Physicists and computer scientists have recently expanded the modern theory of the thermodynamics of computation. By combining approaches from statistical physics and computer science, the researchers introduce mathematical equations that reveal the minimum and maximum predicted energy cost of computational processes that depend on randomness, which is a powerful tool in modern computers.
JMIR Form Res. 2024 May 13;8:e51728. doi: 10.2196/51728.
ABSTRACT
BACKGROUND: Social prescription is seen as a public health intervention tool with the potential to mitigate social determinants of health. On one side, social prescription is not yet well developed in France, where social workers usually attend to social needs, and historically, there is a deep divide between the health and social sectors. On the other side, discharge coordination is gaining attention in France as a critical tool to improve the quality of care, assessed indirectly using unplanned rehospitalization rates.
OBJECTIVE: This study aims to combine social prescription and discharge coordination to assess the need for social prescription and its effect on unplanned rehospitalization rates.
METHODS: We conducted a quasi-experimental study in two departments of medicine in a French university hospital in a disadvantaged suburb of Paris over 2 years (October 2019-October 2021). A discharge coordinator screened patients for social prescribing needs and provided services on the spot or referred the patient to the appropriate service when needed. The primary outcome was the description of the services delivered by the discharge coordinator and of its process, as well as the characteristics of the patients in terms of social needs. The secondary outcome was the comparison of unplanned rehospitalization rates after data chaining.
RESULTS: A total of 223 patients were included in the intervention arm, with recruitment being disrupted by the COVID-19 pandemic. More than two-thirds of patients (n=154, 69.1%) needed help understanding discharge information. Slightly less than half of the patients (n=98, 43.9%) seen by the discharge coordinator needed social prescribing, encompassing language, housing, health literacy, and financial issues. The social prescribing covered a large range of services, categorized into finding a general practitioner or private sector nurse, including language-matching; referral to a social worker; referral to nongovernmental organization or group activities; support for transportation issues; support for health-related administrative procedures; and support for additional appointments with nonmedical clinicians. All supports were delivered in a highly personalized way. Ethnic data collection was not legally permitted, but for 81% (n=182) of the patients, French was not the mother tongue. After data chaining, rehospitalization rates were compared between 203 patients who received the intervention (n=5, 3.1%) versus 2095 patients who did not (n=51, 2.6%), and there was no statistical difference.
CONCLUSIONS: First, our study revealed the breadth of patient’s unmet social needs in our university hospital, which caters to an area where the immigrant population is high. The study also revealed the complexity of the discharge coordinator’s work, who provided highly personalized support and managed to gain trust. Hospital discharge could be used in France as an opportunity in disadvantaged settings. Eventually, indicators other than the rehospitalization rate should be devised to evaluate the effect of social prescribing and discharge coordination.
PMID:38739912 | DOI:10.2196/51728
JMIR Form Res. 2024 May 13;8:e56005. doi: 10.2196/56005.
ABSTRACT
BACKGROUND: Skin cancers are the most common group of cancers diagnosed worldwide. Aging and sun exposure increase their risk. The decline in the number of dermatologists is pushing the issue of dermatological screening back onto family doctors. Dermoscopy is an easy-to-use tool that increases the sensitivity of melanoma diagnosis by 60% to 90%, but its use is limited due to lack of training. The characteristics of “ideal” dermoscopy training have yet to be established. We created a Moodle (Moodle HQ)-based e-learning course to train family medicine residents in dermoscopy.
OBJECTIVE: This study aimed to evaluate the evolution of dermoscopy knowledge among family doctors immediately and 1 and 3 months after e-learning training.
METHODS: We conducted a prospective interventional study between April and November 2020 to evaluate an educational program intended for family medicine residents at the University of Montpellier-Nîmes, France. They were asked to complete an e-learning course consisting of 2 modules, with an assessment quiz repeated at 1 (M1) and 3 months (M3). The course was based on a 2-step algorithm, a method of dermoscopic analysis of pigmented skin lesions that is internationally accepted. The objectives of modules 1 and 2 were to differentiate melanocytic lesions from nonmelanocytic lesions and to precisely identify skin lesions by looking for dermoscopic morphological criteria specific to each lesion. Each module consisted of 15 questions with immediate feedback after each question.
RESULTS: In total, 134 residents were included, and 66.4% (n=89) and 47% (n=63) of trainees fully participated in the evaluation of module 1 and module 2, respectively. This study showed a significant score improvement 3 months after the training course in 92.1% (n=82) of participants for module 1 and 87.3% (n=55) of participants for module 2 (P<.001). The majority of the participants expressed satisfaction (n=48, 90.6%) with the training course, and 96.3% (n=51) planned to use a dermatoscope in their future practice. Regarding final scores, the only variable that was statistically significant was the resident’s initial scores (P=.003) for module 1. No measured variable was found to be associated with retention (midtraining or final evaluation) for module 2. Residents who had completed at least 1 dermatology rotation during medical school had significantly higher initial scores in module 1 at M0 (P=.03). Residents who reported having completed at least 1 dermatology rotation during their family medicine training had a statistically significant higher score at M1 for module 1 and M3 for module 2 (P=.01 and P=.001).
CONCLUSIONS: The integration of an e-learning training course in dermoscopy into the curriculum of FM residents results in a significant improvement in their diagnosis skills and meets their expectations. Developing a program combining an e-learning course and face-to-face training for residents is likely to result in more frequent and effective dermoscopy use by family doctors.
PMID:38739910 | DOI:10.2196/56005
Plast Reconstr Surg. 2024 May 13. doi: 10.1097/PRS.0000000000011534. Online ahead of print.
ABSTRACT
BACKGROUND: Labiaplasty, a surgical procedure designed to address labia minora hypertrophy, has been closely linked to the improvement of genital self-image and the alleviation of symptoms related to body dysmorphic disorder. Brazil stands as the global leader in the prevalence of labiaplasty procedures.
OBJECTIVE: This study aimed to assess alterations in genital self-image and symptoms of body dysmorphic disorder in individuals with labia minora hypertrophy who underwent either wedge or trim labiaplasty.
METHODS: A total of 48 adult women undergoing labiaplasty were enrolled in this randomized clinical trial with two parallel groups. Allocation ratio was 1:1. The Study Group (SG) underwent wedge labiaplasty, while the Control Group (CG) underwent trim labiaplasty. Genital self-image and symptoms of body dysmorphic disorder were assessed both preoperatively and six months postoperatively, using validated tools.
RESULTS: After a six-month intervention period, a statistically significant improvement in genital self-image was observed (p<0.001), alongside a marked decrease in the score of symptoms related to body dysmorphic disorder (p<0.001). There were no significant differences in outcomes between the groups. Furthermore, no statistically significant associations were noted between complications and the specific technique employed.
CONCLUSION: The study findings underscore the noteworthy improvement in genital self-image and a concurrent reduction in symptoms of body dysmorphic disorder, evident in both the wedge and linear labiaplasty groups at the six-month postoperative assessments. These results suggest that the choice of surgical technique does not significantly impact these outcomes.
PMID:38739890 | DOI:10.1097/PRS.0000000000011534
Plast Reconstr Surg. 2024 May 13. doi: 10.1097/PRS.0000000000011532. Online ahead of print.
ABSTRACT
BACKGROUND: To assess the impact of propranolol as the first-line treatment of infantile hemangioma (IH) on the need for surgery in the management of IH.
METHODS: Retrospective study of 420 patients, with IH, referred to our multidisciplinary center between January 2005 and August 2014. Clinical data including sex, age at first consultation and at treatment initiation, location, size, number, aspect, and complication of IH, as well as the type of treatment were collected. Statistical analyses were conducted considering each patient and each tumor independently.
RESULTS: A total of 625 IH(420 patients (P))were reviewed, 113 patients had more than one IH (26.91%). Median age at first consultation was 7 months old. Overall, 243 patients were treated (57.86%) using either surgery (n=128 P/141 IH), propranolol (n=79 P/89 IH), corticosteroids (n=51 P/56 IH), and/or laser (n=34 P /36 IH). Propranolol was effective in all but 2 infants with IH. Seven patients (n=7/79 P; 8.86%) initially treated with propranolol, still required surgery, in contrast to 18 patients (n=18/51 P; 35.29%) initially treated with corticosteroids, and 103 patients (n=103/290 P; 35.51%) with no medical treatment. Since the availability of propranolol, patients were less likely to undergo surgery (48 P versus 80 P; P-Value < 0.001). This demonstrated that the use of propranolol reduced the need for surgery (P-Value < 0.001 with an OR of 0.177: CI 95% 0.079-0.396).
CONCLUSION: Propranolol has dramatically reduced the need for surgery, regarding indications and number of patients. Surgical correction remains important for sequelae management, non-responders or strawberry-like IH.
PMID:38739875 | DOI:10.1097/PRS.0000000000011532
Nano Lett. 2024 May 13. doi: 10.1021/acs.nanolett.4c00598. Online ahead of print.
ABSTRACT
Planar double heterostructures were initially investigated and have been successfully applied in III-V semiconductor lasers due to their excellent roles in confining both the photons and carriers. Here, we design and fabricate a (PEA)2Csn-1PbnX3n+1 (quasi-2D)/CsPbBr3 QD/quasi-2D double-heterostructure sandwiched in a 3/2 λ DBR microcavity, and then demonstrate a single-mode pure-green lasing with a threshold of 53.7 μJ/cm2 under nanosecond-pulsed optical pumping. The thresholds of these heterostructure devices decrease statistically by about 50% compared to the control group with no energy donor layers, PMMA/QD/PMMA in an identical microcavity. We show that there is efficient energy transfer from the barrier regions of the quasi-2D phases to the QD layer by transient absorption and luminescence lifetime spectra and that such energy transfer leads to marked threshold reduction. This work indicates that the double-heterostructure configurations should play a significant role in the future perovskite electrically pumped laser.
PMID:38739874 | DOI:10.1021/acs.nanolett.4c00598
J Am Acad Orthop Surg. 2024 May 10. doi: 10.5435/JAAOS-D-23-01172. Online ahead of print.
ABSTRACT
INTRODUCTION: Firearms are the leading cause of death in the pediatric population, and the incidence of firearm injury is on the rise in the United States. The purpose of this study was to examine the incidence of pediatric gunshot wounds (GSWs) in New Orleans from 2012 to 2023 and evaluate factors that contribute to mortality.
METHODS: A retrospective analysis of pediatric GSWs was conducted using the trauma database at a Level I trauma center in New Orleans, Louisiana. All patients aged 0 to 18 years with a GSW between January 1, 2012, and January 1, 2023, were evaluated. Demographic data, Injury Severity Score (ISS), hospital length of stay (LOS), discharge disposition, intent of injury, mortality, firearm type, orthopaedic injuries, and related surgical procedures were extracted from the database. Linear regression was used to assess the trend of GSWs over time, and logistic regression was used to identify variables that predicted mortality. Statistical significance was defined as α = 0.05. Geographic information system (GIS) mapping was conducted using the ZIP code location of injury to identify geographic areas with the greatest number of GSWs.
RESULTS: A significant increasing trend was observed in the number of pediatric GSWs when adjusted for changes in population (P = 0.014), and the number of GSWs increased 43.2% over the duration of the study. Higher ISS, shorter length of stay, and self-inflicted intent of injury were notable predictors of mortality. Three hundred fifty-four patients (31.4%) had at least one orthopaedic injury, and of the survivors, 365 patients (35.6%) required at least one surgical procedure in the operating room during their admission.
DISCUSSION: The number of GSWs in the pediatric population in New Orleans presenting at a large level 1 trauma center demonstrated a statistically significant increasing trend over the past 11 years. ISS and self-inflicted intent were predictive of mortality within this pediatric patient population.
PMID:38739866 | DOI:10.5435/JAAOS-D-23-01172
J Am Acad Orthop Surg. 2024 May 10. doi: 10.5435/JAAOS-D-23-01147. Online ahead of print.
ABSTRACT
INTRODUCTION: A pronounced gender imbalance is evident among orthopaedic surgeons. In the field of arthroplasty, there exists a dearth of comprehensive data regarding gender representation. This study aimed to analyze the gender diversity, or lack thereof, within the field of total hip arthroplasty (THA). In addition, this study used literature review to identify possible reasons for the gender disparity among THA surgeons and identify the best next steps to promote gender equity within orthopaedics.
METHODS: A retrospective analysis was conducted using the Medicare Provider Utilization and Payment Data: Physician and Other Practitioners data set to quantify orthopaedic surgeons who performed primary THA procedures from 2013 to 2020. To assess trends in the number of hip surgeons by sex and the evolving female-to-male ratio, two-sided correlated Mann-Kendall tests were conducted.
RESULTS: Overall, 3,853 to 4,550 surgeons billed for primary THA annually. Of this number, an average of 1.7% was female. The mean number of services billed for by male surgeons was 31.62 ± 24.78 per year and by female surgeons was 26.43 ± 19.49 per year. Trend analysis of female-to-male ratio demonstrated an increasing trend of statistical significance (P = 0.009). The average number of procedures by female surgeons annually remained stable throughout the study, whereas there was a steady increase in that for male surgeons.
CONCLUSION: Results showed a notable and sustained upward trajectory from 2013 to 2020 in the number of female surgeons billing for THA along with the female-to-male ratio. However, female surgeons constitute a mere 2% of surgeons engaging in primary THA billing. Furthermore, the annual average number of THAs conducted by female surgeons exhibited constancy, whereas there was a gradual increase in the median number of annual procedures performed by their male counterparts. Future studies should aim to identify and resolve specific barriers prohibiting female medical students from pursuing and obtaining a career as an orthopaedic THA surgeon.
STUDY DESCRIPTION: Retrospective analysis using the Medicare Provider Utilization and Payment Data: Physician and Other Practitioners data set.
PMID:38739863 | DOI:10.5435/JAAOS-D-23-01147
Indian J Dent Res. 2023 Oct 1;34(4):438-442. doi: 10.4103/ijdr.ijdr_5_23. Epub 2024 Apr 19.
ABSTRACT
AIM: The aim of the present study is to assess the microhardness of resin-based composites (RBCs) cured with ultrafast curing mode at two different exposure durations.
STUDY DESIGN: This is an experimental in-vitro study. Forty-five cylindrical composite specimens were prepared to a dimension of 5 mm height and 4 mm diameter. Curing was done using three different exposure modes and duration with dual mode LED curing light as follows: Group I: Ultrafast curing mode for 1 second at 2300 mW/cm2 (n = 15); Group II: Ultrafast curing mode for 3 second at 2300 mW/cm2 (n = 15) and Group III: Standard exposure mode for 20 second at 1000 mW/cm2 (n = 15). Vicker’s microhardness measurement was done on both the curing and non-curing sides of the specimen using a motorised diamond-faced micro-indenter (Wilson Wolpwert, Germany) using a load of 50 gram and a dwell time of 30 second.
STATISTICAL ANALYSIS: Kruskal Wallis ANOVA was used to test for difference between the three groups followed by Mann-Whitney U test for post-hoc analysis.
RESULTS: The microhardness values of the composite cured with a conventional curing unit were significantly higher than the ultrafast cured specimens.
CONCLUSION: Low-intensity conventional curing lights were found to perform better than the high-intensity ultrafast curing units.
PMID:38739828 | DOI:10.4103/ijdr.ijdr_5_23
Indian J Dent Res. 2023 Oct 1;34(4):427-432. doi: 10.4103/ijdr.ijdr_519_23. Epub 2023 Dec 27.
ABSTRACT
BACKGROUND: 3D printing technology is replacing manual fabrication in all fields. 3D-printed impression trays should be assessed as they could replace conventional impression trays in the future.
AIM: In-vitro comparison and evaluation of the dimensional stability and retention strength of impressions to custom impression trays fabricated using conventional method and additive technology.
MATERIALS AND METHODS: A maxillary edentulous auto-polymerizing acrylic resin model served as the master model. Two moulds were prepared from the master model in order to obtain 12 casts. One cast was scanned for 3D printing digital light processing (DLP) and fused deposition modelling (FDM) 24 impression trays using polylactic acid (PLA). Twelve casts were used to fabricate light cure impression trays. Polyvinyl-siloxane impressions were made on the master model using 36 impression trays and 18 trays each were used to assess dimensional stability and retention strength.
RESULTS: In dimensional stability analysis, one sample t-test revealed a statistically significant difference between each group and the master model followed by a one-way ANOVA. There were significant differences, but the difference was less with FDM trays (P < 0.05). In retention strength analysis, one-way Analysis of variance (ANOVA) revealed statistically significant difference between each group and post-hoc test revealed specific difference, the highest with FDM trays (P < 0.05).
CONCLUSION: Dimensional changes were observed at 30 minutes and 72 hours. Lesser dimensional changes were observed when impressions were made using FDM trays followed by DLP and light cure trays. The mean retention strength seen in descending order was FDM, followed by DLP and light cure trays. The best retention strength was noticed when impressions were made using FDM trays.
PMID:38739826 | DOI:10.4103/ijdr.ijdr_519_23