Effect of preoperative neuromuscualr training (NEMEX-TJR) on functional outcome after total knee replacement : an assessor-blinded randomized controlled trial

Background: Improving functional status preoperatively through exercise may improve postoperative outcome. Previous knowledge on preoperative exercise in knee osteoarthritis is insufficient. The aim of the study was to compare the difference in change between groups in lower extremity function from baseline to 3 months after Total Knee Replacement (TKR) following a neuromuscular exercise programme (NEMEX-TJR) plus a knee school educational package (KS) or KS alone. Methods: 45 patients (55-83 years, 53% male, waiting for TKR) were randomized to receive a minimum of 8 sessions of NEMEXTJR plus 3 sessions of KS or 3 sessions of KS alone. Function was assessed with the Chair Stand Test (CST, primary endpoint) and the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales focusing on daily living function (ADL) and pain (secondary endpoints). Assessments were performed immediately before and after the intervention, and at 6 weeks, 3 months and 12 months after surgery by a physiotherapist, blinded to group allocation. Results: After intervention before surgery we observed a small improvement for primary and secondary endpoints in both groups, which did not differ significantly between groups: comparing the exercise to the control group the treatment effect for the CST was -1.5 seconds (95% CI: -5.3, 2.2), for KOOS ADL and KOOS pain the treatment effect was 1.3 points (-10.1, 12.8) and -2.3 (-12.4, 7.9) respectively. At 3 months after surgery we observed a small improvement in the primary endpoint in the control group and a significant improvement in the secondary endpoints in both exercise and control groups, which did not differ significantly between groups: comparing the exercise group to the control group the treatment effect in the CST was 2.0 seconds (-1.8, 5.8), for KOOS ADL and KOOS pain the treatment effect was -4.9 points (-16.3, 6.5) and -3.3 points (-13.5, 6.8) respectively. Conclusions: A median (IQR) of 10 (8, 14) exercise sessions before surgery showed an additional small but non-significant improvement in all functional assessments compared to patient education alone. These benefits were not sustained after TKR. Our trial doesn't give a conclusive answer to whether additional preoperative exercise on postoperative functional outcomes is beneficial

Professional Behavior Attributes: A Survey of Occupational Therapy Faculty Perspectives

Professionalism in occupational therapy has been challenging to define due to differing values and behaviors across contexts and professions. There is a difference between how occupational therapy students and faculty view and comprehend professionalism suggesting that occupational therapists may not have an established sense of professionalism when entering the health care field for the first time. The study\u27s purpose was to examine occupational therapy faculty’s perceptions of essential professional behavior attributes that students should possess to succeed in occupational therapy practice. This study utilized a survey methodology to anonymously collect opinions from 150 occupational therapy faculty members across the United States regarding professional behavior attributes essential for entry-level occupational therapy education. Researchers found that the five most frequently observed professional behavior attributes in occupational therapy students were empathy, enthusiasm, being personable, having a positive attitude, and responsibility. The top seven most important professional behavior attributes were being clinically competent and ethical, having communication and interpersonal skills, and being adaptable, responsible, and empathetic. The results of this study indicate that occupational therapy faculty perceive that many vital attributes contribute to professionalism within the occupational therapy field and that teaching professionalism is an integral part of occupational therapy education. This study contributes to the current literature of defining professionalism within occupational therapy to better equip occupational therapy students entering into practice

Added value of combined acromiohumeral distance and critical shoulder angle measurements on conventional radiographs for the prediction of rotator cuff pathology

Purpose: To investigate the role of acromiohumeral distance (AHD) and critical shoulder angle (CSA) measurements from conventional radiographs (CR) in isolation and combined (prognostic index PIAHD-CSA) as predictors of full thickness rotator cuff tendon tears (RCT) and critical fatty degeneration (CFD; i.e. as much fat as muscle). Method: In this retrospective study AHD and CSA were measured in 127 CR. MR arthrograms served as reference standard and were screened for RCT and CFD. Statistical analysis for inter-reader agreement, Spearman's rank correlation, linear stepwise regression and logistic regression for AHD and CSA with ROC analyses including PIAHD-CSA were performed. Results: In 90 subjects (17 females, mean age 36.1 ± 14.1) no RCT were found on MR imaging and served as control group. In 37 patients (13 females, mean age 58.7 ± 13.2) ≥ one RCT was found. Inter-reader agreements rated between к = 0.42-0.82 for categorical and 0.91-0.96 for continuous variables. No significant correlation of AHD and CSA with either age or sex was seen (p = 0.28 and p = 0.74, respectively). Case group had significantly smaller mean AHD (8.7 ± 3.2 vs. 10.8 ± 2.2 mm; p < 0.001) and larger mean CSA (36.5 ± 4.5° vs. 33.1 ± 4.0°; p < 0.001). PIAHD-CSA increased diagnostic performance for prediction of RCT and CFD (AUC = 0.78 and 0.71), compared to isolated AHD (0.74 and 0.71) and CSA (0.71 and 0.66). Conclusions: AHD and CSA do not depend on age or sex but differ significantly between healthy and pathologic rotator cuffs. A decreased AHD is most influenced by infraspinatus muscle atrophy and fatty degeneration. Combined PIAHD-CSA increases diagnostic performance for predicting RCT and CFD. Keywords: Acromiohumeral distance; Conventional radiography; Critical shoulder angle; Fatty degeneration; Magnetic resonance arthrography; Magnetic resonance imaging; Rotator cuff tear

Does the conservative non-pharmacological management of knee osteoarthritis in Switzerland reflect the clinical guidelines? : a survey among general practitioners, rheumatologists, and orthopaedic surgeons

Introduction: The International Guidelines recommend exercise, education and weight management (if appropriate) as the first-line conservative treatment for patients with knee osteoarthritis (OA) to enhance their self-management. The aim of this study was to investigate the current state of conservative non-pharmacological management of patients with knee OA in Switzerland and to explore the perceived barriers and facilitators to the application of the guideline recommendations. Materials and methods: Eleven semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons were performed. Based on these results, an online survey was developed and sent to the members of three scientific medical societies. Questions addressed the frequency of diagnostic measures, treatment options, reasons for referral to exercise and also barriers and facilitators. Results: A total of 234 members responded. They indicated that patients normally present due to pain (n = 222, 98.2%) and functional limitations of the knee (n = 151, 66.8%). In addition to clinical assessment, X-ray (n = 214, 95.5%) and MRI (n = 70, 31.3%) were the most frequently used diagnostic measures. Treatment options usually involved patient education for diagnosis (n = 223, 98.6%) and suitable activities (n = 217, 96%), pharmacological treatment (n = 203, 89.8%) and referral to physiotherapy (n = 188, 83.2%). The participants estimated that they had referred 54% of their patients with knee OA for a specific exercise. The referral to exercise was driven by “patient expectation/high level of suffering” (n = 73, 37.1%) and their “own clinical experience” (n = 49, 24.9%). The specialists rated the most important barriers to referral to exercise as “disinterest of patient” (n = 88, 46.3%) and “physically active patient” (n = 59, 31.1%). As the most important facilitators, they rated “importance to mention exercise despite the short time of consultation” (n = 170, 89.4%) and “insufficiently physically active patient” (n = 165, 86.9%). Discussion: A substantial evidence–performance gap in the management of patients with knee OA appears to exist in Switzerland. For the systematic referral to exercise as the first-line intervention, it might be useful for medical doctors to suggest a structured exercise programme to patients with knee OA, rather than just advising general exercise

Real-space nanophotonic field manipulation using non-perturbative light–matter coupling

The achievement of large values of the light–matter coupling in nanoengineered photonic structures can lead to multiple photonic resonances contributing to the final properties of the same hybrid polariton mode. We develop a general theory describing multi-mode light–matter coupling in systems of reduced dimensionality, and we explore their phenomenology, validating our theory’s predictions against numerical electromagnetic simulations. On one hand, we characterize the spectral features linked with the multi-mode nature of the polaritons. On the other hand, we show how the interference between different photonic resonances can modify the real-space shape of the electromagnetic field associated with each polariton mode. We argue that the possibility of engineering nanophotonic resonators to maximize multi-mode mixing, and to alter the polariton modes via applied external fields, could allow for the dynamical real-space tailoring of subwavelength electromagnetic fields

Digitalisation anxiety: development and validation of a new scale

&lt;jats:title&gt;Abstract&lt;/jats:title&gt;&lt;jats:p&gt;The increasing spread of digital technologies and respective consequences for the way we live, work, and communicate can evoke feelings of tension and discomfort. This so-called digitalisation anxiety is related to existing and future technologies, includes the process of digitalisation in everyday life, and refers to multiple levels (the individual, organisations, and society). Existing scales measuring technology-related fears due not adequately reflect these features. Therefore, we developed the German version of the Digitalisation Anxiety Scale (DAS). Having generated items based on a qualitative interview study (Study 1, n = 26), we demonstrated the DAS’s factor structure, internal consistency and construct validity in Study 2a (n = 109) and test-retest reliability in Study 2b (n = 30). In Study 3 (n = 223), the scale’s structure was confirmed and correlates of digitalisation anxiety were examined. The final version of the DAS consists of 35 items with a four-factor structure (societal triggers for digitalisation anxiety, triggers related to interaction and leadership, triggers within oneself and triggers resulting from the digitalisation implementation process). Digitalisation Anxiety had negative relationships with well-being and performance. The scale allows practitioners and researchers to measure and benchmark individuals’ levels of digitalisation anxiety, and to track changes over time. The scale can inform interventions aiming at reducing digitalisation anxiety and stress resulting from digitalisation. &lt;/jats:p&gt

Long-term leukocyte reconstitution in NSG mice transplanted with human cord blood hematopoietic stem and progenitor cells

Abstract Background Humanized mice (hu mice) are based on the transplantation of hematopoietic stem and progenitor cells into immunodeficient mice and have become important pre-clinical models for biomedical research. However, data about their hematopoiesis over time are scarce. We therefore characterized leukocyte reconstitution in NSG mice, which were sublethally irradiated and transplanted with human cord blood-derived CD34+ cells at newborn age, longitudinally in peripheral blood and, for more detailed analyses, cross-sectionally in peripheral blood, spleen and bone marrow at different time points. Results Human cell chimerism and absolute human cell count decreased between week 16 and 24 in the peripheral blood of hu mice, but were stable thereafter as assessed up to 32 weeks. Human cell chimerism in spleen and bone marrow was maintained over time. Notably, human cell chimerism in peripheral blood and spleen as well as bone marrow positively correlated with each other. Percentage of B cells decreased between week 16 and 24, whereas percentage of T cells increased; subsequently, they levelled off with T cells clearly predominating at week 32. Natural killer cells, monocytes and plasmacytoid dendritic cells (DCs) as well as CD1c + and CD141+ myeloid DCs were all present in hu mice. Proliferative responses of splenic T cells to stimulation were preserved over time. Importantly, the percentage of more primitive hematopoietic stem cells (HSCs) in bone marrow was maintained over time. Conclusions Overall, leukocyte reconstitution was maintained up to 32 weeks post-transplantation in our hu NSG model, possibly explained by the maintenance of HSCs in the bone marrow. Notably, we observed great variation in multi-lineage hematopoietic reconstitution in hu mice that needs to be taken into account for the experimental design with hu mice