Loosening of the hip joint prosthesis is considered as one of the most significant postoperative complications in recent years. The laboratory diagnostic procedure used to differentiate periprosthetic infection from aseptic loosening is very difficult because of the biofilm which microorganisms form on the implant surface. The purpose of this research was to evaluate the level of concordance between clinical classification of implant loosening among 50 patients subjected to reimplantation procedure and laboratory investigation of PJI including microbiological culture results and the levels of inflammatory markers assessed in the patients' synovial fluid samples, serum, and full blood. The synovial fluid was collected for leukocyte count, differential cell count, and culture on standard media. The levels of systemic inflammation markers such as the ESR and CRP concentration were determined in serum and full blood. Tissue samples were collected for microbiological studies. Components from endoprostheses were exposed to ultrasound in a process called sonication. Among the parameters measured in serum and full blood the levels of ESR and CRP were higher in the septic group of patients. Cytologic analysis of synovial fluid was in correlation with microbiologic identification. The most frequent isolated bacteria was Staphylococcus epidermidis. Culture results from materials such as synovial fluid, sonicate and tissues are crucial to establish the infectious aetiology of the loosening. Microscopic analysis of synovial fluid represents a simple, rapid and accurate method for differentiating PJI from aseptic failure. Sonication increases detection of the infectious process, and culture results are in correlation with the cytologic analysis of synovial fluid.
Os movimentos sociais na America Latina apresentam-se como centralidade para a compreensao de fenomenos sociais, politicos, economicos e ambientais, pois expressam a intencionalidade dos seus integrantes ao se organizarem para a resolucao de suas aspiracoes, promovendo a agenda emancipatoria, o diagnostico da realidade social, a construcao de propositivas, a atuacao em redes, a articulacao coletiva em prol da inclusao social. Este artigo, atraves de pesquisa em fontes secundarias geradas por estes atores, fontes primarias obtidas nos estudos de caso: movimento pro-moradia do Jardim Celeste na cidade de Sao Paulo, e na Bolivia, o movimento indigena da regiao Amazonica (CIDOB), analisa movimentos sociais, democratizacao e cidadania investigando-se novas formas de contestacao para o processo em curso de globalizacao e democratizacao das sociedades em questao. Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabela normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabela normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;}
Background: Evidence from the 2009 A/H1N1 influenza pandemic demonstrated that pregnant women are particularly vulnerable to infection and at an increased risk of death. Active data collection through the UK Obstetric Surveillance System (UKOSS) about women admitted to hospital during the 2009 A/H1N1 pandemic was used to inform ongoing clinical guidance regarding the use of antiviral treatment for pregnant women and demonstrated that, in addition to an increased risk of maternal morbidity, influenza infection in pregnancy is associated with poor perinatal outcomes, including an increased risk of stillbirth and preterm birth. This evidence influenced the decision to offer routine influenza immunisation to pregnant women. Even in a non-epidemic period, pregnant women continue to die from influenza. Objective: To establish, and then to put into hibernation, the study mechanisms needed to mount a rapid investigation of the impact of pandemic influenza in pregnancy in the event of a newly emerging pandemic strain. Design: A new UKOSS cohort study was designed, based on the 2009–10 study, and following consultation with the Pandemic Flu Planning Group at the Royal College of Obstetricians and Gynaecologists and the UKOSS Steering Committee, to identify potential previously unanswered questions. Setting: UK maternity units. Participants: All pregnant women admitted to hospital with influenza in a future pandemic. Main outcome measures: Management of pregnant women with influenza infection, intervention rates, treatment and pregnancy outcome for both the mother and fetus. Results: The study was designed and approved by the UKOSS Steering Committee and then placed into hibernation for activation in the event of an influenza pandemic. Conclusions: Pregnant women, as a result of their changed immunological status, appear to be particularly susceptible to infection, including from influenza. The existence of the UKOSS enabled us to rapidly mount a study of pregnant women who were hospitalised with 2009 A/H1N1 influenza. Minor modifications to incorporate previously unanswered questions and our previous study enabled us to design, and then put into hibernation, a new study ready to investigate the impact and management of influenza in pregnancy, which is poised for activation in the event of a newly emerging pandemic strain. This will enable real-time data to be available on which to base rapid changes in clinical management as the as-yet-unforeseen pandemic unfolds. In the event of an influenza pandemic the study will be available to be immediately activated following expedited regulatory approvals. Trial registration: Current Controlled Trials ISRCTN44137563. Funding: The National Institute for Health Research Health Services and Delivery Research programme.
Design and theoretical/conceptual framework: Effective primary care can have an important preventive role, and should therefore be associated with lower emergency admission rates. Quality indicators for mental health have been routinely measured in English primary care over a number of years as part of the Quality and Outcomes Framework (QOF). Our null hypothesis is that there is no association between QOF performance and emergency hospital admissions for people with mental illness either for mental or physical conditions. We will test for an association between changes in practices' mental health QOF indicators and changes in their rates of emergency admission using data on all practices in England over the period 2004/05 to 2009/10. Our analysis will also estimate the impact of potential improvements in the QOF on subsequent mental health expenditure on secondary care. Sampling: We will construct a national dataset covering around 8000 English GP practices by drawing together routinely available secondary data. To examine the impact of the QOF on hospital expenditure, we will merge this national dataset with the costs of all 1.2 million patients who use specialist psychiatric hospital or community care in a given year. Our analysis will therefore be representative and produce generalisable results. Setting/context: We will use Hospital Episode Statistics (HES) data on emergency admissions for mental health patients from general practices for both physical and mental conditions over the period 2001/02 to 2009/10 in England. QOF data is available from 2004/05 to 2009/10. We will merge a number of data sources at practice level to create a panel which will provide statistical power and precision to the econometric analysis. To examine the relationship between the QOF and subsequent mental health expenditure we will use individual level cost data in the Mental Health Minimum Dataset (MHMDS) which has been derived from Reference Costs and is available for 2007/08 and 2008/09 covering care by specialist psychiatric teams in hospital or in the community. Data collection: We will use the following data: QOF Indicators: The Quality Management Analysis System (QMAS) provides QOF achievement and prevalence data at practice level. Some QOF indicators have remained constant, others have been modified, dropped or introduced. This represents a 'natural experiment' that allows variations in admissions between practices to be investigated. Covariates: Local population characteristics: Neighbourhood Statistics (ONS) socio-economic and demographic data will be attributed to GP practices using the Attribution Data Set which contains information on the number of patients in each practice resident in each Lower Super Output Area. The socio-economic data are very rich and include measures of deprivation, education, morbidity, ethnicity, rurality and small area characteristics. GP Practice variables: General Medical Statistics (GMS) data on GP and practice characteristics, and MHMDS data which will be aggregated to practice level. Mental Health Services Mapping Data will be used to construct supply variables. Hospital variables: hospital characteristics and quality indicators. Data analysis: We will estimate both cross-sectional and panel data models for the period 2004/05 to 2009/10 to examine the association between QOF and admissions over time. Examining the within practice temporal variation will remove the risk of unobserved factors which might affect both practice emergency admissions and quality. We will estimate both random and fixed effects multiple regression and count data models. All models will include year indicators to allow for temporal trends, and a rich set of relevant local population and practice covariates [1]. Random effects panel data models will include the average admissions for a practice over the period 2001/02 to 2003/04. This pre-sample 'baseline' will pick up unobserved practice and patient confounding characteristics which are time-invariant [2]. We will also include lags of QOF to allow for delayed effects of quality. We will carry out a variety of robustness checks. For ease of presentation the scores for all variables will be reported as incidence rate ratios (IRR). Our models for examining the association between QOF and subsequent hospital costs will include both OLS cross-sectional and random and fixed effects panel data models where we control for practice fixed effects and year dummies. We will regress costs in 2007/08 and 2008/09 on QOF scores from 2004/05 up to 2008/09. Given the positive skewness of costs we will also estimate transformed OLS and generalised linear models (GLM). We will use two-part models to test if better quality scores have an effect on average patients by reducing the probability of admission and/or by reducing costs once admitted. Possible lagged quality effects on costs will be captured by modelling 'baseline' quality from 2004/05 to 2006/07 on patient expenditure in 2007/08 and 2008/09. [1] Dusheiko M, Doran T, Gravelle H, Fullwood C, Roland M. Does higher quality of diabetes management in family practice reduce unplanned hospital admissions? Health Services Research 2011; 46:27-46. [2] Blundell R, Griffith R, Windmeijer F. Individual Effects and Dynamics in Count Data Models. Journal of Econometrics 2002; 108:113-31.
The societal costs of problematic class A drug use in England and Wales exceed £15B; drug-related crime accounts for almost 90% of costs. Diversion plus treatment and/or aftercare programmes may reduce drug-related crime and costs.To assess the effectiveness and cost-effectiveness of diversion and aftercare for class A drug-using offenders, compared with no diversion.Adult class A drug-using offenders diverted to treatment or an aftercare programme for their drug use.Programmes to identify and divert problematic drug users to treatment (voluntary, court mandated or monitored services) at any point within the criminal justice system (CJS). Aftercare follows diversion and treatment, excluding care following prison or non-diversionary drug treatment.Thirty-three electronic databases and government online resources were searched for studies published between January 1985 and January 2012, including MEDLINE, PsycINFO and ISI Web of Science. Bibliographies of identified studies were screened. The UK Drug Data Warehouse, the UK Drug Treatment Outcomes Research Study and published statistics and reports provided data for the economic evaluation.Included studies evaluated diversion in adult class A drug-using offenders, in contact with the CJS. The main outcomes were drug use and offending behaviour, and these were pooled using meta-analysis. The economic review included full economic evaluations for adult opiate and/or crack, or powder, cocaine users. An economic decision analytic model, estimated incremental costs per unit of outcome gained by diversion and aftercare, over a 12-month time horizon. The perspectives included the CJS, NHS, social care providers and offenders. Probabilistic sensitivity analysis and one-way sensitivity analysis explored variance in parameter estimates, longer time horizons and structural uncertainty.Sixteen studies met the effectiveness review inclusion criteria, characterised by poor methodological quality, with modest sample sizes, high attrition rates, retrospective data collection, limited follow-up, no random allocation and publication bias. Most study samples comprised US methamphetamine users. Limited meta-analysis was possible, indicating a potential small impact of diversion interventions on reducing drug use [odds ratio (OR) 1.68, 95% confidence interval (CI) 1.12 to 2.53 for reduced primary drug use, and OR 2.60, 95% CI 1.70 to 3.98 for reduced use of other drugs]. The cost-effectiveness review did not identify any relevant studies. The economic evaluation indicated high uncertainty because of variance in data estimates and limitations in the model design. The primary analysis was unclear whether or not diversion was cost-effective. The sensitivity analyses indicated some scenarios where diversion may be cost-effective.Nearly all participants (99.6%) in the effectiveness review were American (Californian) methamphetamine users, limiting transfer of conclusions to the UK. Data and methodological limitations mean it is unclear whether or not diversion is effective or cost-effective.High-quality evidence for the effectiveness and cost-effectiveness of diversion schemes is sparse and does not relate to the UK. Importantly this research identified a range of methodological limitations in existing evidence. These highlight the need for research to conceptualise, define and develop models of diversion programmes and identify a core outcome set. A programme of feasibility, pilot and definitive trials, combined with process evaluation and qualitative research is recommended to assess the effectiveness and cost-effectiveness of diversionary interventions in class A drug-using offenders.The National Institute for Health Research Health Technology Assessment programme.
Foam sclerotherapy (foam) and endovenous laser ablation (EVLA) have emerged as alternative treatments to surgery for patients with varicose veins, but uncertainty exists regarding their effectiveness in the medium to longer term.
Otitis media with effusion (OME) is a very common problem in primary care, but one that lacks an evidence-based non-surgical treatment.
A numerical approach is presented to assess the seismic vulnerability of barrel masonry vaults and evaluate the effectiveness of a traditional retrofitting intervention consisting in the reinforcement of the extrados. A linear elastic no–tension model is adopted to cope with the negligible strength in tension of ancient brick and stone masonry and perform a two–dimensional finite element analysis of arch–like sections. Instead of implementing conventional load history analysis or limit load analysis, the minimization of the relevant strain energy function is implemented to solve the non–linear equilibrium under the effect of different load scenarios.\udA segmental barrel vault made of stone masonry is investigated in an ancient building under static and seismic loads. The collapse load of the structural element is computed before and after the intervention and the reduction achieved in terms of seismic vulnerability is evaluated as prescribed by technical codes
The current paper focuses its study on the Southeast Europe (SEE) and tries to identify real passenger needs (demand) which can reveal rail dynamic and competitiveness in specific connections. Based on a dedicated examination of 11 SEE city hubs (Bologna, Venice, Trieste, Ljubljana, Vienna, Bratislava, Budapest, Thessaloniki, Sofia, Zagreb and Bucharest) examined within “Rail4SEE – Rail Hub Cities for South East Europe” project, the paper aims to conclude in a quantitative analysis of demand data at regional and transnational level and on a comparative analysis based both on demand and supply data that will open the ground for the development of an accurate SEE modal split model.