Effect of waiting time on health outcomes and service utilization : A prospective randomized study on patients admitted to hospital for hip or knee replacement

Although the principle of equal access to medically justified treatment has been promoted by official health policies in many Western health care systems, practices do not completely meet policy targets. Waiting times for elective surgery vary between patient groups and regions, and growing problems in the availability of services threaten equal access to treatment. Waiting times have come to the attention of decision-makers, and several policy initiatives have been introduced to ensure the availability of care within a reasonable time. In Finland, for example, the treatment guarantee came into force in 2005. However, no consensus exists on optimal waiting time for different patient groups. The purpose of this multi-centre randomized controlled trial was to analyse health-related quality of life, pain and physical function in total hip or knee replacement patients during the waiting time and to evaluate whether the waiting time is associated with patients health outcomes at admission. This study also assessed whether the length of waiting time is associated with social and health services utilization in patients awaiting total hip or knee replacement. In addition, patients health-related quality of life was compared with that of the general population. Consecutive patients with a need for a primary total hip or knee replacement due to osteoarthritis were placed on the waiting list between August 2002 and November 2003. Patients were randomly assigned to a short waiting time (maximum 3 months) or a non-fixed waiting time (waiting time not fixed in advance, instead the patient followed the hospitals routine practice). Patients health-related quality of life was measured upon being placed on the waiting list and again at hospital admission using the generic 15D instrument. Pain and physical function were evaluated using the self-report Harris Hip Score for hip patients and a scale modified from the Knee Society Clinical Rating System for knee patients. Utilization measures were the use of home health care, rehabilitation and social services, physician visits and inpatient care. Health and social services use was low in both waiting time groups. The most common services used while waiting were rehabilitation services and informal care, including unpaid care provided by relatives, neighbours and volunteers. Although patients suffered from clear restrictions in usual activities and physical functioning, they seemed primarily to lean on informal care and personal networks instead of professional care. While longer waiting time did not result in poorer health-related quality of life at admission and use of services during the waiting time was similar to that at the time of placement on the list, there is likely to be higher costs of waiting by people who wait longer simply because they are using services for a longer period. In economic terms, this would represent a negative impact of waiting. Only a few reports have been published of the health-related quality of life of patients awaiting total hip or knee replacement. These findings demonstrate that, in addition to physical dimensions of health, patients suffered from restrictions in psychological well-being such as depression, distress and reduced vitality. This raises the question of how to support patients who suffer from psychological distress during the waiting time and how to develop strategies to improve patients initiatives to reduce symptoms and the burden of waiting. Key words: waiting time, total hip replacement, total knee replacement, health-related quality of life, randomized controlled trial, outcome assessment, social service, utilization of health services

Salt-tolerant amenity grasses to reduce salt effect

Assess establishment and management of salt tolerant turf grasses on salt affected parklands.

Effect of deprivation of vitamin A on the basic proteins of the nuclei of rat testes

The relative concentrations of the major histones, namely, H1, TH1, H2A, H2B, H3 and H4 are not significantly changed in the testes of the vitamin A-deficient rats, as compared to those in the normal controls. But the testis-specific protein, TP, which is synthesized at the mid-spermatid stage, is markedly reduced in the testes of the deficient rats. On supplementation of the deficient rats with retinyl acetate for 28 days, there was a 50% recovery in the relative concentration of the TP with respect to the total amounts of H1 and TH1.

Size effect on the lattice parameter of KCl during mechanical milling

The size effect on the lattice parameter of ionic KCl nanocrystals was studied systematically during mechanical milling of Pure KCl powder under vacuum. The results suggest anomalous lattice expansion, with the lattice parameter increasing from 6.278 angstrom at d = 6 mu m to 6.30307 angstrom at d = 85 mn. The defects generated during ball milling of KCl and surface stress are deemed to be responsible for this lattice parameter expansion. (C) 2009 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

Phase field study of precipitate growth: Effect of misfit strain and interface curvature

We have used phase field simulations to study the effect of misfit and interfacial curvature on diffusion-controlled growth of an isolated precipitate in a supersaturated matrix. Treating our simulations as computer experiments, we compare our simulation results with those based on the Zener–Frank and Laraia–Johnson–Voorhees theories for the growth of non-misfitting and misfitting precipitates, respectively. The agreement between simulations and the Zener–Frank theory is very good in one-dimensional systems. In two-dimensional systems with interfacial curvature (with and without misfit), we find good agreement between theory and simulations, but only at large supersaturations, where we find that the Gibbs–Thomson effect is less completely realized. At small supersaturations, the convergence of instantaneous growth coefficient in simulations towards its theoretical value could not be tracked to completion, because the diffusional field reached the system boundary. Also at small supersaturations, the elevation in precipitate composition matches well with the theoretically predicted Gibbs–Thomson effect in both misfitting and non-misfitting systems.

Meta-analysis of telomere length in 19 713 subjects reveals high heritability, stronger maternal inheritance and a paternal age effect

Telomere length (TL) has been associated with aging and mortality, but individual differences are also influenced by genetic factors, with previous studies reporting heritability estimates ranging from 34 to 82%. Here we investigate the heritability, mode of inheritance and the influence of parental age at birth on TL in six large, independent cohort studies with a total of 19 713 participants. The meta-analysis estimate of TL heritability was 0.70 (95% CI 0.64–0.76) and is based on a pattern of results that is highly similar for twins and other family members. We observed a stronger mother–offspring (r=0.42; P-value=3.60 × 10−61) than father–offspring correlation (r=0.33; P-value=7.01 × 10−5), and a significant positive association with paternal age at offspring birth (β=0.005; P-value=7.01 × 10−5). Interestingly, a significant and quite substantial correlation in TL between spouses (r=0.25; P-value=2.82 × 10−30) was seen, which appeared stronger in older spouse pairs (mean age ≥55 years; r=0.31; P-value=4.27 × 10−23) than in younger pairs (mean age<55 years; r=0.20; P-value=3.24 × 10−10). In summary, we find a high and very consistent heritability estimate for TL, evidence for a maternal inheritance component and a positive association with paternal age.

Alamethicin and synthetic peptide fragments as uncouplers of mitochondrial oxidative phosphorylation. Effect of chain length and change

Alamethicin, its derivatives and some synthetic fragments have been shown to be uncouplers of oxidative phosphorylation in rat liver mitochondria. A minimum peptide chain length of 13 residues is necessary for this activity. Peptide esters are more efficient uncouplers than the corresponding peptide acids. Esterification of the Glu(18) γ-COOH group in alamethicin does not diminish uncoupling activity. The structural requirements for uncoupling activity parallel those determined for ionophoretic action in small, unilamellar liposomes. Aib, α-aminoisobutyric acid; Z, benzyloxycarbonyl; OMe, methyl ester; OBz, benzyl ester; Ac, acetyl; CTC, chlortetracycline.

A Huge Effect of Weak dc Electrical Fields on Grain Growth in Zirconia

We show that the application of a modest dc electrical field, about 4 V/cm, can significantly reduce grain growth in yttria-stabilized polycrystalline zirconia. These measurements were made by annealing samples, for 10 h at 1300°C, with and without an electrical field. The finding adds a new dimension to the role of applied electrical fields in sintering and superplasticity, phenomena that are critical to the net-shape processing of ceramics. Grain-growth retardation will considerably enhance the rates of sintering and superplasticity, leading to significant energy efficiencies in the processing of ceramics.

Effect of reduced rotation length on Araucaria wood quality.

The review of existing information has identified the following: - the juvenile core in Araucaria is probably contained within the first 15 growth rings in the pith, with spiral grain being a chief determinant of its extent within the stem; - a reduction in rotation length for a given site index will reduce ASV and mature wood volume, with an increase in the proportion of juvenile wood; - for a given rotation length, lower ASV stems were estimated to contain a lower proportion of juvenile wood (based on the assumptions made and crude simulations using WEEDS, PL YSIM and STEPS software); regardless of juvenile wood proportions, smaller stems will yield a higher proportion of pith-in material; - an increase in the proportion of juvenile wood, due to a reduction in rotation length, could affect wood quality due to an increase in the proportion of the recovery containing high spiral grain, shorter tracheids and higher micellar angle; - high spiral grain and high micellar angles adversely impact on wood quality through their influence on twist and longitudinal shrinkage, respectively; - positive outcomes from a reduction in rotation length might include an increase in the proportion of live knots in upper stem sections and a reduction in the extent of brown-stain heartwood; - the uniformity in basic density within Araucaria stems means reduced rotation lengths and lower stem ASVs are unlikely to have a major impact on this wood property, and - the effect of a reduction in rotation length on the incidence of compression wood and timber susceptible to kiln staining could not be established from the available information.

Pyrolysis and combustion of alpha-cellulose: effect of dihydrazinium phosphate (N2H5)2HPO4

A strip of Whatman filter paper (α-cellulose) dipped in an aqueous solution of dihydrazinium phosphate, (N2H5)2HPO4(DHP), and dried, carbonized without flame when ignited. The observed flame retardancy of DHP on α-cellulose has been studied using TG, DTA and mass spectrometry. Dihydrazinium phosphate appears to catalyze the dehydration of α-cellulose, minimizing the depolymerization which produces flammable tars, with the formation of water and char. Flame retardancy of DHP is compared with that of diammonium phosphate and phosphoric acid.

Effect of lutein on the transport of Ca2+ across phospholipid bilayer and mitochondrial membrane

Lutein (3,3'-dihydroxy alpha-carotene), a xanthophyll present in plant chloroplasts, increases the permeability of phospholipid vesicles to Ca2+, even though the pigment does not bind the metal ion. Energy-dependent uptake of Ca2+ by mitochondria is inhibited by lutein, which permits a rapid efflux of the ion from Ca2+-loaded mitochondria. These results are consistent with the view that the deleterious action of lutein on mitochondrial oxidative phosphorylation results from its destabilizing action on membrane structure.

The effect of polyterpenol thin film surfaces on bacterial viability and adhesion

The nanometer scale surface topography of a solid substrate is known to influence the extent of bacterial attachment and their subsequent proliferation to form biofilms. As an extension of our previous work on the development of a novel organic polymer coating for the prevention of growth of medically significant bacteria on three-dimensional solid surfaces, this study examines the effect of surface coating on the adhesion and proliferation tendencies of Staphylococcus aureus and compares to those previously investigated tendencies of Pseudomonas aeruginosa on similar coatings. Radio frequency plasma enhanced chemical vapor deposition was used to coat the surface of the substrate with thin film of terpinen-4-ol, a constituent of tea-tree oil known to inhibit the growth of a broad range of bacteria. The presence of the coating decreased the substrate surface roughness from approximately 2.1 nm to 0.4 nm. Similar to P. aeruginosa, S. aureus presented notably different patterns of attachment in response to the presence of the surface film, where the amount of attachment, extracellular polymeric substance production, and cell proliferation on the coated surface was found to be greatly reduced compared to that obtained on the unmodified surface. This work suggests that the antimicrobial and antifouling coating used in this study could be effectively integrated into medical and other clinically relevant devices to prevent bacterial growth and to minimize bacteria-associated adverse host responses.

Effect of organic gate dielectric material properties on interfacial charging and discharging of pentacene MIM device

The effect of material properties of an environmentally friendly, optically transparent dielectric material, polyterpenol, on the carrier transients within the pentacene-based double-layer MTM device was investigated. Polyterpenol films were RF plasma polymerised under varied process conditions, with resultant films differing in surface chemistry and morphology. Independent of type of polyterpenol, time-resolved EFISHG study of IZO/polyterpenol/pentacene/Au structures showed similar transient behaviour with carriers injected into pentacene from Au electrode only, confirming polyterpenol to be a suitable blocking layer for visualisation of single-species carrier transportation during charging and discharging under different bias conditions. Polyterpenol fabricated under higher input power show better promise due to higher chemical and thermal stability, improved uniformity, and absence of defects.