Preoperative PROMIS Depression Scores Can Predict Failure to Improve after Trapeziectomy and LRTI

INTRODUCTION: Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been utilized in setting realistic post-intervention expectations. Having a model to stratify likelihood of improvement based on pre-operative variables may allow for better decision making and patient counseling. We hypothesized that preoperative PROMIS scores correlate with patients’ subjective level of improvement after trapeziectomy and ligament reconstruction with tendon interposition (LRTI) METHODS: Retrospective chart review was performed to identify patients who underwent trapeziectomy and LRTI. Demographic data along with preoperative PROMIS Upper Extremity (UE), Pain Interference (PI), Depression (DP), and QuickDASH (QD) scores were collected. At their follow-up appointment, patients were asked a follow-up anchor question: “Since your treatment, how would you rate your overall function?”. Possible responses represent a 7-point Likert scale from “Much Worse” to “Much Improved”. Significance between preoperative scores and subjective improvement were modeled using univariable logistic regression. Correlation between preoperative scores and patient anchor question response was calculated using Receiver Operating Characteristic (ROC) Curves and reported as area under the curve (AUC) (values 0.6 - 0.69; moderate predictive ability, 0.7 - 0.79; strong, and \u3e 0.8; excellent). RESULTS: There were 69 patients included in this study. The mean age was 62 years and 78% of patients were female. The median follow-up time was 40 days (interquartile range 13-86 days). Forty-two patients (61%) reported “somewhat improved” or better and 27 patients (39%) reported “no change” or worse. Univariate logistic regression revealed that preoperative PROMIS Depression scores were significantly correlated with achieving subjective improvement (Table 1), with patients with higher pre-operative depression scores demonstrating a lower likelihood of reporting improvement. ROC curves an AUC of 0.76 for preoperative PROMIS Depression scores indicating a strong predictive ability (Table 2). Preoperative PROMIS UE, PI, and QD scores were not significantly correlated with subjective improvement. DISCUSSION: Patients with higher preoperative PROMIS Depression scores are significantly less likely to report improvement after trapeziectomy with LRTI; this had overall strong predictive ability. Development of a predictive model through utilization of preoperative PROMIS Depression scores will allow for providers to elucidate improved decision making and more realistic patient expectations after intervention which may improve patient satisfaction overall. Lack of significant correlation between PROMIS UE, PI, and QD scores and subjective improvement indicates a limitation of this study in utilizing these scores within the predictive model. SIGNIFICANCE/CLINICAL RELEVANCE: This study is significant because use of preoperative PROMIS Depression scores to predict patients’ likelihood to improve after trapziectomy and LRTI may improve patient selection and pre-operative counseling in the future. FIGURES: Table 1. Univariable Logistic Regression. Odds ratio are reported relative to achieving subjective improvement. Non-Improved [Mean (SD)] Improved [Mean (SD)] Odds Ratio (1-point increase) 95% Confidence Interval P-value Preop UE 31.5 (5.6) 32.1 (5.6) 1.03 0.94-1.12 P = 0.56 Preop PI 63 (7.9) 61.4 (5.1) 0.95 0.87-1.04 P = 0.30 Preop DP 52.6 (4.6) 45.8 (9.7) 0.88 0.77-1.00 P = 0.03 Preop QD 55.1 (18.4) 51.0 (17.0) 0.98 0.96-1.01 P= 0.37 Preop, Preoperative; UE, PROMIS Upper Extremity; PI, PROMIS Pain Interference; DP, PROMIS Depression; QD QuickDASH Table 2. ROC Curve illustrating diagnostic abilities of the preoperative PROMIS and QD scores to predict subjective patient outcome (AUC values of 0.6 to 0.69 - moderate predictive ability, 0.7 to 0.79 - strong, and \u3e 0.8 - excellent). Variable AUC UE 0.55 PI 0.65 DP 0.76 QD 0.60 AUC, Area Under the Curve; UE, Preoperative PROMIS UE Score; PI, Preoperative PROMIS PI Score; DP, Preoperative PROMIS Depression Score; QD, Preoperative QuickDASH Scor

Preoperative PROMIS Depression Scores Can Predict Failure to Improve After Trapeziectomy and LRTI

Introduction Patient-Reported Outcomes Measurement Information System (PROMIS) scores have been utilized in setting realistic post-intervention expectations. Predicting likelihood of improvement based on pre-operative variables may allow for better decision-making and patient counseling. We hypothesized that preoperative PROMIS scores correlate with patients’ subjective level of improvement after trapeziectomy and ligament reconstruction with tendon interposition (LRTI) Methods Retrospective chart review was performed to identify patients who underwent trapeziectomy and LRTI. Preoperative PROMIS Upper Extremity (UE), Pain Interference (PI), Depression (DP), and QuickDASH (QD) scores were collected. At follow-up appointments, patients were asked an anchor question: “Since your treatment, how would you rate your overall function?”. Responses represent a 7-point Likert scale from “Much Worse” to “Much Improved”. Univariable logistic regression modeled significance between preoperative scores and subjective improvement. Correlation between preoperative scores and anchor question responses was calculated using Receiver Operating Characteristic (ROC) Curves and reported as area under the curve (AUC). Results There were 69 patients included in this study. Forty-two patients (61%) reported “somewhat improved” or better and 27 patients (39%) reported “no change” or worse. Univariate logistic regression revealed that PROMIS Depression scores were significantly correlated with subjective improvement. Patients with higher PROMIS Depression scores demonstrated a lower likelihood of reporting improvement. AUC of 0.76 for PROMIS Depression scores indicated a strong predictive ability. Conclusion Patients with higher pre-operative PROMIS Depression scores are significantly less likely to report improvement after trapeziectomy with LRTI. This had a strong predictive ability and may improve future patient selection and pre-operative counseling

The Use of MotusBASEBALL For Pitch Monitoring and Injury Prevention

Introduction: MotusBASEBALL (MOTUS) has proven to be a reliable and accurate method for evaluating the multifactorial kinesiology involved with pitching. We sought to review the use of MOTUS in assessment of pitching parameters and identify its practicality as an injury prevention tool across the literature. Methods: A systemic review of the literature was preformed, using key words such as MOTUS, baseball, pitcher, sensor and arm sleeve, identifying 77 total articles. Inclusion criteria entailed original articles that used MOTUS and studied baseball pitchers across any level of sport. Results: A total of 13 articles met the inclusion criteria, producing a sample of 493 male athletes with a mean age of 18.7. Uniformly across studies, elbow torque was a primary metric and was observed in relation to a wide range of variables, such as pitch type, height, weight and arm length. Additionally, MOTUS was able to detect several other pitching metrics, such as arm speed, shoulder rotation and arm slot, displaying a wide range of capabilities. Conclusion: We suspect MOTUS technology could become a significant tool for observing pitching mechanics in real time, as well as an injury prevention tool to be used by players, coaches and trainers across all levels of baseball

A 2D Chaotic Oscillator for Analog IC

In this paper, we have proposed the design of an analog two-dimensional (2D) discrete-time chaotic oscillator. 2D chaotic systems are studied because of their more complex chaotic behavior compared to one-dimensional (1D) chaotic systems. The already published works on 2D chaotic systems are mainly focused either on the complex analytical combinations of familiar 1D chaotic maps such as Sine map, Logistic map, Tent map, and so on, or off-the-shelf component-based analog circuits. Due to complex hardware requirements, neither of them is feasible for hardware-efficient integrated circuit (IC) implementations. To the best of our knowledge, this proposed work is the first-ever report of an analog 2D discrete-time chaotic oscillator design that is suitable for hardware-constrained IC implementations. The chaotic performance of the proposed design is analyzed with bifurcation plots, the transient response, 2D Lyapunov exponent, and correlation coefficient measurements. It is demonstrated that the proposed design exhibits promising chaotic behavior with low hardware cost. The real-world application of the proposed 2D chaotic oscillator is presented in a random number generator (RNG) design. The applicability of the RNG in cryptography is verified by passing the generated random sequence through four standard statistical tests namely, NIST, FIPS, TestU01, and Diehard

Tendonitis and Tendon Rupture in Low-Profile Dorsal versus Volar Plating for Distal Radius Fractures: A Systematic Review and Meta-Analysis

INTRODUCTION: Dorsal plating of distal radius fractures has been associated with high rates of hardware removal, tendonitis, and tendon rupture. Much of this research was performed using 2.5mm thick distal radius plating, whereas modern dorsal plates are thinner (1.2mm-1.5mm). We examine whether modern plates have higher rates of complications than volar plates. METHODS: We search Ovid MEDLINE, Web of Science, and EMBASE for literature describing tendon complications associated with plating of distal radius fractures. Inclusion criteria included any comparison between volar and dorsal plating and report of tendon complication. Exclusion criteria included: failure to specify low-profile dorsal plates; lack of volar plating comparison arm; no reporting of tendon complications. All studies were assessed for quality using MINOR’s criteria. RESULTS: All 5 included studies were retrospective cohorts, totaling 806 subjects; 584 received volar plates and 222 received dorsal plates. Minimum average follow-up was 5 months. Of the volar plate group, 2% had symptoms consistent with tendonitis, 1% experienced a tendon rupture, and 4% underwent hardware removal. In the dorsal group, 6% had tendonitis, 1% had tendon ruptures, and 11% underwent hardware removal. Meta-analysis showed no significant difference in rates of tendonitis (4 studies, Z=0.79, P=0.43) or tendon rupture (5 studies, Z=0.59, P=0.56). DISCUSSION: To our knowledge, this review provides the largest comparison of modern dorsal and volar distal radius plates to date. Our results do not demonstrate increased risk of tendon complications in patients who underwent dorsal plating. This study sets a precedent for more routine use of dorsal plating

Investigating environmental watering options using Source IMS: a case study – the River Murray, Australia

The integrated modelling tool Source IMS developed by eWater and its partner organisations provides a common modelling platform to investigate the increasingly complex nature of water resources management in Australia. This paper describes how a recently built model of the River Murray using Source IMS has incorporated the management, delivery and accounting of water recovered for the environment to achieve required hydrological behavior. The River Murray model in Source IMS is fundamentally different from previous models of the River Murray in that it is run completely on a daily timestep, and has the capacity to run both as a planning model for policy development, and also as a daily operational tool used by River Operators to manage the competing demands for water in this complex system. In the last few decades, there has been significant reform of water resources management in the MDB to address declining environmental condition within the Basin, including an increased focus on delivering water to environmental sites along the river system to achieve specific environmental outcomes. This paper shows how the Source model has been developed to investigate various environmental watering options in river systems planning. One of the major projects to recover water for the environment is The Living Murray (TLM), a joint partnership between the States of the River Murray to recover an average annual volume of 500 GL, to be used to deliver environmental outcomes at nominated icon sites along the river (MDBA, 2011). Icon sites were chosen for the high environmental and ecological values. Specified ecological objectives at each site dictate water requirements: the timing, frequency and magnitude of environmental diversions to the site. Two of the TLM icon sites the Koondrook-Perricoota forest and Hattah Lakes have been presented in this paper. The ordering of water to the icon sites is accomplished through a Source Plugin; a dynamic-link library exposing purpose-built functionality to the Source River Murray project. This plugin triggers environmental watering events at the icon sites based on need and the volume of water available to the TLM. The Resources Assessment functionality in Source undertakes allocation of water to TLM held entitlements over the simulation period. Due to the entitlements being held in a number of different allocation systems, triggers have been developed in Source IMS that transfer the TLM’s available water from the State allocation systems to a TLM system to determine the total available water to the TLM. Individual use at each icon site is tracked across the model simulation, and the total use of TLM water is then accounted for in the State allocation systems based on an assumed priority of use. During a simulation, the model records watering events at each icon site, either by overbank flow or TLM intervention. Once the elapsed time since the last flood exceeds the optimal inter-flood period, the model identifies a watering need at the icon site. During subsequent months, the model attempts to operate the works opportunistically, without placing an order but using flow that is not necessary to meet downstream demands. If the site was able to operate opportunistically for the first month, then it places a demand for subsequent months to complete the intervention. This type of intervention is termed an opportunistic watering. If a site’s dry spell passes the resilience inter-flood period without starting opportunistically, then it registers a demand and initiates a forced watering. When watering needs exist at multiple sites, they are ranked according to need by a rostering algorithm. The paper demonstrates how Source IMS has been able to model the complexity surrounding environmental watering in the River Murray. Further confirmation of the model’s ability to represent the hydrological states of the TLM sites should make the model a useful tool when undertaking future work in environmental water planning and delivery on the River Murray

A Systematic Review of Online Sex Addiction and Clinical Treatments Using CONSORT Evaluation

Researchers have suggested that the advances of the Internet over the past two decades have gradually eliminated traditional offline methods of obtaining sexual material. Additionally, research on cybersex and/or online sex addictions has increased alongside the development of online technology. The present study extended the findings from Griffiths’ (2012) systematic empirical review of online sex addiction by additionally investigating empirical studies that implemented and/or documented clinical treatments for online sex addiction in adults. A total of nine studies were identified and then each underwent a CONSORT evaluation. The main findings of the present review provide some evidence to suggest that some treatments (both psychological and/or pharmacological) provide positive outcomes among those experiencing difficulties with online sex addiction. Similar to Griffiths’ original review, this study recommends that further research is warranted to establish the efficacy of empirically driven treatments for online sex addiction