Patterns and factors associated with dental service utilization among insured people: a data mining approach.

BACKGROUND: Insurance databases contain valuable information related to the use of dental services. This data is instrumental in decision-making processes, enhancing risk assessment, and predicting outcomes. The objective of this study was to identify patterns and factors influencing the utilization of dental services among complementary insured individuals, employing a data mining methodology. METHODS: A secondary data analysis was conducted using a dental insurance dataset from Iran in 2022. The Cross-Industry Standard Process for Data Mining (CRISP-DM) was employed as a data mining approach for knowledge extraction from the database. The utilization of dental services was the outcome of interest, and independent variables were chosen based on the available information in the insurance dataset. Dental services were categorized into nine groups: diagnostic, preventive, periodontal, restorative, endodontic, prosthetic, implant, extraction/surgical, and orthodontic procedures. The independent variables included age, gender, family size, insurance history, franchise, insurance limit, and policyholder. A multinomial logistic regression model was utilized to investigate the factors associated with dental care utilization. All analyses were conducted using RapidMiner Version 2020. RESULTS: The analysis encompassed a total of 654,418 records, corresponding to 118,268 insured individuals. Predominantly, restorative treatments were the most utilized services, accounting for approximately 38% of all services, followed by diagnostic (18.35%) and endodontic (13.3%) care. Individuals aged between 36 and 60 years had the highest rate of utilization for any dental services. Additionally, families comprising three to four members, individuals with a one-year insurance history, people contracted with a 20% franchise, individuals with a high insurance limit, and insured individuals with a small policyholder, exhibited the highest rate of service usage compared to their counterparts. The regression model revealed that all independent variables were significantly associated with the use of dental services. However, the patterns of association varied among different service categories. CONCLUSIONS: Restorative treatments emerged as the most frequently used dental services among insured individuals, followed by diagnostic and endodontic procedures. The pattern of service utilization was influenced by the characteristics of the insured individuals and attributes related to their insurance.

Prediction of in-hospital mortality rate in COVID-19 patients with diabetes mellitus using machine learning methods.

Background: Since its emergence in December 2019, until June 2022, coronavirus 2019 (COVID-19) has impacted populations all around the globe with it having been contracted by ~ 535 M people and leaving ~ 6.31 M dead. This makes identifying and predicating COVID-19 an important healthcare priority. Method and Material: The dataset used in this study was obtained from Shahid Beheshti University of Medical Sciences in Tehran, and includes the information of 29,817 COVID-19 patients who were hospitalized between October 8, 2019 and March 8, 2021. As diabetes has been shown to be a significant factor for poor outcome, we have focused on COVID-19 patients with diabetes, leaving us with 2824 records. Results: The data has been analyzed using a decision tree algorithm and several association rules were mined. Said decision tree was also used in order to predict the release status of patients. We have used accuracy (87.07%), sensitivity (88%), and specificity (80%) as assessment metrics for our model. Conclusion: Initially, this study provided information about the percentages of admitted Covid-19 patients with various underlying disease. It was observed that diabetic patients were the largest population at risk. As such, based on the rules derived from our dataset, we found that age category (51-80), CPR and ICU residency play a pivotal role in the discharge status of diabetic inpatients.

Comparing Diazepam Plus Fentanyl With Midazolam Plus Fentanyl in the Moderate Procedural Sedation of Anterior Shoulder Dislocations: A Randomized Clinical Trial.

BACKGROUND: The reduction of shoulder dislocation requires adequate procedural sedation and analgesia. The mixture of midazolam and fentanyl is reported in the literature, but long-acting benzodiazepines in conjunction with fentanyl are lacking. STUDY OBJECTIVE: Our aim was to compar e IV diazepam with IV midazolam in moderate procedural sedation (based on the classification of the American Society of Anesthesiologists) for the reduction of shoulder dislocation. METHODS: This was a randomized controlled clinical trial conducted from April 2019 to December 2019 in the emergency department of a university-affiliated hospital in Tehran, Iran. Participants were adult patients (aged 18-65 years) with anterior shoulder dislocation. Group A (n = 42) received diazepam 0.1 mg/kg plus fentanyl 1 µg/kg IV and group B received midazolam 0.1 mg/kg plus fentanyl 1 µg g/kg IV. Main outcomes measured were onset of muscle relaxation, time taken to reduction, total procedure time, number of the reduction attempts, patient recovery time, the occurrence of the adverse effects, amount of the pain reported by the patients using visual analog scale, and patients and physicians overall satisfaction with the procedure using a Likert scale question. RESULTS: Eighty-one patients were included. The mean ± standard deviation time of the onset of the muscle relaxation and time taken to reduction was shorter in the diazepam plus fentanyl group (p = 0.016 and p = 0.001, respectively). Adverse effects and pain relief were not statistically different between the two groups. Patient recovery time and total procedure time was shorter in the midazolam plus fentanyl group (p = 0.008 and p = 0.02, respectively). The overall satisfaction of patients and physicians was higher in the diazepam plus fentanyl group. CONCLUSIONS: As compared with midazolam plus fentanyl, diazepam plus fentanyl was superior in terms of the onset of the muscle relaxation, patient and physician satisfaction, and time taken to reduction.

Predicting Gains With Visuospatial Training After Stroke Using an EEG Measure of Frontoparietal Circuit Function.

The heterogeneity of stroke prompts the need for predictors of individual treatment response to rehabilitation therapies. We previously studied healthy subjects with EEG and identified a frontoparietal circuit in which activity predicted training-related gains in visuomotor tracking. Here we asked whether activity in this same frontoparietal circuit also predicts training-related gains in visuomotor tracking in patients with chronic hemiparetic stroke. Subjects (n = 12) underwent dense-array EEG recording at rest, then received 8 sessions of visuomotor tracking training delivered via home-based telehealth methods. Subjects showed significant training-related gains in the primary behavioral endpoint, Success Rate score on a standardized test of visuomotor tracking, increasing an average of 24.2 ± 21.9% (p = 0.003). Activity in the circuit of interest, measured as coherence (20-30 Hz) between leads overlying ipsilesional frontal (motor cortex) and parietal lobe, significantly predicted training-related gains in visuomotor tracking change, measured as change in Success Rate score (r = 0.61, p = 0.037), supporting the main study hypothesis. Results were specific to the hypothesized ipsilesional motor-parietal circuit, as coherence within other circuits did not predict training-related gains. Analyses were repeated after removing the four subjects with injury to motor or parietal areas; this increased the strength of the association between activity in the circuit of interest and training-related gains. The current study found that (1) Eight sessions of training can significantly improve performance on a visuomotor task in patients with chronic stroke, (2) this improvement can be realized using home-based telehealth methods, (3) an EEG-based measure of frontoparietal circuit function predicts training-related behavioral gains arising from that circuit, as hypothesized and with specificity, and (4) incorporating measures of both neural function and neural injury improves prediction of stroke rehabilitation therapy effects.

Choice of Human-Computer Interaction Mode in Stroke Rehabilitation.

BACKGROUND AND OBJECTIVE: Advances in technology are providing new forms of human-computer interaction. The current study examined one form of human-computer interaction, augmented reality (AR), whereby subjects train in the real-world workspace with virtual objects projected by the computer. Motor performances were compared with those obtained while subjects used a traditional human-computer interaction, that is, a personal computer (PC) with a mouse. METHODS: Patients used goal-directed arm movements to play AR and PC versions of the Fruit Ninja video game. The 2 versions required the same arm movements to control the game but had different cognitive demands. With AR, the game was projected onto the desktop, where subjects viewed the game plus their arm movements simultaneously, in the same visual coordinate space. In the PC version, subjects used the same arm movements but viewed the game by looking up at a computer monitor. RESULTS: Among 18 patients with chronic hemiparesis after stroke, the AR game was associated with 21% higher game scores (P = .0001), 19% faster reaching times (P = .0001), and 15% less movement variability (P = .0068), as compared to the PC game. Correlations between game score and arm motor status were stronger with the AR version. CONCLUSIONS: Motor performances during the AR game were superior to those during the PC game. This result is due in part to the greater cognitive demands imposed by the PC game, a feature problematic for some patients but clinically useful for others. Mode of human-computer interface influences rehabilitation therapy demands and can be individualized for patients.

Comparison of the effects of different implant apical designs on the magnitude and distribution of stress and strain in bone: a finite element analysis study.

OBJECTIVES: The aim of this study was to investigate the effects of implant design on the apex area and on stress and stress patterns within surrounding bone. METHODS: Three commercially available implants with the same diameter (3.5 mm), same length (10-11 mm), and same complement abutment were selected for modeling as follows: (1) flat apical design with light tapering degree, (2) dome-shaped apical design with light tapering, and (3) flat apical design with intense tapering in one-third of the apical area. According to human conebeam computed tomography (CBCT), the bone was modeled using a cortical thickness of 2 mm and cancellous bone. Forces of 100 N and 300 N in the vertical and 15° angle directions were applied to the entire abutment surface, and the equivalent stress and strain were calculated using finite element analysis (FEA) methods. RESULTS: In all models, stress was concentrated on the cortical bone around the implant neck; in non-axial loads, stress was concentrated on the buccal side. The maximum strain recorded was a microstrain of 7200 µm µm-1 around the apex of sample C, which also showed the highest level of stress detected in cancellous bone (4.4 MPa). We observed the pathologic overload in the apical area of sample B (with a dome-shaped apex); however, the strain value was less than that of sample C. CONCLUSION: FEA revealed that great sudden changes in diameter along the fixture increases stress and strain in peri-implant bone. Therefore, uniform tapering should be considered as a standard feature for most clinical situations, and a flat apical design, which creates a better stress and strain distribution in surrounding bone than dome-shaped bone, should also be used.

A Review on Technical and Clinical Impact of Microsoft Kinect on Physical Therapy and Rehabilitation.

This paper reviews technical and clinical impact of the Microsoft Kinect in physical therapy and rehabilitation. It covers the studies on patients with neurological disorders including stroke, Parkinson's, cerebral palsy, and MS as well as the elderly patients. Search results in Pubmed and Google scholar reveal increasing interest in using Kinect in medical application. Relevant papers are reviewed and divided into three groups: (1) papers which evaluated Kinect's accuracy and reliability, (2) papers which used Kinect for a rehabilitation system and provided clinical evaluation involving patients, and (3) papers which proposed a Kinect-based system for rehabilitation but fell short of providing clinical validation. At last, to serve as technical comparison to help future rehabilitation design other sensors similar to Kinect are reviewed.

Comparing "pick and place" task in spatial Augmented Reality versus non-immersive Virtual Reality for rehabilitation setting.

Introducing computer games to the rehabilitation market led to development of numerous Virtual Reality (VR) training applications. Although VR has provided tremendous benefit to the patients and caregivers, it has inherent limitations, some of which might be solved by replacing it with Augmented Reality (AR). The task of pick-and-place, which is part of many activities of daily living (ADL's), is one of the major affected functions stroke patients mainly expect to recover. We developed an exercise consisting of moving an object between various points, following a flash light that indicates the next target. The results show superior performance of subjects in spatial AR versus non-immersive VR setting. This could be due to the extraneous hand-eye coordination which exists in VR whereas it is eliminated in spatial AR.

Comparison of the Effect of Three Abutment-implant Connections on Stress Distribution at the Internal Surface of Dental Implants: A Finite Element Analysis.

Background and aims. The aim of this study was to determine the stress patterns within an implant and the effect of different types of connections on load transfer. Materials and methods. Three different types of implant-abutment connections were selected for this study. Sample A: 1.5-mm deep internal hex corresponding to a lead-in bevel; sample B: a tri-channel internal connection; and sample C: in-ternal Morse taper with 110 degrees of tapering and 6 anti-rotational grooves. Four types of loading conditions were simu-lated in a finite element model, with the maximum von Mises stress set as output variables. Results. The maximum stress concentration at the inner surface of the fixtures was higher than the stress value in bone in all of the samples. Stress values in sample B were the lowest amongst all of the models. Any alterations in the amount and direction of the 100-N axial load resulted in an increase in fixture surfaces stress. Overall, the highest amount of stress (112 MPa) was detected in sample C at the inner surface of the fixture under a non-axial load of 300 N. Conclusion. Stress concentration decreased when the internal surface area increased. Creating three or six stops in the internal surface of the fixtures resulted in a decrease in stress.

Effect of microthread design of dental implants on stress and strain patterns: a three-dimensional finite element analysis.

The aim of this study was to use finite element analysis (FEA) to assess the influence of microthread design at the implant neck on stress distribution in the surrounding bone. A commercially available implant with 3.5 mm diameter and 10.5 mm length was selected and used as a model. For the purpose of designing the microthread implant model, microthreads were added to the implant neck in a computerized model. A force measuring 100 N was then applied to the entire surface of the abutment in the vertical direction. The results showed that in both models, stress was mainly concentrated at the cortical bone adjacent to the neck of the implant. Maximum stress values in the cortical bone surrounding the implant surface periphery were 12 and 6.25 MPa for the microthread and conventional models, respectively. In this study, we conclude that adding a microthread design at the implant neck decreased stress values in the adjacent bone.

A Spatial Augmented Reality rehab system for post-stroke hand rehabilitation.

This paper features a Spatial Augmented Reality system for rehabilitation of hand and arm movement. The table-top home-based system tracks a subject's hand and creates a virtual audio-visual interface for performing rehabilitation-related tasks that involve wrist, elbow, and shoulder movements. It measures range, speed, and smoothness of movements locally and can send the real-time photos and data to the clinic for further assessment. To evaluate the system, it was tested on two normal subjects and proved functional.