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Introduction Initiation onto haemodialysis is a critical transition that entails multiple psychosocial and behavioural demands that can compound mental health burden. Interventions guided by self-management and cognitive–behavioural therapy to improve distress have been variably effective yet are resource-intensive or delivered reactively. Interventions with a focus on positive affect for patients with end-stage kidney disease are lacking. This study will seek (1) to develop a positive life skills intervention (HED-Start) combining evidence and stakeholder/user involvement and (2) evaluate the effectiveness of HED-Start to facilitate positive life skills acquisition and improve symptoms of distress and adjustment in incident haemodialysis patients.Methods and analysis This is a single/assessor-blinded randomised controlled trial (RCT) to compare HED-Start to usual care. In designing HED-Start, semistructured interviews, a codesign workshop and an internal pilot will be undertaken, followed by a two-arm parallel RCT to evaluate the effectiveness of HED-Start. A total of 148 incident HD patients will be randomised using a 1:2 ratio into usual care versus HED-Start to be delivered in groups by trained facilitators between January 2021 and September 2022. Anxiety and depression will be the primary outcomes; secondary outcomes will be positive and negative affect, quality of life, illness perceptions, self-efficacy, self-management skills, benefit finding and resilience. Assessments will be taken at 2 weeks prerandomisation (baseline) and 3 months postrandomisation (2 weeks post-HED-Start completion). Primary analyses will use an intention-to-treat approach and compare changes in outcomes from baseline to follow-up relative to the control group using mixed-effect models.Ethics and dissemination Ethics approval was obtained from Nanyang Technological University Institutional Review Board (IRB-2019-01-010). Written informed consent will be obtained before any research activities. Trial results will be disseminated via publications in peer-reviewed journals and conference presentations and will inform revision(s) in renal health services to support the transition of new patients to haemodialysis.Trial registration number NCT04774770.

In Sub-Saharan Africa, agricultural commercialization is a major factor in household food diversification and household income. To move to agricultural transformation, Rwanda has focused on shifting from subsistence-based farming to market-oriented agriculture. Various studies have been conducted on agricultural commercialization, however, women’s role in the commercialization of agriculture has received little attention and none of the studies have associated it with women’s empowerment in agriculture. In Rwanda, women are principal players in agriculture and food security, therefore, it is important to understand the influence of their empowerment in agriculture on its commercialization. To investigate the relationship between women’s empowerment in agriculture and agricultural commercialization, the Women’s Empowerment in Agriculture Index (WEAI) was used to measure women’s empowerment in agriculture. A sample size of 252 households from Musanze and Burera districts in the Northern Province of Rwanda was used. It was obtained using the multistage and random sampling techniques. To analyze data, a fractional regression model was used. The results revealed that farm commercialization in Rwanda was positively and significantly influenced by WEAI score, farm size and the prices of maize, potatoes and beans. On the other hand, the index has a negative relationship with access to extension services. It is recommended that the government should strengthen policies of empowering women in agriculture.

Modular necks were introduced in total hip arthroplasty (THA) to improve restoration of hip-geometry and reduce dislocation-rates. This presumed advantage was evaluated retrospectively for patients with arthritis in otherwise anatomically normal hips. Restoration of hip-geometry was assessed on preoperative and postoperative calibrated radiographs in 95 consecutive primary THAs with a modular neck design and compared with 95 match controlled THAs with a similar monoblock stem. No significant differences were seen in restoration of body moment arm, leg length and cupangle. Offset restoration revealed a borderline significant difference (P = 0.48) with higher values for the monoblock stem. In both groups 4 dislocations within one year were encountered. In this study modular necks did not reveal a clear benefit in restoring hip geometry and dislocation rate after straightforward THA. [ABSTRACT FROM AUTHOR]

O presente artigo busca refletir o homoerotismo em duas obras contemporâneas: a primeira literária, O terceiro travesseiro (2003) de Nelson Luiz de Carvalho e a segunda cinematográfica Do começo ao fim (2009) de Aluizio Abranches. O homoerotismo não está reduzido a um grupo identitário. É um desejo que pode se manifestar de várias formas. As relações homoeróticas podem estar constituídas ou não de sentimento, uma vez que o homoerotismo privilegia o afeto, sendo tal estímulo sexual ou afetivo. Assim, o desejo sexual e o afeto entre dois indivíduos do mesmo gênero podem ser considerados homoerótico. Por conseguinte, busca-se refletir as obras elencadas, valendo-se das teorias de Mario Mieli (1978) e Jurandir Costa (1992), ao analisar de que maneira o desejo entre iguais é apresentado e quais os elementos utilizados para exploração do tema.

Forty-eight unilateral hip resurfacing arthroplasty patients were evaluated for cobalt and chromium levels. The metal ion trend of 42 well-functioning patients was compared with six sub-optimal functioning patients. Median metal ion levels were significantly higher for the sub-optimal group. For the well-functioning implants, the percentage of patients with increasing cobalt/chromium levels between two consecutive time-intervals ('risers') gradually decreased from 90/86% (0-3 months) to 22/22% (24-36 months). The percentage of patients with increasing metal ion levels was higher in the suboptimal group. The median absolute increase of this 'risers' subgroup was significantly lower for the well-functioning group at 12-24 months. Sub-optimal functioning MoM implants have a different metal ion trend than well-functioning implants, a higher chance of 'risers' and a larger absolute increase in time. [ABSTRACT FROM AUTHOR]

Background: In instrumented posterolateral fusion reduction of a spondylolisthesis is appealing on theoretical grounds since this may lead to indirect decompression of the entrapped nerve roots. However, there is no consensus in the literature whether a beneficial effect of reduction on outcome can be expected. The objective of the current study was to evaluate whether a correlation between the extent of listhesis reduction and clinical improvement could be established. Methods: From two ongoing prospective studies 72 patients with a single-level instrumented posterolateral lumbar fusion for low-grade spondylolisthesis (isthmic/degenerative 51/21) were evaluated. Radiographs and clinical outcome scores were available at baseline, 6 weeks and 1 year after surgery. Changes in neuroforaminal morphology were measured on calibrated radiographs. These changes in radiographic parameters were correlated to clinical outcome (Visual Analogue Score (VAS) leg pain, Oswestry Disability Index (ODI)). Fusion status was assessed on Computed Tomography-scan at one year. Results: A mean spondylolisthesis of 25 percent was reduced to 15 percent at 6 weeks with some loss of reduction to 17 percent at one year. The VAS and ODI significantly improved at both time intervals after surgery (p < 0.001). No significant correlations could be established between the extent of slip reduction and improvement in VAS or ODI (Pearson's correlation -0.2 and 0.07 respectively at one year); this also accounted for the other radiographic parameters. A fusion rate of 64 percent was seen on CT-scan. Conclusions: Clinical outcome was not related to the obtained radiographic reduction of the slipped vertebra in patients with a lumbar fusion for low grade spondylolisthesis. Loss of reduction or non-union on CT-scans had no effect on the clinical outcome. Reduction of a low-grade spondylolisthesis in spinal fusion is appealing, however, there is no evidence that it positively affects clinical outcome on the short term. [ABSTRACT FROM AUTHOR]

We intensified our screening protocol for the presence of pseudotumours in a consecutive series of patients with a hip resurfacing arthroplasty (HRA), to establish whether we should be alert to the presence of 'silent' pseudotumours. Patients categorised with high risk (11 hips) and low risk (10 hips) for pseudotumour development and a control group (23 hips) were screened with metal artefact reduction sequence (MARS) magnetic resonance imaging (MRI). The Anderson classification to grade any metal-on-metal (MoM) disease present on MARS-MRI images was used. In 15 out of 44 MRI scans pseudotumours were observed (34.1%), of which six were graded with mild (13.6%), eight with moderate (18.2%) and one with severe MoM disease (2.3%). Twelve pseudotumours were present in asymptomatic patients (27.3%). Metal ion levels were normal in 80% of the MARS-MRI screened patients. As a consequence of our intensified screening protocol, one patient was revised for pseudotumour formation and another patient was scheduled for revision. Silent pseudotumours were observed in all three groups. Before our intensified screening protocol was initiated, no pseudotumours were encountered in our cohort of 289 HRAs. We concluded that clinical outcomes and plain radiographs for screening MoM patients underestimates the presence of pseudotumours in MoM patients. The true clinical relevance of these pseudotumours is still unclear. [ABSTRACT FROM AUTHOR]

Total hip arthroplasty in young patients is associated with high failure rates and the best option for this demanding group of patients remains controversial. We report the long-term results of 73 consecutive Zweymüller total hip arthroplasties with a titanium threaded cup and a polyethylene insert in 67 patients aged under 50 years at the time of surgery (mean 43 years, range 23-49). Independent assessment was performed clinically and radiographically, and Kaplan-Meier analysis was used to determine survival for different end-points. Three hips were revised for septic loosening, three cups for aseptic loosening and one hip because of a periprosthetic fracture. Three patients (3 hips) died and seven patients (8 hips) were lost to radiographic follow-up without any reoperation. The mean follow-up was 17.5 (15-21) years and the mean HHS was 90 (52-100). Survival with an end-point of revision for any reason was 89% (95% C.I. 85-93) and of revision for aseptic loosening was 94% (C.I. 95-99) at 17 years. Zweymüller total hip arthroplasty with a titanium threaded cup and a polyethylene insert showed good long-term results, even in this group of young patients. [ABSTRACT FROM AUTHOR]

Abstract: Metal ions generated from joint replacements are a cause for concern. There is no consensuson the best surrogate measure of metal ion exposure, and both serum and whole blood measurementsare used in clinical practice. This study provides a guideline for interpretation of metal ion analysis in clinical practice. In a prospective trial comparing hip resurfacing (HR) with a conventional metal-on-metal (MoM) total hip arthroplasty (THA) cobalt and chromium levels were determined for whole blood and serum in 343 paired samples at regular intervals up to 24 months postoperatively. Cobalt whole blood and serum levels increased significantly after both procedures. Cobalt concentrations were significantly higher for the HR group compared to the THA group, at 3, 6 and 12 months, for whole blood and serum. At 24 months cobalt levels decreased and differences between HR and THA were no longer significant. In contrast, chromium whole blood levels remained significantly higher for HR until 24 months. Whole blood and serum levels could not be used interchangeably. The mean differences for cobalt and chromium between blood and serum values were +0.13 ?g/L and -0.91 ?g/L respectively. Regression analysis provided a formula for conversion from serum to blood of 0.34+[0.88*Co serum] for cobalt and 0.14+[0.58*Cr serum] for chromium, with an acceptable prediction error below ±1.0 ?g/L. Cobalt and chromium levels were significantly higher for HR versus THA, especially during the run-in phase of one year. Overall, the metal ion levels were well below 5 ?g/L. We cannot recommend the use of whole blood over serum measurements or vice versa. The provided conversion formula between whole blood and serum in combination with the presented practical guidelines may be useful for clinical practice. [ABSTRACT FROM AUTHOR]

Background and purpose Prevention of osteonecrosis after corticosteroid administration would be important. We examined the potential of vitamin E ( α-tocopherol) to reduce the incidence of corticosteroid-induced osteonecrosis in an animal model. Methods Japanese white rabbits were divided into 2 groups; the control group was fed a normal diet and the experimental group was fed α-tocopherol-supplemented diet in which α-tocopherol (600 mg/kg diet) was added to the normal diet. To induce osteonecrosis, high-dose methylprednisolone acetate (MPSL) (20 mg/kg body weight) was injected once into the right gluteus medius muscle of all rabbits. 4 weeks after the injection of MPSL, the presence or absence of osteonecrosis of bilateral femurs was examined histopathologically. The tocopherol/cholesterol ratios were calculated. The plasma levels of thiobarbituric acid-reactive substances (TBARS) were measured. Results Alpha-tocopherol-supplemented diet reduced the incidence of osteonecrosis, which developed in 14 of 20 rabbits in the control group and 5 of 21 rabbits in the experimental group (p = 0.004). The tocopherol/cholesterol ratio was higher in the experimental group than in the control group after the α-tocopherol administration. The plasma TBARS level was lower in the experimental group than in the control group at 4 weeks after the MPSL administration. Interpretation Our findings may offer a new approach for the prevention of corticosteroid-induced osteonecrosis. [ABSTRACT FROM AUTHOR]

Operation of hip resurfacing prosthesis is a technically demanding procedure accompanied by a learning curve. To our knowledge no objective data on this learning curve are available in the literature. For the first 40 resurfacing hip prostheses implanted by a single-surgeon radiographic ‘learning curve’ analysis was performed. Optimal implant positioning on preoperative digital templating was compared with the eventual implant position postoperatively, measured by six establishes radiographic parameters and compared for four chronological cohorts of patients. A learning curve was clearly present and an optimal result was established in the last cohort. Pitfalls were a relatively steep cup position initially and a stem position in the posterior 1/3 of the collum. Besides marginal medialization a fully anatomic reconstruction of the center of rotation was achieved. In total hip resurfacing one should recognize the presence of a learning curve. This learning curve appears to be acceptable and a reproducible optimal implant positioning can be achieved quickly. [ABSTRACT FROM AUTHOR]

Osteochondral transplantation is a successful treatment for full-thickness cartilage defects, which without treatment would lead to early osteoarthritis. Restoration of surface congruency and stability of the reconstruction may be jeopardized by early mobilization. To investigate the biomechanical effectiveness of osteochondral transplantation, we performed a standardized osteochondral transplantation in eight intact human cadaver knees, using three cylindrical plugs on a full-thickness cartilage defect, bottomed on one condyle, unbottomed on the contralateral condyle. Surface pressure measurements with Tekscan pressure transducers were performed after five conditions. In the presence of a defect the border contact pressure of the articular cartilage defect significantly increased to 192% as compared to the initially intact joint surface. This was partially restored with osteochondral transplantation (mosaicplasty), as the rim stress subsequently decreased to 135% of the preoperative value. Following weight bearing motion two out of eight unbottomed mosaicplasties showed subsidence of the plugs according to Tekscan measurements. This study demonstrates that a three-plug mosaicplasty is effective in restoring the increased border contact pressure of a cartilage defect, which may postpone the development of early osteoarthritis. Unbottomed mosaicplasties may be more susceptible for subsidence below flush level after (unintended) weight bearing motion. [ABSTRACT FROM AUTHOR]

Introduction. Autologous osteochondral transplantation is a popular treatment for articular cartilage lesions in the knee joint. The donor defect is commonly left empty and remains a matter of concern. Materials and methods. In 20 knees of 10 goats, we created a standardised donor defect in the knee. In the control group the defects were left empty, whereas in two other groups a bone plug from the proximal tibia was press-fitted into the defect with or without a covering periosteal layer. Results. Histological evaluation after 8 and 16 weeks showed that relatively rapid osteoclastic resorption of the bone plug occurred. Defects were mainly filled with fibrous tissue, and collapse of the adjacent bone and cartilage was visible, especially when the defects were left empty. Occasionally, some consolidation of the graft to the host bone could be detected, and in some samples periosteal chondrogenesis was present. Conclusion. Our findings suggest that transplantation of a tibial bone plug with covering periosteum to the donor defect in a cartilage transplantation procedure does not have any additional value in an attempt to minimise the damage at the donor site. The observed resorption of the bone plug and the collapse of the adjacent joint margin remain a matter of concern with this technique. [ABSTRACT FROM AUTHOR]

The theory post-colonial structure his gaze based on the culture of post-colonial societies, but also turns to the symbolic effects that cause these cultures in displaced communities (colonies) in the historical-cultural exchange process. Based on critical theory and drawing on contemporary authors: Pierre Bourdieu (2005), Clifford Geertz (1997), Stuart Hall (2006), among others, the article proposes an interpretation in relation to the work, "Nos han dado la tierra , "published in 1953 by the Mexican writer Juan Rulfo. The central focus of the study is to discuss the relationship of power that there is, from dominant to dominated, and the effects caused by this system of knowledge acquisition.

Osteochondritis dissecans of the hip is a rare condition with limited treatment options. For patients who have undergone arthroscopic microfracture and chondroplasty, long-term results showing clinical improvement are scarce. Although open osteochondral grafting is a demanding and invasive procedure, promising results are reported after short-term follow-up. We present a technique for an arthroscopic autologous osteochondral transplantation with a graft from the ipsilateral knee to the femoral head.