The aging of the population assures increased prevalence of Individuals Living with Dementia (ILwD) and there will be an increased representation of this cohort requiring physical rehabilitation. If ...physical therapists (PTs) manage these patients as they do their age-matched, cognitively-intact peers, they will likely be unsuccessful. ILwD have unique needs related to interpersonal and pragmatic components of rehabilitation. Therapeutic nihilism (doubting the benefit of therapy) is well-documented in PTs, either because of existing biases about dementia or previous challenges in working with ILwD. Physical rehabilitation eligibility and placement decisions are often made by PTs without special training in dementia, based upon brief exposure to patients in environments not well-designed for their best functioning. This can lead to underestimation of rehabilitation potential and denial of future PT services. PTs who work with ILwD desire more practical knowledge and targeted skills. Those with more education and training have a more positive attitude and outlook related to ILwD.
The purpose of this paper is to introduce a framework for rehabilitation with ILwD equipped with pragmatic ideas to facilitate therapeutic success. The four primary components of the model are: (1) Establish a personal RELATIONSHIP, (2) Use intentional verbal and nonverbal COMMUNICATION, (3) Understand and optimize MOTOR LEARNING capabilities, and (4) Create a safe, purposeful ENVIRONMENT. Specific strategies to help PTs optimize each component are provided with supporting evidence. The model is intended to be dynamic, encouraging PTs to capitalize on the most accessible strategies within their control for a given patient and setting.
This framework provides a practical resource for working with ILwD with immediate implications for facilitating therapeutic success. The model is displayed in a schematic that reminds the reader of ideas at a glance within the context of each of the components. If an appreciation for this content was among core competencies required among PTs working with ILwD, perhaps there would be significantly fewer patients written off as "uncooperative" or "unable to participate" in PT.
Ultra high molecular weight polyethylene (UHMWPE) has been used as a bearing surface in total joint replacements (TJR) for nearly five decades. This semi-crystalline polymer has extraordinary ...energetic toughness owing to its high molecular weight and entanglement density. However, it is challenged by a need to offer a combined resistance to fatigue, wear and oxidation in vivo. The processing, sterilization treatment, and microstructural tailoring of UHMWPE has evolved considerably in the past 50 years but an optimized microstructure remains elusive. This review seeks to provide an overview of this processing history to address two primary questions: First, how does microstructure affect fatigue fracture and fatigue wear mechanisms in UHMWPE? And second, can microstructure be optimized to provide resistance to fatigue, oxidation and wear in vivo? Previous literature demonstrates that while crosslinking improves resistance to adhesive/abrasive wear, it also reduces resistance to fatigue crack propagation and fatigue wear by restricting molecular mobility and rendering the polymer more brittle. Crystallinity improves fatigue resistance but generally increases elastic modulus and concomitant contact stresses in vivo. The presence of fusion defects or oxidation reduces further fatigue resistance and enhances fatigue wear. Thus, UHMWPE microstructural evolution comes with trade-offs. Currently there is no singular formulation of UHMWPE that is ideal for all TJR applications.
•We review microstructural influences on fatigue and fracture of UHMWPE.•Crosslinking decreases wear but leads to faster fatigue crack growth and oxidation.•Crystallinity can be optimized to prevent fatigue crack propagation in UHMWPE.•Heat treatments can mitigate oxidation, but with adverse changes to crystallinity.•Modern UHMWPE microstructure still remains susceptible to fatigue and fracture.
Abstract
Summary
Mutation-Simulator allows the introduction of various types of sequence alterations in reference sequences, with reasonable compute-time even for large eukaryotic genomes. Its ...intuitive system for fine-grained control over mutation rates along the sequence enables the mimicking of natural mutation patterns. Using standard file formats for input and output data, it can easily be integrated into any development and benchmarking workflow for high-throughput sequencing applications.
Availability and implementation
Mutation-Simulator is written in Python 3 and the source code, documentation, help and use cases are available on the Github page at https://github.com/mkpython3/Mutation-Simulator. It is free for use under the GPL 3 license.
The most commonly used bearing couple in prosthetic hip or knee joint replacements consists of a cobalt–chrome (CoCr) metal alloy articulating against ultrahigh‐molecular‐weight polyethylene. ...Ceramics have been used as an alternative to metal‐on‐polyethylene in joint replacement surgery of arthritic hips and knees since the 1970s. In prosthetic hip and knee bearings, ceramic surfaces offer a major benefit of drastically reduced wear rates and excellent long‐term biocompatibility, which can increase the longevity of prosthetic hip and knee joints. This benefit is important clinically because hip and knee replacement has become a very common surgical procedure, particularly in the United States, and because these procedures are being increasingly performed in younger patients who place greater demands on the prosthetic bearings. However, ceramics are brittle and the risk of catastrophic bearing failure in vivo, while rare, is a major concern. Improvements in material quality, manufacturing methods, and implant design have resulted in a drastic reduction of the incidence of such failures, so that modern ceramic bearings are safe and reliable if used with components of proven design and durability. Future material improvements are actively being investigated to reduce the risk of ceramic‐bearing failures even further. The purpose of this article is to review the structure, properties, applications, and limitations of the ceramics that have been used in orthopedic bearings, and to describe the new ceramic composite materials and surface treatments that will be available for joint replacement surgery in the near future.
The ultracold-neutron (UCN) source at the Paul Scherrer Institute serves mainly experiments in fundamental physics. High UCN intensities are the key for progress and success in such experiments. A ...detailed understanding of all source parameters is required for future improvements. Here we present the UCN source components, elements of the neutron optics, the characterization of important related parameters like emptying times, storage times and transmission probabilities of UCNs, which are ultimately defining the UCN intensity delivered at the beamports. We also introduce a detailed simulation model of the PSI UCN source, used to analyze the measurements and to extract surface parameters. This work illustrates the successful construction and operation of a large-scale facility delivering high UCN count rate. The observed characteristics of many neutron-optics parameters has been successfully simulated in a detailed Monte-Carlo model implemented in the MCUCN code.
Rapid identification of agronomically important genes is of pivotal interest for crop breeding. One source of such genes are crop wild relative (CWR) populations. Here we used a CWR population of ...<200 wild beets (B. vulgaris ssp. maritima), sampled in their natural habitat, to identify the sugar beet (Beta vulgaris ssp. vulgaris) resistance gene Rz2 with a modified version of mapping-by-sequencing (MBS). For that, we generated a draft genome sequence of the wild beet. Our results show the importance of preserving CWR in situ and demonstrate the great potential of CWR for rapid discovery of causal genes relevant for crop improvement. The candidate gene for Rz2 was identified by MBS and subsequently corroborated via RNA interference (RNAi). Rz2 encodes a CC-NB-LRR protein. Access to the DNA sequence of Rz2 opens the path to improvement of resistance towards rhizomania not only by marker-assisted breeding but also by genome editing.
It has been proposed that there could be a mirror copy of the standard model particles, restoring the parity symmetry in the weak interaction on the global level. Oscillations between a neutral ...standard model particle, such as the neutron, and its mirror counterpart could potentially answer various standing issues in physics today. Astrophysical studies and terrestrial experiments led by ultracold neutron storage measurements have investigated neutron to mirror-neutron oscillations and imposed constraints on the theoretical parameters. Recently, further analysis of these ultracold neutron storage experiments has yielded statistically significant anomalous signals that may be interpreted as neutron to mirror-neutron oscillations, assuming nonzero mirror magnetic fields. The neutron electric dipole moment collaboration performed a dedicated search at the Paul Scherrer Institute and found no evidence of neutron to mirror-neutron oscillations. Thereby, the following new lower limits on the oscillation time were obtained: τnn′>352 s at B′=0 (95% C.L.), τnn′>6s for 0.4μT<B′<25.7μT (95% C.L.), and τnn′/cosβ>9s for 5.0μT<B′<25.4μT (95% C.L.), where β is the fixed angle between the applied magnetic field and the local mirror magnetic field, which is assumed to be bound to the Earth. These new constraints are the best measured so far around B′∼10μT and B′∼20μT.
BackgroundDeep infection following total hip arthroplasty is a devastating complication for the patient and a costly one for patients, surgeons, hospitals, and payers. The purpose of this study was ...to compare revision total hip arthroplasty for infection, revision total hip arthroplasty for aseptic loosening, and primary total hip arthroplasty with respect to their impact on hospital and surgeon resource utilization and referral patterns to a tertiary-care hospital.MethodsClinical, demographic, and economic data were obtained for twenty-five consecutive patients with an infection after a total hip replacement who underwent a two-stage revision arthroplasty (Group 1) performed by one of two surgeons, between March 2001 and December 2002, at a single institution. Similar data were collected during the same time-period for a cohort of twenty-five consecutive patients who underwent revision of both components because of aseptic loosening (Group 2) and twenty-five consecutive patients who underwent a primary hip arthroplasty (Group 3). Quantitative and categorical variables were compared among the groups. Referral patterns were examined by reviewing the primary diagnosis for all patients referred to our institution for a revision total hip arthroplasty during a five-year period.ResultsRevision procedures for infection were associated with longer operative time, more blood loss, and a higher number of complications compared with revisions for aseptic loosening or primary total hip arthroplasty (p < 0.02 for all). Revisions for infection were also associated with a higher total number of hospitalizations, total number of days in the hospital, total number of operations, total hospital costs, total outpatient visits, and total outpatient charges during the twelve-month period following the index procedure (p < 0.001 for all). The incidence of referrals to our institution for a diagnosis of infection following total hip arthroplasty increased significantly over a five-year period (Spearman rank correlation, 1.0; p = 0.0083), while referral rates for revision for causes other than infection remained relatively constant (Spearman rank correlation, 0.500; p = 0.3910).ConclusionsThe treatment of patients with an infection after a total hip arthroplasty is associated with significantly greater hospital and physician resource utilization compared with the treatment of patients who have a revision because of aseptic loosening or who have a primary total hip arthroplasty. We believe that the lack of incremental reimbursement associated with these procedures results in strong financial disincentives for physicians and hospitals to provide treatment for patients with an infection after a total hip arthroplasty.
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