Sensory Evaluation of Moringa-Probiotic Yogurt Containing Banana, Sweet Potato or Avocado

This study evaluated the effects of adding selected fruits and vegetables local to Mwanza, Tanzania on the sensory qualities of probiotic yogurt supplemented with Moringa oleifera, a local tree with a high micronutrient and protein content. A total of five samples were evaluated: 1) Probiotic yogurt (control), 2) Moringa probiotic yogurt, 3) Moringa-banana probiotic yogurt, 4) Moringa-sweet potato probiotic yogurt, and 5) Moringa- avocado probiotic yogurt. Consumers (n= 37) rated the five different samples on a 9-point hedonic scale for four sensory characteristics (flavour, appearance, texture and overall quality). The control sample and the Moringa-banana sample had significantly higher ratings (p0.05). Overall, the addition of banana to Moringa probiotic yogurt resulted in a product with comparable sensory qualities to probiotic yogurt alone

Changing Organizational Culture through Gaming

This purpose of this project was to examine the impact of an experiential learning activity on staff nurse perceptions of organizational culture following a low cost gaming simulation, Friday Night at the ER®, at a large academic medical center in the Southeast United States. The key content concepts include discussion of organizational culture and patient care, description of the Friday Night at the ER®, and impact of the game on organizational culture scores and staff perceptions. There is a need for innovative methods that communicate elements (trust, communication) of organizational culture to staff to promote patient safety. Patient care has been negatively affected by communication lapses and poor choices that occur when health care employees are uninformed, have poor handoff processes, or make decisions out of fear. Health care costs continue to rise in the United States without a subsequent increase in quality outcomes. Innovative methods for educating staff are needed to improve communication and team processes in an effort to provide efficient and effective patient care. Forty staff nurses participated in Friday Night at the ER® and recorded their perceptions of organizational culture using a pre- and post-survey design through the Diagnosing Organizational Culture Instrument (DOCI). In the post-game survey participants were also asked to provide demographic data and respond to questions about the impact of the game experience. Post-game scores on the DOCI showed more positive perceptions of organizational culture following the learning activity. However, results were not statistically significant. A Likert survey conducted post-game play revealed that participants strongly recommend the game Friday Night at the ER® for colleagues, felt that it was a useful learning activity, learned new things about their organization, and felt that it helped them to be better prepared to provide high quality care. The board game Friday Night at the ER® is a low cost method that can be used to capitalize on team training and lead to improved organizational culture scores that can potentially translate into increased patient safety.Doctor of Nursing Practic

A manual of previously recorded non-indigenous invasive and native transplanted animal species of the Laurentian Great Lakes and coastal United States

This manual presents geographic information by state of occurrence, and descriptions of the socio-economic impact created by the invasion of non-indigenous and native transplanted animal species in the Laurentian Great Lakes and the coastal waters of the United States. It is not a comprehensive literature review, but rather is intended as a primer for those unfamiliar with the socio-economic impacts of invasive aquatic and marine animals. Readers should also note that the information contained in this manual is current as of its publication date. New information and new species are routinely being added to the wider literature base. Most of the information was gathered from a number of web sites maintained by government agencies, commissions, academic institutions and museums. Additional information was taken from the primary and secondary literature. This manual focuses on socio-economic consequences of invasive species. Thus, ecological impacts, when noted in the literature, are not discussed unless a connection to socio-economic factors can be made. For a majority of the species listed, either the impact of their invasion is not understood, or it is not published in sources surveyed. In the species summaries, sources of information are cited except for information from the U.S. Geological Survey’s (USGS) Nonindigenous Aquatic Species Database http://nas.er.usgs.gov. This website formed the base information used in creating tables on geographic distribution, and in many of the species summaries provided. Thus, whenever information is given without specific author/source and date citation, it has come from this comprehensive source. (PDF contains 90 pages

HIVBrainSeqDB: a database of annotated HIV envelope sequences from brain and other anatomical sites

<p>Abstract</p> <p>Background</p> <p>The population of HIV replicating within a host consists of independently evolving and interacting sub-populations that can be genetically distinct within anatomical compartments. HIV replicating within the brain causes neurocognitive disorders in up to 20-30% of infected individuals and is a viral sanctuary site for the development of drug resistance. The primary determinant of HIV neurotropism is macrophage tropism, which is primarily determined by the viral envelope (<it>env</it>) gene. However, studies of genetic aspects of HIV replicating in the brain are hindered because existing repositories of HIV sequences are not focused on neurotropic virus nor annotated with neurocognitive and neuropathological status. To address this need, we constructed the HIV Brain Sequence Database.</p> <p>Results</p> <p>The HIV Brain Sequence Database is a public database of HIV envelope sequences, directly sequenced from brain and other tissues from the same patients. Sequences are annotated with clinical data including viral load, CD4 count, antiretroviral status, neurocognitive impairment, and neuropathological diagnosis, all curated from the original publication. Tissue source is coded using an anatomical ontology, the Foundational Model of Anatomy, to capture the maximum level of detail available, while maintaining ontological relationships between tissues and their subparts. 44 tissue types are represented within the database, grouped into 4 categories: (i) brain, brainstem, and spinal cord; (ii) meninges, choroid plexus, and CSF; (iii) blood and lymphoid; and (iv) other (bone marrow, colon, lung, liver, etc). Patient coding is correlated across studies, allowing sequences from the same patient to be grouped to increase statistical power. Using Cytoscape, we visualized relationships between studies, patients and sequences, illustrating interconnections between studies and the varying depth of sequencing, patient number, and tissue representation across studies. Currently, the database contains 2517 envelope sequences from 90 patients, obtained from 22 published studies. 1272 sequences are from brain; the remaining 1245 are from blood, lymph node, spleen, bone marrow, colon, lung and other non-brain tissues. The database interface utilizes a faceted interface, allowing real-time combination of multiple search parameters to assemble a meta-dataset, which can be downloaded for further analysis.</p> <p>Conclusions</p> <p>This online resource, which is publicly available at <url>http://www.HIVBrainSeqDB.org</url>, will greatly facilitate analysis of the genetic aspects of HIV macrophage tropism, HIV compartmentalization and evolution within the brain and other tissue reservoirs, and the relationship of these findings to HIV-associated neurological disorders and other clinical consequences of HIV infection.</p

More-than-Human Wellbeing: Materialising the Relations, Affects, and Agencies of Health, Kinship, and Care

Introduction The concept of ‘wellbeing’ is typically thought of in human-centric ways, referring to the affective feelings and bodily sensations that people may have which inform their sense of health, safety, and connection. However, as our everyday lives, identities, relationships, and embodiments become digitised and datafied, ‘wellbeing’ has taken on new practices and meanings. The use of digital technologies such as mobile and wearable devices, social media platforms, and networks of information mediate our interactions with others, as well as the ways we conceptualise what it means to be human, including where the body begins and ends. In turn, digital health technologies and ‘wellness’ cultures such as those promoted on social media sites such as Instagram, Pinterest, YouTube, TikTok, and Facebook have also shaped our understanding of ‘wellness’ and ‘wellbeing’, their parameters, and how they ought to be practiced and felt (Baker; Lupton Digital Health; Lupton et al.). For millennia, aspects of human bodies have been documented and materialised in a variety of ways to help people understand states of health and illness: including relationships to the environments in which they lived. Indigenous and other non-Western cosmologies have long emphasised the kinds of vibrancies and distributed agencies that are part of reciprocal more-than-human ‘manifestings’ of kinships, and have called for all people to adopt the role of stewards of the ecosystem (Bawaka Country et al.; Hernández et al.; Kimmerer; Rots; Todd; Tynan). In Western cultures, ideas of the human body that reach back to ancient times adopt a perspective that viewed the continuous flows of forces (the four humours) in conjunction with the elements of air, wind, earth, and fire inside and outside the body as contributing to states of health or ill health. It was believed that good health was maintained by ensuring a balance between these factors, including acknowledgement of the role played by climactic, ecological, and celestial conditions (Hartnell; Lagay). A more-than-human approach is beginning to be re-introduced into Western cultures through political activism and academic thinking about the harms to the planet caused by human actions, including global warming and climate crises, loss of habitats and ecological biodiversity, increased incidence of extreme weather events such as bushfires, floods, and cyclones, and emerging novel pathogens affecting the health not only of humans but of other living things (Lewis; Lupton Covid Societies; Lupton Internet of Animals; Neimanis et al.). Contemporary Western more-than-human philosophers argue for the importance of acknowledging our kinship with other living and non-living things as a way of repositioning ourselves within the cosmos and working towards better health and wellbeing for the planet (Abram; Braidotti; Plumwood). As these approaches emphasise, health, wellbeing, and kinship are always imbricated within material-social assemblages of humans and non-digital things which are constantly changing, and thereby generating emergent rather than fixed capacities (Lupton "Human-Centric"; Lupton et al.). In this article, we describe our More-than-Human Wellbeing exhibition. To date, new media, Internet, and communication studies have not devoted as much attention to more-than-human theory. It is this more-than-digital and more-than-human approach to health information and wellbeing that marks out our research program as particularly distinctive. Our research focusses on the many and varied digital and non-digital forms that information about health and bodies takes. We are interested in health data as they are made and form part of the objects and activities of people’s everyday lives and aim to expand the human-centric approach offered in digital health by positioning human health and embodiment as always imbricated within more-than-human ecosystems. We acknowledge that all environments (natural and human-built) are intertwined with humans, and that to a greater or lesser extent, all are configured with and through the often exploitative and extractive practices and ideologies of those living in late modern societies in which people are positioned as superior to and autonomous from other living things. Together with more-than-human scholarship, we take inspiration from work in which arts-based, multisensory, and museum curation methods are employed to draw attention to the intertwining of people and ecologies (Endt-Jones; Howes). Our exhibition was planned as a research translation and engagement project, communicating several of our studies’ findings in arts-based media (Lupton "Embodying"). In what follows, we outline the concepts leading to the creation of our exhibits and describe how these pieces materialise and extend more-than-human concepts of wellbeing and care. Five of the exhibits we created for this exhibition are discussed. They all draw on our research findings across a range of studies, together with more-than-human theory and medical history (Lupton "More-Than-Human"). We describe how we used these pieces to materialise more-than-human concepts of health, wellbeing, and kinship in ways that we hoped would provoke critical thought, affective responses, and open capacities for action for contributing to both human and nonhuman flourishing. The background, thinking, and modes of making leading to the creation of ‘Cabinet of Human/Digital/Data Curiosities’, ‘Smartphone Fungi’, ‘Hand of Signs’, ‘Silken Anatomies’, and ‘Talking/Flowers’ are explained below. Bodily Curios Vaughan Wozniak-O’Connor and Deborah Lupton. Cabinet of Human/Digital/Data Curiosities. Reclaimed timber, found objects, resin 3D prints. 2023. Fig. 1: Cabinet of Human/Digital/Data Curiosities. Fig. 2: Detail from Cabinet of Human/Digital/Data Curiosities. The objects we have placed in Cabinet of Human/Digital/Data Curiosities (figs. 1 and 2) mix together such things from the past as prosthetic human eyeballs and teeth used in medicine and dentistry in earlier eras. This collection of found and manufactured objects, both old and new, draws on the concept of the ‘cabinet of curiosities’, also known as cabinets of wonder, which first became popular in the sixteenth century. Artefacts were assembled together for viewing in a room or a display case. The items were chosen for being notable in some way by the curator, including objects from natural history, antiquities, and religious relics, as well as works of art. These collections, purchased, curated, and assembled by members of the nobility or the wealthy as a marker of refinement, knowledge, or social status, were the precursor of museums (Endt-Jones). We see digital devices such as mobile phones as one of a multitude of ways that operate to document and preserve elements of human embodiment – indeed, as contemporary ‘cabinets of curiosities’. Our cabinet also refers to the tradition of medical museums, which display preserved human organs, body parts, and tissue in glass bottles for pedagogical purposes. Under this model of health, specimens of both ‘ideal’ health and also ‘ill’ health – abnormalities in the flesh – were documented as a means of categorising wellbeing. Museums such as these would often treat diseased and disabled bodies as oddities and artefacts of ‘curiosity’. In this work, we reimagine and wind back this way of thinking, through displaying and drawing attention and curiosity towards signs of the body and the everyday. We are showing that wellbeing is more than a process of categorisation, comparison, or measurement of ‘ideal’ or ‘abnormal’; it is in the traces we leave behind us when we return to the earth. Our information data are human remains, moving as endless constellations of the interior and exterior of the body (Lupton Data Selves). In this artwork, both reclaimed wood and 3D-printed resin were used as a synergy between the natural and synthetic. Taking our cue from the manner of display of these items in medical museums, we have added our own curios, including 3D-printed body organs sprouting fungi (fig. 2), as a way of demonstrating the entanglements between humans and the fungal kingdom. Interspersed among these relics of human bodies is a discarded mobile phone with its screen badly shattered. It is displayed as a more recent antiquated object for making images and collecting, storing, and displaying information and images about human bodies, which itself is subject to disastrous events despite its original high-tech veneer of glossy impermeability. Technologies are more-than-flesh as human-made simulacra of body parts. Our wellbeing is sensed and made sense of through bodies’ entanglements of human and nonhuman. These curios both materialise traces of our bodies and wellbeing and extend our bodies into the physical spaces we inhabit and through which we move. Reading the Traces and Signs Vaughan Wozniak-O’Connor and Deborah Lupton. Smartphone Fungi. Recycled European oak, 3D printed resin, CNC carved plywood. 2023 Vaughan Wozniak-O’Connor and Deborah Lupton. Hand of Signs. Laser-etched walnut and plywood. 2023. Fig. 3: Smartphone Fungi. / Fig. 4: Detail from Smartphone Fungi. Wellbeing is also a process of mark-making, realised through the reciprocal impressions we leave on each other and the world around us. In Smart Phone Fungi (figs. 3 and 4) we capture the idea of ‘recording’ that takes place between people, technologies, and the natural world. It was inspired by a huge tree which members of our team noticed on a bush walk in the Blue Mountains, near Sydney, Australia. Growing from this tree were fungi of similar size and shape to the smartphone that was used to capture the image. In our interpretation, a piece of reclaimed timber was used to represent the tree, itself marked by its human use, and fungal shapes replicating those on the tree were produced using computer numerical controlled (CNC) carving. The central timber post is covered with human and more-than-human traces, such as old tool marks, weather damage, and wood borer holes. Alongside these traces, the CNC-carved fungi forms add a conspicuously digital layer of human intervention. Fig. 5: Hand of Signs. In Hand of Signs (fig. 5), we extend this idea of both organic and digital data traces as something that can be ‘read’ or interpreted. Inspired by the practice of palmistry, this work re-interprets line reading, the historical wooden anatomical model, and human body scanning as ways of reading for signs of wellbeing in past and future. Palm readers interpret people’s character, health, longevity, and other aspects of their lives through the creases and traces of development, wear, and deteriorations in the skin of our hands (Chinn). Life leaves its traces on our palms. The piece also refers to the newer tradition of digitising human bodies (Lupton Quantified Self; Lupton et al.), employing scanning and data visualising technologies, which uses spatial GPS data to deduce patterns of human activity. For both palmistry and in more contemporary monitoring technologies, one’s wellbeing can be deduced through the map: the lines of the palm and the errant traces collected by satellites and sensors. To reflect this relation between mapping and palmistry, our updated anatomical model references both the contours of 3D geospatial data and of the human palm. However, this piece looks to represent more layers of data beyond those captured by GPS data. By using reclaimed wood to construct this human hand model, we are again making an analogy between the marks of growth and life that timber displays and those that the human body bears and develops as people move through more-than-worlds throughout their lifespans. The piece also seeks to draw attention to the various ‘signs’ that have been used across centuries to interpret the current and future health and wellbeing of humans (once markings on or morphologies of the body, now often the digitised visualisations of the internal operations and physical movements of the body that are generated by digital health technologies), superimposing older and newer modes of corporeal knowledge. Layers of Mediation Megan Rose. Silken Anatomies. Digital print on satin and yoryu silk chiffon. 2023. Ash Watson. Talking/Flowers. Collage and digital inkjet on paper. 2023. Fig. 6: Detail from Silken Anatomies. The ways that we come to sense and understand wellbeing are also mediated through the reproductive interplay of natural and technological elements. Silken Anatomies (fig. 6) was inspired by anatomical prints from the Renaissance showing details of the interiors of human bodies and organs together with living things and objects from the natural world. These webs of interconnectivity were thought to be key to wellbeing and health. Produced at scale through metal engraving and woodblock printing, these natural history and compendia took on major importance as part of these educational resources (Kemp; Swan). In an effort to extend the reach of artefacts beyond their tangible presence, libraries globally have sought to create open access digital scans of historic medical and botanical illustrations. The images reconfigured in Silken Anatomies were downloaded from the Wellcome Trust’s online archive and have been reimagined through digital enhancement and sublimation dye techniques. Referencing shrouds, the yoryu silk panels enfold exhibition visitors, who were able to touch and pass through the silks, causing them to billow in response to human movement. We bring together an animal-made material (crafted by silkworms) with more-than-human images featuring both humans and other living creatures. The vibrancies of these beautifully engraved and coloured anatomical images are given a new life and a new feel, both affectively and sensuously, through this piece. We can both see and touch these more-than-human illustrations that speak to us of the early modern natural science visualisations that underpin contemporary digital images of the human body and the more-than-human world. The vibrancies of these beautifully engraved and coloured anatomical plates are given a new life and a new feel, both affectively and sensuously. The digital is returned to the tangible. Fig. 7: Detail from Talking/Flowers. Even in increasingly digitised healthcare environments, paper and other printed materials remain central documents in the landscape of health and wellbeing. Zines are small-scale, DIY, and typically handcrafted publications, which are often made to express creators’ thoughts and feelings about health and wellbeing (Lupton "Health Zines"; Watson and Bennett). Talking/Flowers (fig. 7), a zine of visual and textual work, explores the materialities of health information and healthcare encounters by creatively layering a diverse range of materials: clippings from MRI scans, digitally warped and recoloured images from medical infographics, and found poetry made from research publications. In this way, the zine remixes and reconstitutes key documents of authority in health institutions which continue to take primacy as evidence. While vital in the pipeline of diagnosis and treatment, such documents can become black boxes of meaning, and serve to distance health professionals from consumers and consumers from agentic understandings of their own health. These evidentiary materials are brought together here with other imagery, textures, and recollections of personal experience; the pages also feature leaves, flowers, fungi, and oceanic tones. Oceans, pools, rivers, lakes, and other coastal forms or waterways offer all-consuming sensory spaces in which people can find calm, balance, buoyancy, and connection with the wider world. Aqua tides, purple eddies, and misshapen pearls flow through the pages as the golden thread of the zine’s aesthetic theme. Also featured are three original poems. The first and third poems, ‘talking to a doctor’ and ‘talking to other people’, explore moments of relational vulnerability. The second poem, ‘untitled’, is a found poem made from the conclusions of sociologist Talcott Parsons’s 1975 article on the sick role reconsidered. In each of these poems, information and communication jar the encounters and more-than-human metaphors hold space for complex feelings. The cover similarly merges imagery from botanical and historical medical illustrations with a silver shell, evoking the morphological dimensions that connect the more-than-human. Exhibition visitors were able to turn the pages of the original copy of the zine, and were invited to take a printed copy away with them. Conclusion More-than-Human Wellbeing is an exhibition which aims to expand the horizons of how we understand wellbeing and our entanglements with the world. Our exhibition was designed to draw on our research into the more-than-human dimensions of health and wellbeing in the context of an increasingly digitised and datafied world. We wanted to attune visitors to the relational connections and multisensory ways of knowing that develop with and through people’s encounters and entanglements with creatures, things, and spaces. We sought to demonstrate that in this digital age, in which digital devices and software are often considered the most accurate and insightful ways to monitor and measure health and wellbeing, multisensory and affective engagements with elements of the natural environment remain crucial to understanding our bodies and health. Through engagements with our artworks, we hoped that new capacities for visitors’ learning and thinking about the relational and distributed dimensions of more-than-human wellbeing would be opened. While traditionally thought of as human-centered, we explore human health and wellbeing as interconnected with both the natural and technological. We used materials from the natural world – timber, paper materials, and silk fabric – in our artworks to capture both the multigenerational traces and entanglements between humans and plant matter. Recent works of natural and cultural history have drawn attention to the mysterious and important worlds of the fungi kingdom and its role in supporting and living symbiotically with other life on earth, including humans as well as plants (Sheldrake; Tsing). We also made sure to acknowledge this third kingdom of living things in our artworks. We combined these images and materials from nature with digitised modes of printing and fabrication to highlight the intersections of the digital with the non-digital in representations and sensory feelings of health and wellbeing. We disrupt and make strange signs of traditional human-centric medicine through reconfigurations, bricolage, and re-imaginations of more-than-human wellbeing. As humans we are interconnected with the natural world, and the signs of these meetings can be traced and read. Through our artistic creations, we hope to re-orient people towards this more open way of thinking about wellbeing. Working with arts practices and creative data visualisations, both digital and analogue, we bring to the fore the role that more-than-human agents play in mediating and making these convivial more-than-digital connections. Acknowledgments This research was funded by the ARC Centre of Excellence for Automated Decision-Making and Society (CE200100005) and a Faculty of Arts, Design &amp; Architecture collaboration grant. UNSW Library provided financial and curatorial support for the mounting of the exhibition. References Abram, David. "Wild Ethics and Participatory Science: Thinking between the Body and the Breathing Earth." Planet. Volume 1. Kinship: Belonging in a World of Relations. Eds. Gavin van Horn et al. Center for Humans &amp; Nature Press, 2021. 50-62. Baker, Stephanie Alice. Wellness Culture: How the Wellness Movement Has Been Used to Empower, Profit and Misinform. Emerald Group, 2022. Bawaka Country, et al. "Working with and Learning from Country: Decentring Human Author-Ity." cultural geographies 22.2 (2015): 269-283. DOI: 10.1177/1474474014539248. Braidotti, Rosi. "'We' Are in This Together, But We Are Not One and the Same." Journal of Bioethical Inquiry 17 (2020): 465-469. DOI: 10.1007/s11673-020-10017-8. Chinn, Sarah E. Technology and the Logic of American Racism: A Cultural History of the Body as Evidence. Continuum, 2000. Endt-Jones, Marion. "Cultivating ‘Response-Ability’: Curating Coral in Recent Exhibitions." Journal of Curatorial Studies 9 (2020): 182-205. DOI: 10.1386/jcs_00020_1. Hartnell, Jack. Medieval Bodies: Life, Death and Art in the Middle Ages. Profile Books, 2018. Hernández, K.J., et al. "The Creatures Collective: Manifestings." Environment and Planning E: Nature and Space 4.3 (2020): 838-863. DOI: 10.1177/2514848620938316. Howes, David. "Introduction to Sensory Museology." The Senses and Society 9.3 (2014): 259-267. DOI: 10.2752/174589314X14023847039917. Kemp, Martin. "Style and Non-Style in Anatomical Illustration: From Renaissance Humanism to Henry Gray." Journal of Anatomy 216.2 (2010): 192-208. DOI: 10.1111/j.1469-7580.2009.01181.x. Kimmerer, Robin. "Restoration and Reciprocity: The Contributions of Traditional Ecological Knowledge." Human Dimensions of Ecological Restoration: Integrating Science, Nature, and Culture. Eds. Dave Egan et al. Springer, 2011. 257-276. Lagay, Faith. "The Legacy of Humoral Medicine." AMA Journal of Ethics 4.7 (2002): 206-208. Lewis, Bradley. "Planetary Health Humanities—Responding to Covid Times." Journal of Medical Humanities 42.1 (2021): 3-16. DOI: 10.1007/s10912-020-09670-2. Lupton, Deborah. Covid Societies: Theorising the Coronavirus Crisis. Routledge, 2022. ———. Data Selves: More-than-Human Perspectives. Polity Press, 2019. ———. Digital Health: Critical and Cross-Disciplinary Perspectives. Routledge,

Trunnion Corrosion Causing Failure in Metal-on-Polyethylene Total Hip Arthroplasty with Monolithic Femoral Components

We describe nine patients who had total hip arthroplasty failure [titanium alloy monolithic stem, cobalt-chromium head (32 mm or 36 mm), highly cross-linked polyethylene liner, metal socket] related to metal wear debris generated at the trunnion. Symptoms included pain with onset 2.9 years after THA. Preoperative serum cobalt metal ion levels were elevated [mean 8.8 ng/ml (normal < 0.9 ng/ml)] and were higher than chromium levels [mean 1.2 ng/ml (normal < 0.3 ng/ml)]. All patients had debridement of the periarticular soft tissues, stem retention, revision to ceramic head and new liner; two patients had acetabular revision. At early follow-up, 7 of 8 available patients did well, with improved cobalt (0.6 ng/ml) and little change in chromium levels. We recommend heightened awareness regarding this mode of failure

Operative and Radiographic Acetabular Component Orientation in Total Hip Replacement: Influence of Pelvic Orientation and Surgical Positioning Technique

Orthopaedic surgeons often experience a mismatch between perceived intra-operative and radiographic acetabular cup orientation. This research aimed to assess the impact of pelvic orientation and surgical positioning technique on operative and radiographic cup orientation. Radiographic orientations for two surgical approaches were computationally simulated: a mechanical alignment guide and a transverse acetabular ligament approach, both in combination with different pelvic orientations. Positional errors were defined as the difference between the target radiographic orientation and that achieved. The transverse acetabular ligament method demonstrated smaller positional errors for radiographic version; 4.0° ± 2.9° as compared to 9.4° ± 7.3° for the mechanical alignment guide method. However, both methods resulted in similar errors in radiographic inclination. Multiple regression analysis showed that intraoperative pelvic rotation about the anterior-posterior axis was a strong predictor for these errors (B TAL = −0.893, B MAG = −0.951, p &lt; 0.01). Application of the transverse acetabular ligament method can reduce errors in radiographic version. However, if the orthopaedic surgeon is referencing off the theatre floor to control inclination when operating in lateral decubitus, this is only reliable if the pelvic sagittal plane is horizontal. There is currently no readily available method for ensuring that this is the case during total hip replacement surgery. </p

Descriptive Analysis of a Baseline Concussion Battery Among U.S. Service Academy Members: Results from the Concussion Assessment, Research, and Education (CARE) Consortium

Introduction The prevalence and possible long-term consequences of concussion remain an increasing concern to the U.S. military, particularly as it pertains to maintaining a medically ready force. Baseline testing is being used both in the civilian and military domains to assess concussion injury and recovery. Accurate interpretation of these baseline assessments requires one to consider other influencing factors not related to concussion. To date, there is limited understanding, especially within the military, of what factors influence normative test performance. Given the significant physical and mental demands placed on service academy members (SAM), and their relatively high risk for concussion, it is important to describe demographics and normative profile of SAMs. Furthermore, the absence of available baseline normative data on female and non-varsity SAMs makes interpretation of post-injury assessments challenging. Understanding how individuals perform at baseline, given their unique individual characteristics (e.g., concussion history, sex, competition level), will inform post-concussion assessment and management. Thus, the primary aim of this manuscript is to characterize the SAM population and determine normative values on a concussion baseline testing battery. Materials and Methods All data were collected as part of the Concussion Assessment, Research and Education (CARE) Consortium. The baseline test battery included a post-concussion symptom checklist (Sport Concussion Assessment Tool (SCAT), psychological health screening inventory (Brief Symptom Inventory (BSI-18) and neurocognitive evaluation (ImPACT), Balance Error Scoring System (BESS), and Standardized Assessment of Concussion (SAC). Linear regression models were used to examine differences across sexes, competition levels, and varsity contact levels while controlling for academy, freshman status, race, and previous concussion. Zero inflated negative binomial models estimated symptom scores due to the high frequency of zero scores. Results Significant, but small, sex effects were observed on the ImPACT visual memory task. While, females performed worse than males (p < 0.0001, pη2 = 0.01), these differences were small and not larger than the effects of the covariates. A similar pattern was observed for competition level on the SAC. There was a small, but significant difference across competition level. SAMs participating in varsity athletics did significantly worse on the SAC compared to SAMs participating in club or intramural athletics (all p’s < 0.001, η2 = 0.01). When examining symptom reporting, males were more than two times as likely to report zero symptoms on the SCAT or BSI-18. Intramural SAMs had the highest number of symptoms and severity compared to varsity SAMs (p < 0.0001, Cohen’s d < 0.2). Contact level was not associated with SCAT or BSI-18 symptoms among varsity SAMs. Notably, the significant differences across competition level on SCAT and BSI-18 were sub-clinical and had small effect sizes. Conclusion The current analyses provide the first baseline concussion battery normative data among SAMs. While statistically significant differences may be observed on baseline tests, the effect sizes for competition and contact levels are very small, indicating that differences are likely not clinically meaningful at baseline. Identifying baseline differences and significant covariates is important for future concussion-related analyses to inform concussion evaluations for all athlete levels

Cognitive predictors of social and occupational functioning in early psychosis : a systematic review and meta-analysis of cross-sectional and longitudinal data

Many individuals with early psychosis experience impairments in social and occupational function. Identification of modifiable predictors of function such as cognitive performance has the potential to inform effective treatments. Our aim was to estimate the strength of the relationship between psychosocial function in early psychosis and different domains of cognitive and social cognitive performance. We conducted a systematic review and meta-analysis of peer-reviewed, cross-sectional, and longitudinal studies examining cognitive predictors of psychosocial function. Literature searches were conducted in PsycINFO, PubMed, and reference lists of relevant articles to identify studies for inclusion. Of the 2565 identified, 46 studies comprising 3767 participants met inclusion criteria. Separate meta-analyses were conducted for 9 cognitive domains. Pearson correlation values between cognitive variables and function were extracted. All cognitive domains were related to psychosocial function both cross-sectionally and longitudinally. Importantly, these associations remained significant even after the effects of symptom severity, duration of untreated psychosis, and length of illness were accounted for. Overall, general cognitive ability and social cognition were most strongly associated with both concurrent and long-term function. Associations demonstrated medium effect sizes. These findings suggest that treatments targeting cognitive deficits, in particular those focusing on social cognition, are likely to be important for improving functional outcomes in early psychosis. [Abstract copyright: © The Author(s) 2021. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.All rights reserved. For permissions, please email: [email protected].

Implementation interventions to promote the uptake of evidence-based practices in stroke rehabilitation (Review)

Background Rehabilitation based upon research evidence gives stroke survivors the best chance of recovery. There is substantial research to guide practice in stroke rehabilitation, yet uptake of evidence by healthcare professionals is typically slow and patients often do not receive evidence‐based care. Implementation interventions are an important means to translate knowledge from research to practice and thus optimise the care and outcomes for stroke survivors. A synthesis of research evidence is required to guide the selection and use of implementation interventions in stroke rehabilitation. Objectives To assess the effects of implementation interventions to promote the uptake of evidence‐based practices (including clinical assessments and treatments recommended in evidence‐based guidelines) in stroke rehabilitation and to assess the effects of implementation interventions tailored to address identified barriers to change compared to non‐tailored interventions in stroke rehabilitation. Search methods We searched CENTRAL, MEDLINE, Embase, and eight other databases to 17 October 2019. We searched OpenGrey, performed citation tracking and reference checking for included studies and contacted authors of included studies to obtain further information and identify potentially relevant studies. Selection criteria We included individual and cluster randomised trials, non‐randomised trials, interrupted time series studies and controlled before‐after studies comparing an implementation intervention to no intervention or to another implementation approach in stroke rehabilitation. Participants were qualified healthcare professionals working in stroke rehabilitation and the patients they cared for. Studies were considered for inclusion regardless of date, language or publication status. Main outcomes were healthcare professional adherence to recommended treatment, patient adherence to recommended treatment, patient health status and well‐being, healthcare professional intention and satisfaction, resource use outcomes and adverse effects. Data collection and analysis Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. The primary comparison was any implementation intervention compared to no intervention. Main results Nine cluster randomised trials (12,428 patient participants) and three ongoing trials met our selection criteria. Five trials (8865 participants) compared an implementation intervention to no intervention, three trials (3150 participants) compared one implementation intervention to another implementation intervention, and one three‐arm trial (413 participants) compared two different implementation interventions to no intervention. Eight trials investigated multifaceted interventions; educational meetings and educational materials were the most common components. Six trials described tailoring the intervention content to identified barriers to change. Two trials focused on evidence‐based stroke rehabilitation in the acute setting, four focused on the subacute inpatient setting and three trials focused on stroke rehabilitation in the community setting. We are uncertain if implementation interventions improve healthcare professional adherence to evidence‐based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence was very low (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.53 to 2.64; 2 trials, 39 clusters, 1455 patient participants; I2 = 0%). Low‐certainty evidence indicates implementation interventions in stroke rehabilitation may lead to little or no difference in patient adherence to recommended treatment (number of recommended performed outdoor journeys adjusted mean difference (MD) 0.5, 95% CI –1.8 to 2.8; 1 trial, 21 clusters, 100 participants) and patient psychological well‐being (standardised mean difference (SMD) –0.02, 95% CI –0.54 to 0.50; 2 trials, 65 clusters, 1273 participants; I2 = 0%) compared with no intervention. Moderate‐certainty evidence indicates implementation interventions in stroke rehabilitation probably lead to little or no difference in patient health‐related quality of life (MD 0.01, 95% CI –0.02 to 0.05; 2 trials, 65 clusters, 1242 participants; I2 = 0%) and activities of daily living (MD 0.29, 95% CI –0.16 to 0.73; 2 trials, 65 clusters, 1272 participants; I2 = 0%) compared with no intervention. No studies reported the effects of implementation interventions in stroke rehabilitation on healthcare professional intention to change behaviour or satisfaction. Five studies reported economic outcomes, with one study reporting cost‐effectiveness of the implementation intervention. However, this was assessed at high risk of bias. The other four studies did not demonstrate the cost‐effectiveness of interventions. Tailoring interventions to identified barriers did not alter results. We are uncertain of the effect of one implementation intervention versus another given the limited very low‐certainty evidence. Authors' conclusions We are uncertain if implementation interventions improve healthcare professional adherence to evidence‐based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence is very low