scholarly journals Identification and Assessment of Repeat Drug Overdose Visits at EDs in Virginia

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Inderbir Sohi ◽  
Erin E Austin ◽  
Jonathan Falk
Keyword(s):  
Medical Record ◽  
Drug Overdose ◽  
Syndromic Surveillance ◽  
Age Groups ◽  
Opioid Overdose ◽  
Medical Record Number ◽  
Significant Difference ◽  
Repeat Visit ◽  
Ed Visits ◽  
Repeat Visits

ObjectiveTo identify and assess the characteristics of individuals with repeated emergency department (ED) visits for unintentional opioid overdose, including heroin, and how they differ from individuals with a single overdose ED visit.IntroductionThe Virginia Department of Health (VDH) utilizes syndromic surveillance ED data to measure morbidity associated with opioid and heroin overdoses among Virginia residents. Understanding which individuals within a population use ED services for repeated drug overdose events may help guide the use of limited resources towards the most effective treatment and prevention efforts.MethodsVDH classified syndromic surveillance visits received from 98 EDs (82 hospitals and 16 emergency care centers) between January 2015 and July 2018. An unintentional opioid overdose, which included heroin, was classified based on the chief complaint and/or discharge diagnosis (ICD-9 and ICD-10) using Microsoft SQL Server Management Studio. ED visits were categorized as either a single or a repeat visit, where a repeat visit was defined as two or more separate ED visit records from the same individual. ED visit records were matched to individuals using medical record number. Each match represented a repeat visit for one person. RStudio was used to conduct Pearson’s chi-square tests for sex, race, and 10-year age groups among both visit groups and to assess visit frequency among the repeat visit group.ResultsBetween January 2015 and July 2018, 9,869 ED visits for opioid overdose were identified, of which 734 (7.4%) were repeat visits among 597 individuals occurring among 57 EDs. The proportion of individuals with repeated opioid overdose visits was significantly different compared to the proportion of individuals with a single opioid overdose visit by sex (male 66% vs. 61%) and age group (20-29 years 34% vs 30%) (p < 0.05). No significant difference was found by race. EDs had an average of 10 individuals who had repeated opioid overdose visits, with a range from 1 to 62 individuals. Individuals with repeated opioid overdose visits made on average 2.2 visits to EDs, with a range of 2 to 6 visits. The overdose visit rate among EDs ranged from 0.6 to 51.3 opioid overdoses per 100,000 ED visits, with four EDs having a rate greater than 40 opioid overdose visits per 100,000 ED visits.ConclusionsApproximately 7% of ED visits during the study period for opioid overdose were identified as repeat visits using the medical record number. Individuals with repeated opioid overdose visits differed from those with a single opioid overdose visit with respect to sex and age. Repeated opioid overdose visits were disproportionately higher for males and individuals aged 20-29. Hospital utilization by individuals with repeated opioid overdose visits can provide information on which EDs or communities that may require further attention. Some limitations of this study are that the method utilized to identify individuals may result in an underestimation of repeat visits because limited personally identifying information was used to match visit records, and repeat visits that occurred before and after the study period would not be captured. 

scholarly journals Using Syndromic Surveillance to Quantify ED Visits for Coagulopathy Cases

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Kelly Walblay ◽  
Megan Patel ◽  
Stacey Hoferka
Keyword(s):  
Data Quality ◽  
Medical Record ◽  
Syndromic Surveillance ◽  
Medical Record Number ◽  
Medical Evaluation ◽  
Prescription Refill ◽  
Ed Visits ◽  
The Mean ◽  
Repeat Visits

ObjectiveTo determine whether emergency department (ED) visits were captured in syndromic surveillance for coagulopathy cases associated with an outbreak linked to synthetic cannabinoid (SC) use and to quantify the number of ED visits and reasons for repeat visits.IntroductionIn March 2018, the Illinois Department of Public Health (IDPH) was informed of a cluster of coagulopathy cases linked to SC use. By June 30, 2018, 172 cases were reported, including five deaths, where 74% were male and the mean age was 35.3 years (range: 18–65 years). All cases presented to an emergency department (ED) at least once for this illness. Ninety-four cases provided clinical specimens and all tested positive for brodifacoum, a long-acting anticoagulant used in rodenticide. Cases were reported to the health department by the Illinois Poison Control Center and direct reporting from hospitals. REDCap was the primary database for tracking cases and collecting demographic information, risk factor data and healthcare facility utilization, including number of ED visits. Syndromic surveillance was utilized to monitor ED visits related to the cluster, assist with case finding and provide situational awareness of the burden on the EDs and geographic spread. In this study, we retrospectively used syndromic surveillance along with the data in REDCap to quantify the number of ED visits per coagulopathy case, understand the reasons for repeat visits, and determine whether visits were captured in syndromic surveillance.MethodsIllinois hospital ED data submitted to the National Syndromic Surveillance Platform instance of ESSENCE (ESSENCE), was compared to data present in our primary REDCap database. A subset of the cases, males 18-44 years of age (n=105; 61% of cases), were included in this analysis. Illinois ESSENCE data in males aged 18-44 years from March 10, 2018–June 30, 2018 were matched to cases in the REDCap database by age, zip code, initial visit date, facility, and reason for visit including: chief complaint, discharge diagnosis, and triage note. If the initial visit was found, the matching criteria and medical record number were used to search for additional related visits. The number of visits in ESSENCE and reasons for visits were totaled for each patient. Reasons for repeat visits were categorized into four categories: continued gross bleeding or symptoms associated with coagulopathy, medical evaluation or follow-up, laboratory work and prescription refill. Repeat visits may fall into more than one category. The number and dates of ED visits captured in ESSENCE per case were compared to that reported in REDCap. An epidemic curve was constructed to display the number of ED visits and type (i.e. primary visit or repeat visit) captured by REDCap only, ESSENCE only or both by visit date.ResultsOf the 105 cases in REDCap, 89 (85%) were matched to at least one ED visit in ESSENCE from March 10, 2018–June 30, 2018. The mean number of ESSENCE ED visits per case was 1.9 visits and the median was one visit (range: 1–11 visits). The main chief complaints for the primary visit included hematuria (n=31), abdominal pain (n=20), back pain/flank pain (n=13), K2 (n=11), bleeding from multiple sites (n=8), vomiting blood (n=7), and urinary tract infection or kidney stones (n=7). Of the 89 cases matched to a visit in ESSENCE, 84 (94%) cases, representing 142 (79%) of ED visits, were captured by syndrome definitions that were being utilized to monitor the cluster. Forty-three cases (48%) had at least two visits in ESSENCE. The reasons for return visits captured in ESSENCE (n=84) were continued gross bleeding or symptoms associated with coagulopathy (n=53), medical evaluation or follow-up (n=14), laboratory work (n=13), prescription refill (n=7) or unknown (n=2). Of the 105 cases, the number of ED visits reported in REDCap matched the number of visits found in ESSENCE for 49 cases (47%). For 24 cases (23%), ESSENCE identified more visits than REDCap and for 16 cases (15%), REDCap had more ED visits reported than captured in ESSENCE. Sixteen cases (15%) in REDCap were not found in ESSENCE. All of the unmatched visits were due to ESSENCE data quality, including a lack of reporting hospital admissions, lack of submitting data to ESSENCE, and missing data including: date of birth, medical record number, and triage notes.ConclusionsSyndromic surveillance was a useful tool in describing the burden of ED visits for patients in the Illinois coagulopathy outbreak linked to SC use. ESSENCE data helped to quantify the number of ED visits per patient and identify patients that re-presented for the same illness. The most common reason for repeat ED visits was continued symptoms, which may be attributed to misdiagnosis at the initial healthcare visit. ED visits that were not picked up by ESSENCE were a result of data quality issues from select facilities that were not reporting hospitalizations or key information such as date of birth, medical record number or triage notes. Engagement with healthcare facilities to provide this information will improve the data quality of syndromic surveillance. 

scholarly journals Enhanced Surveillance of Nonfatal Emergency Department Opioid Overdoses in California

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Natalie Demeter ◽  
Jaynia Angela Anderson ◽  
Mar-y-sol Pasquires ◽  
Stephen Wirtz
Keyword(s):  
Emergency Department ◽  
Drug Overdose ◽  
Health Planning ◽  
Age Groups ◽  
Emergency Department Visits ◽  
Public Health Issue ◽  
Opioid Overdose ◽  
Heroin Overdose ◽  
Drug Overdoses ◽  
Ed Visits

ObjectiveTo track and monitor nonfatal emergency department opioid overdoses in California for use in the statewide response in the opioid epidemic.IntroductionThe opioid epidemic is a multifaceted public health issue that requires a coordinated and dynamic response to address the ongoing changes in the trends of opioid overdoses. Access to timely and accurate data allows more targeted and effective programs and policies to prevent and reduce fatal and nonfatal drug overdoses in California. As a part of a Centers for Disease Control and Prevention Enhanced State Opioid Overdose Surveillance grant, the goals of this surveillance are to more rapidly identify changes in trends of nonfatal drug overdose, opioid overdose, and heroin overdose emergency department visits; identify demographic groups or areas within California that are experiencing these changes; and to provide these data and trends to state and local partners addressing the opioid crisis throughout California. Emergency department (ED) visit data are analyzed on an ongoing quarterly basis to monitor the proportion of all ED visits that are attributed to nonfatal drug, opioid, and heroin overdoses as a portion of the statewide opioid overdose surveillance.MethodsCalifornia emergency department data were obtained from the California Office of Statewide Health Planning and Development. Data were (and continue to be) analyzed by quarter as the data become available, starting in quarter 1 (Q1) 2016 through Q1 2018. Quarters were defined as standard calendar quarters; January-March (Q1), April-June (Q2), July-September (Q3), and October-December (Q4). Counts of nonfatal ED visits for all drug overdoses, all opioid overdoses, and heroin overdoses were defined by the following ICD-10 codes in the principle diagnosis or external cause of injury fields respectively; T36X-T50X (all drug), T40.0X-T40.4X T40.6 and T40.69 (all opioid), and T40.1X (heroin). Eligible ED visits were limited to CA residents, patients greater than 10 years of age, initial encounters, and were classified as unintentional overdoses or overdoses of undetermined intent. Overdose ED visits are described by quarter, drug, sex, and age for Q1 2016 – Q1 2018.ResultsOn average, 6,450 emergency department visits in California are attributed to drug overdose every quarter. Between Q1 2016 and Q1 2018, on average 1,785 (range: 1,559-2,011 ED visits) of those visits were due to opioid overdoses and a further 924 (52%) of those ED visits were due to heroin overdoses. About 26-30% of all drug overdose ED visits were for opioid overdoses in California during Q1 2016 – Q1 2018. Quarterly, that is around 6.00-7.64 opioid overdose ED visits for every 10,000 ED visits (Table 1), with about half those (3.09-4.30 ED visits) being heroin overdose ED visits. Males accounted for approximately 52% of all drug overdose ED visits, 65% of all opioid overdose ED visits, and 76% of all heroin overdose ED visits per quarter. Across all quarters, 25-34 year olds had the highest proportion of emergency department visits attributed to opioid and heroin overdose compared to all other age groups. However, 11-24 year olds had the highest proportion of emergency department visits attributed to all drug overdoses compared to all other age groups for all quarters except one. Between Q1 2016 and Q1 2018, the proportion of emergency department visits attributed to all drug overdoses increased by 1.8%, all opioid overdoses increased 3.1%, and heroin overdoses increased by 13.5%.ConclusionsOverall trends for the proportion of all emergency department visits for all drug overdoses and all opioid overdoses are relatively stable over this time period, however the proportion of heroin overdose ED visits shows a more substantial increase between Q1 2016 and Q1 2018. In addition, heroin overdose ED visits account for over half of all opioid overdose ED visits during this time in California. Ongoing surveillance of drug, opioid, and heroin overdose ED visits is a crucial component of assessing and responding to the opioid overdose crisis in California and helps to better understand the demographics of those who could be at risk of a future fatal opioid overdose. Timely data such as these (in addition to prescribing, hospitalization, and death data) can inform local and statewide efforts to reduce opioid overdoses and deaths. 

scholarly journals Monitoring Sexual Violence Trends in Emergency Department Visits Using Syndromic Data From the National Syndromic Surveillance Program—United States, January 2017–December 2019

2021 ◽  
Vol 111 (3) ◽  
pp. 485-493
Author(s):  
Ashley Schappell D'Inverno ◽  
Nimi Idaikkadar ◽  
Debra Houry
Keyword(s):  
United States ◽  
Emergency Department ◽  
Sexual Violence ◽  
Syndromic Surveillance ◽  
Age Groups ◽  
The United States ◽  
Emergency Department Visits ◽  
Surveillance Program ◽  
Time Period ◽  
Ed Visits

Objectives. To report trends in sexual violence (SV) emergency department (ED) visits in the United States. Methods. We analyzed monthly changes in SV rates (per 100 000 ED visits) from January 2017 to December 2019 using Centers for Disease Control and Prevention’s National Syndromic Surveillance Program data. We stratified the data by sex and age groups. Results. There were 196 948 SV-related ED visits from January 2017 to December 2019. Females had higher rates of SV-related ED visits than males. Across the entire time period, females aged 50 to 59 years showed the highest increase (57.33%) in SV-related ED visits, when stratified by sex and age group. In all strata examined, SV-related ED visits displayed positive trends from January 2017 to December 2019; 10 out of the 24 observed positive trends were statistically significant increases. We also observed seasonal trends with spikes in SV-related ED visits during warmer months and declines during colder months, particularly in ages 0 to 9 years and 10 to 19 years. Conclusions. We identified several significant increases in SV-related ED visits from January 2017 to December 2019. Syndromic surveillance offers near-real-time surveillance of ED visits and can aid in the prevention of SV.

scholarly journals EMS Heroin Overdoses with Refusal to Transport & Impacts on ED Overdose Surveillance

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Peter Rock ◽  
Michael Singleton
Keyword(s):  
Emergency Department ◽  
Emergency Medical Services ◽  
Syndromic Surveillance ◽  
Emergency Department Visits ◽  
Medical Services ◽  
Opioid Overdose ◽  
Billing Data ◽  
Heroin Overdose ◽  
Emergency Medical ◽  
Significant Difference

ObjectiveThe aim of this project was to explore changing patterns in patient refusal to transport by emergency medical services for classified heroin overdoses and possible implications on heroin overdose surveillance in Kentucky.IntroductionAs a Centers for Disease Control and Prevention Enhanced State Opioid Overdose Surveillance (ESOOS) funded state, Kentucky started utilizing Emergency Medical Services (EMS) data to increase timeliness of state data on drug overdose events in late 2016. Using developed definitions of heroin overdose for EMS emergency runs, Kentucky analyzed the patterns of refused/transported EMS runs for both statewide and local jurisdictions. Changes in EMS transportation patterns of heroin overdoses can have a dramatic impact on other surveillance systems, such as emergency department (ED) claims data or syndromic surveillance (SyS) data.MethodsAs part of the ESOOS grant, Kentucky receives all emergency-only EMS runs monthly from Kentucky Board for Emergency Medical Services, Kentucky State Ambulance Reporting System data. Heroin cases were classified based on text and medications (Narcan) administered, with comparisons to historic data discussed elsewhere (Rock & Singleton, 2018). Transportation classifications are based on EMS standard elements defining treatment with transportation vs refusal to transport to hospital and canceled runs were excluded. Initial analysis included trend analysis at state and local levels, as well as demographic comparisons of refusal vs transported heroin overdose encounters.ResultsStatewide trends in EMS heroin overdoses with refusal transport significantly increased from 5% (n=42) in 2016 quarter three to 22% (n=290) in 2018 quarter two (Fig 1). Initial demographic analysis does not show any significant difference between refusals/transported for age, gender, or race. However, there are significant differences among geographic regions in Kentucky with heroin encounter refusal proportion ranging from 3%-48% in 2018 quarter two. Specifically, one urban area (Fig 2) shows the change in proportion of refusal increasing from 15% (n=23) in 2016 quarter three to 47% (n=110) in 2018 quarter two. In this geographic area, combined refused/transported EMS heroin overdoses compared to traditional ED data demonstrates opposing heroin overdose patterns for the same local with EMS showing and increasing trend overtime and ED showing a decreasing trend (Fig 3).ConclusionsTraditional public health surveillance for heroin overdose has historically relied on ED billing data, though agencies are starting to use syndromic surveillance, too (Vivolo-Kantor et al., 2016). These systems share similar underlying ED data, albeit with different components, quality, and limitations. However, in terms of the overdose epidemic, both are limited to only heroin overdoses that result in ED hospital encounters. The recent drastic increase in refused transport can have significant impacts on heroin surveillance. Jurisdictions relying on SyS or ED data for monitoring overdose patterns and/or evaluating interventions may be significantly underestimating acute overdose occurrence in the population. This analysis highlights the importance of this preclinical data source in surveillance of the heroin epidemic.ReferencesRock, P. J., & Singleton, M. D. (2018). Assessing Definitions of Heroin Overdose in ED & EMS Data Using Hospital Billing Data, 10(1), 2579.Vivolo-Kantor, A. M., Seth, P., Gladden, ; R Matthew, Mattson, C. L., Baldwin, G. T., Kite-Powell, A., & Coletta, M. A. (2016). Morbidity and Mortality Weekly Report Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses — United States, 67(9), 279–285. Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6709e1-H.pdf

scholarly journals Tracking suspected heroin overdoses in CDC's National Syndromic Surveillance Program

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Alana M. Vivolo-Kantor ◽  
R. Matthew Gladden ◽  
Aaron Kite-Powell ◽  
Michael Coletta ◽  
Grant Baldwin
Keyword(s):  
Public Health ◽  
United States ◽  
Emergency Department ◽  
Drug Overdose ◽  
Syndromic Surveillance ◽  
Case Definition ◽  
Chief Complaint ◽  
Heroin Overdose ◽  
Ed Visits ◽  
Overdose Deaths

ObjectiveThis paper analyzes emergency department syndromic data in the Centers for Disease Control and Prevention’s (CDC) National Syndromic Surveillance Program’s (NSSP) BioSense Platform to understand trends in suspected heroin overdose.IntroductionOverdose deaths involving opioids (i.e., opioid pain relievers and illicit opioids such as heroin) accounted for at least 63% (N = 33,091) of overdose deaths in 2015. Overdose deaths related to illicit opioids, heroin and illicitly-manufactured fentanyl, have rapidly increased since 2010. For instance, heroin overdose deaths quadrupled from 3,036 in 2010 to 12,989 in 2015. Unfortunately, timely response to emerging trends is inhibited by time lags for national data on both overdose mortality via vital statistics (8-12 months) and morbidity via hospital discharge data (over 2 years). Emergency department (ED) syndromic data can be leveraged to respond more quickly to emerging drug overdose trends as well as identify drug overdose outbreaks. CDC’s NSSP BioSense Platform collects near real-time ED data on approximately two-thirds of ED visits in the US. NSSP’s data analysis and visualization tool, Electronic Surveillance System for the Notification of Community-based Epidemics (ESSENCE), allows for tailored syndrome queries and can monitor ED visits related to heroin overdose at the local, state, regional, and national levels quicker than hospital discharge data.MethodsWe analyzed ED syndromic data using ESSENCE to detect monthly and annual trends in suspected unintentional or undetermined heroin overdose by sex and region for those 11 years and older. An ED visit was categorized as a suspected heroin overdose if it met several criteria, including heroin overdose ICD-9-CM and ICD-10-CM codes (i.e., 965.01 and E850.0; T40.1X1A, T40.1X4A) and chief complaint text associated with a heroin overdose (e.g., “heroin overdose”). Using computer code developed specifically for ESSENCE based on our case definition, we queried data from 9 of the 10 HHS regions from July 2016-July 2017. One region was excluded due to large changes in data submitted during the time period. We conducted trend analyses using the proportion of suspected heroin overdoses by total ED visits for a given month with all sexes and regions combined and then stratified by sex and region. To determine significant linear changes in monthly and annual trends, we used the National Cancer Institute’s Joinpoint Regression Program.ResultsFrom July 2016-July 2017, over 72 million total ED visits were captured from all sites and jurisdictions submitting data to NSSP. After applying our case definition to these records, 53,786 visits were from a suspected heroin overdose, which accounted for approximately 7.5 heroin overdose visits per 10,000 total ED visits during that timeframe. The rate of suspected heroin overdose visits to total ED visits was highest in June 2017 (8.7 per 10,000) and lowest in August 2016 (6.6 per 10,000 visits). Males accounted for a larger rates of visits over all months (range = 10.7 to 14.2 per 10,000 visits) than females (range = 3.8 to 4.7 per 10,000 visits). Overall, compared to July 2016, suspected heroin overdose ED visits from July 2017 were significantly higher for all sexes and US regions combined (β = .010, p = .036). Significant increases were also demonstrated over time for males (β = .009, p = .044) and the Northeast (β = .012, p = .025). No other significant increases or decreases were detected by demographics or on a monthly basis.ConclusionsEmergency department visits related to heroin overdose increased significantly from July 2016 to July 2017, with significant increases in the Northeast and among males. Urgent public health action is needed reduce heroin overdoses including increasing the availability of naloxone (an antidote for opioid overdose), linking people at high risk for heroin overdose to medication-assisted treatment, and reducing misuse of opioids by implementing safer opioid prescribing practices. Despite these findings, there are several limitations of these data: not all states sharing data have full participation thus limiting the representativeness of the data; not all ED visits are shared with NSSP; and our case definition may under-identify (e.g., visits missing discharge diagnosis codes and lacking specificity in chief complaint text) or over-identify (e.g., reliance on hospital staff impression and not drug test results) heroin overdose visits. Nonetheless, ED syndromic surveillance data can provide timely insight into emerging regional and national heroin overdose trends.ReferencesWarner M, Chen LH, Makuc DM, Anderson RN, Minino AM. Drug poisoning deaths in the United States, 1980-2008. NCHS Data Brief 2011(81):1-8.Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep 2016;65(5051):1445-1452.Spencer MRA, F. Timeliness of Death Certificate Data for Mortality Surveillance and Provisional Estimates. National Center for Health Statistics 2017.Richards CL, Iademarco MF, Atkinson D, Pinner RW, Yoon P, Mac Kenzie WR, et al. Advances in Public Health Surveillance and Information Dissemination at the Centers for Disease Control and Prevention. Public Health Rep 2017;132(4):403-410.

Liver Elastography in Healthy Children Using Three Different Systems – How Many Measurements Are Necessary?

2020 ◽  
Author(s):  
Anders Batman Mjelle ◽  
Anesa Mulabecirovic ◽  
Roald Flesland Havre ◽  
Edda Jonina Olafsdottir ◽  
Odd Helge Gilja ◽  
...  
Keyword(s):  
Shear Wave ◽  
Transient Elastography ◽  
Intraclass Correlation ◽  
Age Groups ◽  
Liver Stiffness ◽  
Shear Wave Elastography ◽  
Healthy Children ◽  
Significant Difference ◽  
Pediatric Liver Disease ◽  
Liver Elastography

Abstract Purpose Liver elastography is increasingly being applied in screening for and follow-up of pediatric liver disease, and has been shown to correlate well with fibrosis staging through liver biopsy. Because time is of the essence when examining children, we wanted to evaluate if a reliable result can be achieved with fewer acquisitions. Materials and Methods 243 healthy children aged 4–17 years were examined after three hours of fasting. Participants were divided into four age groups: 4–7 years; 8–11 years; 12–14 years and 15–17 years. Both two-dimensional shear wave elastography (2D-SWE; GE Logiq E9) and point shear wave elastography (pSWE; Samsung RS80A with Prestige) were performed in all participants, while transient elastography (TE, Fibroscan) was performed in a subset of 87 children aged 8–17 years. Median liver stiffness measurement (LSM) values of 3, 4, 5, 6, 7, and 8 acquisitions were compared with the median value of 10 acquisitions (reference standard). Comparison was performed for all participants together as well as within every specific age group. We investigated both the intraclass correlation coefficient (ICC) with absolute agreement and all outliers more than 10 %, 20 % or ≥ 0.5 or 1.0 kPa from the median of 10 acquisitions. Results For all three systems there was no significant difference between three and ten acquisitions, with ICCs ≥ 0.97. All systems needed 4 acquisitions to achieve no LSM deviating ≥ 1.0 kPa of a median of ten. To achieve no LSM deviating ≥ 20 % of a median of ten acquisitions, pSWE and TE needed 4 acquisitions, while 2D-SWE required 6 acquisitions. Conclusion Our results contradict recommendations of 10 acquisitions for pSWE and TE and only 3 for 2D-SWE.

The influence of osteopathic correction on the rate of various rhythms of the body

2019 ◽  
pp. 64-71 ◽  
Author(s):  
A. E. Chernikova ◽  
Yu. P. Potekhina
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Age Groups ◽  
Biomechanical Properties ◽  
Dispersion Analysis ◽  
The Body ◽  
Body Tissues ◽  
Age Related ◽  
Significant Difference ◽  
Before And After

Introduction. An osteopathic examination determines the rate, the amplitude and the strength of the main rhythms (cardiac, respiratory and cranial). However, there are relatively few studies in the available literature dedicated to the influence of osteopathic correction (OC) on the characteristics of these rhythms.Goal of research — to study the influence of OC on the rate characteristics of various rhythms of the human body.Materials and methods. 88 adult osteopathic patients aged from 18 to 81 years were examined, among them 30 men and 58 women. All patients received general osteopathic examination. The rate of the cranial rhythm (RCR), respiratory rate (RR) heart rate (HR), the mobility of the nervous processes (MNP) and the connective tissue mobility (CTM) were assessed before and after the OC session.Results. Since age varied greatly in the examined group, a correlation analysis of age-related changes of the assessed rhythms was carried out. Only the CTM correlated with age (r=–0,28; p<0,05) in a statistically significant way. The rank dispersion analysis of Kruskal–Wallis also showed statistically significant difference in this indicator in different age groups (p=0,043). With the increase of years, the CTM decreases gradually. After the OC, the CTM, increased in a statistically significant way (p<0,0001). The RCR varied from 5 to 12 cycles/min in the examined group, which corresponded to the norm. After the OC, the RCR has increased in a statistically significant way (p<0,0001), the MNP has also increased (p<0,0001). The initial heart rate in the subjects varied from 56 to 94 beats/min, and in 15 % it exceeded the norm. After the OC the heart rate corresponded to the norm in all patients. The heart rate and the respiratory rate significantly decreased after the OC (р<0,0001).Conclusion. The described biorhythm changes after the OC session may be indicative of the improvement of the nervous regulation, of the normalization of the autonomic balance, of the improvement of the biomechanical properties of body tissues and of the increase of their mobility. The assessed parameters can be measured quickly without any additional equipment and can be used in order to study the results of the OC.

The Influence of Age and Gender on Mandibular Indices among the Libyan Population

2019 ◽  
Vol 3 (2) ◽  
Keyword(s):  
Negative Correlation ◽  
Bone Mineralization ◽  
Age Groups ◽  
T Test ◽  
Chi Square ◽  
Age And Gender ◽  
Significant Difference ◽  
Chi Square Test ◽  
And Gender ◽  
Libyan Population

Radiographic Mandibular Indices serve as easy and relatively cheap tools for evaluating bone mineralization. Objectives: To examine the effect of age and gender on three mandibular indices: the panoramic mandibular index (PMI), the mandibular ratio (MR) and the mandibular cortical index (MCI), among Libyan population. Methods: The three indices were measured on 317 digital (OPGs) of adult humans (155 males, 162 females). The sample was divided into six age groups (from 18-25 years through 56-65 years). The measurements were analyzed for interactions with age and sex, using SPSS (Statistical Package for Social Studies) software version no. 22. The tests employed were two way ANOVA, the unpaired T-test and chi-square test. Results: The mean PMI fluctuated between 0.37 s.d. 0.012 and 0.38 s.d. 0.012. among the sixth age groups. One-way ANOVA statistical test revealed no significant of age on PMI. On the other hand gender variation has effect on PMI, since independent sample t-test disclosed that the difference between the male and female PMI means statistically significant. ANOVA test showed that the means of MR among age groups showed a negative correlation i.e. MR mean declined from 3.01 in 18-25 age groups to 2.7 in 55-65 age groups. In contrary, the gender showed no effect on MR according two sample t-test at p> 0.05. In regards with MCI, statistical analysis showed that it affected by age that is C1 was decreasing by age while C2 and C3 were increased by age. Using chi square test the result indicated that there is a significant difference among the different age group and the two genders in MCI readings. Conclusion: PMI was influenced significantly by age but minimally by the gender. MR is not affected by gender but has a negative correlation with age. MCI is affected by both age and gender

Properties of Gliricidia Wood (Gliricidia sepium) lntercropped with Cocoa (Theobroma cocoa) in Malaysia

2014 ◽  
Vol 11 (1) ◽  
pp. 51
Author(s):  
Mohd Helmy Ibrahim ◽  
Mohd Nazip Suratman ◽  
Razali Abd Kader
Keyword(s):  
Cell Wall ◽  
Specific Gravity ◽  
Moisture Content ◽  
Wall Thickness ◽  
Age Groups ◽  
Gliricidia Sepium ◽  
Cell Wall Thickness ◽  
Tree Age ◽  
Lumen Diameter ◽  
Significant Difference

Trees planted from agroforestry practices can become valuable resources in meeting the wood requirements of many nations. Gliricidia sepium is an exotic species introduced to the agricultural sector in Malaysia mainly for providing shade for cocoa and coffee plantations. This study investigates its wood physical properties (specific gravity and moisture content) and fibre morphology (length, lumen diameter and cell wall thickness) of G. sepium at three intervals according to age groups ( three, five and seven years of ages). Specific gravity (0.72) was significantly higher at seven years ofage as compared to five (0.41) and three (0.35) years age group with a mean of 0.43 (p<0.05). Mean moisture content was 58.3% with no significant difference existing between the tree age groups. Fibre diameter (22.4 mm) was significantly lower (p<0.05) for the trees which were three years of age when compared to five and seven years age groups (26.6 mm and 24. 7 mm), respectively. Means of fibre length, lumen diameter and cell wall thickness were 0.83 mm, 18.3 mm, and 6.2 mm, respectively, with no significant differences detected between trees in all age groups. Further calculation on the coefficient of suppleness and runkel ratio suggest that wood from G.sepium may have the potential for insulation board manufacturing and paper making. However, future studies should experiment the utilisation of this species for these products to determine its full potential.

HIP FRACTURES IN 5 YEARS AT HUE UNIVERSITY HOSPITAL

2014 ◽  
pp. 47-50
Author(s):  
Duy Binh Ho ◽  
Nghi Thanh Nhan Le ◽  
Maasalu Katre ◽  
Koks Sulev ◽  
Märtson Aare
Keyword(s):  
Hip Fracture ◽  
Femoral Neck ◽  
Hip Fractures ◽  
Age Groups ◽  
Femoral Fractures ◽  
Femoral Neck Fractures ◽  
University Hospital ◽  
High Risk Population ◽  
Intertrochanteric Fractures ◽  
Significant Difference

Aim: This study aimed to review the clinical findings and surgical intervention of the hip fracture at the Hue University Hospital in Vietnam. Methods:The data of proximal femoral fractures was collected retrospectively. All patients, in a period of 5 years, from Jan 2008 to December 2012, suffered either from intertrochanteric or femoral neck fractures. The numbers of patients were gathered separately for each year, by age groups (under 40, 40-49, 50-59, 60-69, 70-79, older) and by sex. We analyzed what kind of treatment options were used for the hip fracture. Results:Of 224 patients (93 men and 131 women) studied, 71% patients are over 70 years old, 103 women and 56 men (p<0.05). For patients under 40 years, there were 1 woman and 11 men (p<0.05). There were 88 intertrochanteric and 136 femoral neck fractures. There was no significant difference in the two fractures between men and women. The numbers of hip fracture increased by each year, 29/224 cases in 2010, 63/224 cases in 2011, 76/224 cases in 2012. Treatment of 88 intertrochanteric fractures: 49 cases (55.7%) of dynamic hip screw (DHS), 14 cases of hemiarthroplasty (15.9%), 2 cases of total hip replacement (2.3%). Treatment of 136 femoral neck fractures: 48 cases of total replacement (35.3%), 43 cases of hemiarthroplasty (31.6%), 15 cases of screwing (11%). In cases of 40 patients (17.9%) hip fracture was managed conservatively, 23 were femoral neck fractures and 17 were intertrochanteric fractures. Conclusions: Hip fracture is growing challenge in Hue medical university hospital. The conservative approach is still high in people who could not be operable due to severe medical conditions as well as for patients with economic difficulties. Over 70% of the hip fractures in people 70+ are caused by osteoporosis. The number of hip fracture is increasing in the following years, most likely due to the increase in the prevalence of osteoporosis. Early detection and prevention of osteoporosis should be addressed, particularly in high risk population. More aggressive surgical approach should be implemented in order to improve the quality of life in patients with hip fractures. Key words:Hip fracture.

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