Community-Based Inclusive Development: Integrating Survivors into a Broader Victim Assistance System

During the Vietnam War, an estimated 580,000 or more bombing missions were carried out over Laos, dropping two million tons of ordnance across the country.1 This contaminated Laos with approximately 80 million items of unexploded ordnance (UXO),2 including ‘big bombs,’ cluster munition and sub-munition bomblets, grenades, rockets, and other types of ammunition.3 There also remain an unknown number of landmines across the country which are further remnants of the war. Today, fifteen out of eighteen provinces and approximately 25 percent of villages are still affected.4 Between 1964 and 2017, 50,754 people were killed or injured as a result of UXO and landmine accidents.5 While some landmines and UXO have been cleared, the task of demining the entire country will take considerable time and, though decreasing in number, injuries and deaths continue to occur. In response to these challenges, Laos ratified the Convention on Cluster Munitions (CCM) in March 2009, and the United Nation’s Convention on the Rights of Persons with Disabilities (CRPD) in September 2009.6 Additionally, in 2012 Laos launched a National Strategic Plan for the UXO Sector and has committed to reducing the risk of UXO by 2030 through national Sustainable Development Goal (SDG) 18: Lives Safe from UXO. SDG 18 not only provides targets for clearance activities, but also addresses the ongoing needs of survivors and victims.

Image Analysis of the Fat Dispersion in a Comminuted Meat System

In a series of experiments on a comminuted meat system, image analyses were conducted to quantify changes in structure as affected by polyphosphate, fat level, and chopping time and temperature. Four batches of comminuted meat were investigated which contained neck beef, pig head meat, rino, ice, salt (2%), fat at a level of either 27 or 40%, and polyphosphate at a level of either 0 or 0. 5%. Structural changes in different stages of comminution coincided with a shift in size distribution, shape factor, density and area percentage of fat particles. The density of the protein matrix (matrix defined as all disintegrated tissues, without intact pieces of muscle fibres, connective tissue and fat cell clusters) was markedly affected by polyphosphate. Polyphosphate led to a fine dispersion of the fat, as reflected by the formation of a larger proportion of fat droplets smaller than 3.5 um2. Results indicate that in meat batters physical entrapment of larger fat particles as well as emulsification of smaller droplets occur simultaneously in the course of fat stabilization

Institution Origin and Medical School Rank Impact the Citation Frequency and Publication Rate in Orthopaedic Sports Medicine Journals

PURPOSE: To examine the trends between various categories of institutions with their respective published orthopaedic sports medicine content and to determine the publication output and citation rate from the 25 highest-ranked medical schools compared with lower-ranked institutions. METHODS: Publications between 2015 and 2019 from the American Journal of Sports Medicine, Journal of Bone and Joint Surgery, Journal of Shoulder and Elbow Surgery, Clinical Orthopaedics and Related Research, and Arthroscopy were categorized into university/university affiliated hospitals, non-university affiliated teaching hospitals, public/semi-government research institutes, nonprofit research institutes, private sector institutions, government institutions, and other institutions. Citation rates were collected from PubMed for the first and corresponding author. Similarly, corresponding authors were stratified by U.S. News and World Report 2021 medical school research rankings. RESULTS: Of the 12,152 publications identified, 5,044 publications met the inclusion criteria. Nonprofit research institutions garnered the greatest number of citations on average (6.44 based on first author, SD 8.83, n = 214; 6.62 based on corresponding author, SD 9.65, n = 208; P \u3c .001), while university/university-affiliated hospitals produced the majority of published articles (77.0% based on first author, 76.8% based on corresponding author), but had lower average citation rates (4.48 based on first author, SD 6.67, n = 3,886; 4.44 based on corresponding author, SD 6.55, n = 3,873; P \u3c .001). Furthermore, of 1953 medical school publications, the top 25 accounted for 53.1% of publications; however, there was no statistical difference between their citation rates and those of lower rankings (P = 0.47). CONCLUSIONS: Publications are cited at different rates, depending on their institution of origin. In addition, high-ranking medical schools produce a disproportionately greater output of publications than lower-ranking schools, but there is no statistically significant difference in citation rates on an individual publication basis. CLINICAL RELEVANCE: Knowing how an institution\u27s ranking influences publication and citation rates can help us understand bias in the scientific literature

Pain Is the Primary Factor Associated With Satisfaction With Symptoms for New Patients Presenting to the Orthopedic Clinic

PURPOSE: The purpose of the current study was to (1) determine the percentage of new orthopedic patients reporting their symptoms to be acceptable at presentation, as measured by the Patient Acceptable Symptom State (PASS) question, and (2) evaluate whether patient-reported outcome measures (PROMs), including Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) or Upper Extremity, Pain Interference (PI), and Depression (D), or sociodemographic factors are associated with acceptable symptoms at presentation. METHODS: Between February 7, 2020, and March 16, 2020, new orthopedic patients who completed PROMs were identified. Patient records were reviewed for those who also completed the PASS question, a yes/no question about whether a patient\u27s current symptom state is satisfactory. Bivariate analysis was conducted to compare patient characteristics, such as area deprivation index (ADI), between those reporting acceptable symptoms and those who did not. Multivariable logistic regression models were used to determine factors associated with acceptable symptoms at presentation. RESULTS: A total of 570 patients were included, with one-fourth (n = 143 [25%]) reporting acceptable symptoms at presentation. In multivariable regression analysis, only pain, as measured by the PROMIS PI, was associated with acceptable symptoms at presentation (non-upper extremity patient regression: PROMIS PI: odds ratio [OR], 0.84; 95% confidence interval [CI], 0.79-0.90, P \u3c .01; upper extremity patient regression: PROMIS PI: OR, 0.91; 95% CI, 0.85-0.98, P \u3c .01). In both multivariable regression analyses, insurance type (private, Medicare, Medicaid, other), visit subspecialty (sports, hand, joints, foot and ankle, spine, other), PROMIS PF, PROMIS D, and national ADI were not associated with acceptable symptoms at presentation (all P \u3e .05). CONCLUSIONS: One-fourth of new orthopedic patients reported their symptoms to be acceptable at presentation. Of those who considered their symptom state unsatisfactory, pain-not functional status, mental health, or sociodemographic factors-was the primary determinant. LEVEL OF EVIDENCE: Level III, diagnostic

Orthopaedic provider perceptions of virtual care : which providers prefer virtual care?

AIMS: The purpose of our study was to determine which groups of orthopaedic providers favour virtual care, and analyze overall orthopaedic provider perceptions of virtual care. We hypothesize that providers with less clinical experience will favour virtual care, and that orthopaedic providers overall will show increased preference for virtual care during the COVID-19 pandemic and decreased preference during non-pandemic circumstances. METHODS: An orthopaedic research consortium at an academic medical system developed a survey examining provider perspectives regarding orthopaedic virtual care. Survey items were scored on a 1 to 5 Likert scale (1 = strongly disagree , 5 = strongly agree ) and compared using nonparametric Mann-Whitney U test. RESULTS: Providers with less experience were more likely to recommend virtual care for follow-up visits (3.61 on the Likert scale (SD 0.95) vs 2.90 (SD 1.23); p = 0.006) and feel that virtual care was essential to patient wellbeing (3.98 (SD 0.95) vs 3.00 (SD 1.16); p \u3c 0.001) during the pandemic. Less experienced providers also viewed virtual visits as providing a similar level of care as in-person visits (2.41 (SD 1.02) vs 1.76 (SD 0.87); p = 0.006) and more time-efficient than in-person visits (3.07 (SD 1.19) vs 2.34 (SD 1.14); p = 0.012) in non-pandemic circumstances. During the pandemic, most providers viewed virtual care as effective in providing essential care (83.6%, n = 51) and wanted to schedule patients for virtual care follow-up (82.2%, n = 50); only 10.9% (n = 8) of providers preferred virtual visits in non-pandemic circumstances. CONCLUSION: Orthopaedic providers with less clinical experience seem to favourably view virtual care both during the pandemic and under non-pandemic circumstances. Providers in general appear to view virtual care positively during the pandemic but are less accommodating towards it in non-pandemic circumstances

The efficacy of antipsychotics in the treatment of physical aggressive behavior in patients with dementia in nursing homes

Patients with dementia often suffer from behavioral changes. A common behavioral change is acute physical aggressive behavior which is the most distressing change. This can lead to harm, which is especially problematic in nursing homes. Despite the serious safety concerns, antipsychotics are often prescribed to combat this problem. This article is aimed to review the evidence of the efficacy of utilizing antipsychotics in acutely treating physical aggressive behavior in patients with dementia in nursing homes. Therefore, a systematic literature search was performed. The results demonstrated that a meta-analysis confirmed statistically significant reduction in physical aggression when risperidone was compared to placebo. However, a randomized controlled trial showed no change in physical aggressive behavior between quetiapine and placebo. More research is needed to fully investigate the benefits of physical aggressive behavior and safety concerns of all the antipsychotics in patients with dementia in nursing homes

Upper-Extremity Injuries are the 2nd Most Common Workplace Injuries from 1992 to 2018

Musculoskeletal injuries occur frequently in the workplace, yet it is unclear whether upper-extremity, lower-extremity, or trunk injuries are the most prevalent. We hypothesize that: (1) trunk injuries are the most common in the overall workplace, and (2) upper-extremity injuries are more common in labor-based industries than non-labor industries. Workplace related injury data from 1992 to 2018 was collected from the Bureau of Labor Statistics “Workplace Injuries & Illnesses” database. Occurrence of trunk, upper-extremity, and lower-extremity injuries in major industries (agriculture, construction, manufacturing, and healthcare) were aggregated during this time period and compared. Overall workplace related injury occurrence in major industries from 1992 to 2018 for the following body regions were tabulated as follows: upper-extremity (4,471,340 cases), lower-extremity (3,296,547 cases), and trunk (5,889,940 cases) (p\u3c.05). Upper-extremity injury incidence was observed to be significantly higher than lower-extremity injury incidence in the manufacturing industry (p\u3c.001) and significantly lower than trunk injury incidence in the healthcare industry (p\u3c.001). However, differences between upper-extremity injury incidence and both lower-extremity and trunk injury incidence were not significant for the other industries. When comparing the occurrence of upper-extremity injuries across industries from 1992 to 2018, significant differences were determined between all industries except for healthcare (p\u3c.001). When identifying changes in injury occurrence in each respective industry across this time span, manufacturing was shown to have the largest decrease (x=-5,432, r=-.91) followed by construction (x=-966, r=-.87) and then agriculture (x=-270, r=-.79). Weak correlation was observed for healthcare (x=118, r=.15)

Accuracy and Utility of Sarcomere Length Assessment by Laser Diffraction

In two experiments the computation of sarcomere length from laser diffraction patterns was tested for accuracy against phase-contrast microscopy . Particular attention was paid to methodological factors such as sampling location and computation formulae. Correlation coefficients between the laser diffraction technique and the microscopical method were high (r= 0.96) in both experiments. However, when computed from a simplified formula, the sarcomere length values, determined by laser diffraction patterns tended to be approximately 0. 10 lJm lower. It is recommended to use the correct formula in computing the laser diffraction data and to investigate a limited number of fibres (3) in a sufficiently large number (5) of randomly distributed samples