The Effect of Preoperative Behavioral Intervention on Pain, Anxiety, Opioid Use, and Function in Patients Undergoing Total Knee Arthroplasty: A Randomized Controlled Study.

OBJECTIVE: To evaluate the efficacy of preoperative cognitive-behavioral psychoeducation (CBE) for improved pain, anxiety, opioid use, and postoperative function in total knee arthroplasty (TKA) patients. METHODS: A randomized controlled trial was conducted among 36 military health system beneficiaries attending preoperative education for TKA. The standard of care (SOC) group (n = 18) received information on home safety, rehabilitation, postoperative precautions, and pain management. In addition, the occupational therapy led CBE group (n = 16) received information on principles of holistic wellness (healing process, effects of stress on healing, heart-rate control through diaphragmatic breathing, anti-inflammatory nutrition, goal setting, and mental imagery). Outcomes of interest: knee active range of motion, pain (Defense and Veterans Pain Rating Scale), opioid medication use, heart-rate coherence (emwave2), anxiety (Generalized Anxiety Disorder Scale), and function (Knee Outcome Survey Activities of Daily Living [KOS-ADL], modified Functional Independence Measure, and Global Rate of Change). RESULTS: The CBE group demonstrated significantly greater decline in pain overall, with activity, and during sleep in relation to the SOC group when comparing visit 1 to visit 5. Opioid medication use was significantly lower for CBE versus SOC. Postoperative General Anxiety Disorder-7 scores decreased significantly among CBE participants with similar increase in high heart rate coherence. Function significantly improved postoperatively based on KOS-ADL and Global Rate of Change scores. Twice as many CBE participants had same-day discharge compared to SOC participants and most CBE participants continued with healthy lifestyle recommendations at the 3-month follow-up. CONCLUSION: A cognitive-behavioral approach to preoperative education may improve postoperative pain, anxiety, and function while decreasing opioid use among TKA patients. Findings from this pilot study support further research to examine similar interventions among distinct surgical populations and encourage further evaluation on the effects of CBE to enhance health and healthcare delivery.

New Framework for Computing a General Local Self-Diffusion Coefficient Using Statistical Mechanics.

Widely applicable, modified Green-Kubo expressions for the local diffusion coefficient (Dl) are obtained using linear response theory. In contrast to past definitions in use, these expressions are statistical mechanical results. Molecular simulations of systems with anisotropic diffusion and an inhomogeneous density profile confirm the validity of the results. Diffusion coefficients determined from different expressions in terms of currents and velocity correlations agree in the limit of large systems. Furthermore, they apply to arbitrarily small local regions, making them readily applicable to nanoscale and inhomogeneous systems where knowledge of Dl is important.

Utilization of Telemedicine in Addressing Musculoskeletal Care Gap in Long-Term Care Patients.

A notable proportion of patient transfers in Ontario are from long-term care facilities for consultation of musculoskeletal (MSK) issues. These transfers are costly for patients and the healthcare system. This study evaluated the utility of a telemedicine MSK (TeleMSK) service for long-term care patients requiring an orthopaedic consultation. Method: A cross-sectional study was used to assess TeleMSK from September 2018 to April 2019. Twenty-six long-term care facilities participated in this study, which included 32 long-term care patients assessed via TeleMSK and 27 telemedicine liaisons. The Telehealth Satisfaction Scale and the Telemedicine Usability Questionnaire (TUQ) surveys were used to evaluate the usefulness of the TeleMSK program. Results: Patients and families rated voice (64.3%) and visual (71.4%) quality of TeleMSK to be excellent as well as the length of consultation (92.9%). A total of 78.6% of participants rated explanations from physicians to be excellent and 92.9% of the participants rated the carefulness, skillfulness, respect, and sensitivity of the attending physician to be excellent 85.7%. Patients felt privacy and confidentiality was maintained and respected throughout the consultation. Most telemedicine liaisons agreed that TeleMSK improved accessibility and productivity of consultations, and 81.5% of the telemedicine liaisons strongly agreed that they would use TeleMSK again in the future. Conclusion: TeleMSK allowed for accessible, timely orthopaedic consultations without compromising the quality of patient care. Patients, families, and telemedicine liaisons rated their experience and the use of TeleMSK as excellent. Barrier to health care is an important issue in the long-term care population. TeleMSK is an excellent medium to close this gap.

Highly ordered macroporous dual-element-doped carbon from metal-organic frameworks for catalyzing oxygen reduction.

Multiple heteroatom-doped carbons with 3D ordered macro/meso-microporous structures have not been realized by simple carbonization of metal-organic frameworks (MOFs). Herein, ordered macroporous phosphorus- and nitrogen-doped carbon (M-PNC) is prepared successfully by carbonization of double-solvent-induced MOF/polystyrene sphere (PS) precursors accompanied with spontaneous removal of the PS template, followed by post-doping. M-PNC shows a high specific surface area of 837 m2 g-1, nitrogen doping of 3.17 at%, and phosphorus doping of 1.12 at%. Thanks to the hierarchical structure, high specific surface area, and multiple heteroatom-doping, M-PNC exhibits unusual catalytic activity as an electrocatalyst for the oxygen reduction reaction. Computational calculation reveals that the P[double bond, length as m-dash]O group helps stabilize the adsorption of intermediates, and the position of P[double bond, length as m-dash]O relative to graphitic N significantly improves the activity of the adjacent carbons for electrocatalysis.

Misappropriation of medications and equipment in the emergency department.

OBJECTIVE: To determine the nature and extent of misappropriation of medications and equipment from the ED. METHODS: We undertook a retrospective audit of medications procured and administered, and equipment replaced, in 2016, within a tertiary referral ED. Medication procurement and administration data were obtained from our MERLIN® pharmacy system and CERNER® electronic prescribing system, respectively. A medication 'discrepancy rate' was defined as the percentage of a medication procured that could not be accounted for by electronic administrations. The study also comprised a nested intervention sub-study where, from July 1, 2016, all Panadeine Forte tablets were stored in a locked facility. Victorian Hospital Healthcare Equipment invoices were audited to determine which major non-disposable equipment items most commonly needed resupply. RESULTS: Discrepancy rates for paracetamol 500mg and 665mg tablets were 23.3% and 54.9%, respectively. Following the Panadeine Forte intervention, the discrepancy rate for this medication fell from 70.5% to 8.8%. Orally administered medications with the potential for misappropriation had high discrepancy rates: caffeine (90.6%), cephalexin (62.9%), ondansetron (50.1%), pantoprazole (42.9%), amoxicillin (41.1%), metoclopramide (41.0%) and the 'morning after pill' (levonorgestrel) (36.4%). Parenterally administered medications had lower discrepancy rates: ceftriaxone (7.9%) and ampicillin (3.4%). The largest equipment replacement rates were for tourniquets and crutches. CONCLUSION: Discrepancy rates for many medications, especially those administered orally, are high. Further research is required to determine how these medications 'go missing'. Placing a medication with a high discrepancy rate in a locked facility with a 'logbook' substantially reduces this rate. Misappropriation of non-disposable equipment items is uncommon.

Doping Effects on the Performance of Paired Metal Catalysts for the Hydrogen Evolution Reaction.

Metal heteroatoms dispersed in nitrogen-doped graphene display promising catalytic activity for fuel cell reactions such as the hydrogen evolution reaction (HER). Here we explore the effects of the dopant concentration on the synergistic catalytic behavior of a paired metal atom active site comprising Co and Pt atoms that have been shown to be particularly active catalysts in these materials. The metals are coordinated to six atoms in a vacancy of N-doped graphene. We find that the HER activity is enhanced with increasing N concentration, where the free energy of hydrogen atom adsorption ranges from 0.23 to -0.42 eV as the doping changes from a single N atom doped in the pore to fully doped coordination sites. The results indicate that the effect of N is to make the metal atoms more active toward H adsorption, presenting a means through which transition metals can be modified to make more effective and sustainable fuel cell catalysts.

Pressure injury prevention success in a regional hospital.

BACKGROUND: This paper describes quality improvement strategies implemented following the identification of a significantly high prevalence rate and severity of pressure injuries in a regional health care facility in a large health district in Queensland, Australia. AIM: The aim of this paper is to inform health professionals of processes employed to reduce the incidence and financial burden of pressure injuries following the detection of rates that were significantly above the State average. METHOD: An audit of pressure injury prevalence data was conducted on a single day throughout a regional hospital. Prevalence data was compared to State averages and hospital strategies used to prevent injuries were examined. FINDINGS: Audit reports for this acute setting revealed that despite best practice guidelines, prevalence was a major concern. Lack of accountability, poor documentation, limited education and knowledge of risk assessment and prevention were central to the need to implement quality improvement processes. CONCLUSION: This paper outlines the results associated with implementing quality measures to reduce the prevalence of pressure injuries. Following an audit of pressure injury prevalence data, strategies were implemented to reduce noteworthy rates. Employing specific techniques can result in significantly decreasing hospital acquired pressure injuries in health care settings throughout the world.

Chimeric γc cytokine receptors confer cytokine independent engraftment of human T lymphocytes.

Therapeutic responses following adoptive transfer of T cells correlate to levels of long-term T cell persistence. Lymphodepletion and exogenous γc cytokine administration can improve T cell persistence following adoptive transfer, but their effects are not uniform and toxicities are significant. To overcome these limitations, we designed a chimeric γc cytokine receptor (CγCR) composed of Interleukin-7 (IL-7) tethered to IL-7Rα/CD127 that confers exogenous cytokine independent, cell intrinsic, STAT5 cytokine signals. We additionally show that this design is modular in that the IL-2Rß/CD122 cytoplasmic chain can be exchanged for that of IL-7Rα/CD127, enhancing Shc activity. When expressed in central memory-derived primary human CD8(+) CTL (T(E/CM)), these CγCRs signal according to their corresponding wild-type counterparts to support exogenous cytokine independent viability and homeostatic proliferation, while retaining full effector function. In vivo studies demonstrate that both CγCR-CD127(+) and CγCR-CD122(+) CD8(+) T((E/CM)) engraft in mice and persist in an absence of exogenous cytokine administration. Engrafted CγCR-CD127(+) CD8(+) T(E/CM) preferentially retain central memory marker expression in vivo demonstrating a dichotomy between CD127 versus CD122 signaling. Together, these results suggest that expression of CγCR in therapeutic T cells may aid in the in vivo persistence of these cells, particularly under conditions of limiting homeostatic cytokines.

Perimenopausal symptoms, quality of life, and health behaviors in users and nonusers of hormone therapy.

PURPOSE: This pilot study was designed to determine the difference in frequency and distress related to perimenopausal symptoms in users and nonusers of hormone therapy (HT), to identify the difference in quality of life (QoL) indicators, and to determine if there is a relationship between QoL and frequency and distress of symptoms for users and nonusers of HT between the ages of 40 and 55 years. DATA SOURCE: Self-reported responses to the Perimenopause Assessment Questionnaire with five QoL indicators imbedded, the Women's Health Assessment Scale, height, weight, and body mass index from 77 users and 89 nonusers of HT. CONCLUSIONS: More users reported using HT to control perimenopausal symptoms than for birth control or gynecological problems. Nonusers reported a higher percentage of a variety of symptoms compared to users, with more psychosomatic symptoms being reported. Both groups identified lack of energy as the most frequent and distressful symptom. There was a significant difference in frequency of symptoms between groups and a significant difference in distress of symptoms. There were significant negative correlations with the five QoL indicators and frequency and distress of symptoms for users and nonusers of HT, with exception of stress and frequency of symptoms for users. More psychosomatic symptoms were correlated with QoL for nonusers. Cold sweats, loss of interest, miserable and sad, and life not worth living were highly significant for nonusers with QoL, while feeling unattractive, decreased well-being, and lack of enjoyment for users was highly significant. IMPLICATIONS FOR PRACTICE: Perimenopause is more than hot flashes and abnormal menses. A checklist of perimenopausal symptoms should be used as an assessment tool at each annual visit or more frequently to determine the significance of the symptoms a woman might be experiencing. Assessing the perimenopausal knowledge base is very important. Most importantly, there is a need for perimenopausal educational programs to be developed and implemented.

Coronamycins, peptide antibiotics produced by a verticillate Streptomyces sp. (MSU-2110) endophytic on Monstera sp.

Coronamycin is a complex of novel peptide antibiotics with activity against pythiaceous fungi and the human fungal pathogen Cryptococcus neoformans. It is also active against the malarial parasite, Plasmodium falciparum, with an IC(50) of 9.0 ng ml(-1). Coronamycin is produced by a verticillate Streptomyces sp. isolated as an endophyte from an epiphytic vine, Monstera sp., found in the Manu region of the upper Amazon of Peru. Bioassay-guided fractionation of the fermentation broths of this endophyte on silica gel and HPLC chromatography yielded two principal, inseparable, peptides with masses of 1217.9 and 1203.8 Da. Three other minor, but related components, are also present in the preparation. Amino acid analysis of coronamycin revealed residues of component 1, component 2, methionine, tyrosine and leucine at a ratio of 2:2:1:1:3. Other compounds with antifungal activities are also produced by this endophytic streptomycete.

Kakadumycins, novel antibiotics from Streptomyces sp NRRL 30566, an endophyte of Grevillea pteridifolia.

An endophytic streptomycete (NRRL 30566) is described and partially characterized from a fern-leaved grevillea (Grevillea pteridifolia) tree growing in the Northern Territory of Australia. This endophytic streptomycete produces, in culture, novel antibiotics - the kakadumycins. Methods are outlined for the production and chemical characterization of kakadumycin A and related compounds. This antibiotic is structurally related to a quinoxaline antibiotic, echinomycin. Each contains, by virtue of their amino acid compositions, alanine, serine and an unknown amino acid. Other biological, spectral and chromatographic differences between these two compounds occur and are given. Kakadumycin A has wide spectrum antibiotic activity, especially against Gram-positive bacteria, and it generally displays better bioactivity than echinomycin. For instance, against Bacillus anthracis strains, kakadumycin A has minimum inhibitory concentrations of 0.2-0.3 microg x ml(-1) in contrast to echinomycin at 1.0-1.2 microg x ml(-1). Both echinomycin and kakadumycin A have impressive activity against the malarial parasite Plasmodium falciparum with LD(50)s in the range of 7-10 ng x ml(-1). In macromolecular synthesis assays both kakadumycin A and echinomycin have similar effects on the inhibition of RNA synthesis. It appears that the endophytic Streptomyces sp. offer some promise for the discovery of novel antibiotics with pharmacological potential.