Barriers to uptake of the hip fracture core outcome set: an international survey of 80 hip fracture trialists.

Background: Core outcome sets are an agreed recommendation to inform the selection of outcome measures in clinical trials. There has been low uptake of the 2014 hip fracture core outcome set. The reasons for this remain unclear. The aim of this study was to understand the reasons for the non-adoption and approaches to increase adoption of the hip fracture core outcome set. Methods: Randomised controlled trials from PubMed (2017–2019) and ClinicalTrials.gov (2015–2019) were identified. Corresponding authors for each identified trial (n = 302) were surveyed using five questions on awareness of the hip fracture core outcome set, reasons for non-adoption and approaches to increase adoption. Data were analysed descriptively using frequencies, mean values and standard deviations. Results: Fifty-four percent of the respondents (n = 43) were aware of the concept of core outcome set. Only 15% (n = 12) based the outcome measure selection on the 2014 hip fracture core outcome set. Key reasons for non-adoption included the following: authors being unaware and perceived inappropriateness to their trial design. Eighty-six percent (n = 69) of respondents agreed to the need for increased awareness of core outcome sets through research training, academic and clinical journal requirements, and funding or publication stipulations. Eighty-eight percent (n = 70) of respondents indicated the current core outcome set required revision to focus on trials investigating people with cognitive impairment, caregivers, rehabilitation, surgical interventions and anaesthetic trial designs. Conclusion: Barriers to the adoption of the hip fracture core outcome set centre on education, awareness of the core outcome sets and applicability to the breath of hip fracture trial designs. Further consideration should be made to address these, to improve the harmonisation of outcome measures across hip fracture trials

Unprocessed Food Sustainability

This article shows the differences in sustainability of a diet consisting of unprocessed food or processed food. The effect on trophic levels was considered as well as economical, environmental, and social effects

Orientation and verbal fluency in the English Longitudinal Study of Ageing: modifiable risk factors for falls?

Objectives:To determine the relationship between falls and deficits in specific cognitive domains in older adults.Design:An analysis of the English Longitudinal Study of Ageing (ELSA) cohort.Setting:United Kingdom community-based.Participants:5197 community-dwelling older adults recruited to a prospective longitudinal cohort study.Measurements:Data on the occurrence of falls and number of falls, which occurred during a 12-month follow-up period, were assessed against the specific cognitive domains of memory, numeracy skills, and executive function. Binomial logistic regression was performed to evaluate the association between each cognitive domain and the dichotomous outcome of falls in the preceding 12 months using unadjusted and adjusted models.Results:Of the 5197 participants included in the analysis, 1308 (25%) reported a fall in the preceding 12 months. There was no significant association between the occurrence of a fall and specific forms of cognitive dysfunction after adjusting for self-reported hearing, self-reported eyesight, and functional performance. After adjustment, only orientation (odds ratio [OR]: 0.80; 95% confidence intervals [CI]: 0.65-0.98, p = 0.03) and verbal fluency (adjusted OR: 0.98; 95% CI: 0.96-1.00; p = 0.05) remained significant for predicting recurrent falls.Conclusions:The cognitive phenotype rather than cognitive impairment per se may predict future falls in those presenting with more than one fall

The Orbit of the Companion to HD 100453A: Binary-Driven Spiral Arms in a Protoplanetary Disk

HD 100453AB is a 10+/-2 Myr old binary whose protoplanetary disk was recently revealed to host a global two-armed spiral structure. Given the relatively small projected separation of the binary (1.05", or ~108 au), gravitational perturbations by the binary seemed to be a likely driving force behind the formation of the spiral arms. However, the orbit of these stars remained poorly understood, which prevented a proper treatment of the dynamical influence of the companion on the disk. We observed HD 100453AB between 2015-2017 utilizing extreme adaptive optics systems on the Very Large Telescope and Magellan Clay Telescope. We combined the astrometry from these observations with published data to constrain the parameters of the binary's orbit to a=1.06"+/-0.09", e=0.17+/-0.07, and i=32.5+/- 6.5 degrees. We utilized publicly available ALMA CO data to constrain the inclination of the disk to i~28 degrees, which is relatively co-planar with the orbit of the companion and consistent with previous estimates from scattered light images. Finally, we input these constraints into hydrodynamical and radiative transfer simulations to model the structural evolution of the disk. We find that the spiral structure and truncation of the circumprimary disk in HD 100453 are consistent with a companion-dirven origin. Furthermore, we find that the primary star's rotation, its outer disk, and the companion exhibit roughly the same direction of angular momentum, and thus the system likely formed from the same parent body of material.Comment: 28 pages, 11 figures, Accepted to Ap

Barriers and facilitators of weight bearing after hip fracture surgery among older adults. A scoping review

PURPOSE: This scoping review aimed to synthesise the available evidence on barriers and facilitators of weight bearing after hip fracture surgery in older adults. METHODS: Published (Cochrane Central, MEDLINE, EMBASE, CINAHL, and PEDro) and unpublished (Global Health, EThOS, WorldCat dissertation and thesis, ClinicalTrials.gov , OpenAIRE, DART-Europe) evidence was electronically searched from database inception to 29 March 2022. Barriers and facilitators of weight bearing were extracted and synthesised into patient, process (non-surgical), process (surgical), and structure-related barriers/facilitators using a narrative review approach. RESULTS: In total, 5594 were identified from the primary search strategy, 1314 duplicates were removed, 3769 were excluded on title and abstract screening, and 442 were excluded on full-text screening. In total, 69 studies (all from published literature sources) detailing 47 barriers and/or facilitators of weight bearing were included. Of barriers/facilitators identified, 27 were patient-, 8 non-surgical process-, 8 surgical process-, and 4 structure-related. Patient facilitators included anticoagulant, home discharge, and aid at discharge. Barriers included preoperative dementia and delirium, postoperative delirium, pressure sores, indoor falls, ventilator dependence, haematocrit < 36%, systemic sepsis, and acute renal failure. Non-surgical process facilitators included early surgery, early mobilisation, complete medical co-management, in-hospital rehabilitation, and patient-recorded nurses' notes. Barriers included increased operative time and standardised hip fracture care. Surgical process facilitators favoured intramedullary fixations and arthroplasty over extramedullary fixation. Structure facilitators favoured more recent years and different healthcare systems. Barriers included pre-holiday surgery and admissions in the first quarter of the year. CONCLUSION: Most patient/surgery-related barriers/facilitators may inform future risk stratification. Future research should examine additional process/structure barriers and facilitators amenable to intervention. Furthermore, patient barriers/facilitators need to be investigated by replicating the studies identified and augmenting them with more specific details on weight bearing outcomes

Normothermic versus hypothermic cardiopulmonary bypass in children undergoing open heart surgery (thermic-2):study protocol for a randomized controlled trial

BACKGROUND: During open heart surgery, patients are connected to a heart-lung bypass machine that pumps blood around the body (“perfusion”) while the heart is stopped. Typically the blood is cooled during this procedure (“hypothermia”) and warmed to normal body temperature once the operation has been completed. The main rationale for “whole body cooling” is to protect organs such as the brain, kidneys, lungs, and heart from injury during bypass by reducing the body’s metabolic rate and decreasing oxygen consumption. However, hypothermic perfusion also has disadvantages that can contribute toward an extended postoperative hospital stay. Research in adults and small randomized controlled trials in children suggest some benefits to keeping the blood at normal body temperature throughout surgery (“normothermia”). However, the two techniques have not been extensively compared in children. OBJECTIVE: The Thermic-2 study will test the hypothesis that the whole body inflammatory response to the nonphysiological bypass and its detrimental effects on different organ functions may be attenuated by maintaining the body at 35°C-37°C (normothermic) rather than 28°C (hypothermic) during pediatric complex open heart surgery. METHODS: This is a single-center, randomized controlled trial comparing the effectiveness and acceptability of normothermic versus hypothermic bypass in 141 children with congenital heart disease undergoing open heart surgery. Children having scheduled surgery to repair a heart defect not requiring deep hypothermic circulatory arrest represent the target study population. The co-primary clinical outcomes are duration of inotropic support, intubation time, and postoperative hospital stay. Secondary outcomes are in-hospital mortality and morbidity, blood loss and transfusion requirements, pre- and post-operative echocardiographic findings, routine blood gas and blood test results, renal function, cerebral function, regional oxygen saturation of blood in the cerebral cortex, assessment of genomic expression changes in cardiac tissue biopsies, and neuropsychological development. RESULTS: A total of 141 patients have been successfully randomized over 2 years and 10 months and are now being followed-up for 1 year. Results will be published in 2015. CONCLUSIONS: We believe this to be the first large pragmatic study comparing clinical outcomes during normothermic versus hypothermic bypass in complex open heart surgery in children. It is expected that this work will provide important information to improve strategies of cardiopulmonary bypass perfusion and therefore decrease the inevitable organ damage that occurs during nonphysiological body perfusion. TRIAL REGISTRATION: ISRCTN Registry: ISRCTN93129502, http://www.isrctn.com/ISRCTN93129502 (Archived by WebCitation at http://www.webcitation.org/6Yf5VSyyG)

Predicting consistent foraging ecologies of migrating waterbirds: Using stable isotope and parasite measurements as indicators of landscape use

The emergence of novel human pathogens is frequently linked with zoonotic events and human-wildlife interactions that promote disease transmission. Consequently, surveillance of wildlife populations for candidate diseases that could spread to humans is beneficial, but requires widespread collections of numerous samples. A legitimate means to acquire large sample sizes of waterfowl is through cooperation between researchers and hunters, who also work in concert with natural resource managers, landowners, and agricultural entities -e.g., aquaculture facilities. In addition to understanding the occurrence and spread of parasites and pathogens by birds, these samples can be used to answer questions about the ecology of various waterbird species. Body mass and morphometric data on hunter-donated specimen are useful for understanding bird condition and other dynamics of birds; however, when breast meat is removed prior to the acquisition of specimen weight, samples might not be as desirable. Here, we evaluate the utility of data obtained from a bird species that might be targeted by hunters and subsequently used to learn about their disease dynamics. Lesser Scaup (Aythya affinis) collected at aquaculture facilities were assessed for their stable isotope concentrations and parasites communities to learn about the birds’ foraging ecology. Discriminant analyses designed to classify birds by the aquaculture pond type from which they were collected included isotope data, Principal Components derived from parasite community data of 7 types, and birds’ body mass. We compared these to Double-crested Cormorants (Nannopterum auritum) feeding on catfish and found the two waterbird species exhibited different infracommunities of parasites Furthermore, some scaup demonstrated fish aquaculture pond type fidelity. Bird body mass was an important metric to include in analytical models when all parasite datatypes were not available. However, the combination of stable isotope concentrations and parasite infracommunity data (that includes prevalence, abundance, volume, and energy use) in models resulted in host ecology differentiation equal or better than models where bird body mass was included. Hunter-derived samples should be encouraged as a means for sample acquisition and be considered as an approach for aquaculture-wildlife conflict management as the information that can be obtained through these samples is multifaceted