SKELETAL KINEMATICS OF THE ANTERIOR CRUCIATE LIGAMENT DEFICIENT KNEE WITH AND WITHOUT FUNCTIONAL BRACES

Steinmann traction pins were implanted into the femur and tibia of six subjects having a partial or complete anterior cruciate ligament (ACL) rupture. Patients jumped for maximal horizontal distance and landed onto their deficient limb with the knee braced and unbraced. Tibiofemoral rotations and translations showed a general trend across subjects, i.e. skeletally based curves were similar in shape and amplitude. The tibia displaced anteriorly from footstrike to about peak vertical force onset (Fy). Thereafter the tibia moved posteriorly during flexion. Intra-subject kinematics was very repeatable but differences in anterior tibial translations were small between the brace conditions. This may be due to the invasiveness of this protocol, that landings were onto a deficient limb, or subjects jumped within their own comfort limits which did not maximally stress the ACL. Inter-subject differences were typically much larger

WHAT CAN WE LEARN FROM IN VIVO BIOMECHANICAL INVESTIGATIONS OF LOWER EXTREMITY?

In vivo biomechanical investigations of human movement are needed to better understand function and injury mechanism of the musculoskeletal system and to validate models or methods that otherwise could not be validated. In this report, we showcase two biomechanical approaches that use in vivo experiments to directly measure skin movement artefacts and the role of hamstring neuromuscular control in protecting the anterior cruciate ligament (ACL). The study on skin movement artefacts revealed that surface markers provided kinematics which can present repeatable patterns within a participant for various movements. However these repeatable patterns must not be misinterpreted as accurately representing skeletal kinematics, at least beyond the sagittal plane of movement. In the second investigation the neuromuscular control of the hamstring and gastrocnemius muscles showed a protective mechanism to prevent excessive ACL elongation, whereas the quadriceps muscles resisted against the collapsing of the knee joint after foot impact with the ground. This paper highlights the value of in vivo experimentation in contributing to our understanding of biomechanical functions or processes

Management of type 2 diabetes mellitus in people with severe mental illness: an online cross-sectional survey of healthcare professionals

Objectives To establish healthcare professionals’ (HCPs) views about clinical roles, and the barriers and enablers to delivery of diabetes care for people with severe mental illness (SMI). Design Cross-sectional, postal and online survey. Setting Trusts within the National Health Service (NHS), mental health and diabetes charities and professional bodies. Participants HCPs who care for people with type 2 diabetes mellitus (T2DM) and/or SMI in the UK. Primary and secondary outcome measures The barriers, enablers and experiences of delivering T2DM care for people with SMI, informed by the Theoretical Domains Framework (TDF). Results Responders were 273 HCPs, primarily mental health nurses (33.7%) and psychiatrists (32.2%). Only 25% of respondents had received training in managing T2DM in people with SMI. Mental health professionals felt responsible for significantly fewer recommended diabetes care standards than physical health professionals (p<0.001). For those seeing diabetes care as part of their role, the significant barriers to its delivery in the regression analyses were a lack of knowledge (p=0.003); a need for training in communication and negotiation skills (p=0.04); a lack of optimism about the health of their clients (p=0.04) and their ability to manage T2DM in people with SMI (p=0.003); the threat of being disciplined (p=0.02); fear of working with people with a mental health condition (p=0.01); a lack of service user engagement(p=0.006) and a need for incentives (p=0.04). The significant enablers were an understanding of the need to tailor treatments (p=0.04) and goals (p=0.02) for people with SMI. Conclusions This survey indicates that despite current guidelines, diabetes care in mental health settings remains peripheral. Even when diabetes care is perceived as part of a HCP’s role, various individual and organisational barriers to delivering recommended T2DM care standards to people with SMI are experienced

Access to means of suicide, occupation and the risk of suicide: a national study over 12 years of coronial data

BackgroundAvailability of lethal means is a significant risk factor for suicide. This study investigated whether occupations with greater access to lethal means had higher suicide rates than those without access, and further, whether this relationship differed for females versus males.MethodsA retrospective mortality study was conducted across the Australian population over the period 2001 to 2012. Data from the Australian Bureau of Statistics, which collects Census information on occupation for the Australian population, and the National Coroners Information System, which records information on suicide deaths, were combined. Employed suicide records were coded by occupation and work-related access to lethal means. Descriptive analysis and negative binomial regression were used to assess the relationship between access to means and suicide.ResultsPersons in occupations with access to firearms, medicines or drugs, and carbon monoxide more frequently used these methods to end their lives than those without access to means. Females employed in occupations with access to means had suicide rates that were 3.02 times greater (95% CI 2.60 to 3.50, p &lt; 0.001) than those employed in occupations without access. Males in occupations with access had suicide rates that were 1.24 times greater than those without access (95% CI 1.16 to 1.33, p &lt; 0.001).ConclusionWork-related access to means is a risk factor for suicide in the employed population, but is associated with a greater risk for females than males. The findings of this study suggest the importance of controlling access to lethal methods in occupations where these are readily available.<br /

Acceptance patterns and decision-making for human papillomavirus vaccination among parents in Vietnam: an in-depth qualitative study post-vaccination

BACKGROUND: The GAVI Alliance’s decision in late 2011 to invite developing countries to apply for funding for human papillomavirus (HPV) vaccine introduction underscores the importance of understanding levels of HPV vaccine acceptance in developing country settings. In this paper, we present findings from qualitative research on parents’ rationales for vaccinating or not vaccinating their daughters (vaccine acceptance) and their decision-making process in the context of an HPV vaccination demonstration project in Vietnam (2008–2009). METHODS: We designed a descriptive qualitative study of HPV vaccine acceptability among parents of girls eligible for vaccination in four districts of two provinces in Vietnam(a). The study was implemented after each of two years of vaccinations was completed. In total, 133 parents participated in 16 focus group discussions and 27 semi-structured interviews. RESULTS: Focus group discussions and in-depth interviews with parents of girls vaccinated revealed that they were generally very supportive of immunization for disease prevention and of vaccinating girls against HPV. The involvement of the National Expanded Program of Immunization in the demonstration project lent credibility to the HPV vaccine, contributing to high levels of acceptance. For parents who declined participation, concerns about side effects, the possibility that the vaccine was experimental, and the possible impact of the vaccine on future fertility rose to the surface. In terms of the decision-making process, many parents exhibited ‘active decision-making,’ reaching out to friends, family, and opinion leaders for guidance prior to making their decision. CONCLUSION: Vietnam’s HPV vaccination experience speaks to the importance of close collaboration with the government to make the most of high levels of trust, and to reduce suspicions about new vaccines that may arise in the context of vaccine introduction in developing country settings

River infiltration to a subtropical alluvial aquifer inferred using multiple environmental tracers

Chloride (Cl−), stable isotope ratios of water (δ18O and δ2H), sulfur hexafluoride (SF6), tritium (3H), carbon-14 (14C), noble gases (4He, Ne, and Ar), and hydrometry were used to characterize groundwater-surface water interactions, in particular infiltration rates, for the Lower Namoi River (New South Wales, Australia). The study period (four sampling campaigns between November 2009 and November 2011) represented the end of a decade-long drought followed by several high-flow events. The hydrometry showed that the river was generally losing to the alluvium, except when storm-derived floodwaves in the river channel generated bank recharge—discharge cycles. Using 3H/14C-derived estimates of groundwater mean residence time along the transect, infiltration rates ranged from 0.6 to 5 m yr−1. However, when using the peak transition age (a more realistic estimate of travel time in highly dispersive environments), the range in infiltration rate was larger (4–270 m yr−1). Both river water (highest δ2H, δ18O, SF6, 3H, and 14C) and an older groundwater source (lowest δ2H, δ18O, SF6, 3H, 14C, and highest 4He) were found in the riparian zone. This old groundwater end-member may represent leakage from an underlying confined aquifer (Great Artesian Basin). Environmental tracers may be used to estimate infiltration rates in this riparian environment but the presence of multiple sources of water and a high dispersion induced by frequent variations in the water table complicates their interpretation

Hydrographic observations from the US/PRC Cooperative Program in the Western Equatorial Pacific Ocean, cruises 1-4

In support of the Tropical Oceans and Global Atmosphere (TOGA) program, investigators from Woods Hole Oceanographic Institution (WHOI), NOAA Pacific Marine Envionmental Laboratory and the State Oceanic Administration (SOA) from both Qingdao (First Institute) and Guangzhou (South China Sea Branch) conducted hydrographic observations aboard the Chinese Research vessels Xiang Yang Hong 5 and Xiang Yang Hong 14 in the western equatorial Pacific. The objective of this component of the TOGA program was to document the water mass property distributions of the western equatorial Pacific Ocean and describe the oceanic velocity field. The four cruises summarized here were conducted during the period November 1985 to June 1988 and are the first half of an eight cruise repeated survey of the region scheduled to be completed in spring 1990. Conductivity-Temperatue-Depth-Oxygen (CTD/02) stations were collected to a minimum cast depth of 2,500 m or the bottom when shallower. The cruises reoccupied the same stations to provide temporal information. Summarized listings of CTD/O2 data together with selected physical properties of sea water for these cruises are provided here, as well as a description of the hardware used and an explanation of the data reduction tehniques employed.Funding was provided by the National Oceanic and Atmospheric Administration

Lessons learnt from human papillomavirus (HPV) vaccination in 45 low- and middle-income countries.

OBJECTIVE: To synthesise lessons learnt and determinants of success from human papillomavirus (HPV) vaccine demonstration projects and national programmes in low- and middle-income countries (LAMICs). METHODS: Interviews were conducted with 56 key informants. A systematic literature review identified 2936 abstracts from five databases; after screening 61 full texts were included. Unpublished literature, including evaluation reports, was solicited from country representatives; 188 documents were received. A data extraction tool and interview topic guide outlining key areas of inquiry were informed by World Health Organization guidelines for new vaccine introduction. Results were synthesised thematically. RESULTS: Data were analysed from 12 national programmes and 66 demonstration projects in 46 countries. Among demonstration projects, 30 were supported by the GARDASIL® Access Program, 20 by Gavi, four by PATH and 12 by other means. School-based vaccine delivery supplemented with health facility-based delivery for out-of-school girls attained high coverage. There were limited data on facility-only strategies and little evaluation of strategies to reach out-of-school girls. Early engagement of teachers as partners in social mobilisation, consent, vaccination day coordination, follow-up of non-completers and adverse events was considered invaluable. Micro-planning using school/ facility registers most effectively enumerated target populations; other estimates proved inaccurate, leading to vaccine under- or over-estimation. Refresher training on adverse events and safe injection procedures was usually necessary. CONCLUSION: Considerable experience in HPV vaccine delivery in LAMICs is available. Lessons are generally consistent across countries and dissemination of these could improve HPV vaccine introduction

Evaluation of a workplace suicide prevention program in the Australian manufacturing industry : protocol for a cluster-randomised trial of MATES in manufacturing

Males are at higher risk of death by suicide than females in Australia, and among men, blue-collar males are at higher risk compared to other working males. In response, MATES in Construction developed a workplace suicide prevention program for the construction sector in 2007 that has been widely implemented in Australia. In the current project, this program is being adapted and trialled in the manufacturing sector. The common aims of MATES programs are to improve suicide prevention literacy, help-seeking intentions, and helping behaviours. The program will be evaluated using a cluster randomised-controlled trial design with waitlist controls across up to 12 manufacturing worksites in Australia. We hypothesise that after 8 months of the MATES in Manufacturing program, there will be significantly greater improvements in help-seeking intentions (primary outcome) compared to waitlist controls. The project is led by Deakin University in collaboration with the University of Melbourne, and in partnership with MATES in Construction and a joint labour-management Steering Group. Trial registration: The trial was registered retrospectively with the Australian New Zealand Clinical Trials Registry on 25 January 2022 (ACTRN12622000122752)