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Although difficulties processing both symbolic and nonsymbolic proportion compared with absolute number are well established, the mechanisms involved remain unclear. We investigate four potential explanations to account for better number processing in adulthood: (a) number is more salient than proportion, (b) number is encoded more automatically than proportion, (c) proportion is more effortfully processed than number, and (d) number competes with proportion during decision making. Across three experiments, we used a delayed match-to-sample paradigm in which adults were asked which of two alternatives matched a sample set of red and blue dots. We systematically manipulated which dimension of the sample participants matched (number of red dots, total number of dots, proportion of red dots), the presence/absence of the competing quantity in the choice alternatives, and when they were told which quantitative dimension to encode (before vs. after the sample presentation, or not at all). Overall, data reveal that proportion was less salient than the numerical subset. Additionally, the number of items within the subset, but not the total number of items in the superset, interfered with proportion-based responding. Last, even in the absence of response competition and costly task demands, proportion matching took longer than number matching, highlighting basic processing differences. Together, results reveal pervasive difficulties in representing proportion compared with number, even when task demands are unambiguous. However, this varied depending on the numerical set involved and across encoding, processing, and decision processes. We discuss the implications of these findings for theories of ratio processing and of quantity more generally. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Background: Basal cell carcinoma (BCC) is the most frequently diagnosed malignancy worldwide and an ever increasing annual incidence is observed. However, nationwide registries of BCCs are very rare, and often extrapolation of the data has been necessary to estimate the absolute number of diagnoses. As of September 2016, all histopathologically confirmed BCCs are registered in the Netherlands, due to developments in automatic notification and import in the Netherlands Cancer Registry. This offers the unique possibility to assess the nationwide population-based incidence of first and multiple BCCs. Objectives: To assess the nationwide incidence and trends of first and multiple BCCs in the Netherlands and to predict incidence rates up to 2029. Methods: All patients with histopathologically confirmed BCC between 2001 and 2019 were selected from the population-based Netherlands Cancer Registry. Age-standardized incidence rates were calculated and trends were analysed with use of the estimated annual percentage change. Prediction of BCC incidence rates up to 2029 was based on a regression model. Results: In total, 601 806 patients were diagnosed with a first BCC over the period 2001–2019. The age-standardized incidence rates for both men and women with a first BCC increased over these years, from 157 to 304 and from 124 to 274 per 100 000 person-years, respectively. For male and female patients aged 30–39 years, decreases in annual incidences of −3·6% and −3·0%, respectively, were found in recent years. For patients aged 50 years or older an ever increasing trend was found. One-quarter of the patients with a first primary BCC developed one or more subsequent BCCs within 3 years. Increases in incidence of 30·4% (male) and 25·3% (female) are expected in the next 10 years. Conclusions: BCC incidence has doubled over the past two decades. Trends have seemed to stabilize in recent years for patients aged < 50 years. This might be a first sign of a decreasing trend. The incidence continues to rise in patients aged 50 years and older. In the next decade a further increase in BCC incidence is expected.

The use of gamma glutamyl transpeptidase (GGT) levels as screening test for liver function is controversial. The GGT main utility is in cases in which alkaline phosphatase (ALP) is elevated. We aimed to investigate the request over time for alanine amino transferase (ALT), ALP and GGT, study the effect of a new demand management (DM) intervention for optimal GGT measurement in primary care. Our descriptive study was conducted from January 2010 to December 2020. The intervention was established in November 2019 and consisted of the laboratory information system would automatically remove GGT, if the test had been ordered simultaneously with ALP and there was no prior pathological result on record. We counted the absolute number of measured ALT, ALP and GGT, and calculated the ratios for each of the three markers related to creatinine, and GGT related to ALT in a monthly basis. The number of measured GGT increased slightly and progressively along the study until October 2019, when a decrease was observed. The ALT and ALP request from primary care also increased slightly along years. However, the GGT/ALT ratio never reached the 0.2 goal. Out of the 57,614 GGT requested in primary care patients, 38,167 (66.2%) were not measured. 7633.4€ were saved in reagent. The DM intervention to reduce the measurement of GGT when requested redundantly with ALP in primary care was successful, and the results have been maintained over time as observed by monitoring the GGT/CREA and GGT/ALT indicator results.

SUMMARY OBJECTIVE: This study aims to analyze the level of disability and pain in capoeira practitioners. METHODS: This is a cross-sectional study. Data collection took place at the training sites of participants. The Self-Estimated Functional Inability because of Pain questionnaire for athletes (SEFIP-sport) was used to assess the pain and disability. Descriptive analysis was performed with the presentation of variables through mean and standard deviation (SD) or absolute number and percentage. RESULTS: The sample consisted of 65 capoeira practitioners. Of these, 42 (64.61%) reported pain or discomfort. The total score of the SEFIP-sport presented an average of 2.28 points (SD=2.65). The body regions with the highest reports of pain and disability were the knees, lower back, and wrist/hands. However, we observed a mild degree of disability measured by SEFIP-sport. CONCLUSIONS: The knees, lower back, and wrists/hands were the regions of the body with the highest reports of pain and disability. However, the disability presented by capoeira practitioners was slight.

This publication is the official report describing all total hip arthroplasty procedures registered in the database from 01.01.2007 to 31.12.2020. During this period, 74762 operations were performed: 67019 (89.64%) primary and 7743 (10.36%) revision. The proportion of males and females underwent primary arthroplasty was 41.1% and 59.0%, respectively. The age of patients with primary arthroplasty was 57.8 years (95% CI from 57.7 to 57.9), with revision 59.3 years (95% CI from 59.0 to 59.6). The absolute number of primary hip arthroplasty procedures added into the database increased annually from 2007 to 2012. Since 2015, there has been a trend towards a decrease in the number of hip arthroplasty, due to the more intensive growth in the number of knee replacements performed. The number of revision hip arthroplasty operations varies from year to year with a clear tendency to increase, except 2020. The large proportion of revisions are accounted for by early revisions performed in the first years after primary hip arthroplasty, as well as early re-revisions. The main types of implants fixation on primary arthroplasty during the reporting period were cementless (50.89%) and hybrid (32.33%). In patients of older age groups, there is a significant decrease in the proportion of cementless fixation, while the proportion of hybrid, reverse hybrid and cemented structures is increasing. There are significant fluctuations in the ratio of different types of implants fixation in different years.

Banded Roux-en-Y gastric bypass (RYGB) was a common bariatric procedure in the 2000s, and the ring slippage is one of its late adverse events. Both plastic and metallic stents have been reported as adjunct methods to induce erosion and facilitate endoscopic removal of the ring. To compare the safety and effectiveness of self-expanding metallic stents (SEMS) and plastic stents (SEPS) to treat ring slippage. We conducted a retrospective longitudinal study analyzing consecutive patients with ring dysfunction treated with stents plus endoscopic removal. Ninety patients were enrolled (36 SEMS vs. 54 SEPS). The mean age was 48.56 ± 13.07 and 45.6 ± 12.1 in the SEMS and SEPS groups, respectively. All patients had band slippage, but 24 from SEMS group and 23 from SEPS group had further complications. There were more complications in metallic stent concerning mean absolute number of therapy-related adverse events (1.33 ± 0.48 vs. 1.72 ± 0.5, p > 0.05) and time until erosion (14.9 ± 1.6 vs. 13.8 ± 1.4 days, p > 0.05). Female sex and age > 41 years old correlated with longer time to band erosion and higher incidence of adverse events in SEMS patients. In SEPS group, only female sex was a risk factor for adverse events. Both procedures were efficient at inducing band erosion with similar safety profiles. Older and female patients are at a higher risk of treatment-related adverse events, especially those receiving SEMS.

Objective To assess concordance among criteria for inactive disease (ID) and low disease activity (LDA) in juvenile idiopathic arthritis (JIA) and to seek factors driving discordance. Methods The frequency of fulfillment of existing criteria was evaluated in information on 10,186 patients extracted from 3 cross-sectional data sets. Patients were divided up according to the functional phenotypes of oligoarthritis and polyarthritis. Concordance between criteria was examined using weighted Venn diagrams. The role of each individual component in explaining discordance between criteria was assessed by calculating the absolute number and percentage of instances in which the component was responsible for discrepancy between definitions. Results Criteria for ID were met by 28.6–41.1% of patients with oligoarthritis and by 24.0–33.4% of patients with polyarthritis. Criteria for LDA were met by 44.8–62.4% of patients with oligoarthritis and by 44.6–50.4% of patients with polyarthritis. There was a 57.9–62.3% overlap between criteria for ID and a 67.9–85% overlap between criteria for LDA. Parent and physician global assessments and acute-phase reactants were responsible for the majority of instances of discordance among criteria for ID (8.7–15.5%, 10.0–12.3%, and 10.8–17.3%, respectively). Conclusion We found fair concordance between criteria for ID and LDA in JIA, with the main drivers of discordance for ID being physician and parent global assessments and acute-phase reactants. This observation highlights the need for further studies aimed to evaluate the impact of subjective physician and parent perception of disease remission and of laboratory measures of inflammatory activity on the definition of ID.

BACKGROUND: A number of estimates of the infection fatality ratio (IFR) of SARS-CoV-2 in different countries have been published. In Brazil, the fragile political situation, together with socioeconomic and ethnic diversity, could result in substantially different IFR estimates. METHODS: We infer the IFR in Brazil in 2020 by combining three datasets. We compute the prevalence via the population-based seroprevalence survey, EPICOVID19-BR. For the fatalities we obtain the absolute number using the public Painel Coronavirus dataset and the age-relative number using the public SIVEP-Gripe dataset. The time delay between the development of antibodies and subsequent fatality is estimated via the SIVEP-Gripe dataset. We obtain the IFR for each survey stage and 27 federal states. We include the effect of fading IgG antibody levels by marginalizing over the test detectability time window. RESULTS: We infer a country-wide average IFR (maximum posterior and 95% CI) of 1.03% (0.88-1.22%) and age-specific IFRs of 0.032% (0.023-0.041%) [< 30 years], 0.22% (0.18-0.27%) [30-49 years], 1.2% (1.0-1.5%) [50-69 years], and 3.0% (2.4-3.9%) [≥ 70 years]. We find that the fatality ratio in the country increased significantly at the end of June 2020, likely due to the increased strain on the health system. CONCLUSIONS: Our IFR estimate is based on data and does not rely on extrapolating models. This estimate sets a baseline value with which future medications and treatment protocols may be confronted.

Literature suggests that adolescents may not accurately report sexual activity to their providers, impeding risk-based screening efforts for gonorrhea and chlamydia (GC/CT). We assessed the effect of a clinic-based universal GC/CT screening initiative on GC/CT screening frequency and detection of GC/CT infections among adolescents (boys and girls ≥13 years) and the association between positive GC/CT and documented sexual activity.We conducted a pre-post analysis of a primary care clinic affiliated with an academic institution. The electronic medical record was queried to extract all adolescent well and acute encounters for the 12 months preimplementation and postimplementation of universal GC/CT screening in January 2015.Eight hundred fifty-six encounters from 752 unique adolescents were included. Screening increased postimplementation (23.3% vs 61.4%, P0.001) of universal screening. Although there were similar rates of documented sexual activity preimplementation and postimplementation (14.6% vs 16.0%), a larger proportion of unknown sexual activity was documented (10.5% vs 23.7%, P0.001). Provider-level factors were the most frequent reasons for not screening. The absolute number of GC/CT cases increased, although the proportion of cases out of all eligible adolescents remained similar as more testing was completed (chlamydia, 5 of 752 vs 12 of 752; P = 0.09; gonorrhea, 0 of 752 vs 1 of 752; P = 0.32). Nearly half of positive chlamydia infections postimplementation appeared in adolescents who reported no sexual activity.Universal screening in a primary care clinic increased screening and detection of cases of gonorrhea and chlamydia, including in adolescents who did not report sexual activity.

lt;bgt;Background and Objective:lt;/bgt; COVID-19 is a fast-spreading worldwide pandemic caused by SARS-CoV-2. The World Health Organization recommended wearing face masks. Masks have become an urgent necessity throughout the pandemic, the study's goal was to track the impact of wearing masks on immunological responses.lt;bgt;Materials and Methods:lt;/bgt; This study was conducted on 40 healthy people who were working in health care at Nineveh Governorate Hospitals from September-December, 2020. They wore face masks at work for more than 8 months for an average of 6 hrs a day. The control sample included 40 healthy individuals, who wore masks for very short periods. All samples underwent immunological and physiological tests to research the effects of wearing masks for extended periods within these parameters.lt;bgt;Results:lt;/bgt; The results showed a significant decrease in total White Blood Count and the absolute number of neutrophils, lymphocytes, monocytes and phagocytic activity. However, there was a significant increase in the absolute number of eosinophils in participants compared with the control. The results also suggested there were no significant differences in IgE, haemoglobin concentration and blood Olt;subgt;2lt;/subgt;saturation in participants who wore masks for more than 6 hrs compared to the control group. The results showed a significant increase in pulse rate in participants who wore masks for more than 6 hrs compared to the control group. The results also showed a strong correlation coefficient between the time of wearing masks and some immunological, haematological parameters.lt;bgt;Conclusion:lt;/bgt; Wearing masks for long periods alters immunological parameters that initiate the immune response, making the body weaker in its resistance to infectious agents.

Peripheral artery disease (PAD) is a common condition with high socio-economic relevance. Therefore, qualified nationwide provision of interventional treatments of PAD is important for maintaining a high quality medical service in Germany.All data on revascularization procedures from the quality management system of the German interventional radiological society (DeGIR) for the years 2018 and 2019 were retrospectively analysed. Number and distribution of DeGIR certified endovascular specialists and treatment centres was mapped. Documented procedures were broken down to the level of administrative districts. Absolute number of revascularization procedures and normalized number per one million inhabitants were computed.In 2019 there were 57 732 revascularization procedures from 228 participating centres performed by DeGIR certified interventional radiologists. A median of 62 recanalization procedures were documented per centre. 36 centres were considered to be high volume centres, with more than 500 procedures each. On a regional level in the years 2018 and 2019 combined a median (range) of 2324 (323-12 518) revascularization procedures per administrative district were performed by DeGIR certified interventional radiologist.There is a comprehensive nationwide high quality interventional-radiology service for the provision of revascularization procedures available in Germany.· In Germany there is a nationwide comprehensive infratsructure for the interventional-radiological treatment of PAD. · The volume of interventional-radiological treatments for PAD is growing. · There is a sufficient number of training and treatment centres for the delivery of interventional radiology procedures.· Mahnken AH, Nadjiri J, Schachtner B et al. Availability of interventional-radiological revascularization procedures in Germany - an analysis of the DeGIR Registry Data 2018/19. Fortschr Röntgenstr 2022; 194: 160 - 168.Die periphere arterielle Verschlusskrankheit ist eine häufige, sozioökonomisch bedeutsame Erkrankung. Die qualifizierte flächendeckende Versorgung mit interventionellen Therapieangeboten für Patienten mit pAVK ist daher von besonderer Bedeutung für die medizinische Versorgungsqualität in Deutschland.Die Daten der Jahre 2018 und 2019 des Qualitätssicherungsregisters für interventionelle Therapien der Deutschen Gesellschaft für Interventionelle Radiologie (DeGIR) für das Modul A (gefäßeröffnende und gefäßrekonstruierende Verfahren) wurden analysiert. Zahl und Verteilung zertifizierter interventioneller Radiologen der DeGIR für Gefäßmedizin und entsprechende Behandlungszentren wurden erfasst. Es erfolgte eine Aufschlüsselung der dokumentierten Interventionen nach Regionen bis auf Ebene der Regierungsbezirke. Es wurden absolute Zahlen sowie auf 1 Million Einwohner normierte Zahlen bestimmt.Im Jahr 2019 wurden an 228 teilnehmenden Einrichtungen 57 732 interventionell-radiologisch erbrachte Eingriffe im Modul A dokumentiert. Im Jahr 2019 wurden im Median 162,0 Eingriffe je Zentrum dokumentiert. Davon waren 36 Einrichtungen „High Volume“-Zentren mit mehr als 500 dokumentierten Eingriffen pro Jahr. Auf Ebene der Regierungsbezirke wurden 2018 und 2019 zusammengenommen im Median (Bandbreite) 2324 (323–12 518) interventionell-radiologische Gefäßrevaskularisationen je Regierungsbezirk dokumentiert.Die qualitätsgesicherte Versorgung mit interventionell-radiologischen Prozeduren zur Gefäßrevaskularisation durch zertifizierte interventionelle Radiologen ist in Deutschland flächendeckend verfügbar.· In Deutschland existiert eine flächendeckende Versorgung für interventionell-radiologisch geführte Gefäßrekanalisationen.. · Das Untersuchungsvolumen von interventionell-radiologisch geführten Gefäßrekanalisationen nimmt weiter zu.. · In der Fläche besteht eine gute Versorgung mit interventionell-radiologischen Versorgungs- und Ausbildungszentren..· Mahnken AH, Nadjiri J, Schachtner B et al. Availability of interventional-radiological revascularization procedures in Germany – an analysis of the DeGIR Registry Data 2018/19. Fortschr Röntgenstr 2022; 194: 160 – 168.

Cardiovascular disease (CVD) is the leading cause of death worldwide; approximately 80% of CVD deaths occur in low-income and middle-income countries (LMICs). The epidemiologic transition to a high burden of ischemic heart disease (IHD) has happened with greater rapidity in LMICs than in high-income countries. The absolute number of individuals with premature IHD has increased substantially. Higher event rates are observed compared with high-income countries. The technological capability to do extraordinary things for patients has increased, as has patient demand, in a setting of constrained resources and expensive health care of variable quality.

lt;bgt;Background and Objective:lt;/bgt; A well-established treatment for childhood epilepsy, the Ketogenic Diet (KD) is increasingly gaining acceptance as a preventative tool for obesity. The current study aims to compare the effects of a ketogenic diet on some of the immunological parameters among obese individuals and contrast them with non-obese individuals. This includes finding the absolute numbers of white blood cells and estimating the efficacy of phagocytic cells and serum IgA concentration.lt;bgt;Materials and Methods:lt;/bgt; Twenty healthy persons were chosen for the study, with an age range between 18-45 years, a weight range before the ketogenic diet of 80-115 kg and after the ketogenic diet 60-80 kg with a height range between 155-180 cm during a period between 8-16 weeks. Their daily food was composed of high fats (80%), moderate protein (15%) and small amounts of carbohydrates (5%). The control sample included twenty healthy subjects, their food consisted of different types of food carbohydrates (75-80%), proteins (10%) and fats (10%).lt;bgt;Results:lt;/bgt; The results showed a significant increase in the White Blood Cells (WBC) count in KD individuals. Additionally, no significant difference was noticed in the absolute number of neutrophils and lymphocytes. Conversely, a significant increase in the absolute number of monocytes was observed. Moreover, the study showed a significant decrease in IgA concentration in KD individuals compared with control.lt;bgt;Conclusion:lt;/bgt; In the ketogenic system users indicated a rise in the number of monocytes and a decrease in the concentration of IgA. This provides a strong sign that autoimmune disorders are emerging.

OBJECTIVES: This article reports on the experience of an outpatient adolescent substance use disorder treatment program transitioning to virtual care during the COVID-19 pandemic. We describe the processes used to make the transition, including development of a safety protocol for patients seen virtually, present clinical volume data before and after the transition, and we describe a range of patient experiences through 3 clinical vignettes. METHODS: Using data from the electronic health record, we generated counts of the total number of scheduled and completed appointments between December 2019 and June 2020. We used simple proportions to calculate the completed visit rate. RESULTS: Both the absolute number of scheduled appointment and the percent of appointments completed increased with the initiation of virtual care, supporting the acceptability of this modality. Several patients experienced clinical improvements in conjunction with greater engagement, though challenges were also noted. CONCLUSIONS: Virtual visits are a practical mode of treatment for adolescent substance use disorders, and more evidence is needed to understand the risks and benefits of this treatment modality.

Cardiac implantable electronic device (CIED) infection is a potentially devastating complication of CIED procedures, causing significant morbidity and mortality for patients. Of all CIED complications, infection has the greatest impact on mortality, requirement for re-intervention and additional hospital treatment days. Based on large prospective studies, the infection rate at 12-months after a CIED procedure is approximately 1%. The risk of CIED infection may be related to several factors which should be considered with regards to risk minimization. These include technical factors, patient factors, and periprocedural factors. Technical factors include the number of leads and size of generator, the absolute number of interventions which have been performed for the patient, and the operative approach. Patient factors include various non-modifiable underlying comorbidities and potentially modifiable transient conditions. Procedural factors include both peri-operative and post-operative factors. The contemporary PADIT score, derived from a large cohort of CIED patients, is useful for the prediction of infection risk. In this review, we summarize the key information regarding epidemiology, incidence and risk factors for CIED infection., Graphical Abstract

The Ontario Renal Network (ORN), a provincial government agency in Ontario, Canada, launched an initiative in 2012 to increase home dialysis use province-wide. The initiative included a new modality-based funding formula, a standard mandatory informatics system, targets for prevalent home dialysis rates, the development of a ‘network’ of renal programmes with commitment to home dialysis and a culture of accountability with frequent meetings between ORN and each renal programme leadership to review their results. It also included funding of home dialysis coordinators, encouragement and funding of assisted peritoneal dialysis (PD), and support for catheter insertion and urgent start PD. Between 2012 and 2017, home dialysis use rose from 21.9% to 26.5% and then between 2017 and 2019 stabilised at 26% to 26.5%. Over 7 years, the absolute number of people on home dialysis increased 40% from 2222 to 3105, while the number on facility haemodialysis grew 11% from 7935 to 8767. PD prevalence rose from 16.6% to 20.9%, a relative increase of 25%. The initiative showed that a sustained multifaceted approach can increase home dialysis utilisation.

Aims: Heart failure (HF) is the most common primary inpatient diagnosis in Germany. We examined temporal trends of HF hospitalization within Germany focusing on regional differences. Methods and results: We analysed aggregated data of more than 320 million hospitalizations in Germany from 2000 to 2017. Temporal trends of HF-related parameters were analysed, focusing on regional differences between the federal states. The absolute number of HF-related hospitalizations throughout Germany increased continuously and almost doubled (from 239 694 to 464 724 cases, +94%) with the relative increase being higher in East Germany compared with West Germany (119% vs. 88%). These regional differences persisted after age standardization with 609 and 490 cases per 100 000 population, respectively. The length of stay decreased continuously across Germany (from 14.3 to 10.2 days; −29%), while the total number of HF-related hospital days increased by 51% in East Germany and 35% in West Germany. In 2017, HF remained the leading cause of in-hospital death (8.9% of all cases), with a markedly higher rate in East vs. West Germany (65 vs. 43 deaths per 100 000 population). Conclusions: Heart failure remains the most common cause of hospitalization and in-hospital death throughout Germany. The increase in HF-related morbidity and mortality was much higher in East Germany compared with West Germany during the observation period. A more detailed understanding of these striking disparities 30 years after the German reunification requires further investigations. There is an urgent need for action with regard to stronger control of risk factors and improvement of both chronic HF management and healthcare structures. CA Extern

OBJECTIVE: To describe the epidemiological trends and characteristics of extrapulmonary tuberculosis (EPTB) in Galicia, Spain, from 2000 to 2019.METHODS: This was a retrospective cohort study based on data from the Galician TB information system.RESULTS: Of the total number of TB cases (n = 15,871), 5,428 (34.2%) had EPTB. The absolute number of cases and incidence of EPTB decreased dramatically (from 480 cases and 17.8 cases/100,000 in 2000, to 172 and 6.4 cases/100,000 in 2019, respectively), with a mean annual decrease of respectively 64% and 4.7% for absolute cases and incidence rates. The risk for EPTB was higher in men than in women (RR 3.86, 95% CI 3.66–4.07). The most frequent age group was 15–44 years (2,234 patients, 41.2%); overall reductions per age group were 82% (0–14 years), 75% (15–44 years), 44% (45–64 years) and 63% (≥65 years), with statistically significant differences. The most frequently locations were the pleura (1,916 cases; 35.3%) and the lymph nodes (1,504; 27.7%).CONCLUSION: The incidence of EPTB in Galicia has decreased significantly in the last 20 years. The epidemiological characteristics have not changed, except for the number of patients with risk factors. This improvement of EPTB epidemiological trends coincides with the implementation of the programme for the prevention and control of TB, which suggests that it has been very effective in the control of the EPTB.

The absolute number of Never Events is used by UK regulators to help assess hospital safety performance, without account of hospital workload. We applied funnel plots, as an established means of taking workload into account, to published Never Event data for 151 acute Trusts in NHS England, matched to finished consultant episodes for 3 years, 2017-2020. Trusts with excess event rates should have the most Never Events if absolute number is a valid way to judge performance. The absolute number of Never Events was correlated with workload (r2 = 0.51, p

In many spheres of life, from applying for a job to participating in an athletic contest to vying for a date, we face competition. Does the size of the competition pool affect our propensity to behave unethically in our pursuit of the prize? We propose that it does. Across four studies, we found that a larger (vs. smaller) number of competitors led participants to cheat more in a performance task to earn undeserved money. We also explored the psychological mechanisms of competition pool size to explain why and how being in a larger competition pool increases cheating. Our findings reveal a serial mediation pathway whereby having a larger number of competitors increases expectations of the absolute number of cheaters in the competition group, which heightens perceptions that cheating is an acceptable social norm, which leads to more cheating. We also examined and ruled out various alternative psychological mechanisms for this effect. We discuss the theoretical and practical implications of our finding that being in a large group of competitors can increase people’s propensity to cheat for personal gain.

Objective: the development and approbation of the method for comparative analysis of the lists of medicines in different countries and systems of healthcare.Material and methods. Based on the open-access data on the lists of medicines published on official websites of the authorized regulators, the authors selected the national lists of medicines of Russia, England, and Italy for the development and approbation of the method. It was proposed to use three parameters: the absolute number of medicines by international nonproprietary name (INN); the structure of the lists based on anatomical therapeutic chemical (ATC) classification; and the coverage of the indications based on the International Classification of Diseases, 10th edition (ICD-10). The results of the analysis provided grounds for the review of the approaches to the formation of the lists of medicines required for medical help in Russia, England, and Italy and reimbursed from the state budget.Results. The number of medicines by INN in the national lists of England and Italy exceeds the total number of drugs included in the list of vital essential and desirable (VED) in Russia. All the analyzed lists were characterized by an uneven distribution of medicines within the lists by the ATC groups. The lists of medicines in England and Italy significantly exceed the list of VED by the number of the included medicines by all ATC groups excluding groups J and H in comparison with Italy, and groups J and V in comparison with England. At the same time, the list of VED significantly exceeds the list in England by the number of covered indications from the ATC L group. During the approbation, the method showed to be effective and can be used for further comparative studies of the national lists of medicines.Conclusion. Non-uniform lists of medicines by ATC-codes show that each country has priority areas in their healthcare systems. The list of VED can be shorter by the absolute number of the included medicines in England and Italy but it can exceed them by the coverage of indications due to peculiarities of the procedure of the list formation (reimbursement of medicines by all the registered indications). The results of the study with the proposed method can serve for the optimization of the VED list and the analysis of therapeutic areas that are undercovered.

Aim. A scientific assessment of the main indicators of morbidity and mortality of the population from laryngeal cancer in the Far Eastern Federal District over the past ten years (2009-2019).Materials and methods. In the process of work, indicators of morbidity and mortality, reporting forms of statistical registration of oncological patients and regulatory documents of higher organizations, information on ten-year observations on the dynamics of changes in digital values of the investigated pathology were used.Results. The main data on morbidity and mortality of patients with laryngeal cancer are given in the Far Eastern Federal District, where 2019 new cases of malignant neoplasms were registered in 34152, which is 8.5% more than ten years ago. There were 2171 patients with laryngeal cancer under outpatient observation, i.e. 26.5% per 100.000 population in the region. In the structure of primary morbidity and total mortality among all departments of the respiratory system, laryngeal cancer ranked second after malignant neoplasms of the trachea, bronchi and lung. During the study period, the number of patients with advanced forms of the disease increased with a simultaneous decrease in the number of patients with stages I and II of the oncological process. Over the past ten years, the incidence of disease has increased more significantly in the female population. The percentage of actively identified patients during this time increased by several orders of magnitude, with a simultaneous increase in the index of the accumulation of populations of patients with laryngeal cancer. Morphological confirmation of the diagnosis was lower than the Russian average. The proportion of patients registered for five years or more did not reach the average republican values. Lethality in the first year since the diagnosis was established was characterized by dynamically decreasing digital values, despite the increase in the number of neglected cases, which can be explained by the high level of modern methods of treatment.Conclusion. Against the background of the increasing absolute number of patients with malignancies in the Far Eastern Federal District in 2019, there was a decrease in standardized indicators (world standard) of morbidity and mortality from laryngeal cancer in the male population, with an increase in the number of women who fell ill and died from this pathology.

One of the most interesting natural tourist destinations in the Czech Republic are sandstone rocks, located mainly in the Bohemian Cretaceous Basin. Sandstones in these areas create a number of aesthetically valuable geomorphological formations, such as rock towers, gates, windows, overhangs etc. In addition, they provide beautiful views. Regions with a concentration of sandstone rocks are thus among the most visited natural areas in the Czech Republic. Unfortunately, mass tourism also brings negative impacts that negatively affect the condition of sandstone rocks—these are mainly engraving in the rocks, painting or spraying on the rocks, vandalism, pollution by garbage or excrements and destruction of natural rock shapes. However, it is not true that a larger number of visitors automatically means a larger number of negative impacts. This paper analyses the factors that influence the occurrence of the above-mentioned negative impacts in areas of sandstone rocks. The basis for the analysis was mapping of negative impacts in the field, data on traffic to individual geosites, GIS database of business entities in the tourism sector in the area of interest and field survey, aimed at explaining the structure of visitors to individual geosites according to their motivation and preferences. First, data on tourists' motivation and preferences were processed using cluster analysis into their typology. Then, the relationship between the intensity of the occurrence of negative impacts and potential factors—the absolute number of visitors, the distance to a major tourist facility and the type of visitor—was analysed. The results showed that damage to geosites is most affected by some types of visitors and little social control.

This study aims to describe the worldwide epidemiology and changing disease trends of acute appendicitis (AA). Epidemiological data on the incidence of AA and deaths were collected from the Global Health Data Exchange repository from 1990 to 2019. Data were stratified by age, sex and Socio-Demographic Index (SDI). In 2019, there were an estimated 17.7 million cases (incidence 228/100,000) with over 33,400 deaths (0.43/100,000). Both the absolute number and the incidence had increased from 1990 to 2019 (+ 38.8% and + 11.4%, respectively). The number of deaths and deaths per 100,000 declined during this period (− 21.8% and − 46.2%, respectively). These trends were largely similar in all 5 SDI groups. There was a significant difference in the incidence of AA between the SDI groups, with low SDI group having the lowest and high SDI group having the highest. The high SDI group had the lowest mortality rate (Kruskall–Wallis test, p

Purpose To evaluate the effect of a bundled intervention on the number of skin-to-skin (“kangaroo care”) events occurring in a level IV NICU. Design A quality improvement effort centering around the introduction of an intervention bundle intended to safely increase the rate of skin-to-skin holding. Rates of unplanned extubations were recorded as a balancing measure to estimate safety. Sample All infants admitted to the NICU from December 2017 through September 2019 were included. The “preintervention” period was the 6 months prior to the initiation of the intervention bundle (December 2017–May 2018). Results The absolute number of skin-to-skin holds increased from the preintervention phase (range 7–28 holds/month, median 11 holds/month) to the postintervention phase (range 16–100 holds/month, median 55 holds/month). The total unplanned extubations showed no significant change between the preintervention and postintervention periods.

Background: Retraction of articles occurs as a result of scientific misconducts or honest errors. Objectives: This study aimed to identify the frequency of retracted Iranian publications, compared to those of other countries and adjust them with influential parameters. Methods: All publications that were indexed on the Scopus database from 2008 to 2017 and then retracted, due to scientific misconduct were extracted through the Retraction Watch database and selected as the research community. To calculate the growth of retraction for each proposed country (or region), first, the rate of an absolute number of retracted papers for the years 2013-2017 was divided by the similar number for years 2008-2012, then this rate was adjusted to the retracted rate which is similarly computed for the total retracted statistics of the world. Results: Overall, 545 Iranian retracted publications from 2008 to 2017 were identified, of which 240 and 305 retracted articles were related to the first five years and the second five years of the study, respectively. The results showed that less than 1% (0.82) of all scientific articles published by Iranian researchers were retracted. However, the rate of retracted scientific articles in Iran compared to this rate in the world was significantly higher. Conclusion: Although retracted Iranian publications make up a small percentage of all Iranian publications, the number of retracted publications is increasing. It is important to recognize the reasons for scientific misconducts and to provide researchers with proper education.

Introduction: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. Methods: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). Results: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January–July 2019, to 274 per day in January–July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January–July 2019 (19,629) to January–July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January–July 2019 and 21% in January–July 2020. Conclusion: Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally. Keywords: COVID-19, paediatric emergency department, public health measures, SARS

BackgroundLimited data are available on glaucoma surgical trends in Australia.MethodsNationwide study of glaucoma surgery in Australia over 17-year period from 2001 to 2018. The Australian Institute of Health, Welfare and Ageing hospitalisation database was used to review age- and gender-specific trends in glaucoma surgeries from 2001 to 2018 in Australian public and private hospitals.ResultsAlthough there was an increase in the absolute number of trabeculectomy procedures from 2926 to 3244 over the 17-year study period, this represented a decline in the age-standardised and gender-standardised number of trabeculectomy procedures from 15.1 to 13.2 procedures per 100 000 persons. However, during this same period, there was a dramatic increase in the number of glaucoma drainage devices (GDD) from 119 to 3262 procedures, representing an age-standardised and gender-standardised increase from 0.6 to 13.3 procedures per 100 000 persons. Negative binomial regression analysis revealed a decrease in trabeculectomy procedures of 1.1% per year, while there was increase in GDD insertions of 16.3% per year (p60 years, compared with stable or increasing rates in younger age groups. GDD insertion rates demonstrated a progressively greater increase in older compared with younger age groups.ConclusionOur findings demonstrate changing trends in the surgical management of advanced glaucoma in Australia, likely reflecting updated evidence regarding the role of GDD surgeries.

The coronavirus has challenged all medical systems worldwide. Herein both waves of COVID-19 (coronavirus disease 2019) in spring and autumn 2020 differ principally. Whereas Europe was hit by the first wave more or less unprepared, which was aggravated by the high virulence of COVID-19, the second wave is characterized by a much higher contagiosity of the virus with very high incidences. On the other hand the virus has attenuated, which is reflected by the significantly lower incidence-related mortality rate. However, the overall increasing number of infected patients represents again a great challenge for the medical management of the disease. France and Spain are doing better in comparison to Germany and Italy this time. The absolute number of deaths per week is higher than during the peak of the first wave. However, urologists in these countries have also experienced greater restrictions in their activities in the second shutdown than in Germany, where there is only a reduction of beds to between 75 and 90%. Mostly all levels are operated. Of importance for Germany, however, is the plateau on a high level for several weeks probably due to the reduced efficacy of a light lock-down. This finally resulted in a total lock-down in mid-December 2020. Subsequently in Germany some hospitals are also reaching their limits with similar consequences for the departments of urology facing a 50% reduction of beds and operating only level III and IV indications. Nevertheless, the management of urologic patients during the COVID-19 pandemic is carried out in Europa on a high standard. Therefor the risk of secondary harm to our patients is expected to be rather minimal in the long run.

Contains fulltext : 235444.pdf (Publisher’s version ) (Open Access) PURPOSE: Compare patients treated for Retinopathy of Prematurity (ROP) in two consecutive periods. METHODS: Retrospective inventory of anonymized neonatal and ophthalmological data of all patients treated for ROP from 2010 to 2017 in the Netherlands, subdivided in period (P)1: 1-1-2010 to 31-3-2013 and P2: 1-4-2013 to 31-12-2016. Treatment characteristics, adherence to early treatment for ROP (ETROP) criteria, outcome of treatment and changes in neonatal parameters and policy of care were compared. RESULTS: Overall 196 infants were included, 57 infants (113 eyes) in P1 and 139 (275 eyes) in P2, indicating a 2.1-fold increase in ROP treatment. No differences were found in mean gestational age (GA) (25.9 ± 1.7 versus 26.0 ± 1.7 weeks, p = 0.711), mean birth weight (791 ± 311 versus 764 ± 204 grams, p = 0.967) and other neonatal risk factors for ROP. In P2, the number of premature infants born

Introduction When serious medication errors (ME) are identified, communication to the field may be necessary. In the EU, communication of serious safety issues, such as medication errors associated with adverse drug reactions, is done through direct healthcare professional communications (DHPCs). We aimed to identify how often DHPCs about medication errors are distributed, and we explored factors associated with these ME DHPCs. Methods We performed a descriptive study of all centrally authorised products (CAPs) approved before 1 May 2019 in the EU. All DHPCs issued between 1 January 2001 and 1 May 2019 were reviewed for ME content. Characteristics of CAPs were collected from the website of the European Medicines Agency. A Kaplan–Meier survival analysis was performed to estimate the 5- and 10-year probability of the occurrence of a first ME DHPC. A logistic regression was performed to explore risk factors for ME DHPCs. Results A total of 678 CAPs were included, of which 35 required an ME DHPC during the study period. The 5-year probability for a CAP to have a first ME DHPC was 2.5% (95% CI 1.1–3.9) and the 10-year probability was 4.4% (95% CI 2.2–6.5). Among products with an ME DHPC, the 5-year probability of a second ME DHPC was 21.3% (95% CI 0.2–38.0). The risk of ME DHPCs was increased for products with multiple pharmaceutical formulations, enteral liquid or parenteral injection preparations, and products classified as nervous system agents or antineoplastic and immunomodulating agents. Conclusions The absolute number of ME DHPCs for CAPs is low and does not give rise to immediate concern. We identified potential risk factors for ME DHPCs that should be taken into account during approval procedures or line extensions. Electronic supplementary material The online version of this article (10.1007/s40264-020-00995-4) contains supplementary material, which is available to authorized users.

Ready biodegradability tests (RBTs) are extensively used to screen the potential of chemicals to be biodegraded. The use of RBT protocols often results in large variations of test results that may lead to wrong interpretations. The present study aims to obtain a fundamental understanding of this variability. For this, we subjected the compounds 4-chloroaniline (4CA), carbamazepine (CBZ), metformin (MET), and N-methylpiperazine (NMP) to a variety of different test conditions. Inocula from five local wastewater treatment plants (WWTPs) were used in an attempt to enhance the Organisation for Economic Co-operation and Development (OECD) 310 biodegradability tests. The biodegradation capacity in RBTs, community composition and adaptation of the communities were compared after one week of pre-exposure in batch and four months exposure in chemostat. The results confirm that none of the test compounds is readily biodegradable in the standard OECD 310 RBT. However, when pre-exposure under either batch or chemostat conditions was included, 4CA was degraded in some cases and less variability among different inocula was observed for the transformation of MET. Bacterial communities from the five locations were found to be significantly different in composition from one another. In addition, pre-treatment performed before the RBT significantly changed the composition of each community. Results of this experiment show that short-term pre-exposure may increase the absolute number of degraders and deserves to be further investigated as a potential method to reduce the outcome variability of RBTs.

Objective In 2008, the radiofrequency ablation (RFA) procedures registry of the Hellenic Society of Cardiology was created. This online database allowed electrophysiologists around the country to input data for all performed ablation procedures. The aim of this study is to provide a thorough report and interpretation of the data submitted to the registry between 2008 and 2018. Methods In 2008, a total of 27 centers/medical teams in 24 hospitals were licensed to perform RFA in Greece. By 2018, the number had risen to 31. Each center was tasked with inserting their own data into the registry, which included patient demographics (anonymized), type of procedure and technique, complications, and outcomes. Results A total of 18587 procedures in 17900 patients were recorded in the period of 2008-2018. By 2018, slightly more than 70% of procedures were performed in 7 high-volume centers (>100 cases/year). The most common procedure since 2014 was atrial fibrillation ablation, followed by atrioventricular nodal reentry tachycardia ablation. Complication rates were low, and success rates remained high, whereas the 6-month relapse rates declined steadily. Conclusion This online RFA registry has proved that ablation procedures in Greece have reached a very high standard, with results and complication rates comparable to European and American standards. Ablation procedures for atrial fibrillation are increasing constantly, with it being the most common intervention over the last 6-year period, although the absolute number of procedures still remains low, compared to other European countries.

In the Russian Federation (RF) a steady growth of morbidity with oncologic diseases is observed. An important factor of reduction of negative influence of oncopathology on the parameters of public health is provision of the population with specialists and beds of oncological profile, as well as their effective use. Aim. To determine the status and identify dynamics of the main parameters of use of beds of oncological profile of the state healthcare system of RF, federal districts and constituent entities of RF in comparison with tendencies of parameters of morbidity with malignant neoplasms, and also of provision of the population with medical personnel in the period from 2010 to 2019. Materials and Methods. Using the data of the Federal statistical observation forms (№30, 47, 14LC, 7) based on the calculation of absolute and relative parameters by the descriptive statistics method, the analysis of the main parameters of the use of bed resources of oncology profile was carried out in comparison with the parameters of morbidity with malignant neoplasms and provision of the population with medical personnel in 24-hour and day-stay hospitals in the Russian Federation, federal districts and constituent entities of the Russian Federation in 2010-2019. Results. During the study period, with the underlying increase in the morbidity of the population with diseases of neoplasm class (primarily, malignant) in the Russian Federation, there was found a regular increase in: the absolute number of oncological beds for 24-hour stay by 5.216 beds (+16.8%), provision with these beds from 2.17 to 2.47 per 10 000 population (+13.8%), hospitalization rate from 6.1 to 9.6 per 1000 population (+57.4%); and a decrease in: average stay in an oncological bed by 3.7 days (-30.6%, from 12.1 to 8.4 days), and the average bed occupancy by 15 days per year (-4.3%, from 345 to 330 days). Mortality in cancer beds increased from 0.76% in 2010 to 0.95% in 2019 (by 25.0%). There was an increase in the provision of the population with oncological beds in day-stay hospitals by 3.4 times, in day-stay hospitals of polyclinics by 63.6%. Conclusion. With the underlying growth of oncological morbidity in the country, the bed capacity of the oncological profile of 24-hour and day hospitals has significantly increased, with a high level of disproportional development of the bed capacity both between federal districts and between the subjects of the Russian Federation.

The restrictive measures adopted by the Italian Government during the COVID-19 outbreak caused dramatic changes in routine public health care. Surprisingly, emergency activity also registered a reduction in frequency.This multicentre retrospective study aims to investigate eventual changes in ENT surgical emergencies in a highly populated area of southern Italy during the COVID-19 pandemic. Data concerning the period between the February 1 and the May 31, 2020 were collected from the main three hospitals in the district and compared with the same period of 2019.A substantial reduction was found in the number of ENT emergency interventions in 2020 compared to the same period of 2019, particularly in the main lockdown phase and in the tertiary referral centre.The reduction in the absolute number of emergency ENT interventions can be only partially explained by social distancing and home confinement. We have reason to believe that some of these patients may have not sought medical support due to fear of nosocomial SARS-CoV2 infection. This study could represent a trigger for further implementation of health system responses to emergencies in a period of transition that is likely to last for a prolonged period of time.Le urgenze chirurgiche otorinolaringoiatriche durante l’epidemia di COVID-19.Le misure restrittive adottate in Italia durante la pandemia di COVID-19 hanno determinato uno stravolgimento delle attività medico chirurgiche. Inaspettatamente, anche le prestazioni urgenti hanno registrato una riduzione.Abbiamo retrospettivamente confrontato le urgenze chirurgiche ORL eseguite nei tre principali ospedali della Provincia di Bari nel periodo compreso tra il 1° febbraio e il 31 maggio del 2020 con quelle dello stesso periodo del 2019.È stata riscontrata una importante riduzione nel numero di interventi nel 2020 rispetto all’anno precedente, in particolare nella fase del lockdown vero e proprio e nel centro di riferimento terziario.La riduzione del numero di urgenze chirurgiche ORL può essere solo parzialmente spiegata dal distanziamento sociale e dal confinamento domiciliare imposti dalle misure restrittive. Abbiamo motivo di credere che alcuni pazienti potrebbero aver evitato l’assistenza medica per paura di contrarre l’infezione nosocomiale da SARS-CoV2. Questo primo studio potrebbe avviare un processo di implementazione del sistema di risposta alle urgenze ORL che sarebbe auspicabile in un periodo di transizione potenzialmente duraturo.

The objective: analysis of tuberculosis situation among the pediatric population of Russia. Subjects: the data from Federal Statistics Forms no. 8, 30, 33, 47, and 61 were studied. The number of those died is presented as per the data of Rosstat. Research methods: epidemiological and statistical analysis, expert assessment, and content analysis of publications and regulations. Results. In 2005-2019, tuberculosis rates among children and adolescents of 0-17 years old decreased: incidence – from 21.5 to 9.0 per 100,000 children (2.4 times), prevalence – from 28.3 to 10.6 per 100,000 children (2.7 times), mortality – from 0.22 to 0.03 per 100,000 children (7.3 times). The incidence of tuberculosis in children of 0-14 years old decreased from 16.4 to 7.7 per 100,000 children (2.1 times), children of 15-17 years old – from 37.6 to 16.5 per 100,000 children (2.3 times). Boys suffer from tuberculosis less often than girls. The decrease in tuberculosis incidence in children is directly related to the overall improvement of tuberculosis situation in the country including the reduction of exposure to tuberculosis by 2.2 times. In the structure of tuberculosis incidence, the proportion of lung damage increases, while the proportion of other localizations in respiratory organs and extrapulmonary lesions decreases. From 2005 to 2019 among children of 0-14 years old, the proportion of lung damage increased from 18.0 to 32.1%, and among children 15-17 years old – from 80.8 to 89.1%. From 2005 to 2019, among children and adolescents aged 0-17 years notified with tuberculosis at the end of the year, the proportion of those HIV infected increased up to 3.4%, while the absolute number of children decreased down to 108. The proportion of children with MDR TB among those with a positive result of sputum test increases (2005 – 10.0%; 2019 – 45.8%). From 2005 to 2019, the rate of those died of tuberculosis decreased among children of 0-14 years old from 0.17 to 0.02 per 100,000 children (8.5 times), at the age of 15-17 years – from 0.22 to 0.07 per 100,000 children (3.1 times). The number of children aged 0-14 years, registered with post-vaccination complications decreased by 6.2 times (2005 – 947 children, 2019 – 153 children).

Most snacks displayed at supermarket checkouts do not contribute to a healthy diet. We investigated the effects of introducing healthier snack alternatives at checkouts in supermarkets on purchasing behavior. In Study 1, we investigated the effect of completely substituting less healthy with healthier snacks (one supermarket). In Study 2, we investigated the effect of placing and discounting healthier snacks while the less healthy snacks remain in place (two supermarkets). In both studies, the number of purchased snacks (per 1000 customers) was used as the outcome variable. Results for Study 1 showed that the absolute number of purchased checkout snacks was 2.4 times lower (95% confidence interval (CI): 1.9&ndash, 2.7) when healthier snacks instead of less healthy snacks were placed at the supermarket checkouts. Results for Study 2 showed that when additional healthier snacks were placed near the checkouts, the absolute number of healthier purchased snacks increased by a factor of 2.1 (95% CI: 1.3&ndash, 3.3). When additional healthier snacks were placed near the checkouts and discounted, the absolute number of healthier purchased snacks increased by a factor of 2.7 (95% CI: 2.0&ndash, 3.6), although this was not statistically significant higher than placement only (ratio: 1.1, 95% CI: 0.7&ndash, 1.9). Purchases of less healthy snacks did not decline, and even slightly increased, during the intervention period (ratio: 1.3, 95% CI: 1.1&ndash, 1.5). If supermarkets want to promote healthier snack purchases, additional healthier products can be positioned near the checkouts. However, this does not discourages the purchase of less healthy snacks. Therefore, to discourage unhealthy snack purchases at supermarket checkouts, a total substitution of less healthy snacks with healthier alternatives is most effective.

Background Every year, there are an estimated 22.6 million new neurosurgical consultative cases worldwide, of which 13.8 million require surgery. In 2016, the global neurosurgical workforce was estimated and mapped as open-access information to guide neurosurgeons, affiliates, and policymakers. Here we present a subsequent investigation for mapping the global neurosurgical workforce for the year 2018 to demonstrate the replicability of prior data collection methods as well as show any changes in workforce density. Methods We extracted data on the absolute number of neurosurgeons per low and middle-income countries (LMICs) in 2016 from the database of the global neurosurgical workforce mapping project. The estimated number of neurosurgeons in each LMIC during the year 2018 was obtained from collaborators. The median workforce densities were calculated for the year 2016 and the year 2018. Neurosurgical workforce density heat maps were generated. Results We received data from 119 countries (response rate 86.2%) and imputed data for 19 (13.8%) countries. 78 (56.5%, n=138) countries had an increase in their number of neurosurgeons, 9 (6.5%) showed a decrease, while 51 (37.0%) had the same number of neurosurgeons in both years. The pooled median increased from 0.17 (IQR=0.54) in 2016 to 0.18 (IQR=0.59) in 2018. Conclusions Overall, the density of the neurosurgical workforce has increased from 2016 to 2018. However, at the current rate, 80 (58.0%) LMICs will not meet the neurosurgical workforce density target by 2030.

Topic This article presents an overview of the burden of peripheral intravenous catheter infections and current evidence-based recommendations for prevention. Clinical Relevance Peripheral intravenous catheters are ubiquitous in most health care settings, fostering an acceptance of the peripheral intravenous catheter as benign and inevitable. This device, however, is far from benign, with reported failure rates as high as 90% from complications such as infection and phlebitis. Although reported rates of bloodstream infection related to peripheral intravenous catheters are much lower than those attributed to central venous catheters, the exponentially higher use of peripheral intravenous catheters indicates that the absolute number of peripheral venous catheter–related bloodstream infections is likely as high as and may surpass the number of central venous catheter–related bloodstream infections, with significant associated morbidity and mortality. Purpose of Paper Sustained improvements in outcomes related to peripheral intravenous catheters will depend on recognition of the root causes of failure and increased commitment to practice patterns consistent with infusion therapy standards of practice, effective education about peripheral intravenous catheters, accurate documentation of all aspects of peripheral intravenous catheter management, and consistent surveillance of patient outcomes related to peripheral intravenous catheters. Content Covered This article reviews the significant burden of peripheral intravenous catheter infections, barriers to effective peripheral intravenous catheter management, and current evidence-based recommendations to prevent this source of patient harm.

Purpose Unicompartmental knee arthroplasty (UKA) is a treatment option for anteromedial osteoarthritis of the knee. The number of UKA has been increasing constantly worldwide in recent decades. The aim of this study was to determine the most frequently cited scientific articles addressing this subject and to establish a ranking of the 50 most influential papers. Methods The 50 most cited articles related to UKA were searched in Web of Science® (Clarivate Analytics, Penn., USA) by the use of defined search terms. All types of scientific papers with reference to this topic were ranked according to the absolute number of citations and analyzed for the following characteristics: journal title, year of publication, number of citations, citation density, geographic origin, article type, and level of evidence. Results The 50 most cited articles had up to 453 citations. Most papers were published in the Journal of Bone and Joint Surgery (British volume). More than half of the articles were published in the 2000s and 2010s (n = 30). Ten countries contributed to the top 50 list, with most contributions from the UK (n = 17). Most articles could be attributed to the category of Clinical Science (n = 33), and most reported level IV studies. Conclusion Most of the frequently cited articles in UKA are clinical studies that have a low level of evidence. Few basic scientific studies could be identified, which suggests that most product development is done by commercial companies.

Purpose: to analyze information on cases of evacuation of seafarers from seacrafts for medical reasons and make proposals on improvement of health maintenance for personnel of sea and river crafts.Materials and methods: the analysis of information on cases of evacuation of seafarers from seacrafts for medical reasons for the period from 2014 to 2019 was carried out. Results and discussion: increase in mean annual rate of evacuation and absolute number of evacuated seafarers for the period from 2014 to 2019 in comparison with previous period from 2009 to 2013 was revealed. Maximum number of evacuated seafarers among five sea basins for the period from 2014 to 2019 was observed in Far Eastern and Northern sea basins and is equal to 40% and 21% of the total number of evacuated seafarers. The formation of universal health care for sick and injured people at seacrafts in the Russian Federation as well as adoption of joint normative legal documents of Ministry of Labour and Ministry of Health of the Russian Federation on issues relating to organization of medical evacuation and application of telemedicine technologies is required.

How do municipalities strategically use land policy to develop land for housing? The development of housing is a challenge for many European countries, though the scale and time of it differs. Issues are not always about the absolute number of houses that need to be supplied in a country. The distribution and quality of houses affect the demand for housing. Land policy determines where and how future developments take place, and as a result, it has a considerable impact on both supply and demand of housing. Municipalities use different strategies of land policy to pursue housing goals. This paper aims to explore the rationalities underpinning such strategies of land policy. Therefore, a theory on pluralism – Cultural Theory – is employed to understand municipal strategies in different contexts, i.e. Germany (Ruhr region), Belgium (Flanders), and Netherlands. Applying Cultural Theory to land policy results in four ideal-typical strategies of active, passive, reactive, and protective land policies. Despite the fact that the decisions of municipalities are made within (or constrained by) their institutional environments (i.e. national/regional planning systems, development cultures, etc.), we found that there are key similarities between the strategies of the studied municipalities regardless of their different institutional environments.

Food deprivation is a common condition for visceral surgeons and especially laparoscopic approaches require high levels of concentration. The current literature does not provide adequate answers whether intraoperative breaks, especially food intake, might influence the quality of the surgical skills. Thus, the primary aim of this trial was to analyze the influence of food deprivation on the laparoscopic performance.37 laparoscopic novices participated from 10/2017 to 04/2018 in this single center, prospective-randomized trial and were trained during laparoscopic training sessions until they reached a predefined level of proficiency. Subsequently, participants were randomized into 3 different groups: food deprivation of 8 hours, 4 hours, or carbohydrate loading directly prior to the laparoscopic exam. The exam comprised PEG-transfer, precise cutting, gallbladder resection and surgical knot.Completion time for PEG-transfer, precise cutting, gallbladder resection and surgical knot was 63s, 139s, 192s and 272s respectively. Participants starving for 8 hours performed 3 of 4 tasks more slowly whilst participants starving for 4 hours performed 3 of 4 tasks faster than the average. Analyzing self-reported level of appetite revealed: Students with an intermediate level were significantly faster (p0.05) during complex procedures compared to participants that reported hunger prior to performing these tasks (192s vs. 307s). Additionally, hungry students had been more inaccurate during the surgical knot (p0.05) whilst students with intermediate appetite level tend to be most accurate (p - value 0.012).The subjective level of appetite rather than the absolute number of fasting hours influences the laparoscopic performance most. Thus, any extreme level of appetite may be avoided and surgeons may achieve the best performance when they have an intermediate level of appetite. In consequence, heavy meals may be omitted immediately prior to demanding laparoscopic procedures and surgeons may have access to mini-breaks and refreshers during major procedures.

This article examines what explains the performance of Dutch local party branches in the recruitment of candidates for municipal councils. Fielding a list of candidates is the most basic function of political parties. In the Netherlands, party branches are under pressure from the low number of party members. To analyse how branches fulfil their role in recruitment, we employ our own survey of the secretaries of party branches held in the run-up to the 2018 municipal election. We find that party membership drives the successful fulfilment of the recruitment function but that, more than the absolute number of members, the crucial factors are how these party members cooperate, the number of active members and the development of this number.

Choroid melanoma belongs to malignant tumors. The choice of treatment modality depends on a tumor size and site, ocular tunics conditions, clinic logistics, and the patient’s will. The aim of the study was to evaluate the effectiveness of treatment of patients with choroid melanoma. The data of the Belarusian Cancer Registry and the case histories of patients with choroid melanoma (C69.3, ICD-10) over the period of 1999–2018 were studied. The incidence rates were evaluated on the basis of the analysis of the absolute number of persons taken ill with the disease, crude intensive rates calculated per 1,000,000 of population. To calculate the survival, the disease-specific cumulative 5-year survival rate was used. Significance evaluation was made applying the chisquare test. The incidence rates varied over the 20-year period and were 0.9 ‰ on the average. Enucleation was performed in 724 patients, 13.9 % (101 patients) being registered with synchronous and metachronous cancer. Patients with a sole tumor of choroid melanoma were analyzed. The amount of enucleations performed decreased by a factor of 1.8. To evaluate the survival, the groups of patients with large tumors were formed after enucleation and combination treatment was carried out. Of 623 patients subjected to enucleation, disease progression was established in 159 (25.5 %). Of 159 patients, the onset of disease progression occurred in 25 (15.7 %) in the 1st year, in 50 (31.5 %) in the 2nd year, and in 84 (52.8 %) in the 4th year and later. In the combination treatment group, consisting of 58 patients, decease progression was ascertained in 10 (17.2 %): in the 1st year – in 1 (10.0 %), in the 2nd year – in 6 (60.0 %), and in the 4th and later – in 3 (30.0 %). The survival rate after the organ-sparing treatment is insignificantly higher and increases to the 5th year of the follow-up, although the data are statistically insignificant (p > 0.5). At present, enucleation does not play the leading role in the choice of treatment modality for patients with clinical diagnosis of choroid melanoma. The disease-specific cumulative 5-year survival rate in patients receiving organ-sparing treatment was 85.7 ± 5.1 %, and in those subjected to enucleation – 67.2 ± 2.2 %, the data being statistically insignificant (p > 0.5). The promising trend in treating choroid melanoma patients is the development of organ-sparing treatment techniques.

Aim. To assess the current state of the cardiology bed fund in round-the-clock and day-patient facilities in the Russian Federation and the efficiency of its use in 2010–2018.Materials and methods. Using the method of descriptive statistics, the data from the Federal Statistical Observation Forms (No. 30, 47 and 14DS) were analyzed in order to assess the current state and dynamics of the use of cardiology beds during the 2010–2018 period.Results. The absolute number of cardiology hospital beds in Russia in 2018 amounted to 49,578 beds, which number was lower than in 2010 by 5,899 beds. The absolute number of cardiology beds in day-patient facilities of all hospital types increased by 169 beds and equaled 4,019 beds. The provision of the Russian population with round-the-clock hospital cardiology beds decreased from 3.88 per 10,000 population in 2010 to 3.38 in 2018 (–12.9%). The provision of the population with cardiology beds in day-patient facilities in hospitals providing inpatient care increased by 19.6% (from 0.12 to 0.14 per 10,000 population) in 2010–2018. This indicator decreased by 11.5% (from 0.15 to 0.14 per 10,000 population) in day-patient facilities in medical organizations providing outpatient care in 2014–2018. In Russia, the hospitalization rate in round-the-clock cardiology departments increased from 9.3 per 1000 population in 2010 to 10.8 in 2018 (+16.1%). The average length of patient stay in round-the-clock cardiology departments decreased from 13.1 days to 9.7 days (–26.0%), with the indicator of bed turnover growing by 29.2%. The mortality rate decreased by 3.6% (from 1.96% in 2010 to 1.89% in 2018).Conclusion. The total number of patients treated in cardiology beds of both round-the-clock and day-patient facilities was 266,311 people higher in 2018 compared to 2010, out of which 89.6% (236,004 people) were treated in round-the-clock hospital facilities and 10.4% (27,307 people) — in hospitals providing outpatient care. At the same time, the absolute number of round-the-clock hospital beds decreased. As a result, the rate of substituting treatment at round-the-clock hospital facilities with that at outpatient medical organizations remains insignificant.

Hypothesis/aims of study. The perinatal mortality rate is a comprehensive indicator of social well-being, economic development and the state of medical care in any country. The aim of this study was to analyze perinatal loss dynamics in St. Petersburg and the Leningrad Region for 2006-2018 so as to determine the reserves for the reduction of perinatal mortality. Study design, materials and methods. Regional statistical reports on perinatal mortality in St. Petersburg and the Leningrad Region for 2006-2018 were analyzed. Results. A retrospective analysis of perinatal loss dynamics in St. Petersburg and the Leningrad Region was carried out. The structure of perinatal losses by birth weight of the fetus / newborn was surveyed. The proportion of children who died perinatally in the total number of deaths before reaching the age of 18 was determined. The main reserves for reducing perinatal mortality have been identified. Conclusion. With a clear tendency for perinatal mortality in St. Petersburg and the Leningrad Region to decrease during the study period, the absolute number of stillbirths does not show such a tendency.

Introduction: The reduction of infant mortality is still a challenge for health services. Despite the decline observed in Brazil, infant mortality remains a major concern in Public Health. In Piauí with the implementation of the Cegonha Network and the Neonatal Component in recent years, a decline in the maternal, infant and neonatal mortality rate can be noticed, but mothers and babies are still being lost due to preventive causes. Despite the advances that the state had after the implementation of the stork network, this development did not happen equally in all health regions, with most of the centralized assistance still in the capital. Objective: This study aimed to assess the epidemiological profile of neonatal mortality in the state of Piauí. Methodology: A retrospective, descriptive study with a quantitative approach was carried out, and the data were collected in the DATASUS system and tabulated using TABWIN AND TABNET. Results: There was a reduction in the total absolute number of deaths between the years 2007 to 2015, with an increase of approximately 4.5% between the years 2015 and 2016. Early neonatal mortality comprised more than 3/4 of neonatal deaths . Over 53% of deaths are of low birth weight newborns. About 48.7% of deaths refer to premature infants. Conclusions: The findings revealed the main characteristics of neonatal deaths in Piauí in the time series (2007-2016). Introducción: la reducción de la mortalidad infantil sigue siendo un desafío para los servicios de salud. A pesar de la disminución observada en Brasil, la mortalidad infantil sigue siendo una preocupación importante en la salud pública. En Piauí con la implementación de la Red Cegonha y el Componente Neonatal en los últimos años, se puede notar una disminución en la tasa de mortalidad materna, infantil y neonatal, pero las madres y los bebés todavía se están perdiendo debido a causas preventivas. A pesar de los avances que tuvo el estado después de la implementación de la red de cigüeñas, este desarrollo no ocurrió por igual en todas las regiones de salud, con la mayor parte de la asistencia centralizada todavía en la capital. Objetivo: Este estudio tuvo como objetivo evaluar el perfil epidemiológico de la mortalidad neonatal en el estado de Piauí. Metodología: se realizó un estudio descriptivo retrospectivo con un enfoque cuantitativo, y los datos se recopilaron en el sistema DATASUS y se tabularon con TABWIN Y TABNET. Resultados: Hubo una reducción en el número absoluto total de muertes entre los años 2007 a 2015, con un aumento de aproximadamente 4.5% entre los años 2015 y 2016. La mortalidad neonatal temprana comprendió más de 3/4 de las muertes neonatales. . Más del 53% de las muertes son de recién nacidos con bajo peso al nacer. Alrededor del 48.7% de las muertes se refieren a bebés prematuros. Conclusiones: los hallazgos revelaron las principales características de las muertes neonatales en Piauí en la serie temporal (2007-2016). Introdução: A redução da mortalidade infantil é ainda um desafio para os serviços de saúde. Apesar do declínio observado no Brasil, a mortalidade infantil permanece como uma grande preocupação em Saúde Pública. No Piauí com a implantação da Rede Cegonha e do Componente Neonatal nos últimos anos pode-se perceber um declínio no índice de mortalidade materna, infantil e neonatal, mas ainda continua-se perdendo mães e bebês por causas evitais. Apesar dos avanços que o estado teve após a implantação da rede cegonha esse desenvolvimento não se deu por igual em todas as regiões de saúde, ficando a maior parte da assistência centralizada ainda na capital. Objetivo: Este trabalho teve o objetivo de avaliar o perfil epidemiológico da mortalidade neonatal o estado do Piauí. Metodologia: Foi realizado um estudo retrospectivo, descritivo, abordagem quantitativa, e os dados foram coletados no sistema do DATASUS e tabulados utilizando o TABWIN E TABNET. Resultados: Observou-se uma redução do número absoluto total de óbitos entre os anos 2007 a 2015, havendo um aumento de aproximadamente 4,5% entre os anos de 2015 e 2016. A mortalidade neonatal precoce compreendeu mais de 3/4 dos óbitos neonatais. Mais de 53% dos óbitos são de RN de baixo peso. Cerca de 48,7% dos óbitos referem-se aos prematuros. Conclusões: Os achados revelaram as principais características dos óbitos neonatais no Piauí na série temporal (2007-2016).

Population ageing is a natural process characterized by the increase in life expectancy and by a growth in the absolute number and proportion of elderly and senile persons in the population. These demographic changes increase the need for medical and social care among the people of this age group and require the development and implementation of new public policies.