS-CoV-2 were more likely to identify as Hispanic (P = .004), have public insurance or be uninsured (P = .01), exhibited lethargy (P = .02), had feeding difficulties (P = .002), and had lower white blood cell (P = .001), neutrophil (P < .001), and lymphocyte counts (P = .005) than the 81 infants without SARS-CoV-2 infection. None of the infants with SARS-CoV-2 had concurrent serious bacterial infection or detection of another virus. Overall, disease in infants with SARS-CoV-2 was mild.Conclusions: During the peak of the pandemic, SARS-CoV-2 was the predominant pathogen among febrile infants. Socioeconomic, historical, and laboratory features differed significantly between infants infected or not infected with SARS-CoV-2. None of the 20 infants with SARS-CoV-2 infection had an identified coviral or serious bacterial infection. [ABSTRACT FROM AUTHOR]