Short-Term functional comparison of three total knee arthroplasties-Journey II, Genesis II and Profix.

AIM OF THE STUDY: To compare the outcomes of three knee arthroplasty design philosophies and surface tribology.• A zirconium-surfaced, bicruciate-stabilised implant designed to mimic kinematic movement and improve flexion and outcomes;• A cobalt-chrome surfaced, multi-radius design with built-in femoral external rotation to aid balancing and patella tracking through a deeper trochlea groove;• A zirconium-surfaced, single-radius implant designed on surface conformity, particularly within the patello-femoral joint. METHODS: 313 knee replacements - 103 Journey II, 103 Genesis II and 107 Profix - were statistically assessed at a minimum of 2 years using WOMAC, Oxford and SF-12 scores, and range of movement. RESULTS: There was no difference between the actual or unit change in WOMAC scores (p = 0.140 and p = 0.287), SF-12 physical (p = 0.088) or mental scores (p = 0.975) between the three implants; or between the actual or unit change in Oxford score (p = 0.912 and p = 0.874) for the Journey II or Genesis II. The Journey II produced more flexion and range of movement than the Genesis II (p < 0.001 and p = 0.018) and Profix (p < 0.001 and <0.001) with no difference between the latter two (p = 0.402 and 0.568); with no difference in extension between the three implants (p = 0.086). There was no difference between those with or without a resurfaced patella. CONCLUSION: The three design philosophies and surfaces yielded no difference in outcome scores at 2 years post-operatively. The Journey II demonstrated better post-operative flexion. Resurfacing the patella did not alter the outcome scores or flexion.

Factors that predict NCLEX-RN success at a Historically Black College and University: A four-year retrospective study.

INTRODUCTION: Ensuring NCLEX-RN success for graduates of Historically Black Colleges and Universities (HBCUs) is integral to increasing Blacks and other racial/ethnic minorities underrepresented as registered nurses (RNs). PURPOSE: To examine the association between program type (traditional (TBSN) and accelerated Bachelor of Science [ABSN]) and first-time NCLEX-RN exam outcome. METHODS: A retrospective descriptive design was used. TBSN and ABSN students (n = 465) who graduated between 2015-2018 at an HBCU were examined. RESULTS: First-time pass rates for the total sample was 91.58%. Differences were observed between program type in 10 nursing courses for both programs, with Child Health being the only course predicting NCLEX-RN in both programs. In a multivariate logistic regression model, male students were 69% less likely to pass NCLEX-RN exam on first attempt compared to females, AOR = 0.31, p = 0.005. CONCLUSION: HBCUs can successfully prepare a diverse population of BSN graduates who pass NCLEX-RN on first attempt. Increased understanding of factors that decrease NCLEX-RN success of males is a prerequisite to development of strategies to ensure that all students have positive outcomes. There is also a need to understand differential relationships between nursing course grades and NCLEX-RN success among students enrolled in TBSN versus ABSN paths.

The Journey Bicruciate Knee Replacement: Design Modifications Yield Better Early Functional Results and Reduce Complications.

The Journey-I total knee replacement was designed to improve knee kinematics but had several complications including early dislocation. The Journey-II modification was introduced to reduce these while maintaining high function. To assess whether the modified Journey-II prosthesis has succeeded in its designers aims, we undertook an observational study of prospectively recorded data to analyze and compare the two knees. A total of 217 Journey-I and 129 Journey-II knees were identified from the department's prospectively collated registry and were assessed at 1 year by a comparative statistical analysis using numerous factors including pain, functional activity, physical assessment, Short Form-12 (SF-12), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Oxford scores. The statistical tests included Chi-square, Wilcoxon's rank and Mann-Whitney U-tests with the level of significance set at p < 0.05. There was a variation in primary patella resurfacing between the two groups with 14.3% in the Journey-I cohort and 66.7% in the Journey-II cohort. Both replacements demonstrated excellent postoperative function, but the Journey II performed significantly better than Journey I with fewer complications (37 vs. 10) and better improvement in almost all clinical scores including pain (p < 0.01), mobility outcomes (p = 0.018), Oxford (p = 0.004), and WOMAC (p = 0.039) scores but not with flexion improvement and SF-12 score. There was significant improvement in patellofemoral pain postoperatively in both the Journey I (p = 0.011) and Journey II (p = 0.042) arthroplasty; however the primarily resurfaced patella in a Journey-II implant had better postoperative scores. The main complication of dislocation in the Journey I was not seen in the modified Journey-II implant with stiffness requiring intervention reduced in Journey II. These results suggest that the Journey II has improved short-term clinical outcomes compared with Journey I with reduction of dislocation and other complications.

Health equity knowledge development: A conversation with Black nurse researchers.

Can the institutional systems that prepare Black nurse researchers question the ways their systemic pathways have impacted health equity knowledge development in nursing? We invite our readers to keep this question in mind and engage with our conversation as Black nurse researchers, scholars, educators, and clinicians. The purpose of our conversation, and this article, is to explore the transactional impact of knowledge development pathways and Black faculty retention pathways on the state of health equity knowledge in nursing today. Over a series of conversations, we discuss the research exploitation of communities of color, deficit research funding, knowledge capitalization, the marginalization of diversity as a continuous process, a lack of sociocultural authority, and our thoughts on solutions. We conclude by using the wisdom of a generation to answer our initial question.

Tailoring NCLEX-RN Indicator Assessments for Historically Black Colleges and Universities: Literature Review.

A review of the literature was undertaken as the foundation for developing an assessment tool for Blacks/African Americans, other racial/ethnic minorities, and low-income students attending historically Black colleges and universities. Findings revealed a variety of academic and nonacademic indicators were used to evaluate likelihood of success. Course specific grades, grade point average (GPA), standardized comprehensive exams and standardized course specific exams were the most commonly used predictor variables that showed significant outcomes. Indicators more accurately predicted which students would pass NCLEX-RN rather than those who would fail. The type of pre-licensure program may influence best outcome indicators. Increased attention to and reporting of demographic information would increase the usefulness of findings in relation to developing a tailored assessment strategy for students enrolled in nursing programs at historically Black colleges and universities.

Socioeconomic differentials in mortality by cause of death in the Republic of Ireland, 1984-2008.

CONTEXT/PROBLEM: Comparative analysis of relative and absolute mortality differentials between socioeconomic groups are now available. These show consistently increasing relative increases in mortality differentials but complex trends in absolute mortality differentials. OBJECTIVE: This paper provides an analysis of relative and absolute trends in mortality by cause of death and socioeconomic group (SEG) from 1984 to 2008 among men and active women aged 30-64 years in Ireland and compares these results with recent European and US studies to give an overview of trends. METHODS: This paper uses mortality data from the Irish Central Statistics Office from 1984 to 2008 to calculate standardized death rates by age, sex, socioeconomic status and cause of death showing trends in SEG inequalities in mortality in Ireland. These show which specific causes of death are driving all-cause mortality trends. RESULTS: SEG differentials in all-cause mortality among men and women have been increasing since the 1980s. Some of this increase reflects larger falls in cardiovascular causes among advantaged groups, but the trend is largely accounted for by increasing inequalities in mortality in digestive, neoplasm and external causes of deaths. CONCLUSIONS: These findings are in line with international findings that show that socioeconomic differentials in digestive, neoplasm and external cause deaths are driving general socioeconomic differentials in all-cause mortality. External cause deaths may have been influenced by levels of economic activity, particularly in construction, during the economic boom among manual workers. Furthermore, deaths from digestive diseases during the 1990s and 2000s may well be the result of increases in liver disease associated with excessive alcohol consumption.

Medium-term (5-year) comparison of the functional outcomes of combined anterior cruciate ligament and posterolateral corner reconstruction compared with isolated anterior cruciate ligament reconstruction.

PURPOSE: To present a 5-year comparison of the functional outcomes of combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) reconstruction with those of isolated ACL reconstruction. METHODS: All patients were reviewed clinically and completed knee function questionnaires prospectively, by use of the International Knee Documentation Committee (IKDC) 2000, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Lysholm scoring systems, preoperatively and at 1, 2, and 5 years postoperatively. Patients who underwent combined ACL-PLC reconstruction were identified and reviewed. These patients had intact lateral collateral ligaments. A comparison group was created from a group of patients who underwent isolated ACL reconstruction. The ACL group was selected to have the same profile with regard to age, sex, and meniscal procedure. RESULTS: There were 25 patients in the ACL-PLC group and 100 in the ACL group. All patients underwent restoration of their PLC function as shown on dial testing. The preoperative values for all KOOS measures and the Lysholm score were significantly lower in the ACL-PLC group than in the ACL group (P < .001). The IKDC score was not significantly different. All knee scores showed a significant improvement in both groups postoperatively at 1, 2, and 5 years (P < .001). At 5 years, the KOOS symptoms subscore (P < .001), KOOS pain subscore (P < .001), KOOS sports subscore (P < .001), KOOS quality-of-life subscore (P < .05), KOOS activities-of-daily living subscore (P < .001), aggregate score for all KOOS parameters (P < .001), and Lysholm score (P < .001) were significantly lower in the ACL-PLC group than in the ACL group. At 5 years, the IKDC scores were not significantly different. All patients in the ACL-PLC group resumed preinjury employment, and 23 of 25 had resumed sports. CONCLUSIONS: Combined ACL-PLC injuries have greater morbidity than isolated ACL injuries. However, return to work and sporting activity is possible in most cases after combined ACL-PLC reconstruction. The KOOS for sport outcomes suggests that sports were resumed at lower functional levels. LEVEL OF EVIDENCE: Level III, case-control study.

Self-silencing as a predictor of physical activity behavior.

Self-silencing theory suggests that women ignore their own feelings and needs to attend to the desires of others. However, the impact of such self-silencing on physical activity behavior is unknown. This study examined the degree of self-silencing among a group of highly educated and relatively affluent African American women and the strength of self-silencing as a predictor of physical activity. The mean total self-silencing score for participants was 71.46. Overall, women reported spending approximately 193 min per week engaged in physical activity but only 36% met current recommendations for aerobic physical activity. Self-silencing did not predict physical activity behavior.

Influence of a burrowing, metal-tolerant polychaete on benthic metabolism, denitrification and nitrogen regeneration in contaminated estuarine sediments.

We investigated the effects of the burrowing cirratulid polychaete Cirriformia filigera (Delle Chiaje, 1828) on benthic respiration and nitrogen regeneration in metal-contaminated estuarine sediments using laboratory mesocosms. C. filigera is a dominant component of assemblages in the most severely contaminated sediments within the Derwent estuary, southern Australia. In the presence of C. filigera sediment O2 consumption doubled, with approximately 55% of this increase due to their respiration and the remaining 45% attributable to oxidation reactions and increased microbial respiration associated with burrow walls. Combined NO3 and NO2 fluxes were unaffected. The addition of labile organic matter did not affect benthic fluxes, in the presence or absence of C. filigera, presumably due to the short timeframe of the experiment and naturally enriched test sediments. The results suggest that a combination of tolerance and burrowing activity enables this species to provide an ecosystem service in the removal of N from contaminated sites.

Cultural relevance of physical activity intervention research with underrepresented populations.

This article describes cultural relevance in physical activity intervention research with underrepresented populations. Seventy-one extant studies which tested interventions to increase physical activity among underrepresented adults were included. Verbatim descriptions of efforts to enhance cultural relevance of study designs and interventions were extracted and then content analyzed. We found strategies to enhance cultural relevance of interventions as soliciting input from population members, linking intervention content with values, addressing language and literacy challenges, incorporating population media figures, using culturally relevant forms of physical activity, and addressing specific population linked barriers to activity. Methodological approaches included specialized recruitment and study locations, culturally relevant measures, underrepresented personnel, and cost-awareness study procedures to prevent fiscal barriers to participation. Most reported activities were surface matching. Existing research neither compared the effectiveness of cultural relevance approaches to standardized interventions nor addressed economic, education, geographic, or cultural heterogeneity among groups.

Development of scholarly trajectories that reflect core values and priorities: a strategy for promoting faculty retention.

Development of scholarly trajectories that more adequately allow faculty to balance work-related goals with priorities in their larger lives may play an important role in the retention of nursing faculty. This article articulates a process for developing scholarly trajectories consistent with core values and priorities. The potential of Boyer's model of scholarship as a framework for such a trajectory is discussed. Attention is given to consciously think through competing priorities within and across the multiple facets of life as a critical component of staging academic pursuits. An exercise designed to enhance creation of scholarly trajectories that balance needs across different dimensions is presented. Challenges affecting development of scholarly trajectories, including increased scholarly demands, growing preference for doctorally prepared faculty, and tenure/promotion expectations and time frames, are addressed.

Acute carpal tunnel syndrome in a patient with haemophilia.

Acute carpal tunnel syndrome (CTS) is a rare surgical condition usually resulting from wrist trauma. We present the case of a young haemophilic man who developed acute CTS following trivial injury. The patient was initially managed conservatively but symptom progression resulted in carpal tunnel decompression. A literature review and management approach are presented. This is an important complication of haemophilia to be aware of as prompt conservative management can obviate the need for surgery. This case is useful in (a) highlighting the importance of considering a patient's medical history when formulating differential diagnoses and (b) outlining a management approach to this condition.

Measuring hypoxia induced metal release from highly contaminated estuarine sediments during a 40 day laboratory incubation experiment.

Nutrient inputs to estuarine and coastal waters worldwide are increasing and this in turn is increasing the prevalence of eutrophication and hypoxic and anoxic episodes in these systems. Many urbanised estuaries are also subject to high levels of anthropogenic metal contamination. Environmental O(2) levels may influence whether sediments act as sinks or sources of metals. In this study we investigated the effect of an extended O(2) depletion event (40 days) on fluxes of trace metals (and the metalloid As) across the sediment-water interface in sediments from a highly metal contaminated estuary in S.E. Tasmania, Australia. We collected sediments from three sites that spanned a range of contamination and measured total metal concentration in the overlying water using sealed core incubations. Manganese and iron, which are known to regulate the release of other divalent cations from sub-oxic sediments, were released from sediments at all sites as hypoxia developed. In contrast, the release of arsenic, cadmium, copper and zinc was comparatively low, most likely due to inherent stability of these elements within the sediments, perhaps as a result of their refractory origin, their association with fine-grained sediments or their being bound in stable sulphide complexes. Metal release was not sustained due to the powerful effect of metal-sulphide precipitation of dissolved metals back into sediments. The limited mobilisation of sediment bound metals during hypoxia is encouraging, nevertheless the results highlight particular problems for management in areas where hypoxia might occur, such as the release of metals exacerbating already high loads or resulting in localised toxicity.

Storytelling to access social context and advance health equity research.

OBJECTIVE: Increased understanding of individual and social determinants of health is crucial to moving toward health equity. This essay examines storytelling as a vehicle for advancing health equity research. METHOD: Contemplative examination of storytelling as a research strategy. RESULTS: An overview of story theory is provided. This is followed by an examination of storytelling as a tool for increasing understanding about the contexts in which people negotiate health, strengthening participation of communities in addressing health issues, and building bridges between researchers and target populations. CONCLUSION: Storytelling can be a powerful tool for advancing health equity research. However, its effective use requires a renegotiation of relationships between researchers and target communities, as well as setting aside routine time to attend storytelling events and read a variety of stories.