Total Knee Arthroplasty Rehabilitation: Case Report

Background and Purpose: Osteoarthritis (OA) of the knee is a common problem in the world population and total knee replacement has become the gold standard for repair when the OA becomes severe enough. Total knee replacement, however, is not the complete answer to knee OA. Without rehabilitation these patients may struggle to be fully functional. The purpose of this case study was to describe the rehabilitation of a geriatric patient who underwent TKA and benefited from the use of hydrotherapy in his recovery. Case Description: This report will look at the rehabilitation of one 73-year-old male patient and interventions used to help him return to being functionally independent. The patient had undergone right total knee arthroplasty and had previously undergone bilateral total hip replacement. Interventions included manual therapy, hydrotherapy, therapeutic exercise, interferential current and cryotherapy. Outcomes: The main outcome measures used in this case were strength, range of motion, pain and the Outpatient Physical Therapy Improvement in Motion Assessment Log Instrument. The patient was eventually able to make a full return to his activities despite not regaining the complete range of motion expected after total knee arthroplasty

Active-Learning Quality Improvement Training Curriculum for Faculty in Hospital Medicine

Background: There is a growing emphasis on teaching Quality Improvement (QI) to resident physicians and medical students. However, faculty with QI skills and knowledge is lacking at many academic medical centers.Active learning programs to improve faculty capacity for QI have shown positive outcomes. We sought to develop a QI curriculum for faculty within the Division of Hospital Medicine. Description of project/program/innovation: We conducted a needs assessment focus group for Hospital Medicine faculty at our academic medical center. Six faculty members participated and identified priorities and potential challenges. Based on the focus group feedback, we designed a 12-session curriculum that uses an active-learning approach to teach core concepts in QI and includes sessions on effectively mentoring and publishing QI (Table 1). Junior and senior faculty collaborated on curricular design and delivery, with the goal of developing junior faculty into effective QI teachers. Pre-assessment of QI knowledge, skills, and attitudes was conducted using a survey instrument and the revised Quality Improvement Knowledge Application Tool (QIKAT-R). Results: Eighteen faculty completed the pre-assessments (82% completion). At baseline, self-reported comfort was highest for “setting aims for a QI project” and lowest for “presenting results of a QI project”. The mean QIKAT-R score was 16.8 out of 27 (SD 4.5), with the lowest performance in the “setting aims” domain. To date, six sessions have been completed. The selected project focuses on improving hospitalized patients’ experiences around daily bedside rounding. Discussion: We have created a QI curriculum that seeks to address the gap in QI skills among hospitalists. Pre-assessments revealed poor correlation between self-reported comfort level and QIKAT-R scores within each domain, further highlighting educational opportunities. We plan to use feedback from this pilot to refine the curriculum and offer it to faculty in other specialties

An Investigation of the Gallium-Indium Binary System

Twenty-four alloys, at 5 weight per cent or smaller intervals, were investigated by the thermal method. Very low temperatures had to be attained, because most of the alloy melts supercooled remarkably. Analysis showed only a liquidus and solidus line, and the solidus temperature was the same for each alloy

Designing whole-systems commissioning: lessons from the English experience

The paucity of formal evidence, allied to the requirement for strategies that are sensitive to local history and context, means that a ‘blueprint’ for successful strategic commissioning is not currently available for adoption. We are therefore confined to proposing ‘design principles’ for those seeking to embark upon a transition towards a whole systems approach to strategic commissioning. People and relationships are of critical importance all the way through the chain from strategic commissioning to micro-commissioning. Most crucially, experience suggests that structural solutions alone cannot deliver effective relationships and will not be effective when relationships are neglected. The need to ensure staff, partner and political buy-in suggests that relationship management and consensus-building are an integral component of the leadership role in moving toward strategic commissioning. As with any major re-organisation, the move to strategic commissioning is essentially a change management initiative and therefore will stand or fall according to whether it adheres to good practice in the change management process. Central to this, and to achieving commissioning outcomes, is the requirement for meaningful service user and public engagement. Effective commissioning emphasizes individual capabilities as well as needs, and community assets as well as deficits and problems. Adoption of strategic commissioning approaches is still at the developmental and learning stage and arguably all structural arrangements should be regarded as transitional

Modelling an isolated dust grain in a plasma using matched asymptotic expansions

The study of dusty plasmas is of significant practical use and scientific interest. A characteristic feature of dust grains in a plasma is that they are typically smaller than the electron Debye distance, a property which we exploit using the technique of matched asymptotic expansions. We first consider the case of a spherical dust particle in a stationary plasma, employing the Allen–Boyd–Reynolds theory, which assumes cold, collisionless ions. We derive analytical expressions for the electric potential, the ion number density and ion velocity. This requires only one computation that is not specific to a single set of dust–plasma parameters, and sheds new light on the shielding distance of a dust grain. The extension of this calculation to the case of uniform ion streaming past the dust grain, a scenario of interest in many dusty plasmas, is less straightforward. For streaming below a certain threshold we again establish asymptotic solutions but above the streaming threshold there appears to be a fundamental change in the behaviour of the system

Long-term condition self-management support in online communities. A meta-synthesis of qualitative papers

Background: Recent years have seen an exponential increase in people with a long-term condition (LTC) using the internet for information and support. Prior research has examined support for LTC self-management (SM) through the provision of illness, every day and emotional work in the context of traditional offline communities. However, less is known about how communities hosted in digital spaces contribute through the creation of social ties and the mobilisation of an online illness ‘workforce’. Objectives: To understand the negotiation of LTC illness work in patient online communities and how such work may assist the SM of LTCs in daily life. Methods: A systematic search of qualitative papers was undertaken using AMED, CINAHL, Cochrane Database, Delphis, Embase, International Bibliography of Social Sciences, Medline, PsychInfo, Scopus, Sociological Abstracts and Web of Science for papers published since 2004. 21 papers met the inclusion criteria of using qualitative methods and examined the use of peer-led online communities in those with a LTC. A qualitative meta-synthesis was undertaken and the review followed a line of argument synthesis. Results: The main themes identified in relation to the negotiation of Self-Management Support (SMS) were: 1) Redressing offline experiential information and knowledge deficits; 2) The influence of modelling and learning behaviours from others on SM; 3) Engagement which validates illness and negates offline frustrations; 4) Tie formation and community building; 5) Narrative expression and cathartic release; 6) Dissociative anonymity and invisibility. These translated into a line of argument synthesis in which four network mechanisms for SMS in patient online communities were identified. These were collective knowledge and identification through lived experience; support, information and engagement through readily accessible gifting relationships; sociability that extends beyond illness; and online disinhibition as a facilitator in the negotiation of SMS. Conclusion: Social ties forged in online spaces provide the bases for performing relevant SM work that can improve an individual’s illness experience, tackling aspects of SM that are particularly difficult to meet offline. Membership of online groups can provide those living with a LTC with ready access to a SMS illness ‘workforce’ and illness and emotional support. The substitutability of offline illness work may be particularly important to those whose access to support offline is either limited or absent. Furthermore, such resources require little negotiation online, since information and support is seemingly gifted to the community by its members. <br/

1,2-Bis[2-(2-nitro-1H-imidazol-1-yl)eth­oxy]ethane

In the crystal structure, the title compound, C12H16N6O6, lies on an inversion centre. The mol­ecule has an anti­periplanar conformation with respect to the C—C bond of the central ethane unit and the two imidazole rings are parallel to each other. The dihedral angle between the imidazole ring and the mean plane of the C and O atoms of the bis­(eth­oxy)ethane group is 76.04 (6)°. The mol­ecules are stacked along the c axis through a weak C—H⋯O inter­action and a π⋯π inter­action between the imidazole rings with a centroid–centroid distance of 3.5162 (6) Å. An intramolecular C—H⋯O hydrogen bond is also present

Dating of zircon and monazite from diamondiferous quartzofeldspathic rocks of the Saxonian Erzgebirge - hints at burial and exhumation velocities.

In order to better understand the formation and evolution processes of ultrahigh pressure (UHP) felsic rocks, we determined the ages of various domains of zircon and monazite crystals from the diamondiferous quartzofeldspathic rocks of the Saxonian Erzgebirge. According to cathodoluminescence imagery and Th/U ratios, three zircon zones were distinguished. Each was dated using several spot analyses from a sensitive high-resolution ion microprobe (SHRIMP) analysing Pb, U and Th isotopes. The results were: (1) core zone - 21 analyses: Th/U less/equal 0.023 and 337.0 plus/minus 2.7 Ma (2 sigma, combined 206Pb/238U-207Pb/235U age); (2) diamond-bearing intermediate zone - 23 analyses: Th/U greater/equal 0.037 and 336.8 plus/minus 2.8 Ma; and (3) rim zone-12 analyses: Th/U = 0.0150.038 (plus one analysis of 0.164) and 330.2 plus/minus 5.8 Ma. The U-Pb obtained ages are virtually concordant. Furthermore, two oscillatory zoned zircon cores (Th/U greater/equal to 0.8) yielded (~concordant) ages of ~400 Ma. Six SHRIMP analyses of monazites gave an age of 332.4 plus/minus 2.1 Ma. In addition, Pb, Th and U contents in monazite were analysed with an electron microprobe (EMP). A mean age of 324.7 plus/minus 8.0 (2σ) Ma was acquired from 113 analyses.By combining the defined ages with previously published P-T conditions, minimum velocities for burial and exhumation were estimated. In addition, we present a likely geodynamic scenario involving age data from the literature as well as this study: beginning 340 million years ago, gneisses at the base of a thickened continental crust (~1.8 GPa, 650C) were transported to depths of at least 130 km, possibly as deep as 250 km. Here they were heated (>1050C) and partially melted and as a result began to rise rapidly. The burial and subsequent ascent back to a depth of 50 km, where zircon rims and monazite formed, took only a few million years and perhaps significantly less

Grenville Skarn Titanite: Potential Reference Material for Sims U–Th–Pb Analysis

We have investigated the homogeneity, chemical composition, structure, degree of radiation damage, and post-formation evolution of titanite crystals from skarns of the Grenville Province of the Canadian Shield using SHRIMP, TIMS, Raman and PL spectroscopy, EBSD, and EPMA–WDS. These results are used to assess the potential of the titanite as Reference Material (RM) for micro-analytical U–Th–Pb age dating. The SHRIMP data show that these megacrysts (5–31g) have concordant U–Pb isotope systematics, 60 to 500 ppm U, 120 to 1200 ppm Th , 206Pb/204Pb between 500 and 2500, ages of ~1 Ga, and excellent homogeneity at the scale of the analytical volume of the ion probe. The ID–TIMS titanite data for OLT1, OLT2 and TCB show that these crystals are essentially concordant. Data for OLT1 and OLT2 show slight scatter (i.e., in excess of that expected from the uncertainty in an individual analysis). For OLT1, one of seven analyses shows Pb loss or, possibly, a younger period of growth. Crystals OLT1 and OLT2 have respective TIMS concordia ages of 1014.8 ± 2.0 Ma (2s, n = 6, MSWD = 1.8) and 998.0 ± 4.5 Ma (2s, n = 3, MSWD = 3.3) for domains that have not lost Pb.The TIMS analyses of TCB are tightly clustered and give a concordia age of 1018.1 ± 1.7 Ma (2s, n = 4, MSWD = 0.92). Raman and PL spectra show a low to moderate degree of accumulated radiation-induced damage in the Grenville Skarn Titanite crystals and uniform internal distributions of this damage. The EDSB contrast images indicate little or no crystallographic misorientation. The EMPA–WDS data show that the outer 50–100 mm of the OLT1 and TCB crystals are enriched in Al and F, and depleted in Fe and Nb, when compared with the interior. In spite of the variation in composition and degree of radiation damage amongst samples, there are no identifiable matrix effects in our SHRIMP data. Some Grenville skarn titanite (GST) crystals have potential as RM for micro-analytical U–Th–Pb age dating. Crystal TCB has excellent homogeneity of U–Th–Pb isotopic composition. Crystals OLT1 and OLT2 have minor TIMS age heterogeneity. However, this heterogeneity is smaller than that of the Khan titanite, our current in-house titanite standard. Careful selection of analysis areas during SIMS, and of chips for TIMS analysis, allows high-quality isotopic data to be obtained from these large crystals of titanite