Clinical prediction rule for bacterial arthritis: Chi-squared automatic interaction detector decision tree analysis model.

Objectives: Differences in demographic factors, symptoms, and laboratory data between bacterial and non-bacterial arthritis have not been defined. We aimed to identify predictors of bacterial arthritis, excluding synovial testing. Methods: This retrospective cross-sectional survey was performed at a university hospital. All patients included received arthrocentesis from January 1, 2010, to December 31, 2020. Clinical information was gathered from medical charts from the time of synovial fluid sample collection. Factors potentially predictive of bacterial arthritis were analyzed using the Student's t-test or chi-squared test, and the chi-squared automatic interaction detector decision tree analysis. The resulting subgroups were divided into three groups according to the risk of bacterial arthritis: low-risk, intermediate-risk, or high-risk groups. Results: A total of 460 patients (male/female = 229/231; mean ± standard deviation age, 70.26 ± 17.66 years) were included, of whom 68 patients (14.8%) had bacterial arthritis. The chi-squared automatic interaction detector decision tree analysis revealed that patients with C-reactive protein > 21.09 mg/dL (incidence of septic arthritis: 48.7%) and C-reactive protein ⩽ 21.09 mg/dL plus 27.70 < platelet count ⩽ 30.70 × 104/µL (incidence: 36.1%) were high-risk groups. Conclusions: Our results emphasize that patients categorized as high risk of bacterial arthritis, and appropriate treatment could be initiated as soon as possible.

Information Seeking and COVID-19 Preventive Behaviors: A Comparison Between Immigrants and the Host Population in Japan

Little is known about information seeking and its influence on preventive behaviors among immigrants in Japan, despite their vulnerabilities during the coronavirus disease 2019 (COVID-19) pandemic. This study investigated information seeking about COVID-19, and examined differences with compliance with preventive measures between immigrants and the host population in Japan based on an Internet survey conducted in October 2021. We used chi-squared tests to determine the difference in information seeking and preventive behaviors between the two groups, and Poisson regression with robust standard errors to examine the association between information seeking and compliance with preventive measures. Our results show that, although the overall tendencies of information seeking and the preventive behaviors of immigrants were similar to those of the Japanese, significant differences were identified in some behavior: immigrants were more likely to acquire COVID-19 information from social networking services (SNS) and official websites in Japan, and maintain physical distance and ventilation than Japanese locals. Furthermore, immigrants' sources of information diversified according to their sociodemographic characteristics (e.g., educational level, Japanese language skills, length of residence in Japan, and country or region of origin). Additionally, the effects of information seeking on preventive actions against COVID-19 differed according to the information sources;some information sources (e.g., SNS) had different impacts on preventive behaviors between immigrants and Japanese locals. Obtaining information from traditional media and Japanese official websites increases engagement with all five preventive measures among immigrants and four measures among the Japanese. The study highlights the importance of customized health policies for immigrants according to their behavioral tendencies. © Fuji Technology Press Ltd.

Coronavirus in hip fractures (CHIP) 4 : has vaccination improved mortality outcomes in hip fracture patients?

AIMS: Prior to the availability of vaccines, mortality for hip fracture patients with concomitant COVID-19 infection was three times higher than pre-pandemic rates. The primary aim of this study was to determine the 30-day mortality rate of hip fracture patients in the post-vaccine era. METHODS: A multicentre observational study was carried out at 19 NHS Trusts in England. The study period for the data collection was 1 February 2021 until 28 February 2022, with mortality tracing until 28 March 2022. Data collection included demographic details, data points to calculate the Nottingham Hip Fracture Score, COVID-19 status, 30-day mortality, and vaccination status. RESULTS: A total of 337 patients tested positive for COVID-19. The overall 30-day mortality in these patients was 7.7%: 5.5% in vaccinated patients and 21.7% in unvaccinated patients. There was no significant difference between post-vaccine mortality compared with pre-pandemic 2019 controls (7.7% vs 5.0%; p = 0.068). Independent risk factors for mortality included unvaccinated status, Abbreviated Mental Test Score ≤ 6, male sex, age > 80 years, and time to theatre > 36 hours, in decreasing order of effect size. CONCLUSION: The vaccination programme has reduced 30-day mortality rates in hip fracture patients with concomitant COVID-19 infection to a level similar to pre-pandemic. Mortality for unvaccinated patients remained high.Cite this article: Bone Joint J 2022;104-B(12):1362-1368.

Transition to Disease-Site Specific Chart Rounds: An Evaluation of Impact on Quality and Perceptions of Practitioners

Although chart rounds is an established quality assurance process, there remains minimal evidence on various forms of peer review, and some studies report relatively low error-detection rates. One question faced by both academic and community practices is whether to structure chart rounds as practice-site specific (PS) or disease-specific (DS). The global COVID pandemic may also offer new opportunities for structuring peer-review by enhancing virtual connectivity of people and practices. The purpose of this study was to determine if changes to treatment plans were recommended more often and assess perceptions following the transition to DS chart rounds. Data was prospectively collected for 6 months before and 6 months after transition to DS chart rounds at a multi-practice institution. Observed data included frequency of questions asked, educational remarks, and recommended changes to the presented plan or future patients. Time spent per case was recorded. Participants were not aware of data collection. Following 10 months of practicing DS chart rounds, a survey was distributed to faculty, dosimetrists, and trainees to assess perceptions of DS chart rounds. Two-tailed t-testing and chi-square testing were used to analyze the data. Criteria for statistical significance was p<0.05. The study was IRB-approved. Over 1 year, 1460 patients were peer reviewed;781 were reviewed by PS chart rounds and 679 by DS chart rounds. A question was asked more often in DS (49.3%) than PS (31.9%) chart rounds (p<0.001). A change to a presented plan was recommended more often in DS (4.9%) than PS (1.4%) chart rounds (p<0.001). A change was recommended for future patients more often in DS (4.4%) than PS (0.9%) chart rounds (p<0.001). An educational point was raised more often in DS (12.5%) than PS (9.3%) chart rounds (p=0.05). Time spent per case was more for DS (2.7 min) than PS (1.6 min) chart rounds (p<0.001). Overall, there were 35 survey respondents (54% response rate). Among attendings, the response rate was 74%. Of all respondents, 89% agreed DS chart rounds improve the quality of patient plans, 83% agreed DS chart rounds improve patient safety, 86% agreed DS chart rounds encourage more discussion, and 77% agreed DS chart rounds are more educational. Only 37% of respondents agreed DS chart rounds are more time efficient;however, 95% of attendings and 89% of all respondents favored continuing DS chart rounds;no respondents disagreed. Time efficiency was not associated with preference for continuing DS chart rounds (p=0.10). Favoring continuing DS chart rounds was associated with the belief that DS chart rounds improve patient safety (p<0.001), quality of patient plans (p<0.001), and education (p<0.001). DS chart rounds were associated with more discussion and recommended changes to treatment plans than PS chart rounds. Most respondents favored continuing DS chart rounds and reported that this format improved the quality of patient treatment plans and safety. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Forecasting and classification of new cases of COVID 19 before vaccination using decision trees and Gaussian mixture model

Regarding the pandemic taking place in the world from the spread of the Coronavirus pandemic and viral mutations, the need has arisen to analyze the epidemic data in terms of numbers of infected and deaths, different geographical regions, and the dynamics of the spread of the virus. In China, the total number of reported infections is 224,659 on June 11, 2022. In this paper, the Gaussian Mixture Model and the decision tree method were used to classify and predict new cases of the virus. Although we focus mainly on the Chinese case, the model is general and adapted to any context without loss of validity of the qualitative results. The Chi-Squared (χ2) Automatic Interaction Detection (CHAID) was applied in creating the decision tree structure, the data has been classified into five classes, according to the BIC criterion. The best mixture model is the E (Equal variance) with five components. The considered data sets of the world health organization (WHO) were used from January 5, 2020, to 12, November 2021. We provide numerical results based on the Chinese case. © 2022 THE AUTHORS

Generalized Rescaled Polya urn and its statistical application

We introduce the Generalized Resealed Polya (GRP) urn, that provides a generative model for a chi-squared test of goodness of fit for the long-term probabilities of clustered data, with independence between clusters and correlation, due to a reinforcement mechanism, inside each cluster. We apply the proposed test to a data set of Twitter posts about COVID-19 pandemic: in a few words, for a classical chi-squared test the data result strongly significant for the rejection of the null hypothesis (the daily long-run sentiment rate remains constant), but, taking into account the correlation among data, the introduced test leads to a different conclusion. Beside the statistical application, we point out that the GRP urn is a simple variant of the standard Eggenberger-Polya urn, that, with suitable choices of the parameters, shows "local" reinforcement, almost sure convergence of the empirical mean to a deterministic limit and different asymptotic behaviours of the predictive mean. Moreover, the study of this model provides the opportunity to analyze stochastic approximation dynamics, that are unusual in the related literature.

A STATISTICAL STUDY ON THE ROLE OF OUTSOURCING ROMANIAN ACCOUNTING SERVICES IN THE CONTEXT OF THE PANDEMIC CRISIS

The organization and management of the financial accounting function can be done within the economic entity, either through a separate department or through outsourcing, by entrusting, based on a service contract, to professionals. In this context, we were faced with a double scientific challenge. On the one hand, we considered it appropriate to carry out a quantitative study on the perception of managers of economic entities on the importance of outsourcing accounting for business continuity and achieving expected performance, given that the negative effects of crises strongly influence the business environment, in general, and, in particular, the economic crisis caused by the SARS-CoV-2 virus. During the research, the second objective of our scientific approach was outlined, namely to highlight the existence or not of a relationship of dependence between the typologies of the respondents of the questionnaire and their perception of the importance and favorable effects of outsourcing accounting services, using the Chi-squared test, to determine the existence of a statistically significant difference between the expected frequencies and the observed frequencies for one or more variables.

Determination of climate and social community factors in coronavirus disease-19 spread distribution

BACKGROUND: Coronavirus Disease-2019 (COVID-19) is very shocking to the world. Until mid-2020, this virus has not yet found a vaccine that can be produced and can be applied en mass across the country. The spread of COVID-19 differs between regions which implie that regional characteristics have an influence on the rate of growth. Regional and social climate factors are thought to have a role in the growth rate of COVID-19. AIM: This study aims to find the role of climate and social society on the spread of COVID-19. METHODS: This research uses OLS regression analysis method, and then continued with Chi-squared Automatic Interaction Detector analysis to find the segmentation of the role of climate and social factors on the daily growth rate of COVID-19 in positive and deceased patients. RESULTS: The results of this study state that all independent variables of the study have a significant effect on the spread of COVID-19, with R-squared values in positive and deceased patients, respectively 61.1% and 70.0%. Strategic steps are needed to carry out policies that are targeted, effective and efficient. CONCLUSION: The results of this study can be a reference for the government in determining policies to reduce the growth rate of COVID-19, by focusing on areas that have poor sanitary environment and area are on Java Island. © 2021 Faradiba Faradiba, Lodewik Zet.

Hip and distal femur fracture outcomes over three successive UK lockdown periods during the COVID-19 pandemic: what have we learnt? : a single-centre retrospective cohort study.

AIMS: This study assessed the impact of COVID-19 on hip and distal femur fracture patient outcomes across three successive UK lockdown periods over one year. METHODS: A single-centre retrospective cohort study was performed at an acute NHS Trust. Hip and distal femur fracture patients admitted within the first month from each of the three starting dates of each national lockdown were included and compared to a control group in March 2019. Data were collected as per the best practice tariff outcomes including additional outcomes as required. Data collection included COVID-19 status, time to theatre, 30-day mortality, presence of acute kidney injury (AKI) and pneumonia, and do not attempt cardiopulmonary resuscitation (DNACPR) status. Data were analyzed using an independent-samples t-test or chi-squared test with Fisher's exact test where applicable. A p-value of < 0.05 was considered statistically significant. RESULTS: A total of 95 patients during the pandemic were included and 20 were COVID-positive. Patients experienced a statistically significant increase in time to theatre in Lockdown 1 compared to 2019 (p = 0.039) with a decrease with successive lockdown periods by Lockdown 3. The 30-day mortality increased from 8.8% in 2019 to 10.0% to 14.8% in all lockdown periods. COVID-positive patient mortality was 30.0% (p = 0.063, odds ratio (OR) = 4.43 vs 2019). The rates of AKI and pneumonia experienced were higher for patients during the pandemic. The highest rates were experienced in COVID-positive patients, with 45.0% of patients with AKI versus 27.0% in 2019 (p = 0.38, OR = 1.80), and 50.0% of patients diagnosed with pneumonia versus 16.2% in 2019 (p = 0.0012, OR = 5.17). The percentage of patients with a DNACPR increased from 30.0% in 2019 to 60.7% by Lockdown 3 (p = 0.034, OR = 3.61). CONCLUSION: COVID-positive hip and distal femur fracture patients are at a higher risk of mortality due to AKI and pneumonia. Patient outcomes have improved with successive lockdowns to pre-pandemic levels. Cite this article: Bone Jt Open 2021;2(12):1017-1026.

Theatre efficiency in COVID-19 pandemic conditions: The collaborative experience of four level 1 major trauma centres in the UK.

AIMS: As the world continues to fight successive waves of COVID-19 variants, we have seen worldwide infections surpass 100 million. London, UK, has been severely affected throughout the pandemic, and the resulting impact on the NHS has been profound. The aim of this study is to evaluate the impact of COVID-19 on theatre productivity across London's four major trauma centres (MTCs), and to assess how the changes to normal protocols and working patterns impacted trauma theatre efficiency. METHODS: This was a collaborative study across London's MTCs. A two-month period was selected from 5 March to 5 May 2020. The same two-month period in 2019 was used to provide baseline data for comparison. Demographic information was collected, as well as surgical speciality, procedure, time to surgery, type of anaesthesia, and various time points throughout the patient journey to theatre. RESULTS: In total, 1,243 theatre visits were analyzed as part of the study. Of these, 834 patients presented in 2019 and 409 in 2020. Fewer open reduction and internal fixations were performed in 2020 (33.5% vs 38.2%), and there was an increase in the number of orthoplastic cases in 2020 (8.3% vs 2.2%), both statistically significant results (p < 0.000). There was a statistically significant increase in median time from 2019 to 2020, between sending for a patient and their arrival to the anaesthetic room (29 vs 35 minutes; p = 0.000). Median time between arrival in the anaesthetic room and commencement of anaesthetic increased (7 to 9 minutes; p = 0.104). CONCLUSION: Changes in working practices necessitated by COVID-19 led to modest delays to all aspects of theatre use, and consequently theatre efficiency. However, the reality is that the major concerns of impact of service did not occur to the levels that were expected. Cite this article: Bone Jt Open 2021;2(10):886-892.

Implementation of an enhanced recovery protocol at a safety net hospital : a silver lining to COVID-19?

AIMS: This study aimed to evaluate whether an enhanced recovery protocol (ERP) for arthroplasty established during the COVID-19 pandemic at a safety net hospital can be associated with a decrease in hospital length of stay (LOS) and an increase in same-day discharges (SDDs) without increasing acute adverse events. METHODS: A retrospective review of 124 consecutive primary arthroplasty procedures performed after resuming elective procedures on 11 May 2020 were compared to the previous 124 consecutive patients treated prior to 17 March 2020, at a single urban safety net hospital. Revision arthroplasty and patients with < 90-day follow-up were excluded. The primary outcome measures were hospital LOS and the number of SDDs. Secondary outcome measures included 90-day complications, 90-day readmissions, and 30day emergency department (ED) visits. RESULTS: The mean LOS was significantly reduced from 2.02 days (SD 0.80) in the pre-COVID cohort to 1.03 days (SD 0.65) in the post-COVID cohort (p < 0.001). No patients in the pre-COVID group were discharged on the day of surgery compared to 60 patients (48.4%) in the post-COVID group (p < 0.001). There were no significant differences in 90-day complications (13.7% (n = 17) vs 9.7% (n = 12); p = 0.429), 30-day ED visits (1.6% (n = 2) vs 3.2% (n = 4); p = 0.683), or 90-day readmissions (2.4% (n = 3) vs 1.6% (n = 2); p = 1.000) between the pre-COVID and post-COVID groups, respectively. CONCLUSION: Through use of an ERP, arthroplasty procedures were successfully resumed at a safety net hospital with a shorter LOS and increased SDDs without a difference in acute adverse events. The resulting increase in healthcare value therefore may be considered a 'silver lining' to the moratorium on elective arthroplasty during the COVID-19 pandemic. These improved efficiencies are expected to continue in post-pandemic era. Cite this article: Bone Jt Open 2021;2(10):871-878.

Telemedicine in orthopaedic surgery during the COVID-19 pandemic : patient attitudes and barriers.

AIMS: This study assesses patient barriers to successful telemedicine care in orthopaedic practices in a large academic practice in the COVID-19 era. METHODS: In all, 381 patients scheduled for telemedicine visits with three orthopaedic surgeons in a large academic practice from 1 April 2020 to 12 June 2020 were asked to participate in a telephone survey using a standardized Institutional Review Board-approved script. An unsuccessful telemedicine visit was defined as patient-reported difficulty of use or reported dissatisfaction with teleconferencing. Patient barriers were defined as explicitly reported barriers of unsatisfactory visit using a process-based satisfaction metric. Statistical analyses were conducted using analysis of variances (ANOVAs), ranked ANOVAs, post-hoc pairwise testing, and chi-squared independent analysis with 95% confidence interval. RESULTS: The survey response rate was 39.9% (n = 152). The mean age of patients was 51.1 years (17 to 85), and 55 patients (38%) were male. Of 146 respondents with completion of survey, 27 (18.5%) reported a barrier to completing their telemedicine visit. The majority of patients were satisfied with using telemedicine for their orthopaedic appointment (88.8%), and found the experience to be easy (86.6%). Patient-reported barriers included lack of proper equipment/internet connection (n = 13; 8.6%), scheduling difficulty (n = 2; 1.3%), difficulty following directions (n = 10; 6.6%), and patient-reported discomfort (n = 2; 1.3%). Barriers based on patient characteristics were age > 61 years, non-English primary language, inexperience with video conferencing, and unwillingness to try telemedicine prior to COVID-19. CONCLUSION: The barriers identified in this study could be used to screen patients who would potentially have an unsuccessful telemedicine visit, allowing practices to provide assistance to patients to reduce the risk of an unsuccessful visit. Cite this article: Bone Jt Open 2021;2(9):745-751.

Privacy-preserving chi-squared test of independence for small samples.

BACKGROUND: The importance of privacy protection in analyses of personal data, such as genome-wide association studies (GWAS), has grown in recent years. GWAS focuses on identifying single-nucleotide polymorphisms (SNPs) associated with certain diseases such as cancer and diabetes, and the chi-squared (χ2) hypothesis test of independence can be utilized for this identification. However, recent studies have shown that publishing the results of χ2 tests of SNPs or personal data could lead to privacy violations. Several studies have proposed anonymization methods for χ2 testing with ε-differential privacy, which is the cryptographic community's de facto privacy metric. However, existing methods can only be applied to 2×2 or 2×3 contingency tables, otherwise their accuracy is low for small numbers of samples. It is difficult to collect numerous high-sensitive samples in many cases such as COVID-19 analysis in its early propagation stage. RESULTS: We propose a novel anonymization method (RandChiDist), which anonymizes χ2 testing for small samples. We prove that RandChiDist satisfies differential privacy. We also experimentally evaluate its analysis using synthetic datasets and real two genomic datasets. RandChiDist achieved the least number of Type II errors among existing and baseline methods that can control the ratio of Type I errors. CONCLUSIONS: We propose a new differentially private method, named RandChiDist, for anonymizing χ2 values for an I×J contingency table with a small number of samples. The experimental results show that RandChiDist outperforms existing methods for small numbers of samples.