Χ2 Test Of Independence Research Articles

The Intersection between Criminal Accusations, Victimization, and Mental Disorders: A Canadian Population-Based Study.

Understand the relationship between criminal accusations, victimization, and mental disorders at a population level using administrative data from Manitoba, Canada. Residents aged 18 to 64 between April 1, 2007, and March 31, 2012 (N = 793,024) with hospital- and physician-diagnosed mental disorders were compared to those without. Overall and per-person rates of criminal accusations and reported victimization in the 2011/2012 fiscal year were examined. Relative risks were calculated, adjusting for age, sex, income, and presence of a substance use disorder. The overlap between diagnosed mental disorders, accusations, and victimization with a χ2 test of independence was studied. Twenty-four percent (n = 188,693) of the population had a mental disorder over the 5-year time frame. Four to fifteen percent of those with a mental disorder had a criminal accusation, compared to 2.4% of the referent group. Individuals with mental disorders, especially psychotic or personality disorders, were often living in low-income, urban neighborhoods. The adjusted relative risk of accusations and victimization remained 2 to 5 times higher in those with mental disorders compared to the referent group. Criminal accusations and victimization were most prevalent among individuals with a history of attempted suicide (15.2% had an accusation and 8.1% were victims). The risk of victimization in the same year as a criminal accusation was significantly increased among those with mental disorders compared to those without (χ2 = 211.8, P < 0.001). Individuals with mental disorders are at elevated risk of both criminal involvement and victimization. The identification of these multiply-stigmatized individuals may lead to better intervention and support.

Effectiveness of Maternal Safety Bundle for Obstetric Hemorrhage at a Large U.S. Military Hospital [15M

INTRODUCTION: Postpartum hemorrhage is one of the leading causes of maternal deaths worldwide. Attempts to remedy this problem have led to the implementation of multiple maternal safety bundles, of which one was recently implemented at Womack Army Medical Center at Fort Bragg, NC. The goal of our study is to determine the effectiveness of this bundle in predicting postpartum hemorrhage in a military population. METHODS: Our study included patients that delivered from March through December 2017, who were deemed either moderate or high risk for postpartum hemorrhage. We looked at blood transfusion rates and risk factors for receiving transfusions. Numerical variables were compared using Student’s t or Wilcoxon Rank Sum as appropriate. Categorical variables were compared with the χ2 Test of Independence or Fisher’s Exact. RESULTS: There were 423 patients who were considered ‘moderate’ risk (78.7%) or ‘high’ risk (21.3%) for postpartum hemorrhage. Of patients considered high risk, 11.1% required a blood transfusion, whereas significantly fewer patients classified as moderate risk required a transfusion (3.9%, P=.0150). The only significant risk factors for blood transfusion in this sample were patients with history of a prior postpartum hemorrhage (P=.0027, assessed antepartum) and less than 70,000 platelets assessed intrapartum (P=.0082). CONCLUSION: Our study shows that this bundle for obstetric hemorrhage was able to predict a higher rate of transfusion for those deemed high risk. Interestingly, our analysis showed only 2 risk factors of 26 were found to be statistically significant for blood transfusion.

Content Analysis of Family Medicine Resident Peer Observations

Direct observation is a critical part of assessing learners' achievement of the Accreditation Council for Graduate Medical Education (ACGME) Milestones and subcompetencies. Little research exists identifying the content of peer feedback among residents; this study explored the content of residents' peer assessments as they relate to ACGME Milestone subcompetencies in a family medicine residency program. Using content from a mobile app-based observation tool (M3App), we examined resident peer observations recorded between June 2014 and November 2017, tabulating frequency of observation for each ACGME subcompetency and calculating the proportion of observations categorized under each subcompetency, as well as for each postgraduate year (PGY) class. We also coded each observation on three separate dimensions: "positive," "constructive," and "actionable." We used the χ2 test for independence, and estimated odds ratios and 95% confidence intervals for two-by-two comparisons to compare numbers of observations within each category. Our data include 886 peer observations made by 54 individual residents. The most frequently observed competencies were in patient care, communication, and professionalism (56%, 47%, and 38% of observations, respectively). Practice-based learning and improvement was observed least frequently (16% of observations). On average, 97.25% of the observations were positive, 85% were actionable, and 6% were constructive. When asked to review their peers, residents provide comments that are primarily positive and actionable. In addition, residents tend to provide more feedback on certain subcompetencies compared to others, suggesting that programs may rely on peer feedback for specific subcompetencies. Peers can provide perspective on the behaviors and skills of fellow residents.

Clinical and surgical evaluation of gynecomastia: tactic and results

Objectives: To perform an assessment of the clinical and surgical characteristics of gynecomastia as a tactic used and the results obtained in the breast. Methods: A prospective and observational study was carried out in the mastology service of Hospital Barão de Lucena in 40 patients. To determine which factors are associated with the cosmetic outcome, the contingency table was constructed and the χ2 test for independence was applied. In cases in which the assumptions of the χ2 test were violated, Fisher’s exact test was applied. Results: Findings showed that most patients were from the metropolitan region of Recife (72.5%), studied until high school (62.5%), were aged 10 to 20 (42.5%), were in gynecomastia grade III (47.5%), underwent double incision (52.5%), had no complications (75.0%), and had a good and excellent cosmetic outcome (75.0%). The proportion comparison test was significant in all factors evaluated (p&lt;0.05), except for the variable level of education (p=0.114), indicating that the numbers of patients who studied until high school and had higher education are close. The independence test was significant only in the variable complications (p&lt;0.001), indicating that having complications significantly increases the risk for regular/bad cosmetics. Conclusion: Gynecomastia is a pathology of strong social impact. We observed this after analyzing the epidemiological, clinical, and surgical characteristics of our patients. In patients who underwent surgical treatment and who had no complications, there was a greater degree of satisfaction.

Diagnosing dysplasia in Barrett’s oesophagus still requires Seattle protocol biopsy in the era of modern video endoscopy: results from a tertiary centre Barrett’s dysplasia database

Objectives: The role of random, four-quadrant biopsy (i.e. systematic biopsy) in Barrett’s oesophagus surveillance has been questioned given its drawbacks and the emergence of high-resolution endoscopy and advanced imaging modalities. Our study aims to assess whether neoplastic pathology is typically diagnosed in routine clinical practice by random, four-quadrant or targeted biopsy whilst using high-resolution endoscopy.Methods: The Nottingham University Hospital Barrett’s oesophagus dysplasia database was retrospectively analysed. Endoscopic and histopathologic data pertaining to the initial endoscopy in which pathology was diagnosed was extracted from the medical records. The most advanced histopathologic abnormality at initial diagnosis and within twelve months were noted. The corresponding endoscopic impression at initial diagnosis was used to group cases per type of biopsy – random, four-quadrant or targeted. Pearson’s χ2 test of independence was used to analyse the relationship between the type of biopsy and diagnosis, indication for endoscopy, endoscopist level and advanced techniques used.Results: Of the 222 patients involved in the study – a higher proportion were diagnosed through random, four-quadrant biopsy (72.97%) than targeted biopsy (27.03%). 90.91% of low-grade dysplasia, 71.43% of high-grade dysplasia and 50% of intramucosal adenocarcinoma cases were diagnosed by random, four-quadrant biopsy. Across all grades of clinicians, patients were typically diagnosed through random, four-quadrant biopsy. However, amongst specialist consultant endoscopists (n = 10) the proportion was equal.Conclusions: Our findings strongly emphasize the importance of random, four-quadrant biopsy in the detection of not only low-grade dysplasia, but also high-grade dysplasia and early invasive carcinoma as part of Barrett’s oesophagus surveillance.

Quantitative analysis of the development of smart cities in India

Purpose Smart cities are an attempt to recognize the pioneering projects designed to make the cities livable, sustainable, functional and viable. The purpose of this paper is to evaluate funding released by the government city wise and sources available for finance for the development of the smart cities. The impact of fund released by the government for the development of smart cities (Chandigarh, Karnal, Faridabad, Pune, Chennai, Ahmedabad, Kanpur, Delhi, Lucknow and Agra) in India has been studied in detail. Urbanization is a continuous process, which is taking place throughout the globe, especially in developing countries like India. Design/methodology/approach The research is descriptive in nature. The sources of funding for smart cities in India have been taken into consideration, and χ2 test of independence has been employed to study the impact of fund released by the government for smart city development in India by using IBM SPSS. Findings The total investment, area-based projects, pan-city initiatives and O&amp;M costs for smart cities ranged between Rs 133,368 and Rs 203,979 lakh crores, Rs 105,621 and Rs 163,138 lakh crores, Rs 26,141 and Rs 38,840 lakh crores, and Rs 1,604 and Rs 1,999 lakh crores, respectively, in the year 2016 (for 60 smart cities) to 2017 (for 99 smart cities), which shows an increasing trend. The investment in retrofitting projects, redevelopment projects, greenfield projects and area-based projects ranged between Rs 94,419 and Rs 131,003 lakh crores, Rs 8,247 and Rs 23,119 lakh crores, Rs 2,955 and Rs 8,986 lakh crores, and Rs 105,621 and Rs 163,138 lakh crores, respectively, in the year 2016 (60 smart cities) to 2017 (99 smart cities), which shows the division of projects funding for smart city development in India. The funding released for smart city development such as other sources, loans from the financial institution, private investment, convergence, state government share funding and Central Government Funding ranged between Rs 14,828 and Rs 15,930 lakh crores, Rs 7,775 and Rs 9,795 lakh crores, Rs 30,858 and Rs 43,622 lakh crores, Rs 25,726 and Rs 43,088 lakh crores, Rs 27,260 and Rs 45,695 lakh crores, and Rs 29,207 and Rs 47,858 lakh crores, respectively, in the year 2016 (60 smart cities) to 2017 (99 smart cities), which reflects the different sources of funding for the development of smart cities in India. The χ2 test of independence has been applied, which shows that there is no impact of fund released by the government on cities for smart city development in India as the p-values of Chandigarh (0.213), Karnal (0.199), Faridabad (0.213), Pune (0.199), Chennai (0.213), Ahmadabad (0.199), Kanpur (0.199), Delhi (0.199), Kolkata, Lucknow (0.213) and Agra (0.199) are greater than 0.05. Research limitations/implications For the Smart Cities Mission to be financially sustainable, the right policy and institutional framework should be implemented for modernization and aggregation of government landholding. Consolidation of all the landholdings under the smart city project should be properly implemented, and the role of private sectors should be encouraged for public‒private partnership projects to make Smart City Mission more successful. Practical implications The benefits of smart cities development will help provide affordable, cleaner and greener housing infrastructure for all, especially the inclusive group of developers belonging to the lower middle-income strata of India, and the benefits will be replicated when adopted on a smaller scale in the rural part of the country. Originality/value The research paper is original and χ2 test has been used to study the impact of fund released by the government for smart city development in India.

Differentiation between Tuberculous and Pyogenic Spondylodiscitis: The Role of the Anterior Meningovertebral Ligament in Patients with Anterior Epidural Abscess.

Differentiation between tuberculous and pyogenic spondylodiscitis is a diagnostic challenge because imaging often does not reliably distinguish the 2 entities and percutaneous biopsies are often culture-negative. The purpose of this study was to determine whether violation of the anterior meningovertebral ligament in the setting of anterior epidural abscess discriminates between these entities. This was a retrospective cohort study of all patients with acid-fast bacillus testing and anterior epidural abscess diagnosed on spinal MR imaging between May 2014 and September 2019, with a final diagnosis of tuberculous or pyogenic spondylodiscitis. Six cases of tuberculous spondylodiscitis (mean age, 45.5 years; 80% male) and 35 cases of pyogenic spondylodiscitis were evaluated (mean age, 56.6 years; 49% male). Demographic characteristics were recorded. Cases were assessed for anterior meningovertebral ligament destruction on MR imaging, as demonstrated by the shape of the epidural collection. Segmental location of the infection was also assessed. Independent 2-sample t tests and χ2 tests of independence were performed to evaluate the significance of the difference between the groups. Five of 6 (83.3%) cases of tuberculous epidural abscess had an intact anterior meningovertebral ligament, and 0/35 cases of pyogenic epidural abscess demonstrated an intact ligament (P < .001). The presence of an intact anterior meningovertebral ligament had 83.3% sensitivity and 100% specificity for tuberculous spondylodiscitis, a 100% positive predictive value, and a 97.2% negative predictive value. The presence of an intact anterior meningovertebral ligament has high sensitivity and specificity for tuberculous spondylodiscitis-associated epidural abscess, though these results should be validated in a larger sample.

Genetic Absence of Integrin alpha2b Improves Survival of Tissue Factor Pathway Inhibitor Null Mice but Results in Hydrocephalus Formation

Introduction: Genetic deletion of Tissue Factor Pathway Inhibitor (TFPI) exon 4, encoding its Kunitz 1 (K1) domain, results in complete intrauterine lethality (PMID 9242522). TFPI K1 null mice (Tfpi-/-) are born live if Tissue Factor expression is reduced or in the complete absence of Protease Activated Receptor-4 (Par4), and these exhibit a normal life span without overt signs of thrombosis (PMID 15598816, 25954015). Based on these data, it has been postulated that modulation of thrombin-dependent platelet activation by TFPI is essential for survival. Platelet activation results in a number of downstream events. Of these, platelet aggregation via the integrin receptor αIIbβ3 is considered to have a key role in hemostasis and could participate in thrombotic pathology in the absence of TFPI. Binding of αIIbβ3 to its ligands also mediates critical interactions of platelets with endothelial cells, leukocytes and other cell types. In this work, we have investigated whether modulation of platelet activity via genetic absence of integrin receptor αIIbβ3 confers protection and allows generation of adult Tfpi-/- mice. Methods: Tfpi+/- αIIb-/- mice were generated by breeding Tfpi+/- and integrin αIIb-/- mice and identified by PCR-based genotyping of tissues obtained by tail biopsies. Tfpi+/- αIIb-/- intercrosses served as the experimental cross. Pups were genotyped at the time of wean, around 4 weeks of age. In some experiments, surgeries were performed to analyze pregnancies at 18.5 days post coitum (dpc). Embryos and placentae were observed under the dissecting microscope and any phenotypic abnormalities were noted. Presence of heart beats and limb movements were used to identify live embryos. Embryos and placentae were fixed in zinc-formalin and embedded in paraffin for sectioning and histological analysis. T1 weighted Magnetic Resonance Images were acquired on a 9.4T scanner to measure cerebral ventricle sizes of Tfpi-/- αIIb-/- and littermate control mice. Ventricular regions of interest (ROI) were drawn on each image slice from which total ventricular volume was computed. These mice were later perfused with 4% paraformaldehyde for collection of organs and histological analysis. Results: We analyzed 122 pups from intercrosses of Tfpi+/- αIIb-/- mice and observed a genetic distribution 39 Tfpi+/+, 77 Tfpi+/- and 6 Tfpi-/- (25% or 31 Tfpi-/- were expected, 5% observed, 95% CI 1.8 to 10.4%). Thus, genetic absence of αIIb results in incomplete rescue of Tfpi-/- mice (P&amp;lt; 0.000002, Χ2 GOF) with only ~20% surviving past embryonic development to 4 weeks of age. These data contrast with 40% Tfpi-/- offspring surviving in the absence of Par4 (Tfpi+/- Par4-/- intercrosses: 23 Tfpi+/+, 39 Tfpi+/- and 8 Tfpi-/-; PMID 25954015). Thus, the absence of αIIb is much less effective than the absence of Par4 in allowing early survival of TFPI null mice (P &amp;lt; 1.9E-09; Χ2 test of independence). We compared survival of Tfpi-/- αIIb-/- offspring close to term of pregnancy (18.5 dpc) and at 4 weeks of age. TFPI null embryos were found at reduced frequency at 18.5 dpc (12 Tfpi+/+, 21 Tfpi+/- and 5 Tfpi-/-; 25% Tfpi-/- expected, 13% observed, 95% CI 4.4 to 28.1%), but even fewer survived the trauma of birth (P&amp;lt;0.0004, Χ2 test of independence). Of the 6 Tfpi-/- αIIb-/- pups found at 4 weeks of age, 3 died by 9 weeks of age. Dome shaped heads indicative of hydrocephalus or histological evidence of hydrocephalus was noted in the pups that died. Surviving mice were observed for 7 months to 1 year of age and imaged with MRI. Comparison of ventricular volumes between Tfpi-/- mice and Tfpi+/- controls demonstrated a higher volume in Tfpi-/- mice (39.3 ± 18.3 versus 5.3 ± 2.2 mm3; P=0.08). Both Tfpi-/- and Tfpi+/- mice were αIIb-/- in this experiment. Thus, αIIb in not involved in hydrocephalus formation. Hydrocephalus formation in Tfpi-/- mice was confirmed through serial histological sections of the brain (Figure 1). Conclusions: Our data demonstrates that genetic absence of αIIb improves survival of TFPI null mice, but to a much lesser extent than the genetic absence of Par4. Thus, the critical role of Par4 in the demise of TFPI null mice is unlikely to be primarily through excessive platelet aggregation. We further show that TFPI null pups exhibit varying degrees of hydrocephalus formation. While the mechanism of hydrocephalus formation in the absence of TFPI remains unclear, our results demonstrate a critical role of TFPI in the brain. Disclosures No relevant conflicts of interest to declare.

Animal Models Demonstrate a Critical Role of Factor VIII in Par4- and Platelet-Mediated Pathology

Recent studies suggest that Tissue factor (TF)-initiated pathway can directly and rapidly yield FVIIIa-FIXa intrinsic tenase complex prior to coagulation amplification by thrombin (PMID 28729433). FVIII may also mediate TF/FVIIa-dependent FXa generation in the initiation phase of coagulation (PMID 30756344). These new insights prompted us to evaluate whether FVIII plays an important role in generating the minimum level of thrombin required for platelet activation in vivo. We used two distinct murine models of platelet- and Par4-mediated pathology to address this question. We have previously shown that mice homozygous for a hypomorphic thrombomodulin allele (ThbdPro/Pro) are aborted in pregnancies of FV Leiden (FVQ/Q) females before day 12.5 of gestation (Table 1, row 1; PMID 23325830). Par4-activation on maternal platelets plays a key role in fetal death in this model; its absence allows embryonic development and restores Mendelian frequency of live ThbdPro/Pro embryos found at term (Table 1, row 2; PMID 17438064). We examined the effect of reduced TF or genetic deletion of FVIII on embryonic survival of ThbdPro/Pro embryos. We demonstrate that inhibition of TF or the absence of FVIII, each significantly protect the fetus from maternal platelet-mediated death (Table 1, rows 3 &amp; 4). Treatment of the mother with anti-TF antibody 1H1 resulted in 11 ThbdPro/Pro embryos (30 analyzed, 50% or 15 expected; 37% observed, 95% CI 20 to 56%). In the absence of FVIII, 10 ThbdPro/Pro embryos were observed (30 analyzed, 50% or 15 expected; 37% observed, 95% CI 20 to 56%). The outcome of TF inhibition was comparable to the absence of FVIII (P=0.79 Χ2 test of independence). In a second model, Endothelial Protein C Receptor null mice (ProcR-/-) die in midgestation (Table 2, row 1), but reducing TF expression restores Mendelian frequency of ProcR-/- pups (PMID 15956290). We find that ProcR-/- embryos survive past midgestation if the mother is injected with platelet depleting antibodies. Genetic absence of Par4 allows ProcR-/- mice to survive embryonic development (Table 2, row 2; 25% or 18 ProcR-/- neonates expected, 13 observed, 95% CI 10.3 to 29.7%). We investigated the role of FVIII in the midgestational demise of ProcR-/- mice. We demonstrate that genetic absence of FVIII also protects ProcR-/- mice from intrauterine demise (Table 2, row 3; 25% or 12 out of 48 ProcR-/- expected, 12 observed, 95% CI 13.6 to 29.6%). Similar to TF reduction, the absence of FVIII restores Mendelian frequency of ProcR-/- embryos at term. Thus, the outcome from the genetic absence of FVIII was comparable to the absence of Par4 (P=0.4 Χ2 test of independence). In a third model, we have established that epiblast restricted deletion results in normal Mendelian frequency of thrombomodulin-deficient embryos (Meox2Cretg Thbdδ/δ) at term, but about 1/3rd survive the trauma of birth. Most surviving mice later succumb to severe tail and limb thrombosis and several exhibit circling behavior indicative of stroke. Genetic absence of Par4 does not improve perinatal survival, but protects thrombomodulin-deficient mice from stroke and thrombotic disease, significantly improving adult survival. We tested whether genetic absence of FVIII affords protection similar to the absence of Par4. We report that similar to Par4-/- Meox2Cretg Thbdδ/δ mice, FVIII-/- Meox2Cretg Thbdδ/δ mice do not exhibit thrombosis or stroke (current age range 2 to 8 months). Thus, the absence of FVIII is protective in Par4-mediated thrombosis and stroke observed in thrombomodulin-deficient mice. These studies establish an essential role of FVIII in Par4-mediated pathologies. They strongly support the notion that FVIII activation is required for sufficient accumulation of thrombin for platelet activation. Notably, these are models of physiological thrombosis or platelet-mediated fetal death, without the use of artificial injury or insult. All three models that we describe lack a fully functional system for generating activated protein C (aPC). Our results suggest that inactivation of FVIII by aPC may be necessary to tightly regulate thrombin-mediated platelet activation. Reduced platelet activation observed in hemophilia A mice, albeit in the context of prevention of thrombosis, also lends support to the notion that defects in primary hemostasis due to reduced platelet activity could be an important component of bleeding diathesis in hemophilia A patients. Disclosures No relevant conflicts of interest to declare.

Dependence on tips and sexual harassment vulnerability of hotel employees in Accra, Ghana

PurposeThe purpose of this paper is to examine the relationship between perceived dependence on tips and vulnerability to sexual harassment (SH) among hotel employees in Accra Metropolis, Ghana.Design/methodology/approachWithin a cross-sectional research design, 583 employees from 55 hotels completed self-administered questionnaires. Descriptive statistics, χ2 test of independence, Kruskal–Wallis test were used to analyse collected data.FindingsResults of the study reveal that dependence on tips is related to SH vulnerability of food and beverage staff. Furthermore, dependence on tips engenders a perception of SH climate. Compared to guests and co-workers, supervisors were least identified as perpetrators of SH in hotel workspaces. Guests were responsible for unwanted sexual attention, whereas co-workers pose the greatest risk for gender harassment.Practical implicationsHotel management should invest in the publication of educational materials such as leaflets and posters indicating unacceptability of inappropriate sexual behaviours.Originality/valueThis paper is one of the pioneers to have assessed the relationship between dependence on tips and perceived climate for SH as well as vulnerability to SH in a hotel context.

Differences in specific learning disability identification with the Woodcock-Johnson IV.

The Ability Achievement Discrepancy model remains the primary identification method used by school personnel. This study examined identification of a specific learning disability using the Ability Achievement Discrepancy model with the Woodcock-Johnson IV (WJ-IV). Two different test scores can be used to represent the ability construct: one that maintains the overlap between intelligence quotient (IQ) and basic psychological processes (i.e., general intellectual ability) and one that mostly removes the overlap between IQ and basic psychological processes (i.e., fluid-crystallized intelligence). The study included 3,736 individuals from the WJ-IV standardization sample to ascertain whether different proportions of individuals were identified by the 2 methods as well as identify which tests contributed to the differences. χ2 tests of independence and absolute ratios were used to examine the proportion of individuals identified; a multivariate analysis of variance and follow-up Tukey honestly significant differences were conducted to determine whether the groups of individuals identified in each model differed on their academic achievement scores, and Mann-Whitney U tests were used to identify the tests that contributed to differences in identification rates. The results indicated that different proportions of individuals were identified as a function of the IQ score used, even though achievement scores were generally similar across identification methods. Black students were overrepresented and White students were underrepresented compared with their proportion in the total sample. Discrepancy profiles largely varied as a function of the internal psychometrics of the WJ-IV rather than characteristics of the individual. Implications for practice and methodological limitations are reviewed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Lower urinary tract injury: is urology consultation necessary?

There is a paucity of data regarding urology involvement in the management of lower urinary tract injuries (LUTI). We seek to analyze the incidence and epidemiology of LUTI with special attention to trends in urology consultation. A retrospective review was conducted of patients presenting to our Level I trauma center with LUTI from 2002 to 2016. Demographics, mechanism of injury, associated injuries, injury severity score (ISS), American Association for the Surgery of Trauma (AAST) injury scales, and clinical hospital course were analyzed. A total of 140 patients (0.47% of all trauma patients) were identified with LUTI, with 72.1% of these presenting with blunt trauma. Bladder injuries were more common than urethral injuries (79% vs. 14%) with 6% of patients having both. In-hospital mortality was 9.2% (13/140). Among patients with LUTI, 115 patients (82%) received urology consultation. There was no significant difference in sex, age, or LOS (hospital and ICU) between the groups. The consult group had a lower mean ISS (21.7 vs 27.9, p = 0.034), but a higher mean AAST bladder injury scale (2.57 vs 2.00, p = 0.016), than the non-consult group. There was a statistically significant difference in the diagnosis methods between the two groups (χ2 test of independence, p = 0.002). Urology service is important in the management of LUTI with high AAST injury scale. While further study is needed to look at degree of urology service involvement in the management of LUTI, we recommend a consultation for severe LUTI or when the management of injuries is out of the comfort zone of the trauma surgeons. Whether consultation is obtained or not, there is room for improvement in appropriate work up of lower urinary tract injury.

Are Emergency Departments in the United States Following Recommendations by the Emergency Severity Index to Promote Quality Triage and Reliability?

IntroductionThe purpose of this study was to explore and describe (1) the extent to which emergency departments in the United States are promoting the quality of triage and the reliability of triage systems according to recommendations in the Emergency Severity Index (ESI) Handbook and (2) if relationships existed between triage structure (policies) and process (procedures) in emergency departments that promote accuracy of triage decisions. MethodsDonabedian’s Structure, Process, Outcome model guided this descriptive, correlational study. Nurses were recruited from all geographic regions in the United States, and the ED TRiAGE Structure and Process Survey was developed to collect data. Χ2 tests of independence, Fisher’s exact tests, and Kendall’s τ were used to assess relationships of structure and process. ResultsThe majority of emergency departments did not meet at least the minimum recommendations of the ESI triage system. Significant positive relationships were found when an emergency department had structure (policy) to guide process (procedures). Differences were reported in the type, amount, and focus of the policies and procedures. DiscussionDonabedian’s model emphasizes that good structure and process are antecedents of good outcomes. This study serves as a foundation on which to examine the consistency of emergency departments meeting the ESI guidelines that promote triage accuracy and maintaining the reliability of evidence-based triage acuity systems.

The Actual Demand for the Elimination of Architectural Barriers among Senior Citizens in Poland.

The purpose of the study is to determine the actual demand for the elimination of architectural barriers among senior citizens in their place of residence and also in its immediate environment in Poland. The research covered a group of people in the post-productive age, living in the Lower Silesia voivodship in Poland. Different research methods were used in the study, primarily including the public opinion survey based on a questionnaire as well as statistical analyses. The cross-tabulation analysis of differences in quality characteristics was performed using Pearson’s chi-square test (χ2 test of independence) or Fisher’s exact test, when the expected number was lower than five. As a post hoc analysis, checking the nature of differences between the studied groups, the analyses were carried out using the method by Baesley and Schumacker. For all analyses, the maximum permissible error class I α = 0.05 was adopted, whereas p ≤ 0.05 was considered statistically significant. The research revealed that a much larger group of people aged 55 and older suffers from mobility limitations than the ones resulting from disability certificates, thus confirming the assumption that along with the respondents’ age, their mobility limitations intensify, resulting in the need for assistance while moving outside their houses/apartments.

Association of Systemic Inflammation and Fatigue in Osteoarthritis: 2007-2010 National Health and Nutrition Examination Survey.

Mechanistic insight into osteoarthritis fatigue is needed as clinical management of this condition is nonspecific. Systemic inflammation is associated with fatigue in other chronic diseases. The purpose of this study was to explore the relationship between systemic inflammation and fatigue in osteoarthritis, while controlling for covariates. This secondary analysis with a cross-sectional, multiyear retrospective design used data from the 2007-2010 National Health and Nutrition Examination Survey. Adults with self-reported osteoarthritis who participated in an examination at a mobile center and had no comorbidities associated with fatigue or systemic inflammation were included (n = 296). Complex sample analysis, independent samples t tests, and χ2 tests of independence were used to explore differences between nonfatigued and fatigued adults with osteoarthritis. Adjusted hierarchical logistic regression models were used to calculate odds of fatigue as a function of two systemic inflammatory markers, C-reactive protein (CRP), and white blood cell (WBC) count. Fatigued adults with osteoarthritis had significantly higher CRP levels and WBC counts compared to nonfatigued adults with osteoarthritis. In adjusted logistic regression models, increased CRP was associated with higher odds of fatigue when controlling for age, days affected by pain, depressive symptoms, sleep quantity, and body mass index (Odds ratio [OR] = 3.38, 95% CI [1.18, 9.69]). WBC count was not associated with higher odds of fatigue when controlling for these variables (OR = 1.10, 95% CI [0.92, 1.32]). Systemic inflammation may have a relationship with fatigue in osteoarthritis. Future work is necessary to replicate these findings in more robust studies.

Comorbidity and racial differences in risk of mortality of men with breast cancer.

1554 Background: Black men with breast cancer have more concomitant disease and worse survival than white men. Less is known about concomitant disease and survival in Hispanic and Asian/Pacific Islander (API) men with breast cancer. The purpose of this study was to compare differences in survival and risk of mortality of white, black, Hispanic, and Asian/Pacific Islander (API) men with breast cancer with increasing comorbidity. Methods: We identified 1,497 cases of first primary male invasive breast cancer from the California Cancer Registry 2000-2015 with a documented Charlson Comorbidity Index (CCI). The CCI is a weighted index based on the presence of certain comorbid conditions following a cancer diagnosis and weighted by the severity of these conditions. A score of 0 indicates no significant comorbidity and scores of 2 or more are interpreted as a high comorbidity burden. Bivariate associations between race and AJCC stage, tumor grade, estrogen receptor (ER) status, human epidermal growth factor 2 (HER2), and socioeconomic status (SES) were compared using the χ2 Test of Independence. Kaplan Meier Survival analysis was used to compare unadjusted survival among the races. Cox Regression was used to assess risk of mortality for each race when adjusted for factors that had a statistically significant (p &lt; 0.10) bivariate association with race/ethnicity. Analyses were conducted within each level of the CCI (0, 1, and 2 or more). Results: Among men with a CCI of 0 or 2, blacks had worse unadjusted survival than whites. There were no differences in survival for men with a CCI of 1. Stage, SES, ER, and type of surgery all had statistically significant bivariate associations with race/ethnicity. For men with a CCI of 0, Hispanics (HR = 0.367; 95% CI = 0.167, 0.801) and APIs (HR = 0.422; 95% CI = 0.189, 0.941) had a reduced risk of mortality when compared with whites. Black men had the same risk of mortality as white men. There were no differences in risk of mortality by race for men with a CCI of 1 or 2. Conclusions: Black men with breast cancer and no comorbidity have the same risk of mortality as white men while Hispanic and API men have lower risk of mortality. There are no racial disparities in adjusted risk of mortality in men with breast cancer with any concomitant disease.

Optical coherence tomography as a non-invasive method of enamel thickness diagnosis after orthodontic treatment by 3 different types of brackets.

Medical digital imaging is the basis of effective medical diagnosis and is now in the mainstream of a dynamically developing branch of science. Optical coherence tomography (OCT) enables real-time in situ imaging of tissues without the need for biopsy, histological procedures or X-rays. The aim of the study was to evaluate the application of OCT in orthodontic diagnostics and clinical practice by assessing the thickness of the enamel before and after orthodontic treatment. A hundred and eighty teeth in this in vitro study were divided into 3 groups of 60 teeth each. In each group (Group 1 - metal brackets, Group 2 - ceramic brackets and Group 3 - composite brackets), the orthodontic brackets were attached to the enamel using the 5th-generation adhesive system. The image of the enamel tissue was captured with a 3D-OCT camera before installing orthodontic brackets and after debonding and mechanical processing. The obtained OCT scans were subjected to expert IT analysis. For the statistical analysis, the Shapiro-Wilk test, the median test, the Mann-Whitney U test, Friedman 2-way analysis of variance (ANOVA), Wilcoxon matched pairs signed ranks test, the χ2 test of independence with Yates's correction, and Fisher's exact test were used. Maxwell's general principle was followed when using this type of test. The level of significance was set at p = 0.05. The thickness of the enamel varied least when metal brackets were used. The changes in enamel thickness in the composite and ceramic bracket groups were not statistically significant. Optical coherence tomography is an effective diagnostic tool to evaluate the thickness of the enamel tissue before and after orthodontic treatment. Changes in the enamel layer thickness after orthodontic treatment are determined by the type of material which the orthodontic bracket is made of.

Adaptive functioning in children with neurofibromatosis type 1: relationship to cognition, behavior, and magnetic resonance imaging.

To characterize the adaptive behavior profile of children with neurofibromatosis type 1 (NF1) and determine its relationship to neuropsychological functioning and non-neoplastic T2-weighted hyperintense brain lesions on brain magnetic resonance imaging (MRI). In this cross-sectional study, we retrospectively reviewed neuropsychological reports from 104 children with NF1 (56 males, 48 females; mean age 10y 4mo; standard deviation [SD] 3y 4mo; range 3y 5mo-17y 6mo), and extracted data from a range of cognitive and behavioral measures, including the Adaptive Behavior Assessment System (ABAS). Brain MRI was retrospectively reviewed in 42 individuals. Adaptive Behavior Assessment System scores were continuously distributed and pathologically shifted by 0.79 to 1.26SD across Conceptual, Social, and Practical domains, and 46.5% of individuals had a composite score in the borderline or impaired range. Impairment in adaptive functioning was correlated with deficits in executive function (r=-9.543, p<0.001), externalizing problems (r=-0.366, p<0.001), and attention (r=-9.467, p=0.001). Cluster analysis revealed three distinct phenotypic subgroups, one of which exhibited normal cognitive ability, but impaired adaptive functioning, with persistent deficits in executive function, behavioral problems, and attention-deficit/hyperactivity disorder symptomatology. There was no relationship between ABAS scores and the number or location of unidentified bright objects. Adaptive functioning deficits are common among children with NF1 and are associated with impairment in other cognitive/behavioral domains, independent of general cognitive ability. Deficits in adaptive behavior are common in children with neurofibromatosis type 1 (NF1). Poor adaptive functioning is associated with impairments in executive function, externalizing behaviors, and attention, regardless of cognitive ability. The presence or location of unidentified bright objects do not predict adaptive behavior skills in children with NF1.

Effects of Alcohol Consumption and Metabolic Syndrome on Mortality in Patients With Nonalcoholic and Alcohol-Related Fatty Liver Disease

Non-alcoholic and alcohol-related fatty liver disease are overlapping diseases in which metabolic syndrome and alcohol consumption each contribute to progressive liver disease. We aimed to assess the effects of alcohol consumption and metabolic syndrome on mortality in individuals with fatty liver. We searched the National Health and Nutrition and Examination Survey III for adults (20-74 years old) with hepatic steatosis, detected by ultrasound, for whom mortality and follow-up data were available. We collected data from the alcohol use questionnaire (self-reported number of days a participant drank alcohol; the number of drinks [10 g alcohol] per day on a drinking day; the number of days the participant had 5 or more drinks) and calculated the average amount of alcohol consumption in drinks/day for each participant during the year preceding enrollment. Excessive alcohol consumption for men was >3 drinks/day and for women was >1.5 drinks/day. We also collected clinical data, and mortality data were obtained from the National Death Index. Demographic and clinical parameters were compared among consumption groups using the χ2 test for independence or survey regression models. We used Cox proportional hazard models to identify independent predictors of all-cause and cause-specific mortality. The study cohort included 4264 individuals with hepatic steatosis (mean age, 45.9 years; 51% male; 76% white; 46% with metabolic syndrome; 6.2% with excessive alcohol use). There was no significant difference in mean age between individuals with vs without excessive alcohol consumption (P=.65). However, overall mortality was significantly higher among participants with excessive alcohol consumption (32.2%) vs participants with non-excessive alcohol use (22.2%) after mean 20 years of follow up (P=.003), as well as after 5 years of follow up. In multivariate analysis, the presence of metabolic syndrome (adjusted hazard ratio [aHR], 1.43; 95% CI, 1.12-1.83) and excessive alcohol consumption (aHR, 1.79; 95% CI, 1.21-2.66) were independently associated with an increased risk of death in individuals with hepatic steatosis; any lower average amount of alcohol consumption was not associated with mortality (all P>.60). In a subgroup analysis, the association of excessive alcohol use with mortality was significant in individuals with metabolic syndrome (aHR, 2.46; 95% CI, 1.40-4.32) but not without it (P=.74). In review of data from the National Health and Nutrition and Examination Survey III, we associated alcohol consumption with increased mortality in participants with fatty liver and metabolic syndrome. These findings indicate an overlap between non-alcoholic and alcohol-related fatty liver disease.

Six years after: ‘Fukushima memories’ and continued willingness to participate in energy and environmental policy-making process in Japan

ABSTRACTAn internet-based social survey was conducted longitudinally in urbanised and nuclear-power-plant-hosting prefectures from 2015 to 2017, covering 12 prefectures in four regions by 2017, to measure temporal variations and geographical differences in the willingness to participate in random-sample citizen deliberations on energy and environmental policy in post-Fukushima Japan. The four regions were selected to provide extensive coverage of views in relation to perceptions of disaster damage and of nuclear power plant operations after disasters. A χ2 test for independence and regression analysis were applied. Statistical analysis revealed that the willingness of Japanese citizens to be involved in participatory energy and environmental governance has either remained steady or increased. This holds regardless of the prefectures of residence and of different ‘Fukushima memories,’ and despite the apparent indifference to Fukushima in the political arena and in the mass media, as well as concerns of a rapidly decaying psychological Fukushima ‘half-life’ in terms of its significance. Six years later, the damage caused by and the memories of the Fukushima Daiichi disaster are asymmetrically distributed across different regions and individuals. Given the ongoing willingness of Japanese citizens to be involved in participatory governance, a deliberative democratic process could be a tool to reintegrate divided and suffering societies.