Assessing the risk of re-fracture related to the percentage of partial union in scaphoid waist fractures.

Aims: There is ambiguity surrounding the degree of scaphoid union required to safely allow mobilization following scaphoid waist fracture. Premature mobilization could lead to refracture, but late mobilization may cause stiffness and delay return to normal function. This study aims to explore the risk of refracture at different stages of scaphoid waist fracture union in three common fracture patterns, using a novel finite element method. Methods: The most common anatomical variant of the scaphoid was modelled from a CT scan of a healthy hand and wrist using 3D Slicer freeware. This model was uploaded into COMSOL Multiphysics software to enable the application of physiological enhancements. Three common waist fracture patterns were produced following the Russe classification. Each fracture had differing stages of healing, ranging from 10% to 90% partial union, with increments of 10% union assessed. A physiological force of 100 N acting on the distal pole was applied, with the risk of refracture assessed using the Von Mises stress. Results: Overall, 90% to 30% fracture unions demonstrated a small, gradual increase in the Von Mises stress of all fracture patterns (16.0 MPa to 240.5 MPa). All fracture patterns showed a greater increase in Von Mises stress from 30% to 10% partial union (680.8 MPa to 6,288.6 MPa). Conclusion: Previous studies have suggested 25%, 50%, and 75% partial union as sufficient for resuming hand and wrist mobilization. This study shows that 30% union is sufficient to return to normal hand and wrist function in all three fracture patterns. Both 50% and 75% union are unnecessary and increase the risk of post-fracture stiffness. This study has also demonstrated the feasibility of finite element analysis (FEA) in scaphoid waist fracture research. FEA is a sustainable method which does not require the use of finite scaphoid cadavers, hence increasing accessibility into future scaphoid waist fracture-related research.

Inland Waterways and Population Health and Wellbeing: A Cross-Sectional Study of Waterway Users in the UK.

Natural environments, such as inland waterways (IWs), have been identified as a potential means to increase physical activity and promote health and wellbeing. However, further information on predictors of IW usage and their relationship with health and wellbeing outcomes is needed. Data were taken from the cross-sectional UK Waterways Engagement Monitor survey of waterway users (n = 21,537) in 2019/2020. Health outcome measures were life satisfaction, physical activity, and mental wellbeing. Visit frequency was an additional outcome measure. Both bivariate and multivariable associations between outcome measures and features of IWs were explored. The travel-cost method was used to estimate users' demand, expressed by travel costs to waterways. Multivariable models showed positive associations of frequent visits and use for recreational/leisure purposes with life satisfaction and physical activity. Rural visits were associated with higher life satisfaction than urban ones. Lower visit satisfaction negatively impacted life satisfaction and mental wellbeing. Visit frequency was influenced by individual characteristics and purpose of visit, including visits for exercise. Waterway visits were inversely associated with travel costs (IRR = 0.99, p-value ≤ 0.001), and there was greater demand elasticity for short distances (≤5 miles). Socioeconomic-related inequalities were present. Future policies could enhance frequent use of waterways and alleviate accessibility-related inequalities to improve population health outcomes.

The mental health benefits of visiting canals and rivers: An ecological momentary assessment study.

Existing evidence shows positive effects of being in nature on wellbeing, but we know little about the mental health benefits of spending time near canals and rivers specifically. This study investigates the association between visits to canals and rivers and mental wellbeing. We addressed the following questions: Are visits to canals and rivers associated with higher levels of mental wellbeing? Does this association depend on age and gender? Does this association vary between people with and without a diagnosis on mental illness? We used Urban Mind, a flexible smartphone application for examining the impact of different aspects of the built and social environment on mental wellbeing, a strong predictor of mental health. Participants were invited to complete an ecological momentary assessment three times a day for fourteen days. Each assessment included questions about their surrounding environment and mental wellbeing. A total of 7,975 assessments were completed by 299 participants including 87 with a diagnosis of mental illness. Multilevel regression models were used to analyse the data. We found positive associations between visits to canals and rivers and mental wellbeing (p < .05) when compared to being anywhere else and when compared to being in green spaces. Increases in mental wellbeing were still evident after the visit had taken place. These effects remained significant after adjusting for age, gender, ethnicity and education, and were consistent in people with and without a diagnosis of mental illness. Spending time near canals and rivers is associated with better mental wellbeing. These findings have potential implications for mental health as well as urban planning and policy. Visits to canals and rivers could become part of social prescribing schemes, playing a role in preventing mental health difficulties and complementing more traditional interventions.

Radiographer-led discharge for emergency care patients, requiring projection radiography of minor musculoskeletal injuries: a scoping review.

BACKGROUND: Pressure on emergency departments (EDs) from increased attendance for minor injuries has been recognised in the United Kingdom. Radiographer-led discharge (RLD) has potential for improving efficiency, through radiographers trained to discharge patients or refer them for treatment at the point of image assessment. This review aims to scope all RLD literature and identify research assessing the merits of RLD and requirements to enable implementation. METHODS: We conducted a scoping review of studies relating to RLD of emergency care patients requiring projection radiography of minor musculoskeletal (MSK) injuries. MEDLINE, Embase and CINAHL, relevant radiography journals and grey literature were searched. Articles were reviewed and the full texts of selected studies were screened against eligibility criteria. The data were extracted, collated and a narrative synthesis completed. RESULTS: Seven studies with varying study designs were included in the review. The small number of studies was possibly due to a generally low research uptake in radiography. The main outcome for four studies was reduced length of stay in ED, with recall and re-attendance to ED a primary outcome in one study and secondary outcome for two other studies. The potential for increased efficiency in the minor MSK pathway patient pathway and capacity for ED staff was recognised. Radiographers identified a concern regarding the risk of litigation and incentive of increased salary when considering RLD. The studies were broadly radiographer focussed, despite RLD spanning ED and Radiology. CONCLUSION: There were a low number of RLD active radiographers, likely to be motivated individuals. However, RLD has potential for generalisability with protocol variations evident, all producing similar positive outcomes. Understanding radiography and ED culture could clarify facilitators for RLD to be utilised more sustainably into the future. Cost effectiveness studies, action research within ED, and cluster randomised controlled trial with process evaluation are needed to fully understand the potential for RLD. The cost effectiveness of RLD may provide financial support for training radiographers and increasing their salary, with potential future benefit of reduction in workload within ED. RLD implementation would require an inter-professional approach achieved by understanding ED staff and patient perspectives and ensuring these views are central to RLD implementation.

Release of growth factors from a reinforced collagen GAG matrix supplemented with platelet rich plasma: Influence on cultured human meniscal cells.

Damage to meniscal cartilage has been strongly linked to accelerated articular wear and consequently to osteoarthritis. Damage might be ameliorated by delivery of growth factors from platelet rich plasma (PRP) via a fiber reinforced collagen matrix designed for meniscal repair. PRP composition, release of growth factors, and influence on meniscal cell growth and gene expression were investigated. PRP was prepared using Harvest Smartprep (HS-PRP), Cascade Fibrinet (CF-PRP), and a simple centrifuge protocol (DC-PRP) from four donors each. CF-PRP had the highest ratio of platelets, with very few other blood cell types. HS-PRP had the highest total number of platelets but also contained high levels of red and white blood cells. Absorbed to collagen matrices HS-PRP released the highest levels of TGF-ß1 and PDGF-AB with DC-PRP the most IGF-1. Cumulative release from collagen matrix was 48 ng/cm(3) IGF-1, 96 ng/cm(3) TGF-ß1, and 9.6 ng/cm(3) PDGF-AB. Collagen matrix with PRP was able to increase meniscal cell number above peripheral whole blood and up-regulated gene expression of Aggrecan, Collagen type I (α1), and Elastin (3.3 ± 0.8-fold, 2.9 ± 0.6-fold, 4.0 ± 1.4-fold, respectively). Demonstrating that PRP combined with fiber reinforced collagen matrix could influence meniscal cells and might be of use for treating meniscal defects.

Evaluation and comparison of parental needs, stressors, and coping strategies in a pediatric intensive care unit.

OBJECTIVE: To evaluate and compare the needs, stressors, and coping strategies of mothers and fathers in a pediatric intensive care unit, and to advance the development of the COMPASS questionnaire for examining parent experiences. DESIGN: Prospective cohort study using a modified version of a pilot questionnaire, incorporating a series of 58 questions based on a visual analog scale in three categories of needs, stressors, and coping strategies. SETTING: Tertiary pediatric intensive care unit, Southampton University Hospitals, Southampton, UK. SUBJECTS: A total of 182 parents (91 mothers and 91 fathers) of children admitted to the pediatric intensive care unit. INTERVENTIONS: Collection and analysis of needs, stressors, and coping strategies scores. MEASUREMENTS AND MAIN RESULTS: Both parents identified the need for honest, open, timely, and understandable information, with access to their child as paramount. Parents found feelings of uncertainty and helplessness to be particularly stressful. The main coping strategies employed by parents were related to trust, assurance, and believing in positive outcomes. The particular needs and stressors of mothers and fathers were found to be similar. There were, however, some statistically significant differences in stressors: mothers had higher stress scores regarding how their child looked, not being able to care for them, witnessing procedures, and on leaving their child as compared with fathers. There were no statistically significant differences in coping mechanisms between the sexes. CONCLUSIONS: Acute parental experiences can be documented using the COMPASS questionnaire. This study highlights the principal needs, stressors, and coping strategies of parents of children in the pediatric intensive care unit. The experiences of mothers and fathers are similar, but we identify some differences in stressors between the sexes.