Publications by authors named "John Parsons"

136 Publications

Oral Care in Hospital Settings: Breaking the Vicious Circle of Older Adult Deconditioning.

J Gerontol Nurs 2021 Jun 1;47(6):7-12. Epub 2021 Jun 1.

Hospitalized older adults frequently develop aspiration pneumonia, swallowing dys-function (dysphagia), and sarcopenia. In the current study, we propose a framework that incorporates these three factors into a vicious circle that leads to deconditioning, a condition frequently experienced by this vulnerable population. Viewing aspiration pneumonia, dysphagia, and sarcopenia, along with their interrelationships through the lens of this vicious circle, illuminates the critical role that oral health plays in deconditioning. Moreover, this framework highlights oral care as a key nursing intervention for reducing deconditioning in hospitalized older adults. Supporting this view, several studies have shown that oral care can improve health outcomes for hospitalized older adults. However, despite oral care being an essential nursing intervention that restores oral function and promotes patient wellness, it is one of the most neglected nursing interventions. Missed oral care occurs due to staff's limited awareness of its significance for care-dependent older adults in hospital settings. We hope that this vicious circle paradigm helps raise awareness of the significance of oral care to prevent deconditioning in hospitalized older adults. [(6), 7-12.].
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http://dx.doi.org/10.3928/00989134-20210507-01DOI Listing
June 2021

High biodiversity in a benzene-degrading nitrate-reducing culture is sustained by a few primary consumers.

Commun Biol 2021 May 5;4(1):530. Epub 2021 May 5.

Department of Molecular Cell Biology, AIMMS, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

A key question in microbial ecology is what the driving forces behind the persistence of large biodiversity in natural environments are. We studied a microbial community with more than 100 different types of species which evolved in a 15-years old bioreactor with benzene as the main carbon and energy source and nitrate as the electron acceptor. Using genome-centric metagenomics plus metatranscriptomics, we demonstrate that most of the community members likely feed on metabolic left-overs or on necromass while only a few of them, from families Rhodocyclaceae and Peptococcaceae, are candidates to degrade benzene. We verify with an additional succession experiment using metabolomics and metabarcoding that these few community members are the actual drivers of benzene degradation. As such, we hypothesize that high species richness is maintained and the complexity of a natural community is stabilized in a controlled environment by the interdependencies between the few benzene degraders and the rest of the community members, ultimately resulting in a food web with different trophic levels.
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http://dx.doi.org/10.1038/s42003-021-01948-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099898PMC
May 2021

Improving our understanding of the environmental persistence of chemicals.

Integr Environ Assess Manag 2021 Apr 29. Epub 2021 Apr 29.

Institute for Environmental Research, Aachen University, Aachen, Germany.

Significant progress has been made in the scientific understanding of factors that influence the outcome of biodegradation tests used to assess the persistence (P) of chemicals. This needs to be evaluated to assess whether recently acquired knowledge could enhance existing regulations and environmental risk assessments. Biodegradation tests have limitations, which are accentuated for "difficult-to-test" substances, and failure to recognize these can potentially lead to inappropriate conclusions regarding a chemical's environmental persistence. Many of these limitations have been previously recognized and discussed in a series of ECETOC reports and workshops. These were subsequently used to develop a series of research projects designed to address key issues and, where possible, propose methods to mitigate the limitations of current assessments. Here, we report on the output of a Cefic LRI-Concawe Workshop held in Helsinki on September 27, 2018. The objectives of this workshop were to disseminate key findings from recent projects and assess how new scientific knowledge can potentially support and improve assessments under existing regulatory frameworks. The workshop provided a unique opportunity to initiate a process to reexamine the fundamentals of degradation and what current assessment methods can achieve by (1) providing an overview of the key elements and messages coming from recent research initiatives and (2) stimulating discussion regarding how these interrelate and how new findings can be developed to improve persistence assessments. Opportunities to try and improve understanding of factors affecting biodegradation assessments and better understanding of the persistence of chemicals (particularly UVCBs [substances of unknown or variable composition, complex reaction products, or biological materials]) were identified, and the workshop acted as a catalyst for further multistakeholder activities and engagements to take the persistence assessment of chemicals into the 21st century. Integr Environ Assess Manag 2021;00:1-13. © 2021 European Petroleum Refiners Association - Concawe Division. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).
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http://dx.doi.org/10.1002/ieam.4438DOI Listing
April 2021

Prescribed exercise regimen versus usual care and hypochlorous acid wound solution versus placebo for treating venous leg ulcers: study protocol for a randomised controlled trial (Factorial4VLU).

BMJ Open 2021 02 18;11(2):e043420. Epub 2021 Feb 18.

School of Nursing, University of Tasmania, Launceston, Tasmania, Australia.

Introduction: Compression is the mainstay of treatment for venous leg ulcers (VLUs) and there are few effective adjuvant treatments. There is only observational evidence supporting the use of hypochlorous acid (HOCl) as a topical wound solution on VLU and some limited randomised evidence for the effect of a prescribed regimen of exercise.

Methods And Analysis: The Factorial4VLU trial is a pragmatic, blinded, factorial randomised controlled trial, with 380 participants receiving either a prescribed exercise regimen compared with usual care and either active HOCl wound solution or placebo wound solution at each dressing change for up to 24 weeks. All participants will receive compression therapy. The primary outcome is the proportion of participants with healed VLU at 12 weeks after randomisation as adjudicated by blinded review of ulcer photographs. Secondary outcomes are proportion healed at 24 weeks, time to healing, estimated change in ulcer area, change in 2-Minute Walk Test, change in health-related quality of life, incidence of infection and incidence of all-cause adverse events. If either of the interventions shows a statistically significant positive difference on healing outcomes, cost-effectiveness will be modelled using a health service perspective.

Ethics And Dissemination: The Factorial4VLU trial received ethical approval from the Northern B Health and Disability Ethics Committee. We plan to publish the results within 1 year of trial completion and will include the results on the trial registration page.

Trial Registration Numbers: Australia and New Zealand Clinical Trials Register (http://www.anzctr.org.au) (ACTRN12620000116921); Universal Trial Number (WHO) (U1111-1236-2997).
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http://dx.doi.org/10.1136/bmjopen-2020-043420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7896607PMC
February 2021

Clinician knowledge of driving restrictions following a stroke event.

N Z Med J 2021 01 15;134(1528):46-56. Epub 2021 Jan 15.

Professor, School of Psychology, Waikato University, Hamilton.

Aim: To investigate the knowledge and practice of health professionals when advising persons on driving restrictions after a transient ischaemic attack (TIA) or stroke in a tertiary hospital in New Zealand.

Methods: Health professionals working in the area of stroke care across the acute and rehabilitation services in a large tertiary hospital were invited to complete an electronic survey around knowledge of driving restrictions based on the New Zealand Transport Agency (NZTA) guidelines. Knowledge was assessed for both private and commercial vehicle use. The other information gathered included participant profession, level of seniority and experience working in stroke care, previous education around medical-related driving restrictions and how and what driving recommendations were discussed with patients. Knowledge of driving restrictions was established by the number and percentage of correct responses for each condition (single TIA, multiple TIA and stroke with full recovery) relating to the recommended restrictions in both private and commercial vehicle use.

Results: Forty-nine participants' surveys were analysed with representation from across all the health professions (24.5% [12/49] doctors, 38.8% [19/49] nurses and 36.7% [18/49] allied health). Only 38.8% reported having had received training around post-stroke driving restrictions. Knowledge around driving restrictions was highest for a single episode TIA for private vehicle use (73.5% [36/49]). For all other categories, fewer than 50% of participants answered correctly, with knowledge of commercial vehicle restrictions being the least accurate.

Conclusions: Many health professionals have discussions with people about driving restrictions following a TIA or stroke. However, there appears to be limited knowledge of all the restrictions for each condition as they relate to either private or commercial vehicle use. Insufficient training and education for clinicians might explain this gap.
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January 2021

Comparison of the aerobic biodegradation of biopolymers and the corresponding bioplastics: A review.

Sci Total Environ 2021 Jan 25;753:141953. Epub 2020 Aug 25.

Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, Science Park 904, 1098 XH Amsterdam, the Netherlands.

Biodegradable plastics made from biopolymers (made in nature) or from bio-based polymers (made in a factory) are becoming increasingly important in replacing the massive amounts of conventional, non-degradable fossil-based plastics that have been produced and disposed over the past decades. In this review we compare the biodegradation rates and mechanisms of the bioplastics thermoplastic starch, cellulose acetate and lignin based bioplastics with the biodegradation rates and mechanisms of starch, cellulose and lignin, which are the unmodified biopolymers from which these bioplastics are produced. With this comparison we aim to determine to what extent the extensive knowledge on unmodified biopolymer biodegradation can be applied to the biodegradation of bioplastics (modified biopolymers) in the terrestrial environment. This knowledge is important, since it can be of great help in giving direction to the future research and development of bioplastics and for the development of bioplastic waste assessments and policies. We found that the similarities and differences in biodegradation are dependent on the structural changes imposed on a biopolymer during the bioplastic production process. A change in higher level structure, as found in thermoplastic starch, only resulted in a limited number of differences in the biodegradation process. However, when the chemical structure of a polymer is changed, as for cellulose acetate, different microorganisms and enzymes are involved in the biodegradation. Based on the cellulose acetate biodegradation process, a conceptual model was proposed that can be used as a starting point in predicting biodegradation rates of other chemically modified biopolymers used as bioplastics. Future bioplastic biodegradation research should focus on conducting long-term field experiments, since most studies are conducted in a laboratory setting and do not capture all processes occurring in the field situation. This applies even more to lignin based bioplastics, since very little experimental data were available on modified lignin biopolymer biodegradation.
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http://dx.doi.org/10.1016/j.scitotenv.2020.141953DOI Listing
January 2021

Effects of salinity on the treatment of synthetic petroleum-industry wastewater in pilot vertical flow constructed wetlands under simulated hot arid climatic conditions.

Environ Sci Pollut Res Int 2021 Jan 1;28(2):2172-2181. Epub 2020 Sep 1.

Department of Environmental Technology, Wageningen University & Research, P. O. Box 17, 6700 EV, Wageningen, The Netherlands.

Petroleum-industry wastewater (PI-WW) is a potential source of water that can be reused in areas suffering from water stress. This water contains various fractions that need to be removed before reuse, such as light hydrocarbons, heavy metals and conditioning chemicals. Constructed wetlands (CWs) can remove these fractions, but the range of PI-WW salinities that can be treated in CWs and the influence of an increasing salinity on the CW removal efficiency for abovementioned fractions is unknown. Therefore, the impact of an increasing salinity on the removal of conditioning chemicals benzotriazole, aromatic hydrocarbon benzoic acid, and heavy metal zinc in lab-scale unplanted and Phragmites australis and Typha latifolia planted vertical-flow CWs was tested in the present study. P. australis was less sensitive than T. latifolia to increasing salinities and survived with a NaCl concentration of 12 g/L. The decay of T. latifolia was accompanied by a decrease in the removal efficiency for benzotriazole and benzoic acid, indicating that living vegetation enhanced the removal of these chemicals. Increased salinities resulted in the leaching of zinc from the planted CWs, probably as a result of active plant defence mechanisms against salt shocks that solubilized zinc. Plant growth also resulted in substantial evapotranspiration, leading to an increased salinity of the CW treated effluent. A too high salinity limits the reuse of the CW treated water. Therefore, CW treatment should be followed by desalination technologies to obtain salinities suitable for reuse. In this technology train, CWs enhance the efficiency of physicochemical desalination technologies by removing organics that induce membrane fouling. Hence, P. australis planted CWs are a suitable option for the treatment of water with a salinity below 12 g/L before further treatment or direct reuse in water scarce areas worldwide, where CWs may also boost the local biodiversity. Graphical abstract.
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http://dx.doi.org/10.1007/s11356-020-10584-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785543PMC
January 2021

Pilot-scale hybrid constructed wetlands for the treatment of cooling tower water prior to its desalination and reuse.

J Environ Manage 2020 Oct 24;271:110972. Epub 2020 Jun 24.

Department of Environmental Technology, Wageningen University, P.O. Box 17, 6700 EV, Wageningen, the Netherlands.

Cooling towers are responsible for a large part of the industrial fresh water withdrawal, and the reuse of cooling tower water (CTW) effluents can strongly lower industrial fresh water footprints. CTW requires desalination prior to being reused, but various CTW components, such as total organic carbon (TOC), conditioning chemicals and total suspended solids (TSS) hamper physico-chemical desalination technologies and need to be removed from the CTW. A cost-efficient and robust pre-treatment is thus required, which can be provided by constructed wetlands (CWs). The present study is the first study that determined the CTW pre-treatment efficiency of hybrid-CWs and the impact of winter season and biocides in the CTW on the pre-treatment efficiency. The most efficient CW flow type and dominant removal mechanisms for CW components hampering physico-chemical desalination were determined. Subsurface flow CWs removed PO, TSS and TOC as a result of adsorption and filtration. Vertical subsurface flow CWs (VSSF-CW) excelled in the removal of benzotriazole as a result of aerobic biodegradation. Horizontal subsurface flow CWs (HSSF-CW) allowed the denitrification of NO due to their anaerobic conditions. Open water CWs (OW-CWs) did not contribute to the removal of components that hamper physico-chemical desalination technologies, but do provide water storage options and habitat. The biological removal processes in the different CW flow types were negatively impacted by the winter season, but were not impacted by concentrations of the biocides glutaraldehyde and DBNPA that are relevant in practice. For optimal pre-treatment, a hybrid-CW, consisting of an initial VSSF-CW followed by an OW-CW and HSSF-CW is recommended. Future research should focus on integrating the hybrid-CW with a desalination technology, e.g. reverse osmosis, electrodialysis or capacitive ionization, to produce water that meets the requirements for use as cooling water and allow the reuse of CTW in the cooling tower itself.
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http://dx.doi.org/10.1016/j.jenvman.2020.110972DOI Listing
October 2020

Fasting prior to cardiac catheterisation: a single-centre observational study.

N Z Med J 2020 02 21;133(1510):16-22. Epub 2020 Feb 21.

School of Nursing, University of Auckland, Auckland.

Aim: Previous generation contrast agents were associated with high rates of nausea, vomiting and risk of aspiration leading to recommendations to fast prior to the procedure. However, modern contrast agents are well tolerated with a low risk of aspiration. Our current guidelines recommend fasting four to six hours before elective and semi-urgent cardiac catheterisation despite a lack of evidence to support this. We sought to determine the duration and effects of fasting at our centre.

Methods: A single-centre prospective observational study in patients undergoing elective cardiac catheterisation over a six-month period between 7 August 2017 to 7 February 2018 at Auckland City Hospital, New Zealand.

Results: One thousand and thirty patients with a mean age of 66±12 years underwent catheterisation. Sixty-seven percent were male, 26% had diabetes, 72% had hypertension and 23% had stage 3 or worse chronic kidney disease. The mean duration of fasting was 11.6±4.9 hours with 80% fasting longer than recommended. One hundred and eight (48%) patients with documented chronic kidney disease did not receive recommended pre-hydration. The most common symptoms related to fasting were hunger (47 %), nausea (3.9%) and vomiting (0.8%). Hypertension (4.1%) and hyperglycaemia (0.8%) occurred due to missed medication. There were no reports of aspiration.

Conclusion: Most patients were fasted for significantly longer than recommended and pre-hydration was underutilised in patients at high risk of contrast-induced nephropathy. There were no episodes of aspiration with modern contrast agents. Further studies are required to evaluate the need for fasting prior to non-emergency cardiac catheterisation.
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February 2020

Evaluating the effects of an exercise program (Staying UpRight) for older adults in long-term care on rates of falls: study protocol for a randomised controlled trial.

Trials 2020 Jan 8;21(1):46. Epub 2020 Jan 8.

The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand.

Background: Falls are two to four times more frequent amongst older adults living in long-term care (LTC) than community-dwelling older adults and have deleterious consequences. It is hypothesised that a progressive exercise program targeting balance and strength will reduce fall rates when compared to a seated exercise program and do so cost effectively.

Methods/design: This is a single blind, parallel-group, randomised controlled trial with blinded assessment of outcome and intention-to-treat analysis. LTC residents (age ≥ 65 years) will be recruited from LTC facilities in New Zealand. Participants (n = 528 total, with a 1:1 allocation ratio) will be randomly assigned to either a novel exercise program (Staying UpRight), comprising strength and balance exercises designed specifically for LTC and acceptable to people with dementia (intervention group), or a seated exercise program (control group). The intervention and control group classes will be delivered for 1 h twice weekly over 1 year. The primary outcome is rate of falls (per 1000 person years) within the intervention period. Secondary outcomes will be risk of falling (the proportion of fallers per group), fall rate relative to activity exposure, hospitalisation for fall-related injury, change in gait variability, volume and patterns of ambulatory activity and change in physical performance assessed at baseline and after 6 and 12 months. Cost-effectiveness will be examined using intervention and health service costs. The trial commenced recruitment on 30 November 2018.

Discussion: This study evaluates the efficacy and cost-effectiveness of a progressive strength and balance exercise program for aged care residents to reduce falls. The outcomes will aid development of evidenced-based exercise programmes for this vulnerable population.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001827224. Registered on 9 November 2018. Universal trial number U1111-1217-7148.
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http://dx.doi.org/10.1186/s13063-019-3949-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6950827PMC
January 2020

An examination of the role of biochar and biochar water-extractable substances on the sorption of ionizable herbicides in rice paddy soils.

Sci Total Environ 2020 Mar 22;706:135682. Epub 2019 Nov 22.

Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, P.O. Box 94248, 1090 GE Amsterdam, the Netherlands; Institute of Soil Science and Site Ecology, Soil Resources and Land Use, Technische Universität Dresden, Pienner Strasse 19, 01737 Tharandt, Germany.

The application of biochar as a soil amendment can increase concentrations of soil organic matter, especially water-extractable organic substances. Due to their mobility and reactivity, more studies are needed to address the potential impact of biochar water-extractable substances (BWES) on the sorption of herbicides in agricultural soils that are periodically flooded. Two paddy soils (100 and 700 years of paddy soil development), unamended or amended with raw (BC) or washed biochar (BCW), were used to test the influence of BWES on the sorption behavior of the herbicides azimsulfuron (AZ) and penoxsulam (PE). The adsorption of AZ to biochar was much stronger than that to the soils, and it was adsorbed to a much larger extent to BC than to BCW. The depletion of polar groups in the BWES from the washed biochar reduced AZ adsorption but had no effect on PE adsorption. The adsorption of AZ increased when the younger soil (P100) was amended with BC and decreased when it was amended with BCW. In P700, which has lower dissolved organic carbon (DOC) content than P100, the adsorption of AZ increased regardless of whether biochar was raw or washed. The adsorption of PE slightly decreased when P100 was amended with BC or BCW and slightly increased when P700 was amended with BC or BCW. In order to evaluate compositional differences in the biochar and BWES before and after the washing treatment, we performed solid-state C NMR spectroscopy of BC and BCW, and high resolution mass spectrometry of BWES. Our observations stress the importance of proper consideration of soil and biochar properties before their incorporation into paddy soils, since biochar may reduce or increase the mobility of AZ and PE depending on soil properties and time of application.
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http://dx.doi.org/10.1016/j.scitotenv.2019.135682DOI Listing
March 2020

Non-target screening reveals the mechanisms responsible for the antagonistic inhibiting effect of the biocides DBNPA and glutaraldehyde on benzoic acid biodegradation.

J Hazard Mater 2020 03 10;386:121661. Epub 2019 Nov 10.

Institute for Biodiversity and Ecosystem Dynamics (IBED), University of Amsterdam, P.O. Box 94248, 1092 GE, Amsterdam, the Netherlands.

The desalination and reuse of discharged cooling tower water (CTW) as feed water for the cooling tower could lower the industrial fresh water withdrawal. A potential pre-treatment method before CTW desalination is the use of constructed wetlands (CWs). Biodegradation is an important removal mechanism in CWs. In the present study, the impact of the biocides 2,2-dibromo-2-cyanoacetamide (DBNPA) and glutaraldehyde on the biodegradation process by CW microorganisms was quantified in batch experiments in which benzoic acid was incubated with realistic CTW biocide concentrations. DBNPA had a stronger negative impact on the biodegradation than glutaraldehyde. The combination of DBNPA and glutaraldehyde had a lower impact on the biodegradation than DBNPA alone. UHPLC-qTOF-MS/MS non-target screening combined with data-analysis script 'patRoon' revealed two mechanisms behind this low impact. Firstly, the presence of glutaraldehyde resulted in increased DBNPA transformation to the less toxic transformation product 2-bromo-2-cyanoacetamide (MBNPA) and newly discovered 2,2-dibromopropanediamide. Secondly, the interaction between glutaraldehyde and DBNPA resulted in the formation of new products that were less toxic than DBNPA. The environmental fate and toxicity of these products are still unknown. Nevertheless, their formation can have important implications for the simultaneous use of the biocides DBNPA and glutaraldehyde for a wide array of applications.
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http://dx.doi.org/10.1016/j.jhazmat.2019.121661DOI Listing
March 2020

Long-term exposure of activated sludge in chemostats leads to changes in microbial communities composition and enhanced biodegradation of 4-chloroaniline and N-methylpiperazine.

Chemosphere 2020 Mar 22;242:125102. Epub 2019 Oct 22.

Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Science Park 904, 1098 XH, Amsterdam, the Netherlands.

Exposure history and adaptation of the inoculum to chemicals have been shown to influence the outcome of ready biodegradability tests. However, there is a lack of information about the mechanisms involved in microbial adaptation and the implication thereof for the tests. In the present study, we investigated the impact of a long-term exposure to N-methylpiperazine (NMP) and 4-chloroaniline (4CA) of an activated sludge microbial community using chemostat systems. The objective was to characterize the influence of adaptation to the chemicals on an enhanced biodegradation testing, following the OECD 310 guideline. Cultures were used to inoculate the enhanced biodegradability tests, in batch, before and after exposure to each chemical independently in chemostat culture. Composition and diversity of the microbial communities were characterised by 16s rRNA gene amplicon sequencing. Using freshly sampled activated sludge, NMP was not degraded within the 28 d frame of the test while 4CA was completely eliminated. However, after one month of exposure, the community exposed to NMP was adapted and could completely degrade it. This result was in complete contrast with that from the culture exposed for 3 months to 4CA. Long term incubation in the chemostat system led to a progressive loss of the initial biodegradation capacity of the community, as a consequence of the loss of key degrading microorganisms. This study highlights the potential of chemostat systems to induce adaptation to a specific chemical, ultimately resulting in its biodegradation. At the same time, one should be critical of these observations as the dynamics of a microbial community are difficult to maintain in chemostat, as the loss of 4CA biodegradation capacity demonstrates.
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http://dx.doi.org/10.1016/j.chemosphere.2019.125102DOI Listing
March 2020

Post-Acute Care for Older People Following Injury: A Randomized Controlled Trial.

J Am Med Dir Assoc 2020 03 16;21(3):404-409.e1. Epub 2019 Oct 16.

Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.

Objectives: The study sought to determine whether older people, on discharge from hospital and on referral to a supported discharge team (SDT), will have: (1) reduced length of stay in hospital; (2) reduced risk of hospital readmission; and (3) reduced healthcare costs.

Design/intervention: Randomized controlled trial with follow-up at 4 and 12 months of post-acute home-based rehabilitation team (SDT). Programs were delivered by trained healthcare assistants, up to 4 times a day, 7 days a week, under the guidance of registered nurses, allied health, and geriatricians for up to 6 weeks.

Participants/setting: A total of 303 older women and 100 older men (mean age 81) in hospital because of injury, were randomized to either SDT (n = 201) or usual care (n = 202). The intervention was operated from Waikato hospital, a regional hospital in New Zealand.

Methods: Days spent in hospital in the year following randomization and healthcare costs were collected from hospital datasets, and functional status assessed using the interRAI Contact Assessment was gathered by health professional research associates.

Results: Participants randomized to the SDT spent less time in hospital in the period immediately prior to discharge (mean 20.9 days) in comparison to usual care (mean 26.6 days) and spent less time in hospital in the 12 months following discharge home. Healthcare costs were lower in the SDT group in the 12 months following randomization.

Conclusions/implications: SDT can provide an important role in reducing hospital length of stay and readmissions of older people following an injury. Almost a million older people (65+ years of age) a year in the US are hospitalized as a consequence of falls-related injuries, most often fractured hip. Hospitals are not always the best location to provide care for older people. SDTs can help with the transition from hospital to home, while reducing hospital length-of-stay.
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http://dx.doi.org/10.1016/j.jamda.2019.08.015DOI Listing
March 2020

Benzotriazole removal mechanisms in pilot-scale constructed wetlands treating cooling tower water.

J Hazard Mater 2020 02 24;384:121314. Epub 2019 Sep 24.

Department of Environmental Technology, Wageningen University & Research, P.O. Box 17, 6700 EV Wageningen, the Netherlands.

The reuse of discharged cooling tower water (CTW) in the cooling tower itself could reduce fresh water intake and help mitigating fresh water scarcity problems. However, this requires desalination prior to its reuse, and hindering fractions, such as conditioning chemicals, should be removed before desalination to obtain a higher desalination efficiency. Constructed wetlands (CWs) can provide such a pre-treatment. In this study, the mechanisms underlying the removal of conditioning chemical benzotriazole (BTA) in CWs was studied using an innovative approach of differently designed pilot-scale CWs combined with batch removal experiments with substrate from these CWs. By performing these combined experiments, it was possible to determine the optimal CW design for BTA removal and the most relevant BTA removal processes in CWs. Adsorption yielded the highest contribution, and the difference in removal between different CW types was linked to their capability to aerobically biodegrade BTA. This knowledge on the main removal mechanisms for BTA allows for a CW design tailored for BTA removal. In addition, the outcomes of this research show that performing batch experiments with CW substrate allows one to determine the relevant removal mechanisms for a given compound which results in a better understanding of CW removal processes.
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http://dx.doi.org/10.1016/j.jhazmat.2019.121314DOI Listing
February 2020

Randomized Evaluation of the National Collegiate Athletic Association's Concussion Education Fact Sheet for Coaches.

Health Educ Behav 2019 12 30;46(6):960-968. Epub 2019 Sep 30.

National Collegiate Athletic Association, Indianapolis, IN, USA.

. Concussion education for coaches is being increasingly recommended by leading sports organizations, yet the effectiveness of available materials has not often been assessed. This study evaluated the impact of the National Collegiate Athletic Association's (2017) publication: "Concussion safety: What coaches need to know" (the "NCAA Fact Sheet for Coaches") on participants' concussion knowledge and safety supportive intentions. . NCAA head coaches ( = 779) were randomized to view the NCAA Fact Sheet for Coaches either before (intervention condition) or after (control condition) responding to questions assessing concussion knowledge and intentions to engage in three behaviors (talk to team about concussion safety; allow symptomatic athlete to continue play; encourage medical staff to return athlete as quickly as possible). . Knowledge scores were significantly higher among coaches in the intervention condition as compared to the control condition, largely driven by differences in knowledge about the consequences of continued play postconcussion (injury, reaction time, possible death). Fewer coaches in the intervention condition expected that they would allow an athlete with a suspected concussion continue to participate in a game or practice or that they would encourage medical staff to return athletes to play as quickly as possible. . The present study provides evidence that educational content, like that contained in the NCAA Fact Sheet for Coaches, may have a positive short-term impact on concussion knowledge and behavioral intentions of coaches. In light of these findings, sports organizations should consider providing similar educational materials to coaches, evaluating whether the information is impactful in their population.
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http://dx.doi.org/10.1177/1090198119864621DOI Listing
December 2019

Preventing catastrophic injury and death in collegiate athletes: interassociation recommendations endorsed by 13 medical and sports medicine organisations.

Br J Sports Med 2020 Feb 19;54(4):208-215. Epub 2019 Sep 19.

Sport Science Institute, National Collegiate Athletic Association (NCAA), Indianapolis, Indiana, USA

The following organisations endorsed this document: American Association of Neurological Surgeons, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, College Athletic Trainers' Society, Collegiate Strength and Conditioning Coaches Association, Congress of Neurological Surgeons, Korey Stringer Institute, National Athletic Trainers' Association, National Strength and Conditioning Association, National Operating Committee for Standards on Athletic Equipment, Sports Neuropsychology Society. The following organisation has affirmed the value of this document: American Academy of Neurology. The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.
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http://dx.doi.org/10.1136/bjsports-2019-101090DOI Listing
February 2020

Preventing Catastrophic Injury and Death in Collegiate Athletes: Interassociation Recommendations Endorsed by 13 Medical and Sports Medicine Organisations.

J Athl Train 2019 Aug;54(8):843-851

Sport Science Institute, National Collegiate Athletic Association, Indianapolis, IN.

The Second Safety in College Football Summit resulted in interassociation consensus recommendations for three paramount safety issues in collegiate athletics: (1) independent medical care for collegiate athletes; (2) diagnosis and management of sport-related concussion; and (3) year-round football practice contact for collegiate athletes. This document, the fourth arising from the 2016 event, addresses the prevention of catastrophic injury, including traumatic and non-traumatic death, in collegiate athletes. The final recommendations in this document are the result of presentations and discussions on key items that occurred at the summit. After those presentations and discussions, endorsing organisation representatives agreed on 18 foundational statements that became the basis for this consensus paper that has been subsequently reviewed by relevant stakeholders and endorsing organisations. This is the final endorsed document for preventing catastrophic injury and death in collegiate athletes. This document is divided into the following components. (1) Background-this section provides an overview of catastrophic injury and death in collegiate athletes. (2) Interassociation recommendations: preventing catastrophic injury and death in collegiate athletes-this section provides the final recommendations of the medical organisations for preventing catastrophic injuries in collegiate athletes. (3) Interassociation recommendations: checklist-this section provides a checklist for each member school. The checklist statements stem from foundational statements voted on by representatives of medical organisations during the summit, and they serve as the primary vehicle for each member school to implement the prevention recommendations. (4) References-this section provides the relevant references for this document. (5) Appendices-this section lists the foundational statements, agenda, summit attendees and medical organisations that endorsed this document.
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http://dx.doi.org/10.4085/1062-6050-54.085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6756597PMC
August 2019

What is Important to Older People with Multimorbidity and Their Caregivers? Identifying Attributes of Person Centered Care from the User Perspective.

Int J Integr Care 2019 Jul 23;19(3). Epub 2019 Jul 23.

Massey University, NZ.

Introduction: Health systems are striving to design and deliver care that is 'person centred'-aligned with the needs and preferences of those receiving it; however, it is unclear what older people and their caregivers value in their care. This paper captures attributes of care that are important to older people and their caregivers.

Methods: This qualitative descriptive study entailed 1-1 interviews with older adults with multimorbidity receiving community based primary health care in Canada and New Zealand and caregivers. Data were analyzed to identify core attributes of care, important to participants.

Findings: Feeling heard, appreciated and comfortable; having someone to count on; easily accessing health and social care; knowing how to manage health and what to expect; feeling safe; and being independent were valued. Each attribute had several characteristics including: being treated like a friend; having contact information of a responsive provider; being accompanied to medical and social activities; being given clear treatment options including what to expect; having homes adapted to support limitations and having the opportunity to participate in meaningful hobbies.

Conclusions: Attributes of good care extend beyond disease management. While our findings include activities that characterize these attributes, further research on implementation barriers and facilitators is required.
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http://dx.doi.org/10.5334/ijic.4655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6659759PMC
July 2019

Biodegradation of metformin and its transformation product, guanylurea, by natural and exposed microbial communities.

Ecotoxicol Environ Saf 2019 Oct 10;182:109414. Epub 2019 Jul 10.

Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Science Park 904, 1098, XH Amsterdam, the Netherlands.

Metformin (MET) is a pharmaceutical product mostly biotransformed in the environment to a transformation product, guanylurea (GUA). In ready biodegradability tests (RBTs), however, contrasting results have been observed for metformin. The objective of this study was to measure the biodegradation of MET and GUA in RBTs, using activated sludge from the local wastewater treatment plant, either directly or after pre-exposure to MET, in a chemostat. The activated sludge community was cultivated in chemostats, in presence or absence of MET, for a period of nine months, and was used in RBT after one, three and nine months. The results of this study showed that the original activated sludge was able to completely remove MET (15 mg/l) and the newly produced GUA (50% of C) under the test conditions. Inoculation of the chemostat led to a rapid shift in the community composition and abundance. The community exposed to 1.5 mg/l of MET was still able to completely consume MET in the RBTs after one-month exposure, but three- and nine-months exposure resulted in reduced removal of MET in the RBTs. The ability of the activated sludge community to degrade MET and GUA is the result of environmental exposure to these chemicals as well as of conditions that could not be reproduced in the laboratory system. A MET-degrading strain belonging to the genus Aminobacter has been isolated from the chemostat community. This strain was able to completely consume 15 mg/l of MET within three days in the test. However, community analysis revealed that the fluctuation in relative abundance of this genus (<1%) could not be correlated to the fluctuation in biodegradation capacity of the chemostat community.
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http://dx.doi.org/10.1016/j.ecoenv.2019.109414DOI Listing
October 2019

The Role of Microcirculatory Dysfunction in the Pathophysiology and Treatment of Venous Leg Ulcers-Reply.

JAMA Dermatol 2019 07;155(7):862

School of Nursing, University of Auckland, Auckland, New Zealand.

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http://dx.doi.org/10.1001/jamadermatol.2019.0093DOI Listing
July 2019

Headphones and other risk factors for hearing in young adults.

Noise Health 2019 May-Jun;21(100):116-124

School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, USA.

Background: Personal listening device (PLD) use with headphones is increasing in young adults and in most listening environments occur in background noise. Headphone choice can be important because certain headphones are more effective in limiting background noise than stock earbuds. Binge drinking, marijuana, and hard drug use have also been associated with high-volume PLD use. The purpose of this study was to explore the relationship between preferred headphone type, listening level, and other health risk behaviors.

Methods: Two-hundred and twenty undergraduates were recruited and completed a PLD use and risk behavior survey. Survey data included self-reported alcohol and marijuana use. Bilateral otoscopy, tympanometry, and pure-tone threshold testing (0.25-8 kHz) were completed. Participants listened to one hour of music using preferred headphone type with a probe microphone in the ear canal to measure equivalent continuous sound level (LAeq).

Results: Mean LAeq was similar for the three types of headphones used. Participants who reported higher amounts of drinks per month and smoking marijuana within the last month had significantly higher LAeq levels than those who reported lower amounts of drinks per month and not smoking marijuana in the last month. There was no significant interaction between headphone type and reported drinks per month or marijuana use.

Conclusion: Young adults with normal hearing who have higher preferred listening levels also reported more alcohol and marijuana use, although headphone type was not associated with any of these variables.
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http://dx.doi.org/10.4103/nah.NAH_35_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532785PMC
July 2020

A fresh look at nuclear energy.

Science 2019 01;363(6423):105

David Petti is the director of the Nuclear Fuels and Materials Division at the Idaho National Laboratory, Idaho Falls, ID. USA.

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http://dx.doi.org/10.1126/science.aaw5304DOI Listing
January 2019

The evolving landscape of policies, rules, and law in sport-related concussion.

Handb Clin Neurol 2018 ;158:257-267

Department of Health Care Policy, Harvard Medical School, Boston, MA, United States.

Beginning in 2009 with the passage of the Zackery Lystedt law in the state of Washington, all 50 states have passed concussion laws that implement a mandatory framework of care for high school and youth athletes. The structure of these laws generally shares the three primary components of the Lystedt law: (1) preseason concussion education; (2) mandatory removal from play with suspected concussion; and (3) clearance from a healthcare professional prior to return to play. These same three policy components are also found at the collegiate and professional levels of sport, either through established policy or labor contracts. This chapter explores concussion-specific legal and policy developments that currently inform concussion management practices across multiple levels of the US athletic system.
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http://dx.doi.org/10.1016/B978-0-444-63954-7.00025-2DOI Listing
March 2019

"You've got to look after yourself, to be able to look after them" a qualitative study of the unmet needs of caregivers of community based primary health care patients.

BMC Geriatr 2018 11 12;18(1):275. Epub 2018 Nov 12.

Centre for Nursing and Health Research, School of Nursing, College of Health Te Kura Hauora Tangata, Massey University, Albany, New Zealand.

Background: There is growing reliance on unpaid caregivers to provide support to people with care needs. Integrated care approaches that aim to coordinate primary care with community care known as community based primary health care (CBPHC) has been a key policy initiative across health systems; however most attention has been paid to the needs of patients and not caregivers. The objective of this paper was to explore the unmet needs of caregivers of older adults with complex care needs receiving CBPHC.

Methods: This qualitative descriptive study entailed one-to-one interviews with 80 caregivers from Canada and New Zealand where roles, experiences and needs were explored. Interview text related to unmet need was reviewed inductively and core themes identified.

Results: Three themes were identified across CBPHC sites: unrecognized role; lack of personal resources; and no breaks even when services are in place.

Conclusions: To support caregivers, models of care such as CBPHC need to look beyond the patient to meaningfully engage caregivers, address their needs and recognize the insight they hold. This knowledge needs to be valued as a key source of evidence to inform developments in health and social care.
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http://dx.doi.org/10.1186/s12877-018-0962-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6233534PMC
November 2018

Prescribed Exercise With Compression vs Compression Alone in Treating Patients With Venous Leg Ulcers: A Systematic Review and Meta-analysis.

JAMA Dermatol 2018 11;154(11):1304-1311

School of Nursing, University of Auckland, New Zealand.

Importance: Exercise is recommended as an adjuvant treatment for venous leg ulceration (VLU) to improve calf muscle pump function. However, the association of exercise with VLU healing has not been properly aggregated, and the effectiveness of different exercise interventions has not been characterized.

Objective: To summarize the association of different exercise interventions with VLU healing when used as an adjuvant to any form of compression.

Data Sources: The Cochrane Controlled Trials Register, MEDLINE, Embase, CINAHL, PsycInfo, and SCOPUS databases were searched through October 9, 2017.

Study Selection: Randomized clinical trials (RCTs) of any exercise compared with no exercise in participants with VLU were included, where compression was used as standard therapy and a healing outcome was reported. Independent title screening and full text review by 2 authors (A.J., J.S.) with appeal to a third author (J.P.) if disagreement was unresolved. Of the 519 articles screened, a total of 6 (1.2%) studies met the inclusion criteria for systematic review, including 5 for meta-analysis.

Data Extraction And Synthesis: Independent quality assessment for Cochrane risk of bias and data extraction by 2 authors with appeal to third author if disagreement unresolved (PRISMA). Data pooled using fixed effects model.

Main Outcomes And Measures: The a priori primary outcome was any healing outcome (proportion healed, time to healing, or change in ulcer area). Secondary outcomes (adverse events, costs, and health-related quality of life) were only collected if a primary outcome was reported.

Results: Six RCTs were identified and 5 (190 participants) met inclusion criteria for meta-analysis. The exercise interventions were progressive resistance exercise alone (2 RCTs, 53 participants) or combined with prescribed physical activity (2 RCTs, 102 participants), walking only (1 RCT, 35 participants), or ankle exercises (1 RCT, 40 participants). Overall, exercise was associated with increased VLU healing at 12 weeks although the effect was imprecise (additional 14 cases healed per 100 patients; 95% CI, 1-27 cases per 100; P = .04). The combination of progressive resistance exercise plus prescribed physical activity appeared to be most effective, again with imprecision (additional 27 cases healed per 100 patients; 95% CI, 9-45 cases per 100; P = .004).

Conclusions And Relevance: The evidence base may now be sufficiently suggestive for clinicians to consider recommending simple progressive resistance and aerobic activity to suitable patients with VLU while further research is produced.
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http://dx.doi.org/10.1001/jamadermatol.2018.3281DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248128PMC
November 2018

A Research Program on Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH): An International Collaboration.

Int J Integr Care 2018 May 9;18(2):11. Epub 2018 May 9.

University of Auckland, NZ.

Health and social care systems across western developed nations are being challenged to meet the needs of an increasing number of people aging with multiple complex health and social needs. Community based primary health care (CBPHC) has been associated with more equitable access to services, better population level outcomes and lower system level costs. Itmay be well suited to the increasingly complex needs of populations; however the implementation of CBPHC models of care faces many challenges. This paper describes a program of research by an international, multi-university, multidisciplinary research team who are seeking to understand how to scale up and spread models of Integrated CBPHC (ICBPHC). The key question being addressed is "What are the steps to implementing innovative integrated community-based primary health care models that address the health and social needs of older adults with complex care needs?" and will be answered in three phases. In the first phase we identify and describe exemplar models of ICBPHC and their context in relation to relevant policies and performance across the three jurisdictions (New Zealand, Ontario and Québec, Canada). The second phase involves a series of theory-informed, mixed methods case studies from which we shall develop a conceptual framework that captures not only the attributes of successful innovative ICBPHC models, but also how these models are being implemented. In the third phase, we aim to translate our research into practice by identifying emerging models of ICBPHC in advance, and working alongside policymakers to inform the development and implementation of these models in each jurisdiction. The final output of the program will be a comprehensive guide to the design, implementation and scaling-up of innovative models of ICBPHC.
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http://dx.doi.org/10.5334/ijic.4160DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095069PMC
May 2018

Mapping for Conceptual Clarity: Exploring Implementation of Integrated Community-Based Primary Health Care from a Whole Systems Perspective.

Int J Integr Care 2018 Mar 21;18(1):14. Epub 2018 Mar 21.

School of Nursing, College of Health Te Kura Haurora Tengata, Massey University, NZ.

Introduction: Studying implementation of integrated models of community-based primary health care requires a "whole systems" multidisciplinary approach to capture micro, meso and macro factors. However, there is, as yet, no clear operationalization of a "whole systems" approach to guide multidisciplinary research programs. Theoretical frameworks and approaches from diverse academic traditions specify different aspects of the health system in more depth. Enabling analysis across the system, when data and ideas are captured using different taxonomies, requires that we map terms and constructs across the models.

Theory And Methods: This paper uses concept mapping techniques to compare and contrast the theoretical frameworks and approaches used in the iCOACH project including: Ham's Ten Characteristics of the High-Performing Chronic Care System (capturing patient/carer and provider perspectives), the Organizational Context and Capabilities for Integrating Care framework (capturing the organizational perspective), and the Health Policy Monitor framework (capturing the policy system perspective). The aim of the paper is to link concepts across different theoretical framework to guide the iCOACH study.

Results: A concept map was developed that identifies 8 overarching concepts across the heuristic models. A preliminary analysis of one of these overarching concepts, care coordination, demonstrates how different perspectives will assign different meanings, values, and drivers of seemingly similar ideas. For patients and carers care coordination is about having a responsive team of health care providers. Building relationships in teams that exist within and across different organizations is essential for providers to achieve care coordination, where managers and policy makers see care coordination as being more about creating linkages and addressing systems gaps.

Discussion And Conclusion: This work represents a first step towards development of a fully formed conceptual framework that includes key domains, concepts, and mechanisms of implementing integrated community-based primary health care.
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http://dx.doi.org/10.5334/ijic.3082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6095076PMC
March 2018

Can Wii Balance? Evaluating a Stepping Game for Older Adults.

IEEE Trans Neural Syst Rehabil Eng 2018 09 1;26(9):1783-1793. Epub 2018 Aug 1.

Decline in balance control is an issue for older adults as it leads to an increased risk of falling which may result in serious injury. Mitigating this risk may be achieved through balance training and exercise, but lack of adherence to an exercise program often occurs. Improvement in balance control may be difficult to quantify in an unbiased manner given the therapist providing the treatment also assesses the patient. We developed a gamified system using an off-the-shelf technology through an iterative feedback with therapists and clients to evaluate a response time during stepping as a measure of balance control. The game was designed using serious game strategies to increase participant engagement. This game included two Nintendo Wii balance boards between which the individual was required to step while the times were recorded. To provide evidence that the system could be used in a clinical environment, we conducted a cross-sectional study collecting data for five minutes at the beginning of a physiotherapy assessment. One hundred and four individuals older than 50 years of age were recruited who were able to step forward with or without an aid. The response time for a step using the system was negatively correlated to the Berg balance score.
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http://dx.doi.org/10.1109/TNSRE.2018.2862146DOI Listing
September 2018

Outcomes of dilation and evacuation with and without feticide by intra-cardiac potassium chloride injection: a service evaluation.

Contraception 2018 Apr 19. Epub 2018 Apr 19.

Liverpool School of Tropical Medicine, Liverpool, UK; University of Witwatersand Reproductive Health and HIV Institute, Johannesburg; Botswana UPenn Partnership, Gaborone, Botswana.

Objective: To compare procedure duration, complications, and acceptability of dilation and evacuation (D&E) with and without feticide by intra-cardiac potassium chloride (KCL) injection.

Study Design: We evaluated outcomes with D&E at 18-24 weeks of gestation in the 6 months before and 6 months after removing feticide with KCL from the guidelines of a national British abortion provider. We extracted demographic and procedure-related data from medical records and electronic databases. We surveyed women undergoing D&E in both time periods about acceptability and side effects.

Results: We analyzed 291 cases with and 257 cases without KCL. Unadjusted mean procedure duration was shorter with KCL than without (12.7 vs. 16.1 min, respectively, p<.001). After adjustment for age, parity, Cesarean deliveries, gestational age, body mass index, surgeon, and number or duration of osmotic dilators used, KCL remained associated with a 3.5 min (95% CI 2.4-4.6) reduction in D&E duration. Uterine atony was more common with KCL than without (3% vs. 0%, respectively, p=.004), despite more frequent administration of prophylactic utero-tonics to women who received KCL (82% KCL vs. 73% no-KCL, p=.001). Women who had KCL reported more pain in the period between feticide and dilator placement and the evacuation than women who had not received feticide (49% vs. 25%, respectively, p<.001). Most women in both groups found their procedure very acceptable or acceptable (79% KCL vs. 87% no-KCL, p=.2).

Conclusions: Feticide with intra-cardiac KCL reduced D&E procedure duration, but was associated with more pain and uterine atony. Treatment acceptability was high with and without feticide.

Implications: Inducing fetal demise before dilation and evacuation with intra-cardiac potassium chloride may result in shorter operative times but does not appear to improve safety or acceptability. Level I evidence remains needed to support the use of feticide before surgical abortion.
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http://dx.doi.org/10.1016/j.contraception.2018.04.010DOI Listing
April 2018