bluuebunny/crossref_metadata_2025 huggingface dataset:
SkillSim: voice apps similarity detection
Authors: Guo Zhixiu , Liang Ruigang , Meng Guozhu , Chen Kai
Published: July 2023

Virtual personal assistants (VPAs), such as Amazon Alexa and Google Assistant, are software agents designed to perform tasks or provide services to individuals in response to user commands. VPAs extend their functions through third-party voice apps, thereby attracting more users to use VPA-equipped products. Previous studies demonstrate vulnerabilities in the certification, installation, and usage of these third-party voice apps. However, these studies focus on individual apps. To the best of our knowledge, there is no prior research that explores the correlations among voice apps.Voice apps represent a new type of applications that interact with users mainly through a voice user interface instead of a graphical user interface, requiring a distinct approach to analysis. In this study, we present a novel voice app similarity analysis approach to analyze voice apps in the market from a new perspective. Our approach, called SkillSim, detects similarities among voice apps (i.e. skills) based on two dimensions: text similarity and structure similarity. SkillSim measures 30,000 voice apps in the Amazon skill market and reveals that more than 25.9% have at least one other skill with a text similarity greater than 70%. Our analysis identifies several factors that contribute to a high number of similar skills, including the assistant development platforms and their limited templates. Additionally, we observe interesting phenomena, such as developers or platforms creating multiple similar skills with different accounts for purposes such as advertising. Furthermore, we also find that some assistant development platforms develop multiple similar but non-compliant skills, such as requesting user privacy in a non-compliance way, which poses a security risk. Based on the similarity analysis results, we have a deeper understanding of voice apps in the mainstream market.
Parametric study on prestressed skewed box-girder bridge
Authors: Agarwal Preeti , Singh Deepak Kumar
Published: July 2023

This study employs the finite element-based CSiBridge v.20.0.0 software to examine the response of a single-cell prestressed box-girder bridge subjected to Indian loading conditions. The analyses is carried out on a simply supported bridge considering the specifications of Indian Road Congress (IRC) 6:2017, IRC 18:2000 and IRC 21:2000. An existing model of prestressed skewed bridge is validated with the published one. A convergence study is conducted for determining the model’s mesh size. An extensive parametric study is carried out to gain a better understanding of the response of a skewed prestressed bridge. The parameters variables are: Skew angle (0°, 10°, 20°, 30°, 40°, 50°, and 60°); Span (35, 40, 45, 50, 55, and 60 m); and Span-depth ratio (10, 12, 14, 16 and 18). The results of this study are presented as ratios of Bending moment, Shear force, Torsional moment, and Vertical deflection. Finally, equations for estimation of these ratios for different span and span-depth ratio are also deduced from the statistical approach so that the results of skewed bridges may be evaluated directly. It is determined that the skewed bridge outperforms the straight bridge because of its higher span-depth ratio, which results in less bending moment development. Evidence suggests that the skewness may help to lessen the prestress load’s dominance. The findings of this study may be helpful to engineers and designers in the analysis and design of prestresssed skewed box-girder bridges.
Vigorously cited: a bibliometric analysis of the 100 most cited sedentary behaviour articles
Authors: Memon Aamir R. , Chen Sitong , To Quyen G. , Vandelanotte Corneel
Published: July 2023

Objectives

No citation analysis has examined peer-reviewed sedentary behaviour research articles, which is needed to assess the impact of this research and identify knowledge gaps. Therefore, this study aimed to identify the 100 most cited sedentary behaviour articles and examine their bibliometric characteristics.

Methods

All databases indexed in the Web of Science database were searched in October 2022, and bibliometric characteristics of the studies, irrespective of the publication year, were imported and calculated. Descriptive statistics and visualisations by the VOSviewer were used for the presentation of bibliometric characteristics.

Results

The 100 most cited articles received 49,062 citations in total, with a median citation density of 32.5 citations per article per year. The majority of included articles were reviews (n = 48; 22,856 citations), focused on adults (58%; 26,809 citations) and reported on the relationship of sedentary behaviour with health (n = 64; 34,598 citations); more specifically they focused on anthropometric indices (28%), metabolic health (24%), and mortality (23%). The United States was ranked first in terms of the overall for most cited articles. However, Australia was ranked first for institutions and authors contributing to the most cited sedentary behaviour articles.

Conclusions

Papers published after 2007 were predominant in the list of 100 most cited sedentary behaviour papers, as were those focusing on associations with physical health outcomes and those focusing on adults. While original articles were cited more, discussion papers had more impact on the field as they received more citations in less time. Research examining associations between sedentary behaviour and health was cited more. The field is dominated by contributions from high-income countries.
Introduction to this special section: Digitalization in energy
Authors: Kazei Vladimir , Sengupta Mita
Published: July 2023

The concept of open and reproducible research is not entirely new to the field of geophysics, as evidenced by previous studies such as Fomel et al. (2013) . However, the advent of artificial intelligence (AI) and cloud computing have greatly simplified the sharing of technology and resources, and this has accelerated innovation ( Lowndes et al., 2017 ) and brought about a shift in the mindset of geoscientists. For the papers gathered in this special section, the authors made extensive use of open-source material in their underlying research, and they have, in turn, made their data, code, and software tools freely available.
Seeing through the CO2plume: Joint inversion-segmentation of the Sleipner 4D seismic data set
Authors: Romero Juan , Luiken Nick , Ravasi Matteo
Published: July 2023

Time-lapse (4D) seismic inversion is the leading method to quantitatively monitor fluid-flow dynamics in the subsurface, with applications ranging from enhanced oil recovery to subsurface CO2storage. The process of inverting 4D seismic data for reservoir properties is a notoriously ill-posed inverse problem due to the band-limited and noisy nature of seismic data and inaccuracies in the repeatability of 4D acquisition surveys. Consequently, ad-hoc regularization strategies are essential for the 4D seismic inverse problem to obtain geologically meaningful subsurface models and associated 4D changes. Motivated by recent advances in the field of convex optimization, we propose a joint inversion-segmentation algorithm for 4D seismic inversion that integrates total variation and segmentation priors as a way to counteract missing frequencies and present noise in 4D seismic data. The proposed inversion framework is designed for poststack seismic data and applied to a pair of seismic volumes from the open Sleipner 4D seismic data set. Our method has three main advantages over state-of-the-art least-squares inversion methods. First, it produces high-resolution baseline and monitor acoustic models. Second, it mitigates nonrepeatable noise and better highlights real 4D changes by leveraging similarities between multiple data. Finally, it provides a volumetric classification of the acoustic impedance 4D difference model (4D changes) based on user-defined classes (i.e., percentages of speedup or slowdown in the subsurface). Such advantages may enable more robust stratigraphic/structural and quantitative 4D seismic interpretation and provide more accurate inputs for dynamic reservoir simulations. Alongside presenting our novel inversion method, we introduce a streamlined data preprocessing sequence for the 4D Sleipner poststack seismic data set that includes time-shift estimation and well-to-seismic tie. Finally, we provide insights into the open-source framework for large-scale optimization that we used to implement the proposed algorithm in an efficient and scalable manner.
MDIO: Open-source format for multidimensional energy data
Authors: Sansal Altay , Kainkaryam Sribharath , Lasscock Ben , Valenciano Alejandro
Published: July 2023

MDIO is a fully open-source data storage format that enables computational workflows for various high-dimensional energy data sets including seismic data and wind models. Designed to be efficient and flexible, MDIO provides interoperable software infrastructure with existing energy data standards. It leverages an open-source format called Zarr to enable data usage in the cloud and on-premises file systems. An overview of the data model and schema for MDIO is provided, and an open-source Python library developed to work with MDIO data is demonstrated. We explain how MDIO supports different computational workflows and discuss applications for data management, seismic imaging, machine learning, wind resource assessment, and real-time seismic visualization. Overall, MDIO gives researchers, practitioners, and developers in the energy sector a standardized and open approach to managing and sharing multidimensional energy data.
Amplitude preservation and seismic inversion reliability post spectral shaping
Authors: Pranowo Waskito , Herawati Ida
Published: July 2023

Resolution enhancement is often applied to poststack seismic data to obtain higher frequency or wider frequency bandwidth. This enhancement could help seismic interpreters in resolving thinner layers that may not be visible on the original seismic data. The seismic inversion method is the other way to interpret seismic data. The inversion process produces an impedance volume as a layer property that can be used not only for interpretation but also for reservoir characterization. This research aims to study whether vertical resolution enhancement of seismic data preserves the amplitudes and how enhancement affects seismic inversion results. The experiments in this research are performed on synthetic and real data. The modeling is carried out by generating zero-offset synthetic traces using a convolutional model. Meanwhile, real data processing is carried out at the North Sea Volve Data Village at the Ty and Hugin formations. The resolution of the seismic trace is enhanced using a spectral division operator. The inversion techniques used in this research are model-based inversion and sparse spike inversion. The seismic trace after vertical resolution enhancement shows that the separation of events can be improved by this procedure. Inversion of the original and of the enhanced traces shows that the enhancement process still allows obtaining reliable inversion results both from model-based and sparse spike methods; however, there is no significant difference between the inverted impedance using the original trace and enhanced traces. This research concludes that the enhancement process keeps the seismic amplitude preserved for inversion, but it barely improves the inversion result.
Workshop Review: Recent workshop explores near-surface modeling and imaging
Authors: Al-Jahdhami Moosa , Al-Shuhail Abdullatif
Published: July 2023

Modeling of the near surface plays a significant role in subsurface imaging, reservoir characterization, and monitoring. The Near-Surface Modeling and Imaging Workshop was created to address near-surface challenges in geoscience. The workshop has been held previously in 2014, 2016, and 2019. The latest instance of the workshop, 27–29 September 2022 in Muscat, Oman, continued the tradition.
Reviews
Authors: Aitken Julie
Published: July 2023

Integration of Geophysical Technologies in the Petroleum Industry, edited by Hamish Wilson, Keith Nunn, and Matt Luheshi, 2022.
Serum DHEA and Testosterone Levels Associate Inversely With Coronary Artery Calcification in Elderly Men
Authors: Ohlsson Claes , Nethander Maria , Norlén Anna-Karin , Poutanen Matti , Gudmundsson Elias Freyr , Aspelund Thor , Sigurdsson Sigurdur , Ryberg Henrik , Gudnason Vilmundur , Tivesten Åsa
Published: July 2023

Context

Epidemiological and preclinical data support cardiovascular, mainly protective, effects of sex steroids in men, but the mechanisms underlying the cardiovascular actions of sex steroids are poorly understood. Vascular calcification parallels the development of atherosclerosis, but is increasingly recognized as a diversified, highly regulated process, which itself may have pathophysiological importance for clinical cardiovascular events.

Objective

To investigate the association between serum sex steroids and coronary artery calcification (CAC) in elderly men.

Methods

We used gas chromatography tandem mass spectrometry to analyze a comprehensive sex steroid profile, including levels of dehydroepiandrosterone (DHEA), androstenedione, estrone, testosterone, estradiol, and dihydrotestosterone, in men from the population-based AGES-Reykjavik study (n = 1287, mean 76 years). Further, sex hormone–binding globulin (SHBG) was assayed and bioavailable hormone levels calculated. CAC score was determined by computed tomography. The main outcome measures were cross-sectional associations between dehydroepiandrosterone, androstenedione, estrone, testosterone, dihydrotestosterone, and estradiol and quintiles of CAC.

Results

Serum levels of DHEA, androstenedione, testosterone, dihydrotestosterone, and bioavailable testosterone showed significant inverse associations with CAC, while estrone, estradiol, bioavailable estradiol, and SHBG did not. DHEA, testosterone, and bioavailable testosterone remained associated with CAC after adjustment for traditional cardiovascular risk factors. In addition, our results support partially independent associations between adrenal-derived DHEA and testes-derived testosterone and CAC.

Conclusion

Serum levels of DHEA and testosterone are inversely associated with CAC in elderly men, partially independently from each other. These results raise the question whether androgens from both the adrenals and the testes may contribute to male cardiovascular health.
Pseudo-Cushing Syndrome With an Atypically High Cortisol Burden and Clinical Improvement With Adrenal Enzyme Inhibitor
Authors: Park Yeung-Ae , Gao Frank , Sim Ie-Wen , Gilfillan Chris
Published: July 2023

Distinguishing between Cushing syndrome (CS) and pseudo Cushing syndrome (PCS), also known as physiological hypercortisolism, can be difficult. PCS is caused by nonneoplastic overactivity of the hypothalamic-pituitary-adrenal axis and may be secondary to a range of conditions, including obesity, physical stress, malnutrition, and chronic alcoholism, and typically results in a lesser degree of hypercortisolism and fewer clinical features than CS. Management of PCS includes treatment of the underlying cause and reassessment of hypercortisolemia following improvement in the underlying etiology, as this may result in normalization of cortisol levels. The role of adrenal enzyme inhibitors in lowering cortisol levels in those with PCS is poorly understood. We report a case of a man presenting with weight loss who was found to have severe hypercortisolemia and elevated adrenocorticotropin (ACTH) complicated by infection, neuropsychiatric disturbance, and hypokalemia. Despite high cortisol levels, he was phenotypically not cushingoid, and the circadian rhythm of cortisol was preserved. Extensive investigations did not demonstrate a cause of symptoms or source of ACTH. Medical management with ketoconazole improved neuropsychiatric symptoms, and weight gain with nasogastric feeds resulted in the normalization of cortisol levels and resolution of symptoms following ketoconazole cessation.
Internal Carotid Artery Aneurysm Disguised as Pituitary Macroadenoma
Authors: Mulpuri Neha , Ghayee Hans K , Abramowitz Jessica , Mirfakhraee Sasan
Published: July 2023

Hypopituitarism due to an internal carotid artery (ICA) aneurysm is rare. We present a case of hypopituitarism and hyperprolactinemia due to a giant right ICA aneurysm. A 56-year-old woman with a history of primary hypothyroidism presented with fatigue, right-sided headache, and blurred vision. Magnetic resonance (MR) of the brain revealed a sellar mass measuring 3.5 × 2.2 cm involving the right cavernous sinus. Initial neurologic examination was unremarkable, and her biochemical evaluation revealed secondary adrenal insufficiency, central hypogonadism, low serum free thyroxine, and mildly elevated serum prolactin, consistent with stalk effect. Hydrocortisone therapy was started for secondary adrenal insufficiency and her levothyroxine dose was adjusted. The patient was referred to neurosurgery for surgical management of her sellar lesion. Preoperative computed tomography angiography (CTA) of the brain revealed a right ICA aneurysm that contacted the optic chiasm and displaced the pituitary gland. The aneurysm was embolized and diverting stents were placed. Repeat laboratory tests showed resolution of the patient's secondary adrenal insufficiency, normalization of serum prolactin, and an increase in serum gonadotropin concentrations to the postmenopausal range. This case highlights that not all sellar lesions are pituitary adenomas, and CTA should be performed in the evaluation of large cavernous sinus lesions to exclude ICA aneurysm.
Outcomes of arthroscopy of the hip for femoroacetabular impingement based on intraoperative assessment using the Outerbridge classification
Authors: Lu Victor , Andronic Octavian , Zhang James Z. , Khanduja Vikas
Published: July 2023

Aims

Hip arthroscopy (HA) has become the treatment of choice for femoroacetabular impingement (FAI). However, less favourable outcomes following arthroscopic surgery are expected in patients with severe chondral lesions. The aim of this study was to assess the outcomes of HA in patients with FAI and associated chondral lesions, classified according to the Outerbridge system.

Methods

A systematic search was performed on four databases. Studies which involved HA as the primary management of FAI and reported on chondral lesions as classified according to the Outerbridge classification were included. The study was registered on PROSPERO. Demographic data, patient-reported outcome measures (PROMs), complications, and rates of conversion to total hip arthroplasty (THA) were collected.

Results

A total of 24 studies were included with a total of 3,198 patients (3,233 hips). Patients had significantly less improvement in PROMs if they had Outerbridge grade III and IV lesions (p = 0.012). Compared with microfracture, autologous matrix-induced chondrogenesis (AMIC) resulted in significantly reduced rates of conversion to THA (p = 0.042) and of revision arthroscopy (p = 0.038). Chondral repair procedures in these patients also did not significantly reduce the rates of conversion to THA (p = 0.931), or of revision arthroscopy (p = 0.218). However, compared with microfracture, AMIC significantly reduced the rates of conversion to THA (p = 0.001) and of revision arthroscopy (p = 0.011) in these patients. Those with Outerbridge grade III and IV lesions also had significantly increased rates of conversion to THA (p = 0.029) and of revision arthroscopy (p = 0.023) if they had associated lesions of the acetabulum and femoral head. Those who underwent labral debridement had a significantly increased rate of conversion to THA compared with those who underwent labral repair (p = 0.015).

Conclusion

There is universal improvement in PROMs following HA in patients with FAI and associated chondral lesions. However, those with Outerbridge grade III and IV lesions had significantly less improvement in PROMs and a significantly increased rate of conversion to THA than those with Outerbridge grade I and II. This suggests that the outcome of HA in patients with FAI and severe articular cartilage damage may not be favourable.

Cite this article: Bone Joint J 2023;105-B(7):751–759.
Factors influencing patient-reported outcomes following periacetabular osteotomy and open osteochondroplasty in the setting of borderline hip dysplasia
Authors: Andronic Octavian , Germann Christoph , Jud Lukas , Zingg Patrick O.
Published: July 2023

Aims

This study reports mid-term outcomes after periacetabular osteotomy (PAO) exclusively in a borderline hip dysplasia (BHD) population to provide a contrast to published outcomes for arthroscopic surgery of the hip in BHD.

Methods

We identified 42 hips in 40 patients treated between January 2009 and January 2016 with BHD defined as a lateral centre-edge angle (LCEA) of ≥ 18° but < 25°. A minimum five-year follow-up was available. Patient-reported outcomes (PROMs) including Tegner score, subjective hip value (SHV), modified Harris Hip Score (mHHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed. The following morphological parameters were evaluated: LCEA, acetabular index (AI), α angle, Tönnis staging, acetabular retroversion, femoral version, femoroepiphyseal acetabular roof index (FEAR), iliocapsularis to rectus femoris ratio (IC/RF), and labral and ligamentum teres (LT) pathology.

Results

The mean follow-up was 96 months (67 to 139). The SHV, mHHS, WOMAC, and Tegner scores significantly improved (p < 0.001) at last follow-up. According to SHV and mHHS, there were three hips (7%) with poor results (SHV < 70), three (7%) with a fair score (70 to 79), eight (19%) with good results (80 to 89), and 28 (67%) who scored excellent (> 90) at the last follow-up. There were 11 subsequent operations: nine implant removals due to local irritation, one resection of postoperative heterotopic ossification, and one hip arthroscopy for intra-articular adhesions. No hips were converted to total hip arthroplasty at last follow-up. The presence of preoperative labral lesions or LT lesions did not influence any PROMs at last follow-up. From the three hips that had poor PROMs, two have developed severe osteoarthritis (> Tönnis II), presumably due to surgical overcorrection (postoperative AI < -10°).

Conclusion

PAO is reliable in treating BHD with favourable mid-term outcomes. Concomitant LT and labral lesions did not negatively influence outcomes in our cohort. Technical accuracy with avoidance of overcorrection is essential in achieving successful outcomes.

Cite this article: Bone Joint J 2023;105-B(7):735–742.
Consensus guidelines on the management of musculoskeletal infection affecting children in the UK
Authors: Mitchell Piers D. , Abraham Alwyn , Carpenter Clare , Henman Philip D. , Mavrotas Jason , McCaul Janet , Sanghrajka Anish , Theologis Tim
Published: July 2023

Aims

The aim of this study was to determine the consensus best practice approach for the investigation and management of children (aged 0 to 15 years) in the UK with musculoskeletal infection (including septic arthritis, osteomyelitis, pyomyositis, tenosynovitis, fasciitis, and discitis). This consensus can then be used to ensure consistent, safe care for children in UK hospitals and those elsewhere with similar healthcare systems.

Methods

A Delphi approach was used to determine consensus in three core aspects of care: 1) assessment, investigation, and diagnosis; 2) treatment; and 3) service, pathways, and networks. A steering group of paediatric orthopaedic surgeons created statements which were then evaluated through a two-round Delphi survey sent to all members of the British Society for Children’s Orthopaedic Surgery (BSCOS). Statements were only included (‘consensus in’) in the final agreed consensus if at least 75% of respondents scored the statement as critical for inclusion. Statements were discarded (‘consensus out’) if at least 75% of respondents scored them as not important for inclusion. Reporting these results followed the Appraisal Guidelines for Research and Evaluation.

Results

A total of 133 children’s orthopaedic surgeons completed the first survey, and 109 the second. Out of 43 proposed statements included in the initial Delphi, 32 reached ‘consensus in’, 0 ‘consensus out’, and 11 ‘no consensus’. These 11 statements were then reworded, amalgamated, or deleted before the second Delphi round of eight statements. All eight were accepted as ‘consensus in’, resulting in a total of 40 approved statements.

Conclusion

In the many aspects of medicine where relevant evidence is not available for clinicians to base their practice, a Delphi consensus can provide a strong body of opinion that acts as a benchmark for good quality clinical care. We would recommend clinicians managing children with musculoskeletal infection follow the guidance in the consensus statements in this article, to ensure care in all medical settings is consistent and safe.

Cite this article: Bone Joint J 2023;105-B(7):815–820.
Joint awareness following periacetabular osteotomy in patients with hip dysplasia
Authors: Tanaka Shiori , Fujii Masanori , Kawano Shunsuke , Ueno Masaya , Sonohata Motoki , Kitajima Masaru , Mawatari Daisuke , Mawatari Masaaki
Published: July 2023

Aims

The aims of this study were to validate the Forgotten Joint Score-12 (FJS-12) in the postoperative evaluation of periacetabular osteotomy (PAO), identify factors associated with joint awareness after PAO, and determine the FJS-12 threshold for patient-acceptable symptom state (PASS).

Methods

Data from 686 patients (882 hips) with hip dysplasia who underwent transposition osteotomy of the acetabulum, a type of PAO, between 1998 and 2019 were reviewed. After screening the study included 442 patients (582 hips; response rate, 78%). Patients who completed a study questionnaire consisting of the visual analogue scale (VAS) for pain and satisfaction, FJS-12, and Hip disability and Osteoarthritis Outcome Score (HOOS) were included. The ceiling effects, internal consistency, convergent validity, and PASS thresholds of FJS-12 were investigated.

Results

The median follow-up was 12 years (interquartile range 7 to 16). The ceiling effect of FJS-12 was 7.2%, the lowest of all the measures examined. FJS-12 correlated with all HOOS subscales (ρ = 0.72 to 0.77, p < 0.001) and pain and satisfaction-VAS (ρ = -0.63 and 0.56, p < 0.001), suggesting good convergent validity. Cronbach’s α was 0.95 for the FJS-12, which indicated excellent internal consistency. The median FJS-12 score for preoperative Tönnis grade 0 hips (60 points) was higher than that for grade 1 (51 points) or 2 (46 points). When PASS was defined as pain-VAS < 21 and satisfaction-VAS ≥ 77, the FJS-12 threshold that maximized the sensitivity and specificity for detecting PASS was 50 points (area under the curve (AUC) = 0.85).

Conclusion

Our results suggest that FJS-12 is a valid and reliable assessment tool for patients undergoing PAO, and the threshold of 50 points may be useful to determine patient satisfaction following PAO in clinical settings. Further investigation of the factors influencing postoperative joint awareness may enable improved prediction of treatment efficacy and informed decision-making regarding the indication of PAO.

Cite this article: Bone Joint J 2023;105-B(7):760–767.
International orthopaedic trials
Authors: Costa Matt L. , Brealey Stephen D. , Perry Daniel C.
Published: July 2023

Musculoskeletal diseases are having a growing impact worldwide. It is therefore crucial to have an evidence base to most effectively and efficiently implement future health services across different healthcare systems. International trials are an opportunity to address these challenges and have many potential benefits. They are, however, complex to set up and deliver, which may impact on the efficient and timely delivery of a project. There are a number of models of how international trials are currently being delivered across a range of orthopaedic patient populations, which are discussed here. The examples given highlight that the key to overcoming these challenges is the development of trusted and equal partnerships with collaborators in each country. International trials have the potential to address a global burden of disease, and in turn optimize the benefit to patients in the collaborating countries and those with similar health services and care systems.

Cite this article:Bone Joint J2023;105-B(7):719–722.
The painful truth of waiting for hip and knee arthroplasty in Northern Ireland
Authors: Karayiannis Paul N. , Warnock Michael , Cassidy Roslyn , Jones Kenneth , Scott Chloe E. H. , Beverland David
Published: July 2023

Aims

The aim of this study was to report health-related quality of life (HRQoL) and joint-specific function in patients waiting for total hip or knee arthroplasty surgery (THA or TKA) in Northern Ireland, compared to published literature and a matched normal population. Secondary aims were to report emergency department (ED) and out-of-hours general practitioner (OOH GP) visits, new prescriptions of strong opioids, and new prescriptions of antidepressants while waiting.

Methods

This was a cohort study of 991 patients on the waiting list for arthroplasty in a single Northern Ireland NHS trust: 497 on the waiting list for ≤ three months; and 494 waiting ≥ three years. Postal surveys included the EuroQol five-dimension five-level questionnaire (EQ-5D-5L), visual analogue scores (EQ-VAS), and Oxford Hip and Knee scores to assess HRQoL and joint-specific function. Electronic records determined prescriptions since addition to the waiting list and patient attendances at OOH GP/EDs.

Results

Overall, 712/991 (71.8%) responded at ≤ three months for THA (n = 164) and TKA (n = 199), and ≥ three years for THA (n = 88) and TKA (n = 261). The median EQ-5D-5L score in those waiting ≤ three months was 0.155 (interquartile range (IQR) -0.118 to 0.375) and 0.189 (IQR -0.130 to 0.377) for ≥ three years. Matched controls had a median EQ-5D-5L 0.837 (IQR 0.728 to 1.000). Compared to matched controls, EQ-5D-5L scores were significantly lower in both waiting cohorts (p < 0.001) with significant differences found in every domain. Negative scores, indicating a state “worse than death”, were present in 40% at ≤ three months and 38% at ≥ three years. Patients waiting ≥ three years had significantly more opioid (28.4% vs 15.2%; p < 0.001) and antidepressant prescriptions (15.2% vs 9.9%; p = 0.034) and significantly more joint-related attendances at unscheduled care (11.7% vs 0% with ≥ one ED attendance (p < 0.001) and (25.5% vs 2.5% ≥ one OOH GP attendance (p < 0.001)).

Conclusion

Patients on waiting lists in Northern Ireland are severely disabled with the worst HRQoL and functional scores studied. The lack of deterioration in EQ-5D-5L and joint-specific scores between patients waiting ≤ three months and ≥ three years likely reflects floor effects of these scores. Prolonged waits were associated with increased dependence on strong opiates, depression, and attendances at unscheduled care.

Cite this article: Bone Joint J 2023;105-B(7):783–794.
The role of Gender in Operative Autonomy in orthopaedic Surgical Trainees (GOAST)
Authors: Downie Samantha , Cherry Jennifer , Dunn Jennifer , Harding Thomas , Eastwood Deborah , Gill Sarah , Johnson Simon
Published: July 2023

Aims

Global literature suggests that female surgical trainees have lower rates of independent operating (operative autonomy) than their male counterparts. The objective of this study was to identify any association between gender and lead/independent operating in speciality orthopaedic trainees within the UK national training programme.

Methods

This was a retrospective case-control study using electronic surgical logbook data from 2009 to 2021 for 274 UK orthopaedic trainees. Total operative numbers and level of supervision were compared between male and female trainees, with correction for less than full-time training (LTFT), prior experience, and time out during training (OOP). The primary outcome was the percentage of cases undertaken as lead surgeon (supervised and unsupervised) by UK orthopaedic trainees by gender.

Results

All participants gave permission for their data to be used. In total, 274 UK orthopaedic trainees submitted data (65% men (n = 177) and 33% women (n = 91)), with a total of 285,915 surgical procedures logged over 1,364 trainee-years. Males were lead surgeon (under supervision) on 3% more cases than females (61% (115,948/189,378) to 58% (50,285/86,375), respectively; p < 0.001), and independent operator (unsupervised) on 1% more cases. A similar trend of higher operative numbers in male trainees was seen for senior (ST6 to 8) trainees (+5% and +1%; p < 0.001), those with no time OOP (+6% and +8%; p < 0.001), and those with orthopaedic experience prior to orthopaedic specialty training (+7% and +3% for lead surgeon and independent operator, respectively; p < 0.001). The gender difference was less marked for those on LTFT training, those who took time OOP, and those with no prior orthopaedic experience.

Conclusion

This study showed that males perform 3% more cases as the lead surgeon than females during UK orthopaedic training (p < 0.001). This may be due to differences in how cases are recorded, but must engender further research to ensure that all surgeons are treated equitably during their training.

Cite this article: Bone Joint J 2023;105-B(7):821–832.
Contemporary outcomes of primary total hip arthroplasty in patients with inflammatory arthritis
Authors: Wooster Benjamin M. , Kennedy Nicholas I. , Dugdale Evan M. , Sierra Rafael J. , Perry Kevin I. , Berry Daniel J. , Abdel Matthew P.
Published: July 2023

Aims

Contemporary outcomes of primary total hip arthroplasties (THAs) with highly cross-linked polyethylene (HXLPE) liners in patients with inflammatory arthritis have not been well studied. This study examined the implant survivorship, complications, radiological results, and clinical outcomes of THA in patients with inflammatory arthritis.

Methods

We identified 418 hips (350 patients) with a primary diagnosis of inflammatory arthritis who underwent primary THA with HXLPE liners from January 2000 to December 2017. Of these hips, 68% had rheumatoid arthritis (n = 286), 13% ankylosing spondylitis (n = 53), 7% juvenile rheumatoid arthritis (n = 29), 6% psoriatic arthritis (n = 24), 5% systemic lupus erythematosus (n = 23), and 1% scleroderma (n = 3). Mean age was 58 years (SD 14.8), 66.3% were female (n = 277), and mean BMI was 29 kg/m2 (SD 7). Uncemented femoral components were used in 77% of cases (n = 320). Uncemented acetabular components were used in all patients. Competing risk analysis was used accounting for death. Mean follow-up was 4.5 years (2 to 18).

Results

The ten-year cumulative incidence of any revision was 3%, and was highest in psoriatic arthritis patients (16%). The most common indications for the 15 revisions were dislocations (n = 8) and periprosthetic joint infections (PJI; n = 4, all on disease-modifying antirheumatic drugs (DMARDs)). The ten-year cumulative incidence of reoperation was 6.1%, with the most common indications being wound infections (six cases, four on DMARDs) and postoperative periprosthetic femur fractures (two cases, both uncemented femoral components). The ten-year cumulative incidence of complications not requiring reoperation was 13.1%, with the most common being intraoperative periprosthetic femur fracture (15 cases, 14 uncemented femoral components; p = 0.13). Radiological evidence of early femoral component subsidence was observed in six cases (all uncemented). Only one femoral component ultimately developed aseptic loosening. Harris Hip Scores substantially improved (p < 0.001).

Conclusion

Contemporary primary THAs with HXLPE in patients with inflammatory arthritis had excellent survivorship and good functional outcomes regardless of fixation method. Dislocation, PJI, and periprosthetic fracture were the most common complications in this cohort with inflammatory arthritis.

Cite this article: Bone Joint J 2023;105-B(7):768–774.
Prophylactic cable prevents tapered titanium stem subsidence with 2 cm of stem-cortical engagement in a cadaveric model
Authors: Xiang William , Tarity T. D. , Gkiatas Ioannis , Lee Haena-Young , Boettner Friedrich , Rodriguez Jose A. , Wright Timothy M. , Sculco Peter K.
Published: July 2023

Aims

When performing revision total hip arthroplasty using diaphyseal-engaging titanium tapered stems (TTS), the recommended 3 to 4 cm of stem-cortical diaphyseal contact may not be available. In challenging cases such as these with only 2 cm of contact, can sufficient axial stability be achieved and what is the benefit of a prophylactic cable? This study sought to determine, first, whether a prophylactic cable allows for sufficient axial stability when the contact length is 2 cm, and second, if differing TTS taper angles (2° vs 3.5°) impact these results.

Methods

A biomechanical matched-pair cadaveric study was designed using six matched pairs of human fresh cadaveric femora prepared so that 2 cm of diaphyseal bone engaged with 2° (right femora) or 3.5° (left femora) TTS. Before impaction, three matched pairs received a single 100 lb-tensioned prophylactic beaded cable; the remaining three matched pairs received no cable adjuncts. Specimens underwent stepwise axial loading to 2600 N or until failure, defined as stem subsidence > 5 mm.

Results

All specimens without cable adjuncts (6/6 femora) failed during axial testing, while all specimens with a prophylactic cable (6/6) successfully resisted axial load, regardless of taper angle. In total, four of the failed specimens experienced proximal longitudinal fractures, three of which occurred with the higher 3.5° TTS. One fracture occurred in a 3.5° TTS with a prophylactic cable yet passed axial testing, subsiding < 5 mm. Among specimens with a prophylactic cable, the 3.5° TTS resulted in lower mean subsidence (0.5 mm (SD 0.8)) compared with the 2° TTS (2.4 mm (SD 1.8)).

Conclusion

A single prophylactic beaded cable dramatically improved initial axial stability when stem-cortex contact length was 2 cm. All implants failed secondary to fracture or subsidence > 5 mm when a prophylactic cable was not used. A higher taper angle appears to decrease the magnitude of subsidence but increased the fracture risk. The fracture risk was mitigated by the use of a prophylactic cable.

Cite this article: Bone Jt Open 2023;4(7):472–477.
Calculation of Rock Pressure in Loess Tunnels Based on Limit Equilibrium Theory and Analysis of Influencing Factors
Authors: Danjiang Cheng , Junfeng Hua , Jianguo Zhu , Yang Ji , Zhaoguang Hu
Published: July 2023

The research on the calculation method of tunnel envelope pressure is a key issue in the design of tunnel engineering support structure. Based on the limit equilibrium theory, this paper proposes a method to calculate the surrounding rock pressure in shallow buried loess tunnels. Firstly, based on the investigation of the damage mode of the loess tunnel surrounding rock and the field measurement results of the surrounding rock pressure, the damage mode of the loess tunnel is proposed, and then a method of calculating the surrounding rock pressure applicable to the shallow buried loess tunnel is derived according to the limit equilibrium condition of the tunnel square soil body and the side wedge; the basic mechanical parameters are known in this method, so only the rupture angle β needs to be determined, and the rupture angle calculation model in the shallow buried loess tunnel is proposed Three assumptions are made in the rupture angle calculation model, and the rupture angle calculation formula is derived according to the stress state on the slip surface of the surrounding rock; the pressure of the surrounding rock in the loess tunnel obtained by this method is compared with four methods, namely, the pressure theory of the surrounding rock in the existing loose body of Taishaki, the pressure formula of the deeply buried surrounding rock in the railroad tunnel design code, the Beer Baumann method, and the Xie Jiayi method, in order to verify the correctness and validity of the calculation method used, and to analyze the influence of different parameters on the surrounding rock pressure. The innovation of this paper lies in the derivation of a method for calculating the pressure in the surrounding rock of a shallow buried loess tunnel using the limit equilibrium theory, and also further proposes a formula for calculating the rupture angle. The pressure of surrounding rock decreases with the increase of static earth pressure coefficient, lateral pressure coefficient, friction angle and cohesion in soil, but the static earth pressure coefficient has a greater influence on the surrounding rock pressure. With the increase of sagittal span ratio, tunnel burial depth and soil weight, the surrounding rock pressure peaked with the increase of tunnel burial depth, and the surrounding rock pressure curve increased first and then decreased.
Force Characteristics and Mechanical Topology Optimization of Hydraulic Machine Structures: Statics and Dynamics
Authors: Xiaolei Teng
Published: July 2023

In this paper, the design requirements of the hydraulic testing machine are based on the actual force conditions. Static and dynamic performance analyses of the stressed components of the hydraulic machine are carried out and the mechanical topology is optimized. Combining the static and dynamic objective functions of the structure, a fast variable density topology method is proposed, thus improving the optimization efficiency. After setting the positions of the optimized and non-optimized regions. It can be found that the optimized mechanical performance is more superior as the number of iterations increases. The results show that the stress in the strut is 175.75 MPa and the maximum stress in the upper beam structure is 43.708 MPa. The first sixth order frequency is much higher than the operating frequency of 3 Hz. The final results of the mechanical topology optimization analysis show. The optimized structure of the upper, middle and lower crossbeams resulted in a mass reduction of 38%, 36% and 5.57%. The maximum stresses in the upper and middle crossbeams were reduced by 10.33%, 8.3% and 51.8%, respectively. The deformation was reduced by 6.14% at the fastest time; the inherent frequency of the first 3 orders was increased to achieve light weight. The overall mechanical properties became better after optimization, and the dynamic and static stability of the frame was improved.
Translated with www.DeepL.com/Translator (free version)
The Assessment of Cyber Security’s Significance in the Financial Sector of Lithuania
Authors: Gavenaite-Sirvydiene Julija , Miecinskiene Algita
Published: July 2023

Constantly evolving high technologies provide new approaches to business development and deliver unknown business risks. Online financial services and operations are integral to everyday life, making cyber risk one of the most relevant risks for the financial sector’s companies. As the survey conducted by the National Bank of Lithuania at the end of 2018 showed, the possibility of cyber threats and presumable effects on the financial system in Lithuania is one of the critical problems that should be prioritized. Therefore, it is essential to clarify what potential cyber threats in financial sector companies are considered the most significant and likely to occur. As well as identify how companies in the financial sector estimate their dispositions and preparedness for this cyber risk management and control. The findings of this research are significant for financial institutions as a tool to adopt their cyber risk management processes, increase preparedness and cyber security, and identify the possible threats to the organization.
A Multi-Path Approach to Protect DNS Against DDoS Attacks
Authors: Alouneh Sahel
Published: July 2023

Domain Name System (DNS) is considered a vital service for the internet and networks operations, and practically this service is configured and accessible across networks’ firewall. Therefore, attackers take advantage of this open configuration to attack a network’s DNS server in order to use it as a reflector to achieve Denial of Service (DoS) attacks. Most of protection methods such as intrusion prevention and detection systems use blended tactics such as blocked-lists for suspicious sources, and thresholds for traffic volumes to detect and defend against DoS flooding attacks. However, these protection methods are not often successful. In this paper, we propose a new method to sense and protect DNS systems from DoS and Distributed DoS (DDoS) attacks. The main idea in our approach is to distribute the DNS request mapping into more than one DNS resolver such that an attack on one server should not affect the entire DNS services. Our approach uses the Multi-Protocol Label Switching (MPLS) along with multi-path routing to achieve this goal. Also, we use threshold secret sharing to code the distributed DNS requests. Our findings and results show that this approach performs better when compared with the traditional DNS structure.
Wireless Network Safety Status Prediction Based on Fuzzy Logic
Authors: Xue Xiao , Zheng Yangbing , Lu Chao
Published: July 2023

In WN environment, network safety status means to state of information managing in various WN environments, WN transmission information safety status assessment is one of primary research directions in this territory. Existing network safety status awareness methods are difficult to adapt to real-time changes of network structure, and WN environment is complex and changeable, and they can only analyze the current network safety status, and it is difficult to predict and analyze overall tendency of WN safety status. In order to resist potential attacks, evaluate safety of network and detect attack means in network in a timely manner, this paper introduces fuzzy logic to propose a safety status prediction model for wireless sensor networks, which can help administrators to timely perceive and comprehensively grasp the real-time status of network and predict future advancement direction. In order to assess current network status, a safety status evaluation model for wireless network (WN) depended on fuzzy logic is presented. In cluster head node, neighborhood rough set is used for feature extraction to reduce energy consumption of redundant data on the node. Balance data by synthesizing a few over-sampling techniques, and then use random forest to detect attacks on the network to identify attack types. Combined with the status element acquisition mechanism, three status indicators, namely attack frequency, total number of attacks and threat factor, are extracted. According to the status indicators and status calculation method, the network safety status value is calculated, and current network safety status is evaluated by referring to network safety level divided by National Internet Emergency Response Center. Neighborhood rough set is applied to complete attribute reduction, which can effectively deal with underwater mixed data and obtain feature subsets with same classification capability as initial data. Safety status of WSN is predicted based on random forest. The risk degree of WN status is divided into fuzzy subsets, and the process of dynamic prediction of safety status is designed. Based on test values, highest input signal spectrum of the system is 30 mV, and the lowest input signal spectrum is -15 mV, which is consistent with the selected 120 groups of status data sequence diagram, the fluctuation amplitude of the input signal under 40~62 groups of samples is small, basically unchanged, consistent with the selected 120 groups of status data sequence diagram. Fuzzy logic model represented by star broken line has higher precision than decision tree and the limit learning machine in all five different attack types. mapped network safety status grade can also effectively express the actual network safety status. indicating that the prediction results of the system are accurate.
Happy 40th Birthday, Bulletin!
Authors: Glass Jonathan , Kerstein Ryan
Published: July 2023

Our editors celebrate the 40th anniversary of the Bulletin with a look at the journal’s progress over the past four decades, and what the future looks like.