Assessment of chronic postsurgical pain after knee replacement : a systematic review

Objective: Approximately 20% of patients experience chronic pain after total knee replacement (TKR), yet there is no consensus about how best to assess such pain. This systematic review aimed to identify measures used to characterise chronic pain after TKR. Methods: MEDLINE, Embase, PsycINFO, Cochrane Library and CINAHL databases were searched for research articles published in all languages from January 2002- November 2011. Articles were eligible for inclusion if they assessed knee pain at a minimum of 3-months after TKR, yielding a total of 1,164 articles. Data extracted included study design, country, timings of assessments, and outcome measures containing pain items. Outcome measures were compared with domains recommended by IMMPACT for inclusion in assessment of chronic pain related outcomes within clinical trials. Temporal trends were also explored. Results: The review found use of a wide variety of composite and single-item measures, with the American Knee Society Score most common. Many measures used in published studies do not capture the multi-dimensional nature of pain recommended by IMMPACT; of those commonly used, the WOMAC and Oxford Knee Score are most comprehensive. Geographical trends were evident, with nation-specific preferences for particular measures. A recent reduction in use of some clinically-administered tools was accompanied by increased use of patient-reported outcome measures. Conclusion: There was wide variation in methods of pain assessment alongside nation-specific preferences and changing temporal trends in pain assessment after TKR. Standardisation and improvements in assessment is needed to enhance the quality of research and facilitate the establishment of a core outcome set

Reliability and sensitivity to change of the bristol rheumatoid arthritis fatigue scales

Objective. To examine the reliability (stability) and sensitivity of the Bristol Rheumatoid Arthritis Fatigue scales (BRAFs) and patient-reported outcome measures (PROMs) developed to capture the fatigue experience. The Multi-Dimensional Questionnaire (BRAF-MDQ) has a global score and four subscales (Physical Fatigue, Living with Fatigue, Cognitive Fatigue and Emotional Fatigue), while three numerical rating scales (BRAF-NRS) measure fatigue Severity, Effect and Coping. Methods. RA patients completed the BRAFs plus comparator PROMs. Reliability (study 1): 50 patients completed questionnaires twice. A same-day test-retest interval (minimum 60 min) ensured both time points related to the same 7 days, minimizing the capture of fatigue fluctuations. Reliability (study 2): 50 patients completed the same procedure with a re-worded BRAF-NRS Coping. Sensitivity to change (study 3): 42 patients being given clinically a single high dose of i.m. glucocorticoids completed questionnaires at weeks 0 and 2.Results. The BRAF-MDQ, its subscales and the BRAF-NRS showed very strong reliability (r = 0.82-0.95). BRAF-NRS Coping had lower moderate reliability in both wording formats (r = 0.62, 0.60). The BRAF-MDQ, its subscales and the BRAF-NRS Severity and Effect were sensitive to change, with effect sizes (ESs) of 0.33-0.56. As hypothesized, the BRF-NRS Coping was not responsive to the pharmaceutical intervention (ES 0.05). Preliminary exploration suggests a minimum clinically important difference of 17.5% for improvement and 6.1% for fatigue worsening. Conclusion. The BRAF scales show good reliability and sensitivity to change. The lack of BRAF-NRS Coping responsiveness to medication supports the theory that coping with fatigue is a concept distinct from severity and effect that is worth measuring separately. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved

Seabees: CBMU 635

In this book of words and pictures is a compilation of the work, accomplishments, and activities of the Twenty-Sixth United States Naval Construction Battalion (Second Section) which on July 15, 1945, was redesignated Construction Battalion Maintenance Unit Six Hundred Thirty-Five. It is dedicated to each officer and man who gave his\u27 best for the one and only cause, and each can be justly proud of the part he played. The Staff wishes to extend its appreciation to each and every member of this Battalion who helped in procuring and compiling the necessary information, for without your moral support. interest. and actual aid this book would have been impossible. We sincerely hope that in years to come you will refer to this book often in remembrance of the part you and your comrades played in the achievement of the final victory.https://digicom.bpl.lib.me.us/ww_reg_his/1044/thumbnail.jp

Incorporation of silica into baroplastic core-shell nanoparticles

Thesis (S.B.)--Massachusetts Institute of Technology, Dept. of Materials Science and Engineering, 2006.Includes bibliographical references (p. 31-33).Core-shell baroplastics are nanophase materials that exhibit pressure-induced flow at low temperatures and high pressures. Core-shell baroplastics used in this work are comprised of a low Tg poly(butyl acrylate) (PBA) core and a high Tg polystyrene (PS) shell. These novel polymer systems can be molded into fully formed, 3-D shapes with the application of high pressure at room temperature. While the mechanical properties are equivalent to or better than those of commercial thermoplastic elastomers, more can be done to improve upon individual aspects of the mechanical properties, such as elastic modulus. This work looks at creating baroplastic nanocomposites with the goal of improving upon the mechanical properties. To accomplish this goal, two incorporation strategies for introducing silica nanoparticles were developed. The pre-emulsion strategy incorporated hydrophobized silica nanoparticles inside the core-shell nanoparticles to create core-shell-shell nanoparticles. The post-emulsion strategy incorporated charged silica nanoparticles after core-shell emulsion, with the intention of creating crystalline structures with silica and core-shell nanoparticles.(cont.) The pre-emulsion strategy resulted in a decrease in particle size for the core-shell-shell nanoparticles, as shown by dynamic light scattering. Excess silica in the emulsion resulted in phase separation and opaque, brittle samples. Samples made with this incorporation strategy showed poor mechanical properties. The post-emulsion strategy also resulted in poor processing. SAXS data show that there is no long range ordering with the SiO2 and core-shell nanoparticles. However, SAXS did show the possibility of a nanopcomposite with short range ordering of silica and core-shell particles.by Sheldon A. Hewlett.S.B

A Hybrid Sequencing Approach Completes the Genome Sequence of Thermoanaerobacter ethanolicus JW 200

Thermoanaerobacter ethanolicus JW 200 has been identified as a potential sustainable biofuel producer due to its ability to readily ferment carbohydrates to ethanol. A hybrid sequencing approach, combining Oxford Nanopore and Illumina DNA sequence reads, was applied to produce a single contiguous genome sequence of 2,911,280 bp

Influence of MWCNT/surfactant dispersions on the mechanical properties of Portland cement pastes

This work studies the reinforcing effect of Multi Walled Carbon Nanotubes (MWCNT) on cement pastes. A 0.35% solid concentration of MWCNT in powder was dispersed in deionized water with sodium dodecyl sulfate (cationic surfactant), cetylpyridinium chloride (anionic surfactant) and triton X-100 (amphoteric surfactant) using an ultrasonic tip processor. Three concentrations of each surfactant (1mM, 10mM and 100mM) were tested, and all samples were sonicated until an adequate dispersion degree was obtained. Cement pastes with additions of carbon nanotubes of 0.15% by mass of cement were produced in two steps; first the dispersions of MWCNT were combined with the mixing water using an ultrasonic tip processor to guarantee homogeneity, and then cement was added and mixed until a homogeneous paste was obtained. Direct tensile strength, apparent density and open porosity of the pastes were measured after 7 days of curing. It was found that the MWCNT/surfactants dispersions decrease the mechanical properties of the cement based matrix due to an increased porosity caused by the presence of surfactants. © Published under licence by IOP Publishing Ltd

Development of a physical activity programme for people with recently diagnosed rheumatoid arthritis

Background People with rheumatoid arthritis (RA) are less physically active (PA) than the general population and lower PA levels are associated with work disability, reduced physical function and co-morbidities. This suggests an urgent need to identify programmes that effectively promote sustainable PA to improve physical function in RA.Objectives The purpose of this research was to seek patient's views in relation to a range of potential PA programmes.Methods Focus groups were carried out with adults with RA with participants purposefully sampled to reflect a range of age and gender. Prior to commencing the research a draft interview guide was reviewed by the study Patient Research Partner and a pilot interview conducted. The interview guide was designed to explore PA support needs and experiences since diagnosis as well as motivators and facilitators to support engagement in PA. Each focus group was subsequently provided with information regarding potential PA programmes and invited to comment upon their suitability for people with a recent diagnosis of RA. Focus groups were audio recorded, transcribed and anonymised. Ethics approval for the study was obtained. Written informed consent was obtained from all participants. Thematic analysis was used to identify the main themes across the groups. Emerging themes were verified through discussion and a coding framework based on these themes developed. Themes and sub-themes were subsequently reviewed and the interpretation and analysis discussed and agreed.Results Three focus groups were conducted with 19 patients in total (15 female, 4 male); mean age (SD) 60 (±10) years; mean time (SD) since diagnosis 44 (±34) months. There was strong support for a PA programme with four key themes garnered from the focus groups:Recruitment and adherence included programme endorsement from peers and PA endorsement from health professionals; the need for support to overcome barriers to PA, such as pain and fatigue; and prompts such as text messages to improve adherence.Programme scheduling included timing with most suggesting six to 12 months following diagnosis, once a stable drug regime was established; afternoon sessions were preferred; views on frequency of sessions and duration of the programme were disparate.Programme content included support for education on relaxation and coping strategies, medication, flare, fatigue and pain; supervised exercise sessions; home exercise training; and expert physiotherapy input. Goal setting received mixed opinions with emphasis on the need to be patient-led.Programme delivery suggested group sessions were preferred by most, but not all; individual sessions in addition to the group were positively received; telephone support polarised opinion; but an accessible location was an agreed priority.Conclusions Participants supported development of a PA programme delivered at an accessible location, by physiotherapists within six to 12 months of diagnosis. Mixed views relating to delivery suggests a flexible approach may need to be developed.Disclosure of Interest None declare

Men, rheumatoid arthritis, psychosocial impact and self-management: A narrative review.

Rheumatoid arthritis (RA) is a chronic disease affecting fewer men than women. We systematically reviewed the literature on impact and self-management of RA men. Twenty eight papers were included, and grouped into two categories: Psychosocial impact of RA; and Coping and self-management. This review finds gender differences relating to quality of life; work; distress; self-management; coping; and support. We conclude there is a dearth of literature focussing on RA men only, and mixed gender studies include insufficient men to draw strong conclusions about men. Thus, further research is needed to understand the support needs of men with RA in depth

Mechanisms of Addition and Substitution Reactions of Furfural and Derivatives

In a complete series of substitution reactions (such as halogenation, nitration, mercuration, etc.,) of furfural and its derivatives, it appears that substitution is preceded by addition. For example, in bromination, two atoms of bromine first add to give a relatively unstable intermediate which then loses hydrogen bromide. These preliminary additions may be 1, 2- or 1, 4- or 1, 6- additions depending upon reactants and upon experimental conditions. Accompanying some of these transformations are ring fission and ring closure, and rearrangements involving unsaturated linkages. Typical illustrations of these changes were presented

Ranchers Diverse in Their Drought Management Strategies

Farm Management, Livestock Production/Industries,