Search

Addressing threats to the nursing and public health workforce, while also strengthening the skills of current and future workers, requires programmatic solutions. Training programs should be guided by frameworks, which leverage nursing expertise and leadership, partnerships, and integrate ongoing evaluation. This article provides a replicable framework to grow, bolster, and diversify the nursing and public health workforces, known as the Nurse-led Equitable Learning (NEL) Framework for Training Programs. The framework has been applied by several multipronged, federally funded training programs led by investigators embedded in an academic nursing institution. The NEL framework focuses on: (1) increasing equitable access to the knowledge, skills, and competencies needed to prepare a diverse workforce to deliver effective interventions; (2) fostering academic-practice linkages and community partnerships to facilitate the deployment of newly gained knowledge and skills to address ongoing and emerging challenges in care delivery; and (3) continuously evaluating and disseminating findings to inform expansion and replication of programs. Ten programs using this framework have successfully leveraged $18.3 million in extramural funding to support over 1000 public health professionals and trainees. Longitudinal evaluation efforts indicate that public health workers, including nurses, are benefiting from the programs' workplace trainings, future clinicians are being rigorously trained to identify and address determinants of health to improve patient and community well-being, and educators are engaging in novel pedagogical opportunities to enhance their ability to deliver high quality public health education. Training programs may apply the NEL framework to ensure that the nursing and public health workforces achieve equitable, sustainable growth and deliver high quality evidence-based care. • The NEL Framework can guide the design of nurse-led equitable training programs. • 10 programs used the framework to support >1000 trainees with $18.3 million in grants. • Framework for programs to grow, bolster & diversify nursing & public health workforce [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Ophthalmology is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Pseudomonas aeruginosa is an opportunistic bacterium that causes serious hospital-acquired infections. To assess the risk of clinically isolated P. aeruginosa to human health, we analyzed the resistance and virulence mechanisms of a collection of clinical isolates. This was a retrospective study in which P. aeruginosa isolates collected from January 1, 2018 to August 31, 2019 were analyzed using phenotypic and whole-genome sequencing (WGS) methods. The analysis included 48 clinical samples. Median patient age was 54.0 (29.5) years, and 58.3% of patients were women. Data from the microbiology laboratory database were reviewed to identify P. aeruginosa isolates. All unique isolates available for further testing were included, and related clinical data were collected. Infections were defined as hospital acquired if the index culture was obtained at least 48 h after hospitalization. High-risk P. aeruginosa clones, including sequence types (STs) ST235 and ST111, were identified, in addition to 12 new STs. The isolates showed varying degrees of biofilm formation ability when evaluated at room temperature, along with reduced metabolic activity, as measured by metabolic staining, suggesting their ability to evade antimicrobial therapy. Most isolates (77.1%) were multidrug resistant (MDR), with the highest resistance and susceptibility rates to beta-lactams and colistimethate sodium, respectively. The MDR phenotypes of the examined isolates can be explained by the high prevalence of efflux-mediated resistance- and hydrolytic enzyme-encoding genes. These isolates had high cytotoxic potential, as indicated by the detection of toxin production-related genes. [ABSTRACT FROM AUTHOR]

Kidney stone disease in children is rising disproportionate to the general population, representing a disease population with a distinct biological mechanism as compared to adults. Factors influencing recurrent kidney stone disease in children are poorly characterized and the associations of the intestinal microbiome within sub-populations of kidney stone formers, however, are not well described. We evaluated a pilot cohort of children with nephrolithiasis comparing patients based on recurrent kidney stone episodes and abnormal 24-h urinary parameters, with dual aims to compare the microbiome signal in children with initial and recurrent nephrolithiasis and to explore additional associations in microbiome composition and diversity within this population. Children aged 6–18 with a history of nephrolithiasis, without an active ureteral calculus or antibiotic exposure within 30 days of study entry were eligible to participate. All participants had a 24-h urine study within 6 months of study entry and provided a fecal sample. Microbiome samples were analyzed using 16S ribosomal DNA sequencing techniques for alpha and beta diversity comparing initial and recurrent stone formers as well as microbiome multivariate association (MaAsLin2) to determine differentially abundant taxa. Shotgun sequencing reads were aligned to custom oxidase degradation and butyrate production gene databases (5 databases total). Comparisons for MaAsLin2 and shotgun metagenomics, normalized to sequencing depth, were based on stone recurrence, sex, hypercalcuria (≤4 mg/kg/day), hyperoxaluria (≥45 mg/1.73 m2), and hypocitraturia (<310 mg/1.73 m2 [females] or < 365 mg/1.73 m2 [males]). A total of 16 enrolled children provided samples sufficient for analyses, including 9 girls and 7 boys, of whom 5 had experienced recurrent kidney stone events. Three participants had hypercalcuria, 2 had hyperoxaluria, and 4 had hypocitraturia. Comparisons of Formyl-CoA transferase between index and recurrent urinary stone disease revealed a trend towards higher mean abundance of the gene in initial stone formers (0.166% vs 0.0343%, p = 0.2847) (Summary Figure), while trends toward lower biodiversity were also noted in the recurrent stone cohort on both Faith (p = 0.06) and Shannon (p = 0.05) indices. Exploratory analyses found Eubacterium siraeum to be significantly greater in relative abundance in children with documented hypercalciuria (p = 0.001). Our pilot study demonstrates possible signals in both microbial diversity and oxalate gene expression, both of which are lower in recurrent pediatric kidney stone patients. These findings warrant further investigation as a potential diagnostic marker for future kidney stone events. [Display omitted] [ABSTRACT FROM AUTHOR]

Aseptic lymphocyte-dominated vasculitis-associated lesions (ALVALs) are typically described in the context of metal-on-metal (MoM) hip bearings. This study explores the diagnostic utility of preoperative serum cobalt and chromium ion levels in determining the histological grade of ALVAL in revision hip and knee arthroplasty. This was a multicenter retrospective review of 26 hips and 13 knees assessing the correlation between preoperative ion levels (mg/L (ppb)) and the histological grade of ALVAL from intraoperative specimens. The diagnostic ability of preoperative serum cobalt and chromium levels to determine high-grade ALVAL was assessed using a receiver operating characteristic (ROC) curve. In the knee cohort, there was a higher serum cobalt level in high-grade ALVAL cases (10.2 mg/L (ppb) versus 3.1 mg/L (ppb)) (P =.0002). The Area Under the Curve (AUC) was 1.00 (95% confidence interval (CI) 1.00 to 1.00). There was a higher serum chromium level in high-grade ALVAL cases (12.25 mg/L (ppb) versus 7.77 mg/L (ppb)) (P =.0002). The AUC was 0.806 (95% CI 0.555 to 1.00). In the hip cohort, there was a higher serum cobalt level in high-grade ALVAL cases (333.5 mg/L (ppb) versus 119.9 mg/L (ppb)) (P =.0831). The AUC was 0.619 (95% CI 0.388 to 0.849). There was a higher serum chromium level in high-grade ALVAL cases (186.4 mg/L (ppb) versus 79.3 mg/L (ppb)) (P =.183). The AUC was 0.595 (95% CI 0.365 to 0.824). Histologically, high-grade ALVAL has significantly higher preoperative serum cobalt and chromium ion levels in revision TKA. Preoperative serum ion levels have excellent diagnostic utility in revision TKA. Cobalt levels in revision THA have a fair diagnostic ability and chromium levels had a poor diagnostic ability. [ABSTRACT FROM AUTHOR]

We conducted this phase I, open-label safety and feasibility trial of autologous cord blood (CB) stem cell (CBSC) therapy via a novel blood cardioplegia-based intracoronary infusion technique during the Norwood procedure in neonates with an antenatal diagnosis of hypoplastic left heart syndrome (HLHS). CBSC therapy may support early cardiac remodeling with enhancement of right ventricle (RV) function during the critical interstage period. Clinical grade CB mononucleated cells (CBMNCs) were processed to NetCord-FACT International Standards. To maximize yield, CBSCs were not isolated from CBMNCs. CBMNCs were stored at 4 °C (no cryopreservation) for use within 3 days and delivered after each cardioplegia dose (4 × 15 mL). Of 16 patients with antenatal diagnosis, 13 were recruited; of these 13 patients, 3 were not treated due to placental abruption (n = 1) or conditions delaying the Norwood for >4 days (n = 2) and 10 received 644.9 ± 134 × 106 CBMNCs, representing 1.5 ± 1.1 × 106 (CD34+) CBSCs. Interstage mortality was 30% (n = 3; on days 7, 25, and 62). None of the 36 serious adverse events (53% linked to 3 deaths) were related to CBMNC therapy. Cardiac magnetic resonance imaging before stage 2 (n = 5) found an RV mass index comparable to that in an exact-matched historical cohort (n = 22), with a mean RV ejection fraction of 66.2 ± 4.5% and mean indexed stroke volume of 47.4 ± 6.2 mL/m2 versus 53.5 ± 11.6% and 37.2 ± 10.3 mL/m2, respectively. All 7 survivors completed stage 2 and are alive with normal RV function (6 with ≤mild and 1 with moderate tricuspid regurgitation). This trial demonstrated that autologous CBMNCs delivered in large numbers without prior cryopreservation via a novel intracoronary infusion technique at cardioplegic arrest during Norwood palliation on days 2 to 3 of life is feasible and safe. [ABSTRACT FROM AUTHOR]

To evaluate the association between capillary refill time (CRT) measured by a medical device and sepsis among patients presenting to the Emergency Department (ED). This prospective observational study enrolled adult and pediatric patients during ED triage when sepsis was considered a potential diagnosis by the triage nurse. Patients were enrolled at an academic medical center between December 2020 and June 2022. CRT was measured by a research assistant using an investigational medical device. The outcomes included sepsis and septic shock defined using sep-3 criteria, septic shock defined as IV antibiotics and a vasopressor requirement, ICU admission, and hospital mortality. Other measures included patient demographics and vital signs at ED triage. We evaluated univariate associations between CRT and sepsis outcomes. We enrolled 563 patients in the study, 48 met Sep-3 criteria, 5 met Sep-3 shock criteria, and 11 met prior septic shock criteria (IV antibiotics and vasopressors to maintain mean arterial pressure of 65). Sixteen patients were admitted to the ICU. The mean age was 49.1 years, and 51% of the cohort was female. The device measured CRT was significantly associated with the diagnosis of sepsis by sep-3 criteria (OR 1.23, 95% CI 1.06–1-43), septic shock by sep-3 criteria (OR 1.57, 95% CI 1.02–2.40), and septic shock defined as receipt of IV antibiotics and a vasopressor requirement (OR 1.37, 95% CI 1.03–1.82). Patients with CRT >3.5 s measured by the DCR device had an odds ratio of 4.67 (95%CI 1.31–16.1) of septic shock (prior definition), and an odds ratio of 3.97 (95% CI 1.99–7.92) of ICU admission, supporting the potential for the 3.5-s cutoff of the DCR measurement. CRT measured by a medical device at ED triage was associated with the diagnosis of sepsis. Objective CRT measurement using a medical device may be a relatively simple way to improve sepsis diagnosis during ED triage. [ABSTRACT FROM AUTHOR]

Controversies in management of biliary atresia (BA) after hepatoportoenterostomy (HPE) lead to variable treatment protocols. We implemented standardized medical management after HPE, customizing the use of antibiotics and corticosteroids based on patient-specific factors. In this retrospective analysis, 20 consecutive infants underwent HPE for BA and were compared to a historical cohort. Analysis of successful biliary drainage 3 months after HPE (defined as serum total bilirubin <2 mg/dL) was the primary endpoint; survival with native liver at 2 years was the secondary endpoint. Sixteen of 20 (80%) infants had successful bile drainage, compared to 8 of 20 (40%) infants in the historical cohort (P = 0.0225). Sixteen of 20 patients in the new protocol have reached 2 years of age or required liver transplantation. Among the sixteen, 11 (68.8%) are alive with native livers versus 10 of 20 (50%) in the historical cohort (P = 0.0970). This preliminary report suggests the potential benefit of tailored use of postoperative antibiotics and corticosteroids in improving biliary drainage after HPE. III. [ABSTRACT FROM AUTHOR]

Pediatric mental health presentations continue to increase across the US. These patients often board for significant periods of time and may require more resources than other acute non-mental health patients. This has important implications for the overall function of the emergency department (ED) as well as care of all ED patients. This study evaluated a policy developed to allow for inpatient hospital admission when 30% of the ED was occupied by boarding patients at a tertiary care children's hospital. We found an increase in the number of patients for whom this policy applied, and increased days/month this policy was executed over time. There was an increase in the average ED LOS and left without being seen rate during this time which we hypothesize would have been higher without this policy. A hospital policy allowing mental health patients to be admitted to the inpatient hospital once stabilized has the potential to improve ED flow and functionality. [ABSTRACT FROM AUTHOR]

[Display omitted] • Fibre transfer from unconstrained physical assaults involving human subjects. • More fibres transfer in person-person contact than previous data suggests. • Realistic fibre transfer quantities to inform better decision making. • Care must be taken in assigning 'roles' in physical assaults using fibre evidence. • Broad fibre distribution maps evident despite garments stored in paper bags. Knowledge of the number of fibres transferred during a particular activity is essential for the interpretation of findings in similar criminal cases. In this regard, violent contacts and physical assaults still present a challenge, due to a lack of robust published data. Hereby, we present the outcome of an empirical study where different assault activities were simulated by a Jiu Jitsu team and participants were asked to play either the role of an aggressive 'assailant' or a defensive 'victim', wearing cotton garments (i.e., Gi's). Four different scenarios were simulated in replicates (n = 5), each of them involving different intensity levels (low and high) and duration times (30 and 60 s). Results showed that approximately 1,000 to 44,000 fibres were cross-transferred between the participants' garments, with noticeable differences between the different scenarios. These values were significantly larger than those published in previous studies and, therefore, suggested the possibility of a current underestimation of the number of fibres transferred in physical assaults. Furthermore, statistical analysis by ANOVA indicated that the all the variables tested (i.e., intensity level, duration time, and participants role) had a significant effect on the number of transferred fibres (p < 0.001) and, consequently, that some knowledge of the case circumstances may be important to make more educated estimations. This is the first time that such a methodology has been applied for the quantitative assessment of fibre transfer between participants in assault activities. Data are expected to help practitioners with the interpretation of findings in real casework and lead to a more robust evidential assessment. [ABSTRACT FROM AUTHOR]

With respect to survivorship following total knee arthroplasty (TKA), joint registries consistently demonstrate higher revision rates for both genders in those aged less than 55 years. The present study analyzed the survivorship of 500 cementless TKAs performed in this age group in a high-volume primary joint unit where cementless TKA has traditionally been used for the majority of patients. This was a retrospective review of 500 consecutive TKAs performed in patients aged less than 55 years between March 1994 and April 2017. The primary outcome measures for the study were survivorship and all-cause revisions. Secondary outcome measures included nonrevision procedures, clinical, functional, and radiological outcomes. An all-cause survival rate of 98.4% and an aseptic survival rate of 99.2% at a median time of 10.7 years (interquartile range 7.3-14.9, range 0.2-27.7) were found. Four patents were revised for infection, 2 for stiffness, 1 for aseptic loosening of the tibial component, and 1 for a patella that was resurfaced for anterior knee pain. Thirty four patients (6.8%) had a nonrevision procedure with manipulation under anesthetic accounting for 27. On a multivariate analysis, preoperative range of motion and female gender were negatively associated with postoperative range of motion (P <.001 and P =.003, respectively). Sixty seven patients (17.3%) had radioluscent lines and on a multivariate analysis, there were no significant predictors of radiolucent lines. Cementless TKA in the young patient can achieve excellent clinical and functional outcomes. At a median of 10.7 years, aseptic revision rates are exceptionally low at 0.8% for the entire cohort. [ABSTRACT FROM AUTHOR]

• Video case studies are an effective alternative to the traditional case study. • Video case studies with SLT provide an interactive way to learn about leadership. • SLT can be used for teaching leadership content to undergraduate nursing students. Leadership is an essential nursing competency. Specific leadership competencies of assignment, delegation, and supervision are imperative. While written case studies are commonly used, use of video case studies may increase student engagement. An alternative teaching strategy using synthetic learning technologies can be used to meet the same objectives while increasing student interest. There were 99 participants in the intervention group and 94 participants in the control group between 2 campuses. A traditional case study was transformed into a video case study with the help of the university technology team using standardized patients, video recordings, and a storyboard in the Learning Management System. There were statistically significant differences on 4 exam items about assignment, delegation, and supervision. Students can effectively learn about assignment, delegation, and supervision through synthetic learning technologies. There is potential to develop additional activities using this technology in nursing education. [ABSTRACT FROM AUTHOR]

The purpose of this study is to understand the pre-examination worries of individuals who experience sexual assault, and whether those worries were experienced or resolved during a telehealth-enabled, sexual assault nurse examiner-led sexual assault examination. Patient surveys were administered to understand pre-examination worries, whether those worries were ultimately experienced during the consultation, and patient perceptions of care quality, telehealth consultation, and whether the examination helped individuals feel better. Data analysis was conducted using descriptive statistics and binomial proportion tests. Surveys were collected from 74 adolescents and adults who obtained sexual assault care at 6 rural and 2 suburban hospitals. Study findings showed individuals overcome substantial worries to access care, with 66% having at least 1 worry and 41% endorsing 3 or more pre-examination worries. Most participants felt believed (83%) and did not feel judged (88%) or blamed (85%) during their examination. Analysis of pre-examination worries and worry resolution during the examination showed 88% to 100% resolution of worries related to being believed, judged, blamed or lacking control. Participants highly rated the quality of care received (92%) and 84% stated the examination helped them feel better, suggesting a sexual assault nurse examiner-led examination is an important step toward recovery and healing. These findings have implications for emergency department support for sexual assault nurse examiner-led care and public health messaging to demystify sexual assault care, allay fears, and highlight care benefits. [ABSTRACT FROM AUTHOR]

Genetics play an important role in several medical domains; however, the influence of human leukocyte antigen (HLA) genotype on the development of periprosthetic joint infection (PJI) in total hip arthroplasty (THA) remains unknown. The primary aim of this study was to determine if HLA genotype is associated with the development of bacterial PJI in THA. Secondarily, we evaluated the association between HLA genotype and PJI treatment success. A retrospective, matched, case-control study was performed using prospectively collected data from a single institution. A total of 49 patients who underwent primary THA were included, with a mean follow-up of 8.5 years (range, 4.2 to 12.9). The 23 cases (PJI) and 26 controls (no PJI) were matched for age, sex, follow-up, body mass index, primary diagnosis, and comorbidities (P >.05). High-resolution genetic analysis targeting 11 separate HLA loci was performed in all patients using serum samples. The HLA gene frequencies and carriage rates were determined and compared between cohorts. A subgroup analysis of PJI treatment success (18) and failure (5) was performed. Statistical significance was set at P =.10 for genetic analysis and at 0.05 for all other analyses. There were 4 HLA alleles that were significantly associated with the development of PJI. The 3 at-risk alleles included HLA-C∗06:02 (odds ratio 5.25, 95% CI [confidence interval] 0.96 to 28.6, P =.064), HLA-DQA1∗04:01 (P =.096), and HLA-DQB1∗04:02 (P =.096). The single protective allele was HLA-C∗03:04 (odds ratio 0.12, 95% CI 0.01 to 1.10, P =.052). There were no specific HLA alleles that were associated with treatment success or failure. This study suggests that there are at-risk and protective HLA alleles associated with the development of PJI in THA. To our knowledge, this is the first study to demonstrate an association between patient HLA genotype and the development of PJI. A larger study of the subject matter is necessary and warranted. [ABSTRACT FROM AUTHOR]

Egalitarian gender norms and legislative rights to property may be a threat to the successful intergenerational transfer of the family farm. This article examines how the land holding generation perceives the role of daughters-in-law in reproducing the family farm. We examine the site of farm succession and intergenerational transfer. We draw on interviews with 22 farm succession professionals. Our analysis demonstrates the land holding generation see the financial reproduction of the Australian family farm as reliant on women's off-farm work and the biological, social and cultural reproduction of the family farm is reliant on women's role adherence to traditional gender norms. This creates tensions within family farms that the landholding generation aim to resolve through legal protections of the farm asset against a claim by the daughter-in-law and by discursively punishing role digression. Given the reliance of Australian family farms on women's labour contributions, these actions may threaten rather than ensure the continuity of family farming. • The reproduction of the family farm is reliant on the flexibility of family labour. • The daughter-in-law is valued for her reproductive role and capacity to provide off-farm income. • In light of changes to Family Law, the daughter-in-law is also perceived as a risk to the continuity of the family farm. • Role construction of the daughter-in-law limits her role identity formation within the business and her potential contribution to farm viability. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe an approach to surgical management of the hook of hamate fractures in professional baseball players. A retrospective chart review was performed on Major and Minor League Baseball players who underwent surgical excision for the hook of hamate fracture between the years 2003 and 2019 by a single surgeon. Patient demographics, the mechanism and timing of the injury, diagnostic and operative details, postoperative complications, and timeline to return to baseball activities were recorded. A total of 145 professional baseball players affiliated with 17 Major League Baseball organizations were studied, with the majority of athletes playing at the Minor League Baseball level (91.7%). Subacute or chronic patterns of injury (81.7%) were found to be more common than acute patterns based on radiographic and intraoperative findings. Two patients reported transient numbness in the fourth and fifth digits after surgery, 6 patients reported pisotriquetral pain when returning to a hitting program, and 1 patient developed heterotopic ossification after surgery. All complications resolved during a strength and conditioning program. On average, players in our cohort began a hitting program at 4.6 weeks after surgery and were released into full baseball activities at 7.1 weeks after surgery. Surgical excision remains an effective method of management, with a low risk of minor complications for both acute and chronic hook of hamate fractures in professional baseball players. Therapeutic Level IV. [ABSTRACT FROM AUTHOR]

Background: The ability of a group of high-volume arthroplasty surgeons to simultaneously change their preferred primary total knee arthroplasty (TKA) implant of choice to another, has not been explored in the literature to date. The main hypothesis was that such a change could be made with no significant impact on clinical outcomes.Methods: This is a retrospective cohort study comparing the last 500 consecutive TKAs implanted of a routinely used TKA implant (NexGen; Zimmer, Warsaw, IN) with the first 500 consecutive TKAs implanted of a newly adopted TKA implant (Triathlon; Stryker, Mahwah, NJ) at an institutional level. Primary outcomes of importance included all complications that occurred either intraoperatively or early postoperatively, early all-cause revision rate, and early reintervention rate.Results: There was a 1.2% (n = 6) complication rate in the NexGen cohort compared to 0.8% (n = 4) in the newly adopted Triathlon cohort (P = .75). The rate of intraoperative fracture was 1% in the NexGen cohort and 0.6% in the Triathlon cohort (P = .72). The early all-cause revision rate for the NexGen TKA was 1% (n = 5) compared to 0.8% (n = 4) in the Triathlon cohort (P = 1.0). The manipulation under anesthesia (MUA) rate in the NexGen cohort was 2.4% compared to 4.6% in the Triathlon cohort (P = .058). The only predictor variable associated with MUA rate was American Society of Anesthesiologists grade, where there was a significantly lower rate of MUA with a higher American Society of Anesthesiologists grade (P = .042).Conclusion: It is possible to implement the institution-wide adoption of an established, high-performing TKA implant without any negative implications in relation to early revision rates, perioperative complication rates, and reintervention rates. This study is the first of its kind to be reported in the literature. [ABSTRACT FROM AUTHOR]

Background: To date, the literature has not yet revealed superiority of Minimally Invasive (MI) approaches over conventional techniques. We performed a systematic review to determine whether minimally invasive approaches are superior to conventional approaches in total hip arthroplasty for clinical and functional outcomes. We performed a meta-analysis of level 1 evidence to determine whether minimally invasive approaches are superior to conventional approaches for clinical outcomes.Methods: All studies comparing MI approaches to conventional approaches were eligible for analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were adhered to throughout this study. Registries were searched using the following MeSH terms: 'minimally invasive', 'muscle-sparing', 'THA', 'THR', 'hip arthroplasty' and 'hip replacement'. Locations searched included PubMed, the Cochrane Library, ClinicalTrials.gov, the European Union (EU) clinical trials register and the International Clinical Trials Registry Platform (World Health Organisation).Results: Twenty studies were identified. There were 1,282 MI total hip arthroplasty (THAs) and 1,351 conventional THAs performed. There was no difference between MI and conventional approaches for all clinical outcomes of relevance including all-cause revision (P = .959), aseptic revision (P = .894), instability (P = .894), infection (P = .669) and periprosthetic fracture (P = .940). There was also no difference in functional outcome at early or intermediate follow-up between the two groups (P = .38). In level I studies exclusively, random-effects meta-analysis demonstrated no difference in aseptic revision (P = .461) and all other outcomes between both groups.Conclusion: Intermuscular MI approaches are equivalent to conventional THA approaches when considering all-cause revision, aseptic revision, infection, dislocation, fracture rates and functional outcomes. Meta-analysis of level 1 evidence supports this claim. [ABSTRACT FROM AUTHOR]

Background: Community pharmacists are in a prime position to communicate with and assist those with mental health needs. However, mental health literacy, which includes beliefs and knowledge of mental health conditions, can impact the provision of pharmacy services. The mental health literacy of community pharmacists in New Zealand is currently unknown.Objectives: To assess the mental health literacy of community pharmacists in New Zealand.Methods: We employed a national cross-sectional online survey, evaluating attitudes towards mental illness, ability to recognise depression using a vignette and followed by questions related to the helpfulness of various interventions, and willingness to provide pharmacy services for people with mental illness in comparison to cardiovascular diseases. Additionally, opportunities for mental health training were explored. Participants were community pharmacists working in New Zealand contacted via mailing lists of professional bodies.Results: We received responses from 346 participants. The majority of participants showed positive attitudes towards mental illness and correctly identified depression in the vignette (87%). Participants rated counsellors (84%) and physical activity (92%) as the most helpful professionals and intervention respectively while only 43% considered antidepressants as helpful for depression. When compared to other people in the community, long-term functioning of the individual described in the vignette was rated poorly, especially in terms of increased likelihood to attempt suicide (85%) and reduced likelihood to be a productive worker (64%). Approximately 30% of participants reported reduced confidence/comfort while approximately half of participants reported greater interest in providing mental health-related care compared to cardiovascular disease. The participants also highlighted several areas for future mental health training they wished to undertake.Conclusions: We have identified positive attitudes towards mental illness in our study. Participants correctly identified and supported evidence-based interventions for mild to moderate depression. However, we highlighted the need for ongoing mental health training to address knowledge gaps and enhance the confidence in providing mental health-related care. [ABSTRACT FROM AUTHOR]

Adequate pain control after outpatient pediatric urologic surgery is important for both providers and caregivers; however, opioid pain medications are often prescribed in excess of utilization. The resultant excess opioid medication has potential to be diverted or misused. While families are instructed to dispose of leftover opioids, a significant proportion may not dispose of leftover medication. We performed a quality improvement (QI) initiative within a tertiary academic care center to examine opioid excess, opioid disposal, and whether a two-component QI intervention of provider education and family education via automated SMS messages on opioid disposal could improve excess opioid prescribing and leftover opioid disposal. Prospective parent surveys were performed on a baseline cohort of 73 patients undergoing outpatient pediatric urologic surgery between July 27 and September 4, 2020. Based on baseline data, a two-component quality improvement initiative was implemented. The first component was non-binding surgeon education regarding opioid prescribing versus opioid utilization. The second component was initiation of automated SMS messages to families after surgery with information on expected postoperative course and hyperlinked instructions for opioid disposal with GPS search for opioid disposal sites nearby. We then repeated the survey for a second cohort of patients between September 14 and October 29, 2021, including additional questions regarding SMS message utility. Of 73 patients in the baseline group, 46% were prescribed opioids (Summary Table). Of patients prescribed opioids, a median of 3 doses were used and 96% had leftover opioid medication. Seventeen percent of parents in the baseline group disposed of unused opioids prior to survey completion (1–4 weeks postop). After the intervention, 19 of 74 (26%) patients were prescribed opioids. In the group that received opioids, a median of 2 doses were used and 63% reported disposing of opioids. Ninety-six percent of parents reported satisfaction with SMS messages. Many competing priorities exist for surgical providers and parents of children undergoing outpatient pediatric urologic surgery. A passive program that delivers just-in-time information in the postoperative period has high utility for both parents and providers. Automated SMS messages and provider education about opioid utilization are associated with decreased excess opioid after outpatient pediatric urologic surgery and improved opioid disposal rates by parents. These interventions are easily implemented without significant manpower and should be considered by organizations interested in decreasing excess community opioids after outpatient pediatric urologic surgery. Summary Table Opioid Prescription Rates, Pain Outcomes, Opioid Disposal Summary Table Baseline Group % Intervention Group % p-value Opioid Prescribed (Patient number)∗ 33 46% 19 26% 0.015 Mean Opioid Prescribed Per Patient (MMEs)∗ 21.4 10.4 0.023 Pain Perception 0.199 Poor 3 5% 0 0% Adequate 15 24% 2 8% Good 45 71% 24 92% Pain Expectation 0.199 Worse 2 3% 0 0% The Same 27 43% 7 27% Better 34 54% 19 73% Opioid Disposal (Yes)∗ 4 17% 5 63% 0.023 ∗p value < 0.05. [Display omitted] [ABSTRACT FROM AUTHOR]

Despite copious data linking brain function with changes to social behavior and mental health, little is known about how puberty relates to brain functioning. We investigated the specificity of brain network connectivity associations with pubertal indices and age to inform neurodevelopmental models of adolescence. We examined how brain network connectivity during a peer evaluation fMRI task related to pubertal hormones (dehydroepiandrosterone and testosterone), pubertal timing and status, and age. Participants were 99 adolescents assigned female at birth aged 9–15 (M = 12.38, SD = 1.81) enriched for the presence of internalizing symptoms. Multivariate analysis revealed that within Salience, between Frontoparietal – Reward and Cinguloopercular – Reward network connectivity were associated with all measures of pubertal development and age. Specifically, Salience connectivity linked with age, pubertal hormones, and status, but not timing. In contrast, Frontoparietal – Reward connectivity was only associated with hormones. Finally, Cinguloopercular – Reward connectivity related to age and pubertal status, but not hormones or timing. These results provide evidence that the salience processing underlying peer evaluation is jointly influenced by various indices of puberty and age, while coordination between cognitive control and reward circuitry is related to pubertal hormones, pubertal status, and age in unique ways. [ABSTRACT FROM AUTHOR]

Almost 800 million people currently lack access to reliable electricity, for many of whom solar microgrid systems are expected to be the most cost-effective solution. Quantifying current and future electricity demand is crucial for cost-effective design of reliable microgrids. However, electricity usage is connected to a wide range of social and economic factors alongside climatic conditions, making estimation of demand challenging. This paper presents a framework facilitating each stage of solar microgrid design from demand estimation through to cost-optimal sizing of the microgrid and its economic and environmental characterisation. Household demand is simulated based upon (1) climatic conditions, (2) appliance ratings and usage patterns, and (3) rates of growth in appliance ownership based upon the Multi-Tier Framework for measuring household electricity access. Microgrid demands are simulated based on the combination of these with (4) nondomestic demand based upon locally available data. The framework is demonstrated across four rates of domestic demand growth and two climatic conditions ('tropical savanna' and 'humid subtropical'), alongside nondomestic demand based upon two operational microgrids (one rural and one peri-urban). When growth rates are high, newly introduced appliances tend to dominate, with differing impacts on the demand profile depending on power and usage times. Cooling represents a modest contribution to demand in the tropical savanna climate. However, in the hotter and more seasonally varying humid subtropical climate, cooling becomes the dominant driver of demand, increasing seasonality and proportion of demand at night. Nondomestic demand in the rural microgrid is primarily agricultural, and exhibits more seasonality and better alignment with daylight hours than demand in the peri-urban setting, which is more service-based. Across cases, increased seasonality and proportion of demand at night lead to poorer alignment with PV generation, increasing cost and GHG emissions per unit of electricity used in a cost-optimised microgrid system. • A framework is presented to facilitate demand estimation and solar microgrid design. • Household load is simulated based upon appliance ownership and climatic conditions. • Nondomestic load data is derived from deployed microgrids across economic contexts. • Load growth, climatic condition, and nondomestic load all play a key role in shaping load profiles. • Data are combined in a technoeconomic model to inform cost-optimal sizing strategies. [ABSTRACT FROM AUTHOR]

Existing methods of quantifying agricultural employment mask the changing profile of agricultural employment occurring in response to the pressures of competitive productivism, general progress in scientific and technical knowledge, an increasingly complex value chain and changing consumer expectations. This article critically reviews the traditional sources of data used to inform the quantification of the agricultural labor force data and presents a method, the Professional Agricultural Services Sector (PASS) Trident, which measures employment in the agriculture sector more fully, by including employment in professional services and capturing key demographic characteristics. Applying the PASS Trident, our analysis of the industry and occupation level data indicates that the existing method of measuring agricultural employment under-counts the contribution of agribusiness professionals. Moreover, people employed in the professional agricultural services sector are highly educated, younger than the traditional on-farm workforce and reside in urban areas. The methodology proposed in this paper provides a framework for future studies for monitoring shifts in agricultural employment. • Agricultural producers are increasingly seeking professional services. • This is in response to economic pressures, scientific progress, value chain complexity, and changing consumer expectations. • Existing methods of measuring agricultural employment under-count the contribution ofagribusiness professionals. • Those employed in professional agricultural services sector are highly educated, young, and reside in urban areas. • The methodology proposed in this paper provides a framework formonitoring shifts in agricultural employment. [ABSTRACT FROM AUTHOR]

The deployment of the resilient city concept remains divided between those who see resilience as a set of (bottom-up) enabling capacities, and those who accuse it of (top- down) post-political tendencies that normalize the status quo and cast off the vulnerable. This paper offers a conceptual framework that overcomes this binary. We argue that a critical and trans-historical deployment of resilience to the actually-existing conditions of urban crisis can re-politicize the very conditions necessitating cities to be resilient. Politicizing the lived experiences of resilience draws attention to the relationality and agency of resilience: how resilience is constructed, negotiated and resourced, at which temporal and spatial scales, and with what political antecedents, consequences and power struggles. The paper considers the lived politics of the resilient city juxtaposed across two purposefully disparate case studies: Leningrad during the 872-day siege in 1941-1944, and New Orleans following Hurricane Katrina in 2005. This unorthodox comparison both transgresses clear-cut ideological and epistemological conventions and develops a complex picture of how resilience unfolds in reality. These tragic events show a range of conditions that incorporated state-imposed cast-off top-down resilience and, in response, individual and community-led bottom-up resilience. We demonstrate the pre-eminent role of the state in how both disaster and resilience are constructed and (mis)managed, but also how cast-off resilience compels citizens and communities to activate mechanisms for negotiating disaster and recovery, generating a co-constituted resilience of cities and individuals. [ABSTRACT FROM AUTHOR]

Background: There are limited data on zoster recurrence.Objective: To examine in detail zoster recurrence in a population-based cohort.Methods: Using data from a large cohort (The 45 and Up Study) with linked medical data (2004-2015), the incidences of first and recurrent zoster were examined by using survival analysis methods.Results: Over 1,846,572 person-years of follow-up, of 17,413 participants who had a first zoster episode (incidence, 9.43 per 1000 person-years; 95% confidence interval, 9.29-9.57), 675 (3.9%) experienced a recurrence. The mean time between first and recurrent zoster was 2 years for those aged 45-54 years and 3 years for those aged 55 years and older. Among those with a first zoster, the incidence of recurrence was 11.05 (95% confidence interval, 10.24-11.91) per 1000 person-years, and higher recurrence incidence occurred in women compared to men, in younger compared to older participants, and in immunosuppressed compared to nonimmunosuppressed participants. Recurrence appeared lower in the 12 months after zoster onset but then remained consistent at approximately 12.00 per 1000 person-years in the following 8 years.Limitations: Recurrence may be underestimated because of the use of administrative data for case ascertainment. Potential misclassification of nonimmunosuppressed participants.Conclusions: Our results support the vaccination of people who have already experienced zoster and underpin the need for additional studies on immunogenicity and vaccine efficacy in these populations. [ABSTRACT FROM AUTHOR]

Background: The increasing in primary total knee arthroplasty has led to an increase in infectious complications, revision surgery, and bone loss. Knee joint bone defects (KJBD) may be managed using bone transport and arthrodesis with Ilizarov or bone transport over nail (BTON) techniques. The aim of this study is to compare both techniques in the reconstruction of KJBDs.Methods: This was a retrospective cohort study of 29 patients with extensive KJBD. All patients underwent reconstruction of the KJBD using bone transport (either Ilizarov or BTON techniques). The primary outcome variables for comparison between the two groups included time in frame (days), external fixation index (EFI, days/cm), residual limb length discrepancy (cm), and complications (Caton classification).Results: Gender and age profiles were comparable. Mean time spent in frame for bone transport was 566 days (σ = 236, 95% CI 429-702) for the Ilizarov cohort and 191 days (σ = 162, 95% CI 101-280) for BTON (P < .0001). EFI for the period of bone transport was 75.1 d/cm (σ = 41.5, 95% CI 51.1- 99.1) for the Ilizarov cohort and 24.7 d/cm (σ = 24.0, 95% CI 11.4-38) for BTON (P = .0004). Union, limb length discrepancy and complication rates were comparable between both groups.Conclusion: For the management of KJBD after failed total knee arthroplasty, BTON is preferred due to significantly less time spent in frame, lower EFI, and higher rates of normal mechanical alignment. The Ilizarov method may be useful when there is a contraindication to BTON. [ABSTRACT FROM AUTHOR]

Background: We evaluated whether there is equitable distribution across sexes of treatment and outcomes for aortic valve replacement (AVR), via surgical (SAVR) or transcatheter (TAVR) methods, in symptomatic severe aortic stenosis (ssAS) patients.Methods: Using de-identified data, we identified 43,822 patients with ssAS (2008-2016). Multivariate competing risk models were used to determine the likelihood of any AVR, while accounting for the competing risk of death. Association between sex and 1-year mortality, stratified by AVR status, was evaluated using multivariate Cox regression models with AVR as a time-dependent variable.Results: Among patients with ssAS, 20,986 (47.9%) were female. Females were older (median age 81 vs. 78, P<0.001), more likely to have body mass index <20 (8.5% vs. 3.5%), and home oxygen use (4.4% vs. 3.4%, P<0001 for all). Overall, 12,129 (27.7%) patients underwent AVR for ssAS. Females were less likely to undergo AVR compared with males (24.1% vs. 31.0%, adjusted hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.77-0.83), but when treated, were more likely to undergo TAVR (37.9% vs. 30.9%, adjusted HR 1.21, 95% CI 1.15-1.27). Untreated females and males had similarly high rates of mortality at 1 year (31.1% vs. 31.3%, adjusted HR 0.98, 95% CI 0.94-1.03). Among those undergoing AVR, females had significantly higher mortality (10.2% vs. 9.4%, adjusted HR 1.24, 95% CI 1.10-1.41), driven by increased SAVR-associated mortality (9.0% vs. 7.6%, adjusted HR 1.43, 95% CI 1.21-1.69).Conclusions: Treatment rates for ssAS patients remain suboptimal with disparities in female treatment. [ABSTRACT FROM AUTHOR]

Background: Youth of color from low-income urban communities are crucial participants in research, as their involvement can shape effective, culturally responsive interventions and policy to promote youth health and well-being. These young people, however, are an often-neglected research population, due in part to perceived challenges associated with their inclusion as well as marginalized communities' justifiable mistrust of research.Objectives: Based on our experience conducting a school-based randomized intervention trial in Baltimore, Maryland, we present strategies for conducting research with low-income, urban youth of color. We discuss strategies in three domains: university-community partnership development, participant recruitment, and participant retention.Methods: We reviewed partnership building and recruitment strategies employed by our team across four years of trial implementation and evaluated success of participant retention at our final survey timepoint.Results: Partnership building was facilitated by selection of a study design that maximized benefits for all participants, promotion of capacity building at partner institutions, and attention to research staff hiring and training practices. Effective study recruitment strategies included personal contact with parents and close cooperation between school personnel and study staff. Providing incentives and collecting multiple types of participant contact information contributed to increased retention rates. On average, those who participated in the final survey timepoint were less likely to be male and Latinx and exhibited more favorable baseline mental health than those who did not, suggesting differential attrition based on youth characteristics.Conclusions: Lessons learned from this school-based trial can be applied more broadly to research with low-income urban youth of color. Researchers should strive to maximize scientific rigor, minimize harm to vulnerable adolescents and their communities, promote positive research experiences for young people, and provide concrete benefits to those who participate. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has challenged the capacity of interventional radiology departments worldwide to effectively treat COVID-19 and non-COVID-19 patients while preventing disease transmission among patients and healthcare workers. In this review, we describe the various data driven infection control measures implemented by the interventional radiology department of a large tertiary care center in the United States including the use and novel re-use of personal protective equipment, COVID-19 testing strategies, modifications in procedural workflows and the leveraging of telehealth visits. Herein, we provide effective triage, procedural, and management algorithms that may guide other interventional radiology departments during the ongoing COVID-19 pandemic and in future infectious disease outbreaks. [ABSTRACT FROM AUTHOR]

Measures of oxygen uptake efficiency (OUE) have been used to evaluate cardiorespiratory fitness (CRF) in adolescents unable to perform maximal exercise. The oxygen uptake efficiency slope (OUES) and oxygen uptake efficiency plateau (OUEP) have been proposed as surrogates for maximal oxygen consumption (V̇O 2max). We assessed the validity of the OUES and OUEP as predictors of V̇O 2max in healthy male adolescents. Sixty-three healthy male adolescents aged 15.40 ± 0.34 years underwent an incremental treadmill test to determine V̇O 2max , OUES and OUEP. OUE throughout the test was assessed by dividing each V̇O 2 value by the corresponding minute ventilation (V̇ E) value. OUEP was determined as the 90 s average highest consecutive values for OUE. OUES was determined using data up to the ventilatory threshold (VT) by calculating the slope of the linear relation between V̇O 2 and the logarithm of V̇ E. Limits of agreement for V̇O 2max predicted by OUES (±13.3 mL kg−1.min−1) and OUEP (±16.7 mL kg−1.min−1) relative to V̇O 2max were wide and a magnitude bias was found for OUES and OUEP as predictors of V̇O 2max (p < 0.001). The OUES and OUEP do not accurately predict V̇O 2max in male adolescents and should not replace V̇O 2max when assessing CRF in this population. [ABSTRACT FROM AUTHOR]

Purpose: To determine how changing the P value threshold of statistical significance from .05 to .005 could affect the statistical significance of findings in previously published orthopaedic sports medicine randomized controlled trials (RCTs).Methods: The authors searched PubMed from January 1, 2016, to December 31, 2017, for RCTs published in the American Journal of Sports Medicine, Arthroscopy, and Knee Surgery, Sports Traumatology, Arthroscopy. Data were extracted blinded and in duplicate fashion by 2 of us. The authors then extracted P value data for primary end points, since RCTs are most often powered for these end points. Discrepancies were resolved by consensus. Google Forms were used for data extraction and STATA 15.1 for the data analysis.Results: In total, 275 primary end points were identified from 132 trials. Analysis of primary end points found 45.8% (126/275) had a P value less than .05 and were classified as statistically significant under the current threshold, whereas 54.2% (149/275) had a P value greater than .05 and were not classified as suggestive. Of those end points that were previously considered statistically significant, 38.9% (49/126) were less than .005, whereas 61.1% (77/126) were between .005 and .05 and thereby would be reclassified as suggestive rather than statistically significant under the proposed threshold. Overall, when analyzing the 275 primary end points, we found only 49 (17.8%) of the end points were less than .005 and would hold statistical significance with the proposed threshold.Conclusions: The results suggest that if the threshold of statistical significance were to change to .005, the significance of orthopaedic sports medicine RCTs would be heavily altered. The authors also acknowledge the many issues research faces in regard to P value reliability and therefore interpretation of study results. Because P values from RCTs can often influence the ways physicians choose interventions, it is important to implement methodology that decreases incidence of bias and misrepresentation of these results. However, the authors also understand that lowering the P value could increase the needed sample size and by consequence increase study costs as well, while not directly correlating to clinical significance. Thus, the authors recommend that this proposed threshold should be further evaluated and cautiously interpreted.Clinical Relevance: If the statistical significance threshold is changed, clinical practice guideline recommendations also may be affected. [ABSTRACT FROM AUTHOR]

The impacts of climate change on planetary health are multifaceted and threaten public health gains made since World War II. Healthcare is the fifth largest global emitter of greenhouse gas emissions, demanding significant efforts to transition to an environmentally sustainable future. Addressing these issues will require collective societal action. In this regard, universities have a dual responsibility – (1) to tackle complex social, economic, and environmental challenges by championing sustainability initiatives designed to positively impact planetary health; and (2) to ensure that graduates are equipped with the knowledge, attitudes and skills needed to steward planetary health towards a more sustainable future. The future nursing and midwifery workforce must be educated to mitigate the health sector's impact on the environment, advocate for action on climate change, prepare for ongoing health impacts of unpredictable climate and environmental changes, and help communities and healthcare systems become more climate resilient. To help increase nursing and midwifery educators' and students' capacity to support planetary-health related interventions, the overarching purpose of this paper is to provide a series of exemplars that illustrate sustainability initiatives used in four university-based clinical skills laboratories. These initiatives each demonstrate a commitment to the United Nation's Sustainable Development Goals and can be used to help embed the importance of planetary health in student learning. [ABSTRACT FROM AUTHOR]

Acid mine drainage (AMD) is a form of environmental pollution from mining activity that can negatively affect soil environments by acidification, salinisation, and metal(loid) contamination. The use of plants to remediate (phytoremediation) these impacted environments while generating plant-based value is a promising approach to more accessible and cost-benefiting restoration of post-mining, marginal lands. In this study, a 3-month growth-chamber pot experiment was conducted to investigate the influence of co-cropping two plant species, Chrysopogon zizanioides (vetiver grass) and the legume Medicago truncatula (barrel clover) with a wheat straw biochar amendment on the phytostabilisation of metal(loid)s Cr, Zn, and As and the phytoextraction of rare earth element (REE) in an AMD impacted soil from a gold mining region in South Africa. The results showed that co-cropping with vetiver significantly lowered the legume's Cr, Zn, and As root contents by 80%, 32% and 54%, respectively, and improved the plant's overall metal(loid) tolerance by increasing its translocation from root to shoot tissue. The biochar further inhibited root uptake of Cr and Zn, by 71% and 36%, and increased the legume biomass by 40%. Both plant species and cropping treatments exhibited low REE extraction capabilities by shoot tissue, which accounted for less than 0.2% of total soil REE contents. The study shows that co-cropping with vetiver and biochar amendment are effective tools for the phytoremediation of AMD impacted soil mainly by lowering plant uptake and improving plant metal(loid) tolerance. Likely mechanisms at play include the alteration of rhizosphere chemistry and species-specific physiological and molecular responses. These effects offer support for the phytostabilisation of AMD impacted soil with the generation of plant-based value through dual (and safe) cultivation (phytoprotection) rather than through REE recovery from plant biomass (phytoextraction). These techniques could allow for the simultaneous restoration of post-mining, mining-impacted and marginal lands with agricultural production. [Display omitted] • Co-cropping was investigated as a phytoremediation tool for acid mine drainage impacted soil. • A vetiver grass and legume co-cropping system improved plant metal tolerance. • Vetiver grass could be used for phytoprotection and phytostabilisation in mining polluted soil. • Co-cropping was not an effective strategy for phytoextraction of rare earth elements. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: Propagation-based phase-contrast CT (PB-CT) is an advanced X-ray imaging technology that exploits both refraction and absorption of the transmitted X-ray beam. This study was aimed at optimizing the experimental conditions of PB-CT for breast cancer imaging and examined its performance relative to conventional absorption-based CT (AB-CT) in terms of image quality and radiation dose.Materials and Methods: Surgically excised breast mastectomy specimens (n = 12) were scanned using both PB-CT and AB-CT techniques under varying imaging conditions. To evaluate the radiological image quality, visual grading characteristics (VGC) analysis was used in which 11 breast specialist radiologists compared the overall image quality of PB-CT images with respect to the corresponding AB-CT images. The area under the VGC curve was calculated to measure the differences between PB-CT and AB-CT images.Results: The highest radiological quality was obtained for PB-CT images using a 32 keV energy X-ray beam and by applying the Homogeneous Transport of Intensity Equation phase retrieval with the value of its parameter γ set to one-half of the theoretically optimal value for the given materials. Using these optimized conditions, the image quality of PB-CT images obtained at 4 mGy and 2 mGy mean glandular dose was significantly higher than AB-CT images at 4 mGy (AUCVGC = 0.901, p = 0.001 and AUCVGC = 0.819, p = 0.011, respectively).Conclusion: PB-CT achieves a higher radiological image quality compared to AB-CT even at a considerably lower mean glandular dose. Successful translation of the PB-CT technique for breast cancer imaging can potentially result in improved breast cancer diagnosis. [ABSTRACT FROM AUTHOR]

k• Independent direct replication is crucial for research validation. • Neurosurgical trials are not being replicated. • Replication studies would increase confidence in the field of neurosurgery. • Researchers, editors and academic institutes can help foster replication practises. A concerning phenomenon has been identified within the scientific literature. In multiple fields, systematic efforts to replicate peer reviewed studies have been successful in fewer than half of the originals attempted. Currently it is unclear how many influential neurosurgical trials have undergone direct replication. In this study we conducted a publication search to estimate the proportion of classic trials (>400 citations) to have undergone independent direct replication. Published replications would then be assessed for agreement with the original study findings. Our search included all journal articles in the Web of Science written in English and published between 1900 and 2019. This yielded 110 highly-cited trials published in 28 medical journals. Screening of the citation index for these classic studies (113,387 articles) identified 4632 articles to be scrutinised for evidence of replication. Review of these articles did not find any self-identified direct replication studies. This apparent absence of direct replication of classic trials in neurosurgery raises questions about the strength of the evidence base for widespread neurosurgical practices. Direct replication studies must be attempted and published in order to confirm the robustness of influential findings from neurosurgical research. [ABSTRACT FROM AUTHOR]

• Transcranial doppler can be used to calculate and monitor cerebrovascular function. • Variability of transcranial doppler does not significantly affect secondary indices. • Transcranial doppler derived mean index of cerebral autoregulation Mxa seems robust. • Fist study on robustness of non-invasive cerebral autoregulation monitoring. • Transcranial doppler derived 'critical closing pressure' (CrCP) seems robust. Continuous measurement of cerebral blood flow velocity (CBFV) of the middle cerebral artery (MCA) using transcranial Doppler (TCD) and arterial blood pressure (ABP) monitoring enables assessment of cerebrovascular haemodynamics. Further indices describing cerebrovascular function can be calculated from ABP and CBFV, such as the mean index (Mxa) of cerebrovascular autoregulation, the 'time constant of the cerebral arterial bed' (tau), the 'critical closing pressure' (CrCP) and a 'non-invasive estimator of ICP' (nICP). However, TCD is operator-dependent and changes in angle and depth of MCA insonation result in different readings of CBFV. The effect of differing CBFV readings on the calculated secondary indices remains unknown. The aim of this study was to investigate variation in angle and depth of MCA insonation on these secondary indices. In eight patients continuous ABP and ipsilateral CBFV monitoring was performed using two different TCD probes, resulting in four simultaneous CBFV readings at different angles and depths per patient. From all individual recordings, the K-means clustering algorithm was applied to the four simultaneous longitudinal measurements. The average ratios of the between-clusters, sum-of-squares and total sum-of-squares were significantly higher for CBFV than for the indices Mxa, tau and CrCP (p < 0.001, p = 0.007 and p = 0.016) but not for nICP (p = 0.175). The results indicate that Mxa, tau and CrCP seemed to be not affected by depth and angle of TCD insonation, whereas nICP was. [ABSTRACT FROM AUTHOR]

Over the last several decades, multiple environmental issues have led to dramatic changes in the water clarity of the Great Lakes. While many of the key factors are well-known and have direct anthropogenic origins, climatic variability and change can also impact water clarity at various temporal scales, but their influence is less often studied. Building upon a recent examination of the univariate relationships between synoptic-scale weather patterns and water clarity, this research utilizes nonlinear autoregressive models with exogenous input (NARX models) to explore the multivariate climate-to-water clarity relationship. Models trained on the observation period (1997–2016) are extrapolated back to 1979 to reconstruct a daily-scale historical water clarity dataset, and used in a reforecast mode to estimate real-time forecast skill. Of the 20 regions examined, models perform best in Lakes Michigan and Huron, especially in spring and summer. The NARX models perform better than a simple persistence model and a seasonal-trend model in nearly all regions, indicating that climate variability is a contributing factor to fluctuations in water clarity. Further, six of the 20 regions also show promise of useful forecasts to at least 1 week of lead-time, with three of those regions showing skill out to two months of lead time. [ABSTRACT FROM AUTHOR]

• Significant differences between the blade design and clothing damage. • A correlation between the rounded tip knife and no resulting clothing damage. • Rounded-end tip knives are a safer alternative to conventional knife blade designs. Bladed weapons are frequently encountered in violent crime offences including street based and armed robberies, murder, sexual assaults and terrorism. A study was conducted involving four frequently encountered clothing fabrics: t-shirt (knitted cotton), denim jeans (twill woven cotton), long sleeved top (knitted synthetic blend), and skirt (non-woven faux leather) and five knives to investigate any damage resulting from a downward stabbing motion, with 300 stabs in total. Any resultant penetrating severance damage was then photographed, measured and analysed. Statistical analysis revealed significant differences between the stab hole size and shape, as a consequence of the design of a bladed weapon (in particular, the tip shape) that caused it. There is a notable correlation between the Assure knife (rounded tip) and no resulting severance damage, as the fabric surfaces were not breached with this knife. This suggests a clear alternative to pointed tip knife blades. These findings will be of interest to investigators of knife crime offences, crime-reduction units, knife manufacturers and practitioners, who share the goal of identifying a safer alternative to conventional knife blade design. [ABSTRACT FROM AUTHOR]

We describe the intraoperative parameters that affect stem subsidence rates in tapered modular femoral stems for revision total hip arthroplasty (THA). We also determine the effect of the stem bicortical contact on subsidence rates and whether there is a minimum threshold bicortical contact that must be achieved to avoid the complication of subsidence. This is a retrospective cohort study consisting of 109 hips in 105 patients (53 males and 52 females) at a minimum of 2 years of follow-up. All revisions were carried out for Paprosky type 3A and 3B femoral deficits. Clinical outcomes included the indication for revision, aseptic re-revision surgery, specifications of the stem inserted, and specifications of the femoral head and acetabular components implanted. Radiographic outcome measures included subsidence (mm) and bicortical contact (mm). Using multivariate regression analysis, 3 parameters were associated with an increased rate of stem subsidence. A reduced bicortical contact distance (P <.001) and a stem length of ≤155 mm (P <.001) were both associated with higher subsidence rates. We also demonstrated a novel threshold of 20-mm bicortical contact which must be achieved to significantly reduce subsidence rates in these modular femoral stems for revision THA. Subsidence rates of modular tapered femoral stems for revision THA can be significantly reduced by increasing the initial bicortical contact of the stem within the diaphysis and the overall length of the femoral stem >155 mm. We describe a minimum threshold bicortical contact distance of 20 mm that should ideally be exceeded to significantly reduce the risk of stem subsidence within the femoral canal. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID 2019) pandemic has presented myriad challenges to an underprepared health care system. Health care providers are facing unprecedented acute workplace stress compounded by a high baseline rate of physician burnout. This article discusses the relationship between acute stress disorder, posttraumatic stress disorder, and burnout through a literature review focusing on the mental health impact on health care providers after prior epidemics and natural disasters. We offer both a framework for understanding the mental health impact of the COVID-19 epidemic on physicians while proposing a systems based model to respond to these challenges. [ABSTRACT FROM AUTHOR]