The Biomechanics Research and Innovation Challenge: Development, Implementation, Uptake, and Reflections on the Inaugural Program.

Biomechanics as a discipline is ideally placed to increase awareness and participation of girls and women in science, technology, engineering, and mathematics. A nationwide Biomechanics and Research Innovation Challenge (BRInC) centered on mentoring and role modeling was developed to engage high school girls (mentees) and early-mid-career women (mentors) in the field of biomechanics through the completion of a 100-day research and/or innovation project. This manuscript describes the development, implementation, and uptake of the inaugural BRInC program and synthesizes the research and innovation projects undertaken, providing a framework for adoption of this program within the global biomechanics community. Eighty-seven high school girls in years 9 and 10 (age range: 14-16 y) were mentored in teams (n = 17) by women in biomechanics (n = 24). Using a design thinking approach, teams generated solutions to biomechanics-based problem(s)/research question(s). Eight key reflections on program strengths, as well as areas for improvement and planned changes for future iterations of the BRInC program, are outlined. These key reflections highlight the innovation, impact, and scalability of the program; the importance of a program framework and effective communication tools; and implementation of strategies to sustain the program as well as the importance of diversity and building a sense of community.

Health Equity Beyond Data: Health Care Worker Perceptions of Race, Ethnicity, and Language Data Collection in Electronic Health Records.

BACKGROUND: Recent research and policy initiatives propose addressing the social determinants of health within clinical settings. One such strategy is the expansion of routine data collection on patient Race, Ethnicity, and Language (REAL) within electronic health records (EHRs). Although previous research has examined the general views of providers and patients on REAL data, few studies consider health care workers' perceptions of this data collection directly at the point of care, including how workers understand REAL data in relation to health equity. OBJECTIVE: This qualitative study examines a large integrated delivery system's implementation of REAL data collection, focusing on health care workers' understanding of REAL and its impact on data's integration within EHRs. RESULTS: Providers, staff, and administrators expressed apprehension over REAL data collection due to the following: (1) disagreement over data's significance, including the expected purpose of collecting REAL items; (2) perceived barriers to data retrieval, such as the lack of standardization across providers and national tensions over race and immigration; and (3) uncertainty regarding data's use (clinical decision making vs. system research) and dissemination (with whom the data may be shared; eg, public agencies, other providers, and insurers). CONCLUSION: Emerging racial disparities associated with COVID-19 highlight the high stakes of REAL data collection. However, numerous barriers to health equity remain. Health care workers need greater institutional support for REAL data and related EHR initiatives. Despite data collection's central importance to policy objectives of disparity reduction, data mandates alone may be insufficient for achieving health equity.

COVID-19 transport restrictions in Ireland: impact on air quality and respiratory hospital admissions.

AIM: Exposure to poor air quality is a well-established factor for exacerbation of respiratory system diseases (RSDs); whether air pollutants are a cause of the development of RSD, however, remains unclear. This study aimed to examine the relationship between COVID-19 transport restrictions and hospital admissions because of RSD in Dublin city and county for 2020. STUDY DESIGN: This was a retrospective population-based cohort. METHODS: Admission data were collected from the Health Service Executive Hospital In-patient Enquiry. Daily count of hospital admissions with Dublin city and county address with primary diagnosis of RSD was performed. The daily air nitrogen dioxide (NO2) data were obtained from the Environmental Protection Agency (EPA). RESULTS: During the period of transport restrictions, there was a reduction in the annual mean NO2 from 25 µg/m3 to 17 µg/m3 (P < 0.001), and decreases in hospital admissions for RSD were observed. Among the 9934 patient episodes included in this study, the mean age at admission was 61.5 years, 57.8% were female (n = 5744), and mean (standard deviation) length of stay was 7.5 (13.52) days. CONCLUSION: This study, using routinely gathered data, suggests that decreases in ambient NO2 as related to COVID-19 transport restrictions were significantly associated with lower asthma and chronic obstructive pulmonary disease admissions.

Impact of COVID-19 Lockdown Restrictions: Ambient NO2 and Asthma Hospital Admissions.

Aim The World Health Organization (WHO) declared the COVID-19 pandemic a global health emergency. Many countries of the world, including Ireland, closed their borders and imposed nationwide lockdown. During this period, all major anthropogenic transport activities, which contribute to atmospheric pollution, were restricted. The current study examines the impact of the transport restrictions on ambient nitrogen dioxide (NO2) concentrations and hospital admissions for asthma across Ireland. Methods This is a retrospective population-based cohort study. National ambient air quality monitoring network data were analysed to investigation variations in NO2 concentrations. Asthma hospital admissions data were collected from the HSE Hospital In-patient Enquiry (HIPE) for Cork, Dublin, and Meath. Results During the period of transport restrictions, there were reductions in the annual mean NO2 for Cork, Dublin and Meath (i.e. 12µg/m3 to 11µg/m3 (p = 1); 25µg/m3 to 17µg/m3 (p < 0.001); and 23µg/m3 to 21µg/m3 (p = 1)). Reductions in asthma hospital admissions were also observed. Among the 8,471 patient episodes included in this study, the mean [SD] age at admission was 47.2[22.9] years; 61% were female (n=5,134); mean [SD] length of stay was 4.9[10.9] days. Conclusion The findings of this study provide an opportunity to explore the impact of NO2 emissions for Cork, Dublin and Meath on asthma hospital admissions, in order to improve air quality modelling and policy development of management of asthma.

Reduced risk of suicidal behaviours associated with the treatment of hidradenitis suppurativa with tumour necrosis factor alpha antagonists: results from the US FDA Adverse Events Reporting System pharmacovigilance database.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, recurrent condition that presents as painful, suppurating lesions in the apocrine gland-bearing skin regions. HS has been associated with increased suicidal behaviours (SB), independent of any treatment. TNF-alpha antagonists are used to treat moderate-to-severe HS and have also been associated with SB, a factor that could confound the decision to use the TNF-α antagonists in the moderately to severely affected HS patients, who may already be experiencing increased SB risk. OBJECTIVES: To determine presence or absence of a safety signal for SB when HS is treated with TNF-α antagonists. METHODS: We calculated the reporting odds ratios (ROR) with 95% CI of SB associated with treatment for HS with TNF-α antagonists vs. the reference group of all other treatments for HS in the US Food and Drug Administration pharmacovigilance database from 1 January 2004 to 31 March 2019. A second analysis excluded isotretinoin (which has been used to treat HS and has also been associated with SB) from the reference group. RESULTS: There was a signal for decreased risk of SB with TNF-α antagonists (ROR = 0.1959, 95% CI 0.1247-0.3079; z = 7.071, P < 0.0001] vs. all other HS treatments; the ROR did not change significantly after isotretinoin was excluded from the reference group. CONCLUSIONS: Treatment of HS with TNF-α antagonists is associated with a decreased risk of SB.

Counting the Toll of Smoking-Attributable Hospitalisations.

Aim In Ireland, 20% of adults smoke. Many current and ex-smokers live with ill-health and disability as a result of smoking, and this study aimed to quantify the extent of smoking-related hospitalisations in Irish publicly-funded hospitals. Methods A population attributable fractions approach was used in this analysis utilising smoking prevalence data from the Healthy Ireland Survey and combining this with internationally-recognised relative-risks for current and past smoking, and hospitalisation data and hospital base costs data sourced from HIPE, for the years 2011-2016. Results In 2016, there were 21,486 day case admissions, 33,615 inpatient hospital admissions consuming 309,117 bed days, attributable to smoking and exposure to second-hand smoke, with an estimated cost of €172 million in publicly funded hospitals. This represents 2% of day case admissions, 5% of inpatient admissions, and 8% of inpatient bed days for that year. Conclusion Smoking continues to cause a considerable impact on hospital services in Ireland.

Air Quality and Its Association with Cardiovascular and Respiratory Hospital Admissions in Ireland.

Aim Cardiovascular (CVD) and respiratory (RSD) diseases are leading causes of morbidity and mortality in Ireland. Clear links have been demonstrated in the literature between poor air quality and these diseases. This study aimed to use routinely available data to examine the relationship between air quality index for health (AQIH) (Available URL: http://www.epa.ie/air/quality/index/) and hospital admissions due to CVD and RSD in Dublin City and County between 2014 and 2018. Methods Admission data were collected from the HSE Hospital In-Patient Enquiry (HIPE). Daily count of hospital admissions with Dublin city and county address with a primary diagnosis of CVS and RSD was performed. The daily AQIH were obtained from the EPA for Dublin. Results Overall, AQIH distribution was: Good: 96% (1,575/1,642); Fair: 3% (52/1,642); and Poor: 1% (11/1,642). There were significant rises in admissions with change in AQIH (i.e. from good to very poor) for asthma, chronic obstructive airways disease and heart failure. There were also varying significant changes in short-term admission rates (i.e. up to 72 hours) following change in AQIH. Conclusions This study, using routinely gathered data, suggests that in Dublin city, where the AQ is predominantly good, that change in ambient AQ appears to impact admissions with CVD and RSD.

Reasons for Summoning Ambulance Services in the Hilly Region of Nepal.

Background Nepal lacks a unified and countrywide emergency medical services system as other developing countries. However, the emergence of ambulance service initiatives in the past decade shows a promising future for pre-hospital care. Nepal Ambulance Service (Est. 2011) and Dhulikhel Emergency Medical Services (Est. 2013) are the existing emergency medical services initiatives in Nepal. Objective To describe the reason for summoning ambulance services and demographics of the patients who were transported by Dhulikhel Emergency Medical Services at Dhulikhel hospital, hilly region of Nepal. Method One thousand three hundred and ninety three patient records at Dhulikhel hospital transported by Dhulikhel Emergency Medical Services during the five-year period (2013 - 2018) were included in the study. Chief complaints and demographic data were collected and categorized into overarching systemic categories. Result Among 1393 patients, majority were female (60.4%) and the most common age group was 20-29 years. The most common reason for calling ambulances was gastrointestinal problem (22.6%). Similarly, respiratory (17%), obstetric and gynecological (15.2%), trauma (12.7%) and neurological (9.6%) problems were other common reasons. The number of respiratory problem was increased during the winter season. The overall percentage of patients arriving at hospital with trauma problems was increased steadily, but it was not statistically significant. Conclusion Gastrointestinal problem was the most common reason, followed by respiratory and obstetric and gynecological problems for summoning ambulances services in the hilly regions of Nepal. The incidence of respiratory problem significantly increased during the winter season.

Bra band size measurements derived from three-dimensional scans are not accurate in women with large, ptotic breasts.

This study investigated differences in standard measurements used to determine bra size, under-bust chest circumference (UBCC) and over-bust chest circumference (OBCC), measured from a three-dimensional scan (hand-held scanner) compared to the direct measurement in 111 women (age 21-56 years; right breast volume 57-1672 mL; bra size 10A-18G). Bland-Altman plots of UBCC measurements showed a large positive bias and wide limits of agreement (12 cm; -4.6 to 28 cm), which increased as band size increased but decreased when the breasts were digitally removed from the scan prior to the UBCC measurement. The difference in UBCC measurements determined from scans compared to direct measurement had a strong positive correlation with breast volume and breast ptotis. The OBCC measurements showed a small positive bias (2.4 cm; -3.4 to 8.4), consistent across the range of bra sizes. Bra band size measurements determined from three-dimensional scans can be inaccurate in women with large, ptotic breasts. Practitioner Summary: We investigated potential errors in anthropometric data derived from three-dimensional scans used for bra design and fit. Bra band size measurements taken from three-dimensional scans were over-estimated in women with large breasts, whereas bra cup size measurements were accurate to within one-cup size across the entire range of bra sizes.

Biomechanical analysis of different osteosyntheses and the combination with bone substitute in tibial head depression fractures.

BACKGROUND: Tibial head depression fractures demand a high level of fracture stabilization to prevent a secondary loss of reduction after surgery. Elderly individuals are at an increased risk of developing these fractures, and biomechanical investigations of the fractures are rare. Therefore, the aim of this study was to systematically analyze different types of osteosyntheses in combination with two commonly used bone substitutes. METHODS: Lateral tibial head depression fractures were created in synthetic bones. After reduction, the fractures were stabilized with eight different treatment options of osteosynthesis alone or in combination with a bone substitute. Two screws, 4 screws and a lateral buttress plate were investigated. As a bone substitute, two common clinically used calcium phosphate cements, Norian® Drillable and ChronOS™ Inject, were applied. Displacement of the articular fracture fragment (mm) during cyclic loading, stiffness (N/mm) and maximum load (N) in Load-to-Failure tests were measured. RESULTS: The three different osteosyntheses (Group 1: 2 screws, group 2: 4 screws, group 3: plate) alone revealed a significantly higher displacement compared to the control group (Group 7: ChronOS™ Inject only) (Group 1, 7 [p < 0.01]; group 2, 7 [p = 0.04]; group 3, 7 [p < 0.01]). However, the osteosyntheses in combination with bone substitute exhibited no differences in displacement compared to the control group. The buttress plate demonstrated a higher normalized maximum load than the 2 and 4 screw osteosynthesis. Comparing the two different bone substitutes to each other, ChronOS™ inject had a significantly higher stiffness and lower displacement than Norian® Drillable. CONCLUSIONS: The highest biomechanical stability under maximal loading was provided by a buttress plate osteosynthesis. A bone substitute, such as the biomechanically favorable ChronOS™ Inject, is essential to reduce the displacement under lower loading.

Effect of sports bra type and gait speed on breast discomfort, bra discomfort and perceived breast movement in Chinese women.

This study investigated the effect of sports bra type (encapsulation versus compression) and gait speed on perceptions of breast discomfort, bra discomfort and breast movement reported by Chinese women. Visual analogue scales were used to evaluate breast discomfort, bra component discomfort and perceived breast movement of 21 Chinese participants when they wore an encapsulation or a compression sports bra, while static and while exercising at three different gait speeds. Participants perceived less breast discomfort and breast movement when wearing a compression bra compared to an encapsulation bra at a high gait speed, suggesting that compression bras are likely to provide the most effective support for Chinese women. However, significantly higher bra discomfort was perceived in the compression bra compared to the encapsulation bra when static and at the lower gait speed, implying that ways to modify the design of sports bras, particularly the straps, should be investigated to provide adequate and comfortable breast support. PRACTITIONER SUMMARY: The compression sports bra provided more comfortable support than the encapsulation sports bra for these Chinese women when running on a treadmill. However, these women perceived higher bra discomfort when wearing the compression bra when stationary. Further research is needed to modify the design of sports bras, particularly the straps, to provide adequate and comfortable breast support.

Under-reporting of notifiable infectious disease hospitalizations: significant improvements in the Irish context.

Notification of infectious disease is essential for prompt public health action and epidemiological analysis. The aim of this study was to compare national hospitalization data to national notification data in order to assess if there was significant under-reporting of hospitalized notifiable infectious diseases in recent years in Ireland. All in-patient discharges from public hospitals in the Republic of Ireland from 2006 to 2011 with a principal diagnosis of a notifiable disease were compared with national notification data. It was found that only a potential 1·8% of extra notifications could have arisen due to these hospitalization events and would represent a tenfold reduction on a previous estimate of under-reporting in the Irish context. Viral meningitis, viral encephalitis, bacterial meningitis not otherwise specified and malaria were the most common diseases for which there were more hospitalizations than notifications reported. The results of this study support the conclusion that the reduction in under-reporting can mainly be accounted for by the introduction of laboratories as notifiers in conjunction with the roll out of the Computerized Infectious Disease Reporting system (CIDR). However, for the diseases highlighted, the notification data underestimates the true burden of disease and this has implications for understanding the epidemiology of these diseases.

Exercise bra discomfort is associated with insufficient exercise levels among Australian women treated for breast cancer.

PURPOSE: Although participating in exercise is beneficial for breast cancer survivors, not being able to find a comfortable exercise bra can be a barrier to exercise. It is likely that side effects specific to breast cancer treatment exacerbate exercise bra discomfort. This study aimed to determine the relationship between patient characteristics, physical side effects, exercise bra discomfort and exercise behaviours. METHODS: Four hundred thirty-two breast cancer survivors completed an online survey related to their treatment and demographic background, current exercise levels, reported exercise bra discomfort and breast cancer treatment side effects. Patient characteristics and exercise levels were considered in a binary logistic regression against reporting bra discomfort to ascertain significant relationships (p < 0.05) and predictive value (odds ratio). Pearson's chi-square statistics was used to determine significant relationships between reporting a side effect and exercise bra discomfort. RESULTS: Eight out of nine physical side effects were significantly related to reporting exercise bra discomfort. Reporting exercise bra discomfort was significantly related to not achieving a minimal recommended level of exercise. CONCLUSIONS: This is the first study in the scientific literature that systematically links the reporting of exercise bra discomfort to not achieving recommended levels of exercise. This effect of bra discomfort on exercise was found after controlling for age, surgery type and current treatment among a large cohort of women treated for breast cancer. Furthermore, results from this study suggest that physical side effects, as a result of surgery and treatment associated with breast cancer, are linked to experiencing bra discomfort during exercise.

IgG, IgM, and IgA antinuclear antibodies in discoid and systemic lupus erythematosus patients.

IgG antinuclear antibodies (ANAs) are elevated in patients with systemic lupus erythematosus (SLE) compared with patients with discoid lupus erythematosus (DLE). To provide an expanded immunologic view of circulating ANAs in lupus patients, we compared the expressions of IgG, IgM, and IgA ANAs in DLE and SLE patients. In this cross-sectional study, sera from age-, gender-, and ethnic-matched SLE (N = 35), DLE (N = 23), and normal patients (N = 22) were tested for IgG, IgM, and IgA ANAs using enzyme-linked immunosorbent assays (ELISAs) and indirect immunofluorescence (IIF) with monkey esophagus as substrate. ELISAs showed elevated levels of IgG ANA, IgM ANA, and IgG/IgM ANA ratios in SLE patients compared with DLE and normal patients. IgA ANA expression was higher in SLE and DLE patients versus normal patients. IIF studies showed higher percentages of patients positive for IgG, IgM, and IgA ANAs in the SLE group. Higher IgG/IgM ANA ratios in SLE than DLE show enhanced class-switching and a more sustained humoral response in SLE. They also suggest a potential connection of IgM ANAs with disease containment.

Evidence-based recommendations for building better bras for women treated for breast cancer.

Participating in exercise is beneficial for women who have been treated for breast cancer. However, not being able to find a comfortable exercise bra can be a barrier to exercise participation. This study aimed to systematically investigate what breast support women treated for breast cancer want when they exercise in order to provide evidence-based recommendations to improve exercise bra designs for these women. Based on 432 responses from a national online survey, frequency and relationship data were analysed (binary logistic regression) to understand exercise bra issues pertinent to this population. These issues included being able to control for asymmetrical cup sizes, managing heightened skin sensitivity, managing fluid (size) fluctuations, managing a prosthesis and restoring body image by restoring shape. This study provides evidence-based recommendations to inform an exercise bra design that will meet the unique needs of women treated for breast cancer. Rigorous, evidence-based evaluations of exercise bras for women treated for breast cancer may contribute to their well-being and quality of life through enhanced designs.

An analysis of the recording inpatients in Irish hospitals of tobacco use among.

Smoking is the largest avoidable cause of premature mortality in the world. Hospital admission is an opportunity to identify and help smokers quit. This study aimed to determine the level of recording of tobacco use (current and past) in Irish hospitals. Information on inpatient discharges with a tobacco use diagnosis was extracted from HIPE. In 2011, a quarter (n=84, 679) of discharges had a recording of tobacco use, which were more common among males (29% (n=50,161) male v. 20% (n=30,162) female), among medical patients (29% (n=54,375) medical v. 20% (n=30,162) other) and was highest among those aged 55-59 years (30.6%; n=7,885). SLAN 2007 reported that 48% of adults had smoked at some point in their lives. This study would suggest an under- reporting of tobacco use among hospital inpatients. Efforts should be made to record smoking status at hospital admission, and to improve the quality of the HIPE coding of tobacco use.

Self-reported side effects of breast cancer treatment: a cross-sectional study of incidence, associations, and the influence of exercise.

PURPOSE: Side effects as a result of breast cancer treatment may have a lasting detrimental impact on quality of life. Exercise has been shown to be an effective intervention in post-treatment care. This study aimed to gain a better understanding of breast cancer treatment-related side effects through identifying potential patient characteristic associations, including current levels of exercise. METHODS: Four hundred and thirty-two breast cancer patients completed an online survey covering their treatment and demographic background, current exercise levels, and self-reported treatment side effects. Side effects were considered in a binary logistic regression against age, surgery, currently undergoing treatment, and exercise levels to ascertain significant relationships (p < 0.05) and associative values (Odds Ratio). RESULTS: Lumpectomy patients were less likely to report aching muscles (OR 0.61, 95 % CI 0.39-0.96), hot flushes (OR 0.60, 95 % CI 0.38-0.96), and weight gain (OR 0.59, 95 % CI 0.38-0.92) than mastectomy patients. Women currently undergoing treatment were more likely to report hot flushes (OR 3.77, 95 % CI 2.34-6.08), aching muscles (OR 1.62, 95 % CI 1.02-2.57), and weight gain (OR 1.89, 95 % CI 1.19-2.99) than women finished treatment. Sedentary women were more likely to experience shoulder limitations (OR 1.77, 95 % CI 1.14-2.77), muscular chest wall pain (OR 1.69, 95 % CI 1.07-2.65), weight gain (OR 2.29, 95 % CI 1.44-3.64), lymphedema (OR 1.68, 95 % CI 1.04-2.71), and breathlessness (OR 2.30 95 % CI 1.35-3.92) than their physically active counterparts. CONCLUSIONS: Patient characteristics may inform interventions to improve care post-breast cancer treatment. Sufficient levels of exercise were consistently associated fewer side effects and should be encouraged.

Applying the OIE Terrestrial Animal Health Code to the welfare of animals exported from Australia.

Australia has implemented a through-chain regulatory framework to address animal welfare issues in the livestock export trade. The framework places the responsibility for ensuring that the welfare of exported animals meets internationally accepted standards on those who hold the licences issued for the export of Australian livestock. It applies to all livestock (cattle, buffalo, sheep, goats, camels) exported from Australia, either for immediate slaughter or for feeding and eventual slaughter. The development of the framework began when the Australian Standards for the Export of Livestock were implemented in December 2004, to safeguard animal welfare from the point when the animals are selected for export up until the moment when they are offloaded in the destination country. The framework has recently been extended to incorporate animal welfare requirements through to the point of slaughter in the destination country. The requirements draw on, and are consistent with, the animal welfare chapters of the World Organisation for Animal Health (OIE) Terrestrial Animal Health Code.

The global reach of social media in oral and maxillofacial surgery.

PURPOSE: Social media use among oral and maxillofacial surgeons (OMSs) has grown in recent years, serving as an important resource for the dissemination of medical/surgical knowledge, research, education, diplomacy, and advocacy. However, no studies have attempted to characterize the global reach of social media in OMS. METHODS: This study examined the profile activity, content performance, and demographic characteristics of followers from a single OMS-related Instagram account. Variables assessed include the total number of followers since the account's inception, profile views over the selected time period, and unique media content posts, as well as likes, comments, saves, impressions, and reach for all media content posts. The top 45 countries, cities, and languages based on each follower's geolocation and user settings were also included. RESULTS: There were 9569 followers of which 6208 (64.9%) were listed as public accounts. Of the 6208 followers with public accounts, 2496 (40.2%) were female. The countries with the most followers included the United States (31.7%), India (12.5%), Malaysia (5.3%), Mexico (4.0%), and Pakistan (3.6%). The cities with the most followers included New York, New York (8.9%), Boston, Massachusetts (5.2%), Cairo, Egypt (4.3%), Santiago, Chile (3.7%), and Karachi, Pakistan (3.5%). CONCLUSION: OMS-related social media is uniquely positioned to facilitate global collaboration and augment the dissemination of surgical knowledge and expertise. This information is critical in understanding the distribution and demographics of the OMS workforce, trainees, and affiliates around the world.