Comparison of student nurses' expectations and newly qualified nurses' experiences regarding clinical practice: A secondary analysis of a cross-sectional survey.

AIM: To compare student nurses' expectations and newly qualified nurses' experiences regarding clinical practice in Switzerland 1 year after graduation. DESIGN: A secondary explorative analysis of a cross-sectional survey. METHODS: The data were sourced from the Swiss National Graduate Survey of Health Professionals covering six universities of applied sciences between 2016 and 2019, with information on three cohorts of bachelor student nurses, with a 1-year follow-up between each year. The participants were 533 bachelor-prepared nursing graduates. RESULTS: The student nurses' overall expectations included the following top two prioritized aspects: 'contributing to something important' and 'adequate time to spend with patients'. Newly graduated nurses' clinical practice experiences demonstrated that not all expectations were met 1 year after graduation. The largest gaps were found in 'adequate time to spend with patients', 'work-life balance' and experiencing 'good management'. CONCLUSION: The most crucial expectation gaps are related to having sufficient time to spend with patients and a good work-life balance. The most important result is whether there is a shortage of places for nurses to work rather than the oft-cited shortage of nurses. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: The expectations of Swiss newly qualified nurses can be better met by an assessment in the first year about which individual perceptions of workplace characteristics cause them to make choices to change something about their work, affect their job satisfaction or influence their intention to stay. IMPACT: Few of the student nurses' expectations were met 1 year after graduation, therefore Swiss healthcare institutions should improve needs assessments to strengthen the nurse workforce starting early in employment. The results underscore the importance of a constructive management culture, such as that in magnet hospitals in the United States which underpins the philosophy of changing in nursing. The results can be used internationally as a benchmark and as a basis for introducing potential interventions for nurse retention. REPORTING METHOD: This study was reported following the Standardized Reporting of Secondary Data Analyses Checklist. PATIENT OR PUBLIC CONTRIBUTION: There were no patient or public contributions. TRIAL AND PROTOCOL REGISTRATION: This study has not been registered.

The Clinical Frailty Scale is a Strong Predictor of 1-Year Mortality in Surgically Managed Hip Periprosthetic Fracture: An Analysis From a High-Volume Institution.

BACKGROUND: Hip periprosthetic fractures (PPFs) after primary total hip arthroplasty are increasing with the number of primary implants and aging population. Mortality has been reported up to 34% at 1-year. The aim of this study was to evaluate the association of Clinical Frailty Scale (CFS) and 1-year mortality, complication rate, and length of stay (LOS) in surgically managed hip PPFs. METHODS: This was a retrospective study of prospectively collected data from January 2008 to January 2021. A total of 282 surgically managed hip PPFs were identified. Mean age was 79 years (range, 42 to 106). Preoperative scores were analyzed through linear regression to identify significant association with mortality, complication and LOS. Receiver operating characteristic curve and Area Under the Curve (AUC) were generated to evaluate the quality of the models and the discriminatory ability of each clinical score. Significance was considered at P values < .05. RESULTS: Mortality was 7.8% at 3-months and 15.7% at 1-year. Complication rate requiring surgery was 19.5% and mean LOS was 8.9 ± 7 days. The CFS was significantly associated with 3-month (odds ratio 2.23, P < .001) and 1-year mortality (odds ratio 2.01, P < .001). The receiver operating characteristic curve test for 1-year mortality showed a greater AUC for the CFS when compared with American Society for Anesthesiologists score and age-adjusted Charlson Comorbidity Index (AUC 0.80 versus 0.68 versus 0.72, respectively). CONCLUSIONS: Frailty is a syndrome with increased risk of mortality after surgically managed PPF. The CFS can be easily assessed at the time of admission and could be considered as a strong and reliable predictor of 1-year mortality with a greater AUC than the conventionally used American Society for Anesthesiologists score.

What are the Outcomes of Secondary Patella Resurfacing for Dissatisfaction Following Primary Knee Arthroplasty? A Systematic Review and Meta-Analysis of 604 Knees.

BACKGROUND: Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this meta-analysis was to evaluate outcomes of secondary patella resurfacing. METHODS: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting on patients who underwent secondary patella resurfacing after previous primary knee arthroplasty with retention of the native patella were considered eligible. The risk of bias was assessed using the Methodological Index for Non-Randomized studies tool. A random-effects model and the inverse-variance weighting method was used for meta-analysis. There were sixteen retrospective studies including 604 knees (594 patients) with a mean follow up of 42 months (range, 2 to 197). RESULTS: An overall improvement in patient-reported outcomes (PROMs) was achieved in 53% of cases from pooled data available for 293 knees [95% Confidence Interval (CI) (0.44, 0.62), I2=68% - moderate heterogeneity]. The pooled proportion of patients satisfied with the procedure was 59% [95% CI (48, 68), I2 = 70% - moderate heterogeneity] in a sample size of 415. There was a minimal rate (2%) of complication incidence when performing secondary patella resurfacing and a pooled rate of revision surgery of 10%. CONCLUSIONS: An improvement in pain, satisfaction, and PROMs was achieved in slightly more than half of the patients following secondary patella resurfacing. However, studies lacked standardized objective selection criteria for the procedure and the available data was predominantly retrospective, with high heterogeneity and variation in outcome reporting.

Musculoskeletal pain in health professionals at the end of their studies and 1 year after entry into the profession: a multi-center longitudinal questionnaire study from Switzerland.

BACKGROUND: Musculoskeletal pain, especially back pain, is common among health care professionals (HP). For prevention purposes, it is important to know whether HP develop their symptoms before or after entering the health care workforce. Cross-sectional studies among HP cannot answer this question. This follow-up study measures the prevalence and individual course of musculoskeletal pain among full-time HP students at the end of their studies and one year after entering the health care workforce. METHOD: Self-reported one-year prevalence for low back pain, neck/shoulder pain, pain in arms/hands, and pain in legs/feet was collected at two timepoints from 1046 participating HP using an online questionnaire. Participants were asked whether their musculoskeletal pain was related to study or work conditions. Generalized estimating equation (GEE) models of the binomial family with log link were used to estimate adjusted prevalence and corresponding normal based 95% confidence intervals were derived using the bootstrap method with 1000 replications. RESULTS: The prevalence of low back pain as well as neck and shoulder pain was very high at baseline and follow-up in all full-time students and later HP. Prevalence for pain in arms/hands, legs/feet was low and there were significant differences between the professions. HP clearly associated their low back pain and neck/shoulder pain with study and work conditions; HP strongly associated pain in arms/hands, legs/feet only with work conditions. CONCLUSION: Many HP suffer from back/neck/shoulder pain already as students before starting their professional career. The prevention of back/neck/shoulder pain must be part of the education of all health professions at universities. As an example of best practice, universities should incorporate ergonomic measures and exercises into the daily routine of training health professionals. The effects of physically demanding professional tasks on the upper and lower extremities need to be investigated in further studies to take preventive measures.

Solid-phase extraction of estrogens and herbicides from environmental waters for bioassay analysis-effects of sample volume on recoveries.

Ecotoxicological screening of surface waters can involve multiple analyses using multiple bioassay and chemical analytical methods that require enriched samples to reach low concentrations. Such broad screening of the same sample necessitates sufficient sample volume-typically several liters-to produce a sufficient amount of enriched sample. Often, this is achieved by performing parallel solid-phase extractions (SPE) where extracts are combined into a pool-this is a laborious process. In this study, we first validated our existing SPE method for the chemical recovery of an extended set of compounds. We spiked four estrogenic compounds and 11 herbicides to samples from independent rivers (1 L) and wastewater treatment plant effluents (0.5 L). Then, we investigated the effect of increased sample loading of the SPE cartridges on both chemical and biological recoveries by comparing the validated volumes with four times larger sample volumes (i.e., 4 L river water and 2 L effluent). Samples were analyzed by LC-MS/MS and three bioassays: an estrogen receptor transactivation assay (ERα-CALUX), the combined algae test, and a bacterial bioluminescence inhibition assay. Our existing SPE method was found to be suitable for enriching the extended set of estrogens and herbicides in river water and effluents with near to perfect chemical recoveries (~ 100%), except for the herbicide metribuzin (46 ± 19%). In the large volume river and effluent samples, the biological activities and concentrations of the spiked compounds were between 87 and 104% of those measured with the lower sample loading, which is adequate. In addition, the ratio between the large and original volume SPE method for the non-target endpoint (bacterial bioluminescence inhibition) was acceptable (on average 82 ± 9%). Results indicate that our current water extraction method can be applied to up to four times larger sample volumes, resulting in four times more extract volumes, without significant reductions in recoveries for the tested estrogens and herbicides. Graphical abstract ᅟ.

Higher low back and neck pain in final year Swiss health professions' students: worrying susceptibilities identified in a multi-centre comparison to the national population.

BACKGROUND: Low back pain (LBP) and neck pain (NP) are of considerable socioeconomic burden. Considering the escalating demand on health services that LBP and NP have globally, they represent an arguably unsustainable drain on resources with the projected increased demand secondary to an ageing population. Identifying populations at risk for LBP and NP may inform public health prevention strategies. Health professions' (HP) students may be more susceptible due to their demographic factors and potentially risky postural demands of their education and formative clinical practice. The aim of our study was to compare self-reported LBP and NP of HP students with the general and stratified Swiss population to identify their prevalence. In addition, we compared the prevalence of LBP and NP in students studying different professions in order to identify whether susceptibilities exist. METHODS: In this cross-sectional study, self-reported LBP and NP reported by final-year HP students (n = 1848) were compared with the Swiss national population aged ≥15 years living in private households (n = 21,597). Binary regression models estimated crude prevalence and prevalence adjusted for age, gender, and education. Design-based F-Tests assessed differences between students and the Swiss population. RESULTS: Crude, overall four-week (4w) prevalence (mean (95% CIs)) for LBP was 61.0% (58.4-63.5) in all HP students versus 40.0% (39.2-40.9) in the Swiss population. Female HP students aged 21-30 years (63.3% (60.5-66.1)) reported higher LBP than the same-aged Swiss female population with secondary (43.7% (39.5-47.9)) or tertiary (36.6% (30.8-42.9)) education. Crude, overall 4w prevalence for NP was 59.8% (57.2-62.3) in all HP students versus 36.4% (35.6-37.3) in the Swiss population. Female health professions' students aged 21-30 years reported higher NP (63.2% (60.4-66.0)) than the same-aged Swiss female population with secondary (36.6% (32.7-40.8)) or tertiary (35.4% (29.6-41.8)) education. The inter-professional differences shown indicate midwifery to be most susceptible to reporting both conditions. CONCLUSIONS: Considerably higher LBP and NP were reported by final year HP students when compared with the general and stratified Swiss population. Worrying inter-professional susceptibilities were shown and reveal the need for further explanatory studies. Measures to reduce complex health problems like LBP and NP should be introduced into curricula in order to optimize the longevity of clinical careers and to protect the future HP workforce.

Does the ingrowth surface make a difference? A retrieval study of 423 cementless acetabular components.

The effect of factors such as design, alloy and coating type on bony or fibrous tissue ingrowth was evaluated in a study of 423 retrieved cementless acetabular shells representing 16 shell designs. Small-beaded (250µm) porous coatings, either with or without hydroxyapatite (HA) coatings, proved to be the superior porous surface for bone ingrowth. Small-beaded shells that were Duofix coated had predominantly fibrous tissue ingrowth. In addition to bead size, alloy type and surface type have significant effect on bone ingrowth. In contrast, there is no significant association between bone ingrowth and time in situ, with most bone ingrowth occurring early. Although roughened, press-fit shells have acceptable clinical and Registry data, they showed some of the lowest ingrowth/ongrowth scores of all the shells tested.

Treatment strategy and clinical outcomes of surgically managed hip periprosthetic fractures: analysis from a high-volume centre.

BACKGROUND: Hip periprosthetic fractures (PPF) after total hip arthroplasty (THA) are becoming increasingly prevalent. Their management is secondary to the fracture type and the stability of the implant. This study aimed to provide the outcomes of operatively managed PPF from a high-volume centre to help guide future decision making. METHODS: This was a retrospective study of prospectively collected data from January 2008 to January 2021. Patient demographics, implant specific details, and fixation strategy were collected. Complications including infection, reoperation, re-fracture, re-revision, were collected. Short-term mortality was evaluated at 3 months and 1 year. P-values <0.05 were considered significant. RESULTS: 282 surgically managed PPF were identified. Vancouver B2 were predominant in 52% of the cases. Revision alone and revision with additional fixation were the most frequent strategies in 168 cases (60%). Complications requiring reoperation occurred in 20% of the cases, with infection as the most frequent (8.5%). Mortality rate was 7.8% at 3 months and 15.7% at 1 year, with significantly lower rates in B2 type. B2 fractures treated with cemented stems had a significantly lower 1-year mortality than distal fit revisions. CONCLUSIONS: PPF is associated with a high complication rate. Revision alone and revision with additional fixation remain the preferred method in B2/B3 type fractures, however, cemented revision can yield similar outcomes with lower short-term mortality. Considering the high-risk elderly and frail category of patients, a multidisciplinary team is necessary to improve outcomes and reduce mortality.

Pregnancy, Hip Pain, and Total Hip Replacement.

➤ Young women who are 15 to 45 years of age and undergo total hip replacements are at increased risk for revision compared with women >75 years of age.➤ Among women of childbearing age with a total hip replacement, 12% to 17% will later have at least 1 pregnancy.➤ Young women who undergo total hip replacement do not have an increased risk of pregnancy complications.➤ Of the 60% of women who experienced pain with a total hip replacement during pregnancy, 21% had persisting pain, and 4% reported the pain as severe.➤ Women who have a total hip replacement and later experience pregnancy and childbirth have no increased risk of pregnancy complications or increased revision rates; there was no effect of the mode of delivery on revision rates or complications including fracture, dislocation, or loosening, according to the limited studies available.

Unconscious Bias among Health Professionals: A Scoping Review.

BACKGROUND: Unconscious biases are one of the causes of health disparities. Health professionals have prejudices against patients due to their race, gender, or other factors without their conscious knowledge. This review aimed to provide an overview of research on unconscious bias among health professionals and to investigate the biases that exist in different regions of the world, the health professions that are considered, and the research gaps that still exist. METHODS: We conducted a scoping review by systematically searching PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, and AMED. All records were double-screened and included if they were published between 2011 and 2021. RESULTS: A total of 5186 records were found. After removing duplicates (n = 300), screening titles and abstracts (n = 4210), and full-text screening (n = 695), 87 articles from 81 studies remained. Studies originated from North America (n = 60), Europe (n = 13), and the rest of the world (n = 6), and two studies were of global scope. Racial bias was investigated most frequently (n = 46), followed by gender bias (n = 11), weight bias (n = 10), socio-economic status bias (n = 9), and mental illness bias (n = 7). Most of the studies were conducted by physicians (n = 51) and nurses (n = 20). Other health care professionals were rarely included in these studies. CONCLUSIONS: Most studies show that health professionals have an implicit bias. Racial biases among physicians and nurses in the USA are well confirmed. Research is missing on other biases from other regions and other health professions.

The exeter cemented stem provides outstanding long-term fixation and bone load at 15 years follow-up: A systematic review and meta-analysis.

PURPOSE: Since its introduction in 1988, the double-tapered polished Exeter cemented stem has been widely adopted in primary total hip arthroplasty (THA). Despite the results coming from the arthroplasty registries have proven great survivorship, the aim of this study was to dig deeper and describe the modes of failure of the Exeter stem at 15 years follow-up while reporting the clinical and radiographic outcomes. METHODS: A search of PubMed, MEDLINE, and Embase was performed using the Preferred Reporting Items for Systematic Review and Meta-Analyses since inception of database to January 2022. A meta-analysis was performed on stem's failure rates and clinical outcomes using random effects models. Publication bias was assessed with funnel plots. RESULTS: Overall, ten studies met the inclusion criteria with 2167 hips at mean 14.8 ± 4.1 years follow-up. The meta-effect estimate for revision rate for stem-related reasons was 3.8% (CI 95% 2.1-5.6, p < 0.01). The meta-effect for revision rate for stem aseptic loosening (AL) was 0.22% (CI 95% 0-0.4, p = 0.048) and for periprosthetic fracture was 0.6% (CI95% 0.3-0.9, p < 0.001). The meta effect estimate for Oxford Hip Score (OHS) at final follow-up was 32.4 (moderate; CI 95% 23.2-41.6, p <0.001) with and heterogeneity among the studies of I2 0%. Radiolucent lines were reported in 5.5% of cases, with 1.0% of cases (21 hips) reported to be progressive. CONCLUSION: Current evidence suggests that the Exeter cemented stem not only has proven long-term outstanding reliability with a revision rate of 3.8%, but also incredibly low revision rates for AL (0.22%) and periprosthetic fracture (0.6%). It is suitable for a variety of indications, and the consistent radiological appearances indicate durable fixation and load transmission while being associated with a remarkably low stem-related complication rate.

Evaluation of Three ISO Estrogen Receptor Transactivation Assays Applied to 52 Domestic Effluent Samples.

Estrogens are released to the aquatic environment by wastewater treatment plant (WWTP) effluents and can affect wildlife. In the last three decades, many in vitro assay platforms have been developed to detect and quantify estrogenicity in water. In 2018, the International Organization for Standardization (ISO) standardized protocols became available for three types of in vitro estrogen receptor transactivation assays (ERTAs) detecting estrogenicity in 96-well plates (ISO19040 1-3). Two ERTAs-lyticase Yeast Estrogen Screen (L-YES) and Arxula YES (A-YES)-use genetically modified yeast strains, whereas the third utilizes stably transfected human cells. One human cell based assay is ERα-CALUX, which is based on a genetically modified human bone osteosarcoma cell line. In the present study, we characterized the performance, comparability, and effectiveness of these three ERTAs, including an evaluation involving proposed water quality thresholds (effect-based trigger values [EBTs]). For a robust evaluation, we collected 52 effluent samples over three sampling campaigns at 15 different WWTPs in Switzerland. Estrogen receptor transactivation assay results were correlated and compared with results from chemical analysis targeting known estrogens. The three ERTAs showed comparable data over all campaigns. However, the selection of EBTs plays a significant role in the interpretation and comparison of bioassay results to distinguish between acceptable and unacceptable water quality. Applying a fixed cross-assay EBT for effluent of 4 ng L-1 resulted in varying numbers of threshold exceedances ranging between zero and four samples depending on the ERTA used. Using assay-specific EBTs showed exceedances in eight samples (ERα-CALUX) and in one sample (A-YES), respectively. Thus, proposed EBTs do not produce similar risk profiles across samples and further refinement of assay-specific EBTs is needed to account for assay-specific differences and to enable the application of ERTAs as effect-based methods in environmental monitoring. Environ Toxicol Chem 2022;41:2512-2526. © 2022 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.

Neonatal systemic delivery of scAAV9 in rodents and large animals results in gene transfer to RPE cells in the retina.

Systemic delivery of recombinant adeno-associated virus (rAAV) vectors has recently been shown to cross the blood brain barrier in rodents and large animals and to efficiently target cells of the central nervous system. Such approach could be particularly interesting to treat lysosomal storage diseases or neurodegenerative disorders characterized by multiple organs injuries especially neuronal and retinal dysfunctions. However, the ability of rAAV vector to cross the blood retina barrier and to transduce retinal cells after systemic injection has not been precisely determined. In this study, gene transfer was investigated in the retina of neonatal and adult rats after intravenous injection of self-complementary (sc) rAAV serotype 1, 5, 6, 8, and 9 carrying a CMV-driven green fluorescent protein (GFP), by fluorescence fundus photography and histological examination. Neonatal rats injected with scAAV2/9 vector displayed the strongest GFP expression in the retina, within the retinal pigment epithelium (RPE) cells. Retinal tropism of scAAV2/9 vector was further assessed after systemic delivery in large animal models, i.e., dogs and cats. Interestingly, efficient gene transfer was observed in the RPE cells of these two large animal models following neonatal intravenous injection of the vector. The ability of scAAV2/9 to transduce simultaneously neurons in the central nervous system, and RPE cells in the retina, after neonatal systemic delivery, makes this approach potentially interesting for the treatment of infantile neurodegenerative diseases characterized by both neuronal and retinal damages.

Terahertz refractive index-based morphological dilation for breast carcinoma delineation.

This paper reports investigations led on the combination of the refractive index and morphological dilation to enhance performances towards breast tumour margin delineation during conserving surgeries. The refractive index map of invasive ductal and lobular carcinomas were constructed from an inverse electromagnetic problem. Morphological dilation combined with refractive index thresholding was conducted to classify the tissue regions as malignant or benign. A histology routine was conducted to evaluate the performances of various dilation geometries associated with different thresholds. It was found that the combination of a wide structuring element and high refractive index was improving the correctness of tissue classification in comparison to other configurations or without dilation. The method reports a sensitivity of around 80% and a specificity of 82% for the best case. These results indicate that combining the fundamental optical properties of tissues denoted by their refractive index with morphological dilation may open routes to define supporting procedures during breast-conserving surgeries.

Comprehensive paternity assignment: genotype, spatial location and social status in song sparrows, Melospiza Melodia.

Comprehensive, accurate paternity assignment is critical to answering numerous questions in evolutionary ecology. Yet, most studies of species with extra-pair paternity (EPP) fail to assign sires to all offspring. Common limitations include incomplete and biased sampling of offspring and males, particularly with respect to male location and social status, potentially biasing estimated patterns of paternity. Studies that achieve comprehensive sampling and paternity assignment are therefore required. Accordingly, we genotyped virtually all males and >99% of 6-day-old offspring over 16 years in a song sparrow (Melospiza melodia) population and used three complementary statistical methodologies to attempt complete paternity assignment for all 2207 offspring. Assignments were highly consistent across maximum likelihood methods that used solely genotype data, and heuristic and integrated Bayesian analyses that included data describing individual locations. Sires were assigned to >99% of all genotyped offspring with ≥95% confidence, revealing an EPP rate of c. 28%. Extra-pair sires primarily occupied territories neighbouring their extra-pair offspring; spatial location was therefore highly informative for paternity assignment. EPP was biased towards paired territorial males, although unpaired territorial and floater males sired c. 13% of extra-pair offspring. Failing to sample and include unpaired males as candidate sires would therefore substantially reduce assignment rates. These analyses demonstrate the integration of genetic and ecological information to achieve comprehensive paternity assignment and direct biological insight, illustrate the potential biases that common forms of incomplete sampling could have on estimated patterns of EPP, and provide an essential basis for understanding the evolutionary causes and consequences of EPP.

Inbreeding coefficient and heterozygosity-fitness correlations in unhatched and hatched song sparrow nestmates.

Heterozygosity-fitness correlations use molecular measures of heterozygosity as proxy estimates of individual inbreeding coefficients (f) to examine relationships between inbreeding and fitness traits. Heterozygosity-fitness correlations partly depend on the assumption that individual heterozygosity and f are strongly and negatively correlated. Although theory predicts that this relationship will be strongest when mean f and variance in f are high, few studies of heterozygosity-fitness correlations include estimates of f based on pedigrees, which allow for more thorough examinations of the relationship between f, heterozygosity and fitness in nature. We examined relationships between pedigree-based estimates of f, multilocus heterozygosity (MLH) and the probability of survival to hatch in song sparrow nestmates. f and MLH were weakly, but significantly negatively correlated. Inbreeding coefficient predicted the probability of survival to hatch. In contrast, MLH did not predict the probability of survival to hatch nor did it account for residual variation in survival to hatch after statistically controlling for the effects of f. These results are consistent with the expectation that heterozygosity-f correlations will be weak when mean and variance in f are low. Our results also provide empirical support for recent simulation studies, which show that variation in MLH among siblings with equal f can be large and may obscure MLH-fitness relationships.

Catastrophic failure of the Accolade I hip arthroplasty stem: a retrieval analysis study.

PURPOSE: Modular Morse tapered femoral arthroplasty stems have been used for many years with great success and minimal complications. 1 stem, the Accolade by Stryker is noted to have increased failure when used in combination with LFIT V40 CoCr or the MITCH CoCr femoral heads. The failure has been in the form of corrosion, metallosis, fretting and trunnion fracture. This paper explores 10 cases with trunnion failure. METHODS: A retrospective retrieval analysis of ten femoral stems retrieved at four different centres across Western Australia over a 3-year time frame. Inclusion criteria for this analysis included the use of Accolade 1 TMZF femoral stem plus either a MITCH or LFIT modular head. RESULTS: 10 Accolade I (Stryker) stems were retrieved as part of the analysis, 6 with the LFIT V40 36-mm femoral head and 4 with a MITCH TRH femoral head. Average in situ time was 8.9 years. The hips were revised for either trunnion dislocation (6 cases) or trunnion fracture (4 cases). A characteristic destructive wear pattern of the femoral taper (trunnion) a "bird beak" appearance was present in all stems. This wear pattern created excessive movement and loosening resulting in a trunnion/head dislocation or brittle fracture of the trunnion. CONCLUSIONS: Catastrophic femoral neck fracture was likely due to a combination of material composition mismatch and mechanically assisted fretting corrosion at the head-neck junction leading to gross metallosis and failure. We suggest a recall on patients with an Accolade 1 stems in combination with a 36-mm or above LFIT or MITCH head, and for these patients to have clinical and radiological review.

Spraying of Ultrathin Isoporous Block Copolymer Membranes-A Story about Challenges and Limitations.

Isoporous membranes can be prepared by a combination of self-assembly of amphiphilic block copolymers and the non-solvent induced phase separation process. As the general doctor-blade technique suffers from high consumption of expensive block copolymer, other methods to reduce its concentration in the casting solution are sought after. Decreasing the block copolymer concentration during membrane casting and applying the block copolymer solution on a support membrane to obtain ultrathin isoporous membrane layers with e.g., spraying techniques, can be an answer. In this work we focused on the question if upscaling of thin block copolymer membranes produced by spraying techniques is feasible. To upscale the spray coating process, three different approaches were pursued, namely air-brush, 1-fluid nozzles and 2-fluid nozzles as generally used in the coating industry. The different spraying systems were implemented successfully in a membrane casting machine. Thinking about future development of isoporous block copolymer membranes in application it was significant that a continuous preparation process can be realised combining spraying of thin layers and immersion of the thin block copolymer layers in water to ensure phase-separation. The system was tested using a solution of polystyrene-block-poly(4-vinylpyridine) diblock copolymer. A detailed examination of the spray pattern and its homogeneity was carried out. The limitations of this method are discussed.

Factors affecting self-reported sexuality in men with obstructive sleep apnea syndrome.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) is known to induce erectile dysfunction and to reduce overall sexual satisfaction in affected men. Data on the effects of disease severity and other contributing factors such as the age of the patient are missing. AIM: To compare self-reported sexuality in men with newly diagnosed sleep apnea with a group of disease-free men, and to evaluate the impact of disease severity and age on the response pattern. MAIN OUTCOME MEASURES: Self-reported erectile function, desire, and frequencies for petting, tenderness, masturbation, sexual intercourse, and overall satisfaction with sexuality over a recall period of 3 months. METHODS: A prospective survey in men admitted to a multidisciplinary sleep center using a standardized validated German questionnaire. RESULTS: One hundred-sixteen men 51.1 +/- 11.4 years (mean +/- standard deviation) with OSAS (OSAS+) and 42 men age 46.6 +/- 13.7 years without OSAS (OSAS-) completed the survey. OSAS+ men were older (P = 0.01) and more often divorced (P = 0.048). OSAS was significantly associated with erection problems (P = 0.024) and decreased overall sexual satisfaction (P = 0.04). In contrast disease severity did affect masturbation frequency only (P = 0.02), whereas patient age affected erection (P = 0.001), and the desire for tenderness (P = 0.02) and intercourse (P = 0.0003). CONCLUSION: Patient age might be a more important factor affecting sexuality in men with sleep apnea than the disease severity. Future studies assessing sexuality in men with OSAS should include age as an additional variable.

Formation of Thin, Isoporous Block Copolymer Membranes by an Upscalable Profile Roller Coating Process-A Promising Way to Save Block Copolymer.

In this work we present a method to manufacture flat sheet membranes with a thin isoporous block copolymer (BCP) layer (thickness <3 µm) by profile roller coating (breadth: 30 cm) on top of a porous support membrane. Highly diluted BCP-solutions were used for this coating process. While we cast membranes with dimensions of 30 cm × 50 cm in this work, the procedure can easily be extended to endless dimensions in this roll to roll (R2R) process. The method offers the possibility to save >95% of BCP raw material compared to common doctor blade casting, by strongly decreasing the layer thickness to below 3 µm in combination with a highly open substructure. Additionally, we report a straightforward method to investigate the influence of the solvent evaporation time between coating and precipitation (phase inversion) on the membrane morphology using one sample only, which also ensures that all other influencing parameters remain constant.