bluuebunny/crossref_metadata_2025 huggingface dataset:
Geopolitical culture
Authors: Ternovaya Lyudmila
Published: May 2021

The monograph examines geopolitics from the point of view of filling its content with the meanings of geopolitical culture, in which not only geographical, but also historical images occupy a prominent place, and linguistic constructions allow us to attach a symbolic meaning to established concepts. Geopolitical culture, like any other, acts as a tool for processing consciousness and transforming space. The space itself, from the perspective of studies of geopolitical culture, turns into a multidimensional model that simultaneously combines real objects and elements related to the world of geopolitical imagination.
It is intended for specialists in geopolitics, history and theory of international relations, sociology and cultural studies. It will also be of interest to a wide range of readers.
Learning to solve math problems in the 4th grade
Authors: Beloshistaya Anna
Published: May 2021

The textbook considers the methodology of working on problems in the 4th grade when teaching mathematics according to any textbook included in the Federal Educational Package. It contains a detailed methodological analysis of all types of problems that are found in various textbooks of mathematics for the 4th grade, as well as specific fragments of situations of working with problems in the classroom.
It will be useful for teachers of mathematics methodology in universities and pedagogical schools, as well as students of pedagogical specialties, as well as practical teachers working in schools, tutors of all levels and parents who help children in their studies.
The Bitburg Controversy from the New Cold War Perspective: Reagan’s Views on WWII Nazi Germany’s Soldiers’ Victimhood
Authors: Nycz Grzegorz
Published: May 2021

The Bitburg Controversy from the New Cold War Perspective: Reagan’s Views on WWII Nazi Germany’s Soldiers’ Victimhood Why to go back to 1985 to discuss present-day key concerns of international relations fromthe perspective of World War II history during the Cold War? The May 5, 1985 Bitburg cemetery celebrations, when US president altogether with German chancellor (Helmut Kohl) paid tribute to WWII veterans (of both sides of the conflict) was an example of the Ronald Reagan administration’s public relations fiasco: the “Great Communicator” failed to refer to WWII history in a manner that would save him from harsh criticism. Importantly, the 1985 debate concerning the Bitburg ceremony and the moral aspects of a homage to German (Axis) WWII soldiers gave an incentive to “Historikerstreit” in Germany, a dispute regarding WWII history in a manner comparable to Holocaust responsibility as a collective burden carried by Germans. The Bitburg cemetery, since the 1930s a monument (Kolmeshöhe Ehrenfriedhof) to WWI German military victims, and then to their younger colleagues during WWII (Wehrmacht and, controversially, Waffen-SS) remained a broadly commented upon focal point of Cold War disputes, allowing such questions that might bring about a possibilityof ground-breaking change in present-day political rivalries caused by failed (or successful) Cold War propaganda related to WWII choices. The Bitburg case as a particularly illustrative one and could also shed more light on the post-Soviet Russian effort to increase its influence by relying on the myths of the “Great Patriotic War”.
Progression or Stagnancy? Portraying Native Americans in Michael Apted’s Thunderheart (1992)
Authors: Toka Karolina
Published: May 2021

Progression or Stagnancy? Portraying Native Americans in Michael Apted’s Thunderheart (1992) As argued by Wilcomb Washburn, no other ethnic group has been misrepresented in media and popular culture to such extent as the Native Americans (2010). Movies that shaped their image did so by crystallizing stereotypes and misconceptions, through which indigenous peoples have been perceived until the present day. Thomas Edison’s vignettes, early westerns, as well as subsequent motion pictures of the 1960s and 1970s strengthened the stereotypes of the vanishing Indians, bloodthirsty savages, and their noble alter ego. The 1990s brought about a revival of the western in its new, revisionist form, mainly due to the achievements of the American Indian Movement. This paper argues that the movie Thunderheart (1992) by Michael Apted — albeit belonging to that ostensibly revolutionary current — continues to reproduce various well established stereotypes in the portrayal of the Native Americans . It examines significantachievements of this partly liberal motion picture, as well as its failures and faults. Thisarticle argues that Thunderheart departs from traditional, dualistic portrayals of Native Americans as bloodthirsty and noble savages and manages to present a revisionist version of historical events; at the same time, it fails to omit numerous Hollywood clichés, such as stereotypical representation of native spirituality, formation of an “Indian identity”, and “othering” of the Native Americans, which contributes to their further alienation and cultural appropriation. This paper provides an insightful analysis of the movie, drawing on scholarship in the field of cultural and indigenous studies in order to lay bare the ambivalence towards indigenous people in the United States, that is reflected in the movie industry. Moreover, it indicates towards the commodification of native culture, as well as the perception of Native Americans as primitive and inferior, allowing to classify Thunderheartas an unfortunate product of colonialism.
Why did President Obama Not Recognize the Armenian Genocide? Hints from the Obama Administration Memoirs – and Other Sources
Authors: Zarifian Julien
Published: May 2021

Why did President Obama Not Recognize the Armenian Genocide? Hints from the Obama Administration Memoirs – and Other Sources This paper discusses the reasons and processes that led the Obama administration to notrecognize the Armenian Genocide. Although Barack Obama had promised he would doso during his presidential campaign of 2008, he never did once in office, despite many of his administration members, including Vice-President Joe Biden and Secretaries of State Hillary Clinton and John Kerry, having strong records in support of such a recognition. To investigate this hitherto poorly explored question, this paper uses primarily — although not exclusively — memoirs written by Barack Obama and members his administration, some of them addressing the issue directly, others dealing with it indirectly. This study focuses on President Obama’s personal choice, and therefore responsibility, to not recognize the genocide, but also expands on the geopolitical determinants of this non-recognition (related mostly to the geostrategic importance of Turkey) as well as on its diplomatic aspects (involving particularly the argument that US recognition would hamper a hypothetical Turkey-Armenia rapprochement). Two episodes of possible presidential recognition of the genocide will be particularly discussed; one in April 2009 (three months after Obama became president of the United States and coinciding with April 24, the anniversary of the genocide), and the other in 2015 (corresponding to its centenary). Finally, stress will be placed on the positions and role of the president’s entourage at the White House, and on his State and Defense Secretaries.
Missed Diagnosis of Subarachnoid Haemorrhage
Authors: Kawahigashi Teiko , Shimiszu Taro , Kawabe Takashi , Kida Yoshitoshi , Watanabe Kazunao
Published: May 2021

A 79-year-old woman presented with left retro-orbital pain, headache and blurred vision. Based on negative radiological tests, life-threatening conditions like subarachnoid haemorrhage (SAH) were ruled out and outpatient follow-up was planned. However, the patient returned to the hospital that night because of progressively declining consciousness and was diagnosed with SAH by head computed tomography. The diagnosis of SAH is often challenging, especially in cases with negative radiological results. We describe some strategies, other than radiological examination, for ruling out SAH, such as performing a lumbar puncture and repeating tests to take account of disease progression, and describe biases which can affect clinical decision-making.
Abdominal aortic aneurysms
Authors: Ahmed Aadil , Heyes Adam , Pandher Jagraj , Rajagopalan Sriram
Published: May 2021

Vascular surgery is a relatively new surgical sub-speciality in the UK, with treatment of abdominal aortic aneurysms forming a substantial proportion of the emergency and elective caseload. This article summarises the guidance from the National Institute of Health and Care Excellence and the European Society for Vascular Surgery that outlines the epidemiology, diagnosis and management of abdominal aortic aneurysms. This is important for both vascular and non-vascular trainees to understand because of the critical nature of the disease, which can cause catastrophic haemorrhage, limb loss and mortality. However, if discovered in time, abdominal aortic aneurysms are a very treatable condition.
Challenges to professionalism and ethics in perioperative clinical practice
Authors: Kumar Bid
Published: May 2021

Perioperative medicine can pose myriad challenges to professionalism and ethical practice. Medicine is a science, but definite end points, and predictable results and outcomes do not consistently occur. There is the potential for error during all steps of a patient's assessment and treatment. Examination findings, laboratory investigations, diagnosis, plans for and outcomes of surgery and long-term outcomes can all be uncertain and/or not meet expectations. Factors including pressures in the workplace, conflicts, ego, prescribed guidelines and pathways, the need to achieve healthcare targets, desire for autonomy and need to maintain multidisciplinary involvement in patient care can lead to an environment in which it is challenging for professionalism and ethics to thrive.
Development of antibiotic resistance in periprosthetic joint infection after total knee arthroplasty
Authors: Klasan Antonio , Schermuksnies Arne , Gerber Florian , Bowman Matt , Fuchs-Winkelmann Susanne , Heyse Thomas Jan
Published: May 2021

Aims

The management of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA) is challenging. The correct antibiotic management remains elusive due to differences in epidemiology and resistance between countries, and reports in the literature. Before the efficacy of surgical treatment is investigated, it is crucial to analyze the bacterial strains causing PJI, especially for patients in whom no organisms are grown.

Methods

A review of all revision TKAs which were undertaken between 2006 and 2018 in a tertiary referral centre was performed, including all those meeting the consensus criteria for PJI, in which organisms were identified. Using a cluster analysis, three chronological time periods were created. We then evaluated the antibiotic resistance of the identified bacteria between these three clusters and the effectiveness of our antibiotic regime.

Results

We identified 129 PJIs with 161 culture identified bacteria in 97 patients. Coagulase-negative staphylococci (CNS) were identified in 46.6% cultures, followed by Staphylococcus aureus in 19.8%. The overall resistance to antibiotics did not increase significantly during the study period (p = 0.454). However, CNS resistance to teicoplanin (p < 0.001), fosfomycin (p = 0.016), and tetracycline (p = 0.014) increased significantly. Vancomycin had an 84.4% overall sensitivity and 100% CNS sensitivity and was the most effective agent.

Conclusion

Although we were unable to show an overall increase in antibiotic resistance in organisms that cause PJI after TKA during the study period, this was not true for CNS. It is concerning that resistance of CNS to new antibiotics, but not vancomycin, has increased in a little more than a decade. Our findings suggest that referral centres should continuously monitor their bacteriological analyses, as these have significant implications for prophylactic treatment in both primary arthroplasty and revision arthroplasty for PJI. Cite this article: Bone Joint J 2021;103-B(6 Supple A):171–176.
Are surgeons still performing primary total knee arthroplasty in the morbidly obese?
Authors: DeMik David E. , Carender Christopher N. , Glass Natalie A. , Brown Timothy S. , Callaghan John J. , Bedard Nicholas A.
Published: May 2021

Aims

The purpose of this study was to assess total knee arthroplasty (TKA) volume and rates of early complications in morbidly obese patients over the last decade, where the introduction of quality models influencing perioperative care pathways occurred.

Methods

Patients undergoing TKA between 2011 to 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients were stratified by BMI < 40 kg/m2 and ≥ 40 kg/m2 and evaluated by the number of cases per year. The 30-day rates of any complication, wound complications, readmissions, and reoperation were assessed. Trends in these endpoints over the study period were compared between groups using odds ratios (ORs) and multivariate analyses.

Results

In total, 314,695 patients underwent TKA and 46,362 (15%) had BMI ≥ 40 kg/m2. The prevalence of morbid obesity among TKA patients did not change greatly, ranging between 14% and 16%. Reoperation rate decreased from 1.16% to 0.96% (odds ratio (OR) 0.81 (95% confidence interval (CI) 0.66 to 0.99)) for patients with BMI < 40 kg/m2, as did rates of readmission (4.46% to 2.87%; OR 0.61 (0.55 to 0.69)). Patients with BMI ≥ 40 kg/m2 also had fewer readmissions over the study period (4.87% to 3.34%; OR 0.64 (0.49 to 0.83)); however, the rate of reoperation did not change (1.37% to 1.41%; OR 0.99 (0.62 to 1.56)). Significant improvements were not observed for infective complications over time for either group; patients with BMI ≥ 40 kg/m2 had increased risk of both deep infection and wound complications compared to non-morbidly obese patients. Rate of any complication decreased for all patients.

Conclusion

The proportion of TKAs in morbidly obese patients has not significantly changed over the past decade. Although readmission rates improved for all patients, reductions in reoperation in non-morbidly obese patients were not experienced by the morbidly obese, resulting in a widening of the complication gap between these cohorts. Care improvements have not lowered the differential risk of infective complications in the morbidly obese. Cite this article: Bone Joint J 2021;103-B(6 Supple A):38–44.
Robotic-assisted total knee arthroplasty improves accuracy and precision compared to conventional techniques
Authors: Deckey David G. , Rosenow Christian S. , Verhey Jens T. , Brinkman Joseph C. , Mayfield Cory K. , Clarke Henry D. , Bingham Joshua S.
Published: May 2021

Aims

Robotic-assisted total knee arthroplasty (RA-TKA) is theoretically more accurate for component positioning than TKA performed with mechanical instruments (M-TKA). Furthermore, the ability to incorporate soft-tissue laxity data into the plan prior to bone resection should reduce variability between the planned polyethylene thickness and the final implanted polyethylene. The purpose of this study was to compare accuracy to plan for component positioning and precision, as demonstrated by deviation from plan for polyethylene insert thickness in measured-resection RA-TKA versus M-TKA.

Methods

A total of 220 consecutive primary TKAs between May 2016 and November 2018, performed by a single surgeon, were reviewed. Planned coronal plane component alignment and overall limb alignment were all 0° to the mechanical axis; tibial posterior slope was 2°; and polyethylene thickness was 9 mm. For RA-TKA, individual component position was adjusted to assist gap-balancing but planned coronal plane alignment for the femoral and tibial components and overall limb alignment remained 0 ± 3°; planned tibial posterior slope was 1.5°. Mean deviations from plan for each parameter were compared between groups for positioning and size and outliers were assessed.

Results

In all, 103 M-TKAs and 96 RA-TKAs were included. In RA-TKA versus M-TKA, respectively: mean femoral positioning (0.9° (SD 1.2°) vs 1.7° (SD 1.1°)), mean tibial positioning (0.3° (SD 0.9°) vs 1.3° (SD 1.0°)), mean posterior tibial slope (-0.3° (SD 1.3°) vs 1.7° (SD 1.1°)), and mean mechanical axis limb alignment (1.0° (SD 1.7°) vs 2.7° (SD 1.9°)) all deviated significantly less from the plan (all p < 0.001); significantly fewer knees required a distal femoral recut (10 (10%) vs 22 (22%), p = 0.033); and deviation from planned polyethylene thickness was significantly less (1.4 mm (SD 1.6) vs 2.7 mm (SD 2.2), p < 0.001).

Conclusion

RA-TKA is significantly more accurate and precise in planning both component positioning and final polyethylene insert thickness. Future studies should investigate whether this increased accuracy and precision has an impact on clinical outcomes. The greater accuracy and reproducibility of RA-TKA may be important as precise new goals for component positioning are developed and can be further individualized to the patient. Cite this article: Bone Joint J 2021;103-B(6 Supple A):74–80.
Differences in time to return to work among patients undergoing simultaneous versus staged bilateral total knee arthroplasty
Authors: Kahlenberg Cynthia A. , Krell Ethan C. , Sculco Thomas P. , Katz Jeffrey N. , Nguyen Joseph T. , Figgie Mark P. , Sculco Peter K.
Published: May 2021

Aims

Many patients undergoing total knee arthroplasty (TKA) have severe osteoarthritis (OA) in both knees and may consider either simultaneous or staged bilateral TKA. The implications of simultaneous versus staged bilateral TKA for return to work are not well understood. We hypothesized that employed patients who underwent simultaneous bilateral TKA would have significantly fewer days missed from work compared with the sum of days missed from each operation for patients who underwent staged bilateral TKA.

Methods

The prospective arthroplasty registry at the Hospital for Special Surgery was used. Baseline characteristics and patient-reported outcome scores were evaluated. We used a linear regression model, adjusting for potential confounding variables including age, sex, preoperative BMI, and type of work (sedentary, moderate, high activity, or strenuous), to analyze time lost from work after simultaneous compared with staged bilateral TKA.

Results

We identified 152 employed patients who had undergone simultaneous bilateral TKA and 61 who had undergone staged bilateral TKA, and had completed the registry’s return to work questionnaire. The simultaneous group missed a mean of 46.2 days (SD 29.1) compared with the staged group who missed a mean total of 68.0 days of work (SD 46.1) when combining both operations. This difference was statistically significant (p < 0.001). In multivariate mixed regression analysis adjusted for age, sex, BMI, American Society of Anesthesiologists status, and type of work, the simultaneous group missed a mean of 16.9 (SD 5.7) fewer days of work compared with the staged group (95% confidence interval 5.8 to 28.1; p = 0.003).

Conclusion

Employed patients undergoing simultaneous bilateral TKA missed a mean of 17 fewer days of work as a result of their surgical treatment and rehabilitation compared with those undergoing staged bilateral TKA. This information may be useful to surgeons counselling employed patients with bilateral OA of the knee who are considering surgical treatment. Cite this article: Bone Joint J 2021;103-B(6 Supple A):108–112.
Increased risk of periprosthetic joint infection after acute, traumatic wound dehiscence following primary total knee arthroplasty
Authors: Gausden Elizabeth B. , Shirley Matthew B. , Abdel Matthew P. , Sierra Rafael J.
Published: May 2021

Aims

To describe the risk of periprosthetic joint infection (PJI) and reoperation in patients who have an acute, traumatic wound dehiscence following total knee arthroplasty (TKA).

Methods

From January 2002 to December 2018, 16,134 primary TKAs were performed at a single institution. A total of 26 patients (0.1%) had a traumatic wound dehiscence within the first 30 days. Mean age was 68 years (44 to 87), 38% (n = 10) were female, and mean BMI was 34 kg/m2 (23 to 48). Median time to dehiscence was 13 days (interquartile range (IQR) 4 to 15). The dehiscence resulted from a fall in 22 patients and sudden flexion after staple removal in four. The arthrotomy was also disrupted in 58% (n = 15), including a complete extensor mechanism disruption in four knees. An irrigation and debridement with component retention (IDCR) was performed within 48 hours in 19 of 26 knees and two-thirds were discharged on antibiotic therapy. The mean follow-up was six years (2 to 15). The association of wound dehiscence and the risk of developing a PJI was analyzed.

Results

Patients who sustained a traumatic wound dehiscence had a 6.5-fold increase in the risk of PJI (95% confidence interval (CI) 1.6 to 26.2; p = 0.008). With the small number of PJIs, no variables were found to be significant risk factors. However, there were no PJIs in any of the patients who were treated with IDCR and a course of antibiotics. Three knees required reoperation including one two-stage exchange for PJI, one repeat IDCR for PJI, and one revision for aseptic loosening of the tibial component.

Conclusion

Despite having a traumatic wound dehiscence, the risk of PJI was low, but much higher than experienced in all other TKAs during the same period. We recommend urgent IDCR and a course of postoperative antibiotics to decrease the risk of PJI. A traumatic wound dehiscence increases risk of PJI by 6.5-fold. Cite this article: Bone Joint J 2021;103-B(6 Supple A):191–195.
Cobalt-chromium femoral components developed scratches and released metal debris in simulated wear whereas ceramic femoral components did not
Authors: Roy Marie E. , Whiteside Leo A. , Ly Kevin K. , Gauvain Matthew J.
Published: May 2021

Aims

The aims of this study were to evaluate wear on the surface of cobalt-chromium (CoCr) femoral components used in total knee arthroplasty (TKA) and compare the wear of these components with that of ceramic femoral components.

Methods

Optical profilometry was used to evaluate surface roughness and to examine the features created by the wear process in a knee wear simulator. We developed a method of measuring surface changes on five CoCr femoral components and quantifying the loss of material from the articular surface during the wear process. We also examined the articular surface of three ceramic femoral components from a previous test for evidence of surface damage, and compared it with that of CoCr components.

Results

We found that the surface roughness of CoCr components rapidly increased during the first 1,000 wear cycles, then reached a steady state, but material loss from the surface continued at a rate of 1,778,000 μm3 per million cycles as carbides were removed from its matrix. These carbides formed third-body wear particles, leading to the formation of new scratches even as older scratches were worn away. In contrast, no scratching, loss of material, or other surface damage, when evaluated with one nanometer resolution, was found on the surface of the ceramic components after a 15 M wear cycle test.

Conclusion

This study showed wear and loss of CoCr material from scratching and microabrasive wear in TKA. The material loss from the surface continued in a linear relationship with increasing cycles. We also found the absence of scratching and roughening of ceramic femoral components in simulated wear, suggesting an advantage in wear rate and avoiding metal sensitivity. This may have implications in the management of persistent pain after TKA. Cite this article: Bone Joint J 2021;103-B(6 Supple A):94–101.
Social determinants of health in total knee arthroplasty
Authors: Delanois Ronald E. , Tarazi John M. , Wilkie Wayne A. , Remily Ethan , Salem Hytham S. , Mohamed Nequesha S. , Pollack Andrew N. , Mont Michael A.
Published: May 2021

Aims

Social determinants of health (SDOHs) may contribute to the total cost of care (TCOC) for patients undergoing total knee arthroplasty (TKA). The aim of this study was to investigate the association between demographic data, health status, and SDOHs on 30-day length of stay (LOS) and TCOC after this procedure.

Methods

Patients who underwent TKA between 1 January 2018 and 31 December 2019 were identified. A total of 234 patients with complete SDOH data were included. Data were drawn from the Chesapeake Regional Information System, the Centers for Disease Control social vulnerability index (SVI), the US Department of Agriculture, and institutional electronic medical records. The SVI identifies areas vulnerable to catastrophic events with four themed scores: socioeconomic status; household composition and disability; minority status and language; and housing and transportation. Food deserts were defined as neighbourhoods located one or ten miles from a grocery store in urban and rural areas, respectively. Multiple regression analyses were performed to determine associations with LOS and costs after controlling for various demographic parameters.

Results

Divorced status was significantly associated with an increased LOS (p = 0.043). Comorbidities significantly associated with an increased LOS included chronic obstructive pulmonary disease/asthma and congestive heart failure (p = 0.043 and p = 0.001, respectively). Communities with a higher density of tobacco stores were significantly associated with an increased LOS (p = 0.017). Comorbidities significantly associated with an increased TCOC included chronic obstructive pulmonary disease (p = 0.004), dementia (p = 0.048), and heart failure (p = 0.007). Increased TCOCs were significantly associated with patients who lived in food deserts (p = 0.001) and in areas with an increased density of tobacco stores (p = 0.023).

Conclusion

Divorced marital status was significantly associated with an increased LOS following TKA. Living in food deserts and in communities with more tobacco stores were significant risk factors for increased LOS and TCOC. Food access and ease of acquiring tobacco may both prove to be prognostic of outcome after TKA and an opportunity for intervention. Cite this article: Bone Joint J 2021;103-B(6 Supple A):113–118.
3D-printed titanium metaphyseal cones in revision total knee arthroplasty with cemented and cementless stems
Authors: Anderson Lucas A. , Christie Matthew , Blackburn Brenna E. , Mahan Chad , Earl Christian , Pelt Christopher E. , Peters Christopher L. , Gililland Jeremy
Published: May 2021

Aims

Porous metaphyseal cones can be used for fixation in revision total knee arthroplasty (rTKA) and complex TKAs. This metaphyseal fixation has led to some surgeons using shorter cemented stems instead of diaphyseal engaging cementless stems with a potential benefit of ease of obtaining proper alignment without being beholden to the diaphysis. The purpose of this study was to evaluate short term clinical and radiographic outcomes of a series of TKA cases performed using 3D-printed metaphyseal cones.

Methods

A retrospective review of 86 rTKAs and nine complex primary TKAs, with an average age of 63.2 years (SD 8.2) and BMI of 34.0 kg/m2 (SD 8.7), in which metaphyseal cones were used for both femoral and tibial fixation were compared for their knee alignment based on the type of stem used. Overall, 22 knees had cementless stems on both sides, 52 had cemented stems on both sides, and 15 had mixed stems. Postoperative long-standing radiographs were evaluated for coronal and sagittal plane alignment. Adjusted logistic regression models were run to assess malalignment hip-knee-ankle (HKA) alignment beyond ± 3° and sagittal alignment of the tibial and femoral components ± 3° by stem type.

Results

No patients had a revision of a cone due to aseptic loosening; however, two had revision surgery due to infection. In all, 26 (27%) patients had HKA malalignment; nine (9.5%) patients had sagittal plane malalignment, five (5.6%) of the tibia, and four (10.8%) of the femur. After adjusting for age, sex, and BMI, there was a significantly increased risk for malalignment when a cone was used and both the femur and tibia had cementless compared to cemented stems (odds ratio 3.19, 95% confidence interval 1.01 to 10.05).

Conclusion

Porous 3D-printed cones provide excellent metaphyseal fixation. However, these central cones make the use of offset couplers difficult and may generate malalignment with cementless stems. We found 3.19-times higher odds of malalignment in our TKAs performed with metaphyseal cones and both femoral and tibial cementless stems. Cite this article: Bone Joint J 2021;103-B(6 Supple A):150–157.
Cobalt-induced cardiomyopathy – do circulating cobalt levels matter?
Authors: Jenkinson Mark R. J. , Meek R. M. Dominic , Tate Rothwell , MacMillan Sandy , Grant M. Helen , Currie Susan
Published: May 2021

Elevated levels of circulating cobalt ions have been linked with a wide range of systemic complications including neurological, endocrine, and cardiovascular symptoms. Case reports of patients with elevated blood cobalt ions have described significant cardiovascular complications including cardiomyopathy. However, correlation between the actual level of circulating cobalt and extent of cardiovascular injury has not previously been performed. This review examines evidence from the literature for a link between elevated blood cobalt levels secondary to metal-on-metal (MoM) hip arthroplasties and cardiomyopathy. Correlation between low, moderate, and high blood cobalt with cardiovascular complications has been considered. Elevated blood cobalt at levels over 250 µg/l have been shown to be a risk factor for developing systemic complications and published case reports document cardiomyopathy, cardiac transplantation, and death in patients with severely elevated blood cobalt ions. However, it is not clear that there is a hard cut-off value and cardiac dysfunction may occur at lower levels. Clinical and laboratory research has found conflicting evidence of cobalt-induced cardiomyopathy in patients with MoM hips. Further work needs to be done to clarify the link between severely elevated blood cobalt ions and cardiomyopathy.

Cite this article: Bone Joint Res 2021;10(6):340–347.
Chicken or the thumb? Comparing chicken femora with human metacarpals
Authors: Sargazi N , Oskrochi Y , Houghton J , Rai B , Brown D , Cheung G
Published: May 2021

Introduction

While the gold standard for simulation training in hand surgery is cadaveric hands, ethical issues and cost limit their use. Chicken thighbones have been utilised to replicate human metacarpals but there is a lack of literature to validate such a model. The aim of this study was to determine whether chicken femurs are morphologically similar to human metacarpal bones.

Methods

Computed tomography imaging was obtained of hands undertaken at our institute between 1 January and 31 December 2015. A total of 114 chicken thighs were also scanned. Bones with previous trauma or incomplete imaging were excluded. Bone length, distance to isthmus, radius of curvature, medullary canal diameter and cortical thickness were compared between the groups. Statistical analysis was conducted using Student’s t-test or the Mann-Whitney U test, with statistical significance implied with a p-value of < 0.05.

Results

A total of 146 human CT scans were identified, of which 36 were included in the study, resulting in 158 human metacarpals in 5 female and 31 male patients, with an average age of 39.5 years (range: 16–77 years). Of 114 chickens scanned, 101 were suitable for analysis. Mean length, distance to isthmus, radius of curvature, medullary canal diameter and cortical thickness were 57.3mm (standard deviation [SD]: 8.7mm), 32.9mm (SD: 8.2mm), 68.8mm (SD: 19.5mm), 9.3mm (SD: 1.6mm) and 1.7mm (SD: 0.4mm) respectively in human metacarpals, compared with 66.7mm (SD: 5.1mm), 34.1mm (SD: 6.4mm), 89.1mm (SD: 15.1mm), 6.4mm (SD: 0.6mm) and 1.6mm (SD: 0.1mm) respectively in chicken femurs. There was no significant difference in bone geometry between the groups, with p-values of >0.05 for all parameters described.

Conclusions

The chicken thigh model provides an anatomically suitable and more cost effective alternative to human cadaveric metacarpals in simulation training for hand surgery.
How has the NHS pension affected a surgeon's theatre sessions?
Authors: Phan YC , Ismail M
Published: May 2021

The impact of NHS pensions on the workforce.
Overcoming challenges in septorhinoplasty training faced by UK otorhinolaryngology trainees
Authors: Oremule B , Khwaja S , Saleh HA
Published: May 2021

Introduction

The aim of this study was to assess UK otorhinolaryngology trainees’ perceptions of their septorhinoplasty training. The possible effects that the COVID-19 pandemic may have on current and future training opportunities are also discussed.

Methods

A cross-sectional survey of members of the Association of Otolaryngologists in Training was conducted in March 2019.

Results

A total of 64 trainees responded to the survey. All deaneries were represented. A variety of challenges regarding septorhinoplasty training were highlighted. The most common hurdle was the low number of cases being undertaken. A third of the ST7–ST8 trainees in this sample (8/25, 32%) had not yet performed a single septorhinoplasty even though they were into the final two years of their training.

Conclusions

The COVID-19 pandemic is a new additional threat to septorhinoplasty training for otorhinolaryngology trainees, particularly those in the final two years of the programme. In the short term, clarification is needed regarding what level of operative proficiency is required for the Certificate of Completion of Training. In the longer term, threats to training can be mitigated by providing cadaveric courses, embracing simulation and considering private sector placements in areas of low NHS volume.
Subtrochanteric Femur Fracture in Monostotic Pagets Disease and its Management – A Case Report and Review of Literature
Authors: Mahajan Neetin P , Sadar Amey , Kumar G S Prasanna , Kondewar Pranay , Atal Shubham
Published: May 2021

Introduction: Paget disease of bone is a chronic progressive disease of the bone of uncertain etiology, characterized initially by an increase in bone resorption, followed by a disorganized and excessive formation of bone, leading to pain, fractures, and deformities. It can manifest as a monostotic or polyostotic disease. Pathological fracture secondary to Paget’s disease requires surgical management.
Case Report: A 60-year-old male patient came with complaint of pain and swelling over the left hip for 30 days. The patient had a history of a trivial fall. Radiological investigations were suggestive of pathological subtrochanteric femur fracture with Paget’s disease of the left femur. We managed with the long proximal femoral nail (PFN). Histopathological examination confirmed the diagnosis of Paget’s disease. At present 1-year follow-up, the patient is having good radiological and functional outcome with no implant failure.
Conclusion: Subtrochanteric pathological femur fractures in Paget’s disease are best managed with the long PFN with good outcome and fewer complications, which help in early mobilization and weight-bearing. Long PFN spans the entire pathologic femur and prevents the secondary fractures.
Keywords: Pagets disease, femur subtrochanteric fracture, long proximal femur nail.
A Novel Technique of Approach in a Skeletally Immature Case of Chondroblastoma – A Case Report
Authors: Vinoth A , Kumar D Bharani , Manivannan S
Published: May 2021

Introduction: Chondroblastoma is a rare benign cartilaginous neoplasm arising in the epiphysis of long bones in young patients. It is an uncommon benign but locally aggressive tumor, mostly located in the secondary centers of ossification. These tumors arise near a joint or growth plate and surgical excision is always challenging.
Case Report: A 13-year-old boy presented with intermittent knee pain, swelling, and limitation of movements for 1 year. On examination, magnetic resonance imaging revealed a hyperintense lesion in distal femoral epiphysis with superior transphyseal extension and inferior thinning of cortex with cartilage breach. Histopathological examination confirmed the diagnosis of chondroblastoma of distal femur. We report a novel technique of approach in a case of distal femoral chondroblastoma in a skeletally immature individual.
Conclusion: The technique we incorporated had an adequate exposure to reach the lesion for a complete curettage and bone grafting. It also reduced further injury to cartilage and physeal plate.
Keywords: Chondroblastoma, cartilage breach, curettage, bone grafting.
“Dry Arthroscopy” is a Valuable Tool in the Excisional Curettage of Chondroblastoma: A Case Series
Authors: Kellish Alec S , Qureshi Mahir , Mostello Andrew , Kim Tae Won , Gutowski Christina J
Published: May 2021

Introduction: Chondroblastomas are benign, locally aggressive bone tumors that occur in the epiphysis of young patients, requiring surgical excision. The anatomic locations of these lesions pose technical challenges to the surgeon; their proximity to the articular surface and the physis make surgical approach and visualization difficult. This case series describes the use of intramedullary arthroscopic assistance during excisional curettage of three distal femoral chondroblastomas.
Case Report: Three patients with distal femoral chondroblastomas underwent excisional curettage with intraosseous “dry” arthroscopic assistance. We describe a two-tunnel technique, using medial and lateral windows so the arthroscope and working instruments could be within the lesion simultaneously; as well as a one-tunnel technique, where the arthroscope was inserted into the working tunnel once curettage was complete, to assess the excision.
Conclusion: Achieving adequate exposure and visualization, while protecting the articular surface and physis, during excision of chondroblastomas, is essential for avoiding local recurrence and complications. “Dry” arthroscopic assistance provides the surgeon with an enhanced view of the tumor and tumor cavity, minimizes invasiveness, and has the potential to reduce complications without compromising the completeness of the excision.
Keywords: Chondroblastoma, orthopedic oncology, arthroscopy, dry arthroscopy, bone tumor.
Adaptive high-precision demodulation method based on vector matching and cluster-competitive particle swarm optimization for multiplexed FPIs
Authors: Yao Kun , Lin Qijing , Jiang Zhuangde , Zhao Na , Tian Bian , Peng Gang-Ding
Published: May 2021

Multiplexed fiber optic Fabry–Perot interferometer (FPI) sensors are well known for their precision, simple construction, simpler wiring, and high sensing qualities. However, the limitations on existing demodulation methods degrade the measurement accuracy of multiplexed FPI sensors and necessitate large cavity length differences. In this paper, we propose an adaptive high-precision demodulation method based on vector matching and cluster-competitive particle swarm optimization (CCPSO), which transforms cavity length demodulation into searching for the global extreme. The proposed CCPSO, which uses agglomeration within clusters and competition between clusters simultaneously, enables the improvement of the global extreme search capabilities. The theoretical analysis and experimental results show that the proposed demodulation method decreases the lower limit of the needed cavity length differences to 22 μm, which is reduced by 76.9% compared with the fast Fourier transform-based method. An accuracy of 1.05 nm is achieved with a cavity length difference of 27.5 μm and a signal-to-noise ratio of 36.0 dB for the noise.
Tunable terahertz topological edge and corner states in designer surface plasmon crystals
Authors: Wang Jiayi , Liu Yang , Yang Donghao , Hu Zhichan , Zhang Xinzheng , Xia Shiqi , Song Daohong , Ren Mengxin , Gao Shaohua , Wang Ride , Chen Zhigang , Xu Jingjun
Published: May 2021

In this work, we study topological edge and corner states in two-dimensional (2D) Su-Schrieffer-Heeger lattices from designer surface plasmon crystals (DSPCs), where the vertical confinement of the designer surface plasmons enables signal detection without the need of additional covers for the sample. In particular, the formation of higher-order topological insulator can be determined by the two-dimensional Zak phase, and the zero-dimensional subwavelength corner states are found in the designed DSPCs at the terahertz (THz) frequency band together with the edge states. Moreover, the corner state frequency can be tuned by modifying the defect strength, i.e., the location or diameter of the corner pillars. This work may provide a new approach for confining THz waves in DSPCs, which is promising for the development of THz topological photonic integrated devices with high compactness, robustness and tunability.
Grade impact investigation during stopping sight distance determination on 3D road environment
Authors: Mavromatis Stergios , Matragos Vassilios
Published: May 2021

In the present research, Stopping Sight Distance (SSD) adequacy is assessed through a three-dimensional approach, which associates road visibility in terms of grade effect. SSD adequacy is controlled through the difference between the available and the required SSD. The research is focused on a right turned, two lane rural road, associated with a crest vertical curve for a given speed value. The road design is in accordance with the Greek Road Design Guidelines (OMOE-X, 2001) by utilizing the control design parameters for a design speed of 80 km/h and a wide range of grade values, where the vertex point of the crest vertical curve is positioned at fixed points along the road axis. The investigation is based on a vehicle speed exceeding the design speed by 20 km/h. In total 1874 cases of compound alignments were examined and the results revealed that the available sight distance is decreasing while grade increases. The vehicle speed on the tangent sections was proved unacceptable in terms of providing SSD adequacy. However, it was found that SSD adequacy is granted when the vertical vertex falls inside the circular arc of the curve’s horizontal alignment, while the optimum area is defined shortly before the horizontal vertex point.
Comunicação efetiva da equipe multiprofissional na promoção da segurança do paciente em ambiente hospitalar
Authors: Santos Tatiane De Oliveira , Cunha Lima Maria Adriely , Alves Victória Santos , Ribeiro Maria Caroline Andrade , Alves Raquel Santos , Souza Mércia Rocha , Correia Fernanda Vasconcelos Prado , Oliveira Ana Carolina Amorim , Sales Larissa Ferreira , Oliveira Halley Ferraro
Published: May 2021

Demonstrar a importância de uma boa comunicação efetiva entre a equipe multiprofissional para a segurança do paciente. Trata-se de uma revisão integrativa de artigos encontrados através de descritores das bases de dados BVS e SciELO, em que foi encontrado 15 artigos após a seleção baseada nos critérios de inclusão e de exclusão. Observou-se, que os artigos descrevem resultados similares, visto que explicam a necessidade e a relevância da comunicação efetiva não só na qualidade do atendimento, mas também na segurança do paciente durante a assistência multiprofissional. É valido mencionar, que a comunicação efetiva não somente interfere no desfecho clínico do paciente, mas também promove bem-estar dos profissionais, dado que há redução do estresse entre os membros, por exemplo. A efetiva comunicação da equipe gera benefícios mútuos, através da melhora na assistência e na segurança, e para os profissionais, uma vez que melhora a qualidade do ambiente no trabalho.
Marketing Digital: Estratégias de Vendas com o Varejo Digital na Pandemia do COVID-19 / Digital Marketing: Sales Strategies with Digital Retail during COVID-19 Pandemic
Authors: Pinheiro Aurilene Figueiredo , Macêdo Maria Erilucia Cruz
Published: May 2021

Resumo: A pandemia do covid-19 veio a assolar nosso país e desde então só prejuízos foram acarretados. O Brasil entrou por fim não somente em uma gigantesca crise sanitária, como também econômica. Com essas perspectivas os governadores viram a necessidade em implementar barreiras para evitar a disseminação do vírus, como por exemplo o fechamento de comércios e todo e qualquer veículo comercial, tido como não essencial. Por essas e outras medidas, o marketing digital veio para tentar implementar estratégias de vendas ao varejo digital, com o colapso financeiro em que a pandemia deixou nosso país. Deste modo, as estratégias que o marketing on-line utilizou, se basearam na divulgação e venda de produtos pela internet. São várias as ferramentas utilizadas para a divulgação dos produtos, como por exemplo as redes sociais: instagram, facebook, whasapp, dentre outros. Sendo assim, a pesquisa tem como objetivo geral: analisar os pontos positivos que o marketing digital apresenta para o segmento do varejo com as novas mídias de comunicação. Os objetivos específicos sem baseiam em: Analisar as vantagens e desvantagens do marketing digital; identificar a influência que o varejo digital aplica sobre o processo de compra dos consumidores; compreender como ocorreu o processo de compra de produtos no varejo digital com a pandemia. O desígnio metodológico deste estudo pautou-se em apresentar uma pesquisa com abordagem qualitativa do tipo bibliográfica, identificando subsídios importantes a respeito do marketing digital; e suas estratégias, analisando os pontos positivos que o próprio apresentou para o segmento do varejo com as novas mídias de comunicação. Com a análise dos dados é possível observar que a ferramenta digital fornece uma excelente opção para as divulgações de produtos, ofertas, enfim, infinitas possibilidades e maneiras de se trabalhar. Com o desenvolvimento do estudo, foi possível explanar todas as vantagens e desvantagens que a mediante ferramenta proporciona, obtendo um excelente resultado positivo sob as suas vantagens, alcançando e explanando todos os objetivos e fortalecendo cada vez mais a dinâmica ampla e confiante que o marketing digital oferta as empresas e usuários.
Apendicite Aguda e suas Complicações Desencadeadas pela Pandemia COVID-19 / Acute Apendicitis and its Complications Unleashed by Pandemia COVID-19
Authors: Cidade Pedro Ivo Martins , Batista Hermes Melo Teixeira , Rolim Francisco Felippe De Araújo , Carvalho Victor Hugo Melo de , Macedo Allan Sávio Soares , Rocha Kaio Danilo Leite da Silva , Frutuoso Ádria Larisa Meira , Frutuoso Jairo Fernandes
Published: May 2021

Objetivo: analisar os fatores relacionando complicações da Apendicite Aguda (AA) com a pandemia de coronavírus (COVID-19) dos pacientes atendidos em um hospital terciário da macrorregião do Cariri (HRC). Métodos: estudo transversal e retrospectivo, comparando os atendimentos por AA no ano de 2019 com o ano de 2020. As variáveis elencadas foram número de dias com dor, idade, fase evolutiva, incisão cirúrgica, uso de dreno, tipo de acesso cirúrgico, internamento em UTI, uso de antibióticos, tempo de internação e complicações. Resultados: a AA foi mais prevalente no adulto jovem. Houve aumento do tempo médio para busca hospitalar, dos casos de AA Complicada e de incisões medianas durante a pandemia de COVID-19. A técnica operatória e o uso de drenos não sofreram influências no período em estudo. O uso de antibioticoterapia foi mais prevalente no ano de 202o, bem como o internamento em UTI, infecção de ferida operatória e hemicolectomia. Conclusão: a pandemia de COVID-19 determinou demora na procura médica resultando em tratamento tardio, elevação na permanência hospitalar e infecções de sítio cirúrgico.