Curated ACUE Reflections

This curated set of ACUE reflections provides insight into the pedagogical skills learned through the ACUE program offered through the TRC at CSUSB. This set of reflections highlights the teaching techniques and skills implemented during the fall 2019 and winter 2020 terms. The techniques include “Implement practices that support student success: Focus on learning,” “Send motivational messages,” “Connect learning to career and other long term goals,” and “Implement classroom or online assessment techniques to obtain responses from your entire class: Analyze student responses for patterns to inform your teaching.” Overall, the ACUE techniques worked to improve the level of instruction in my courses, elicited actionable student feedback of instruction and learning, and helped me build stronger connections with students

Do Older Adults with Low Muscle Mass or Strength, in the Presence of Obesity, Have an Increased Risk of Joint Replacement Over 13 Years?

This study aims to assess whether older adults with low muscle mass or strength, in the presence of obesity, have an increased risk of knee (TKR) and hip replacement (THR) over 13 years. 1082 community-dwelling older adults (51% women; mean age 62.9 - 7.5 years) were studied at baseline and multiple time points over 13 years. The incidence of TKR and THR was determined by data linkage to National Joint Replacement Registry. Appendicular lean and fat mass were measured using DXA. Lower-limb muscle strength (LMS) was assessed by dynamometer. Low muscle mass and strength were defined as the lowest sex-specific tertiles for appendicular lean mass (adjusted for height and total body fat mass) and lower-limb strength, respectively. Obesity was defined as the highest sex-specific tertile for total body fat mass. Competing risk regres- sion models were used to estimate the sub-distribution hazard ratio (SHR) for TKR and THR. Over 13 years of follow-up, 6.8% (n = 74/1082) of the participants had a TKR and 4.7% (n = 50/1066) had THR. Participants with the combination of obesity and low muscle strength (SHR 3.36, 95% CI 1.50, 7.53) but low muscle mass (SHR 1.11, 95% CI 0.52, 2.40) had a significantly increased risk of TKR, compared to individuals with neither obesity nor low muscle mass/strength. However, obesity with low muscle strength did not lead to a significantly greater risk of TKR compared to having low muscle strength or obesity alone. There was no evidence for an association between obesity with low muscle mass or strength and THR (all p > 0.05). This finding suggests that combining muscle and fat assessments to predict the future risk of TKR is no better than each condition on its own.This work was supported by the National Health and Medical Research Council of Australia (302204); Arthritis Foundation of Australia (MRI06161); Royal Hobart Hospital Research Foundation; and Tasmanian Community Fund (D0015018). SB is supported by the Australian Rheumatology Association and the Farrell Family research fellowship. DS, GJ and DA are supported by the National Health and Medical Research Council of Australia Fellowships

Mortality and implant survival with simultaneous and staged bilateral total knee arthroplasty experience from the Australian Orthopaedic Association National Joint Replacement Registry

BACKGROUND: Total knee arthroplasty (TKA) is an effective procedure for relieving pain and restoring function in osteoarthritis, with a significant proportion of patients having severe disease bilaterally. However, although there are differences in patient selection criteria for bilateral procedures, there is no consensus regarding the optimal timing for bilateral TKA. The aim of this study was to compare rates and causes of revision and 30-day mortality between simultaneous and staged bilateral TKA using data from the Australian Orthopaedic Association National Joint Replacement Registry. METHODS: Data for over 36,000 bilateral TKAs were collected from September 1999 to December 2015. Rates and causes of revision and 30-day mortality rates were obtained for simultaneous bilateral and staged procedures with intervals of 1 day-6 weeks, 6 weeks-3 months, and 3-6 months. Yearly cumulative percent revision or cumulative percent survival with 95% confidence intervals calculated using the Kaplan-Meier method and adjusted hazard ratios were used for comparisons. RESULTS: There was no significant difference between revision rates or reasons for revision between staged bilateral and simultaneous TKA (hazard ratio 1.09 [95% confidence interval {CI} 0.85-1.40; P = .511] for 1 day-6 weeks, 0.93 [95% CI 0.77-1.14; P = .494] for 6 weeks-3 months, and 1.10 [95% CI 0.98-1.23; P = .115] for 3-6 months). The most common reasons for revision were loosening/lysis and infection. The 30-day mortality rates were lower in the 6 weeks-3 months group than simultaneous bilaterals (P = .007). CONCLUSION: This study demonstrates that simultaneous and staged bilateral TKA have similar rates of revision over the medium term but that 30-day mortality is reduced in the 6 weeks-3 months group

Predictors of total hip replacement in community based older adults : a cohort study

This work was supported by the National Health and Medical Research Council of Australia (NHMRC Grant ID – 302204); Tasmanian Community Fund (Grant ID – D0015018); Masonic Centenary Medical Research Foundation; Royal Hobart Hospital Research Foundation; Arthritis Foundation of Australia (Grant ID – MRI06161); and University of Tasmania institutional research grants scheme (D0015019). The study sponsor had no role in the design of the study; the collection, analysis, and interpretation of the data; or the writing of the article and the decision to submit it for publication. Laura Laslett is supported by a National Health and Medical Research Council of Australia Early Career Fellowship (1070586). Graeme Jones is supported by a NHMRC Practitioner Fellowship (1023222).Peer reviewedPostprin

Galactic populations of radio and gamma-ray pulsars in the polar cap model

We simulate the characteristics of the Galactic population of radio and $\gamma$-ray pulsars using Monte Carlo techniques. At birth, neutron stars are spatially distributed in the Galactic disk, with supernova-kick velocities, and randomly dispersed in age back to $10^9$ years. They are evolved in the Galactic gravitational potential to the present time. From a radio luminosity model, the radio flux is filtered through a selected set of radio-survey parameters. $\gamma$-ray luminosities are assigned using the features of recent polar cap acceleration models invoking space-charge-limited flow, and a pulsar death valley further attenuates the population of radio-loud pulsars. Assuming a simple emission geometry with aligned radio and $\gamma$-ray beams of 1 steradian solid angle, our model predicts that EGRET should have seen 7 radio-loud and 1 radio-quiet, $\gamma$-ray pulsars. With much improved sensitivity, GLAST, on the other hand, is expected to observe 76 radio-loud and 74 radio-quiet, $\gamma$-ray pulsars of which 7 would be identified as pulsed sources. We also explore the effect of magnetic field decay on the characteristics of the radio and $\gamma$-ray pulsar populations. Including magnetic field decay on a timescale of 5 Myr improves agreement with the radio pulsar population and increases the predicted number of GLAST detected pulsars to 90 radio-loud and 101 radio-quiet (9 pulsed) $\gamma$-ray pulsars. The lower flux threshold allows GLAST to detect $\gamma$-ray pulsars at larger distances than those observed by the radio surveys used in this study.Comment: 38 pages, 11 figures, accepted for publication v565 n1 Ap

Associations between socioeconomic status and primary total knee joint replacements performed for osteoarthritis across Australia 2003-10: data from the Australian Orthopaedic Association National Joint Replacement Registry

Relatively little is known about the social distribution of total knee joint replacement (TKR) uptake in Australia. We examine associations between socioeconomic status (SES) and TKR performed for diagnosed osteoarthritis 2003-10 for all Australian males and females aged ≥30 yr

Meta-analysis of individual registry results enhances international registry collaboration

Background and purpose — Although common in medical research, meta-analysis has not been widely adopted in registry collaborations. A meta-analytic approach in which each registry conducts a standardized analysis on its own data followed by a meta-analysis to calculate a weighted average of the estimates allows collaboration without sharing patient-level data. The value of meta-analysis as an alternative to individual patient data analysis is illustrated in this study by comparing the risk of revision of porous tantalum cups versus other uncemented cups in primary total hip arthroplasties from Sweden, Australia, and a US registry (2003–2015).Patients and methods — For both individual patient data analysis and meta-analysis approaches a Cox proportional hazard model was fit for time to revision, comparing porous tantalum (n = 23,201) with other uncemented cups (n = 128,321). Covariates included age, sex, diagnosis, head size, and stem fixation. In the meta-analysis approach, treatment effect size (i.e., Cox model hazard ratio) was calculated within each registry and a weighted average for the individual registries’ estimates was calculated.Results — Patient-level data analysis and meta-analytic approaches yielded the same results with the porous tantalum cups having a higher risk of revision than other uncemented cups (HR (95% CI) 1.6 (1.4–1.7) and HR (95% CI) 1.5 (1.4–1.7), respectively). Adding the US cohort to the meta-analysis led to greater generalizability, increased precision of the treatment effect, and similar findings (HR (95% CI) 1.6 (1.4–1.7)) with increased risk of porous tantalum cups.Interpretation — The meta-analytic technique is a viable option to address privacy, security, and data ownership concerns allowing more expansive registry collaboration, greater generalizability, and increased precision of treatment effects.</p

The changing climates of global health.

The historical trajectories of three crises have converged in the 2020s: the COVID-19 pandemic, rising inequality and the climate crisis. Global health as an organising logic is being transformed by the COVID-19 pandemic. We point to an emerging consensus that the triple threats of global heating, zoonoses and worsening, often racialised inequalities, will need to be met by models of cooperation, equitable partnership and accountability that do not sustain exploitative logic of economic growth. Health governance is challenged to reconsider sustainability and justice in terms of how local and global, domestic and transnational, chronic and infectious, human and non-human are interdependent. In this article, we discuss their intersection and suggest that a new set of organising ideals, institutions and norms will need to emerge from their conjunction if a just and liveable world is to remain a possibility for humans and their cohabitants. Future health governance will need to integrate pandemic preparedness, racial justice, inequality and more-than-human life in a new architecture of global health. Such an agenda might be premised on solidarities that reach across national, class, spatial and species divisions, acknowledge historical debts and affirm mutual interdependencies

UNBOUND

UNBOUND showcases the graduating class from the fashion design school at Fanshawe College.https://first.fanshawec.ca/famd_design_fashiondesign_unbound/1007/thumbnail.jp

Low Vitamin B12 levels among newly-arrived refugees from Bhutan, Iran and Afghanistan: a multicentre Australian study

Extent: 6p.Background: Vitamin B12 deficiency is prevalent in many countries of origin of refugees. Using a threshold of 5% above which a prevalence of low Vitamin B12 is indicative of a population health problem, we hypothesised that Vitamin B12 deficiency exceeds this threshold among newly-arrived refugees resettling in Australia, and is higher among women due to their increased risk of food insecurity. This paper reports Vitamin B12 levels in a large cohort of newly arrived refugees in five Australian states and territories. Methods: In a cross-sectional descriptive study, we collected Vitamin B12, folate and haematological indices on all refugees (n = 916; response rate 94% of eligible population) who had been in Australia for less than one year, and attended one of the collaborating health services between July 2010 and July 2011. Results: 16.5% of participants had Vitamin B12 deficiency (<150 pmol/L). One-third of participants from Iran and Bhutan, and one-quarter of participants from Afghanistan had Vitamin B12 deficiency. Contrary to our hypothesis, low Vitamin B12 levels were more prevalent in males than females. A higher prevalence of low Vitamin B12 was also reported in older age groups in some countries. The sensitivity of macrocytosis in detecting Vitamin B12 deficiency was only 4.6%. Conclusion: Vitamin B12 deficiency is an important population health issue in newly-arrived refugees from many countries. All newly-arrived refugees should be tested for Vitamin B12 deficiency. Ongoing research should investigate causes, treatment, and ways to mitigate food insecurity, and the contribution of such measures to enhancing the health of the refugee communities.Jill Benson, Christine Phillips, Margaret Kay, Murray T. Webber, Alison J. Ratcliff, Ignacio Correa-Velez, Michelle F. Lorime