Reducing wait times and medical costs for patients: the physiotherapy-led Spine Triage and Rehabilitation (STAR) Clinic.

The Sengkang General Hospital Orthopaedic Spine Outpatient Service is facing a growing challenge of increasing number of referrals and waiting times, placing a significant burden on the system. Primary care referrals have an average wait time of 61.1 days, with 34.5%f patients waiting longer than 60 days from referral to appointment, to see a spine physician.Back pain is a very common presentation, with the vast majority resolving after conservative management which commonly includes analgesia, physiotherapy and reassurance. Unfortunately, many referrals from primary care involve patients who have yet to explore the avenues of conservative management with 90% of our referrals being managed without surgery. Globally, triage services in Western countries conducted by allied health professionals have shown to be an effective method at addressing the escalating wait times with high satisfaction rates. We have endeavoured to emulate this within our department through the implementation of the Spine Triage and Rehabilitation (STAR) Clinic. The STAR clinic aims to empower physiotherapists with the ability to triage patients into surgical and non-surgical categories with their primary physiotherapy expertise to reduce waiting times and increase outpatient capacity.More than 300 patients were recruited, and their progress was tracked over 13 months under the four Ss of: waiting timeS, cost Savings, Safety and patient Satisfaction. This pilot study has been overwhelmingly positive, with significantly reduced waiting times and high cost savings, without any compromise on patient safety and satisfaction.

Adjacent tooth migration after maxillary first molar loss in patients with sinus augmentation: A retrospective research.

PURPOSE: The objectives of this study are to: (1) investigate the extent of antagonistic and distal neighboring tooth migration in the maxillary posterior single tooth-missing site during the healing period of bone augmentation and implant surgery; (2) identify factors associated with tooth migration. MATERIALS AND METHODS: One hundred and forty-three cases that lost the maxillary first molar were included, and their CBCT data during the edentulous period were obtained. Dentition models were reconstructed from CBCT, and superimpositions were performed, followed by measuring migration distances and calculating migration rates of antagonistic and distal neighboring teeth. Factors were analyzed using multivariate generalized estimating equations (GEE). RESULTS: The mean migration distances were 208 ± 137 µm and 403 ± 605 µm for antagonistic teeth and distal teeth, and the mean migration rates were 26.8 ± 21.2 µm/month and 48.5 ± 76.7 µm/month, respectively. One hundred and nineteen out of 143 distal neighboring teeth migrated toward the edentulous site, and all antagonistic teeth migrated occlusally. Occlusal contact loss and chronic apical periodontitis both significantly accelerated antagonistic tooth migration (p < 0.05), the latter also accelerated distal tooth migration (p < 0.05). Besides, the displacement of the distal teeth was somewhat accelerated by the impacted adjacent third molar and root protrusion into the sinus. CONCLUSIONS: The neighboring teeth tend to migrate toward the edentulous gap in the maxillary posterior region. Occlusal contact loss and chronic apical periodontitis are two significant risk factors for accelerating antagonistic tooth migration, and for distal teeth, chronic apical periodontitis is the risk factor. The impacted adjacent third molar and root protrusion into the sinus are also potential risk factors for accelerating the migration of the maxillary distal tooth. Thus, to prevent maxillary edentulous gap reduction, the factors mentioned above should be taken into consideration when planning treatment flow.

Dietary Intake Levels of Iron, Copper, Zinc, and Manganese in Relation to Cognitive Function: A Cross-Sectional Study.

Background: Previous studies have related circulating levels of trace metal elements, of which dietary intake is the major source, to cognitive outcomes. However, there are still relatively few studies evaluating the associations of dietary intake levels of iron, copper, zinc, and manganese with cognitive function (CF). Methods: We leveraged the data of 6863 participants (mean [standard deviation] age = 66.7 [10.5] years) in the Health and Retirement Study (2013/2014). Dietary intake levels of iron, copper, zinc, and manganese were calculated from a semi-quantitative food frequency questionnaire. CF was assessed using the 27-point modified Telephone Interview for Cognitive Status (TICS). We used linear regression models to calculate the mean differences in global CF scores by quintiles of dietary intake levels of trace metal elements. Results: Among the study participants, the mean (SD) values of daily dietary intake were 13.3 (6.3) mg for iron, 1.4 (0.7) mg for copper, 10.7 (4.6) mg for zinc, and 3.3 (1.6) mg for manganese. Compared with the lowest quintile of dietary iron intake (<8.1 mg), the highest quintile (≥17.7 mg) was associated with a lower cognitive score (-0.50, -0.94 to -0.06, P-trend = 0.007). Higher dietary copper was significantly associated with poorer CF (P-trend = 0.002), and the mean difference in cognitive score between extreme quintiles (≥1.8 vs. <0.8 mg) was -0.52 (95% confidence interval: -0.94 to -0.10) points. We did not observe significant associations for dietary intake of zinc (P-trend = 0.785) and manganese (P-trend = 0.368). Conclusion: In this cross-sectional study, higher dietary intake of iron and copper was related to worse CF, but zinc and manganese intake levels were not significantly associated with CF.

Degeneration of Key Structural Components Resulting in Ageing of Supercapacitors and the Related Chemical Ageing Mechanism.

The research on supercapacitors (SCs) is one of the hot topics in the field of energy storage, and the intrinsic ageing mechanism of SCs is significant from both the economic and the scientific point of view. In this paper, the negative effects of decay of the key structural components on ageing of SCs were investigated by factorial design and analysis of variance (ANOVA). The ANOVA results showed that the degree of the negative influence on ageing of SCs could be ranked in descending order as anode > separator > cathode. The ageing would be accelerated due to the interaction between the electrode and separator, especially at a high charge-discharge current density. Further, the intrinsic chemical ageing mechanism of SCs was revealed by the morphology, microstructure, and chemical composition analyses of the fresh and aged key components (the electrode carbon materials, current collectors, and separators) with scanning electron microscopy (SEM), Brunauer-Emmett-Teller (BET), X-ray photoelectron spectra (XPS), time-of-flight secondary ion mass spectrometry (TOF-SIMS), wide-angle X-ray diffraction (WAXD), differential scanning calorimetry (DSC), Fourier transform infrared (FTIR), etc. Moreover, the minimum pore width of electrode carbon materials suitable for electrolyte ion diffusion was obtained by density functional theory (DFT) calculations, which corroborated the assumption that the pore structure deterioration was one of the direct causes of capacitance loss for aged SCs. Generally, the ageing mechanism of key components of SCs could be a reference to develop advanced electrode materials and separators for SCs.

Radiographic Outcomes Following the Suture Fixation of Mid-pole Patellar Fractures.

Background Mid-pole patellar fractures are typically fixed with metal implants in the conventional "11-8" tension band construct. However, this technique is fraught with numerous implant-related complications. The aim of this study is to evaluate the union rate following "all-suture" fixation of mid-pole patellar fractures. Methods We retrospectively evaluated a consecutive case series of patients with displaced mid-pole patella fractures treated with "all-suture" fixation in our institution. Fifteen cases were available for this study. The average age was 61.5 years. Clinical and radiological outcomes were evaluated. Union time, complications, and revision rate were recorded. The minimum follow-up was one year. Results There were eight males and seven females, with a mean age of 61.5 ± 13.3 years. Fourteen out of 15 cases (93.3%) achieved radiographic union at 12 weeks postoperatively. The average time to radiographic union was 8.0 ± 2.7 weeks. Five cases (33.3%) had an increase in the fracture gap (>2 mm) at around four to six weeks postoperatively. Four of these cases had an eventual union, whereas one patient had fibrous non-union. There was one case of superficial surgical site infection and one case of infected hematoma. None of the patients required revision surgery. Conclusion "All-suture" fixation of mid-pole transverse patellar fractures is a safe and viable alternative to the conventional "11-8" tension band constructs with metal implants, with good union time, rates, and added benefits of not requiring additional surgery for implant removal.

Experimental and Theoretical Investigation of Laser Pretreatment on Strengthening the Heterojunction between Carbon Fiber-Reinforced Plastic and Aluminum Alloy.

Besides aluminum alloys, lightweight carbon fiber-reinforced plastics (CFRPs) have been adopted progressively in automobiles to save energy and reduce emission, so constructing a reliable heterojunction between aluminum alloys and CFRPs has come to be the key issue. In this study, ultrafast picosecond infrared (IR) and excimer ultraviolet (UV) lasers were introduced to pretreat the joint surface to enhance the adhesive strength. Scanning electron microscopy, white light interferometry, and X-ray photoelectron spectroscopy examinations indicated that because the energy absorptivities for the two lasers were different, the variation of the roughness, wettability, and chemical composition were a little different for the patterned surface. Correspondingly, the shear strengths of the adhesive joints were increased from 5.6 to 24.8 and 21.9 MPa for IR and UV laser-pretreated samples, respectively. Furthermore, finite element analysis was adopted to evaluate the effects of strengthened mechanical interlocking and fortified chemical bonding force on the enhancement of joint strength. It was shown that chemical bonding, instead of mechanical interlocking, played the dominant role in reinforcing the heterogeneous joints. As a whole, the picosecond IR laser was more preferable for surface pretreatment in adhesive heterojunctions due to its higher processing and enhancing efficiency.

Hierarchically Mesostructured Aluminum Current Collector for Enhancing the Performance of Supercapacitors.

Aluminum (Al) current collector is one of the most important components of supercapacitors, and its performance has vital effects on the electrochemical performance and cyclic stability of supercapacitors. In the present work, a scalable and low-cost, yet highly efficient, picosecond laser processing method of Al current collectors was developed to improve the overall performance of supercapacitors. The laser treatment resulted in hierarchical micro-nanostructures on the surface of the commercial Al foil and reduced the surface oxygen content of the foil. The electrochemical performance of the Al foil with the micro-nanosurface structures was examined in the symmetrical activated carbon-based coin supercapacitors with an organic electrolyte. The results suggest that the laser-treated Al foil (laser-Al) increased the capacitance density of supercapacitors up to 110.1 F g-1 and promoted the rate capability due to its low contact resistance with the carbonaceous electrode and high electrical conductivity derived from its larger specific surface areas and deoxidized surface. In addition, the capacitor with the laser-Al current collector exhibited high cyclic stability with 91.5% capacitance retention after 10 000 cycles, 21.3% higher than that with pristine-Al current collector due to its stronger bonding with the carbonaceous electrode that prevented any delamination during aging. Our work has provided a new strategy for improving the electrochemical performance of supercapacitors.

Reasons and Factors Behind Post-Total Knee Arthroplasty Dissatisfaction in an Asian Population.

INTRODUCTION: Up to 20% of patients who underwent total knee arthroplasty (TKA) reported dissatisfaction with surgical outcome. Despite the multiple studies looking into the factors contributing to patients' dissatisfaction, little research has been done to examine the subjective reasons and complaints patients have post-arthroplasty. This study aimed to look at an Asian patient population which underwent TKA and examine the factors contributing to patient dissatisfaction and the reasons they were dissatisfied with their surgery. MATERIALS AND METHODS: A total of 3069 TKAs were performed between January 2011 to April 2013 in a single institution. Preoperative and postoperative variables were prospectively captured, such as standardised knee scores, knee range of motion and patient satisfaction scores. These variables were then analysed with a multiple logistic regression model to determine the statistically significant factors that contribute to patients' satisfaction. Dissatisfied patients were individually interviewed to find the reasons for their unhappiness. Preoperative variables were then analysed to identify the statistically significant factors associated with these subjective complaints. RESULTS: Minimum duration of follow-up was 2 years, with an overall patient satisfaction rate of 91.3%. Preoperative variables contributing to patient dissatisfaction included female gender and better knee flexion. Postoperative variables included lesser improvement in knee flexion at 6 months postoperatively, as well as poorer scores in various validated knee scores at both 6 months and 2 years postoperatively. The top reason for dissatisfaction was pain. Weakness, another reason for patient dissatisfaction, had statistically significant preoperative predictors of increased age and poorer Short-Form 36 Physical Component Score. CONCLUSION: Although TKA has an impressive patient satisfaction rate in this Asian population, factors contributing to postoperative dissatisfaction suggest a targeted group of patients would benefit from preoperative counselling. The top reason for postoperative dissatisfaction in the study was pain.

Sleep deprivation predisposes liver to oxidative stress and phospholipid damage: a quantitative molecular imaging study.

Sleep disorders are associated with an increased rate of various metabolic disturbances, which may be related to oxidative stress and consequent lipid peroxidation. Since hepatic phosphatidylcholine plays an important role in metabolic regulation, the aim of the present study was to determine phosphatidylcholine expression in the liver following total sleep deprivation. To determine the effects of total sleep deprivation, we used adult rats implanted for polygraphic recording. Phosphatidylcholine expression was examined molecularly by the use of time-of-flight secondary ion mass spectrometry, along with biochemical solid-phase extraction. The parameters of oxidative stress were investigated by evaluating the hepatic malondialdehyde levels as well as heat shock protein 25 immunoblotting and immunohistochemistry. In normal rats, the time-of-flight secondary ion mass spectrometry spectra revealed specific peaks (m/z 184 and 224) that could be identified as molecular ions for phosphatidylcholine. However, following total sleep deprivation, the signals for phosphatidylcholine were significantly reduced to nearly one-third of the normal values. The results of solid-phase extraction also revealed that the phosphatidylcholine concentration was noticeably decreased, from 15.7 micromol g-1 to 9.4 micromol g-1, after total sleep deprivation. By contrast, the biomarkers for oxidative stress were drastically up-regulated in the total sleep deprivation-treated rats as compared with the normal ones (4.03 vs. 1.58 nmol mg-1 for malondialdehyde levels, and 17.1 vs. 6.7 as well as 1.8 vs. 0.7 for heat shock protein 25 immunoblotting and immunoreactivity, respectively). Given that phosphatidylcholine is the most prominent component of all plasma lipoproteins, decreased expression of hepatic phosphatidylcholine following total sleep deprivation may be attributed to the enhanced oxidative stress and the subsequent lipid peroxidation, which would play an important role in the formation or progression of total sleep deprivation-induced metabolic diseases.

Reactions of amides with organoaluminum compounds: factors affecting the coordination mode of aluminum amidates.

Factors affecting the coordination mode of an amidato group on aluminum will be presented. The reaction of N-tert-butylalkylacetamide ((t)BuNHCR([double bond]O)) with 1.1 molar equiv of Me(3)Al in refluxing hexane affords a pentacoordinated, dimeric compound [Me(2)Al[eta(2)-(t)BuNC(R)(mu(2)-O)]](2) (3, R = p-(t)Bu-C(6)H(4); 4, R = 2,6-F,F-C(6)H(3); 5, R = Me; 6, R = CF(3); 7, R = p-F(3)C-C(6)H(4)). However, in the presence of 2.2 molar equiv of Me(3)Al, N-tert-butyl-4-tert-butylbenzamide ((t)BuNHC(p-(t)Bu-C(6)H(4))([double bond]O in refluxing hexane gives [Me(2)Al[eta(2)-(t)BuNC(p-(t)Bu-C(6)H(4))(mu(2)-O)]AlMe(3)], 8. In contrast, the reaction of R'NHCR' '([double bond]O) with 1 molar equiv of R(3)Al at room temperature produces tetracoordinated, dimeric, eight-membered ring aluminum compounds [R(2)Al[mu,eta(2)-R'NC(R' ')O]](2) (9, R = Me, R' = 2,6-(i)Pr, (i)()Pr-C(6)H(3), R' ' = Ph; 10, R = Me, R' = (i)Bu, R' ' = Ph; 11, R = Et, R' = Bn, R' ' = Ph; 12, R = Me, R' = Ph, R' ' = CF(3); 13, R = Me, R' = Bn, R' ' = CF(3)). On the other hand, 4'-chlorobenzanilide ((p-Cl-C(6)H(4))NHCPh([double bond]O)) reacts with R(3)Al to produce trimeric, twelve-membered ring aluminum compounds [R(2)Al[mu, eta(2)-(p-Cl-C(6)H(4))NC(Ph)O]](3) (14, R = Me; 15, R = Et). Furthermore, the reaction of 2'-methoxybenzanilide with 1 molar equiv of Me(3)Al in hexane yields a dinuclear aluminum complex [Me(2)Al(o-OMe-Ph)NC(Ph)(O)AlMe(3)], 16.