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Introduction Following the publication of GIRFT guidelines for Total hip replacement operative note documentation produced from analysis of medical negligence claims notified to NHS resolutions by NHS trusts, we reviewed our compliance against the 24 criteria. This was a crucial exercise as inadequate documentation had huge medico-legal consequences and adverse outcome on patient safety. We proposed a pragmatic solution of incorporating prepopulated personalised template into ‘Trackcare' system and providing a dedicated desktop installed in surgeon's room for completion of operative notes. Method We led a team of 4 doctors to review our compliance against 24 criteria laid out by GIRFT. After retrospectively examining 20 operative records from a spread of consultants in the department. A re-audit following incorporation of personalised surgeon templates was conducted to close the loop. Results Our results showed out of 24 criteria; 8 criteria were met with 80-100% compliance while 15 criteria had 90-100% in all 24 criteria. Conclusions A preliminary review of a single surgeon template has shown that it is simple to use, has excellent compliance, quick to complete the operative notes, advocates patient safety, is user-friendly and is very promising in minimising medico-legal claims for surgeons and the Trust.

PURPOSE: To examine the incidence, characteristics and outcomes of posterior capsular rupture (PCR) cases amongst the ophthalmology trainees and to evaluate the trainees’ confidence in managing PCR. METHODS: A two-staged cross-sectional study was carried out between September 2017 and April 2018 in the North East of England, UK. All ophthalmology trainees were surveyed on their confidence level in managing PCR and the characteristics and outcomes of their PCR cases. RESULTS: Fifteen (71.4%) out of 21 trainees completed the study. The mean number of phacoemulsification was 268.9 ± 250.9 cases (range, 0–705) per trainee. There were 82 (1.9%) cases of PCR reported among 4303 phacoemulsification. PCR occurred most commonly during quadrant removal (44.0%) and cortex removal (21.3%). The best-corrected visual acuity (in logMAR) improved significantly from 0.47 ± 0.32 preoperatively to 0.20 ± 0.19 postoperatively (p 500 cases (p = 0.005). Confidence in managing PCR (without supervision) improved from 0% (9/9) at junior level to 50% (3/6) at senior level, and the average number of anterior vitrectomies performed was 0.6 ± 0.9 (range: 0.0–2.0). CONCLUSIONS: We observed a low PCR rate among the trainees in our region, with the majority of cases achieving good visual outcome. A significant reduction in PCR rate was observed at the threshold of >500 cases. There is however a lack of confidence among trainees in managing PCR, highlighting the need for devising new training strategies in this area.

Background Chlamydia is the most commonly reported notifiable sexually transmitted infection in Canada. Rates have been steadily increasing since 1997. Objective To summarize trends in chlamydia rates for the period 2010-2015 in Canada. Methods Laboratory-confirmed cases of chlamydia were reported to the Public Health Agency of Canada by all the Canadian provinces and territories. The overall national rate was computed, as were rates per sex, age group and province/territory. Results In 2015, a total of 116,499 cases of chlamydia were reported in Canada, corresponding to a rate of 325 cases per 100,000 population. Females accounted for the majority (two-thirds) of chlamydia infections from 2010 to 2015. However, rates among males rose faster during this time period. Youth and young adults aged 15-29 years had the highest rates in 2015. While increased rates were observed over time for most age groups, adults aged 40 years and older had the greatest increase (51%) between 2010 and 2015. Chlamydia rates increased in most provinces during this period, with the highest rates being reported by the Northwest Territories and Nunavut in 2015. Conclusion Between 2010 and 2015, chlamydia rates increased by 16.7% and were highest among females and young adults. Although a number of factors may account for this rising trend, the possibility of a true increase in incidence cannot be ruled out. Ongoing monitoring of chlamydia and research into the reasons for the observed changes will help guide sexually transmitted infection (STI) prevention and control activities.

Background Syphilis is the third most commonly reported notifiable sexually transmitted infection (STI) in Canada, following chlamydia and gonorrhea, respectively. Rates of this STI have been rising rapidly in Canada since 2001. Objective To summarize trends observed in syphilis rates for 2010 to 2015 in Canada. Methods Laboratory-confirmed cases of infectious syphilis and early congenital syphilis were reported to the Public Health Agency of Canada by all of the Canadian provinces and territories. National infectious syphilis rates were computed, as were rates per sex, age group and province/territory. Rates of congenital syphilis were also calculated. Results From 2010 to 2015, the rate of infectious syphilis in Canada increased by 85.6%, from 5.0 to 9.3 cases per 100,000 population. In 2015, a total of 3,321 cases of infectious syphilis were reported, mainly in males (93.7%), among whom the rate was 17.5 cases per 100,000 males versus 1.2 per 100,000 females. The rate also rose faster among males in 2010-2015, a 90.2% increase versus 27.8% among females. Individuals aged 20-39 years had the highest rates. Across the provinces and territories, the highest rates of infectious syphilis were in Nunavut, British Columbia and Manitoba.​: The rate of congenital syphilis decreased from 2010 to 2014 (1.6 to 0.3 cases per 100,000 live births) before increasing to 1.5 cases per 100,000 live births in 2015, which corresponds to six reported cases. Conclusion Rates of syphilis continue to rise in Canada, especially among young men, and this is consistent with trends in the United States of America and European Union. Based on data from Canada and from these regions, the sexual behaviour of men who have sex with men (MSM) is thought to be a major risk factor for syphilis.

Background Gonorrhea is the second most commonly reported sexually transmitted infection (STI) in Canada after chlamydia, and rates for this STI have been increasing since 1997. Objective To summarize trends observed in gonorrhea rates for 2010-2015 in Canada. Methods Laboratory-confirmed cases of gonorrhea are reported to the Public Health Agency of Canada (PHAC) by all of the Canadian provinces and territories. The overall national rate was computed, as were rates per sex, age group and province/territory. Results In 2015, 19,845 cases of gonorrhea were reported in Canada, corresponding to a rate of 55.4 cases per 100,000 population and a 65.4% increase from 2010 (33.5 cases per 100,000 population). Males had consistently higher rates than did females (70.2 per 100,000 versus 40.6 per 100,000 in 2015) and faster rising rates (85.2% versus 39.5% in 2010-2015). Rates among adults 60 years and older increased faster than rates among younger people, although the highest rates were among those 15-29 years of age. The Northwest Territories, Nunavut and Yukon had the highest gonorrhea rates in 2015. Conclusion Males, adolescents and young adults continue to represent the majority of gonorrhea cases. Research is needed to better understand the current trends in gonorrhea infection in order to maintain, evaluate and improve primary and secondary STI prevention activities.

Globally, older people have tended to be relatively slow adopters of ICTs. As services and facilities are increasingly delivered online, concerns about the implications for social inclusion and participation have spawned many initiatives aimed at encouraging older peoples' digital engagement. However little attention has been paid to whether and how their usage can be sustained over time. This chapter describes the research undertaken in the Sus-IT project, which sought to address this gap. The aims were to examine older people’s use of information and communication technologies (ICTs), to identify the factors which can prevent or promote sustained use, and to explore solutions to support sustained use. A participatory, mixed methods approach was adopted, and around 1000 older ICT users were involved in the research. The findings show that while many older people are enthusiastic, competent and confident users of ICTs, they also report a range of challenges in reaching and maintaining this position. These include technological complexity and change, age-related capability changes and a lack of appropriate learning and support mechanisms. Intrinsic motivation and social support are important in enabling older people to overcome these challenges. The important implications of the findings for policy and practice are discussed.

While non-contrast head computed tomography is effective in detecting blood, it is not sensitive in diagnosing hyperacute ischemic stroke. One neuroradiologic marker for early thromboembolic occlusion of the distal middle cerebral artery is the middle cerebral artery “dot” sign. The “dot” seen on the typical axial plane represents a hyperdensity of the middle cerebral artery in the Sylvian fissure. A review of medical literature was conducted via PubMed utilizing search phrases “MCA,” “dot,” and “sign.” The review was limited to the intravenous tissue-type plasminogen activator era, 1996 and on. Articles were analyzed to determine the use of the sagittal plane of non-contrast head computed tomography to locate the middle cerebral artery “dot” sign. The search terms yielded 11 results which revealed that computed tomography reconstruction and sagittal planes were not used for detection of the middle cerebral artery “dot” signs. Our patient had no known past medical history. The initial non-contrast head computed tomography was read as having a hypodensity in the right insular region and a middle cerebral artery “dot” sign. Multiplanar reconstruction of the computed tomography demonstrated a hyperdense sagittal string-like appearance of the middle cerebral artery along the Sylvian fissure. Computed tomography angiography confirmed the M2 occlusion. This is the first report of using the head computed tomography sagittal plane for diagnosis of the middle cerebral artery “dot” sign. Incorporating multiplanar reconstruction and producing the sagittal plane may lead to a higher sensitivity of the middle cerebral artery “dot” sign. Further studies incorporating a patient cohort will be needed to determine how much the sagittal plane view augments predictive value of the middle cerebral artery “dot” sign.

Normal.dotm 0 0 1 263 1504 OSU Medical Center 12 3 1847 12.0 0 false 18 pt 18 pt 0 0 false false false /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0pc .45pc 0pc .45pc; mso-para-margin:0pc; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Objective: To determine the efficacy of spirulina supplementation in enhancing isometric muscle strength and endurance in trained and untrained human beings. Design: Placebo controlled, different subject experimental. Setting : University level athletes and college students of Guru Nanak Dev University, Amritsar, India. Subjects: Forty healthy subjects (20 trained and 20 untrained) participated in the study and were divided into 4 groups, supplemented untrained (n=10), placebo untrained (n=10), supplemented trained (n=10), placebo trained (n=10). Subjects in both supplemented groups volunteered to take spirulina for 8 weeks in addition to their normal diet. Subjects in the placebo groups served as control and were given capsules filled with flour. Outcome measures: Peak force, average force and fatigue index of dominant quadriceps muscle were measured before and after 8 weeks of supplementation. Values were compared within and between the groups. Results : The results showed that supplementation with spirulina at the dose studied were effective in increasing peak force (p 0.05) was found between the groups with ANOVA in decreasing fatigue index. Conclusion: Spirulina for 8 weeks is effective in increasing the isometric muscle strength and isometric muscle endurance. Spirulina supplementation with training was found to be better than the spirulina only and training only in increasing muscle strength but no group was found to be better in increasing muscular endurance. Key words : Spirulina - Muscle Strength - Fatigue - Sports Nutrition

In this note, we consider certain structural aspects of estimation and control over relative sensing networks (RSNs). In this venue, using tools from basic algebraic graph theory-namely, the incidence matrix and cut and cycle spaces of a connect graph- we examine transformations among relative sensing topologies for a networked system. These transformations are parameterized for noise-free as well as noisy networks and their utility in the context of network-centric robust control and control reconfigurations is explored.

An important technique for discovering and characterizing planets beyond our solar system relies upon measurement of weak Doppler shifts in the spectra of host stars induced by the influence of orbiting planets. A recent advance has been the introduction of optical frequency combs as frequency references. Frequency combs produce a series of equally spaced reference frequencies and they offer extreme accuracy and spectral grasp that can potentially revolutionize exoplanet detection. Here we demonstrate a laser frequency comb using an alternate comb generation method based on electro-optical modulation, with the comb centre wavelength stabilized to a molecular or atomic reference. In contrast to mode-locked combs, the line spacing is readily resolvable using typical astronomical grating spectrographs. Built using commercial off-the-shelf components, the instrument is relatively simple and reliable. Proof of concept experiments operated at near-infrared wavelengths were carried out at the NASA Infrared Telescope Facility and the Keck-II telescope., Laser frequency combs emit a spectrum of equally spaced peaks that can provide precise frequency references useful for astronomy. Here, the authors demonstrate a frequency comb using electro-optical modulation, which has a line spacing that is resolvable using grating spectrographs unlike the mode-locking approach.

Objective: This article compares trends in CD4 + T-cell recovery and proportions achieving optimal restoration (≥500cells/μl) after viral suppression following combination antiretroviral therapy (cART) initiation between rapid and nonrapid progressors. Methods: We included HIV-1 seroconverters achieving viral suppression within 6 months of cART. Rapid progressors were individuals experiencing at least one CD4 + less than 200cells/μl within 12 months of seroconverters before cART. We used piecewise linear mixed models and logistic regression for optimal restoration. Results: Of 4024 individuals, 294 (7.3%) were classified as rapid progressors. At the same CD4 + T-cell count at cART start (baseline), rapid progressors experienced faster CD4 + T-cell increases than nonrapid progressors in first month [difference (95% confidence interval) in mean increase/month (square root scale): 1.82 (1.61; 2.04)], which reversed to slightly slower increases in months 1-18 [-0.05 (-0.06; -0.03)] and no significant differences in 18-60 months [-0.003 (-0.01; 0.01)]. Percentage achieving optimal restoration was significantly lower for rapid progressors than nonrapid progressors at months 12 (29.2 vs. 62.5%) and 36 (47.1 vs. 72.4%) but not at month 60 (70.4 vs. 71.8%). These differences disappeared after adjusting for baseline CD4 + T-cell count: odds ratio (95% confidence interval) 0.86 (0.61; 1.20), 0.90 (0.38; 2.17) and 1.56 (0.55; 4.46) at months 12, 36 and 60, respectively. Conclusion: Among people on suppressive antiretroviral therapy, rapid progressors experience faster initial increases of CD4 + T-cell counts than nonrapid progressors, but are less likely to achieve optimal restoration during the first 36 months after cART, mainly because of lower CD4 + T-cell counts at cART initiation. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

By developing an appropriate immunization protocol for SCID (hu-PBL-SCID) mice engrafted with human peripheral blood lymphocytes in combination with scFv phage display library, we were able to establish an efficient strategy to obtain human scFv clones against a human self-antigen, TNF-alpha. The mice pretreated with gamma-radiation (3Gy) and anti-asialo GM1 antibody were immunized with a mixture of human TNF-alpha-keyhole limpet hemocyanin and Freund's adjuvant. Human antibody maturation was suggested to be induced in the mice with the immunization protocol. The scFv clones obtained from the mice were shown to exhibit binding affinities in the range of 10(7)-10(8) M(-1). Together with our previously published work on the isolation of respiratory syncytial virus neutralizing scFvs, the results of this study have implicated that this combined approach is one of the effective alternatives for the cloning of human monoclonal antibodies specific for a wide range of antigens of interest.

Outbreaks of shigellosis have been documented in men who have sex with men (MSM), associated with interpersonal transmission and underlying HIV infection. We observed a rise in Shigella flexneri isolates identified in a downtown tertiary-care hospital laboratory located within the city centre community health area (CHA-1) of Vancouver, Canada. The objectives of this study were to evaluate clinical outcomes of shigellosis cases among MSM admitted to hospital and to evaluate trends in Shigella cases within Vancouver, Canada.Adult rates of shigellosis were analysed by gender and health region, from 2005 to 2011, followed by retrospective chart review of all hospital laboratory-identified S. flexneri cases from 2008 to 2012. Serotyping and pulsed-field gel electrophoresis (PFGE) were performed on these isolates.Although shigellosis rates in men within CHA-1 did not change from 2005 to 2011 (range 33.4-68.5 per 100 000; P = 0.74), they were significantly higher than in other regions within the city of Vancouver (P ≤ 0.001) and the province of British Columbia (P ≤ 0.001). Shigella flexneri rates in men within CHA-1 increased significantly (range 2.3-51.4 per 100 000; P 0.001), starting in 2008, and were higher than in other regions within Vancouver (P ≤ 0.01). Seventy-nine isolates of S. flexneri from 72 patients were identified by a single hospital laboratory. All patients were male and predominantly MSM (91.7%) and HIV-infected (86.1%), with most (92.6%) demonstrating CD4 counts ≥ 200 cells/μL. In total, 38.0% required hospitalization. Most (87.3%) had S. flexneri serotype 1 infection, with 72.9% of these representing a single PFGE pattern.We identified high levels of transmission of a primarily clonal strain of S. flexneri serotype 1 in our local MSM population, resulting in a substantial burden of illness and health care resource use secondary to hospital admissions.

Hepatitis C virus (HCV) is an emerging global public health issue with particular relevance in multiply transfused renal dialysis patients. This cross-sectional study evaluated the prevalence and risk factors for HCV infection among renal dialysis patients in northern Alberta, Canada. Ninety-two percent of eligible patients (n = 336) provided informed consent to participate. Participants were interviewed to gather risk factor information and, using multiple logistic regression analysis with exact inference, a predictive model for HCV infection in this population was developed. The prevalence of HCV infection in the population was 6.5%, and all positive patients had at least one identifiable risk factor. The multivariate analysis showed that the risk of HCV infection was greater for those in the 18-55 years age category (odds ratio (OR) = 4.9, 95% confidence interval (CI) 1.2-27.9), patients who had been on dialysis > 5 years (OR = 3.7, 95% CI 1.2-12.0), and patients who had > or = 2 high risk life-style behaviors (OR = 5.0, 95% CI 1.5-16.7). Transfusion prior to 1990 was marginally associated with HCV status (OR = 4.0, 95% CI 0.96-16.3). This study documented previously unreported life-style risk factors for HCV infection in patients with renal failure, confirmed the expected decline in transfusion-acquired HCV infection in this population, and provided evidence against nosocomial transmission of HCV.