The coronavirus disease 2019 pandemic restricted movement of individuals and altered provision of health care, abruptly transforming health care-use behaviors. It serves as a natural experiment to ...explore changes in presentations for surgical diseases including acute appendicitis. The objective was to determine if the pandemic was associated with changes in incidence of acute appendicitis compared to a historical control and to determine if there were associated changes in disease severity.
The study is a retrospective, multicenter cohort study of adults (N = 956) presenting with appendicitis in nonpandemic versus pandemic time periods (December 1, 2019–March 10, 2020 versus March 11, 2020–May 16, 2020). Corresponding time periods in 2018 and 2019 composed the historical control. Primary outcome was mean biweekly counts of all appendicitis presentations, then stratified by complicated (n = 209) and uncomplicated (n = 747) disease. Trends in presentations were compared using difference-in-differences methodology. Changes in odds of presenting with complicated disease were assessed via clustered multivariable logistic regression.
There was a 29% decrease in mean biweekly appendicitis presentations from 5.4 to 3.8 (rate ratio = 0.71 0.51, 0.98) after the pandemic declaration, with a significant difference in differences compared with historical control (P = .003). Stratified by severity, the decrease was significant for uncomplicated appendicitis (rate ratio = 0.65 95% confidence interval 0.47–0.91) when compared with historical control (P = .03) but not for complicated appendicitis (rate ratio = 0.89 95% confidence interval 0.52–1.52); (P = .49). The odds of presenting with complicated disease did not change (adjusted odds ratio 1.36 95% confidence interval 0.83–2.25).
The pandemic was associated with decreased incidence of uncomplicated appendicitis without an accompanying increase in complicated disease. Changes in individual health care–use behaviors may underlie these differences, suggesting that some cases of uncomplicated appendicitis may resolve without progression to complicated disease.
Objectives
To characterize the incidence, risk factors, and consequences of delirium in older adults undergoing spine surgery.
Design
Prospective observational study.
Setting
Academic medical center.
...Participants
Individuals aged 70 and older undergoing spine surgery (N = 89).
Measurements
Postoperative delirium and delirium severity were assessed using validated methods, including the Confusion Assessment Method (CAM), CAM for the Intensive Care Unit, Delirium Rating Scale‐Revised‐98, and chart review. Hospital‐based outcomes were obtained from the medical record and hospital charges from data reported to the state.
Results
Thirty‐six participants (40.5%) developed delirium after spine surgery, with 17 (47.2%) having purely hypoactive features. Independent predictors of delirium were lower baseline cognition, higher average baseline pain, more intravenous fluid administered, and baseline antidepressant medication. In adjusted models, the development of delirium was independently associated with higher quintile of length of stay (odds ratio (OR) = 3.66, 95% confidence interval (CI) = 1.48–9.04, P = .005), higher quintile of hospital charges (OR = 3.49, 95% CI = 1.35–9.00, P = .01), and lower odds of discharge to home (OR = 0.22, 95% CI = 0.07–0.69, P = .009). Severity of delirium was associated with higher quintile of hospital charges and lower odds of discharge to home.
Conclusion
Delirium is common after spine surgery in older adults, and baseline pain is an independent risk factor. Delirium is associated with longer stay, higher charges, and lower odds of discharge to home. Thus, prevention of delirium after spine surgery may be an important quality improvement goal.
We report results of a search for narrow resonances in e super(+e) super(-) annihilation at center-of-mass energies between 1.85 and 3.1 GeV performed with the KEDR detector at the VEPP-4M e ...super(+e) super(-) collider. The upper limit on the leptonic width of a narrow resonance inline image has been obtained (at 90% C.L.).
In diffuse interstellar clouds the chemistry that leads to the formation of the oxygen-bearing ions OH+, H2O+, and H3O+ begins with the ionization of atomic hydrogen by cosmic rays, and continues ...through subsequent hydrogen abstraction reactions involving H2. Given these reaction pathways, the observed abundances of these molecules are useful in constraining both the total cosmic-ray ionization rate of atomic hydrogen (ζH) and molecular hydrogen fraction (f_H_2). We present observations targeting transitions of OH+, H2O+, and H3O+ made with the Herschel Space Observatory along 20 Galactic sight lines toward bright submillimeter continuum sources. Both OH+ and H2O+ are detected in absorption in multiple velocity components along every sight line, but H3O+ is only detected along 7 sight lines. From the molecular abundances we compute f_H_2 in multiple distinct components along each line of sight, and find a Gaussian distribution with mean and standard deviation 0.042 ± 0.018. This confirms previous findings that OH+ and H2O+ primarily reside in gas with low H2 fractions. We also infer ζH throughout our sample, and find a lognormal distribution with mean log (ζH) = –15.75 (ζH = 1.78 × 10–16 s–1) and standard deviation 0.29 for gas within the Galactic disk, but outside of the Galactic center. This is in good agreement with the mean and distribution of cosmic-ray ionization rates previously inferred from H_3^+ observations. Ionization rates in the Galactic center tend to be 10-100 times larger than found in the Galactic disk, also in accord with prior studies.
There are limited long-term studies reporting on outcomes of the Zimmer Modular Revision (ZMR) stem, and concerns remain regarding failure. Our primary aim was to determine long-term survival free ...from all-cause revision and stem-related failure for this modular revision stem in revision total hip arthroplasty (THA). Secondary aims included evaluating radiological and functional outcomes.
We retrospectively identified all patients in our institutional database who underwent revision THA using the ZMR system from January 2000 to December 2007. We included 106 patients (108 hips) with a mean follow-up of 14.5 years (2.3 to 22.3). Mean patient age was 69.2 years (37.0 to 89.4), and 51.9% were female (n = 55). Indications for index revision included aseptic loosening (73.1%), infection (16.7%), fracture (9.3%), and stem fracture (0.9%). Kaplan-Meier analysis was used to determine the all-cause and stem-related failure revision-free survival. At most recent follow-up, Oxford Hip Scores (OHS) were collected, and radiological stem stability was determined using the Engh classification.
A total of 17 hips (15.7%) underwent re-revision of any component. Indications for re-revision were stem failure (35.3%; n = 6), infection (29.4%; n = 5), instability (29.4%; n = 5), and acetabular aseptic loosening (5.9%; n = 1). The five- and 15-year all-cause survival was 89.7% (95% confidence interval (CI) 86.7 to 92.7) and 83.3% (95% CI 79.6 to 87.0), respectively. There were six re-revisions (5.6%) for stem failure; five for stem fracture and one for aseptic loosening. The five- and 15-year survival free from stem-related failure was 97.2% (95% CI 95.6 to 98.8) and 94.0% (95% CI 91.6 to 96.4), respectively. At final follow-up, the mean OHS was 36.9 (8.0 to 48.0) and 95.7% (n = 66) of surviving modular revision stems were well-fixed in available radiographs.
Femoral revision with the ZMR offers satisfactory long-term all-cause revision-free survival, good survival free of stem-related failure, and favourable clinical outcomes. Stem fracture was the most common reason for stem-related failure and occurred both early and late. This highlights the importance of both early and long-term surveillance for stem-related failure.
The long-term survivorship and functional outcomes of the mobile-bearing (MB) compared to the fixed-bearing (FB) unicompartmental knee arthroplasty (UKA) implant design remain a topic of debate. The ...aim of the current study was to compare the survivorship and functional outcomes of MB and FB UKA at a minimum 10-year follow-up.
We retrospectively reviewed 106 consecutive medial UKAs (89 patients) from our institution with a minimum 10-year follow-up. The 38 MB and 68 FB knees had follow-up of 14.2 years (12.9-15.5) and 11.5 years (10.2-15.1), respectively. Validated patient-reported outcomes and radiographs were evaluated as were etiology, timing, and complexity of revision. Kaplan-Meier 10-year survival was calculated with revision to total knee arthroplasty as the end point.
The 10-year survival was 82.9% (95% confidence interval CI 65.8-91.9) for MB and 90.9% (95% CI 79.4-96.2) for FB UKA (P = .102), and 88.0% (95% CI 79.3-93.2) for the entire cohort. Patient outcomes were similar between groups, as were timing and etiologies for revision to total knee arthroplasty. One-third of revisions required either stems or tibial augments, and of these, all were of MB design.
Survival and functional outcomes were similar between MB and FB designs. One-third of revisions required either stems or augments, all were of MB design.
This Tropospheric Ozone Assessment Report (TOAR) on the current state of knowledge of ozone metrics of relevance to vegetation (TOAR-Vegetation) reports on present-day global distribution of ozone at ...over 3300 vegetated sites and the long-term trends at nearly 1200 sites. TOAR-Vegetation focusses on three metrics over vegetation-relevant time-periods across major world climatic zones: M12, the mean ozone during 08:00–19:59; AOT40, the accumulation of hourly mean ozone values over 40 ppb during daylight hours, and W126 with stronger weighting to higher hourly mean values, accumulated during 08:00–19:59.
Although the density of measurement stations is highly variable across regions, in general, the highest ozone values (mean, 2010–14) are in mid-latitudes of the northern hemisphere, including southern USA, the Mediterranean basin, northern India, north, north-west and east China, the Republic of Korea and Japan. The lowest metric values reported are in Australia, New Zealand, southern parts of South America and some northern parts of Europe, Canada and the USA. Regional-scale assessments showed, for example, significantly higher AOT40 and W126 values in East Asia (EAS) than Europe (EUR) in wheat growing areas (p < 0.05), but not in rice growing areas. In NAM, the dominant trend during 1995–2014 was a significant decrease in ozone, whilst in EUR it was no change and in EAS it was a significant increase.
TOAR-Vegetation provides recommendations to facilitate a more complete global assessment of ozone impacts on vegetation in the future, including: an increase in monitoring of ozone and collation of field evidence of the damaging effects on vegetation; an investigation of the effects on peri-urban agriculture and in mountain/upland areas; inclusion of additional pollutant, meteorological and inlet height data in the TOAR dataset; where not already in existence, establishing new region-specific thresholds for vegetation damage and an innovative integration of observations and modelling including stomatal uptake of the pollutant.
Wearable biometric monitoring devices (WBMD) show promise as a cutting edge means to improve health and prevent disease through increasing accountability. By regularly providing real-time ...quantitative data regarding activity, sleep quality, and recovery, users may become more aware of the impact that their lifestyle has on their health. The purpose of this study was to examine the efficacy of a biometric tracking ring on improving sleep quality and increasing physical fitness over a one-year period.
Fifty-six participants received a biometric tracking ring and were placed in one of two groups. One group received a 3-month interactive behavioral modification intervention (INT) that was delivered virtually
a smartphone app with guided text message feedback (GTF). The other received a 3-month non-directive wellness education control (CON). After three months, the INT group was divided into a long-term feedback group (LT-GTF) that continued to receive GTF for another nine months or short-term feedback group (ST-GTF) that stopped receiving GTF. Weight, body composition, and VO
max were assessed at baseline, 3months, and 12months for all participants and additionally at 6 and 9months for the ST-GTF and LT-GTF groups. To establish baseline measurements, sleep and physical activity data were collected daily over a 30-day period. Daily measurements were also conducted throughout the 12-month duration of the study.
Over the first 3months, the INT group had significant (
<0.001) improvements in sleep onset latency, daily step count, % time jogging, VO
max, body fat percentage, and heart rate variability (rMSSD HRV) compared to the CON group. Over the next 9months, the LT-GTF group continued to improve significantly (
<0.001) in sleep onset latency, daily step count, % time jogging, VO
max, and rMSSD HRV. The ST-GTF group neither improved nor regressed over the latter 9months except for a small increase in sleep latency.
Using a WBMD concomitantly with personalized education, encouragement, and feedback, elicits greater change than using a WBMD alone. Additionally, the improvements achieved from a short duration of personalized coaching are largely maintained with the continued use of a WBMD.
Using the KEDR detector at the VEPP-4M e+e− collider, we have measured the values of Ruds and R at seven points of the center-of-mass energy between 3.12 and 3.72 GeV. The total achieved accuracy is ...about or better than 3.3% at most of energy points with a systematic uncertainty of about 2.1%. At the moment it is the most accurate measurement of R(s) in this energy range.
Abstract
Empathy is crucial for successful interpersonal interactions, and it is impaired in many psychiatric and neurological disorders. Action-perception matching, or action simulation mechanisms, ...has been suggested to facilitate empathy by supporting the simulation of perceived experience in others. However, this remains unclear, and the involvement of the action simulation circuit in cognitive empathy (the ability to adopt another’s perspective) vs emotional empathy (the capacity to share and react affectively to another’s emotional experience) has not been quantitatively compared. Presently, healthy adults completed a classic cognitive empathy task (false belief), an emotional empathy task and an action simulation button-pressing task during functional magnetic resonance imaging. Conjunction analyses revealed common recruitment of the inferior frontal gyrus (IFG), thought to be critical for action-perception matching, during both action simulation and emotional, but not cognitive, empathy. Furthermore, activation was significantly greater in action simulation regions in the left IFG during emotional vs cognitive empathy, and activity in this region was positively correlated with mean feeling ratings during the emotional empathy task. These findings provide evidence for greater involvement of action simulation mechanisms in emotional than cognitive empathy. Thus, the action simulation circuit may be an important target for delineating the pathophysiology of disorders featuring emotional empathy impairments.
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