A mixed methods study of knee confidence and self-efficacy: perceptions of knee osteoarthritis patients from the good life with osteoarthritis in Denmark initiative

Purpose: The Good Life with osteoArthritis in Denmark (GLA:D) Initiative is an evidence-based treatment programme for patients with knee and hip osteoarthritis (OA). It incorporates training physiotherapists to deliver care in accordance with the clinical guidelines by educating patients on their condition and by delivering supervised neuromuscular exercises to relieve pain and improve function. The importance of self-efficacy, and confidence in exercise, to exercise adherence has not been reported for the GLA:D population. In addition, worse knee confidence in people with knee OA is associated with higher pain and greater perceived knee instability. The aims of this study were to investigate the association between knee confidence and self-efficacy in patients with knee OA in the GLA:D registry; and to explore patients’ perception of their experiences with the GLA:D programme, and whether confidence and self-efficacy has a role to play in continuing with the GLA:D exercises in the long-term. Methods: This study used a mixed methods design. Patients with knee OA who were offered at least two educational sessions and six weeks of GLA:D exercise programme between January–March 2015 were identified from the GLA:D registry (n = 484) and sent an online survey. Ordinal regression analyses were performed. Knee confidence, assessed using the Knee injury and Osteoarthritis Outcomes Score (KOOS; quality of life subscale, question 3), was the dependent variable and self-reported measures for exercise self-efficacy; arthritis self-efficacy; multidimensional outcomes expectations for exercise; and KOOS pain and activities of daily living (ADL) were the independent variables. Knee confidence score ranged from 0–4 with 0 indicating higher knee confidence. The independent variables ranged from 0–10 or 0–100 with 0 indicating worse symptoms or confidence. Subsequently, semi-structured interviews (n = 4) were used to explore patients’ perceived confidence and adherence to the GLA:D exercises. Interviews were transcribed verbatim, and analysed using interpretative phenomenological analysis. Results: 200 patients (41.3%) responded to the survey. At 7–10 months following treatment initiation, 9.5% of patients were not at all troubled by lack of knee confidence; 39.5% were mildly troubled; 31.5% were moderately troubled; 15.5% were severely troubled; and 4% were extremely troubled. Patients with higher arthritis self-efficacy score were more likely to have higher knee confidence (odds ratio [OR] = 0.76; 95% confidence interval [CI] 0.63, 0.93; P = 0.007). Patients with higher KOOS ADL score were more likely to have higher knee confidence, although this association was small (OR = 0.96; 95% CI 0.93, 0.99; P = 0.006). No association was found between knee confidence and exercise self-efficacy (OR = 1.00; 95% CI 0.99, 1.01; P = 0.90). Patients reflected on seeing great improvements in their confidence, pain and mobility with the programme. They felt their symptoms got worse if they did not keep up with the exercises. Patients reflected on the importance of continued contact with their physiotherapist after the 6-week programme for further motivation and reassurance. One of the barriers that discouraged patients from continuing with the exercises in the long-term was the cost for additional GLA:D exercise classes with their physiotherapist. Conclusions: Patients are troubled by the lack of knee confidence after the GLA:D exercise programme; they reflected this was due to their negative experiences prior to entering the GLA:D programme. Arthritis self-efficacy and KOOS ADL were significantly associated with knee confidence, but no association was found with exercise self-efficacy. Patients from the interview reflected that maintaining contact with their physiotherapist was an important factor to motivate them to continue exercising

Ecology and Evolution of Drosophila ambochila, A Rare Picture-Winged Species Endemic to the Wai'anae Range of O'ahu, Hawaiian Islands

The rare O'ahu picture-winged fly Drosophila ambochila Hardy & Kaneshiro is endemic to two windward ravines in the Wai'anae Mountains that harbor its host plant. Drosophila ambochila is an ecological specialist that breeds on Pisonia stems and trunks in an intermediate stage of decay. By providing field-collected females with suitable substrate material, we have been able to observe the oviposition behavior of this species in the laboratory and obtain F 1 larvae. In nature, females oviposit each batch of mature eggs ("'4050) in a single cluster, by repeatedly inserting their long ovipositor into the same crack or beetle hole in the decaying Pisonia bark. Ovipositor, ovary, and egg morphology are characteristic of bark-breeding Hawaiian Drosophila, but SEM studies revealed a distinctive chorionic ultrastructure for the eggs of this species. Larval salivary chromosome analyses indicated that the O'ahu D. ambochila is most closely related to D. alsophila from the island of Hawai'i and have helped to resolve the phylogenetic relationships among six of the nine species belonging to the vesciseta subgroup of the glabriapex species group

Experiences of transitioning between settings of care from the perspectives of patients with advanced illness receiving specialist palliative care and their family caregivers: A qualitative interview study

Background: Transitions between care settings (hospice, hospital and community) can be challenging for patients and family caregivers and are often an under-researched area of health care, including palliative care. Aim: To explore the experience of transitions between care settings for those receiving specialist palliative care. Design: Qualitative study using thematic analysis. Setting/participants: Semi-structured interviews were conducted with adult patients (n = 15) and family caregivers (n = 11) receiving specialist palliative care, who had undergone at least two transitions. Results: Four themes were identified. (1) Uncertainty about the new care setting. Most participants reported that lack of information about the new setting of care, and difficulties with access and availability of care in the new setting, added to feelings of uncertainty. (2) Biographical disruption. The transition to the new setting often resulted in changes to sense of independence and identity, and maintaining normality was a way to cope with this. (3) Importance of continuity of care. Continuity of care had an impact on feelings of safety in the new setting and influenced decisions about the transition. (4) Need for emotional and practical support. Most participants expressed a greater need for emotional and practical support, when transitioning to a new setting. Conclusions: Findings provide insights into how clinicians might better negotiate transitions for these patients and family caregivers, as well as improve patient outcomes. The complexity and diversity of transition experiences, particularly among patients and families from different ethnicities and cultural backgrounds, need to be further explored in future research

Elastic Chain in a Random Potential: Simulation of the Displacement Function <(u(x)−u(0))2><(u(x)-u(0))^2> and Relaxation

We simulate the low temperature behaviour of an elastic chain in a random potential where the displacements $u(x)$ are confined to the {\it longitudinal} direction ($u(x)$ parallel to $x$) as in a one dimensional charge density wave--type problem. We calculate the displacement correlation function $g(x)=< (u(x)-u(0))^2>$ and the size dependent average square displacement $W(L)=$. We find that $g(x)\sim x^{2\eta}$ with $\eta\simeq3/4$ at short distances and $\eta\simeq3/5$ at intermediate distances. We cannot resolve the asymptotic long distance dependence of $g$ upon $x$. For the system sizes considered we find $g(L/2)\propto W\sim L^{2\chi}$ with $\chi\simeq2/3$. The exponent $\eta\simeq3/5$ is in agreement with the Random Manifold exponent obtained from replica calculations and the exponent $\chi\simeq2/3$ is consistent with an exact solution for the chain with {\it transverse} displacements ($u(x)$ perpendicular to $x$).The distribution of nearest distances between pinning wells and chain-particles is found to develop forbidden regions.Comment: 19 pages of LaTex, 6 postscript figures available on request, submitted to Journal of Physics A, MAJOR CHANGE

Editorial: Structured operational research and training in the public health sector: the Kenyan experience

No Abstrac

The societal costs of femoral neck fracture patients treated with internal fixation

__Abstract__ The study rationale was to provide a detailed overview of the costs for femoral neck fracture treatment with internal fixation in the Netherlands. Mean total costs per patient at 2-years follow-up were €19,425. Costs were higher for older, less healthy patients. Results are comparable to internationally published costs. Introduction The aim of this study was to provide a detailed overview of the cost and healthcare consumptio

A Crystal Structure of the Bifunctional Antibiotic Simocyclinone D8, Bound to DNA Gyrase

Simocyclinones are bifunctional antibiotics that inhibit bacterial DNA gyrase by preventing DNA binding to the enzyme. We report the crystal structure of the complex formed between the N-terminal domain of the Escherichia coli gyrase A subunit and simocyclinone D8, revealing two binding pockets that separately accommodate the aminocoumarin and polyketide moieties of the antibiotic. These are close to, but distinct from, the quinolone-binding site, consistent with our observations that several mutations in this region confer resistance to both agents. Biochemical studies show that the individual moieties of simocyclinone D8 are comparatively weak inhibitors of gyrase relative to the parent compound, but their combination generates a more potent inhibitor. Our results should facilitate the design of drug molecules that target these unexploited binding pockets

Sex-Biased Expression of Sex-Differentiating Genes FOXL2 and FGF9 in American Alligators, Alligator mississippiensis

Across amniotes, sex-determining mechanisms exhibit great variation yet the genes that govern sexual differentiation are largely conserved. Studies of evolution of sex-determining and sex- differentiating genes require an exhaustive characterization of functions of those genes such as FOXL2 and FGF9. FOXL2 is associated with ovarian development and FGF9 is known to play a role in testicular organogenesis in mammals and other amniotes. As a step toward characterization of the evolutionary history of sexual development, we measured expression of FOXL2 and FGF9 across three developmental stages and eight juvenile tissue types in male and female American alligators, Alligator mississippiensis. We report surprisingly high expression of FOXL2 before the stage of embryonic development when sex is determined in response to temperature and sustained and variable expression of FGF9 in juvenile male but not female tissue types. Novel characterization of gene expression in reptiles with temperature-dependent sex determination such as American alligators may inform the evolution of sex-determining and sex-differentiating gene networks as they suggest alternative functions from which the genes may have been exapted. Future functional profiling of sex-differentiating genes should similarly follow other genes and other species to enable a broad comparison across sex-determining mechanisms.Organismic and Evolutionary Biolog