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The REGAIN (Regional versus General Anesthesia for Promoting Independence after Hip Fracture) trial found similar ambulation and survival at 60 days with spinal versus general anesthesia for hip fracture surgery. Trial outcomes evaluating pain, prescription analgesic use, and patient satisfaction have not yet been reported.To compare pain, analgesic use, and satisfaction after hip fracture surgery with spinal versus general anesthesia.Preplanned secondary analysis of a pragmatic randomized trial. (ClinicalTrials.gov: NCT02507505).46 U.S. and Canadian hospitals.Patients aged 50 years or older undergoing hip fracture surgery.Spinal or general anesthesia.Pain on postoperative days 1 through 3; 60-, 180-, and 365-day pain and prescription analgesic use; and satisfaction with care.A total of 1600 patients were enrolled. The average age was 78 years, and 77% were women. A total of 73.5% (1050 of 1428) of patients reported severe pain during the first 24 hours after surgery. Worst pain over the first 24 hours after surgery was greater with spinal anesthesia (rated from 0 [no pain] to 10 [worst pain imaginable]; mean difference, 0.40 [95% CI, 0.12 to 0.68]). Pain did not differ across groups at other time points. Prescription analgesic use at 60 days occurred in 25% (141 of 563) and 18.8% (108 of 574) of patients assigned to spinal and general anesthesia, respectively (relative risk, 1.33 [CI, 1.06 to 1.65]). Satisfaction was similar across groups.Missing outcome data and multiple outcomes assessed.Severe pain is common after hip fracture. Spinal anesthesia was associated with more pain in the first 24 hours after surgery and more prescription analgesic use at 60 days compared with general anesthesia.Patient-Centered Outcomes Research Institute

Evidence suggests that where people live, learn, work, and play affects a range of health outcomes for children and adults. Differential access to social, economic, and environmental supports puts some community members at greater risk, leading to disparities in health and well-being. The 2014 release of the For the Sake of All report highlighted persistent health disparities for African Americans in St. Louis, Missouri, and their social and economic impacts on the St. Louis region. This study extends this work by developing partnerships with community organizations and neighborhood residents to address health disparities. Community-based participatory research (CBPR) methods were utilized to engage partners in a 10-month research process to address community concerns that impact health. Seven community residents, neighborhood researchers, engaged in workshops to learn about the research process and used techniques to gather information to implement action strategies. Neighborhood researchers selected 14 vacant lots to implement their action plan, which included visions for repurposing the land into a community park, produced a report for dissemination, and organized a community action forum to communicate their findings. This study highlights a promising approach to promote healthy communities and health equity by empowering neighborhood residents using participatory methodologies.

Summary Engaging patients—defined broadly as individuals with lived experience of a given condition, family members, caregivers, and the organisations that represent them—as partners in research is a priority for policymakers, funders, and the public. Nonetheless, formal efforts to engage patients are absent from most studies, and models to support meaningful patient engagement in clinical anaesthesia research have not been previously described. Here, we review our experience in developing and implementing a multifaceted patient engagement strategy within the Regional Versus General Anesthesia for Promoting Independence After Hip Fracture (REGAIN) surgery trial, an ongoing randomised trial comparing spinal vs general anaesthesia for hip fracture surgery in 1600 older adults across 45 hospitals in the USA and Canada. This strategy engaged patients and their representatives at both the level of overall trial oversight and at the level of individual recruiting sites. Activities spanned a continuum ranging from events designed to elicit patients' input on key decisions to longitudinal collaborations that empowered patients to actively participate in decision-making related to trial design and management. Engagement activities were highly acceptable to participants and led to concrete changes in the design and conduct of the REGAIN trial. The REGAIN experience offers a model for future efforts to engage patients as partners in clinical anaesthesia research, and highlights potential opportunities for investigators to increase the relevance of anaesthesia studies by incorporating patient voices and perspectives into the research process.

The white-flowered variant of the Early Dog-violet hasn’t been validly published under the specific epithet Viola reichenbachiana. We name it here as Viola reichenbachiana Jord. ex Boreau var. leucantha (Beck) M.S. Porter, M.J.Y. Foley & L. Lewis.

The significant role of hydrogen-bonding (H ) interactions in the formation and/or stabilization of liquid crystalline phases have been recognized in recent years and excellent work has been conducted. Following the first and well-established examples of nanomaterials and graphene dispersed liquid crystal (NDLC/GDLC) matrix formation through the dimerization of aromatic carboxylic acids. ZnO-nanowires/graphene dispersed with liquid crystal composites based on H-bonding were explored using a model system. Several classes of hybrid compounds have been prepared by the interaction of complementary molecules, the liquid crystalline behavior of which is crucially dependent on the structure of the resulting supramolecular systems. We present the nanosecond electro-optic response of liquid crystal (LC) in the nematic and isotropic phases. The results demonstrate that in the isotropic phase and both are dielectrically positive and negative liquid crystal belongs to a larger field induced birefringence than in the nematic phase. This also leads to the formation of supramolecular complexes that may exhibit thermotropic liquid crystalline character. Depending on the nature, number and position of the groups able to form hydrogen bonds (H-), a diversity of supramolecular structures, both dimeric and polymeric, have been obtained, affording in turn various liquid crystalline phases. Smart LC cells with electrodes made of graphene, attributes an excellent performance with a high contrast ratio. The feature article investigates the advantages of graphene compared to conventional use metal oxides in terms of low resistivity, high transparency, and chemical stability. Observed various textural phases due to nanostructures and stability of these HBLC hybrid complexes, may have benefits for the ultrafast novel electro-optic applications in smart switchable device modulation, optoelectronic and optical shutters those brand new features well established.

A facile solvo-thermal route is employed in the synthesis of Graphene/ZnO-nanocomposite. Analysis of Graphene/ZnO-nanocomposite synthesized and performed using spectroscopes and electron microscopic in various investigations like: X-ray diffraction (XRD), FTIR, FT-Raman spectroscopy, Scanning electron microscope (SEM), Transmission electron microscope (SEM), Atomic Force Microscopy (AFM), dielectric contacts and loss investigations. Crystalline structure was examined by XRD patterns, while the morphology was investigated was carried out using typical electron microscopic investigations of FE-SEM and HR-TEM equipped with Electron Dispersion Spectroscopy (EDS) analogous to the detection of chemical elements in hybrid composite. The thickness of thin film and surface topography were confirmed by AFM. The UV–visible absorption spectroscopy, while calculating optical band gap energy (E g ) of Graphene/ZnO-nanocomposite was found to be 3.15 eV. The photoluminescence spectrum was also used to determine the optical properties. Hence, the FTIR and Raman spectrum was used in identifying the functional groups. At various frequencies and at an ambient condition of temperatures, the dielectric studies like: dielectric constant, dielectric loss and AC conductivity properties were investigated. We reported the smartest applied methodologies for the designing of ZnO nanostructures homogeneous dispersion with graphene for this hybrid nanocomposite. A range of remarkable characteristics is then presented, organized into sections describing the optical switching of phase transition with temperature. In this article, we provide an overview idea of the most recent progresses in Graphene/ZnO-nanocomposite doping-induced to control the novel switching operation for the first time. This optimization puts the Graphene/ZnO hybrid structure of the high impact level applications in nanoelectronics and optoelectronics.

Introduction The Safety Pharmacology Society (SPS) and National Centre for the Replacement, Refinement & Reduction of Animals in Research (NC3Rs) conducted a survey and workshop in 2015 to define current industry practices relating to housing of non-rodents during telemetry recordings in safety pharmacology and toxicology studies. The aim was to share experiences, canvas opinion on the study procedures/designs that could be used and explore the barriers to social housing. Methods Thirty-nine sites, either running studies (Sponsors or Contract Research Organisations, CROs) and/or outsourcing work responded to the survey (51% from Europe; 41% from USA). Results During safety pharmacology studies, 84, 67 and 100% of respondents socially house dogs, minipigs and non-human primates (NHPs) respectively on non-recording days. However, on recording days 20, 20 and 33% of respondents socially house the animals, respectively. The main barriers for social housing were limitations in the recording equipment used, study design and animal temperament/activity. During toxicology studies, 94, 100 and 100% of respondents socially house dogs, minipigs and NHPs respectively on non-recording days. However, on recording days 31, 25 and 50% of respondents socially house the animals, respectively. The main barriers for social housing were risk of damage to and limitations in the recording equipment used, food consumption recording and temperament/activity of the animals. Conclusions Although the majority of the industry does not yet socially house animals during telemetry recordings in safety pharmacology and toxicology studies, there is support to implement this refinement. Continued discussions, sharing of best practice and data from companies already socially housing, combined with technology improvements and investments in infrastructure are required to maintain the forward momentum of this refinement across the industry.

Amniotic fluid embolism is a leading cause of maternal mortality in developed countries. Our understanding of risk factors, diagnosis, treatment, and prognosis is hampered by a lack of uniform clinical case definition; neither histologic nor laboratory findings have been identified unique to this condition. Amniotic fluid embolism is often overdiagnosed in critically ill peripartum women, particularly when an element of coagulopathy is involved. Previously proposed case definitions for amniotic fluid embolism are nonspecific, and when viewed through the eyes of individuals with experience in critical care obstetrics, would include women with a number of medical conditions much more common than amniotic fluid embolism. We convened a working group under the auspices of a committee of the Society for Maternal-Fetal Medicine and the Amniotic Fluid Embolism Foundation whose task was to develop uniform diagnostic criteria for the research reporting of amniotic fluid embolism. These criteria rely on the presence of the classic triad of hemodynamic and respiratory compromise accompanied by strictly defined disseminated intravascular coagulopathy. It is anticipated that limiting research reports involving amniotic fluid embolism to women who meet these criteria will enhance the validity of published data and assist in the identification of risk factors, effective treatments, and possibly useful biomarkers for this condition. A registry has been established in conjunction with the Perinatal Research Branch of the Eunice Kennedy Shriver National Institute of Child Health and Human Development to collect both clinical information and laboratory specimens of women with suspected amniotic fluid embolism in the hopes of identifying unique biomarkers of this condition.

Ectopic thyroid is a rare embryogenic anomaly that occurs during its migration from foramen caecum to its pretracheal position. An intracardiac ectopic location is even rarer and found most commonly in the right ventricular outflow tract in sporadic reports. While surgery in symptomatic patients seems appropriate, resection of non-neoplastic ectopic tissue remains a clinical equipoise. Its occurrence is often unsuspected by clinicians, but its possibility should be considered due to its typical location in the right ventricular outflow tract. Unlike true neoplastic intracardiac tumour which mandates surgical resection, both surgical and non-surgical approach may be considered for an intracardiac ectopic thyroid mass.