Mcginnishartvig1145
A 60° threshold was also found to best discriminate between hips with and without cam morphology in a large cohort study based on a bimodal distribution of the alpha angle. Studies (n = 8) using the upper limit of the 95% reference interval as threshold proposed a wide overall threshold range between 58° and 93°. When stratified by sex, thresholds between 63° and 93° in male patients and between 58° and 94° in female patients were reported.
Based on the available evidence, mostly based on studies using ROC curve analysis, an alpha angle threshold of ≥60° is currently the most appropriate to classify cam morphology. Further research is required to fully validate this threshold.
Based on the available evidence, mostly based on studies using ROC curve analysis, an alpha angle threshold of ≥60° is currently the most appropriate to classify cam morphology. Further research is required to fully validate this threshold.
To assess the feasibility of a patient-centered complex intervention for multimorbidity (CIM) based on general practice in collaboration with community health-care centers and outpatient clinics.
Inclusion criteria were age ≥18 years, diagnoses of two or more of three chronic conditions (diabetes, chronic obstructive pulmonary disease (COPD), and chronic heart conditions), and a hospital contact during the previous year. The CIM included extended consultations and nurse care manager support in general practice and intensified cross-sectorial collaboration. Elements included a structured care plan based on patients' care goals, coordination of services, and, if appropriate, shifting outpatient clinic visits to general practice, medication review, referral to rehabilitation, and home care. The acceptability dimension of feasibility was assessed with validated questionnaires, observations, and focus groups.
Forty-eight patients were included (mean age 72.2 (standard deviation (SD) 9.5, range 52-89); 23 (48%) were men. Thirty-seven patients had two diseases; most commonly COPD and cardiovascular disease (46%), followed by diabetes and cardiovascular disease (23%), and COPD and diabetes (15%). Eleven (23%) patients had all three conditions. Focus group interviews with patients with multimorbidity identified three main themes (1) lack of care coordination existed across health-care sectors before the CIM, (2) extended consultations provided better care coordination, and (3) patients want to be involved in planning their treatment and care. In focus groups, health-care professionals discussed two main themes (1) patient-centered care and (2) culture and organizational change. Completion rates for questionnaires were 98% (47/48).
Patients and health-care professionals found the CIM acceptable.
Patients and health-care professionals found the CIM acceptable.
Child maltreatment is associated with long-term conditions (LTCs) in adulthood. Its relationship to multimorbidity (≥2 LTCs) is less clear. We explore the relationship between child maltreatment, multimorbidity and factors complicating management.
Cross-sectional analysis of 157,357 UK Biobank participants. Experience of four maltreatment types (physical/sexual/emotional/neglect) was identified. selleck chemicals llc We explored the relationship between type, number and frequency of maltreatment and LTC count (0, 1, 2, 3, ≥4) using multinomial logistic regression. Binary logistic regression assessed the relationship between maltreatment and self-rated health, loneliness, social isolation, frailty and widespread pain in those with multimorbidity, adjusting for sociodemographics and lifestyle factors.
52,675 participants (33%) experienced ≥1 type of maltreatment; 983 (0.6%) experienced all four. Type, frequency and number of types of maltreatment were associated with higher LTC count. People experiencing four types of maltreatment were 5 times as likely to have a LTC count of ≥4 as those experiencing none (odds ratio (OR) 5.16; 99% confidence interval (CI) 3.77-7.07). Greater number of types of maltreatment was associated with higher prevalence of combined physical/mental health LTCs (OR 2.99; 99% CI 2.54-3.51 for four types of maltreatment). Compared to people who reported no maltreatment, people experiencing all four types of maltreatment were more likely to have poor self-rated health (OR 3.56; 99% CI 2.58-4.90), loneliness (OR 3.16; 99% CI 2.17-4.60), social isolation (OR 1.45; 99% CI 1.03-2.05), widespread pain (OR 3.19; 99% CI 1.87-5.44) and frailty (OR 3.21; 99% CI 2.04-5.05).
Peoplewith a history of maltreatment have higher LTC counts and potentially more complicated management needs reinforcing calls for early intervention.
Peoplewith a history of maltreatment have higher LTC counts and potentially more complicated management needs reinforcing calls for early intervention.Our societal needs for greener, economically viable products and processes have grown given the adverse environmental impact and unsustainable development caused by human activities, including chemical releases, exposure, and impacts. To make chemical processes safer and more sustainable, a novel sustainability-oriented control strategy is developed in this work. This strategy enables the incorporation of online sustainability assessment and process control with sustainability constraints into chemical process operations. Specifically, U.S. Environmental Protection Agency (EPA)'s GREENSCOPE (Gauging Reaction Effectiveness for the ENvironmental Sustainability of Chemistries with a multi-Objective Process Evaluator) tool is used for sustainability assessment and environmental release minimization of chemical processes. The multivariable GREENSCOPE indicators in real time can be represented using a novel visualization method with dynamic radar plots. The analysis of the process dynamic behavior in terms of sustainability performance provides means of defining sustainability constraints for the control strategy to improve process sustainability aspects with lower scores. For the control tasks, Biologically Inspired Optimal Control Strategy (BIO-CS) is implemented with sustainability constraints so that the control actions can be calculated considering the sustainability performance. This work leads to a significant step forward towards augmenting the capability of process control to meet future demands on multiple control objectives (e.g., economic, environmental, and safety related). The effectiveness of the proposed framework is illustrated via two case studies associated with a fermentation system. The results show that the proposed control strategy can effectively drive the system to the desired setpoints while meeting a preset sustainability constraint and improving the transient sustainability performance by up to 16.86% in terms of selected GREENSCOPE indicators.
