Osteotomy around the knee: Assessment of quality,content and readability of online information

BackgroundAs knee osteotomy surgery becomes increasingly accessible, more patients may turn to the Internet for information. This study examined the source, quality, content and readability of online information regarding osteotomy around the knee.MethodsThe first 70 websites returned by the top four search engines were identified using the key words: “knee osteotomy” and “high tibial osteotomy.” The websites were categorised by type and assessed using the DISCERN score, Journal of the American Medical Association (JAMA) benchmark criteria and a novel Knee Osteotomy-Specific Score (KOSS). The presence of the Health On the Net (HON) code accreditation seal was noted. Readability of each website was assessed using eight readability formulae. The mean reading grade level (RGL) was compared to the 6th and 8th grade reading levels. The mean RGL of each category was also compared.ResultsOf the 45 unique websites analysed, the majority were Physician (33%) and Journal websites (31%). The mean DISCERN score was 36.7 (±8.9) which is classified as ‘poor.’ The mean JAMA benchmark criteria score was 2.04 (±1.5) and Physician websites were most likely to be scored zero. The mean KOSS was 15.4 (±5.7). The highest scoring website was a Commercial site but, overall, Journal category sites provided the best quality information. Websites that bore the HONcode seal obtained higher DISCERN, JAMA benchmark criteria and Knee Osteotomy - Specific Scores.The cumulative mean RGL was 13.2 (±2.2) which exceeded the 6th grade level by an average of 7.2 grade levels and the 8th grade level by an average of 5.2 grade levels. No website (0%) was written at or below either the 6th or the 8th grade reading levels. The mean Flesch Reading Ease Score of all websites was 41.13 (±14.7) which is classified as ‘difficult.’ Journal websites had the highest RGL.ConclusionThe information available online regarding osteotomy around the knee varies tremendously in quality and completeness. Physician sites predominate, but these were among the lowest scoring of all websites. Even where high quality information is available, it is set at too high a level to be easily understood.Level of evidenceSurvey of materials – Internet.     

Benefits of the DICOM Modality Performed Procedure Step

A few years ago, the Digital Imaging and Communications in Medicine standard introduced a network transaction that is initiated by modality equipment, mainly at the beginning and at the end of the acquisition. This transaction, the Modality Performed Procedure Step (MPPS), is sent to the Picture Archiving and Communication System and/or to the Radiology Information System. It carries information about what really has been performed by the modality equipment during acquisition. In this paper, we present MPPS and discuss its benefits. We show how MPPS enables efficient radiology workflow and how it ensures accuracy and completeness of imaging information. We think our paper helps bridge the gap between MPPS implementation and deployment. By understanding all the MPPS benefits, the end user becomes aware of the great enhancement in patient care that this transaction provides.     

Effects of marathon running on running economy and kinematics

The present study was designed to investigate interactions between running economy and mechanics before, during, and after an individually run marathon. Seven experienced triathletes performed a 5-min submaximal running test on a treadmill at an individual constant marathon speed. Heart rate was monitored and the expired respiratory gas was analyzed. Blood samples were drawn to analyze serum creatine kinase activity (S-CK), skeletal troponin I (sTnI), and blood lactate (B-La). A video analysis was performed (200 frames · s⁻¹) to investigate running mechanics. A kinematic arm was used to determine the external work of each subject. The results of the present study demonstrate that after the marathon, a standardized 5-min submaximal running test resulted in an increase in oxygen consumption, ventilation, and heart rate (P < 0.05), with a simultaneous decrease in the oxygen difference (%) between inspired and expired air, and respiratory exchange ratio (P < 0.05). B-La did not change during the marathon, while sTnI and S-CK values increased (P < 0.05), peaking 2 h and 2 days after the marathon, respectively. With regard to the running kinematics, a minor increase in stride frequency and a similar decrease in stride length were observed (P < 0.01). These results demonstrate clearly that weakened running economy cannot be explained by changes in running mechanics. Therefore, it is suggested that the increased physiological loading is due to several mechanisms: increased utilization of fat as an energy substrate, increased demands of body temperature regulation, and possible muscle damage. Accepted: 20 March 2000     

Optimum cycle frequencies in hand-rim wheelchair propulsion

Summary To study the effect of different cycle frequencies on cardio-respiratory responses and propulsion technique in hand-rim wheelchair propulsion, experienced wheelchair sportsmen (WS group; n=6) and non-wheel chair users (NW group; n=6) performed wheelchair exercise tests on a motor-driven treadmill. The WS group wheeled at velocities of 0.55, 0.83, 1.11 and 1.39 m · s^–1 and a slope of 2°. The NW group wheeled at 0.83, 1.11 and 1.39 m · s^–1 and a 1° slope. In each test, a 3-min period at a freely chosen cycle frequency (FCF: 100%) was followed by four 3-min blocks of paced cycle frequencies at 60%, 80%, 120% and 140% FCF. Effects of both cycle frequency and velocity on physiological and propulsion technique parameters were studied.Analysis of variance showed a significant effect (p<0.05) of cycle frequency on oxygen cost and gross mechanical efficiency in both the WS and NW group. This indicated the existence of an optimum cycle frequency which is close to the FCF at any given velocity. The optimum cycle frequency increased with velocity from 0.67 to 1.03 cps over the range studied (p< 0.05). Oxygen cost was 10% less at 100% FCF than at 60% or 140% FCF. Gross mechanical efficiency for the WS group at 100% FCF was 8.5%, 9.7%, 10.4% and 10.1%, respectively, at the four velocities. The similarity in the trend of oxygen cost and gross mechanical efficiency data in both the WS and NW groups suggests that an optimum cycle frequency is not merely a consequence of practice alone, but also reflects a physiologically determined optimum, dependent on muscle mechanics, e.g. velocity of contraction and power output of the muscles used.     

Estimating relative physical workload using heart rate monitoring: a validation by whole-body indirect calorimetry

Measuring physical workload in occupational medicine is fundamental for risk prevention. An indirect measurement of total and relative energy expenditure (EE) from heart rate (HR) is widely used but it has never been validated. The aim of this study was to validate this HR-estimated energy expenditure (HREEE) method against whole-body indirect calorimetry. Twenty-four-hour HR and EE values were recorded continuously in a calorimetric chambers for 52 adult males and females (19–65 years). An 8-h working period was retained, comprising several exercise sessions on a cycloergometer at intensities up to 65% of the peak rate of oxygen uptake. HREEE was calculated with reference to cardiac reserve. A corrected HREEE (CHREEE) was also calculated with a modification to the lowest value of cardiac reserve. Both values were further compared to established methods: the flex-HR method, and the use of a 3rd order polynomial relationship to estimate total and relative EE. No significant difference was found in total EE when measured in a calorimetric chamber or estimated from CHREEE for the working period. A perfect linear and identity relationship was found between CHREEE and energy reserve values for intensities ranging from 15% to 65%. Relative physical workload can be accurately assessed from HR recordings when expressed in CHREEE between 15% to 65%, and EE can be accurately estimated using the CHREEE method.     

NEAT – non‐exercise activity thermogenesis – egocentric & geocentric environmental factors vs. biological regulation

Non‐exercise activity thermogenesis (NEAT) is the energy expenditure of all physical activities other than volitional sporting‐like exercise. NEAT includes all those activities that render us vibrant, unique and independent beings such as going to work, playing guitar, toe‐tapping and dancing. The factors that account for the 2000 kcal day^?1 variability of NEAT can be categorized as environmental or biological. The environmental determinants of NEAT can be view using one of two models. In the egocentric model we consider a single person as the focus, e.g. ‘my job’. In the geocentric model we consider the ‘environment’ as the focus, e.g. well‐lit and safe walk ways. These models provide us with a theoretical framework to understand NEAT and how best to intervene to promote NEAT. As well as environmental effectors of NEAT, there are also biological regulatory mechanisms that enable us to account for three‐quarters of the biological variance in susceptibility and resistance to fat gain with human over‐feeding. NEAT is likely to be regulated through a central mechanism that integrates NEAT with energy intake and energy stores so that NEAT is activated with over‐feeding and suppressed with under‐feeding. In conclusion, NEAT is likely to serve as a crucial thermoregulatory switch between energy storage and dissipation that is biologically regulated and influenced, and perhaps over‐ridden, by environment. Deciphering the role of NEAT may lead to a better understanding of the pathogenesis, prevention and treatment of obesity.     

Total energy expenditure of elite synchronized swimmers measured by the doubly labeled water method

To determine the daily energy requirement of elite synchronized swimmers during moderate-intensity training, the average daily energy expenditure measured by the doubly labeled water method, was calculated for nine female Japanese national team synchronized swimmers [four senior; mean (SD) 22.5 (1.0) years old, 52.2 (3.6) kg, and five junior; 17.6 (1.1) years old, 52.8 (2.3) kg]. Their total energy expenditure (TEE) was 11.5 (2.8) MJ · day⁻¹ [2738 (672) kcal · day⁻¹]. When compared with estimated energy requirements derived from “Recommended Dietary Allowances for the Japanese”, 12.1 (0.6) MJ · day⁻¹ [2897 (139) kcal · day⁻¹], there was no difference between mean actual and estimated energy requirements. However, there were considerable differences observed on an individual basis. Their energy intake, estimated from 7- day self-reported dietary records, was 8.9 (1.7) MJ · day⁻¹ [2128 (395) kcal · day⁻¹], which was significantly lower than their TEE (P < 0.05). Resting energy expenditure (REE), as determined by indirect calorimetry, was 5.2 (0.3) MJ · day⁻¹ [1247 (75) kcal · day⁻¹]. Their physical activity level (TEE/REE) was 2.18 (0.43). These results demonstrate that the TEE values of elite female synchronized swimmers are not dissimilar to those reported for athletes participating in other sports, especially competitive swimmers during moderate-intensity training. Accepted: 26 May 2000     

流动人口住院费医保报销现状及影响因素分析

目的 了解流动人口住院费医保报销现状及其影响因素,为减轻流动人口医疗经济负担提供参考。方法 利用2018年全国流动人口卫生计生动态监测数据,运用χ2检验和logistic回归分析流动人口住院费医保报销现状及其影响因素。结果 3 364名调查对象中,2 346名（69.7%）流动人口报销住院费,其中有18人重复报销,报销总人次为2 364次。2 346名报销者中,66.5%在流入地报销住院费。从报销总人次来看,不同参保类型的流动人口住院费报销情况不同,参加城镇职工医疗保险的报销率最高,为82.2%;而报销地点上,参加城乡居民医保、城镇居民医保、城镇职工医保的选择在流入地报销分别占76.1%、79.9%和89.8%。多因素结果显示,年龄为35～44岁（OR = 1.474,95%CI:1.083～2.007）、45～54岁（OR = 2.223,95%CI:1.587～3.115）、55～64岁（OR = 2.320,95%CI:1.562～3.446）、65岁及以上（OR = 4.179,95%CI:2.576～6.778）,受教育层次为高中（OR = 1.397,95%CI:1.077～1.811）、大专（OR = 1.887,95%CI:1.390～2.562）、本科及以上（OR = 2.427, 95%CI:1.660～3.548）,流动时间6～10年（OR = 1.282,95%CI:1.058～1.554）、10年以上（OR = 1.264,95%CI:1.018～1.570）,省内流动（OR = 1.483,95%CI:1.234～1.781）、市内流动（OR = 1.883,95%CI:1.502～2.360）,异地养老（OR = 2.305,95%CI:1.052～5.052）,流入西部（OR = 1.283,95%CI:1.061～1.551）是流动人口报销住院费的保护因素;从事商业及服务业 （OR = 0.429,95%CI:0.301～0.611）、生产及运输业（OR = 0.645,95%CI:0.431～0.966）、其他（OR = 0.421,95%CI:0.295～0.600）是流动人口报销住院费的危险因素。结论 流动人口住院费医保报销仍有较大的提升空间。应提高医保区域统筹层次,优化医保报销流程,加强对流动人口医保政策宣传,做好流动人口医保报销工作。     

中国人口老龄化对居民医疗卫生支出的影响研究

在人口老龄化的背景下,如何控制医疗费用、促进健康老龄化已经成为世界性难题。本文通过实证研究分析中国人口老龄化对医疗卫生支出的影响机制,为医疗和养老政策的制定提供参考。面板门槛效应模型的回归结果显示,中国人口老龄化对居民医疗卫生支出的影响与城镇化水平有关。城镇化水平存在双重门槛效应,当城镇化水平低于第二个门槛值,人口老龄化显著地减少了医疗卫生支出;当城镇化水平高于第二个门槛值,人口老龄化对医疗卫生支出的影响机制发生改变,显著地增加了医疗卫生支出。因此,如何在城镇化进程中增进老年人口的社会福祉是控制医疗费用、促进健康老龄化的关键。