Rates of interlock screw back-out are high with the retrograde femoral nailing advanced system for distal femur fractures.

PURPOSE: The retrograde femoral nailing advanced (RFNA) system (DePuy synthes) is a commonly used implant for the fixation of low distal femur and periprosthetic fractures. There is concern that the rate of distal interlock screw back-out may be higher for the RFNA compared to other nails (ON). The purpose of this study was to evaluate the incidence of interlock screw back-out and associated screw removal for RFNA versus ON, along with associated risk factors. METHODS: A retrospective comparative study of patients who underwent retrograde nailing for a distal femur fracture at an academic level one trauma center was performed. The incidence of distal interlock screw back-out and need for screw removal were compared for RFNA versus a propensity score matched cohort who received other nails. RESULTS: One hundred and ten patients underwent retrograde nailing with the RFNA for a distal femur fracture from 2015 to 2022 (average age: 66, BMI: 32, 52.7% smokers, 54.5% female, 61.8%). There was a significantly higher rate of interlock back-out in the RFNA group compared to the ON (27 patients, 24.5% vs 12 patients, 10.9%, p = 0.01), which occurred 6.3 weeks postoperatively. Screw removal rates for back-out were not significantly different for the RFNA group versus ON (8 patients, 7.3% vs 3 patients, 2.7%, p = 0.12). CONCLUSION: In this retrospective comparative study of distal femur fractures treated with retrograde nailing, the RFNA implant was associated with an increased risk of distal interlock screw back-out compared to other nails

Homelessness Monitor Great Britain 2022

The Homelessness Monitor series is a longitudinal study providing an independent analysis of the homelessness impacts of recent economic and policy developments across Great Britain. With the Homelessness Monitor study now in its eleventh year, this comparative report takes stock of homelessness policies, trends and outcomes in England, Scotland and Wales in 2022, and analyses key developments in the five year period running up to 2022

Homelessness Monitor England 2022

The homelessness monitor is a longitudinal study providing an independent analysis of the homelessness impacts of recent economic and policy developments across Great Britain. Separate reports are produced for England, Scotland and Wales. This tenth annual report updates our account of how homelessness stands in England in 2021, or as close to 2021 as data availability allows. It also highlights emerging trends and forecasts some of the likely future changes, identifying the developments likely to have the most significant impacts on homelessness

A functional human motor unit platform engineered from human embryonic stem cells and immortalized skeletal myoblasts.

Although considerable research on neuromuscular junctions (NMJs) has been conducted, the prospect of in vivo NMJ studies is limited and these studies are challenging to implement. Therefore, there is a clear unmet need to develop a feasible, robust, and physiologically relevant in vitro NMJ model. We aimed to establish a novel functional human NMJs platform, which is serum and neural complex media/neural growth factor-free, using human immortalized myoblasts and human embryonic stem cells (hESCs)-derived neural progenitor cells (NPCs) that can be used to understand the mechanisms of NMJ development and degeneration. Immortalized human myoblasts were co-cultured with hESCs derived committed NPCs. Over the course of the 7 days myoblasts differentiated into myotubes and NPCs differentiated into motor neurons. Neuronal axon sprouting branched to form multiple NMJ innervation sites along the myotubes and the myotubes showed extensive, spontaneous contractile activity. Choline acetyltransferase and βIII-tubulin immunostaining confirmed that the NPCs had matured into cholinergic motor neurons. Postsynaptic site of NMJs was further characterized by staining dihydropyridine receptors, ryanodine receptors, and acetylcholine receptors by α-bungarotoxin. We established a functional human motor unit platform for in vitro investigations. Thus, this co-culture system can be used as a novel platform for 1) drug discovery in the treatment of neuromuscular disorders, 2) deciphering vital features of NMJ formation, regulation, maintenance, and repair, and 3) exploring neuromuscular diseases, age-associated degeneration of the NMJ, muscle aging, and diabetic neuropathy and myopathy

Development of a complex intervention to test the effectiveness of peer support in type 2 diabetes

BACKGROUND: Diabetes is a chronic illness which requires the individual to assume responsibility for their own care with the aim of maintaining glucose and blood pressure levels as close to normal as possible. Traditionally self management training for diabetes has been delivered in a didactic setting. In recent times alternatives to the traditional delivery of diabetes care have been investigated, for example, the concept of peer support which emphasises patient rather than professional domination. The aim of this paper is to describe the development of a complex intervention of peer support in type 2 diabetes for a randomised control trial in a primary care setting. METHODS: The Medical Research Council (MRC) framework for the development and evaluation of complex interventions for randomised control trials (RCT) was used as a theoretical guide to designing the intervention. The first three phases (Preclinical Phase, Phase 1, Phase 2) of this framework were examined in depth. The Preclinical Phase included a review of the literature relating to type 2 diabetes and peer support. In Phase 1 the theoretical background and qualitative data from 4 focus groups were combined to define the main components of the intervention. The preliminary intervention was conducted in Phase 2. This was a pilot study conducted in two general practices and amongst 24 patients and 4 peer supporters. Focus groups and semi structured interviews were conducted to collect additional qualitative data to inform the development of the intervention. RESULTS: The four components of the intervention were identified from the Preclinical Phase and Phase 1. They are: 1. Peer supporters; 2. Peer supporter training; 3. Retention and support for peer supporters; 4. Peer support meetings. The preliminary intervention was implemented in the Phase 2. Findings from this phase allowed further modeling of the intervention, to produce the definitive intervention. CONCLUSION: The MRC framework was instrumental in the development of a robust intervention of peer support of type 2 diabetes in primary care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN42541690

Measures of satisfaction with care during labour and birth: a comparative review

Background Satisfaction is the one of the most frequently reported outcome measures for quality of care. Assessment of satisfaction with maternity services is crucial, and psychometrically sound measures are needed if this is to inform health practices. This paper comparatively reviews current measures of satisfaction with care during labour and birth. Methods A review of the literature was conducted. Studies were located through computerised databases and hand searching references of identified articles and reviews. Inclusion criteria were that the questionnaire was a multi-item scale of satisfaction with care during labour and birth, and some form of psychometric information (either information about questionnaire construction, or reliability, or validity) had to be reported. Results Nine questionnaires of satisfaction with care during labour and birth were identified. Instruments varied in psychometric properties and dimensions. Most described questionnaire construction and tested some form of reliability and validity. Measures were generally not based on the main theoretical models of satisfaction and varied in scope and application to different types of samples (e.g. satisfaction following caesarean section). For an in-depth measure of satisfaction with intrapartum care, the Intrapartal-Specific Quality from the Patient’s Perspective questionnaire (QPP-I) is recommended. Brief measures with good reliability and validity are provided by the Six Simple Questions (SSQ) or Perceptions of Care Adjective Checklist (PCACL-R). Conclusions Despite the interest in measures of satisfaction there are only a small number of validated measures of satisfaction with care during labour and birth. It is important that brief, reliable and valid measures are available for use in general and specific populations in order to assist research and inform practice

Milky Way Tomography IV: Dissecting Dust

We use SDSS photometry of 73 million stars to simultaneously obtain best-fit main-sequence stellar energy distribution (SED) and amount of dust extinction along the line of sight towards each star. Using a subsample of 23 million stars with 2MASS photometry, whose addition enables more robust results, we show that SDSS photometry alone is sufficient to break degeneracies between intrinsic stellar color and dust amount when the shape of extinction curve is fixed. When using both SDSS and 2MASS photometry, the ratio of the total to selective absorption, $R_V$, can be determined with an uncertainty of about 0.1 for most stars in high-extinction regions. These fits enable detailed studies of the dust properties and its spatial distribution, and of the stellar spatial distribution at low Galactic latitudes. Our results are in good agreement with the extinction normalization given by the Schlegel et al. (1998, SFD) dust maps at high northern Galactic latitudes, but indicate that the SFD extinction map appears to be consistently overestimated by about 20% in the southern sky, in agreement with Schlafly et al. (2010). The constraints on the shape of the dust extinction curve across the SDSS and 2MASS bandpasses support the models by Fitzpatrick (1999) and Cardelli et al. (1989). For the latter, we find an $R_V=3.0\pm0.1$(random) $\pm0.1$(systematic) over most of the high-latitude sky. At low Galactic latitudes (|b|<5), we demonstrate that the SFD map cannot be reliably used to correct for extinction as most stars are embedded in dust, rather than behind it. We introduce a method for efficient selection of candidate red giant stars in the disk, dubbed "dusty parallax relation", which utilizes a correlation between distance and the extinction along the line of sight. We make these best-fit parameters, as well as all the input SDSS and 2MASS data, publicly available in a user-friendly format.Comment: Submitted to ApJ, 55 pages, 37 figure

Diet breadth, coexistence and rarity in bumblebees

Factors that determine the relative abundance of bumblebee species remain poorly understood, rendering management of rare and declining species difficult. Studies of bumblebee communities in the Americas suggest that there are strong competitive interactions between species with similar length tongues, and that this competition determines the relative abundance of species. In contrast, in Europe it is common to observe several short-tongued species coexisting with little or no evidence for competition shaping community structure. In this study we examine patterns of abundance and distribution in one of the most diverse bumblebee communities in Europe, found in the mountains of southern Poland. We quantify forage use when collecting nectar and pollen for 23 bumblebee species, and examine patterns of co-occurrence and niche overlap to determine whether there is evidence for inter-specific competition. We also test whether rarity can be explained by diet breadth. Up to 16 species were found coexisting within single sites, with species richness peaking in mountain pasture at ~1000m altitude. Results concur with previous studies indicating that the majority of pollen collected by bumblebees is from Fabaceae, but that some bee species (e.g. B. ruderatus) are much more heavily dependent on Fabaceae than others (e.g. B. lucorum). Those species that forage primarily on Fabaceae tended to have long tongues. In common with studies in the UK, diet breadth was correlated with abundance: rarer species tended to visit fewer flower species, after correcting for differences in sample size. No evidence was found for similarity in tongue length or dietary overlap influencing the likelihood of co-occurrence of species. However, the most abundant species (which co-occurred at most sites) occupied distinct dietary niche space. While species with tongues of similar length tended, overall, to have higher dietary niche overlap, among the group of abundant short-tongued species that commonly co-occurred there was marked dietary differentiation which may explain their coexistence

The association of academic tracking to depressive symptoms among adolescents in three Caribbean countries

<p>Abstract</p> <p>Background</p> <p>Students who are tracked into low performing schools or classrooms that limit their life chances may report increased depressive symptoms. Limited research has been conducted on academic tracking and its association with depressive symptoms among high school students in the Caribbean. This project examines levels of depressive symptoms among tenth grade students tracked within and between high schools in Jamaica, St. Vincent and St. Kitts and Nevis.</p> <p>Methods</p> <p>Students enrolled in grade ten of the 2006/2007 academic year in Jamaica, St. Kitts and Nevis and St. Vincent were administered the Beck Depression Inventory II (BDI-II). In Jamaica and St. Vincent, academic tracking was operationalized using data provided by the local Ministries of Education. These Ministries ranked ordered schools according to students' performance on Caribbean school leaving examinations. In St. Kitts and Nevis tracking was operationalized by classroom assignments within schools whereby students were grouped into classrooms according to their levels of academic achievement. Multiple regression analyses were conducted to examine the relationships between academic tracking and BDI-II depression scores.</p> <p>Results</p> <p>A wide cross-section of 4^thform students in each nation was sampled (n = 1738; 278 from Jamaica, 737 St. Kitts and Nevis, 716 from St. Vincent; 52% females, 46.2% males and 1.8% no gender reported; age 12 to 19 years, mean = 15.4 yrs, sd = .9 yr). Roughly half (53%) of the students reported some symptoms of depression with 19.2% reporting moderate and 10.7% reporting severe symptoms of depression. Students in Jamaica reported significantly higher depression scores than those in either St. Kitts and Nevis or St. Vincent (p < .01). Students assigned to a higher academic track reported significantly lower BDI-II scores than students who were assigned to the lower academic track (p < .01).</p> <p>Conclusions</p> <p>There appears to be an association between academic tracking and depressive symptoms that is differentially manifested across the islands of Jamaica, St. Kitts and Nevis and St. Vincent.</p

Prevalence and architecture of de novo mutations in developmental disorders.

The genomes of individuals with severe, undiagnosed developmental disorders are enriched in damaging de novo mutations (DNMs) in developmentally important genes. Here we have sequenced the exomes of 4,293 families containing individuals with developmental disorders, and meta-analysed these data with data from another 3,287 individuals with similar disorders. We show that the most important factors influencing the diagnostic yield of DNMs are the sex of the affected individual, the relatedness of their parents, whether close relatives are affected and the parental ages. We identified 94 genes enriched in damaging DNMs, including 14 that previously lacked compelling evidence of involvement in developmental disorders. We have also characterized the phenotypic diversity among these disorders. We estimate that 42% of our cohort carry pathogenic DNMs in coding sequences; approximately half of these DNMs disrupt gene function and the remainder result in altered protein function. We estimate that developmental disorders caused by DNMs have an average prevalence of 1 in 213 to 1 in 448 births, depending on parental age. Given current global demographics, this equates to almost 400,000 children born per year