Responses to the correspondence from McDowell et al.'s on CAM integrative review of health care professionals in New Zealand.

The authors of the manuscript 'Complementary and alternative medicine - practice, attitudes, and knowledge among healthcare professionals in New Zealand: an integrative review' [1] disagree with the assertion by McDowell et al. that our manuscript has extrapolation errors.

Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study.

BACKGROUND: Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care. OBJECTIVE: We sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access. METHODS: In this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Maori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis. RESULTS: We identified five major themes: (1) the 'Significant Impact of CTS' of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; (2) 'Waiting and Paying for Care'- the enacting, relational, and appraising work to avoid long wait times unless paying privately, particularly where quality of care was low, employment relations poor, or injury compensation processes faltered; (3) circumstances of 'Occupation and CTS Onset' whereby the burden of proof to relate onset of CT symptoms to occupation created excessive relational and enacting work; (4) the 'Information Scarcity' of good information about CTS and the high relational and appraising work associated with using online resources; (5) 'Negotiating Telehealth Perspectives' where telehealth was valued if it meant earlier access for all despite the challenges it held for many. CONCLUSION: Quality, culturally and linguistically responsive information and communication from clinicians and health services will improve equitable early access to CTS care including realising the potential of telehealth modes of care. Policy changes that reduce individual burden of proof in injury compensation claims processes, enable time off work to attend health appointments, and increase public funding for surgical resources would improve early access to CTS care particularly for Maori and Pacific populations and those in small and rural workplaces. NPT is valuable for understanding where opportunities lie to reduce inequitable delays to accessing care including the impact of racism, particularly for populations more likely to underutilise care.

Acupoints sensitization in people with and without chronic low back pain:A matched-sample cross-sectional study.

BACKGROUND: Acupoints are considered a dynamic functional area, which can reflect the internal condition of the body. In pathological states, disease-related acupoints are believed to be activated, which is known as acupoint sensitization. OBJECTIVE: This study aimed to investigate the major manifestations of acupoint sensitization in patients with chronic low back pain (cLBP) to provide better understanding of acupoint sensitization phenomena in the context of cLBP. METHODS: This study was a matched-sample cross-sectional study 16 participants diagnosed with cLBP and 16 healthy controls matched in age, sex, and ethnicity were included. The following aspects of sensitization phenomena of targeted points were compared: pressure pain threshold (PPT), skin temperature, surface electrical conductance, receptive field, and morphological change of skin. RESULTS: PPT at points of interest were significantly lower in cLBP participants compared with healthy controls (P< 0.05); in addition, receptive field was found to be larger at left BL 23 in cLBP participants (P< 0.05). There was no statistically significant difference in skin temperature, electrical conductance, or morphology between the two groups. CONCLUSIONS: Reduced PPT at all detected points and enlarged receptive field at left BL 23 were found in cLBP participants. These two features appear key in defining acupoint sensitization in cLBP, and provide evidence for selecting and locating acupuncture points in future clinical studies.

Clinical conversations in the management of chronic musculoskeletal pain in vulnerable patient populations: a meta-ethnography.

PURPOSE: The purpose of this meta-ethnography was to synthesize the research exploring patient/provider perceptions of clinical conversations (CC) centered on chronic musculoskeletal pain (CMP) in vulnerable adult populations. MATERIALS AND METHODS: A systematic search for qualitative/mixed method studies in CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used PRIMSA-P guidelines. Data synthesis used eMERGe guidelines; findings were presented in nested hierarchal theoretical frameworks. RESULTS: The included studies explored patients' (n = 18), providers' (n = 2), or patients' and providers' perspectives (n = 5) with diversity in patient participants represented (n = 415): immigrants, indigenous people, women, and veterans. Themes for each level of the nested hierarchal models revealed greater complexity in patients' perceptions about the CC in CMP relative to clinicians' perceptions. A unique finding was sociopolitical/historical factors can influence CC for vulnerable populations. CONCLUSION: The combined nested hierarchical models provided insight into the need for clinicians to be aware of the broader array of influences on the CC. Key themes indicated that improving continuity of care and cultural training are needed to improve the CC. Additionally, due to patients' perception of how healthcare systems' policies influence the CC, patients should be consulted to guide the change needed to improve inequitable outcomes.IMPLICATIONS FOR REHABILITATIONHealthcare providers wishing to improve the clinical conversation in chronic musculoskeletal pain can more broadly explore potential factors influencing patients' experiences and perceptions.Screening during the clinical conversation can include assessing for sociopolitical and historical influences on patients' experiences with chronic musculoskeletal pain.Healthcare providers can explore how to minimize disjointed care in an effort to improve the clinical conversation and outcomes in chronic musculoskeletal pain.Healthcare providers and patients can work together to improve inequitable outcomes for vulnerable adults with chronic musculoskeletal pain.This may include cultural training for healthcare providers that is informed by patients.

Views of men with Parkinson's disease regarding physical activity health messaging.

BACKGROUND: Many men with Parkinson's Disease (PD) do not meet the recommended levels of physical activity (PA) for health benefits. Tailored, meaningful, and culturally sensitive PA health messages may be a catalyst to shape men's motivations toward participation. OBJECTIVE: We explored the views of New Zealand (NZ) men with PD about existing PA health messages, and how these could be adapted to be more effective. METHODS: This qualitative study recruited six community dwelling, regularly physically active, NZ European men with PD (aged 54-69 years, 2-18 years post-diagnosis) from a community exercise class in Canterbury, NZ. Participants engaged in semi-structured interviews which were audio-recorded, transcribed verbatim, and analyzed inductively for themes. RESULTS: Participants expressed that effective PA health messages should reflect men's motivations for PA which included physical and mental well-being and social connection. Inclusive, positive, and relatable language and imagery were considered crucial PA message communication strategies. Participants viewed health professionals' PA advice as superficial and unhelpful; however, celebrities with PD were considered inspirational messengers. Messages endorsed by trustworthy sources, such as the Parkinson's Society, were perceived to enhance the credibility. CONCLUSIONS: Effective PA messages should be gain framed and tailored to the target audience. We recommend health professionals provide comprehensive PA advice or consider onward referral. Future research which uses a co-design participatory methodology to collaborate with men with PD from culturally diverse backgrounds and represent all stages of PA behaviour change is recommended to provide comprehensive insights for meaningful, effective, and culturally sensitive PA health messaging.

The impact of offering multiple cervical screening options to women whose screening was overdue in Dumfries and Galloway, Scotland.

Most women who develop cancer have not been screened regularly. One in four women in Scotland, is overdue for cervical screening. Aim was to assess the impact of offering multiple cervical screening options to women whose screening is overdue. A prospective cohort study including all women whose screening was overdue, aged 30-60 years in Dumfries and Galloway in 2012. Potentially eligible women (n = 4146) were identified split into six groups. Women aged 30-55 years were allocated to three different groups. Group 1 (letter, n = 1246), Group 2 (letter and kit, n = 221), Group 3 (letter, n = 2031). Women aged 56-60 years were allocated to: Group 4 (letter, n = 292), Group 5 (letter and kit, n = 292) and Group 6 (control, n = 64). Women who self-collected a vaginal sample were requested to complete a questionnaire. The percentages of women responding were 24 % (21-26), 32 % (25-38), 16 % (14-18), 15 % (11-20) and 12 % (9-17) in groups 1 to 5 respectively, compared with 3 % (0-11) among controls. A significantly higher number of women (n = 383, 10 % of 3815) opted for self-sampling in comparison with undergoing a cervical screening test (CST) at the GP practice (n = 197, 5 %, x2 = 59.0, p < 0.0001). The Evalyn® Brush was well accepted (218/313 = 70 %) by those who requested self-sampling. Almost all (265/272 = 97 %) women who self-collected a vaginal sample said that if they had the option of self-sampling, they would regularly participate in future cervical screening. Offering more flexible screening options, self-sampling in particular, appears to increase cervical screening participation.

Effect of initial infection size on a network susceptible-infected-recovered model.

We consider the effect of a nonvanishing fraction of initially infected nodes (seeds) on the susceptible-infected-recovered epidemic model on random networks. This is relevant when the number of arriving infected individuals is large, or to the spread of ideas with publicity campaigns. This model is frequently studied by mapping to a bond percolation problem, in which edges are occupied with the probability p of eventual infection along an edge. This gives accurate measures of the final size of the infection and epidemic threshold in the limit of a vanishingly small seed fraction. We show, however, that when the initial infection occupies a nonvanishing fraction, f, of the network, this method yields ambiguous results, as the correspondence between edge occupation and contagion transmission no longer holds. We propose instead to measure the giant component of recovered individuals within the original contact network. We derive exact equations for the size of the epidemic and the epidemic threshold in the infinite size limit in heterogeneous sparse random networks, and we confirm them with numerical results. We observe that the epidemic threshold correctly depends on f, decreasing as f increases. When the seed fraction tends to zero, we recover the standard results.

Hidden transition in multiplex networks.

Weak multiplex percolation generalizes percolation to multi-layer networks, represented as networks with a common set of nodes linked by multiple types (colors) of edges. We report a novel discontinuous phase transition in this problem. This anomalous transition occurs in networks of three or more layers without unconnected nodes, [Formula: see text]. Above a critical value of a control parameter, the removal of a tiny fraction [Formula: see text] of nodes or edges triggers a failure cascade which ends either with the total collapse of the network, or a return to stability with the system essentially intact. The discontinuity is not accompanied by any singularity of the giant component, in contrast to the discontinuous hybrid transition which usually appears in such problems. The control parameter is the fraction of nodes in each layer with a single connection, [Formula: see text]. We obtain asymptotic expressions for the collapse time and relaxation time, above and below the critical point [Formula: see text], respectively. In the limit [Formula: see text] the total collapse for [Formula: see text] takes a time [Formula: see text], while there is an exponential relaxation below [Formula: see text] with a relaxation time [Formula: see text].

Somatosensory assessments in patients with inflammatory bowel disease: a cross-sectional study examining pain processing pathways and the role of multiple patient factors.

BACKGROUND: Pain affects the majority of patients with inflammatory bowel disease (IBD), where pain experiences may be influenced by multiple patient factors and changes within central pain processing pathways, termed central sensitization. The current study aimed to investigate pain processing pathways in patients with IBD through somatosensory testing and associations with multiple patient factors. METHODS: A cross-sectional study of adults with IBD. Assessments included: somatosensory tests [i.e. pressure pain thresholds (PPT), temporal summation (TS), conditioned pain modulation (CPM)], and patient factors (i.e. demographics, comorbidity, sleep quality, psychological, pain severity and interference, and IBD features). Multiple regression analyses explored associations between somatosensory tests and multiple patient factors. RESULTS: Decreased CPM in participants (N = 51) was associated with worse abdominal pain severity and use of biologic therapies (R2 = 0.30, F(5,44) = 5.18, P = 0.001). Increased TS was associated with biologic use (R2 = 0.11, F(1,49) = 6.13, P = 0.017). Decreased PPT at the low back (R2 = 0.29, F(2,48) = 11.21, P < 0.001) and Tibialis anterior (R2 = 0.41, F(2,48) = 18.26, P < 0.001) were associated with female sex and the absence of a stoma. CONCLUSION: Study results demonstrated associations between multiple patient factors and somatosensory tests in patients with IBD. The absence of a stoma and female sex was associated with greater sensitivity to pressure in two remote body regions, suggestive of widespread hyperalgesia. Worse abdominal pain severity and biologic use were associated with decreased pain inhibition, and biologic use was also associated with increased pain facilitation. These findings suggest the presence of altered pain processing and mechanisms of central sensitization in patients with IBD.

Patient and Provider Attitudes, Beliefs, and Biases That Contribute to a Marginalized Process of Care and Outcomes in Chronic Musculoskeletal Pain: A Systematic Review-Part I: Clinical Care.

OBJECTIVE: Chronic musculoskeletal pain (CMP) outcomes are affected by numerous variables, including the clinical conversation. When good therapeutic/working alliances are formed, congruent clinical conversations can lead to improved CMP outcomes. Identifying patient/provider attitudes, beliefs, and biases in CMP that can influence the clinical conversation, and thus clinical management decisions, is foundationally important. DESIGN: The aims of this systematic review were to 1) summarize the evidence of the attitudes and beliefs of patients and health care providers (HCPs) involved in the clinical conversation about CMP, and 2) examine whether and how these perceptions impacted the process of care. METHODS: A systematic search of CINAHL, PubMed, Scopus, Sociology Database in ProQuest, and Web of Science used the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Included studies were those investigating vulnerable adult populations with chronic pain. Study bias was examined with the Downs and Black tool. RESULTS: Seven retrospective studies were included. When making pharmaceutical management decisions, HCPs demonstrated negative implicit biases toward minorities and women. When making referrals to multidisciplinary care, HCPs demonstrated negative implicit biases toward women with lower educational attainment. Unmet patient expectations resulted in higher dropout rates at multidisciplinary pain management programs. Patients' trust was influenced by the health care setting, and patients often had limited options secondary to health insurance type/status. CONCLUSION: These findings suggest that patients with CMP may experience a marginalized process of care due to HCPs' negative implicit biases, unmet patient expectations, and the health care setting. Results suggest several factors may contribute to inequitable care and the recalcitrant nature of CMP, particularly in vulnerable populations with limited health care choices.

Characterization of tissue types in basal cell carcinoma images via generative modeling and concept vectors.

The promise of machine learning methods to act as decision support systems for pathologists continues to grow. However, central to their successful adoption must be interpretable implementations so that people can trust and learn from them effectively. Generative modeling, most notable in the form of adversarial generative models, is a naturally interpretable technique because the quality of the model is explicit from the quality of images it generates. Such a model can be further assessed by exploring its latent space, using human-meaningful concepts by defining concept vectors. Motivated by these ideas, we apply for the first time generative methods to histological images of basal cell carcinoma (BCC). By simultaneously learning to generate and encode realistic image patches, we extract feature rich latent vectors that correspond to various tissue morphologies, namely BCC, epidermis, keratin, papillary dermis and inflammation. We show that a logistic regression model trained on these latent vectors can achieve high classification accuracies across 6 binary tasks (86-98%). Further, by projecting the latent vectors onto learned concept vectors we can generate a score for the absence or degree of presence for a given concept, providing semantically accurate "conceptual summaries" of the various tissues types within a patch. This can be extended to generate multi-dimensional heat maps for whole-image specimens, which characterizes the tissue in a similar way to a pathologist. We additionally find that accurate concept vectors can be defined using a small labeled dataset.

Symptoms of central sensitization in patients with inflammatory bowel diseases: a case-control study examining the role of musculoskeletal pain and psychological factors.

OBJECTIVES: Musculoskeletal (MSK) pain is a common complaint in patients with inflammatory bowel diseases (IBD). MSK pain in IBD has previously demonstrated association with symptoms of central sensitization; however it is uncertain whether these symptoms are influenced simply by the presence of MSK pain and/or IBD. Primary aim of this study was to investigate whether symptoms of central sensitization differed across three groups: IBD patients with and without MSK pain and healthy controls. Secondary aim was to investigate between-group differences for measures of somatosensory functioning. METHODS: Cross-sectional study was performed on adults with IBD. Assessments included: central sensitization inventory (CSI), pressure pain threshold, temporal summation, conditioned pain modulation, perceived stress, affect style, anxiety, depression, and pain catastrophizing. One-way analyses of variance and covariance were used to investigate between-group differences for measures of central sensitization and potential confounding by psychological factors. RESULTS: Study participants (n=66) were age/gender matched across three study groups. Between-group differences were solely demonstrated for CSI scores [F(2,63)=19.835, p<0.001, r=0.62], with IBD patients with MSK pain demonstrating the highest CSI scores and healthy controls the lowest. After controlling for individual psychological features, post hoc comparisons indicated that CSI scores were significantly different between-groups (p≤0.025) after controlling for most psychological variables, with the exception of perceived stress (p=0.063) and pain catastrophizing (p=0.593). CONCLUSIONS: IBD patients as a whole demonstrated significantly greater symptoms of central sensitization compared to healthy controls. However, IBD patients with persistent MSK pain demonstrated the greatest symptoms of central sensitization compared to patients without MSK pain and healthy controls. Between-group differences for CSI in IBD patients with MSK were not confounded by psychological features. IMPLICATIONS: Study results indicate that persistent MSK pain in IBD represents patients with greater central sensitization symptomology. This increased symptomology is suggestive of underlying mechanisms related to central sensitization, highlighting patient potentially at risk for worse pain experiences.

Criterion validity and discriminatory ability of the central sensitization inventory short form in individuals with inflammatory bowel diseases.

OBJECTIVES: Increased symptoms related to central sensitization have previously been reported in inflammatory bowel disease (IBD) patients, identified by the original central sensitization inventory (CSI-25). However, the recently developed CSI short form (CSI-9) may be more clinically useful. The aim of the present study was to evaluate the performance of CSI-9 compared to the original CSI-25 in individuals with IBD. Study objectives were to investigate the criterion validity of the CSI-9 to the CSI-25, assess individual association of the CSI measures with clinical features of IBD and pain presentations, and to establish disease-specific CSI-9 and CSI-25 cut-off scores for discriminating the presence of self-reported pain in individuals with IBD. METHODS: Cross-sectional online survey was performed on adults with IBD exploring self-reported demographics, comorbidity, and clinical IBD and pain features. Criterion validity of the CSI-9 was investigated using intraclass correlation coefficient (ICC)3,1. Area under the receiver operating characteristic curve (AUC-ROC) analysis was conducted to investigate the discriminative ability of both versions of CSI. RESULTS: Of the 320 participants, 260 reported the presence of abdominal and/or musculoskeletal pain. CSI-9 and CSI-25 demonstrated substantial agreement (ICC3,1=0.64, 95% CI [0.58, 0.69]). AUC (95% CI) indicated that CSI-9 (0.788 (0.725, 0.851), p<0.001) and CSI-25 (0.808 (0.750, 0.867), p<0.001) were able to adequately discriminate the presence of pain using cut-offs scores of ≥17 (CSI-9) and ≥40 (CSI-25). Abdominal pain severity was the only feature to differ in significant association to CSI-25 (p=0.002) compared to CSI-9 (p=0.236). All other features demonstrated significant associations to both CSI versions, except age (p=0.291 and 0.643) and IBD subtype (p=0.115 and 0.675). CONCLUSIONS: This is the first study to explore and validate the use of CSI-9 in IBD patients. Results demonstrated concurrent validity of the CSI-9 to CSI-25, with similar significant association to multiple patient features, and a suggested cut-off value of 17 on CSI-9 to screen for individuals with pain experiences. Study findings suggest that CSI-9 is suitable to use as a brief tool in IBD patients.

Opportunities in cancer imaging: risk-adapted breast imaging in screening.

In the UK, women between 50-70 years are invited for 3-yearly mammography screening irrespective of their likelihood of developing breast cancer. The only risk adaption is for women with >30% lifetime risk who are offered annual magnetic resonance imaging (MRI) and mammography, and annual mammography for some moderate-risk women. Using questionnaires, breast density, and polygenic risk scores, it is possible to stratify the population into the lowest 20% risk, who will develop <4% of cancers and the top 4%, who will develop 18% of cancers. Mammography is a good screening test but has low sensitivity of 60% in the 9% of women with the highest category of breast density (BIRADS D) who have a 2.5- to fourfold breast cancer risk. There is evidence that adding ultrasound to the screening mammogram can increase the cancer detection rate and reduce advanced stage interval and next round cancers. Similarly, alternative tests such as contrast-enhanced mammography (CESM) or abbreviated MRI (ABB-MRI) are much more effective in detecting cancer in women with dense breasts. Scintimammography has been shown to be a viable alternative for dense breasts or for follow-up in those with a personal history of breast cancer and scarring as result of treatment. For supplemental screening to be worthwhile in these women, new technologies need to reduce the number of stage II cancers and be cost effective when tested in large scale trials. This article reviews the evidence for supplemental imaging and examines whether a risk-stratified approach is feasible.

Complementary and alternative medicine - practice, attitudes, and knowledge among healthcare professionals in New Zealand: an integrative review.

BACKGROUND: The prevalence of CAM use is increasing. This integrative review investigated New Zealand healthcare professionals' practice of, attitudes toward, and knowledge about complementary and alternative medicine (CAM). METHODS: Literature search was conducted in four databases from inception to April 2020. Studies were included if they reported results from primary data collection on practice of, attitudes toward, or knowledge about CAM amongst New Zealand healthcare professionals. RESULTS: Eleven studies (two of 'high-quality', seven of 'moderate-quality', and two of 'low-quality') were identified with 2060 healthcare professionals including general practitioners (GPs), nurses, midwives, pharmacists, physiotherapists, and medical specialists. New Zealand healthcare professionals were generally positive regarding CAM use, but have concerns on the scientific evidence, regulation, safety, financial costs of CAM, and encourage an evidence-based CAM practice and stronger CAM regulation. Findings indicated that around 25% of GPs practise CAM, and 82.3% refer patients to CAM practitioners. When treating pregnant women, 48.4% of physiotherapists practise acupuncture, and 37.3% of midwives recommend CAM. GPs believe that acupuncture is the most helpful CAM modality, and most commonly practiced and referred patients to acupuncture. Up to 58% of GPs and Plunket nurses wanted to receive further education on CAM, and up to 66.7% GPs favour the idea CAM should be included in medical curriculums. CONCLUSIONS: Nine of the 11 included studies were of moderate to high quality, thus enhancing the reliability of the review findings. In order to better manage CAM in New Zealand New Zealand clinical settings, there is a need to invest in CAM research and education, and enhance CAM regulation. This review is a first step in developing an evidence base to offer insights for further development of effective CAM policies regarding safety, efficacy, regulation and integration in New Zealand.

A randomized controlled trial investigating effects of an individualized pedometer driven walking program on chronic low back pain.

BACKGROUND: Walking is an easily prescribed physical activity for people with low back pain (LBP). However, the evidence for its effectiveness to improve pain and disability levels for people with chronic low back pain (CLBP) within a community setting has not been evaluated. This study evaluates the effectiveness of a clinician guided, pedometer-driven, walking intervention for increasing physical activity and improving clinical outcomes compared to education and advice. METHODS: Randomized controlled trial recruiting N = 174 adults with CLBP. Participants were randomly allocated into either a standardized care group (SG) or pedometer based walking group (WG) using minimization allocation with a 2:1 ratio to the WG. Prior to randomization all participants were given a standard package of education and advice regarding self-management and the benefits of staying active. Following randomization the WG undertook a physiotherapist guided pedometer-driven walking program for 12 weeks. This was individually tailored by weekly negotiation of daily step targets. Main outcome was the Oswestry Disability Index (ODI) recorded at baseline, 12 weeks, 6 and 12 months. Other outcomes included, numeric pain rating, International Physical Activity Questionnaire (IPAQ), Fear-Avoidance Beliefs Questionnaire (FABQ), Back Beliefs questionnaire (BBQ), Physical Activity Self-efficacy Scale, and EQ-5D-5L quality of life estimate. RESULTS: N = 138 (79%) participants completed all outcome measures at 12 weeks reducing to N = 96 (55%) at 12 months. Both observed and intention to treat analysis did not show any statistically significant difference in ODI change score between the WG and the SG at all post-intervention time points. There were also no significant between group differences for change scores in all secondary outcome measures. Post hoc sensitivity analyses revealed moderately disabled participants (baseline ODI ≥ 21.0) demonstrated a greater reduction in mean ODI scores at 12 months in the WG compared to SG, while WG participants with a daily baseline step count < 7500 steps demonstrated a greater reduction in mean ODI scores at 12 weeks. CONCLUSIONS: Overall, we found no significant difference in change of levels of (ODI) disability between the SG and WG following the walking intervention. However, ODI responses to a walking program for those with moderate levels of baseline disability and those with low baseline step count offer a potential future focus for continued research into the benefit of walking as a management strategy for chronic LBP. TRIAL REGISTRATION: United States National Institutes of Health Clinical Trails registry (http://ClinicalTrials.gov/) No. NCT02284958 (27/10/2014).

Impact of Thumb Carpometacarpal Joint Osteoarthritis: A Pragmatic Qualitative Study.

OBJECTIVE: First carpometacarpal (CMC1) joint osteoarthritis (OA) is typically understood as part of the disease entity of hand OA. However, CMC1 joint OA often occurs in isolation or is a primary source of symptoms. The aim of the current study was to explore the experiences of New Zealanders with CMC1 joint OA to better understand the unique impact of this condition, ascertain outcomes of importance, and identify treatment targets. METHODS: In this pragmatic qualitative study, patients who either reported a history suggestive of CMC1 joint OA or had been diagnosed by a physician were recruited from health and community settings in 2 centers on the South Island of New Zealand. Thirty participants (11 men and 19 women, mean ± SD age 65.4 ± 11.36 years) took part in individual face-to-face interviews and kept diaries. The interviews were audio recorded, and along with the diaries, transcribed. Data were analyzed by thematic analysis using a primarily inductive approach. The Health Impact Model was employed to help with interpretation of the results. RESULTS: Five interrelated levels of health impact were identified: symptom status, functional limitations, restrictions in social activities and roles, negative thoughts and feelings, and an altered sense of self. Constant pain and pain at night were key symptoms that were associated with impact at the other levels. CONCLUSION: Constant pain, pain at night, functional capacity, medication burden, emotional impact, and sense of self are important outcomes and treatment targets in people with CMC1 joint OA.

A meta-analysis comparing the diagnostic performance of abbreviated MRI and a full diagnostic protocol in breast cancer.

AIM: To undertake a meta-analysis of the diagnostic performance of abbreviated (ABB) magnetic resonance imaging (MRI) and full diagnostic protocol MRI (FDP-MRI) in breast cancer. MATERIALS AND METHODS: This meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Diagnostic Test Accuracy (PRISMA-DTA) guidelines. The PubMed and EMBASE databases were searched through August 2019 for studies comparing the diagnostic performance of ABB-MRI and FDP-MRI in the breast. Studies were reviewed by two authors independently according to eligibility and exclusion criteria and split into two subgroups (screening population studies and studies using cohorts enriched with known cancers) to avoid bias. Quality assessment and bias for diagnostic accuracy was determined with Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). The diagnostic accuracy for each subgroup was pooled using a bivariate random effects model and summary receiver operating characteristic (sROC) curves produced. Sensitivities and specificities were compared using a paired t-test. RESULTS: Five screening (62/2,588 cancers/patients) and eight enriched cohort (540/1,432 cancers/patients) studies were included in the meta-analysis. QUADAS-2 assessment showed a low risk of bias in most studies. The pooled sensitivity/specificity/area under the receiver operating characteristic curve (AUC) for screening studies was 0.90/0.92/0.94 for ABB-MRI and 0.92/0.95/0.97 for FDP-MRI. The pooled sensitivity/specificity/AUC for enriched cohort studies was 0.93/0.83/0.94 for ABB-MRI and 0.93/0.84/0.95 for FDP-MRI. There was no significant difference in sensitivity or specificity using ABB-MRI or FDP-MRI (p=0.18 and 0.27, p=0.18 and 0.93, respectively). CONCLUSION: The diagnostic performances of the ABB-MRI and FDP-MRI protocols used in either screening or enriched cohorts were comparable. There was a large variation in patient population, study methodology, and abbreviated protocols reported.

Filtering Statistics on Networks.

Compression, filtering, and cryptography, as well as the sampling of complex systems, can be seen as processing information. A large initial configuration or input space is nontrivially mapped to a smaller set of output or final states. We explored the statistics of filtering of simple patterns on a number of deterministic and random graphs as a tractable example of such information processing in complex systems. In this problem, multiple inputs map to the same output, and the statistics of filtering is represented by the distribution of this degeneracy. For a few simple filter patterns on a ring, we obtained an exact solution of the problem and numerically described more difficult filter setups. For each of the filter patterns and networks, we found three key numbers that essentially describe the statistics of filtering and compared them for different networks. Our results for networks with diverse architectures are essentially determined by two factors: whether the graphs structure is deterministic or random and the vertex degree. We find that filtering in random graphs produces much richer statistics than in deterministic graphs, reflecting the greater complexity of such graphs. Increasing the graph's degree reduces this statistical richness, while being at its maximum at the smallest degree not equal to two. A filter pattern with a strong dependence on the neighbourhood of a node is much more sensitive to these effects.

Exotic critical behavior of weak multiplex percolation.

We describe the critical behavior of weak multiplex percolation, a generalization of percolation to multiplex or interdependent networks. A node can determine its active or inactive status simply by referencing neighboring nodes. This is not the case for the more commonly studied generalization of percolation to multiplex networks, the mutually connected clusters, which requires an interconnecting path within each layer between any two vertices in the giant mutually connected component. We study the emergence of a giant connected component of active nodes under the weak percolation rule, finding several nontypical phenomena. In two layers, the giant component emerges with a continuous phase transition, but with quadratic growth above the critical threshold. In three or more layers, a discontinuous hybrid transition occurs, similar to that found in the giant mutually connected component. In networks with asymptotically powerlaw degree distributions, defined by the decay exponent γ, the discontinuity vanishes but at γ=1.5 in three layers, more generally at γ=1+1/(M-1) in M layers.