Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Genomic epidemiology of SARS-CoV-2 in a UK university identifies dynamics of transmission

AbstractUnderstanding SARS-CoV-2 transmission in higher education settings is important to limit spread between students, and into at-risk populations. In this study, we sequenced 482 SARS-CoV-2 isolates from the University of Cambridge from 5 October to 6 December 2020. We perform a detailed phylogenetic comparison with 972 isolates from the surrounding community, complemented with epidemiological and contact tracing data, to determine transmission dynamics. We observe limited viral introductions into the university; the majority of student cases were linked to a single genetic cluster, likely following social gatherings at a venue outside the university. We identify considerable onward transmission associated with student accommodation and courses; this was effectively contained using local infection control measures and following a national lockdown. Transmission clusters were largely segregated within the university or the community. Our study highlights key determinants of SARS-CoV-2 transmission and effective interventions in a higher education setting that will inform public health policy during pandemics.</jats:p

Generalized multilevel structural equation modeling

multilevel structural equation models, generalized linear mixed models, latent variables, random effects, hierarchical models, item response theory, factor models, adaptive quadrature, empirical Bayes, GLLAMM,

Speech Sound Disorders in a Community Study of Preschool Children

To undertake a community (nonclinical) study to describe the speech of preschool children who had been identified by parents/teachers as having difficulties "talking and making speech sounds" and compare the speech characteristics of those who had and had not accessed the services of a speech-language pathologist (SLP). Stage 1 : Parent/teacher concern regarding the speech skills of 1,097 4- to 5-year-old children attending early childhood centers was documented. Stage 2a: One hundred forty-three children who had been identified with concerns were assessed. Stage 2b: Parents returned questionnaires about service access for 109 children. The majority of the 143 children (86.7%) achieved a standard score below the normal range for the percentage of consonants correct (PCC) on the Diagnostic Evaluation of Articulation and Phonology (Dodd, Hua, Crosbie, Holm, & Ozanne, 2002). Consonants produced incorrectly were consistent with the late-8 phonemes (Shriberg, 1993). Common phonological patterns were fricative simplification (82.5%), cluster simplification (49.0%)/reduction (19.6%), gliding (41.3%), and palatal fronting (15.4%). Interdental lisps on /s/ and /z/ were produced by 39.9% of the children, dentalization of other sibilants by 17.5%, and lateral lisps by 13.3%. Despite parent/teacher concern, only 41/109 children had contact with an SLP. These children were more likely to be unintelligible to strangers, to express distress about their speech, and to have a lower PCC and a smaller consonant inventory compared to the children who had no contact with an SLP. A significant number of preschool-age children with speech sound disorders (SSD) have not had contact with an SLP. These children have mild-severe SSD and would benefit from SLP intervention. Integrated SLP services within early childhood communities would enable earlier identification of SSD and access to intervention to reduce potential educational and social impacts affiliated with SSD