Background
In patients with asymptomatic bacteriuria undergoing hip arthroplasty, the risk of prosthetic joint infection (PJI) and appropriateness of specific antibiotics are unclear.
...Questions/purposes
We determined (1) the prevalence of asymptomatic bacteriuria; and (2) the incidence of PJI in patients with asymptomatic bacteriuria managed with or without specific antibiotics.
Methods
We conducted a prospective, randomized study of all 471 patients without urinary symptoms receiving a total hip arthroplasty (THA; n = 228; average age 68 years; 122 female) or hemiarthroplasty (HA; n = 243; average age 85 years; 170 female) between April 2009 and November 2010. No patients were catheterized in the perioperative period and all received intravenous cefazolin (allergy, vancomycin) for 48 hours postoperatively. Urinalysis was conducted on all patients; if abnormal, a urine culture was performed. Patients with bacteriuria (> 100,000 colonies/mL cultured) were randomly assigned to receive specific antibiotics (Group A) or not (Group B). Minimum followup was 1 month including those six who died or were lost to followup (average, 10.4 months; range, 1–12 months).
Results
Asymptomatic bacteriuria occurred in eight of 228 patients undergoing THAs (three of eight with specific antibiotics) and 38 of 243 patients undergoing HAs (23 of 38 with specific antibiotics). Arthroplasty infection after 3 months occurred in one of 228 patients undergoing THAs and 12 of 243 patients undergoing HAs (six of 117 in Group A and six of 126 in Group B); bacteria cultured from the wound were dissimilar to those cultured in urine samples in any case. No patient presented signs of PJI by 1 year after the index surgery.
Conclusions
We identified no case of PJI from urinary origin in patients with asymptomatic bacteriuria whether or not they had been treated with specific antibiotics.
Level of Evidence
Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
Se presentan las caracteristicas de la supervision clinica conductual abstraidas de un analisis de tipo etnografico de entrevistas realizadas a 18 supervisores de la primera, segunda y tercera ...generacion de terapias conductuales. Los entrevistados contaban con experiencia de 17 anos en promedio (DE = 9.85) como clinicos y 16 anos en promedio (DE =10.51) como supervisores. Se utilizo el software Altlas.ti 6.2 para analizar y relacionar las caracteristicas centrales de la supervision. Los resultados mostraron la supervision conductual como categoria central con dos subcategorias axiales: factores que afectan la supervision y proceso de supervision. Los procedimientos de ensenanza con mayor fundamentacion fueron: la formulacion de caso, la discusion teorica, la retroalimentacion, el modelamiento y el moldeamiento. Se concluye que la supervision clinica se conceptualiza como un proceso y no como un resultado, y se discuten las implicaciones para los programas psicologia clinica en la formacion de futuros terapeutas. Palabras clave supervision clinica; terapias conductuales; formacion clinica; proceso de supervision; educacion informal. The characteristics of behaviorally based clinical supervision are presented. Eighteen open-ended interviews were conducted to supervisors from first, second, and third-wave behavioral therapies. These were analyzed based on an ethnographic approach. Participants reported an average of 17-years (SD = 9.85) practicing as clinicians and 16-years (SD = 10.51) as supervisors. The Altlas.ti 6.2 software was employed to analyze and synthesize the central processes embedded in supervision. Results found behavioral oriented supervision as the core category which encloses the following two axial subcategories: factors influencing supervision and supervision process. Case conceptualization, theoretical discussion, verbal feedback, shaping, and modeling were the most utilized teaching methods by the experts interviewed. We concluded that clinical supervision would be conceptualized as a process rather than an outcome. We discussed implications for clinical psychology programs when training future clinicians. Keywords clinical supervision; behavior therapies; clinical training; supervision process; continue education.
Purpose
Verify if the use of locking plates in displaced three- and four-part proximal humerus fractures has meant an improvement even in patients over 70 years of age.
Material and methods
We ...performed surgery with locking plate fixation in 56 consecutive patients with three- and four-part proximal humerus fractures according to Neer's classification between 1/1/15 and 12/31/20 at our Hospital. Patient satisfaction, quality of life, functionality and radiological variables, as well as the comparison between patients older and younger than 70 years were the main outcomes. Likewise, factors and complications that may have influenced these variables were analyzed as secondary outcomes. The analysis of all these variables was performed after a minimum follow-up time of 24 months after surgery.
Results
51 patients (92%) ended up satisfied or very satisfied according to the SF-36 test and with no disability or mild disability according to the DASH Score questionnaire. 46 patients (82%) obtained a satisfactory or excellent result according to the Neer scale modified by Cofield and 38 (68%) a good or excellent function according to the Constant Murley questionnaire. In 47 cases (84%) good radiological alignment was observed. Complications occurred in 20 patients (36%). The complications and the results of the SF-36, DASH Score, Neer scale modified by Cofield and Constant Murley tests depended on the radiological alignment (
p
= 0.009,
p
= 0.006,
p
= 0.025,
p
= 0.0008 and
p
= 0.0004). There were 37 patients younger than 70 years and 19 older than 70 years with no statistically significant differences when comparing the two groups.
Conclusions
This study demonstrates that satisfactory results can be obtained with osteosynthesis with locking plates in displaced proximal humerus fractures even in patients older than 70 years of age.
Level of evidence III
Retrospective Cohort, Treatment Study.
Introduction
The risk of knee arthroplasty infection and appropriateness of antibiotic treatment are not clearly established in patients with preoperative asymptomatic bacteriuria. It has been the ...purpose to analyze the prevalence of preoperative asymptomatic bacteriuria in knee arthroplasty patients, as well as the incidence of prosthetic joint infection in those with asymptomatic bacteriuria treated and not with specific antibiotics.
Patients and methods
This prospective study included 215 consecutive knee arthroplasty patients (73 ± 6 years, 168 females) with neither urinary symptoms nor perioperative urethral catheterization. A “clean-catch” urinalysis was obtained from all patients before surgery and an urine culture if urinalysis was abnormal. Asymptomatic bacteriuria was diagnosed if >100,000 colony-forming units/ml were cultured. Patients were treated (Group A) or not (Group B) with additional specific antibiotics for urine bacteria according to surgeon criteria. Minimum follow-up reached 48 months. No patient was lost to follow-up.
Results
Asymptomatic bacteriuria was diagnosed in 11/215 patients (5.1 %) (11/11 females), and four of these 11 were treated with specific antibiotics (Group A). Only one patient in Group A suffered a prosthesis infection along the first 3 months (1/125, 0.5 %), but bacteria cultured from the wound were absolutely different to those in urine culture. No patient in Group B suffered a prosthesis infection.
Conclusions
Asymptomatic bacteriuria presents a low prevalence. We have not found any case of arthroplasty infection from urinary focus in patients with asymptomatic bacteriuria whether they received or not specific antibiotics.
Se presentan las características de la supervisión clínica conductual abstraídas de un análisis de tipo etnográfico de entrevistas realizadas a 18 supervisores de la primera, segunda y tercera ...generación de terapias conductuales. Los entrevistados contaban con experiencia de 17 años en promedio (DE = 9.85) como clínicos y 16 años en promedio (DE =10.51) como supervisores. Se utilizó el software Altlas.ti 6.2 para analizar y relacionar las características centrales de la supervisión. Los resultados mostraron la supervisión conductual como categoría central con dos subcategorías axiales: factores que afectan la supervisión y proceso de supervisión. Los procedimientos de enseñanza con mayor fundamentación fueron: la formulación de caso, la discusión teórica, la retroalimentación, el modelamiento y el moldeamiento. Se concluye que la supervisión clínica se conceptualiza como un proceso y no como un resultado, y se discuten las implicaciones para los programas psicología clínica en la formación de futuros terapeutas.
Entre las razones por las cuales se sancionan a las empresas en términos tributarios están la omisión de ingresos y la inclusión de costos inexistentes en las declaraciones, lo que va en contra de la ...planeación fiscal y tal conducta puede denominarse evasiva. La ley determina la gravedad de las conductas inadecuadas y las sanciones pertinentes, estas van desde una amonestación, hasta la cancelación de la inscripción de la tarjeta profesional. El abordaje metodológico es inductivo, mediante análisis de hechos particulares, de tipo cualitativo, se busca identificar, recopilar y analizar el problema mediante una revisión documental sobre la influencia de la ética profesional del contador público en la evasión fiscal. Es posible afirmar que las principales faltas éticas cometidas por los contadores sancionados son la integridad, responsabilidad, competencia y diligencia profesional, conducta ética y comportamiento profesional, ya que la totalidad de los sancionados han violado estos cinco principios.
Perceived exertion, as measured by psychometric scales, has been proven to be a valid tool to assess training load, and to highly correlate with physiological and mechanical dimensions of physical ...effort. However, little is known about the emotional correlates of exertion, and how perceived exertion is influenced by mental workload. In the two experiments reported here, ratings of perceived exertion (RPE) were found to be significantly influenced by mental workload (generated by means of a cognitive task, unrelated to, but temporally overlapping with the physical task) during active recovery after exhausting exercise, but not during incremental exercise. Importantly, perceived exertion was found to strongly correlate with reported emotional/hedonic valence, but not so tightly with reported arousal. These findings strengthen the motivational value of perceived exertion, and its linkage to other psychological constructs. PUBLICATION ABSTRACT
The aim of the present study was twofold: first, to determine the meeting all three 24‐h movement guidelines in Colombian preschool‐aged children, and second, to explore the associations between ...different socio‐ecological correlates and the meeting of these guidelines. This was a cross‐sectional study with data from the Encuesta Nacional de Situación Nutricional (ENSIN‐2015) in Colombia, 2015–2016. The sample comprised 3002 low‐income preschoolers (3–4 years old, 50.7% boys). Data on physical activity, screen time, and sleep time were collected using the Cuestionario para la Medición de Actividad Física y Comportamiento Sedentario, reported by their parents. In total, 18 potential correlates (individual, interpersonal, organizational, and community level) were analyzed. Backward binary logistic regression analysis was performed with the potential correlates as independent variables and meeting all three 24‐h movement guidelines as dependent variables. The prevalence of preschoolers meeting all three 24‐h movement guidelines or none was 4.8% and 16.6%, respectively. In the final model, boys (odds ratio OR = 1.87, 95% confidence interval CI 1.00–3.50) and those who do not have television in their bedroom (OR = 2.09, 95%CI 1.05–4.14) were more likely to meet all three 24‐h movement guidelines compared to with girls and those who have television, respectively. In conclusion, strategies to promote adherence to all 24‐h movement guidelines among low‐income preschoolers are warranted, and should focus on actions considering the importance of sex and home environment changes to support these movement behaviors.
In this study, the results of simulations generated from different thermodynamic models of Stirling engines are compared, including characterizations of both instantaneous and indicated operative ...parameters. The aim was to develop a tool to guide the decision-making process regarding the optimization of both the performance and reliability of Stirling engines, such as the 2.9 kW GENOA 03 unit—the focus of this work. The behavior of the engine is characterized using two different approaches: an ideal isothermal model, the simplest of those available, and analysis using the ideal adiabatic model, which is more complex than the first. Some of the results obtained with the referred ideal models deviated considerably from the expected values, particularly in terms of thermal efficiency, so a set of modifications to the ideal adiabatic model are proposed. These modifications, mainly related to both heat transfer and fluid friction phenomena, are intended to overcome the limitations due to the idealization of the engine working cycle, and are expected to generate results closer to the actual behavior of the Stirling engine, despite the increase in the complexity derived from the modelling and simulation processes.
In the absence of medical contraindications, physical activity (PA) can offer health maternal and fetal health outcomes during pregnancy. However, most pregnant women may not consider PA to be ...feasible, suitable and safe. Hence, it is essential to determine the prevalence of pregnant women who meet the PA recommendations and the possible factors associated with that meeting, since it might be important from the perspective of pregnant women's health. The aim of the present study was to establish the prevalence of meeting the World Health Organization PA recommendations for Colombian pregnant women, as well as possible factors that may be associated with meeting that recommendations. A cross-sectional study including representative data from the National Nutritional Situation Survey (2015) in Colombia was performed. Data were collected in 2015-2016. From an initial sample of 1140 Colombian pregnant women, 702 participants with complete data were included in the final analysis. PA was assessed by self-reported information through the long version of the International Physical Activity Questionnaire. Several potential factors were analysed according to four levels of the socioecological model: the individual, interpersonal, organizational and community levels. The prevalence of Colombian pregnant women who met with the PA recommendations was 7.5%. Indigenous and Mestizo pregnant women showed lower probabilities of meeting the PA recommendations Indigenous: OR 0.05, 95% CI (0.01-0.18); Mestizo: OR 0.12, 95% CI (0.06-0.22) than Afro-Colombian participants. Additionally, participants who lived near green and safe spaces for PA were more likely to meet the PA recommendations OR 2.30, 95% CI (1.06-4.79) than those who did not live near green areas. In conclusion, a low percentage of Colombian pregnant women met the new PA recommendations. The associations found according to race/ethnicity and living near green and safe areas underline the presence of fundamental disparities associated with meeting PA recommendations.
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