Notes

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This study provides insights into the longitudinal relation between multimorbidity, mental wellbeing, and social support. The analysis used the German Sociomedical Panel of Employees, a study of the German working population aged 40 to 54. In the context of multimorbidity, this population has been little studied. Multimorbidity is significantly associated with reduced mental wellbeing and social support, whereas social support increases mental wellbeing. We argue that, especially among the working population, multimorbidity reduces perceived social support and decreases mental wellbeing. We elaborate on the mediation process empirically by comparing two distinct structural equation models a cross-lagged panel mediation model that models a potential reverse-causality between social support and mental wellbeing; and a synchronous mediation model that allows for more immediate mediation. Both models estimated significant mediation. The relative size of the mediation effect, however, varied widely based on the added mediational paths (8.57% vs. 28%). Fit statistics for both models were good, and the comparison did not favour either model. We conclude that theoretical reasoning must prevail over empirical testing. The cross-lagged model implies a more longitudinal (lagged) mediation process for social support. However, we suggest an immediate, flexible mediation as more plausible. Nevertheless, we suggest that cross-lagged models, when given a data structure and time gaps, reflect the social processes adequately.The aim of the current study was to evaluate whether workplace health promotion programs improve self-perceived health of employees with a low socioeconomic position (SEP), and whether differential effects exist between individuals with a low SEP for gender, marital status or age. Individual participant data from six Dutch intervention studies aiming at promoting healthy behavior and preventing obesity in the work setting, with a total of 1906 participants, were used. The overall intervention effect and interaction effects for gender, marital status and age were evaluated using two-stage meta-analyses with linear mixed regression models. In the first stage effect sizes of each study were estimated, which were pooled in the second stage. Compared to control conditions, workplace health promotion programs did not show an overall improvement in self-perceived health of employees with a low SEP (β0.03 (95%CI -0.03 to 0.09)). Effects did not differ across gender, marital status and age. Future research could be focused on the determinants of self-perceived health next to health behavior to improve the health of employees with a low SEP.
Epithelioid trophoblastic tumor is a rare form of gestational trophoblastic neoplasia. We present the first known case of this rare malignancy presenting as a Caesarean scar defect.

A patient with 3 prior Caesarean sections presented with vaginal bleeding 2months following management of retained products of conception. Her hCG was negative. She underwent surgical repair of a Caesarean scar defect, and pathology was consistent with epithelioid trophoblastic tumor.

This case highlights the possibility of malignancy presenting to the general gynecologist as a Caesarean scar defect. The diagnosis of gestational trophoblastic neoplasia should always be considered in the differential diagnosis of a patient with postpartum vaginal bleeding. Limited evidence on fertility conserving treatment of epithelioid trophoblastic tumors does not seem favorable.
This case highlights the possibility of malignancy presenting to the general gynecologist as a Caesarean scar defect. The diagnosis of gestational trophoblastic neoplasia should always be considered in the differential diagnosis of a patient with postpartum vaginal bleeding. Limited evidence on fertility conserving treatment of epithelioid trophoblastic tumors does not seem favorable.We describe an extremely rare case of a 66-year-old woman with a vaginal epithelioid angiosarcoma. She presented with constitutional symptoms, pelvic pain, vaginal bleeding, and a violaceous vaginal lesion. A thorough gynaecological examination, tissue biopsy and imaging were crucial to establish an accurate diagnosis. With only 3 other cases reported in the literature, epithelioid angiosarcoma of the vagina seem to present late due to their nonspecific presentation and secluded location. Once diagnosed, optimal treatment is difficult to determine and together with the overly aggressive behaviour of these tumours, they are associated with a poor prognosis. To our knowledge, our case study and systematic literature review is the first to compare the management outcomes of epithelioid subtype angiosarcomas of the vagina. The rarity of this pathology contributes to diagnostic difficulties and lack of consensus regarding treatment of angiosarcomas of the vagina.
Citation analysis is commonly used to evaluate the impact of academic publications within an area of study. The purpose of this study is to review the publications with the highest Altmetric scores related to total hip arthroplasty (THA) and total knee arthroplasty (TKA) and assess the correlation with traditional bibliometrics.

Altmetric scores were obtained for the top articles relating to THA and TKA and organized from highest to lowest scores. The Clarivate Analytics Web of Knowledge database was used to search the top articles by Altmetric score. Articles meeting inclusion criteria were reviewed for various metrics, including number of citations, journal impact factor at the time of publication, and study type and design.

The top THA and TKA publications were cited 3042 times and 7523 times, respectively. The former were published in journals with an average impact factor of 17.861, and the latter in journals with an average impact factor of 15.564. For THA, Altmetric score demonstrated a significant, weakly positive correlation with the number of citations (
= .008). For TKA, Altmetric score was found to have a significant, weakly positive correlation with impact factor of journal (
= .04); however, it was nonsignificant for citation count (
= .11). When one outlier is removed, the correlation with citation count is statistically significant (
= .009).

While alternative metrics cannot replace traditional bibliometrics, they may serve a complimentary role in describing the influence of research. Thus, the Altmetric score represents an additional tool to identify the most influential articles to guide learning and evidence-based practice.
While alternative metrics cannot replace traditional bibliometrics, they may serve a complimentary role in describing the influence of research. Thus, the Altmetric score represents an additional tool to identify the most influential articles to guide learning and evidence-based practice.
The purpose of this study was to determine demographic and psychosocial factors that influence the effectiveness of cooled radiofrequency genicular nerve ablation (C-RFA) and block in patients with chronic knee pain secondary to osteoarthritis (OA).

A retrospective review was completed including patients with knee OA who underwent genicular nerve ablation or block or both. Patient information collected included opioid use, psychological comorbidities, smoking history, body mass index, and medical comorbidities. Success was defined using the Osteoarthritis Research Society International criterion of greater than or equal to 50% reported pain relief from the procedure. Patients without a diagnosis of knee OA and patients with ipsilateral total knee arthroplasty were excluded. Patient factors were compared between (1) those that did or did not respond to the initial block and (2) those that did or did not respond to C-RFA.

Of the 176 subjects that underwent genicular nerve block, 31.8% failed to respond to the procedure. Subjects that failed the initial block were significantly more likely to have psychological comorbidities, smoking history, and diabetes. Of the subjects that proceeded to genicular nerve ablation, 53.7% reported less than 50% pain relief, and 46.3% reported pain relief greater than or equal to 50% at the first follow-up visit. While the presence of psychological comorbidities, smoking, and diabetes were associated with first-stage block failures, these patient factors were not associated with second-stage ablation failures.

C-RFA may be an effective adjunct therapy as part of a multimodal pain regimen; however, individual patient characteristics must be considered.
C-RFA may be an effective adjunct therapy as part of a multimodal pain regimen; however, individual patient characteristics must be considered.
The Bundled Payment for Care Improvement initiative is a program designed by Center for Medicare and Medicaid Services in an attempt to increase the value of care delivered to Medicare recipients by rewarding providers who can deliver more cost-efficient, high-value care. This article reports the results of a coordinated care redesign program in an independent, medium-sized private-practice orthopedic group.

A committee of stakeholders worked to redesign care protocols for patients receiving upper and lower joint replacement procedures. These protocols included preoperative, intraoperative, and postoperative care. Baseline metrics for post-acute care and readmissions were compared to the same metrics after initiating care redesign.

Incidence of discharge to inpatient facilities decreased as did length of stay at these facilities. Home health utilization and readmission rates were lowered. Average cost of the 90-day episodes decreased to a statistically significant degree.

These initial results indicate that coordinated care redesign in the private practice setting can yield higher value care with decreased utilization of high-cost care, particularly in the post-acute period.
These initial results indicate that coordinated care redesign in the private practice setting can yield higher value care with decreased utilization of high-cost care, particularly in the post-acute period.Underwater imagery is widely used for a variety of applications in marine biology and environmental sciences, such as classification and mapping of seabed habitats, marine environment monitoring and impact assessment, biogeographic reconstructions in the context of climate change, etc. This approach is relatively simple and cost-effective, allowing the rapid collection of large amounts of data. However, due to the laborious and time-consuming manual analysis procedure, only a small part of the information stored in the archives of underwater images is retrieved. Emerging novel deep learning methods open up the opportunity for more effective, accurate and rapid analysis of seabed images than ever before. We present annotated images of the bottom macrofauna obtained from underwater video recorded in Spitsbergen island's European Arctic waters, Svalbard Archipelago. Our videos were filmed in both the photic and aphotic zones of polar waters, often influenced by melting glaciers. We used artificial lighting and shot close to the seabed ( less then 1 m) to preserve natural colours and avoid the distorting effect of muddy water. The underwater video footage was captured using a remotely operated vehicle (ROV) and a drop-down camera. The footage was converted to 2D mosaic images of the seabed. 2D mosaics were manually annotated by several experts using the Labelbox tool and co-annotations were refined using the SurveyJS platform. A set of carefully annotated underwater images associated with the original videos can be used by marine biologists as a biological atlas, as well as practitioners in the fields of machine vision, pattern recognition, and deep learning as training materials for the development of various tools for automatic analysis of underwater imagery.
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