HIP fracture Supplemental Therapy to Enhance Recovery (HIPSTER): a protocol for a randomised controlled trial.

INTRODUCTION: Hip fractures result in substantial health impacts for patients and costs to health systems. Many patients require prolonged hospital stays and up to 60% do not regain their prefracture level of mobility within 1 year. Physical rehabilitation plays a key role in regaining physical function and independence; however, there are no recommendations regarding the optimal intensity. This study aims to compare the clinical efficacy and cost-effectiveness of early intensive in-hospital physiotherapy compared with usual care in patients who have had surgery following a hip fracture. METHODS AND ANALYSIS: This two-arm randomised, controlled, assessor-blinded trial will recruit 620 participants who have had surgery following a hip fracture from eight hospitals. Participants will be randomised 1:1 to receive usual care (physiotherapy according to usual practice at the site) or intensive physiotherapy in the hospital over the first 7 days following surgery (two additional sessions per day, one delivered by a physiotherapist and the other by an allied health assistant). The primary outcome is the total hospital length of stay, measured from the date of hospital admission to the date of hospital discharge, including both acute and subacute hospital days. Secondary outcomes are functional mobility, health-related quality of life, concerns about falling, discharge destination, proportion of patients remaining in hospital at 30 days, return to preadmission mobility and residence at 120 days and adverse events. Twelve months of follow-up will capture data on healthcare utilisation. A cost-effectiveness evaluation will be undertaken, and a process evaluation will document barriers and facilitators to implementation. ETHICS AND DISSEMINATION: The Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients and carers. TRIAL REGISTRATION NUMBER: ACTRN12622001442796.

Measurement of Mobility and Physical Function in Patients Hospitalized With Hip Fracture: A Systematic Review of Instruments and Their Measurement Properties.

OBJECTIVE: Hip fractures are common and significantly impact mobility and physical function. Measurement of patient progress post hip fracture in the acute hospital setting is important to monitor early recovery and outcomes. The objective of this systematic review was to assess the measurement properties (reliability, validity, responsiveness), interpretability, and clinical utility of instruments used to measure mobility and physical function in patients with hip fracture in the acute hospital setting. METHODS: Three databases (MEDLINE, Embase, and CINAHL) were searched. Studies reporting direct clinician assessment instruments to measure mobility or physical function in patients with hip fracture were included. Data were extracted by 2 reviewers, and the quality of each study was determined using the COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist. RESULTS: Sixty-eight studies were included with 19 measurement instruments identified. The most frequently used instruments were the Timed "Up & Go" Test (TUG) (19 studies), Barthel Index (BI) (18 studies), Cumulated Ambulation Score (CAS) (18 studies), and Functional Independence Measure (FIM) (14 studies). All 4 of these instruments demonstrated good predictive validity (clinical outcomes and mortality) and responsiveness over time (effect sizes 0.63-2.79). The BI and CAS also had good reliability (intraclass correlation coefficient [ICC] >0.70). Floor effects were demonstrated for the TUG, CAS, and FIM (16%-60% of patients). The TUG, CAS, and BI all had good clinical utility. CONCLUSION: Depending on the context (use by treating clinicians, research, benchmarking), 1 or a combination of the BI, CAS, and TUG provide robust measurement of mobility and physical function for patients with hip fracture in the acute hospital setting. IMPACT: This study identified 3 instruments suitable for measuring mobility and physical function in hospitalized patients following hip fracture. This provides clinicians with tools to measure patient progress and benchmark across sites to improve patient outcomes.

Characterisation of thiocyanate degradation in a mixed culture activated sludge process treating coke wastewater.

Microbial degradation of thiocyanate (SCN-) has been reported to suffer from instability highlighting the need for improved understanding of underlying mechanisms and boundaries. Respirometry, batch tests and DNA sequencing analysis were used to improve understanding of a mixed culture treating coke wastewater rich in SCN-. An uncultured species of Thiobacillus was the most abundant species (26%) and displayed similar metabolic capabilities to Thiobacillus denitrificans and Thiobacillus thioparus. Thiocyanate was hydrolysed/oxidised to NH4+-N, HCO3- and SO42-. Nevertheless, at 360-2100 mg SCN-/L a breakdown in the degradation pathway was observed. Respirometry tests demonstrated that NH4+-N was inhibitory to SCN- degradation (IC50: 316 mg/L). Likewise, phenol (180 mg/L) and hydroxylamine (0.25-16 mg/L) reduced SCN- degradation by 41% and ca. 7%, respectively. The understanding of the SCN- degradation pathways can enable stable treatment efficiencies and compliance with effluent of <4 mg SCN/L, required by the Industrial Emissions Directive.

Alkalinity and external carbon requirements for denitrification-nitrification of coke wastewater.

The Industrial Emissions Directive requires that coke wastewater is treated to reach an effluent with < 50 mg/L total nitrogen (TN). A shortage of alkalinity (3.6 mg as CaCO3/mg [Formula: see text]) in the wastewater limited nitrification to 45%. Various compounds were tested as a source of additional alkalinity, with optimal results being found for sodium carbonate, which enabled 95% nitrification at 300 mg/L (as CaCO3). Sodium bicarbonate led to incomplete ammonia oxidation (76%) whilst soda ash prevented nitrite oxidation. Addition of sodium hydroxide enabled 98% nitrification but was associated with [Formula: see text] accumulation. Ammonia and nitrite oxidation had optimal pH ranges of 7.0-8.3 and 5.5-6.8, respectively. As organic carbon concentrations in coke wastewater are at times insufficient for effective denitrification external organic carbon was also considered to enhance denitrification. A laboratory-scale anoxic-aerobic activated sludge process was used to investigate glycerol and acetic acid as carbon sources. Glycerol was associated with a low biomass production (0.18 mg of biomass produced per 1 mg of glycerol) and mixed liquor suspended solids (MLSS) declined from 2235 to 750 mg/L leading to incomplete nitrification (< 30%) and an effluent TN of 59 mg/L. Acetic acid had a higher biomass production (0.31 mg of biomass produced per 1 mg of acetic acid) maintaining stable MLSS concentrations (3137 mg/L). Overall, a denitrification-nitrification process with alkalinity (Na2CO3 at 300 mg/L) and acetic acid dosing enabled an effluent TN of 24 mg/L.