Return to driving after total hip and knee arthroplasty - the perspective of employed patients.

PURPOSE: To address the paucity of research on patient perspectives regarding return to driving after Total Hip and Total Knee arthroplasty (THA; TKA), and how this impacts on return-to-work. MATERIALS AND METHODS: Employed participants, who had undergone THA or TKA, took part in semi-structured telephone interviews. They were asked about support received regarding driving, who provided this information, and the impact of this on their return to driving and consequently work. RESULTS: Thirty-eight people were interviewed. Although sources of information and advice were available, patients struggled to know who to approach. Interviewees reported variations and contradictions in the advice given on when they could safely return to driving after surgery. Of note, there was little difference in the advice given to those who had undergone THA compared to TKA. Many participants devised their own plan for returning to driving. CONCLUSIONS: There is inconsistency in driving advice provided after THA and TKA. Consequently, patients make their own decisions about how and when to drive, and develop strategies to accelerate the process. Greater clarity is required from healthcare professionals on time frames for driving post-surgery and for advising patients on their responsibilities around informing the DVLA and insurance companies of their surgery.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should be aware of medico-legal requirements when advising patients about their legal responsibilities regarding driving after joint arthroplasty.Given the pivotal role of driving in the resumption of work after joint arthroplasty, there needs to be greater importance placed on the provision of explicit advice and support on driving for those undergoing orthopaedic surgery.As driving is a complex skill, the advice given to patients should be individualised.Factors to be considered should be the type of vehicle driven e.g., automatic/manual transmission; height of the vehicle from the ground; the side of the surgery; any medication prescribed which might impact on driving, and consideration of any comorbidities.

A unified call to action from Australian nursing and midwifery leaders: ensuring that Black lives matter.

Nurses and midwives of Australia now is the time for change! As powerfully placed, Indigenous and non-Indigenous nursing and midwifery professionals, together we can ensure an effective and robust Indigenous curriculum in our nursing and midwifery schools of education. Today, Australia finds itself in a shifting tide of social change, where the voices for better and safer health care ring out loud. Voices for justice, equity and equality reverberate across our cities, our streets, homes, and institutions of learning. It is a call for new songlines of reform. The need to embed meaningful Indigenous health curricula is stronger now than it ever was for Australian nursing and midwifery. It is essential that nursing and midwifery leadership continue to build an authentic collaborative environment for Indigenous curriculum development. Bipartisan alliance is imperative for all academic staff to be confident in their teaching and learning experiences with Indigenous health syllabus. This paper is a call out. Now is the time for Indigenous and non-Indigenous nurses and midwives to make a stand together, for justice and equity in our teaching, learning, and practice. Together we will dismantle systems, policy, and practices in health that oppress. The Black Lives Matter movement provides us with a 'now window' of accepted dialogue to build a better, culturally safe Australian nursing and midwifery workforce, ensuring that Black Lives Matter in all aspects of health care.

Return to work advice after total hip and knee replacement.

BACKGROUND: Little is known about the information and advice on return to work received by patients undergoing total hip and knee replacement. AIMS: To investigate patients' views and experiences of work-related advice provided by clinicians, and how this might be improved. METHODS: Semi-structured interviews with patients who had undergone total hip and knee replacement, were working prior to surgery and intended to return to work. Data were analysed thematically. RESULTS: Forty-five patients from three UK regions were consented. Eight themes were identified including lack of information, lack of an individualized approach and accessibility and acceptability of information dissemination methods. Patients identified their information needs and who they felt was best placed to address them. CONCLUSIONS: Patients receive little information and advice on return to work following total hip and knee replacement, although not all patients required this. However, more focus is needed on providing this, and patients should be screened to ensure resources are best targeted with interventions being tailored to the individual.

Caracterização microbiológica, físico-química e das condições de produção e comercialização da carne de sol de Salinas, Minas Gerais / Microbiological and physical-chemical characterization and conditions of production and commercialization of sun-dried meat from Salinas, Minas Gerais

Para avaliar as condições higiênico-sanitárias e tecnológicas (HST) de produção e comercialização da carne de sol no município de Salinas, na região Norte do estado de Minas Gerais, foram coletadas 40 amostras no comércio local para a realização de análises físico-químicas e microbiológicas. A carne de sol é produzida artesanalmente em estabelecimentos comerciais e considerada uma tradição da região. Nas análises físico-químicas de umidade, proteína, gordura, cinzas, cloretos e pH, foram encontrados valores médios de 70,13%, 22,35%, 2,25%, 5,09%, 3,63% e 5,8, respectivamente. Duas amostras (5%) foram positivas para Salmonella spp. e 16 (40%) apresentaram contagens de S. aureus superiores a 103UFC/g. Os valores encontrados nas análises de mesófilos aeróbicos, bolores e leveduras e coliformes totais e termotolerantes foram de 2,50x107 UFC/g, 1,73x104 UFC/g, 9,1NMP/g e 4,3NMP/g, respectivamente. A carne de sol produzida em Salinas é um produto artesanal, portanto heterogêneo quanto às características de produção, comercialização e de qualidade microbiológica e físico-química. A importância socioeconômica da carne de sol na região é considerável, o que justifica a necessidade de se conhecer melhor suas características para auxiliar no desenvolvimento de eventuais políticas públicas regionais visando ao controle sanitário desse produto.(AU)

In order to evaluate the hygienic-sanitary and technological conditions (HST) of production and commercialization of sun-dried meat, in the city of Salinas, in the North of Minas Gerais, 40 samples of the product were collected in the local commerce for carrying out physicochemical and microbiological analyses. The sun-dried meat is produced in the commercial establishments and considered a tradition of the region. In the physicochemical analyzes of moisture, protein, fat, ash content, chlorides and pH were found values of 70.13%, 22.35%, 2.25%, 5.09%, 3.63% and 5.8, respectively. Two samples (5%) were positive for Salmonella spp. and 16 (40%) had Staphylococcus aureus counts higher than 10 3 CFU/g. The values found for the analyses of aerobic mesophilic microorganisms, yeasts and molds and total and thermotolerant coliforms were 2.50 x 10 7 CFU/g, 1.73 x 10 4 CFU/g, 9.1MPN/g and 4.3MPN/g, respectively. The sun-dried meat from Salinas is a handmade product, therefore heterogeneous in terms of production, and physicochemical and microbiological quality. The socioeconomic importance of the sun-dried-meat in the region is considerable, which justifies the need to know its characteristics better to help in the development of regional public policies aiming at sanitary control of the product.(AU)

Sun-related risks and risk reduction practices in Irish outdoor workers.

BACKGROUND: Ultraviolet radiation (UVR) is an occupational hazard for outdoor workers. AIMS: This descriptive study aimed to describe the solar UVR risk, and explore associations between demographic characteristics and sun-safety knowledge, risks and practices, in golf-course maintenance workers on the island of Ireland. METHODS: A survey, designed to collect demographic and occupational information, measures of skin cancer knowledge and sun protection practices, was completed by 154 male outdoor workers in the golf-course maintenance industry. Statistical analysis included tests of association and non-parametric tests. RESULTS: Less than 10% of this mainly male worker group had received education/training on solar UVR risks (sun safety) and two-thirds were more concerned about workplace injury. While a majority used routine precautionary measures, those with greater knowledge of skin cancer, senior grades and workers under 45 years were significantly more likely to use sunscreen and/or sunglasses. CONCLUSIONS: Findings indicate that these workers were a high risk group for skin cancer, with good knowledge of the risk, but limited training or education in risk reduction. While the prevalence of sunscreen and sunglasses use is relatively good, it was better among younger workers and those in senior grades, and could be improved if they were routinely provided as a control measure by the employer.

Engaging workplace representatives in research: what recruitment strategies work best?

Background: Workplaces are key stakeholders in work and health but little is known about the methods used to recruit workplace representatives (WRs), including managers, occupational health advisers and colleagues, to externally funded healthcare research studies. Aims: To detail the strategies used in recruiting WRs from three areas of the UK to a qualitative study concerning their experience of employees undergoing hip or knee replacement, to compare the strategies and inform recruitment methods for future studies. Methods: Six strategies were used to recruit WRs from organizations of different sizes and sectors. Data on numbers approached and responses received were analysed descriptively. Results: Twenty-five WRs were recruited. Recruitment had to be extended outside the main three study areas, and took several months. It proved more difficult to recruit from non-service sectors and small- and medium-sized enterprises. The most successful strategies were approaching organizations that had participated in previous research studies, or known professionally or personally to team members. Conclusions: Recruiting a diverse sample of WRs to healthcare research requires considerable resources and persistence, and a range of strategies. Recruitment is easier where local relationships already exist; the importance of building and maintaining these relationships cannot be underestimated. However, the potential risks of bias and participant fatigue need to be acknowledged and managed. Further studies are needed to explore how WRs can be recruited to health research, and to identify the researcher effort and costs involved in achieving unbiased and representative samples.

Mini Fiberglass Post for Ankylosed Tooth Reconstruction: A Clinical Technique.

It was possible to restore the shape and function of a severely ankylosed tooth by fabricating a ceramic crown for placement on a resin reconstruction supported by mini fiberglass posts. By increasing the retention of the morphological reconstruction for the future support of indirect restorations, cementable intradentinal fiberglass posts enhance the longevity of these restorations. Ultimately, all proposals that seek to improve the long-term prognosis of restorations on ankylosed teeth, especially severely impacted ones, are of extreme clinical relevance.

A pilot randomized controlled trial comparing effectiveness of prism glasses, visual search training and standard care in hemianopia.

OBJECTIVE: Pilot trial to compare prism therapy and visual search training, for homonymous hemianopia, to standard care (information only). METHODS: Prospective, multicentre, parallel, single-blind, three-arm RCT across fifteen UK acute stroke units. PARTICIPANTS: Stroke survivors with homonymous hemianopia. INTERVENTIONS: Arm a (Fresnel prisms) for minimum 2 hours, 5 days per week over 6 weeks. Arm b (visual search training) for minimum 30 minutes, 5 days per week over 6 weeks. Arm c (standard care-information only). INCLUSION CRITERIA: Adult stroke survivors (>18 years), stable hemianopia, visual acuity better than 0.5 logMAR, refractive error within ±5 dioptres, ability to read/understand English and provide consent. OUTCOMES: Primary outcomes were change in visual field area from baseline to 26 weeks and calculation of sample size for a definitive trial. Secondary measures included Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual, Short Form-12 questionnaires and Radner reading ability. Measures were post-randomization at baseline and 6, 12 and 26 weeks. RANDOMIZATION: Randomization block lists stratified by site and partial/complete hemianopia. BLINDING: Allocations disclosed to patients. Primary outcome assessor blind to treatment allocation. RESULTS: Eighty-seven patients were recruited: 27-Fresnel prisms, 30-visual search training and 30-standard care; 69% male; mean age 69 years (SD 12). At 26 weeks, full results for 24, 24 and 22 patients, respectively, were compared to baseline. Sample size calculation for a definitive trial determined as 269 participants per arm for a 200 degree2 visual field area change at 90% power. Non-significant relative change in area of visual field was 5%, 8% and 3.5%, respectively, for the three groups. Visual Function Questionnaire responses improved significantly from baseline to 26 weeks with visual search training (60 [SD 19] to 68.4 [SD 20]) compared to Fresnel prisms (68.5 [SD 16.4] to 68.2 [18.4]: 7% difference) and standard care (63.7 [SD 19.4] to 59.8 [SD 22.7]: 10% difference), P=.05. Related adverse events were common with Fresnel prisms (69.2%; typically headaches). CONCLUSIONS: No significant change occurred for area of visual field area across arms over follow-up. Visual search training had significant improvement in vision-related quality of life. Prism therapy produced adverse events in 69%. Visual search training results warrant further investigation.

A randomised controlled trial to compare the clinical and cost-effectiveness of prism glasses, visual search training and standard care in patients with hemianopia following stroke: a protocol.

INTRODUCTION: Homonymous hemianopia is a common and disabling visual problem after stroke. Currently, prism glasses and visual scanning training are proposed to improve it. The aim of this trial is to determine the effectiveness of these interventions compared to standard care. METHODS AND ANALYSIS: The trial will be a multicentre three arm individually randomised controlled trial with independent assessment at 6 week, 12 week and 26 week post-randomisation. Recruitment will occur in hospital, outpatient and primary care settings in UK hospital trusts. A total of 105 patients with homonymous hemianopia and without ocular motility impairment, visual inattention or pre-existent visual field impairment will be randomised to one of three balanced groups. Randomisation lists will be stratified by site and hemianopia level (partial or complete) and created using simple block randomisation by an independent statistician. Allocations will be disclosed to patients by the treating clinician, maintaining blinding for outcome assessment. The primary outcome will be change in visual field assessment from baseline to 26 weeks. Secondary measures will include the Rivermead Mobility Index, Visual Function Questionnaire 25/10, Nottingham Extended Activities of Daily Living, Euro Qual-5D and Short Form-12 questionnaires. Analysis will be by intention to treat. ETHICS AND DISSEMINATION: This study has been developed and supported by the UK Stroke Research Network Clinical Studies Group working with service users. Multicentre ethical approval was obtained through the North West 6 Research ethics committee (Reference 10/H1003/119). The trial is funded by the UK Stroke Association. Trial Registration: Current Controlled Trials ISRCTN05956042. Dissemination will consider usual scholarly options of conference presentation and journal publication in addition to patient and public dissemination with lay summaries and articles. TRIAL REGISTRATION: Current Controlled Trials ISRCTN05956042.

Registered Replication Report: Schooler and Engstler-Schooler (1990).

Trying to remember something now typically improves your ability to remember it later. However, after watching a video of a simulated bank robbery, participants who verbally described the robber were 25% worse at identifying the robber in a lineup than were participants who instead listed U.S. states and capitals-this has been termed the "verbal overshadowing" effect (Schooler & Engstler-Schooler, 1990). More recent studies suggested that this effect might be substantially smaller than first reported. Given uncertainty about the effect size, the influence of this finding in the memory literature, and its practical importance for police procedures, we conducted two collections of preregistered direct replications (RRR1 and RRR2) that differed only in the order of the description task and a filler task. In RRR1, when the description task immediately followed the robbery, participants who provided a description were 4% less likely to select the robber than were those in the control condition. In RRR2, when the description was delayed by 20 min, they were 16% less likely to select the robber. These findings reveal a robust verbal overshadowing effect that is strongly influenced by the relative timing of the tasks. The discussion considers further implications of these replications for our understanding of verbal overshadowing.

Occupational therapy predischarge home visits for patients with a stroke (HOVIS): results of a feasibility randomized controlled trial.

OBJECTIVE: To assess the feasibility of conducting a randomized controlled trial of occupational therapy predischarge home visits for people after stroke. DESIGN: Randomized controlled trial and cohort study. We randomized eligible patients for whom there was clinical uncertainty about the need to conduct a home visit to a randomized controlled trial; patients for whom a visit was judged 'essential' were enrolled into a cohort study. SETTING: Stroke rehabilitation unit of teaching hospital. PARTICIPANTS: One hundred and twenty-six participants hospitalized following recent stroke. INTERVENTIONS: Predischarge home visit or structured, hospital-based interview. MAIN OUTCOME MEASURES: The primary objective was to collect information on the feasibility of a randomized controlled trial, including eligibility, control intervention and outcome assessments. The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale at one month after discharge from hospital. Secondary outcomes included mood, quality of life and costs at one week and one month following discharge. RESULTS: Ninety-three people were allocated to the randomized controlled trial; 47 were randomized to intervention and 46 to control. Thirty-three were enrolled into the cohort study. More people were allocated to the randomized controlled trial as the study progressed. One hundred and thirteen people (90%) received the proposed intervention, although there was a need for stricter protocol adherence. Follow-up was good: at one month 114 (90%) were assessed. There were no significant differences between the groups in the randomized controlled trial for the primary outcome measure at one month. The average cost of a home visit was £208. CONCLUSION: A trial is feasible and warranted given the resource implications of predischarge occupational therapy home visits.

Cardiovascular disease burden in acute public hospitals in Ireland: estimates for 2021 and 2031.

BACKGROUND: Ireland is undergoing a demographic shift to a higher proportion of older people in the population. It is expected that this demographic shift will significantly increase the burden of care on an already overstretched acute hospitals system. AIM: This study was conducted to estimate the future burden of care on acute public hospitals pertaining to 'diseases of the circulatory system' and 'procedures on cardiovascular system' in Ireland using Hospital In-Patient Enquiry (HIPE) data for 2006 and population projections for 2021 and 2031. METHODS: Age-specific rates derived from HIPE data for 2006 and census figures for the same year were applied to population projections for 2021 and 2031 to get case number estimates in those years. RESULTS: The number of discharges with a primary diagnosis of diseases of the circulatory system is estimated to increase by 51 % by 2021 and 97 % by 2031 relative to 2006 figures. For people aged 65+ years, case numbers are estimated to increase by 65 % by 2021 and 133 % by 2031 relative to 2006 case numbers. The number of procedures performed is estimated to increase by 47 % by 2021 and 82 % by 2031 relative to 2006 figures. For people aged 65+ years, case numbers are estimated to increase by 63 % by 2021 and 120 % by 2031 relative to 2006 case numbers. CONCLUSION: The results reflect the aging of the Irish population. The expected increases in case numbers will pose significant burden on acute public hospitals and the cost of providing care.

Reducing size-dispersion in one-pot aqueous synthesis of maghemite nanoparticles.

Nanosized maghemite-like particles with reduced size-distribution were obtained using a one-pot synthesis route in aqueous medium. Forced hydrolysis of iron ions in ammoniac solution led to the formation of magnetite nanoparticles that were oxidized to maghemite in a hydrothermal digestion step that reduced the polydispersity of nanograins. The prepared nanoparticles were characterized by chemical analysis, X-ray diffractometry, magnetization, Raman spectroscopy and transmission electron microscopy measurements. Data showed that 14 nm-sized particles with polydispersity of about 0.14 were produced and, differently from other procedures, neither additional steps nor toxic reagents were needed to reduce size-dispersion or to oxidize magnetite to maghemite. These facts per se turn such nanodevice into a good potential choice for biomedical applications.

Within-host demographic fluctuations and correlations in early retroviral infection.

In this paper we analyze the demographic fluctuations and correlations present in within-host populations of viruses and their target cells during the early stages of infection. In particular, we present an exact treatment of a discrete-population, stochastic, continuous-time master equation description of HIV or similar retroviral infection dynamics, employing Monte Carlo simulations. The results of calculations employing Gillespie's direct method clearly demonstrate the importance of considering the microscopic details of the interactions which constitute the macroscopic dynamics. We then employ the τ-leaping approach to study the statistical characteristics of infections involving realistic absolute numbers of within-host viral and cellular populations, before going on to investigate the effect that initial viral population size plays on these characteristics. Our main conclusion is that cross-correlations between infected cell and virion populations alter dramatically over the course of the infection. We suggest that these statistical correlations offer a novel and robust signature for the acute phase of retroviral infection.

Queijo de minas artesanal da Serra da Canastra: influência da altitude das queijarias nas populações de bactérias acidolácticas / Influence of altitute on lactic acid bacteria population of minas artisanal cheese from Serra da Canastra

Amostras de queijo de minas artesanal foram coletadas em 18 queijarias localizadas em propriedades rurais da região da Serra da Canastra, Minas Gerais, com o objetivo de avaliar a influência da altitude sobre a população de bactérias acidolácticas. As queijarias estavam distribuídas nas altitudes de 600 a 900m, 900 a 1000m e mais de 1000m. Observaram-se populações mais elevadas de bactérias acidolácticas nas amostras de queijo da altitude de 600 a 900m. Lactobacillus rhamnosus, Lactobacillus casei e Lactobacillus plantarum foram os principais microrganismos isolados e identificados por PCR ARDRA 16S-23S rDNA, além de Enterococcus spp., Lactococcus spp. e outras espécies de Lactobacillus. Sugere-se que estas espécies estejam adaptadas ao ambiente de produção do queijo de minas artesanal produzido na região, o que resultaria em características sensoriais próprias do produto.

Samples of minas artisanal cheese were collected in 18 small-scale producer properties located in the rural region of Serra da Canastra, Minas Gerais state, aiming to evaluate the influence of three altitudes, from 600 to 900m, 900 to 1000m, and higher than 1000m, on the lactic acid bacteria (LAB) population. High populations of LAB were observed in the cheese samples, mainly in the lowest altitude. Lactobacillus rhamnosus, Lactobacillus casei, and Lactobacillus plantarum were the major LAB isolated from the cheese samples and identified according to PCR ARDRA 16S-23S rDNA. Enterococcus spp., Lactococcus spp., and other species of Lactobacillus genus were also found. It is suggested that these microorganisms are adapted to the production environment of the minas artisanal cheese which result in the unique sensorial properties of the product.