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Objective: The aim of this study was to compare the 30-day emergency department (ED) return rate between patients given a Take Home Medication pack (THM) versus a standard paper prescription (SPP) prior to discharge. Methods: This was an observational, prospective cohort study in an urban, university-affiliated, level I trauma center. Patients were identified through daily pharmacy reports. Consecutive adult patients discharged from the ED with either a THM or equivalent SPP were included. For each patient, baseline characteristics including age, gender, primary care provider (PCP), primary language, ethnicity, marital status, and insurance status were recorded from the electronic medical record (EMR). Review of the EMR was used to determine whether patients returned to the ED within 30 days and whether the return visit was for all-causes or for the same complaint targeted by the THM or SPP from the index visit. Similarly, visits to other providers in the health system within 30 days were recorded. Results: A total of 711 patients were included in the study, with 268 receiving a THM and 443 receiving a SPP. In comparison with the SPP group, the THM group was more likely to have an all-cause return (Relative Risk [RR] = 1.7, P < .01). Variables associated with increased odds of returning to the ED within 30 days included study group (adjusted Odds Ratio [aOR]: 1.7), male gender (aOR: 1.6), African American ethnicity (aOR: 3.0), public insurance (aOR: 3.3), and institutional financial assistance (aOR: 5.0). The difference between study groups for index visit complaint-specific returns was not significant. Conclusions: Patients receiving a THM demonstrated a higher all-cause return rate than patients receiving a SPP. A randomized study is needed evaluating the effect of THM on return ED visits. [ABSTRACT FROM AUTHOR]

Objectives: During the 21st century, opioid medication prescription and consumption has increased, which has led to an increase in opioid abuse, dependence, and fatal overdoses. Health care providers, particularly surgeons, have recently focused on decreasing the amount of opioids prescribed, as overprescribing is a known cause contributing to the opioid epidemic. Patients undergoing anterior cruciate ligament reconstruction (ACLR) would especially benefit for the identification of an ideal opioid prescription amount for post-op pain, as the average age of patients undergoing ACLR is 29.8 years old, which falls within the age group that experienced the largest increase in opioid related deaths between 2001 and 2016. It is unknown if prescribing patterns change patient behavior related to opioid consumption. The purpose of this randomized, prospective trial was to evaluate the effects of different quantities of prescribed opioid tablets on opioid utilization by patients, post-operative pain, and patient satisfaction following ACL reconstruction. Methods: This study was a prospective, randomized trial enrolling patients undergoing primary ACLR following ACL tear. Patients were randomly assigned to one of 3 prescription groups pre-operatively: 15 tablets, 25 tablets, or 35 tablets of oxycodone-5mg. Standard of care nerve blocks were utilized in all patients in addition to general anesthesia for the surgical procedure. Patients were instructed to take acetaminophen and NSAIDs as needed with the opioid medication to be used for "breakthrough" pain. Exclusion criteria included concomitant procedure other than meniscectomy or meniscal repair, ACL revision, history of chronic pre-operative opioid use, history of substance abuse, pregnancy, or workman's compensation claims. Patients in all 3 groups were asked to complete pain and medication logs 2 times a day for the first 14 days post-operatively, along with an opioid medication satisfaction survey at 2 weeks, and IKDC questionnaires before surgery and up to 6 months post-operatively. Demographics and complication information were gathered from the medical record. Requests for prescription refills were recorded as well. Analysis assessed for statistical differences in post-op pain and medication usage. All usage of narcotics was verified with the state database monitoring system for narcotic pain medication. Results: One hundred thirty patients were included in the analysis (41 who received 15 oxycodone tablets, 40 who received 25 oxycodone tablets, and 49 who received 35 oxycodone tablets). There were no significant differences between the two groups in mean age at surgery (33.6 vs. 31.6 vs 33.3; P=0.328), BMI (27.7 vs 26.1 vs 25.7; P=0.525), or sex ratio (24M/17F, 20M/19F, 25M/24F; P=0.735). There were also no significant preoperative differences in subjective pain and function, as measured by IKDC scores (46.8 vs 48.7 vs 46.5; P=0.794). There were no significant differences in mean total morphine milligram equivalents (MME) consumed between the three groups (72.3 in the 15 tablet group, 61.9 in the 25 tablet group, 78.1 in the 35 tablet group; P>0.05). There was a significant difference between those who received 15 tablets and those who received 25 and 35 tablets when asked if they thought they were prescribed too few/too many narcotics, with a greater percentage of the 15 tablet group reporting that they felt they received too few at 20.6%, (P=0.05) as depicted in Figure 1. Despite this difference, there was no significant difference between the three groups on subjective morning or afternoon pain for the first 14 days after surgery, total opioid pills consumed, patient satisfaction on ability of the narcotic to treat their condition, patient satisfaction on amount of pain relief they experienced since surgery, or patient satisfaction regarding the amount of narcotics initially prescribed after surgery. Finally, there was no difference between the three groups on postoperative function at 2 weeks, 6 weeks, 3 months, and 6 months, as measured by IKDC scores (Figure 2). Conclusions: Despite a significantly larger portion of the group who received 15 oxycodone tablets reporting that they felt they received too few opioid tablets, there was no difference between those who received 15, 25, or 35 oxycodone-5mg tablets in reported pain levels, opioid consumption, or any satisfaction metrics. In addition, there was no difference between the three groups in pain and function as reported in the IKDC surveys. Given these results, giving lower quantities of opioid medication appears to be as effective in appropriately controlling post-operative pain as higher quantities, and may help to limit amount of opioids prescribed and possible diversion of unused prescription opioid medication. [ABSTRACT FROM AUTHOR]

Background: The United States is increasingly recognizing period product insecurity, insufficient access to menstrual products and limited private spaces for managing menstruation due to financial constraints, as an issue impacting the well-being and dignity of Americans. One strategy to address period product insecurity has been distributing free period products via period supply banks. The outcomes of period product distribution outside the school setting are absent from the literature. Objectives: This study, a formative evaluation of the free period product distribution efforts of the Alliance for Period Supplies, aims to identify (1) characteristics of individuals receiving products from period supply banks and their experiences of period product insecurity and (2) health and social outcomes experienced by recipients of free period products. Design: Survey data collection occurred at two points: baseline and one-year follow-up. All study participants provided verbal consent. Methods: Between Fall 2018 and Spring 2020, 1863 baseline and 80 follow-up surveys were administered. Participants received free period products for themselves and/or a household member from one of 20 participating Alliance for Period Supplies period supply banks directly or from one of their 64 partner agencies. Results: At baseline, 72.4% of participants had to choose between buying period products and another basic need. One year after accessing a period supply bank, 36.3% of participants reported this experience (p = 0.018). Participants reported at baseline, on average, 7.8 days in the past year of avoiding seeing others, canceling appointments, or skipping work or school because they did not have access to period products. At follow-up, this was reduced to 1.2 days, on average, t (68) = 2.214, p < 0.05. Conclusion: Period supply banks play an essential role in facilitating access to period products and the resulting benefits. Our study highlights the need for sustainable, well-funded policies and interventions to address period product insecurity effectively in society. Plain Language Summary: How people in the United States benefit when they get free period products from a period supply bank Why we did this study: In the United States, many individuals cannot afford to buy period supplies and the other stuff they need to live. Period supply banks want to help by giving them free period products. Researchers do not know if getting free period products is helpful for individuals. What we wanted to learn: The Alliance for Period Supplies is a membership program for period supply banks. We wanted to learn about the individuals who get free period products and whether getting them was helpful. What we did: For a year, starting in Fall 2018, we asked 1863 individuals to fill out paper surveys. A year later, we asked 80 of those same individuals to fill out a second survey. We asked participants to take the survey if they got free period products from a period supply bank for themselves or someone they live with. Individuals only participated in the study if they told us they wanted to. What we learned: Individuals who cannot afford period products must navigate difficult decisions between purchasing products or choosing other basic needs. Providing free products through a period supply bank has lessened the burden on these individuals, reducing the number who had to choose. Individuals unable to afford period products may sometimes opt out of going places they want to go for pleasure or miss important events, like work or school, because they do not have period products. Getting free period products has eased these challenges, letting individuals participate more fully in activities and engagements without worry about period products. Why is this important: Period supply banks are essential places where individuals receive free period products. The period supply banks need more individuals, including our government, to donate period supplies or money to buy them so they can help more individuals. [ABSTRACT FROM AUTHOR]

Objectives: Subtle syndesmotic instability (SSI) is a difficult albeit important diagnosis to make, as undiagnosed instability frequently leads to posttraumatic ankle arthritis. Stressed conventional radiographs, ultrasonography, bilateral comparative conventional computed tomography (CT) and magnetic resonance imaging (MRI) serve as important diagnostic tools, however, the current diagnostic gold-standard is arthroscopic assessment, an invasive surgical method. The advent of weight-bearing computed tomography (WBCT) is considered to be an important additional diagnostic tool for improved non-invasive SSI diagnosis, particularly by utilizing distal tibiofibular syndesmotic (DTFS) area and volume measurements. However, to date, no studies have assessed WBCT diagnostic accuracy for chronic SSI. The purpose of this study was to prospectively evaluate the diagnostic accuracy of WBCT area and volumetric measurements in patients with suspected chronic SSI, when compared to the gold-standard arthroscopic assessment. Methods: In this IRB-approved prospective comparative study, 11 patients with suspected SSI were enrolled from July 2019 to December 2020. Patients were assessed preoperatively by bilateral standing WBCT. Raw 3D WBCT was automatically segmented by dedicated software. WBCT measurements included semi-automatic DTFS area (1cm proximally to tibial dome apex) and DTFS volumes (1, 3 and 5cm proximally to tibial dome apex). Threshold values for WBCT abnormality were defined based on currently available data (area>105mm2 and volumes>796mm3, >3062 mm3, and >6733 mm3 for 1, 3 and 5cm, respectively). Subjects underwent surgical treatment including DTFS instability arthroscopic assessment, defined as positive when a 3mm diameter sphere could enter the syndesmotic incisura. Confirmed unstable cases were treated with open reduction/internal fixation. WBCT measurements sensitivity, specificity, positive and negative predictive values (PPV/NPV) and accuracy were calculated using confirmed arthroscopic instability as diagnostic gold standard. Paired t-tests/Wilcoxon analysis was used to compare measurements. P-values<0.05 were considered significant. Results: When compared to non-injured sides, DTFS area and volumes were significantly higher in injured ankles at 1cm (667 vs 554mm3) and 3cm (2331 vs 2038mm3). Medial gutter volumes were also increased in injured sides (398 vs 370 mm3). DTFS volumes at 5cm and lateral gutter volumes were not different. Nine of eleven patients had confirmed arthroscopic DTFS instability. Considering WBCT area measurements, 4/11 patients were found to be positive (>105mm2), including 3 true positives (+WBCT/+Arthroscopy), 1 false positive (+WBCT/-Arthroscopy), 6 false negatives (-WBCT/+Arthroscopy), and 1 true negative (-WBCT/-Arthroscopy), leading to a 33.3% sensitivity, 50%, specificity, 75% PPV 75%, 14.3% NPV and 36% accuracy. When analysing WBCT DTFS volumes (1cm), 3/11 patients were found positive (>796mm3), depicting 3 true positives, 0 false positives, 2 true negatives and 6 false negatives, with resultant diagnostic accuracy of: 33.3% sensitivity, 100% specificity, 100% PPV, 25% NPV 25%, and 45% accuracy. Conclusions: This is the first study to prospectively assess the diagnostic accuracy of WBCT area and volume measurements in detecting chronic SSI and to compare it to the arthroscopic diagnostic gold standard. When compared to uninjured side, DTFS area and volumetric measurements were significantly increased in injured sides of patients with suspected SSI, including medial gutter volumes, consistent with associated deltoid ligament instability. However, interestingly, we observed a diagnostic accuracy for WBCT area and volumetric measurements to be lower than initially expected. Further incorporation of additional patients, as well as introduction of an external rotational stress can potentially optimize the WBCT diagnostic accuracy for chronic SSI. [ABSTRACT FROM AUTHOR]

Dynamic Pattern Synthesis (DPS) provides a new longitudinal method for evaluating the impacts of macroeconomic and public policy interventions. Situated within complexity theory and critical realism, it has evolved from the established methods of Cluster Analysis and Configurational Modelling approaches. Dynamic Pattern Synthesis identifies case convergence and divergence (using quantitative techniques), while remaining close to the qualitative uniqueness of each case. In this paper, the DPS approach is used to consider macroeconomic convergence across Sub-Saharan Africa during the Millennium Development Goals, and the possible impacts of IMF interventions in stimulating long-term macroeconomic outcomes. The findings reveal a high degree of economic instability experienced across the region and varying responses to an external shock. The importance of 'outliers' and inconsistency in country convergence are also observed. The DPS method highlights the importance of individual country experiences in relation to external shocks. When factoring in IMF interventions, the findings highlight multiple paths to a given policy outcome, rather than a single optimal economic strategy. This opens up the debate on policy issues associated with economic complexity, including how best to create an overall environment of stability that might promote convergence and reduce the instability that undermines planning and investment. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Social determinants of health (SDoH) screening and intervention in pediatric primary care depends upon caregiver disclosure of adverse household or social conditions and thus may be influenced by perceived bias or stigma. This paper examines to what extent parents' experience of their child's medical home is associated with their perceptions of a practice-based social needs intervention. Methods: We conducted a cohort study of data reported by 73 parents of children obtaining care in a medical home with an embedded SDoH navigation program. Using survey data collected in October 2021 and October 2022, we calculated descriptive statistics and non-parametric bivariate analyses of the association between engagement with the SDoH navigation program and parent-reported social needs, stress, and perception of care quality as measured by the Person-Centered Primary Care Measure (PCPCM). Results: Initial ratings of care quality were high (mean baseline PCPCM score = 3.63) and remained high on second interview (mean change in PCPCM score = −0.04, 95%CI −0.16, 0.09, P =.58) despite significant reductions in parents' ratings of access to care over time. Parents reported substantial stress, unmet social needs, and unmet healthcare needs, with 41 families (56%) ever using the practice-based SDoH program, including 16 (22%) who were new users in 2022. There was no association observed between PCPCM score and parent stress, unmet social needs, or use of SDoH services. Conclusions: Parents' perceptions of care delivered in their child's medical home appears to be stable on repeat measurement, and independent of family context or interactions with social needs navigation services offered in the practice. [ABSTRACT FROM AUTHOR]

Objectives: The diagnosis and treatment of distal tibiofibular syndesmosis (DTFS) injury can be challenging, especially in cases of subtle instability that may be masked on two-dimensional conventional radiographs. Weightbearing computed tomography (WBCT) has recently emerged as a useful diagnostic tool allowing direct assessment of distal tibiofibular widening. Area measurements of the distal tibiofibular incisura assessed one centimeter proximal to the ankle joint have been proposed as an accurate diagnostic tool to differentiate stable and unstable DTFS, however the literature lacks information regarding normal DTFS area measurements in asymptomatic ankles. The purpose of the current study was to examine and report normal threshold values for DTFS area measurements in a cohort of healthy volunteers, assessing the ankles in natural weightbearing position and under external rotation stress. Methods: In this prospective study, we enrolled twenty-five healthy volunteers without a history of DTFS injury or high ankle sprain, previous foot and ankle surgery, or current ankle pain. Study participants underwent bilateral standing non-stress and external rotation stress WBCT scans. On non-stress WBCT scans, subjects stood with feet shoulder width apart in a natural, upright position with body weight evenly distributed. For external rotation stress images, patients were instructed to position their lower extremity in maximal internal rotation while the foot was held in a fixed plantigrade position. The DTFS area (mm2) was semi-automatically quantified on axial-plane WBCT images one centimeter proximal to the apex of the talar dome using dedicated software (Figure 1). Syndesmosis area values were compared between non-stressed and stressed ankles, as well as left and right ankles. Statistical analysis was performed utilizing independent t-tests/Wilcoxon analysis with statistical significance defined as p<0.05. Results: The study cohort consisted of 50 ankles in 25 patients (12 males, 48%) with a mean age of 28.7 + 9.3 years. In the unstressed ankle, the mean pooled DTFS area was determined to be 99.1 + 2.8 mm2. The mean syndesmosis area of unstressed left ankles in the cohort was 96.5+4.0 mm2, while unstressed right ankles had a mean area of 101.6 mm2 (p=0.378). With external rotation stress, the DTFS area of left ankles (mean difference 1.2 mm2; CI: -9.8-11.8; p=0.765), right ankles (mean difference -3.1 mm2; CI: -16.1-6.6; p=0.453), and all ankles (mean difference -1.2 mm2; CI: -12.4-9.3; p=0.775) remained similar. Conclusions: This is the first study to assess standing WBCT DTFS area measurements in a cohort of volunteer controls, with and without external rotation stress. We found a mean DTFS value of 99 mm² ± 18.8. We also observed that in normal ankles with expected intact ligaments, external rotation stress did not result in significant widening of the DTFS space. The results of this study can be utilized in the literature as normal threshold values for DTFS area measurements, fostering additional investigations with patients with suspected and confirmed DTFS instability. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 (C19) pandemic shocked primary care systems around the world. Those systems responded by supporting patients in the community, and acute care facilities in crisis. In Canada, the Patient Medical Home (PMH) is a widely adopted care model that aims to operationalize the tenets and principles of Primary Health Care (PHC) as developed since the Alma-Ata Declaration. This paper describes how personnel working in and with Primary Care Networks (PCNs) in Alberta, Canada deployed the PMH model and its underlying PHC principles to frame and respond to the C19 shock. Methods: Using purposive and snowball sampling techniques, we interviewed 57 participants who worked in public health and primary care, including community-based family physicians. We used interpretive description to analyze the interviews. Results: PCN staff and physicians described how the PMH model was foundational to normal operations, and how C19 responses were framed by the patient-centric, team-delivered, and continuous care principles the model shares with PHC. Specifically, participants described ensuring access to care, addressing the social determinants of health, being patient centered, and redeploying and expanding PHC teams to accomplish these goals. Discussion: Delivering PHC through the PMH allowed physicians and allied health staff to deliver patient-centered, team-based, holistic bio-medical services to Albertans. In tailoring services to meet the specific social and health needs of the populations served by each PCN, healthcare providers were able to ensure relevant support remained available and accessible. [ABSTRACT FROM AUTHOR]

Introduction: This study explores the association between self-perceived personal and community changes due to COVID-19 and health among vulnerable primary care patients experiencing multiple chronic conditions. Methods: Between September 2017 and February 2021, we obtained data from 2,426 primary care patients managing multiple chronic conditions from across the United States. We assessed the relationship between self-perceived personal and community changes due to COVID-19 and change in health measured by the PROMIS-29 mental and physical health summary scores, GAD-7 (anxiety), andPHQ-9 (depression), and DASI (functional capacity) adjusting for relevant demographic, neighborhood characteristics, and county covariates. Results: After adjustment, self-perceived personal and community changes due to COVID-19 were associated with significantly worse mental health summary scores (ß = -0.55; 95% Confidence Interval (CI) = -0.72, -0.37), anxiety (ß = 0.28; 95% CI = 0.16, 0.39), depression (ß = 0.35; 95% CI = 0.22, 0.47), and physical health summary scores (ß = -0.44; 95% CI = 0.88, 0.00). There was no association with functional capacity (ß = - 0.05; 95% CI = -0.16, 0.05). Discussion: Among adults managing multiple chronic conditions, self-perceived personal and community changes due to COVID-19 were associated with health. This vulnerable population may be particularly susceptible to the negative effects of COVID-19. As we do not know the long-term health effects of COVID, this paper establishes a baseline of epidemiological data on COVID-19 burden and health among primary care patients with multiple chronic conditions. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity has emerged as a major challenge facing health services globally, which will place a substantial burden on health systems going forward. This paper seeks to estimate the association between multimorbidity and direct healthcare costs among older people in Ireland from a healthcare system perspective. Methods: Cross-sectional analysis of data on 8,447 community-dwelling adults aged 50 and over collected between 2009 and 2011 as part of the Irish Longitudinal Study on Ageing. Multivariable generalised linear model regression, employing a log-link and Poisson family distribution, is used to assess the association between self-reported multimorbidity status and direct healthcare costs. Results: For the full sample, 21.20% reported having no chronic conditions, 27.39% had one chronic condition, and 51.40% had multimorbidity. After controlling for a range of socio-demographic and health status variables, we found that relative to those reporting no chronic conditions, one chronic condition was associated with additional average annual costs of €513 (95% CIs: 245, 781), increasing to €1277 (95% CIs: 942, 1612) for those with 6 or more chronic conditions. Relative to those reporting 2 chronic conditions, 4 chronic conditions were associated with additional costs of €411 (95% CIs: 106, 716), 5 chronic conditions with €591 (95% CIs: 214, 969), and 6 or more chronic conditions with additional average costs of €1006 (95% CIs: 641, 1371). Conclusion: This study finds positive and significant associations between the number of chronic conditions and direct healthcare costs and further highlights the potential economic benefits from preventing the onset and progression of multimorbidity [ABSTRACT FROM AUTHOR]

Background and aims: Participatory research involves academic partners working together with the community that is affected by research to make decisions about that research. Such approaches often result in research that is more respectful of, and responsive to, community preferences – and is vital in the context of autism research with culturally and linguistically diverse (CALD) communities. Whilst participatory approaches are becoming more commonplace within CALD autism research, no studies have explored the experiences of being involved in autism research from the perspectives of CALD community partners over the course of a study. This paper intended to address this gap by reporting on the experiences of CALD parents of autistic children who were community partners in a 1-year Australian research project exploring home–school partnerships for CALD parents of autistic children. We aimed to: (1) report on how parents' involvement in the research process shaped the home–school partnerships study over time and (2) understand their experiences of being community partners on the home–school partnerships project. Methods: Using key principles of participatory approaches, we established Chinese and Vietnamese parent advisory groups to contribute to a project exploring home–school partnerships for parents of autistic children from CALD backgrounds in Australia. Advisory groups included parents of autistic children from Chinese/Vietnamese backgrounds, as well as interpreters, professionals and researchers. We documented how parents' participation as community partners shaped the home–school partnerships study over the course of the project. We also elicited parents' own views and experiences of being community partners through informal, open-ended questions at the beginning and end of the study. Results: We found that parents' input fundamentally shaped the broader home–school partnership study, from meaningful, accurate translation of interview schedules through to making decisions regarding community-specific recommendations and dissemination plans. Parents themselves reported being keen to collaborate and to hear and share opinions for the purpose of the home–school partnership study – although they noted how emotionally difficult sharing their stories could be. While they initially had some concerns about combining being involved as a community partner with their existing responsibilities, ultimately, parents were surprised by the scope of the home–school partnership study and their level of involvement as community partners. Through hearing others' stories and sharing their own in advisory group meetings, parents reported ancillary benefits of their involvement, including increased self-advocacy and well-being. Conclusions: These findings show how research that is conducted in partnership with diverse members of the autism community has the capacity to improve the quality of the research and benefit community partners. Implications: This study clearly documents the benefits and potential challenges of participatory approaches with CALD communities. These findings emphasise to researchers and funders the importance of including extra time and money within budgets in order to produce meaningful research that is respectful and responsive to communities. [ABSTRACT FROM AUTHOR]

Objectives: Saccharin test (ST) is a convenient method to assess the efficiency of mucociliary clearance, the primary defense mechanism of the upper airways' tract. The study objectives are to: (1) substantiate its short- (3 days) and long-term (30 days) repeatability; (2) assess its tolerability; (3) conduct a systematic literature review and to compare our results with the existing evidence. Methods: Twenty-nine healthy subjects were enrolled in an observational prospective study to perform an ST on three separate visits (at baseline; at follow-up visits at day 3 and at day 30). Transit times were recorded and self-reported nasal and general symptoms noted. A systematic review of the literature was conducted to compare our results with the existing literature. Results: The mean values (±SD) of ST transit time (STTT) were 7.085 (±2.19), 7.788 (±2.11), and 7.790 (±2.06) minutes at baseline, day 3, and day 30, respectively. Significant linear regression analysis was observed between day 3 and baseline (r =.193; P =.019) and day 30 and baseline (r =.182 P =.024). Significant agreement for the intrasession repeatability was observed with an ICC =.354 (P =.001). Outcomes' comparisons between baseline vs day 3 (P =.197) and baseline vs day 30 (P =.173) were not statistically significant. ST was well tolerated. Concordance with existing literature's data and high level of STTT repeatability were confirmed by the qualitative analysis. Conclusion: STTT reproducibility was good both in the short- and long-term. ST tolerability was very good. Our study data are consistent with the existing literature, indicating ST as a sound methodology for detection of early respiratory health changes and for specific regulatory application in respiratory research. [ABSTRACT FROM AUTHOR]

Qualitative Longitudinal Research (QLR) is an evolving methodology used in understanding the rich and in-depth experiences of individuals over time. QLR is particularly conducive to pandemic or disaster-related studies, where unique and rapidly changing environments warrant fuller descriptions of the human condition. Despite QLR's usefulness, there are a limited number of articles that detail the methodology and analysis, especially in the social sciences, and specifically social work literature. As researchers adjust their focus to incorporate the impact of the COVID-19 global pandemic, there is a growing need in understanding the progression and adaptation of the pandemic on individuals' lives. This article provides a process and strategy for implementing QLR and analyzing data in online diary entries. In the provided case example, we explore a phenomenological QLR conducted with graduate level students during the COVID-19 pandemic (Saltzman et al., 2021), and outline a matrix framework for QLR analysis. This paper provides an innovative way in which to engage in qualitative data collection and analysis for social science research. [ABSTRACT FROM AUTHOR]

Background: The purpose of this paper is to provide a preliminary evaluation of treatment outcomes, retention and client satisfaction following a 12-week combined cognitive behavioural therapy (CBT) and motivational enhancement therapy (MET) group treatment for cannabis use disorder (CUD) delivered in an outpatient setting. Implementation of the program is also described. Methods: A retrospective observational cohort study was conducted using data collected from medical records and self-report assessments. Participants were treatment-seeking cannabis users at the Centre for Addiction and Mental Health, Toronto. Cannabis use, cannabis-related problems, craving, withdrawal symptoms, self-efficacy for remaining abstinent, depression and anxiety were assessed pre- and post-treatment. Treatment retention was calculated by inspecting clinic attendance records, and client satisfaction was evaluated using an anonymous feedback survey. Potential predictors of treatment outcomes and retention were investigated in exploratory analyses. Results: Cannabis use was lower and days of abstinence higher post-treatment (vs pre-treatment). Post-treatment improvements in cannabis-related problems, craving, withdrawal symptoms, self-efficacy and mood were also observed. Completion of group treatment (⩾75% of sessions attended) was 57% and moderate levels of treatment satisfaction were reported. Conclusions: This study provides preliminary evidence that a 12-week combined CBT and MET treatment for cannabis use disorder delivered in a novel group setting improves cannabis use outcomes. Potential predictors of reduced cannabis use and retention were identified. Future controlled studies are warranted, and strategies for increasing retention should be explored. [ABSTRACT FROM AUTHOR]

The Gender and Adolescence: Global Evidence programme is a decade long cross-country longitudinal study of adolescents in low- and middle-income countries. The programme's large sample size and variety of contexts make it an important case study of how to deal with large and complex qualitative datasets. In this methodological article, we explore some of the challenges and opportunities that occur when working with large datasets of longitudinal qualitative research. We provide examples of lessons learnt during GAGE data collection, coding, analysis and data management. This paper also explores the use of the qualitative data analysis software MAXQDA for simplifying the analysis of longitudinal data and providing opportunities for novel analytical techniques. We find that large longitudinal qualitative datasets can provide extremely rich and detailed data; however, there needs to be attention to key processes to ensure rigour and effectively utilise the breadth and depth of the data. These include mechanisms to work effectively with large teams of researchers, strong data management and coding procedures, and using qualitative software to manage and simplify data. [ABSTRACT FROM AUTHOR]

Documentary films play an important role in how we see and position ourselves in the world. While traditionally viewed as a creative practice, documentary filmmaking has been transitioning into the academic world as a way to undertake and engage with research practices. Some question marks remain, however, over the nature of documentary filmmaking as a research method. This paper seeks to build a case for documentary as a research practice using Guba and Lincoln's quality criteria, which is typically employed to ensure the trustworthiness of collected data, as a frame for sense making. This case for research innovation also draws upon the first author's previous experiences with video ethnography and the second author's expertise as a documentary film maker. Their collaboration resulted in a longitudinal research project that foregrounded documentary practices as key to data gathering and sense making. This research project sought to understand the early career experiences of Australian graduate teachers from their perspective. Using this research project as a context, this paper unpacks how seven quality criteria can be explored and addressed using documentary filmmaking as method. This work highlights the possibilities and challenges inherent in innovating in the qualitative methodology space when considering the use of documentary filmmaking practices. It also adds meaningful and practical insights to a growing groundswell of voices that recognize documentary filmmaking as a viable and valuable research method. [ABSTRACT FROM AUTHOR]

Objective: During the COVID-19 pandemic in the United States, mitigation measures were implemented on a state-by-state basis. Governors were responsible for establishing interventions appropriate for their states and the timing of implementation. This paper evaluated the association between the presence and timing of a mask mandate and the severity of the COVID-19 epidemic by state. Methods: The states were divided into 3 categories based on when the governors of each state implemented a mask mandate: Early (mask mandate implemented between March 2020 and June 2020), Late (July 2020-December 2020), and Never (no mask mandate implemented). The rates of hospitalizations and mortality (per 100 000) were assessed at the different time points during the pandemic across these categories from March to December 2020. Results: The mortality rates across all 3 groups were observed to be highest in the beginning and toward the end of the pandemic in 2020 with the peak observed in the Early group between April and May 2020. Also, the rates of hospitalization increased steadily across all groups. The Early mask group was comprised of 86.7% and 13.3% states with Democratic and Republican governors respectively, and no states in the Never category had Democratic governors. Conclusion: These results support the benefit of implementing a mask mandate to minimize the impact of the COVID-19 pandemic and the role of political affiliation of governors on that impact. [ABSTRACT FROM AUTHOR]

Objective: The goal of this paper was to analyze patient outcomes related to gout treatment including, serum uric acid (sUA) measures and treatment adherence across patients in metropolitan, micropolitan or rural counties. Methods: We conducted a drug-disease cohort study among patients with gout initiating urate lowering therapy. The proportion of patients with sUA < 6 mg/dL at 1 year of follow-up is compared over the cohort groups using a chi-square test and adjusted logistic regression. Adherence to urate lowering therapy was calculated using the proportion of days covered (PDC). A T -test was used to compare the average PDC and an adjusted logistic regression model was used to estimate the odds of a PDC greater than 80%. Results: A total of 9922 patients were included in the study. Most patients were in a metropolitan (77.4%) area, followed by micropolitan (11.8%) and finally, (10.8%) in a rural area. We found no statistically significant difference among the proportion of patients achieving target sUA of <6 mg/dL, 37.17% among metropolitan patients, 38.9% among micropolitan patients, and 37.7% for those in a rural area, P -value =.502. The proportion of patients achieving 80% treatment adherence was 49.92% in the metropolitan, 51.78% in the micropolitan, and 55.05% in the rural areas, P -value =.005. Adjusted regression models showed no statistically significant difference in proportions achieving target sUA levels or 80% adherence. Conclusions: Urban patients treated for gout did not have better gout outcomes compared to rural patients. Future research should consider provider-based interventions to improve outcomes. [ABSTRACT FROM AUTHOR]

Narratives, like the people who tell them, are fluid, changing through time and in response to context. Longitudinal narrative interviewing enables researchers to explore the meaning of stability and change in narratives over time. Despite much attention to and application of longitudinal narrative interviews in recent years, the ways that time is conceptualized and the ways it is applied are markedly different. In this paper the authors present a scoping review to examine the methodological and empirical literature on longitudinal narrative interviewing in health-related research. This research is used to highlight a methodological tension between narrative theorizing of time and analytic practice in research involving longitudinal narrative interviews. Longitudinal narrative research struggles to acknowledge time as both chronological and interpretative, and in doing so misses an opportunity to examine interviews as both multiple data collections and as multiple instances of narrative re-configuration. The authors suggest that future theorizing and empirical work can strive to bridge an onto-epistemological gap by intentionally foregrounding theoretical orientations to time within narrative analytic approaches using repeated interviews. [ABSTRACT FROM AUTHOR]

Objective: Given limited critical care resources and an aging population, early interventions to prevent critical illness are vital. In this work, we measured post-implementation outcomes after introducing a novel electronic scoring system (Elders Risk Assessment—ERA) and a risk-factor checklist, Checklist for Early Recognition and Treatment of Acute Illness (CERTAIN), to detect older patients at high risk of critical illness in a primary care setting. Methods: The study was conducted at a family medicine clinic in Kasson, MN. The ADAPT-ITT framework was used to modify the CERTAIN checklist for primary care during 2 co-design workshops involving interdisciplinary clinicians, held in April 2023. The ERA score and modified CERTAIN checklist were implemented between May and July 2023 and identify and assess all patients age ≥60 years at risk of critical illness during their primary care visits. Implementation outcomes were evaluated at the end of the study via an anonymous survey and EHR data extraction. Results: Fourteen clinicians participated in 2 co-design workshops. A total of 19 clinicians participated in a post-pilot survey. All survey items were rated on a 5-point Likert type scale. Mean acceptability of the ERA score and checklist was rated 3.35 (SD = 0.75) and 3.09 (SD = 0.64), respectively. Appropriateness had a mean rating of 3.38 (SD = 0.82) for the ERA score and 3.19 (SD = 0.59) for the checklist. Mean feasibility was rated 3.38(SD = 0.85) and 2.92 (SD = 0.76) for the ERA score and checklist, respectively. The adoption rate was 50% (19/38) among clinicians, but the reach was low at 17% (49/289) of eligible patients. Conclusions: This pilot study evaluated the implementation of an intervention that introduced the ERA score and CERTAIN checklist into a primary care practice. Results indicate moderate acceptability, appropriateness, and feasibility of the ERA score, and similar ratings for the checklist, with slightly lower feasibility. While checklist adoption was moderate, reach was limited, indicating inconsistent use. Recommendations: We plan to use the open-ended resurvey responses to further modify the CERTAIN-FM checklist and implementation process. The ADAPT-ITT framework is a useful model for adapting the checklist to meet the primary care clinician needs. [ABSTRACT FROM AUTHOR]

Negative attitudes and stigmatization of substance-using patients lead to treatment avoidance and poor physical and health outcomes. Research suggests that training in substance use disorders is a vital tool to abate negative attitudes among health workers. The present longitudinal study trained students and experienced practitioners from various disciplines on the evidence-based Screening, Brief Intervention, and Referral to Treatment (SBIRT) model. The study found significant improvements in the attitudes of students—but not practitioners—who were trained during the program. The paper discusses policy and implementation implications to support and complement sustained impact of training on models such as SBIRT. [ABSTRACT FROM AUTHOR]

Objective: When prescribed with opioids, sedative-hypnotics substantially increase the risk of overdose. The objective of this paper was to describe characteristics and trends in opioid sedative-hypnotic co-prescribing in a network of safety-net clinics serving low-income, publicly insured, and uninsured individuals. Methods: This retrospective longitudinal analysis of prescription orders examined opioid sedative-hypnotic co-prescribing rates between 2009 and 2018 in the OCHIN network of safety-net community health centers. Sedative-hypnotics included benzodiazepine and non-benzodiazepine sedatives (eg, zolpidem). Co-prescribing patterns were assessed overall and across patient demographic and co-morbidity characteristics. Results: From 2009 to 2018, 240 587 patients had ≥1 opioid prescriptions. Most were White (65%), female (59%), and had Medicaid insurance (43%). One in 4 were chronic opioid users (25%). During this period, 55 332 (23%) were co-prescribed a sedative-hypnotic. The prevalence of co-prescribing was highest for females (26% vs 19% for males), non-Hispanic Whites (28% vs 13% for Hispanic to 20% for unknown), those over 44 years of age (25% vs 20% for <44 years), Medicare insurance (30% vs 21% for uninsured to 22% for other/unknown), and among those on chronic opioid therapy (40%). Co-prescribing peaked in 2010 (32%) and declined steadily through 2018 (20%). Trends were similar across demographic subgroups. Co-prescribed sedative-hypnotics remained elevated for those with chronic opioid use (27%), non-Hispanic Whites (24%), females (23%), and those with Medicare (23%) or commercial insurance (22%). Conclusions: Co-prescribed sedative-hypnotic use has declined steadily since 2010 across all demographic subgroups in the OCHIN population. Concurrent use remains elevated in several population subgroups. [ABSTRACT FROM AUTHOR]

Background and Method: There is an absence of research on the prevalence of bereavement during early childhood and the relationship between childhood bereavement and socioeconomic status (SES) and this poses a challenge in both understanding and supporting children's bereavement experiences. Using longitudinal data from the Growing Up in Scotland study, which tracks the lives of three nationally representative cohorts of children, this paper aimed to address these gaps in research. It specifically drew on data from Birth Cohort 1 to document the recorded bereavements of 2,815 children who completed all 8 sweeps of data collection, from age 10 months to 10 years. Findings: The study found that 50.8% of all children are bereaved of a parent, sibling, grandparent or other close family member by age 8 and this rises to 62% by age 10. The most common death experienced was that of a grandparent or other close relative. The study also found that children born into the lowest income households are at greater risk of being bereaved of a parent or sibling than those born into the highest income households. Discussion and Conclusion: Given the prevalence of childhood bereavement and its relationship with disadvantage, this paper argues that there is an important need to understand bereavement as a universal issue that is affected by the social conditions in which a child becomes bereaved, as well as an individual experience potentially requiring specialist support. This paper thus seeks to position childhood bereavement more firmly within the public health approach to palliative and bereavement care discourse and contends that doing so provides a unique and comprehensive opportunity to better understand and holistically respond to the experience of bereavement during childhood. [ABSTRACT FROM AUTHOR]

Focus group methods specialize in the analysis of interactive discourse, but are only rarely employed as a stand-alone method to study such phenomena, owing to inherent limitations concerning the comparability and generalizability of findings. In this paper, we argue that focus groups undergo three kinds of transformations, involving changes in participants' cognitive states, social ties, and discursive behavior, which raise both analytic challenges and valuable opportunities for the study of shared meanings and interactive negotiation processes in society. Introducing Serial Focus Groups, we extend familiar focus group designs as a method for studying interactive discourse in a longitudinal perspective, capitalizing on the analytic potentials raised by these transformations. Reviewing the methodological literature and drawing upon two large-scale focus group studies of socially interactive sense-making, we argue that serial focus groups can help overcome some of the limitations of cross-sectional focus groups and offer valuable new opportunities for analysis and validation. [ABSTRACT FROM AUTHOR]

Introduction: Percutaneous thermal ablation of inconspicuous lesions can be challenging. Fusion ultrasound (FUS) allows the use of previously performed diagnostic imaging like computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET–CT) to localise hepatocellular carcinoma (HCC) for treatment. This paper illustrates FUS case studies of pre-, intra- and post-ablation imaging of inconspicuous HCC, supplemented by use of contrast-enhanced ultrasound (CEUS). Method: Four prospective cases during September 2014 to October 2018, with HCC amenable to ablation, which were poorly identified on ultrasound, underwent FUS. FUS pre-screening was scheduled within three months of the previous CT or MRI, and between one to four weeks prior to the scheduled ablation date. Post-ablation imaging with FUS was performed between four to six weeks to coincide with their routine follow-up CT or MRI. Findings: There were potential benefits observed in the cases with combined techniques of FUS and CEUS for limiting circumstances such as heat sink effect, multiple lesions targeting, inconspicuous lesion detection and pre-ablation technical feasibility assessment. Discussion: The combined use of FUS and CEUS improves tumour visibility, increases operator imaging confidence and reduces heat sink effect during percutaneous thermal ablation. Conclusion: FUS imaging is helpful in targeting poor conspicuity lesions that cannot be detected on grey-scale ultrasound. It facilitates in ensuring optimal treatment of hepatic lesions for improvement of patient prognosis and follow-up imaging. [ABSTRACT FROM AUTHOR]

It is traditionally believed that the effects of exposure to noise cease once the exposure itself has ceased. If this is the case, exposure to noise relatively early in life, for example during military service, should not affect the subsequent progression of hearing loss. However, recent data from studies using animals suggest that noise exposure can accelerate the subsequent progression of hearing loss. This paper presents new longitudinal data obtained from 29 former male military personnel. Audiograms obtained at the end of military service were compared with those obtained at least five years later. Rates of change of hearing threshold level (HTL) in dB/year were compared with those expected from ISO7029 (2017) for men at the 50th percentile. The results are consistent with the hypothesis that noise exposure during military service accelerates the progression of hearing loss for frequencies where the hearing loss is absent or mild at the end of military service, by about 1.7 dB/year on average for frequencies from 3 to 8 kHz, but has no effect on or slows the progression of hearing loss for frequencies where the hearing loss exceeds about 50 dB. Acceleration appears to occur over a wide frequency range, including 1 kHz. There remains a need for further longitudinal studies using larger sample sizes. Longitudinal studies are also needed to establish whether exposure to other types of sounds, for example at rock concerts or from work in heavy industries, affects the subsequent progression of hearing loss. [ABSTRACT FROM AUTHOR]

In modern day, from planetary exploration, disaster response to antiterrorism mission multiped robot has become the major tool. Smart robot with effective gait plan may play a significant role in such missions. But if a leg is injured, it is not possible to repair in this kind of mission. Then robot needs some alternative strategies to complete its mission. This paper proposes a removable sliding leg approach to solve this problem. A fault leg can be detaches and other legs can be slide to better position by the command of operator to get optimum alternative gait configuration. Based on leg sequence, stride length, longitudinal stability and efficiency, alternative gaits are evaluated. This paper recommends tables for different gait sequence with progressive efficiency. These tables can provide options for alternative gait and information about certain damaged leg. Moreover, a procedure for a multi-legged robot to complete its mission after serious leg failure is included. By taking the recommended tables and procedure, the multiped Robot can overcome any fault event and maintain stability and efficiency. [ABSTRACT FROM AUTHOR]

Introduction: In the background of the aging population, an increase of geriatric patients with specific age-related comorbidities has already been seen over the years for proximal femur fractures in orthopaedic surgery as well as other medical disciplines. However, the geriatric aspect has not been well recognized in periprosthetic joint infection (PJI) patients so far. Therefore, this paper seeks to provide an overview on the co-morbidities of PJI patients with respect to the definition of geriatric patients. Material and methods: In this single-center retrospective study, patients treated between 2007 and 2020 for PJI were included (n = 255). Patients were defined as geriatric according to the consensus definition criteria of the Federal Working Group of Clinical Geriatric Facilities e.V., the German Society for Geriatrics e.V. and the German Society for Gerontology and Geriatrics e.V. based on age (=70 years), geriatric multimorbidity and the Barthel index (≤30). Results: Applying the criteria defined 184 of the 255 (72.2%) PJI patients as geriatric infection patients. Regarding geriatric comorbidity, incontinence was most prevalent (38.1%), followed by immobility (25.6%). Comparing the geriatric infection patients with those classified as non-geriatric (n = 71) revealed that geriatric patients had a longer hospital stay and spent more days in the intensive care unit (ICU). Also, the amputation rate and the 5-year mortality rate was significantly increased (n = 15, 8.2% vs n = 1, 1.4%, P = .007 and n = 24, 13.0% vs n = 5, 7.0%, P = .005). The Barthel index showed a significant correlation with mortality (r = -.22, P = .011). Discussion: We propose to use the term orthogeriatric infection patients in those cases in order to focus treatment not only on the orthopaedic infections but also on the important geriatric aspects. Conclusion: The inclusion of geriatric physicians into the multidisciplinary team approach for PJI patients might be beneficial. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: This paper reports on participant retention from an ongoing prospective, multi-site cohort caries risk study involving parent/infant pairs. The objectives were to: (1) compare the retention rates at each intermediate contact (every 4 months) and dental visit (every 18 months) across the 3 clinical sites, (2) assess primary caregivers' perceptions at the end of the study about the retention efforts used in this longitudinal study, and (3) determine whether primary caregiver baseline demographic characteristics and child's baseline caries experience were associated with retention. Methods: 1325 primary caregiver-child pairs recruited at the child's first birthday were followed for 36 months at 3 sites. Dental visits occurred at children's ages of approximately 12, 30, and 48 months. Telephone/email intermediate contacts with the primary caregiver occurred 6 times between dental visits. The outcome variable was the retention rates at each dental visit and each intermediate contact. Primary caregivers' perceptions of intermediate contacts were evaluated. Retention rates were compared by maternal age, race, ethnicity, Medicaid status, yearly household income, baseline caries experience (defined as decayed, missing due to caries, or filled tooth surfaces) at 12 months, and the number of teeth erupted. Results: 1325 primary caregiver/infant pairs were enrolled and completed the first in-person dental visit, 1062 pairs (80%) completed the second visit and 985 (74%) completed the third. Most primary caregivers were female (94%), with a mean age of 29 years and 667 (50%) self-identified as White, 544 (41%) as Black, and 146 (11%) as Hispanic. The percentages of successful intermediate contacts were 95% at 4 months decreasing to 82% at 34 months. Almost all 964 (98%) of 985 primary caregivers reported at the last visit that they were comfortable/very comfortable with 4-month intermediate contacts. The multivariable analysis showed that primary caregivers who were older (OR = 1.07; 95% CI, 1.04-1.09) and White (OR = 1.52; 95% CI, 1.12-2.06) were more likely to complete the study. Conclusions: Retention strategies were focused on frequent routine contact and increasing monetary incentives. Those strategies may have resulted in retention exceeding the proposed goals. At the end of the study, primary caregivers were comfortable with the 4-month intermediate contacts. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Patients with co-occurring autism spectrum disorders (ASD) and substance use disorder (SUD) require special attention from clinical services. Screening for this co-occurrence is not generally an integral part of routine clinical assessments, and failure to identify and understand this group of patients may contribute to a worsening of their symptoms and/or an increase in drug abuse. Thus, there is a need to review the evidence base on patients with co-occurring ASD and SUD in order to enhance clinical practice and future research. METHODS: We reviewed all identified papers on patients with co-occurring ASD and SUD. The focus of the review was on epidemiology, patient characteristics, function of drug use, and the effect of current interventions. RESULTS: A total of 18 papers were included in the analysis. Eleven papers were based on epidemiological studies, although only one study reported the prevalence of ASD in an SUD population. Two papers explored the role of personality, three papers studied subgroups of individuals serving prison for violent or sexual crimes, and one paper explored the function of drugs in the ASD patient group. There were no studies testing specific treatment interventions. CONCLUSIONS: In most of the treatment settings studied, there were relatively few patients with co-occurring ASD and SUD, but due to differences in study samples it was difficult to establish a general prevalence rate. The one consistent finding was the lack of focused treatment studies. There is clearly a need for research on interventions that take account of the special needs of this patient group. [ABSTRACT FROM AUTHOR]

Maintaining participant engagement in longitudinal surveys has been a key focus of survey research, and has implications for the quality of response and cost of administration. This paper presents new research measuring the impact of the design of between-wave keeping-in-touch mailings on response to the mailing and subsequent wave of a longitudinal survey. Three design attributes of the mailings were randomly implemented: the form of response request (whether respondents were asked to respond only if their address had changed, or in all cases to confirm or update their address); the newsletter included with the mailing (contrasting a newsletter with content tailored to respondent characteristics with a general newsletter and no newsletter); and the outgoing postage used (stamped or franked). The experiments were fielded on a new longitudinal study, the English and Welsh Civil and Social Justice Panel Survey (CSJPS), and took place between waves one and two. Fieldwork for both waves was conducted by Ipsos MORI face-to-face interviewers. Our main finding was that the tailored newsletter was associated with a significant increase in the wave-two response rate. However, in relation to response to the request, the tailored newsletter, or sending no newsletter at all, were equally effective at inducing response, and significantly better than the general newsletter. We also found that, in relation to the form of request, the 'change of address' request was as effective as the more costly 'confirmation' request. Findings are discussed with reference to the design of keeping-in-touch mailings for longitudinal surveys. [ABSTRACT FROM AUTHOR]

This paper presents a method for modeling time-varying effects of categorical covariates in event-history analysis using statistics obtained from the saturated hazard rate model. First, the closed-form solution for the maximum likelihood estimators of parameters and their variance-covariance matrix for general saturated models of hazard rates are presented. The paper then presents methods that use statistics obtained from the saturated model to conduct (1) a proportionality test of the covariate effect for multiplicative hazard rate models and a linear-additivity test of the covariate effect for additive hazard rate models; (2) a goodness of fit test for various parametric models for time variations in the covariate effects; and (3) a test for comparing the relative goodness of fit among alternative parametric models. This paper also discusses the advantages and limitations of the proposed methods compared with other methods for modeling time variations in the covariate effects, and the choice between additive versus multiplicative hazard rate models. An application analyzes the rate of first marriage as a function of age and employment using data from the 1973 Occupational Changes in a Generation Survey. [ABSTRACT FROM AUTHOR]

Aims: A novel coronavirus SARS-CoV-2 has resulted in an ongoing global pandemic of Coronavirus disease 2019 (COVID-19). However, the outcomes of recovered patients have not been well defined. Methods: This is a prospective observational follow-up study of survivors with COVID-19 from a designated tertiary center in Hefei, China. We examined chest computed tomography (CT) scanning, pulmonary function, 6-min walk distance (6MWD), and 36 item Short Form General Health Survey (SF-36). Results: Among 81 enrolled patients, 62 (77%) patients and 61 (75%) patients, respectively, completed 1-month and 3-month follow-ups. Abnormal CT findings were still present in 73% of patients at 1 month and 54% at 3 months, whereas chest CT scan scores improved progressively at 1-month (5.0 ± 5.1) and 3-month follow up (3.0 ± 4.5) compared with that during hospitalization (11 ± 6.8). Mild restrictive pulmonary impairment was detected in 11% and 10% of patients at 1-month and 3-month follow up, respectively. The 6MWD was 523 ± 77 m in male patients and 484 ± 58 m in female patients, which was significantly lower than in healthy controls (606 ± 68 m, 568 ± 78 m, p < 0.001). SF-36 scores were significantly impaired in the domains of role physical (RP), role emotional (RE), and social functioning (SF) compared with the normal age-matched population. RP was improved at 3-month compared with 1-month follow up in the 41–64 years group (p < 0.01). Multivariable analysis showed that older age (over 40 years) and steroid administration during hospitalization were independently associated with worse chest CT scores at 3-month follow up. Conclusions: At 3 months, chest CT abnormalities were present in one half of COVID-19 survivors and worse chest CT scores were independently associated with older age and steroid administration during hospitalization. Residual pulmonary function impairments were modest, whereas exercise capacity and SF-36 scores were significantly lower than the general population. Support program and further follow-up evaluations may be needed. The reviews of this paper are available via the supplemental material section. [ABSTRACT FROM AUTHOR]

Background and aims: Various prediction indices based on the single time point observation have been proposed in chronic obstructive pulmonary disease (COPD), but little was known about disease trajectory as a predictor of future exacerbations. Our study explored the association between disease trajectory and future exacerbations, and validated the predictive value of the modified and simplified short-term clinically important deterioration (CID). Methods: This study was a multicenter, prospective observational study. Patients with COPD were recruited into our study and followed up for 18 months. The modified CID (CID-C) was defined as a decrease of 100 mL in forced expiratory volume in 1 second (FEV1), or suffering exacerbations, or increase of 2 units in COPD Assessment Test (CAT) during the first 6 months follow-up. Simplified CID was defined when excluding CAT from the CID-C model. Results: A total of 127 patients were enrolled in our final analysis. Compared with patients without exacerbations during the period of the 6th to the 18th month, patients with exacerbations were more likely to have frequent short-term exacerbations in the first 6 months (2.14 versus 0.21, p < 0.001). The short-term exacerbations were the best predictor for future exacerbations [odds ratio (OR): 13.25; 95% confidence interval: 5.62–34.67; p < 0.001], followed by the history of exacerbation before study entry, short-term changes in FEV1 and CAT. CID-C and Simplified CID were both significantly associated with exacerbations (OR: 7.14 and 9.74, both p < 0.001). The receiver operating characteristic curves showed that the Simplified CID had slightly better predictive capacity for future exacerbation than CID-C (0.754 versus 0.695, p = 0.02). Conclusion: Disease trajectory, including both the CID-C and the Simplified CID had significant predictive value for future exacerbations. The reviews of this paper are available via the supplemental material section. [ABSTRACT FROM AUTHOR]

In this paper we describe and reflect upon the process of setting up the first wave of a complex qualitative longitudinal study with young people in Vienna. We explain the project's agenda, design, and organizational structure connecting experienced and early career researchers with master's students. In particular, we describe the tools used to coordinate the research, the challenges and benefits of blending research and teaching, and the materials and strategies we employed to ensure data quality and self-reflexivity. We conclude with reflections upon ethical challenges associated with incorporating marginalized young people into the research within the context of school, especially concerning pseudonymization, informed consent, and hierarchical settings shaping the research. [ABSTRACT FROM AUTHOR]

Qualitative longitudinal research is a useful method for studying adolescent development, not least because the dimension of temporality in the analysis of longitudinal studies can help researchers understand the complexity of transitions during this unique and dynamic life stage. The Gender and Adolescence: Global Evidence programme is a multi-year cross-country longitudinal study of adolescents in low- and middle-income countries. This article presents the methodological opportunities and challenges involved in analyzing such datasets, and seeks to offer insights for researchers undertaking qualitative longitudinal research. To ensure that both breadth and depth of such data are accurately represented in the analysis, a range of analytical approaches can be used. In this article, we provide key examples of how this data has been analyzed across a cohort of adolescent participants, exploring changes both pre- and post-Covid-19 including interactions with critical health and education services, and within individual life histories, exploring individual adolescent trajectories over multiple time points. Furthermore, we highlight how including caregivers' and key informants' perspectives can enhance triangulation of results. We show the importance of using a range of different approaches when analyzing a qualitative longitudinal dataset. [ABSTRACT FROM AUTHOR]

Background: Treatment retention is a major factor contributing to favourable outcome in the treatment of substance misuse, but the literature remains very limited. Despite evidence of the association of personality with drug use experimentation and relapse, surprisingly little is known about its role in the treatment process. Clients' personality functioning as measured by malleable and context sensitive characteristic adaptations in treatment are of concern. Aims: This study examines whether, and to what extent, personality functioning contributes to or hinders treatment completion. This paper examined the extent to which service users' characteristic adaptations may be potential determinants of treatment completion. Methodology: A longitudinal multi-site design was utilised, examining the therapy process in a naturalistic setting in five inpatient treatment units. The study examined whether service users' characteristic adaptations (SIPP-118) predict completion, while controlling psychosocial, motivational and treatment engagement indicators involving n = 340 participants from 5 inpatient centres. Multivariate regression analyses were applied to examine the predictive role of characteristic adaptations on treatment completion. Results: Findings indicated that certain dysfunctional characteristic adaptations emerged as strong predictors of treatment completion. Dysfunctional levels on Self-control and Social concordance were significant predictors of drop out from treatment. Individuals with low capacity to tolerate, use and control one's own emotions and impulses were almost three times more likely to drop-out compared to those without [OR] = 2.73, Wald = 6.09, P =.014, 95% CI [1.2, 6.0]. Individuals with dysfunctional levels on the ability to value someone's identity, withhold aggressive impulses towards others and work together with others were 2.21 more times more likely to complete treatment [OR] = 2.21, Wald = 4.12, P =.042, 95% CI [1.0, 4.7]. The analysis at the facet level provided additional insight. Individuals with higher adaptive levels on Effortful Control were 46% more times likely to complete treatment than the group [OR] = 4.67, Wald = 10.231, P =.001, 95% CI [1.81, 12.04], 47% more likely on Aggression regulation [OR] = 4.76, Wald = 16.68, P <.001, 95% CI [2.1, 10.3], and 26% more likely on Stable self-image [OR] = 2.62, Wald = 6.75, P <.009, 95% CI [0.9, 3.0]. Conclusions: These findings extend our knowledge of the predictive role of characteristic adaptations in treatment completion and highlight the clinical utility of capturing these individual differences early on. Delineating the role of characteristic adaptations in treatment may provide the basis for enhancing treatment effectiveness through individualized interventions that are scientifically driven and may open new avenues for the scientific enquiry of personality and treatment. [ABSTRACT FROM AUTHOR]

Background: Despite the frequency and negative impact of low physical activity among patients with chronic obstructive pulmonary disease (COPD), little is known about how it persists and remits over time or the factors predicting new states of low physical activity. The aim of the study was to determine the probability of a transition between states of low and nonlow physical activity in a cohort of patients with stable COPD followed for 2 years. We also investigated different potentially modifiable factors to determine whether they can predict new states of low physical activity. Methods: We prospectively included 137 patients with stable COPD (mean age 66.9 ± 8.3 years). Physical activity was measured at baseline and at 1 and 2 years of follow up. Low physical activity was defined according to energy expenditure by cut-off points from the Fried frailty model. The likelihood of annual transition towards new states and recovery was calculated. We evaluated demographic, frailty, nonrespiratory, and respiratory variables as potential predictors, using generalized estimating equations. Results: At baseline, 37 patients (27%) presented with low physical activity. During the study period, a total of 179 annual transitions were identified with nonlow physical activity at the beginning of the year; 17.5% transitioned to low physical activity. In contrast, 34.3% of the 67 transitions that started with low physical activity recovered. Predictors of transition to new states of low physical activity were dyspnea ⩾2 (odds ratio = 3.21; 95% confidence interval: 1.20–8.61) and poor performance on the five sit-to-stand test (odds ratio = 4.75; 95% confidence interval: 1.30–17.47). Conclusions: The change between levels of low and nonlow physical activity is dynamic, especially for recovery. Annual transitions toward new states of low physical activity are likely among patients with dyspnea or poor performance on the five sit-to-stand test. The reviews of this paper are available via the supplemental material section. [ABSTRACT FROM AUTHOR]

Background: Angiopoietin-2 (Ang-2), as one of the ligands of endothelial receptor Tie2, is known to be significant for vessel maturation and stabilization after birth. Previous studies showed the relationship between Ang-2 level and the risk of mortality in patients with acute respiratory distress syndrome (ARDS). However, the link between circulating Ang-2 and the risk of mortality in patients with ARDS varied in different investigations. Results: We performed a systematic review and meta-analysis of all available cohort studies regarding the association between baseline circulating Ang-2 and mortality in patients with ARDS. Among the 10 eligible studies, pooled odds ratio (OR) showed that high Ang-2 level contributed to ARDS mortality [OR = 1.56, 95% confidence interval (CI): 1.30–1.89, I 2 = 76.2%]. Stratified analysis revealed that higher circulating Ang-2 was related to a 30% higher risk in the high-quality scores group (OR = 1.68, 95% CI: 1.33–2.68, I 2 = 62.4%). The I 2 of the bad compliance group decreased from 76.2% to 8.5%, which suggested that compliance is a significant source of heterogeneity. This association may be blunted by potential bias, although the results was not meaningfully changed by omitting only one study at a time. Further subgroup analysis and meta-regression support that compliance of patients also affects the results significantly, compared with the publication year, follow-up duration, the samples, or population characteristics. Conclusion: Participants with higher baseline Ang-2 were at a higher risk for future risk of mortality in patients with ARDS. Higher circulating Ang-2 levels could independently predict the risk of mortality in patients with ARDS. However, further large scale prospective cohorts or even interventional studies are warranted to evaluate the diagnostic power of Ang-2 and its causative role on ARDS outcome. The reviews of this paper are available via the supplemental material section. [ABSTRACT FROM AUTHOR]

Introduction: Rotator cuff tears (RCTs) are a common source of pain in the shoulder girdle. There is still debate about the optimal treatment for older adults with RCTs. In clinical practice, patients who do not respond well to non-surgical management may still be eligible for operative treatment. In this study, we assessed the outcome of arthroscopic repair of RCTs in patients ≥60 years old. Material and method: A retrospective case series was conducted to include patients who underwent arthroscopic repair of RCTs from 1 January 2018 to 1 January 2021. The study included individuals aged ≥60 years who had radiologically confirmed RCTs (verified by MRI) and clinical findings including sleep-disturbing pain and reduced range of motion. Preoperative treatment included physiotherapy for at least 6 months and one subacromial corticosteroid injection. Results: Fifty-three RCTs were treated during the study period. After exclusion because of incomplete documentation, 45 patients remained. The mean age was 66 years and 80% had isolated supraspinatus tears and 25% had variable degrees of fatty infiltration (Goutallier grade 1-3) on MRI examination with positive tangent sign. There were no surgical site infections and three symptomatic re-ruptures (6%). At follow-up, (71%) reported no remaining sleep-disturbing shoulder pain. Abduction improved from 62° to 122°. Flexion improved from 68° to 135°. This study found that people aged 60 years and older who underwent repair of RCTs showed statistically significant clinical improvement in shoulder flexion and abduction with less sleep-disturbing shoulder pain. These encouraging results may contribute to the existing literature, favoring the choice of surgical treatment for symptomatic RCTs in this age group with failed nonoperative treatment. Conclusion: The arthroscopic repair of RCTs in patients 60 years and older yielded a substantial increase in shoulder flexion and abduction, significantly reducing sleep-disturbing shoulder pain. Postoperative complications were minimal. [ABSTRACT FROM AUTHOR]

Background: Charles Bonnet syndrome (CBS) is a condition in which people with vision loss experience complex visual hallucinations. These complex visual hallucinations may be caused by increased excitability in the visual cortex that are present in some people with vision loss but not others. Objectives: We aimed to evaluate the association between γ-aminobutyric acid (GABA) in the visual cortex and CBS. We also tested the relationship among visually evoked responses, functional connectivity, and CBS. Design: This is a prospective, case-controlled, cross-sectional observational study. Methods: We applied 3-Tesla magnetic resonance spectroscopy, as well as task-based and resting state (RS) connectivity functional magnetic resonance imaging in six participants with CBS and six controls without CBS. GABA+ was measured in the early visual cortex (EVC) and in the lateral occipital cortex (LOC). Participants also completed visual acuity and cognitive tests, and the North-East Visual Hallucinations Interview. Results: The two groups were well-matched for age, gender, visual acuity and cognitive scores. There was no difference in GABA+ levels between groups in the visual cortex. Most participants showed the expected blood oxygenation level dependent (BOLD) activation to images of objects and the phase-scrambled control. Using a fixed effects analysis, we found that BOLD activation was greater in participants with CBS compared to controls. Analysis of RS connectivity with LOC and EVC showed little difference between groups. A fixed effects analysis showed a correlation between the extent of functional connectivity with LOC and hallucination strength. Conclusion: Overall, our results provide no strong evidence for an association between GABAergic inhibition in the visual cortex and CBS. We only found subtle differences in visual function and connectivity between groups. These findings suggest that the neurochemistry and visual connectivity for people with Charles Bonnet hallucinations are comparable to a sight loss population. Differences between groups may emerge when investigating subtle and transient changes that occur at the time of visual hallucinations. Plain language summary: Brain imaging in Charles Bonnet syndrome In Charles Bonnet Syndrome (CBS), people with sight loss start to see hallucinations that they know are not real but can be disturbing. In this study we used MRI scanning to measure how the chemistry in the visual brain differs in people with CBS and those who have sight loss but no hallucinations. Surprisingly we did not find any differences in chemistry between these groups, suggesting that their brains do not differ greatly. Any differences in how their visual brain works may be too small to measure, or only present when people hallucinate. [ABSTRACT FROM AUTHOR]

Background: Most employees will experience serious illness, caregiving, dying and loss (End-of-Life (EoL) experiences) at multiple points throughout their working lives. These experiences impact affected employees but also their colleagues in terms of health and wellbeing, and the workplace as a whole in terms of workplace safety, productivity and labour relations. The impact of EoL experiences on employees means that workplaces are called to play a more active role in providing support for EoL experiences. Aim: To describe how the EU-CoWork (2024–2028) project addresses its main aims to (1) create Compassionate Workplace cultures, practices and policies and improve health and wellbeing for employees dealing with EoL experiences in different national work contexts in Europe; (2) describe and evaluate the process of co-creation and implementation of Compassionate Workplace Programs (CWPs) and how these influence the programs' outcomes. Design: EU-CoWork employs a facilitated and co-creative Developmental Evaluation approach to the development of 12 tailored CWPs across four European countries (Belgium, Austria, Sweden and Greece). Methods: To evaluate the outcomes and processes leading to these outcomes, a mixed-methods Realist Evaluation methodology is applied, formulating and testing Context-Mechanism-Outcomes configurations and combining longitudinal quantitative and qualitative data collections. Results: EU-CoWork will generate evidence to support an expanded model of occupational health and safety risk factors sensitive to the specific challenges related to employees' EoL experiences. In doing so, several challenges will have to be navigated: involving employees with EoL experiences while avoiding overburdening them, avoiding tokenistic engagement, managing power differentials, balancing the need for scientific rigour with the flexibility required in co-creation, reconciling different epistemologies and disciplinary traditions and organisational resistance to change. Conclusion: There are potential long-lasting broader societal impacts through the stimulation of open discourse on EoL topics, the reconciliation of work and care, and changes in gendered work and care patterns. [ABSTRACT FROM AUTHOR]

Background: Studies in the United States are scarce that assess the survival differences between breast-conserving surgery plus radiation (Breast-Conserving Therapy; BCT) and mastectomy groups using population-based data while accounting for sociodemographic and clinical factors that affect the survival of women with early-stage breast cancer (ESBC). Objective: To assess whether BCT provides superior long-term overall survival (OS) and breast cancer-specific survival (BCSS) compared with mastectomy in women with ESBC, while considering key factors that impact survival. Design: Cohort study. Methods: We analyzed data on women aged 20 years and older diagnosed with stage I-II breast cancer (BC) in 2004 who received either BCT or mastectomy. The data were collected by 5 state cancer registries through the Centers for Disease Control and Prevention-funded Patterns of Care study. Multivariable Cox proportional hazard models, accounting for sociodemographic and clinical factors, were used to calculate hazard ratios (HRs) with 95% confidence intervals (CI). Sensitivity analysis involved optimal caliper propensity score (PS) matching to address residual confounding. Results: Of the 3495 women, 41.5% underwent mastectomy. The 10-year OS and BCSS were 82.7% and 91.1% for BCT and 72.3% and 85.7% for mastectomy, respectively. Adjusted models showed that mastectomy recipients had a 22% higher risk of all-cause deaths (ACD) (HR = 1.22, 95% CI = [1.06, 1.41]) and a 26% higher risk of breast cancer-specific deaths (BCD) (HR = 1.26, 95% CI = [1.02, 1.55]) than BCT recipients. Sensitivity analysis demonstrated that mastectomy was associated with a higher risk of ACD (P <.05) but did not exhibit a statistically significant risk for BCD. Women with HR+/HER2+ (luminal B) or invasive ductal carcinoma BC who underwent mastectomy had higher risks of ACD and BCD compared with BCT recipients, while the hazards for ACD in triple-negative BC did not remain significant after adjusting for covariates. Conclusion: ESBC BCT recipients demonstrate superior OS and BCSS compared with mastectomy recipients. Plain Language Summary: Breast-preserving treatment leads to higher 10-year survival in early-stage breast cancer This study compared the long-term survival outcomes of breast-conserving therapy (BCT) and mastectomy for early-stage breast cancer. Analyzing data from over 3400 women diagnosed in 2004, researchers found that BCT recipients had higher 10-year overall and breast cancer-specific survival rates compared with mastectomy recipients. Adjusted models showed a 22% higher risk of all-cause death [ABSTRACT FROM AUTHOR]

Background: Physiological and psychosocial changes experienced by women during the perinatal period may put them at risk for postpartum mental health disturbances. Accumulating evidence suggests that dietary patterns may influence mental health through the modulation of the gut microbiota and its effects on host immune activity. Thus, targeting the gut microbiota via dietary intake could serve as both a preventative and therapeutic strategy in improving perinatal mental health. Objectives: Here, we present a protocol for a prospective cohort study that primarily aims to determine if diet quality during pregnancy is protective against postpartum depression severity. Secondary objectives will examine if microbiota- and blood-based inflammatory markers may be associated with the relationship between prenatal diet quality and postpartum depression severity, as well as with associations between additional dietary and mental health outcomes. Methods and Analysis: Dietary patterns and mental health symptoms will be documented in 100 pregnant women at 4 time points during pregnancy and postpartum. Participants will also provide stool and blood samples at the same time points to determine microbiota composition and predicted function and inflammatory factors, respectively. Stool microbiota will be analyzed using 16S ribosomal RNA gene sequencing and bioinformatics tools (QIIME 2/PICRUSt2). Inflammatory factors will be determined using high-sensitivity antibody-based immunoassays. Statistical analyses will include linear mixed models and hierarchical linear mixed effect models. Ethics: The study was approved by the Research Ethics Boards of the Royal Ottawa Health Care Group (#2022002) and of the University of Ottawa (#H-06-22-8013). Informed consent will be obtained from all participants before their enrollment. Discussion: Findings from this study will help develop evidence-based dietary recommendations and potential interventions for women susceptible to or suffering from postpartum mental health issues that are accessible, noninvasive, and have potential to play a role in prevention and treatment. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of outcomes data on surgical reconstruction for multiligament knee injury (MLKI) in the orthopaedic literature. Purpose: To examine functional and return-to-sports (RTS) outcomes and revision rates after single-stage reconstruction for MLKIs in a cohort containing a large proportion of competitive athletes over a 20-year period. Study Design: Case series; Level of evidence, 4. Methods: We identified all patients at our institution who underwent surgical reconstruction for an anterior cruciate ligament (ACL) or bicruciate (ACL-posterior cruciate ligament) MLKI between 2001 and 2020 and had ≥2 years of postoperative outcome data. Patient-reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) form, a surgical satisfaction survey, and questions about subsequent knee surgery and RTS administered via telephone. Summary statistics for all outcomes data were calculated, and predictors of IKDC scores at follow-up were examined using univariable linear regression. Results: Out of 151 patients eligible for this study, outcomes data were collected in 119 patients (79%). The mean follow-up time was 8.3 ± 4.4 years, and the mean IKDC score at follow-up was 79 ± 17. A total of 83 competitive athletes were included; 62 of these athletes attempted to return to preinjury sport. Among the 62 who attempted RTS, 50 (81%) were successful, and 12 were unable to return due to limitations from their surgery. At follow-up, 112 of the overall cohort of 119 patients (94%) were either satisfied or very satisfied with their surgical outcome, and 91% stated the surgery met or exceeded their expectations. In addition, 24% had subsequent ipsilateral knee operations after their index multiligament knee reconstruction. Older age at surgery and female sex were associated with worse IKDC scores at follow-up. Conclusion: Despite the severity of the injuries in our cohort, we found high levels of patient-reported function and a high rate of successful RTS in the competitive athletes. Older age and female sex were associated with worse patient-reported knee function at follow-up. [ABSTRACT FROM AUTHOR]

Background: Long-term follow-up for anterior cruciate ligament reconstruction (ACLR) is limited due to heterogeneity in the number of techniques utilized, the number of surgeons included, and attrition bias. Purpose: To analyze a single surgeon's 35-year experience with ACLR using the transtibial technique, with an emphasis on temporal trends in graft selection and subanalyses on rates of revision surgery, contralateral ACLR, and nonrevision reoperation among different demographic cohorts of patients. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent arthroscopically assisted single-bundle ACLR between 1986 and 2021 were identified from a prospectively maintained single-surgeon registry. Outcomes of interest included revision, reoperation, and contralateral rupture rates. Results: A total of 2915 ACLRs were performed during the senior surgeon's career. The mean age for primary ACLR was 29.4 ± 14.8 years. During primary ACLR, 98.4% of patients received a central-third bone-patellar tendon-bone (BPTB) graft. Increasing patient age was associated with increasing allograft usage (P <.01), with a significant temporal increase in allograft usage over the senior surgeon's career (P <.01). There was a higher revision rate among younger patients (P <.01), female patients aged 21 to 25 years (P =.01), and patients who received an allograft during the primary procedure (P =.04). The contralateral rupture rate showed no difference between sexes (P =.34); however, patients who underwent ACLR with autograft had a greater rate of contralateral injury compared with those with allograft (P <.01). The contralateral rupture rate was greater than the revision rate (P <.01). The most common causes of nonrevision reoperation were failed meniscal repair, new meniscal tears, arthrofibrosis, and painful hardware removal. Conclusion: The findings of this single-surgeon registry reveal temporal trends in ACLR over a 35-year career. There was a trend toward increasing BPTB allograft use in ACLR, especially in older patients and revision cases. A greater revision rate was observed among younger patients, female patients, and those receiving allografts during primary surgery. Contralateral ACLR was more common than revision surgery. [ABSTRACT FROM AUTHOR]

Qualitative Longitudinal Research (QLR) is a dynamic and evolving methodology using time as a lens to inform study design, data collection and analysis. A key feature of QLR is the collection of data on more than one occasion, often described as waves or time points. Thus, researchers embarking on designing a new study need to consider several key features including the study duration (timeframe) and the frequency and intensity of data collection (tempo). Yet, how to embed these features in practice is not well described. Leveraging the intensive-extensive temporal plane of time, we explore research approaches employing both shorter and longer timeframes, as well as intensive and extensive tempos. Drawing on six studies that we have conducted, we discuss four pivotal aspects including: (i) crafting intensive-extensive tempo and timeframes; (ii) defining baseline and closure points; (iii) planning for flexibility; and (iv) working ethically within a temporal lens. By examining and critically analysing these case studies through the lens of the intensive-extensive plane of time, this article aspires to offer insights for researchers interested in using the QLR design in healthcare. We thus aim to prepare researchers for embedding these features during the research process. [ABSTRACT FROM AUTHOR]

Introduction: The surgical approach of hemiarthroplasty for displaced femoral neck fractures remains debated. The study objective was to compare in-hospital outcomes for geriatric displaced femoral neck fractures treated with hemiarthroplasty based on surgical approach (direct lateral vs. posterior approach). Materials and Methods: This retrospective cohort study included geriatric patients (≥60 y/o) admitted 7/1/2016-3/31/2020 treated with hemiarthroplasty. Outcomes included: operative time (incision to closure), length of stay (HLOS), and blood loss volume (mL). The Harding direct lateral approach was compared to the posterior approach; P <.05. Results: There were 164 patients (59% direct lateral, 41% posterior). Patients treated with the direct lateral approach had an advanced directive (P =.03), dementia, (P =.03), or were functionally dependent (P =.03) more often than patients treated with the posterior approach. Time to surgery was comparable between groups (P =.52). The direct lateral approach was associated with a shorter operative time (2.3 vs. 2.8 h, P =.03), a longer HLOS (5.0 vs. 4.0 days, P <.01), and a lower median volume of blood loss (50 vs. 100 mL, P =.01), than the posterior approach, respectively. In a stratified analysis, for those who were not functionally dependent, did not have dementia or an advanced directive, the direct lateral approach led to a longer HLOS (P =.03) and shorter operative time (P =.04) than the posterior approach. Whereas among those who were functionally dependent, had dementia or had an advanced directive, the direct lateral approach led to less blood loss (P =.02) than the posterior approach. Discussion: While those treated with the direct lateral approach lost significantly less blood, they had a significantly longer HLOS than those treated with the posterior approach. Comorbidities significantly modified outcomes, which may suggest their presence could assist with treatment decisions. Conclusions: This study found neither approach, the direct lateral nor posterior, to be superior. Surgical approach could remain physician preference. [ABSTRACT FROM AUTHOR]

Evaluating stroke campaigns and associated behavioural changes is crucial to assess intervention effectiveness and inform future strategies. We aimed to evaluate patient's and bystanders' foreknowledge of stroke signs and symptoms and their response at stroke onset. We interviewed stroke patients using a validated questionnaire or their bystanders if the stroke patient had disabling stroke. The questionnaire was administered to 165 participants, 142 (86.1%) stroke patients and 23 (13.9%) bystanders. The mean age was 52.6 (SD = 11.7), and male–female ratio was 7:1. Among the participants, 33 (20.1%) had foreknowledge of stroke signs, and of these, 27 (16.5%) were aware of the stroke campaign in Qatar. The behavioural responses at stroke onset included; activating Emergency Medical Services (EMS) (n = 55, 33.3%), calling friends/relatives (n = 69, 41.8%), driving to hospital (n = 33, 20%), waiting for improvement in condition (n = 21, 12.7%). There was no association of ethnicity, marital status, or campaign awareness with EMS activation. Despite limited community awareness of stroke signs and campaign, help-seeking behaviour through EMS activation was generally high, underscoring the need for focused educational efforts and public health interventions. [ABSTRACT FROM AUTHOR]

Background: Little is known regarding the opinions of the general population on anterior cruciate ligament (ACL) graft options. Purpose: To evaluate the general population's perception of the use of allografts versus autografts in ACL reconstruction using a previously validated online marketplace platform. Methods: A prospective 34-question survey was distributed via the online marketplace. After collecting baseline demographics, participant preferences for ACL reconstruction with an allograft or autograft were established. All respondents completed a preeducation survey, reviewed an evidence-based education sheet, and completed a posteducation survey to assess their understanding. Upon completion, participants were asked which graft they would prefer. Participants were then asked if they would be willing to change their preference based on surgeon recommendation. Finally, participants were asked to rank the factors from the education sheet that were most influential. Study Design: Cross-sectional study. Results: There were 491 participants that completed the survey (mean age, 39.9 years [range, 19-72 years]; 244 male, 241 female, and 6 nonbinary/third-gender participants). Before reading the education sheet, 276 (56%) reported no graft preferences, 146 (30%) preferred autograft, and 69 (14%) preferred allograft. After reading the provided sheet, 226 (46%) participants preferred autograft, 185 (38%) preferred allograft, and 80 (16%) had no preference. The mean score on the preeducation test was 45%, and the mean score on the posteducation test was significantly greater (61%; P <.01). Overall, 345 participants (83.9%) stated they would change their preference for autograft or allograft if their surgeon recommended it. Surgeon preference (n = 330; 67%), educational information provided (n = 117; 24%), and previous knowledge (n = 44; 9%) were the most important factors for making graft selections. The mean ages of the participants selecting each graft type before and after education were as follows: allograft (37.8 ± 10.1 vs 40.6 ± 11.8 years; P =.05), autograft (38 ± 11.5 vs 39.5 ± 10.1 years; P =.21), and no preference (41.5 ± 11.2 vs 39.4 ± 11.8 years; P =.16). Conclusion: Education resulted in a greater number of individuals' reporting a preference in graft type (either allograft or autograft) compared with preinformation questioning. In addition, 83.9% of the participants were willing to switch their graft choice if recommended by their surgeon. [ABSTRACT FROM AUTHOR]