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Abstract Background Evidence-informed practice is fundamental to the delivery of high quality health care. Delays and gaps in the translation of research into practice can impact negatively on patient care. Previous studies have reported that problems facing health care professionals such as information overload, underdeveloped critical appraisal skills, lack of time and other individual, organisational and system-level contextual factors are barriers to the uptake of evidence. Health services research in this area has been restricted largely to the evaluation of program outcomes. This paper aims to describe the implementation process of an educational initiative for health care professionals working in midwifery, neonatology or obstetrics aimed at disseminating evidence and enhancing evidence-informed clinical care. Methods We designed and implemented an educational initiative called Evidence Rounds for health care professionals working in the women and children’s division of an urban hospital in Ireland. It consisted of three core components: (1) group educational sessions examining evidence on topics chosen by staff (2) a dedicated website and (3) facilitation, enablement and support from a knowledge translation professional. We evaluated user engagement in the educational program by monitoring attendance figures and website analytics. We followed up with staff at 3, 16 and 21-month intervals after the last educational session to find out whether evidence had been implemented. We use Lavis’s organising framework for knowledge transfer and the Template for Intervention Description and Replication (TIDieR) checklist to describe the educational program and document the implementation process. Results Six educational sessions presented by 18 health care professionals took place over a nine month period with 148 attendances of which 85 were unique (individuals who attended at least one session). During the period spanning from one month before, during and one month after the running of the group sessions, 188 unique visitors, 331 visits and 862 page views were recorded on our website. Conclusions Audit and feedback processes can provide quantitative data to track practice outcomes. Achieving sustainable educational programs can be challenging without dedicated resources such as staffing and funding.

OBJECTIVE: To evaluate the skeletal, dental and soft tissue cephalometric changes by addition of daytime Class III elastics to the Alternate Rapid Maxillary Expansion-Constriction (AltRAMEC) and Reverse Headgear (RH) protocol in skeletal Class III patients with maxillary retrusion. Material and Methods: 54 patients with maxillary retrusion and CVMI (Cervical vertebral maturity index)

OBJECTIVE: The aim of this study was to compare the efficiency of canine retraction using modified Marcotte and T-loop retraction springs. MATERIALS AND METHODS: Twenty-four subjects with a treatment plan involving bilateral extractions of upper first premolars were included in the study. A split-mouth design was used to randomly allocate opposite quadrants to either modified Marcotte spring (MS) or T-loop spring (TLS) for canine retraction. Cephalometric radiographs and models were used to measure the rate of canine retraction (primary outcome) and compare the angular/rotational changes in the canines and anchorage loss in molars (secondary outcomes) following retraction. Subjective assessment of pain and discomfort was compared using visual analog scale (VAS). Paired and independent t-tests were used to evaluate changes. RESULTS: The mean amount and rate of retraction of the canine were found to be significantly higher for MS (3.56 ± 0.696 mm and 1.188 ± 0.232 mm, respectively) when compared with TLS (2.125 ± 0.472 mm and 0.71 ± 0.157 mm, respectively). Distopalatal rotation of the canine was also significantly lesser for MS (2.42°±1.868°) than TLS (5.65° ±2.84°, P < 0.001). However, the amount of anchorage loss and canine tipping were significantly higher for MS. Statistically significant higher values in the VAS score for TLS indicated greater discomfort. CONCLUSION: MS exhibited increased rate of retraction and rotation control when compared with TLS during sectional canine retraction. Patient comfort was better for MS as evidenced by the VAS scores. However, the amount of tipping and anchorage loss obtained with MS were significantly higher than TLS.

Routine radiographs made in the orthodontic office can often give way to detection and diagnosis of unusual syndromes, signs or foreign bodies. A case report of one such accidental detection of a very unusual foreign body within the nasal cavity of an orthodontic patient has been presented here to emphasize the importance of routine radiographic views, which over and above aiding in Orthodontic diagnosis, can also often detect potentially life threatening problems in the Oro-facial region.

The novel coronavirus (COVID-19) pandemic has altered every aspect of life across the world. The global economy, health care systems, social life and most importantly education have all been affected. The severity of the virus forced students, educators, and all other non-essential workers to confine to their respective homes to limit the spread of the virus. Many states have enacted curfew laws, restaurants and grocery stores have established new rules and regulations, and teachers are obliged to alter their teaching pedagogy from the face physical walls of the classroom [face-to-face learning] to web-based distance learning. The resulted massive exposure towards web-based learning is well administered by institutions with previous competency while other institutions find it difficult to operate remotely. This communication briefly examines the nature of web-based learning caused by the COVID-19 global pandemic.

A detailed variable temperature neutron total scattering study of the potential nuclear waste matrix TlTcO4 was conducted. The long-range average structure of TlTcO4 undergoes an orthorhombic Pnma to tetragonal I41/amd phase transition below 600 K, consistent with previous synchrotron X-ray diffraction studies. However, several anomalies were observed in the Rietveld refinements to the neutron powder diffraction data, such as large atomic displacement parameters at low temperature and a shortening of the Tc-O bond distance upon heating. Modelling the short-range local structure of both the low- and high-temperature data required a lowering of symmetry to the monoclinic P21/c model due to the stereochemical activity of the Tl+ 6s2 lone pairs. Density functional theory calculations also verified this model to have a lower ground state energy than the corresponding long-range average structure. It is concluded that at low temperatures, the Tl+ 6s2 lone pairs are 'frozen' into the structure. Upon heating, the rigid TcO4 tetrahedra begin to rotate, as governed by the ...3+ and M4+ modes. However, there is a disconnect between the two length scales, with the 6s² lone pair electrons remaining stereochemically active on the local scale, as observed in the neutron pair distribution function fits. The orthorhombic Pnma to tetragonal I41/amd phase transition is seemingly the result of a change in the correlation length of the Tl+ 6s² lone pairs, leading to a larger unit cell volume due to their uncorrelated displacements. [ABSTRACT FROM AUTHOR]

The title hydrated salt, tris[hexaamminecobalt(III)] tetraoxidorhenate(VII) tetrakis[hexafluoridorhenate(IV)] hexahydrate, arose unexpectedly due to possible contamination of the K2ReF6 starting material with KReO4. It consists of octahedral [Co(NH3)6]3+ cation (Co1 site symmetry 1), tetrahedral [ReVIIO4]- anions (Re site symmetry 1) and octahedral [ReIVF6]2- anions (Re site symmetries 1and 3). The [ReF6]2- octahedral anions (mean Re--F =1.834 Å), [Co(NH3)6]3+ octahedral cations (mean Co--N = 1.962Å), and the [ReO4]- tetrahedral anion (mean Re--O = 1.719 Å) are slightly distorted. A network of N--H···F hydrogen bonds consolidates the structure. The crystal studied was refined as a two-component twin. [ABSTRACT FROM AUTHOR]

The A2[ReF6] (A = K, Rb and Cs) salts are isotypic and crystallize in the trigonal space group type Pm1, adopting the K2[GeF6] structure type. Common to all A2[ReF6] structures are slightly distorted octa­hedral [ReF6]2− anions with an average Re—F bond length of 1.951 (8) Å. In those salts, symmetry lowering on the local [ReF6]2− anions from Oh (free anion) to D3d (solid-state structure) occur. The distortions of the [ReF6]2− anions, as observed in their Raman spectra, are correlated to the size of the counter-cations. [ABSTRACT FROM AUTHOR]

A detailed variable temperature neutron total scattering study of the potential nuclear waste matrix TlTcO 4 was conducted. The long-range average structure of TlTcO 4 undergoes an orthorhombic Pnma to tetragonal I 4 1 / amd phase transition below 600 K, consistent with previous synchrotron X-ray diffraction studies. However, several anomalies were observed in the Rietveld refinements to the neutron powder diffraction data, such as large atomic displacement parameters at low temperature and a shortening of the Tc-O bond distance upon heating. Modelling the short-range local structure of both the low- and high-temperature data required a lowering of symmetry to the monoclinic P 2 1 / c model due to the stereochemical activity of the Tl + 6s 2 lone pairs. Density functional theory calculations also verified this model to have a lower ground state energy than the corresponding long-range average structure. It is concluded that at low temperatures, the Tl + 6s 2 lone pairs are 'frozen' into the structure. Upon heating, the rigid TcO 4 tetrahedra begin to rotate, as governed by the Γ 3 + and M 4 + modes. However, there is a disconnect between the two length scales, with the 6s 2 lone pair electrons remaining stereochemically active on the local scale, as observed in the neutron pair distribution function fits. The orthorhombic Pnma to tetragonal I 4 1 / amd phase transition is seemingly the result of a change in the correlation length of the Tl + 6s 2 lone pairs, leading to a larger unit cell volume due to their uncorrelated displacements.

This paper focuses on activity recognition using a single wearable inertial measurement sensor placed on the subject's chest. The ten activities that need to be identified include lying down, standing, sitting, bending and walking, among others. The activity recognition approach is based on using and identifying a transfer function associated with each activity. The appropriate input and output signals for each transfer function are first determined based on the norms of the sensor signals excited by that specific activity. Then the transfer function is identified using training data and a Wiener filter based on the auto-correlation and cross-correlation of the output and input signals. The activity occurring in real-time is recognized by computing and comparing the input-output errors associated with all the transfer functions. The performance of the developed system is evaluated using data from a group of Parkinson's disease subjects, including data obtained in a clinical setting and data obtained through remote home monitoring. On average, the developed system provides better than 90% accuracy in identifying each activity as it occurs. Activity recognition is particularly useful for PD patients in order to monitor their level of activity, characterize their postural instability and recognize high risk-activities in real-time that could lead to falls.

Uranium-based microspheres are of interest due to their potential applications as targets for medical isotopes production, as fuel for nuclear reactors, and as standardized materials for nuclear forensics. Here, for the first time, UO 2 F 2 microspheres (1-2 μm) have been prepared from the reaction between UO 3 microspheres and AgHF 2 in an autoclave. In this preparation, a new fluorination method has been applied, and HF (g) -produced in situ from the thermal decomposition of AgHF 2 and NH 4 HF 2 -was used as the fluorinating agent. The microspheres were characterized by powder X-ray diffraction (PXRD) and scanning electron microscopy (SEM). Diffraction results indicated that the reaction performed with AgHF 2 at 200 °C led to anhydrous UO 2 F 2 microspheres, while at 150 °C, hydrated UO 2 F 2 microspheres were obtained. Meanwhile, NH 4 HF 2 led to the formation of contaminated products as driven by the formation of volatile species., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

The use of wearable sensors in movement disorder patients such as Parkinson's disease (PD) and normal pressure hydrocephalus (NPH) is becoming more widespread, but most studies are limited to characterizing general aspects of mobility using smartphones. There is a need to accurately identify specific activities at home in order to properly evaluate gait and balance at home, where most falls occur. We developed an activity recognition algorithm to classify multiple daily living activities including high fall risk activities such as sit to stand transfers, turns and near-falls using data from 5 inertial sensors placed on the chest, upper-legs and lower-legs of the subjects. The algorithm is then verified with ground truth by collecting video footage of our patients wearing the sensors at home. Our activity recognition algorithm showed >95% sensitivity in detection of activities. Extracted features from our home monitoring system showed significantly better correlation (~69%) with prospectively measured fall frequency of our subjects compared to the standard clinical tests (~30%) or other quantitative gait metrics used in past studies when attempting to predict future falls over 1 year of prospective follow-up. Although detecting near-falls at home is difficult, our proposed model suggests that near-fall frequency is the most predictive criterion in fall detection through correlation analysis and fitting regression models., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Nouriani, Jonason, Sabal, Hanson, Jean, Lisko, Reid, Moua, Rozeboom, Neverman, Stowe, Rajamani and McGovern.)

Objective: The aim of this study was to characterize the clinical utilization and associated charges of autologous bone flap (ABF) versus synthetic flap (SF) cranioplasty and to characterize the postoperative infection risk of SF versus ABF using the National Readmissions Database (NRD)., Methods: The authors used the publicly available NRD to identify index hospitalizations from October 2015 to December 2018 involving elective ABF or SF cranioplasty after traumatic brain injury (TBI) or stroke. Subsequent readmissions were further characterized if patients underwent neurosurgical intervention for treatment of infection or suspected infection. Survey Cox proportional hazards models were used to assess risk of readmission., Results: An estimated 2295 SF and 2072 ABF cranioplasties were performed from October 2015 to December 2018 in the United States. While the total number of cranioplasty operations decreased during the study period, the proportion of cranioplasties utilizing SF increased (p < 0.001), particularly in male patients (p = 0.011) and those with TBI (vs stroke, p = 0.012). The median total hospital charge for SF cranioplasty was $31,200 more costly than ABF cranioplasty (p < 0.001). Of all first-time readmissions, 20% involved surgical treatment for infectious reasons. Overall, 122 SF patients (5.3%) underwent surgical treatment of infection compared with 70 ABF patients (3.4%) on readmission. After accounting for confounders using a multivariable Cox model, female patients (vs male, p = 0.003), those discharged nonroutinely (vs discharge to home or self-care, p < 0.001), and patients who underwent SF cranioplasty (vs ABF, p = 0.011) were more likely to be readmitted for reoperation. Patients undergoing cranioplasty during more recent years (e.g., 2018 vs 2015) were less likely to be readmitted for reoperation because of infection (p = 0.024)., Conclusions: SFs are increasingly replacing ABFs as the material of choice for cranioplasty, despite their association with increased hospital charges. Female sex, nonroutine discharge, and SF cranioplasty are associated with increased risk for reoperation after cranioplasty.

Uranium metal is associated with several aspects of nuclear technology; it is used as fuel for research and power reactors, targets for medical isotope productions, explosive for nuclear weapons and precursors in synthetic chemistry. The study of uranium metal at the laboratory scale presents the opportunity to evaluate metallic nuclear fuels, develop new methods for metallic spent fuel reprocessing and advance the science relevant to nuclear forensics and medical isotope production. Since its first isolation in 1841, from the reaction of uranium chloride and potassium metal, uranium metal has been prepared by solid-state reactions and in solution by electrochemical, chemical and radiochemical methods. The present review summarizes the methods outlined above and describes the chemistry associated with each preparation., Competing Interests: We declare we have no competing interests., (© 2022 The Authors.)

The title hydrated salt, tris-[hexa-amminecobalt(III)] tetraoxidorhenate(VII) tetra-kis-[hexa-fluorido-rhenate(IV)] hexa-hydrate, arose unexpectedly due to possible contamination of the K 2 ReF 6 starting material with KReO 4 . It consists of octa-hedral [Co(NH 3 ) 6 ] 3+ cation (Co1 site symmetry 1), tetra-hedral [Re VII O 4 ] - anions (Re site symmetry 1) and octa-hedral [Re IV F 6 ] 2- anions (Re site symmetries 1and ). The [ReF 6 ] 2- octa-hedral anions (mean Re-F = 1.834 Å), [Co(NH 3 ) 6 ] 3+ octa-hedral cations (mean Co-N = 1.962 Å), and the [ReO 4 ] - tetra-hedral anion (mean Re-O = 1.719 Å) are slightly distorted. A network of N-H⋯F hydrogen bonds consolidates the structure. The crystal studied was refined as a two-component twin.

Reverse micelles (RMs) containing aqueous solutions of Ag(+) ions in their core produce fluorescent Ag species, upon exposure to gamma irradiation. A two-phase liquid system is used for RM formation. The RMs can be employed in novel gamma radiation detectors with appearance of fluorescence indicating that radiation was once present.

Background: Inferior vena cava (IVC) filters have proven to be a viable alternative to anticoagulation therapy for the prevention of life-threatening pulmonary emboli (PE) for patients who have contraindications to anticoagulation therapy. The clinical benefit of placing IVC filters in patients with advanced-stage cancer is controversial. The current study reported the authors' experience with IVC filters in patients with cancer., Methods: Between January 2000 and May 2003, IVC filters were placed in 308 patients with venous thromboembolic (VTE) disease. Of these patients, 267 had solid tumors and 41 had liquid tumors. Outcome was reviewed retrospectively with regards to patient survival as well as procedural and filter-related complications. Patients with solid and liquid tumors were used to generate Kaplan-Meier estimates for survival and the probability of surviving 30, 90, and 365 days was also calculated. The prognostic effect of age, primary malignancy, gender, extent of disease, indication, admission to the intensive care unit, and IVC thrombus on overall survival was also evaluated using univariate and multivariate Cox models for patients with solid tumors., Results: The median survival periods for patients with solid and liquid tumors were 145 days and 207 days, respectively. The probability of survival at 30, 90, and 365 days was 0.81, 0.60, and 0.35, respectively, for patients with solid tumors and 0.85, 0.67, and 0.48, respectively, for patients with liquid tumors. There was no statistically significant difference in survival based on primary malignancy for solid tumors (P = 0.628) or between solid and liquid tumors (P = 0.16). For patients with solid tumors, a statistically significant difference in survival was found by extent of disease (P = 0.002). Patients with solid tumors classified as local disease (n = 15), locally advanced disease (n = 95), and widely metastatic or disseminated disease (n = 153) had a probability of survival at 30 days of 0.93, 0.87, and 0.76, respectively. Compared with patients with local disease, patients with metastatic or disseminated disease were 3.7 times more likely to die (P = 0.013). Patients with a history of deep venous thrombosis (DVT) and hemorrhage were 2 times more likely to die than patients with DVT and no history of hemorrhage (P = 0.0057). Documented complications occurred in 22 of 308 (7.1%) patients and included PE (n = 4), new caval thrombosis (n = 14), retroperitoneal hemorrhage (n = 2), and maldeployed filters (n = 2)., Conclusions: IVC filters were shown to be safe and highly effective in preventing PE-related deaths in patients with cancer with VTE disease. Patients with a history of DVT and bleeding or metastatic/disseminated stage of disease had the lowest survival after IVC filter placement.