2-year Period Research Articles

Trends in allergic sensitization and diseases in the Korean general population over a 9-year period.

The prevalence of allergic sensitization and diseases varies over time owing to climate, environment, and lifestyle changes. To analyze changes in sensitization to house dust mites (HDM) and dogs and the prevalence of allergic diseases in the Korean general population over a 9-year period and identify contributing factors. This cross-sectional study used data from the Korean National Health and Nutrition Examination Survey conducted in 2010 and 2019. Participants were aged ≥10 years, with the analysis stratified by adolescents (10-18 years) and adults (≥19 years). We evaluated the prevalence of allergic sensitization and diseases, examining links to clinicodemographic factors, across the two years. Multivariate logistic regression was performed to evaluate the association between sensitization and clinicopathological factors. In total, 4084 participants (2010: n=2,019; 2019: n=2,065) were enrolled. In 2010, HDM sensitization was 36.9%, declining to 36.6% in 2019. Dog sensitization decreased from 6.1% in 2010 to 5.8% in 2019. There were no significant differences between the two years in total participants; however, dog sensitization increased significantly among adolescents (2010: 8.7% vs. 2019: 15.3%; p=.027). In 2010, HDM sensitization was negatively associated with urban residence (odds ratio [95% confidence interval], 0.76 [0.60-0.96]) and apartment dwelling (0.78 [0.64-0.95]), without significance in 2019. In adolescents, dog sensitization was strongly correlated with urban residence (8.06 [1.53-42.49]) in 2010, whereas HDM sensitization was associated with obesity (2.02 [1.04- 3.91]) in 2019. In adults, heavy drinking was linked to dog sensitization (2.35 [1.20-4.62]) in 2010, and HDM sensitization in 2019 (1.44 [1.03-2.02]). : The prevalence of HDM sensitization remained stable over 9 years, with an increase in dog sensitization among adolescents. Factors associated sensitization differed between age groups and years. Understanding these trends and related factors in the general population can inform healthcare providers in developing new strategies to reduce allergic sensitization and diseases.

Association between sex work occupational stigma and inconsistent condom use: findings from a community-based cohort of women sex workers in Vancouver, Canada (2014–2022)

BackgroundWomen sex workers face substantial health inequities due to structural barriers including criminalisation and stigma. Stigma has been associated with HIV-related inequities among marginalised populations, however, we know less about...

An Advanced Neonatal Resuscitation Educational Program in a Surgical Neonatal Intensive Care Unit: Development, Implementation and Audit from 2014 to 2023.

The design, implementation and audit of a multidisciplinary advanced neonatal resuscitation education initiative for "in unit" events in a quaternary NICU over a 9-year period, divided into 3-year epochs of "pre", "implementation" and "maintenance" is described. A didactic and simulation quality improvement initiative focused on teaching and reinforcing specific algorithms endorsed by the American Heart Association (AHA) to target resuscitation needs of older neonates including surgical and cardiac conditions. Qualitative and quantitative data pre and post implementation was audited. Post education implementation, team members performed quicker hemodynamic assessments and applied CPR and/or bolus epinephrine correctly in higher proportions during acute events. During supraventricular tachycardia, vagal maneuver use and medication administration time improved. Advanced neonatal resuscitation education and reinforcement targeted for event etiology, allow for AHA algorithms to be successfully taught and performed within a quaternary NICU with improvement in hemodynamic assessments and AHA algorithm implementation.

First Report on Macrofungi in the Greenhouses of the Donetsk Botanical Garden (Russia)

Totally, 26 species of macrofungi of two phyla, Basidiomycota (23 species, 88%) and Ascomycota (three species, 12%) – were recorded in the greenhouses of the Donetsk Botanical Garden over a 12-year period (2007–2008 and 2015–2024). Seven species – Cyathus striatus, Gymnopilus liquiritiae, Mycena epipterygia, M. leptocephala, Panaeolus fimicola, Peziza varia, and P. vesiculosa – were reported for the first time for the territory of the Donetsk Botanical Garden. The species diversity of macrofungi in greenhouses is relatively low – 10–18% of the species recorded in the anthropogenically transformed regional ecosystems of Donbass. Multiregional cosmopolitans (20 species, 77%) and saprotrophs (17 species, 65%) dominated among fungal species by species composition and trophic spectrum respectively. Two peaks of fruiting body formation were observed: the winter peak – in January and February, and the autumn peak – in October. Macrofungi communities of greenhouses are composed mostly of accidentally introduced species. The incoming of fungi into the greenhouses occurred with organic substrates of local and foreign origin. This may facilitate the introduction and subsequent naturalization of alien fungi in the regional phytocoenoses.

Sarcoidosis in north African people: about 35 cases.

Sarcoidosis is a systemic disease of unknown cause characterized by the formation of non-caseating granulomatous inflammation in various organs, mainly lungs and intrathoracic lymph nodes. Its clinical and paraclinical presentation can vary from mild to life-threatening. Our objective is to study the clinical, paraclinical and evolution profile of mediastino-pulmonary sarcoidosis. This is a retrospective, descriptive and analytic study conducted over a 20-year period (January 2002 to December 2022). It compiled records of patients who were followed up for confirmed mediastino-pulmonary sarcoidosis. The study included 35 patients with a mean age of 56.69 ± 14.42 . There was a clear predominance of female patients, with a male-to-female sex ratio of 0.346. The most common functional respiratory signs were dyspnea (82.9%) and dry cough (80%). Extra-respiratory symptoms were noted in 45.7% of cases, with the most common being polyarthralgia (28.6%), xerophthalmia (20%) and xerostomia (14.3%). The most common parenchymal lesions were micronodules (71.4%), nodules (51.4%), and peribronchovascular thickening (40%). The The right upper lobe (77.1%) and middle lobe (74.3%) were the most affected lobes. Hilar adenopathy (71.4%), paratracheal adenopathy (60%), and the aorto-pulmonary window (54.3%) were the most frequent lymph node involvements. Respiratory function tests revealed a restrictive ventilatory defect in 32% of cases and an obstructive ventilatory defect in 13%.Oral corticosteroids were initially administered in 60% of cases. Chronic respiratory failure was observed in 20% of cases. Factors significantly associated with an unfavorable outcome included hemoptysis (p=0.008), the need for corticosteroid treatment (p=0.009), Acute respiratory failure (p=0.05), and echographic dilation of the right cavities (p=0.002). The clinical phenotype of sarcoidosis can be extremely diverse.Thoracic computed tomography plays an important role in the diagnosis and monitoring of the disease. The evolution of sarcoidosis is variable and depends on the occurrence of complications.

The Implementation of Integrated Youth Services in Canada: Planning and Costing of a Pan-Canadian Model: La mise en œuvre des services intégrés pour les jeunes au Canada : planification et établissement des coûts d'un modèle pancanadien.

The implementation of Integrated Youth Services (IYS) can help ensure that youth are adequately supported. The objective of this analysis was to provide a model for the planning and costing of IYS throughout Canada over a 15-year period. To estimate resource allocation for IYS, we determined the number of hubs and hub staffing requirements by service level and jurisdiction, backbone support and infrastructure requirements by jurisdiction. A needs-based analytic framework for planning was employed to estimate the number of hubs required. The optimal mix of hub staffing requirements was determined based on prior literature. The costs of running each hub were estimated using publicly available data and internal documents from existing IYS agencies. Finally, the cost of setting up IYS hubs, IYS virtual care and respective backbone support throughout Canada was estimated and projected over 15 years and the cost-savings of IYS were calculated. At maturity, it was estimated that 399 hubs-188 small, 43 medium, 168 large-across Canada would be required to address youth mental health and substance use needs. The cost of implementing IYS initiatives across Canada would vary between $4,349,126 (for less populous jurisdictions) and $248,950,524 (for more populous jurisdictions), for a total annual cost of $676,633,388 (excluding costs of infrastructure). It was estimated that the implementation of IYS hubs would lead to cost-savings of $2.1 billion annually and have the potential to be cost-effective. The implementation of IYS hubs can provide good value for money, in the form of high client satisfaction, earlier supports with improved youth outcomes and decreased health care costs. Future work should address gaps in data availability on mental health and substance use-related needs of youth with neurodevelopmental disorders, youth experiencing homelessness, youth in congregate living and foster care, and Indigenous youth.

Clinical Outcomes of Liver Abscesses in Adults: A 10-Year Experience at a Tertiary Care Center in Northern India.

Purpose Hepatic abscesses remain a significant clinical challenge due to high morbidity and mortality. This research aims to examine the etiological spectrum, management approaches, clinical features, and results in hepatic abscesses in a tertiary care facility in northern India, emphasizing the distinctions among pyogenic liver abscesses (PLAs) and amoebic liver abscesses (ALAs). Methods This retrospective study was done at GSVM Medical College, Kanpur, analyzing 725 patients with hepatic abscesses over a 10-year period. Patients were included based on confirmed diagnoses of ALAs or PLAs through clinical, serological, and microbiological evidence. Data on demographics, clinical presentation, imaging findings, laboratory results, and management approaches were extracted from hospital records.IBMSPSSStatistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States)was employed for statistical analysis, and continuous variables were displayed accordingly as means or medians and categorical variables as frequencies. Subgroup analyses were conducted based on abscess characteristics, including size, location, and etiology. Results Of the 725 patients analyzed, the mean age was 42.7 ± 15.8 years, with men comprising 85.93% of the cohort. ALAs accounted for 82.3% of cases, while PLAs comprised 12%. PLA cases frequently involved Gram-negative pathogens, such as Escherichia coli and Klebsiella pneumoniae, with 64% of PLA patients exhibiting positive pus or blood cultures. Common presenting symptoms included abdominal pain (87%) and fever (84.5%). Significant comorbidities included alcoholism (43.6%) and diabetes mellitus (34.2%). Right lobe involvement was predominant (75.9%), and multiple abscesses were noted in 47.5% of patients. Complications included pleural effusion (53.9%), abscess rupture (16.3%), and systemic inflammatory response syndrome (25.7%). Management strategies comprised antibiotics, percutaneous catheter drainage (74.8%), and needle aspiration (43.4%), with conservative treatment being effective in smaller abscesses. Mortality rates were low, at 1.6% for ALAs and 1.5% for PLAs. Hospital stays were shorter for PLA cases (median: five days) compared to ALAs (median: 7.3 days). Conclusion This study underscores the predominance of ALAs in endemic regions like India and highlights the significant role of Gram-negative bacteria in PLAs. Tailored management strategies, including percutaneous interventions and early antibiotic therapy, were associated with favorable outcomes and low mortality. However, the emergence of antimicrobial resistance in PLAs warrants robust antimicrobial stewardship. Public health measures focused on sanitation and clean water are critical to reducing the prevalence of ALAs.

Visual and anatomical failure of anti-VEGF therapy for retinal vascular diseases: a survival analysis of real-world data.

Predicting undesirable outcomes following anti-VEGF initiation in macular oedema is critical for effective clinical decision-making and optimised care. To estimate the time to undesirable events in diabetic macular oedema (DMO), central and branch vein occlusions (CRVO and BRVO) after appropriate loading doses with either ranibizumab or aflibercept and identified baseline predictors of negative outcome. A retrospective cohort study of 3277 patients (N = 2107 in DMO, N = 413 in CRVO and N = 757 in BRVO) collected over a 10-year period, in a large UK tertiary centre. Only one eye was included per patient. Inclusion criteria pre-specified a minimum of two clinic visits with one being at least 6 months post treatment. The main outcome measure was absence of visual acuity (VA) improvement due to macular oedema failure of anti-VEGF therapy (defined as VA gain <5 ETDRS letters and CST increase of 50 µm or CST > 325 µm) modelled using time-event analyzes of appropriately loaded patients. Secondary outcomes included survival curves by individual condition (DMO, CRVO, BRVO) and factors associated with negative outcomes. After starting anti-VEGF, there was a 50% chance of undesirable outcomes at 2.3, 5.24 and 6.16 years for DMO, CRVO and BRVO, respectively. Cox proportional hazards modelling identified presenting age, intraretinal (IRF) volume, presence of DMO and VA as predictors of negative outcomes, whilst South East Asian ethnicity conferred an independent protective effect. Real-world data suggest that undesirable events following anti-VEGF injections is likely to in 50% of patients by the third year of treatment in spite of appropriate loading. The definition of undesirable treatment events captured nearly all patients who were escalated to another therapy, but this proportion represented a small percentage of our definition of failed response.

Managing Lead Fractures in Deep Brain Stimulation for Movement Disorders: A Decade-Long Case Series from a National Neurosurgical Centre.

Background: Deep brain stimulation (DBS) is an effective treatment for movement disorders, but its long-term efficacy may be undermined by hardware complications such as lead fractures. These complications increase healthcare costs and necessitate surgical revisions. The frequency, timing, and clinical factors associated with lead fractures remain poorly understood. Objective: This study aimed to determine the incidence, timing, and clinical factors associated with lead fractures in a large cohort of DBS patients over a 10-year period. Methods: This retrospective study analyzed data from 325 patients who underwent bilateral DBS implantation at the National Centre for Neurosurgery from 2013 to 2023. The analysis specifically focused on 17 patients who experienced lead fractures during the long-term follow-up period. Results: Among the 325 patients, lead fractures were identified in 17 patients (5.23%), affecting 18 electrodes. The majority of cases involved patients with Parkinson's disease (76.5%) or dystonia (23.5%), with an average age of 59.17 ± 8.77 years. Nearly all patients with lead fractures had a history of trauma. Additionally, two cases were associated with active engagement in sports, particularly activities involving movements like pulling up on a horizontal bar, while Twiddler's Syndrome was identified in two other cases. All electrode fractures required surgical revision. Conclusions: Lead fractures, while rare, remain a significant complication in DBS systems. Precise surgical techniques, early detection, and advancements in DBS hardware design may help to mitigate this risk. Future innovations, such as durable leads or wireless systems, may improve long-term outcomes in DBS therapy for movement disorders.

Cancer Risk in Thyroid Nodules: An Analysis of Over 1000 Consecutive FNA Biopsies Performed in a Single Canadian Institution

Objective: To determine the cancer risk in thyroid nodules using ACR TI-RADS. Methods: A retrospective analysis of all thyroid biopsies was performed over a 3-year period (2021 to 2023). Variables including gender, age, history of thyroid cancer or neck irradiation, nodule size and location, TR level, and sonographic features such as punctate echogenic foci (PEF), a very hypoechoic appearance, taller-than-wide shape, and suspected extrathyroidal extension were analyzed. Results: A total of 1140 nodules were assessed in 993 patients, including 740 females (74.5%) and 253 males (25.5%). The mean patient age was 57.1 ± 15.4 years. Variables significantly associated with nodule malignancy included (1) younger age, (2) a prior history of thyroid cancer or neck irradiation, (3) a higher TR level, (4) a taller-than-wide shape in nodules &lt;1 cm, (5) PEF, (6) a very hypoechoic appearance, and (5) suspected extrathyroidal extension (p &lt; 0.05). Gender, nodule location and size were not associated with a higher cancer risk (p &gt; 0.05). Malignancy was found in 40.7% of TR5, 4.8% of TR4, 0.3% of TR3, and 0% of TR1 and 2 nodules. The odds ratios (ORs) for cancer were as follows: TR4 or 5, OR = 19; PEF, OR = 11; a very hypoechoic appearance, OR = 13.3; and suspected extrathyroidal extension, OR = 27.2 (p &lt; 0.01). Conclusions: Higher TR levels, PEF, a very hypoechoic appearance, and suspected extrathyroidal extension are important features for predicting cancer risk. These findings affirm the effectiveness of ACR TI-RADS in nodule risk stratification.

Gravity-Driven Membrane Filtration with Passive Hydraulic Fouling Control for Drinking Water Treatment: Demonstration of Long-Term Performance at Full Scale.

The present study evaluated the performance of a full-scale gravity-driven membrane filtration system with passive hydraulic fouling control (PGDMF) for drinking water treatment in a small community over a 3-year period. The PGDMF system consistently met the design flow and regulated water quality/performance parameters (i.e., total coliform, Escherichia coli, turbidity, and membrane integrity). The instantaneous temperature-corrected permeability (TCP) varied seasonally, being greater during the winter months. The overall TCP decreased slowly to ∼60% of the initial value by the end of 3 years, a TCP that is much greater than would have been expected without passive hydraulic fouling control. Although it was not possible to directly link the observed seasonal changes in TCP to potential seasonal changes in the biofilm microbiome, the analysis did suggest that the lower TCP during summer months was due to a greater microorganism richness in the feed and presence of filamentous, stalked, and biofilm-forming bacteria in the biofilm. Operation with higher trans-membrane pressure (i.e., ∼30 vs ∼20 mbar) and more frequent passive hydraulic fouling control (i.e., every 12 vs 24 h) enabled a greater flow to be sustained. The study demonstrated the long-term robustness and performance of GDMF with passive hydraulic fouling control for drinking water treatment.

Development of individualized risk assessment models for predicting post-traumatic epilepsy 1 and 2 years after moderate-to-severe traumatic brain injury: A traumatic brain injury model system study.

Although traumatic brain injury (TBI) and posttraumatic epilepsy (PTE) are common, there are no prospective models quantifying individual epilepsy risk after moderate-to-severe TBI (msTBI). We generated parsimonious prediction models to quantify individual epilepsy risk between acute inpatient rehabilitation for individuals 2 years after msTBI. We used data from 6089 prospectively enrolled participants (≥16 years) in the TBI Model Systems National Database. Of these, 4126 individuals had complete seizure data collected over a 2-year period post-injury. We performed a case-complete analysis to generate multiple prediction models using least absolute shrinkage and selection operator logistic regression. Baseline predictors were used to assess 2-year seizure risk (Model 1). Then a 2-year seizure risk was assessed excluding the acute care variables (Model 2). In addition, we generated prognostic models predicting new/recurrent seizures during Year 2 post-msTBI (Model 3) and predicting new seizures only during Year 2 (Model 4). We assessed model sensitivity when keeping specificity ≥.60, area under the receiver-operating characteristic curve (AUROC), and AUROC model performance through 5-fold cross-validation (CV). Model 1 (73.8% men, 44.1 ± 19.7 years, 76.1% moderate TBI) had a model sensitivity = 76.00% and average AUROC = .73 ± .02 in 5-fold CV. Model 2 had a model sensitivity = 72.16% and average AUROC = .70 ± .02 in 5-fold CV. Model 3 had a sensitivity = 86.63% and average AUROC = .84 ± .03 in 5-fold CV. Model 4 had a sensitivity = 73.68% and average AUROC = .67 ± .03 in 5-fold CV. Cranial surgeries, acute care seizures, intracranial fragments, and traumatic hemorrhages were consistent predictors across all models. Demographic and mental health variables contributed to some models. Simulated, clinical examples model individual PTE predictions. Using information available, acute-care, and year-1 post-injury data, parsimonious quantitative epilepsy prediction models following msTBI may facilitate timely evidence-based PTE prognostication within a 2-year period. We developed interactive web-based tools for testing prediction model external validity among independent cohorts. Individualized PTE risk may inform clinical trial development/design and clinical decision support tools for this population.

Sex-based differences in risk of revision for infection after hip, knee, shoulder, and ankle arthroplasty in osteoarthritis patients: a multinational registry study of 4,800,000 implants.

We aimed to determine sex differences for periprosthetic joint infections after primary arthroplasty of the hip, knee, ankle, and shoulder in osteoarthritis patients in an international perspective. This is a multinational combined arthroplasty registry study. Each arthroplasty registry performed Cox-regression analysis of their data and reported the crude and adjusted hazard ratios (HR) with an a priori designed data form. A random-effects model was used to pool these HRs to estimate an overall HR with 95% confidence interval (CI). Adjustment was undertaken for patient age, BMI, ASA grade, type of fixation, and type of implant. 9 arthroplasty registries participated. Patients who received primary total joint arthroplasty for primary osteoarthritis were considered: 2,134,313 hip arthroplasties, 2,658,237 knee arthroplasties, 57,889 shoulder arthroplasties, and 8,445 ankle arthroplasties. We calculated hazard ratios (HR) for the overall risk of complete revision due to infection for each implant type and follow-up. The pooled HR for revision due to infection for men compared with women at 1-year follow-up was 1.60 (95% confidence interval [CI] 1.42-1.80) for hip arthroplasties; 2.06 (CI 1.90-2.46) for knee arthroplasties; 4.51 (CI 2.99-6.80) for shoulder arthroplasties; and 0.87 (CI 0.46-1.62) for ankle arthroplasties. These results remained consistent over time and were identified in both unadjusted and adjusted models. Men have a higher risk of revision due to infection than women after primary hip, knee, and shoulder arthroplasty. No evidence of difference was found for ankle arthroplasty. These elevated relative risks persist in the fully adjusted investigations and over the 10-year postoperative period studied.

Gender equity in authorship of emergency medicine publications in Australasia.

To evaluate gender authorship trends in the official journal of the Australasian College for Emergency Medicine (ACEM), Emergency Medicine Australasia (EMA). A bibliometric review of author gender in EMA during the 10-year period 2013-2022. The gender of first/last authors were determined by www.genderize.io, or a manual internet search where gender was not determined with at least 90% certainty. Descriptive statistics were used with percentages of women as first and last author compared to current percentages of ACEM Fellows (FACEMs) who identify as women. The final analysis included 1703 articles. Women accounted for 27.4% fewer authors than men (36.3% vs 63.7%). Women were outnumbered by men by 20.0% among first authors (40% vs 60%), and 36.2% (31.9% vs 68.1%) for last authors. When the last author was a woman, there was a similar rate of women (49.2%) and men (50.8%) as first authors. However, when the last author was a man, first authors were 37.1% women versus 62.9% men. If the last author was a woman, there was a 60% greater probability that the first author was also a woman (odds ratio 1.6, 95% CI 1.3-2.1). First authorship rate by women was equal to or exceeds the proportion of women FACEMs, however, last authorship by women still lags behind. The emergency medicine community in Australasia must continue to tackle existing gender disparities which exist in our specialty. A creative and active strategy on the part of publishers, editors, academics and authors is needed to redress this balance.

Patch Testing in Solid Organ Transplant Recipients: Experience From a Tertiary Medical Center Over 13 Years (2010-2022).

Background: It is generally recommended that patients not be on immunosuppressive medications for patch testing, as these medications may suppress delayed-type hypersensitivity and lead to false negative results. There is a paucity of literature describing organ transplant recipients who underwent patch testing. Objective: The aim of this study is to examine patch testing results in solid organ transplant recipients over a 13-year period at our institution. Methods: We performed a retrospective analysis of patch test data from adult transplant recipients at our institution. Transplant patients who underwent patch testing were identified from a clinical patch test database, and a chart review was conducted. Results: Eighteen patients were included in the study. Patients had received kidney, liver, or heart transplants. Seven patients (38.9%) had at least one positive reaction. The highest reaction rates were seen with methylisothiazolinone (12.5%), methyldibromo glutaronitrile (12.5%), and benzalkonium chloride (10.0%). Limitations included small sample size, data from a tertiary referral center, and retrospective analysis. Conclusions: Liver and kidney transplant recipients displayed allergic reactions during patch testing. Patients may benefit from patch testing even if receiving immunosuppressive therapy, but some reactions may be falsely negative because of immunosuppression.

Recent data on the biology and population dynamics of Oulema hoffmannseggii (Coleoptera: Chrysomelidae) and its associated parasitoids

Oulema melanopus and Oulema hoffmannseggii have been mistaken for a single species. However, their differentiation has been definitively established through the examination of male genitalia. The analysis revealed that the aedeagus size of O. hoffmannseggii was smaller (1.125 ± 0.007 mm) than to O. melanopus (1.375 ± 0.008 mm). Over a 4-year period, the study of species abundance highlights a significant prevalence of O. hoffmannseggii (77%). Both species were observed to have one generation per year, with the highest emergence of new adults occurring in May; however, no egg-laying was observed until adults declined in June. Notably, the peak number of O. hoffmannseggii pupae was recorded at the end of April. Subsequently, from 86% of collected pupae parasitoids successfully emerged within an average of 10.8 ± 0.8 days, with 93% originating from pupae collected on spikes and 79% from those collected on leaves. Molecular analysis of these parasitoids identified them as belonging to the Ichneumonidae family. Among them, six specimens were classified under the Pimplinae subfamily, closely related to Itoplectis maculator, while five specimens grouped within Cryptininae subfamily, and two specimens were linked to representatives of the Pteromalidae family.

Suicidality and use of psychotropic medications in patients with schizophrenia: a prospective cohort study.

The lifetime prevalence of suicide is around 5% in patients with schizophrenia. Non-adherence to antipsychotic medication is an important risk factor, but prospective studies investigating joint effects of antipsychotic drugs, antidepressants, and benzodiazepines on suicidality are scarce. We aimed to investigate how use and non-use of psychotropic medications are associated with suicidality in schizophrenia. An open cohort study followed all patients consecutively admitted to a psychiatric acute unit during a 10-year period with a diagnosis of schizophrenia (n = 696). Cox multiple regression analyses were conducted with use of antipsychotics, antidepressants, and benzodiazepines as time-dependent variables. Adjustments were made for age, gender, depressive mood, agitated behavior, and use of alcohol and illicit substances. A total of 32 (4.6%) suicide events were registered during follow-up. Of these, 9 (28%) were completed suicides and 23 (72%) were attempted suicides. A total of 59 (8.5%) patients were readmitted with suicidal plans during the follow-up. Compared to non-use, use of antipsychotics was associated with 70% lower risk of attempted or completed suicide (adjusted hazard ratio [AHR] = 0.30, p < 0.01, CI 0.14-0.65) and 69% reduced risk of readmission with suicidal plans (AHR = 0.31, p < 0.01, CI 0.18-0.55). Use of prescribed benzodiazepines was associated with 126% increased risk of readmission with suicidal plans (AHR = 2.26, p = 0.01, CI 1.24-4.13). Adherence to antipsychotic medication is strongly associated with reduced suicidal risk in schizophrenia. The use of prescribed benzodiazepines was identified as a significant risk factor for being readmitted with suicidal plans.

Labral size measured on preoperative magnetic resonance imaging not predictive of the need for labral reconstruction in patients undergoing primary hip arthroscopy

Abstract Preoperative radiographic measurements may help predict which patients with hip labral tears ultimately undergo repair versus primary reconstruction. This study investigated if radiographic parameters: (i) preoperatively predict labral repair versus reconstruction and (ii) correlate with T2 magnetic resonance imaging (MRI) mapping values of the labrum. This retrospective comparative study included patients aged 14–50 years who underwent labral repair or reconstruction at a single institution over a 2-year period. Patients with prior open or arthroscopic hip surgery or who had inadequate preoperative computed tomography (CT) and MRI imaging were excluded. Labral size was measured at multiple positions on preoperative MRI images. A blinded reviewer used three-dimensional CT analysis to record lateral center edge angle (LCEA), acetabular version, Tonnis angle, acetabular coverage, alpha angle, femoral torsion, and neck-shaft angle (FNSA). T2 MRI mapping values of the labrum were obtained via sequencing analyses on each patient’s optimal sagittal cut. Univariate mixed linear models were used to identify associations between each radiographic measurement and decision to repair or reconstruct the labrum. Fifty-two operations were included. Labral size had no predictive effect on undergoing labral reconstruction versus repair. Likelihood for undergoing labral reconstruction was associated with LCEA (P = .003) and Tonnis angle (P = .034). There was an association (P &amp;lt; .05) between labral T2 mapping values and all radiographic parameters except for FNSA and combined version. Labral size was not associated with whether patients underwent labral reconstruction or repair. The data showed an association between labrum T2 mapping values and nearly all radiographic parameters.

Risk factors for complications following titanium mesh cranioplasty.

Studies on complications following titanium mesh cranioplasty have predominantly focused on patients with cranial defects after decompressive craniectomy. This study investigates possible risk factors for complications using titanium mesh for smaller cranial defects. All patients treated with titanium mesh cranioplasty over a 5-year period at Copenhagen University Hospital were identified. Demographics, comorbidities, and active smoking and drinking status were recorded in addition to indication for cranioplasty and operative findings. Severe complications recorded included superficial and deep infection, delayed wound defects, postoperative hematomas, and death within 30 days postoperatively. Minor complications recorded included skin atrophy, cosmetic complaints, pain, and loosening of the mesh. The management of complications was also documented. A total of 247 patients with primary titanium mesh cranioplasty were included in the study. The overall complication rate was 17.4%. 15.0% suffered from severe complications and 2.4% developed minor complications. Elderly smokers, patients previously treated with radiation, and patients operated via a posterolateral approach to the skull base had the strongest association with complications. The complication rate was not higher in patients with cranioplasty after postoperative infections or in those with a frontobasal approach to the skull base compared with patient operated on for smaller cranial tumors. The risk of complications following titanium mesh for smaller cranial defects is higher in elderly smokers, patients with a history of radiation, and those undergoing a posterolateral approach to the skull base.

Cost-effectiveness of remote sensing technology for spruce budworm monitoring in Maine, USA

Forest pests are a major disturbance factor in forest ecosystems, which can result in tree mortality and loss of ecosystem services, leading to further negative impacts on the forest economy. Spruce budworm (Choristoneura fumiferana (Clem.); SBW) is a native forest pest in the northeastern USA and Canada, including the state of Maine, which defoliates balsam fir (Abies balsamea (L.) Mill.) and spruce (Picea spp.) trees with cyclical outbreaks every 30-60 years. SBW is typically monitored via ground sampling techniques such as pheromone traps and overwintering second instar larvae (L2) branch sampling. Remote sensing data can also provide information about defoliation patterns across the landscape and forest susceptibility to outbreaks. This study presents a cost-effectiveness analysis comparing remote sensing data, ground sampling techniques, and an integrated monitoring approach, combining remote sensing change detection with field sampling. Over a 10-year project period, Sentinel-2 imagery emerged as the most cost-effective option, ranging from US$33 to US$63/square kilometer (sq km), offering wide spatial coverage and moderate resolution suitable for the identification of defoliation patterns. PlanetScope imagery ranged from US$77 to US$241/sq km, and unmanned aerial vehicle (UAV) imagery had the greatest variation, from US$9,220 to US$58,481/sq km. Labor costs are the most influential in our study, ranging from 30% of total costs for remote sensing approaches to 80% for field sampling. The integrated monitoring approach proposed in this study presents a synergistic strategy for effective and timely SBW monitoring, ranging from US$144 to US$213/sq km. Utilizing this integrated approach leverages both remote sensing and L2 branch surveys to enhance the accuracy and timeliness of monitoring efforts, leading to more effective management strategies for mitigating pest outbreaks for landowners. Our research highlights the importance of adaptive monitoring strategies and integrating remote sensing for forest pest detection.