compared to usual care, a multi-faceted intervention increased referrals to physiotherapy and occupational therapy but did not reduce risk of falls. Similar falls reduction interventions cannot be recommended based on the results of this study.

BackgroundOsteoporosis-related fractures are a significant public health concern. Interventions that increase detection and treatment of osteoporosis are underutilized. This pragmatic randomised study was done to evaluate the impact of a multifaceted community-based care program aimed at optimizing evidence-based management in patients at risk for osteoporosis and fractures.MethodsThis was a 12-month randomized trial performed in Ontario, Canada. Eligible patients were community-dwelling, aged ≥55 years, and identified to be at risk for osteoporosis-related fractures. Two hundred and one patients were allocated to the intervention group or to usual care. Components of the intervention were directed towards primary care physicians and patients and included facilitated bone mineral density testing, patient education and patient-specific recommendations for osteoporosis treatment. The primary outcome was the implementation of appropriate osteoporosis management.Results101 patients were allocated to intervention and 100 to control. Mean age of participants was 71.9 ± 7.2 years and 94% were women. Pharmacological treatment (alendronate, risedronate, or raloxifene) for osteoporosis was increased by 29% compared to usual care (56% [29/52] vs. 27% [16/60]; relative risk [RR] 2.09, 95% confidence interval [CI] 1.29 to 3.40). More individuals in the intervention group were taking calcium (54% [54/101] vs. 20% [20/100]; RR 2.67, 95% CI 1.74 to 4.12) and vitamin D (33% [33/101] vs. 20% [20/100]; RR 1.63, 95% CI 1.01 to 2.65).ConclusionsA multi-faceted community-based intervention improved management of osteoporosis in high risk patients compared with usual care.Trial RegistrationThis trial has been registered with clinicaltrials.gov (ID: NCT00465387)

No abstract

Implementing a protocol to screen for woman abuse into an existing maternal child home visiting program demonstrated improved practices related to the safety and privacy of women, and an increase in abuse disclosures.

Robot-assisted ureterectomy and ureteral reconstruction is safe and feasible, and offers patients the advantages of minimally invasive surgery. Future studies with additional patients and longer follow-up will determine the oncologic effectiveness of this procedure.

No abstract

No abstract

This article discusses the importance and need of bearing simulation models for designing efficient and high-performing bearing systems. Bearings play a key role in ensuring critical rotating parts spin freely under all operating conditions. Yet bearings remain among the more difficult components to model accurately. Bearings are a key component in industrial gears, but they are rarely modeled with any fidelity. Most simulations rely on simplified bearing models or simply assume rotating parts will spin perfectly. Accurate and validated bearing models must represent many rotating and interacting components. They must also consider complex boundary conditions, since bearing performance is highly dependent on the application and its operating environment. Many different system design and operating parameters influence the performance of bearings. Some can be controlled during operation. Others cannot, but may still have a significant impact on system performance. Design for Six Sigma enables engineers to gain insight into these parameters by designing experiments for virtual testing.