Work related musculoskeletal injuries sustained by Australian osteopaths: Qualitative analysis of effects on practitioner health, clinical practice, and patient care

Background: There is limited literature that explores the experiences of osteopaths injured while engaging in clinical practice. Evidence from other similar health professions has described the numerous effects of work-related musculoskeletal injuries (WRMI). Work-related musculoskeletal injury refers to trauma to joints, ligaments, muscles and tendons resulting from injury sustained while undertaking work duties. This research aimed to gain a contextualised understanding of the experiences of osteopaths who have sustained a work-related musculoskeletal injury while performing clinical practice. Method: This research used a descriptive qualitative design. Participants were recruited as part of a larger cross-sectional study. Thirteen Australian osteopaths who had sustained a work-related musculoskeletal injury consented to participate in semi-structured interviews during May and June 2016. Thematic analysis was used to elicit important themes from the interview transcripts that had been recorded and transcribed verbatim. The qualitative accounts provided by the participants were coded for the impacts of their injuries on work, home life and leisure activities. Results: The participants provided detailed, contextual information about their injuries, including the contributing factors and the experience of living with a WRMI. The findings indicate that injured osteopaths often continue working because of financial commitments and their dedication to patient care. The participants offered insights into the challenges they faced due to the injury and the management strategies they used to deal with the impact on their work and personal life. The injuries were mostly unreported, the burden being carried by the participants and their families. Conclusion: This is the first research that explores the experiences of osteopaths who have sustained a WRMI. We anticipate that this research will encourage a broad and constructive discussion within the profession of the issues associated with WRMIs, including risk minimisation and injury prevention. Further research is warranted to understand the relationship between osteopaths training in ergonomics and injury prevention. This would lead to the development of guidelines and educational curricula addressing safe work for osteopaths. © 2017 The Author(s)

Precision, Reliability, and Responsiveness of a Novel Automated Quantification Tool for Cartilage Thickness: Data from the Osteoarthritis Initiative

Objective; Accurate automated segmentation of cartilage should provide rapid reliable outcomes for both epidemiological studies and clinical trials. We aimed to assess the precision and responsiveness of cartilage thickness measured with careful manual segmentation or a novel automated technique. Methods; Agreement of automated segmentation was assessed against two manual segmentation datasets: 379 MR images manually segmented in-house (Training set), and 582 from the OAI with data available at 0, 1, and 2 years (Biomarkers set). Agreement of mean thickness was assessed using Bland-Altman plots, change with pairwise Students t-test, in the central medial femur and tibia regions (cMF, cMT). Repeatability was assessed on a set of 19 knees imaged twice on the same day. Responsiveness was assessed using standardised response means (SRMs). Results; Agreement of manual vs automated methods was excellent with no meaningful systematic bias (Training set cMF bias 0.1mm 95%CI ±0.35, Biomarkers set bias 0.1mm ±0.4). The smallest detectable difference (SDD) for cMF was 0.13mm, coefficient of variation (CoV) 3.1%; cMT 0.16 mm, 2.65%. Reported change using manual segmentations in the cMF region at 1 year was -0.031mm, confidence limit (-0.022, -0.039), p<10-4, SRM -0.31 (-0.23,-0.38); at 2 years was -0.071 (-0.058,-0.085), p<10-4, SRM -0.43(-0.36,-0.49). Reported change using automated segmentations in the cMF at 1 year was - 0.059 (-0.047, -0.071), p<10-4, SRM -0.41(-0.34,-0.48) ; 2 years: -0.14 (-0.123,-0.157), p<10-4, SRM -0.67 (-0.6,-0.72). Conclusion; A novel cartilage segmentation method provides highly accurate and repeatable measures with comparable cartilage thickness measurements to careful manual segmentation, but with improved responsiveness

Controlling molten carbonate distribution in dual-phase molten salt-ceramic membranes to increase carbon dioxide permeation rates

Dual-phase molten salt-ceramic membranes show high permselectivity for CO2 when molten carbonate is supported in a porous oxygen-ion and/or electron conductor. In this arrangement, the support likely contributes to permeation. Thus, if one is to understand and ultimately design membranes, it is also important to perform experiments with an inert support where permeation relies upon the molten carbonate properties alone. Here, a nominally inert material (Al2O3) was used in order to restrict permeation to molten carbonate. Model Al2O3 dual-phase membranes were fabricated using laser drilling to provide an order of magnitude difference in molten salt-gas interfacial area between feed and permeate sides. Molten carbonate thickness in the model membranes was also varied, independent of the molten salt-gas interfacial area. For all thicknesses studied, CO2 permeation rates showed a significant temperature dependence from 500 to 750 °C, suggesting an activated process was rate-limiting, likely a permeate-side molten salt-gas interfacial process, i.e. desorption of CO2. We applied these findings in asymmetric hollow-fibre supports, a geometry with inherent modularity and scalability, by developing a new carbonate infiltration method to control molten carbonate distribution within the hollow fibre. Compared to a conventionally prepared dual-phase hollow-fibre membrane with an uncontrolled distribution of carbonates, permeation rates were increased by up to 4 times when the molten salt was confined to the packed-pore network, i.e. without infiltrating the hollow-fibre micro-channels. X-ray micro-CT investigations supported the idea that the resulting increase in interfacial area for desorption of CO2 was the key structural difference contributing to increased permeation rates. For CO2 separation, where large volumes of gas must be processed, such increases in permeation rates will reduce the demand for membrane materials, although one must note the higher permeation rates achievable with oxygen-ion and/or electron conducting supports

High CO2 permeability in supported molten-salt membranes with highly dense and aligned pores produced by directional solidification

Composite molten salt-ceramic membranes are promising devices for high-temperature CO2 separation. Intensive material properties impact on separation performance as do membrane geometry (thickness) and microstructure (pore volume fraction, size, connectivity, and tortuosity factor). Although controlling pore size is considered somewhat routine, achieving pore alignment and connectivity is still challenging. Here we report the production of the first gas separation membrane using a porous ceramic matrix obtained from a directionally-solidified magnesium-stabilised zirconia (MgSZ) - MgO fibrilar eutectic as the membrane support. MgO was removed from the parent material by acid-etching to create a porous matrix with highly aligned pores with diameters of similar to 1 mu m. X-ray nano-computed tomography of a central portion (similar to 32, 000 mu m(3)) of the support identified similar to 21% porosity, with all pores aligned within 10 degrees and similar to 76% percolating along the longest sampled length. Employing the matrix as a support for a carbonate molten salt, a high CO2 permeability of 1.41x10(-10) mol m(-1).s(-1).Pa-1 at 815 degrees C was achieved, among the highest reported for supported molten-carbonate membranes (typically 10(-12) to 10(-10) mol m(-1).s(-1).Pa-1 at similar temperatures). We suggest that the high permeability is attributable to the excellent pore characteristics resulting from directional solidification, namely a dense array of parallel, micron-scale pores connecting the feed and permeate sides of the membrane

Fe-N-Doped Carbon Capsules with Outstanding Electrochemical Performance and Stability for the Oxygen Reduction Reaction in Both Acid and Alkaline Conditions

The Supporting Information is available free of charge on the ACS Publications website at DOI: 10.1021/acsnano.6b01247. Tables of reported ORR performance; Figures S1−S9 showing additional data as discussed in the text (PDF)This research work was supported by the Spanish Ministerio de Economıa y Competitividad, MINECO (MAT2012-31651), ́ Fondo Europeo de Desarrollo Regional (FEDER), and FICYT Regional Project (GRUPIN14-102). G.A.F. thanks the MINECO for his predoctoral contract, and M.S. thanks the Spanish Ministerio de Ciencia e Innovacion for her Ramo ́ n y ́ Cajal contract

Threat of an influenza pandemic: family physicians in the front line

<p>Abstract</p> <p>Background</p> <p>The chance of an influenza pandemic is real and clinicians should keep themselves informed about the rationale and science behind preventive and therapeutic principles relating to an (impending) influenza pandemic.</p> <p>Discussion</p> <p>Vaccination is considered the best prevention in case of a pandemic threat and first choice to contain the impact of a pandemic. Pending the availability of an effective pandemic vaccine, antivirals are likely the only effective agents for prevention and treatment. When an influenza pandemic is impending, all interventions aim to prevent people becoming infected and to suppress replication and transmission of the virus as much as possible. Antivirals will be prescribed to patients with laboratory confirmed pre-pandemic influenza as well as to their contacts (post-exposure prophylaxis) which may delay development of or even prevent a pandemic. During a manifest influenza pandemic, however, there is large-scale spreading of the influenza virus. Therefore, preventive use of antivirals is less efficient to prevent transmission. Delaying the pandemic is then important in order to prevent exhausting public health resources and disruption of society. Thus, during a manifest pandemic everyone with influenza symptoms should receive antivirals as quickly as possible, regardless of virological confirmation. To ensure optimal effectiveness of antivirals and to minimize development of drug resistant viral strains, the use of antivirals for annual influenza should be restrictive. The crucial position of family physicians during an (impending) influenza pandemic necessitates the development of primary health care guidelines on this topic for all countries.</p> <p>Summary</p> <p>Family physicians will play a key role in assessing and treating victims of a new influenza virus, and in reassuring the worried well. We outline various possible interventions in the event of an impending and a manifest influenza pandemic, such as non-medial measures, prescription of antivirals, and vaccination, and emphasize the need for pandemic influenza preparedness.</p

Quantification of radial arterial pulse characteristics change during exercise and recovery

It is physiologically important to understand the arterial pulse waveform characteristics change during exercise and recovery. However, there is a lack of a comprehensive investigation. This study aimed to provide scientific evidence on the arterial pulse characteristics change during exercise and recovery. Sixty-five healthy subjects were studied. The exercise loads were gradually increased from 0 to 125 W for female subjects and to 150 W for male subjects. Radial pulses were digitally recorded during exercise and 4-min recovery. Four parameters were extracted from the raw arterial pulse waveform, including the pulse amplitude, width, pulse peak and dicrotic notch time. Five parameters were extracted from the normalized radial pulse waveform, including the pulse peak and dicrotic notch position, pulse Area, Area1 and Area2 separated by notch point. With increasing loads during exercise, the raw pulse amplitude increased significantly with decreased pulse period, reduced peak and notch time. From the normalized pulses, the pulse Area, pulse Area1 and Area2 decreased, respectively, from 38 ± 4, 61 ± 5 and 23 ± 5 at rest to 34 ± 4, 52 ± 6 and 13 ± 5 at 150-W exercise load. During recovery, an opposite trend was observed. This study quantitatively demonstrated significant changes of radial pulse characteristics during different exercise loads and recovery phases

Resource utilization and costs before and after total joint arthroplasty

<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to compare pre- and post-surgical healthcare costs in commercially insured total joint arthroplasty (TJA) patients with osteoarthritis (OA) in the United States (U.S.).</p> <p>Methods</p> <p>Using a large healthcare claims database, we identified patients over age 39 with hip or knee OA who underwent unilateral primary TJA (hip or knee) between 1/1/2006 and 9/30/2007. Utilization of healthcare services and costs were aggregated into three periods: 12 months "pre-surgery," 91 days "peri-operative," and 3 to 15 month "follow-up," Mean total pre-surgery costs were compared with follow-up costs using Wilcoxon signed-rank test.</p> <p>Results</p> <p>14,912 patients met inclusion criteria for the study. The mean total number of outpatient visits declined from pre-surgery to follow-up (18.0 visits vs 17.1), while the percentage of patients hospitalized increased (from 7.5% to 9.8%) (both <it>p </it>< 0.01). Mean total costs during the follow-up period were 18% higher than during pre-surgery ($11,043 vs.$9,632, <it>p </it>< 0.01), largely due to an increase in the costs of inpatient care associated with hospital readmissions ($3,300 vs.$1,817, p < 0.01). Pharmacotherapy costs were similar for both periods ($2013 [follow-up] vs.$1922 [pre-surgery], p = 0.33); outpatient care costs were slightly lower in the follow-up period ($4338 vs.$4571, <it>p </it>< 0.01). Mean total costs for the peri-operative period were $36,553.</p> <p>Conclusions</p> <p>Mean total utilization of outpatient healthcare services declined slightly in the first year following TJA (exclusive of the peri-operative period), while mean total healthcare costs increased during the same time period, largely due to increased costs associated with hospital readmissions. Further study is necessary to determine whether healthcare costs decrease in subsequent years.</p

Early menopause, association with tobacco smoking, coffee consumption and other lifestyle factors: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Early onset of menopause is a risk factor for several health problems. The objective was primarily to investigate the association between early menopause and current, past active and passive smoking. A second aim was to investigate the association between coffee and alcohol consumption and early menopause.</p> <p>Methods</p> <p>The present population-based cross-sectional study included a sub-sample of 2123 postmenopausal women born in 1940–41 who participated in the Oslo Health Study. Early menopause was defined as menopause occurring at an age of less than 45 years. We applied logistic regression analyses (crude and adjusted odds ratio (OR)) to examine the association between early menopause and selected lifestyle factors.</p> <p>Results</p> <p>Current smoking was significantly associated with early menopause (adj. OR, 1.59; 95% CI, 1.11–2.28). Stopping smoking more than 10 years before menopause considerably reduced the risk of early menopause (adj. OR, 0.13; 95% CI, 0.05–0.33). Total exposure to smoking (the product of number of cigarettes per day and time as a smoker) was positively related to early menopause and, at the highest doses, nearly doubled the odds (adj. OR, 1.93; 95% CI, 1.12–3.30). These data suggest a possible dose-response relationship between total exposure to smoking and early menopause, but no dose-response relationship was detected for the other variables examined. We found no significant association of coffee or alcohol consumption with early menopause. Of the lifestyle factors tested, high educational level (adj. OR, 0.50; 95% CI, 0.34–0.72) and high social participation (adj. OR, 0.60, 95% CI, 0.39–0.98) were negatively associated with early menopause.</p> <p>Conclusion</p> <p>This cross-sectional study shows an association between current smoking and early menopause. The data also suggest that the earlier a woman stops smoking the more protected she is from early menopause. Early menopause was not significantly associated with passive smoking, or alcohol or coffee consumption.</p