Telephone-based weight loss support for patients with knee osteoarthritis: a pragmatic randomised controlled trial.

OBJECTIVE: To determine the effectiveness of telephone-based weight loss support in reducing the intensity of knee pain in patients with knee osteoarthritis, who are overweight or obese, compared to usual care. DESIGN: We conducted a parallel randomised controlled trial (RCT), embedded within a cohort multiple RCT of patients on a waiting list for outpatient orthopaedic consultation at a tertiary referral hospital in NSW, Australia. Patients with knee osteoarthritis, classified as overweight or obese [body mass index (BMI) between ≥27 kg/m2 and <40 kg/m2] were randomly allocated to receive referral to an existing non-disease specific government funded 6-month telephone-based weight management and healthy lifestyle service or usual care. The primary outcome was knee pain intensity measured using an 11-point numerical rating scale (NRS) over 6-month follow-up. A number of secondary outcomes, including self-reported weight were measured. Data analysis was by intention-to-treat according to a pre-published analysis plan. RESULTS: Between May 19 and June 30 2015, 120 patients were randomly assigned to the intervention (59 analysed, one post-randomisation exclusion) or usual care (60 analysed). We found no statistically significant between group differences in pain intensity [area under the curve (AUC), mean difference 5.4, 95%CI: -13.7 to 24.5, P = 0.58] or weight change at 6 months (self-reported; mean difference -0.4, 95%CI: -2.6 to 1.8, P = 0.74). CONCLUSIONS: Among patients with knee osteoarthritis who are overweight, telephone-based weight loss support, provided using an existing 6-month weight management and healthy lifestyle service did not reduce knee pain intensity or weight, compared with usual care. TRIAL REGISTRATION NUMBER: ACTRN12615000490572.

Day care and illness: evidence, cost, and public policy.

Parents, pediatricians, social scientists, and policymakers have become increasingly concerned that infants and children in day care, especially those younger than 3 years of age, are at risk for morbidity associated with several types of acute illness. We have examined the empirical evidence on the impact of day-care attendance on frequency of respiratory illnesses, diarrhea, hepatitis A, meningitis, and cytomegalovirus disease in children, day-care staff, and household contacts. The short- and long-term costs of day-care-associated illnesses were assessed, wherever possible within a benefit-cost framework. Available evidence suggests that children in day care, and sometimes their teachers and household contacts, have higher rates of diarrhea, hepatitis A, meningitis, and possible otitis media than children not in day care. There is only weak or moderate evidence that children and their families are at risk for high rates of respiratory illness (other than otitis media) or cytomegalovirus infection. Taken together, the excess of these illnesses among children in day care may impose moderate net costs on families and on society. Revisions of state regulatory policy regarding health practices in day care and policy initiatives designed to provide parents with more information and authority are recommended to protect the health and development of children in day care.

Use of carbon fibers for repair of abdominal-wall defects in rats.

Carbon in the form of 8-micron fibers induces growth of connective tissue. The purpose of this study was to measure and histologically characterize tissue ingrowth occurring in carbon fibers implanted for up to 12 months in abdominal-wall defects in rats, compared with polypropylene mesh. Carbon fibers induced significantly more tissue ingrowth than polypropylene mesh at 6 to 12 months postoperatively. The predominant tissues associated with carbon fibers and polypropylene mesh were dense connective tissue and fat, respectively. Fragmentation of the implants did not occur, and implant debris was not found in the regional lymph nodes. Carbon fibers are potentially useful for reinforcing abdominal-wall defects.

Intramural leiomyoma during pregnancy becoming pedunculated postpartally. A case report.

BACKGROUND: The natural history of uterine leiomyomas during pregnancy has been reported. CASE: A 39-year-old primigravida presented with vaginal spotting in the 10th week of pregnancy. Ultrasonic evaluation revealed a large intramural leiomyoma. Unsuccessful tocolysis at 25 weeks' gestation resulted in a cesarean section for breech presentation. At hysterotomy a 10-cm intramural leiomyoma was found in the right fundus and was left in situ. Six months later, at open laparotomy for myomectomy, the 10-cm leiomyoma was pedunculated, on a 4-cm stalk. CONCLUSION: Large intramural leiomyomas found at cesarean section may become pedunculated postpartally, thus making myomectomy easier and safer at a postpartum intervention than at the time of cesarean section. Also, prior knowledge of the possibility of myoma transformation from intramural to pedunculated postpartally may help in planning a later myomectomy. Myomectomy prior to pregnancy should be considered when it has caused a prior pregnancy complication.

Public school aggression among children with varying day-care experience.

59 children with varying amounts and types of day-care experience were followed over their first 2 or 3 years of public schooling. Schoolteachers rated aggressiveness of several types and in several situations by these children, and also supplied information about managing the children, about children's use of strategies to avoid conflict, and about several associated skills and behaviors. Multivariate analyses indicated that children who had attended a cognitively oriented day-care program beginning in infancy were more aggressive than all other groups of children who had attended day care. Aggression among these children, however, declined over time, the children were not considered difficult to manage, and they were well liked by teachers. It was speculated that the increased aggressiveness among children attending cognitively oriented day care may have been caused by several problems of adaptation to the school setting.

Staffing in small rural hospital emergency rooms: dependence on community family physicians.

OBJECTIVE: This study describes the characteristics of emergency room staffing at rural hospitals in Kansas. METHODS: Administrators at 84 rural hospitals in communities of less than 5,000 were surveyed by telephone using a scripted interview. RESULTS: Seventy-seven hospitals provided physician-staffed emergency room services. Their average daily emergency room census was 4.4. The average hospital medical staff consisted of 2.9 physicians. Eighty-six percent of all hospital staff physicians were family physicians. Ninety-six percent of all hospital emergency room staffing was provided by the local medical staff. Fee-for-service was the only method of reimbursement to physicians in 44 hospitals. Alternatives to emergency room staffing by local physicians included contracted part-time emergency room physicians, locum tenens physicians, mid-level practitioners, or emergency room closure. CONCLUSIONS: Rural family physicians have considerable responsibility for providing emergency care. Physicians must have adequate training in emergency medical care to practice in communities such as these.

Effect of inhibitors of sterol biosynthesis on growth and sexuality of Pythium and Zygorhynchus.

Seven commercial inhibitors of sterol biosynthesis were tested for their effect upon vegatative growth and sexuality in Pythium acanthicum and Zygorhynchus moelleri. Five compounds (SKF 525, Chlorpropamide, Tolbutamide, Benzmalacene, AY 9944) inhibited both growth and sexuality of both fungi and two (SKF 7732 and SKF 7997) were ineffective. Pythium was more sensitive to the activity of the inhibitors than was Zygorhynchus. None of the compounds tested inhibited sexuality without similarly reducing vegetative growth.

Craniofacial malformations and their syndromes. An overview for the speech and hearing practitioner.

Congenital malformations of the craniofacial region represent an important class of human developmental disorders. Abnormalities of speech and hearing frequently occur in this vast array of conditions. Knowledge of the diagnostic criteria, genetics, and natural history of these conditions is important for audiologists and speech-language pathologists because of their close involvement with the children and families in their care-providing role. Awareness of the important distinction between individuals with isolated defects vs. individuals who have their facial defect as part of a syndrome is important in diagnosis and management. Referral for genetic counseling is always indicated in families who have questions about these issues. The dysmorphologist, genetics professional, and speech-language pathologists are among those who play key roles in the care of persons with these disorders.

Production of m-Cresol by Valsa friesii.

m-Cresol has been isolated from culture filtrates of Valsa friesii. The yield after 10 days of growth on glucose-phytone broth was 160 mg/liter.

Frontonasal malformation and the oculoauriculovertebral spectrum: the oculoauriculofrontonasal syndrome.

Frontonasal malformation (FNM) is a developmental field defect representing abnormal morphogenesis of the frontonasal eminence. The oculoauriculovertebral spectrum (OAVS) has been used to describe a broader range of first and second branchial-arch defects including hemifacial microsomia and Goldenhar's syndrome. A combination of FNM and OAVS has been described in the literature in 13 cases. This condition has been labeled as the oculoauriculofrontonasal syndrome, as well as ophthalmofrontonasal dysplasia. We have evaluated four patients with both FNM and OAVS. The pattern of malformation involves only the craniofacies: they have no vertebral defects, heart disease, or encephaloceles. The categorization of these four individuals and those in the literature raises interesting issues regarding syndrome classification. Originally, it was suggested that perhaps this disorder was a variation of Goldenhar's syndrome. However, now that it has become evident that FNM and OAVS are malformation patterns of etiologic and presumably pathogenetic heterogeneity, a more likely hypothesis is that when these two defects occur together, this represents a unique syndrome pattern. The purpose of this article is to suggest that the combination of OAVS and FNM may be a distinct entity, representing a discreet subset of patients.

Ultrastructural aspects of wall regeneration by Pythium protoplasts.

Electron microscope studies were made of wall regeneration by Pythium protoplasts. Wall regeneration began with the formation of a loose network of fibrils on the surface of the protoplast followed by increase in density of the fibrillar mesh and deposition of granular mitrix material. The majority of the protoplasts did not develop beyond the loose fibrillar network stage, however a small percentage were able to complete wall formation and to form hyphal tubes. A clear zone of demarcation was visible between the fibrillar surface of the protoplast and the smooth surface at the base of the developing hyphal tube.

Effects of repeated assessment on standardized test performance by infants.

Infant-intervention programs that evaluate their effectiveness by repeatedly testing infants with standardized tests may confound intervention effects with repeated-testing effects. Further, maternal participation in testing may increase infants' test scores, either directly by giving infants practice with test-like items at home between test administrations or indirectly by helping infants adapt to the test setting. Thirty-five infants were tested at 3-month intervals between 4 and 28 months of age with the Bayley Scales of Infant Development and at 31 months of age with the Stanford-Binet; 25 infants were tested with the Bayley at 4 months and the Stanford-Binet at 31 months. Mothers of some infants in each group participated in the testing process. Between-subjects analysis on the Stanford-Binet revealed no effects for repeated testing or maternal participation. Within-subjects analyses for repeatedly tested groups demonstrated that maternal presence during testing, but not repeated testing, was associated with significantly higher Bayley scores. It was concluded that maternal presence is a potent influence on Bayley performance, that repeated experience with the Bayley biased neither performance on another standardized test of development nor subsequent Bayley performance, and that infant intervention programs are not likely to confound their evaluation designs by testing infants repeatedly.

The accuracy of the Marshall 85 oscillometric sphygmomanometer in the ambulatory care setting.

The purpose of this study was to evaluate a partially automated sphygmomanometer for accuracy in the ambulatory care setting. Patients seen in 80 consecutive office visits served as subjects. Blood pressures were measured simultaneously under standard conditions. The oscillometric test instrument and a standard mercury manometer were connected with a Y tube. Paired t-tests were used to determine statistical differences between values obtained from the two instruments. Analyses were done by age, sex, and blood pressure range. While mean differences in blood pressure values were statistically significant in almost every instance, the quantitative differences were 5 mmHg or less with one exception. The differences, although statistically significant, were not great enough to be clinically important. We conclude that the Marshall 85 oscillometric sphygmomanometer is sufficiently accurate for limited use in the ambulatory care setting.