Social media and postsecondary student adoption of mental health labels: protocol for a scoping review.

INTRODUCTION: Many postsecondary students use social media at an age when mental health issues often arise for the first time. On social media, students describe their mental states or social interactions using psychiatric language. This is a process of mental health labelling as opposed to receiving a formal diagnosis from a psychiatrist. Despite substantial literature on psychiatric labelling effects such as stigma, little research has addressed the mechanisms and effects of labelling through social media. Our objective is to summarise the existing evidence to address this gap. METHODS AND ANALYSIS: This review includes articles in English published since 1995 on how postsecondary students interact with mental health labels in their use of social media. We will consider empirical studies and theses. The search strategy includes SCOPUS, PubMed, OVID MEDLINE (to access APA PsycINFO), Web of Science and ProQuest Global Dissertations and Theses. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extensions for protocols and Scoping Reviews guidelines. The artificial intelligence application, Connected Papers, will assist in identifying additional references. The outcomes of interest are labelling by self or others and changes in self-concept and presentation associated with these labels. Two researchers will independently identify the included studies and extract data, solving disagreements with a third opinion. We will produce tables and narrative descriptions of the operationalisation and measurement methods of labelling and social media use, reported effects and uses of labelling, and explanatory mechanisms for the adoption of labels. ETHICS AND DISSEMINATION: This literature review does not require ethics approval. The researchers will present their findings for publication in an open-access peer-reviewed journal and at student/scientific conferences. Potential knowledge users include university students, social media users, researchers, mental health professionals and on-campus mental health services.

Detecting Risky Authentication Using the OpenID Connect Token Exchange Time.

With the rise in sophisticated cyber threats, traditional authentication methods are no longer sufficient. Risk-based authentication (RBA) plays a critical role in the context of the zero trust framework-a paradigm shift that assumes no trust within or outside the network. This research introduces a novel proposal as its core: utilization of the time required by OpenID Connect (OIDC) token exchanges as a new RBA feature. This innovative approach enables the detection of tunneled connections without any intervention from the user's browser or device. By analyzing the duration of OIDC token exchanges, the system can identify any irregularities that may signify unauthorized access attempts. This approach not only improves upon existing RBA frameworks but is also in alignment with the broader movement toward intelligent and responsive security systems.

Systematic Comparison of Ligament Reconstruction With Tendon Interposition and Suture-Button Suspensionplasty for Trapeziometacarpal Osteoarthritis.

Ligament reconstruction tendon interposition (LRTI) and suture-button suspensionplasty (SBS) are both common treatment options for trapeziometacarpal osteoarthritis. The primary purpose of this systematic review was to compare the subjective improvement in patient-reported outcomes in regard to disability for patients undergoing LRTI and SBS for trapeziometacarpal osteoarthritis. A secondary purpose was to compare the subjective improvement, objective outcome scores, and complication rates following both procedures. We performed a systematic review using PubMed, Scopus, and Embase to compare the clinical outcomes of LRTI and SBS. Inclusion criteria were level I-IV evidence articles reporting postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) or QuickDASH scores. Study methodological quality, risk of bias, and recommendation strength were assessed. This systematic review included 31 studies for final analysis with 1289 thumbs undergoing LRTI (25 studies) and 113 thumbs undergoing SBS (6 studies). Both procedures demonstrated similar improvement in DASH and/or QuickDASH scores, while key pinch and grip strength inconsistently improved following both procedures. Complication rate was similar between the 2 procedures; LRTI 12% and SBS 13%. Although both LRTI and SBS seem to provide improved short-term patient-reported functional improvement and objective strength, there was significant heterogeneity within the included studies, and those studies discussing SBS were of lower quality evidence than those of LRTI. Thus, to truly delineate whether a difference exists between these 2 techniques for the treatment of first carpometacarpal joint arthritis, larger prospectively designed studies of high-quality evidence are necessary.

Effects of COVID-19 on Geographical Trends in the Orthopaedic Surgery Residency Match.

Historically, medical students often match within the same geographic location or to an orthopaedic surgery residency program affiliated with their medical school. The objective of this investigation was to determine differences in geographic trends between orthopaedic residents matching before and during the Coronavirus-19 (COVID-19) pandemic. METHODS: This study analyzed 2 groups of orthopaedic residents: Pre-COVID cohort (years 2016-2020) and COVID-impacted cohort (year 2021). A list of accredited orthopaedic surgery residency programs (n = 202) was obtained. Orthopaedic residency program webpages were located (region [n = 4], division [n = 9], state [n = 50]). For each resident, their medical school and year of postgraduate training were recorded. Year 2021 resident information was obtained from the orthopaedic residency program webpages, social media accounts, and medical school match lists. Residency programs affiliated with a medical school were also assigned. Descriptive statistics were performed. Two sample Student t tests with Bonferroni correction applied to p-values (α < 0.05 significant) were performed. RESULTS: There were 4,832 residents analyzed (4,074 in Pre-COVID cohort; 758 in COVID-impacted cohort [758/868 of all positions in 2021 Match]). Statistically significant differences were detected between the COVID-impacted cohort (39.6%, p < 0.001) matching in the same state as their medical school (Pre-COVID 33.1%) and the COVID-impacted cohort (28.0%, p < 0.001) matching to a residency program affiliated with their medical school (Pre-COVID 21.2%). In the COVID-impacted cohort, students who matched in state matched to their home program more frequently (69.3%) compared with the Pre-COVID cohort (60.5%). Geographically, there was a difference in the COVID-impacted cohort (52.5%, p < 0.011) matching in the same division (Pre-COVID 47.5%). No statistically significant differences were identified for residents matching to the same region as their medical school (Pre-COVID 60.1%; COVID-impacted 61%, p = 0.968). CONCLUSION: Residents matching in the same state, in the same division, and to a residency program affiliated with their medical school increased significantly in the COVID-impacted cohort. There was no difference between cohorts matching in the same region as their medical school. Level of Evidence: Observational/Cross-Sectional.

[Corrigendum] The cranberry flavonoids PAC DP­9 and quercetin aglycone induce cytotoxicity and cell cycle arrest and increase cisplatin sensitivity in ovarian cancer cells.

Following the publication of this article, an interested reader drew to the author's attention that, in Fig. 5D on p. 1931, the two rightmost panels appeared to have been inverted for the SKOV3 cell line (i.e., the 'Q­aglycone' and 'PAC DP­9' data panels appeared to have been included in this figure the wrong way around). The authors checked the figure, and realized that these panels had indeed erroneously been inverted during the assembly of the figure. The corrected version of Fig. 5 is shown on the next page. The authors regret that this error was not picked up upon before the paper was sent to press, and thank the Editor of International Journal of Oncology for allowing them the opportunity to publish this corrigendum. Furthermore, they regret any inconvenience caused to the readership. [International Journal of Oncology 46: 1924­1934, 2015; DOI: 10.3892/ijo.2015.2931].

Comprehensive analysis of trends in Medicare utilization and reimbursement in Physical Medicine & Rehabilitation: 2012 to 2017.

INTRODUCTION: There is an absence of literature describing Medicare utilization by physiatrists, despite their key role in treating Medicare enrollees with qualifying disabilities and common neuromusculoskeletal conditions. OBJECTIVE: To analyze Medicare data regarding physiatrists and their beneficiaries, services, and reimbursement, as well as trends in utilization and geographic distribution. DESIGN AND SETTING: Retrospective analysis of publicly available Centers for Medicare & Medicaid Services data for Medicare beneficiaries receiving physiatric services from 2012 to 2017. MAIN OUTCOME MEASURES: After adjustment for inflation, variables assessed for changes over time included provider and beneficiary demographics, total Medicare reimbursement, and the number of services provided, subsequently separated by drug and medical service metrics. Lorenz curves and Gini coefficients were computed to study reimbursement inequality. Choropleth maps were generated to assess geographic differences in physician density and reimbursement, both by state and ZIP code. RESULTS: The number of physiatrists utilizing Medicare increased from 7230 to 7895 from 2012 to 2017, whereas the average number of unique beneficiaries per clinician remained constant (307 vs. 310; p = .51). The beneficiaries' mean hierarchical conditions category (HCC) health risk score, normalized to 1.0 for the average beneficiary, increased significantly from 2012 to 2017 (1.72 vs. 1.80; p < .01). The mean Medicare reimbursement per physiatrist decreased significantly from 2012 to 2017 ($131,960 vs. $117,623; p < .001), whereas the mean number of services remained constant (3243 vs. 3077; p = .132). Botulinum toxin and baclofen injections were the two most reimbursed drug-related services. Gini coefficients ranged from 0.52 to 0.53 for 2012 to 2017, suggesting moderate reimbursement inequality, with the 75th percentile receiving on average two times the median. Both physician density and top earners were concentrated in urban and metropolitan areas. CONCLUSIONS: Despite rising health care costs and the increasing medical complexity of physiatrists' beneficiaries, Medicare payments have decreased over time. These trends are relevant to both providers and policymakers, particularly in light of unequal geographic distribution of physiatrists across the country.

Percutaneous Needle Fasciotomy versus Collagenase Injection for Dupuytren's Contracture: A Systematic Review of Comparative Studies.

Introduction The purpose of this study was to review and compare clinical outcomes between percutaneous needle fasciotomy (PNF) and collagenase Clostridium histolyticum (CCH) injection for the treatment of Dupuytren's contracture. Materials and Methods A systematic review was performed including all level I-III evidence studies investigating the clinical outcomes of PNF and CCH injection in the treatment of Dupuytren's contracture. Results Five studies (278 CCH patients, 225 PNF patients; 285 CCH fingers, 246 PNF fingers, 405 males, and 98 females) were analyzed. Two randomized studies were level I evidence, one randomized study was level II, and two nonrandomized studies were level III. Two studies analyzed a total of 205 patients, each demonstrating statistically superior outcomes in one outcome measure (contracture improvement and Michigan Hand Questionnaire (MHQ) satisfaction subscore) with PNF, while the remaining three studies demonstrated no significant differences in outcomes between the two techniques. Three studies reported a statistically higher rate of minor complications (local pain, edema, ecchymosis, lymphadenopathy, pruritis) with CCH, while the remaining two studies demonstrated no significant difference in complication rates. Conclusion For the treatment of Dupuytren's contracture, there is some evidence that suggests superior clinical outcomes of PNF compared with CCH and a higher minor complication rate with CCH.

On-site Clinical Care for Professional Dance Companies.

Thirty years ago the introduction of on-site health care for professional dance companies was a novel concept and dance medicine clinicians often had limited on-site hours, restricted treatment space, and small budgets. Companies are now developing fully staffed on-site clinics and backstage care that provide a multidisciplinary approach to dancer health and wellness. On-site dance medicine programs focus on holistic dancer health and preventive care rather than just triage and rehabilitation. Best practice recommendations for care of professional dancer patients allow for streamlined patient care within a network of medical professionals who understand the demands of a professional dance career.

The benefits of combining water and land-based therapy.

As the general population ages and lives longer with chronic disease and related disability, an increasing number of individuals may be pre-cluded from participating and excelling in traditional land-based therapy or exercise alone, despite its known benefits. This article discusses the benefits of water as an exercise and therapeutic medium, as well as the value of combining both water and land modalities, which enhance the benefits of exercise synergistically. This combined water and land approach has the potential to help clients achieve greater therapeutic benefits and clinical outcomes. As an example, described in this article are the rationale and basic framework for one treatment paradigm supported by research literature, the Burdenko Method, which has utilized combined exercise in water and on land for over four decades. These perspectives will hopefully foster increased understanding and application of exercise principles and programs outside of traditional land-based approaches.

Readability of Patient Education Materials in Physical Medicine and Rehabilitation (PM&R): A Comparative Cross-Sectional Study.

BACKGROUND: Patients are increasingly using the Internet to access health information. Patient awareness and education are crucial to advancing the field of PM&R, but many U.S. adults have insufficient health literacy skills to read and understand patient education materials (PEM), frequently written at the 10th-15th-grade level. Reading ability is key for health literacy, but no previous research has assessed the readability of PEM provided by professional PM&R societies. OBJECTIVES: Evaluate whether the readability of PM&R PEM meets the NIH-recommended eighth-grade reading level; compare readability of PM&R PEM to two commonly accessed patient resources for sports and rehabilitation medicine topics, handouts from the American Academy of Orthopaedic Surgeons (AAOS) and American Academy of Family Physicians (AAFP), whose readability has been previously analyzed. DESIGN: Cross-sectional study. METHODS: Publicly accessible entries within the patient education section of websites sanctioned by professional PM&R societies, as well as the AAOS and AAFP, were analyzed for readability using two validated and widely used tools, the Flesch-Kincaid Grade Level (FKGL) and Simplified Measure of Gobbledygook (SMOG) formulas. Comparative statistics were performed between the three surveyed specialties. MAIN OUTCOME MEASURES: FKGL and SMOG readability scores, which estimate U.S. grade level, or years of education, needed to comprehend text. RESULTS: A total of 167 online PM&R resources were identified and compared to 94 articles from AAOS and 65 from AAFP. Mean SMOG and FKGL levels exceeded the eighth-grade level for both PM&R (SMOG-9.71, 95% CI 9.42-10.0; FKGL-10.35, 95% CI 9.99-10.7) and AAOS (SMOG-9.15, 95% CI 8.96-9.35; FKGL-9.51, 95% CI 9.29-9.74), whereas AAFP met readability guidelines for both measures (SMOG-7.00, 95% CI 6.74-7.27; FKGL-6.76, 95% CI 6.45-7.07). SMOG and FKGL scores suggested significantly higher reading difficulty for PM&R compared to AAOS (SMOG P = .017; FKGL P = .0001) and AAFP (SMOG P < .0001; FKGL P < .0001). Results indicated that 17% of PM&R resources complied with NIH guidelines, vs 8% for AAOS and 83% for AAFP. CONCLUSIONS: The average readability of PM&R PEM exceeds the NIH-recommended and average U.S. adult eighth-grade reading level. The physiatry community can make its patient materials more comprehensible and accessible for patients by providing resources at a more appropriate reading level.

HLA-B57 micropolymorphism defines the sequence and conformational breadth of the immunopeptidome.

Immunophenotypic differences between closely related human leukocyte antigen (HLA) alleles have been associated with divergent clinical outcomes in infection, autoimmunity, transplantation and drug hypersensitivity. Here we explore the impact of micropolymorphism on peptide antigen presentation by three closely related HLA molecules, HLA-B*57:01, HLA-B*57:03 and HLA-B*58:01, that are differentially associated with the HIV elite controller phenotype and adverse drug reactions. For each allotype, we mine HLA ligand data sets derived from the same parental cell proteome to define qualitative differences in peptide presentation using classical peptide binding motifs and an unbiased statistical approach. The peptide repertoires show marked qualitative overlap, with 982 peptides presented by all allomorphs. However, differences in peptide abundance, HLA-peptide stability, and HLA-bound conformation demonstrate that HLA micropolymorphism impacts more than simply the range of peptide ligands. These differences provide grounds for distinct immune reactivity and insights into the capacity of micropolymorphism to diversify immune outcomes.

Diagnostic Criteria and Clinical Outcomes in Sarcopenia Research: A Literature Review.

By the sixth decade of life, nearly one quarter of the population has substantial muscle atrophy, or sarcopenia. Despite the creation of a standardized definition of sarcopenia by the European Working Group on Sarcopenia in Older People, variability may exist in the diagnostic criteria utilized for clinical sarcopenia research. The primary objectives of this review were to characterize diagnostic criteria used for measurement of sarcopenia in original studies, and to describe associations between sarcopenia and important clinical outcomes. We performed a literature review of the term "sarcopenia" in PubMed. Inclusion criteria were English language, original data, a clear and specific definition for diagnosing sarcopenia, and the analysis of sarcopenia's effect on a clinical outcome. A total of 283 studies met inclusion criteria. More than half of the included sarcopenia investigations were level IV studies (54.1%), while 43.1% provided level II evidence. Under one third (27.6%) of studies examined sarcopenia with regard to surgical outcomes. In terms of diagnostic criteria for sarcopenia, 264 (93.3%) studies used measures of skeletal muscle mass, with dual energy X-ray absorptiometry (DEXA) being the most common modality (43.6%). Sarcopenia was found to be a consistent predictor of chronic disease progression, all-cause mortality, poorer functional outcomes, and postoperative complications. In conclusion, there is substantial evidence that sarcopenia impacts both medical and surgical outcomes. However, current research has utilized heterogeneous diagnostic criteria for sarcopenia. Further efforts to standardize the modalities used to diagnose sarcopenia in clinical research and practice will help strengthen our ability to study this important phenomenon.

Trajectories of Quality of Life and Associated Risk Factors in Patients With Knee Osteoarthritis: Findings From the Osteoarthritis Initiative.

OBJECTIVE: Knee osteoarthritis (OA) has a significant impact on quality of life (QOL). Although QOL is generally thought to diminish over time, it is unknown whether different patient groups demonstrate unique patterns of change in QOL. We sought to identify and characterize QOL trajectories in knee OA. DESIGN: This prospective cohort study included 1013 individuals with symptomatic knee OA from the osteoarthritis initiative. We used group-based trajectory modeling to identify distinct temporal patterns of change in the Knee Injury and Osteoarthritis Outcome Score QOL subscale for 8 yrs. Baseline covariates included age, sex, ethnicity, education, co-morbidities, body mass index, substance use, depression, knee pain, and functional tests. RESULTS: Group-based trajectory modeling revealed the following three distinct QOL trajectories: a high QOL trajectory (32% of the cohort) experiencing improvement for 8 yrs as well as moderate (49%) and low QOL (20%) trajectories maintaining similar levels over time. Low QOL trajectory membership was significantly associated with younger age (P < 0.001), nonwhite race (P < 0.001), less education (P < 0.001), more co-morbidities (P < 0.001), higher body mass index (P < 0.001), and more depressive symptoms (P < 0.001). Higher QOL trajectory members were less likely to undergo knee replacement surgery (P < 0.001). CONCLUSIONS: Distinct QOL trajectories exist in knee OA and are associated with modifiable factors, with a subset of patients showing potential to improve their QOL over time.

Inpatient costs and blood transfusion rates of sarcopenic patients following thoracolumbar spine surgery.

OBJECTIVE Sarcopenia, the muscle atrophy associated with aging and disease progression, accounts for nearly $18.5 billion in health care expenditures annually. Given the high prevalence of sarcopenia in patients undergoing orthopedic surgery, the goal of this study was to assess the impact of sarcopenia on inpatient costs following thoracolumbar spine surgery. METHODS Patients older than 55 years undergoing thoracolumbar spine surgery from 2003 to 2015 were retrospectively analyzed. Sarcopenia was measured using total psoas area at the L-4 vertebra on perioperative CT scans. Hospital billing data were used to compare inpatient costs, transfusion rate, and rate of advanced imaging utilization. RESULTS Of the 50 patients assessed, 16 were sarcopenic. Mean total hospital costs were 1.75-fold greater for sarcopenic patients compared with nonsarcopenic patients ($53,128 vs $30,292, p = 0.04). Sarcopenic patients were 2.1 times as likely to require a blood transfusion (43.8% vs 20.6%, p = 0.04). Sarcopenic patients had a 2.6-fold greater usage of advanced imaging (68.8% vs 26.5%, p = 0.002) with associated higher diagnostic imaging costs ($2452 vs $801, p = 0.01). Sarcopenic patients also had greater pharmacy, laboratory, respiratory care, and emergency department costs. CONCLUSIONS This study is the first to show that sarcopenia is associated with higher postoperative costs and rates of blood transfusion following thoracolumbar spine surgery. Measuring the psoas area may represent a strategy for predicting perioperative costs in spine surgery patients.

The Intergenic Recombinant HLA-B∗46:01 Has a Distinctive Peptidome that Includes KIR2DL3 Ligands.

HLA-B∗46:01 was formed by an intergenic mini-conversion, between HLA-B∗15:01 and HLA-C∗01:02, in Southeast Asia during the last 50,000 years, and it has since become the most common HLA-B allele in the region. A functional effect of the mini-conversion was introduction of the C1 epitope into HLA-B∗46:01, making it an exceptional HLA-B allotype that is recognized by the C1-specific natural killer (NK) cell receptor KIR2DL3. High-resolution mass spectrometry showed that HLA-B∗46:01 has a low-diversity peptidome that is distinct from those of its parents. A minority (21%) of HLA-B∗46:01 peptides, with common C-terminal characteristics, form ligands for KIR2DL3. The HLA-B∗46:01 peptidome is predicted to be enriched for peptide antigens derived from Mycobacterium leprae. Overall, the results indicate that the distinctive peptidome and functions of HLA-B∗46:01 provide carriers with resistance to leprosy, which drove its rapid rise in frequency in Southeast Asia.

The Use of Dehydrated Human Amnion/Chorion Membrane Allograft Injection for the Treatment of Tendinopathy or Arthritis: A Case Series Involving 40 Patients.

BACKGROUND: Degenerative joint and tendon injuries remain difficult to treat, with few effective conservative treatment options available. Regenerative approaches aim to promote the inherent healing capacity of injured tissues. Micronized dehydrated human amnion/chorion membrane (dHACM) injection is an emerging regenerative option with promising preclinical results. OBJECTIVE: To test the clinical effectiveness of dHACM injection in patients with chronic tendinopathy and arthropathy. DESIGN: Case series. SETTING: Academic medical center outpatient sports medicine clinic. PATIENTS: A total of 40 patients with chronic tendinosis or arthropathy who received dHACM over a period of 9 months. METHODS: A structured interview was administered to patients by telephone to supplement the clinical information available in the medical chart. All patients received an ultrasound-guided injection of dHACM. MAIN OUTCOME MEASURES: The primary outcome was change in pain level, and the secondary outcome was change in activities of daily living (ADLs) and sports/recreation function. More than 30% improvement in average pain and function was considered a successful outcome. RESULTS: Patient pain and function were measured at 1, 2, and 3 months after the procedure. Patient-reported average pain scores decreased from a baseline value of 6.4 (95% confidence interval [CI] = 5.7-7.0) to 2.7 (95% CI = 2.1-3.3; P < .001) at 1 month, 1.7 (95% CI = 1.1-2.2; P < .001) at 2 months, and 1.4 (95% CI = 0.9-1.9; P < .001) at 3 months. The percentage of patients achieving clinical success, defined as 30% or greater improvement in pain levels, was 68% at 1 month, 82% at 2 months, and 91% at 3 months. Patient-reported functional impairment in ADLs decreased from 6.8 (95% CI = 6.0-7.5) to 2.0 (95% CI = 1.4-2.7) (P < .001); impairment in sports/recreation decreased from 8.5 (95% CI = 7.9-9.1) to 3.2 (95% CI = 2.6-3.9) (P < .001). Frequency of pain medication use decreased from 29 of 40 patients (72.5%) before the procedure to 9 of 40 patients (22.5%) at final follow up (P < .001). Localized pain at the injection site was common, but no other adverse events or side effects were reported. CONCLUSION: In the setting of tendinosis or arthropathy, dHACM injection was clinically effective in reducing pain and improving function in a majority of adults. LEVEL OF EVIDENCE: IV.

Bonobos Maintain Immune System Diversity with Three Functional Types of MHC-B.

Fast-evolving MHC class I polymorphism serves to diversify NK cell and CD8 T cell responses in individuals, families, and populations. Because only chimpanzee and bonobo have strict orthologs of all HLA class I, their study gives unique perspectives on the human condition. We defined polymorphism of Papa-B, the bonobo ortholog of HLA-B, for six wild bonobo populations. Sequences for Papa-B exon 2 and 3 were determined from the genomic DNA in 255 fecal samples, minimally representing 110 individuals. Twenty-two Papa-B alleles were defined, each encoding a different Papa-B protein. No Papa-B is identical to any chimpanzee Patr-B, human HLA-B, or gorilla Gogo-B. Phylogenetic analysis identified a clade of MHC-B, defined by residues 45-74 of the α1 domain, which is broadly conserved among bonobo, chimpanzee, and gorilla. Bonobo populations have 3-14 Papa-B allotypes. Three Papa-B are in all populations, and they are each of a different functional type: allotypes having the Bw4 epitope recognized by killer cell Ig-like receptors of NK cells, allotypes having the C1 epitope also recognized by killer cell Ig-like receptors, and allotypes having neither epitope. For population Malebo, these three Papa-B are the only Papa-B allotypes. Although small in number, their sequence divergence is such that the nucleotide diversity (mean proportional distance) of Papa-B in Malebo is greater than in the other populations and is also greater than expected for random combinations of three Papa-B Overall, Papa-B has substantially less diversity than Patr-B in chimpanzee subspecies and HLA-B in indigenous human populations, consistent with bonobo having experienced narrower population bottlenecks.