Mild acetabular dysplasia and risk of osteoarthritis of the hip : a case-control study

Objective To determine whether mild variation in acetabular depth (AD) and shape is a risk factor for osteoarthritis (OA) of the hip. Methods The unaffected contralateral hip of patients with unilateral hip OA was compared with hips of asymptomatic controls without hip OA, derived from the Nottingham Genetics Osteoarthritis and Lifestyle case–control study. Standardised anteroposterior x-rays of the pelvis were used to measure centre edge (CE) angle and AD. Cut-off points for narrow CE angle and shallow AD were calculated from the control group (mean −1.96×SD). The relative risk of hip OA associated with each feature was estimated using OR and 95% CI and adjusted risks were calculated by logistic regression. Results In controls, both the CE angle and the AD were lower in the left hip than in the right hip. The CE angle related to age in both hips, and AD of the right hip was lower in men than in women. The contralateral unaffected hip in patients with unilateral hip OA had a decreased CE angle and AD compared with controls, irrespective of side. The lowest tertile of the CE angle in contralateral hips was associated with an eightfold risk of OA (aOR 8.06, 95% CI 4.87 to 13.35) and the lowest tertile of AD was associated with a 2.5-fold risk of OA (aOR 2.53, 95% CI 1.28 to 5.00). Significant increases in the risk of OA were also found as the CE angle and AD decreased

Exploring women's experiences, views and understanding of vaginal examinations during intrapartum care:A meta-ethnographic synthesis

Objective: To conduct a systematic review exploring women’s experiences, views and understanding of any vaginal examinations during intrapartum care, in any care setting and by any healthcare professional. Intrapartum vaginal examination is deemed both an essential assessment tool and routine intervention during labour. It is an intervention that can cause significant distress, embarrassment, and pain for women, as well as reinforce outdated gender roles. In view of its widespread and frequently reported excessive use, it is important to understand women’s views on vaginal examination to inform further research and current practice.Design: A systematic search and meta-ethnography synthesis informed by Noblit and Hare (1988) and the eMERGe guidance (France et al. 2019) was undertaken. Nine electronic databases were searched systematically using predefined search terms in August 2021, and again in March 2023. Studies meeting the following criteria: English language, qualitative and mixed-method studies, published from 2000 onwards, and relevant to the topic, were eligible for quality appraisal and inclusion.Findings: Six studies met the inclusion criteria. Three from Turkey, one from Palestine, one from HongKong and one from New Zealand. One disconfirming study was identified. Following both a reciprocal and refutational synthesis, four 3rd order constructs were formed, titled: Suffering the examination, Challenging the power dynamic, Cervical-centric labour culture embedded in societal expectations, and Context of care. Finally, a line of argument was arrived at, which brought together and summarised the 3rd orde rconstructs.Key conclusions and implications of practice: The dominant biomedical discourse of vaginal examination and cervical dilatation as central to the birthing process does not align with midwifery philosophy or women’s embodied experience. Women experience examinations as painful and distressing but tolerate them as they view them as necessary and unavoidable. Factors such as context of care setting, environment, privacy, midwifery care, particularly in a continuity of carer model, have considerable positive affect on women’s experience of examinations. Further research into women’s experiences of vaginal examination in different care models as well as research into less invasive intrapartum assessment tools that promote physiological processes is urgently require

Exploring women's experiences, views and understanding of vaginal examinations during intrapartum care:A meta-ethnographic synthesis

Objective: To conduct a systematic review exploring women’s experiences, views and understanding of any vaginal examinations during intrapartum care, in any care setting and by any healthcare professional. Intrapartum vaginal examination is deemed both an essential assessment tool and routine intervention during labour. It is an intervention that can cause significant distress, embarrassment, and pain for women, as well as reinforce outdated gender roles. In view of its widespread and frequently reported excessive use, it is important to understand women’s views on vaginal examination to inform further research and current practice.Design: A systematic search and meta-ethnography synthesis informed by Noblit and Hare (1988) and the eMERGe guidance (France et al. 2019) was undertaken. Nine electronic databases were searched systematically using predefined search terms in August 2021, and again in March 2023. Studies meeting the following criteria: English language, qualitative and mixed-method studies, published from 2000 onwards, and relevant to the topic, were eligible for quality appraisal and inclusion.Findings: Six studies met the inclusion criteria. Three from Turkey, one from Palestine, one from HongKong and one from New Zealand. One disconfirming study was identified. Following both a reciprocal and refutational synthesis, four 3rd order constructs were formed, titled: Suffering the examination, Challenging the power dynamic, Cervical-centric labour culture embedded in societal expectations, and Context of care. Finally, a line of argument was arrived at, which brought together and summarised the 3rd orde rconstructs.Key conclusions and implications of practice: The dominant biomedical discourse of vaginal examination and cervical dilatation as central to the birthing process does not align with midwifery philosophy or women’s embodied experience. Women experience examinations as painful and distressing but tolerate them as they view them as necessary and unavoidable. Factors such as context of care setting, environment, privacy, midwifery care, particularly in a continuity of carer model, have considerable positive affect on women’s experience of examinations. Further research into women’s experiences of vaginal examination in different care models as well as research into less invasive intrapartum assessment tools that promote physiological processes is urgently require

Sex and Gender in Medical Education, and proceedings from the 2015 Sex and Gender Education Summit

The Sex and Gender Medical Education Summit: a roadmap for curricular innovation was a collaborative initiative of the American Medical Women\u27s Association, Laura W. Bush Institute for Women’s Health, Mayo Clinic, and Society for Women\u27s Health Research (www.sgbmeducationsummit.com). It was held on October 18–19, 2015 to provide a unique venue for collaboration among nationally and internationally renowned experts in developing a roadmap for the incorporation of sex and gender based concepts into medical education curricula. The Summit engaged 148 in-person attendees for the 1 1/2-day program. Pre- and post-Summit surveys assessed the impact of the Summit, and workshop discussions provided a framework for informal consensus building. Sixty-one percent of attendees indicated that the Summit had increased their awareness of the importance of sex and gender specific medicine. Other comments indicate that the Summit had a significant impact for motivating a call to action among attendees and provided resources to initiate change in curricula within their home institutions. These educational efforts will help to ensure a sex and gender basis for delivery of health care in the future

Implication of nurse intervention on engagement with urate-lowering drugs: a qualitative study of participants in a RCT of nurse led care

Objectives To explore patient perception of the role of a nurse-led complex package of care in facilitating engagement with urate-lowering therapies (ULTs) in the management of gout.Methods Thirty people who had participated in a randomised controlled trial investigating the effect of a nurse-led complex package of care for gout, were purposively sampled and interviewed between 18–26 months after the end of the trial. Interviews were recorded, transcribed and analysed using a modified grounded-theory approach. Data were managed using Nvivo. STATA v15 was used to describe summary statistics.Results Participants described their views and experiences of engaging with a nurse-led intervention designed to provide holistic assessment, individualised patient education, and involvement in shared decision-making for the long-term management of gout. The analysis revealed key themes in how nurse-led intervention facilitated engagement with ULT, namely by proving improved knowledge and understanding of gout and its treatment, involvement of patients in decision-making about treatment, and increased confidence about benefits from treatment. However, some treatment uncertainty and concern remained and one participant free of gout flares discontinued ULT, while another halved the dose after the end of the trial.Conclusions This study reports data on patient experience of engaging with ULT to manage gout after receiving nurse-led care. It demonstrates that shared decision-making and the joint efforts of fully informed practitioners and patients persuades patients to engage with ULTs, and that experiencing the benefits of curative treatment motivates them to maintain adherence

Promising Practices for Community College Developmental Education

Developmental education is a key part of the college experience of a great number of community college students. Nationwide, about 60 percent of recent high school graduates who enter postsecondary education through community college take at least one remedial course (Bailey, Leinbach, and Jenkins, 2005). Yet, despite the prevalence of students who take developmental courses at community colleges, there is surprisingly little definitive research evidence on what makes for effective developmental education practice. Many studies of community college developmental education (or “remedial” education; we use these terms interchangeably) are based on programs and students at single institutions. These studies often do not make use of carefully selected comparison groups, and they typically do not track individuals long enough to find out whether students are eventually able to earn degrees or transfer to baccalaureate programs (see Levin and Calcagno, 2007). This document provides a summary of key findings from the research literature on developmental education practices that appear promising. It was produced as a discussion resource for community college educators and state agency staff in Connecticut. We hope that the practices described in this document encourage community college educators in Connecticut to reflect on how they currently approach developmental education and discuss ways they might strengthen program outcomes

The Value of Balanced Growth for Transportation

The Ohio Balanced Growth Program is a voluntary, locally-driven, incentive-driven program which aims to encourage compact, nodal development patterns. The Ohio Department of Transportation provided support for this research to evaluate potential links between Balanced Growth-type policy, land use and development patterns, and transportation benefits. A literature review was completed to understand the existing body of knowledge regarding the connection between policy, land use, and transportation. This included a scan of Balanced Growth-type programs across the US. Twenty-six US Metropolitan Statistical Areas (MSAs) were selected and reviewed for general geographic and policy characteristics. Land use and transportation outcome data were examined via scatterplot and linear regression across all of the MSAs. The results were evaluated broadly in light of policy frameworks in effect in each MSA, by categorizing land use policy into “tiers” based on voluntary vs. mandatory provisions, and applicability to private and public investment. Finally, a policy review was completed to understand the potential benefits of policy change at the state, regional, and local agency levels. Significant relationships were found between land use patterns, measured in terms of a sprawl composite index, and transportation outcomes for freeway lane miles, hours of delay, vehicle miles traveled, emissions, and safety. MSAs with “Tier 3” policies (mandatory, rigorous policy affecting both public and private investment) clustered together on both axes (transportation outcomes and sprawl); and MSAs within states clustered together along the sprawl score axis. Otherwise, there was no apparent pattern in the location of policy tiers along either the transportation or land use axes. Possible alternative explanations that could be evaluated in the future include overall transportation investment levels; inter-state and inter-regional travel demand; size and shape of the MSA; and market, economic and social factors. Conclusions included policy recommendations for ODOT in supporting compact, nodal development at the local, regional and state levels. Future study recommendations include pursuing future data collection, monitoring and evaluation over time

The Value of Balanced Growth for Transportation

The Ohio Balanced Growth Program is a voluntary, locally-driven, incentive-driven program which aims to encourage compact, nodal development patterns. The Ohio Department of Transportation provided support for this research to evaluate potential links between Balanced Growth-type policy, land use and development patterns, and transportation benefits. A literature review was completed to understand the existing body of knowledge regarding the connection between policy, land use, and transportation. This included a scan of Balanced Growth-type programs across the US. Twenty-six US Metropolitan Statistical Areas (MSAs) were selected and reviewed for general geographic and policy characteristics. Land use and transportation outcome data were examined via scatterplot and linear regression across all of the MSAs. The results were evaluated broadly in light of policy frameworks in effect in each MSA, by categorizing land use policy into “tiers” based on voluntary vs. mandatory provisions, and applicability to private and public investment. Finally, a policy review was completed to understand the potential benefits of policy change at the state, regional, and local agency levels. Significant relationships were found between land use patterns, measured in terms of a sprawl composite index, and transportation outcomes for freeway lane miles, hours of delay, vehicle miles traveled, emissions, and safety. MSAs with “Tier 3” policies (mandatory, rigorous policy affecting both public and private investment) clustered together on both axes (transportation outcomes and sprawl); and MSAs within states clustered together along the sprawl score axis. Otherwise, there was no apparent pattern in the location of policy tiers along either the transportation or land use axes. Possible alternative explanations that could be evaluated in the future include overall transportation investment levels; inter-state and inter-regional travel demand; size and shape of the MSA; and market, economic and social factors. Conclusions included policy recommendations for ODOT in supporting compact, nodal development at the local, regional and state levels. Future study recommendations include pursuing future data collection, monitoring and evaluation over time

The Value of Balanced Growth for Transportation: Executive Summary

This project evaluates the benefit that programs like the Ohio Balanced Growth Program could bring to transportation agencies in Ohio

First validation of the gout activity score against gout impact scale in a primary care based gout cohort

Objectives To validate the gout activity score (GAS) against the gout impact scale in a primary care based gout cohort. Methods This was a single-centre cross-sectional study. People with gout who participated in previous research at Academic Rheumatology, University of Nottingham, UK, and consented for participation in future studies were mailed a questionnaire in September 2015. Those returning completed questionnaires were invited to attend for a study visit at which blood was collected and musculoskeletal examination was performed. The Gout Assessment Questionnaire, which contains the gout impact scale (GIS), and short form (SF) 36v2 questionnaires were completed. The GAS3-step-c score was calculated. Spearman’s correlation coefficient was calculated to examine correlation between GAS and SF-36 v2, and GIS. Statistical analyses were performed using PASW v22. Results 102 (93% men) of the 150 participants who were mailed a questionnaire attended the study visit. Their mean (SD) age, BMI, serum uric acid and GAS were 67.94 (9.93) years, 29.96 (4.57) kg/m2, 5.25 (1.75) mg/dl, and 2.99 (0.74) respectively. There was moderate correlation between GAS and gout concern overall, unmet gout treatment need, and gout concern during an attack components of GIS (r= 0.306 to 0.453), but no to poor correlation between GAS and summary scores and scales of SF-36 v2 (r= -0.090 to -0.251). Conclusion This first study to validate GAS against the GIS found moderate correlation. However, this study did not examine the predictive validity of GAS, and prospective studies are needed before GAS can be used widely