Start Date Research Articles

Stepped-Wedge Trial of Decision Support for Acute Kidney Injury on Surgical Units

IntroductionAKI is common in the perioperative setting and associated with poor outcomes. Whether clinical decision support improves early management and outcomes of AKI on surgical units is uncertain. MethodsIn this cluster-randomized, stepped-wedge trial, eight surgical units in Alberta, Canada were randomized to various start dates to receive an education and clinical decision support intervention for recognition and early management of AKI. Eligible patients were ≥18 years of age, receiving care on a surgical unit, not already receiving dialysis, with AKI. ResultsThere were 2135 admission in 2038 patients who met the inclusion criteria; mean (SD) age 64.3 (16.2) years, 885 (41.4%) females. The proportion of patients who experienced the composite primary outcome of progression of AKI to a higher stage, receipt of dialysis, or death was 16.0 % (178 events / 1113 admissions) in the intervention group and 17.5 % (179 events / 1022 admissions) in the control group (time adjusted odds ratio, 0.76; 95% confidence interval [CI], 0.53 to 1.08; p=0.12). There were no significant differences between groups in process of care outcomes within 48 hours of AKI onset, including administration of intravenous fluids or withdrawal of medications affecting kidney function. Both groups experienced similar lengths of stay in hospital after AKI and change in eGFR at 3 months. ConclusionAn education and clinical decision support intervention did not significantly improve processes of care or reduce progression of AKI, length of hospital stay, or recovery of kidney function in patients with AKI on surgical units.

Sodium-Glucose Co-Transporter 2 Inhibitors and the Risk of Genitourinary Infections at HbA1c ≥10%: A Population Health-Based Retrospective Review.

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are first-line treatment for type 2 diabetes. Evidence has shown a 3- to 5-fold increase in the risk of genitourinary infections with their use due to inhibition of renal glucose reabsorption, resulting in glucosuria. Increased glucosuria is thought to increase the risk of genitourinary infections at a greater degree in patients with a significantly elevated HbA1c (≥10%), and initiation of SGLT2i is often delayed in these patients. While a limited body of evidence exists indicating that A1c level is not an independent risk factor for SGLT2i-induced genitourinary infection, pragmatically this concern remains a barrier to SGLT2i utilization. Evaluate the real-world genitourinary (GU) infection rate in patients receiving SGLT2i with a baseline HbA1c ≥10% compared to patients with a baseline HbA1c <10%. This retrospective cohort study evaluated data from 5542 adult patients treated between January 2013 and January 2023, who were prescribed an SGLT2i. Data collected included sex, age, race/ethnicity, renal function, date of SGLT2i start, number of SGLT2i orders, name and dose of SGLT2i, HbA1c, and a predetermined set of diagnosis codes related to bacterial and fungal genitourinary infections. The primary outcome was the overall GU infection rate after SGLT2i initiation within groups of baseline HbA1c of ≥10% and <10%, and the secondary outcome was total GU infections within these same groups. The primary outcome was equivalent between those with HbA1c <10% and HbA1c ≥10% (0.0064 ± 0.0565 vs 0.0030 ± 0.0303 infection per month [mean ± standard deviation]; P < 0.0001 for both lower and upper bounds). There was no statistically significant difference in total GU infections between the same groups (0.027 ± 0.21 vs 0.015 ± 0.14, P = 0.11). Female gender and prior recurrent infection were associated with increased GU infection after SGLT2i. A baseline HbA1c ≥ 10% was not significantly associated with an increased risk of GU infection following the initiation of SGLT2i compared to those with a baseline HbA1c of <10%.

Addiction Consultation Services for Opioid Use Disorder Treatment Initiation and Engagement

Medications for opioid use disorder (MOUD) are highly effective, but only 22% of individuals in the US with opioid use disorder receive them. Hospitalization potentially provides an opportunity to initiate MOUD and link patients to ongoing treatment. To study the effectiveness of interprofessional hospital addiction consultation services in increasing MOUD treatment initiation and engagement. This pragmatic stepped-wedge cluster randomized implementation and effectiveness (hybrid type 1) trial was conducted in 6 public hospitals in New York, New York, and included 2315 adults with hospitalizations identified in Medicaid claims data between October 2017 and January 2021. Data analysis was conducted in December 2023. Hospitals were randomized to an intervention start date, and outcomes were compared during treatment as usual (TAU) and intervention conditions. Bayesian analysis accounted for the clustering of patients within hospitals and open cohort nature of the study. The addiction consultation service intervention was compared with TAU using posterior probabilities of model parameters from hierarchical logistic regression models that were adjusted for age, sex, and study period. Eligible participants had an admission or discharge diagnosis of opioid use disorder or opioid poisoning/adverse effects, were hospitalized at least 1 night in a medical/surgical inpatient unit, and were not receiving MOUD before hospitalization. Hospitals implemented an addiction consultation service that provided inpatient specialty care for substance use disorders. Consultation teams comprised a medical clinician, social worker or addiction counselor, and peer counselor. The dual primary outcomes were (1) MOUD treatment initiation during the first 14 days after hospital discharge and (2) MOUD engagement for the 30 days following initiation. Of 2315 adults, 628 (27.1%) were female, and the mean (SD) age was 47.0 (12.4) years. Initiation of MOUD was 11.0% in the Consult for Addiction Treatment and Care in Hospitals (CATCH) program vs 6.7% in TAU, engagement was 7.4% vs 5.3%, respectively, and continuation for 6 months was 3.2% vs 2.4%. Patients hospitalized during CATCH had 7.96 times higher odds of initiating MOUD (log-odds ratio, 2.07; 95% credible interval, 0.51-4.00) and 6.90 times higher odds of MOUD engagement (log-odds ratio, 1.93; 95% credible interval, 0.09-4.18). This randomized clinical trial found that interprofessional addiction consultation services significantly increased postdischarge MOUD initiation and engagement among patients with opioid use disorder. However, the observed rates of MOUD initiation and engagement were still low; further efforts are still needed to improve hospital-based and community-based services for MOUD treatment. ClinicalTrials.gov Identifier: NCT03611335.

Construction of Virtual Simulation Experiment Platform for Intelligent Construction Based on Statistical Machine Learning System Modelling

In the construction of a virtual simulation experiment platform for intelligent construction, cutting-edge technologies converge to revolutionize traditional project management methodologies. By harnessing the power of virtual reality, statistical modeling, and machine learning, this platform empowers stakeholders to predict, optimize, and simulate construction projects with unprecedented accuracy and efficiency. This paper introduces the Virtual Statistical Machine Learning (VS-ML) platform and demonstrates its application in intelligent construction processes. Through comprehensive experimentation and simulation, the VS-ML platform accurately estimates construction project parameters, optimizes resource utilization, schedules tasks efficiently, and classifies project outcomes with high accuracy. Numerical results from our study showcase the platform's effectiveness in various aspects of construction project management. For instance, in construction projects estimation, scenarios ranging from Scenario 1 to Scenario 10 exhibit project durations between 100 to 150 days, cost estimates ranging from $470,000 to $550,000, and safety ratings varying from "Good" to "Excellent". Furthermore, labor efficiency and material waste estimations across scenarios demonstrate percentages ranging from 85% to 93% and 3% to 7%, respectively, with corresponding safety ratings. Additionally, task computations elucidate the durations, start dates, end dates, and resource allocations for individual tasks within construction projects. Lastly, classification results exhibit the predicted probabilities and class labels for samples, showcasing the platform's ability to accurately predict project outcomes. Overall, the findings underscore the potential of VS-ML in revolutionizing traditional construction practices through data-driven approaches, leading to improved project management, cost savings, and enhanced safety standards in the construction industry.

Forecast models for start and peak dates of Poaceae pollen season in Tétouan (NW Morocco) using multiple regression analysis.

Poaceae pollen is one of the most widespread sources of aeroallergens in the world. The aim of this study is to build predictive models for the pollen season start day (PSsd) and peak dates of the Poaceae pollen season and thus give an overview of the climatic parameters that have the greatest influence. In Tétouan, sampling was carried out using a volumetric spore trap of the Burkard Hirst type. The relationships between the PSsd, peak dates and meteorological parameters were determined using correlation analysis. The models were constructed using multiple regression analysis with data from 2008 to 2019 and tested on data from 2022. The PSsd was especially significantly influenced by minimum temperature during winter and precipitation in the autumn of the previous year. The peak dates were significantly correlated with precipitation in January, March and April, but not with temperature. Three models were obtained for each of the season's parameters; the most accurate model for the PSsd explained a variability of 61% and includes as main predictors rainfall from the autumn of the previous year and the mean daily average temperature from 23 February to 8 March. The two most efficient peak dates models included precipitation in January and April as the main predictor variables, and explained greater variability (87 and 88%). Precipitation in autumn and the mean daily and the sum of minimum temperature in winter, showed significant decreasing tendencies. However, the PSsd trend delay was not statistically significant. This study draws the importance of the weather during preseason for grass pollen production and emphasises the usefulness of the models for allergic patients to take preventive measures and for healthcare professionals in allergy therapy.

Agricultural subsidies and land rental prices: New evidence from meta-analysis

The capitalization of agricultural subsidies is highly relevant to sustainable agricultural development. This study applies meta-analysis to systematically investigate the overall mean effects of capitalization of agriculture subsidies in China, the EU, and the USA. We explore capitalization rates across different types and recipients, including potential sources of heterogeneity. Our primary objective is to address the debate of whether agricultural subsidies are ultimately capitalized into land rental prices. Results show that the overall mean effect of subsidies on land capitalization in the European Union (5.5%) is greater than that in the United States (2.9%), with no significant and positive effects observed in Chinese markets. Additionally, we conclude that decoupled payments may not reduce the capitalization of agricultural subsidies in the European Union and the USA. Notably, agricultural subsidies received by landowners/contractors tend to be lower than those received by tenants. Finally, the capitalization of agricultural subsidies is influenced by several potential sources of heterogeneity, including farmland scales, aggregated data, sample sizes, lagged subsidies, and the starting and ending dates of publications. These findings provide comprehensive insights into the capitalization of agricultural subsidies and offer practical policy recommendations for the effective mitigation of capitalization rates.

Trapping efficacy of invasive crows is affected by environmental factors and deployment history

AbstractHouse crows (Corvus splendens) are considered an invasive species and are prevalent in parts of Europe, Africa, and Southeast Asia. Existing crow management measures include food limitation, habitat modification, and direct population control. The latter method provides a more immediate solution, particularly in nesting locations where crow attacks occur more frequently. Crow ladder traps are widely adopted to capture crows, but a thorough examination of the environmental conditions that optimize trapping efficacy is lacking. We assessed factors affecting crow trap efficacy in Singapore to better advise future deployment strategies of crow traps. We obtained data from 170 crow trapping operations including the identities of the contractors conducting the trapping operations, operation start date, crow density, intensity of bird feeding, various land use cover proportions, and an index to quantify the spatial‐temporal proximity to previous trapping operations. We used a spatial gamma generalized linear mixed model (GLMM) to determine the factors affecting the daily number of crows captured and a spatial binomial GLM to determine the factors affecting the probability that crows will be captured. The number of bird‐feeding incidents had a negative effect on crow trap efficacy suggesting that crows are probably less inclined to enter traps if proximate anthropogenic food abundance is high. Trapping efficacy increased if traps were placed in high crow‐density areas, likely because more crows could detect the traps. The probability of capture also declined if the traps were placed closer to prior trapping locations or with a shorter time interval from previous trapping operations. Capture rates of crows can be increased by placing traps in high crow density areas, limiting bird‐feeding incidences, and lengthening the spatial and temporal proximities to previous trapping operations. The deployment of ladder traps is a viable means to control the population of house crows and consideration of environmental conditions and trapping history can improve capture rates.

It’s possible to measure racism! Analysis of measures and scales of the racism construct

Purpose: This research aims to analyze the construction and validation of measures and scales of the racism construct through a systematic literature review. The purpose is to examine how these instruments are built based on statistical recommendations for scale development.Methodology: A systematic literature review followed well-defined inclusion and exclusion criteria. Data were collected from databases available on the Portal de Periódicos Capes, covering a period up to December 2023 (with no start date limitation). After removing duplicate articles and applying the defined filters, six studies were selected for the analysis of scale construction.Findings: Three specific scales were identified to measure and evaluate the racism construct: the Modern Racism Scale, the Symbolic Racism Scale, and the Ethno-Racial Attitudes Scale. Although there is a predominance of studies on the Modern Racism Scale, other instruments were excluded from the analysis corpus due to non-compliance with inclusion criteria, especially related to article availability.Originality: Among the 82 analyzed articles, those focused on measures and scales of the racism construct do not provide an analysis of the development of these instruments. This study brings to light an analysis of the construction and validation of these measures and scales.

Covid-19 infection and vaccination during first trimester and risk of congenital anomalies: Nordic registry based study

ObjectivesTo evaluate the risk of major congenital anomalies according to infection with or vaccination against covid-19 during the first trimester of pregnancy.DesignProspective Nordic registry based study.SettingSweden, Denmark, and Norway.Participants343 066...

Predicting malaria hyper endemic zones in West Africa using a regional scale dynamical malaria model

Due to the continuing large number of malaria-related deaths in tropical Africa, the need to develop a robust Malaria Early Warning System (MEWS) for effective action is growing to guide cost-effective implementation of interventions. This study employs a two-stage hierarchical evaluation technique to evaluate the ability of the VECTRI malaria model to simulate malaria dynamics at seasonal time scale (1 - 7 months) over Nigeria and West Africa. Two sets of malaria simulations are considered. The first set is based on VECTRI simulations driven by observed rainfall and temperature datasets (hereafter referred to as control run). The second is based on malaria simulations driven by the European Centre for Medium-Range Weather Forecasting (ECMWF) System5 ensemble seasonal forecasting system (hereafter referred to as Forecast run). Different metrics are employed to assess the skill of the VECTRI malaria model. Results based on the control run indicate that the model can reproduce hyper-endemic zones and the evolution of malaria cases, particularly the observed increase in cases with decreasing population density. Despite having significant biases and low correlation, the model successfully predicts annual anomalies in malaria cases across Nigeria, particularly in the savannah region that experience large malaria burden. Annual correlations between the VECTRI Forecast run and the VECTRI Control run are relatively low at all lead times (LT) and for each start date (SD) across West Africa, although correlation generally increases from the Gulf of Guinea to the Sahel. Despite low correlations, the Rank Probability Skill Score (RPSS) reveals that the model has a statistically significant skill in predicting malaria occurrences across all categories of malaria cases, regardless of start date or lead time. While the Guinea Forest has the strongest RPSS, the increase or decrease in skill from the first to seventh lead time varies significantly across the region. In addition, the VECTRI malaria model has a good ability to discriminate variability in malaria cases across all regions, with an average Area Under the Relative Operating Characteristics (ROC) Curve (AUC) of approximately 0.62. Our findings suggest that the VECTRI malaria model could be used as a reliable Malaria Early Warning System (MEWS), particularly for identifying malaria hyper-endemic zones in West Africa at seasonal time scale.

Internal response of vegetation growth to degrees of permafrost degradation in Northeast China from 2001 to 2020

ABSTRACT Ecosystems at the southern edge of the permafrost distribution are highly sensitive to global warming. Changes in soil freeze-thaw cycles can influence vegetation growth in permafrost regions. Extant studies mainly focused on analyzing the differences of vegetation dynamics in different permafrost regions. However, the intrinsic drivers of permafrost degradation on vegetation growth remain elusive yet. Based on the top temperature of permafrost (TTOP) model, we simulated the spatial distribution of permafrost in Northeast China (NEC) from 2001 to 2020. Using the data of the vegetation Net Primary Productivity (NPP), vegetation phenology, climate and permafrost phenology, and analytical methods including partial correlation, multiple linear regression, and path analysis, we explored the response of vegetation growth and phenology to soil freeze-thaw changes and climate change under different degrees of permafrost degradation. Overall, the start date of the growing season (SOS) was very sensitive to the start date of soil thaw (SOT) changes, and multiple regression analyses showed that SOT was the main factor influencing SOS in 41.8% of the NEC region. Climatic factors remain the main factors affecting vegetation NPP in NEC, and the results of partial correlation analysis showed that only 9.7% of the regional duration of soil thaw (DOT) had a strong correlation with vegetation NPP. Therefore, we determined the mechanism responsible for the soil freeze-thaw changes and vegetation growth relationship using the path analysis. The results indicated that there is a potential inhibitory effect of persistent permafrost degradation on vegetation growth. Our findings would contribute to the improvement of process-based models of forest dynamics in the boreal region, which would help to plan sustainable development and conservation strategies in permafrost areas.

How feasible or useful are timeliness metrics as a tool to optimise One Health outbreak responses?

IntroductionAs timeliness metrics gain traction to assess and optimise outbreak detection and response performance, implementation and scale-up require insight into the perspectives of stakeholders adopting these tools. This study sought...

Regional differences in the impact paths of climate on aboveground biomass in alpine grasslands across the Qinghai-Tibet Plateau

Alpine grasslands on the Qinghai-Tibet Plateau (QTP) play an essential role in water conservation, biodiversity protection and climate feedback, with aboveground biomass (AGB) serving as a crucial indicator of grassland health and functionality. While previous studies have independently explored the phenological differences, cumulative effects, and spatial variability of climatic impacts on biomass/productivity in alpine grasslands, the cascading effects regarding climate and phenology on AGB still present knowledge gaps. Here, using peak AGB measurements, remote sensing and gridded climate data in the QTP alpine grasslands during 2002–2018, we systematically analyzed the impact paths of climatic variables (i.e., cumulative precipitation, CP; growing degree-days, GDD) and phenology-mediated paths (start and peak date of the growing season, SOS and POS) on AGB and their regional differences. During the preseason (pre60) or the growing season (sos-pos), climate primarily directly impacted variations in AGB across different climatic regions, although a phenology-mediated path by which climate indirectly affected AGB existed (i.e., GDDsos-pos → POS → AGB). Three general patterns were revealed: In the plateau temperate arid regions, an increase in CPpre60 significantly promoted AGB (path coefficients w = 0.61–0.71), whereas an increase in GDDpre60 inhibited AGB (w = −0.42 ~ −0.49); In the plateau sub-cold regions, increases in both CPsos-pos and GDDsos-pos significantly promoted AGB, respectively (w = 0.46–0.81 and w = 0.37–0.70); Similarly, in the plateau temperate arid or semi-arid regions, increases in CPsos-pos also significantly promoted the AGB (w = 0.56–0.73). This study highlights that the water and heat accumulation mainly exert direct impacts on alpine grassland AGB across various climatic regions and phenological stages, providing insights into the mechanism driving AGB by climate and phenology during spring and summer.

Primary outcomes and characteristics of clinical trial registries (up to October 2021) on COVID-19 vaccines.

To analyse the general and primary outcome-related characteristics of clinical trials protocols on COVID-19 vaccines. A meta-research study. A search for clinical trial protocols on COVID-19 vaccines was conducted on the ClinicalTrials.gov platform. We considered all protocols of comparative trials registered up to October 26, 2021. Two hundred and eighty-two trials were analysed. The median expected trial duration was 445 days (interquartile range [IQR] = 225), and the median target sample size was 420 participants (IQR = 1638). A retrospective registry (after the start date) was observed for 42.55% of the trials. Randomization procedures were planned by 84.75% and full-blinding procedures by 34.75% of the 282 trials. Most trials were labelled as active or still recruiting, and 14 trials (5%) were completed. None of the 14 trials labelled as completed on our search date had results available. Industry funding was reported by 198 trials (70.2%). Most studies declared more than one primary outcome, usually a safety or immunogenicity outcome, and 59 studies (20.9%) had at least one primary efficacy outcome. The description of the primary efficacy outcomes was limited in most cases, referred to as a non-specified 'efficacy' outcome (18.6%) or described as 'COVID-19 cases' (32.2%). the primary outcomes of clinical trials on COVID-19 vaccines are poorly described, and the registers provide insufficient information about them. The registry was retrospectively fulfilled for many trials, which may lead to bias and research waste. Outcomes were generically described and did not provide transparent information for replication in practice, further trials or meta-analyses.

Migration tracking assists harvest management of overabundant Canada geese in Manitoba, Canada

AbstractSimilar to other jurisdictions across North America, populations of temperate‐nesting giant Canada geese (Branta canadensis maxima) have increased to unprecedented levels in Manitoba, Canada, causing extensive damage to crops and property, posing risks to human safety, and mostly avoiding mortality risk from fall hunting seasons. As a result, this population in southern Manitoba was declared overabundant in 2019, through an amendment to the Canada Migratory Birds Regulations. Management authorities sought to increase harvest rates by introducing an additional hunting period in spring, or conservation season, wherein harvest could be concentrated on this population. An important consideration was the need to avoid additional harvest on non‐target populations that do not meet the criteria to be classified as overabundant, specifically, sub‐arctic nesting Canada geese (Branta canadensis interior) and mid‐continent cackling geese (Branta hutchinsii hutchinsii). To investigate differences in migration timing of populations, and ultimately determine start and closure dates for the spring conservation season, we deployed light‐level geolocators on adult females of each population between 2016 and 2018. We used Bayesian approaches to derive locations from light‐level data and generalized linear mixed models to investigate potential differences in timing of international border crossing among goose populations. Migration data confirmed that movement of these populations overlapped extensively in fall, but in spring, a narrow period existed where mainly the target population was present. Our findings provide the basis for decisions about timing of spring conservation seasons for overabundant temperate‐nesting Canada geese in Manitoba, the first season of its kind for this population in North America. Additionally, our work represents the first large‐scale use of light‐level geolocator technology for assisting with waterfowl harvest management decisions.

Age differences in primary moult of the Black-headed Gull Chroicocephalus ridibundus

Flight feather moult is an energetically expensive stage of the annual cycle of birds. Its timing is adjusted to other important time- and energy-demanding activities, including migration. In the vast majority of migratory birds, primary moult occurs before or after migration or moulting is suspended during migration. The Black-headed Gull is an exception: it starts moulting flight feathers at the onset of the autumn migration. The course of primary moult in this species is still poorly understood due to the difficulty in obtaining sufficient data from the entire period of flight feather replacement. In this paper, we employed digital photos taken in the field to estimate the start, variation in the start date and duration of primary moult in adult and immature Black-headed Gulls, by using the Underhill–Zucchini likelihood moult model. On average, immatures started their moult on 7 June, 25 days earlier than adults, but their moult lasted 5 days longer. Consequently, there was a 20-day difference in the end of moult – that is, on average it occurred on 16 September and 6 October in immature and adult gulls, respectively. Adults showed greater variability in the mean primary moult start date than immatures, as the beginning of flight feather replacement may depend on breeding success (earlier after breeding failure) and on breeding phenology. The overlap of primary moult and migration produces a trade-off in resource allocation between those two processes, which leads to a low number of simultaneously growing primaries and a decrease in the growth rate of the two external, heaviest flight feathers. Existing reports of a later completion of primary moult in the first half of November in this species are based on the faulty assumption that the outermost primary is always the longest, which is not the case in 34% of individuals.

HEAT BUDGET OF THE BARENTS SEA SURFACE IN WINTER

Variability of the total heat balance (HB) of the Barents Sea during the cold period of the year has been studied. The cold period is that of cooling of the sea surface when the heat flux is permanently oriented towards the atmosphere. The contribution of two major components of the HB, i. e. sensible and latent heat fluxes, to the observed increase of the total winter heat transfer at the sea-atmosphere interface has been estimated. Data on short-wave and long-wave radiation fluxes, and sensible and latent heat values were obtained from the atmos-pheric reanalysis of the European Center for Medium-term Weather Forecasting ERA5. HB of the sea surface was calculated as a sum of short-wave and long-wave radiation fluxes and those of sensible and latent heat. The total HB, as well as the total flux of sensible and latent heat for the cold period were calculated by summing up the corresponding values between the start and end dates of the cooling season. Calculations demonstrated an increase in the sum of HB over the cold season for the northern part of the Barents Sea (up to 2000 MJ/m2 over 40 years), and a decrease in the southern part of the sea (up to 1000 MJ/m2 over 40 years). In the northern part of the sea, the contribution of sensible and latent heat fluxes decreases to 0,3-0,4. The observed trend of sum of HB over the cold season and its turbulent components could with high probability be explained by increasing difference between air temperature and sea surface temperature.

Indenture Beyond the ‘Coolie’ Trade: Reinitiating Chinese Indentured Migration to Cuba after the Chinese Commission Report (1874–1920)

ABSTRACT The historiography of Chinese indenture in Cuba is very clear when it comes to its periodization, establishing the start date of the trade in 1847 and the end in 1874. This periodization is based upon the arrival of the first and the last ships carrying Chinese indentured labourers. Thus, studies on the so-called ‘coolie trade’ focus on the period between these dates. What happened after the arrival of the last ship has attracted less attention. The end of the trade, after all, did not coincide with the end of indenture in Cuba, either in legal terms or in practice. By the 1880s there were still Chinese indentured labourers in Cuba who had not finished their contracts. Furthermore, after 1874 there were attempts to restore the trade in Chinese migrants: firstly, in 1877; and later, in 1919. Chinese indenture in Cuba is an excellent case study by which to problematize the meaning of ‘abolition’ and inquire on the nature of ‘indenture’. Using multilingual source material, this article suggests a continuous view of indenture in Cuba beyond the 1874 hallmark, and pinpoints the debt generated at the moment of recruitment to pay for the emigrating costs as the single most important defining mechanism of indenture.

Publicly Available Anatomic Total Shoulder Arthroplasty Rehabilitation Protocols Show High Variability and Frequent Divergence from the 2020 ASSET Recommendations.

In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA). The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines. This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA. A web-based search was conducted in April 2022 of publicly available rehabilitation protocols for TSA. Each collected protocol was independently reviewed by two authors to identify recommendations regarding immobilization, initiation, and progression of passive (PROM) and active range of motion (AROM), as well as the initiation and progression of strengthening and post-operative exercises and activities. The time to initiation of various components of rehabilitation was recorded as the time at which the activity or motion threshold was permitted by the protocol. Comparisons between ASSET start dates and mean start dates from included protocols were performed. Of the 191 academic institutions included, 46 (24.08%) had publicly available protocols online, and a total of 91 unique protocols were included in the final analysis. There were large variations seen among included protocols for the duration and type of immobilization post-operatively, as well as for the initiation of early stretching, PROM, AROM, resistance exercises, and return to sport. Of the 37 recommendations reported by both the ASSET and included protocols, 31 (83.78%) were found to be significantly different between groups (p\<0.05). Considerable variability was found among online post-operative protocols for TSA with substantial deviation from the ASSET guidelines. These findings highlight the lack of standardization in rehabilitation protocols following anatomic TSA. 3b.

Ascertaining accurate exposure to aspirin and other antithrombotic medications using structured electronic health record data

BackgroundAscertaining accurately the exposure to antithrombotic medications for both research and quality initiatives has been challenging due to a multitude of reasons: aspirin, the most commonly used antithrombotic, is available over the counter in the United States. Additionally, antithrombotic medications are frequently interrupted for bleeding and procedures. ObjectivesWe aimed to develop and validate an algorithm to capture accurately the longitudinal exposure to antithrombotic medications including aspirin using the electronic health record. MethodsWe used the Medical Inpatient Thrombosis and Hemostasis cohort, which consists of primary care patients at a university medical center followed for a median of 6.2 years. Exposure to antithrombotic medications was captured using the medication reconciliation data linked to each ambulatory encounter. We developed an algorithm that used the taking “yes” or “no” tab as well as start and stop dates to define the duration of exposure for each medication. Eighty charts were reviewed and compared with results of the algorithm for validation. We estimated the sensitivity, specificity, and positive and negative predictive values. ResultsThe algorithm was 97% (95% CI, 94%-100%) sensitive and 95% (95% CI, 90%-100%) specific in identifying exposure to any antithrombotic medication. This translated to a 93% (95% CI, 85%-100%) positive predictive value and 98% (95% CI, 96%-100%) negative predictive value. When looking at aspirin alone, the sensitivity and the positive predictive value were 95% (95% CI, 88%-100%) and 87% (95% CI, 71%-100%). ConclusionThis current algorithm provides a new and easily adaptable strategy to capture accurately exposure to aspirin and other antithrombotic medications.