Nonparametric item response models: a comparison on recovering true scores / Modelos de resposta ao item não-paramétricos: comparando a recuperação de escores verdadeiros / Modelos de respuesta al item no-paramétricos: comparando la recuperación de puntuaciones verdaderas

Nonparametric procedures are used to add flexibility to models. Three nonparametric item response models have been proposed, but not directly compared: the Kernel smoothing (KS-IRT); the Davidian-Curve (DC-IRT); and the Bayesian semiparametric Rasch model (SP-Rasch). The main aim of the present study is to compare the performance of these procedures in recovering simulated true scores, using sum scores as benchmarks. The secondary aim is to compare their performances in terms of practical equivalence with real data. Overall, the results show that, apart from the DC-IRT, which is the model that performs the worse, all the other models give results quite similar to those when sum scores are used. These results are followed by a discussion with practical implications and recommendations for future studies.(AU)

Procedimentos não paramétricos são usados para adicionar flexibilidade aos modelos. Três modelos não paramétricos de resposta ao item foram propostos, mas não comparados diretamente: o Kernel smoothing (KS-IRT); a Curva Davidiana (DC-IRT); e o modelo semiparamétrico Rasch Bayesiano (SP-Rasch). O objetivo principal do presente estudo é comparar o desempenho desses procedimentos na recuperação de escores verdadeiros simulados, utilizando escores de soma como benchmarks. O objetivo secundário é comparar seus desempenhos em termos de equivalência prática com dados reais. De forma geral, os resultados mostram que, além do DC-IRT, que é o modelo que apresenta o pior desempenho, todos os outros modelos apresentam resultados bastante semelhantes aos de quando se usam somatórios. Esses resultados são seguidos de uma discussão com implicações práticas e recomendações para estudos futuros.(AU)

Se utilizan procedimientos no paramétricos para agregar flexibilidad a los modelos. Se propusieron tres modelos de respuesta al ítem no paramétricos, pero no se compararon directamente: Kernel smoothing (KS-IRT); la curva davidiana (DC-IRT); y el modelo bayesiano de Rasch semiparamétrico (SP-Rasch). El objetivo principal del presente estudio es comparar el desempeño de estos procedimientos en la recuperación de puntajes verdaderos simulados, utilizando puntajes de suma como puntos de referencia. El objetivo secundario es comparar su desempeño en términos de equivalencia práctica con datos reales. En general, los resultados muestran que, a excepción de DC-IRT, que es el modelo con peor desempeño, todos los otros modelos presentan resultados bastante similares a los obtenidos cuando se utilizan sumatorios. Estos resultados son seguidos por una discusión con implicaciones prácticas y recomendaciones para estudios futuros.(AU)

Energy efficiency evaluation, changing trends and determinants of energy productivity growth across South Asian countries: SBM-DEA and Malmquist approach.

Energy efficiency is widely regarded as the most efficient means of supplying additional energy to meet the rising demand. However, extensive energy consumption causes greenhouse emissions, environmental destruction, and a decrease in energy efficiency (EE). This study investigates the role of energy efficiency and productivity growth in the ecological improvement of South Asia. Moreover, it evaluates the determinants (efficiency change or technology change) of energy productivity change across different SA (South Asian) countries. To estimate the energy efficiency and productivity change, we employed SBM-DEA and Malmquist Productivity Index methods with three inputs (capital stock, labor, and energy consumption), a single desirable output (gross domestic product) and a single undesirable output (CO2 emissions) on the well-extended dataset (2001-2019) for 6 South Asian countries. Furthermore, to check the impact of energy policy (2010) over the study period, the statistical significance of the change in mean scores for energy efficiency and productivity over two time periods (2001-2010 and 2011-2019) and six countries was examined using the Mann-Whitney U and Kruskal-Wallis tests. Results reveal that the average EE score of all 6 SA countries for the study period is 0.7278. This score shows that SA countries still have the potential of 27.22% to improve their energy efficiency to minimize the inputs to get the optimum output level with the least emissions. The primary determinant of energy productivity growth is technological change instead of efficiency. The average energy efficiency level is significantly different for two time periods, 2001-2010 and 2011-2019. Results conclude that energy efficiency and productivity in SA declined over the period, and potential causes are an inefficiency in the energy conversion process, extensive utilization of inputs, and less output growth.

Effect of Quality of Dental Health Services to Patient Satisfaction in Indonesia 2019: Importance-Performance Analysis

ABSTRACT Objective: To determine the effect of the quality of dental health services based on dimensions of empathy and responsiveness to patient satisfaction in urban and rural areas in Bone District, Indonesia. Material and Methods: This survey used an analytical observational method with a pilot pathfinder survey design. The total of participants included in this survey was 442, with 223 in the urban area and 219 in the rural area. This survey was held on 25 February - 1 March 2019. The Mann-Whitney test was applied, adopting a significance level of 5%. Results: Empathy and responsive dimensions in urban (3.58 ± 0.94 and 3.50 ± 0.94) and rural (3.43 ± 0.99 and 3.63 ± 0.86) areas were in the moderate category. The administration staff was able to complete administrative procedures, and the Dental assistant responded promptly to the patient's request and needs. Conclusion: The quality of empathy and responsiveness dimensions in dental treatment fall in the moderate category for urban and rural areas; this means that empathy and responsiveness dimensions in dental service in hospital/public health need to be improved.

Resiliência: avaliação de pacientes queimados em um hospital de urgência e emergência / Resilience: evaluation of burned patients in an urgency and emergency hospital / Resiliencia: evaluación de pacientes quemados en un hospital de urgencias y emergencias

A recuperação de vítimas de queimaduras é longa e dolorosa e afeta diversas esferas da vida do paciente. A resiliência, que se refere à capacidade humana de enfrentar e se adaptar a eventos adversos, exerce grande importância no processo de recuperação da queimadura. Logo, este trabalho objetiva avaliar a capacidade de resiliência de pacientes queimados, no momento da admissão e da alta hospitalar, em um hospital de emergência e urgência de Goiânia. Trata-se de um estudo descritivo, quantitativo e transversal que utiliza a Escala de Resiliência de Connor-Davidson (CD-RISC) como instrumento de mensuração. Na admissão hospitalar, a média da resiliência foi de 71,35, tendo sido observada uma relação significativa entre o fator Amparo da escala CD-RISC e a presença do(a) companheiro(a). O escore de resiliência encontrado nesta pesquisa é consistente com outros achados da literatura científica internacional e nacional referente à expressão da resiliência em vítimas de queimaduras e outros adoecimentos. A relação entre o fator Amparo e a presença de um(a) companheiro(a) enfatiza a importância da rede de apoio familiar na reabilitação do paciente queimado.(AU)

The recovery of burned patients is long and painful and impacts on different areas of people's lives. Resilience, which refers to the human capacity to face and adapt to adverse events, plays a major role in the process of recovery from burns. Therefore, the present study aims to assess the resilience of burned patients, on admission and hospital discharge, in an emergency and urgency hospital in Goiânia. This is a descriptive, quantitative and cross-sectional study that uses the Connor-Davidson Resilience Scale (CD RISC) as a measuring instrument. At hospital admission, the mean resilience was 71.35, with a significant association between the Support factor on the CD RISC scale and the presence of a partner. The resilience score found in the present study is consistent with other findings in the international and national scientific literature regarding the expression of resilience in victims of burns and other illnesses. The relationship between the Support factor and the presence of a partner emphasizes the importance of the family support network in the rehabilitation of the burned patient.(AU)

La recuperación de los pacientes quemados es larga y dolorosa e impacta en diferentes esferas de la vida de las personas. La resiliencia, que se refiere a la capacidad humana para enfrentar y adaptarse a eventos adversos, juega un papel importante en el proceso de recuperación de las quemaduras. Por tanto, el presente estudio tiene como objetivo evaluar la resiliencia de los pacientes quemados, en el momento del ingreso y el alta, en un hospital de emergencia y urgencia en Goiânia. Se trata de un estudio descriptivo, cuantitativo y transversal que utiliza la Escala de Resiliencia Connor-Davidson (CD RISC) como instrumento de medida. Al ingreso hospitalario, la resiliencia media fue de 71,35, con associación significativa entre el factor Amparo de la escala CD RISC y la presencia de pareja. El puntaje de resiliencia encontrado en el presente estudio es consistente con otros hallazgos en la literatura científica nacional e internacional sobre la expresión de resiliencia en víctimas de quemaduras y otras enfermedades. La relación entre el factor Amparo y la presencia de pareja enfatiza la importancia de la red de apoyo familiar en la rehabilitación del paciente quemado.(AU)

Specialized Dental Care in the Brazilian Unified National Health System (SUS)

ABSTRACT Objective: To analyze specialized dental care through access, demand and the work processes provided by the CEO's, using secondary data from the cycles of the PMAQ-CEO. Material and Methods: Cross-sectional study using public domain data. Variables of interest were selected from the external evaluation instrument data matrices and were grouped in categories. The categories were geographic distribution, structural, human resources, work processes and access and coordination. Results: The total of 932 CEO's were evaluated in 2014 and 1,042 in 2016, most of them type II, present in the Northeast region. In both cycles, the highest average of dentists worked in the endodontic specialty (2.4 professionals per CEO) and the lowest in oral medicine (0.8 professionals per CEO). Of the two cycles, 91.5% of the CEO's had a manager, 79.5% performed action planning activities and 74.5% realized internal self-assessment processes. There was an increase in the mean number of days to be seen at the CEO in all analyzed specialties (p<0.001) and 85.2% of the CEO's managers reported that there is a reference for oral cancer confirmed cases. Conclusion: Between the PMAQCEO cycles the number of CEO has increased, but there are still a big pent-up demand and the presence of care gaps. However, an expansion and improvement of the CEO's actions was evidenced, mainly related to the work processes.

Caregivers' Sense of Coherence and Untreated Dental Caries in Children and Adolescents: A Cross-Sectional Study

ABSTRACT Objective: To associate caregivers' sense of coherence (SOC) and untreated caries with oral health status in children covered by a dental public health system. Material and Methods: A convenience sample of caregivers/children in Angra dos Reis, Brazil, was surveyed. Caregivers' SOC was evaluated using the 13-question version questionnaire. For both caregivers/children, sociodemographic information was acquired and caries experience was evaluated by DMFT/dmft and PUFA/pufa index. Statistical associations between children's untreated carious teeth and interest variables from the caregivers were evaluated by binary logistic regression assessed by generalized linear modeling. Results: A total of 233 pairs of caregivers-children were included. Children's untreated permanent and primary carious teeth represented 34.8% and 62.2% of the caries experience, respectively and at least one PUFA/pufa scored tooth was detected in 22.7% of them. Caregivers' DMFT was 13.5±7.0, while 33.6% scored on PUFA. A total of 62.1% of them presented untreated carious lesions. Results from the univariate model, correlating children's untreated caries and caregivers' attributes showed a statistical significance for SOC values (p<0.015), untreated decayed teeth (p<0.035), self-perception of oral health (p<0.022) and oral impact on daily performance (p<0.010). The multivariate logistic first model kept the statistical significance only for the caregiver's untreated decayed teeth. Conclusion: Caregivers' SOC and untreated carious teeth could be used as indicators of dental treatment needs in their offspring.

Impact of Mobile Dental Clinics on the Quality of Life of Children

ABSTRACT Objective: To evaluate the impact of mobile dental clinics on the oral health-related quality of life (OHRQL) of children. Material and Methods: A longitudinal epidemiological study was conducted with participants from seven mobile dental clinics carried out between May 2019 and January 2020 by the NGO Missão Sorrisos. Parents and children who attended the program had their sociodemographic data collected. Both completed the Scale of Oral Health 5 (SOHO-5) self-reported questionnaire before treatment and again 30 days after treatment. Results: The improvement in the children's oral health after treatment at the mobile clinics is reflected in the pre-and post-treatment medians measured by the SOHO-5 total score from the children's own reports from the parents' reports. The procedures performed were effective in reducing pain and difficulties in eating, drinking, and sleeping. An improvement in the perception of the children's appearance and self-confidence was reported, both from the perspective of the parents/guardians and the children themselves. The chance of improvement in the perception of the children's oral health was greater for parents (OR=5.96; CI95%: 1.32-26.84) and children (OR=5.76; CI95%: 1.28-25.95) from families whose main caregiver was not professionally active at the time of the study. Conclusion: The mobile dental clinics had a positive impact on the OHRQL of children from the perspective of the participants of the study.

[The role of oropharyngoesophageal scintigraphy in the assessment of dysphagia in neurological patients.] / Ruolo dello studio scintigrafico del transito orofaringoesofageo nella valutazione della disfagia nei pazienti affetti da patologia neurologica.

PURPOSE: The aim of this study was to assess the role of oropharingoesophageal scintigraphy (OPES) in the management of neurological patients, investigating the clinical value of semiquantitative analysis. MATERIALS AND METHODS: We enrolled 39 neurological patients clinically evaluated and scored according to the Dysphagia Outcome Severity Scale (DOSS) scale who underwent fibrolaryngoscopic swallowing examination (FEES) and OPES using a 99mTc-nanocolloid-radioblabelled semiliquid bolus. We calculated the following semiquantitative parameters: Oral Transit Time (OTT), Pharyngeal Transit Time (PTT), Esophageal Transit Time (ETT), Retention Index (RI), and Esophageal Emptying Rate (EER10s). Differences in OPES semiquantitative parameters between patients classified according to the DOSS scale were performed using the nonparametric Mann-Whitney U test. Optimal semiquantitative parameters cut-off values that correlated with DOSS classification were investigated with ROC curves. The agreement between OPES, FEES and DOSS results was measured using Cohen's Kappa test (K). RESULTS: A significantly higher OTT (p=0.028), PTT (p=0.011) and ETT (p=0.030) and lower EER10s (p=0.016) values were identified. Moderate agreement resulted between OPES and DOSS results (k=0.429, 95%CI: 0.143-0.715, p=0.002). CONCLUSIONS: Our study revealed a significant correlation between clinical dysphagia graded using DOSS scale and semiquantitative parameters obtained by OPES evaluation. Despite reliable and reproducible OPES results, allowing an adequate study also of the esophageal phase, nowadays scintigraphic study remains an underestimated method to be considered in the diagnosis of dysphagia and related complications.

Avaliação dos padrões cardiovasculares e da concentração sérica de catecolaminas em pacientes submetidos à exodontias por via alveolar, sob anestesia local com epinefrina: um ensaio clínico controlado, cego e randomizado / Assessment of cardiovascular patterns and serum catecholamine concentration in patients undergoing alveolar extraction under local anesthesia with epinephrine: a controlled, blind and randomized clinical trial

Objetivos: Um ensaio clínico controlado, cego e randomizado foi desenvolvido para avaliar os efeitos cardiovasculares em pacientes saudáveis e com hipertensão submetidos à exodontia por via alveolar utilizando lidocaína com epinefrina 1:100.000. Materiais e métodos: Vinte pacientes foram divididos em grupos experimental (GE ­ pacientes hipertensos) e controle (GC ­ pacientes normotensos). As variáveis analisadas foram a frequência cardíaca (FC), saturação de oxigênio (SO2), pressão arterial sistólica e diastólica (PAsis e PAdias), concentração sérica de catecolaminas (dopamina, epinefrina e norepinefrina), extrassístoles ventriculares e supraventriculares (ESV e ESSV respectivamente) e depressão do segmento do ST. Os dados foram colhidos em três momentos distintos: inicial, transoperatório (trans) e final. Amostras de sangue foram coletadas para a mensuração das catecolaminas, e um aparelho de Holter foi utilizado para coleta de dados do eletrocardiograma incluindo um período de avaliação de 24 horas pós-operatório. Foram utilizados o teste de Mann-Whitney para identificar diferenças entre os grupos e o teste de Friedman com o pós-teste de Wilcoxon ajustado para a avaliação intragrupos das amostras repetidas. Resultados: O GE apresentou menor SO2 no momento inicial (p = 0,001) enquanto a PAsis apresentou diferença estatística para os três momentos de avaliação com o GE apresentando os maiores valores. As ESV foram maiores para o GE no período de avaliação pós-operatória de 24 horas (p = 0,041). As ESSV e as catecolaminas séricas foram similares nos dois grupos. A análise intragrupo revelou diferença significativa na avaliação da PAsis para o GE com o período trans operatório apresentando os maiores valores. Já avaliação das extrassístoles demonstrou que o período pós-operatório de 24 horas teve a maioria dos eventos sendo que apenas o GC não apresentou diferença significativa para a variável ESV durante esse período (p = 0,112). Não houve depressão do segmento ST para nenhum dos grupos, ou seja, a isquemia do miocárdio não foi observada durante o estudo. Conclusões: As exodontias por via alveolar, com o uso de ALVC com epinefrina podem ser realizadas de forma segura em pacientes hipertensos. A pressão arterial sistêmica deve ser monitorada durante todo o procedimento, sobretudo nos pacientes hipertensos, devido à tendência de aumento da pressão arterial nesses pacientes. Já o nível sérico de catecolaminas não sofre alteração nas condições estudadas assim como o uso de ALVC parecem não influenciar os padrões cardiovasculares nesse tipo de cirurgia (AU).

Objectives: A blind, randomized controlled clinical trial was developed to evaluate the cardiovascular effects of local anesthetics with vasoconstrictors (LAVC) containing epinephrine in healthy and hypertensive patients undergoing teeth extraction with lidocaine 2% with epinephrine 1:100.000. Materials and methods: 20 patients were divided into control (CG ­ normotensive patients) and experimental groups (EG ­ hypertensive patients). The variables analyzed were heart rate (HR), oxygen saturation (O2S), systolic and diastolic blood pressure (sysBP and diasBP), serum catecholamines concentration (dopamine, epinephrine, and norepinephrine), ventricular and supraventricular extrasystoles (VES and SVES respectively), and ST segment depression. Data was obtained in three different moments (initial, trans and final). Blood samples were taken to measure the catecholamines and a Holter device was used to measure data from the electrocardiogram including a 24-hour postoperative evaluation period. The Mann-Whitney test was used to identify differences between the two groups and the Friedman test with the adjusted Wilcoxon post-test were used for intragroup evaluation for repeated measures. Results: The EG presented a lower O2S in the initial period (p = 0,001) while the sysBP showed a statistical difference for the three evaluation periods with the EG presenting the highest values. The VES where higher for the EG during the 24-hour postoperative evaluation period (p = 0,041). The SVES and the serum catecholamines showed were similar between the groups. The intragroup analysis revealed significant statistical difference for the sysBP in the EG with the trans period presenting the highest measurements. The extrasystoles evaluation showed that the 24- hour postoperative period presented most events with only the CG not presenting statistical difference for the variable VES during this period (p = 0,112). No ST segment depression was noticed for both groups, ie, Myocardial ischemia was not observed. Conclusions: Teeth extraction with LAVC containing epinephrine can be safely executed in hypertensive patients. Blood pressure should be monitored during the entire procedure, especially in hypertensive patients due to a tendency to high blood pressure within these patients. Serum catecholamines concentration levels are not altered in the conditions seen in this study and the use of LAVC seem not to influence cardiovascular changes in this type of surgery (AU).

Patient Out-of-Pocket Cost Burden With Elective Orthopaedic Surgery.

INTRODUCTION: Out-of-pocket (OOP) costs for medical and surgical care can result in substantial financial burden for patients and families. Relatively little is known regarding OOP costs for commercially insured patients receiving orthopaedic surgery. The aim of this study is to analyze the trends in OOP costs for common, elective orthopaedic surgeries performed in the hospital inpatient setting. METHODS: This study used an employer-sponsored insurance claims database to analyze billing data of commercially insured patients who underwent elective orthopaedic surgery between 2014 and 2019. Patients who received single-level anterior cervical diskectomy and fusion (ACDF), single-level posterior lumbar fusion (PLF), total knee arthroplasty (TKA), and total hip arthroplasty (THA) were identified. OOP costs associated with the surgical episode were calculated as the sum of deductible payments, copayments, and coinsurance. Monetary data were adjusted to 2019 dollars. General linear regression, Wilcoxon-Mann-Whitney, and Kruskal-Wallis tests were used for analysis, as appropriate. RESULTS: In total, 10,225 ACDF, 28,841 PLF, 70,815 THA, and 108,940 TKA patients were analyzed. Most patients in our study sample had preferred provider organization insurance plans (ACDF 70.3%, PLF 66.9%, THA 66.2%, and TKA 67.0%). The mean OOP costs for patients, by procedure, were as follows: ACDF $3,180 (SD = 2,495), PLF $3,166 (SD = 2,529), THA $2,884 (SD = 2,100), and TKA $2,733 (SD = 1,994). Total OOP costs increased significantly from 2014 to 2019 for all procedures (P < 0.0001). Among the insurance plans examined, patients with high-deductible health plans had the highest episodic OOP costs. The ratio of patient contribution (OOP costs) to total insurer contribution (payments from insurers to providers) was 0.07 for ACDF, 0.04 for PLF, 0.07 for THA, and 0.07 for TKA. CONCLUSION: Among commercially insured patients who underwent elective spinal fusion and major lower extremity joint arthroplasty surgery, OOP costs increased from 2014 to 2019. The OOP costs for elective orthopaedic surgery represent a substantial and increasing financial burden for patients.

A head-to-head comparison of EQ-5D-5L and SF-6D in Dutch patients with fractures visiting a Fracture Liaison Service.

AIMS: This study compared the psychometric properties of EQ-5D-5L and SF-6D to assess the interchangeability of both instruments in patients with a recent fracture presenting at a Fracture Liaison Service (FLS). MATERIALS AND METHODS: Data from a prospective observational study in a Dutch FLS clinic were used. Over 3 years, subjects were interviewed at several time points using EQ-5D-5L and SF-36. Floor and ceiling effects were evaluated. Agreement was evaluated by intra-class correlation coefficients and visualized in Bland-Altman plots. Spearman's rank correlation coefficients were applied to assess convergent validity. Mann-Whitney U test or Kruskal-Wallis H test as well as effect size (ES) were used to explore known-groups validity. Responsiveness was explored using standardized response mean (SRM) and ES. For each measurement property, hypotheses on direction and magnitude of effects were formulated. RESULTS: A total of 499 patients were included. EQ-5D-5L had a considerable ceiling effect in comparison to SF-6D (21 vs. 1.2%). Moderate agreement between the (UK and Dutch) EQ-5D-5L and SF-6D was identified with intra-class correlation coefficients of 0.625 and 0.654, respectively. Bland-Altman plots revealed proportional bias as the differences in utilities between two instruments were highly dependent on the health states. High correlation between instruments was found (UK: rho = 0.758; Dutch: rho = 0.763). EQ-5D-5L and SF-6D utilities showed high correlation with physical component score but low correlation with mental component score of SF-36. Both instruments showed moderate discrimination (ES > 0.5) for subgroup by baseline fracture type, and moderate responsiveness (SRM > 0.5) in patients that sustained a subsequent fracture. CONCLUSION: Both EQ-5D-5L and SF-6D appeared to be valid utility instruments in patients with fractures attending the FLS. However, they cannot be used interchangeably given only moderate agreement was identified, and differences in utilities and ceiling effect were revealed. Comparable construct validity and responsiveness were indicated, and neither instrument was found to be clearly superior.

The EQ-5D and SF-36 as generic multi-domain questionnaires are widely used to measure the health-related quality-of-life (HRQoL) in a sample of the persons who suffer from the diseases or the general population. Their responses could be converted to patients or societal Health State Utility Values (HSUVs) with the range of 0 ("death") to 1 ("full health"). A specific application of HSUV is to calculate quality-adjusted life years as the indicator of effectiveness to evaluate whether the cost of a new intervention is justified in terms of health gains through cost-utility analysis in health economics, the evidence can be further used to inform decision-making. However, different instruments differ in construct and valuation, potentially leading to different estimates for the person's same "health state", and healthcare decisions could be compromised when researchers or decision-makers are not aware of potential differences in HSUV. Therefore, it is important to gain insight into the specific psychometric properties of these instruments, and to understand whether instruments are interchangeable. Our study is based on data from a Dutch Fracture Liaison Service (FLS is a program for secondary fracture prevention), compared the psychometric properties and interchangeability of two instruments (EQ-5D-5L and SF-6D) in patients with a recent fracture presenting at the FLS, and suggested both instruments are valid in utility elicitation in our target population. However, they cannot be used interchangeably given only moderate agreement and differences in utilities. Neither instrument was found to be clearly superior given comparable construct and longitudinal validity, but different instruments values in different aspects of HRQoL assessment.

Response to 1-Year Fixed-Regimen Bevacizumab Therapy in Treatment-Naïve DME Patients: Assessment by OCT Angiography.

PURPOSE: To evaluate the effectiveness of intravitreal bevacizumab treatment in patients with diabetic macular edema (DME) by assessing retinal changes using optical coherence tomography angiography (OCT-A). METHODS: This prospective study was performed in patients with treatment-naïve DME. The eyes of patients were imaged using a swept-source OCT system with a scan area of 6 × 6 mm. The DME patients with a central macular thickness (CMT) of ≥300 µm received nine bevacizumab injections within 12 months. The demographic, systemic, and ocular parameters, including the best-corrected visual acuity (BCVA), CMT, microaneurysm (MA) count, and foveal avascular zone (FAZ) area in both superficial capillary plexus (SCP) and deep capillary plexus (DCP), as well as vessel density in SCP, were assessed in the patients. In addition, the response (good or poor) of the DME eyes to bevacizumab treatment and the final visual acuity (BCVA of 75 letters) were analyzed. RESULTS: Seventy-seven eyes of DME patients were subjected to the final analysis. Bevacizumab treatment reduced CMT from 425.06 µm (±77.15) to 350.25 µm (±82.04) and improved BCVA by about 8.61 letters (from 64.73 to 73.34) in the patients. The mean number of MAs in SCP decreased from 3.51 ± 2.07 to 2.31 ± 1.15 (p < 0.001) and in DCP from 17.12 ± 11.56 to 12.21 ± 6.99 (p < 0.001), whereas the area of FAZ increased in SCP from 328.22 ± 131.38 to 399.70 ± 156.98 (p < 0.001) and in DCP from 571.13 ± 396.01 to 665.89 ± 412.77 (p = 0.001). The final BCVA letter score and CMT were statistically significant in both poor and good responders, as well as in BCVA < 75 and BCVA ≥ 75 groups. CONCLUSION: The fixed-regimen intravitreal bevacizumab therapy was effective in treating DME. Apart from noninvasive visualization of microvascular damage, OCT-A showed limited usefulness in predicting treatment response. Although the study showed that the number of MAs was significantly reduced during treatment, which is an OCT-A predictor of a good response to bevacizumab treatment at a 12-month visit, commonly observed artifacts may reduce the usefulness of OCT-A.

Avaliação da acurácia dos modelos dentários digitais obtidos para cirurgia ortognática / Assessment of the accuracy of digital dental models obtained for orthognathic surgery

O objetivo deste estudo laboratorial foi avaliar a acurácia dos modelos digitais obtidos por duas técnicas de escaneamento (escâner intraoral - Itero 5d Element® - e escâner de bancada -Straumann ®) de um modelo experimental (Nacional Ossos ®) da arcada superior confeccionada em poliuretano e do modelo de gesso obtido desta arcada. Os pontos A ­ 3mm acima do elemento 17; B ­ 3mm acima do elemento 14; C ­ 3mm acima do elemento 24; D ­ 3mm acima do elemento 27; E ­ cúspide mesiovestibular do elemento 16; F - ponto de contato mais incisal entre os elementos 11 e 21; G - Cúspide mesiovestibular do elemento 26 foram utilizados como referência para as medidas realizadas. As medidas foram realizadas em um software (Geomagic®) de simulação cirúrgica e analisadas quanto a validade e precisão das técnicas de escaneamento utilizadas em todos os grupos (1 a 5). O grupo 1 corresponde ao grupo padrão-ouro; o 2 ao grupo do escaneamento com escâner intraoral do modelo de poliuretano; o 3 ao escaneamento de bancada do modelo; o 4 ao escaneamento com escâner intraoral do modelo de gesso; e 5 ao escaneamento de bancada do modelo de gesso. Na análise da validação, todas as técnicas apresentaram-se válidas quando comparadas ao grupo controle com exceção da medida FG que apresentou diferenças estatisticamente significativas (p<0,05) entre os grupos 1 e 2. A precisão foi avaliada através do índice de correlação intraclasse (CCI) e todas as técnicas apresentaram-se altamente precisas com (CCI) próximo de 1. Desta forma, conclui-se que o escâner intraoral e o escâner de bancada utilizados neste estudo foram confiáveis quando comparados ao grupo controle e que os dois modelos de escâner utilizados se apresentaram com alta precisão (AU).

The objective of this experimental study was to evaluate the accuracy of digital models generated by two scanning techniques (intraoral scanner - Itero 5d Element® - and desktop scanner -Straumann ®) of an experimental model of the upper arch (Nacional Ossos ®) made of polyurethane and the plaster model obtained from this arch. Points A ­ 3mm above element 17; B ­ 3mm above element 14; C ­ 3mm above element 24; D ­ 3mm above element 27; E ­ mesiobuccal cusp of element 16; F - most incisal point of contact between elements 11 and 21; G - Mesiobuccal cusp of element 26 were used as a reference for the measurements performed. The measurements were performed in a surgical simulation software (Geomagic ®) and analyzed for the validity and precision of the scanning techniques used in all groups (1 to 5). Group 1 corresponds to the gold standard group; 2 to the scanning group with intraoral scanner of the polyurethane model; 3 to the desktop scan of the model; 4 to intraoral scanner scanning of the plaster model; and 5 to the desktop scan of the plaster model. In the validation analysis, all techniques showed to be valid compared to the control group, except the FG measure, which showed statistically significant differences (p<0.05) between groups 1 and 2. Precision was assessed using the intraclass correlation(ICC) index, and all techniques were highly accurate with an ICC close to 1. Thus, it is concluded that the intraoral scanner and the bench scanner used in this study were reliable compared to the control group and that the two scanner models used presented themselves with high precision (AU).

Assessment and associations between quality of life and risk of suicide / Avaliações e associações entre qualidade de vida e risco de suicídio / Evaluaciones y asociaciones entre calidad de vida y riesgo de suicidio

This study aimed to verify the extent to which the levels of quality of life are related to and influence suicide risk indices. A descriptive, correlational, quantitative research was performed. A non-probabilistic sample was used which was composed of 11,863 Brazilian participants all over 18 years old, who responded to the Risk Assessment Suicide Scale (RASS) and the World Health Organization Quality of Life BREF Instrument (WHOQOL-BREF), and whose data were analyzed by using descriptive statistics, the Spearman correlation and multiple linear regression using the Statistical Package for Social Sciences (SPSS). The results identify negative, moderate and significant correlations between the constructs, and that the domains of quality of life influence 47.8% of the variations in the suicide risk indices, confirming that the psychological domain is the most relevant within the explanatory model created. The conclusion is that there is a the need for public policies to improve the quality of life and prevent suicide (AU).

Este estudo objetivou verificar em que medida os níveis de qualidade de vida se relacionam e influenciam os índices de risco de suicídio. Realizou-se uma pesquisa descritiva, correlacional, de abordagem quantitativa. Contou-se com uma amostra não probabilística composta por 11.863 participantes - brasileiros e maiores de 18 anos, que responderam à Risk Assessment Suicide Scale (RASS) e ao Word Health Organization Quality of Life Instrument Bref(WHOQOL-bref), cujos dados foram analisados por meio de estatística descritiva, correlação de Spearman e regressão linear multivariada pormeio do Statistical Package for Social Science (SPSS). Os resultados identificam correlações negativas, moderadas e significativas entre os construtos; e que os domínios de qualidade de vida influenciam em 47,8% as variações nos índices de risco de suicídio, constatando que o domínio psicológico é o mais relevante dentro do modelo explicativo criado. Conclui-se a necessidade de políticas públicas para melhoria da qualidade de vida e prevenção de suicídio (AU).

Este estudio objetivó comprobar hasta qué medida los niveles de calidad de vida se relacionan e influyen en las tasas de riesgo de suicidio. Se realizó una investigación descriptiva, correlacional y cuantitativa. Hubo una muestra no probabilística compuesta por 11.863 participantes brasileños mayores de 18 años, que respondieron a la Risk Assessment Suicide Scale (RASS) y al Word Health Organization Quality of Life Instrument Bref(WHOQOL-bref), cuyos datos fueron analizados mediante estadística descriptiva, correlación de Spearman y regresión lineal multivariante en Statistical Package for Social Science (SPSS). Los resultados identifican correlaciones negativas, moderadas y significativas entre los constructos; y que los dominios de calidad de vida influyen en un 47,8% en las variaciones de los índices de riesgo de suicidio, encontrando que el dominio psicológico es el más relevante dentro del modelo explicativo creado. Estos hallazgos revelan la necesidad de políticas públicas para mejorar la calidad de vida y prevenir el suicidio (AU).

Prevalence and epidemiological profile of celiac disease in children with type 1 diabetes mellitus: Experience from a tertiary care center of India.

BACKGROUND: The HLA associations of celiac disease (CD) in north Indians differ from that in Europeans. Our dietary gluten is among the highest in the world. Data on CD in people with diabetes (PWD) in north India is scant. OBJECTIVE: To estimate the prevalence and clinical profile of CD in children with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: Retrospective review of case records of PWD with onset ≤18 years of age, registered between 2009 and 2020, having at least one anti tissue-transglutaminase (anti-tTG) serology report. RESULTS: Of 583 registered PWD, 398 (68.2%) had celiac serology screening. A positive report was obtained in 66 (16.6%). Of 51 biopsied people, 22 (5.5%) were diagnosed to have CD, 12 in the first 2 years of diabetes onset. Symptomatic CD at diagnosis was seen in 63% (14/22). Age at diabetes onset (median [IQR] age 5.5 years, [2-12]) was lower in PWD and CD compared to PWD alone (10 years, [7-14], p < 0.016). Of 36 biopsied children with anti-tTG >100 au/ml, 20 (55.5%) had CD, while 2 out of 15 (13.3%) of those with lower anti-tTG titer had histopathology suggestive of CD. Of 23 seropositive children not diagnosed with CD, 5 of 8 with anti tTG >100 au/ml, and all 15 with lower anti-tTG, had normalization of titers over the 24 (10-41) months. CONCLUSIONS: Our prevalence of CD is comparable to international data. Celiac disease was common with younger age at onset of T1D and higher titer of celiac serology. A high proportion was symptomatic of CD at diagnosis.

Evaluating the Cost for Robotic vs "Non-Robotic" Transhiatal Esophagectomy.

INTRODUCTION: This study was undertaken to analyze and compare the cost of robotic transhiatal esophagectomy (THE) to "non-robotic" THE (ie, "open" and laparoscopic). METHODS: With IRB approval, we prospectively followed 82 patients who underwent THE. We analyzed clinical outcomes and perioperative charges and costs associated with THE. To compare profitability, the robotic approach was analyzed against "non-robotic" approaches of THE using F-test, Mann-Whitney U test/Student's t-test, and Fisher's exact test. Statistical significance was reported as P ≤0.05. Data are presented as median (mean ± SD). RESULTS: 67 patients underwent the robotic approach, and 15 patients underwent "non-robotic" approach; 4 were "open" and 11 were laparoscopic. 79 patients had adenocarcinoma. Operative duration for robotic THE was 327 (331 ± 82.8) vs 213 (225 ± 62.0) minutes (P = 0.0001) and estimated blood loss was 150 (184 ± 136.1) vs 300 (476 ± 708.7) mL (P = 0.0001). Length of stay was 7 (11 ± 11.8) vs 8 (12 ± 10.6) days (P = 0.76). 16 patients had post-operative complications with a Clavien-Dindo score of three or more. Hospital charges for robotic THE were $197,405 ($259,936 ± 203,630.8) vs "non-robotic" THE $159,588 ($201,565 ± $185,763.5) (P = 0.31). Cost of care for robotic THE was $34,822 ($48,844 ± $45,832.8) vs "non-robotic" THE was $23,939 ($39,386 ± $44,827.2) (P = 0.47). Payment received for robotic THE was $14,365 ($30,003 ± $40,874.7) vs "non-robotic" THE was $28,080 ($41,087 ± $44,509.1) (P = 0.41). 15% of robotic operations were profitable vs 13% of "non-robotic" operations. CONCLUSIONS: Patients were predominantly older overweight men who had adenocarcinoma of the esophagus. The robotic approach had increased operative time and minimal blood loss. More than a fourth of operations included concomitant procedures. Patients were discharged approximately one week after THE. Overall, the robotic approach has no apparent significant differences in charges, cost, or profitability.

Self-Declared Oral Health Conditions and Oral Health-Related Quality of Life of the Brazilian Homeless Population: A Cross-Sectional Study

Abstract Objective: To associate the impact of oral health-related quality of life with socio-demographic determinants, self-perception, oral health conditions and access to dental treatment among homeless adults. Material and Methods: A cross-sectional study was carried out in a medium-sized Brazilian city in Minas Gerais. Socio-demographic data on the use of dental services and access to hygiene supplies for oral health were collected. Clinical aspects were collected by clinical observation using the Community Oral Health Indicator and oral health-related quality of life using the Oral Health Impact Profile (OHIP-14). Medians and interquartile distance were compared using the Mann-Whitney and Kruskal-Wallis tests. Multiple linear regression included significant variables (p<0.05) of the bivariate analysis according to each OHIP-14 domain. Results: Women had the lowest scores for the physical and social disability domains. Oral health conditions were associated with physical and psychological limitations and disability. The presence of more teeth was associated with a negative impact on the functional and physical domains, and inflamed gums, lack of need for dental prosthesis, and use of private services were associated with a greater psychological disability. Conclusion: Oral health-related quality of life of the homeless population is affected, especially in the physical and psychological aspects. Equitable and inclusive health actions aimed at this population should include oral health (AU).

Sífilis gestacional e congênita: evolução e relação com estratégia saúde da família no sul e extremo sul baiano / Gestational and congenital syphilis: evolution and relationship with the family health strategy in Southern Bahia / Sífilis gestacional y congénita: evolución y relación con la estrategia de salud familiar sur/extremo sur de Bahia

Sífilis em gestantes e sífilis congênita representam importantes problemas de saúde pública no Brasil. Este estudo descreve a situação epidemiológica dos casos de sífilis em gestantes e sífilis congênita na região sul/extremo sul baiana e compara a evolução das taxas de detecção dessas doenças com a ampliação da cobertura da Estratégia Saúde da Família (ESF). Este é um estudo observacional e descritivo do período de 2009-2019. Foram analisados municípios agrupados em diferentes portes populacionais e casos analisados, segundo características maternas e assistenciais. Foram correlacionadas taxas de detecção e incidência com a cobertura da Estratégia Saúde da Família utilizando o coeficiente de correlação de postos de Spearman. Os dados foram coletados do Painel de Indicadores Epidemiológicos do Ministério da Saúde. O grupo com população inferior a 20 mil habitantes foi excluído pela precariedade de registros. Foram notificados um total de 3.028 casos de sífilis em gestantes e 1.454 de sífilis congênita, nos 22 municípios selecionados, que formaram três grupos. Todos os grupos apresentaram aumento nas taxas de detecção e incidência e, quando correlacionadas com a cobertura da Estratégia de Saúde da Família, mostraram resultados positivos, sendo os mais fortes para o de menor população. Em todos os grupos prevaleceram casos de mulheres jovens, com baixa escolaridade, em sua maioria negras e que realizaram pré-natal, mas com diagnóstico de sífilis primária no terceiro trimestre gestacional. O tratamento da gestante e do parceiro foi inadequado ou não realizado na maioria dos grupos. O desafio atual está em qualificar o pré-natal, controlar desigualdades e barrar a transmissão vertical.

Gestational and congenital syphilis is a serious public health issue in Brazil. This study describes the epidemiological situation of gestational and congenital syphilis cases in southern Bahia, comparing the evolution of the detection rates of these diseases with the expanded coverage of the Family Health Strategy (FHS). An observational and descriptive research was conducted for the period of 2009-2019, in municipalities grouped by population sizes, analyzing cases according to maternal and care characteristics. Detection and incidence rates were correlated with the Family Health Strategy coverage using Spearman's rank correlation coefficient. Data were collected from the Epidemiological Indicators Panel of the Ministry of Health. The group with a population of less than 20,000 inhabitants was excluded due to poor records. A total of 3028 cases of gestational syphilis and 1454 cases of congenital syphilis were reported in the 22 selected municipalities divided into three groups. All groups presented increased detection and incidence rates and showed positive correlations with the coverage of the Family Health Strategy, stronger for the smallest population. Results show a prevalence of cases involving mostly young black women, with low schooling level, who received prenatal care, with a diagnosis of primary syphilis in the third gestational trimester. Treatment of the pregnant woman and her partner was inadequate or not performed in most groups. The current challenge is to qualify prenatal care, control inequalities, and stop vertical transmission.

Gestational and congenital syphilis is a serious public health issue in Brazil. This study describes the epidemiological situation of gestational and congenital syphilis cases in southern Bahia, comparing the evolution of the detection rates of these diseases with the expanded coverage of the Family Health Strategy (FHS). An observational and descriptive research was conducted for the period of 2009-2019, in municipalities grouped by population sizes, analyzing cases according to maternal and care characteristics. Detection and incidence rates were correlated with the Family Health Strategy coverage using Spearman's rank correlation coefficient. Data were collected from the Epidemiological Indicators Panel of the Ministry of Health. The group with a population of less than 20,000 inhabitants was excluded due to poor records. A total of 3028 cases of gestational syphilis and 1454 cases of congenital syphilis were reported in the 22 selected municipalities divided into three groups. All groups presented increased detection and incidence rates and showed positive correlations with the coverage of the Family Health Strategy, stronger for the smallest population. Results show a prevalence of cases involving mostly young black women, with low schooling level, who received prenatal care, with a diagnosis of primary syphilis in the third gestational trimester. Treatment of the pregnant woman and her partner was inadequate or not performed in most groups. The current challenge is to qualify prenatal care, control inequalities, and stop vertical transmission.

Denoising Diffusion MRI via Graph Total Variance in Spatioangular Domain.

Diffusion MRI (DMRI) plays an essential role in diagnosing brain disorders related to white matter abnormalities. However, it suffers from heavy noise, which restricts its quantitative analysis. The total variance (TV) regularization is an effective noise reduction technique that penalizes noise-induced variances. However, existing TV-based denoising methods only focus on the spatial domain, overlooking that DMRI data lives in a combined spatioangular domain. It eventually results in an unsatisfactory noise reduction effect. To resolve this issue, we propose to remove the noise in DMRI using graph total variance (GTV) in the spatioangular domain. Expressly, we first represent the DMRI data using a graph, which encodes the geometric information of sampling points in the spatioangular domain. We then perform effective noise reduction using the powerful GTV regularization, which penalizes the noise-induced variances on the graph. GTV effectively resolves the limitation in existing methods, which only rely on spatial information for removing the noise. Extensive experiments on synthetic and real DMRI data demonstrate that GTV can remove the noise effectively and outperforms state-of-the-art methods.

Assessment of the Safe Consumption of Nuts in Terms of the Content of Toxic Elements with Chemometric Analysis.

Nuts are characterized by high nutritional value and are recommended as a part of a healthy diet. At the same time, toxic elements could also be found in them. In this research, we measured the content of As, Cd, Pb and Hg in a wide variety of edible nuts. To determine the As content, inductively coupled plasma mass spectrometry (ICP-MS) was applied. Cd and Pb were detected by the electrothermal atomic absorption spectrometry analytical technique (ETAAS) with Zeeman background correction, while atomic absorption spectrometry method (AAS) with the amalgamation technique in the case of Hg was used. The study material consisted of 120 samples without replications (10 for each subgroup) including the following nuts: Almonds, Brazil nuts, cashew nuts, hazelnuts, macadamia nuts, peanuts, pecan nuts, pine nuts, pistachios and walnuts. Indicators such as the target hazard quotient (THQ), cancer risk (CR) and hazard index (HI) were used to assess the health risk. The highest median As, Cd, Pb and Hg contents were observed for pistachios (192.42 µg/kg), pine nuts (238.40 µg/kg), peanuts (82.06 µg/kg) and pecans (82.06 µg/kg), respectively. The exceedance of the established limits was found in the case of Pb for nine samples: macadamia nuts (221.49 µg/kg; 2350.94 µg/kg; 2581.43 µg/kg), pine nuts (266.33 µg/kg), peanuts (1353.80 µg/kg) and pecans (2689.13 µg/kg, 2758.26 µg/kg, 2992.29 µg/kg and 3169.41 µg/kg). Extremely high (>2500 µg/kg) Pb content was found in 33% of studied pecans imported from the USA. The health risk indicators did not identify increased health risk. This research is significant considering the food safety issues and indicates the need to regularly control the content of toxic elements in food, as well as to establish the specific limits for heavy metals content in nuts. The chemometric analysis included cluster analysis and principal component analysis (PCA). Cluster analysis made it possible to distinguish four subgroups on the basis of the ability to accumulate toxic elements: pine nuts, pecans, pistachios and other analysed nuts. PCA indicated primarily factor 1, distinguishing mainly pecans, macadamia nuts and peanuts. Chemometric analysis can be a useful tool in estimating the ability of different nut species to accumulate contaminants.