Assessment of Musculoskeletal Discomfort and Evaluation of Radiology Workstation Ergonomics in a National Radiology Workforce.

RATIONALE AND OBJECTIVES: We assessed the presence of musculoskeletal discomfort and evaluated the ergonomics parameters of radiology workstations and the impact of poor radiology workstation ergonomics on musculoskeletal discomfort in a national radiology workforce. METHODS: This was a cross-sectional, questionnaire-based study. All radiologist and radiology trainee members of the Canadian Association of Radiologists were eligible to participate. Radiology workstation ergonomics parameters and self-reported data on musculoskeletal discomfort were recorded. A binary logistic regression model was fitted to the data to ascertain the impact of participants' radiology workstation ergonomics parameters on the likelihood of experience of musculoskeletal discomfort while adjusting for demographic variables. RESULTS: A total of 191 questionnaires were completed. The median (interquartile range) age of participants was 42.0 years (17.0 years) and 56.8% of participants were female. One hundred fifty participants (78.5%) self-reported the presence of musculoskeletal discomfort. Ergonomics parameters most commonly implemented included having monitors an arm's length away (82.6%) and hands being shoulder-width apart (77.1%). Binary logistic regression revealed participants either not having the top of the monitor screen at eye level when in a seated position or not having the wrists straight and relatively flat when using the mouse was associated with an increased likelihood of experience of musculoskeletal discomfort. The majority of participants (92.7%) self-reported their musculoskeletal discomfort to affect work productivity. CONCLUSION: A high proportion of musculoskeletal discomfort, limited implementation of ergonomics parameters of radiology workstations, and an association of two of these ergonomics parameters with an increased likelihood of experience of musculoskeletal discomfort were observed in a national radiology workforce.

Analysis of the health product pipeline for poverty-related and neglected diseases using the Portfolio-to-Impact (P2I) modeling tool.

Background: To estimate how much additional funding is needed for poverty-related and neglected disease (PRND) product development and to target new resources effectively, policymakers need updated information on the development pipeline and estimated costs to fill pipeline gaps. Methods: We previously conducted a pipeline review to identify candidates for 35 neglected diseases as of August 31, 2017 ("2017 pipeline"). We used the Portfolio-to-Impact (P2I) tool to estimate costs to move these candidates through the pipeline, likely launches, and additional costs to develop "missing products." We repeated this analysis, reviewing the pipeline to August 31, 2019 to get a time trend. We made a direct comparison based on the same 35 diseases ("2019 direct comparison pipeline"), then a comparison based on an expanded list of 45 diseases ("2019 complete pipeline"). Results: In the 2017 pipeline, 538 product candidates met inclusion criteria for input into the model; it would cost $16.3 billion (B) to move these through the pipeline, yielding 128 launches. In the 2019 direct comparison pipeline, we identified 690 candidates, an increase of 152 candidates from 2017; the largest increase was for Ebola.  The direct comparison 2019 pipeline yields 196 launches, costing $19.9B. In the 2019 complete pipeline, there were 754 candidates, an increase of 216 candidates from 2017, of which 152 reflected pipeline changes and 64 reflected changes in scope. The complete pipeline 2019 yields 207 launches, costing $21.0B. There would still be 16 "missing products" based on the complete 2019 pipeline; it would cost $5.5B-$14.2B (depending on product complexity) to develop these products. Conclusion: The PRNDs product development pipeline has grown by over a quarter in two years. The number of expected new product launches based on the 2019 pipeline increased by half compared to 2017; the cost of advancing the pipeline increased by a quarter.

A randomised controlled trial to investigate the efficacy of an oxalate strip for the management of dentine hypersensitivity pain.

OBJECTIVES: To compare a 3.14% potassium oxalate strip and 8% arginine calcium carbonate toothpaste for the reduction of dentine hypersensitivity after 2 and 4 weeks. METHODS: This was an examiner-blind, parallel study in 80 healthy adults with dentine hypersensitivity (Schiff score >2) in >1 tooth. After acclimatisation, participants were randomised to the oxalate desensitising strip with fluoride toothpaste or the arginine desensitising toothpaste control which also contained fluoride. Products were applied under supervision of study staff after measuring baseline sensitivity, thereafter the strip or control toothpaste (fingertip application) was applied after 1 and 2 weeks, and teeth brushed twice-daily with the fluoride (test group) or the fluoridated arginine control toothpaste. Sensitivity was assessed following airblast (Schiff and VAS) and tactile stimuli (Yeaple probe) at baseline, 2 and 4 weeks. RESULTS: Both groups showed significant reductions from baseline in VAS, Schiff and Yeaple sensitivity scores after 2 and 4 weeks (p < 0.0005). The oxalate group had significantly lower Schiff and higher Yeaple probe scores compared to control after both time points (p < 0.0002 and p < 0.05), but while scores favoured the oxalate group, there were no significant differences in VAS. CONCLUSIONS: This study demonstrated application of a 3.14% potassium oxalate strip combined with toothbrushing with paste was more effective in pain management of dentine hypersensitivity than brushing with arginine toothpaste. CLINICAL SIGNIFICANCE: Treatment of sensitive teeth with the oxalate strip reduced dentine hypersensitivity after 2 and 4 weeks to a significantly greater degree than a positive control sensitivity toothpaste demonstrating that oxalate strips are an effective targeted treatment for dentine hypersensitivity sufferers.

Use of tranexamic acid in trauma patients requiring massive transfusion protocol activation: an audit in a major trauma centre in New Zealand.

AIM: To investigate prescribing behaviours around tranexamic acid (TXA) use in the early management of severe trauma, and compare against standards considered to be best practice internationally, as established by the current body of research. METHODS: We undertook a retrospective analysis of all trauma patients requiring massive transfusion protocol (MTP) activation across a 20-month period. A combination of physical and electronic inpatient records and ambulance documentation were reviewed to determine dose and timing of TXA administration. RESULTS: During the period studied, 27 adult trauma patients who required activation of the MTP were identified. Of the patients where TXA was indicated, 76.2% received at least an initial dose of TXA, with 19.0% receiving both doses. 21.1% of patients who received TXA were administered an initial dose within one hour of injury, 52.6% between one and three hours, 26.3% outside three hours. CONCLUSIONS: TXA was found to be under-utilised and significant departures from best practice were found, likely due to persisting uncertainty and unfamiliarity. In particular, delayed administration beyond the three-hour therapeutic window occurred in a quarter of patients, increasing the risk of mortality secondary to haemorrhage. This pattern of use may apply to the wider population of trauma patients in this centre, and requires remedy and reassessment.

Developing new health technologies for neglected diseases: a pipeline portfolio review and cost model.

Background: Funding for neglected disease product development fell from 2009-2015, other than a brief injection of Ebola funding. One impediment to mobilizing resources is a lack of information on product candidates, the estimated costs to move them through the pipeline, and the likelihood of specific launches. This study aimed to help fill these information gaps. Methods: We conducted a pipeline portfolio review to identify current candidates for 35 neglected diseases. Using an adapted version of the Portfolio to Impact financial modelling tool, we estimated the costs to move these candidates through the pipeline over the next decade and the likely launches. Since the current pipeline is unlikely to yield several critical products, we estimated the costs to develop a set of priority "missing" products. Results: We found 685 neglected disease product candidates as of August 31, 2017; 538 candidates met inclusion criteria for input into the model. It would cost about $16.3 billion (range $13.4-19.8B) to move these candidates through the pipeline, with three-quarters of the costs incurred in the first 5 years, resulting in about 128 (89-160) expected product launches.  Based on the current pipeline, there would be few launches of complex new chemical entities; launches of highly efficacious HIV, tuberculosis, or malaria vaccines would be unlikely. Estimated additional costs to launch one of each of 18 key missing products are $13.6B assuming lowest product complexity or $21.8B assuming highest complexity ($8.1B-36.6B). Over the next 5 years, total estimated costs to move current candidates through the pipeline and develop these 18 missing products would be around $4.5B (low complexity missing products) or $5.8B/year (high complexity missing products). Conclusions: Since current annual global spending on product development is about $3B, this study suggests the annual funding gap over the next 5 years is at least $1.5-2.8B.

An interproximal model to determine the erosion-protective effect of calcium silicate, sodium phosphate, fluoride formulations.

OBJECTIVES: Previous work has shown the effectiveness of a newly developed interproximal model to differentiate between the amount of remineralization caused by toothpastes used with or without a dual-phase gel treatment system containing calcium silicate, sodium phosphate salts and fluoride to repair acid-softened enamel. The aim of this study was to utilize the same interproximal model to identify how effective calcium silicate phosphate toothpastes are at reducing surface softening in the early stages of erosion. The model was also used to identify the effect of increasing the frequency of acid exposure on the reduction in surface hardness. METHODS: Human enamel specimens were prepared and mounted in an interproximal face-to-face arrangement and exposed to a cycling regime of whole human saliva, treatment, artificial saliva and 1% citric acid pH 3.75. Specimens were measured by surface microhardness at baseline and after three and seven days. The frequency of acid exposure was increased from 2 to 4 cycles a day for the second part of the study. RESULTS: The results showed that specimens treated with the calcium silicate phosphate toothpastes softened less than those treated with control fluoridated or non-fluoride toothpastes at each time point and following an increase in the frequency of acid exposure. SIGNIFICANCE: This work has demonstrated how an interproximal model can also be successfully used to determine differences in the erosion protection of various treatments as well as determining how they perform when the frequency of acid exposure is increased.

Extension Casting For Both-Bone Forearm Fractures In Children.

Paediatric forearm fractures are commonly treated with closed reduction and cast immobilization. Determining the best way to cast these fractures during the initial presentation may prevent the need for re-manipulation . An analysis of casting technique for all patients under eighteen years of age treated with closed reduction and cast immobilization for both-bone fractures of the forearm at a regional tertiary referral hospital over 7 years was undertaken. One-hundred and eighty-nine consecutive patients with 207 fractures were reviewed. No significant association was found between casting technique and failure rates (p=0.124). However, if manipulation and plaster was performed by a trainee, failure rates were significantly reduced when extension casting was utilized (p=0.029). Closed reduction and cast immobilization with the elbow in an extended position is an effective treatment option for both-bone forearm fractures in a paediatric population and is a safer option when performed by more junior staff-members.

Roots, water, and nutrient acquisition: let's get physical.

Improved root water and nutrient acquisition can increase fertiliser use efficiency and is important for securing food production. Root nutrient acquisition includes proliferation, transporter function, exudation, symbioses, and the delivery of dissolved nutrients from the bulk soil to the root surface via mass flow and diffusion. The widespread adoption of simplified experimental systems has restricted consideration of the influence of soil symbiotic organisms and physical properties on root acquisition. The soil physical properties can directly influence root growth and explain some of the disparities obtained from different experimental systems. Turning this to an advantage, comparing results obtained with the same model plant Arabidopsis (Arabidopsis thaliana) in different systems, we can tease apart the specific effects of soil physical properties.

Water supply and not nitrate concentration determines primary root growth in Arabidopsis.

Understanding how root system architecture (RSA) adapts to changing nitrogen and water availability is important for improving acquisition. A sand rhizotron system was developed to study RSA in a porous substrate under tightly regulated nutrient supply. The RSA of Arabidopsis seedlings under differing nitrate (NO3⁻) and water supplies in agar and sand was described. The hydraulic conductivity of the root environment was manipulated by using altered sand particle size and matric potentials. Ion-selective microelectrodes were used to quantify NO3⁻ at the surface of growing primary roots in sands of different particle sizes. Differences in RSA were observed between seedlings grown on agar and sand, and the influence of NO3⁻ (0.1-10.0 mm) and water on RSA was determined. Primary root length (PRL) was a function of water flux and independent of NO3⁻. The percentage of roots with laterals correlated with water flux, whereas NO3⁻ supply was important for basal root (BR) growth. In agar and sand, the NO3⁻ activities at the root surface were higher than those supplied in the nutrient solution. The sand rhizotron system is a useful tool for the study of RSA, providing a porous growth environment that can be used to simulate the effects of hydraulic conductivity on growth.