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Introduction Association between Hydraulic Fracturing and Perinatal Outcomes Hydraulic fracturing (HF), more commonly known as fracking, is the injection of water, sand, and chemicals into the ground at high pressures [...], BACKGROUND: Risk of preterm birth (PTB) and low birth weight (LBW) due to hydraulic fracturing (HF) exposure is a growing concern. Regional studies have demonstrated links, but results are often contradictory among studies. OBJECTIVES: This is the first US national study to our knowledge linking fracturing fluid ingredients to the human hormone pathways targeted--estrogen, testosterone, or other hormones (e.g., thyroid hormone)--to assess the effect of HF ingredients on rates of PTB and LBW. METHODS: We constructed generalized linear regression models of the impact of HF well density and hormone targeting chemicals in HF fluids (2001-2018) on the county-level average period prevalence rates of PTB and LBW (2015-2018) with each outcome measured in separate models. Our data sources consisted of publicly available datasets, including the WellExplorer database, which uses data from FracFocus, the March of Dimes Peristats, the US Census Bureau, the US Department of Agriculture, and the Centers for Disease Control and Prevention. We conducted additional stratified analyses to address issues of confounding. We used stratification to address issues regarding outcomes in rural vs. urban communities by assessing whether our models achieved similar results in nonmetro counties, as well as farming and mining counties. We also stratified by the year of the HF data to include HF data that was closer to the time of the birth outcomes. We also added covariate adjustment to address other important factors linked to adverse birth outcomes, including the proportion of the population belonging to various racial and ethnic minority populations (each modeled as a separate variable); education (bachelor's degree and high school); use of fertilizers, herbicides, and insecticides, acres of agricultural land per square mile; poverty; insurance status; marital status; population per square mile; maternal care deserts; and drug deaths per 100,000 people. RESULTS: We found that the density of HF wells in a county was significantly associated with both PTB and LBW rates (percentage of live births) in our fully adjusted models. We report the results from our more restrictive stratified analysis with a subset including only the 2014-2018 data, because this resulted in the most meaningful time frame for comparison. Across all models, the magnitude of effect was highest for wells with ingredients that include estrogen targeting chemicals (ETCs), testosterone targeting chemicals (TTCs) and other hormone targeting chemicals (OHTCs), and, finally, all wells grouped regardless of chemical type. For every unit increase in well density per square mile of wells that use chemicals that include an ETC, we observed a 3.789-higher PTB rate (95% CI: 1.83,5.74) compared with counties with no ETC wells from 2014 to 2018 and likewise, we observed a 1.964-higher LBW rate (95% CI: 0.41,3.52). Similarly, for every unit increase in well density per square mile of wells that use TTC, we observed a 3.192-higher PTB rate (95% CI: 1.62,4.77) compared with counties with no TTC wells. Likewise, for LBW, we found a 1.619-higher LBW rate (95% CI: 0.37,2.87). We also found that an increase in well density per square mile among wells that use chemicals that include an OHTC resulting in a 2.276-higher PTB rate (95% CI: 1.25, 3.30) compared with counties with no OHTC wells, and for LBW, we found a 1.244-higher LBW rate (95% CI: 0.43,2.06). We also explored the role of HF well exposure in general (regardless of the chemicals used) and found that an increase in total well density (grouped regardless of hormonal targeting status of the chemicals used) resulted in a 1.228-higherPTB rate (95% CI: 0.66, 1.80) compared with counties with no wells, and for LBW, we found a 0.602-higher LBW rate (95% CI: 0.15,1.05) compared with counties with no wells. We found similar results in our primary analysis that used all data without any exclusions and the statistical significance did not change. DISCUSSION: Our findings reinforce previously identified regional associations between HF and PTB and LBW, but on a national scale. Our findings point to dysregulation of hormonal pathways underpinning HF exposure risk on birth outcomes, which warrants further exploration. Future research must consider the specific ingredients used in HF fluids to properly understand the differential effects of exposure. https://doi.org/10.1289/EHP12628

* Context.--Respiratory infections complicate lung transplantation and increase the risk of allograft dysfunction. Allograft lungs may have different susceptibilities to infection than native lungs, potentially leading to different disease severity in lungs of single lung transplant recipients (SLTRs). Objective.--To study whether infections affect allograft and native lungs differently in SLTRs but similarly in double LTRs (DLTRs). Design.--Using an institutional database of LTRs, medical records were searched, chest computed tomography studies were systematically reviewed, and histopathologic features were recorded per lung lobe and graded semiquantitatively. A multilobar-histopathology score (MLHS) including histopathologic data from each lung and a bilateral ratio ([MLHS.sub.ratio]) comparing histopathologies between both lungs were calculated in SLTRs and compared to DLTRs. Results.--Six SLTRs died of infection involving the lungs. All allografts showed multifocal histopathologic evidence of infection, but at least 1 lobe of the native lung was uninvolved. In 4 of 5 DLTRs, histopathologic evidence of infection was seen in all lung lobes. On computed tomography, multifocal ground-glass and/or nodular opacities were found in a bilateral distribution in all DLTRs but in only 2 of 6 SLTRs. In SLTRs, the [MLHS.sub.Allograft] was higher than [MLHS.sub.Native] (P = .02). The [MLHS.sub.ratio] values of SLTR and DLTR were significantly different (P < .001). Conclusions.--Allograft and native lungs appear to harbor different susceptibilities to infections. The results are important for the management of LTRs. doi: 10.5858/arpa.2023-0227-OA), The median overall survival of lung transplant recipients (LTRs) is only 6.7 years, which is shorter than for other solid organ transplantations. (1) Noncytomegalovirus (nonCMV) infections play a major role [...]

* Context.--Progressive independence in medicine is critical to building confidence and decisiveness in trainees. However, this can be difficult to accomplish in the strict regulatory environment of pathology. Objective.--To pilot and adopt a process whereby surgical pathology fellows independently manage a subset of cases and release preliminary reports. Design.--Upon program approval, board-certified surgical pathology fellows were eligible for preliminary report sign-out at their discretion. Eligible cases were sent from outside institutions for confirmatory review. Preliminary reports were viewable in the electronic medical record. Safety measures were used to ensure timely release of final reports by attending pathologists. Results.--Fellows participating in the pilot (n = 4) released 59 preliminary reports out of 101 cases reviewed (58%), with 1 potentially significant discrepancy between preliminary and final report. Turnaround time was not affected. The process was endorsed by all participants and adopted as standard practice. During the first year, eligible fellows (n = 8) released 123 preliminary reports out of 1260 cases reviewed (9.8%). There were no major diagnostic discrepancies and no effects on turnaround time. The number of preliminary reports released by each fellow was variable (range, 2-48; median, 8), likely a reflection of both external factors (number of trainees on service, volume) and trainee-specific factors (confidence, efficiency). Conclusions.--Fellows showed good judgment when independently managing cases, with just 1 potentially significant discrepancy out of 182 cases ( doi: 10.5858/arpa.2022-0223-OA, Increasing resident and fellow independence as they progress through training is a cornerstone of medical education. Medical educators and trainees perceive many benefits from resident/fellow autonomy, including increased confidence and [...]

A country's borders, an often-overlooked physical space in which people are either admitted or denied entry, contain a wealth of cultural information. Within the field of architectural history, however, immigration [...]

The current study sought to examine the continuity between criterion-based and trait-based models of Personality Disorders (PDs) in an Iranian community sample to investigate the convergence between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Section II and Section III PDs. For this purpose, we first evaluated the cross-cultural factorial structure of the Personality Inventory for DSM-5 (PID-5; Krueger et al. Psychological Medicine, 42(9), 1879-1890, Krueger et al., 2012 (See CR40)); a self-report instrument which is designed to assess DSM-5 section III personality traits. Participants were 695 Iranian community members, aged 18-55, who completed the PID-5 and the Structured Clinical Interview for DSM-5-Screening Personality Questionnaire (SCID-5-SPQ; First et al., 2016 (See CR22)). Exploratory Structural Equation Modeling results revealed that the five-factor structure of the PID-5 was fairly consistent with theoretical expectations. Findings also provided support for the use of the hypothesized traits making up DSM-5 Section III PD criteria in the prediction of their Section II PD counterparts. However, several non-hypothesized facets also displayed moderate to large correlations with Section II PD counterparts; we found that (1) the core features of paranoid, borderline, avoidant, and dependent PDs were best described with the facets located on PID-5 Negative Affectivity domain; (2) the facets of PID-5 Detachment reflected the core feature of schizoid PD; (3) the core features of narcissistic, histrionic, and antisocial PDs were well presented by a series facets which belonged to PID-5 Antagonism domain; (4) the low level of PID-5 Disinhibition was demonstrated the core feature of obsessive-compulsive PD, which is rigid perfectionism; and finally (5) the common features of schizotypal PD were clearly defined by facets of PID-5 Psychoticism. Implications for these findings are discussed., Author(s): Zahra Ghamkhar Fard [sup.1] , Abbas Pourshahbaz [sup.1] , Jaime L. Anderson [sup.2] , Jennifer K. Boland [sup.2] , Shima Shakiba [sup.1] , Arash Mirabzadeh [sup.3] Author Affiliations: (1) [...]

Many individuals use social media on a daily basis worldwide. Social media use has both positive and negative effects on mental health, which may be based on an individuals' reasons for utilizing social media sites. The Motivations for Electronic Interaction Scale (MEIS; Nesi & Prinstein, 2015 (See CR12)) was developed to assess attitudes and behaviors regarding the use of social media sites, allowing researchers to examine how motivation for social media site use relates to other important variables. Because there is no existing factor structure for the MEIS in the published literature, the current study seeks to gain an increased understanding of the underlying structure of the MEIS through exploratory factor analysis. Further, it has not been validated with a college student population. In an effort to gain an increased understanding of the construct validity of the MEIS, researchers performed an exploratory factor analysis on the MEIS with a sample of 643 college students. Results yielded a 22-item five-factor model with the following factors: Sexual Health, Feedback Seeking, Social Comparison, Emotion Regulation, and Romantic Communication. The current study's identification and statistical support for differing subscales of the MEIS suggests it is a valuable tool for further exploration of social media use motivations., Author(s): Jennifer Harmon [sup.1] , Jennifer Boland [sup.1] , Amanda Venta [sup.2] Author Affiliations: (1) grid.263046.5, 0000 0001 2291 1903, Department of Psychology, Sam Houston State University, , Huntsville, TX, [...]

Rhodococcus equi is a soilborne aerobic actinomycete bacterium that infects animals and humans. Human infections are opportunistic, zoonotic in origin, and considered to be linked to exposure to farm environments [...]

Context.--Studies of lungs in patients with COVID-19 have focused on early findings. Objective.--To systematically study histopathologic and imaging features and presence of SARS-CoV-2 RNA in lung tissue from patients in later stages of COVID-19. Design.--Autopsies, explants, surgical lung biopsies, transbronchial biopsies, cryobiopsies, and needle biopsies from patients with COVID-19 whose onset of symptoms/ confirmed diagnosis was more than 28 days before the procedure were studied. Available images were reviewed. Reverse transcription droplet digital polymerase chain reaction for SARS-CoV-2 RNA was performed on lung tissue. Results.--Of 44 specimens (43 patients; median age, 59.3 years; 26 [60.5%] male) features of acute lung injury (ALI) were seen in 39 (88.6%), predominantly organizing pneumonia and diffuse alveolar damage, up to 298 days after onset of COVID-19. Fibrotic changes were found in 33 specimens (75%), most commonly fibrotic diffuse alveolar damage (n = 22) and cicatricial organizing pneumonia (n = 12). Time between acquiring COVID-19 and specimen was shorter in patients with diffuse ALI (median, 61.5 days) compared with patients with focal (140 days) or no AlI (130 days) (P =.009). Sixteen (of 20; 80%) SARS-CoV-2 reverse transcription droplet digital polymerase chain reaction tests were positive, up to 174 days after COVID-19 onset. Time between COVID-19 onset and most recent computed tomography in patients with consolidation on imaging was shorter (median, 43.0 days) versus in patients without consolidation (87.5 days; P =.02). Reticulations were associated with longer time to computed tomography after COVID-19 onset (median, 82 versus 23.5 days; P =.006). Conclusions.--ALI and SARS-CoV-2 RNA can be detected in patients with COVID-19 for many months. ALI may evolve into fibrotic interstitial lung disease., Coronavirus disease 2019 (COVID-19) is a viral infection caused by SARS-CoV-2. More than 235 million people have been infected globally, with a death burden in excess of 4.8 million since [...]

Beer is one of the most popular beverages in the world, and consistently ranks at the top of the list for consumers of alcoholic drinks. Growth of craft breweries and [...]

* Context.--Distinguishing pulmonary sarcomatoid carcinoma from pleural sarcomatoid mesothelioma is challenging because of overlapping histology, immunophenotype, and clinical features. Reliable immunohistochemical markers to aid in this distinction would be very valuable. Recent studies have proposed that MUC4 expression is common in sarcomatoid carcinoma but not in sarcomatoid mesothelioma, with the converse pattern reported for GATA3. Objective.--To further explore the utility of MUC4 and GATA3 in distinguishing pulmonary sarcomatoid carcinoma from sarcomatoid mesothelioma. Design.--Well-characterized cases of sarcomatoid carcinoma (n = 32) and sarcomatoid mesothelioma (n = 64) were included. Diagnoses were confirmed by thoracic pathologists with incorporation of immunophenotype, clinical, and radiographic features. Whole-tissue sections were stained for GATA3 and MUC4. Results.--Patients with sarcomatoid carcinoma and sarcomatoid mesothelioma had similar mean age and male predominance. GATA3 was positive in 63 of 64 sarcomatoid mesotheliomas (98%; 42 diffuse, 16 patchy, 5 focal), and 15 of 32 sarcomatoid carcinomas (47%; 3 diffuse, 8 patchy, 4 focal). MUC4 was positive in 2 of 64 sarcomatoid mesotheliomas (3%; 1 patchy, 1 focal), and in 12 of 32 sarcomatoid carcinomas (38%; 5 diffuse, 6 patchy, 1 focal). Conclusions.--Diffuse GATA3 expression favors sarcomatoid mesothelioma over sarcomatoid carcinoma, which rarely shows diffuse expression (sensitivity and specificity of diffuse staining 66% and 94%, respectively). Focal and patchy GATA3 expression is observed in both tumor types, and therefore is not helpful in this distinction. Sensitivity of MUC4 for sarcomatoid carcinoma was low in our cohort, positive in only 38% with frequent patchy staining, but it was quite specific. doi: 10.5858/arpa.2019-0647-OA, Pathologic diagnosis of sarcomatoid neoplasms in the lung and pleura is quite difficult, because the differential diagnosis includes a long list of primary and metastatic tumors. While many entities, such [...]

Rhodococcus equi is a soilbome facultative intracellular actinobacterium that causes pyogranulomatous infections in multiple animal species, including humans. Rhodococcal infection is particularly severe in young foals and immunocompromised persons, in [...]

* Context.--Respiratory failure appears to be the ultimate mechanism of death in most patients with severe coronavirus disease 2019 (COVID-19) infection. Studies of postmortem COVID-19 lungs largely report diffuse alveolar damage and capillary fibrin thrombi, but we have also observed other patterns. Objective.--To report demographic and radiographic features along with macroscopic, microscopic, and microbiologic postmortem lung findings in patients with COVID19 infections. Design.--Patients with confirmed COVID-19 infection and postmortem examination (March 2020-May 2020) were included. Clinical findings were abstracted from medical records. Lungs were microscopically reviewed independently by 4 thoracic pathologists. Imaging studies were reviewed by a thoracic radiologist. Results.--Eight patients (7 men, 87.5%; median age, 79 years; range, 69-96 years) died within a median of 17 days (range, 6-100 days) from onset of symptoms. The median lung weight was 1220 g (range, 960-1760 g); consolidations were found in 5 patients (62.5%) and gross thromboemboli were noted in 1 patient (12.5%). Histologically, all patients had acute bronchopneumonia; 6 patients (75%) also had diffuse alveolar damage. Two patients (25%) had aspiration pneumonia in addition. Thromboemboli, usually scattered and rare, were identified in 5 patients (62.5%) in small vessels and in 2 of these patients also in pulmonary arteries. Four patients (50%) had perivascular chronic inflammation. Postmortem bacterial lung cultures were positive in 4 patients (50%). Imaging studies (available in 4 patients) were typical (n = 2, 50%), indeterminate (n = 1, 25%), or negative (n = 1, 25%) for COVID-19 infection. Conclusions.--Our study shows that patients infected with COVID-19 not only have diffuse alveolar damage but also commonly have acute bronchopneumonia and aspiration pneumonia. These findings are important for management of these patients. (Arch Pathol Lab Med. 2021;145:11-21; doi: 10.5858/arpa.2020-0491-SA), Acute lung injury appears to be the most serious complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the subsequent clinical disease, coronavirus disease 2019 (COVID-19), resulting in [...]

Context.--Pulmonary carcinoids are classified as typical or atypical by assessing necrosis and mitoses, which usually cannot be adequately assessed on small biopsies. Ki-67 is not currently used to grade pulmonary carcinoids, but it may be helpful to determine preliminary grade in biopsies. However, the rate at which Ki-67 could underestimate or overestimate grade on small biopsies has not been well studied. Objective.--To compare Ki-67 labeling obtained on small biopsies to subsequent resection. Design.--Ki-67 was performed on paired biopsy and resection specimens from 55 patients. Slides were scanned using Aperio ScanScope. Labeling index was determined using automated hot spot and tumor tracing methods. Results.--The study included 41 typical and 14 atypical carcinoids. Atypical carcinoids were larger and had more distant metastases. Death from disease occurred in 3 patients (all had atypical carcinoids). Median hot spot Ki67 labeling index was greater in resection compared with biopsy by 0.7% (P = .02). Median tumor tracing Ki-67 was lower in resection compared with biopsy by 0.5% (P < .001). Receiver-operating characteristic analysis showed similar hot spot Ki-67 cutoffs to predict atypical histology (3.5% for biopsy, 3.6% for resection; area under the curve [AUC], 0.75 and 0.74, respectively). Different optimal cutoffs were needed for tracing method based on biopsy (2.1%; AUC, 0.75) compared with resection (1.0%; AUC, 0.67). Conclusions.--Hot spot Ki-67 tends to underestimate grade on small biopsies, whereas grade is overestimated by tumor tracing. Hot spot Ki-67 cutoff of 3.5% predicted atypical histology for both biopsy and resection. Different biopsy and resection cutoffs were necessary for tumor tracing, which would make clinical implementation more difficult. doi: 10.5858/arpa.2019-0374-OA, Pulmonary neuroendocrine tumors are a heterogeneous group of neoplasms that includes carcinoid tumors, which have somewhat unpredictable but relatively indolent behavior, as well as small cell and large cell neuroendocrine [...]

Recent research has documented impaired ability to resist interference from visual distractors in individuals with autism spectrum disorder (ASD) and suggests that this phenomenon may be more pronounced in young versus older children (Christ et al., Neuropsychology 25(6):690-701, 2011). The present study extends previous findings by examining visual filtering inhibitory ability within an older adolescent population. A flanker visual filtering task was administered to 36 adolescents with ASD and 44 adolescents without ASD (age: 11-20 years). Analysis revealed no evidence of group differences in visual filtering performance. Taken together with previous research, these results suggest that during early adolescence the previously observed impairment may resolve or compensatory strategies develop, allowing individuals with ASD to perform as well as their neurotypical peers., Author(s): Kelly M. Boland [sup.1] , Janine P. Stichter [sup.2] [sup.3] , David Q. Beversdorf [sup.1] [sup.2] [sup.4] , Shawn E. Christ [sup.1] [sup.2] Author Affiliations: (Aff1) 0000 0001 2162 [...]

Background There is a rising prevalence of multimorbidity, particularly in older patients, and a need for evidence-based medicines management interventions for this population. The Supporting Prescribing in Older Adults with Multimorbidity in Irish Primary Care (SPPiRE) trial aimed to investigate the effect of a general practitioner (GP)-delivered, individualised medication review in reducing polypharmacy and potentially inappropriate prescriptions (PIPs) in community-dwelling older patients with multimorbidity in primary care. Methods and findings We conducted a cluster randomised controlled trial (RCT) set in 51 GP practices throughout the Republic of Ireland. A total of 404 patients, aged [greater than or equal to]65 years with complex multimorbidity, defined as being prescribed [greater than or equal to]15 regular medicines, were recruited from April 2017 and followed up until October 2020. Furthermore, 26 intervention GP practices received access to the SPPiRE website where they completed an educational module and used a template for an individualised patient medication review that identified PIP, opportunities for deprescribing, and patient priorities for care. A total of 25 control GP practices delivered usual care. An independent blinded pharmacist assessed primary outcome measures that were the number of medicines and the proportion of patients with any PIP (from a predefined list of 34 indicators based predominantly on the STOPP/START version 2 criteria). We performed an intention-to-treat analysis using multilevel modelling. Recruited participants had substantial disease and treatment burden at baseline with a mean of 17.37 (standard deviation [SD] 3.50) medicines. At 6-month follow-up, both intervention and control groups had reductions in the numbers of medicines with a small but significantly greater reduction in the intervention group (incidence rate ratio [IRR] 0.95, 95% confidence interval [CI]: 0.899 to 0.999, p = 0.045). There was no significant effect on the odds of having at least 1 PIP in the intervention versus control group (odds ratio [OR] 0.39, 95% CI: 0.140 to 1.064, p = 0.066). Adverse events recorded included mortality, emergency department (ED) presentations, and adverse drug withdrawal events (ADWEs), and there was no evidence of harm. Less than 2% of drug withdrawals in the intervention group led to a reported ADWE. Due to the inability to electronically extract data, primary outcomes were measured at just 2 time points, and this is the main limitation of this work. Conclusions The SPPiRE intervention resulted in a small but significant reduction in the number of medicines but no evidence of a clear effect on PIP. This reduction in significant polypharmacy may have more of an impact at a population rather than individual patient level. Trial registration ISRCTN Registry ISRCTN12752680., Author(s): Caroline McCarthy 1,*, Barbara Clyne 1, Fiona Boland 1,2, Frank Moriarty 1,3, Michelle Flood 3, Emma Wallace 1, Susan M. Smith 1, for the SPPiRE Study team Introduction Advances [...]

Background: Decision aids help patients make total joint arthroplasty decisions, but presurgical evaluation might influence the effects of a decision aid. We compared the effects of a decision aid among patients considering total knee arthroplasty at 2 surgical screening clinics with different evaluation processes. Methods: We performed a subgroup analysis of a randomized controlled trial. Patients were recruited from 2 surgical screening clinics: an academic clinic providing 20-minute physician consultations and a community clinic providing 45-minute physiotherapist/nurse consultations with education. We compared the effects of decision quality, decisional conflict and surgery rate using Cochran-Mantel-Haenszel [chi square] tests and the Breslow-Day test. Results: We evaluated 242 patients: 123 from the academic clinic (61 who used the decision aid and 62 controls) and 119 from the community clinic (59 who used the decision aid and 60 controls). Results suggested a between-site difference in the effect of the decision aid on the patients' decision quality (p = 0.09): at the academic site, patients who used the decision aid were more likely to make better-quality decisions than controls (54% v. 35%, p = 0.044), but not at the community site (47% v. 51%, p = 0.71). Fewer patients who used decision aids at the academic site than at the community site experienced decisional conflict (p = 0.007) (33% v. 52%, p = 0.05 at the academic site and 40% v. 24%, p = 0.08 at the community site). The effect of the decision aid on surgery rates did not differ between sites (p = 0.65). Conclusion: The decision aid had a greater effect at the academic site than at the community site, which provided longer consultations with more verbal education. Hence, decision aids might be of greater value when more extensive total knee arthroplasty presurgical assessment and counselling are either impractical or unavailable. Contexte : Les aides à la décision guident les patients dans leurs choix quant à l'arthroplastie par prothèse totale, mais l'évaluation préopératoire pourrait modifier leur influence. Nous avons comparé cette influence chez les patients qui envisagent une arthroplastie totale du genou dans 2 cliniques de dépistage chirurgical ayant des processus d'évaluation différents. Méthodes : Nous avons effectué une analyse par sous-groupes d'un essai clinique randomisé. Les patients ont été recrutés dans 2 cliniques de dépistage chirurgical : une clinique universitaire offrant des consultations de 20 minutes avec un médecin et une clinique communautaire offrant des consultations de 45 minutes avec un physiothérapeute ou une infirmière et de l'enseignement. Nous avons comparé l'influence sur la qualité des décisions, les conflits décisionnels et le taux d'intervention chirurgicale à l'aide des tests de Cochran-Mantel-Haenszel ([chi square]) et du test de Breslow-Day. Résultats : Nous avons évalué 242 patients : 123 de la clinique universitaire (61 qui ont utilisé l'outil et 62 témoins) et 119 de la clinique communautaire (59 qui ont utilisé l'outil et 60 témoins). Les résultats semblaient indiquer une différence entre les sites quant à l'influence de l'aide sur la qualité des décisions des patients (p = 0,09) : au site universitaire, les patients qui l'ont utilisée étaient plus susceptibles de prendre des décisions de qualité que les témoins (54 % c. 35 %, p = 0,044), mais ce n'était pas le cas au site communautaire (47 % c. 51 %, p = 0,71). Moins de patients qui ont utilisé les aides à la décision au site universitaire qu'au site communautaire avaient vécu un conflit décisionnel (p = 0,007) (33 % c. 52 %, p = 0,05 au site universitaire; 40 % c. 24 %, p = 0,08 au site communautaire). L'influence de l'outil sur les taux d'intervention chirurgicale était la même aux 2 sites (p = 0,65). Conclusion : L'aide à la décision a eu un plus grand effet au site universitaire qu'au site communautaire, qui offrait de plus longues consultations et plus d'enseignement verbal. Ce type d'outil aurait donc plus de valeur dans les cas où il est difficile ou impossible d'offrir une évaluation préopératoire détaillée et des conseils approfondis pour l'arthroplastie totale du genou., In Canada, patients considering total knee arthroplasty (TKA) have traditionally been referred from primary care directly to an orthopedic surgeon, causing unequal referral distribution and variation in wait times among [...]

Background Older adults frequently attend the emergency department (ED) and experience high rates of adverse events following ED presentation. This randomised controlled trial evaluated the impact of early assessment and intervention by a dedicated team of health and social care professionals (HSCPs) in the ED on the quality, safety, and clinical effectiveness of care of older adults in the ED. Methods and findings This single-site randomised controlled trial included a sample of 353 patients aged [greater than or equal to]65 years (mean age = 79.6, SD = 7.01; 59.2% female) who presented with lower urgency complaints to the ED a university hospital in the Mid-West region of Ireland, during HSCP operational hours. The intervention consisted of early assessment and intervention carried out by a HSCP team comprising a senior medical social worker, senior occupational therapist, and senior physiotherapist. The primary outcome was ED length of stay. Secondary outcomes included rates of hospital admissions from the ED; hospital length of stay for admitted patients; patient satisfaction with index visit; ED revisits, mortality, nursing home admission, and unscheduled hospital admission at 30-day and 6-month follow-up; and patient functional status and quality of life (at index visit and follow-up). Demographic information included the patient's gender, age, marital status, residential status, mode of arrival to the ED, source of referral, index complaint, triage category, falls, and hospitalisation history. Participants in the intervention group (n = 176) experienced a significantly shorter ED stay than the control group (n = 177) (6.4 versus 12.1 median hours, p < 0.001). Other significant differences (intervention versus control) included lower rates of hospital admissions from the ED (19.3% versus 55.9%, p < 0.001), higher levels of satisfaction with the ED visit (p = 0.008), better function at 30-day (p = 0.01) and 6-month follow-up (p = 0.03), better mobility (p = 0.02 at 30 days), and better self-care (p = 0.03 at 30 days; p = 0.009 at 6 months). No differences at follow-up were observed in terms of ED re-presentation or hospital admission. Study limitations include the inability to blind patients or ED staff to allocation due to the nature of the intervention, and a focus on early assessment and intervention in the ED rather than care integration following discharge. Conclusions Early assessment and intervention by a dedicated ED-based HSCP team reduced ED length of stay and the risk of hospital admissions among older adults, as well as improving patient satisfaction. Our findings support the effectiveness of an interdisciplinary model of care for key ED outcomes. Trial registration ClinicalTrials.gov NCT03739515; registered on 12 November 2018., Author(s): Marica Cassarino 1,2, Katie Robinson 1, Dominic Trépel 3,Íde O'Shaughnessy 4, Eimear Smalle 4, Stephen White 4, Collette Devlin 1, Rosie Quinn 5, Fiona Boland 6, Marie E. Ward [...]

Abstract. We consider the inventory routing problem, in which a supplier has to replenish a set of customers by means of a limited fleet of capacitated vehicles over a discrete [...]

Abstract. A significant drawback of the usual sequential airline scheduling approach is the long lead time between solution of the aircraft routing and aircrew planning problems, and the day of [...]