Spearman Rank Order Correlation Research Articles

Characteristics Associated With Outstanding General Surgery Residency Graduate Performance, as Rated by Surgical Educators

Characteristics of outstanding graduating surgical residents are currently undefined. Identifying these qualities may be important in guiding resident selection and resident education. To determine characteristics that are most strongly associated with being rated as an outstanding graduating surgical resident. The multi-institutional study had 3 phases. First, an expert panel developed a list of characteristics embodied by top graduating surgical residents. Second, groups of faculty from 14 US general-surgery residency programs ranked 2017 through 2020 graduates into quartiles of overall performance. Third, faculty evaluated their graduates on each characteristic using a 5-point Likert scale. Data were analyzed using Spearman rank-order correlation to identify which individual characteristics were associated with overall graduate performance. A least absolute shrinkage and selection operator (LASSO) ordinal regression was performed to select a parsimonious model to predict the outcome of overall performance rating from individual characteristic scores. Surgical educators' rankings of general surgery residency graduates' overall performance. Fifty faculty from 14 US residency programs with a median of 13 (range, 5-30) years of surgical education experience evaluated 297 general surgery residency graduates. Surgical educators identified 21 characteristics that they believed outstanding graduating surgical residents possessed. Two hundred ninety-seven surgical residency graduates were evaluated. Higher scores in every characteristic correlated with better overall performance. Characteristics most strongly associated with higher overall performance scores were surgical judgment (r = 0.728; P < .001), leadership (r = 0.726; P < .001), postoperative clinical skills (r = 0.715; P < .001), and preoperative clinical skills (r = 0.707; P < .001). The remainder of the characteristics were moderately associated with overall performance. The LASSO regression model identified 3 characteristics from which overall resident performance could be accurately predicted without measuring other qualities: surgical judgment (odds ratio [OR] per 1 level of 5-level Likert scale OR, 1.27; 95% CI, 1.03-1.51), leadership (OR, 1.27; 95% CI, 1.06-1.48), and medical knowledge (OR, 1.16; 95% CI, 1.01-1.33). All individual characteristics identified by surgical educators as being qualities of outstanding graduating surgical residents were positively associated with overall graduate performance. Surgical judgment and leadership skills had the strongest individual associations. Assessment of only 3 qualities (surgical judgment, leadership, and medical knowledge) were required to predict overall resident performance ratings. These findings highlight the importance of developing specific surgical judgment and leadership skills curricula and assessments during surgical residency.

Brand Innovation Strategies and Customer Retention of Soft Drink Firms in South-East Nigeria

This study examined brand innovation strategies and customer retention of soft drink firms in South-East Nigeria. The study adopted the correlational research design. The population of the study consisted of all the soft drink firms in South-East Nigeria. The unit of analysis was made up of managers of the three (3) soft drink firms in South-East Nigeria. Eighteen (18) managers per firm who fall under the categories of branch managers, operations managers, production managers, marketing managers and sales managers were identified in the three (3) soft drink firms in South-East Nigeria and they formed the sampling frame of the study. The census sampling technique was adopted in this study where all the 18 managers of the above categories were used as the sample for the study. A structured questionnaire was used to obtain data from the respondents. The data collected were analyzed statistically while the hypotheses were tested using Spearman Rank Order Correlation Coefficient (rho). The SPSS version 23.0 was used to perform the correlation analysis. The findings revealed that soft drink firms in South-East Nigeria adopt incremental and radical innovation as a way of keeping their brand competitive and enticing to their customers. The study revealed that incremental innovation is a strong and significant predictor of repeat patronage and customer referral. Based on these findings, it was concluded that brand innovation strategies (incremental and radical innovation) and customer retention of soft drink firms in South-East Nigeria. Based on the findings and conclusion, it was recommended that soft drink firms in South-East Nigeria especially those that are experiencing high level of customer defection should adopt brand innovation strategies as it would help to retain their existing customers.

Age and Sex Differences in the State and Relationships between Process and Product Assessments of Fundamental-Motor Skills in Five to Eight-Year-Olds: The ExAMIN Youth SA Study.

Adequate development of Fundamental Motor Skills (FMS) at a young age benefit holistic development and positive health outcomes. This study determined age and sex developmental differences in the state and the relationships between process and product assessments of four fundamental-motor skills (FMS) in five to eight-year-olds. An availability sample of 636 children; 291 boys, 345 girls, mean age of 6.8 ± 0.97 years in the North West Province of South Africa participated in the study. Spearman rank order correlations analyzed relationships between assessments, while sex and age differences were examined using independent t-testing and one-way ANOVA. Age showed significant developmental trajectories in all FMS. Older children were found to be more at risk for not learning FMS to mastery, while unique developmental patterns were also established compared to international trends. Strong to moderate significant practical associations (p < 0.05) emerged between process and product assessments in catching (r = 0.79), jumping (r = 0.40) running (r = −0.33) and kicking (r = 0.20), while also confirming that the strength of the associations varies depending upon the skill type. Associations strengthened with increasing age, were higher in girls in all FMS, while associations between behavioral criteria in all FMS also differed between FMS and sexes. These strong associations, need to be taken into consideration during the development of FMS towards obtaining full mastery.

Adverse events during neoadjuvant chemotherapy for muscle invasive bladder cancer-a Swedish retrospective multicentre study of a clinical database.

BackgroundAdverse events (AEs) during neoadjuvant chemotherapy (NAC) for muscle invasive bladder cancer (MIBC) are known but insufficiently reported. Clinical implications include affected cardiac, pulmonary, urinary, vascular and haematological organ systems. The main purpose was to evaluate the incidence and severity of AEs for ascertaining possible clinical significance. Further investigating possible effects of AEs on downstaging outcomes—downstaging is considered a surrogate marker for overall survival (OS).MethodsA retrospective evaluation of AEs during ongoing NAC for MIBC patients analysing individual patient data in a clinical database. We identified 687 cystectomies between 2009–2020 at four Swedish urological centres. Inclusion criteria were cT2–4aN0M0 in 261 NAC patients undergoing radical cystectomy (RC). Medical files were reviewed and AEs were assessed and graded, including detailed measurements by the Common Terminology Criteria for Adverse Events (CTCAE) v.5. Data were retrospectively analysed in SPSS statistics 27.0 with Spearman rank-order correlation coefficient and Mann-Whitney U-test (MWU).ResultsA total of 251/261 patients [95% confidence interval (CI), 93–98%] experienced AEs during NAC pre-RC (mean two AEs/patient). In total, 208 (80%) patients received methotrexate, vinblastine, adriamycin (doxorubicin) and cisplatin (MVAC). In the total cohort, 200 (76.6%) received all pre-planned NAC-cycles. Most common AEs were anaemia (88.9%), thrombocytopenia (44.8%) and acute kidney injury (40.6%). Patients with prematurely terminated cycles had higher AE-grades (P=0.042 MWU). A correlation between higher AE-grades and decrease in downstaging existed, in the entire cohort (−0.133; P=0.033) and in patients undergoing all pre-planned NAC-cycles (−0.148; P=0.038). Anaemia and acute kidney injury were individually associated with decreased downstaging (−0.360, P=0.025 and −0.183, P=0.010, respectively).ConclusionsNAC in MIBC poses a significant risk for AEs before RC with clinical implications. For instance, patients terminating chemotherapy prematurely, have higher AE-grades and decreased downstaging. Further, acute kidney injury and anaemia are individually associated with decreased downstaging. We propose that early detection and prevention of AEs may increase downstaging of the primary tumour.

Victimisation, Depression and Suicidal Ideation among Lesbian, Gay and Bisexual Adults in Malaysia.

BackgroundLesbian, gay and bisexual (LGB) individuals have been found to experience a high prevalence of psychological conditions. The present study aims to examine the relationship between victimisation, depression and suicidal ideation among LGB adults in Malaysia.MethodsThis study used a cross-sectional design. We distributed the questionnaire online using snowball sampling and self-identified LGB adults responded to the survey. Scales on sexual minority-specific victimisation, depression and suicidal ideation were employed. The data were analysed using Spearman rank order correlation and Kruskal-Wallis tests.ResultsThe study included 220 adults in Malaysia (156 males and 64 females; 58 lesbian, 112 gays and 50 bisexuals). Ninety-two participants (41.8%) reported experiencing sexual minority-specific victimisation; 29 participants (13.2%), 35 participants (15.9%) and 23 participants (10.5%) were mildly, moderately and severely depressed, respectively and 44.0% participants were experiencing current suicidal ideation. The correlations were fair (rs = 0.30) between victimisation and depression, poor (rs = 0.16) between victimisation and suicidal ideation, and moderate (rs = 0.60) between depression and suicidal ideation. There were no differences between homosexual and bisexual participants in victimisation, depression and suicidal ideation.ConclusionThis study contributes to a better understanding of the relationship between victimisation, depression and suicidal ideation among LGB adults in Malaysia.

Community structure and environmental determinants of the bacterial and fungal gut microflora in Hainan gibbons (Nomascus hainanus)

High-throughput sequencing technology was used to establish the OTU (Operational Taxonomic Units) composition and diversity of bacteria and fungi in the gut of three family groups of Hainan gibbons ( Nomascus hainanus ) in the Bawangling National Nature Reserve on Hainan Island, southern China. Firmicutes (47.23%) and Bacteroidetes (36.54%) predominated at the phylum level, while the predominant genera were Prevotella-7 (15.30%), Lachnospiraceae_NK3A20_group (12.49%), and uncultured_bacterium_f_Erysipelotrichaceae (11.79%). At the phylum level, the dominant fungi were Ascomycota (66.41%), as well as Hanseniaspora (23.33%), Schwanniomyces (13.44%), and Pichia (5.43%) at the genus level. We found significant differences in the bacterial OTU diversity (Shannon index) between family groups living in Tropical Lowland or Tropical Montane Rain Forest, compared to those inhabiting Tropical Montane Evergreen Forest at higher altitudes. Bacterial OTU community composition also differed between family groups, unraveling significant differences among the 30 most dominant bacterial core taxa. Furthermore, we unraveled a significant difference of OTU richness in the fungal microbiome (Chao 1) between family groups living at lower altitudes, i.e., Tropical Lowland or Tropical Montane Rain Forest and those inhabiting the Tropical Montane Evergreen Forest. Our analysis further indicated significant differences in the fungal OTU community composition between the three family groups, especially regarding the three most dominant fungal core taxa. Subsequently, two habitat factors, and nine environmental and anthropogenic variables were used to explore possible causes of disparity in the microbial flora of gibbon groups. A factor reduction procedure resulted into three principal components which were correlated to bacterial and fungal OTU richness and diversity using Spearman's rank-order correlations. Bacterial and fungal OTU diversity was high in areas of high altitude, steep slopes, high tree density, but low tree height, while high fungal OTU richness corresponded to high altitude habitats, i.e., in the Tropical Montane Evergreen Forest. Distance to human settlements and to the next water body showed no significant relation with bacterial and fungal richness and diversity.

Decreased online hepatitis information seeking during the COVID-19 pandemic: an Infodemiology study.

SummaryIntroductionViral hepatitis remains a public health concern worldwide, mainly in developing countries. The public’s awareness and interest in viral hepatitis information are essential in preventing and controlling this disease. Infodemiology has been used as a surrogate to assess the general understanding of disease and measure public awareness of health topics. However, this analysis has not been applied to viral hepatitis. Thus, this study investigated the online global search interest for viral hepatitis in the last decade, focusing on the period before and during the COVID-19 pandemic.MethodsGlobal online search interest for hepatitis was measured using the Google Trends™ database. Spearman’s rank-order correlation correlated country-specific characteristics and prevalence data with search volume index.ResultsThere was a significant reduction in online search interest for hepatitis during the COVID-19 pandemic (2020). People searching for hepatitis are also interested in hepatitis vaccination. Search volume index is positively correlated with viral hepatitis and HIV prevalence and negatively correlated with GDP. This correlation mirrors the high burden of viral hepatitis in developing countries and their citizens’ desire to be informed about this disease.ConclusionsOur study found decreased global online interest in viral hepatitis during the pandemic. Moreover, higher online interest in hepatitis was observed in countries with a lower gross domestic product and high viral hepatitis and HIV prevalence. We demonstrated that global online interest toward viral hepatitis could be assessed through the infodemiologic approach using Google Trends™.

The relationship between foot and ankle joint flexibility measures and barefoot plantar pressures in healthy older adults: a cross-sectional study

BackgroundRestriction in foot and ankle joint range of motion, such as an ankle equinus, has been associated with increased plantar pressure and its complications. However, previous research is limited by its scope of measures and study populations. The aim of this study was to investigate the relationship between foot and ankle joint range of motion on barefoot plantar pressures during walking in healthy older adults.MethodsThis cross-sectional study recruited 49 older adults. Participants underwent measures of foot (first metatarsophalangeal dorsiflexion range of motion, and navicular drop and drift) and ankle joint range of motion, foot posture, body mass index, and plantar pressure during barefoot walking. Spearman Rank Order Correlations were used to explore the relationship between foot and ankle measures, body mass index, and plantar pressure, with significant correlations explored in a hierarchical regression analysis. A Mann-Whitney U test was performed to compare plantar pressure values between those with and without ankle equinus per region of the foot.ResultsMean (SD) age and BMI were 72.4 years (5.2) and 29.8 kg/m2 (5.9) respectively. A total of 32 of the 49 participants (65%) identified as female sex. Mean (SD) ankle joint range of motion was 32.7 (6.4) degrees with 17/49 (34.7%) participants classified as having an ankle equinus (defined as < 30 degrees of ankle joint dorsiflexion range of motion). We found that an ankle equinus predicted a statistically significant amount of peak forefoot plantar pressure (p = 0.03). Participants with an ankle equinus displayed significantly higher forefoot peak pressure 677.8 kPa (589.9 to 810.4) compared to those with no equinus 565.58 kPa (447.3 to 651.2), p = 0.02. A statistically significant correlation was found between body mass index and midfoot peak pressure (p < 0.01) and pressure-time integral (p < 0.01). No other significant correlations were found.ConclusionClinicians should consider screening for an ankle equinus and body mass index as a simple way to identify which healthy older adults may be at risk of pressure-related complications in the mid- and forefoot.

Pregnant Women’s Perception of Corona Virus Pandemic, and the Precautionary Measures they adopt toward Curtailing the Pandemic in South-South Nigeria

The decreased immunologic competency during pregnancy calls for intensified precautionary measures against corona virus disease among pregnant women. This Cross-Sectional study focused on pregnant women’s perception of corona-virus pandemic and the precautionary measures they adopt toward curtailing the pandemic. The objectives of the study were to determine pregnant women’s view/beliefs about Covid-19 pandemic, the extent of their compliance with wearing of face masks and maintenance of social distancing. Multistage sampling technique was used to select 144 pregnant women from the primary, secondary and tertiary health facilities in Edo State out of the six States that constitute South-South Nigeria. The instrument used for data collection was a self-developed Questionnaire on pregnant women’s Perception and the precautionary measures they adopt for corona-virus pandemic (QPWPPMCP). The reliability of the instrument was conducted using internal consistency test for reliability, and the Cronbach alpha yielded coefficient of 0.711. Data collected were analysed using frequencies, percentages, mean and Spearman Rank Order correlation. Majority of the respondents indicated that Covid-19 is real (87.5%) and is existing (86.1%). 63.9% indicated that Covid-19 is caused by germ, 68.1% indicated that they always wore face masks, and 73.6% maintained physical/social distancing. There was significant relationships between pregnant women’s view about existence of Covid-19 and their compliance with wearing of face masks (rho = 0.334; p-value = &lt; 0.001), as well as between belief about cause of Covid-19 and wearing of face masks (rho = 0.173; p-value = 0.038).

Upper extremity field tests and isokinetic shoulder internal and external strength and power in sports active males

BACKGROUND: In order to guide sports active subjects with musculoskeletal (MSK) shoulder dysfunctions it is essential to have precise insights of possible weak links in the kinetic chain of their shoulder girdle with access to reference data. Equally, it is uncertain whether so-called functional shoulder strength tests are complementary to an isokinetic shoulder strength test. OBJECTIVE: To establish reference values and to clarify the relationship between two upper extremity field tests – the Scapular Muscle Endurance test (SME) and the Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST) and the isokinetic strength test of the shoulder internal (IR) and external rotators (ER). METHODS: Seventy-six male sport active men performed the CKCUEST, the SME, and underwent a bilateral isokinetic strength test to establish reference values of the isokinetic shoulder relative to body mass Peak Moment (PM/kg) and Power (Power/kg) for the IR and ER. A mixed-design ANOVA calculated possible side-to-side differences and one-way ANOVA was applied for eventually age group differences. Additionally, the relationship between the three tests was examined with a Spearman rank-order correlation coefficient. RESULTS: No significant correlations were indicated between the SME and the criterion isokinetic test and between the SME and CKCUEST. CONCLUSIONS: The main outcome parameters in this study warrant individual assessment as they measure different constructs, leading to a diverse profile of the shoulder.

Long-term tracking and population characteristics of lipoprotein (a) in the Cardiovascular Risk in Young Finns Study

Background and aimsLipoprotein (a) (Lp(a)) is a causal risk factor for cardiovascular diseases and its levels are under strict genetic control. Therefore, it is hypothesized that the concentration of Lp(a) remains stable throughout life. Finns have lower Lp(a) levels than central Europeans, but it is unknown whether there are differences within Finland, especially between the eastern and western parts of the country with known genetic duality and persistent differences in cardiovascular disease rates. We have examined the long-term stability of Lp(a) levels over 25 years in the Cardiovascular Risk in Young Finns Study (YFS), and the characteristics of individuals with different Lp(a) levels, including their geographical origin within Finland. MethodsIn YFS, the first large baseline examination was conducted in 1980 (baseline age, 3–18 years). Several follow-ups during the past 40 years have been conducted to investigate the determinants of cardiometabolic health. Lp(a) levels have been measured in study years 1986 (N = 2464, ages 9–24 years), 2001 (N = 2281, ages 24–39 years), 2007 (N = 2204, ages 35–45 years) and 2011 (N = 2044, ages 39–49 years). Tracking of Lp(a) was estimated by calculating Spearman's rank order correlations between the study years, and by cross-tabulating how many individuals diagnosed with either elevated or non-elevated Lp(a) levels in 1986, 2001 and 2007 remained in the same category in the latest follow-up in 2011. ResultsSpearman's correlation coefficients varied between r = 0.84–0.96. Most individuals (87–94%) who had a high Lp(a) level (>30 mg/dl) in any of the previous study years had a high level also in 2011. On average, the median Lp(a) levels were consistently ∼20% higher in the individuals originating from eastern Finland compared to those from western Finland, but there were no differences in the distribution of known genetic determinants between eastern and western Finns that would have explained the observed difference. ConclusionsThese data confirm that Lp(a) levels remain very stable over the life-course. In line with the genetic duality between eastern and western parts of Finland, we observed about 20% higher Lp(a) levels in individuals originating from eastern Finland compared to those originating from western Finland.

Job Satisfaction and Work Commitment of Hospitality Industry Employees in Dapitan City

This study investigated the relationship between job satisfaction and work commitment among Dapitan City’s hospitality industry employees. It used a descriptive research method utilizing a questionnaire as the principal tool for gathering data. Data were statistically treated using frequency, weighted mean, Mann-Whitney U-Test, Kruskal-Wallis H-Test, and Spearman Rank-Order Correlation. The study revealed that employees were satisfied with their salary (existence), work environment (relatedness), and the way they were mentored in the performance of their jobs (growth). Most of the employees were committed to their work as they identified that the establishment had a deep sense of personal meaning to them (affective); that, for now, choosing to remain in the organization is motivated by both necessity and desire (continuance); and the establishment deserves their loyalty (normative). A significant difference resulted in job satisfaction when analyzed according to civil status. Moreover, when analyzed according to educational attainment and employment status, a significant difference was identified in employees' work commitment. Finally, it was discovered that among hospitality industry employees in Dapitan City, job satisfaction and work commitment have a considerably high positive relationship. Hospitality industry stakeholders and employees are encouraged to support educational advancement and enhance management practices to minimize employee turnover. Legislators and policymakers are encouraged to enact policies and measures in line with the improvement and advancement of hospitality industry employees.

Evaluation of the compatibility of C2, C3, and C4 fractal dimension values with hand-wrist and cervical vertebra maturation methods in determining skeletal maturation.

To examine the correlation between the fractal dimension (FD) values of cervical vertebrae (C2, C3, and C4) and hand-wrist maturation (HWM) and cervical vertebra maturation (CVM) methods. In addition, the correlation between the pubertal growth spurt (PGS) and FD values was examined. The lateral cephalometric and hand-wrist radiographs of 120 subjects (61 females and 59 males) aged 8-18 years with a mean age of 13 years, were evaluated retrospectively. The CVM stages were determined in accordance with Hassel-Farman's modification of Lamparski criteria. The HWM stages were determined in accordance with Björk and Grave-Brown criteria. Both HWM and CVM stages were divided into two according to PGS. Fractal analysis of cervical vertebrae was performed according to the White-Rudolph method. The relationships between HWM stages, CVM stages and other variables were evaluated by Spearman's rank-order correlation coefficient. The relationships between FD values, chronological age, and divided stages were evaluated by the Pearson correlation coefficient. The Mann-Whitney U test was used to compare the FD values of two divided stages. There were positive and statistically significant positive correlations between chronological age and both HWM and CVM stages. There was a positive and statistically significant correlation between CVM and HWM stages. In females and total, there were negative and statistically significant correlations between C4 FD values and divided HWM stages, and the differences between C4 FD values of divided HWM stages were also statistically significant. In total, there was a negative and statistically significant correlation between C4 FD values and divided CVM stages, and the difference between C4 FD values of divided CVM stages was also statistically significant. The negative correlations found between C4 FD values and divided HWM and CVM stages suggest the fractal analysis of cervical vertebrae, especially of C4, may be used as an objective tool for evaluating the PGS.

An Improved Method for Evaluating Image Sharpness Based on Edge Information

In order to improve the subjective and objective consistency of image sharpness evaluation while meeting the requirement of image content irrelevance, this paper proposes an improved sharpness evaluation method without a reference image. First, the positions of the edge points are obtained by a Canny edge detection algorithm based on the activation mechanism. Then, the edge direction detection algorithm based on the grayscale information of the eight neighboring pixels is used to acquire the edge direction of each edge point. Further, the edge width is solved to establish the histogram of edge width. Finally, according to the performance of three distance factors based on the histogram information, the type 3 distance factor is introduced into the weighted average edge width solving model to obtain the sharpness evaluation index. The image sharpness evaluation method proposed in this paper was tested on the LIVE database. The test results were as follows: the Pearson linear correlation coefficient (CC) was 0.9346, the root mean square error (RMSE) was 5.78, the mean absolute error (MAE) was 4.9383, the Spearman rank-order correlation coefficient (ROCC) was 0.9373, and the outlier rate (OR) as 0. In addition, through a comparative analysis with two other methods and a real shooting experiment, the superiority and effectiveness of the proposed method in performance were verified.

Evaluation of the multiple tissue factors in bone of primary osteoplasty and rhinoplasty in patients affected by cleft lip palate.

Clefts of the lip and/or palate (CLP) are visible disruptions of standard facial structure. The aim of our study was to determine a relative number and appearance of the tissue factors in bone of patients with CLP during first time plastic alveolar osteoplasty or rhinoplasty. Immunohistochemistry was performed with matrix metalloproteinase-8 (MMP-8), matrix metalloproteinase-9 (MMP-9), osteopontin (OPN), osteocalcin (OC), Runt-related transcription factor 2 (Runx2), beta-defensin-2 (βdef-2), beta-defensin-3 (βdef-3), interleukin-1 alpha (IL-1α), and interleukin-10 (IL-10). The bone formation was observed by Masson-trichrome (Masson) staining. For the quantification of structures, the semi-quantitative census method was used. Spearman rank order correlation coefficient and Mann-Whitney U test were used for the statistical analysis. A significantly higher number of OPN positive osteocytes was observed in the CLP group when compared to the control group (p=0.002). The number of OC positive osteocytes (p=0.000) and βdef-2 positive osteocytes (p=0.003) was significantly lower in the CLP group in comparison to the control group. Strong, positive correlations between IL-10 and OC (rs=0.608; p=0.002), IL-1α and MMP-9 (rs=0.666; p=0.000), OPN and MMP-8 (rs=0.620; p=0.002) were detected in the CLP group. A tendency for the increased appearance of MMP-8, MMP-9 positive osteocytes of the patients with CLP, suggests elevated tissue remodelling properties. Increased appearance of OPN positive osteocytes in bone of the patients with CLP shows increased bone homeostasis based on seriously decreased mineralization, which may be a possible compensatory reaction to decreased quality of postsurgical bone.

Poster 264: Ambulatory Surgery Centers Reduce Day-of-Surgery Expenditures for Anterior Cruciate Ligament Reconstruction Without Increasing Patient Out-of-Pocket Expenditure: A Breakdown and Comparison of Expenditures on 34,862 Patients

Objectives: Anterior cruciate ligament reconstruction (ACLR) is one of the most performed orthopedic procedures in the United States and the volume and cost are increasing annually. Patients are increasingly expected to share a larger economic burden with out-of-pocket expenditures. Recently, there has been a shift to perform more ACLR surgeries outside of the hospital setting to reduce costs. The purpose of this project is to understand the differences in costs between ACLR performed in ambulatory surgery center (ASC) versus outpatient hospital settings and if or how this affects the patient’s out-of-pocket expenditure. Methods: We identified patients who had undergone outpatient arthroscopic ACLR in the United States (U.S.) using the IBM MarketScan Commercial Claims and Encounters Database. The database was chosen for its large, national sample of privately insured patients. Patients who had Current Procedural Terminology (CPT) code 29888 between April 1, 2013 and June 30, 2017 were included. Revision ACL procedures and procedures with a concomitant microfracture, medial collateral ligament, lateral collateral ligament, or posterior cruciate ligament repair or reconstruction (CPT: 29879, 27405, 27409, 27427, 29889) were excluded. Day-of-surgery expenditure was identified by summing all claims billed with an “immediate-procedure-related code” in a 3-day window surrounding the date of the procedure (Procedure Date ± 1 Day). The day-of-surgery expenditure was broken down into implant, anesthesia services, regional anesthesia, operating room facility, surgical team, and other expenditures. Regional anesthesia is not included in anesthesia services expenditure. Median and interquartile range were calculated for each variable. The breakdown of day-of-surgery expenditure and patient out-of-pocket expenditure between the outpatient hospital and ASC settings were compared using two-tailed Mann Whitney U Tests. Spearman Rank Order Correlation was done for all variables to test for association between expenditure and year to determine trends over time. All values were inflation adjusted to 2017 dollars. Results: A total of 34,862 patients were identified. Our results indicated that ACLR performed in the outpatient hospital setting result in 60% greater day-of-surgery expenditure (p &lt; 0.001) than in the ASC setting. In the outpatient hospital setting, operating room facility cost was 36% greater (p &lt;0.001), anesthesia services was 7.1% greater (p&lt;0.001), implant was 28% greater (p&lt;0.001), but regional anesthesia was 22% lower (p&lt;0.001). Additionally, for ACLRs performed in the outpatient hospital setting, Spearman coefficients demonstrated that expenditure for anesthesia services decreased (rho = -0.037, p &lt; 0.001) and operating room facility cost increased (rho = 0.058, p &lt; 0.001) over our study period. For ACLRs performed in the ASC setting, expenditure for regional anesthesia decreased (rho = -0.039, p &lt; 0.001). Surgical team reimbursement decreased over time for ACLRs performed in both the ASC (rho = -0.156, p &lt; 0.001) and outpatient hospital (rho = -0.11, p &lt; 0.001) settings. Lastly, total patient out-of-pocket expenditure for ACLRs performed in the outpatient hospital setting vs. ASC setting was very similar though statistically different (p = 0.02, &lt;$10 difference). Conclusions: ACLR performed in an ASC setting results in significant cost savings for payers with no change in surgeon reimbursement. Most of the cost savings came from operating room facility expenditure. For patients, there is almost no financial difference regarding where the ACLR was performed, with the difference in patient out-of-pocket expenditure being less than $10. For the surgeon, surgical team reimbursements are essentially neutral between the ASC and outpatient hospital settings. However, the overall trend in surgical team reimbursement is downwards in both the ASC and outpatient hospital settings. For the two biggest stakeholders in the surgery (surgeon and patient), there are no financial incentives to do an ACLR at an outpatient hospital over an ASC. For a healthcare system, especially under a population health perspective, the incentive to perform ACLRs at an ASC is significant. The cost savings come from every breakdown category, with implant and operating room facility costs being significantly decreased in the ASC setting. Decreased implant costs were likely due to preferred vendor contracts for ASCs. The cost savings achieved per ACLR in an ASC vs. an outpatient hospital equals almost $6000. With nearly 100,000 ACLRs performed per year, the U.S. healthcare system could save a projected $600 million per year on ACLRs alone when the surgery is performed in an ASC. Thus, our study shows that there is a clear financial advantage to the healthcare system for ACLRs being done at ASCs, although the patient does not realize these cost savings. [Figure: see text][Table: see text][Table: see text][Table: see text]

P052 Un-Branding Surveys for Improved Access to Evaluation Tools

<h3>Background</h3> USDA's Food and Nutrition Service (FNS) requires that surveys used to evaluate SNAP-Ed direct education interventions must not include images with or references to brand name (branded) items (USDA-FNS, 2021). Agencies may want to replace branded images with unbranded images, but differences in images, such as items presented, could impact how participants respond to survey questions. This study tested whether replacing images influenced responses. <h3>Objective</h3> The primary aim of this study was to determine if replacing branded images with unbranded images would affect how individuals responded to existing SNAP-Ed survey questions. <h3>Study Design, Setting, Participants</h3> Participants were asked to respond to two surveys, one with branded images and one with unbranded images. Participants were randomly assigned to either take the branded version first or the unbranded version first. Participants consisted of SNAP-Ed-eligible adults who had internet access and could respond to the online surveys administered three days apart. <h3>Measurable Outcomes/Analysis</h3> Four questions taken from existing SNAP-Ed surveys were used. The independent variable was the time point of the first and second survey (pre/post), and the dependent variable was the survey question response. A Spearman's rank-order correlation was used to compare pre- and post-survey responses. <h3>Results</h3> A total of 54 participants completed both pre- and post-surveys and were included in analyses. Results found a significant (<i>P</i> < .001) moderate (<i>rs</i> = 0.62) to strong (<i>rs</i> = 0.82) correlations for the four questions tested. <h3>Conclusions</h3> Results provide support for agencies to update existing surveys with unbranded images for the four questions included in the study. These findings make surveys and questions more accessible to agencies who stopped using them as a result of the branded images. Additionally, a recommendation has been made to FNS to host a webpage with a library of unbranded images that agencies can use for their surveys. <h3>Funding</h3> USDA

Relationship between personal and professional self-determination among high school students

Introduction. Many international organizations are increasingly raising the issue of developing state vocational guidance programs. An intensive study of the labor market, its changes and the evolution of skills needs is being carried out. An important aspect was the possibility of choosing a profession in accordance with the abilities and interests of not only everyone, but also taking into account the needs of society. Now it is not necessary to follow the principles of profitability or prestige of the profession. Now you can choose a business to your liking. The most significant group of the population in this area are schoolchildren who are just starting their career path. It became possible to choose a job due to one’s liking. So, a natural question arises about the features of students’ professional and personal self-awareness. The research aims to study the relationship between students’ professional self-determination and personal self-awareness. Materials and methods. The sample consisted of 60 students from the secondary school "Eureka-Development №96" and the Specialized educational and scientific center of the Southern Federal District, whose average age was 17 years. The respondents completed socio-demographic survey as well as psychological assessment of personal and professional identity. To assess personal self-awareness, the authors used Pantileeva’s self-attitude test, and to indicate the level of professional self-determination, we used A.A. Azbel - A.G. Gretsovas’ questionnaire of students’ self-determination. For data analysis, we used Spearman's Rank-Order Correlation and the Friedman test, processed in the software of RStudio and STATISTICA 13.3. Results. There was significant correlation between such variables as status of imposedon professional identity and openness (r = 0.37; p &lt; 0.05), uncertain professional identity and internal conflict (r = 0.39; p &lt; 0.05), moratorium and self-blame (r = -0.44; p &lt; 0.05), also between formed status of professional identity and self-guidance (r = 0.3; p &lt; 0.05). Results show that almost 40% of respondents are in a state of crisis in choosing a profession. At the same time only 20 % of students are ready to make a conscious and independent choice in their further professional development. Conclusion. High school students are in a difficult period when self-confidence, faith in the surmountability of obstacles collides with inner experiences for their qualities and actions. The study showed that for self-determination, schoolchildren need to see their gaps and shortcomings, but at the same time consider themselves the main source of personal development, a regulator of achievements and success and accept responsibility for their professional choices.

Spinal Cord Injury: The Global Incidence, Prevalence, and Disability From the Global Burden of Disease Study 2019.

Study Design.A retrospective cohort study.Objective.The authors aimed to estimate the incidence, prevalence and years lived with disability (YLDs) of spinal cord injury (SCI) by location, sex, age, injury site and socio-demographic index (SDI) based on the data of the Global Burden of Disease Study (GBD) 2019.Summary of Background Data.GBD 2019 estimates the burden of 369 diseases and injuries worldwide in 2019 and the temporal trends in the past 30 years. SCI is estimated as a result of injury from various causes.Methods.A Bayesian meta-regression tool, DisMod-MR2.1, was used to produce the estimates. Estimated annual percentage change (EAPC) was calculated based on a linear regression mode of the age standardized rates and the calendar year to represent the temporal trends of the age standardized rates. Spearman rank order correlation was used to determine the correlation between SDI and the incidence and burden of SCI.Results.Globally, there were 0.9 [95% uncertainty interval (UI), 0.7 to 1.2] million incident cases, 20.6 (95% UI, 18.9–23.6) million prevalent cases and 6.2 (95% UI, 4.5–8.2) million YLDs of total SCI in 2019. The ASPR increased (EAPC, 0.1; 95% confidence interval, −0.01 to 0.2), while the age standardized incidence rate (ASIR) (EAPC, −0.08; 95% UI, −0.24 to 0.09) and age standardized YLD rate (ASYR) (EAPC, −0.08; 95% confidence interval, −0.24 to 0.09) decreased. Males had higher ASIR and ASYR, and the rate of incidence, prevalence and YLD increased with age. Spinal injuries at neck level caused higher ASYR than injuries below neck level. A positive correlation existed between SDI and ASIR (ρ=0.1626, P<0.05), while a negative correlation was observed between SDI and EAPC of ASYR (ρ=−0.2421, P<0.01).Conclusion.Conclusively, the incidence and burden of SCI has increased over the last 30 years. Males and the elderly were affected to a greater degree than females and younger individuals.Level of Evidence.Level III.

Characterizing Pelvic Floor Muscle Activity During Walking and Jogging in Continent Adults: A Cross-Sectional Study.

IntroductionThe pelvic floor muscles (PFM) are active during motor tasks that increase intra-abdominal pressure, but little is known about how the PFM respond to dynamic activities, such as gait. The purpose of this study was to characterize and compare PFM activity during walking and jogging in continent adults across the entire gait cycle.Methods17 able-bodied individuals (8 females) with no history of incontinence participated in this study. We recorded electromyography (EMG) from the abdominal muscles, gluteus maximus (GM), and PFM while participants performed attempted maximum voluntary contractions (aMVC) of all muscles and completed 60–70 strides in four gait conditions: slow walk (1 km/h); regular walk (self-selected comfortable pace); transition walk (self-selected fastest walking pace); jog (same speed as transition walking). We quantified activity throughout the whole gait cycle (%aMVCGC) and during periods of bursting (%aMVCBR) for each participant, and analyzed the timing of PFM bursting periods to explore when the PFM were most active in the gait cycle. We also conducted a phase metric analysis on the PFM and GM burst timings. We performed a Spearman's rank-order correlation to examine the effect of speed on %aMVCGC, %aMVCBR, and phase metric score, and used the Wilcoxon Signed-Rank test to evaluate the effect of gait modality, matched for speed (walking vs. jogging), on these variables.ResultsThe PFM were active throughout the gait cycle, with bursts typically occurring during single-leg support. The PFM and GM were in phase for 44–69% of the gait cycle, depending on condition. There was a positive correlation between gait speed and both %aMVCGC and %aMVCBR (p < 0.001). Phase metric scores were significantly higher during jogging than transition walking (p = 0.005), but there was no difference between gait modality on %aMVCGC or %aMVCBR (p = 0.059). Where possible we disaggregated data by sex, although were unable to make statistical comparisons due to low sample sizes.ConclusionThe PFM are active during walking and jogging, with greater activity at faster speeds and with bursts in activity around single-leg support. The PFM and GM co-activate during gait, but are not completely in phase with each other.