The environmental impact of hip and knee arthroplasty: An analysis of carbon emissions and disposal costs.

BACKGROUND AND PURPOSE: The rise in hip and knee arthroplasty for osteoarthritis requires addressing healthcare system pollution to support Ireland's climate change goals. This research aimed to quantify waste generated and determine environmental and economic impacts to promote sustainable strategies in joint arthroplasty and shed light on the suboptimal waste management practices. METHODS: The study was conducted at National Orthopaedic Hospital Cappagh (NOHC), measuring waste generated during hip and knee arthroplasty. Clinical, domestic, and recycled waste weights were recorded, including the segregation of Central Sterile Supply Department (CSSD) Blue Wrap waste in ten operations. Kilograms of carbon dioxide emissions (kgCO2e) and disposal costs were calculated. RESULTS: In a sample of 100 joint arthroplasty operations, the study found that revision knees produced 23.58 â€‹kgCO2e per case, revision hips 23.50 â€‹kgCO2e, primary knees 15.82 â€‹kgCO2e, and primary hips 14.64 â€‹kgCO2e. CSSD Blue Wrap contributed on average 13.5% of OT waste. Extrapolating these findings to the estimated number of joint arthroplasties performed in 2022 â€‹at NOHC (1556 hip and knee joint arthroplasties), the emissions were estimated to be 24,576 kgCO2e, with the cost of disposal up to €29,228. Strategies to mitigate this waste have been identified and proposed. CONCLUSION: The research aimed to address the environmental impact of orthopaedic joint arthroplasties, offering strategies to reduce waste generation, carbon emissions, and cost. Utilising our methodology to calculate greenhouse gas emissions will empower sustainability offices to conduct their own waste audits and implementing our strategies for waste management practices can help minimise environmental waste.

Does previous fragility fracture impact upon mortality in a hip fracture cohort? a retrospective study.

BACKGROUND: Fragility fractures are described as fractures resulting from low-energy trauma and are considered diagnostic of reduced bone mineral density or osteoporosis. They often present as hip fractures with hip fractures remaining a common but devastating injury among older patients. Many factors influence a patient's risk of hip fracture and their subsequent risk of death. AIM: In this study, we examined if previous fragility fracture impacts upon mortality after hip fracture. METHODS: This was a retrospective single-center cohort study of patients included in the Irish Hip Fracture registry over a 5-year time period. Epidemiological data including gender, age, type of fracture, type of surgery, bone protection medication, American Society of Anesthetics (ASA) grade, and post-fracture outcomes including death at 30 days and death at 1 year were recorded. The presence or absence of a previous fragility fracture was examined to explore if a previous fragility fracture was an independent predictor of mortality. RESULTS: There were 964 patients included, and 290 of whom had sustained a previous fragility fracture; 289 patients were males and 675 females, 33 patients had died in the 30 days following their surgery, and 180 patients had died within 1 year. We found statistically significant results for gender and age but not for previous fragility fracture influencing mortality (p value 0.230). CONCLUSION: We found that previous fragility fracture does not impact upon mortality in a hip fracture cohort. However, gender and age did impact upon mortality in this study.

Modified trauma assessment clinic: A rapid, scalable model.

INTRODUCTION: Trauma Assessment Clinic (TAC) has become a very useful tool in managing busy trauma clinics and reducing attendances. There is good evidence of safety and efficacy. Extension of pre-existing TAC during the COVID pandemic has proven successful. Rapid start-up models for establishing TACs are not well described in the literature. This study aimed to prove that a modified TAC has similar efficacy and can be initiated in rapid start-up manner with minimal cost. METHODS: A new electronic pathway of referral with a template was created between the Emergency Department (ED) and the Orthopaedic department. RESULTS: Following introduction of our modified TAC 32% of patients referred to the TAC did not require in-person review thereby avoiding any additional hospital visit. Average time to first in-person review appointment was 15 days. Combining these, the projected reduction in all fracture clinic attendance was 48%. CONCLUSION: This paper describes the process of how a major teaching and tertiary referral orthopaedic unit developed an accelerated establishment process for a Trauma Assessment Clinic as an alternative to the traditional "Glasgow model". This can be instituted quickly, safely, and is scalable for use in a large hospital. The template provided can be used as a guide or "blueprint" should other orthopaedic departments require a rapid start-up of a Trauma Assessment Clinic.

A Case of Multi-focal Osteonecrosis in the Context of Liver Transplant Following Ingestion of Amanita phalloides Mushroom Toxin.

We present the case of a 44-year-old female who presented with atraumatic avascular necrosis (AVN) of the patella and hips bilaterally, following ingestion of the deadly fungus Amanita phalloides or 'death cap' and subsequent liver transplant. Upon presentation, in the hours following ingestion, our patient required a liver transplant and ICU admission. She was treated by a multidisciplinary team, with input from various specialities. Our patient required steroids in the months following this event. Six months after the liver transplant and subsequent ICU admission, our patient developed hip pain, thus limiting her mobility, ability to engage in physiotherapy and rehabilitation. X-rays were performed that excluded any acute pathology. She was still receiving high-dose steroids at this time. When the pain did not resolve with analgesia, MRI of pelvis and knee was performed and the patient was found to have polyarticular AVN. Acute bilateral total hip replacement was performed and within weeks, the patient returned to physiotherapy and to full rehabilitation. Conservative management of the patella was favoured. Over two years later, the patient can now mobilise independently. The role of acute total hip replacement is evident in this case, and how in performing this surgery, the overall conditioning and health of our patient improved drastically. Currently, cases reporting A. phalloides ingestion are few and we wish to use this case to highlight the differential diagnosis in a patient presenting with joint pain in this context of fungus ingestion, organ transplant or prolonged steroid use.

Factors Associated with "Survivor Identity" in Men with Breast Cancer.

Cancer patients vary in their comfort with the label "survivor". Here, we explore how comfortable males with breast cancer (BC) are about accepting the label cancer "survivor". Separate univariate logistic regressions were performed to assess whether time since diagnosis, age, treatment status, and cancer stage were associated with comfort with the "survivor" label. Of the 70 males treated for BC who participated in the study, 58% moderately-to-strongly liked the term "survivor", 26% were neutral, and 16% moderately-to-strongly disliked the term. Of the factors we explored, only a longer time since diagnosis was significantly associated with the men endorsing a survivor identity (OR = 1.02, p = 0.05). We discuss how our findings compare with literature reports on the comfort with the label "survivor" for women with BC and men with prostate cancer. Unlike males with prostate cancer, males with BC identify as "survivors" in line with women with BC. This suggests that survivor identity is more influenced by disease type and treatments received than with sex/gender identities.

The Utility of a Plain Film Arthrogram to Confirm Acute Liner Dissociation in the Setting of Primary Total Hip Arthroplasty.

Acute Liner dissociation is a well-documented, but uncommon complication of total hip arthroplasty, yet the journey to diagnosis remains undefined. This clinical case report outlines the use of plain film arthrogram for diagnosis in a 53-year-old female who presented to the ED following a fall, describing symptoms of increasing groin pain, reduced range of movement, difficulty weight-bearing and a grinding sensation in her left hip, all on a background of total hip replacement two years ago. Examination revealed impaired flexion, rotation and abduction while AP pelvic X-ray confirmed mild eccentric placement of the femoral head, and lateral X-ray proved joint enlocation. An arthrogram of the left hip was performed the following day with injection of 4mls of iodinated contrast injected into the joint. Inferior dissociation of the liner from the shell was evident. The femoral head and liner were replaced two days later, and the liner was found to have shearing and gross plastic deformation at the rim. The patient reported immediate relief from the groin pain and was discharged on the fourth day postoperatively. This shows how plain film imaging fails in diagnosing acute liner dissociation dynamic fluoroscopic tests, post-arthrography CT and metal artifact reduction sequence magnetic resonance imaging (MARS MRI) have previously been proposed despite their associated wait-time, radiation exposure and financial costs. This case report highlights the role of plain film arthrography as a low risk and low-cost diagnostic tool. The report also suggests the incorporation of radio-dense markers in liners to facilitate the use of arthrography when diagnosing dissociation, also raising awareness of prevention and recognition in what may be an under-reported complication of hip arthroplasty.

Embracing Death: Mexican Parent and Child Perspectives on Death.

A mixed-method approach was used to explore parent and child perspectives on death in Mexico. Parents' and children's death-related experiences and understanding of death were examined. While all children in this sample displayed a biological understanding of death, older children were less likely to endorse that all living things die. Children also displayed coexistence of beliefs related to death that can be attributed to both their biological and spiritual understanding of death. We also found that older children were more likely to report that a child should feel sad following the death of a loved one. These findings highlight how cultural practices shape the development of cognitive and affective processes related to death.

Reexamining the Verbal Environments of Children From Different Socioeconomic Backgrounds.

Amid growing controversy about the oft-cited "30-million-word gap," this investigation uses language data from five American communities across the socioeconomic spectrum to test, for the first time, Hart and Risley's (1995) claim that poor children hear 30 million fewer words than their middle-class counterparts during the early years of life. The five studies combined ethnographic fieldwork with longitudinal home observations of 42 children (18-48 months) interacting with family members in everyday life contexts. Results do not support Hart and Risley's claim, reveal substantial variation in vocabulary environments within each socioeconomic stratum, and suggest that definitions of verbal environments that exclude multiple caregivers and bystander talk disproportionately underestimate the number of words to which low-income children are exposed.

Language Does Matter: But There is More to Language Than Vocabulary and Directed Speech.

In response to Golinkoff, Hoff, Rowe, Tamis-LeMonda, and Hirsh-Pasek's (2018) commentary, we clarify our goals, outline points of agreement and disagreement between our respective positions, and address the inadvertently harmful consequences of the word gap claim. We maintain that our study constitutes a serious empirical challenge to the word gap. Our findings do not support Hart and Risley's claim under their definition of the verbal environment; when more expansive definitions were applied, the word gap disappeared. The word gap argument focuses attention on supposed deficiencies of low-income and minority families, risks defining their children out of the educational game at the very outset of their schooling, and compromises efforts to restructure curricula that recognize the verbal strengths of all learners.

Registered Nurse Perception of Patient Assignment Linking to Working Conditions and Outcomes.

PURPOSE: To examine nurse working conditions and outcomes (job satisfaction, intent to stay, and RN-rated quality of care) among registered nurses (RNs) with different perceptions of patient assignments. DESIGN AND METHODS: A descriptive study was conducted using data from 106,439 RNs in 751 acute care hospitals that participated in the National Database of Nursing Quality Indicators® (NDNQI® ) RN Survey. To compare the nurse working conditions and three outcomes by the two RN groups on perceptions of patient assignment, chi-square and t tests were performed with Stata version 14. FINDINGS: All comparisons of nurse working conditions and outcomes examined in this study were significantly different between the two RN groups on perceptions of patient assignment. RNs who rated their patient assignments to be appropriate were significantly more likely to report positive working conditions (e.g., fewer assigned patients and appropriate meal break) than those who rated their patient assignments to be inappropriate. RNs who rated their patient assignments as appropriate also reported higher job satisfaction, intent to stay in current positions, and quality of care compared with their counterparts of patient assignment perception. CONCLUSIONS: Positive perceptions of patient assignments among RNs were significantly related to better nurse working conditions as well as positive outcomes. CLINICAL RELEVANCE: To create nursing work environments that significantly affect nurse and patient outcomes, nursing administrators or managers should pay attention to ensure not only adequate nurse staffing levels, but also optimal nurse-to-patient assignments.

Día de los Muertos: Learning About Death Through Observing and Pitching In.

The chapter explores how young children in the state of Puebla, Mexico are socialized with respect to death by observing and pitching in during the annual celebration for día de los muertos. This chapter focuses on observations made of children's participation in practices related to día de los muertos and their experiences with death as explored through ethnographic interviews of preschool children and adults from the cities of Cholula and Puebla. We found that children were included in all aspects of día de los muertos and participated by hanging out, observing, pitching in, and listening. Parents (and grandparents) viewed this active participation as crucial for children to acquire the skills and traditions necessary to be responsible adults in their culture. The current research provides new perspectives regarding the study of children and death within the field of developmental psychology by focusing on how multiple modes of participation are an integral part of young children's socialization with death.

Narrative making and remaking in the early years: prelude to the personal narrative.

Although very young children are unable to formulate a personal narrative of the life course, their everyday lives are steeped in narratives. Drawing on ethnographic studies in diverse sociocultural worlds, we argue that the early years of life form a vital preamble to the personal narrative. In this phase of life, the universal predisposition to narrative takes root and burgeons as young children step into whichever narrative practices are at hand, practices that are culturally differentiated from the beginning. As children narrate their experiences, they orient themselves in time and establish the interpretive grounds for intelligibility. This process is highly dynamic. Stories recur, stories are repeated, stories are revamped, and stories disappear. These dynamics constitute, for many children, an intense narrative initiation that defines early childhood as a developmental context. By the end of early childhood, they are well versed in making and remaking narratives and show an incipient ability to open a wider temporal window on their own experience.

Evaluating the benefits of a live, simulation-based telebehavioral health training for a deploying army reserve unit.

Telebehavioral health (TBH) has previously been reported as underutilized in the Afghan Theater of Operations despite efforts to expand the number of operational TBH sites. A lack of training on TBH services and equipment was identified as a probable cause. The National Center for Telehealth and Technology (T2) provided members of the 1972nd Medical Detachment (Combat Stress Control [CSC]) U.S. Army Reserve with an in-person TBH training designed to provide the unit with hands-on knowledge and skills to deliver TBH services in theater. A key training component consisted of placing unit members in live, simulated clinical and technical scenarios they were likely to encounter while deployed. Evaluations suggest that the training was successful at preparing the 1972nd CSC for its TBH mission. During its deployment, the 1972nd CSC led an approximate 40% expansion of TBH services, including the direct provision of around 700 clinical encounters. Several best practice recommendations were identified including: (1) maintain the hands-on component, (2) use lessons learned to develop scenarios, (3) incorporate training into daily activities, and (4) tailor training while ensuring that all stakeholders have the same base knowledge set. To our knowledge, this is the most comprehensive process improvement evaluation of a predeployment telehealth training available.

A longitudinal analysis of nursing specialty certification by Magnet® status and patient unit type.

The objective of this study was to examine nursing specialty certification trends by Magnet® status and unit type. Research exploring organizational and unit attributes associated with higher specialty certification rates is timely given the beginning evidence that certification is associated with lower patient adverse events. The sample included 6047 units in 1249 National Database of Nursing Quality Indicators hospitals. Hierarchical linear modeling was used to predict growth in percentage of specialty-certified RNs within each unit type and Magnet status. Data (Bayesian Information Criteria = 224 583.30) demonstrated significant growth in specialty certification rates over time (P < .0001). Magnet-designated organizations had significantly different starting certification rates (P = .0002) and rates of change (P = .0002). Unit types also had significantly different starting certification rates (P < .0001) and different rates of change (P < .0001). Magnet recognition is associated with increases in specialty certification rates. Certification rates have risen faster in unit types such as pediatric critical care than in unit types such as adult step-down and adult surgical.

A multilevel confirmatory factor analysis of the Practice Environment Scale: a case study.

BACKGROUND: Practice Environment Scale (PES) data are collected from RNs in nursing units in hospitals that are members of the National Database of Nursing Quality Indicators (NDNQI). Patient and RN information are collected to aid in quality improvement and research at the nursing unit level. The data were collected from the individual RN, but items are worded so that analyses can be conducted at the individual, unit, or hospital level. There is a need to examine the validity of the PES at both the individual and the unit level. OBJECTIVE: To describe multilevel confirmatory factor analysis via a case study for investigating the validity of the PES, a measure of the nursing practice environment. APPROACH: The PES was administered to 72,889 RNs from 4,783 nursing units (16 unit types; e.g., critical care and obstetric) in 2007. The PES has 31 items in five different domains. A multilevel confirmatory factor analytic model was fit with a structure on the basis of the five domains. From this model, an estimate was sought between unit loadings and within unit loadings to investigate factorial, convergent, and discriminant validity at both the unit and the RN levels. To investigate criterion-related validity, the five PES domains were correlated with the seven job enjoyment items adapted from the National Database of Nursing Quality Indicators at the unit and RN levels (also using a multilevel model). RESULTS: The multilevel factor analysis provides evidence of factorial, convergent, discriminant, and criterion-related validity at both the unit and the RN levels. DISCUSSION: The PES is a valid instrument for use in quality improvement and research both at the unit and individual RN levels.