Patients’ perceptions of physical activity before and after joint replacement: A systematic review with meta-ethnographic analysis

Background: It has been perceived that people following hip (THA) or knee arthroplasty (TKA) have the capability, with reduced pain, to increase their levels of physical activity. Objectives: To determine the attitudes and perceptions of people awaiting or having undergone THA or TKA to physical activity post-arthroplasty, and to identify potential facilitators or barriers to engage in active living and physical activity pursuits. Methods: Systematic review of published and unpublished databases was undertaken from their inception to November 2014. Studies exploring the attitudes and perceptions of people awaiting or having undergone THA or TKA to physical activity post-arthroplasty were included. Data was analysed through a meta-ethnography approach. Results: From 528 citations, 13 papers were eligibility, sampling 282 people post-THA or TKA. The literature was judged moderate to high quality. Following THA and TKA, people either wish to return to their pre-pathology level of physical activity or simply be able to engage in less physically demanding activities that are meaningful to them and their lifestyles. Barriers to engaging in higher levels of physical activity were largely related to limited information, which culminated in fear surrounding “doing the right thing” both for individual’s recovery and the longevity of the joint replacement. Conclusions: Whilst many people post-THA or TKA wish to return to pre-pathological physical activity status, there limited interest in actually undertaking greater levels of physical activity post-arthroplasty either for pleasure or health gains. Improvement in education and awareness of this may be key drivers to improve habitualisation of physical activity post-arthroplasty

Freedom and Mourning in "Charlotte Temple" and "The Coquette"

My thesis analyzes the expressions of feminine freedom as well as mourning in Charlotte Temple and The Coquette, two late 18th-century seduction novels. In my analysis, I examine two angles to understand how death functions in these texts. Specifically, I analyze how the heroines utilized their limited agency to navigate their disenfranchised social positions as well as how Christian themes intersect with women&rsquo;s rights, both in textual allusions and critiques. The heroines&rsquo; deaths at the end of the novels serve both as a cautionary &ldquo;punishment&rdquo; for their social transgressions and as an avenue for mourning &ldquo;fallen&rdquo; women who could not survive their own self-determination. By connecting freedom and death in these novels, I illustrate how these texts explored the precarious nuances of womanhood in the late 18th century.&nbsp;</p

Low False-Positive Rate of Kepler Candidates Estimated From A Combination Of Spitzer And Follow-Up Observations

(Abridged) NASA's Kepler mission has provided several thousand transiting planet candidates, yet only a small subset have been confirmed as true planets. Therefore, the most fundamental question about these candidates is the fraction of bona fide planets. Estimating the rate of false positives of the overall Kepler sample is necessary to derive the planet occurrence rate. We present the results from two large observational campaigns that were conducted with the Spitzer telescope during the the Kepler mission. These observations are dedicated to estimating the false positive rate (FPR) amongst the Kepler candidates. We select a sub-sample of 51 candidates, spanning wide ranges in stellar, orbital and planetary parameter space, and we observe their transits with Spitzer at 4.5 microns. We use these observations to measures the candidate's transit depths and infrared magnitudes. A bandpass-dependent depth alerts us to the potential presence of a blending star that could be the source of the observed eclipse: a false-positive scenario. For most of the candidates (85%), the transit depths measured with Kepler are consistent with the depths measured with Spitzer as expected for planetary objects, while we find that the most discrepant measurements are due to the presence of unresolved stars that dilute the photometry. The Spitzer constraints on their own yield FPRs between 5-40%, depending on the KOIs. By considering the population of the Kepler field stars, and by combining follow-up observations (imaging) when available, we find that the overall FPR of our sample is low. The measured upper limit on the FPR of our sample is 8.8% at a confidence level of 3 sigma. This observational result, which uses the achromatic property of planetary transit signals that is not investigated by the Kepler observations, provides an independent indication that Kepler's false positive rate is low.Comment: 33 pages, 16 figures, 3 tables; accepted for publication in ApJ on February 7, 201

Short-Term Outcomes in Elderly Patients with SARS-CoV-2 Infections Discharged from Community Hospitals

open access journalIntroduction: Clinical outcomes from very elderly hospitalised patients with SARS-COV-2 (Covid-19), are poor, with a reported in-patient mortality as high as 20%. Age, sex, comorbidities, ethnicity and deprivation have all been shown to correlate with worse outcomes in patients with Covid-19, however the outcomes of elderly hospitalised patients once discharged remains unknown. We looked at our cohort of very elderly patients treated within community hospital settings. Methods & Results: A retrospective case note analysis was undertaken within our 222 bedded community hospital structure during the first wave of the pandemic from April to August 2020. A total of 129 patients were treated during this period. The average age of the patients was 78.8 ± 2.7 years. In patient mortality was 11% (14 patients). 83% of patients were discharged from the hospitals. 27% were discharged to care home facilities. At 90 days, 83% of patients were still alive but a third of these patients were re-admitted into hospital with various different diagnoses. Conclusion: Elderly patients who survived Covid-19 infection and left hospital have a relatively high mortality rate in the short-term. Also connected with this is a high morbidity rate and therefore care must be directed within primary care to ensure that this group stay out of hospital

The mental health of NHS staff during the COVID-19 pandemic:Two-wave Scottish cohort study

Background: Health and social care workers (HSCWs) are at risk of experiencing adverse mental health outcomes (e.g. higher levels of anxiety and depression) because of the COVID-19 pandemic. This can have a detrimental effect on quality of care, the national response to the pandemic and its aftermath. Aims: A longitudinal design provided follow-up evidence on the mental health (changes in prevalence of disease over time) of NHS staff working at a remote health board in Scotland during the COVID-19 pandemic, and investigated the determinants of mental health outcomes over time. Method: A two-wave longitudinal study was conducted from July to September 2020. Participants self-reported levels of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7) and mental well-being (Warwick-Edinburgh Mental Well-being Scale) at baseline and 1.5 months later. Results: The analytic sample of 169 participants, working in community (43%) and hospital (44%) settings, reported substantial levels of depression and anxiety, and low mental well-being at baseline (depression, 30.8%; anxiety, 20.1%; well-being, 31.9%). Although mental health remained mostly constant over time, the proportion of participants meeting the threshold for anxiety increased to 27.2% at follow-up. Multivariable modelling indicated that working with, and disruption because of, COVID-19 were associated with adverse mental health changes over time. Conclusions: HSCWs working in a remote area with low COVID-19 prevalence reported substantial levels of anxiety and depression, similar to those working in areas with high COVID-19 prevalence. Efforts to support HSCW mental health must remain a priority, and should minimise the adverse effects of working with, and disruption caused by, the COVID-19 pandemic

Two Earth-sized planets orbiting Kepler-20

Since the discovery of the first extrasolar giant planets around Sun-like stars, evolving observational capabilities have brought us closer to the detection of true Earth analogues. The size of an exoplanet can be determined when it periodically passes in front of (transits) its parent star, causing a decrease in starlight proportional to its radius. The smallest exoplanet hitherto discovered has a radius 1.42 times that of the Earth's radius (R Earth), and hence has 2.9 times its volume. Here we report the discovery of two planets, one Earth-sized (1.03R Earth) and the other smaller than the Earth (0.87R Earth), orbiting the star Kepler-20, which is already known to host three other, larger, transiting planets. The gravitational pull of the new planets on the parent star is too small to measure with current instrumentation. We apply a statistical method to show that the likelihood of the planetary interpretation of the transit signals is more than three orders of magnitude larger than that of the alternative hypothesis that the signals result from an eclipsing binary star. Theoretical considerations imply that these planets are rocky, with a composition of iron and silicate. The outer planet could have developed a thick water vapour atmosphere.Comment: Letter to Nature; Received 8 November; accepted 13 December 2011; Published online 20 December 201

Evaluation of community-level interventions to increase early initiation of antenatal care in pregnancy: protocol for the Community REACH study, a cluster randomised controlled trial with integrated process and economic evaluations

BACKGROUND: The provision of high-quality maternity services is a priority for reducing inequalities in health outcomes for mothers and infants. Best practice includes women having their initial antenatal appointment within the first trimester of pregnancy in order to provide screening and support for healthy lifestyles, well-being and self-care in pregnancy. Previous research has identified inequalities in access to antenatal care, yet there is little evidence on interventions to improve early initiation of antenatal care. The Community REACH trial will assess the effectiveness and cost-effectiveness of engaging communities in the co-production and delivery of an intervention that addresses this issue. METHODS/DESIGN: The study design is a matched cluster randomised controlled trial with integrated process and economic evaluations. The unit of randomisation is electoral ward. The intervention will be delivered in 10 wards; 10 comparator wards will have normal practice. The primary outcome is the proportion of pregnant women attending their antenatal booking appointment by the 12th completed week of pregnancy. This and a number of secondary outcomes will be assessed for cohorts of women (n = approximately 1450 per arm) who give birth 2-7 and 8-13 months after intervention delivery completion in the included wards, using routinely collected maternity data. Eight hospitals commissioned to provide maternity services in six NHS trusts in north and east London and Essex have been recruited to the study. These trusts will provide anonymised routine data for randomisation and outcomes analysis. The process evaluation will examine intervention implementation, acceptability, reach and possible causal pathways. The economic evaluation will use a cost-consequences analysis and decision model to evaluate the intervention. Targeted community engagement in the research process was a priority. DISCUSSION: Community REACH aims to increase early initiation of antenatal care using an intervention that is co-produced and delivered by local communities. This pragmatic cluster randomised controlled trial, with integrated process and economic evaluation, aims to rigorously assess the effectiveness of this public health intervention, which is particularly complex due to the required combination of standardisation with local flexibility. It will also answer questions about scalability and generalisability. TRIAL REGISTRATION: ISRCTN registry: registration number 63066975 . Registered on 18 August 2015

Global selective sweep of a highly inbred genome of the cattle parasite Neospora caninum

Neospora caninum, a cyst-forming apicomplexan parasite, is a leading cause of neuromuscular diseases in dogs as well as fetal abortion in cattle worldwide. The importance of the domestic and sylvatic life cycles of Neospora, and the role of vertical transmission in the expansion and transmission of infection in cattle, is not sufficiently understood. To elucidate the population genomics of Neospora, we genotyped 50 isolates collected worldwide from a wide range of hosts using 19 linked and unlinked genetic markers. Phylogenetic analysis and genetic distance indices resolved a single genotype of N. caninum. Whole-genome sequencing of 7 isolates from 2 different continents identified high linkage disequilibrium, significant structural variation, but only limited polymorphism genome-wide, with only 5,766 biallelic single nucleotide polymorphisms (SNPs) total. Greater than half of these SNPs (∼3,000) clustered into 6 distinct haploblocks and each block possessed limited allelic diversity (with only 4 to 6 haplotypes resolved at each cluster). Importantly, the alleles at each haploblock had independently segregated across the strains sequenced, supporting a unisexual expansion model that is mosaic at 6 genomic blocks. Integrating seroprevalence data from African cattle, our data support a global selective sweep of a highly inbred livestock pathogen that originated within European dairy stock and expanded transcontinentally via unisexual mating and vertical transmission very recently, likely the result of human activities, including recurrent migration, domestication, and breed development of bovid and canid hosts within similar proximities

Masses, radii, and orbits of small Kepler planets : The transition from gaseous to rocky planets

We report on the masses, sizes, and orbits of the planets orbiting 22 Kepler stars. There are 49 planet candidates around these stars, including 42 detected through transits and 7 revealed by precise Doppler measurements of the host stars. Based on an analysis of the Kepler brightness measurements, along with high-resolution imaging and spectroscopy, Doppler spectroscopy, and (for 11 stars) asteroseismology, we establish low false-positive probabilities (FPPs) for all of the transiting planets (41 of 42 have an FPP under 1%), and we constrain their sizes and masses. Most of the transiting planets are smaller than three times the size of Earth. For 16 planets, the Doppler signal was securely detected, providing a direct measurement of the planet's mass. For the other 26 planets we provide either marginal mass measurements or upper limits to their masses and densities; in many cases we can rule out a rocky composition. We identify six planets with densities above 5 g cm-3, suggesting a mostly rocky interior for them. Indeed, the only planets that are compatible with a purely rocky composition are smaller than 2 R ⊕. Larger planets evidently contain a larger fraction of low-density material (H, He, and H2O).Peer reviewedFinal Accepted Versio