A safe method for the retrieval of a dislocated trial head in total hip arthroplasty

Total hip arthroplasty is a life changing procedure providing a significant improvement in the quality of life for those receiving treatment. An 81-year-old male with severe right sided hip osteoarthritis underwent uncemented total hiparthroplasty. Intraoperatively the 32mm trial head dislodged from the trial stem over the anterior rim of the acetabulum relocating to within the pelvic cavity. Time efficient retrieval was performed during primary surgery through a mini-incision at the iliac crest

Internet competency predicts practical hearing aid knowledge and skills in first-time hearing aid users

Purpose. The purpose of the study was to assess whether Internet competency predicted practical hearing aid knowledge and handling skills in first-time hearing aid users. Method. The design was a prospective, randomized controlled trial of a multimedia educational intervention consisting of interactive video tutorials (or reusable learning objects [RLOs]). RLOs were delivered through DVD for TV or PC, and online. Internet competency was measured at the hearing aid fitting appointment, whereas hearing aid knowledge and practical handling skills were assessed 6 weeks postfitting. Results. Internet competency predicted practical hearing aid knowledge and handling skills, controlling for age, hearing sensitivity, educational status, and gender for the group that received the RLOs. Internet competency was inversely related to the number of times the RLOs were watched. Conclusion. Associations between Internet competency and practical hearing aid knowledge, handling skills, and watching the RLOs fewer times may have arisen because of improved self-efficacy. Therefore, first-time hearing aid users who are more competent Internet users may be better equipped to apply newly learned information to effectively manage their hearing loss

Disease activity flares and pain flares in an early rheumatoid arthritis inception cohort; characteristics, antecedents and sequelae

© 2019 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: RA flares are common and disabling. They are described in terms of worsening inflammation but pain and inflammation are often discordant. To inform treatment decisions, we investigated whether inflammatory and pain flares are discrete entities. Methods: People from the Early RA Network (ERAN) cohort were assessed annually up to 11 years after presentation (n = 719, 3703 person-years of follow up). Flare events were defined in 2 different ways that were analysed in parallel; DAS28 or Pain Flares. DAS28 Flares satisfied OMERACT flare criteria of increases in DAS28 since the previous assessment (≥1.2 points if active RA or ≥ 0.6 points if inactive RA). A ≥ 4.8-point worsening of SF36-Bodily Pain score defined Pain Flares. The first documented episode of each of DAS28 and Pain Flare in each person was analysed. Subgroups within DAS28 and Pain Flares were determined using Latent Class Analysis. Clinical course was compared between flare subgroups. Results: DAS28 (45%) and Pain Flares (52%) were each common but usually discordant, with 60% of participants in DAS28 Flare not concurrently in Pain Flare, and 64% of those in Pain Flare not concurrently in DAS28 Flare. Three discrete DAS28 Flare subgroups were identified. One was characterised by increases in tender/swollen joint counts (14.4%), a second by increases in symptoms (13.1%), and a third displayed lower flare severity (72.5%). Two discrete Pain Flare subgroups were identified. One occurred following low disease activity and symptoms (88.6%), and the other occurred on the background of ongoing active disease and pain (11.4%). Despite the observed differences between DAS28 and Pain Flares, each was associated with increased disability which persisted beyond the flare episode. Conclusion: Flares are both common and heterogeneous in people with RA. Furthermore our findings indicate that for some patients there is a discordance between inflammation and pain in flare events. This discrete flare subgroups might reflect different underlying inflammation and pain mechanisms. Treatments addressing different mechanisms might be required to reduce persistent disability after DAS28 and Pain Flares.Peer reviewedFinal Published versio

Grain Physics and Rosseland Mean Opacities

Tables of mean opacities are often used to compute the transfer of radiation in a variety of astrophysical simulations from stellar evolution models to proto-planetary disks. Often tables, such as Ferguson et al. (2005), are computed with a predetermined set of physical assumptions that may or may not be valid for a specific application. This paper explores the effects of several assumptions of grain physics on the Rosseland mean opacity in an oxygen rich environment. We find that changing the distribution of grain sizes, either the power-law exponent or the shape of the distribution, has a marginal effect on the total mean opacity. We also explore the difference in the mean opacity between solid homogenous grains and grains that are porous or conglomorations of several species. Changing the amount of grain opacity included in the mean by assuming a grain-to-gas ratio significantly affects the mean opacity, but in a predictable way.Comment: 19 pages, 6 figures, accepted for publication in Ap

Acute post-disaster medical needs of patients with diabetes: emergency department use in New York City by diabetic adults after Hurricane Sandy.

OBJECTIVE: To evaluate the acute impact of disasters on diabetic patients, we performed a geospatial analysis of emergency department (ED) use by New York City diabetic adults in the week after Hurricane Sandy. RESEARCH DESIGN AND METHODS: Using an all-payer claims database, we retrospectively analyzed the demographics, insurance status, and medical comorbidities of post-disaster ED patients with diabetes who lived in the most geographically vulnerable areas. We compared the patterns of ED use among diabetic adults in the first week after Hurricane Sandy\u27s landfall to utilization before the disaster in 2012. RESULTS: In the highest level evacuation zone in New York City, postdisaster increases in ED visits for a primary or secondary diagnosis of diabetes were attributable to a significantly higher proportion of Medicare patients. Emergency visits for a primary diagnosis of diabetes had an increased frequency of certain comorbidities, including hypertension, recent procedure, and chronic skin ulcers. Patients with a history of diabetes visited EDs in increased numbers after Hurricane Sandy for a primary diagnosis of myocardial infarction, prescription refills, drug dependence, dialysis, among other conditions. CONCLUSIONS: We found that diabetic adults aged 65 years and older are especially at risk for requiring postdisaster emergency care compared to other vulnerable populations. Our findings also suggest that there is a need to support diabetic adults particularly in the week after a disaster by ensuring access to medications, aftercare for patients who had a recent procedure, and optimize their cardiovascular health to reduce the risk of heart attacks

On the primordial scenario for abundance variations within globular clusters. The isochrone test

Self-enrichment processes occurring in the early stages of a globular cluster lifetime are generally invoked to explain the observed CNONaMgAl abundance anticorrelations within individual Galactic globulars.We have tested, with fully consistent stellar evolution calculations, if theoretical isochrones for stars born with the observed abundance anticorrelations satisfy the observational evidence that objects with different degrees of these anomalies lie on essentially identical sequences in the Color-Magnitude-Diagram (CMD). To this purpose, we have computed for the first time low-mass stellar models and isochrones with an initial metal mixture that includes the extreme values of the observed abundance anticorrelations, and varying initial He mass fractions. Comparisons with 'normal' alpha-enhanced isochrones and suitable Monte Carlo simulations that include photometric errors show that a significant broadening of the CMD sequences occurs only if the helium enhancement is extremely large (in this study, when Y=0.35) in the stars showing anomalous abundances. Stellar luminosity functions up to the Red Giant Branch tip are also very weakly affected, apart from - depending on the He content of the polluting material - the Red Giant Branch bump region. We also study the distribution of stars along the Zero Age Horizontal Branch, and derive general constraints on the relative location of objects with and without abundance anomalies along the observed horizontal branches of globular clusters.Comment: Accepted for publication in Ap

Board # 114 : Progress toward Optimizing Student Team Skill Development using Evidence-Based Strategies

The broad goal of this work is to study the effectiveness of various teamwork training interventions. This research requires the use of a common model of teamwork and a system for training, collecting ratings data, and providing feedback. We will leverage the NSF’s prior investment in the CATME system, which meets the research criteria and automates some of the data collection and feedback, which will aid in executing the research protocol consistently. Seven empirical studies will determine the effect sizes of training, practice in teams, practice rating, and feedback interventions on cognitive development (improvement of team skills) and metacognitive development (improvement of self- and peer-evaluation skills). Outcomes. We focus both on cognitive skills related to team-member effectiveness and on metacognitive skills that enable competent self- and peer-evaluation of team members’ effectiveness. An intermediate knowledge-level outcome affects both—developing an improved cognitive model of teamwork. Students must learn what skills are necessary for effective teamwork to be able to develop and evaluate them. Strategies. To achieve these outcomes, we have several strategies. Frame-of-reference training, which is well-established and empirically supported, will align students’ cognitive model of teamwork with ours by teaching students the ways team members can contribute effectively to teams in the five key areas summarized earlier. Experience working in teams and evaluating teamwork will improve team skills and self- and peer-evaluation skills. Experience in teams increases as students work on multiple teams. Rating practice will be accomplished by showing students descriptions or videotapes of fictitious team members and having them rate the contributions these fictitious team members make, in addition to rating themselves and their real teammates following work in teams. Finally, we will examine how the degree to which and manner in which feedback on team skills is provided affect student outcomes. This presentation (Executive Summary and Poster) will provide a valuable update on this project, share various lessons for classroom practice, and provide guidance to other faculty who seek to use CATME in their research

Stellar models of multiple populations in globular clusters - I. The main sequence of NGC 6752

We present stellar atmosphere and evolution models of main-sequence stars in two stellar populations of the Galactic globular cluster NGC 6752. These populations represent the two extremes of light-element abundance variations in the cluster. NGC 6752 is a benchmark cluster in the study of multiple stellar populations because of the rich array of spectroscopic abundances and panchromatic Hubble Space Telescope photometry. The spectroscopic abundances are used to compute stellar atmosphere and evolution models. The synthetic spectra for the two populations show significant differences in the ultraviolet and, for the coolest temperatures, in the near-infrared. The stellar evolution models exhibit insignificant differences in the Hertzsprung-Russell (H–R) diagram except on the lower main sequence. The appearance of multiple sequences in the colour–magnitude diagrams (CMDs) of NGC 6752 is almost exclusively due to spectral effects caused by the abundance variations. The models reproduce the observed splitting and/or broadening of sequences in a range of CMDs. The ultraviolet CMDs are sensitive to variations in carbon, nitrogen, and oxygen but the models are not reliable enough to directly estimate abundance variations from photometry. On the other hand, the widening of the lower main sequence in the near-infrared CMD, driven by oxygen variation via the water molecule, is well described by the models and can be used to estimate the range of oxygen present in a cluster from photometry. We confirm that it is possible to use multiband photometry to estimate helium variations among the different populations, with the caveat that the estimated amount of helium enhancement is model dependen

Optimizing Student Team Skill Development Using Evidence-Based Strategies

The critical importance of effective teamwork in engineering is widely recognized. Surprisingly, however, relatively little is known about how to develop teamwork skills in higher education classes, including what factors contribute to effective teamwork, their relative importance in a team\u27s overall performance, and the underlying individual and interpersonal dynamics. Increasing numbers of engineering instructors are adopting instructional practices relying on teamwork, yet many instructors simply form student teams and hope the members individually and collectively learn on their own how to work in teams and succeed in their task(s). Instructors do this because they do not have guidance for a better approach. This research project aims to address this gap in faculty knowledge. The empirical studies conducted as part of this project build on research in engineering education, cognitive psychology, social psychology, and other fields in a coordinated large-scale research project that will provide faculty with needed knowledge and tools to ensure that students learn team skills. The research team is conducting seven separate studies measuring the impact of teamwork training, experience working in teams, practice rating the teamwork of fictitious team members, and giving and receiving peer feedback. The research is measuring each of these effects in real teams on three learning outcomes: improved teamwork knowledge, improved ability to evaluate teamwork, and improved ability to function effectively in teams. These studies will result in practical recommendations for time-pressed faculty to implement

Exploring the Impact of Efficacy Messages on Cessation-Related Outcomes Using Ecological Momentary Assessment

Introduction:Observational studies indicate that cigarette package inserts with efficacy messages about the benefits of quitting (i.e. response efficacy) and recommendations for successful cessation increase smokers’ self-efficacy to quit and promote sustained cessation. However, the effects of inserts with such efficacy messages have not been studied using experimental designs. This study used ecological momentary assessment (EMA) to assess smokers’ responses to efficacy inserts.Material and Methods:In a randomized case-crossover study among smokers from the United States (n=23), participants received a one-week supply of cigarettes with efficacy inserts and a one-week supply without any inserts, and were randomized to use the packs with inserts on either the first or second week of the study. For 14 consecutive days, participants used a smartphone to answer brief surveys on cessation-related variables during smoking sessions and at the beginning of each day. Multilevel mixed-effects linear and logistic regression models compared responses during the insert period to those of the non-insert period.Results:The insert period was associated with greater desire to quit (b=0.21, p=0.012), motivation to quit (b=0.18, p=0.001), self-efficacy to cut down (b=0.26, p\u3c0.001) and to quit (b=0.28, p\u3c0.000), and response efficacy/ perceived benefits of quitting (b=0.13, p=0.012). Insert exposure was not significantly associated with forgoing cigarettes (OR=1.9, p=0.2).Conclusions:Results from this EMA study suggest that inserts with efficacy messages may promote determinants of smoking cessation. This is consistent with observational research in Canada, which is the only country to use inserts with efficacy messages as well as pictorial warnings about smoking risks on the outside of packs. Future studies should assess the extent to which efficacy inserts can not only be used to communicate health information to smokers but also work in synergy with pictorial warnings