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Around two-thirds of women who are of reproductive age use some type of contraception. Two of the most effective long-acting reversible contraceptives (LARC) are the intrauterine device (IUD) and the subdermal contraceptive implant (SCI). Despite their effectiveness, women often report abnormal uterine bleeding as the reason for discontinuation. In this review, we analyze key aspects regarding the mechanisms of action of IUDs (both copper-containing and levonorgestrel-releasing) and SCIs, as well as how they change the intrauterine environment in order to provide effective contraception at a physiological level. Additionally, we introduce the pathophysiology of different types of abnormal intrauterine bleeding provoked by the mentioned LARCs. These three contraceptive methods work in diverse ways, thus, the etiology of abnormal uterine bleeding is different and multifactorial according to each LARC. This review intends to provide information in order to better our understanding of bleeding induced by these contraceptive methods, as well as introduce current and potential new therapies. Furthermore, this review intends to provide updated and concise information that could be available firsthand not only to health care providers but scientists who are innovating and revolutionizing this field. In 2013, the American College of Obstetricians and Gynecologists published a management of abnormal uterine bleeding, however, there is limited updated data regarding the physiology and pathophysiology of abnormal uterine bleeding and its treatment based on different LARCs (hormonal and non-hormonal).

Around two-thirds of women who are of reproductive age use some type of contraception. Two of the most effective long-acting reversible contraceptives (LARC) are the intrauterine device (IUD) and the subdermal contraceptive implant (SCI). Despite their effectiveness, women often report abnormal uterine bleeding as the reason for discontinuation. In this review, we analyze key aspects regarding the mechanisms of action of IUDs (both copper-containing and levonorgestrel-releasing) and SCIs, as well as how they change the intrauterine environment in order to provide effective contraception at a physiological level. Additionally, we introduce the pathophysiology of different types of abnormal intrauterine bleeding provoked by the mentioned LARCs. These three contraceptive methods work in diverse ways, thus, the etiology of abnormal uterine bleeding is different and multifactorial according to each LARC. This review intends to provide information in order to better our understanding of bleeding induced by these contraceptive methods, as well as introduce current and potential new therapies. Furthermore, this review intends to provide updated and concise information that could be available firsthand not only to health care providers but scientists who are innovating and revolutionizing this field. In 2013, the American College of Obstetricians and Gynecologists published a management of abnormal uterine bleeding, however, there is limited updated data regarding the physiology and pathophysiology of abnormal uterine bleeding and its treatment based on different LARCs (hormonal and non-hormonal).

Percutaneous closure of paravalvar leaks (PVLs) was once only performed in extreme or non-surgical risk cases not suitable for redo-surgery with tissue or mechanical valves. This technique is now the treatment of choice with long term outcomes that are better than redo operations.123 As interventionalists become more familiar with using PVL devices, more off label device use has been reported in non-surgical cases involving complex native mitral valve regurgitation (NVMR). In this review, we appraise the literature regarding percutaneous treatment of paravalvar leaks and more recently esoteric off label use. We also describe two recent challenging cases where percutaneous devices were used to treat severe leaks that developed as a sequela of previous infective endocarditis. We also provide specific recommendations regarding periprocedural strategy and focus on the importance of device choice to provide an optimal outcome.

Objectives: To examine whether adolescents exceed recommended noise exposure limits when using personal listening devices (PLDs) and to investigate the relationship between objectively measured PLD use and hearing thresholds Study Design: Cross-sectional study. Setting: This study was embedded within an ongoing prospective birth cohort study in Rotterdam, the Netherlands. Data were collected from May 2017 to September 2019. Methods: A smartphone application was developed to measure daily noise exposure from PLDs. Listening habits were monitored among 314 adolescents with a mean age of 13 years 7 months (SD, 5 months), of whom 51.6% were male. Hearing acuity was measured by pure tone audiometry, and tympanometry was performed in both ears. Results: Within the study group, 2.2% adolescents exceeded the recommended daily noise dose (85 dBA as an 8-hour time-weighted average) among all days when the application was active and 9.9% when among only the listening days. No significant correlation was found between the daily noise dose from PLDs and pure tone thresholds. Conclusions: The majority of adolescents exhibited listening habits that could be considered safe. As noise-induced hearing loss develops slowly over time, it could be that the effects of PLD use on hearing are not evident yet in this young population with a relatively short duration of PLD use.

Introduction: The objective of this study was to assess the influence of postponing the first post-activation follow-up due to the COVID-19 pandemic on the aided sound field detection thresholds and speech recognition of cochlear implant (CI) users. Methods: A retrospective review was performed at a tertiary referral center. Two groups of adult CI recipients were evaluated: (1) patients whose first post-activation follow-up was postponed due to COVID-19 closures (postponed group; n = 10) and (2) a control group that attended recommended post-activation follow-ups prior to the COVID-19 pandemic (control group; n = 18). For both groups, electric thresholds were estimated at initial activation based on comfort levels and were measured behaviorally at subsequent post-activation follow-ups. For the control group, behavioral thresholds were measured at the 1-month follow-up. For the postponed group, behavioral thresholds were not measured until 3 months post-activation since the 1-month follow-up was postponed. The aided pure-tone average (PTA) and word recognition results were compared between groups at the 3-month follow-up and at an interim visit 2–9 weeks later. Results: At the 3-month follow-up, the postponed group had significantly poorer word recognition (23 vs. 42%, p = 0.027) and aided PTA (42 vs. 37 dB HL, p = 0.041) than the control group. No significant differences were observed between 3-month data from the control group and interim data from the postponed group. Conclusions: The postponed follow-up after CI activation was associated with poorer outcomes, both in terms of speech recognition and aided audibility. However, these detrimental effects were reversed following provision of an individualized map, with behaviorally measured electric threshold and comfort levels. While adult CI recipients demonstrate an improvement in speech recognition with estimated electric thresholds, the present results suggest that behavioral mapping within the initial weeks of device use may support optimal outcomes.

A 2020-ban kezdődött koronavírus-járvány az első év tavaszán teljes lezárást okozott a gyermekintézményekben. A szülők a világon mindenütt arra kényszerültek, hogy kiskorú gyermekeikről otthon gondoskodjanak, ami gyakran felborította a családok életet. Az otthonmaradt kisgyermekekkel való törődés és a munka nehezen sikeredő összeegyeztetése miatt az érintett családok gyermekei gyakrabban használtak, használnak digitális eszközöket. Kutatásunkban hat év alatti gyermekeket nevelő szülőket (N=391) vizsgáltunk a kisgyermekek médiaeszköz-használatával kapcsolatos általános és pandémia alatti „vészhelyzeti” nézetei és gyakorlata vonatkozásában, online kérdőív segítségével, kényelmi mintavétellel. Eredményeink szerint a megkérdezett családokban a kisgyermekek nagy része a járvány előtt is IKT-eszközhasználó volt, és a pandémia a vizsgált gyerekek 46%-ánál képernyőidő-emelkedéssel járt. A digitális eszközhasználat általános szabályozásával kapcsolatban a kutatásban sikerült négy faktort feltárni, melyek közül a „megengedő, nem szabályozó” és az „ellenőrző, kontrolláló” faktorok mutattak összefüggést a járvánnyal összefüggő változásokkal. Az általános „megengedő, nem szabályozó” attitűd (amely az idősebb és kevésbé iskolázott szülők és az idősebb gyerekek esetén jobban jellemző), a járvány alatt is összefüggést mutat az IKT-eszközhasználat növekedésével a gyermekek körében Az általános „ellenőrző, kontrolláló” attitűd esetén, kutatásunk szerint, a szülő a krízisben sem engedte a gyermekek túlzott képernyőhasználatát. Eredményeink a szülők tudatosságának fokozására hívják fel a figyelmet a kisgyermekek túlzott médiaeszköz használatával összefüggésben.

Background: Despite advancements in diabetes technologies, disparities remain with respect to diabetes device use in youth with type 1 diabetes (T1D). We compared sociodemographic, diabetes, and psychosocial characteristics associated with device (pump and continuous glucose monitor [CGM]) use in 13- to 17-year-old teens with T1D. Materials/Methods: Data were derived from a multicenter clinical trial to optimize self-care and glycemic control in teens with T1D. We categorized teens as pump users versus non-users and CGM users versus non-users based on their diabetes device usage. Chi-square and t-tests compared characteristics according to device use. Results: The sample comprised 301 teens (50% female) with baseline mean ± SD age 15.0 ± 1.3 years, T1D duration 6.5 ± 3.7 years, and HbA1c 8.5 ± 1.1% (69 ± 12 mmol/mol). Two-thirds (65%) were pump users, and 27% were CGM users. Pump users and CGM users (vs. non-users) were more likely to have a family annual household income ≥$150,000, private health insurance, and a parent with a college education (all P < .001). Pump users and CGM users (vs. non-users) also performed more frequent daily blood glucose (BG) checks (both P < .001) and reported more diabetes self-care behaviors (both P < .05). Pump users were less likely to have baseline HbA1c ≥9% (75 mmol/mol) ( P = .005) and to report fewer depressive symptoms ( P = .02) than pump non-users. Parents of both CGM and pump users reported a higher quality of life in their youth ( P < .05). Conclusion: There were many sociodemographic, diabetes-specific, and psychosocial factors associated with device use. Modifiable factors can serve as the target for clinical interventions; youth with non-modifiable factors can receive extra support to overcome potential barriers to device use.

After decades of investigation, the role of near work in myopia remains unresolved, with some studies reporting no relationship and others finding the opposite. This systematic review is intended to summarize classic and recent literature investigating near work and the onset and progression of myopia, potential mechanisms and pertinent clinical recommendations. The impact of electronic device use is considered. PubMed and Medline were used to find peer-reviewed cross-sectional and longitudinal studies related to near work and myopia from 1980 to July 2020 using the PRISMA checklist. Studies were chosen using the Joanna Briggs Institute checklist, with a focus on studies with a sample size greater than 50. Studies were independently evaluated; conclusions were drawn per these evaluations. Numerous cross-sectional studies found increased odds ratio of myopia with increased near work. While early longitudinal studies failed to find this relationship, more recent longitudinal studies have found a relationship between myopia and near work. Rather than daily duration of near work, interest has increased regarding absolute working distance and duration of continuous near viewing. Several reports have found that shorter working distances (30 cm) and continuous near-work activity (30 min) are risk factors for myopia onset and progression. Novel objective continuously measuring rangefinding devices have been developed to better address these questions. The literature is conflicting, likely due to the subjective and variable nature in which near work has been quantified and a paucity of longitudinal studies. We conclude that more precise objective measures of near viewing behaviour are necessary to make definitive conclusions regarding the relationship between myopia and near work. Focus should shift to utilizing objective and continuously measuring instruments to quantify near-work behaviours in children, followed longitudinally, to understand the complex factors related to near work. A better understanding of the roles of absolute working distance, temporal properties, viewing breaks and electronic device use on myopia development and progression will aid in the development of evidence-based clinical recommendations for behavioural modifications to prevent and slow myopia.

Alba Ramírez-Sarmiento,1– 3 Orlando Aya,3,4 Diana Cáceres-Rivera,1,2 Carlos F Reyes,2– 4 Angela Espitia,1,2 Camilo Pizarro,3,4 Joaquim Gea,5,6 Victor R Castillo,7,8 Mauricio Orozco-Levi1– 3,6 1Respiratory Department, Instituto Cardiovascular y Hospital Internacional de Colombia, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia; 2EMICON Research Group MINCIENCIAS, Bogotá, Cundinamarca, Colombia; 3Universidad de Santander (UDES), Bucaramanga, Santander, Colombia; 4Department of Critical Care, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia; 5Respiratory Department, Parc de Salut Mar, Barcelona, Catalonia, Spain; 6CEXS-Universidad Pompeu Fabra, Barcelona, Catalonia, Spain; 7Department of Cardiovascular Surgery, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia; 8Biomedical and Translational Research Group, Fundación Cardiovascular de Colombia, Floridablanca, Santander, ColombiaCorrespondence: Mauricio Orozco-LeviRespiratory Department, ICV-HIC, Fundación Cardiovascular de Colombia, Calle 155a no. 23-58, El Bosque, Floridablanca, Santander, ColombiaTel +57 3175741421Email mauricioorozco@fcv.orgBackground: Bronchoaspiration of content that accumulates in the supraglottic area (eg, saliva, gastroesophageal reflux) is a risk factor for ventilator-associated pneumonia. A continuous supraglottic suction system may decrease the risk of bronchoaspiration in these patients.Objective: (1) Constructing a conceptual model and functional prototype of a continuous supraglottic suction device for use in humans; (2) defining functional characteristics in ex vivo swine head models; and (3) evaluating its efficacy and safety in mechanically ventilated patients.Methods: Study conducted in three phases. First phase: definition of distances and diameters of the triangle determined by dental arch, posterior oropharynx and vallecula, and diameter of the oropharynx in axial projection; and identification of the declining area of supraglottic suction. Second phase: design engineering and functional prototype evaluated in ex vivo models. Third phase: evaluation of device use in terms of safety and efficacy in ventilated patients.Results: We obtained a final functional model of the SUPRAtube device injected into PVC for medical use. Device effectiveness in in vitro simulation showed a high and fast suction capacity of liquid and thick volumes. Study of swine heads allowed to validate the shape, size and functional fenestration of the device. Study in intubated and mechanically ventilated patients showed a high supraglottic suction capacity and the absence of local adverse events during 72 (7– 240) hours of continuous operation.Conclusion: Our study describes the process of conceptualization, design and production of a practical, safe, low-cost continuous supraglottic suction device without representing antibiotic pressure, which appears to be a new complementary preventive strategy for the standard management of intubated and mechanically ventilated patients.Keywords: mechanical ventilation, bronchoaspiration, supraglottic suction, SUPRAtube, endotracheal tube, gastroesophageal reflux

OBJECTIVE: Although the use of closure devices (CD) for femoral artery antegrade access (AA) is not in the instructions for use (IFU) for many devices, AA has been reported to be associated with a lower incidence of access site complications compared to manual compression alone. We hypothesized that CD use for AA would not be associated with a clinically significant increased odds of access site complications compared to CD use for retrograde access (RA). METHODS: This was a retrospective review of the Vascular Quality Initiative from 2010 to 2019 for infrainguinal peripheral vascular interventions with common femoral artery access closed with a CD. Patients who had a cutdown or multiple access sites were excluded. Cases were then stratified into whether access was antegrade or retrograde. Hierarchical multivariable logistic regressions controlling for hospital level variation were used to examine the independent association between AA and access site complications. The primary outcomes were access site hematoma, stenosis, or occlusion as defined in the VQI. The secondary outcome was the development of an access site hematoma requiring an intervention, which was defined as transfusion, thrombin injection, or surgery. Sensitivity analyses after coarsened exact matching were performed to reduce residual bias. RESULTS: Overall, 72,463 cases were identified and 6,070 (8.4%) had AA. Patients with AA were less likely to be smokers (27.2% vs 33.0%) or obese (31.5% vs 35.6%; all P

SIGNIFICANCE: After 6 to 8 weeks of mandatory lockdown due to coronavirus disease 2019 (COVID-19) in Spain, the encouraged change in daily habits resulted in a significant increase in electronic device use. Computer vision syndrome-related symptoms were reported more often in participants who used electronic device for more time and spent less time outdoors. PURPOSE: The main purpose of this study was to evaluate computer vision syndrome-related eye symptoms due to the use of electronic devices during COVID-19 lockdown decreed in Spain in 2020. METHODS: After 6 to 8 weeks of strict lockdown, a total of 730 participants (18 to 73 years old) filled in a customized questionnaire divided into three sections: (1) general demographics, (2) usage habits of electronic devices during this period, and (3) computer vision syndrome-related ocular and visual symptoms associated with their use and with ergonomic practices. RESULTS: The daily duration of use of electronic devices increased an average of 3.1 ± 2.2 h/d during the lockdown, with computer use increasing the most. The main symptoms reported by the participants were headache (36.7%), dry eye (31.1%), irritation (24.1%), blurred vision (21.2%), and ocular pain (14.9%). There was a significant relationship between computer vision syndrome-related symptoms and age (greater in participants between 18 and 30 years old than in those older than 45 years, P < .001), primary activity (greater in studying from home and remote working, P < .001), and extended periods of electronic device use (greater when used more than 10 h/d, P = .05). Symptoms were also associated with time spent outdoors (greater in participants with

Joanne Blair, 1 Kelly Warth, 2 Yashasvi Suvarna, 3 Marco Cappa 4 1Department of Endocrinology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK; 2Instar, London, UK; 3Global Medical Affairs, Novo Nordisk Global Business Services (GBS), Bangalore, India; 4Endocrinology Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, ItalyCorrespondence: Joanne BlairDepartment of Endocrinology, Alder Hey Children’s NHS Foundation Trust, Liverpool, L12 2AP, UKTel +44 151 252 5335 Fax +44 151 282 4606Email Jo.Blair@alderhey.nhs.ukPurpose: This study investigated why some clinicians switched growth hormone (GH) brands in pediatric patients with GH-related disorders to Norditropin® since the start of the COVID-19 pandemic, the clinicians’ perceptions of the results, and whether observations from this period of disruption could inform clinical practice in the future.Patients and Methods: Clinicians (N=106) from the UK, France, Italy, and Japan who had switched at least one patient to Norditropin® from a GH therapy manufactured by a different pharmaceutical company between February and November 2020 participated. They completed an online survey and submitted patient report forms for up to three switched patients.Results: Since the start of COVID-19, 39– 54% of the reported consultations were virtual (ie, via telephone or online means) in the UK, France, and Italy. Overall, 17% of patients seen by respondents in the survey were switched to a different GH brand; approximately two-thirds of switches were to Norditropin®. Clinicians’ top considerations in choosing a GH brand were patient/carer feedback, patient support programs, and the need for easy-to-use therapies in the context of virtual consultations. The top reasons for switching patients to Norditropin® included ease of use, device features and benefits, better patient/carer feedback, and ease of training in device use via virtual consultations. Norditropin® was considered suitable for use in virtual or in-person consultations or a mixture of both. Based on patient/carer feedback, 66% of clinicians believed that patients preferred Norditropin® to their previous therapy in terms of overall satisfaction.Conclusion: In this survey, key considerations in prescribing GH therapy were ease of use and acceptability to patients and carers. If virtual consultations increasingly replace in-person ones, ease in training patients/carers in device use will be particularly important. A majority of clinicians considered that their patients preferred Norditropin® to their previous therapy.Keywords: growth disorders, somatropin, virtual consultations, ease of use, Norditropin&reg

Objective To evaluate the compliance of infertile men with the use of scrotal cooling devices. As a secondary objective, sperm parameters, deoxyribonucleic acid fragmentation, and hormone profiles were examined. Design This exploratory study on scrotal cooling provided scrotal cooling devices to men with primary infertility and abnormal semen parameters. Feedback on the devices after their use was gathered in the form of a questionnaire, and semen parameters were examined after device use. Setting Single center infertility clinic in Toronto, Ontario, Canada. Patient(s) Patients with primary infertility and abnormal semen parameters were prospectively evaluated before and after scrotal cooling. Intervention(s) One of two scrotal cooling devices (Underdog or Snowballs) was used, on the basis of patient preference. Main Outcome Measure(s) Questionnaires were completed by patients on compliance with device use and concerns about and recommendations for improving the cooling devices. Baseline deoxyribonucleic acid fragmentation index, sperm parameters, and hormones were measured at the initial visit (t = 0) and at subsequent visits (t = 4–12 weeks). Statistical comparison of values before and after scrotal cooling was performed. Result(s) Forty patients were enrolled in the study, and the questionnaire was completed by 65.0% (n = 26). Most respondents (76.9%) used scrotal cooling less than the recommended duration. Respondents believed that the devices were uncomfortable (31.5%), impeded work (21.0%), and lost cooling rapidly (14.3%). Significant increases in sperm motility and vitality (from 25.4 % to 29.0% and from 64.8% to 71.7%, respectively) were demonstrated after scrotal cooling. Conclusion(s) Most patients were not compliant with the recommended use of the scrotal cooling devices because of issues of comfort, convenience, and concealability. Further work on improving scrotal cooling devices is necessary to enhance their potential as a therapeutic tool for men with abnormal sperm parameters and infertility.

BACKGROUND The pattern of perioperative use of personal electronic devices (PEDs) among anesthesia providers in the United States is unknown. METHODS We developed a 31-question anonymous survey of perioperative PED use that was sent to 813 anesthesiologists, anesthesiology residents, and certified registered nurse anesthetists at 3 sites within one health system. The electronic survey assessed patterns of PED use inside the operating room (OR), outside the OR, and observed in others. Questions were designed to explore the various purposes for PED use, the potential impact of specific hospital policies or awareness of medicolegal risk on PED use, and whether PED was a source of perioperative distraction. RESULTS The overall survey response rate was 36.8% (n = 299). With regard to often/frequent PED activity inside the OR, 24% reported texting, 5% reported talking on the phone, and 11% reported browsing on the Internet. With regard to often/frequent PED activity outside the OR, 88% reported texting, 26% reported talking on the phone, and 63% reported browsing the Internet. With regard to often/frequent PED activity observed in others, 52% reported others texting, 14% reported others talking on the phone, and 34% reported others browsing the Internet. Two percent of respondents self-reported a distraction compared to 15% who had observed a distraction in others. Eighty percent of respondents recognized PED as a potential distraction for patient safety. CONCLUSIONS Our data reinforce that PED use is prevalent among anesthesia providers.

Mobile electrocardiogram (mECG) devices are being used increasingly, supplying recordings to providers and providing automatic rhythm interpretation. Given the intermittent nature of certain cardiac arrhythmias, mECGs allow instant access to a recording device. In the current COVID-19 pandemic, efforts to limit in-person patient interactions and avoid overwhelming emergency and inpatient services would add value. Our goal was to evaluate whether a mECG device would reduce healthcare utilization overall, particularly those of urgent nature. We identified a cohort of KardiaMobile (AliveCor, USA) mECG users and compared their healthcare utilization 1 year prior to obtaining the device and 1 year after. One hundred and twenty-eight patients were studied (mean age 64, 47% female). Mean duration of follow-up pre-intervention was 9.8 months. One hundred and twenty-three of 128 individuals completed post-intervention follow-up. Patients were less likely to have cardiac monitors ordered (30 vs 6; p

OBJECTIVE To evaluate the outcomes and factors influencing colorectal endoscopic submucosal dissection (ESD) with a long procedure time. MATERIALS AND METHODS In this single-center, retrospective study, we included 1,100 patients with 1,199 lesions who underwent colorectal ESD between April 2016 and December 2020. ESD was performed using an advanced system knife for lesions >20 mm. An S-O clip was used as the traction device. The long-time group (LP; procedure time >120 min) and normal-time group (NP; procedure time

BACKGROUND Bullying is destructive and pervasive. Although the literature suggests children with chronic health conditions are at higher risk of being bullied, there is minimal research regarding the prevalence of bullying among children with orthopaedic conditions. Our study aimed to assess the prevalence of bullying among pediatric orthopaedic outpatients and evaluate the association of orthopaedic conditions and use of orthopaedic devices with perceptions of bullying. METHODS Patients in outpatient pediatric orthopaedic clinics, ages 10 to 17 and their parents were surveyed using the Child-Adolescent Bullying Scale-9. Basic demographic, information about the child's orthopaedic condition, and parent's perception of their child being subject to bullying were also collected. Children were asked if they had used any orthopaedic devices in the last 3 months, whether they were bullied because of their device, and if bullying affected their compliance with device use. The analysis utilized a t test or analysis of variance to compare mean Child-Adolescent Bullying Scale-9 scores across different groups. RESULTS Among the 198 patients surveyed, 61% (N=121) perceived no-to-minimal exposure to bullying, 36% (N=72) moderate exposure, and 3% (N=5) severe exposure. Children ages 10 to 13 (N=100) and children ages 14 to 17 (N=98) reported similar rates of bullying (P=0.97). Higher rates of moderate to severe bullying were reported by patients with foot deformity (80%), multiple orthopaedic diagnoses (55%), chronic pain (39%), fracture/acute injury (37%), and scoliosis (33%). Moderate to severe bullying was reported by 37% of patients who wore a cast, 40% who wore a brace/orthotic, and 52% who used multiple orthopaedic devices. Parental concern that their child was being bullied was highly correlated with their child's bullying score (P=0.0002). CONCLUSIONS More than one third of our pediatric orthopaedic outpatients (39%) experience moderate to severe levels of bullying, which is higher than the general population's reported rates of 20% to 35%. Exposure to bullying may be higher in certain diagnoses or with use of certain orthopaedic devices. Further research is needed to delineate who is at highest risk. LEVEL OF EVIDENCE Level IV.

Aim: To study associations between the duration of the use of mobile electronic devices by schoolchildren and students and functional state of the eyes. Methods: The study was performed from September-May 2017-2020. Altogether 805 schoolchildren and students in Moscow and the Moscow region participated in the study. The pattern of mobile electronic device use was assessed by a questionnaire. Continuous variables were analyzed using unpaired t-tests. Associations between visual acuity and duration of the use of mobile devices were assessed using non-parametic correlation analysis. Spearman's correlation coefficients were calculated. Results: Almost 100 % of students reported using use mobile electronic devices. The device of choice was a smartphone. The total time of use of mobile electronic devices by middle and senior schoolchildren during school hours, on weekends and during vacation time significantly exceeded the daily total time of use by primary school students. Students spent more hours with mobile devices than schoolchildren. Students who had a day without a mobile device had a significantly higher volume of accommodation (ACV) (0.54 diopters) than those who used it daily (0.45 diopters; p < 0.05). Conduisons: Hygienic recommendations for the use of mobile electronic devices by students and schoolchildren should include organizing a day off during the week in which the smartphone is not used.

A combined surgical and orthodontic approach to midface and mandibular distraction optimizes stability and outcomes. Orthodontic considerations include proper planning of the distraction vector, appropriate device use, and thorough follow-up through the consolidation and postoperative period. The dental occlusion must be managed throughout treatment in order to achieve ideal results.

Parental mobile device use during parent–child interactions has become increasingly common and has been linked to a reduction in parental sensitivity. This study extends previous research in two ways: first it explores the relationship between independent and joint caregiver device use and a wide range of attachment behaviors; second, it acknowledges the bidirectional nature of attachment relationships by evaluating how young children behave throughout individual and joint use. Sixty-six naturalistic, nonparticipant observations were conducted with caregiver–child dyads in Australian malls in 2018. Children aged 12-years-old and under were eligible for observation. Fifty-four caregivers utilized a mobile device independently, and three caregivers jointly used a device with children. Caregivers who used devices joined in play, initiated conversations, and responded to attentional bids less often than non-device using caregivers. During device use, four caregivers were inattentive when children engaged in risky situations which may have caused injury and four caregivers spoke to or interacted harshly with children. When caregivers used devices, children either continued their activity, sought caregiver interaction, or demonstrated escalated bids for attention. In response to joint device use, children remained engaged with the device and failed to interact with the caregiver. This research may be useful for parents, or healthcare providers working with parents, to assist them in making conscious decisions about device use. This research also suggests that parental device use guidelines may be valuable.

OBJECTIVES The purpose of this study was to identify, characterize and compare attitudes, beliefs, behaviors and other factors related to electronic device (ED) use and distracted driving (DD) among taxi and app-based drivers. METHODS A survey among drivers in San Diego and across the United States was used to collect self-reported attitudes and behaviors among taxi and app-based passenger-carrying drivers from October 1, 2016 to January 31, 2017. Chi-square or Fisher's exact test was used to assess the difference between sociodemographics, ED use, ED use attitudes, and citation and crash history by driver type. Prevalence ratios were assessed for differences in ED use and ED use attitudes by driver type using Poisson regression models with robust error variance and a log link function. The final models adjusted for age, sex, level of experience, education and English fluency. All analyses were performed using SAS version 9.4. RESULTS Of the 175 drivers that met eligibility criteria, 131 reported driving for app-based services and 44 identified as taxi drivers. Compared to taxi drivers, app-based drivers were more likely to be female, native English speaking, and have fewer than 3 years of experience in the transportation business. All drivers reported at least one type of DD while the car was in motion. App-based drivers were significantly more likely to use a smartphone while driving (adjusted prevalence ratio (APR): 1.42), report that while driving it is safe or very safe to accept a call (APR: 1.73), receive/respond to a passenger request (APR: 3.40), or process a payment (APR: 5.39). Taxi drivers were more likely to either receive a citation for ED use (31.8% v 7.6%, p

Unlike performance evaluations, which are often conducted under ideal conditions, adverse events occur during actual device use for people with diabetes. This report summarizes the number of adverse events for the years 2018 to 2020 for the 3 diabetes devices: blood glucose meters (BG), continuous glucose monitors (CGM), and insulin pumps. A text example of a CGM injury is provided. Possible reasons are suggested for trends. Whereas the rate per test result (events/usage) is exceedingly small, the rate per patient (events/people with diabetes that use insulin) is of concern. Hence, it is important to determine event causes and provide corrective actions. The first step is to put in place routine analysis of adverse event data for diabetes devices.

Objective This study investigated how caregivers’ mobile device use influenced the quality of their interactions with their children. The associations between quality of interactions and the type of activity (eg, typing/swiping, looking at screen), setting, caregiver-child proximity, and child behaviors were also examined. Method Researchers anonymously and systematically observed and coded the behavior of 98 caregiver-child dyads in public settings (eg, parks, food courts) during real-time, naturally occurring interactions using time sampling. Results Caregivers who used a mobile device for the entire observation engaged in less joint attention and were less responsive than caregivers who used the device some of the time. When looking at patterns within caregivers who used the device intermittently, the probability that they would engage in joint attention, initiate interactions with their child, talk, and display positive emotions was lower when they used a mobile device than when they did not. Child talking and positive affect were unrelated to caregiver device use. Activity type with the device, caregiver-child proximity and setting also related to interaction quality. Conclusions Caregiver device use was negatively associated with adult behaviors that are key components of high-quality caregiver-child interactions. Additionally, setting, activity type, and caregiver-child proximity are factors that should be considered because they relate to the quality of caregiver-child interactions in the context of mobile screen technologies.

In any power system or grid network transformer device use for power from one circuit to another circuit without changing the frequency with high efficiency levels. Due to number of usages Transformer protection is very important now a days for electric supply which is fault free, efficiency and to increase the transformer life cycle. This paper is a brief discussion about the concentration of different gases like CO, CO2, H2, C2H6, C2H4, C2H2 and CH4 related faults which is known as DGA analysis with the help of various classical techniques gives different conditions for the same sample unit. This paper presents MATLAB simulation of ANN and Machine learning based high accuracy design techniques for DGA analysis and the results are compared with the classical techniques like Key Gas Method, IEC Ratio method, Duval triangle Method and Rogers Ratio Method, but in this paper we have done only Duval triangle Method for Comparison using Matlab. The Simulation result of the proposed methods shows that overall DGA analysis using Machine learning algorithm is better than conventional Duval triangle method Performance.

Many physicians receive payments from medical device companies that make products physicians can use or recommend. Such payments are controversial because of concerns that they might influence physicians to treat patients with devices made by the firms that make those payments, even if those devices are not optimal for patients. This issue has been studied extensively in the drug industry. Medical devices entail a greater degree of physician-industry interaction regarding treatment, training, and innovation than pharmaceuticals, and they have been less studied because of data limitations. We summarize and compare device and drug firm payment rates and magnitudes reported in Open Payments data by payment type, physician specialty, and Medicare billing amount. Relative to drug firm payments, device firm payments as a percentage of industry revenue were seven times as large; device firm payments were also more often related to product development and training and were more strongly correlated with physicians' Medicare billing amounts. Using Food and Drug Administration product approval data, we further document that top-paying firms dominate high-revenue device categories. Our results suggest that optimal policy regarding physician-industry relationships for medical devices may be very different from that for pharmaceuticals. Estimating the causal relationships between payments and device use, pricing, and innovation to inform policy makers will be possible only with greater data transparency, such as including device identifiers in medical claims.

School-based speech-language pathologists (SLPs) are increasingly confronted with opportunities to use screen-based devices. In order to fully investigate how technology impacts therapeutic efficacy, it is imperative to first understand how and why SLPs utilize technology. This study explores: (a) the frequency with which SLPs use eight types of screen-based devices during direct intervention; (b) how student and SLP characteristics impact device use; and (c) the clinical rationales supporting device use. Using a self-administered, online questionnaire, 261 SLPs reported that technology use contributes to perceptions of increased clinical effectiveness. Results indicate tablets are the most frequently used device; however, student age, specific communication disorders, and service delivery model significantly impact the type and frequency of device use. Furthermore, academic materials and traditional activities continue to be the predominant format of intervention activities. Findings provide insight into how SLPs balance the allure of screen-based devices with student needs, professional characteristics, and the educational environment.

Background and objectives: Administration of inhaled medication for asthma and COPD is often difficult and incorrect device use is associated with unfavorable outcomes. We aimed to evaluate device ...

Objective: To perform a systematic review of the literature to identify the long-term effects of presurgical orthopedic (PSO) device use on patient outcomes. Design: A comprehensive literature review of Embase and Ovid databases was performed to identify all English-language publications related to unilateral cleft lip and palate, presurgical devices, and patient outcomes. Studies were excluded if they did not report patient outcomes beyond 2 years of age, did not describe the use of a PSO device, were case reports (n < 10), or were purely descriptive studies. Main Outcome Measures: Reported patient outcomes following the use of PSO devices. Results: Following a review of all articles by 2 independent reviews, 30 articles were selected for inclusion. Overall, there was no reported consensus as to the long-term effects of PSO devices. Furthermore, this study identified that only 10% of published research controlled for confounding factors that could influence the reported results. Confounding factors that were identified included different operating surgeon, different surgical protocols, and different rates of revision surgeries. Conclusions: Overall, this systematic review identified 2 important conclusions. Firstly, there is no consensus in the literature about the long-term effects of PSO devices on long-term patient outcomes. Secondly, research in this domain is limited by confounding factors that influence the applicability of the reported results.

Mesfin Gebremedhin Jnr,1 Addisu Alemayehu,2 Manaye Yihune,1 Samuel Dessu,3 Tamirat Melis,4 Negash Nurahmed5 1Arba Minch University, College of Medicine & Health Sciences, Department of Public Health, Arba Minch, Ethiopia; 2Dilla University, College of Medicine & Health Sciences, Department of Public Health, Dilla, Ethiopia; 3Wolkite University, College of Medicine & Health Sciences, Department of Public Health, Wolkite, Ethiopia; 4Wachamo University, College of Medicine & Health Sciences, Department of Public Health, Hosanna, Ethiopia; 5Paster Ethiopian Public Health Institute, Addis Ababa, EthiopiaCorrespondence: Mesfin Gebremedhin Jnr Email mesfing762@gmail.comBackground: An intrauterine contraceptive device is suitable for women of all reproductive age groups for preventing unwanted pregnancies. Immediate postpartum family planning (PPFP) services need to be emphasized when the woman leaves the hospital. Despite the accepted demand for PPFP, many women do not access the services. Therefore, this study aimed to assess acceptability and factors associated with immediate postpartum intrauterine contraceptive device use among women who gave birth at government hospitals of Gamo Zone, Southern Ethiopia.Methods: A cross-sectional study was conducted from March 1 to 30, 2019 with 452 participants studied using systematic random sampling technique. Data was collected using a pretested interviewer-administered questionnaire from March 1 to 30, 2019. The data were coded, cleaned and entered into Epi-data manager version 4.2.2.1 and exported to SPSS version 23 for advanced analysis. Binary logistic regression was performed to identify associated factors of immediate PPIUCD acceptability.Results: This study revealed that about 161 (35.6%) in 95% CI (31.0, 39.6) of the study participants accepted immediate PPIUCD. Multiparty (AOR = 2.33, 95% CI, (1.29, 4.20)), completed antenatal follow up (AOR = 3.65, 95% CI, (2.22, 5.99)), counselling (AOR= 8.38, 95% CI, (4.85, 14.48)) and prior discussion (AOR=2.57, 95% CI, (1.51, 4.36)) were statistically significant.Conclusion and Recommendation: Even though 58% of the mothers were counselled about PPIUCD during the important cascade of pregnancy and 53% of the mothers completed antenatal service, efforts need to improve antenatal care services and integrate counselling services through the whole cascade of pregnancy.Keywords: acceptability, immediate postpartum intrauterine contraceptive device

Purpose The aim of the study was to examine the concurrent and longitudinal associations between adolescents' text messaging frequency and mental health symptoms across 4 years of high school. Methods A total of 203 adolescents (aged 14–18 years) consented and were provided smartphones across 4 years of high school. Using billing records, daily frequencies of text messaging were created for each year. Adolescents reported on their mental health symptoms (internalizing, externalizing, social problems, and inattention) each summer. Results Multilevel analyses tested the between- and within-person associations between texting and mental health symptoms. Between-person analyses revealed an association only between externalizing symptoms and texting. Girls who texted more (vs. less) frequently reported more externalizing and inattention symptoms, whereas there were no significant associations for boys. There were no significant within-person concurrent associations between texting and symptoms. Autoregressive latent cross-lagged model with structured residuals testing the longitudinal, bidirectional associations also did not find significant relations across 4 years of adolescence. Conclusions Across analyses, few robust associations emerged. Adolescent girls who text messaged more frequently reported greater externalizing and inattention symptoms. Contrasting the popular narrative that smartphones cause depression, this study did not find any consistent within-person or longitudinal associations between texting and mental health symptoms across adolescence. Research on the content, rather than quantity, of texts and device use is necessary to understand the potential effects on development.

Healthcare is an area that has benefitted from the developments in wearable device technology. Seniors, who usually suffer from multiple comorbidities, are among the target users of these devices, ...

Oral devices that treat obstructive sleep apnea are an easy and influential option to protect the upper airways from sleep obstructions. One example is the mandibular advancement device (MAD), which is a non-invasive apparatus specified in adults with simple snoring and mild obstructive sleep apnea. Recently, due to the constraints of other therapies, like positive airway pressure treatment and surgical methods, there has been growing interest in the use of oral appliance for simple snoring patients. MAD is managed to improve the upper airway volume, minimize upper airway collapse and reduce snoring. On the other hand, it remains inferior to CPAP in the reduction of the apnea-hypopnea scores, with therapy success varying from 24% to 72%. The treatment modalities include skilled physicians and multidisciplinary strategies to treat patients with snoring and obstructive sleep apnea (OSA) effectively. Some researchers also suggest potential predictors of progress in care, but specific criteria for patient selection and predictive clinical principles for effectiveness in all treatment modalities are still needed. The aim of this brief clinical Study is to review MAD brief history, design, indications, contraindications, therapy efficiency, side effects, and current perspectives.

Hyaluronic acid intraarticular injections are gel-like medical devices used in osteoarthritis. Patients may only experience modest improvement with these devices, which may be reclassified as medications in the United States (US). Medications may require more testing than devices, and device adverse event reporting in the US has come under scrutiny. We undertook an exploratory analysis of fatal adverse events for these injections in the US. We reviewed all adverse events reported to the US Manufacturer and User Facility Device Experience and Alternative Summary Reporting databases between 2014 and 2019 under the relevant product names and product codes. Reports assigned an outcome of “death” were retained, as were reports that were found to pertain to fatality after review. Of 3449 reports, 103 were found to pertain to 63 distinct fatalities. In 54 of these fatalities, the cause of death was stated to be unknown in narratives. We judged that eight fatalities may have had a logical nexus to device use; six of these fatalities were associated with infection. Low-quality information in reports suggests that the US should review its medical device adverse event reporting processes and providers who administer hyaluronic acid intraarticular injections should use meticulous aseptic technique.

A sample of 10,460 U.S. elementary schoolchildren was analyzed to identify early predictors of frequent use of online technologies (i.e., messaging, online gaming, and social networking). Children (Mage = 67.44 months) at greater risk displayed more externalizing problem behaviors in kindergarten (messaging OR = 1.11; online gaming OR = 1.21; social networking OR = 1.12) or were Black (messaging OR = 1.65; online gaming OR = 1.64; social networking OR = 1.68). Children from higher-income families were at lower risk (online gaming OR = 0.89; social networking OR = 0.89). Boys were more frequent users of online gaming (OR = 3.35) but less frequent users of messaging (OR = 0.62) and social networking (OR = 0.80). Protective factors included specific parenting behaviors.

Background: Substances that can be vaped include nicotine, marijuana, cocaine, heroin, and a range of synthetic drugs called new psychoactive substances (NPS). Due to the rising popularity of vaping among adolescents, it is crucial to understand the relationships between vaping and illicit drug use. Objectives: This paper examined the prevalence and trends of using vaping devices, marijuana vaping, marijuana products, synthetic cannabinoids and mist contents among youth. Methods: The study utilized 5 sets of public cross-sectional national data from the "Monitoring the Future" surveys during 2014-2018. It employed logistic regression to analyze the data. Results: There was an increase from 10.5% in 2017 to 20.8% in 2018 for the past 30-day use of vaping devices among 12th graders. Furthermore, there was an increase from 21.6% in 2017 to 34.5% in 2018 for the past 12-month use of marijuana via vaping device among 12th-grade marijuana users. Additionally, there were significant associations between vaping device use and marijuana vaping, between vaping device use and marijuana use, between vaping device use and synthetic cannabinoids use, and between marijuana use and synthetic cannabinoids use from 2016 to 2018. Conclusions: Vaping emerged as another major route of marijuana administration among youth. Adolescent marijuana users had higher odds of using synthetic cannabinoids. This finding highlighted the importance of understanding what adolescent substance consumption pattern would be where marijuana was legalized. It also supported the hypothesis that vaping devices use correlates with, or is associated with, marijuana and synthetic cannabinoids use.

Background. The use of physical activity tracker devices has increased within the general population. However, there is limited medical literature studying the efficacy of such devices in adolescents with obesity. In this study, we explored the feasibility of using wearable activity tracking devices as an adjunct intervention on adolescents with obesity. Methods. Randomized controlled pilot trial evaluated the feasibility (attrition ≤50%) of an activity tracking intervention (ATI) and its effects on weight loss in adolescents with obesity enrolled in an adolescent weight management clinic (AWMC). Outcomes included feasibility (attrition rate) and absolute change in BMI. Differences between groups at 6, 12, and 18 weeks were examined. Results. Forty-eight participants were enrolled in the study. Eighteen subjects were randomly assigned to the ATI group and 30 to control. The average age was 14.5 years. Overall, the majority of participants were Hispanic (56%). Sexes were equally distributed. The average baseline BMI was 37.5 kg/m2. At the study conclusion, the overall attrition rate was 52.1%, 44.4% in the ATI group versus 56.6% in the control group, with a differential attrition of 12.2%. The ATI and control groups each showed an absolute decrease in BMI of −0.25 and −2.77, respectively, with no significant differences between the groups. Conclusion. The attrition rate in our study was >50%. Participation in the AWMC by the ATI and control groups resulted in maintenance of BMI and body weight for the study duration. However, the use of an activity tracking device was not associated with greater weight loss. This trial is registered with NCT03004378.

Context: Headaches can negatively impact children's quality of life. Nevertheless, data on the parental awareness of childhood headache is very limited. Aim: The objective was to estimate the prevalence of childhood headaches and parental awareness of headaches among their elementary school children. Settings and Design: A cross-sectional study was conducted among parents who were shopping in five malls in Riyadh between March and July 2019. Methods and Material: Data were collected using a self-completed questionnaire, which included data on socio-demographic characteristics of the parents and their children, the presence of headache in children, and parental awareness about headache susceptibility, possible causes, associated symptoms, and management. Statistical Analysis Used: Descriptive and inferential statistics were employed as appropriate using the software SPSS. Results: A total of 292 parents were included. The majority were mothers (75.3%) in the age range of 26–45 years (83.2%). Approximately 62.3% of the parents reported headaches in their children. Approximately 47.6% of the headaches were attributed to “the use of electronic devices”. The overall parental awareness of headaches was 55.1%, with scores being highest for management questions (67.0%) and lowest for susceptibility questions (45.4%). In a multivariate logistic regression analysis adjusted for socio-demographic characteristics, parental awareness was positively associated with the presence of children with headaches in the family and negatively associated with Saudi nationality of the children. Conclusions: Parental awareness of childhood headache is insufficient. There is a need to increase the awareness of parents about childhood headaches and the problems associated with heavy electronic device use.

Background Previous literature suggests the use of smartphones and tablet devices may result in various postural and musculoskeletal disorders, predominantly of the neck and upper extremities. However, factors that contribute to the symptoms have not been adequately explored. Methods This study aimed to investigate the prevalence and patterns (e.g. types, sites and temporal distributions) of musculoskeletal symptoms among adult smartphone and tablet device users. It also investigated device usage in terms of usage time, postures adopted during use, operational methods and purposes of device use in order to explain the symptom occurrences. Participants from eastern states of Australia retrospectively reported device usage and symptoms in the preceding two-week period, via an online survey. Data was analysed using Chi-square [χ2] analysis to determine the relationships between categorical variables; Mann-Whitney U tests to compare two groups (e.g. smartphone-only users versus tablet users) where dependant variables were ordinal; independent samples t-tests if dependent variables were continuous and approximated a normal distribution; and Spearman’s correlation analysis to assess the relationships between pairs of continuous or ordinal variables. Results Of the 207 participants, 59.9% reported musculoskeletal symptoms during or after device use; for 64.5% of these, symptoms began within the first 30 min (mostly between 15 and 30 min) of commencing usage. No statistically significant differences were observed between smartphone-only users and tablet device users in proportions reporting symptoms during device use (χ2 = .350, N = 207, p = .554). The most prevalent symptom was stiffness. The most prevalent symptom occurred in the neck (18.1% in smartphone-only users and 19.3% in tablet device users). Tablet users who were 18–24 year-old and used their device for more than 30 min in each usage session more often experienced symptoms (82.4% prevalence) than those who used a device for 30 min or less (52.2%) (χ2 = 4.723, N = 63, p = .030). Conclusion These findings suggest that user age, duration and frequency of usage, and type of device are important factors to consider in the formation of evidence-based guidelines to reduce experiences of musculoskeletal symptoms among smartphone and tablet device users. If usage was capped at

Background: Myopia is the most common refractive error worldwide and is a growing global burden. Although myopia is a well-recognized problem, it has not been extensively studied in Saudi Arabia. This study aimed to determine the prevalence of myopia and assess the association between e-reading and myopia. Methodology: This cross-sectional study included data collected from 571 male medical students in Riyadh between February 2019 and May 2019. The participants were categorized into three groups using stratified random cluster sampling: 187, 194, and 190 students from the fifth, third, and first years, respectively. The prevalence of myopia was self-reported through a questionnaire that also included details regarding the pattern of electronic device use. Statistical analyses were performed using Statistical Package for the Social Sciences to determine the prevalence with 95% confidence level. Results: Among the 291 medical students who responded, 117 (40%) had myopia (95% confidence interval = 33.4%-48.0%), of whom 70% were diagnosed before attending the university. When comparing between myopic and non-myopic students with respect to electronic device usage, no significant difference was found (p = 0.28). However, a significant difference was found between the groups in terms of laptop utilization compared to other types of electronic devices, such as smartphones and tablets (p = 0.03). Conclusions: The prevalence of myopia among university medical students was 40%. A significant difference was found between myopic and non-myopic students regarding laptop use compared with other types of electronic devices.

Background Portable electronic devices are used regularly within the veterinary and medical environments. Use of these in clinical areas may predispose them to bacterial contamination and they could act as fomites, transmitting infection between clinicians and patients. Aim To determine the prevalence, origin and nature of Staphylococcal bacterial contamination on the surface of portable electronic devices used in a large small animal hospital. Materials and methods Staff were surveyed on the frequency of portable electronic device use and device-cleaning routines. Portable electronic devices were swabbed for staphylococcus species. Cultured cocci were tested for antimicrobial resistance and identified at the species level to help determine the likely source (human or animal). Findings Forty one of 48 (85%) of staff used a portable electronic device every day within the hospital. Useable swabs were obtained from 47 portable electronic devices. Staphylococci were found on 68% of portable electronic devices. Vancomycin and Oxacillin resistance were seen in 17 of 46 (37%) and 1 of 46 (2%) isolated colonies respectively, including four vancomycin resistant, coagulase-positive staphylococci. 44% of staff never cleaned their device. Clinical significance Portable electronic devices are commonly used in veterinary hospitals, but few staff routinely disinfect them. The use of disinfectant to reduce colony counts should be implemented when forming protocols for these devices in the hospital. The majority of staphylococci found were of likely human origin. It is suggested that contamination is therefore more likely to be originating from staff rather than patients.