Average Number Of Weeks Research Articles

Reported Variability in General Surgery Training Across Integrated Plastic Surgery Residency Programs.

Since their development, integrated plastic and reconstructive surgery (PRS) residency training programs have established diverse methods of incorporating general surgery training into graduate medical education. Programs have questioned the necessary duration and timing of such training. The aim of this study is to assess the landscape of general surgery exposure in integrated PRS residency programs. Thirty-six integrated PRS residency programs were included based on the availability of postgraduate year (PGY)-level rotation data. Rotations were measured in units of weeks with descriptive titles maintained as advertised by the program. Individual general surgery rotations were also categorized as being either PRS-aligned, American Board of Plastic Surgery (ABPS) Required Clinical (RC) or ABPS Strongly Suggested (SS). Statistical analyses were carried out on the relative proportions of each subcategory in the 2 parent groups. All 36 programs evaluated required general surgery rotations in years PGY- 1 to -2. By PGY-3, 69% of programs required general surgery, and by PGY-6, 25%, and these were limited to 4- to 6-week rotations in burn, breast, or trauma. Looking across all 6 years, with 312 weeks of training total, the minimum number of weeks spent in general surgery rotations was 32, and the maximum number was 119, with an average of 61 weeks (±21).Programs were subcategorized into 2 groups based on whether they spent more (n = 16) or less (n = 20) than the net average number of weeks in ABPS RC + SS rotations. No significant difference was found in the relative proportion of PRS-aligned general surgery across groups. Programs with <60 weeks of general surgery had a relatively greater proportion of ABPS RC and SS rotations. These data demonstrate that there exists significant variability in overall duration of general surgery training across integrated PRS training programs. When controlling overall general surgery exposure for variables of interest like PRS-aligned exposure or compatibility with ABPS requirements, we found no discernable educational model or patterns to explain the observed range in exposure. These results warrant reexamination of an ideal general surgery track within the integrated plastic surgery training model that optimizes training for the PRS resident.

Delivering the National Diabetes Prevention Program: Assessment of Outcomes in In-Person and Virtual Organizations.

The Centers for Disease Control and Prevention's Diabetes Prevention Recognition Program (DPRP) has helped organizations deliver the National Diabetes Prevention Program (National DPP) lifestyle change program for over 10 years. Four delivery modes are now approved: in person, online (self-paced, asynchronous delivery), distance learning (remote, synchronous delivery), and combination (hybrid delivery using more than one delivery mode). We assessed outcomes using data from 333,715 participants who started the 12-month program between January 1, 2012, and December 31, 2018. The average number of sessions attended was highest for in-person participants (15.0), followed by online (12.9), distance learning (12.2), and combination (10.7). The average number of weeks in the program was highest for in-person participants (28.1), followed by distance learning (20.1), online (18.7), and combination (18.6). The average difference between the first and last reported weekly physical activity minutes reflected an increase for in person (42.0), distance learning (27.1), and combination (15.0), but a decrease for online (-19.8). Among participants retained through session 6 or longer, average weekly physical activity minutes exceeded the program goal of 150 for all delivery modes. Average weight loss (percent of body weight) was greater for in person (4.4%) and distance learning (4.7%) than for online (2.6%) or combination (2.9%). Average participant weight loss increased gradually by session for all delivery modes; among participants who remained in the program for 22 sessions, average weight loss exceeded the program goal of 5% for all delivery modes. In summary, if participants stay in the program, most have positive program outcomes regardless of delivery mode; they have some outcome improvement even if they leave early; and their outcomes improve more the longer they stay. This highlights the benefits of better retention and increased enrollment in the National DPP lifestyle change programs, as well as enhancements to online delivery.

37. How Integrated are Plastic Surgery Residency Programs? Analyzing Discrepancy and Heterogeneity among Curriculums

Background: There are 84 integrated plastic surgery residency programs in the United States. Residents undergo six or seven years of training, with varying exposure to general surgery and other surgical subspecialties. This study evaluates the heterogeneity among integrated plastic surgery residencies to non-plastic surgery rotations. Methods: Curriculum as well as program integration data were obtained from individual programs’ websites, the Accreditation Council for Graduate Medical Education (ACGME), Doctority.co and Doximity websites. Data included number of weeks spent on general surgery and various general surgical subspecialties. Differences in average weeks spent on different services were compared via t tests. Results: Curriculum data from 76 integrated plastic surgery programs (86% of all programs) was analyzed. The average number of weeks spent in general surgery in total during the first three years of residency was 48.7 weeks across all programs. Residents in programs that were integrated for less than 10 years (n=33) spent 55.5 weeks in general surgery compared to 45.5 weeks for programs that have been integrated for 10+ years (n=43) (p=0.05). Residents in programs that were integrated for less than 10 years and longer than 10 years spent 1.8 and 0.39 weeks respectively (p=0.003) on colorectal surgery rotation with a similar trend for emergency general surgery (4.7 vs 1.8, p=0.004). Other rotations did not achieve statistical significance. Conclusion: No formal studies have been conducted to objectively and systematically demonstrate differences in curriculum breakdown for integrated plastic surgery programs. Understanding the heterogeneity in resident exposure to non-plastic surgery rotations can assist in improving current curricula and can assist new integrated plastic surgery residencies to achieve a balance in their curriculum.

Increased duration of pollen and mold exposure are linked to climate change

Pollen and molds are environmental allergens that are affected by climate change. As pollen and molds exhibit geographical variations, we sought to understand the impact of climate change (temperature, carbon dioxide (CO2), precipitation, smoke exposure) on common pollen and molds in the San Francisco Bay Area, one of the largest urban areas in the United States. When using time-series regression models between 2002 and 2019, the annual average number of weeks with pollen concentrations higher than zero increased over time. For tree pollens, the average increase in this duration was 0.47 weeks and 0.51 weeks for mold spores. Associations between mold, pollen and meteorological data (e.g., precipitation, temperature, atmospheric CO2, and area covered by wildfire smoke) were analyzed using the autoregressive integrated moving average model. We found that peak concentrations of weed and tree pollens were positively associated with temperature (p < 0.05 at lag 0–1, 0–4, and 0–12 weeks) and precipitation (p < 0.05 at lag 0–4, 0–12, and 0–24 weeks) changes, respectively. We did not find clear associations between pollen concentrations and CO2 levels or wildfire smoke exposure. This study’s findings suggest that spore and pollen activities are related to changes in observed climate change variables.

Cessation of Deliberate Self-Harm Behavior in Patients With Borderline Personality Traits Treated With Outpatient Dialectical Behavior Therapy.

The first aim of the study was to identify when deliberate self-harm (DSH) behavior ceased in patients with borderline symptoms undergoing dialectical behavioral treatment (DBT). The second aim was to compare patients who ceased their self-harm behavior early or late in the course of treatment, with regard to demographics, comorbidity, and symptom severity. The study used a naturalistic design and included 75 treatment completers at an outpatient DBT clinic. Of these 75 patients, 46 presented with self-harming behavior at pre-treatment. These 46 participants where split into two groups, based on median amount of time before ceasing self-harm behavior, termed early (up to 8 weeks) and late (8+ weeks) responders. Treatment duration varied from 16 to 160 weeks. Patients were assessed pre- and post-treatment using measures of depression, hopelessness, personality traits, quality of life, and global assessment of symptoms and functioning. The majority (93.5%) ceased their self-harming within the first year, and the average number of weeks was 15.5 (SD = 17.8). Twenty-five percent of patients ceased their DSH behavior during the first week of treatment. For the remaining patients, the cessation of DSH continued gradually across a 1 year period. We found no differences between early and late responders with respect to demographics, comorbidity, symptom severity, or treatment outcome. None of the patients committed suicide. The findings indicate that self-harming behavior decreases gradually across the first year after starting DBT.

Degree of employment, sick leave, and costs following notification of occupational contact dermatitis-A register-based study.

Occupational contact dermatitis (OCD) is the most commonly recognized occupational disease in Denmark. To examine the impact of recognized OCD on degree of employment, sick leave, unemployment, and job change. Data on all recognized individuals with OCD notified in Denmark between 2010 and 2015 (n = 8940) were linked to information on social transfer payments in the years before and after notification. The number of weeks on unemployment benefits or sick leave and the degree of employment during the 2 years prior to notification was compared with the 2 years following notification. The degree of employment decreased on average 8.9 work-hours/month, corresponding to an average annual loss of income per worker of approximately €1570. The average number of weeks that workers were receiving unemployment benefits and paid long-term sick leave rose by 2.5 and 3.4 weeks, respectively, corresponding to an average additional annual cost per worker of approximately €420 and €770, respectively. Longer case-processing time was significantly associated with lower degree of employment and higher levels of unemployment and sick leave. OCD has a significant negative impact on employment and economics, thus highlighting the need for a national, strategic action plan for effective prevention of OCD.

Measuring the Total Cost of Ankle Fractures: A Prospective Analysis

Category:Trauma; AnkleIntroduction/Purpose:Ankle fractures (AFx) are the most common foot and ankle fracture seen at hospitals in the United States, and are undoubtedly costly to patients. Quantification of the costs of fractures and their associated treatments has garnered increased attention in orthopedics in recent years through cost-effectiveness analysis. However, literature pertaining to AFx’s almost never reports on the indirect costs of AFx’s, and thus fails to accurately assess the true value of treatments. The purpose of this study was to prospectively assess the direct and indirect costs of AFx’s in operatively and nonoperatively treated patients. Secondary analysis included evaluation of the composition of indirect cost, the duration these costs are endured, and the factors that influence their magnitude.Methods:A prospective observational single-center study was performed. Adult patients presenting for initial consult for an AFx that could speak English or Spanish were enrolled. Polytrauma patients and those unable to provide complete indirect cost data were excluded. Patients completed a cost form that asked the money they had spent in the last week on transportation, household chores, and self-care due to their AFx. Patients were considered to have complete indirect cost data if they returned for follow-up visits until they reported no recurring indirect costs and had returned to work. Direct cost data was obtained directly from the hospital billing department. Amount collected was utilized. Direct costs included any costs incurred from staff treating the patient, supplies required for treatment, and the use of healthcare facilities. A descriptive analysis of the entire cohort and stratification by operative status was performed for the primary comparative analysis.Results:60 patients were ultimately analyzed. Average age was 46.5 years. 55% were female. 10% of patients were diabetic. 17% smoked cigarettes actively. Weber A, B, and C fractures composed 12%, 72%, and 18% of fractures, respectively. Operatively treated patients (n=37) had a significantly higher total and direct cost than non-operative patients (P<0.01). Average salary of the 39 employed patients was $61,416 and return to work period was 11.2 weeks. In all patients, lost income accounted for the largest portion of total and indirect cost, averaging 38% of total cost. Longer periods of return to work were significantly associated with undergoing surgery and having less than a college-level education (P<0.05). Average number of weeks for indirect costs to amount to zero was 19.1.Conclusion:In patients treated operatively and nonoperatively, the largest cost component was an indirect cost: missed wages at 28.6% and 63.3%, respectively. While the majority of the direct costs of AFx’s are accrued in the period immediately following the injury, indirect cost components will regularly be incurred for nearly 5 months and often longer. The degree and duration to which these indirect costs accumulate are novel findings. Future research should no longer neglect reporting on an intervention’s impact on the indirect costs of AFx’s.

Abstract 580: Effects of oral crofelemer on neratinib-induced diarrhea in beagle dogs

Abstract Crofelemer is a novel allosteric modulator of cystic fibrosis transmembrane conductance regulator (CFTR) that is approved as an antidiarrheal in HIV patients receiving antiretroviral therapy. Neratinib is an oral, irreversible pan-HER tyrosine kinase inhibitor approved for extended adjuvant treatment of early stage HER2+ breast cancer. The objective of this study was to evaluate the effects of crofelemer in reducing the incidence and severity of diarrhea following daily oral neratinib dosing for 28 days in healthy female dogs, without concomitant use of loperamide. Female beagle dogs (mean 7.2 kg (6.4-8.5)) were randomized into three groups of 8 dogs each and all groups received neratinib oral doses (40 mg for the first 5 days, then 80 mg) for 28 days. Group 1 dogs received one placebo capsule orally four times daily, control (CTR) group; group 2 dogs received one crofelemer 125 mg tablet four times a day (QID group); and group 3 dogs received one crofelemer 125 mg tablet twice daily (BID group). Dogs were evaluated twice daily for bowel movements, which were scored according to a 7-point scale analogous to the human Bristol Stool Form Scale. Dogs with moderate dehydration were given subcutaneous fluids and/or a single-day neratinib dose reduction or holiday. Weekly assessments of clinical chemistry and hematology parameters were conducted. Pharmacological effects were assessed by: 1) determining the proportion of “responder” dogs, defined as dogs with &amp;lt;7 watery stools per week for at least 2 weeks of the 4 week period; 2) reduction in the number of watery stools over the 28-day period; and 3) assessment of change in stool consistency. Summary statistics were computed at each week and pair-wise p-values were computed via t-test to determine differences from control group. Analysis of covariance (ANCOVA) was conducted using baseline fecal scores as a covariate. Following 28 days of oral dosing of neratinib receiving concomitant crofelemer tablets or placebo capsules, 3 of 8 placebo (CTR) dogs were “responders”; 6/8 crofelemer BID group dogs (p=0.03) and 7/8 QID group dogs (p=0.02) were “responders”. The average number of watery stools per week, a measure of the incidence of diarrhea, across the 4-week treatment period were 9, 6, and 6 for the control, BID, and QID groups (p=0.01) respectively. The average number of weeks with no loose/watery stools were determined to be 1.3, 2.1, and 2.3 for the control, BID, and QID groups respectively, with 1-sided p-values of 0.043 and 0.0295, respectively. Least squares weekly mean fecal scores, a measure of diarrhea severity reflecting stool consistency, averaged across the 4-week period were 5.1, 3.9, and 4.1 for control, BID, and QID groups (p=0.005 and p=0.017, respectively). In this experimental preclinical model, concomitant treatment of crofelemer without any use of loperamide reduces the incidence and severity of neratinib-associated diarrhea in female dogs by about 30% over a 28-day treatment period. Citation Format: Michael K. Guy, Andre Teixeira, Alshad S. Lalani, Irmina Diala, Leanne McCulloch, James Bolognese, Pravin Chaturvedi. Effects of oral crofelemer on neratinib-induced diarrhea in beagle dogs [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 580.

Relationship between Size of the Foveal Avascular Zone and Carbohydrate Metabolic Disorders during Pregnancy.

Aim To determine whether the area of the foveal avascular zone (FAZ), as a morphological indicator of the microcirculation of the perifoveal capillary network, changes in the carbohydrate metabolism disorders during pregnancy (the gestational age of patients with gestational diabetes mellitus (GDM) and preexisting diabetes (PexD)). Methods Ten normal individuals and 41 eyes of 41 patients, 28 with GDM and 13 with PexD, were studied. A 3 × 3 mm area of the FAZ of the superficial capillary plexus layer (SCP) and the deep capillary plexus layer (DCP) was determined by optical coherence tomography angiography (OCTA; RS-3000 Advance, NIDEK). The significance of the correlation between the size of the FAZ and the weeks of pregnancy was determined. Results The area of the FAZ of the SCP was 0.38 ± 0.11 mm2 (normal eyes), 0.41 ± 0.16 mm2 (GDM), and 0.43 ± 0.10 mm2 (PexD). The area of the FAZ of the DCP was 0.78 ± 0.23 mm2 (normal eyes), 0.69 ± 0.16 mm2 (GDM), and 0.79 ± 0.25 mm2 (PexD). No significant difference in the FAZ sizes was observed between the groups. The average number of weeks of pregnancy was 24.1 ± 8.2 weeks in the eyes with GDM and 23.3 ± 11.4 weeks in the eyes with PexD (P > 0.05). Significant correlations were found between the size of the FAZ of the SCP and the number of weeks (r = 0.37, P=0.04 for GDM, and r = 0.49, P=0.04 for PexD, Spearman's rank-order correlation coefficient). Conclusions For GDM and PexD under established glycemic control, the area of the FAZ is not affected, but vascular changes occurred at the early phase of pregnancy.

Decreasing Postoperative Narcotic Utilization with the Use of Concentrated Bone Marrow Aspirate in First Metatarsophalangeal Joint Interposition Arthroplasty

Category: Midfoot/Forefoot Introduction/Purpose: Interposition arthroplasty is an interim procedure for the treatment of first metatarsophalangeal osteoarthritis demonstrating excellent survivorship. The procedure is commonly performed at our institution and successful long-term results have been described. Furthermore, we have utilized concentrated, autologous, bone marrow aspirate (BMAC) to augment and accelerate patient recovery, decrease postoperative pain, reduce postoperative narcotic requirement, and improve tissue healing for a variety of ankle and foot pathology. The purpose of this study was to compare the early outcomes of interpositional arthroplasty with patients receiving BMAC augmentation versus controls and to evaluate postoperative analgesia and narcotic requirements. Methods: After IRB approval, patients undergoing interposition arthroplasty for hallux rigidus at our institution from 2009-2014 were identified. All cases were performed using autograft capsular interposition by a single surgeon. 18 BMAC cases with complete records were identified. These were matched to controls in a 1:1 manner by age, gender, and laterality. A retrospective analysis of prospectively collected data was performed. Demographics, clinical range of motion, complications, VAS scoring, FAAM, FFI, AOFAS scores were recorded and analyzed. Postoperative analgesia requirements, narcotic usage, and prescription data were collected. Follow-up was conducted at 2,6,12,24, &amp; 52 weeks postoperatively. Time experiencing pain and time to achieve maximum functional satisfaction were recorded. Results: 89% (32/36) of patients undergoing interposition arthroplasty were female, average age 58 years (range, 39-74). The average number of weeks experiencing pain, narcotic utilization, and time to achieve functional satisfaction was statistically lower in the BMAC group, 11 weeks (range, 6-24) versus controls, 27.4 weeks (range, 6-52), (p=0.001). The number of post-operative days of pain requiring narcotic analgesia was significantly lower in patients receiving BMAC 4.2 days (range, 1-14) compared to controls averaging 13.8 days (range, 2-48) (p=0.02). Both groups demonstrated improvements in pre- and postoperative VAS scores, increase in motion, SF-36, FAAM, FFI, and AOFAS scores at 52 week follow up. There were no failures and there was one superficial infection requiring oral antibiotics. Conclusion: This study confirms that patients undergoing interpositional arthroplasty demonstrate excellent clinical improvements in short-term follow-up with few complications. Moreover, augmentation of this procedure with BMAC results in a significant decrease in narcotic utilization and recovery time post-operatively. BMAC may be a useful adjunct in diminishing postoperative narcotics we prescribe to our patients.

De novo Occurrence and Recurrence of HCC in HCV Infected Patients Treated With DAAʼs: A Single Center 2-Year Experience

Introduction: Multiple studies have shown the efficacy of new direct-acting antivirals (DAA) with cure rate of over 90% in HCV infected patients. Recently published studies have suggested increased incidence of de novo and recurrent HCC(Hepatocellular carcinoma) in cirrhotic patients in SVR(sustained virological response) after completing therapy. A possible mechanism is breakdown of immune surveillance after starting DAA. We report a small case series in a population of chronic HCV infected patients, with and without prior history of HCC, who developed HCC after receiving direct acting antivirals (DAAs) with the aim of adding to existing literature.Table: Table. Clinical Variables Related To HCV and HCCTable. DAA: therapy associated variablesMethods: We retrospectively reviewed 16 patients reported to have HCC out of 290 patients who were treated with DAA at the Oklahoma City VA Medical Center over 2 years (2014-2015). Descriptive analysis including mean and standard deviation for different variables was performed. Results: All 16 patients were male, with the majority (75%) being white. Mean age was 66 years. All patients had cirrhosis as indicated by Fib-4 score > 3.25 and confirmed by imaging. Average Fib-4 score was 7.88. Most were Child Pugh Class A, with average MELD of 11. 6 (37.5%) were treatment naïve. Majority, 9 (56.25%) were genotype 1a. The frequencies of other HCV genotypes 1b, 2 and 3 were 3 (18.75%), 2 (12.5%) and 2 (12.5%) respectively. The median pretreatment HCV viral load was 1,286,176. EVR(Early viral response) was achieved in all patients. ETR(end treatment response) and Sustained Viral Response (SVR) was achieved in 12 (75%) and 10 (62.5%) patients respectively. In patients who achieved SVR, average number of weeks from SVR to HCC detection was 33.3 weeks. All HCC were diagnosed on surveillance ultrasound (USG) imaging (6 monthly) later confirmed via CT-Scan/MRI. 11/16 had denovo occurance of HCC Average time period from DAA therapy to HCC diagnosis was 48.2 weeks. 9/16 patients had more than 1 nodule at diagnosis, and only 7 fulfilled Milan Criteria. Conclusion: Our case series reiterates previously confirmed concern of increased HCC recurrence in patients with history of eradicated HCC. It may be associated with more aggressive occurance (given multiple nodules in >50% patients). It also adds to growing literature which suggest SVR may not be protective against HCC occurrence. It is unclear if treatment with DAA leads to increased HCC occurrence. There is a need of statistically stronger studies on larger cohorts before further conclusions are drawn.

Family-Wage Gap and Highly Skilled Women

Family-Wage Gap and Highly Skilled Women Pooja Khosla, PhD Abstract The paper estimates the family wage gap (FWG), which is the pay gap between women with children and women without children, among highly skilled female scientists and researchers. The paper uses a rich dataset from the longitudinal Survey of Doctorate Recipients in the US to estimate FWG and to investigate its sources. The sources evaluated include, one, human capital characteristics such as: field of majors, school quality, and years since Ph.D. Two, maternity leaves and other self-reported-career breaks adjusted experience. Three, current job characteristics such as: extent to which job is related to highest degree, authority level, tenure status, occupation major group, choice to work part-time, working outside field of research, employment type, experience in current job, average number of hours worked and average number of weeks worked in a year. Lastly, the paper examines the role of family and the demographic status of women such as: marital status, number of children, age of the youngest child, age of woman at the time of first born, and timing of first born before or after graduation. The results indicate that the family wage gap does exist among women with Ph.D. and is about 6.8 percent. However, most of the existing wage difference can be explained by differences in human capital characteristics and current job characteristics. Results indicate that this wage difference increases with the increase in number of children. The wage gap is highest for married women, women with younger children, for women who opt for early motherhood, and for women who plan children before the doctoral degree. Full Text: PDF DOI: 10.15640/ijgws.v5n1a4

Utilization of the Family and Medical Leave Act in Radiology Practices According to the 2016 ACR Commission on Human Resources Workforce Survey

PurposeTo assess gender utilization of the Family and Medical Leave Act (FMLA) in radiology practices across the United States. MethodsThe Practice of Radiology Environment Database was utilized to identify U.S. practice leaders, who were asked to complete an electronic survey developed by the ACR Human Resources (HR) Commission. In 2016, new survey questions asked about number of radiologists in each practice who took FMLA, the reasons why, the average number of weeks taken, and how such absences were covered. ResultsThirty-two percent (579/1815) of practice group leaders responded to the survey and of these, 73% (432/579) answered FMLA questions, with 15% of those (64/432) answering affirmatively that a radiologist in their practice had taken FMLA leave. Reasons for this in 2015 included to care for a newborn/adopted child (49%), because of a personal serious health condition (42%), to care for an immediate family member (8%), or for active military duty (1%). Women took a greater number of weeks of FMLA leave than men for all reasons (care of newborn/adopted child: 10.7 versus 4.7; personal serious health condition: 10.3 versus 8.0; care of immediate family member: 9.7 versus 8.7) except for military duty (24 weeks taken, all by men). At least 69% of leave time was paid, irrespective of reason for leave or gender of person taking it. Most practices (82%) made no workforce changes to cover FMLA leave. ConclusionsBoth genders of radiologists needed absences from work for FMLA-sanctioned reasons.

Model-Based Comprehensive Analysis of School Closure Policies for Mitigating Influenza Epidemics and Pandemics.

School closure policies are among the non-pharmaceutical measures taken into consideration to mitigate influenza epidemics and pandemics spread. However, a systematic review of the effectiveness of alternative closure policies has yet to emerge. Here we perform a model-based analysis of four types of school closure, ranging from the nationwide closure of all schools at the same time to reactive gradual closure, starting from class-by-class, then grades and finally the whole school. We consider policies based on triggers that are feasible to monitor, such as school absenteeism and national ILI surveillance system. We found that, under specific constraints on the average number of weeks lost per student, reactive school-by-school, gradual, and county-wide closure give comparable outcomes in terms of optimal infection attack rate reduction, peak incidence reduction or peak delay. Optimal implementations generally require short closures of one week each; this duration is long enough to break the transmission chain without leading to unnecessarily long periods of class interruption. Moreover, we found that gradual and county closures may be slightly more easily applicable in practice as they are less sensitive to the value of the excess absenteeism threshold triggering the start of the intervention. These findings suggest that policy makers could consider school closure policies more diffusely as response strategy to influenza epidemics and pandemics, and the fact that some countries already have some experience of gradual or regional closures for seasonal influenza outbreaks demonstrates that logistic and feasibility challenges of school closure strategies can be to some extent overcome.

Early Success Is Vital in Minimal Worksite Wellness Interventions at Small Worksites.

In an effort to increase physical activity, 15 workplaces participated in a minimal-contact 10,000-steps-a-day program sponsored by the Sedgwick County Health Department in 2007 and 2008. Pedometers were provided to measure participants' weekly steps for the 10-week intervention. Participants were defined as those who completed the preregistration survey and logged at least 1 week of results. Registrants were defined as those who completed a registration survey but did not log any weekly results. The primary dependent variable was whether or not participants achieved weekly success, as measured by achieving at least 70,000 steps in a week. A secondary dependent variable was participants' number of steps each week during the weeks they logged results. Repeated measures logistic regression analysis was conducted to identify factors associated with weekly success. Of the 2,515 registrants, 1,292 (51%) were participants. The average number of weeks of participation for this 10-week intervention was 5.6 weeks (SD = 3.4). Those from small employers (n < 750) were more likely (OR = 2.0) than those from large organizations (n > 750) to become participants. Participants who achieved at least 70,000 steps in the first week of the intervention were 7.3 times more likely than participants who walked less than 70,000 steps in the first week to achieve 70,000 steps each week for all 10 weeks. Results from implementing a minimal-contact 10,000-step intervention can be maximized by targeting small worksites and supporting employees to achieve 70,000 steps in their first week.

Static or Dynamic Intramedullary Nailing of Femur and Tibia

Introduction:The basic principle of non-surgical fracture treatment is to restore the original anatomical position of fractured fragments by different techniques, without direct access to the bone and without further traumatizing of tissues. Intramedullary nailing is synthesis and consolidation of fracture fragments with the main goal to gain strength and permanent placement of the implants. Two techniques of intramedullary osteosynthesis are used: with dynamic or with static intramedullary nail. Dynamization include conversion of static nail by removing screws from the longest fragment.Aim:The aim of this study is to determine whether there is a difference in the speed and quality of healing of the type A and B fractures of the femur and tibia treated by static or dynamic intramedullary nails and to compare the results.Material and methods:The study was conducted at the Clinic for Orthopaedics and Traumatology, Clinical Center University Sarajevo from January 2004 to June 2009. The study was retrospective-prospective, manipulative, controlled and it was conducted on a total of 129 patients with closed fractures of the diaphysis of the femur and tibia type A and type B, with different segments of bone, regardless of sex and age structure, with the exception of children under 14 years of age.Results:Precisely there were 47 patients with femoral fractures and 82 patients with tibial fractures. The average number of weeks of healing femoral and tibial fractures was slightly in advantage of static intramedullary osteosynthesis, it was 17.08 weeks (SD=3.382). The average number of weeks of healing in 23 patients with fractures of the femur, treated by dynamic intramedullary osteosynthesis was 17.83 (SD=2.978). We can conclude that static intramedullary nailing osteosynthesis unable movements between fragments which directly stimulates bone formation and formation of minimal callus.Conclusion:Static intramedullary osteosynthesis resolve the problem of stabilizing the fracture, limb shortening and rotation of fragments.

Trigonometric Regression for Analysis of Public Health Surveillance Data

Statistical challenges in monitoring modern biosurveillance data are well described in the literature. Even though assumptions of normality, independence, and stationarity are typically violated in the biosurveillance data, statistical process control (SPC) charts adopted from industry have been widely used in public health for communicable disease monitoring. But, blind usage of SPC charts in public health that ignores the characteristics of disease surveillance data may result in poor detection of disease outbreaks and/or excessive false-positive alarms. Thus, improved biosurveillance systems are clearly needed, and participation of statisticians knowledgeable in SPC alongside epidemiologists in the design and evaluation of such systems can be more productive. We describe and study a method for monitoring reportable disease counts using a Poisson distribution whose mean is allowed to vary depending on the week of the year. The seasonality is modeled by a trigonometric function whose parameters can be estimated by some baseline set of data. We study the ability of such a model to detect an outbreak. Specifically, we estimate the probability of detection (POD), the average number of weeks to signal given that a signal has occurred (conditional expected delay, or CED), and the false-positive rate (FPR, the average number of false-alarms per year).

The Cumulative Dose But Not The Frequency Of Infusions Is a Risk Factor For The Development Of Osteonecrosis Of The Jaw (ONJ) In Myeloma Patients Who Receive Zoledronic Acid (ZA)

The administration of ZA in patients with symptomatic myeloma is associated with reduction of SREs and possible improvement of survival; its use however, is associated with increased risk of osteonecrosis of the jaw (ONJ). Longer exposure and more infusions of ZA have been associated with higher incidence of ONJ. It has been suggested that longer intervals between ZA infusions may reduce the risk of ONJ; however, this has not been proven. Since 2008, we have adopted a strategy in which ZA is discontinued in patients who remain in remission for more than 2 years, while ZA is administered every 8-12 weeks, after the first year, in patients who have achieved vgPR or CR. The aim of our analysis was to assess the incidence of ONJ in a prospectively studied population treated with ZA and to asses potential risk factors related to dosing and schedule of ZA.Since 2003, all patients in the Department of Clinical Therapeutics (Athens, Greece) undergo dental evaluation before ZA initiation and are instructed to avoid procedures that predispose to ONJ. Only patients who received ZA and survived at least 6 months post their first ZA infusion were included in the analysis. Relative dose frequency of ZA (RDF) was calculated as the average number of weeks between infusions of ZA (weeks between first and last infusion divided by the number of infusions). Time of exposure to ZA was calculated from the date of first infusion until the date of last infusion. Death due to myeloma and development of ONJ were treated as competing events.Between January 2000 and January 2013, 266 patients with symptomatic myeloma fulfilled the above criteria and were included in the analysis. Median age was 68 years (range 36-87 years) and 47% were males. Median follow up was 36 months and 35% of the patients have died. The median number of ZA infusions was 16 (range 1-107) and the median time of exposure to ZA was 29 months, corresponding to 9073 person-months of exposure. Median RDF was one infusion per 7.9 weeks (interquartile range (IQR) 5.8-11.4 weeks). ONJ developed in 26 (10%) patients. Median time from first ZA infusion to development of ONJ was 28 months (range 6-122 months). Accounting for death as a competing event, 1-year risk of ONJ was 1.2% (95% CI 0.3-3%), 2-year risk was 5% (95% CI 2.5-8.5%), 3-year risk was 8.5% (95% CI 5-13%), 4-year risk was 11.5% (95% CI 7.3-17%) and 5-year risk was 14% (95% CI 9-19%) (Figure). The respective survival rates were 93%, 84%, 76%, 65% and 56% at 1, 2, 3, 4 & 5 years. The median time of exposure to ZA was 28 months (IQR 22-46 months) for patients who developed ONJ vs. 24 months (IQR 11-42 months) for those who did not (p=0.2). However, the median number of ZA infusions was 23 for those who developed vs. 14 for those who did not develop ONJ (p=0.004). Increasing number of ZA infusions was associated with higher risk of ONJ: 2.3% of patients who received <10 infusions developed ONJ vs. 12% of patients who received 10-19 infusions vs. 15% of patients who received 20 or more ZA infusions (p=0.012). The incidence rate of ONJ for patients who started ZA before 2008 was 0.31 per 100 person-months vs. 0.26 per 100 person-months for those who started after 2008 (p=0.4). The incidence of ONJ at 3-years was 13.6% (95% CI 8-20%) for patients with an RDF <8 weeks vs. 2.6% (95% CI 0.5-8%) for patients with RDF of ≥8 weeks (p=0.018). However, after adjusting for RDF of ZA infusions, only the number of ZA infusions remained significant (p=0.03). The multivariate analysis showed that both the number and the frequency of ZA infusions were associated with a shorter time to ONJ development. More specifically, average frequency of infusion <8 weeks was associated with a 15-fold (95% CI 4-55, p<0.001) increase in the risk of ONJ, while for every infusion of ZA the risk of ONJ increased by 9% (95% CI 4-14%, p<0.001).In conclusion, our data, in a large population of consecutive unselected patients with symptomatic myeloma who received ZA, indicate that ONJ remains a frequent complication in patients who receive ZA for prolonged periods and the risk increases with the number of ZA infusions. More frequent infusions of ZA are associated with earlier development of ONJ, but the risk of ONJ is associated mainly with the cumulative dose of ZA. Prospective clinical trials should examine if less frequent administration of ZA can reduce the risk of ONJ without compromising its antiresorptive effect. [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Perfil das crianças atendidas no setor fonoaudiológico do ambulatório de crianças de alto risco da prefeitura municipal de Franca/SP

OBJETIVO: caracterizar o perfil das crianças atendidas no setor fonoaudiológico do ambulatório de crianças de alto risco da Prefeitura Municipal de Franca- SP. MÉTODO: trata-se de um estudo descritivo do tipo transversal e contemporâneo, realizado por meio da consulta de 62 prontuários de recém-nascidos atendidos no ano de 2010. RESULTADOS: os resultados revelaram que a maioria da amostra era composta por neonatos do gênero masculino; prematuros, com média de 32 semanas de idade gestacional; baixo peso ao nascer e crescimento intra-uterino adequado; peso médio de 1.774 gramas; fazendo uso de sondas para a alimentação, sendo a sonda parenteral a mais utilizada; ingestão de leite materno associado à fórmula; presença dos reflexos de busca, sucção, mordida e gap. O tempo médio que os bebês levaram para passar para a via oral exclusiva foi de três semanas. A frequência média de atendimentos fonoaudiológicos recebidos ficou em sete estimulações. Verificou-se que os aspectos que interferem na transição da via de alimentação do recém-nascido para via oral exclusiva são: prematuridade e a classificação do peso. CONCLUSÃO: os dados obtidos nessa pesquisa apontam a importância da intervenção fonoaudiológica com relação à estimulação precoce da sucção em recém-nascido pré-termo, estando relacionada com o desenvolvimento global do bebê. A estimulação precoce realizada pelos fonoaudiólogos nos recém-nascidos pré-termos é fundamental para uma alimentação adequada e nutritiva.

Doctor-certified sickness absence in first and second trimesters of pregnancy among native and immigrant women in Norway

The authors sought to estimate differences in doctor-certified sickness absence during pregnancy among immigrant and native women. Population-based cohort study of pregnant women attending three Child Health Clinics in Groruddalen, Oslo, and their offspring. Questionnaire data were collected at gestational weeks 10-20 and 28. The participation rate was 74%. A multivariate Poisson regression was used to analyse differences in sickness absence in pregnancy between immigrant and native women. A total of 573 women who were employed prior to their pregnancies were included, 51% were immigrants. After adjusting for age, years of education, marital status, number of children, occupation, part-time/full-time work, health status, severe pregnancy-induced emesis and language proficiency, the immigrant/native differences in number of weeks with sickness absence decreased from 2.0 to 1.2 weeks. Part-time/full-time work, health status, severe pregnancy-induced emesis and language proficiency were significant predictors of sickness absence. Immigrant women had higher sickness absence than native women during pregnancy. The difference in average number of weeks between native and immigrant women was partly explained by poorer health status prior to pregnancy, severe pregnancy-induced emesis and poorer proficiency in the Norwegian language among the immigrant women.