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Background: Finding the balance of good postoperative analgesia while facilitiating mobility is important for a safe and satisfactory patient experience during Total Knee Arthroplasty (TKA). This study aimed to compare the efficacy of intrathecal morphine, adductor canal block, and their combination in optimizing pain management and postoperative recovery in TKA patients. This retrospective analysis of prospectively collected data evaluated postoperative pain scores, time to mobilisation, and length of hospital stay., Methods: 1006 consecutive patients undergoing elective TKA across two large tertiary centres were included over six years. They were divided into one of four groups according to the type of analgesia received: Group N patients received no neuraxial morphine or regional block. Group B patients received adductor canal block (ACB) only. Group M patients received intrathecal morphine (ITM) but no regional block. Group BM patients received both ACB and ITM., Results: Patients who received an ACB had faster postoperative mobilization compared to those without (p < 0.001). Patients in Group BM had the lowest pain scores at rest (Visual Analogue Scale (VAS) 2.9) and with movement (VAS 5.3), while Group B patients experienced the highest pain scores at rest (VAS 3.7) and on movement (VAS 6.5) (p = 0.005). Patients who received ITM had the lowest opioid requirements (p < 0.001). There was no significant differences between groups in requirement for rescue pain management strategies (p = 0.06)., Conclusions: The combination of ITM and ACB in patients undergoing TKA provides improved postoperative analgesia with lower postoperative opioid requirement and earlier mobilization compared with ACB or ITM alone., (© 2024. Crown.)

eHealth literacy is the ability to access, assess, and use digital health information. This study compared the effects of a multimedia tutorial versus a paper-based control in improving older adults' eHealth literacy from pre- to posttest. A total of 99 community-dwelling older adults (63-90 years old; mean = 73.09) participated from July 2019 to February 2020. Overall, knowledge about computer/Internet terms, eHealth literacy efficacy, knowledge about the quality of health information websites, and procedural skills in computer/Internet use improved significantly from pre- to posttest. No interaction effect was found between time and group. Participants in both groups had an overwhelmingly positive attitude toward training. Their attitudes toward training approached a statistically significant difference between the two conditions: F (1, 89) = 3.75, p = .056, partial η 2 = .040, with the multimedia condition showing more positive attitudes. These findings have implications for designing effective eHealth literacy interventions for older adults.

Colonic ischemia most often presents with abdominal pain and rectal bleeding. Presentation of colonic ischemia as a prominent mass is exceptionally unique and is not often reported. Concern for neoplasm prompted a repeat scope, which revealed the mass had vanished. We present a case of colonic ischemia, which produced a transient colonic mass formed by inflammatory tissue and clots., (© 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Introduction: The purpose of this study was to characterize using MRI the effects of a 10-week supervised exercise program on lower extremity skeletal muscle composition, nerve microarchitecture, and metabolic function in individuals with diabetic peripheral neuropathy (DPN)., Research Design and Methods: Twenty participants with DPN completed a longitudinal trial consisting of a 30-day control period, during which subjects made no change to their lifestyle, followed by a 10-week intervention program that included three supervised aerobic and resistance exercise sessions per week targeting the upper and lower extremities. The participants' midcalves were scanned with multinuclear MRI two times prior to intervention (baseline 1 and baseline 2 ) and once following intervention to measure relaxation times (T1, T1ρ, and T2), phosphocreatine recovery, fat fraction, and diffusion parameters., Results: There were no changes between baseline 1 and baseline 2 MRI metrics (p>0.2). Significant changes (p<0.05) between baseline 2 and postintervention MRI metrics were: gastrocnemius medialis (GM) T1 -2.3%±3.0% and soleus T2 -3.2%±3.1%. Trends toward significant changes (0.052 and postintervention MRI metrics were: calf adipose infiltration -2.6%±6.4%, GM T1ρ -4.1%±7.7%, GM T2 -3.5%±6.4%, and gastrocnemius lateral T2 -4.6±7.4%. Insignificant changes were observed in gastrocnemius phosphocreatine recovery rate constant (p>0.3) and tibial nerve fractional anisotropy (p>0.6) and apparent diffusion coefficient (p>0.4)., Conclusions: The 10-week supervised exercise intervention program successfully reduced adiposity and altered resting tissue properties in the lower leg in DPN. Gastrocnemius mitochondrial oxidative capacity and tibial nerve microarchitecture changes were not observed, either due to lack of response to therapy or to lack of measurement sensitivity., Competing Interests: Competing interests: The authors declare that they have no competing interests. PP is currently employed by Regeneron Pharmaceuticals, Inc and declares no conflict of interest regarding the content of this manuscript., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Increasing research is investigating the COVID-19 pandemic's impact on older adults, but relatively little is known about the complexities of community-dwelling older adults' lived experiences during this historical period. This study aimed to address this gap in the literature by taking a bottom-up, theory-generating, inductive approach. Older adults living in Central Texas ( N = 200; age, 65-92 years, M = 73.6 ± 6.33) responded to a telephone interview during June-August 2020. Data were analyzed using inductive thematic analysis. We identified three key themes: positive, mixed, and negative experiences, with a total of 11 subthemes. A thematic map was developed, illustrating potential connections to mental health. These findings reveal the complexities of older adults' lived experiences during COVID-19 and have implications for developing aging-related policies and community-based interventions during future public health crises. Recognizing the complexities of older adults' lived experiences, tailored policies and interventions can be developed to effectively leverage older adults' effective coping and resilience while at the same time helping overcome negative effects among specific subgroups.

Objective: Aneurysmal subarachnoid hemorrhage remains a devastating event with poorly understood pathophysiology. Previous studies have suggested that aneurysm wall inflammation may play a part in the development and potential rupture of aneurysms. The rabbit elastase aneurysm model is a well-established model, which produces aneurysms closely mimicking human cerebral aneurysms in flow dynamics and histopathology. The primary aim of this study was to correlate inflammatory changes after aneurysm formation using sequential vessel wall imaging with histopathologic analysis. A secondary aim was to evaluate the potential effect of gender and anti-inflammatory treatment with aspirin on this inflammatory response., Methods: Twenty-seven New Zealand rabbits underwent surgery to create an aneurysm using elastase infusion at the right common carotid artery origin. Vessel wall imaging and histopathologic analysis was obtained at different time points after aneurysm creation. The rabbits were also randomized by gender and to treatment groups with or without aspirin., Results: Histopathologic analysis revealed 3 distinct phases after aneurysm formation. These phases were an initial inflammatory phase, followed by a regeneration phase, and finally a connective tissue deposition phase. Vessel wall imaging demonstrated 2 distinct imaging patterns. No appreciable differences were seen in histology or imaging when comparing gender or treatment with aspirin., Conclusions: Inflammatory changes induced by the rabbit elastase aneurysm model can be correlated with histopathologic findings and observed on noninvasive vessel wall imaging. This may provide a method to study the inflammatory pathway as it pertains to aneurysmal development and subsequent rupture., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective . Advances in neural decoding have enabled brain-computer interfaces to perform increasingly complex and clinically-relevant tasks. However, such decoders are often tailored to specific participants, days, and recording sites, limiting their practical long-term usage. Therefore, a fundamental challenge is to develop neural decoders that can robustly train on pooled, multi-participant data and generalize to new participants. Approach . We introduce a new decoder, HTNet, which uses a convolutional neural network with two innovations: (a) a Hilbert transform that computes spectral power at data-driven frequencies and (b) a layer that projects electrode-level data onto predefined brain regions. The projection layer critically enables applications with intracranial electrocorticography (ECoG), where electrode locations are not standardized and vary widely across participants. We trained HTNet to decode arm movements using pooled ECoG data from 11 of 12 participants and tested performance on unseen ECoG or electroencephalography (EEG) participants; these pretrained models were also subsequently fine-tuned to each test participant. Main results . HTNet outperformed state-of-the-art decoders when tested on unseen participants, even when a different recording modality was used. By fine-tuning these generalized HTNet decoders, we achieved performance approaching the best tailored decoders with as few as 50 ECoG or 20 EEG events. We were also able to interpret HTNet's trained weights and demonstrate its ability to extract physiologically-relevant features. Significance . By generalizing to new participants and recording modalities, robustly handling variations in electrode placement, and allowing participant-specific fine-tuning with minimal data, HTNet is applicable across a broader range of neural decoding applications compared to current state-of-the-art decoders., (Creative Commons Attribution license.)

Competing Interests: Competing interests: None declared.

Objective: This article describes lessons learned from the collaborative creation of logical models and standard Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) profiles for family planning and reproductive health. The National Health Service delivery program will use the FHIR profiles to improve federal reporting, program monitoring, and quality improvement efforts., Materials and Methods: Organizational frameworks, work processes, and artifact testing to create FHIR profiles are described., Results: Logical models and FHIR profiles for the Family Planning Annual Report 2.0 dataset have been created and validated., Discussion: Using clinical element models and FHIR to meet the needs of a real-world use case has been accomplished but has also demonstrated the need for additional tooling, terminology services, and application sandbox development., Conclusion: FHIR profiles may reduce the administrative burden for the reporting of federally mandated program data., Competing Interests: None declared., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Stroke patients requiring decompressive craniectomy are at high risk of prolonged mechanical ventilation and ventilator-associated pneumonia (VAP). Tracheostomy placement may reduce the duration of mechanical ventilation. Predicting which patients will require tracheostomy and the optimal timing of tracheostomy remains a clinical challenge. In this study, the authors compare key outcomes after early versus late tracheostomy and develop a useful pre-operative decision-making tool to predict post-operative tracheostomy dependence., Methods: We performed a retrospective analysis of prospectively collected registry data. We developed a propensity-weighted decision tree analysis to predict tracheostomy requirement using factors present prior to surgical decompression. In addition, outcomes include probability functions for intensive care unit length of stay, hospital length of stay, and mortality, based on data for early (≤ 10 days) versus late (> 10 days) tracheostomy., Results: There were 168 surgical decompressions performed on patients with acute ischemic or spontaneous hemorrhagic stroke between 2010 and 2015. Forty-eight patients (28.5%) required a tracheostomy, 35 (20.8%) developed VAP, and 126 (75%) survived hospitalization. Mean ICU and hospital length of stay were 15.1 and 25.8 days, respectively. Using GCS, SOFA score, and presence of hydrocephalus, our decision tree analysis had 63% sensitivity and 84% specificity for predicting tracheostomy requirement. The early group had fewer ventilator days (7.3 versus 15.2, p  < 0.001) and shorter hospital length of stay (28.5 versus 44.4 days, p  = 0.014). VAP rates and mortality were similar between the two groups. Withdrawal of treatment interventions shortly post-operatively confounded mortality outcomes., Conclusion: Early tracheostomy shortens duration of mechanical ventilation and length of stay after surgical decompression for stroke, but it did not impact mortality or VAP rates. A decision tree is a practical tool that may be helpful in guiding pre-operative decision-making with patients' families., Competing Interests: This study was approved by the Institutional Review Board of University of North Carolina at Chapel Hill with study number 15-2372.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Post-consumer recycled (PCR) plastic material is made by collecting used plastic products (e.g., bottles and other plastic packaging materials) and reprocessing them into solid-state pellets or flakes. Plastic recycling has positive environmental benefits, but may also carry potential drawbacks due to unwanted organic and inorganic contaminants. These contaminants can migrate into food packaging made from these recycled plastic materials. The purpose of this research was to identify economically viable real-time monitoring technologies that can be used during the conversion of virgin and recycled resin feedstocks (i.e., various blends of virgin pellets and recycled solid-state pellet or mechanically ground flake) to final articles to ensure the safety, quality and sustainability of packaging feedstocks. Baseline analysis (validation) of real-time technologies was conducted using industry-standard practices for polymer analysis. The data yielded supervised predictive models developed by training sessions completed in a controlled laboratory setting. This technology can be employed to evaluate compliance and aid converters in commodity sourcing of resin without exceeding regulatory thresholds. Furthermore, this technology allowed for real-time decision and diversion strategies during the conversion of resin and flake to final articles or products to minimise the negative impact on human health and environmental exposure.

Objectives: To evaluate the feasibility and potential clinical benefits of medicines optimisation through comprehensive geriatric assessment (CGA) of frail patients with multiple conditions, by secondary care geriatricians in a general practice care setting., Methods: Seven general practitioner (GP) practices in one region of Stoke-on-Trent volunteered to take part. GPs selected patients (n=186) who were local permanent residents, at least 65 years old and on eight or more medications per day. Patients were sent a written invitation outlining the assessment purpose/format. Prior to patient assessments, primary care staff prepared packs detailing patient medical history, recent consultations, current medications, recent laboratory tests and social circumstances. One hour was allocated for the CGA per patient, with one of three geriatricians, to enable sufficient time to explore all relevant aspects. Assessment comprised a full history, thorough clinical examination, assessment of balance and mobility, mental function and information on home environment and support arrangements. After consultation, geriatricians made recommendations regarding further assessments, investigations or medication changes. Geriatricians entered their main findings and recommendations onto a standard template., Results: In total, 687 recommendations for changes in patients' medication regimens were made for 169 (91%) patients. In 17 (9%) patients there was no recommendation to alter medications. This resulted in an average of four alterations in medication per patient. The predominant changes to medications were to stop medications (34%) or to reduce the dosage (24%). Starting a new medication represented 18% of all the medication changes. Adherence rates to geriatrician medication recommendations were 72% at 6 months and 65% at 12 months., Conclusions: CGA of older patients with complex needs, by geriatricians in a general practice care setting, is feasible. Our study demonstrated constructive collaboration between GPs and geriatricians from secondary care, suggesting further studies and clinical trials are feasible and have scope to yield beneficial outcomes., Competing Interests: Competing interests: Sally-Ann Chambers, one of the geriatricians who undertook the comprehensive geriatric assessments, is the daughter-in-law of RC., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Alzheimer's disease (AD) and mild cognitive impairment (MCI) affect the limbic system, causing medial temporal lobe (MTL) atrophy and posterior cingulate cortex (PCC) hypometabolism. Additionally, diffusion tensor imaging (DTI) studies have demonstrated that MCI and AD involve alterations in cerebral white matter (WM) integrity., Objectives: To test if (1) patients with MCI and AD exhibit decreases in the integrity of limbic WM pathways; (2) disconnection between PCC and MTL, manifested as disruption of the cingulum bundle, contributes to PCC hypometabolism during incipient AD., Methods: We measured fractional anisotropy (FA) and volume of the fornix and cingulum using DTI in 23 individuals with MCI, 21 with mild-to-moderate AD, and 16 normal control (NC) subjects. We also measured PCC metabolism using (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) in AD and MCI patients., Results: Fornix FA and volume were reduced in MCI and AD to a similar extent. Descending cingulum FA was reduced in AD while volume was reduced in MCI and even more so in AD. Both FA and volume of the fornix and descending cingulum reliably discriminated between NC and AD. Fornix FA and descending cingulum volume also reliably discriminated between NC and MCI. Only descending cingulum volume reliably discriminated between MCI and AD. In the combined MCI-AD cohort, PCC metabolism directly correlated with both FA and volume of the descending cingulum., Conclusions: Disruption of limbic WM pathways is evident during both MCI and AD. Disconnection of the PCC from MTL at the cingulum bundle contributes to PCC hypometabolism during incipient AD., (Copyright © 2011 Wiley Periodicals, Inc.)

The intermediate filament protein synemin is present in astrocyte progenitors and glioblastoma cells but not in mature astrocytes. Here we demonstrate a role for synemin in enhancing glioblastoma cell proliferation and clonogenic survival, as synemin RNA interference decreased both behaviors by inducing G1 arrest along with Rb hypophosphorylation and increased protein levels of the G1/S inhibitors p21(Cip1) and p27(Kip1). Akt involvement was demonstrated by decreased phosphorylation of its substrate, p21(Cip1), and reduced Akt catalytic activity and phosphorylation at essential activation sites. Synemin silencing, however, did not affect the activities of PDPK1 and mTOR complex 2, which directly phosphorylate Akt activation sites, but instead enhanced the activity of the major regulator of Akt dephosphorylation, protein phosphatase type 2A (PP2A). This was accompanied by changes in PP2A subcellular distribution resulting in increased physical interactions between PP2A and Akt, as shown by proximity ligation assays (PLAs). PLAs and immunoprecipitation experiments further revealed that synemin and PP2A form a protein complex. In addition, treatment of synemin-silenced cells with the PP2A inhibitor cantharidic acid resulted in proliferation and pAkt and pRb levels similar to those of controls. Collectively these results indicate that synemin positively regulates glioblastoma cell proliferation by helping sequester PP2A away from Akt, thereby favoring Akt activation.

Cadaveric allografts and a large variety of other biologic dressings have been reported as being useful for the postoperative management of Mohs micrographic surgery (MMS) wounds. Although the use of porcine xenografts for the immediate postoperative management of these wounds is known, their use has not been detailed in the dermatology literature. A case series of 15 consecutive Mohs micrographic surgery patients (mean age = 74.9 years, range = 49 to 89 years) with wounds initially managed with porcine xenografts is described. Porcine xenografts were useful in a variety of clinical settings following MMS. These included: (1) wound management when tumor margins were indeterminate pending additional dermatopathology studies and (2) wound management when there are issues such as through and through nasal defects involving the mucosa, large wound depth, exposed cartilage and or bone, or patient medical comorbidities that delay or prevent plans for immediate wound reconstruction. Future controlled studies of biologic dressings are needed to determine which options are best for micrographic surgery wounds. Comparisons should also include the traditional option of second intention healing without biologic dressings.

Epidemiological evidence suggests positive correlations between pesticide usage and the incidence of Parkinson's disease (PD). To further explore this relationship, we used wild type (N2) Caenorhabditis elegans (C. elegans) to test the following hypothesis: Exposure to a glyphosate-containing herbicide (TD) and/or a manganese/zinc ethylene-bis-dithiocarbamate-containing fungicide (MZ) may lead to neurotoxicity. We exposed N2 worms to varying concentrations of TD or MZ for 30 min (acute) or 24h (chronic). To replicate agricultural usage, a third population was exposed to TD (acute) followed by MZ (acute). For acute TD exposure, the LC(50)=8.0% (r(2)=0.6890), while the chronic LC(50)=5.7% (r(2)=0.9433). Acute MZ exposure led to an LC(50)=0.22% (r(2)=0.5093), and chronic LC(50)=0.50% (r(2)=0.9733). The combined treatment for TD+MZ yielded an LC(50)=12.5% (r(2)=0.6367). Further studies in NW1229 worms, a pan-neuronally green fluorescent protein (GFP) tagged strain, indicated a statistically significant (p<0.05) and dose-dependent reduction in green pixel number in neurons of treated worms following each paradigm. This reduction of pixel number was accompanied by visual neurodegeneration in photomicrographs. For the dual treatment, Bliss analysis suggested synergistic interactions. Taken together, these data suggest neuronal degeneration occurs in C. elegans following treatment with environmentally relevant concentrations of TD or MZ., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Overweight and obesity are at epidemic proportions. This study examines the attitudes and actions of Oklahoma clinicians in obesity treatment, and the characteristics and perceptions of a subset of their patients who lost weight and were able to maintain weight loss., Methods: Our study was a small mixed method study involving both surveys and interviews. Descriptive statistics were calculated, content analysis of interviews performed, and a model outline for obesity counseling was developed., Results: Only 38% of the 66 clinicians surveyed try to motivate their patients to lose weight. Patients interviewed recommended that clinicians treat obesity as a medical problem. We incorporated themes from the patient interviews into the S-MASS model for obesity screening and counseling.This was positively reviewed by clinicians and patients., Conclusion: The S-MASS model can function as a guide to help the clinician/patient team develop successful strategies for weight loss and maintenance of weight loss.

Background: The efficient use of operating theatres is important to ensure optimum cost-benefit for the hospital and to clear waiting lists. This audit uses the orthopaedic trauma theatre as a model to assess the theatre efficiency at our institution., Methods: We performed a retrospective audit using data gathered from the operating theatre database at our institution. We considered each component of the operating theatre process and integrated them to give a combined value for surgical and anaesthetic time (end utilization) and total theatre efficiency (operating theatre utilization)., Results: Results showed that relative to the standards set, changeover time and start times were sub-standard, with consistently prolonged changeovers and late starts. End utilization and operating theatre utilization were 78.8 and 81%, against a standard of 77 and 85-90%, respectively. However, these figures may be misleading due to sub-standard performance in changeover time and other variables., Conclusions: We have highlighted inefficiency in the orthopaedic trauma theatre at our institution and suggest various strategies to improve this that may be applied universally.

Objectives: The authors assessed relocated Hurricane Katrina survivors' emotional and biological stress measures 20 months postdisaster to understand effects of both hurricane exposure and forced relocation on emotional and physical health., Design: Psychiatric diagnoses, post-traumatic stress disorder (PTSD) and depressive symptoms, and biological stress measures were compared for total survivor and control groups and subgroups by PTSD diagnoses and lifetime trauma., Setting: Outpatient university psychiatry clinics in Oklahoma City and Tulsa., Participants: Thirty-four healthy adult Katrina survivors relocated to Oklahoma, and 34 healthy, demographically matched Oklahoma comparison participants., Main Outcome Measures: Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, assessed Axis I psychiatric disorders. Clinician-Administered PTSD Scale and Beck Depression Inventory quantified PTSD and depression symptoms. Biological stress measures were physiologic reactivity (heart rate and blood pressure responses to a trauma interview), interleukin-2 (IL-2; cell-mediated immunity), and interleukin-6 (IL-6; proinflammatory cytokine)., Results: Both groups had high lifetime trauma exposure. Among survivors, current hurricane-related and predisaster PTSD were diagnosed in 35.3 and 11.8 percent. Controls had current (11.8 percent) and lifetime (14.7 percent) PTSD. Survivors' PTSD and depression symptom levels were higher than controls and within illness ranges. The survivors had higher IL-6 than nontraumatized controls, higher IL-6 in the presence of PTSD, and higher baseline heart rates and mean arterial blood pressure reactivity than controls., Conclusions: Higher IL-6 and autonomic measures for several Katrina survivor subgroups than control subgroups may confer future cardiovascular risks. The results are discussed relative to increased myocardial infarct rates in New Orleans after Katrina. Even healthy survivors should be assessed for cardiovascular risks and mental health sequelae.

Background: Several specialties and textbooks continue to advocate that local anesthesia using epinephrine should not be used during surgery involving the digits., Objective: We sought to assess the association between local anesthesia (buffered 0.5% lidocaine and 1:200,000 epinephrine) injected into digits, comorbid patient conditions, and postoperative complications including ischemia or necrosis., Methods: A retrospective review of all patients presenting for Mohs micrographic surgery in a private practice ambulatory surgery center was performed between October 2002 and January 2009. Patient factors including amount of anesthesia injected; preoperative vitals; history of hypertension, stroke, or circulatory disorders; and presence of anticoagulation were assessed., Results: Three Mohs surgeons' patients were included in the study. No digital blocks were performed; local anesthesia was infiltrated directly into the tumor site. Patients received buffered 0.5% lidocaine plus epinephrine 1:200,000. Of 63 patients presenting for surgery (59 fingers and 4 toes), there were no cases of digital ischemia or necrosis. Approximately one-third had a circulatory disorder or diabetes, and more than half had a diagnosis of hypertension or were taking anticoagulation. The average amount of anesthesia injected was 6.92 mL, with the greatest amount being 25 mL., Limitations: This was a retrospective review with possible overestimation of adverse effects as a result of referral bias of complicated patients to an ambulatory surgery center for treatment., Conclusion: There is no evidence that buffered 0.5% lidocaine with epinephrine 1:200,000 causes ischemia or necrosis when injected into digits. This is true despite a history of circulatory disorders, thrombosis, diabetes, smoking, anticoagulation, or significant preoperative hypertension.