Final Criteria Research Articles

The State of Urotrauma Education Among Residency Programs in the United States: A Systematic Review and Meta-Analysis.

Management of urotrauma is a crucial part of a urologist's knowledge and training. We therefore sought to understand the state of urotrauma education in the United States. Using themes of "Urotrauma" and "Education," we performed a systematic review and meta-analysis by searching for studies in MEDLINE, all Cochrane libraries, EMBASE, BIOSIS, Scopus, and Web of Science through May 2023. The primary outcome was the pooled rate of urology trainee and program director attitudes toward urotrauma education. Secondary outcomes involved a descriptive summary of existing urotrauma curricula and an assessment of factors affecting urotrauma exposure. Of 12,230 unique records, 11 studies met the final eligibility criteria, and we included 2 in the meta-analysis. The majority of trainees and program directors reported having level 1 trauma center rotations (range 88-89%) and considered urotrauma exposure as an important aspect of residency education (83%, 95% CI 76-88%). Despite possible increases in trainee exposure to Society of Genitourinary Reconstructive Surgeons (GURS) faculty over the preceding decade, nearly a third of trainees and program directors currently felt there remained inadequate exposure to urotrauma during training (32%, 95% CI 19-46%). Factors affecting urotrauma education include the limited exposure to GURS-trained faculty and clinical factors such as case infrequency and non-operative trauma management. Urology resident exposure to urotrauma is inadequate in many training programs, underscoring the potential value of developing a standardized curriculum to improve urotrauma education for trainees. Further investigation is needed to characterize this issue and to understand how it impacts trainee practice readiness.

A Superolateral Cam Lesion Location Increases Odds of Total Hip Arthroplasty 5 Years After Hip Arthroscopy

To determine if radiographic cam location is associated with hip survivorship and postoperative patient-reported outcomes (PROs) at 5-year follow-up. We conducted a review of prospectively collected data of patients with cam lesions who underwent hip arthroscopy for femoroacetabular impingement syndrome. Cam lesions were categorized into 3 locations: superolateral, anterolateral, or anterior. Conversion to total hip arthroplasty (THA), revision rates, and reoperation rates were assessed. Patient-reported outcome measures, including modified Harris Hip Scores (mHHS) and Non-Arthritic Hip Scores (NAHS), were collected preoperatively and at 5-year follow-up. Of the 156-patients, 125 met the final criteria (80.1%). Mean age was 41.1 ± 12.7 years. Seventy-one patients (56.8%) had superolateral cam lesions, 41 (32.8%) had anterolateral lesions, and 13 (10.4%) had anterior lesions. Revision rates within 5 years were 7.7% for anterior, 24.4% for anterolateral, and 14.1% for superolateral lesions; conversions to THAs were 15.4% for anterior), 7.3% for anterolateral, and 8.5% for superolateral. Reoperations were 23.1% for anterior, 29.3% for anterolateral, and 21.1% for superolateral. The superolateral cohort was younger than the anterior and anterolateral cohorts (anterior, 46.6 ± 12.2 years; anterolateral, 44.7 ± 12.2 years; superolateral, 38.1 ± 12.3 years; P= .006). Multivariable analysis showed the anterolateral group was significantly predictive of lower odds of undergoing THA compared to the superolateral group (odds ratio, 0.01; 95% CI, <0.01-0.72; P= .03). There were no differences in the 5-year improvement in mHHS (anterior, 32.4; anterolateral, 36.8; superolateral, 33.0; P= .29) or NAHS (anterior, 34.8; anterolateral, 39.0; superolateral, 37.3; P= .65). A superolateral cam lesion increases the odds of conversion to THA within 5 years of hip arthroscopy compared to those with anterolateral lesions on multivariable analysis. Those with superolateral lesions were significantly younger compared to those with anterior or anterolateral lesions. Cam lesion location did not affect improvement in PROs at 5-year follow-up. Level III, retrospective comparative prognostic trial.

Association of Benign Paroxysmal Positional Vertigo with Depression and Anxiety-A Systematic Review and Meta-Analysis.

To evaluate the extent to which Benign Paroxysmal Positional Vertigo (BPPV) is associated with a higher prevalence of depression and anxiety in patients. Three databases including PubMed, Embase, and The Cochrane Library were searched by two independent authors from inception to June 12, 2022 for observational studies and randomized controlled trials investigating the association between BPPV and depression and anxiety. We included studies published as full-length articles in peer-reviewed journals with an adult population aged at least 18 years who have BPPV, detected through validated clinical methods like clinical diagnosis, interview and Dix-Hallpike test. A total of 23 articles met the final inclusion criteria and 19 articles were included in the meta-analysis. BPPV was associated with a 3.19 increased risk of anxiety compared to controls, and 27% (17%-39%) of BPPV patients suffered from anxiety. Furthermore, the weighted average Beck's Anxiety Inventory score was 18.38 (12.57; 24.18), while the weighted average State-Trait Anxiety Index score was 43.08 (37.57; 48.60). There appears to be some association between BPPV and anxiety, but further studies are required to confirm these associations. Laryngoscope, 134:526-534, 2024.

Use of Area Deprivation Index to Predict Minimal Clinically Important Difference for Patient Reported Outcomes Measurement Information System After Arthroscopic Rotator Cuff Repair

Background: Socioeconomic disparities correlate with worse outcomes after arthroscopic rotator cuff repair. However, use of a surrogate to describe socioeconomic disadvantage has been a challenge. The Area Deprivation Index (ADI) is a tool that encompasses 17 socioeconomic variables into a single metric based on census location. Hypothesis: Higher ADI would result in a worse minimal clinically important difference (MCID) for the Patient Reported Outcomes Measurement Information System (PROMIS) and have less improvement in range of motion (ROM) following arthroscopic rotator cuff repair (ARCR). Study Design: Cohort study; Level of evidence, 3. Method: A retrospective review was performed for patients who underwent arthroscopic rotator cuff repair. Patients in the most socioeconomically disadvantaged quartile (ADIHigh) were compared with the least disadvantaged quartile (ADILow) in the ability to reach MCID. Demographic and surgical features were assessed for attainment of MCID. Results: In total 1382 patients were identified who underwent ARCR, of which a total of 306 patients met final inclusion criteria. A higher percentage of patients within the ADIHigh cohort identified as “Black” or “other” race and had government-issued insurance compared with the ADILow cohort (P < .05). The ADIHigh cohort had significantly worse postoperative forward flexion compared with the ADILow cohort (145.0°± 32.5° vs 156.3°± 23.4°; P = .001) despite starting with comparable preoperative ROM (P = .17). Logistic regression showed that ADI was the only variable significant for predicting achievement of MCID for all 3 PROMIS domains, with the ADIHigh cohort having significantly worse odds of achieving MCID Physical Function (odds ratio [OR], 0.31; P = .001), Pain Interference (OR, 0.21; P = .001), and Depression (OR, 0.28; P = .001). Meanwhile, age, sex, body mass index, and smoking history were nonsignificant. Moreover, “other” for race and Medicare insurance were significant for achievement of MCID Depression but not Physical Function or Pain Interference. Finally, ADI was the main feature for predictive logistic regression modeling. Conclusion: ADI served as the only significant predictor for achieving MCID for all 3 PROMIS domains after arthroscopic rotator cuff repair. Patients who face high levels of socioeconomic disadvantage have lower rates of achieving MCID. In addition, patients with greater neighborhood disadvantage demonstrated significantly worse improvement in active forward flexion. Further investigation is required to understand the role of ADI on physical therapy compliance and to identify the barriers that prevent equitable postoperative care.

Primary care engagement in health system change: a scoping review of common barriers and effective strategies

BackgroundThe complexity of health systems necessitates coordination between a multitude of stakeholders to enact meaningful change. Primary care physicians are a crucial partner to engage, as their investment and participation are critical to the success of any system-level initiative. The aim of this scoping review is to identify common barriers and effective strategies when engaging primary care physicians in designing and implementing health system change.MethodsA scoping review was performed. A literature search was performed in March 2020 using five databases. 668 unique articles were identified and underwent a title and abstract review. 23 articles met criteria for full text review and 10 met final inclusion criteria. A backward citation analysis identified two articles. 12 articles underwent data extraction and thematic analysis.ResultsSeveral barriers to engagement were identified including a lack of trust between primary care physicians and decision-makers, strong professional physician identity, clinically irrelevant and complex proposals, and a lack of capacity and supports. Described strategies to overcome these barriers included building trust and relationships, contextual engagement strategies, working with physician leadership, enabling open and intentional communication channels, designing clinically relevant and straightforward initiatives, and considering financial incentives.ConclusionsBarriers to primary care engagement should be addressed with contextually designed strategies and a focus on relationship building, collaborative efforts, and implementing relevant and feasible initiatives. Further research should explore how to best develop relationships with primary care, working with collective voices of primary care physicians, and to better understanding the impact of financial incentives on engagement.

3D-Printed Modular Endoprosthesis Reconstruction Following Total Calcanectomy in Calcaneal Malignancy.

The use of 3D-printed endoprosthesis has been proposed as a viable limb-salvage procedure following total calcanectomy in patients with calcaneal malignancy. However, certain drawbacks persist concerning the prosthetic design. In this case series, we designed a modular endoprosthesis incorporating a novel drainage system, aiming to improve the functional outcomes and to promote wound healing. We retrospectively analyzed patients with calcaneal malignancy who underwent 3D-printed modular endoprosthesis reconstruction. Clinically, we evaluated functional outcomes using the 10-cm visual analog scale (VAS) score, the 1993 version of the Musculoskeletal Tumor Society (MSTS-93) score, and the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score. Complications were also recorded. Five male patients met the final inclusion criteria. The median age was 20 years (range 13-47 years). The median follow-up time was 28 months (range, 13-65 months). Median postoperative functional MSTS-93, VAS, and AOFAS scores were 27 points (range, 25-29), 0 points (range, 0-1), and 86 points (range, 83-93), respectively. Wound healing was observed in all patients, and there were no complications related to the endoprosthesis at the last follow-up. The use of 3D-printed modular endoprosthesis was associated with satisfactory short-term outcomes in patients undergoing calcaneal reconstruction. The incorporation of a novel design featuring an integrated draining system has the potential to enhance wound healing and expedite functional recovery. Level IV, case series.

Nalmefene combined noninvasive positive-pressure ventilation in Chinese patients with chronic obstructive pulmonary disease coupled with type II respiratory failure: A meta-analysis.

Nalmefene is an opioid system modulator with antagonist activity at the μ and δ receptors and partial agonist activity at the κ receptor. Previous studies have suggested that nalmefene could improve respiratory function in patients with chronic obstructive pulmonary disease (COPD). However, there is no comprehensive systematic review published regarding the clinical efficacy of nalmefene. We explored the following electronic bibliographic databases: EMBASE, Web of Science, PubMed, Wanfang, and Chinese national knowledge infrastructure. To collect data from randomized controlled trials on the therapy of COPD coupled with type II respiratory failure and nalmefene + noninvasive ventilator treatment. The retrieved articles were screened to determine the final inclusion criteria and to extract relevant data, such as the clinical efficacy rate, pulmonary function, blood gas analysis, and adverse reactions. In our study, we used relative risk and weighted mean deviation, as well as a 95% confidence interval for describing nalmefene effectiveness and safety while treating COPD with type II respiratory failure. The outcomes of the meta-analysis demonstrated that the clinical efficacy rate of the nalmefene + noninvasive ventilation group was higher than that of the naloxone + noninvasive ventilation and noninvasive ventilation groups. Moreover, the improvement indices of pH value, partial pressure and saturation of blood oxygen, partial pressure of carbon dioxide, and pulmonary function of the nalmefene + noninvasive ventilation group were better than those of the noninvasive ventilation group, and there was no increase in the occurrence of adverse drug reactions. Nalmefene combined with noninvasive ventilation can significantly improve the blood gas index and lung function in patients with COPD combined with type II respiratory failure.

Development of a Tool to Determine Excellence in the Provision of Physical Therapist Clinical Education: A Modified Delphi Study.

The purpose of this study was to create a Site of Excellence in Clinical Education (SECE-PT) tool with the essential criteria used to determine excellence in the provision of physical therapist clinical education at a clinical site using a consensus-building approach. The development of the SECE-PT tool was divided into 2 parts. Part 1 involved the development of an initial set of proposed criteria, whereas part 2 employed a modified Delphi approach for consensus building. Purposive selection and snowball sampling techniques were used to recruit clinical instructors, recent graduates, site coordinators of clinical education, and directors of clinical education who met the inclusion criteria for the modified Delphi study. Three web-based survey rounds were used to achieve consensus, defined as a mean score of ≥7 on the 11-point Likert scale. The first round gathered demographic information on participants and collected information about clarity and redundancy in the criteria provided, the second gathered information once again about clarity and redundancy on the revised criteria provided, and the third asked participants to rate how essential it was for a site of excellence to demonstrate each of the final criteria. A total of 123 participants, equally representing clinical and academic perspectives, completed the demographic survey and round 1. Ninety-four participants completed round 2, and 80 participants completed the third and final round. Consensus revealed that 44 criteria were deemed essential for a SECE-PT to demonstrate. This study provides a measure to evaluate clinical sites providing clinical education. The SECE-PT tool should be widely adopted to evaluate the quality of the clinical site providing the education to student physical therapists. The SECE-PT tool can be used by clinical sites for self-assessment to examine aspects of their clinical education programs and determine whether parts of their program should be further developed. This can provide a framework for discussion and collaboration between clinical and academic partners, as well as regional consortia.

Chronic Calcific Tendonitis of the Rotator Cuff: A Systematic Review and Meta-analysis of Randomized Controlled Trials Comparing Operative and Non-operative Interventions.

Calcific tendinitis is a relatively common shoulder disorder, with 7% to 17% of individuals with shoulder pain having rotator cuff calcium deposits. Several nonoperative interventions, extracorporeal-shockwave-therapy (ESWT) and ultrasound-guided-needling (UGN), and surgical techniques have been described to treat calcific tendonitis with satisfactory outcomes. Clinical guidelines are lacking for surgical excision in cases refractory to nonoperative treatment. Several arthroscopic and open operative techniques have been described to treat calcific tendonitis with satisfactory clinical outcomes. The purpose of this systematic review of randomized controlled trials is to compare outcomes and complications of nonoperative versus operative management of chronic calcific tendinitis of the rotator cuff, to provide evidence-based treatment guidelines for practitioners. EMBASE, PubMed, and OVID [MEDLINE] were searched from database inception until February 20, 2022, for randomized controlled trials reporting outcomes related to operative or nonoperative management for calcific tendonitis of the shoulder. Clinical outcomes including pain on visual analog scale (VAS), Constant-Murley Shoulder Outcome Score (CMS), and resolution of calcific deposits were evaluated. Continuous data at last follow-up was pooled into mean differences using a random effects model for meta-analysis. A total of 27 studies (2,212 nonoperative patients and 140 operative patients) met the final inclusion criteria. Pooled mean difference in VAS for ESWT was -3.83 (95% Confidence Interval [CI] -5.38, -2.27); p < 0.00001), compared to -4.83 (95%CI -5.44, -4.22; p < 0.00001) for UGN, and -4.65 (95%CI -5.47, -3.82; p < 0.00001) for the operative interventions. Pooled mean difference in CMS score after ESWT was 18.30 (95%CI 10.95, 25.66; p < 0.00001) compared to 22.01 (95%CI 8.17, 35.84; p = 0.002) for UGN, and 38.35 (95%CI 31.68, 45.02; p < 0.00001) for the operative interventions. 85% of patients receiving operative and 67% of patients receiving UGN management had complete radiographic resolution of calcific deposit. Surgical treatment of chronic calcific tendonitis of the rotator cuff results in larger improvement in functional outcome scores and comparable pain reduction to nonoperative interventions, particularly UGN. Both operative and nonoperative treatment modalities are likely to have clinically significant improvements in function and pain and thus it is reasonable to trial UGN and ESWT as first-line treatment. Cost-effectiveness analyses will be needed to support one treatment over the other. High quality RCTs directly comparing nonoperative interventions to operative interventions in patients prior to failing conservative treatment are needed to establish high-quality evidence-based guidelines.

INCIDENCE OF COMPLICATIONS AFTER THIRD MANDIBULAR MOLAR CORONECTOMY

Coronectomy is a technique that involves the removal of the crown of the third molar, leaving the root in place. It is recommended when the risks of complete extraction outweigh the benefits, especially in cases where there is a high risk of inferior alveolar nerve (IAN) injury. The success of coronectomy depends on adherence to the operating protocol, which is controlled by the oral sur­geon. The aim of this systematic review is to assess the incidence and nature of complications associated with the coronectomy of mandibular third molars. The systematic literature search was conducted according to PRISMA guidelines in MEDLINE (PubMed), and EMBASE (Sci­enceDirect) databases. A total of 287 titles were identi­fied. 9 studies met the final inclusion criteria. The results showed that coronectomy had a low incidence of IAN sensory disturbance, with 1.6% to 4.3% of cases expe­riencing such complications, while other studies recor­ded no cases of sensitivity loss. Infection and dry socket occurred in a small percentage of cases. Coronectomy is a safe and useful technique for treating impacted mandi­bular third molars. Similar or lower incidence of com­plications compared to those from extraction were seen. Further prospective homogenous randomized controlled clinical trials are necessary to evaluate the effectiveness of coronectomy in third mandibular molars.

The impact of neck pain on gait health: a systematic review and meta-analysis

BackgroundEvidence exists demonstrating the negative impacts of chronic musculoskeletal pain on key measures of gait. Despite neck pain being the second most common musculoskeletal pain condition, there is a paucity of evidence exploring the impacts of neck pain specifically on these outcomes. The aims of this work were to systematically review the current evidence of the associations between chronic neck pain and measures of gait health and to conduct meta-analysis for quantitative assessment of the effect sizes under different walking conditions.MethodsSystematic review was conducted following PRISMA guidelines. Databases searched included MEDLINE, Embase, Web of Science, CINAHL, and PEDro. Eligible study designs included observational studies consisting of an exposure group with chronic neck pain and control group without chronic neck pain and primary outcomes relating to gait health. For outcomes amenable to meta-analysis, a random-effects model was used to derive summary estimates of Hedge’s g depicted graphically with forest plots. Other gait outcomes were narratively summarized. Risk of bias was also assessed.ResultsThe original search yielded 1918 articles; 12 met final eligibility criteria including 10 cross-sectional studies. Outcomes were grouped first by the five domains of gait: pace, rhythm, asymmetry, variability, and postural control; and second by the tested walking conditions. Meta-analyses for gait speed revealed large effect-sizes indicating that individuals with chronic neck pain had slower measures of gait and lower measures of cadence. Gait outcomes that were narratively summarized supported these findings.ConclusionThe quantitative and qualitative findings of this systematic review and meta-analysis suggest a negative impact of CNNP on measures of gait health, particularly gait speed, under various walking conditions. However, broad interpretation of these results should be cautious. Testing gait under dual task conditions may be particularly sensitive to the impact of CNNP, and future work is needed to better understand how pain disrupts this important functionality of the locomotor system. Additionally, consideration should be made to assess measures of variability and investigate these relationships in the older adult population.

Hemorrhagic Transformation Assessment Based on Dual Energy CT of Immediately and Twenty-Four Hours after Endovascular Thrombectomy for Acute Ischemic Stroke.

Dual-energy CT (DECT) shows good performance in differentiating hemorrhage from contrast staining (CS). However, no guidelines have standardized the post-endovascular thrombectomy (EVT) examination time. We evaluated the value of performing DECT immediately and 24 h post-EVT in the diagnosis and prediction of hemorrhagic transformation (HT). Two readers evaluated simulated conventional CT (sCCT) images compared with a second reading with DECT, establishing the diagnosis of HT immediately and 24 h post-EVT. Another reader's diagnosis 2-7 days post-EVT using non-contrast CT was identified as the final diagnostic criteria. DECT performed immediately and 24 h post-EVT changed 22.4% (52/232) and 12.5% (29/232) of sCCT-based HT diagnoses, respectively (χ2 = 10.7, p < 0.05). The sensitivity, negative predictive value (NPV), and accuracy of DECT performed immediately post-EVT for predicting the final diagnosis of HT were 33.6%, 58.9%, and 65.9%, respectively, whereas those for DECT performed 24 h post-EVT were 82.4%, 84.3%, and 90.9%, respectively (χ2 = 58.0, χ2 = 42.9, χ2 = 13.6; p < 0.05). The specificity and positive predictive value were both 100.0%. Delayed HT occurred in 50.0% (78/156) and 42.2% (19/45) of patients with CS diagnosed immediately and 24 h post-EVT, respectively. DECT performed immediately post-EVT changed a greater proportion of real-time HT diagnoses, whereas that performed 24 h post-EVT had higher sensitivity, NPV, and accuracy in predicting the final diagnosis of HT. A substantial proportion of patients with CS diagnosed at these two post-EVT timepoints subsequently developed delayed HT.

Doula Support and Pregnancy-Related Complications and Death Among Childbearing Women in the United States: A Scoping Review.

The potential benefits of perinatal doula support are many; however, doulas are underutilized, which may heighten pregnancy-related complications. In this scoping review, we assess the influence of perinatal doula support on pregnancy-related complications and death in the United States. We searched PubMed, CINAHL, Scopus, and Alt HealthWatch for literature on doula support and its influence on pregnancy-related complications (maternal fever or infection, postpartum hemorrhage, amniotic fluid embolism, complications from anesthesia, preeclampsia, eclampsia, cardiomyopathy, pulmonary or thrombotic embolism, and cerebrovascular accident). Peer-reviewed articles written in English and conducted in the United States from 1969 to 2021 were included. Screening at all levels was blinded. We extracted data based on title, author, year, design, population, sample size, methods, limitations, recommendations, and definition of doula support. Following removal of duplicates, review of 3679 article titles and abstracts yielded 42 articles for full-text review; 3 articles met final inclusion criteria. One included study focused on intrapartum doula support and 2 on doula support that extended throughout the perinatal period. Within the included studies, doula support was associated with decreased rates of intrapartum maternal fever and gestational hypertension; however, it was not associated with decreased rates of gestational diabetes or depression. The literature has addressed the benefits of perinatal doula support, but studies with validated tools to examine associations between doula support and pregnancy-related complications and death are lacking. The studies that addressed intrapartum and continuous doula care included large generalizable samples, from which future research can draw to improve the practice of caring for patients during the perinatal period. Extensive research shows that unfavorable conditions can influence perinatal outcomes across generations. Implementing doula support may offer a potential approach to reduce and help alleviate resulting disparities in perinatal health.

A meta-analysis study on peer influence and adolescent substance use

AbstractThe extent to which adolescents are influenced by their peers has been the focus of developmental psychological research for over 50 years. That research has yielded contradicting evidence and much debate. This study consists of a systematic review and meta-analysis, with the main aim of quantifying the effect of peer influence on adolescent substance use, as well as investigation into the factors that moderate this effect. Included studies needed to employ longitudinal designs, provide the necessary statistics to calculate cross-lagged regression coefficients controlling for target adolescent’s initial substance use, and comprise participants aged 10–19 years. A search of academic databases and reference lists generated 508 unique reports, which were screened using Covidence. The final inclusion criteria yielded a total of 99 effect sizes from 27 independent studies. A four-level meta-analytic approach with correction to allow the inclusion of multiple effect sizes from a given study was used to estimate an average effect size. Results revealed a significant effect of peer influence ($$\overline{\upbeta }$$ β ¯ = .147, p &lt; .001), indicating that adolescents changed their substance use behaviour in accordance with their peers’ perceived or actual use. Moderation analyses found peer influence effects varied significantly as a function of substance use behaviour (categorised as alcohol, tobacco, marijuana, or composite substance use) and peer influence measure (perceived vs. actual peer report); however, no significant effects emerged in the multivariate moderation model simultaneously examining all five main moderators. These results suggest that adolescent substance use is affected by peer influence processes across multiple substance use behaviours and both directly and indirectly through perceived norms. This has significant implications for substance use prevention, including the potential of harnessing peer influence as a positive force and the need to target misperceptions of substance use.

The Impact of Covid-19 Pandemic on Child Routine Immunization Programs: A Systematic Review

Immunization is one of the most successful, most accepted and proven cost-effective public health preventive interventions in the world and has saved 2 to 3 million children from immunization-preventable diseases. The COVID-19 outbreak and the effort being made to overcome the outbreak could cause negative impacts on the utilization of basic immunization services. During the outbreak, basic immunization coverage rate in various regions had decreased. This article conducted a comprehensive and systematic literature search in electronic databases (PubMed, ScienceDirect, Sage Journal, SpringerLink, ClinicalKey, and Oxford Academic) with articles published in the last 5 years and adjusted according to inclusion and exclusion criteria. This systematic review use PRISMA (Preferred, Reporting Items for Systematic Review and Meta-analysis). There were 2 studies that met the final inclusion criteria. The results showed a significant reduction of basic immunization coverage happen especially during the early period of pandemic. Six themes are identified related to the decrease: 1) Covid-19 lockdown; (2) motivation for childhood immunization; (3) availability of biosafety procedures and personal protective equipment (PPE); (4) service adjustments and guidelines during the pandemic; (5) the availability of vaccines; and (6) the resilience of the immunization program in view of COVID-19. Childhood routine immunization coverage rate significantly decreased during the early period of the pandemic. Interventions for providers and parents is required to ensure adequate catch-up of delayed/missed immunizations in order to prevent potential outbreaks of vaccine-preventable diseases.

Evaluating AI rib fracture detections using follow-up CT scans

PurposeThis study compares the results of Artificial Intelligence (AI) diagnosis of rib fractures using initial CT and follow-up CT as the final diagnostic criteria, and studies AI-assisted diagnosis in improving the detection rate of rib fractures. MethodsA retrospective study was conducted on 113 patients who underwent initial and follow-up CT scans due to trauma. The initial and follow-up CT were used as diagnostic criteria, respectively. All images were transmitted to the AI software (V2.1.0, Huiying Medical Technology Co., Beijing, China) for rib fracture detection. The radiologist group (Group 1), AI group (Group 2), and Radiologist with AI group (Group 3) reviewed CT images at an interval of one month, recorded and compared the differences in the sensitivity and specificity for diagnosing rib fractures. Results589 and 712 rib fractures were diagnosed by the initial and follow-up CT, respectively. The initial CT diagnosis failed to detect 127 rib fractures, resulting in a missed rate of 17.84%. In addition, four normal ribs were mistakenly identified as being fractured. The follow-up CT was regarded as the diagnostic standard for rib fractures. The sensitivity and specificity were 82.16% and 99.80% for Group 1, 79.35% and 84.90% for Group 2, and 91.57% and 99.70% for Group 3. The sensitivity of Group 3 was higher than that of Group 1 and Group 2 (p < 0.05). The specificity was lower for Group 2 compared with Group 1 and Group 3 (p < 0.05). ConclusionAI-assisted diagnosis improved the detection rate of rib fractures, the follow-up CT should be used for the diagnosis standard of rib fractures, and AI misdiagnoses can be greatly reduced when a radiologist reviews the diagnosis.

Bringing function to the forefront of cell therapy: how do we demonstrate potency?

Unlike conventional pharmaceuticals, biologics and Advanced Therapy Medicinal Products (ATMPs) are required to meet a standard of "potency" as part of the final release criteria at completion of manufacture. During early phase clinical trials, most regulatory agencies have been willing to accept very immature potency assays with an expectation that these will be improved, qualified and validated during the clinical development of the drug to Marketing Authorisation Application (MAA) or Biologics License Application (BLA) submission.This model of continuous development of potency assay in parallel with drug development has already led to at least two notable problem cases; namely Iovance and Mesoblast. Both companies completed successful phase III clinical trials but, in both cases, the initial BLA was rejected on the basis that their potency assay for drug product release was inadequate. Fortunately these issues appear to have been overcome in March of this year, with Mesoblast receiving acceptance of their BLA for Remestemcel and Iovance obtaining a rolling BLA approval for Lifileucel.

A Quality Assessment Methodology for Sign Language Mobile Apps Using Fusion Of Enhanced Weighted Mobile App Rating Scale (MARS) and Content Expert Standardized Criteria

Mobile sign language apps have drawn a lot of interest recently as a way to minimize communication barriers between hearing people and people with hearing impairments. However, there are issues with the criteria and standards that should be taken into account when developing these apps. This study proposes a set of development criteria for sign language mobile apps and standardizes these criteria using the Fuzzy Delphi approach. Furthermore, the Fuzzy-Weighted Zero Inconsistency (FWZIC) approach is utilized to assign weights to the criteria and establish a ranking order. An initial set of requirements is developed based on the literature review. The Fuzzy Delphi technique is used, involving a panel of experts made up of developers, sign language experts, and users of sign language mobile apps, to assess the validity and reliability of the criteria. The FWZIC technique is used to give the criterion weights and determine their ranking order in order to further improve the decision-making process. The relative relevance of each criterion is determined by the FWZIC technique, which involves expert input and makes use of their knowledge and expertise. A thorough ranking is generated by taking into account the effects of each criterion on several zones, assisting in efficient decision-making during the creation of sign language mobile apps. Six Malaysian Sign Language apps that have been shortlisted are being utilized as a proof of concept to test the idea. The result of 6 apps is obtained based on the final standard criteria, their weights, and rankings.

The GABAergic system in Alzheimer's disease: a systematic review with meta-analysis.

The γ-aminobutyric acid (GABA)ergic system is the primary inhibitory neurotransmission system in the mammalian brain. Its dysregulation has been shown in multiple brain conditions, but in Alzheimer's disease (AD) studies have provided contradictory results. Here, we conducted a systematic review with meta-analysis to investigate whether the GABAergic system is altered in AD patients compared to healthy controls (HC), following the PRISMA 2020 Statement. We searched PubMed and Web of Science from database inception to March 18th, 2023 for studies reporting GABA, glutamate decarboxylase (GAD) 65/67, GABAA, GABAB, and GABAC receptors, GABA transporters (GAT) 1-3 and vesicular GAT in the brain, and GABA levels in the cerebrospinal fluid (CSF) and blood. Heterogeneity was estimated using the I2 index, and the risk of bias was assessed with an adapted questionnaire from the Joanna Briggs Institute Critical Appraisal Tools. The search identified 3631 articles, and 48 met the final inclusion criteria (518 HC, mean age 72.2, and 603 AD patients, mean age 75.6). Random-effects meta-analysis [standardized mean difference (SMD)] revealed that AD patients presented lower GABA levels in the brain (SMD = -0.48 [95% CI = -0.7, -0.27], adjusted p value (adj. p) < 0.001) and in the CSF (-0.41 [-0.72, -0.09], adj. p = 0.042), but not in the blood (-0.63 [-1.35, 0.1], adj. p = 0.176). In addition, GAD65/67 (-0.67 [-1.15, -0.2], adj. p = 0.006), GABAA receptor (-0.51 [-0.7, -0.33], adj. p < 0.001), and GABA transporters (-0.51 [-0.92, -0.09], adj. p = 0.016) were lower in the AD brain. Here, we showed a global reduction of GABAergic system components in the brain and lower GABA levels in the CSF of AD patients. Our findings suggest the GABAergic system is vulnerable to AD pathology and should be considered a potential target for developing pharmacological strategies and novel AD biomarkers.

Paper 24: Reliability of Posterior Tibial Slope Measurement on Magnetic Resonance Imaging Versus Computed Tomography

Objectives: Increased posterior tibial slope (PTS) has been linked to higher rates of anterior cruciate ligament (ACL) injury and ACL graft failure post-reconstruction. In recent years, more specific investigations have delineated distinct roles of the medial tibial plateau (MTP) and lateral tibial plateau (LTP) geometries on anteroposterior and rotatory stability of the knee. While the diagnostic workup of patients with ACL insufficiency typically consists of radiographs and magnetic resonance imaging (MRI), computed tomography (CT), which is the gold standard for evaluating the osseous geometry of the proximal tibia, is not routinely obtained. With increased understanding of the roles of the MTP and LTP geometries on tibiofemoral kinematics, accurate sagittal slope measurements of both the MTP and LTP will be crucial for further defining the treatment algorithm for ACL insufficiency. It is currently unknown whether traditional MRI can be used to accurately measure PTS and how well these measurements correlate to those on CT. Therefore, the purpose of this study was to compare PTS measurements of the MTP and LTP on MRI versus CT. Methods: After Institutional Review Board approval was obtained, an institutional picture archiving and communication system imaging database was retrospectively queried for patients that received concurrent MRI and CT imaging of the same knee within a one-year interval. Knees with significant arthrosis (Kellgren-Lawrence grade &gt;2), deformity, proximal tibia fracture, or artifact that obscured visualization of proximal tibia landmarks were excluded. On paired MRI and CT studies, PTS of the MTP and LTP were measured using a previously described, validated method (Hudek et al, Clin Orthop Relat Res, 2009) by two independent raters (Figure 1). Interrater reliability of PTS measurements was assessed using the intraclass correlation coefficient (ICC). Intermethod agreement between MRI and CT measurements was assessed using the ICC and Bland-Altman analysis. Results: A total of 41 knees in 40 patients (mean age, 37.9±13.4 years, 78.0% male) met final inclusion criteria. Interrater reliability was moderate for MRI measurements (ICC = 0.62-0.73) and high for CT measurements (ICC = 0.83-0.86). Mean measurements of PTS at the MTP were 3.3±2.8° (range, -4.7-8.4°) and 3.7±3.1° (range, -3.8-10.4°) on MRI and CT, respectively. Mean measurements of PTS at the LTP were 4.5±3.8° (range, -8.0-10.6°) and 5.2±3.6° (range, -3.6-15.7°) on MRI and CT, respectively. The mean absolute differences in PTS measurements between MRI and CT were 2.6±2.1° and 2.6±2.6° at the MTP and LTP, respectively. Poor intermethod agreement between MRI and CT was observed at the MTP (ICC = 0.31-0.41), while moderate intermethod agreement was observed at the LTP (ICC = 0.61-0.62). Bland-Altman plots demonstrated high variability and minimal bias of PTS measurements on MRI compared to CT (-0.9° [95% Limit of Agreement (LOA) -7.5-5.6°] for MTP; -1.0° [95% LOA -7.2-5.2°] for LTP) (Figure 2). Conclusions: With increased understanding of the roles of the medial and lateral tibial plateau geometries on tibiofemoral stability in the setting of ACL insufficiency, accurate measurements of PTS are necessary to guide treatment decisions. In this study, PTS measurements on MRI demonstrated lower interrater reliability compared to PTS measurements on CT. Poor-to-moderate agreement was observed for measurements of PTS of the MTP and LTP between paired MRI and CT studies, with high variability and minimal bias. Therefore, measurements of medial and lateral PTS may not be reliable on traditional MRI.