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The doctrine of adverse possession presents a risk to forestland ownership because timber management is infrequent. In this study, the extent of adverse possession claims on forestland in the United States is examined through a set of 243 published legal cases, and the determinants of the case outcomes are analyzed by a multinomial logit model. Those cases are from 32 states and distributed over 200 years, with an average of 12 cases per decade. Adverse possession claimants win 44% of the cases. The regression analysis reveals that whether an adverse possessor has a defective title is the leading factor in determining the case outcomes, and the periods required by statutes tend to negatively impact the winning probability of adverse possessors. The empirical findings have implications for landowners to defend their titles or remove a cloud on titles and for legislators to revise relevant laws in the future. [ABSTRACT FROM AUTHOR]

Purpose: Hashimoto's thyroiditis (HT) is one of the most commonly encountered types of autoimmune thyroid disorders (AITDs), influenced by environmental factors, genetics, and the immune system. Previous research has shown a correlation between gut microbiota and HT, as well as the involvement of immune cells in its onset and progression. We aimed to investigate whether immune cells act as intermediaries in the causal relationship between gut microbiota and HT. Methods: In this study, we conducted bidirectional two-sample Mendelian randomization (MR) analyses to explore the relationship between gut microbiota and HT using data from genome-wide association studies (GWAS) and the MiBioGen study. Subsequently, MR analyses were performed to investigate the interactions between 731 immune cells and gut microbiota. Additionally, an MR analysis was performed to examine the association between HT and these 731 immune cells, using a GWAS dataset that included 3,757 European subjects. This approach provided insights into the impact of 22 million genetic variants on 731 immune cell signatures. Results: There was a causal relationship between the increase in the number of 15 gut microbiota and HT. We observed that the genus Akkermansia, family Alcaligenaceae, family Desulfovibrionaceae, family Verrucomicrobiaceae, class Verrucomicrobiae, order Verrucomicrobiales, phylum Verrucomicrobia, class Alphaproteobacteria, order Desulfovibrionales, genus Ruminococcus torques group, genus Butyrivibrio, and genus Coprococcus3 were negatively correlated with HT. In addition, the genus Intestinimonas, genus Turicibacter, and genus Anaerostipes were positively correlated with HT. We identified EM CD4 + T cells as a mediator between the gut microbiota and HT. Conclusion: In conclusion, we presented causal associations between the EM CD4 + T cell-mediated gut microbiota and HT, as inferred from the MR findings derived from extensive aggregated GWAS data. Our research offers guidance and direction for treating and preventing HT. [ABSTRACT FROM AUTHOR]

Abstract Background There is increasing evidence that exposure to PM2.5 and its constituents is associated with an increased risk of gestational diabetes mellitus (GDM), but studies on the relationship between exposure to PM2.5 constituents and the risk of GDM are still limited. Methods A total of 17,855 pregnant women in Guangzhou were recruited for this retrospective cohort study, and the time-varying average concentration method was used to estimate individual exposure to PM2.5 and its constituents during pregnancy. Logistic regression was used to assess the relationship between exposure to PM2.5 and its constituents and the risk of GDM, and the expected inflection point between exposure to PM2.5 and its constituents and the risk of GDM was estimated using logistic regression combined with restricted cubic spline curves. Stratified analyses and interaction tests were performed. Results After adjustment for confounders, exposure to PM2.5 and its constituents (NO3 −, NH4 +, and OM) was positively associated with the risk of GDM during pregnancy, especially when exposure to NO3 − and NH4 + occurred in the first to second trimester, with each interquartile range increase the risk of GDM by 20.2% (95% CI: 1.118–1.293) and 18.2% (95% CI. 1.107–1.263), respectively. The lowest inflection points between PM2.5, SO4 2−, NO3 −, NH4 +, OM, and BC concentrations and GDM risk throughout the gestation period were 18.96, 5.80, 3.22, 2.67, 4.77 and 0.97 µg/m3, respectively. In the first trimester, an age interaction effect between exposure to SO4 2−, OM, and BC and the risk of GDM was observed. Conclusions This study demonstrates a positive association between exposure to PM2.5 and its constituents and the risk of GDM. Specifically, exposure to NO3 −, NH4 +, and OM was particularly associated with an increased risk of GDM. The present study contributes to a better understanding of the effects of exposure to PM2.5 and its constituents on the risk of GDM.

Background: There is increasing evidence that exposure to PM2.5 and its constituents is associated with an increased risk of gestational diabetes mellitus (GDM), but studies on the relationship between exposure to PM2.5 constituents and the risk of GDM are still limited. Methods: A total of 17,855 pregnant women in Guangzhou were recruited for this retrospective cohort study, and the time-varying average concentration method was used to estimate individual exposure to PM2.5 and its constituents during pregnancy. Logistic regression was used to assess the relationship between exposure to PM2.5 and its constituents and the risk of GDM, and the expected inflection point between exposure to PM2.5 and its constituents and the risk of GDM was estimated using logistic regression combined with restricted cubic spline curves. Stratified analyses and interaction tests were performed. Results: After adjustment for confounders, exposure to PM2.5 and its constituents (NO3−, NH4+, and OM) was positively associated with the risk of GDM during pregnancy, especially when exposure to NO3− and NH4+ occurred in the first to second trimester, with each interquartile range increase the risk of GDM by 20.2% (95% CI: 1.118–1.293) and 18.2% (95% CI. 1.107–1.263), respectively. The lowest inflection points between PM2.5, SO42−, NO3−, NH4+, OM, and BC concentrations and GDM risk throughout the gestation period were 18.96, 5.80, 3.22, 2.67, 4.77 and 0.97 µg/m3, respectively. In the first trimester, an age interaction effect between exposure to SO42−, OM, and BC and the risk of GDM was observed. Conclusions: This study demonstrates a positive association between exposure to PM2.5 and its constituents and the risk of GDM. Specifically, exposure to NO3−, NH4+, and OM was particularly associated with an increased risk of GDM. The present study contributes to a better understanding of the effects of exposure to PM2.5 and its constituents on the risk of GDM. [ABSTRACT FROM AUTHOR]

Abstract Background The breast cancer is common cancer in women globally. The risk of breast cancer is strongly associated with women’s menstrual and reproductive factors that have been established in different countries. Therefore present study was aim to explore the association between menstrual and reproductive factors and the risk of breast cancer screening in Indian women. Methods The present study data has been used fifth round of the National Family Health Survey (NFHS-V) with 724,115 women in aged 15–49 in 2019-21. The self-reported ever screened of breast cancer for women aged 30–49 was the main outcome variable of the study. Logistic regression models were used to estimate odds ratios and 95% confidence intervals for breast cancer by menstrual and reproductive factors adjusted for potential confounders. Results Late menarche (OR = 2.20, 95% CI: 1.48–3.28), irregular menstrual cycle (OR = 1.29, 95% CI: 1.08–3.53)), delay age at first birth (OR = 1.93, 95% CI: 1.11–3.04) and contraceptive pill used (OR = 1.11, 95% CI: 0.74–2.10) were significantly associated to increases the uptake of screening breast cancer. While, a higher number of birth (OR = 0.52, 95% CI: 0.10–1.03), and long duration of breast-feeding practice (OR = 0.75, 95% CI: 0.63–0.91) were reduced to participate for screening breast cancer. Conclusion The results of the study confirm the role of menstrual and reproductive factors in breast cancer in Indian women. Therefore, our findings are imperative for developing breast cancer prevention strategies and better preparedness. Creating awareness and providing knowledge on cancer could be key strategies for the reduction of breast cancer in Indian reproductive age group women.

The degree to which romantic and sexual feelings correspond to one's sexual identity may signify how a person comes to embrace a specific sexual identity. People who endorse an essentialist perspective may expect to see a high degree of concordance between feelings and identity, and a lack of concordance may be associated with negative consequences. People who endorse a social constructionist perspective may view sexual identity as constructed in situ; a lack of concordance is inevitable and may not be associated with negative consequences. This research tests the levels of concordance of feelings and identity by comparing those with and without romantic and sexual feelings using risk ratios and odds ratios. A representative sample of college students in Taiwan was recruited (N = 3882, with 2440 females and 2988 who identified as heterosexual). The findings suggest that (1) people's romantic and sexual feelings largely correspond to their sexual identity, with all risk ratios and odds ratios higher than 1; (2) the concordance was at its lowest level among those with different-sex feelings; (3) gender differences in concordance were trivial; (4) individuals who were questioning their identity were the least clear about what they expect and want in intimate relationships; and (5) no general negative consequences in intimate relationships were observed among discordant/branched individuals. Implications regarding romantic and sexual feelings, sexual identity, and intimate relationships are further discussed. [ABSTRACT FROM AUTHOR]

This study investigated the impact of fitness test performance on firefighter trainee ability to graduate an academy using ordinal logistic generalized linear models. Retrospective analysis was conducted on trainee data (N = 686) from one fire department who completed an occupational physical ability test (OPAT) that included the following: Illinois agility test (IAT); push-ups; pull-ups; leg tucks; maximal aerobic capacity (...); backward overhead 4.54-kg medicine ball throw (BOMBT); 10-repetition maximum deadlift; and 91.44-m farmer's carry. Data were recorded in raw and scaled scores based on internal scoring (tests scored from 0 to 100; maximum total OPAT score of 800). Trainees were split into graduated (n = 576) or released (n = 110) groups. Data were analyzed through ordinal logistic generalized linear models (p < 0.05). Raw and scaled scores were investigated separately, with odds ratios (OR) and confidence intervals (CI) produced. Regarding raw scores, there was a difference in the odds of graduating relative to the IAT (OR = 1.357; CI = 1.047-1.760; p = 0.021), BOMBT (OR = 0.744; CI = 0.628-0.882; p < 0.001), and V... (OR = 0.907; CI = 0.862-0.954; p < 0.001). For scaled scores, there was a difference in the odds of graduating relative to the points attained for the BOMBT (OR = 0.985; CI = 0.972-0.999; p = 0.032), deadlift (OR = 0.982; CI = 0.968-0.995; p = 0.008), and total OPAT (OR = 0.994; CI = 0.988-1.000; p = 0.047). Change-of-direction speed (IAT), total-body power (BOMBT), aerobic fitness (..., lower-body strength (deadlift), and overall fitness (total OPAT points) impacted the odds of trainee fire academy graduation. The IAT presented as the largest impacting variable where, for every unit increase in time (i.e., a slower IAT), there was 1.36 greater chance of a trainee being released from the academy. [ABSTRACT FROM AUTHOR]

Background: The breast cancer is common cancer in women globally. The risk of breast cancer is strongly associated with women's menstrual and reproductive factors that have been established in different countries. Therefore present study was aim to explore the association between menstrual and reproductive factors and the risk of breast cancer screening in Indian women. Methods: The present study data has been used fifth round of the National Family Health Survey (NFHS-V) with 724,115 women in aged 15–49 in 2019-21. The self-reported ever screened of breast cancer for women aged 30–49 was the main outcome variable of the study. Logistic regression models were used to estimate odds ratios and 95% confidence intervals for breast cancer by menstrual and reproductive factors adjusted for potential confounders. Results: Late menarche (OR = 2.20, 95% CI: 1.48–3.28), irregular menstrual cycle (OR = 1.29, 95% CI: 1.08–3.53)), delay age at first birth (OR = 1.93, 95% CI: 1.11–3.04) and contraceptive pill used (OR = 1.11, 95% CI: 0.74–2.10) were significantly associated to increases the uptake of screening breast cancer. While, a higher number of birth (OR = 0.52, 95% CI: 0.10–1.03), and long duration of breast-feeding practice (OR = 0.75, 95% CI: 0.63–0.91) were reduced to participate for screening breast cancer. Conclusion: The results of the study confirm the role of menstrual and reproductive factors in breast cancer in Indian women. Therefore, our findings are imperative for developing breast cancer prevention strategies and better preparedness. Creating awareness and providing knowledge on cancer could be key strategies for the reduction of breast cancer in Indian reproductive age group women. [ABSTRACT FROM AUTHOR]

BackgroundThe cutaneous manifestations of COVID-19 may be useful disease markers and prognostic indicators. Recently, postinfectious telogen effluvium and trichodynia have also been reported.ObjectiveTo evaluate the presence of trichodynia and telogen effluvium in patients with COVID-19 and describe their characteristics in relation to the other signs and symptoms of the disease.MethodsPatients with a history of COVID-19 presenting to the clinics of a group of hair experts because of telogen effluvium and/or scalp symptoms were questioned about their hair signs and symptoms in relation to the severity of COVID-19 and associated symptoms.ResultsData from 128 patients were collected. Telogen effluvium was observed in 66.3% of the patients and trichodynia in 58.4%. Trichodynia was associated with telogen effluvium in 42.4% of the cases and anosmia and ageusia in 66.1% and 44.1% of the cases, respectively. In majority (62.5%) of the patients, the hair signs and symptoms started within the first month after COVID-19 diagnosis, and in 47.8% of the patients, these started after 12 weeks or more.LimitationsThe recruitment of patients in specialized hair clinics, lack of a control group, and lack of recording of patient comorbidities.ConclusionThe severity of postviral telogen effluvium observed in patients with a history of COVID-19 infection may be influenced by COVID-19 severity. We identified early-onset (12 weeks) telogen effluvium.

Introduction: The triglyceride-glucose (TyG) index has been recommended as an alternative indicator of insulin resistance (IR). However, the association between the TyG index and adverse pregnancy outcomes remains to be elucidated. Methods: The present retrospective study was conducted at Women's Hospital, Zhejiang University School of Medicine and involved a total of 8,514 participants. Maternal fasting lipid profiles and glucose concentrations were measured. Based on the TyG index, the participants were categorized into quartiles. Logistic regression analysis was used to calculate odds ratios (ORs) for each quartile with reference to the first quartile, while receiver operating characteristic (ROC) curve analysis, Hosmer–Lemeshow test, and calibration curve analysis were employed to evaluate the predictive ability of the TyG index for adverse pregnancy outcomes. Results: The TyG index was higher in patients with preeclampsia, preterm birth, and macrosomia. On univariate analysis, there was an increased risk of developing adverse pregnancy outcomes with increasing quartiles of the TyG. After adjusting for potential confounders in multivariable logistic regression analysis, a positive independent correlation was found between the TyG index and preeclampsia, preterm birth, and macrosomia. In ROC curve analysis for predicting the risks of preeclampsia, preterm birth, and macrosomia, the area under the curve (AUC) could reach 0.665, 0.588, and 0.606, respectively. These predictive models demonstrated good calibration (all P > 0.05). Conclusions: The TyG index showed a good predictive capacity for assessing the risk of adverse pregnancy outcomes, and it should receive sufficient clinical attention.

Difference-in-differences is undoubtedly one of the most widely used methods for evaluating the causal effect of an intervention in observational (i.e., nonrandomized) settings. The approach is typically used when pre- and postexposure outcome measurements are available, and one can reasonably assume that the association of the unobserved confounder with the outcome has the same absolute magnitude in the two exposure arms and is constant over time; a so-called parallel trends assumption. The parallel trends assumption may not be credible in many practical settings, for example, if the outcome is binary, a count, or polytomous, as well as when an uncontrolled confounder exhibits nonadditive effects on the distribution of the outcome, even if such effects are constant over time. We introduce an alternative approach that replaces the parallel trends assumption with an odds ratio equi-confounding assumption under which an association between treatment and the potential outcome under no treatment is identified with a well-specified generalized linear model relating the pre-exposure outcome and the exposure. Because the proposed method identifies any causal effect that is conceivably identified in the absence of confounding bias, including nonlinear effects such as quantile treatment effects, the approach is aptly called universal difference-in-differences. We describe and illustrate both fully parametric and more robust semiparametric universal difference-in-differences estimators in a real-world application concerning the causal effects of a Zika virus outbreak on birth rate in Brazil. A supplementary digital video is available at: http://links.lww.com/EDE/C90 [ABSTRACT FROM AUTHOR]

Children and adolescents account for a small proportion of confirmed COVID-19 cases, with mild and self-limiting clinical manifestations. The distribution and determinants of COVID-19 among this group in Sudan are unclear. This study used national COVID-19 surveillance data to study the epidemiology of COVID-19 among children and adolescents in Sudan during 2020–2021. A cross-sectional study was performed to estimate the reported incidence of children and adolescents with COVID-19; the clinical features; and the mortality among those who tested positive for COVID-19. A total of 3150 suspected cases of COVID-19 infection fulfilled the study criteria. The majority of cases were above 10 years of age, 52% (1635) were males, and 56% (1765) were asymptomatic. The reported incidence rates of COVID-19 among children and adolescents in Sudan was 1.3 per 10,000 in 2021. Fever, cough, and headache were the most frequent symptoms reported among the suspected cases. The case fatality rate was 0.2%. Binary logistic regression revealed that loss of smell was the most significantly associated symptom with a positive test. We recommend further study to identify risk factors. Additionally, we recommend including these age groups in the vaccination strategy in Sudan.

Objective Meconium is a common finding in amniotic fluid and placental specimens, particularly in term and post-term pregnancies. The objective of this paper was to perform a meta-analysis to examine the impact of endotracheal suctioning on the occurrence of meconium aspiration syndrome (MAS), mortality, and complications. Study Design PubMed, EMBASE, and the Cochrane library were systematically searched for comparative studies. Odds ratios (ORs), weighted mean differences (WMDs), and corresponding 95% confidence intervals (CIs) were used to compare the outcomes. Results Twelve studies were included in the meta-analysis. There were no significant impacts of endotracheal suctioning on the occurrence of MAS (OR = 3.05, 95% CI: 0.48–19.56), mortality (OR = 1.25, 95% CI: 0.35–4.44), the need for mechanical ventilation (OR = 4.20, 95% CI: 0.32–54.72), the occurrence of pneumothorax (OR = 0.99, 95% CI: 0.34–2.85), persistent pulmonary hypertension of the newborn (PPHN), (OR = 1.31, 95% CI: 0.58–2.98), hypoxic-ischemic encephalopathy (HIE) (OR = 0.82, 95% CI: 0.52–1.30), and length of stay (WMD = −0.11, 95% CI: −0.99–0.77). Conclusion Routine endotracheal suctioning at birth is not useful in preventing MAS, mortality, mechanical ventilation, PPHN, HIE, and prolonged length of stay in neonates born through MSAF. Key Points Routine suctioning is not recommended for newborns. Endotracheal aspiration is not beneficial for MAS. Future research may focus on selected neonates. [ABSTRACT FROM AUTHOR]

Children and adolescents account for a small proportion of confirmed COVID-19 cases, with mild and self-limiting clinical manifestations. The distribution and determinants of COVID-19 among this group in Sudan are unclear. This study used national COVID-19 surveillance data to study the epidemiology of COVID-19 among children and adolescents in Sudan during 2020–2021. A cross-sectional study was performed to estimate the reported incidence of children and adolescents with COVID-19; the clinical features; and the mortality among those who tested positive for COVID-19. A total of 3150 suspected cases of COVID-19 infection fulfilled the study criteria. The majority of cases were above 10 years of age, 52% (1635) were males, and 56% (1765) were asymptomatic. The reported incidence rates of COVID-19 among children and adolescents in Sudan was 1.3 per 10,000 in 2021. Fever, cough, and headache were the most frequent symptoms reported among the suspected cases. The case fatality rate was 0.2%. Binary logistic regression revealed that loss of smell was the most significantly associated symptom with a positive test. We recommend further study to identify risk factors. Additionally, we recommend including these age groups in the vaccination strategy in Sudan. [ABSTRACT FROM AUTHOR]

Key points Several risk factors for shoulder injuries were identified specifically in handball players Isometric external rotation strength was the only modifiable risk factor supported by strong evidence. Further research is required as only 50% of the studies were of high quality Future studies should address the multifactorial nature of shoulder injuries in handball.

Visual analysis is the primary method of analyzing single‐case research data, yet relatively little is known about the variables that influence raters' decisions and rater agreement. Previous research has suggested that trend, variability, and autocorrelation may negatively affect interrater agreement, but studies have been limited by small numbers of graphs and participants whose knowledge of single‐case research was not described. The purpose of this study was to examine the main and interaction effects of two values of each of six data characteristics (e.g., level, trend, and number of data points) on agreement among visual analysts. Using data from Lanovaz and Hranchuk (2021), we examined odds ratios to identify data characteristics that influence interrater agreement. Results suggest that trend and effect size, and to a lesser extent variability, have the largest effects on interrater agreement. We discuss the implications of our results for future research on improving interrater agreement among visual analysts. [ABSTRACT FROM AUTHOR]

There is increasing and inconsistent evidence of a relationship between hypertensive disorders in pregnancy (HDPs) and season of delivery or conception. In this systematic review and meta-analysis, we assessed the association between season and HDPs. The review protocol was registered in PROSPERO (CRD42021285539). Four databases, the Cochrane Library, PubMed, EMBASE, and Web of Science, were searched until September 29th, 2021. Two authors extracted data independently and used the Newcastle–Ottawa quality assessment scale (NOS) to evaluate study quality. A random effects model and the Mantel–Haenszel method were used to calculate pooled Odds ratios (ORs) and 95% confidence intervals (95% CIs). Subgroup analyses and sensitivity analyses were performed to find the source of heterogeneity and Begg's funnel plot and Egger's test were used to check for the risk of publication bias. Finally, twenty articles were included in the systematic review, and 11 articles were included in the meta-analysis. The quantitative analysis of the association between delivery season and HDPs showed that the odds of HDPs was higher in women who delivered in winter than in those who delivered in summer (OR = 1.18, 95% CI 1.02–1.38, P < 0.001) and all other seasons (OR = 1.17, 95% CI 1.03–1.34, P < 0.001). In the qualitative analysis of the association between conception season and HDPs, four of seven studies suggested that women who conceived in summer had a higher risk of HDPs than those who conceived in other seasons. Based on the evidence to date, we found weakly positive relationships between HDPs and summer conception and winter delivery. [ABSTRACT FROM AUTHOR]

Background: Although the human immunodeficiency virus (HIV) is spatially heterogeneous in Ethiopia, current regional estimates of HIV prevalence hide the epidemic's heterogeneity. A thorough examination of the prevalence of HIV infection using district-level data could assist to develop HIV prevention strategies. The aims of this study were to examine the spatial clustering of HIV prevalence in Jimma Zone at district level and assess the effects of patient characteristics on the prevalence of HIV infection. Methods: The 8440 files of patients who underwent HIV testing in the 22 Districts of Jimma Zone between September 2018 and August 2019 were the source of data for this study. The global Moran's index, Getis–Ord  G i * local statistic, and Bayesian hierarchical spatial modelling approach were applied to address the research objectives. Results: Positive spatial autocorrelation was observed in the districts and the local indicators of spatial analysis using the Getis–Ord statistic also identified three districts, namely Agaro, Gomma and Nono Benja, as hotspots, and two districts, namely Mancho and Omo Beyam, as coldspots with 95% and 90% confidence levels, respectively, for HIV prevalence. The results also showed eight patient-related characteristics that were considered in the study were associated with HIV prevalence in the study area. Furthermore, after accounting for these characteristics in the fitted model, there was no spatial clustering of HIV prevalence suggesting the patient characteristics had explained most of the heterogeneity in HIV prevalence in Jimma Zone for the study data. Conclusions: The identification of hotspot districts and the spatial dynamic of HIV infection in Jimma Zone at district level may allow health policymakers in the zone or Oromiya region or at national level to develop geographically specific strategies to prevent HIV transmission. Because clinic register data were used in the study, it is important to use caution when interpreting the results. The results are restricted to Jimma Zone districts and may not be generalizable to Ethiopia or the Oromiya region. [ABSTRACT FROM AUTHOR]

Simple Summary: Escherichia coli (E. coli) carrying antibiotic resistance genes (ARGs) and virulence-associated genes (VAGs), which are considered as emerging environmental pollutants, undoubtedly causes adverse health effects on humans and animals. With the implementation of the Wild Release Plan of captive giant pandas, antibiotic-resistant E. coli carrying ARGs/VAGs in giant pandas' feces that are discharged into the environment may become pollutants for nature. To evaluate the potential threat of E. coli strains from captive giant pandas, we analyzed the distribution and the association of ARGs and VAGs in antibiotic-resistant E. coli. Our results revealed a high prevalence of ARGs and a significant positive association among ARGs and VAGs, suggesting that the continuous monitoring of the impact of the spread of antibiotic-resistant E. coli (carried various ARGs and VAGs) is needed in future studies. Recent studies showed that Escherichia coli (E. coli) strains isolated from captive giant pandas have serious resistance to antibiotics and carry various antibiotic resistance genes (ARGs). ARGs or virulence-associated genes (VAGs) carried by antibiotic-resistant E. coli are considered as a potential health threat to giant pandas, humans, other animals and the environment. In this study, we screened ARGs and VAGs in 84 antibiotic-resistant E. coli strains isolated from clinically healthy captive giant pandas, identified the association between ARGs and VAGs and analyzed the phylogenetic clustering of E. coli isolates. Our results showed that the most prevalent ARG in E. coli strains isolated from giant pandas is blaTEM (100.00%, 84/84), while the most prevalent VAG is fimC (91.67%, 77/84). There was a significant positive association among 30 pairs of ARGs, of which the strongest was observed for sul1/tetC (OR, 133.33). A significant positive association was demonstrated among 14 pairs of VAGs, and the strongest was observed for fyuA/iroN (OR, 294.40). A positive association was also observed among 45 pairs of ARGs and VAGs, of which the strongest was sul1/eaeA (OR, 23.06). The association of ARGs and mobile gene elements (MGEs) was further analyzed, and the strongest was found for flor and intI1 (OR, 79.86). The result of phylogenetic clustering showed that the most prevalent group was group B2 (67.86%, 57/84), followed by group A (16.67%, 14/84), group D (9.52%, 8/84) and group B1 (5.95%, 5/84). This study implied that antibiotic-resistant E. coli isolated from captive giant pandas is a reservoir of ARGs and VAGs, and significant associations exist among ARGs, VAGs and MGEs. Monitoring ARGs, VAGs and MGEs carried by E. coli from giant pandas is beneficial for controlling the development of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

CKDu is one of the most serious health problems in Sri Lanka. The country's Uva Province (UP) faces an increasing number of CKDu patients. Therefore, this study develops a statistical model to identify the socio-economic determinants of CKDu in UP, Sri Lanka. This cross-sectional study draws on a questionnaire survey conducted with 229 farmers, of which 24% were CKDu patients, to ascertain the socio-economic predictors that contribute to CKDu. The relationship between socio-economic risk factors and CKDu was delineated using a logistic regression model and by analyzing odds ratios. The highest risk of CKDu was observed among participants who consume agrochemical-applied foods (OR 7.9657, 95% CI = 2.2205, 28.5755) and potentially contaminated drinking water (OR 3.3693, 95% CI = 1.5540, 7.3053). Furthermore, age (OR 1.1097 95% CI = 1.0542, 1.1680), gender (OR 4.4980, 95% CI = 1.1406, 17.7382), and education level (OR 21.1018, 95% CI = 1.7753, 250.8250) were also identified as significant risk factors. [ABSTRACT FROM AUTHOR]

Background: Handball is a sport with a high number of severe injuries. The shoulder is one of the most commonly injured joints, with an average prevalence of 17–41%. Objective: The primary aim is to identify the most significant risk factors related to shoulder injuries in handball. The secondary aim is to propose recommendations based on the available evidence concerning potential injury prevention strategies. Methods: Systematic searches of PubMed, MEDLINE, CINAHL, Proquest, SPORTDiscus, Web of Science, EMBASE, and Scopus were undertaken for peer reviewed articles published between 15 July 1995 and 15 July 2019. The same search strategy was repeated on 24 April 2022. Prospective cohort studies, written in English and published in a journal with a peer-review process aiming to investigate at least one modifiable or/and a non-modifiable potential risk factor for shoulder injuries, specifically in handball players, were included. Only papers published after 1995 were included. The methodological quality of the eligible studies was assessed using the modified version of the Downs and Black Checklist. The Best Evidence Synthesis (BES) approach was used for synthesizing and reporting the results. Results: 1849 studies were identified, of which 8 were included. A total of 2536 (males = 1354, females = 1182) participants of which 2522 were handball athletes, were included. Four of the eight studies were rated as high methodological quality studies (> 85%) while the rest were rated as medium (50–85%). The risk factors for shoulder injuries in handball identified in the studies were strength imbalances (n = 6), glenohumeral range of motion (ROM) imbalances (n = 5), scapular dyskinesis (n = 5), incorrect dosage of training load (n = 2), previous injury (n = 1), sex (n = 2), player's position, school grade, playing level (n = 1), altered shoulder joint position sense (n = 1). Conclusion: Overall, from all the risk factors evaluated, there was strong evidence that the weakness of the shoulder external rotator muscles and the female sex increase the probability of shoulder injury in handball athletes. Nevertheless, the evidence for the other risk factors was moderate due to the methodological quality and the limited number of studies. Protocol registration: PROSPERO ID: CRD42020138233. Key points: Several risk factors for shoulder injuries were identified specifically in handball players Isometric external rotation strength was the only modifiable risk factor supported by strong evidence. Further research is required as only 50% of the studies were of high quality Future studies should address the multifactorial nature of shoulder injuries in handball. [ABSTRACT FROM AUTHOR]

Objective To investigate the prevalence of lumbosacral transition vertebrae (LSTVs) in both the normal population and the lumbar disc herniation (LDH) population and to determine the risk factors for LDH. Methods Between January 2019 and September 2020, all patients aged 18–39 years and underwent an anteroposterior (AP) X‐ray of the lumbar vertebrae were retrospective reviewed in our institution. Those patients who were diagnosed with LDH were eligible for inclusion in the LDH group. During the same period, those patients admitted to our hospital who underwent an anteroposterior X‐ray of the lumbar spine and had not been diagnosed with LDH were included in the control group. Those patients with disease that might affect the lumbar anatomy were excluded from both groups. The type of LSTV was classified according to the Castellvi classification. The height of the lumbar vertebral lamina was evaluated through the h/H index. The inter‐ and intra‐observer reliability was evaluated by one senior radiologist and one senior orthopedist using intraclass correlation coefficient (ICC). The association between the LSTV and the herniation level was also investigated. Binary logistic regression was used to explore the association of different factors between the LDH group and the control group. Results Two hundred LDH patients (115 male and 85 female) and 200 individuals (108 male and 92 female) were investigated retrospectively. The prevalence of LSTVs was 71.5% (n = 143) in the LDH group and 34.0% (n = 68) in the control group. The most frequent LSTV types were type Ib and type IIa. The inter‐ and intra‐observer ICCs of the measurement of “h/H” index and the classification of LSTV were all “excellent” (ICC > 0.90). The median h/H index in the control group was significantly higher than that in the LDH group (0.28 (0.26, 0.31) vs 0.34 (0.31, 0.37), P = 0.000). The distribution of the Castellvi classification in the L4/5 and L5/S1 herniation patients was significantly different (P = 0.048). LSTVs, BMI and the h/H index were closely associated with LDH, with odds ratios of 3.06 (95% CI: 2.12–4.43), 1.23 (95% CI: 1.13–1.33) and 0.09 (95% CI: 0.05–0.15), respectively. The incidence of L4/5 disc herniation in patients with an LSTV was significantly more common than that in patients with L5/S1 disc herniation (P = 0.048). Conclusion The prevalence of LSTVs was 34.0% in the control group and 71.5% in the LDH group; LSTVs and BMI were positively correlated with LDH, and h/H was negatively correlated with LDH.

Objective: To investigate the clinical, laboratory and genetic features of NAFLD patients based on MRI-PDFF in China. Design: Patients with high ALT and with a diagnosis of fatty liver were included in this cross-sectional study. Fasting blood was collected to test biomarkers and SNPs. A total of 266 patients underwent MRI-PDFF and FibroScan examinations, and 38 underwent liver biopsy. Diagnostic models (decision tree, LASSO, and elastic net) were developed based on the diagnosis from MRI-PDFF reports. Results: Approximately, 1/3 of the patients were found to have NASH and fibrosis. After quantifying liver steatosis by MRI-PDFF (healthy: n = 47; mild NAFLD: n = 136; moderate/severe NAFLD: n = 83; liver fat content (LFC): 3.6% vs. 8.7% vs. 19.0%), most biomarkers showed significant differences among the three groups, and patients without obesity were found to have a similar LFC as those with obesity (11.1% vs. 12.3%). Models including biomarkers showed strong diagnostic ability (accuracy: 0.80–0.91). Variant alleles of PNPLA3, HSD17B13 and MBOAT7 were identified as genetic risk factors causing higher LFC (8.7% vs. 12.3%; 11.0% vs. 14.5%; 8.5% vs. 10.2%, p < 0.05); those with the UQCC1 rs878639 variant allele showed lower LFC (10.4% vs. 8.4%; OR = 0.58, p < 0.05). Patients with more risk alleles had higher LFCs (8.1% vs. 10.7% vs. 11.6% vs. 14.5%). Conclusions: Based on MRI-PDFF, a combination of several specific biomarkers can accurately predict disease status. When the effects of genes on liver steatosis were first quantified by MRI-PDFF, the UQCC1 rs878639 G allele was identified as a protective factor, and the MBOAT7 T allele was identified as a risk only among nonobese individuals. [ABSTRACT FROM AUTHOR]

Since 1990, when our laboratory published the association of the DRD2 Taq A1 allele and severe alcoholism in JAMA, there has been an explosion of genetic candidate association studies, including GWAS. To develop an accurate test to help identify those at risk for at least Alcohol Use Disorder (AUD), Blum's group developed the Genetic Addiction Risk Severity (GARS) test, consisting of ten genes and eleven associated risk alleles. In order to statistically validate the selection of these risk alleles measured by GARS, we applied strict analysis to studies that investigated the association of each polymorphism with AUD or AUD-related conditions published from 1990 until 2021. This analysis calculated the Hardy–Weinberg Equilibrium of each polymorphism in cases and controls. If available, the Pearson's χ2 test or Fisher's exact test was applied to comparisons of the gender, genotype, and allele distribution. The statistical analyses found the OR, 95% CI for OR, and a post-risk for 8% estimation of the population's alcoholism prevalence revealed a significant detection. The OR results showed significance for DRD2, DRD3, DRD4, DAT1, COMT, OPRM1, and 5HTT at 5%. While most of the research related to GARS is derived from our laboratory, we are encouraging more independent research to confirm our findings. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic hastened hundreds of thousands of deaths in the United States. Many of these excess deaths are directly attributed to COVID-19, but others stem from the pandemic's social, economic, and health care system disruptions. This study compares provisional mortality data for age and sex subgroups across different time windows, with and without COVID-19 deaths, and assesses whether mortality risks are returning to pre-pandemic levels. Using provisional mortality reports from the CDC, we compute mortality risks for 22 age and sex subgroups in 2021 and compare against 2015-2019 using odds ratios. We repeat this comparison for the first twelve full months of the COVID-19 pandemic in the United States (April 2020-March 2021) against the next twelve full months (April 2021-March 2022). Mortality risks for most subgroups were significantly higher in 2021 than in 2015-2019, both with and without deaths involving COVID-19. For ages 25-54, Year 2 (April 2021-March 2022) was more fatal than Year 1 (April 2020-March 2021), whereas total mortality risks for the 65 + age groups declined. Given so many displaced deaths in the first two years of the COVID-19 pandemic, mortality risks in the next few years may fall below pre-pandemic levels. Provisional mortality data suggest this is already happening for the 75 + age groups when excluding COVID-19 deaths. [ABSTRACT FROM AUTHOR]

Demographers and other social scientists often study effect heterogeneity (defined here as differences in outcome-predictor associations across groups defined by the values of a third variable) to understand how inequalities evolve between groups or how groups differentially benefit from treatments. Yet answering the question "Is the effect larger in group A or group B?" is surprisingly difficult. In fact, the answer sometimes reverses across scales. For example, researchers might conclude that the effect of education on mortality is larger among women than among men if they quantify education's effect on an odds-ratio scale, but their conclusion might flip (to indicate a larger effect among men) if they instead quantify education's effect on a percentage-point scale. We illuminate this flipped-signs phenomenon in the context of nonlinear probability models, which were used in about one third of articles published in Demography in 2018-2019. Although methodologists are aware that flipped signs can occur, applied researchers have not integrated this insight into their work. We provide formal inequalities that researchers can use to easily determine if flipped signs are a problem in their own applications. We also share practical tips to help researchers handle flipped signs and, thus, generate clear and substantively correct descriptions of effect heterogeneity. Our findings advance researchers' ability to accurately characterize population variation. [ABSTRACT FROM AUTHOR]

Background: Although the human immunodeficiency virus (HIV) is spatially heterogeneous in Ethiopia, current regional estimates of HIV prevalence hide the epidemic’s heterogeneity. A thorough examination of the prevalence of HIV infection using district-level data could assist to develop HIV prevention strategies. The aims of this study were to examine the spatial clustering of HIV prevalence in Jimma Zone at district level and assess the effects of patient characteristics on the prevalence of HIV infection. Methods: The 8440 files of patients who underwent HIV testing in the 22 Districts of Jimma Zone between September 2018 and August 2019 were the source of data for this study. The global Moran’s index, Getis–Ord Gi* local statistic, and Bayesian hierarchical spatial modelling approach were applied to address the research objectives. Results: Positive spatial autocorrelation was observed in the districts and the local indicators of spatial analysis using the Getis–Ord statistic also identified three districts, namely Agaro, Gomma and Nono Benja, as hotspots, and two districts, namely Mancho and Omo Beyam, as coldspots with 95% and 90% confidence levels, respectively, for HIV prevalence. The results also showed eight patient-related characteristics that were considered in the study were associated with HIV prevalence in the study area. Furthermore, after accounting for these characteristics in the fitted model, there was no spatial clustering of HIV prevalence suggesting the patient characteristics had explained most of the heterogeneity in HIV prevalence in Jimma Zone for the study data. Conclusions: The identification of hotspot districts and the spatial dynamic of HIV infection in Jimma Zone at district level may allow health policymakers in the zone or Oromiya region or at national level to develop geographically specific strategies to prevent HIV transmission. Because clinic register data were used in the study, it is important to use caution when interpreting the results. The results are restricted to Jimma Zone districts and may not be generalizable to Ethiopia or the Oromiya region.

Some studies show that low serum vitamin D levels are associated with white matter hyperintensity (WMH), while other studies report no association. This meta-analysis aimed to investigate the presence of an association between serum 25-hydroxy vitamin D [25(OH)D] levels and WMH. PubMed, Embase, the Cochrane Library, CNKI, WANFANG, and VIP were searched for available papers published up to December 2020. The outcomes were the odds ratios (ORs) with 95% confidence intervals (CIs) for the association between different vitamin D statuses and WMH. All meta-analyses were performed using a random-effects model. Five studies (4393 patients) were included. Compared with sufficient 25(OH)D levels, 25(OH)D deficiency was not associated with WMH (OR = 1.67, 95%CI: 0.92–3.04; I2 = 70.2%, Pheterogeneity = 0.009), nor was 25(OH)D insufficiency (OR = 1.21, 95%CI: 0.89–1.65; I2 = 48.1%, Pheterogeneity = 0.103). A decrease of 25 nmol/L in 25(OH)D levels was associated with WMH (OR = 1.83, 95%CI: 1.34-2.49; I2 = 0%, Pheterogeneity= 0.512). The sensitivity analyses showed that the results were robust. 25(OH)D deficiency and insufficiency are not associated with WMH. A decrease of 25 nmol/L in 25(OH)D levels was associated with WMH, but this result will have to be confirmed. Prospective trials, both cross-sectional and longitudinal, are necessary to examine the association between 25(OH)D levels and WMH.

Some studies show that low serum vitamin D levels are associated with white matter hyperintensity (WMH), while other studies report no association. This meta-analysis aimed to investigate the presence of an association between serum 25-hydroxy vitamin D [25(OH)D] levels and WMH. PubMed, Embase, the Cochrane Library, CNKI, WANFANG, and VIP were searched for available papers published up to December 2020. The outcomes were the odds ratios (ORs) with 95% confidence intervals (CIs) for the association between different vitamin D statuses and WMH. All meta-analyses were performed using a random-effects model. Five studies (4393 patients) were included. Compared with sufficient 25(OH)D levels, 25(OH)D deficiency was not associated with WMH (OR = 1.67, 95%CI: 0.92–3.04; I2 = 70.2%, P heterogeneity = 0.009), nor was 25(OH)D insufficiency (OR = 1.21, 95%CI: 0.89–1.65; I2 = 48.1%, P heterogeneity = 0.103). A decrease of 25 nmol/L in 25(OH)D levels was associated with WMH (OR = 1.83, 95%CI: 1.34-2.49; I2 = 0%, P heterogeneity= 0.512). The sensitivity analyses showed that the results were robust. 25(OH)D deficiency and insufficiency are not associated with WMH. A decrease of 25 nmol/L in 25(OH)D levels was associated with WMH, but this result will have to be confirmed. Prospective trials, both cross-sectional and longitudinal, are necessary to examine the association between 25(OH)D levels and WMH. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prevalence of lumbosacral transition vertebrae (LSTVs) in both the normal population and the lumbar disc herniation (LDH) population and to determine the risk factors for LDH. Methods: Between January 2019 and September 2020, all patients aged 18–39 years and underwent an anteroposterior (AP) X‐ray of the lumbar vertebrae were retrospective reviewed in our institution. Those patients who were diagnosed with LDH were eligible for inclusion in the LDH group. During the same period, those patients admitted to our hospital who underwent an anteroposterior X‐ray of the lumbar spine and had not been diagnosed with LDH were included in the control group. Those patients with disease that might affect the lumbar anatomy were excluded from both groups. The type of LSTV was classified according to the Castellvi classification. The height of the lumbar vertebral lamina was evaluated through the h/H index. The inter‐ and intra‐observer reliability was evaluated by one senior radiologist and one senior orthopedist using intraclass correlation coefficient (ICC). The association between the LSTV and the herniation level was also investigated. Binary logistic regression was used to explore the association of different factors between the LDH group and the control group. Results: Two hundred LDH patients (115 male and 85 female) and 200 individuals (108 male and 92 female) were investigated retrospectively. The prevalence of LSTVs was 71.5% (n = 143) in the LDH group and 34.0% (n = 68) in the control group. The most frequent LSTV types were type Ib and type IIa. The inter‐ and intra‐observer ICCs of the measurement of "h/H" index and the classification of LSTV were all "excellent" (ICC > 0.90). The median h/H index in the control group was significantly higher than that in the LDH group (0.28 (0.26, 0.31) vs 0.34 (0.31, 0.37), P = 0.000). The distribution of the Castellvi classification in the L4/5 and L5/S1 herniation patients was significantly different (P = 0.048). LSTVs, BMI and the h/H index were closely associated with LDH, with odds ratios of 3.06 (95% CI: 2.12–4.43), 1.23 (95% CI: 1.13–1.33) and 0.09 (95% CI: 0.05–0.15), respectively. The incidence of L4/5 disc herniation in patients with an LSTV was significantly more common than that in patients with L5/S1 disc herniation (P = 0.048). Conclusion: The prevalence of LSTVs was 34.0% in the control group and 71.5% in the LDH group; LSTVs and BMI were positively correlated with LDH, and h/H was negatively correlated with LDH. [ABSTRACT FROM AUTHOR]

COVID-19 has disrupted society and health care systems, creating a fertile environment for deaths beyond the virus. The year 2020 will prove to be the most deadly year on record in the United States. Direct deaths due to COVID-19 have been well documented and reported. Older people (those over 65) have been hardest hit, with over 80% of the COVID-19 deaths in this age group. What has been less clear is the impact on those under 65 years old, particularly those under 44 years old. This study considers both COVID-19 deaths and non-COVID-19 deaths during a 39 weeks period beginning 1 March in both 2020 and averaged over the five years from 2015 to 2019. Across 22 age and gender cohorts, death risks are compared using odds ratios. The results indicate that younger people (those under 15 years old) have experienced the same or a reduction in death risk between 2020 and the average from 2015 to 2019, suggesting that societal changes were protective for some of them. With all COVID-19 deaths removed from the 2020 death counts, 15-64 year olds experienced increased death risk between 2020 and the 2015 to 2019 average. For example, 15-44 year old males experienced a significant increase in their death risk, even though the absolute number of COVID-19 deaths for this cohort is small. The key take away from this study is that COVID-19 resulted in a large number of additional deaths in 2020 compared to the average from 2015 to 2019, both directly from the virus and indirectly due to societal responses to the virus. [ABSTRACT FROM AUTHOR]

Recent studies showed that Escherichia coli (E. coli) strains isolated from captive giant pandas have serious resistance to antibiotics and carry various antibiotic resistance genes (ARGs). ARGs or virulence-associated genes (VAGs) carried by antibiotic-resistant E. coli are considered as a potential health threat to giant pandas, humans, other animals and the environment. In this study, we screened ARGs and VAGs in 84 antibiotic-resistant E. coli strains isolated from clinically healthy captive giant pandas, identified the association between ARGs and VAGs and analyzed the phylogenetic clustering of E. coli isolates. Our results showed that the most prevalent ARG in E. coli strains isolated from giant pandas is blaTEM (100.00%, 84/84), while the most prevalent VAG is fimC (91.67%, 77/84). There was a significant positive association among 30 pairs of ARGs, of which the strongest was observed for sul1/tetC (OR, 133.33). A significant positive association was demonstrated among 14 pairs of VAGs, and the strongest was observed for fyuA/iroN (OR, 294.40). A positive association was also observed among 45 pairs of ARGs and VAGs, of which the strongest was sul1/eaeA (OR, 23.06). The association of ARGs and mobile gene elements (MGEs) was further analyzed, and the strongest was found for flor and intI1 (OR, 79.86). The result of phylogenetic clustering showed that the most prevalent group was group B2 (67.86%, 57/84), followed by group A (16.67%, 14/84), group D (9.52%, 8/84) and group B1 (5.95%, 5/84). This study implied that antibiotic-resistant E. coli isolated from captive giant pandas is a reservoir of ARGs and VAGs, and significant associations exist among ARGs, VAGs and MGEs. Monitoring ARGs, VAGs and MGEs carried by E. coli from giant pandas is beneficial for controlling the development of antimicrobial resistance.

Objectives: To describe change in trunk flexor endurance and intra-abdominal pressure (IAP) associated with trunk flexor assessment and explore factors associated with change in trunk flexor endurance during the first postpartum year. Design: Ancillary analysis of an ongoing prospective cohort study. Methods: Participants (N = 282) were primiparous women delivered vaginally. They completed trunk flexor endurance testing while assessing IAP, body habitus measures (body mass index, waist circumference, and body composition), and questionnaires 5–10 weeks and 11–15 months postpartum. We investigated change in trunk flexor endurance by quartile of improvement and factors associated with improvement (Q4 vs. Q1-Q3) using multivariable models, adjusted for baseline endurance. Results: Mean age was 28 ± 5 years. The median (IQR) trunk flexor hold time increased from early to late postpartum (129/IQR = 68, 217 vs 148/IQR = 80, 265 seconds, p =.01) and mean (SD) IAP decreased (55/SD = 13 vs 48/SD = 14 cmH20, p <.0001). The most improved group (Q4) increased endurance time by 176 seconds (95% CI = 103, 254), were less likely to be Hispanic, more likely to be older, more educated, and have lower measures of body habitus than women in Q1-Q3. Conclusion: Trunk flexor endurance increased and IAP decreased over one year postpartum. Lower body habitus and higher age early postpartum predicted greatest improvement in trunk flexor endurance at 1 year. [ABSTRACT FROM AUTHOR]

Complications and revisions following anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty have deleterious effects on patient function and satisfaction. The purpose of this study is to evaluate patient-specific, implant-specific and technique-specific risk factors for intraoperative complications, postoperative complications, and the occurrence of revisions after aTSA and rTSA. A total of 2964 aTSA and 5616 rTSA patients were enrolled in an international database of primary shoulder arthroplasty. Intra- and postoperative complications, as well as revisions, were reported and evaluated. Multivariate analyses were performed to quantify the risk factors associated with complications and revisions. aTSA patients had a significantly higher complication rate (P =.0026) and a significantly higher revision rate (P <.0001) than rTSA patients, but aTSA patients also had a significantly longer average follow-up (P <.0001) than rTSA patients. No difference (P =.2712) in the intraoperative complication rate was observed between aTSA and rTSA patients. Regarding intraoperative complications, female sex (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.17-3.68) and previous shoulder surgery (OR 2.9, 95% CI 1.73-4.90) were identified as significant risk factors. In regard to postoperative complications, younger age (OR 0.987, 95% CI 0.977-0.996), diagnosis of rheumatoid arthritis (OR 1.76, 95% 1.12-2.65), and previous shoulder surgery (OR 1.42, 95% CI 1.16-1.72) were noted to be risks factors. Finally, in regard to revision surgery, younger age (OR 0.964, 95% CI 0.933-0.998), more glenoid retroversion (OR 1.03, 95% CI 1.001-1.058), larger humeral stem size (OR 1.09, 95% CI 1.01-1.19), larger humeral liner thickness or offset (OR 1.50, 95% CI 1.18-1.96), larger glenosphere diameter (OR 1.16, 95% CI 1.07-1.26), and more intraoperative blood loss (OR 1.002, 95% CI 1.001-1.004) were noted to be risk factors. Studying the impact of numerous patient- and implant-specific risk factors and determining their impact on complications and revision shoulder arthroplasty can assist surgeons in counseling patients and guide patient expectations following aTSA or rTSA. Care should be taken in patients with a history of previous shoulder surgery, who are at increased risk of both intra- and postoperative complications. [ABSTRACT FROM AUTHOR]

Regionally scaled assessments of hydrologic alteration for small streams and its effects on freshwater taxa are often inhibited by a low number of stream gages. To overcome this limitation, we paired modeled estimates of hydrologic alteration to a benthic macroinvertebrate index of biotic integrity data for 4522 stream reaches across the Chesapeake Bay watershed. Using separate random-forest models, we predicted flow status (inflated, diminished, or indeterminant) for 12 published hydrologic metrics (HMs) that characterize the main components of flow regimes. We used these models to predict each HM status for each stream reach in the watershed, and linked predictions to macroinvertebrate condition samples collected from streams with drainage areas less than 200 km2. Flow alteration was calculated as the number of HMs with inflated or diminished status and ranged from 0 (no HM inflated or diminished) to 12 (all 12 HMs inflated or diminished). When focused solely on the stream condition and flow-alteration relationship, degraded macroinvertebrate condition was, depending on the number of HMs used, 3.8–4.7 times more likely in a flow-altered site; this likelihood was over twofold higher in the urban-focused dataset (8.7–10.8), and was never significant in the agriculture-focused dataset. Logistic regression analysis using the entire dataset showed for every unit increase in flow-alteration intensity, the odds of a degraded condition increased 3.7%. Our results provide an indication of whether altered streamflow is a possible driver of degraded biological conditions, information that could help managers prioritize management actions and lead to more effective restoration efforts. [ABSTRACT FROM AUTHOR]

Housing first models have become increasingly common for supporting persons experiencing homelessness. However, successful implementation of the housing first model can vary from program to program. To better understand what factors, influence whether a person experiencing homelessness can secure housing in a housing first model, we constructed a logistic Bayesian model. With data from 69 clients enrolled in a housing first program in Indiana, we tested demographic factors, depression, drug use, health status, hospital and acute care and outpatient visits, probation/parole status, and number of crimes committed as prospective predictors of securing housing six months later. We found that older participants, those who had recently utilized acute care services, and those with lower depression scores were more likely to secure housing after six months. [ABSTRACT FROM AUTHOR]

Abstract: Little is known about risk factors for emergency department (ED) attendance for chronic pain (CP) management and the relative service burden. We examined ED utilisation in patients with CP, identified risk factors associated with attendance for chronic musculoskeletal pain (CMP), and estimated the comparative cost of treatment. The study cohort comprised a random sample of 3700 adults from the general population in Tayside, Scotland. Linked regional extracts, spanning a 12-month period, were obtained from national registers, providing information on ED attendances, community-dispensed prescribing, and outpatient clinic attendances. The National Health Service Scotland Cost Book was used to ascertain the current average cost of an ED attendance (£130; ∼$167). All-cause ED attendance was higher in those with CP (68.5%; n = 252) than without (29.3%; n = 967). In the entire cohort, more patients attended the ED for the treatment of CMP than for any other medical condition (n = 119; 32.3% of those with CP). Risk factors for ED attendance for CMP were: recent analgesic dose decreases (OR = 4.55); and transitioning from opioid to nonopioid analgesics (OR = 5.08). Characteristics protective of ED attendance for CMP were: being in receipt of strong opioids (OR = 0.21); transitioning from nonopioid to opioid analgesics (OR = 0.25); recent analgesic dose increases (OR = 0.24); and being prescribed tricyclic antidepressants (OR = 0.10), benzodiazepines (OR = 0.46), or hypnotics (OR = 0.45). Chronic musculoskeletal pain was one of the most expensive conditions to treat (£17,680 [∼$22,668] per annum), conferring a substantial burden on ED services. Improved understanding of the risk/protective factors could inform healthcare redesign to reduce avoidable ED attendances for CMP management. [ABSTRACT FROM AUTHOR]