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Achilles allograft interposition arthroplasty for the treatment of proximal radio-ulnar stump impingement pain
Get PDFBackground: Proximal radio-ulnar stump impingement (PRUSI) describes a painful condition occurring following radial head loss. Pain occurs due to the proximal radial stump impinging against the ulna. This study aimed to evaluate the safety of a novel interposition arthroplasty method. Methods: A retrospective observational consecutive case series study was undertaken from case note review of patients with PRUSI, treated by Achilles allograft interposition arthroplasty. The technique utilised donor Achilles tendons to cushion the proximal radio-ulnar stump articulation. The primary outcome was a change in pain levels. Secondary outcomes included changes in: elbow and forearm range of movement, Mayo Elbow Performance Score (MEPS), patient satisfaction on an 11-point numerical rating scale (NRS) and adverse events. Results: From baseline to six months post intervention, the mean NRS pain score was reduced from 9/10 to 2/10 with a mean difference in NRS pain scores of -7 (95% CI -4, -10; p = 0.004). Mean MEPS increased from 56/100 (s.d. 8) to 91 (s.d. 8), with a mean difference of 35/100 (95% CI 18, 52; p = 0.005). Conclusion: Achilles tendon allograft arthroplasty represents a safe procedure for treating PRUSI. This IDEAL phase 1 study shows promising results, indicating the need for further trials. <br/
The Use of Virtual Patients to Provide Feedback on Clinical Reasoning:A Systematic Review
Get PDFPurpose Virtual patients (VPs) are increasingly used in health care professions education to support clinical reasoning (CR) development. However, the extent to which feedback is given across CR components is unknown, and guidance is lacking on how VPs can optimize CR development. This systematic review sought to identify how VPs provide feedback on CR. Method Seven databases (MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, and ProQuest Dissertations) were searched in March 2023 using terms (e.g., medical education, virtual patient, case-based learning, computer simulation) adapted from a previous systematic review. All studies that described VP use for developing CR in medical professionals and provided feedback on at least 1 CR component were retrieved. Screening, data extraction, and quality assessment were performed. Narrative synthesis was performed to describe the approaches used to measure and provide feedback on CR. Results A total of 6,526 results were identified from searches, of which 72 met criteria, but only 35 full-text articles were analyzed because the reporting of interventions in abstracts (n = 37) was insufficient. The most common CR components developed by VPs were leading diagnosis (23 [65.7%]), management or treatment plan (23 [65.7%]), and information gathering (21 [60%]). The CR components were explored by various approaches, from redefined questions to free text and concept maps. Conclusions Studies describing VP use for giving CR feedback have mainly focused on easy-to-assess CR components, whereas few studies have described VPs designed for assessing CR components, such as problem representation, hypothesis generation, and diagnostic justification. Despite feedback being essential for learning, few VPs provided information on the learner's use of self-regulated learning processes. Educators designing or selecting VPs for CR use must consider the needs of learner groups and how different CR components can be explored and should make the instructional design of VPs explicit in published work.</p
Factors influencing primary care physicians recommending patients to use digital health technologies for self-management: A cross-sectional study across 20 countries
Get PDFABSTRACTBackground: Expanding access to self-management via Digital Health Technologies may supplement traditional care, mitigating pressures on primary care through self-management. Primary Care Physicians (PCP) can play a critical role in the integration of digital health technologies into patient care, but it is unclear what factors influence PCPs’ recommendation of such technologies.Aims: To identify the factors associated with PCPs recommending digital health technologies to patients for self-management before and during the pandemic.Methods: PCPs across 20 countries completed an online questionnaire between June and September 2020. The outcome was a self-report of recommending patients to at least one of six listed forms of digital health technologies. Univariable logistic regression models were performed to explore factors associated with recommending digital health technologies to patients before and during the pandemic.Results: 1,592 PCPs were included. Before the pandemic, the odds of recommending digital health technologies for self-management were lower for PCPs not involved in teaching, or practising in Turkey, Australia, Chile, Colombia, France, Italy, Poland, Portugal, Slovenia, and Spain. During the pandemic, PCPs practising in rural settings had higher odds of starting to recommend digital health technologies, as well as those from Brazil, Colombia, and Italy. There was no significant difference in recommending digital health technologies before and during the pandemic.Conclusions: Involvement in teaching (pre-pandemic) and practising in a rural setting (during the pandemic) positively influenced the recommendation of digital health technologies. Significant variation in recommending digital health technologies was present across countries
Tackle Height and Tackle Success—An Analysis of 52,204 Tackle Events
Get PDFTo compare the probability of tackle success (the tackler preventing the ball-carrier and ball from progressing towards the tackler try-line) when contacting the ball-carrier at different heights (shoulder, mid-torso and legs) for different types of tackles (active, passive, smother and arm) while accounting for other tackler situational factors within seven playing levels. Video footage of 271 male rugby union matches were analysed across seven playing groups (Under [U] 12, n = 25 matches; U14, n = 35; U16, n = 39; U18 Amateur n = 39; U18 Elite n = 38; Senior Amateur, n = 40 and Senior Elite, n = 50) across England, New Zealand, South Africa, Portugal and USA (a total of 51,106 tackles). A multi-level logistic regression model with tackle success as the outcome variable and first point of contact and type of tackle as the explanatory variables were computed. Included in the model as cofounders were the situational variables tackle direction, tackle sequence, number of players in the tackle and attacker intention. Post-estimation marginal effects were used to calculate the probabilities (expressed as a percentage %) of tackle success for each interaction between tackle type (active shoulder, smother, passive shoulder and arm) and the first point of contact (shoulder, mid-torso and legs). The probability of tackle success in relation to where the ball-carrier is contacted varied by tackle type and within each age group. The probabilities (Pr) for contacting the shoulder versus mid-torso at the senior levels (elite and amateur) did not differ in relation to tackle success (for instance, for active shoulder tackles within senior elite; shoulder Pr 86% 95% CI 82–89 and mid-torso Pr 82% 95% CI 77–86), whereas at the junior levels, contacting the shoulder had a higher probability than other points of contact. Active shoulder tackles had the highest probability of tackle success across the different playing levels across the different contact heights, whereas arm tackles had the lowest probability (for instance, for mid-torso tackles within senior elite, active Pr 82% 95% CI 77–86 vs. arm Pr 69% 95% CI 64–75). Coaches and practitioners can use this information to improve tackle training design and planning within the different age groups and facilitate player development.</p
A Cloud-Based Framework for the Quantification of the Uncertainty of a Machine Learning Produced Satellite-Derived Bathymetry
Get PDFThe estimation of accurate and precise Satellite-Derived Bathymetries (SDBs) is important in marine and coastal applications for a better understanding of the ecosystems and science-based decision-making. Despite the advancements in related Machine Learning (ML) studies, quantifying the anticipated bias per pixel in the SDBs remains a significant challenge. This study aims to address this knowledge gap by developing a spatially explicit uncertainty index of a ML-derived SDB, capable of providing a quantifiable anticipation for biases of 0.5, 1, and 2 m. In addition, we explore the usage of this index for model optimization via the exclusion of training points of high or moderate uncertainty via a six-fold iteration loop. The developed methodology is applied across the national coastal extent of Belize in Central America (~7017 km2) and utilizes remote sensing data from the European Space Agency’s twin satellite system Sentinel-2 and Planet’s NICFI PlanetScope. In total, 876 Sentinel-2 images, nine NICFI six-month basemaps and 28 monthly PlanetScope mosaics are processed in this study. The training dataset is based on NASA’s system Ice, Cloud and Elevation Satellite (ICESat-2), while the validation data are in situ measurements collected with scientific equipment (e.g., multibeam sonar) and were provided by the National Oceanography Centre, UK. According to our results, the presented approach is able to provide a pixel-based (i.e., spatially explicit) uncertainty index for a specific prediction bias and integrate it to refine the SDB. It should be noted that the efficiency of the optimization of the SDBs as well as the correlations of the proposed uncertainty index with the absolute prediction error and the true depth are low. Nevertheless, spatially explicit uncertainty information produced by a ML-related SDB provides substantial insight to advance coastal ecosystem monitoring thanks to its capability to showcase the difficulty of the model to provide a prediction. Such spatially explicit uncertainty products can also aid the communication of coastal aquatic products with decision makers and provide potential improvements in SDB modeling
The Use of Virtual Patients to Provide Feedback on Clinical Reasoning:A Systematic Review
Get PDFPurpose Virtual patients (VPs) are increasingly used in health care professions education to support clinical reasoning (CR) development. However, the extent to which feedback is given across CR components is unknown, and guidance is lacking on how VPs can optimize CR development. This systematic review sought to identify how VPs provide feedback on CR. Method Seven databases (MEDLINE, EMBASE, CINAHL, ERIC, PsycINFO, Scopus, and ProQuest Dissertations) were searched in March 2023 using terms (e.g., medical education, virtual patient, case-based learning, computer simulation) adapted from a previous systematic review. All studies that described VP use for developing CR in medical professionals and provided feedback on at least 1 CR component were retrieved. Screening, data extraction, and quality assessment were performed. Narrative synthesis was performed to describe the approaches used to measure and provide feedback on CR. Results A total of 6,526 results were identified from searches, of which 72 met criteria, but only 35 full-text articles were analyzed because the reporting of interventions in abstracts (n = 37) was insufficient. The most common CR components developed by VPs were leading diagnosis (23 [65.7%]), management or treatment plan (23 [65.7%]), and information gathering (21 [60%]). The CR components were explored by various approaches, from redefined questions to free text and concept maps. Conclusions Studies describing VP use for giving CR feedback have mainly focused on easy-to-assess CR components, whereas few studies have described VPs designed for assessing CR components, such as problem representation, hypothesis generation, and diagnostic justification. Despite feedback being essential for learning, few VPs provided information on the learner's use of self-regulated learning processes. Educators designing or selecting VPs for CR use must consider the needs of learner groups and how different CR components can be explored and should make the instructional design of VPs explicit in published work.</p
Effects of acute static stretching and dynamic warm-up protocols on shoulder function in young adult male athletes with shoulder impingement syndrome:A randomized controlled crossover trial
Get PDFBackground: Shoulder impingement syndrome (SIS) is common among overhead athletes. Static stretching (SS) and dynamic warm-up (DW) are widely used, but their acute effects on comprehensive shoulder function in athletes with SIS are not fully understood. This study compared the acute effects of SS, DW, and a combined protocol (SS+DW) on range of motion (ROM), stability, proprioception, and strength in male athletes with SIS and healthy controls. Methods: In this randomized controlled crossover trial, 25 male athletes with SIS and 25 healthy controls performed SS, DW, and SS+DW protocols in a randomized order. Outcomes included shoulder internal rotation (IR) and external rotation (ER) ROM, Y-Balance Test (YBT) performance, joint position sense (JPS) accuracy, and isokinetic strength, measured at baseline, immediately post-intervention, and an hour follow-up. Data were analyzed using mixed-design ANOVA. Results: All protocols significantly improved IR and ER ROM (p < 0.05), with SS producing the greatest gains for the SIS group (IR +4.4°, d = 1.25; ER +3.4°, d = 1.02). For the SIS group, DW resulted in the largest improvements in YBT performance (+7.4 cm, d = 1.09; p < 0.05) and markedly enhanced JPS accuracy (error reduction of –3.8°, d = 6.66; p < 0.05). In contrast, SS increased proprioceptive error in SIS athletes (+1.2°, d = 2.91; p < 0.05). Isokinetic strength analysis showed that SS significantly reduced eccentric IR strength at 60°/s (–2.5 Nm, d = 0.69; p < 0.05), whereas DW improved concentric ER strength at 60°/s (+0.6 Nm, d = 0.13; p < 0.05). Across all outcomes, the combined protocol produced effect sizes ranging from d = 0.08 to 3.06, representing small to large effects (p < 0.05). Conclusions: The findings indicate that while all warm-ups improve ROM and stability, DW offers the most comprehensive benefits for athletes with SIS by enhancing proprioception and strength without the performance inhibition associated with SS. DW is recommended for pre-activity routines when neuromuscular readiness is critical
Building Global Collaborative Research Networks in Paediatric Critical Care:a roadmap
Get PDFPaediatric critical care units are designed for children at a vulnerable stage of development, yet the evidence base for practice and policy in paediatric critical care remains scarce. In this Health Policy, we present a roadmap providing strategic guidance for international paediatric critical care trials. We convened a multidisciplinary group of 32 paediatric critical care experts from six continents representing paediatric critical care research networks and groups. The group identified key challenges to paediatric critical care research, including lower patient numbers than for adult critical care, heterogeneity related to cognitive development, comorbidities and illness or injury, consent challenges, disproportionately little research funding for paediatric critical care, and poor infrastructure in resource-limited settings. A seven-point roadmap was proposed: (1) formation of an international paediatric critical care research network; (2) development of a web-based toolkit library to support paediatric critical care trials; (3) establishment of a global paediatric critical care trial repository, including systematic prioritisation of topics and populations for interventional trials; (4) development of a harmonised trial minimum set of trial data elements and data dictionary; (5) building of infrastructure and capability to support platform trials; (6) funder advocacy; and (7) development of a collaborative implementation programme. Implementation of this roadmap will contribute to the successful design and conduct of trials that match the needs of globally diverse paediatric populations.</p
Rock coast geomodel: process-response dynamics, resilience and vulnerability
Get PDFGeology and geomorphology are linked starkly in coastal environments, exemplifying the importance of Fookes’ geomodel approach to understanding site dynamics. Cliffs, and the shore platforms that front them, are subject to both marine and subaerial processes. Throughout his work, Fookes emphasizes the role of climate as a weathering agent, influencing material properties and requiring consideration in engineering projects. Comparatively, more is known about the operation of rock weathering processes on shore platforms than on cliffs. Yet, with the changing climate, it is becoming apparent that winter salt and frost weathering, and summer salt and wetting–drying weathering, contribute to more frequent occurrences of coastal rockfalls. Increasing storm activity and rising sea-levels are enhancing marine and subaerial processes. Rock coasts are amongst the most rapidly eroding coastlines in Europe. New applications of technologies, including seismometers, LiDAR and InSAR, provide a fuller understanding of rock coast process–response geomodel behaviour and the resilience of rock coasts on engineering timescales. Communicating scientific understanding of rock coast dynamics to policy-makers, planners and the public remains a challenge. Assessments of the hazard, risk, resilience and vulnerability of rock coasts associated with climate change provide useful communication tools. Databases such as the British Geological Survey GeoCoast geohazard data product and EMODnet Geology (European Marine Observation and Data Network) coastal behaviour data products integrate and visualize available data and information to communicate situational awareness to a broad audience
Improving Mental Health and Well-Being Through the Paradym App: Quantitative Study of Real-World Data
Get PDFBackground:With growing evidence suggesting that levels of emotional well-being have been decreasing globally over the past few years, demand for easily accessible, convenient, and affordable well-being and mental health support has increased. Although mental health apps designed to tackle this demand by targeting diagnosed conditions have been shown to be beneficial, less research has focused on apps aiming to improve emotional well-being. There is also a dearth of research on well-being apps structured around users’ lived experiences and emotional patterns and a lack of integration of real-world evidence of app usage. Thus, the potential benefits of these apps need to be evaluated using robust real-world data.Objective:This study aimed to explore usage patterns and preliminary outcomes related to mental health and well-being among users of an app (Paradym; Paradym Ltd) designed to promote emotional well-being and positive mental health.Methods:This is a pre-post, single-arm evaluation of real-world data provided by users of the Paradym app. Data were provided as part of optional built-in self-assessments that users completed to test their levels of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), life satisfaction (Satisfaction With Life Scale), and overall well-being (World Health Organization-5 Well-Being Index) when they first started using the app and at regular intervals following initial usage. Usage patterns, including the number of assessments completed and the length of time between assessments, were recorded. Data were analyzed using within-subjects t tests, and Cohen d estimates were used to measure effect sizes.Results:A total of 3237 app users completed at least 1 self-assessment, and 787 users completed a follow-up assessment. The sample was diverse, with 2000 users (61.8%) being located outside of the United States. At baseline, many users reported experiencing strong feelings of burnout (677/1627, 41.6%), strong insecurities (73/211, 34.6%), and low levels of thriving (140/260, 53.8%). Users also experienced symptoms of depression (mean 9.85, SD 5.55) and anxiety (mean 14.27, SD 6.77) and reported low levels of life satisfaction (mean 12.14, SD 7.42) and general well-being (mean 9.88, SD 5.51). On average, users had been using the app for 74 days when they completed a follow-up assessment. Following app usage, small but significant improvements were reported across all outcomes of interest, with anxiety and depression scores improving by 1.20 and 1.26 points on average, respectively, and life satisfaction and well-being scores improving by 0.71 and 0.97 points, respectively.Conclusions:This real-world data analysis and evaluation provided positive preliminary evidence for the Paradym app’s effectiveness in improving mental health and well-being, supporting its use as a scalable intervention for emotional well-being, with potential applications across diverse populations and settings, and encourages the use of built-in assessments in mental health app research