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Purpose: Level 1 evidence supports the use of acupuncture/acupressure (A/A) to manage post-operative nausea and vomiting (PONV). This study aimed to survey healthcare professionals’ attitudes towards A/A, influencing factors and barriers to implementing this effective non-drug intervention into peri-operative care.Methods: A validated, anonymous survey with 43 questions was emailed or distributed as a hard copy at meetings to anaesthetists, midwives, nurses, obstetricians, gynaecologists and surgeons at a public hospital in Australia. Descriptive data were presented. Influencing factors were explored using chi-square analysis. Multinomial logistical regression was used to identify the influences of confounding factors.Results: A total of 155 completed surveys were returned, reflecting a response rate of 32%. The majority of participants were female (69%), nurses/midwives (61%) and aged between 20 and 50 years old (76%). Eighty-three percent of respondents considered A/A ‘clearly alternative’ medicine or ‘neither mainstream nor alternative’. Eighty-one percent would encourage patients to use acupressure for PONV if it was offered at the hospital. Previous personal use of A/A was the key factor influencing attitudes and openness to clinical use. The key barriers to implementation were perceived lack of evidence and lack of qualified providers and time.Conclusion: Hospital-based healthcare professionals strongly supported the evidence-based use of A/A for PONV despite considering the therapy to be non-mainstream and having limited A/A education or history of personal use, providing a positive context for an acupressure implementation study. Significant gaps in training and a desire to learn were identified.

Transition-metal phosphides (TMPs) are versatile materials with tunable electronic and structural properties that have led to exceptional catalytic performances for important energy applications. Identifying predictive relationships between the catalytic performance and key features such as the composition, morphology, and crystalline structure hinges on the ability to independently tune these variables within a TMP system. Here, we have developed a versatile, low-temperature solution synthesis route to alloyed nickel phosphide (Ni1.6M0.4P, where M = Co, Cu, Mo, Pd, Rh, or Ru) nanoparticles (NPs) that retains the structure of the parent Ni2P NPs, allowing investigation of compositional effects on activity without convoluting factors from differences in morphology and crystalline phase. As a measure of the controlled changes introduced within the isostructural series by the second metal, the binary and alloyed ternary TMP NPs supported on carbon at a nominal 5% weight loading were studied as electrocatalysts for the hydrogen evolution reaction (HER). The resultant activity of the electrocatalyst series spanned a 125 mV range in overpotential, and composition-dependent trends were investigated using density functional theory calculations on flat (0001) and corrugated (101̅0) Ni1.67M0.33P surfaces. Applying the adsorption free energy of atomic H (GH) as a descriptor for HER activity revealed a facet-dependent volcano-shaped correlation between the overpotential and GH, with the activity trend well represented by the corrugated (101̅0) surfaces on which metal–metal bridge sites are available for H adsorption but not the flat (0001) surfaces. The versatility of the rational synthetic methodology allows for the preparation of a wide range of compositionally diverse TMP NPs, enabling the investigation of critical composition–performance relationships for energy applications.

Conservative management, specifically with active surveillance (AS), has emerged as the preferred approach for low-risk prostate cancer (LRPC). We evaluated the trend for conservative management (ie, no active treatment within 12mo of diagnosis) for LRPC in an Australian population-based cohort of men captured in the Prostate Cancer Outcomes Registry Victoria (PCOR-Vic). Of the 3201 men diagnosed with LRPC between January 2009 and December 2016, 60% (1928/3201) had conservative management, and 52% (1664/3201) were documented to be on AS. There was an increase in conservative management from 52% in 2009 to 73% in 2016 (p<0.001), largely attributable to an increase in AS from 33% in 2009 to 67% in 2016 (p<0.001). When stratified by age group, the increase in conservative management was more pronounced among younger patients: from 37% to 66% for men aged <60yr versus from 72% to 86% for men aged ≥70yr. In multivariable analyses, increasing age, lower prostate-specific antigen and clinical category, lower socioeconomic status, and being diagnosed in public metropolitan institutions were all independently associated with a greater likelihood of conservative management. Identification of sociodemographic and institutional variations in practice allows for targeted strategies to improve management for men with LRPC.

Anthropogenic mercury emission to the atmosphere adversely affects the environment, wildlife, and human health. Accordingly, the design and implementation of improved mercury-capture technologies have received increased attention. We present a computational chemistry-based screening study to guide the development of mercury-capture materials. We use density functional theory (DFT) to probe the efficacy of metal salts and metal oxides (NaCl, NaBr, KCl, KBr, CaCl2, CaBr2, NaNO3, and MgO) toward mercury capture and their ability to be regenerated for continued use. We focus on three primary sources of mercury emission as elemental gaseous mercury (Hg(0)) or oxidized gaseous mercury species (Hg(II); HgCl2or HgBr2): (i) Hg(0) emission from artisanal Au production; (ii) Hg(II)/Hg(0) emission from inlet/outlet streams for flue-gas desulfurization (FGD) operation; and (iii) Hg(0) and Hg(II) emission from cement production. Our results suggest that CaCl2and CaBr2are good candidates for capturing Hg(0) in artisanal Au production. For FGD operation, KBr, MgO, CaCl2, and CaBr2are good candidates for capturing HgCl2and HgBr2, while CaBr2is the only studied material that can capture Hg(0) from the outlet FGD stream. For cement production, CaBr2is the only material of those studied that can capture Hg(0), HgCl2, and HgBr2. Our DFT results can accelerate the development of cheap and regenerable mercury-capture materials, as well as better prevent the release of mercury to the environment.

The aim of this study was to investigate the effect of a single dose of prednisolone on (A) high-intensity interval cycling performance and (B) post-exercise metabolic, hormonal and haematological responses. Nine young men participated in this double-blind, randomised, cross-over study. The participants completed exercise sessions (4 × 4 min cycling bouts at 90–95% of peak heart rate), 12 h after ingesting prednisolone (20 mg) or placebo. Work load was adjusted to maintain the same relative heart rate between the sessions. Exercise performance was measured as total work performed. Blood samples were taken at rest, immediately post exercise and up to 3 h post exercise. Prednisolone ingestion decreased total work performed by 5% (P< 0.05). Baseline blood glucose was elevated following prednisolone compared to placebo (P< 0.001). Three hours post exercise, blood glucose in the prednisolone trial was reduced to a level equivalent to the baseline concentration in the placebo trial (P> 0.05). Prednisolone suppressed the increase in blood lactate immediately post exercise (P< 0.05). Total white blood cell count was elevated at all time-points with prednisolone (P< 0.01). Androgens and sex hormone-binding globulin were elevated immediately after exercise, irrespective of prednisolone or placebo. In contrast, prednisolone significantly reduced the ratio of testosterone/luteinizing hormone (P< 0.01). Acute prednisolone treatment impairs high-intensity interval cycling performance and alters metabolic and haematological parameters in healthy young men. Exercise may be an effective tool to minimise the effect of prednisolone on blood glucose levels.

To examine the effect of a system of expedited review of critically ill patients in the Emergency Department (ED) on ED length of stay (LOS) and Intensive Care Unit (ICU) outcomes.

Protein cage self-assembly enables encapsulation and sequestration of small molecules, macromolecules, and nanomaterials for many applications in bionanotechnology. Notably, wild-type thermophilic ferritin from Archaeoglobus fulgidus(AfFtn) exists as a stable dimer of four-helix bundle proteins at a low ionic strength, and the protein forms a hollow assembly of 24 protomers at a high ionic strength (∼800 mM NaCl). This assembly process can also be initiated by highly charged gold nanoparticles (AuNPs) in solution, leading to encapsulation. These data suggest that salt solutions or charged AuNPs can shield unfavorable electrostatic interactions at AfFtn dimer–dimer interfaces, but specific “hot-spot” residues controlling assembly have not been identified. To investigate this further, we computationally designed three AfFtn mutants (E65R, D138K, and A127R) that introduce a single positive charge at sites along the dimer–dimer interface. These proteins exhibited different assembly kinetics and thermodynamics, which were ranked in order of increasing 24mer propensity: A127R < wild type < D138K ≪ E65R. E65R assembled into the 24mer across a wide range of ionic strengths (0–800 mM NaCl), and the dissociation temperature for the 24mer was 98 °C. X-ray crystal structure analysis of the E65R mutant identified a more compact, closed-pore cage geometry. A127R and D138K mutants exhibited wild-type ability to encapsulate and stabilize 5 nm AuNPs, whereas E65R did not encapsulate AuNPs at the same high yields. This work illustrates designed protein cages with distinct assembly and encapsulation properties.

Study Design: Meta-analysis and systematic review of literature.Objective: In the late 1990s, spinal surgeons experimented by using maxillofacial fixation plates as an alternative to sutures, anchors, and local spinous process autografts to provide a more rigid and lasting fixation for laminoplasty. This eventually led to the advent of laminoplasty mini-plates, which are currently used. The objective is to compare laminoplasty techniques with plate and without plate with regard to functional outcome results.Methods: Qualitative and quantitative analyses were performed to evaluate the currently available studies in an attempt to justify the use of a plate in laminoplasty.Results: The principal finding of this study was that there was no statistically significant difference in clinical outcome between the 2 different techniques of laminoplasty.Conclusion: There is not enough evidence in the literature to support one technique over the other, and hence, there is no evidence to support change in practice (using or not using the plate in laminoplasty). A randomized controlled trial will give a better comparison between the 2 groups.

Prognostic biomarkers are useful in allogeneic stem cell transplantation (SCT) to predict survival and relapse outcomes. We sought to derive a prognostic scoring system, which augmented the predictive power of the disease risk index (DRI) by incorporating biomarkers and validating their significance after SCT. The outcomes of overall survival (OS) and relapse were assessed with non-relapse mortality (NRM) treated as a competing risk to relapse. Six hundred and two patients were identified through a retrospective analysis of allogeneic SCT recipients for haematological malignancy between 2000 and 2013 in a single centre. Multivariate analysis confirmed the significant predictors of OS pre-SCT were serum ferritin >1000 μg/L (hazard ratio (HR) 1.94, 95% comorbidity index (CI): 1.44–2.60), Hb <100 g/L (HR 1.71, 95% CI: 1.27–2.30) and albumin <30 g/L (HR 2.65, 95% CI: 1.30–5.40). In combination with DRI, these biomarkers significantly improved the Harrell’s Cstatistic (excluding biomarkers: C=0.60, 95% CI: 0.57–0.64; with biomarkers: C=0.65, 95% CI: 0.62–0.69, P<0.001). Four prognostic groups were derived at the pre-SCT time point: Group 1 (Scores 0–1, n=180, HR=1 (ref)), Group 2 (Scores 2–5, n=298, HR 2.7, 95% CI: 1.8–3.9), Group 3 (Scores 6–7, n=87, HR 4.5, 95% CI: 3.0–6.9) and Group 4 (scores 8–10, n=9, HR 13.4, 95% CI: 5.9–30.2). These prognostic models were also predictive of relapse and NRM and remained valid at day 100, 12 months and 24 months post SCT.

Aims:The aim of this study was to compare the prevalence of depressive symptoms in Australian and Japanese populations of community-dwelling older women using the Geriatric Depression Scale (GDS-15). In addition, the relationship between lifestyle and health factors and higher ratings of depressive symptoms was also examined to determine if there were culturally consistent risk factors associated with higher depressive symptom scores.Methods:A total of 444 community based women aged between 65 and 77 years completed a depressive symptom measure (GDS-15) and provided information on common lifestyle factors. The Australian sample (n= 222) were drawn from the Women's Healthy Ageing Project and the age-matched, Japanese sample from the Kumamoto Ageing Study of Mental Health (n= 222). The GDS was chosen to; (1) reduce the impact of physical symptoms associated with old age and, (2) reduce the inflation in scores that may result from the Japanese tendency to endorse somatic items more often than Western adults.Results:Mean GDS total scores were significantly higher for the Japanese population 3.97 ± 3.69 compared with 1.73 ± 2.7 for Australian women. The percentages of women scoring in the normal; mild and moderate ranges for depression were 91, 7 and 2% for Australia and 67, 24 and 9% for Japan. Scores remained significantly higher for the Japanese cohort when controlling for lifestyle and health factors associated with depression. The analysis of lifestyle and health characteristics showed that the greatest difference between cohorts was in the area of living status, with more Australian women living with their partner and more than three times as many Japanese women living with their children. When the data for the countries was considered independently employment status affected the likelihood of higher depression scores in the Australian sample while heart disease and poor sleep impacted the risk for the Japanese population.Conclusions:Significantly more Japanese women scored within the mild and moderate ranges on the GDS compared with their Australian peers, even when controlling for possible confounding factors. Of the lifestyle and health factors assessed in this analysis no single variable was a common risk factor for higher depressive scores for both countries. The presence of cultural influences that may impact the risk of experiencing depressive symptoms, and culture specific patterns of item endorsement on depressive symptom measures, needs to be explored in more detail.

Guidelines recommend healthcare workers (HCWs) undertake fit testing of P2/N95 respirators to mitigate the risk of infectious aerosols, however few studies have assessed whether fit testing reduces COVID-19 infection.

Pre–medical emergency team (MET) calls are an increasingly common tier of Rapid Response Systems, but the epidemiology of patients who trigger a Pre-MET is not well understoof.

Endotracheal tube (ETT) cuff pressure management is an essential part of airway management in intubated and mechanically ventilated patients. Both under- and over-inflation of the ETT cuff can lead to patient complications, with an ideal pressure range of 20–30 cmH2O defined. A range of techniques are employed to ensure adequate ETT cuff inflation, with little comparative data. We performed an observational cross-sectional study in a tertiary metropolitan ICU, assessing the relationship between the minimal leak test and cuff manometry. Forty-five mechanically ventilated patients, over a three-month period, had ETT cuff manometry performed at the same time as their routine cuff maintenance (minimal leak test). Bedside nurse measurements were compared with investigator measurements. At the endpoint of cuff inflation, 20 of 45 patients (44%) had cuff pressures between 20 and 30 cmH2O; 11 of 45 patients (24%) had cuff pressures <20 cmH2O; 14 of 45 patients (31%) had cuff pressures >30 cmH2O. Univariate analysis demonstrated an association between both patient obesity and female gender requiring less ETT cuff volume (P=0.008 and P<0.001 respectively), though this association was lost on multivariate analysis. No association was demonstrated between any measured variables and cuff pressures. Inter-operator reliability in performing the minimal leak test showed no evidence of bias between nurse and investigators (Pearson coefficient = 0.897). We conclude the minimal leak test for maintenance of ETT cuffs leads to both over- and under-inflation, and alternative techniques, such as cuff manometry, should be employed.

Purpose To assess the maximum and end torque of a fourth-generation composite humerus model with no screw inserted or with a screw inserted in the distal (subpectoral) position or proximal (suprapectoral) position.Methods 24 large-size, fourth-generation composite humeri were randomised to the control (n=8), proximal (n=8), or distal (n=8) group. For the latter 2 groups, an 8-mm-head interference screw (7times25 mm) was inserted at 1 cm proximal and 1 cm distal to the superior aspect of the insertion of the pectoralis major tendon, respectively. The maximum and end torque of each humerus was assessed.Results Respectively for the control, proximal, and distal groups, the maximum torque was 81.8, 78.7, and 74.3 Nm, and the end torque was 80.7, 78.6, and 71.8 Nm; only the difference between control and distal groups was significant (p=0.005 for maximum torque and p=0.033 for end torque). All fractures in both control and proximal groups involved the distal 1/3 humerus. In the distal group, the fractures involved either the distal 1/3 humerus (n=6) or the screw-hole (n=2); the difference between the 2 types of fracture was not significant in terms of maximum torque (75.7 vs. 70.0, p=0.086) or end torque (75.3 vs. 61.4, p=0.40).Conclusion Compared with proximal placement of an interference screw, distal placement decreased the maximum torque (though not significantly) and may increase the risk of proximal humeral fracture.

Purpose This study was aimed to highlight neck notching as a potential cause of failure in modular neck total hip arthroplasty. It aimed to identify both the combination of modular components that place patients at greatest risk of failure and the potential mechanism for failure.Methods This study involved a retrospective review of 301 total hip arthroplasties (THA) using Kinectiv modular neck Technology (Zimmer, Warsaw, Indiana). The primary outcome was the presence of neck notching requiring revision. Patient records, operative notes and postoperative radiographs were reviewed. A statistical analysis was performed.Results A total of 301 THA were performed on 290 patients. There were 7 failures (2.3%). All 7 failures involved a modular combination of an anteverted neck, extended offset and length code -8 (failure rate of 36.8%, p<0.001).Conclusions We identified femoral neck notching as a potential cause of failure in modular neck THA. The combination of an anteverted neck, extended offset and length code -8 was associated with a high rate of neck notching using the Kinectiv modular neck Technology (Zimmer, Warsaw, Indiana). Based on our experience with this prosthesis we advise caution when using this particular combination of implants.

The Making Cancer History Voices Oral History Project is run by the Research Medical Library at the University of Texas MD Anderson Cancer Center in Houston, Texas. The project is unique among bio-and-medical institutions and archives because of its commitment to a three-part project mission: ongoing interview collection; extensive post-processing of interviews to map content; and the development of access tools for traditional and non-traditional users. The project began, however, with a narrowly conceived mission and fragmentary post-processing protocol. The authors describe the strategies adopted to implement a new mission, transforming the project into an efficient and integrated system with significant content mapping capacity. Implementation was significantly shaped by the multi-disciplinary nature of the oral history team: an oral historian and an archivist have collaborated to address the special challenges that spoken language presents to content management. They describe how they developed a meme-based coding system, developed search and navigation tools to facilitate use and staff workflow and organised a relational database.

Insist on reaching, into thorns to blow off ants, or wind your fingers around webs, beads of raindrops run together in slow succession, an edging down anchor threads: would you believe me if I told you: night comes piercing in like antelope horn, right in and out the midsection, bearing all but head. WEB EXTRA Listen to Tacey M. Atsitty recite her poem at hcn.org/horned-monster Baby's breath, as they sometimes call it, ugly with fly egg sacs is sometimes used to line diapers: it masks the smell of sin & urine. [Extracted from the article]

It is now well-recognised that patients with autoimmune rheumatic disease (AIRD) have a predisposition to cardiovascular disease that results in increased morbidity and mortality. Following myocardial infarction (MI), patients with rheumatoid arthritis have been shown to have an increased case fatality rate; however, this has not been demonstrated in other forms of AIRD. The aim of this study was to compare case fatality rates following a first MI in patients with AIRD versus the general population. The secondary aim was to compare revascularisation treatment following MI in patients with AIRD versus the general population. A retrospective cohort study using two population-based linked databases was undertaken. Cases of first MI from July 2001 to June 2007 were identified based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, codes. Thirty-day and one-year mortality rates were calculated (all-cause and cardiovascular causes of death). Logistic regression models were fitted to calculate the odds of mortality by AIRD status with adjustment for relevant characteristics. There were 79,390 individuals with a first MI, of whom 1,409 (1.8%) had AIRD. After adjusting for relevant covariates, the odds ratio (OR) for 30-day cardiovascular mortality in patients with AIRD was 1.44 (95% confidence interval (CI): 1.25 to 1.66), and the OR for 12-month cardiovascular mortality was 1.71 (95% CI: 1.51 to 1.94). The 90-day adjusted odds of percutaneous transluminal coronary angioplasty and coronary artery bypass graft were significantly lower in the AIRD group compared with controls (OR: 0.81, 95% CI: 0.70 to 0.94, and OR: 0.52, 95% CI: 0.39 to 0.69, respectively). We identified a higher risk-adjusted mortality rate for the majority of patients with AIRD at 30 days and 12 months after first MI. We also identified lower post-MI revascularisation rates in the AIRD group, suggesting there may be current gaps in cardiovascular treatment for patients with AIRD.

It is unclear whether increases to overnight junior medical staffing levels can improve ICU patient outcomes. We conducted a retrospective cohort study before and after the introduction of a third overnight ICU registrar at a 24-bed metropolitan ICU in February 2012. We hypothesised that this change would be associated with decreased intubation time for elective cardiac surgery patients and an increase in the proportion of these patients being extubated during the overnight period. All elective cardiac surgery patients were included from two temporally matched six-month periods (May to October) in 2011 and 2012. The primary outcome was median duration of intubation, and the secondary outcome was proportion of patients extubated during the ‘overnight’ period (2200 to 0700). A total of 142 and 188 patients were included in the control and intervention cohorts, respectively. Median (IQR) intubation time was 8.7 (6.6 to 14.5) hours in the control cohort and 8.2 (6.0 to 13.4) hours in the intervention cohort, with no significant difference between groups (P=0.40). The proportion of elective cardiac surgery patients extubated during the overnight period was similar, 54.2% in the control group compared to 50.0% in intervention group (P=0.45). In our unit, increasing overnight ICU registrar staffing levels was not associated with a significant reduction in duration of intubation for elective cardiac surgery patients or a reduction in the proportion of these patients extubated overnight. This is likely due to factors other than medical staffing levels influencing timing of extubation of these patients.