Trends In Characteristics Research Articles

Trends in Electroconvulsive Therapy Utilization in South Korea: Health Insurance Review Data From 2008 to 2018.

The study aimed to analyze and clinically correlate 10-year trends in the demographic characteristics of patients receiving electroconvulsive therapy (ECT) to provide an overview of ECT utilization in South Korea. Using health insurance claims data from 2008 to 2018 retrieved from Health Insurance Review and Assessment Service database in South Korea, we identified individuals undergoing ECT based on procedural codes. Descriptive analysis evaluated baseline clinical characteristics, and trend analysis used a linear regression model. The prevalence of ECT increased by 240.49% (0.405/105 inhabitants in 2008 to 0.974/105 inhabitants in 2018). The increasing trend was more pronounced in younger and older patients. The proportion of women consistently exceeded that of men. A rise in the proportion of patients with affective disorders, and a decrease in the proportion of psychotic disorders was observed. More antidepressants and atypical antipsychotics were prescribed to patients undergoing ECT. The proportion of ECT sessions conducted in large hospital inpatient settings also decreased during the observation period. Despite increasing global trends, ECT prevalence in South Korea remains significantly lower than worldwide rates. This study demonstrated an increasing trend of ECT across a wide range of population demographics and in more accessible settings. The comparatively low prevalence of ECT in Korea compared to other countries might be attributed to insufficient mental health literacy and the stigma associated with ECT. Given the elevated suicide rates in Korea, more extensive adoption of ECT appears imperative.

Hybrid simulation of a capacitive Ar/SiH4 discharge driven by electrically asymmetric voltage waveforms

Voltage waveforms associated with the electrical asymmetry effect (EAE) have the potential to be used in the deposition of the silicon-based film, since they are expected to decouple ion energy and flux at the wafer surface, and further facilitate control of the process. In this study, a one-dimensional fluid/electron Monte Carlo hybrid model is employed to examine the EAE in a capacitively coupled argon-silane discharge, encompassing both amplitude asymmetry effect (AAE) and slope asymmetry effect (SAE). In the case of AAE, with the increasing pressure, the discharge electronegativity gradually intensifies, in conjunction with a transition of the electron heating mode from α to drift-ambipolar, a reduction of the absolute value of the DC self-bias voltage, and a decrease in Ar+ content, with an increase in SiH3 + content. For SAE, the trend in the discharge characteristics with the increasing pressure is similar to that for AAE, but the details are different. In SAE, the electronegativity and bulk electric field are much enhanced, resulting in higher content of high-energy electrons and Ar+ in the bulk. In addition, the absolute value of the self-bias is lower, but shows a fewer decline with the increasing pressure. The deposition rate is lower in SAE, due to the lower electron heating efficiency. However, larger voltage drop difference between two sheaths leads to a wider range of ion energy modulation at higher pressures. This study systematically investigates and compares Ar/SiH4 discharges driven by two electrically asymmetric voltage waveforms across various parameters including electron dynamics, ion and neutral transport properties, and deposition rates, with the aim of providing valuable insights and a reference for industrial applications.

Assessment, diagnosis and management characteristics of people with acute Charcot neuro-osteoarthropathy in a regional Australian health service: A 3-year retrospective audit.

Acute Charcot neuro-osteoarthropathy (CN) is highly destructive, causing bone and joint damage that can result in devastating structural changes to the foot. The objective of this study was to determine the characteristics of assessment, diagnosis and management of people with acute CN attending a large regional Australian health service. Three-year retrospective medical record audit. Large regional health service with catchment area of >250 000 people in regional Australia. People with acute CN who attended emergency, orthopaedic clinics or High Risk Foot Clinic (HRFC). Participant characteristics and acute CN assessment, diagnosis and management characteristics. Trends in characteristics were investigated according to rurality as measured by the Modified Monash Model (MMM) scale. Seventeen participants (20 presentations) of acute CN were identified. Mean age was 57.1 ± 10.8 years, with 11 female participants. Median duration to seek help was 31 (IQR 14-47) days. Total Contact Casting was undertaken for 85% of cases, with those who resided in MMM1-2 regions experienced significantly shorter time to TCC therapy compared to those residing in MMM3-7 regions (U = 3.0, p < 0.01). Resolution of acute CN with or without deformity occurred in 70% of cases. Those who lived in smaller regional and rural communities were more likely to experience delayed access to gold standard treatment for acute CN. Regional models of care for acute CN should include activities to improve the knowledge of people at risk of acute CN about the condition and upskill regional health professionals for timely and local TCC therapy.

Trend of prevalence and characteristics of preserved ratio impaired spirometry (PRISm): Nationwide population-based survey between 2010 and 2019.

This study aimed to evaluate the prevalence, trends, and factors of preserved ratio with impaired spirometry (PRISm) by using a nationally representative sample. The datasets of the Korea National Health and Nutrition Examination Survey 2010-2019 were used: of total 32,949 participants aged ≥40 and no missing data on spirometry, 24,523 with normal, 4,623 with obstructive, and 3,803 with PRISm were identified. PRISm was defined as FEV1/FVC ≥70% and FEV1% of the predicted value (%pred) <80. PRISm-lower limit of normal (LLN) was defined when FEV1/FVC ≥LLN and FEV1 <LLN. The prevalence and trend of PRISm were estimated using the Joinpoint regression method. The trend was calculated for the periods 2010-2015 and 2017-2019, due to a change in spirometry device in June, 2016. A complex sample multivariable-adjusted regression model was used to identify factors associating PRISm. Estimated average prevalence of PRISm was 10.4% (PRISm-LLN 11.1%). Joinpoint regression analyses found a relatively stable trend of PRISm for both fixed ratio and LLN. The multivariable-adjusted logistic regression model showed female sex, BMI ≥25 kg/m2, metabolic syndrome, hypertriglyceridemia, abdominal obesity, low HDL-choleterol, hypertension, and diabetes were associated with the increased probability of PRISm. Whenever a PRISm pattern is identified in a clinical context, it may be necessary to measure absolute lung volumes to investigate underlying physiological abnormalities and to identify factors that is modifiable.

Using patient feedback to predict effects of quality improvement initiatives.

Internationally, continuous efforts have been put into developing patient complaint channels to understand patients' experience and expectation of care, which can guide the improvement of health service quality. Despite agreement among the value of patient feedback, limited attention has been paid to using patient feedback to predict and promote the actual quality improvement initiatives. To determine whether patient feedback collected from a public feedback hotline can be used to predict the effect of hospital quality service improvement initiatives. A retrospective analysis of patient complaint data of a tertiary hospital from 2018 to 2021 was performed. Patient complaints were first coded by the standard classification method of the Australian Hospital Patient Experience Question Set. The characteristics of patients' complaints were then analysed by frequency and contingency table analysis. Finally, through Nonparametric Mann-Kendall test and Joinpoint regression model, the trends of each complaint characteristics were tested. Amongst the 771 complaints received against clinicians, approximately 75% of them were concerning doctors. 'Harm and distress' was the key reason of complaints, followed by 'not cared for', 'lack of confidence', 'needs unmet' and 'not informed'. In 2021, the number of complaints received in relation to moderate 'harm and distress' caused by doctors increased by 667% from 2020. The categories of 'not informed', 'not cared for' and 'harm and distress' were also on the rise with statistical significance. In addition, complaints related to the lack of respect, bad attitude and unprofessional behaviour demonstrated by nurses (n=83) and doctors (n=121) were also recorded. Patient feedbacks collected via a public feedback hotline provides a useful platform to gain insight into patient experience of care which are valuable to guide quality care improvement. To improve the care quality, clinicians need to participate in quality improvement strategies development at an early stage. Efforts in improving communication and interaction between doctors and patients are needed to improve patients' experience of care and developing patients' trust in both of the clinicians and the medical services. The study highlights the value of using public feedback hotline to generate evidence that can guide hospital service improvement.

Musculoskeletal disorders in Norway: trends in health care utilization and patient pathways: a nationwide register study

Objective Describe trends in health care utilization, demographic characteristics and patient pathways among patients with musculoskeletal disorders (MSD) in Norway. Design Register-based cohort study. Settings Data were obtained from two Norwegian National registries; the Norwegian Control and Payment of Health Reimbursements Database (KUHR) and the Norwegian Patient Registry (NPR). Subjects Patients with MSD according to ICPC-2 and ICD-10 during 2014–2017. Main outcome measures Patient pathways from the first contact and the following two years, described in a Sankey Diagram for all MSD patients and three common diagnoses: spine pain, osteoarthritis (OA) and fibromyalgia (FM). Result About 26% of the Norwegian population consulted PHC annually while 7% were treated in SHC. Mean age was 47 and 53 years in PHC and SHC, respectively. The proportion of women increased by age. Spine pain was the most common diagnosis; 33% and 22% in PHC and SHC, respectively. Over 90% visited a GP first, 50% of them were treated by PT and/or in SHC during follow-up. Patients visiting the PT first were less likely to be treated in SHC. OA patients were most likely to be treated by more than one health care professional (>70%). Conclusion One third of the Norwegian population consulted health care services due to MSD annually between 2014–2017. GP was the most consulted health care professional. Among MSD patients with long-term use of health care services, 50% were treated by a PT and/or in SHC in addition to a GP.

Experimental study of ammonia storage characteristics of selective catalytic reduction for diesel engine based on Cu-based catalysts

In this paper, the ammonia storage characteristics of Cu-based zeolite catalysts at different exhaust temperatures in heavy-duty diesel engines were experimentally investigated. The data such as exhaust temperature, rotational speed, torque, urea consumption, NOx concentration at selective catalytic reduction (SCR) inlet and outlet, ammonia storage, and NH3 leakage of the diesel engine were recorded respectively. The trend of ammonia storage characteristics of the SCR system was analyzed using the urea injection stopping time as the cut-off point. Both the SCR catalyst ammonia storage volume and the time to saturation of ammonia storage volume decreased with the increase in exhaust temperature. The maximum value of ammonia storage was 9.58 g at 193 °C and 1.08 g at 376 °C. The saturation time decreased from 466.4 s to 96.8 s. The increase in catalyst activity at high temperatures increased the rate of denitrification reaction, but it was observed that the ammonia slippage occurred earlier from 450 s to 100 s, which was mainly due to a more active ammonia desorption reaction at high temperatures. The larger ammonia storage at low temperatures made the effect on NOx conversion efficiency more significant, and the effect of exhaust temperature gradually increased when the temperature was further increased.

Epidemiology of traumatic spinal cord injury in Spain: A ten-year analysis of trend of clinical and demographic characteristics

Context The study of epidemiological changes of traumatic spinal cord injury (TSCI) is needed due to its highly variable incidence. Objective To determine the incidence of TSCI in Spain and to describe the trend of clinical and demographic characteristics according to age group during a 10-year period. Methods A prospective cohort study was conducted. A multidisciplinary team evaluated all individuals with new TSCI. The data were recorded according to the International Spinal Cord Injury Core Data Sets. Results In a 10-year period, 933 new patients with TSCI were admitted to the hospital. The annual incidence of TSCI was 6.2 per million. The leading causes of injury were traffic accidents (38.5%), low-level falls (20.6%), and high-level falls (19.1%). Males, age group of 31–45 years, and cervical level of injury were the most common profiles of TSCI. In patients over 60 years,71.5% were injured following a fall, particularly low-level falls (47.2%). In patients under 60 years old, the leading cause of SCI was traffic accidents (46%). The proportion of tetraplegia in patients above 60 years was 68.3%, compared to 43.7% in patients under 60 years of age. Patients in the age group above 60 years were hospitalized with a shorter duration of rehabilitation compared to younger age group. Conclusions Compared with globally estimated data reported in previous studies, this research demonstrated a low incidence of TSCI in Spain, suggesting a decrease in the last years. Falls and traffic accidents were the most common causes of TSCI in elderly and youth, respectively. Prevention programs should focus on these issues.

What Is the Epidemiology of Cervical and Thoracic Spine Fractures?

Vertebral fractures are associated with enduring back pain, diminished quality of life, as well as increased morbidity and mortality. Existing epidemiological data for cervical and thoracic vertebral fractures are limited by insufficiently powered studies and a failure to evaluate the mechanism of injury. What are the temporal trends in incidence, patient characteristics, and injury mechanisms of cervical and thoracic vertebral fractures in the United States from 2003 to 2021? The United States National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) database collects data on all nonfatal injuries treated in US hospital emergency departments and is well suited to capture epidemiological trends in vertebral fractures. As such, the NEISS-AIP was queried from 2003 to 2021 for cervical and thoracic fractures. The initial search by upper trunk fractures yielded 156,669 injuries; 6% (9900) of injuries, with a weighted frequency of 638,999 patients, met the inclusion criteria. The mean age was 62 ± 25 years and 52% (334,746 of 638,999) of patients were females. Descriptive statistics were obtained. Segmented regression analysis, accounting for the year before or after 2019 when the NEISS sampling methodology was changed, was performed to assess yearly injury trends. Multivariable logistic regression models with age and sex as covariates were performed to predict injury location, mechanism, and disposition. The incidence of cervical and thoracic fractures increased from 2.0 (95% CI 1.4 to 2.7) and 3.6 (95% CI 2.4 to 4.7) per 10,000 person-years in 2003 to 14.5 (95% CI 10.9 to 18.2) and 19.9 (95% CI 14.5 to 25.3) in 2021, respectively. Incidence rates of cervical and thoracic fractures increased for all age groups from 2003 to 2021, with peak incidence and the highest rate of change in individuals 80 years or older. Most injuries occurred at home (median 69%), which were more likely to impact older individuals (median [range] age 75 [2 to 106] years) and females (median 61% of home injuries); injuries at recreation/sports facilities impacted younger individuals (median 32 [3 to 96] years) and male patients (median 76% of sports facility injuries). Falls were the most common injury mechanism across all years, with females more likely to be impacted than males. The proportion of admissions increased from 33% in 2003 to 50% in 2021, while the proportion of treated and released patients decreased from 53% to 35% in the same period. This epidemiological study identified a disproportionate increase in cervical and thoracic fracture incidence rates in patients older than 50 years from 2003 to 2021. Furthermore, high hospital admission rates were also noted resulting from these fractures. These findings indicate that current osteoporosis screening guidelines may be insufficient to capture the true population at risk of osteoporotic fractures, and they highlight the need to initiate screening at an earlier age. Level III, prognostic study.

Trends in Top Surgery Patient Characteristics, Wound Complications, and CPT Code Use by Plastic Surgeons: A Decade-Long Analysis.

Gender-affirming top surgery is becoming increasingly common, with greater diversity in the patients receiving top surgery. The purpose of this study was to examine national trends in patient demographics, characteristics, wound complication rates, and concurrent procedures in patients receiving gender-affirming top surgeries. Patients with gender dysphoria who underwent breast procedures, including mastectomy, mastopexy, breast augmentation, or breast reduction by a plastic surgeon between 2013 and 2022, were identified from the American College of Surgeons National Surgical Quality Improvement Program database. These procedures were considered to be gender-affirming "top surgery." Univariate analyses were performed to examine trend changes in the patient population and types of additional procedures performed over the last decade. There was a 38-fold increase in the number of patients who received top surgery during the most recent years compared to the first 2 years of the decade. Significantly more individuals receiving top surgery in recent years were nonbinary ( P < 0.01). There was a significant decrease in percentage of active smokers ( P < 0.01) while there was an increase in percentage of patients with diabetes ( P = 0.03). While there was a significant increase in the number of obese patients receiving top surgery ( P < 0.01), there were no differences in postoperative wound complications between the years. Significantly more patients received additional procedures ( P < 0.01) and had about a 9-fold increase in distinct number of additional CPT codes from 2013-2014 to 2021-2022. Our study found that there has been (1) a significant increase in the number of top surgery patients from 2013 to 2022 overall and (2) a particular increase in patients with preoperative comorbidities, such as a higher body mass index and diabetes. Understanding current and evolving trends in patients undergoing surgical treatment for gender dysphoria can inform individualized care plans that best serve the needs of patients and optimize overall outcomes.

Trends in severe acute malnutrition admissions, characteristics, and treatment outcomes in Malawi from 2011 through 2019

Background Community-based Management of Acute Malnutrition (CMAM) has been successfully implemented across Malawi, yet trends in admissions, characteristics, and treatment outcomes in children with severe acute malnutrition (SAM) have not been examined. The objective was therefore to investigate trends in admissions, characteristics including percentage of children with SAM with HIV and oedema, and treatment outcomes across the decade following implementation of CMAM.Methods This research involved a retrospective analysis of existing data routinely collected across Malawi by the Ministry of Health between 2011 and 2019.ResultsThese data showed an increase in outpatient therapeutic feeding (OTP) admissions from 30323 children in 2011 to 37655 in 2019 (p=0.045). However, a significant decrease in nutritional rehabilitation unit (NRU) admissions was observed, from 11389 annual admissions in 2011 to 6271 in 2019 (p=0.006). In children identified with SAM, the percentage with oedema decreased in OTPs with an average annual rate of reduction (AARR) of 5.6% (p=0.001) and by 26.2% in NRUs in this timeframe with an AARR of 8.5% (p&lt;0.001). The percentage of children with SAM who had HIV decreased over time in OTPs with an AARR of 16.1% (p=0.001). HIV rates also decreased in NRUs with an AARR of 7.2% (p=0.4), but this difference was not significant. Death rates decreased in OTPs with an AARR of 6.0% (p=0.01). Mortality rates did not change in NRUs over time with an AARR of 0.9% (p=0.5) with the NRU mortality rate in 2019 being 11.0%.Conclusions These trends indicate that there has been an increase in OTP admissions and a corresponding decrease in NRU admissions. There have been decreases in the percentage of children with oedematous SAM in OTPs and in NRUs and with HIV in OTPs. Children remain at high risk of mortality in NRUs.

Changing clinical practice and prognosis for severe respiratory failure over time: A nationwide inpatient database study

BackgroundSevere respiratory failure requires numerous interventions and its clinical implementation changes over time. We aimed to clarify the clinical practice and prognosis of severe respiratory failure and its changes over time. MethodsIn a nationwide Japanese administrative database from 2016 to 2019, we identified nonoperative patients with severe respiratory failure without congestive heart failure as the main diagnosis who received mechanical ventilation (MV) for more than four days. We examined trends in patient characteristics, adjunctive interventions, and prognosis. ResultsAmong 66,905 patients included in this study, patients received antibiotics (90%), high-dose corticosteroids (14%), low-dose corticosteroids (18%), and 51% were admitted to the critical care unit. Hospital mortality was 35%. Median mechanical ventilation lasted 10 days. Tracheostomy occurred in 23% of cases. Median critical care and hospital stays were 10 and 25 days, respectively. Among survivors, 23% had mechanical ventilation dependency at hospital discharge. Large relative changes in adjunctive therapies included fentanyl (30%–38%), rocuronium (4.4%–6.7%), vasopressin (3.8%–6.0%), early rehabilitation (27%–38%), extracorporeal membrane oxygenation (0.7%–1.2%), dopamine (15%–10%), and sivelestat (8.6%–3.5%). No notable changes were seen in mechanical ventilation duration, tracheostomy, critical care unit stay, hospital stay, or ventilator dependency at discharge, except for a slight reduction in hospital mortality (36%–34%). ConclusionsSeveral adjunctive therapies for severe respiratory failure changed from 2016 to 2019, with an increase in evidence-based practices and a slight decrease in hospital mortality.

Geographic and demographic trends with the initiation of virtual interviews in general surgery: A 7-program evaluation

BackgroundAlthough most general surgery residency interviews remain virtual, the effect of this format remains understudied. Single-institution data have shown an increase in the number of applications received and interviews conducted with virtual interviewing but no change in the geographic backgrounds of interviewed or matched applicants. This study sought to compare national trends in geographic characteristics of general surgery applicants, interviewed applicants, and matched applicants between in-person and virtual application cycles. Study DesignA retrospective review of 7 general surgery residency programs from application years 2016–2019 (in-person) and 2020–2021 (virtual) was conducted. Data collected included birth year, sex, race, medical school state, and contact location at the time of application. Data were analyzed using generalized mixed effects linear models. ResultsA total of 52,742 applicants, 4,550 interviewed applicants, and 329 matched applicants were included. During virtual application cycles, there were no increases in the average number of applicants (P = .25), interviewed applicants (P = .36), or matched (P = .84) applicants per year. Virtual cycles were associated with a larger proportion of interviews conducted with applicants from out-of-state medical schools (P < .01) and listing out-of-state contact locations (P < .01) compared with in-person application cycles. There were no significant geographic differences in matched applicants between virtual and in-person application cycles. ConclusionVirtual application cycles had greater geographic diversity among interviewed applicants. However, similar differences were not seen in the geographic diversity of matched applicants. Additional efforts should focus on why no changes in the geographic diversity of matched applicants were identified.

Secular trends in anthropometric characteristics and their associations with external skeletal robustness among Slovenian young adults’ population

Objectives: To determine secular trends in body height, fat-mass, fat-free mass, and external skeletal robustness in young adults and examine possible relationship between them. Methods: Anthropometric data (body height, body mass; skinfold thickness (SFT) – triceps, abdominal, thigh; circumferences (C) – waist, upper arm, thigh; width – elbow, knee) of young adults aged 20-25 years (N = 5303; males 1985, females 3318) were used from the Slovenian (data)Base of Anthropometric Measurements from 1960 to 2023. Multiple linear regressions were performed. Results: The most significant positive secular trends (p &lt; 0.000) were observed in males for abdominal SFT (B = 0.151, R2 = 0.169) and thigh SFT (B = 0.131, R2 = 0.142). In females, similar trend was observed in waist C (B = 0.151; R2 = 0.169). The most significant negative secular trend (p &lt; 0.001) was observed in muscle area of lower limbs in both sexes (males: B = - 0.427, R2 = 0.000; females: B = - 0.875, R2 = 0.300). Body height and overall body mass were the most important factors influencing the observed decline in external skeletal robustness assessed with frame index according to elbow and knee width according to multiple linear regression. Conclusion: Over the last 60 years, a positive secular trend was observed in body height and body fat, while a negative trend was noted in muscle mass. Increases in body height and overall body mass had the most significant impact on the observed decrease in assessed external skeletal robustness over time.

Tunable Band‐to‐Band Tunneling and Conducting Path Transition in Local‐Control‐Gate Heterostructure Transistor

AbstractTransition metal dichalcogenide (TMD) material‐based heterostructures have exhibited great potential for building advanced architectures in novel logic devices. A local‐control‐gate (LCG) transistor based on MoTe2/MoS2 heterostructure is fabricated and analyzed, illustrating its tunable electrical characteristics and achieving band‐to‐band tunneling (BTBT) enhancement with an improved peak‐to‐valley current ratio (PVCR) value of 3.04. Compared to the basic dual‐gate tunnel field‐effect transistor (TFET) structure, adding LCG at the bottom not only isolates defect‐induced doping effects from the deposition of top gate dielectrics, but also paves the way for broader applications in multivalued logic and artificial intelligence. Aiming to further verify the operating mechanism of conducting path transition and electrical characteristic trends, commercial technology computer‐aided design (TCAD) is systematically employed assisted by density functional theory (DFT). So that the transition of conducting paths in the heterostructure channel including interlayer quantum effects can be visibly demonstrated while applying various voltages to the LCG. In summary, this work highlights the feasibility of a new LCG structure with tunable electrical characteristics and presents DFT‐assisted TCAD simulations for effective verifications.

Exposure-Response and Subgroup Analyses to Support Body Weight-Based Dosing of Brentuximab Vedotin in Children and Young Adults with Newly Diagnosed High-risk Classical Hodgkin Lymphoma.

The purpose of the study was to evaluate the relationships between brentuximab vedotin (BV) pharmacokinetics, age, and body weight (BW) with efficacy and safety in pediatric and young adult patients with previously untreated, high-risk classical Hodgkin lymphoma in the phase III AHOD1331 study. Overall, 296 patients (age 2-21 years) in the overall population were randomized to and received BV + chemotherapy; the pharmacokinetic subpopulation comprised 24 patients (age <13 years). Age- and/or BW-based (pharmacokinetic surrogates) subgroup analyses of efficacy and safety were conducted for the overall population. Exposure-response analyses were limited to the pharmacokinetic subpopulation. There were no visible trends in disease characteristics across pediatric age subgroups, whereas BW increased with age. Observed antibody-drug conjugate exposures in patients ages <12 years were lower than those in adults administered BV 1.8 mg/kg every 3 weeks, as exposure increased with BW. Nevertheless, no detrimental impact on event-free survival was seen in younger subgroups: 3-year event-free survival rates were 96.2% (2-<12 years) and 92.0% (12-<18 years), with no events observed in those ages <6 years. Neither early response nor lack of need for radiation therapy was associated with high pharmacokinetic exposure. No evidence of exposure-driven grade ≥2 or ≥3 peripheral neuropathy or grade ≥3 neutropenia was seen in exposure-safety and BW-based subgroup analyses; the incidence of these safety events was comparable across pediatric age subgroups, despite lower exposure in younger children. No further adjustments based on age or BW are required for the BV dosage (1.8 mg/kg every 3 weeks) approved in children.

The changing shape of general practice in Scotland: the rise of the ‘megapractice’

ObjectivesTo describe the trends in the nature of general practices in Scotland between 2014/15 and 2023. Study designDescriptive ecological study. MethodsWe obtained data from Public Health Scotland and used general practitioner (GP) practice codes, practice names, and the General Medical Council (GMC) numbers of their listed GPs to describe trends in practice characteristics and to identify individual practices that were likely to be operating as a single entity. ResultsDefining practice entities is difficult because different GP practice codes are often retained when GPs are performing across multiple practices. If GP practice codes alone are used, the median practice list size increased from 5094 to 5881, and the mean from 5588 to 6289, between 2013/14 and 2020/21. There was one outlier practice that grew to have over 45,000 patients registered by 2020/21. However, this underestimates the extent of this new mega-practice phenomenon. Using the GMC numbers of GPs listed as performers to identify where the same GPs are working across multiple GP practice codes, we identified a series of mega-practices that span across health board areas and which have experienced a dramatic increase in their list size (with the two largest having list sizes of over 101,000 and 77,000 patients, respectively). ConclusionsFurther research is needed to better understand: how mega-practices provide services and whether this differs from other practices; where financial rewards accumulate within mega-practices; differences in staffing between mega-practices and other models; and the impacts mega-practices have on the quality and continuity of care and on health and inequality outcomes.

Evaluation for long-term skid resistance of ultra-thin asphalt overlay based on texture characteristics

To evaluate the durability of ultra-thin asphalt overlays in terms of skid resistance accurately, the long-term degradation trends in texture characteristics need to be carried out comprehensively. In this paper, three types of ultra-thin asphalt overlays with different gradations were selected. The long-term abrasion test was conducted, with friction coefficient and texture characteristics tested in each abrasion cycle. Additionally, the stress state changes at the interface of the tire and mixtures were also obtained. Finally, the reliability of texture characteristics was validated based on the correlation between different indicators. The results show that the friction coefficient and texture characteristic show a two-stage decay pattern during the abrasion process, with a significant decrease in stress between 0.75 and 2.5 MPa at the interface of tire and mixtures. The surface mean texture depth (SMTD), root-mean-square deviation of surface (Sq), peak density of surface (Spd), and spatial fluctuations of texture (Δα) were correlated with British pendulum number (BPN) strongly, and the Sq and Δα were recommended as reliable evaluation parameters for the long-term skid resistance of ultra-thin asphalt overlays. This study provides theoretical guidance for the optimal design and field monitoring of ultra-thin asphalt overlays from the perspective of surface texture characteristics.

Low vision aids provision in an urban setting in Germany between 2014 and 2017: a regional population based study with healthcare claims data.

Little is known about the utilization of low vision services (LVS) in Germany. To understand which persons and how often these services would be utilized, this study aimed to investigate low vision aids (LVAs) provision in an urban setting and to describe user characteristics and trends in their characteristics. A retrospective study based on a population-based healthcare claims database in Cologne (N = ~ 500,000), Germany. The study population comprised individuals, who were continuously insured at four large statutory health insurers and who redeemed a prescription for visual aids or aids for blindness between January 2014 and December 2017. We examined their socio-demographic and clinical characteristics. Trends in characteristics were examined with logistic and linear regression models over time. Out of ~ 500,000 persons, 781 unique individuals (~ 0.2%) redeemed an LVA prescription. They were mainly female (68.7%), 60 years or older (75.3%) and had macular degeneration (50.6%) and/or glaucoma (25.9%). In the working-age subgroup, 33.8% were employed. Visual aids were most often prescribed (74.1%) and of all types of LVAs, individuals most commonly redeemed a prescription for magnifiers (35.8%), screen readers (34.3%) and/or canes (17.1%). Of the entire study population, 75.4% received their prescription from an ophthalmologist, 5.3% from a general practitioner and 7.1% from other medical specialists. Significant trends in characteristics of individuals who redeemed an LVA prescription were not found. Between 2014 and 2017, 781 individuals in Cologne redeemed an LVA prescription. They had characteristics which mostly can be explained by the epidemiology of VI. Results indicate that individuals that redeemed LVAs have a magnification requirement of ≥ 1.5-fold and ≥ 6-fold. Furthermore, next to ophthalmologists, general practitioners and other medical specialists seem to play a role in LVA provision as well, which should be taken into account by policy makers when planning interventions for increasing LVS provision. Our findings provide a starting point to examine LVS provision in Germany.

Being all-seeing gymnast within kidney cavity: analysis of the optical and flexibility characteristics trends of 61 flexible ureteroscopes over four decades.

The purpose of this review is to analyze the trend in optical features and flexibility changes of flexible ureteroscopes over the past decades, and determine the correlation of individual parameters with release period as well as with dimensional parameters. Flexible ureteroscopes mentioned in the literature or those commercially available were searched. To minimize the search bias, the instruments were grouped by release date time-periods of < 2000 year, 2000-2009, 2010-2019, and 2020 onwards. The final review included only those instrument models for which data on minimum and maximum depth of field, field of view, direction of view, and deflection degree had been determined. The correlation among features investigated as well as with release period was also determined. 61 models of flexible ureteroscopes (27 fibreoptic and 34 digital scopes) were included. Among the different features investigated among fiberoptic endoscopes, minimum depth of field positively and negatively correlated with channel size and field of view, respectively, whereas maximum depth of view and field of view positively correlated with overall shaft and deflection degree, respectively. Up and down deflection strongly correlated with each other and both were negatively proportional to the distal tip size. For the digital endoscopes, minimum depth of field negatively and positively correlated with distal tip size and working length, respectively. Maximum depth of field positively correlated with field of view, whereas the latter was negatively proportional to the overall shaft. As for the fiberoptic counterparts, up and down deflection strongly correlated with each other. Field of view, up and down deflection of fiberoptic flexible ureteroscopes, were significantly increased among fiberoptic and digital endoscopes over decades. As flexible ureteroscopy technology has evolved, there has been a trend towards increasing field of view with up and down deflection. Given the importance of scope ergonomics, one aspect of this popularity is the improvement of optical characteristics and deflection degree, which significantly correlates with the release period.