Psychological treatments for the management of pain following musculoskeletal injury:a systematic review and meta-analysis

Musculoskeletal injury is a leading cause of pain and disability worldwide; 35-75% of people experience persistent pain for months and years after injury. Psychological treatments can reduce pain, functional impairment and psychological distress, but are not widely utilized following injury. This systematic review and meta-analysis (PROSPERO ID: CRD42021236807) aimed to synthesize the literature testing psychological treatments for pain following musculoskeletal injury. We searched EMBASE, MEDLINE, PubMed, PsycINFO, and CENTRAL from inception to May 2022. We extracted participant, treatment, and injury characteristics, and primary (e.g., pain intensity, functional impairment, depression, anxiety, PTSD symptoms) and secondary (treatment feasibility and acceptability) outcomes. 24 RCTs (N = 1,966) were included. Immediately post-treatment, people who received psychological treatments (versus any control) reported lower pain intensity (SMD = -0.25, 95% CI [-0.49, -0.02]), functional impairment (SMD = -0.32 [-0.55, -0.09]), and symptoms of depression (SMD = -0.46 [-0.64, -0.29]), anxiety (SMD = -0.34 [-0.65, -0.04]) and PTSD (SMD = -0.43 [-0.70, -0.15]); at 6-month follow-up, only depression symptoms were significantly lower. Included trials varied widely in treatment and injury characteristics. The certainty of evidence was low or very low for most effects, and heterogeneity moderate to substantial. Most studies had risk of bias domains judged to be high or unclear. Due to very low certainty of results, we are unsure whether psychological therapies reduce pain and functional impairment following musculoskeletal injury; they may result in improved depression immediately post-treatment and at follow-up. More research is needed to identify treatments that result in enduring effects

Psychological treatments for the management of pain following musculoskeletal injury:a systematic review and meta-analysis

Musculoskeletal injury is a leading cause of pain and disability worldwide; 35-75% of people experience persistent pain for months and years after injury. Psychological treatments can reduce pain, functional impairment and psychological distress, but are not widely utilized following injury. This systematic review and meta-analysis (PROSPERO ID: CRD42021236807) aimed to synthesize the literature testing psychological treatments for pain following musculoskeletal injury. We searched EMBASE, MEDLINE, PubMed, PsycINFO, and CENTRAL from inception to May 2022. We extracted participant, treatment, and injury characteristics, and primary (e.g., pain intensity, functional impairment, depression, anxiety, PTSD symptoms) and secondary (treatment feasibility and acceptability) outcomes. 24 RCTs (N = 1,966) were included. Immediately post-treatment, people who received psychological treatments (versus any control) reported lower pain intensity (SMD = -0.25, 95% CI [-0.49, -0.02]), functional impairment (SMD = -0.32 [-0.55, -0.09]), and symptoms of depression (SMD = -0.46 [-0.64, -0.29]), anxiety (SMD = -0.34 [-0.65, -0.04]) and PTSD (SMD = -0.43 [-0.70, -0.15]); at 6-month follow-up, only depression symptoms were significantly lower. Included trials varied widely in treatment and injury characteristics. The certainty of evidence was low or very low for most effects, and heterogeneity moderate to substantial. Most studies had risk of bias domains judged to be high or unclear. Due to very low certainty of results, we are unsure whether psychological therapies reduce pain and functional impairment following musculoskeletal injury; they may result in improved depression immediately post-treatment and at follow-up. More research is needed to identify treatments that result in enduring effects

An FPGA Kalman-MPPT implementation adapted in SST-based dual active bridge converters for DC microgrids systems

The design of digital hardware controllers for the integration of renewable energy sources in DC microgrids is a research topic of interest. In this paper, a Kalman filter-based maximum power point tracking algorithm is implemented in an FPGA and adapted in a dual active bridge (DAB) converter topology for DC microgrids. This approach uses the Hardware/Software (HW/SW) co-design paradigm in combination with a pipelined piecewise polynomial approximation design of the Kalman-maximum power point tracking (MPPT) algorithm instead of traditional lookup table (LUT)-based methods. Experimental results reveal a good integration of the Kalman-MPPT design with the DAB-based converter, particularly during irradiation and temperature variations due to changes in weather conditions, as well as a good balanced hardware design in complexity and area-time performance compared to other state-of-art FPGA designs

Simulation and experimental testbed for adaptive video streaming in ad hoc networks

[EN] This paper presents a performance evaluation of the scalable video streaming over mobile ad hoc networks. In particular, we focus on the rate-adaptive method for streaming scalable video (H.264/SVC). For effective adaptation a new cross-layer routing protocol is introduced. This protocol provides an efficient algorithm for available bandwidth estimation. With this information, the video source adjusts its bit rate during the video transmission according to the network state. We also propose a free simulation framework that supports evaluation studies for scalable video streaming. The simulation experiments performed in this study involve the transmission of SVC streams with Medium Grain Scalability (MGS) as well as temporal scalability over different network scenarios. The results reveal that the rate-adaptive strategy helps avoid or reduce the congestion in MANETs obtaining a better quality in the received videos. Additionally, an actual ad hoc network was implemented using embedded devices (Raspberry Pi) in order to assess the performance of the proposed adaptive transmission mechanism in a real environment. Additional experiments were carried out prior to the implementation with the aim of characterizing the wireless medium and packet loss profile. Finally, the proposed approach shows an important reduction in energy consumption, as the study revealed.This paper was performed with the support of the National Secretary of Higher Education, Science, Technology and Innovation (SENESCYT)–Ecuador Government (scholarship 195-2012) and the Multimedia Communications Group (COMM) belong to the Institute of Telecommunications and Multimedia Applications (iTEAM)-Universitat Politècnica de València.Gonzalez-Martinez, SR.; Castellanos Hernández, WE.; Guzmán Castillo, PF.; Arce Vila, P.; Guerri Cebollada, JC. (2016). Simulation and experimental testbed for adaptive video streaming in ad hoc networks. Ad Hoc Networks. 52:89-105. https://doi.org/10.1016/j.adhoc.2016.07.007S891055

Effect of Aspirin Versus Low-Molecular-Weight Heparin Thromboprophylaxis on Medication Satisfaction and Out-of-Pocket Costs: A Secondary Analysis of a Randomized Clinical Trial

BACKGROUND: Current guidelines recommend low-molecular-weight heparin for thromboprophylaxis after orthopaedic trauma. However, recent evidence suggests that aspirin is similar in efficacy and safety. To understand patients\u27 experiences with these medications, we compared patients\u27 satisfaction and out-of-pocket costs after thromboprophylaxis with aspirin versus low-molecular-weight heparin. METHODS: This study was a secondary analysis of the PREVENTion of CLots in Orthopaedic Trauma (PREVENT CLOT) trial, conducted at 21 trauma centers in the U.S. and Canada. We included adult patients with an operatively treated extremity fracture or a pelvic or acetabular fracture. Patients were randomly assigned to receive 30 mg of low-molecular-weight heparin (enoxaparin) twice daily or 81 mg of aspirin twice daily for thromboprophylaxis. The duration of the thromboprophylaxis, including post-discharge prescription, was based on hospital protocols. The study outcomes included patient satisfaction with and out-of-pocket costs for their thromboprophylactic medication measured on ordinal scales. RESULTS: The trial enrolled 12,211 patients (mean age and standard deviation [SD], 45 ± 18 years; 62% male), 9725 of whom completed the question regarding their satisfaction with the medication and 6723 of whom reported their out-of-pocket costs. The odds of greater satisfaction were 2.6 times higher for patients assigned to aspirin than those assigned to low-molecular-weight heparin (odds ratio [OR]: 2.59; 95% confidence interval [CI]: 2.39 to 2.80; p \u3c 0.001). Overall, the odds of incurring any out-of-pocket costs for thromboprophylaxis medication were 51% higher for patients assigned to aspirin compared with low-molecular-weight heparin (OR: 1.51; 95% CI: 1.37 to 1.66; p \u3c 0.001). However, patients assigned to aspirin had substantially lower odds of out-of-pocket costs of at least $25 (OR: 0.15; 95CONCLUSIONS: Use of aspirin substantially improved patients\u27 satisfaction with their medication after orthopaedic trauma. While aspirin use increased the odds of incurring any out-of-pocket costs, it protected against costs of ≥$25, potentially improving health equity for thromboprophylaxis. LEVEL OF EVIDENCE: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence

Demographic variation in incidence of adult glioma by subtype, United States, 1992-2007

<p>Abstract</p> <p>Background</p> <p>We hypothesized that race/ethnic group, sex, age, and/or calendar period variation in adult glioma incidence differs between the two broad subtypes of glioblastoma (GBM) and non-GBM. Primary GBM, which constitute 90-95% of GBM, differ from non-GBM with respect to a number of molecular characteristics, providing a molecular rationale for these two broad glioma subtypes.</p> <p>Methods</p> <p>We utilized data from the Surveillance, Epidemiology, and End Results Program for 1992-2007, ages 30-69 years. We compared 15,088 GBM cases with 9,252 non-GBM cases. We used Poisson regression to calculate adjusted rate ratios and 95% confidence intervals.</p> <p>Results</p> <p>The GBM incidence rate increased proportionally with the 4^thpower of age, whereas the non-GBM rate increased proportionally with the square root of age. For each subtype, compared to non-Hispanic Whites, the incidence rate among Blacks, Asians/Pacific Islanders, and American Indians/Alaskan Natives was substantially lower (one-fourth to one-half for GBM; about two-fifths for non-GBM). Secondary to this primary effect, race/ethnic group variation in incidence was significantly less for non-GBM than for GBM. For each subtype, the incidence rate was higher for males than for females, with the male/female rate ratio being significantly higher for GBM (1.6) than for non-GBM (1.4). We observed significant calendar period trends of increasing incidence for GBM and decreasing incidence for non-GBM. For the two subtypes combined, we observed a 3% decrease in incidence between 1992-1995 and 2004-2007.</p> <p>Conclusions</p> <p>The substantial difference in age effect between GBM and non-GBM suggests a fundamental difference in the genesis of primary GBM (the driver of GBM incidence) versus non-GBM. However, the commonalities between GBM and non-GBM with respect to race/ethnic group and sex variation, more notable than the somewhat subtle, albeit statistically significant, differences, suggest that within the context of a fundamental difference, some aspects of the complex process of gliomagenesis are shared by these subtypes as well. The increasing calendar period trend of GBM incidence coupled with the decreasing trend of non-GBM incidence may at least partly be due to a secular trend in diagnostic fashion, as opposed to real changes in incidence of these subtypes.</p

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

La gestión publica y la generación de valor publico de la universidad nacional de Tumbes durante el periodo 2013 al 2015

La investigación tiene como objetivo determinar la relación entre la gestión pública y la generación del valor público de la Universidad Nacional de Tumbes durante el periodo 2013 al 2015, la obtención de la data se realizó mediante la aplicación de un cuestionario, que ha sido elaborado y adaptado por Comisión Nacional de Evaluación y Acreditación Universitaria (CONEAU). La investigación tiene un enfoque cuantitativo y No experimental, de carácter descriptivo correlacional. En este sentido la investigación permite describir las variables de estudio: “Gestión pública” y “Valor público” en las Universidad Nacional de Tumbes durante el periodo del 2013 al 2015. El cuestionario fue aplicado a una muestra de 133 personas, entre directivos, docentes, personal administrativos, estudiantes y padres de familia; la elección de la muestra fue a través del muestreo aleatorio simple, la muestra de directivos, docentes, administrativos y estudiantes se determinó a través de la fórmula para calcular el tamaño de la muestra y se aplicó la fórmula de ajuste o corrección de la muestra; para los padres de familia se determinó por muestreo accidental; para el análisis de los resultados se trabajó con método estadístico del coeficiente correlacional de Pearson, que permitió medir el nivel de significancia de correlación entre las variables gestión pública y valor público. La investigación mostró que las dimensiones tienen relación significativa Buena, concluyendo si existe correlación en un 57,8% entre las variables gestión pública y generación de valor público de La Universidad Nacional de Tumbes durante el periodo 2013 al 2015.Tesi

La gestión publica y la generación de valor publico de la universidad nacional de Tumbes durante el periodo 2013 al 2015

TesisLa investigación tiene como objetivo determinar la relación entre la gestión pública y la generación del valor público de la Universidad Nacional de Tumbes durante el periodo 2013 al 2015, la obtención de la data se realizó mediante la aplicación de un cuestionario, que ha sido elaborado y adaptado por Comisión Nacional de Evaluación y Acreditación Universitaria (CONEAU). La investigación tiene un enfoque cuantitativo y No experimental, de carácter descriptivo correlacional. En este sentido la investigación permite describir las variables de estudio: “Gestión pública” y “Valor público” en las Universidad Nacional de Tumbes durante el periodo del 2013 al 2015. El cuestionario fue aplicado a una muestra de 133 personas, entre directivos, docentes, personal administrativos, estudiantes y padres de familia; la elección de la muestra fue a través del muestreo aleatorio simple, la muestra de directivos, docentes, administrativos y estudiantes se determinó a través de la fórmula para calcular el tamaño de la muestra y se aplicó la fórmula de ajuste o corrección de la muestra; para los padres de familia se determinó por muestreo accidental; para el análisis de los resultados se trabajó con método estadístico del coeficiente correlacional de Pearson, que permitió medir el nivel de significancia de correlación entre las variables gestión pública y valor público. La investigación mostró que las dimensiones tienen relación significativa Buena, concluyendo si existe correlación en un 57,8% entre las variables gestión pública y generación de valor público de La Universidad Nacional de Tumbes durante el periodo 2013 al 2015