Osteotomy of the greater trochanter, tension band fixation, and femoral conformation

Call number: LD2668 .T4 1978 H38Master of Scienc

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The effect of team affective tone on team performance : the roles of team identification and team cooperation

Affective tones abound in work teams. Drawing on the affect infusion model and social identity theory, this study proposes that team affective tone is related to team performance indirectly through team identification and team cooperation. Data from 141 hybrid-virtual teams drawn from high-tech companies in Taiwan generally supported our model. Specifically, positive affective tone is positively associated – while negative affective tone is negatively associated – with both team identification and team cooperation, team identification is positively associated with team cooperation, and team cooperation is positively associated with team performance. Managerial implications and limitations are discussed

Efficacy of trapping protocols for Agrilus jewel beetles

The genus Agrilus is one of the most diverse insect genera worldwide. The larval feeding activity causes extensive damage in both forests and orchards. In addition, more than 30 species have been introduced outside their native range so far, including the emerald ash borer Agrilus planipennis Fairmaire. Thus, the availability of efficient trapping protocols for early detection of Agrilus species at entry points is of utmost importance. In this study we tested whether trapping protocols developed for surveillance of A. planipennis in North America were also effective for other Agrilus species. In particular, through a multi-country assessment we compared the efficacy of detecting Agrilus species on: (i) green glue-coated prism traps vs. green Fluon-coated multi-funnel traps when baited with the green leaf volatile (Z)-3-hexenol or left unbaitedand (ii) green multi-panel traps vs. green multi-panel traps baited with dead adult Agrilus beetles (decoys). A total of 23,481 individuals from 45 Agrilus species were caught. Trap design significantly affected both species richness and abundance of Agrilus species in several of the countries where the trapping experiments were carried out, and green prism traps outperformed green multi-funnel traps in most cases. On the contrary, the addition of a (Z)-3-hexenol lure or dead adult beetle decoys on to traps did not improve trap catches. Our study highlights that reliable trap models to survey Agrilus species are already available, but also that there is the clear need to further investigate chemical ecology of Agrilus species to develop semiochemical lures that can improve detection efficacy

Current Management of Hyponatremia in Acute Heart Failure: A Report From the Hyponatremia Registry for Patients With Euvolemic and Hypervolemic Hyponatremia (HN Registry)

Hyponatremia (HN) occurs commonly in patients with acute heart failure and confers a worse prognosis. Current HN treatment varies widely, with no consensus. This study recorded treatment practices currently used for patients hospitalized with acute heart failure and HN. Data were collected prospectively from 146 US sites on patients hospitalized with acute heart failure and HN (serum sodium concentration [Na+] ≤130 mEq/L) present at admission or developing in the hospital. Baseline variables, HN treatment, and laboratory values were recorded. Of 762 patients, median [Na+] was 126 mEq/L (interquartile range, 7) at baseline and increased to 130 mEq/L at discharge. Fluid restriction was the most commonly prescribed therapy (44%), followed by no specific HN treatment beyond therapy for congestion (23%), isotonic saline (5%), tolvaptan (4%), and hypertonic saline (2%). Median rate of change in [Na+] varied by treatment (0.5 [interquartile range, 1.0] to 2.3 [8.0] mEq/L/d) and median treatment duration ranged from 1 (interquartile range, 1) to 6 (5) days. Fluid restriction and no specific HN treatment resulted in similar changes in [Na+], and were least effective in correcting HN. Few patients (19%) had [Na+] ≥135 mEq/L at discharge. The most commonly used treatment approaches for HN (fluid restriction and no specific treatment) in acute heart failure increased [Na+] minimally, and most patients remained hyponatremic at discharge

Technological Forecasting and Strategic Decision Making

121 p., tabl., graph., fig

Evaluation of Tre Gai bamboo (Bambusa spinosa) bending strength perpendicular-to-fibre along the culm length

The continued need to decarbonize buildings has led to a deeper exploration of the use of bamboo culms in building systems. For the design and use of full culm bamboo structures, the bending strength perpendicular-to-fibre has received little comprehensive study along the length of commercially produced bamboo poles. We intensively measured the bending strength perpendicular-to-the-fibre for both node and internode sections along the length of commercially purchased Tre Gai (Bambusa spinosa) culms. Eight culms, each four meters long, were sectioned to measure the bending strength terms including tension and compression strengths in both the N-S (top/bottom) and E/W (left/right) directions using ISO 22157 procedures. Digital scanning was used to measure the inner and outer diameter of each section. Node strength was approximately 2.64 times greater than the internode strength. The performances of perpendicular-to-fibre strength terms were related to the primary tissue strength rather than the bamboo fibre strength within the culm. Based upon observations and measurements, the fmT,NS and fmC,EW strengths had greater values with lower variability, and were less sensitive to changes in length. Implications of perpendicular-to-fibre strength design in building elements are discussed