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• Moral injury involves distress from exposure to traumatic events • Nurses are vulnerable to moral injury which has largely been under-addressed • The concept of moral injury can be integrated into nursing education to help prepare nurses for the potential • Educational strategies include use of recognition and support, ethics education, and promotion of self-care. [ABSTRACT FROM AUTHOR]

Thanks to methodological advances, large-scale data collections, and longitudinal designs, psychiatric neuroimaging is better equipped than ever to identify the neurobiological underpinnings of youth mental health problems. However, the complexity of such endeavors has become increasingly evident, as the field has been confronted by limited clinical relevance, inconsistent results, and small effect sizes. Some of these challenges parallel those historically encountered by psychiatric genetics. In past genetic research, robust findings were historically undermined by oversimplified biological hypotheses, mistaken assumptions about expectable effect sizes, replication problems, confounding by population structure, and shared biological patterns across disorders. Overcoming these challenges has contributed to current successes in the field. Drawing parallels across psychiatric genetics and neuroimaging, we identify key shared challenges as well as pinpoint relevant insights that could be gained in psychiatric neuroimaging from the transition that occurred from the candidate gene to (post) genome-wide "eras" of psychiatric genetics. Finally, we discuss the prominent developmental component of psychiatric neuroimaging and how that might be informed by epidemiological and omics approaches. The evolution of psychiatric genetic research offers valuable insights that may expedite the resolution of key challenges in psychiatric neuroimaging, thus potentially moving our understanding of psychiatric pathophysiology forward. • There are several challenges shared by psychiatric genetics and neuroimaging. • Challenges include distributed, small effects, replicability, and oversimplified hypotheses. • Insights from psychiatric genetics' history can inform psychiatric neuroimaging. [ABSTRACT FROM AUTHOR]

The circular economy (CE) has been one of the key environmental policy concepts of the last decade. Despite the growing number of CE policies, applications and research, we still lack a detailed understanding of what kind of policy idea we are referring to with the CE. Our purpose in this perspective is to untangle the ideational features of the CE by separating three dynamic dimensions from the idea: economic model, conceptual innovation and policy objectives. In addition, we propose the research of hybridity as a fitting theoretical discussion to understand the plural societal setup in which the idea of the CE has been implemented. • Paper clarifies the nature of the circular economy (CE) as a policy idea. • Three dynamic ideational dimensions of the CE are discussed. • The research of hybridity is proposed as a resource for CE policy analysis. [ABSTRACT FROM AUTHOR]

An 11-year-old male common marmoset (Callithrix jacchus) presented with chronic, progressive weight loss and diarrhoea. Response to treatment with nutritional supplementation, antibiotics and immunosuppressants was modest and transient, and the animal was humanely euthanized. At necropsy, the proximal 8 cm of small intestine was diffusely pale with transmural thickening. The lungs contained coalescing tan, firm nodules measuring up to 4 mm in diameter. Histological examination revealed infiltrative mucinous adenocarcinoma of the duodenum with extensive metastases to the lungs, liver and left parapatellar adipose tissue. The mucinous matrix secreted by the primary and metastatic lesions was strongly periodic acid–Schiff positive. Warthin Starry staining for spirochaetes was negative. Pancytokeratin expression was attenuated in the primary tumour as well as in the metastases, which correlated to a poorly differentiated phenotype. To the authors' knowledge, this is the first report of a proximal duodenal adenocarcinoma with extensive metastatic disease in a common marmoset. [ABSTRACT FROM AUTHOR]

Despite variation in licensure requirements and models for pharmacy practice nationwide, there is little published data within the United States regarding pharmacist perspectives. The purpose of this study was to identify the demographics, awareness, and perceptions about current pharmacist licensure models. A fifteen-question mixed-methods survey was created and distributed via Qualtrics-XM Survey to all Utah licensed pharmacists (n = 4154). Data collection was August 22-September 22, 2022. Before survey distribution, pilot feedback was sought from the Utah Board of Pharmacy and pharmacists at the 118th National Association of Boards of Pharmacy (NABP) national conference. Exempt status was granted by Roseman University Institutional Review Board. Quantitative and qualitative data analysis allowed for descriptive statistics and thematic content identification. The survey collected 972 responses for a response rate of 23% and a completion rate of 94%. Respondents self-identified 36 practice areas. Distribution of years in practice was well dispersed between the predefined ranges. Primary state of licensure was Utah (80%), with additional representation from all 50 states and Guam. The survey showed a variation in awareness regarding other healthcare professional licensing models with 40.83% "aware," 40.62% "unaware," and 18.55% "unsure". A majority showed awareness of the NABP Verify program (55.8%), but unawareness of the Electronic Licensure Transfer Program program (56.14%). Respondents agreed with increased license portability for medically underserved and rural areas (71.79%) and preference for having a law exam (56.72%). Pharmacists (n = 405) noted concerns regarding multistate renewal requirements, fees, and continuing education. This study provided baseline data on a topic that is missing in existing literature. Results illustrated a high completion rate, a diversity of demographics including well dispersed age ranges, years in practice, and qualitative responses. The quantitative data shed light on a variety of pharmacist perspectives and varied awareness about NABP licensure programs and compacts. [ABSTRACT FROM AUTHOR]

This article examines the issues involved in publicly funded regional arts initiatives, through two contrasting examples of art works that creatively repurpose grain silos in rural Australia: the Silo Art Trail in north-west Victoria, and the silo art practices of the small town of Natimuk in the same region. Via desktop analysis supported by observation and interviews, we consider these initiatives in the context of a turn to arts-led regeneration and creative place-making in rural and regional development approaches and the role of public cultural policy within this. With the majority of public funding for cultural and creative projects in regional communities coming from urban-based governments in Australia (eg federal and state governments), decisions tend to be informed by urban-centric frameworks. Public cultural funding programmes often expect to develop projects that create jobs and generate market demand for creative products that will ensure creative enterprises are economically sustainable. This overlooks broader economic impacts and non-economic values that arts activities bring to rural and regional places, resulting in a misalignment between funding intention and outcomes. A lack of equity inherent in the relationship between urban-generated cultural funding approaches and regional priorities suggests a need for a rethink, to better understand and develop policies for creative practice in the regions that are driven by and responsive to regional priorities and capacities. • Rural arts development offers to redress declining local benefits of agriculture. • Strategies for rural arts regeneration are determined by urban-centric policy. • Large-scale public art on disused rural infrastructure attracts tourism. • Rural public art outcomes are greater when grounded in local community objectives. • Economic success from public art is greater when informed by local conditions. [ABSTRACT FROM AUTHOR]

Background: Total joint arthroplasty procedures continue to provide consistent, long-term success and high patient satisfaction scores. However, early unplanned readmission to the hospital imparts significant financial risks to individual institutions as we shift away from the traditional fee-for-service payment model.Methods: Using a combination of our hospital's administrative database and retrospective chart reviews, we report the 30-day and 90-day readmission rates and all causes of readmission following all unilateral, primary elective total hip and knee arthroplasty procedures at a large, urban, academic hospital from 2004 to 2013.Results: In total, 1165 primary total hip (511) and knee (654) arthroplasty procedures were identified, and the 30-day and 90-day unplanned readmission rates were 4.6% and 7.3%, respectively. A multivariate regression model controlled for a variety of potential clinical and surgical confounders. Increasing body mass index levels, an American Society of Anesthesiologists score of ≥3, and discharge to an inpatient rehab facility each independently correlated with risk of both 30-day and 90-day unplanned readmission to our institution. Additionally, use of general anesthesia during the procedure independently correlated with risk of readmission at 30 days only, while congestive heart failure independently correlated with risk of 90-day unplanned readmission. Readmissions related directly to the surgical site accounted for 47% of the cases, and collectively totaled more than any single medical or clinical complication leading to unplanned readmission within the 90-day period.Conclusion: Increasing body mass index values, general anesthesia, an American Society of Anesthesiologists score of ≥3, and discharge to an inpatient rehab facility each were independent risk factors for early unplanned readmission. [ABSTRACT FROM AUTHOR]

While the distribution patterns of cold-water corals, such as Paragorgia arborea , have received increasing attention in recent studies, little is known about their in situ activity patterns. In this paper, we examine polyp activity in P. arborea using machine learning techniques to analyze high-resolution time series data and photographs obtained from an autonomous lander cluster deployed in the Stjernsund, Norway. An interactive illustration of the models derived in this paper is provided online as supplementary material. We find that the best predictor of the degree of extension of the coral polyps is current direction with a lag of three hours. Other variables that are not directly associated with water currents, such as temperature and salinity, offer much less information concerning polyp activity. Interestingly, the degree of polyp extension can be predicted more reliably by sampling the laminar flows in the water column above the measurement site than by sampling the more turbulent flows in the direct vicinity of the corals. Our results show that the activity patterns of the P. arborea polyps are governed by the strong tidal current regime of the Stjernsund. It appears that P. arborea does not react to shorter changes in the ambient current regime but instead adjusts its behavior in accordance with the large-scale pattern of the tidal cycle itself in order to optimize nutrient uptake. [ABSTRACT FROM AUTHOR]

There remains a clinical need for endovascular repair of the ascending aorta and the aortic arch in patients who are prohibitively high risk for open surgical repair. Herein we present a case of a total endovascular arch repair by means of a novel technique for graft fenestration using a trans-septal needle with extracorporeal membrane oxygenation support. Although the use of trans-septal needle fenestration use has been described, the use in arch fenestrations has not. We present this case as an example of techniques that may be useful in the expanding landscape of endovascular ascending and arch repair. [ABSTRACT FROM AUTHOR]

Objectives To measure the retention of basic sciences knowledge in a PharmD program over a period of two years. Methods The study was conducted in two phases using assessment scores of the students. The first phase measured the whether basic science knowledge was retained over a period of two years using historical data. The aim of the second phase was the same, but used a prospective study design. Additionally, the second phase also examined subject wise retention of knowledge. Results The first phase data analysis across all subjects showed a slight decay of knowledge over two years. The second phase data analysis showed relatively small significant knowledge gain across all subjects and moderately significant knowledge gain for biomedical sciences. Conclusions The results of the study demonstrate a varying level of retention of biomedical science s and pharmacology knowledge over time. With the understanding that the graduating pharmacy students are not expected to retain or remember all the knowledge they gained from the first year of the program, these results demonstrate a satisfactory level of retention. [ABSTRACT FROM AUTHOR]

Background: This study investigated the risk and cost of postoperative complications associated with morbid and super obesity after total knee arthroplasty (TKA).Methods: A retrospective cohort study was conducted of patients who underwent TKA using Medicare hospital claims data. The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code V85.4x was used to identify morbidly obese patients (body mass index [BMI] ≥40 kg/m(2)) and superobese patients (BMI ≥50 kg/m(2)) in 2011-2013. Patients without any BMI-related diagnosis codes were used as controls. Twelve complications occurred in the 90-day period after TKA were analyzed using multivariate Cox models, adjusting for patient demographic, morbidity, and institutional factors. In addition, hospital charges and payments were compared from primary surgery through subsequent 90 days.Results: Morbidly obese patients showed a significantly elevated risk in most complications examined, with a 2-fold or higher risk in dislocation and wound dehiscence. In addition, death, periprosthetic joint infection, acute renal failure, and knee revision had significant hazard ratios between 1.5 and 2.0. However, risk of deep vein thrombosis and acute myocardial infarction did not increase for the morbidly obese patients. Superobese patients had significant increase in risk of infection, wound dehiscence, acute renal failures, revisions, death, and readmission compared with patients with BMI 40-49 kg/m(2). Significant dose-response trend was found between the level of BMI and risk for death, dislocation, implant failure, infection, readmission, revision, wound dehiscence, and acute renal failure. Controlling for patient and institutional factors, each TKA had an average total hospital charges of $75,884 among superobese patients, compared to $65,118 for the control group, a difference of $10,767. Medicare payment for the superobese patients was also higher, but only by $2703.Conclusion: Morbidly obese patients pose a significantly higher risk profile than normal-weight patients in a broad range of complications after TKA. Superobese patients add another layer of risk compared with less obese patients and are considerably more expensive to treat by health care systems. Technical difficulties and the high demand on resources present a severe challenge for providing treatment for such patients. [ABSTRACT FROM AUTHOR]

Identifying BMI via administrative data is a useful way to evaluate outcomes in total joint arthroplasty (TJA) for varying degrees of obesity. The purpose of this study was to evaluate the concordance between BMI coding in administrative claims data and actual clinical BMI measurements in the medical record for patients undergoing TJA. Clinical BMI value was shown to be a significant determinant of whether ICD-9 codes were used to report the patient's obesity status (P<0.01). Although a higher clinical BMI strongly increased the likelihood of having either of the ICD-9 diagnosis codes used to identify obesity status, only the accuracy of the V85 code increased with increasing levels of BMI. [ABSTRACT FROM AUTHOR]

Abstract: We used our database of primary total hip arthroplasties to identify those patients who had acetabular fractures fixed with percutaneous screws under the same anesthesia as for the arthroplasty procedure. There were 19 patients with the average follow-up of 22months. Fourteen patients sustained the fracture secondary to a low-energy trauma, while the remaining patients were involved in a high-energy trauma accident. The mean survival time was calculated to be 2.5±0.6years for the low-energy group and 4±1.4years for the high-energy group. We believe that this unique treatment of acetabular fractures has a role in carefully selected patients and provides the necessary reduction and immediate stability of the fracture needed to ensure adequate fit for the acetabular cup in the subsequent THA. [Copyright &y& Elsevier]

Abstract: A private payer database was used to examine the incidence and rates of knee arthroscopy in patients less than 65years of age and the subsequent risk of knee arthroplasty. Time to event analysis was performed using the Kaplan–Meier method; also, Cox regression analysis was used to evaluate the relative risk of subsequent knee arthroplasty for arthroscopic patients. Overall, 247,034 knee arthroscopies, done for injury or arthropathy, were identified between 2004 and 2009. Within 1-year of arthroscopy, 2.2% of arthropathy patients and 0.9% of injury patients underwent a knee arthroplasty. These increased to 5.2% and 2.4% at 5-years, respectively. The risk of arthroplasty following arthroscopy increased significantly with age. Further study is warranted to examine the benefit of arthroscopy in younger patients with OA. [Copyright &y& Elsevier]

Purpose: To determine the proportion of critically ill adults developing impaired gastrointestinal transit (IGT) using a clinically pragmatic definition, its associated morbidity and risk factors. Materials and Methods: Critically ill adult patients receiving enteral nutrition for .72 hours and mechanically ventilated for .48 hours were prospectively identified. IGT was defined as absence of a bowel movement for .3 days, treatment for constipation, and one of the following: (1) radiologic confirmed ileus, (2) feed intolerance, (3) abdominal distention, or (4) gastric decompression. Results: One thousand patients were screened, and 248 were included for analysis. Fifty patients (20.1%; 95% confidence interval, 15.1-25.6%) developed IGT persisting for 6.5 ± 2.5 days. Patients with IGT had longer lengths of intensive care unit stay and were less likely to reach nutrition targets compared to patients without IGT or traditional definitions of constipation. Daily opioid use and pharmacological constipation prophylaxis were identified risk factors for IGT. Conclusion: Traditional definitions of constipation or ileus in intensive care unit patients are simplistic and lack clinical relevance. Pragmatically defined IGT is a common complication of critical illness and is associated with significant morbidity. Future interventional studies for IGT in critically ill adults should use a more clinically relevant definition and evaluate energy deficits and lengths of stay as clinically relevant outcomes. [ABSTRACT FROM AUTHOR]

AIM: The aims of this study were to describe the characteristics of and outcome of patients with chest pain in relation to transport by the emergency medical services (EMS) and to describe possible changes in this relationship in a 20-year perspective. METHODS: In the 2 periods, 1986 to 1987 and 2008, all patients with chest pain admitted to hospitals in Gothenburg, Sweden, were retrospectively evaluated in terms of previous history, final diagnosis, and mortality. P values were age adjusted. RESULTS: In 1986 to 1987 and 2008, 34% of 4270 patients with chest pain and 39% of 2286 patients, respectively, were transported to the hospital by the EMS (P = .0001). In both periods, patients who used EMS were older and had a higher prevalence of previous cardiovascular diseases and more often had a final diagnosis of acute myocardial infarction (AMI) than those who did not use EMS. The EMS users were more frequently hospitalized in 1986 to 1987 than in 2008 (P < .0001). Emergency medical service use was related to a significantly higher age-adjusted 1-year mortality in both periods for all patients with chest pain as well as for those hospitalized. Among hospitalized patients with myocardial ischemia and among patients with a final diagnosis of AMI, EMS use was associated with a higher 30-day mortality in 1986 to 1987. Regardless of the use of EMS, there was a decrease in the proportion of patients developing AMI as well as the rate of death at 30 days and 1 year in 2008 as compared with 1986 to 1987. CONCLUSIONS: For 20 years, the proportion of patients with chest pain using the EMS increased. EMS users were more frequently hospitalized in 1986 to 1987 than in 2008. In overall terms, mortality was higher among EMS users than among nonusers in both periods. Among hospitalized patients with myocardial ischemia and among patients with a final diagnosis of AMI, EMS use was associated with a higher 30-day mortality only in 1986 to 1987. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to identify sex differences in the early chain of care for patients with chest pain. Design: This is a retrospective study performed at 3 centers including all patients admitted to the emergency department because of chest pain, during a 3-month period in 2008, in the municipality of Göteborg. Chest pain or discomfort in the chest was the only inclusion criterion. There were no exclusion criteria. Data Sources: Data were retrospectively collected from ambulance and medical records and electrocardiogram (ECG), echocardiography, and laboratory databases. Main Findings: A total of 2588 visits (1248 women and 1340 men) made by 2393 patients were included. When adjusting for baseline variables, female sex was significantly associated with a prolonged delay time (defined as above median) between (a) admission to hospital and admission to a hospital ward (odds ratio [OR], 1.59; 95% confidence interval [CI], 1.25-2.03), (b) first physical contact and first dose of aspirin (OR, 2.22; 95% CI, 1.30-3.82), and (c) admission to hospital and coronary angiography (OR, 2.50; 95% CI, 1.29-5.13). Delay time to the first ECG recording did not differ significantly between women and men. Principal Conclusions: Among patients hospitalized due to chest pain, when adjusting for differences at baseline, female sex was associated with a prolonged delay time until admission to a hospital ward, to administration of aspirin, and to performing a coronary angiography. There was no difference in delay to the first ECG recording. [Copyright &y& Elsevier]

Objectires: To define constipation, assess the pharmacist's role in identifying and treating constipation, and review clinical evidence for the efficacy, safety, and tolerability of polyethylene glycol (PEG) 3350 (MiraLAX--Merck Consumer Care) an osmotic laxative now available over the counter (OTC), across a variety of patient populations routinely encountered in pharmacy settings. Data sources: Systematic PubMed search of the primary literature for constipation treatment guidelines and clinical trial results for PEG 3350. Data synthesis: Pharmacists have a unique role in assisting patients with identifying and managing constipation. Multiple controlled clinical trials have established the efficacy, safety, and tolerability of PEG 3350 at its recommended dose of 17 g once daily. On the basis of this evidence, various professional groups have recommended PEG 3350 for use in improving stool frequency and consistency in patients with constipation. PEG 3350 is approved for short-term use, including treatment of constipation caused by medications. Conclusion: Pharmacists can play an important role in managing constipation with OTC agents. Compared with other available OTC agents, PEG 3350 can be recommended to patients suffering from constipation on the basis of a large body of clinical evidence supporting its efficacy and safety, as well as the high patient acceptance shown for its palatability and once-daily dosing. [ABSTRACT FROM AUTHOR]

Abstract: Mixed results have been reported with bulk and cancellous bone graft to fill defects during acetabular revision arthroplasty. Jumbo cups have been used to maximize host bone contact, and if adequate initial stability can be achieved, this approach may provide a superior long-term outcome. We retrospectively reviewed a consecutive series of 107 acetabular revisions performed using jumbo cups without bone graft. Bone defects were assessed using a validated radiographic classification system that yielded 64 hips with significant bone defects for inclusion. Mean change in American Academy of Orthopaedic Surgeons lower extremity core and pain scores and in Short Form-12 scores showed increases of 22.01, 37.52, and 17.08 points, respectively. Postoperative radiographs consistently demonstrated host bone ingrowth into the jumbo acetabular shells, except for 3 failures. Careful incremental reaming up to a size that optimizes host bone support and contact may eliminate the need for bone graft in most acetabular revision arthroplasties. [Copyright &y& Elsevier]

The aim of this study is to test the applicability of snow surveying in the collection and detailed characterization of vehicle-derived magnetic particles. Road dust extracted from snow, collected near a busy urban highway and a low traffic road in a rural environment (southern Finland), was studied using magnetic, geochemical and micro-morphological analyses. Significant differences in horizontal distribution of mass specific magnetic susceptibility (χ) were noticed for both roads. Multi-domain (MD) magnetite was identified as the primary magnetic mineral. Scanning electron microscope (SEM) analyses of road dust from both roads revealed: (1) angular-shaped particles (diameter ∼1–300 μm) mostly composed of Fe, Cr and Ni, derived from circulation of motor vehicles and (2) iron-rich spherules (d ∼ 2–70 μm). Tungsten-rich particles (d < 2 μm), derived from tyre stud abrasion were also identified. Additionally, a decreasing trend in χ and selected trace elements was observed with increasing distance from the road edge. [Copyright &y& Elsevier]

Abstract: Background: Several studies suggest that total breastfeeding time reduces breast cancer risk. The underlying mechanisms are unclear. Whether breastfeeding also affects the prognosis is not yet investigated. A number of tumour characteristics, i.e. histological type of cancer, grade, tumour size, Nottingham prognostic index, vascular invasion and DNA-ploidy, have been demonstrated to be of prognostic value. Methods: We have searched for a possible link between these prognostic markers and breastfeeding time, age at first child and number of children. 250 women treated for breast cancer have answered a questionnaire. Results: No significant interactions were found possibly with one exception, LVI vs. age at first child. We found, significant correlations between lobular cancer, and thereby also DNA-ploidy, and age at first childbirth. Conclusions: We have found that lobular cancer (and thereby also diploid tumours) are connected, independently, to age at first childbirth and possibly also to number of children but no other correlations between reproductive data, breastfeeding included, and prognostic markers used in this study were found. [Copyright &y& Elsevier]

Purpose: Individuals with spinal cord injuries resulting in tetraplegia may receive tendon transfer surgery to restore grasp and pinch function. These procedures often involve rerouting the brachioradialis (Br) and the extensor carpi radialis longus tendons volar to the flexion-extension axis of the wrist, leaving the extensor carpi radialis brevis (ECRB) muscle to provide wrist extension strength. The purpose of this study was to determine whether externally stabilizing the wrist after transfer procedures would improve the ability to activate the transferred Br and resulting pinch force, similar to the effect observed when the elbow is externally stabilized. Methods: We used a one-way repeated-measures study design to determine the effect of 3 support conditions on muscle activation and lateral pinch force magnitude in 8 individuals with tetraplegia and previous tendon transfer surgeries. Muscle activation was recorded from Br and ECRB with intramuscular electrodes and from biceps and triceps muscles with surface electrodes. We quantified pinch strength with a 6-axis force sensor and custom grip. We recorded measurements in 3 support conditions: with the arm self-stabilized, with elbow stabilization, and with elbow and wrist stabilization. Pairwise differences were tested using Wilcoxon signed-rank tests. Results: Maximum effort pinch force magnitude and Br activation were significantly increased in both supported conditions compared with the self-supported trials. The addition of wrist stabilization had no significant effect compared with elbow stabilization alone. Conclusions: A strong ECRB has adequate strength to extend the wrist, even after multiple transfers that contribute an additional flexion moment from strong activation of donor muscles. Anatomical and functional differences between the wrist and elbow musculature are important determinants for self-stabilizing joints proximal to the tendon transfer. The ability to increase Br activation and resulting pinch force may be determined, in part, by the individual''s ability to develop new coordination strategies. Type of study/level of evidence: Therapeutic IV. [Copyright &y& Elsevier]

Abstract: This study examined the incidence and rates of knee arthroscopy in patients older than 65 years and the risk of subsequent knee arthroplasty. Medicare claims data (1997-2006, 5% sample) were used to identify 78 137 knee arthroscopy patients. Performance of arthroscopy increased 56.1%. Prevalence increased 44.6% from 362.2 to 523.7 per 100 000 Medicare patients. The prevalence was greater for women and white patients. Prevalence of knee arthroscopy was greater in the South. Within 1 year after arthroscopy, 10.2% of arthropathy patients and 8.5% of injury patients underwent knee arthroplasty. A progressive increase was seen in the rates of use of knee arthroscopy in elderly Medicare patients for a 10-year period. A 10.2% failure rate 1 year after knee arthroscopy may be a reasonable benchmark against which performance of knee arthroscopy in patients older than 65 years can be measured. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To better define the indications for adrenalectomy for adrenal metastasis we have analysed factors predicting survival in our institutional series. Methods: A consecutive series of 30 patients undergoing adrenalectomy for metastasis (1996–2007), excluding patients with simultaneous ipsilateral renal cell carcinoma (RCC), was studied. Metastases were regarded as synchronous (<6 mo), or metachronous (>6 mo), depending on the interval after primary surgery. Survival was calculated from time of adrenalectomy and factors influencing survival were identified. Results: The tumour diagnoses were RCC n = 9, malignant melanoma n = 5, non-small-cell lung cancer n = 5, colorectal carcinoma n = 4, foregut carcinoid n = 2, adrenocortical carcinoma, breast cancer, hepatocellular carcinoma, urothelial carcinoma, and liposarcoma (one each); nine adrenal metastases were synchronous and 21 metachronous. Ten patients had undergone previous surgery for extra-adrenal metastases. Out of 30 adrenalectomies 10 were laparoscopic (LAdx) and 20 open (OAdx) procedures without surgical complications. The local recurrence rate was low: LAdx 1/10, OAdx 1/20, and the median survival was 23 months. Independent prognosticators of favourable survival were adrenalectomy for potential cure (p = 0.01), no previous metastasis surgery (p = 0.02), and tumour type (p = 0.043), with better prognosis for patients with adrenal metastasis from colorectal carcinoma and RCC and worse prognosis in non-small-cell lung cancer and malignant melanoma. Conclusions: Surgery for adrenal metastasis is safe and the indication for this procedure in an individual patient can be supported by several prognostic factors. The survival benefit in patients with adrenalectomy for potential cure indicates a therapeutic value of adrenalectomy in selected patients. [Copyright &y& Elsevier]

Abstract: Preoperative classification of acetabular bone loss in revision total hip arthroplasty has been problematic. An evidence-based approach involves having a validated and widely accepted system of classification. A prerequisite would be a system that describes each defect in terms that are mutually exclusive, hierarchical, surgically relevant, and corresponding to experienced clinicians'' preoperative estimates of surgical complexity. Of the 6 systems reviewed, only 1 demonstrated the reliability and validity required for a standardized grading system. Although high-grade defects were seen in only 17% of the 1094 hips, the failure rate associated with them was 30%. A larger population of high grade defects is necessary to determine which treatment alternatives are successful. [Copyright &y& Elsevier]

The purpose of the study is to examine whether the predictors that decrease employee intention to leave will also increase employees¿ intention to stay. Therefore, the objective of the study is twofold: (1) to examine the influence of perceived organizational support, perceived supervisors¿ support, and organizational commitment regarding intent to leave and (2) to investigate the influence of the same variables on intent to stay. A total of 416 hospitality employees in the U.S. participated. The results suggest that perceived organizational support and organizational commitment decreased intent to leave while only perceived organizational support had a positive impact on intention to stay. Implications detail ways that hospitality organizations can focus on increasing their employees¿ commitment through perceived organizational support as a critical component of turnover culture. [Copyright &y& Elsevier]

Abstract: Background: During acute myocardial infarction, both ST elevation and QRS distortion on the initial electrocardiogram (ECG) have been correlated with poorer prognosis. Studies in dogs and humans suggest that these ECG markers provide information about myocardial protection from both collateral blood flow and ischemic preconditioning. Methods: In a protocol designed to precondition the heart with ischemia, we examined both ST-segment elevation and QRS complex prolongation in lead II of the ECG in 23 mongrel dogs during the first and fourth episode of 5 minutes of left circumflex artery occlusion. Myocardial collateral flow was measured during each of these episodes by injection of radioactive microspheres 2.5 minutes into the episode of ischemia. Results: During ischemia, the degree of elevation of the ST segments was reduced markedly in hearts preconditioned with ischemia and/or in hearts with the greatest amounts of collateral arterial flow. During the first episode of ischemia, the ST segments increased to a similar extent in severe and moderate ischemia, but less in hearts in which the ischemia was mild. However, marked QRS prolongation was present only in hearts with severe ischemia, and decreased when the hearts were preconditioned. In addition, large ischemic beds exhibited the most marked QRS prolongation, whereas small but even severely ischemic beds showed little or no change in QRS duration. Conclusion: Both ST elevation and QRS prolongation are reduced by the presence of collateral flow and ischemic preconditioning. The QRS complex merits further study as an important marker of the degree of myocardial protection during human acute myocardial ischemia/infarction. [Copyright &y& Elsevier]

BACKGROUND: Previous research has suggested technology may dehumanise patient care and also that technology may restrict nurses' freedom of action. This raises questions about the relationship between technology, care and medicine in units where the patient's need for treatment is often an emergency. AIM: The aim of the study was to explore how staff members in an intensive care unit (ICU) make sense of technology in their everyday practice. METHOD: Twelve staff members from one ICU were interviewed about their understanding of technology in their everyday practice. RESULT: Three main findings emerged from the analysis: Technology seems to be considered decisive as it directs and controls medical treatment and results in the patients' well being; technology is seen as facilitating everyday practice because it makes treatment more secure and decreases workload; however technology can complicate the staff members' everyday practice as it is not completely trustworthy, is not easy to handle and can cause ethical dilemmas. CONCLUSION: Contrary to previous findings this study shows that technology seems to be embedded in care and medical treatment. Furthermore, the meaning of technology appears to be dependent on the different staff members' accounting practices. [ABSTRACT FROM AUTHOR]

Summary: Background: Previous research has suggested technology may dehumanise patient care and also that technology may restrict nurses’ freedom of action. This raises questions about the relationship between technology, care and medicine in units where the patient''s need for treatment is often an emergency. Aim: The aim of the study was to explore how staff members in an intensive care unit (ICU) make sense of technology in their everyday practice. Method: Twelve staff members from one ICU were interviewed about their understanding of technology in their everyday practice. Result: Three main findings emerged from the analysis: Technology seems to be considered decisive as it directs and controls medical treatment and results in the patients’ well being; technology is seen as facilitating everyday practice because it makes treatment more secure and decreases workload; however technology can complicate the staff members’ everyday practice as it is not completely trustworthy, is not easy to handle and can cause ethical dilemmas. Conclusion: Contrary to previous findings this study shows that technology seems to be embedded in care and medical treatment. Furthermore, the meaning of technology appears to be dependent on the different staff members’ accounting practices. [Copyright &y& Elsevier]

Abstract: Evidence-based practice implies the conscientious, explicit and judicious use of current best evidence in making clinical decisions about patient care. Historically the evidence is derived from research using quantitative methodologies based on positivist assumptions about the nature of science. However, as we comment in this paper, postpostivism is a philosophy that has a unique perspective about human behavior associated with rehabilitation that promises to contribute to clinical decisions. Physical therapy is a relational practice, and invariably relationships are established within the context of the patients and therapist''s values, emotions, and perspectives. Research is emerging from both quantitative and qualitative methods that the behaviors, attitudes, and values of our patients influence the nature and course of treatment as well as its outcomes. Postpositivist research in physical therapy seeks to understand how human and social interactions may influence treatment outcomes. The purpose of this paper is to discuss the potential benefits of qualitative techniques for data collection and analyses based on postpositivist assumptions for the clinical practices of orthopedic and sports physical therapists. In order to address the purpose, this paper will explore the following questions. What is postpositivism? What are the applications of postpositivism in orthopedic and sports physical therapy? What methods are involved in doing research informed by postpositivist assumptions? How rigorous are qualitative research techniques based on postpositivism? What are its limitations? [Copyright &y& Elsevier]

Abstract: Background: Analysis of ST-segment elevation for assessment of patients with suspected acute coronary occlusion is in widespread use for diagnostic and prognostic purposes. In this study, changes in the QRS complex also were analyzed to determine if these changes that are seldom used clinically can provide additional prognostic information. An acute coronary occlusion canine model, in which direct measurements of myocardial salvage were made, was used to assess whether ST-segment and QRS complex changes during coronary occlusion yielded independent estimates of the amount of salvage provided by reperfusion with arterial blood. Methods and Results: Continuous electrocardiographic recordings were obtained from 14 study dogs undergoing a 90-minute period of coronary artery occlusion in which the severity of the ischemia during the occlusion was estimated at 10 and 45 minutes by microsphere injections. After 3 hours of reperfusion, the myocardium at risk and postmortem infarct size was measured. Myocardial salvage correlated inversely with both ST-segment elevation (r = −0.85; P < .0001), and QRS complex prolongation (r = −0.72; P = .003). When dogs were paired so that they had equal amounts of ST elevation but differed with respect to the presence of QRS prolongation, less myocardial salvage was found in those with QRS prolongation. The independent value of QRS prolongation was supported further by the observation that presence of QRS prolongation resulted in a loss of the highly significant correlation between ST elevation and salvage (r = −0.60; P = .2). Conclusions: High magnitudes of ST elevation are correlated significantly with less myocardial salvage. Moreover, for a given magnitude of ST elevation, the presence of concurrent QRS prolongation is associated with even less myocardial salvage. [Copyright &y& Elsevier]

Background & Aims:: The aim was to compare esomeprazole with lansoprazole for the maintenance of healed erosive esophagitis and resolution of gastroesophageal reflux disease–related symptoms in a United States population. Methods: Patients who entered this double-blind, randomized, parallel-group, multicenter, maintenance trial had been treated and healed (no endoscopic evidence of erosive esophagitis) with esomeprazole 40 mg or lansoprazole 30 mg once daily (patients with Los Angeles grades C and D erosive esophagitis at baseline) or esomeprazole 40 mg (patients with Los Angeles grades A and B erosive esophagitis at baseline) and had no heartburn or acid regurgitation symptoms during the previous week. Patients were randomized to maintenance once-daily therapy with esomeprazole 20 mg (n = 512) or lansoprazole 15 mg (n = 514) for up to 6 months. Esophagogastroduodenoscopies were done at months 3 and 6, and investigators assessed symptom severity at months 1, 3, and 6. Endoscopic/symptomatic remission was defined as no erosive esophagitis and no study withdrawal as a result of reflux symptoms. Results: The estimated endoscopic/symptomatic remission rate during a period of 6 months was significantly higher (P = .0007) for patients who received esomeprazole 20 mg once daily (84.8%) compared with those who received lansoprazole 15 mg (75.9%). Most patients had no heartburn (383/462 and 369/466) or acid regurgitation (401/462 and 400/466) symptoms at 6 months, and there were no significant differences between treatments. Both treatments were well-tolerated. Conclusion: Esomeprazole 20 mg is more effective than lansoprazole 15 mg in maintaining endoscopic/symptomatic remission in patients with healed erosive esophagitis. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose was to determine the effects of a gastrocnemius stretching program on passive ankle dorsiflexion range of motion and ankle dorsiflexion and time-to-heel-off during the stance phase of gait. Design: This study was a randomized-control trial design. Setting: The study was conducted in a biomechanical laboratory setting. Participants: Nineteen volunteers (17 women and 2 men, mean age=30.3 years; SD=9.8 years), with less than 8° of passive ankle dorsiflexion range of motion bilaterally and a history of lower extremity overuse injury were randomly assigned to the experimental (n=11) or control group (n=8). Intervention: The experimental group participated in a static gastrocnemius stretching program of five repetitions held for 30-s, two times daily, for 3 weeks. The control group received no intervention. Main outcome measures: Passive ankle dorsiflexion range of motion and ankle dorsiflexion and time-to-heel-off during the stance phase of gait were measured before and after the intervention. Results: The experimental group had significantly greater passive dorsiflexion range of motion at post-test than the control group on both the right (p=0.000) and left (p=0.002) sides. Ankle dorsiflexion and time-to-heel-off during the stance phase of gait were not different among group, time, or foot (p>0.05). Conclusions: A gastrocnemius stretch performed two times daily, for 3 weeks increased passive ankle dorsiflexion, but did not alter ankle dorsiflexion or time-to-heel-off during the stance phase of gait. Thus, when an increase in ankle dorsiflexion or time-to-heel-off during the stance phase of ambulation is a clinical goal, it is unlikely to result from the stretching regimen used in this study. [Copyright &y& Elsevier]

Purpose: Surgical transfers of muscles are used to restore lateral pinch in tetraplegia; however, outcomes are variable. The purpose of this study was to compare activation of the brachioradialis (Br) after transfer to the flexor pollicis longus during maximum effort in its primary function (elbow flexion) with maximum effort in its postoperative function (lateral pinch) and to record Br activation during functional tasks. Methods: Fine-wire electrodes recorded activation of the Br in 11 arms with tetraplegia. Subjects produced maximum lateral pinch force with and without elbow stabilization and were classified according to elbow strength. The elbow was stabilized by supporting the arm and limiting elbow motion. A force sensor mounted on a custom grip recorded the pinch force. Electromyographic (EMG) signals recorded during lateral pinch were expressed as a percentage of the maximum voluntary contraction recorded during maximum-effort elbow flexion. Results: The EMG activation was significantly lower during lateral pinch compared with resisted elbow flexion. The mean EMG during lateral pinch in the self-supported elbow condition was 34% of the maximum voluntary contraction; with the elbow stabilized the EMG increased to 55% of the maximum voluntary contraction. Postoperative pinch-force magnitude was 14 N with self-support and 20 N with the elbow stabilized. Subjects with weak elbow extension strength produced significantly lower pinch forces compared with subjects with strong elbow extension but had similar ability to activate the Br. The Br activation was higher when the pinch tasks were performed successfully. Conclusions: These findings suggest a reduced ability to activate the transferred muscle fully in lateral pinch function after surgery, even with the addition of elbow support. The Br activation is linked to successful performance of lateral pinch tasks. The subjects’ inability to activate the transferred muscle fully may be affected by postoperative muscle re-education and contribute to postoperative weakness. [Copyright &y& Elsevier]

Abstract: Massive osteolytic bone loss in revision total knee arthroplasty has been an uncommon challenge. From 2001 to 2002, 11 knees in 10 patients underwent revision of failed modular PFC (Johnson and Johnson Orthopaedics, Raynham, Mass) total knee arthroplasties with distal femoral allografts and long-stemmed revision implants for massive osteolytic induced femoral bone loss. The mean follow-up was 42 months (range, 36-48 months). Radiographic graft incorporation was demonstrated in all 11 knees with no cases of loosening. The Knee Society Pain Scores improved by an average of 25.4 points, and the function scores improved by an average of 23.3 points. The outcomes of distal femoral allografts in the reconstruction of massive osteolytic bone loss associated with failed modular PFC (Johnson and Johnson Orthopaedics) total knee arthroplasties are favorable. [Copyright &y& Elsevier]

Background Trauma to the perineum is a serious and frequent problem after childbirth, with about 350 000 women each year in the UK needing sutures for perineal injury after spontaneous vaginal delivery, and many millions more worldwide. We compared the continuous technique of perineal repair with the interrupted method, and the more rapidly absorbed polyglactin 910 suture material with the standard polyglactin 910 material.Methods 1542 women who had a spontaneous vaginal delivery with a second-degree perineal tear or episiotomy were randomly allocated to either the continuous (n=771) or interrupted (771) suturing method, and to either the more rapidly absorbed polyglactin 910 suture material (772) or standard polyglactin 910 material (770). Primary outcomes were pain 10 days after delivery and superficial dyspareunia 3 months postpartum. Analysis was by intention to treat.Findings At day 10, three women had dropped out of the study. Significantly fewer women reported pain at 10 days with the continuous technique than with the interrupted method (204/770 [26·5%] vs 338/769 [44·0%], odds ratio 0·47, 95% CI 0·38–0·58, p<0·0001). Occurrence of pain did not differ significantly between groups assigned the more rapidly absorbed material or standard material (256/769 [33·3%] vs 286/770 [37·1%], 0·84, 0·68–1·04, p=0·10). Women reported no difference in superficial dyspareunia at 3 months for the continuous vs the interrupted method (98/581 [16·9%] vs 102/593 [17·2%], 0·98, 0·72–1·33, p=0·88) or the more rapidly absorbed versus standard material (105/586 [17·9%] vs 95/588 [16·2%], 1·13, 0·84–1·54, p=0·42). Suture removal was done less with the more rapidly absorbed material than with standard suture material (22/769 [3%] vs 98/770 [13%], p<0·0001), and with the continuous versus interrupted method (24/770 [3%] vs 96/769 [12%], p<0·0001).Interpretation A simple and widely practicable continuous repair technique can prevent one woman in six from having pain at 10days. Also, the more rapidly absorbed polyglactin 910 material obviates need for suture removal up to 3 months postpartum for one in ten women sutured. [Copyright &y& Elsevier]

Objective: Vitamin and mineral supplements are widely used for self-care of a variety of medical conditions, but little is known about the specific conditions for which they are used. This study mined consumer product reviews to determine specific ways vitamin and mineral supplements are being used therapeutically.Design/setting: A cross-sectional analysis of user reviews for top-selling, single-ingredient vitamin and mineral products from a popular online retailer was performed to identify the most frequently appearing words associated with medical conditions. Results of individual analyses were compared to achieve consensus on the top, relevant keywords for each supplement. The full text of the reviews was searched for these keywords to distinguish whether they referred to therapeutic uses or adverse effects.Results: A total of 14 vitamin and 11 mineral supplements were analyzed. The number of user reviews for the analyzed products varied from 41 for manganese to over 5000 for biotin and vitamin D (median = 547 reviews per product). Cohen's kappa test for investigator-selected keywords related to medical conditions was generally greater than 0.6, indicating good interrater reliability. From these lists, the top consumer self-care uses were identified for 24 supplements. Commonly reported adverse effects were also noted for several products.Conclusion: This study used data mining to identify the top ways consumers use an array of bestselling, single-ingredient vitamin and mineral supplements. These results can provide healthcare and nutrition professionals with information to anticipate the supplement-related education needs of patients and provide researchers with priority areas for clinical studies. [ABSTRACT FROM AUTHOR]

Upper limb reconstructive surgical procedures for individuals with tetraplegia are performed in many centers internationally. Most recipients of surgery return to local communities and nonsurgical centers for postoperative rehabilitation and long-term follow-up. This supplement focuses on the clinical significance of upper extremity reconstruction, addressing issues related to the availability and choice for surgery, preoperative assessments, postoperative training paradigms, and appropriate outcome measures. Comprehensive intervention protocols are described in terms of dose, timing, specific activities, modalities, and related outcomes. Shared knowledge of current rehabilitation practice, as it relates to reconstructive surgery, can expand treatment options communicated to patients, increase the availability of postoperative muscle reeducation programs, and motivate long-term follow-up assessments. [ABSTRACT FROM AUTHOR]

Reconstructive arm/hand surgery for tetraplegia is performed to improve arm/hand function and therefore personal well-being for individuals who accept such elective surgeries. However, changes at an impairment level do not always translate into functional or quality of life changes. Therefore, multiple outcome tools should be used that incorporate sufficient responsiveness to detect changes in arm/hand function, activity and participation, and quality of life of the individuals involved. This narrative review aims to assist clinicians to choose the most appropriate tools to assess the need for reconstructive surgery and to evaluate its outcomes. Our specific objectives are (1) to describe aspects to consider when choosing a measure and (2) to describe the measures advised by an international therapist consensus group established in 2007. All advised measures are appraised in terms of the underlying construct, administration, and clinical relevance to arm/hand reconstructions. Essentially there are currently no criterion standard measures to evaluate the consequences of reconstructive arm/hand surgery. However, with judicious use of available measures it is possible to ensure the questions asked or tasks completed are relevant to the surgical reconstruction(s) undertaken. Further work in this field is required. This would be best met by immediate collaboration between 2 outcome's tool developers and by analysis of pre- and postoperative data already held in various international sites, which would allow further evaluation of the measures already in use, or components thereof. [ABSTRACT FROM AUTHOR]

Objective To quantify changes in pinch force and brachioradialis (BR) activation after a task-based training program designed to improve pinch force after BR to flexor pollicis longus (FPL) transfer. Design One-group repeated-measures design compared pinch force and BR activation pre- and posttraining. Significant differences were tested with Wilcoxon signed-rank tests for pairwise comparisons at the P ≤.05 level. Setting Testing occurred in a Veterans Affairs Medical Center research laboratory and training was in a home setting. Participants Participants with cervical spinal cord injury (SCI) and previous BR to FPL transfer were enrolled in the study (N=8). Six patients completed the training program and posttraining measures. Interventions The 10-week training was a home program that included novel activities to increase BR activation and practice producing pinch force in a variety of upper limb postures. Participants were provided with the task-based training equipment and instructed to practice 3 times per week. Main Outcome Measures Fine-wire electromyography of the transferred BR was recorded in maximum effort pinch force (N). Secondary measures included the strength and activation of the antagonist elbow extensor. Results Pinch force increased 3.7N (.38kg) and BR muscle activation increased 10% ( P ≤.05) after the training. There was no increase in elbow extension strength, but participants with previous posterior deltoid to triceps transfer achieved greater activation of the antagonist elbow extensor. Conclusions The findings from this pilot study suggest that outcomes of tendon transfer and conventional therapy can be improved for patients with chronic cervical SCI. [ABSTRACT FROM AUTHOR]