Influence Of Risk Research Articles

Risk-agility interactive model: a new look at agility drivers

PurposeAccording to the definitions presented for agility drivers, it can be mentioned that supply chain risk factors in terms of feature have very close roles to agility drivers and both of these factors impact the uncertainty in the environment. However, the risk factors with a wider domain are more comprehensive. This study aims to examine the effectiveness of risk as a driver on the organizational agility.Design/methodology/approachTo conduct the research, after identification of influential risk factors of supply chain and indicators of organizational agility, questionnaires needed for the research were designed and after confirming their validity and reliability were distributed among the member of the sample. To assess the relationship between supply chain risk and the amount of organizational agility, data obtained from the questionnaires were analyzed using structural equation modeling technique.FindingsThe results of data analysis showed that supply chain risk factors could be considered as a driver affecting the organizational agility. In addition, in this study, supply chain risk factors were ranked using interpretive structural modeling. The presented comprehensive model indicated that based on causal relationships between risk factors, sovereign risk as the basis for model (three levels) and product and customer satisfaction risks as the output of the model (Level 1) were considered.Originality/valueThis paper fulfills an identified need to study how the risk factors as drivers of supply chain agility can have effect on agility.

Mining electronic health records to identify predictive factors associated with hospital admission for Campylobacter infections

BackgroundCampylobacter infection is one of the most common bacterial infections in human beings. Most cases of Campylobacter infection are not well explained by commonly recognised risk factors. Data-driven clinical rules offer patients an unprecedented measure of control over their own health information. This study sought to identify influential predictors from general practice (GP) data to predict the outcomes of Campylobacter infections—ie, being admitted to hospital or remaining with GP care. MethodsDiagnosis of Campylobacter infection was collected from GP and hospital data in Wales between Jan 1, 1990, and Dec 31, 2015, via the Secure Anonymised Information Linkage databank. A specially designed feature selection scheme was used to select the most influential factors from a large number of initial variables formed by GP read codes (a hierarchical thesaurus of clinical terms) and from other codes (sex, age, location, and Townsend deprivation scores). Information retrieval and decision tree techniques were used to construct predictive models. The linked data were split into training, validation, and testing subsets. The testing dataset was used to assess the predictive performance of the identified risk factors. FindingsHealth records of 20 376 patients with Campylobacter infections were used, of whom 12 324 were admitted to hospital at least once. Higher rates of infections occurred in male patients (10 793/20 376), but female patients had higher rates of being admitted to hospital (6207 of 9583 admissions). From an initial 33 471 variables, 31 most predictive variables were finally identified and aggregated, such as “second pneumococcal conjugated vaccination”, and “stool culture. 30 if–then clinical rules with these 31 variables were generated by decision tree (eg, if patients had “second pneumococcal conjugated vaccination”, then “not admitted”). These rules were applied to an independent test dataset and performed significantly above chance to predict the outcomes (sensitivity 0·642, 95% CI 0·638–0·644; specificity 0·62, 0·616–0·622; positive prediction value 0·724, 0·72–0·73). InterpretationOur findings suggest that construction of machine learning models from routine GP data enables the influential risk factors identified to predict outcomes of Campylobacter infections significantly above chance. To address some unexplained model variations, incorporation of more information about the infection and symptoms (strain, severity) is required. FundingNational Centre for Population Health and Wellbeing Research (CA02), Centre for Improvement in Population Health through E-records Research (CIPHER) within the Farr Institute of Health Informatics Research (MR/K006525/1).

Marginal structural Cox model to estimate the causal effect of clinical mastitis on Québec dairy cow culling risk

Health disorders, such as milk fever, displaced abomasum, or retained placenta, as well as poor reproductive performance, are known risk factors for culling in dairy cows. Clinical mastitis (CM) is one of the most influential culling risk factors. However the culling decision could be based either on the disease status or on the current milk yield, milk production being a significant confounder when modelling dairy cow culling risk. But milk yield (and somatic cell count) are time-varying confounders, which are also affected by prior CM and therefore lie on the causal pathway between the exposure of interest, CM, and the outcome, culling. Including these time-varying confounders could result in biased estimates. A marginal structural model (MSM) is a statistical technique allowing estimation of the causal effect of a time-varying exposure in the presence of time-varying covariates without conditioning on these covariates. The objective of this paper is to estimate the causal effect on culling of CM occurring between calving and 120 days in milk, using MSM to control for such time-varying confounders affected by previous exposure. A retrospective longitudinal study was conducted on data from dairy herds in the Province of Québec, Canada, by extracting health information events from the dairy herd health management software used by most Québec dairy producers and their veterinarians. The data were extracted for all lactations starting between January 1st and December 31st, 2010. A total of 3952 heifers and 8724 cows from 261 herds met the inclusion criteria and were used in the analysis.The estimated CM causal hazard ratios were 1.96 [1.57–2.44] and 1.47 [1.28–1.69] for heifers and cows, respectively, and as long as causal assumptions hold. Our findings confirm that CM was a risk factor for culling, but with a reduced effect compared to previous studies, which did not properly control for the presence of time-dependent confounders such as milk yield and somatic cell count. Cows experienced a lower risk for CM, with milk production having more influence on culling risk in cows than heifers.

Selected aspects of education process realization in preventive cardiology

IntroductionPrevention is necessary in order to decrease the incidence of cardiovascular diseases. Effective intervention is an educational activity in the competence of general nurses. This research was focused on the educational activity regarding cardio prevention (nurse activities during the education of patients with cardiovascular disease). AimTo monitor the conditions for realization of the educational process in preventive cardiology used by nurses in the Czech Republic (CR). MethodA quantitative method using the questionnaire technique of a voluntary standardized guided interview. Data were processed using descriptive statistics and the SASD programme, as well as contingency tables of chosen indicators of the second classification degree. The degree of dependence of selected signs was determined based on chi-squared and t-tests and the independence test. The sample group consisted of 1000 general nurses from surgeries of general practitioners, internists, cardiologists and hospital wards focused on cardiovascular diseases. Nurses were selected by quotas from 14 regions of CR. The questionnaire areas included identification data, data on realization of the educational process aimed at individual risk factors influencing the incidence of cardiovascular diseases and effectiveness of the educational process. The tested individuals had the possibility of selecting one or more answers, or they decided on the level of their experience and opinion on a scale of 1–5; the degree of agreement was: absolutely yes, yes, no, certainly no, I cannot say. The frequency was: always, often, sometimes, seldom, never. For the comparison of cardio preventive activity of nurses in selected European countries a survey with a half-structured interview was used through e-mail communication with representatives of nurse sections of professional cardiovascular societies (Slovakia, Poland, Hungary, the Netherlands, Finland and Switzerland). ResultsOverall the answers received from the questioned individuals were positive, at the same time they vary in terms of the conditions that influence the effectivity of educational activity in cardio prevention. Most nurses (75.2%) employed in surgeries of general practitioners, internal and cardiology clinics lack the education focused on cardio prevention. Nurses in these surgeries (75.3%) state they have an agreement with the physician on who is responsible for conducting the educational activities. In relation to nurse education focused on cardio education this is more frequent (p<0.05). During their clinics, 60.8% of nurses always or often conduct health education about influential risk factors responsible for cardiovascular diseases. In relation to the education of nurses aimed at cardio prevention this is a much more frequent occurrence (p<0.01). In 81.0% cases the time of cardio education does not exceed 15minutes per patient. The absolute majority of nurses (92.3%) educate the patients on how they can improve their health state. Nurses (59.9%) see the time they spend on educating the patients as sufficient. Also, in 77.0% of cases nurses judge their health-educational activity in the area of the heart and blood vessel diseases as sufficient. Also in the cases when nurses are educated in cardio prevention the frequency is higher (p<0.05). ConclusionGeneral nurses working in surgeries of general practitioners, internists, cardiologists, and hospital wards focused on these areas usually lack education aimed at cardio prevention but state they conduct the education. They aim the education at risk factors although the quality and effectiveness is questionable due to the existing barriers they encounter. To these belong above all the lack of time available for each patient for him to not only learn but also adapt to, live in and keep to the necessary lifestyle suitable for prevention of cardiovascular diseases.

Investigation of musculoskeletal symptoms in a manufacturing company in Brazil: a cross-sectional study

BackgroundMusculoskeletal disorders are prevalent and represent the most common health problem among the working population in industrially-developing countries, with considerable costs and impact on quality of life. Despite the high incidence of disability insurance claims among Brazilian manufacturing-sector workers, only a few studies assessed musculoskeletal disorders prevalence. ObjectiveTo provide information on the prevalence of musculoskeletal disorders among manufacturing-sector workers and to explore the relationship between musculoskeletal disorders and sociodemographic and occupational characteristics in a medium metallurgical company located in Brazil. MethodsA cross-sectional study was carried out. Data was collected through the use of a specifically-designed questionnaire and the items used to collect musculoskeletal disorders data were based on the Nordic Musculoskeletal Questionnaire. Descriptive statistics were used and multivariate logistic regression analysis (p<0.02) was performed to explore the associations between musculoskeletal disorders and potential risk factors. ResultsThe upper limb was the most frequently affected body region among manufacturing-sector workers: shoulder (24.8%), elbow and/or forearm (15.5%), wrist and/or hand (19.0%). Adjusted logistic regression analysis showed that company experience (p=0.02), presence of sleep disorders (p=0.00), self-reported general health state (p=0.00) and perform work pause (p=0.00) were significant risk factors for development of musculoskeletal disorders. ConclusionSociodemographic and work-related aspects are influential risk factors for musculoskeletal disorders. These results add comprehension about musculoskeletal disorders prevalence and suggest a need for greater emphasis on prevention strategies.

Underweight increases the risk of pulmonary tuberculosis in adult

&lt;p&gt;Background&lt;br /&gt;Tuberculosis (TB) is a leading cause of morbidity and mortality, especially in middle- and low-income countries. The risk of developing TB may be related to nutritional status. Socioeconomic and behavioral factors are also shown to increase the susceptibility to TB infection. The objective of this study was to determine nutritional factors as risk factors of pulmonary TB in adult.&lt;/p&gt;&lt;p&gt;Methods&lt;br /&gt;This was an observational study of case control design. The study subjects were community members consisting of 19 adult cases of pulmonary tuberculosis and 38 controls. Data on nutritional intakes were obtained by semiquantitative food frequency questionnaire (FFQ), while smoking behavior, history of DM, body mass index, education, and income were obtained by structured interviews. The data were analyzed by independent t-test and logistic regression for calculation of the odds ratio (OR).&lt;/p&gt;&lt;p&gt;Results&lt;br /&gt;The bivariate test showed that the adequacy levels for energy (OR=6.8; 95% CI: 1.51-30.54), protein (OR=5.1; 95% CI: 1.52-17.14), vitamin A (OR=4.2; 5% CI: 1.31-13.54), vitamin C (OR=3.8;95% CI: 1.21-12.36), selenium (OR=4.2; 95% CI: 1.34-13.58), body mass index (OR=4.4; 95% CI: 1.32-14.35) and smoking behavior (OR=3.7; 95% CI: 1.15-11.9), were significant risk factors for pulmonary tuberculosis. Multiple logistic regression test showed that low body mass index (&amp;lt;18.5 kg/m2) (OR=6.0; 95% CI: 1.32-27.18) was a the most influential risk factor of pulmonary tuberculosis.&lt;/p&gt;&lt;p&gt;Conclusion&lt;br /&gt;Low body mass index is the most influential risk factor for pulmonary tuberculosis incidence in adult. Nutrition profile in adult is an important determinant of TB incidence.&lt;/p&gt;

Age-Related Macular Degeneration Cases in Prof. RD Kandou General Hospital, Manado

Background: To report the data of patients with age-related macular degeneration (AMD) at Vitreo-Retina Division of Ophthalmology Department of Prof. RD Kandou General Hospital, Manado.Methods: This study was descriptive retrospective using medical records at the OphthalmologyDepartment of Prof. RD Kandou General Hospital, Manado period of January 2014 until June 2016.The subjects of research were the medical records of patients diagnosed with age-related maculardegeneration.Results: Of 27 patients, 14 (51.9%) were male and 13 (48.1%) were female with age ranging from 41to 81 years old. By type of AMD, the distribution was 85.2% dry and 14.8% wet AMD. Among therisk factors of AMD were hypertension in 12 patients (44.4%), diabetes mellitus in 2 patients (7.4%),and both hypertension and diabetes mellitus in 3 patients (11.1%).Conclusion: The number of patients diagnosed with AMD was 27 patients, with insignificant genderdifference. Most of the patients fell on the 61 to 71 years old group (48.2%), with majority type weredry AMD. Hypertension was the most influential risk factor.

Financial difficulties in childhood and adult depression in Europe.

Financial difficulties in childhood may be associated with immediate and long-term consequences for mental health. The aim of the current paper is to investigate the association between childhood financial difficulties and adult depression, and assess the relative contribution of financial difficulties in childhood to symptoms of adult depression across different age groups. Using three age cohorts (25–40, 41–59, 60–75) from 19 countries in the European Social Survey Round 7 (N =18 401), multi-level and country-wise OLS regression analyses were used to investigate the association between financial difficulties in childhood and adult depression, while adjusting for age, education, gender, highest education in family, level of family conflict, number of social meetings and marital status. Financial difficulties in childhood was found to be influential predictors of depression scores for 25–40 year olds in 10 out of 19 countries in fully adjusted models. In older participants, depression scores were mostly influenced by frequency of social meetings and marital status. There was great variation in the pattern of influential risk factors across countries, and the predicted effect childhood financial difficulties had on adult depression scores. Childhood financial difficulties as predictors of depression appear to, by themselves, exert the strongest influence in younger adults. There was, however, large variation between countries in the magnitude of associated risk, and in the pattern of risk factors contributing to adult depression, which underscores the need to account for country-level factors when aiming to gain knowledge about mental health.

Inter-Individual Responses of Maximal Oxygen Uptake to Exercise Training: A Critical Review.

It has recently been reported how to quantify inter-individual differences in the response to an exercise intervention using the standard deviation of the change scores, as well as how to appraise these differences for clinical relevance. In a parallel-group randomised controlled trial, the key trigger for further investigation into inter-individual responses is when the standard deviation of change in the intervention sample is substantially larger than the same standard deviation derived from a suitable comparator sample. 'True' and clinically relevant inter-individual differences in response can then be plausibly expected, and potential moderators and mediators of the inter-individual differences can be explored. We now aim to critically review the research on the inter-individual differences in response to exercise training, focusing on maximal oxygen uptake (VO2max). A literature search through the relevant bibliographic databases resulted in the identification of six relevant studies that were published prior to the influential HEalth, RIsk factors, exercise Training And GEnetics (HERITAGE) Family Study. Only one of these studies was found to include a comparator arm. Re-analysis of the data from this study, accounting for random within-subjects variation, revealed an absence of clinically important inter-individual differences in the response of VO2max to exercise training. The standard deviation of change was, in fact, larger (±5.6mL/kg/min) for the comparator than the intervention group (±3.7mL/kg/min). We located over 180 publications that resulted from the HERITAGE Family Study, but we could not find a comparator arm in any of these studies. Some authors did not explain this absence, while others reasoned that only inter-individual differences in exercise response were of interest, thus the intervention sample was investigated solely. We also found this absence of a comparator sample in on-going studies. A perceived high test-retest reliability is offered as a justification for the absence of a comparator arm, but the test-retest reliability analysis for the HERITAGE Family Study was over a much shorter term than the length of the actual training period between baseline and follow-up measurements of VO2max. We also scrutinised the studies in which twins have been investigated, resulting in concerns about how genetic influences on the magnitude of general within-subjects variability has been partitioned out (again in the absence of a comparator no-training group), as well as with the intra-class correlation coefficient approach to data analysis. Twin pairs were found to be sometimes heterogeneous for the obviously influential factors of sex, age and fitness, thereby inflating an unadjusted coefficient. We conclude that most studies on inter-individual differences in VO2max response to exercise training have no comparator sample. Therefore, true inter-individual differences in response cannot be quantified, let alone appraised for clinical relevance. For those studies with a comparator sample, we found that the inter-individual differences in training response were not larger than random within-subjects variation in VO2max over the same time period as the training intervention.

Abstract 12519: Identification of Novel Atrial Fibrillation Risk Factors in The Women’s Health Initiative Database Utilizing the Random Generalized Linear Model

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia and confers significant risk of morbidity and mortality. The etiology of AF remains incompletely understood. The Women’s Health Initiative (WHI) provides an opportunity to evaluate an extensive and diverse set of covariates in a large population to identify novel risk factors. Hypothesis: We hypothesized that we would validate existing predictors of AF and discover novel markers associated with AF using a random generalized linear model (RGLM). Methods: A training subset of women enrolled into the WHI without pre-existing AF were included. Women were followed for AF using self-report and medical records coding. 104 demographic, medical history and environmental exposure covariates were selected for analysis in a RGLM. RGLM is a bootstrapped aggregated generalized linear model (GLM) that combines the predictive accuracy of random forests, a machine-learning algorithm, with the interpretability of forward selected GLM’s. Variables that are most commonly found in the best-performing regression models with randomly generated covariates are determined the most influential. Results: Of the 60,000 women included in this training set, 5,047 developed AF over an average of 16.3 years. The women were on average 61.9 years old at enrollment, 1.7% were African American, 0.9% were Hispanic, 35.2% had hypertension and 4.2% had diabetes. The RGLM generated 100 sub-cohorts with 75 covariates through random sampling. The top 50 covariates, based on correlation with incident AF, were evaluated by forward selection to generate GLM’s. The variables identified by the RGLM as being the most influential predictors were history of leukemia, prior pregnancy, systolic blood pressure, waist circumference, history of DVT, depression, and vegetable consumption. Conclusions: Using RGLM, we validated several established risk factors for AF. We also, for the first time in a large population cohort, identified history of leukemia as an influential risk marker of AF. Additional study will be needed to determine if leukemia-specific chemotherapy mediates this association. Finally, these novel markers will need to be validated in additional cohorts.

Effect of herd size on subclinical infection of swine in Vietnam with influenza A viruses.

BackgroundInfluenza A viruses of swine (IAV-S) cause acute and subclinical respiratory disease. To increase our understanding of the etiology of the subclinical form and thus help prevent the persistence of IAV-S in pig populations, we conducted active virologic surveillance in Vietnam, the second-largest pig-producing country in Asia, from February 2010 to December 2013.ResultsFrom a total of 7034 nasal swabs collected from clinically healthy pigs at 250 farms and 10 slaughterhouses, we isolated 172 IAV-S from swine at the weaning and early-fattening stages. The isolation rate of IAV-S was significantly higher among pigs aged 3 weeks to 4.5 months than in older and younger animals. IAV-S were isolated from 16 large, corporate farms and 6 family-operated farms from among the 250 farms evaluated. Multivariate logistic regression analysis revealed that “having more than 1,000 pigs” was the most influential risk factor for IAV-S positivity. Farms affected by reassortant IAV-S had significantly larger pig populations than did those where A(H1N1)pdm09 viruses were isolated, thus suggesting that large, corporate farms serve as sites of reassortment events.ConclusionsWe demonstrate the asymptomatic circulation of IAV-S in the Vietnamese pig population. Raising a large number of pigs on a farm has the strongest impact on the incidence of subclinical IAV-S infection. Given that only some of the corporate farms surveyed were IAV-S positive, further active monitoring is necessary to identify additional risk factors important in subclinical infection of pigs with IAV-S in Vietnam.Electronic supplementary materialThe online version of this article (doi:10.1186/s12917-016-0844-z) contains supplementary material, which is available to authorized users.

Entwicklung und Prüfung eines Screenings zur komplexen Posttraumatischen Belastungsstörung (SkPTBS)

Chronic interpersonal traumata systematically result in psychological impairments referred to as complex post-traumatic stress disorder (cPTSD or DESNOS). This diagnosis will be newly established in the ICD-11 system. However, there is need for diagnostic instruments to assess cPTSD. The aim was to develop a screening form to identify patients at risk for cPTSD. The Screening for complex PTSD (SkPTBS) tests a) experience of potential traumatic events, b) related influential features and risk factors, and c) symptoms of cPTSD. 325 patients (mean age 51.5±8.7 years; 62.1% female) filled out the screening instrument at the beginning of their inpatient psychotherapy. The primary criterion for testing SkPTBS validity was the diagnosis of complex PTSD at the end of the inpatient treatment. The proportion of patients with cPTSD was 8.9% (n=29). SkPTBS items were selective, and the scale showed very good reliability (α=0.91). Factor analysis revealed a one-dimensional structure. SkPTBS total values predicted having cPTSD diagnosis and were correlated with global symptom severity (SCL-90-R) and depressive symptoms (BDI-II). There is evidence for high clinical utility of SkPTBS. A revised version was developed.

Risk factors for treatment failure and recurrence of anisometropic amblyopia.

The aim of this study was to identify factors associated with failed vision improvement and recurrence following occlusion therapy for anisometropic amblyopia in children aged 7-9years. We retrospectively reviewed the medical records of 64 children aged 7-9years who had been diagnosed as having anisometropic amblyopia and were treated with patching. Functional treatment failure was defined as final visual acuity in the amblyopic eye of worse than 20/32. Improvement of fewer than two logMAR lines was considered relative treatment failure. Recurrence was defined as the reduction of at least two logMAR levels of visual acuity after decreased or discontinued patching. Functional and relative success rates were 51.6 and 62.5%, respectively. The most important factor for functional treatment failure [adjusted odds ratio (OR) (95% confidence interval, CI)11.57 (1.4-95.74)] and the only risk factor for recurrence [adjusted OR (95% CI)3.04 (1.13-8.12)] were the same: high spherical equivalent (SE) of the amblyopic eye. A large interocular difference in the best-corrected visual acuity was found to be a risk factor for both functional and relative failure. High SE of the amblyopic eye was the most influential risk factor for treatment failure and recurrence in compliant children aged 7-9years.

Primary analysis and prioritization of risks of biowaiver procedure

Aim: To conduct cause-effect analysis of identified risks, ranking and prioritization according to general risk assessment methodology to ensure proper execution of biowaiver procedure in compliance with necessary requirements for its reproduction. Methods: Was used method of cause-effect analysis with construction of Ishikawa diagram. Prioritization of risks was performed with help of expert evaluation.Results: Performed analysis allowed to identify the most influential risk factors, negative effect of which can cause significant consequences during conduction of bioequivalence studies of generic drug and reference drug based on biowaiver procedure.Conclusions: Identified and justified priorities among identified risks are carriers of primary causes of potential risk of problem arising in ensuring the quality of conduction of biowaiver procedure. Further studies should be linked to a more profound analysis and risk assessment with regard to their potential threat and probability and formulation of proposals for preventive actions to ensure compliance with established requirements of biowaiver procedure

Advanced uncertainty modelling for container port risk analysis

Globalization has led to a rapid increase of container movements in seaports. Risks in seaports need to be appropriately addressed to ensure economic wealth, operational efficiency, and personnel safety. As a result, the safety performance of a Container Terminal Operational System (CTOS) plays a growing role in improving the efficiency of international trade. This paper proposes a novel method to facilitate the application of Failure Mode and Effects Analysis (FMEA) in assessing the safety performance of CTOS. The new approach is developed through incorporating a Fuzzy Rule-Based Bayesian Network (FRBN) with Evidential Reasoning (ER) in a complementary manner. The former provides a realistic and flexible method to describe input failure information for risk estimates of individual hazardous events (HEs) at the bottom level of a risk analysis hierarchy. The latter is used to aggregate HEs safety estimates collectively, allowing dynamic risk-based decision support in CTOS from a systematic perspective. The novel feature of the proposed method, compared to those in traditional port risk analysis lies in a dynamic model capable of dealing with continually changing operational conditions in ports. More importantly, a new sensitivity analysis method is developed and carried out to rank the HEs by taking into account their specific risk estimations (locally) and their Risk Influence (RI) to a port’s safety system (globally). Due to its generality, the new approach can be tailored for a wide range of applications in different safety and reliability engineering and management systems, particularly when real time risk ranking is required to measure, predict, and improve the associated system safety performance.

Domestic abuse, crime surveys and the fallacy of risk: Exploring partner and domestic abuse using the Scottish Crime and Justice Survey

The Scottish Crime and Justice Survey (SCJS) consistently suggests similar prevalence of domestic abuse among men and women, a finding used variously to indicate men and women’s equal risk of abuse and to dismiss the survey as a means to explore such experiences. However, assertions of equal risk are based on limited analyses of data reduced to ‘key’ figures for public dissemination, and subsequent criticisms fail to meaningfully engage with the broader data offered by the survey. Theoretically informed multivariate analyses demonstrate that risk of abuse is inadequately captured by such figures, supporting that women and men are not at equal risk, and that gender is but one of a number of influential risk factors. This article proposes the SCJS data could be put to greater use, offering rich information for developing theory and responses to violence, and that critical engagement with the survey is necessary to facilitate methodological improvement.

Rehabilitation Predictors of Clinical Outcome following Revision ACL Reconstruction

Objectives:Revision ACL reconstruction has been documented to have worse outcomes compared with primary ACL reconstructions. The reasons why remain unknown. The purpose of this study was to determine whether rehabilitation-related factors prescribed at the time of ACL revision reconstruction significantly influence two year outcomes, as well as the incidence of incurring a subsequent re-operation. Our hypothesis was that immediate versus passive, active range of motion (ROM) and weightbearing will result in improved outcomes without incidence of subsequent surgery. Use of postoperative and functional return to sport braces will not improve return to sports function.Methods:Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, prescribed post-op and rehabilitation instructions (ie. timing of weightbearing, timing of passive and active ROM, use of postoperative and return to sport braces) and a series of validated patient reported outcome instruments (IKDC, KOOS, and Marx activity rating score). Patients were followed up for 2 years, and asked to complete the identical set of outcome instruments. Because meniscal repair, meniscal transplants, HTOs, concurrent ligamentous reconstructions, and certain chondral treatments (ie. microfracture, abrasion arthroplasty, mosiacplasty, etc) are known to affect prescribed rehab treatments, patients with these pathologies were excluded from the analyses. Regression analysis was used to control for age, gender, activity level, baseline outcome scores, and the above-mentioned rehabilitation-related variables, in order to assess the risk factors for clinical outcomes 2 years after revision ACL reconstruction.Results:A total of 843 patients met the inclusion criteria and were successfully enrolled. 482 (57%) were males, with a median cohort age of 27 years. Baseline characteristics of the cohort are summarized in Table 1. At 2 years, follow-up was obtained on 82% (694/843). There were two rehabilitation-related factors which were found to be influential of 2 year outcomes. Patients who were prescribed an ACL brace for return to sport had significantly better KOOS sports/rec scores at 2 years (odds ratio=1.50; 95% CI=1.07-2.11; p=0.019). Patients who were prescribed an ACL derotation brace to be used in post-op rehab were 2.26 times more likely to have a subsequent surgery by 2 years (OR = 2.26; 95% CI=1.11-4.60; p=0.024). Lower baseline outcome scores, activity level, and female gender all significantly increased the odds of reporting poorer clinical outcomes (IKDC, all KOOS subscales, and Marx activity rating score) at 2 years. Alternatively, whether or not a physician restricted a patient’s passive or active ROM post-operatively, restricted full weight-bearing without support, or prescribed a motion control brace post-op, were all found not to be influential risk factors for 2 year outcomes in this revision cohort.Conclusion:There are rehabilitation-related factors that the physician can control at the time of an ACL revision which have the ability to modify clinical outcomes at 2 years. The odds of having a higher KOOS sports/rec score increases by 50% in patients who wore a functional brace for sports (versus patients who didn’t). However, patients who were prescribed a derotation brace used for post-op rehab were 2.3 times more likely to incur a subsequent surgery by 2 years.

Progress in the Prevention and Treatment of AIDS Associated with Tuberculosis

AbstractEpidemiological studies have shown that infection with the human immunodeficiency virus (HIV) is an influential risk factor for infection withMycobacterium tuberculosis(MTb), the rapid progression of the initial infection to active tuberculosis (TB), and the reactivation of latent TB infection. MTb infection is also one of the most common opportunistic infections in people with HIV, including AIDS patients receiving anti-retroviral therapy. Given the prevalence of HIV infection, the incidence of TB infection, which had begun to decline, is facing a severe situation. HIV associated with TB exerts an immense burden on the public health-care system, especially in countries with high incidences of HIV infection. Therefore, the global policies for the prevention and control of TB should be revised. Moreover, an increased investment in TB control has to be guaranteed. The purpose of this review is to summarize the recent progress in the prevention, treatment, and control of HIV and TB co-infection.

Large Residual Volume, Not Low Packing Density, Is the Most Influential Risk Factor for Recanalization after Coil Embolization of Cerebral Aneurysms.

BackgroundTight coil packing with density of at least 20%–25% is known to be important for preventing recanalization after embolization of cerebral aneurysms. However, large aneurysms sometimes recanalize regardless of the packing density, suggesting that the absolute residual volume which is determined by aneurysm volume and packing density may be more important risk factor for recanalization. To validate this hypothesis, we analyzed the factors affecting the outcomes of treated aneurysms at our institute.Methods and FindingsWe included 355 small and large aneurysms. The following six factors were obtained from every case: aneurysm volume (mL), neck size (mm), packing density (%), residual volume (mL), rupture status at presentation, and stent assistance (with or without stent). The data were then subjected to multivariate logistic regression analysis to identify significant risk factors for recanalization. Recanalization occurred in 61 aneurysms (17.2%). Significant predictors for recanalization were aneurysm volume (odds ratio, 15.3; P < 0.001) and residual volume (odds ratio, 30.9; P < 0.001), but not packing density (odds ratio, 0.98; P = 0.341). These results showed that for each 0.1-mL increase in aneurysm volume and residual volume, the risk of recanalization increased by 1.3 times and 1.4 times, respectively.ConclusionsThe most influential risk factor for recanalization after coil embolization was residual volume, not packing density. The larger the aneurysm volume, the greater the packing density has to be to minimize the residual volume and risk of recanalization. Since tight coil packing has already been aimed, further innovation of coil property or embolization technique may be needed. Otherwise, different treatment modality such as flow diverter or parent artery occlusion may have to be considered.

Association of infant and young child feeding practices with under-nutrition: evidence from the Nepal Demographic and Health Survey

Background: Childhood undernutrition remains a highly influential risk factor in terms of the global burden of disease. Increasing evidence links infant and young child feeding (IYCF) practices to undernutrition. However, the results are inconsistent, and more country-specific studies are needed.Objectives: To determine the associations between IYCF practices and nutritional outcomes among children aged 0–23 months using a nationally representative dataset.Methods: The study used data from the 2011 Nepal Demographic and Health Survey, and the data were analysed for children aged 0–23.9 months who had corresponding data for the outcome variables of interest (n = 890). Multiple linear and logistic regressions were undertaken and adjusted for the complex design of the survey, controlling for child, maternal, household and community characteristics.Results: Of the 890 children included in the study, 83% received age-appropriate breastfeeding but only 48% were breastfed within 1 hour of birth. Exclusive breastfeeding under 6 months of age was associated with a higher weight-for-age Z-score (WAZ) and a lower probability of wasting, but the estimated effects were of borderline significance. A significant negative association was found between continued breastfeeding at 1 year and WAZ and weight-for-height Z-score (WHZ). Timely introduction of complementary feeding in children aged 6–8 months was associated with a higher WAZ [effect size (ES) 0.6, P < 0.01] and higher WHZ (ES 0.6, P < 0.05). Higher dietary diversity index (DDI) was associated with higher height-for-age Z-score (ES 0.1, P < 0.05 for each DDI point). Children who achieved minimum meal frequency had a higher WAZ (ES 0.3, P < 0.05).Conclusion: This is the first study to relate the wide ranges of IYCF indicators with child nutritional outcomes in Nepal, and it underscores the need to improve age-appropriate complementary feeding practices with a sustained focus on exclusive breastfeeding to reduce undernutrition in infants and young children.