bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum γ-glutamyltransferase level and incidence risk of metabolic syndrome in community dwelling adults: longitudinal findings over 12 years
Authors: Kwak Jiwon , Seo In-Ho , Lee Yong-Jae
Published: February 2023

Purpose

Although a recent meta-analysis demonstrated a positive association between serum γ-glutamyltransferase (GGT) and metabolic syndrome (MetS), sex differences in the relationship between GGT levels and MetS risk were not fully considered. We prospectively examined the relationship between serum GGT levels and incidence risk of MetS.

Methods

Data were collected from the Korean Genome and Epidemiology Study (KoGES) enrolled in 2001–2002. Among 10,030 total participants, 5960 adults (3130 men and 2830 women) aged 40–69 without MetS were included and divided according to sex-specific quartiles of baseline serum GGT levels and followed up biennially until 2014. The hazard ratios (HRs) with 95% confidence intervals (CIs) for incident MetS were prospectively analyzed using multiple Cox proportional hazards regression analysis models.

Results

Among 5960 participants, 1215 males (38.8%) and 1263 females (44.6%) developed MetS during 12-year follow up. Higher quartiles of GGT showed significantly higher cumulative incidence of MetS in both sexes (log-rank test P < 0.001). The HRs (95% CIs) for incident type 2 diabetes for the highest quartile versus referent lowest quartile for serum GGT levels were 3.01 (2.35–3.76) for men and 1.83 (1.30–2.57) for women after adjusting for age, smoking status, daily alcohol intake (g/day), regular exercise, family history of diabetes, and log-transformed LDL-cholesterol, creatinine, and aminotransferase levels.

Conclusion

In conclusion, high levels of GGT were found to be associated with increased risk of Mets in both men and women and the positive associations were stronger in men than in women.
Chinese expert consensus on the treatment of MMD
Authors: Bao Xiang-Yang , Duan Lian
Published: February 2023

Moyamoya disease (MMD), also known as spontaneous occlusion of the circle of Willis, is defined by progressive stenosis or occlusion of the internal carotid arteries, and it can progress to the anterior, middle, and posterior cerebral arteries. As these arteries are gradually stenosed, a collateral network of capillaries develops at the base of the brain, producing the characteristic reticulate appearance (“puff of smoke”) on angiography. Therefore, it was named by Suzuki and Takaku in 1969 after the Japanese term “moyamoya” (Suzuki and Takaku, Arch Neurol 20:288–299, 1969). MMD is most common in East Asian countries such as Japan and Korea, and it shows a slight female predominance. MMD is mainly characterized by ischemia and hemorrhage. Hemorrhagic MMD is very rare in children, and most cases occur in adults due to the rupture of the compensatory blood vessels, which often leads to hemorrhagic symptoms (Scott and Smith, N Engl J Med 360:1226–1237, 2009). In recent years, the diagnosis rate has increased with the popularization of imaging techniques. However, the pathogenesis of MMD is still not completely understood, and there is currently no evidence to suggest that drug treatment can delay or even reverse the progression of MMD. The current drug treatment for in MMD only targets its clinical symptoms, including ischemia and hemorrhage. The main choice of treatment for MMD is surgical revascularization. As an increasing number of hospitals have developed surgical treatment for MMD, our compiling group has jointly discussed the formulation of a consensus among Chinese experts on the treatment of MMD.
Understanding treatment burden in hemophilia: development and validation of the Hemophilia Treatment Experience Measure (Hemo-TEM)
Authors: Brod Meryl , Bushnell Donald M. , Neergaard Jesper Skov , Waldman Laura Tesler , Busk Anne Kirstine
Published: February 2023

Background

To capture the broad range of treatment burden issues experienced by adolescent and adult people with hemophilia (PWH), the Hemophilia Treatment Experience Measure (Hemo-TEM) was developed. We describe the development of this new hemophilia-specific patient-reported outcome (PRO) measure including concept elicitation, cognitive debriefing, and psychometric validation.

Results

Concept elicitation interviews were conducted with 5 clinical experts and 30 adult PWH in the United States (US). The qualitative analysis of these interviews and a review of the literature informed the PRO measure development. The project team reviewed concept endorsement rates and generated a 27-item preliminary version of the Hemo-TEM. Cognitive debriefing interviews were conducted to ensure participant understanding and item relevance in samples of (adolescent (n = 20) and adult (n = 14)) PWH in the US. The refined, validation-ready version of the Hemo-TEM included 30 items. Lastly, data from 3 clinical trials comprised the 4 analysis sets used for the psychometric validation with a sample size of N = 88. Item reduction dropped 4 items resulting in a final 26-item measure. Factor analysis generated 5 domains in the Hemo-TEM [injection difficulties (3 items), physical impact (6 items), treatment bother (7 items), interference with daily life (4 items), and emotional impact (6 items)] and a total score. All scores were reliable [internally consistent (0.84–0.88)]. For convergent validity, with the exception of one domain, all hypothesized associations were met. Preliminary sensitivity to change effect sizes were between − 0.30 and − 0.70. Meaningful change thresholds ranged from 6 points (physical impact and emotional impact) to 10 points (treatment bother) with 8 points for the Hemo-TEM total score.

Conclusions

Findings from the concept elicitation, cognitive debriefing, and psychometric validation phases provide evidence that the Hemo-TEM is a well-designed, valid, and reliable measure of the burden of hemophilia treatment, including treatment impact on adolescent and adult PWH.
Susceptibility of Cosmopolites sordidus (Germar) (Coleoptera: Curculionidae) to Heterorhabditis sp. (Poinar), Steinernema feltiae (Filipjev) and isolates of entomopathogenic fungi
Authors: Tabima Lizeth , Silva Gómez Edelberto , Gaigl Andreas
Published: February 2023

Background

The weevils Cosmopolites sordidus (Germar), Metamasius hemipterus (Linnaeus), and M. hebetatus (Gyllenhal) (Coleoptera: Curculionidae) form a complex of important pests of plantain crops, causing crop losses of over 60%. Using synthetic insecticides to control these insects has not been efficient; for this reason, the present study searched for using entomopathogenic fungi (EPF) and nematodes (EPN) as alternative control tools.

Results

Compatibility of 74 combinations among 30 native fungal isolates and two EPNs (Steinernema feltiae and Heterorhabditis sp.) through inhibition tests was evaluated. It was found that the bacteria carried by Heterorhabditis sp. inhibited the growth of all fungi. In the biological test with EPF and EPN simultaneously against adults of C. sordidus, antagonistic interactions were observed when Heterorhabditis sp. was applied. Only the combination of the fungus strain B14 (Beauveria bassiana) + the EPN, S. feltiae had synergistic effects with a mortality rate of (93.3%).

Conclusions

This study revealed that S. feltiae and B. bassiana (strain B14) showed a synergistic effect against adults of C. sordidus. This combination could be an excellent candidate for developing a highly efficient biopesticide prototype in further trials and, together with other strategies of integrated pest management has the potential to improve control of the banana weevil complex.
Calculation of oil saturation in water-flooded layers based on the modified Archie model
Authors: Zhao Xiaodong , Wang Weilong , Li Qi , Zhen Guinan , Zhou Boyu , Liu Beibei , Qin Jiamin , Zhang Yaxuan
Published: February 2023

The Archie model is the foundation for calculating oil saturation, but limitations exist when the model is used to calculate oil saturation in the water-flooded layer. In the process of water injection, the dynamic change in oil saturation will be caused by the different degrees of water flooding and the properties of the injected water. Under the dynamic condition of water flooding, the Archie model is not suitable for calculating the oil saturation of water-flooded layers. By combining dynamic and static methods, a “double-ratio” model of the same sedimentary facies layer in the later development stage was established: [Formula: see text]. Based on the parameters of rock resistivity and formation water resistivity, an improved Archie model for calculating oil saturation in water-flooded layers of the same sedimentary facies was established. The interpretation of the actual data of the Zhenwu oilfield in Jiangsu, China finds that the average relative error between the calculation result and the core analysis result is 5.46%. The calculation result is reasonable, which offers a scientific basis for predicting the remaining oil distributions. The computational results have been validated by real data sets. This improved mode can provide experience-based guidance for the calculation of the remaining oil saturation of the water-flooded layer in the same sedimentary interpretation layer.
Deviating Alternative Splicing as a Molecular Subtype of Microsatellite Stable Colorectal Cancer
Authors: Meier Strømme Jonas , Johannessen Bjarne , Skotheim Rolf I.
Published: February 2023

PURPOSE

Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. Biomarkers to aid in prognostication and treatment decisions are in high demand, and to facilitate their development, a better understanding of the underlying biology of the highly heterogeneous disease is needed.

METHODS

A genome-scale alternative splicing (AS) analysis using RNA-sequencing data from primary microsatellite stable (MSS) CRCs from 127 patients was performed. Splice variant–specific expression levels of individual cancer samples were compared with the total set of samples, and a metric for a tumor sample's global amount of deviating AS was developed. This metric varied considerably across the cohort and ranged from 6 to 282 deviating AS events per tumor sample. A threshold of 45 or more deviating events was set to distinguish cancers with high (n = 44) and low (n = 83) levels of deviating AS.

RESULTS

Patients with high amounts of AS deviations had significantly shorter time to relapse compared with patients with fewer deviations ( P = .04). Furthermore, differential gene expression analysis revealed nine known cancer-critical genes that are significantly upregulated in samples with high amounts of deviating AS. Validation of the results in an independent cohort of MSS CRCs showed the same tendency toward shorter progression-free survival among the high-deviation group. In both cohorts, enrichment for growth factors was identified among upregulated genes associated with this phenotype.

CONCLUSION

There is a large variation in the amount of deviating AS among MSS CRCs, and we provide evidence that those with high amounts of deviations represent different cancer biology.
Pharmacokinetics and RP2D analysis from ETCTN 10388: A phase I trial of triapine and lutetium Lu-177 dotatate in well-differentiated somatostatin receptor–positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs).
Authors: Chauhan Aman , Christner Susan M. , Beumer Jan Hendrik , Kunos Charles , Khurana Aman , El Khouli Riham , Weiss Heidi , Yan Donglin , Soares Heloisa P. , Halfdanarson Thorvardur Ragnar , Li Daneng , Carson William Edgar , Evers Mark B , Ivy Percy , Kohn Elise C. , Rubinstein Larry , Arnold Susanne M. , Kolesar Jill , Anthony Lowell Brian , Konda Bhavana
Published: February 2023

648

Background: Radiation is a potent inducer of DNA double-strand breaks, and ribonucleotide reductase (RNR) is the rate-limiting enzyme for conversion of ribonucleoside diphosphate to deoxyribonucleotide diphosphate, and thus repair of DNA in this setting. ETCTN 10388 evaluated safety of combination Lu-177 DOTATATE, a beta-emitting radionuclide in combination with triapine, a ribonucleotide reductase (RNR) inhibitor. Methods: This investigator initiated, NCI sponsored, multicenter phase 1 trial, enrolled a total of 31 patients in the dose escalation [using the Bayesian optimal interval design (BOIN)] and dose expansion cohorts. Oral triapine was administered on days 1-14 and Lu-177 DOTATATE [200 mCi] intravenously on day 1 of every 56-day cycle. A total of 4 cycles were administered. All enrolled patients had blood samples collected for triapine pharmacokinetic (PK) analysis in EDTA tubes prior to and at 0.5, 1, 1.5, 2, 3, 4, 6, and 8 h after oral administration during cycle 1. Results: Five patients were enrolled in triapine Dose Level 1 (100 mg/day), twenty-five to dose level two (150 mg/day), and one patient to dose level three (200 mg/day). PK data were available for 12 patients enrolled in the dose escalation cohort. The geometric mean (SD) AUC0-inf was 1159 (1.22) µg/L•h for the 100mg dose level and 1862 (1.76) µg/L•h for the 150 mg dose level, suggesting that exposure increased with dose, and inter-patient variability was as expected for an oral agent. Triapine PK parameter values observed in this trial, were comparable to previous reports that used a previous formulation [ 1 ]. While exposure was similar, variability appeared smaller with the current oral formulation. Adverse events (AE) were assessed in all 31 patients per CTCAE 5.0. A total of one DLT in dose level 1, seven DLTs (Transient cytopenia; primarily neutropenia and rarely thrombocytopenia) in dose level 2, and one grade 5 DLT (Death probably from progressive cancer and carcinoid heart disease but possibly from trial drugs) in dose level 3 were observed. Detailed AE profile will be presented at the meeting. Conclusions: The RP2D of triapine is 150 mg QD on days 1-14 in combination with Lu-177 DOTATATE on day 1 of every 56-day cycle. Clinical trial information: 04234568 .
Functional Engagement of the PD-1/PD-L1 Complex But Not PD-L1 Expression Is Highly Predictive of Patient Response to Immunotherapy in Non–Small-Cell Lung Cancer
Authors: Sánchez-Magraner Lissete , Gumuzio Juan , Miles James , Quimi Nicole , Martínez del Prado Purificación , Abad-Villar María Teresa , Pikabea Fernando , Ortega Laura , Etxezarraga Carmen , Martín-Algarra Salvador , Lozano María D. , Saiz-Camin Mónica , Egurrola-Izquierdo Mikel , Barredo-Santamaría Inmaculada , Saiz-López Alberto , Gomez-Mediavilla Jenifer , Segues-Merino Nerea , Juaristi-Abaunz María Aranzazu , Urruticoechea Ander , Geraedts Erica J. , van Elst Kim , Claessens Niels J.M. , Italiano Antoine , Applebee Christopher J. , del Castillo Sandra , Evans Charles , Aguirre Fernando , Parker Peter J. , Calleja Véronique
Published: February 2023

PURPOSE

In many cancers, the expression of immunomodulatory ligands leads to immunoevasion, as exemplified by the interaction of PD-L1 with PD-1 on tumor-infiltrating lymphocytes. Profound advances in cancer treatments have come with the advent of immunotherapies directed at blocking these immuno-suppressive ligand-receptor interactions. However, although there has been success in the use of these immune checkpoint interventions, correct patient stratification for these therapies has been challenging.

MATERIALS AND METHODS

To address this issue of patient stratification, we have quantified the intercellular PD-1/PD-L1 interaction in formalin-fixed paraffin-embedded tumor samples from patients with non–small cell lung carcinoma, using a high-throughput automated quantitative imaging platform (quantitative functional proteomics [QF-Pro]).

RESULTS

The multisite blinded analysis across a cohort of 188 immune checkpoint inhibitor-treated patients demonstrated the intra- and intertumoral heterogeneity of PD-1/PD-L1 immune checkpoint engagement and notably showed no correlation between the extent of PD-1/PD-L1 interaction and PD-L1 expression. Importantly, PD-L1 expression scores used clinically to stratify patients correlated poorly with overall survival; by contrast, patients showing a high PD-1/PD-L1 interaction had significantly better responses to anti–PD-1/PD-L1 treatments, as evidenced by increased overall survival. This relationship was particularly strong in the setting of first-line treatments.

CONCLUSION

The functional readout of PD-1/PD-L1 interaction as a predictive biomarker for the stratification of patients with non–small-cell lung carcinoma, combined with PD-L1 expression, should significantly improve the response rates to immunotherapy. This would both capture patients excluded from checkpoint immunotherapy (high PD-1/PD-L1 interaction but low PD-L1 expression, 24% of patients) and additionally avoid treating patients who despite their high PD-L1 expression do not respond and suffer from side effects.
Association Between Metabolic Syndrome Inflammatory Biomarkers and COVID-19 Severity
Authors: Pham Thaidan T , Zu Yuanhao , Ghamsari Farhad , Oh Janice , Mauvais-Jarvis Franck , Zheng Hui , Filbin Michael , Denson Joshua L
Published: February 2023

Context

Metabolic syndrome (MetS) is associated with increased risk of severe COVID-19. MetS inflammatory biomarkers share similarities with those of COVID-19, yet this association is poorly explored.

Objective

Biomarkers of COVID-19 patients with and without MetS, the combination of diabetes, hypertension, obesity, and/or dyslipidemia, were analyzed to identify biological predictors of COVID-19 severity.

Methods

In this prospective observational study, at a large academic emergency department in Boston, Massachusetts, clinical and proteomics data were analyzed from March 24 to April 30, 2020. Patients age ≥18 with a clinical concern for COVID-19 upon arrival and acute respiratory distress were included. The main outcome was severe COVID-19 as defined using World Health Organization COVID-19 outcomes scores ≤4, which describes patients who died, required invasive mechanical ventilation, or required supplemental oxygen.

Results

Among 155 COVID-19 patients, 90 (58.1%) met the definition of MetS and 65 (41.9%) were identified as Control. The MetS cohort was more likely to have severe COVID-19 compared with the Control cohort (OR 2.67 [CI 1.09-6.55]). Biomarkers, including CXCL10 (OR 1.94 [CI 1.38-2.73]), CXCL9 (OR 1.79 [CI 1.09-2.93]), HGF (OR 3.30 [CI 1.65-6.58]), and IL6 (OR 2.09 [CI 1.49-2.94]) were associated with severe COVID-19. However, when stratified by MetS, only CXCL10 (OR 2.39 [CI 1.38-4.14]) and IL6 (OR 3.14 [CI 1.53-6.45]) were significantly associated with severe COVID-19.

Conclusions

MetS-associated severe COVID-19 is characterized by an immune signature of elevated levels of CXCL10 and IL6. Clinical trials targeting CXCL10 or IL6 antagonism in this population may be warranted.
Barriers and facilitators to refugees, asylum seekers and people experiencing homelessness accessing non hospital based care: A mixed methods systematic review protocol
Authors: Fitzharris Laura , McGowan Emer , Broderick Julie
Published: February 2023

Context: Social exclusion is characterised by and represents a form of disadvantage and marginalisation of vulnerable groups of people in society, who cannot fully participate in the normal activities of daily living.  Socially excluded groups consist of, but are not limited to the following groups: people experiencing homelessness, asylum seekers and refugees.  People from socially excluded groups have complex healthcare needs including infectious and non-communicable diseases. People from socially excluded groups tend to present more to the acute hospital setting as emergency presentations.  Little is known about barriers and facilitators experienced by these groups to accessing non hospital based care.

Objectives: This mixed methods systematic review, will critically examine the concept of barriers and facilitators for refugees, asylum seekers and people experiencing homelessness, to accessing non hospital based care.

Methods:  This methodological review will follow the Joanna Briggs Institute guidance for conducting mixed methods reviews.  The following databases will be searched: Central Medline, PubMed, Embase, CINAHL, and the Cochrane Library. Relevant grey literature will be included. Title and abstract screening, followed by full-text screening will be undertaken independently by two reviewers. The Joanna Briggs Institute extraction tool will be adapted for data extraction.  

Discussion: This mixed method review will comprehensively evaluate quantitative and qualitative data, synthesise both barriers and facilitators and follow a systematic approach through establishing use of mixed methods research across a number of marginalised groups, and how they affect accessing non hospital based care.   It will explore conceptual models of access to healthcare and how they influence these factors.
Digital Finance: Reaching New Frontiers
Authors: Osterrieder Joerg , Hadji Misheva Branka , Machado Marcos
Published: February 2023

Digital Finance must become the center of academic research in finance if the European financial industry is to remain competitive in the future. We argue that the new interdisciplinary field of Digital Finance should be prioritized based on the strategic priorities of the European Union, the needs of the finance industry, and the academic research gaps. Digital Finance as an interdisciplinary field will contribute to the strategic priorities of the European Union, such as financing for growth and jobs, financial stability and supervision, financial education, financing for small and medium-sized enterprises, and combating exclusion and inequality in access to credit.
The genome sequence of the Mottled Sedge, Glyphotaelius pellucidus (Retzius, 1783)
Authors: McSwan Emma , Broad Gavin R. , Wallace Ian , Price Benjamin W. ,   Natural History Museum Genome Acquisition Lab,   Darwin Tree of Life Barcoding collective,   Wellcome Sanger Institute Tree of Life programme,   Wellcome Sanger Institute Scientific Operations: DNA Pipelines collective,   Tree of Life Core Informatics collective,   Darwin Tree of Life Consortium
Published: February 2023

We present a genome assembly from an individual male Glyphotaelius pellucidus (Mottled Sedge, Arthropoda; Insecta; Trichoptera; Limnephilidae). The genome sequence is 1,037.1 megabases in span. Most of the assembly is scaffolded into 30 chromosomal pseudomolecules, including the assembled Z sex chromosome. The mitochondrial genome has also been assembled and is 16.0 kilobases in length. Gene annotation of this assembly on Ensembl identified 12,805 protein coding genes.
Digital “x”—Charting a Path for Digital-Themed Research
Authors: Baiyere Abayomi , Grover Varun , Lyytinen Kalle J. , Woerner Stephanie , Gupta Alok
Published: February 2023

We live in a time when digital technologies reshape most aspects of business and social life. This challenges received assumptions about modes of operation in organizations. As a result, scholars and practitioners increasingly use the label “digital” to signify that something has changed to the extent that a plethora of long-established management concepts are expressed in a new formulaic form of “digital x,” and x can stand for innovation, strategy, transformation, infrastructure, etc. In the information systems discipline and beyond, “digital” has emerged as an oft-used conceptual label to characterize age-long phenomena hitherto described by the IT (or x) label. There is a sense among academic and practitioner communities that digital and IT are not mere synonyms, but beyond the hype, something fundamentally different is being signaled when the “digital” label is invoked. This paper traces the intellectual roots and foundations of the growing use of “digital” as a conceptual label, identifies when the label use is warranted as well as outlines implications that the moniker holds for future scholarship, policy, and practice. In particular, the paper offers actionable guidance that enables more reflective use of the term “digital” as we move forward.
Rebates Offered by a Multiproduct Firm
Authors: Mamadehussene Samir
Published: February 2023

Whereas the literature on rebates has focused on single-product firms, this paper analyses the role of rebates offered by a multiproduct firm
Platform Governance in the Presence of Within-Complementor Interdependencies: Evidence from the Rideshare Industry
Authors: Chung Hyuck David , Zhou Yue Maggie , Ethiraj Sendil
Published: February 2023

Existing studies suggest that platform access restriction may cause restricted complementors to switch to competing platforms, which will increase complement quantity on competing platforms. We re-examine this prediction by accounting for the impact of economies of scope on complementor responses to platform access restriction. We argue that restricting a complementor’s access on a platform may prevent it from achieving economies of scope from multi-homing, thereby incentivizing it to abandon both the restricted and (unrestricted) competing platforms. Using rideshare data in New York City, we compare the numbers of trips made by Lyft and Uber drivers, respectively, before and after Lyft restricted drivers’ access on its platform. We find that Lyft’s access restriction reduced trip numbers not only on Lyft but also on Uber. In addition, both Lyft’s and Uber’s trip numbers decreased not only during the restricted low-demand periods (e.g., non-rush hours) but also during the unrestricted high-demand periods (e.g., rush hours). In contrast, after a substantial number of multi-homing drivers left both platforms following Lyft’s access restriction, a subsequent access restriction by Uber led to an increase in trip numbers on Lyft. These results highlight the importance of accounting for interdependencies across complementor activities when designing platform governance policies.

This paper was accepted by Alfonso Gambardella, business strategy.

Funding: H. D. Chung acknowledges support from the Strategic Research Foundation’s Dissertation Research [Grant SRF-2021-DRG-8363].

Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4706 .
Packing Feedback Arc Sets in Tournaments Exactly
Authors: Chen Xujin , Ding Guoli , Zang Wenan , Zhao Qiulan
Published: February 2023

Let [Formula: see text] be a tournament with a nonnegative integral weight w(e) on each arc e. A subset F of arcs is called a feedback arc set (FAS) if [Formula: see text] contains no cycles (directed). A collection [Formula: see text] of FASs (with repetition allowed) is called an FAS packing if each arc e is used at most w(e) times by the members of [Formula: see text]. The purpose of this paper is to give a characterization of all tournaments [Formula: see text] with the property that, for every nonnegative integral weight function w defined on A, the minimum total weight of a cycle is equal to the maximum size of an FAS packing.

Funding: This work was supported by the National Natural Science Foundation of China [Grants 11801266 and 11971228]; the Chinese Academy of Sciences [Grants XDA27000000 and ZDBS-LY-7008]; the Ministry of Science and Technology of China [Grant 2018AAA0101002]; the Research Grants Council of Hong Kong; the Fundamental Research Funds for the Central Universities [Grant 020314380035].
GDPR: Don’t Run the Risk
Authors: Russell Kristina
Published: February 2023

The way companies, including manufacturers, use and store their data is changing in May. If you haven’t already started thinking about complying, now is the time to start
Protecting The Planet
Authors: Offord Adam
Published: February 2023

Tackling waste pollution has hit the headlines recently. Industry may not immediately seem green, but many manufacturers are helping nature and the environment
Hedging Your Bets
Authors: Bernstein Adam
Published: February 2023

Since the Brexit vote, the value of the pound has made it very attractive for manufacturers to export. However, they need to be aware of some of the risks that can arise when currency begins to fluctuate
Diesel Demand
Authors: Offord Adam
Published: February 2023

The UK new car market saw diesel demand decline last year, in the wake of negative press coverage and tighter Legislation. Could the same be about to happen to the forklift truck market?
Around The Regions: The Midlands
Authors: Horobin Charlotte
Published: February 2023

As part of a new series looking at the challenges facing the manufacturing industry around the UK, EEF, the manufacturers’ organisation, examines how the country’s regions have been faring in the first few months of 2018
Autonomy or Enemy?
Authors: Beck Chris
Published: February 2023

Two-thirds of British workers are worried about losing their jobs to automation. However, all the evidence shows that, in reality, robotics will actually create more jobs than they take. So how do we get this message to the industry?
Why Maintenance Matters
Authors: Wheatley Malcolm
Published: February 2023

Maintenance may not be at the forefront of your mind, but a good maintenance strategy could be the difference between major breakdowns and smooth sailing
Supporting Industry
Authors: Bernstein Adam
Published: February 2023

For manufacturers looking for financial support, it can often feel like there are myriad options available, each more confusing than the last. But businesses that take the time to properly research the best deal will be well-placed to reap the rewards
End-of-life support and after-death body care for pets: what pet owners want
Authors: Kogan Lori R , Cooney Kathleen A , Brooks Summer L , Ellis Coleen
Published: February 2023

Background/Aims:

Pet owners caring for a pet during the end of its life are faced with numerous aftercare choices and decisions. This study was undertaken to explore the perceptions and expectations of pet owners regarding end-of-life issues.

Methods:

An anonymous online survey was distributed via Amazon's Mechanical Turk, an open online marketplace providing access to potential survey respondents.

Findings:

A total of 2043 dog and/or cat owners (41.4% male, 57.9% female) responded to the survey. The majority of these owners indicated they preferred to work with a specific crematorium (43%) or cemetery (70%) and over 95% reported feeling it is important to work with their preferred after-death body care service. Eighty-six per cent of owners reported relying on their veterinary team to help them with end-of-life decisions and arrangements with pet aftercare services and companies. Participants expressed significant concern over several aspects of after-death body care (e.g. body mislabelling or the type of container used for short-term and long-term storage).

Conclusions:

Results suggest that owners look to their veterinary teams to offer ethical after-death body care. These findings can help guide veterinary teams' efforts related to end-of-life communication and services.
NEW ZEALAND PROVINCIAL ORTHOPAEDIC TRAUMA STUDY (NZPOTS): THE EFFECTS OF INCREASING TRAUMA ON ELECTIVE ORTHOPAEDIC SURGERY IN PROVINCIAL NEW ZEALAND
Authors: Roffe L. , Peterson R. , Smith G. , Penumarthy R. , Atkinson N. , Ross M. , Singelton L. , Bodian C. , Timoko-Barnes S.
Published: February 2023

Trauma and elective orthopaedic demands in New Zealand are increasing. In this study, prospective and retrospective data has been collected at Nelson Hospital and across New Zealand to identify the percentage of elective theatre time lost due to cancellation for acute patient care. Data has been collected from theatre management systems, hospital data systems and logged against secretarial case bookings, to calculate a percentage of elective theatre time lost to acute operating or insufficient bed capacity.

Data was collected over a five-month period at Nelson Hospital, with a total of 215 elective and 226 acute orthopaedic procedures completed. A total of 95 primary hip or knee arthroplasties were completed during this trial while 53 were cancelled. The total number of elective operative sessions (one session is the equivalent of a half day operating theatre time) lost to acute workload was 47.9. Thirty-three percent of allocated elective theatre time was cancelled - an equivalent of approximately one-full day elective operating per week.

Over a five-week period data was collected across all provincial hospitals in New Zealand, with an average of 18% of elective operating time per week lost due to acute workload. Elective cancellations were due to acute operating 40% of the time and bed shortages 60% of the time. The worst effected centre was Palmerston North which had an average of 33% of elective operating cancelled per week to accommodate acute surgery or due to bed shortages.

New Zealand's provincial orthopaedic surgeons are under immense pressure from acute operating that impedes provision of elective surgery. The New Zealand government definition of an ‘acute case’ does not reflect the nature of today's orthopaedic burden. Increasing and aging populations along with staff and infrastructure shortages have financial and societal impacts beyond medicine and require better definitions, further research, and funding from governance.
OVER 50% OF PATIENTS AT RISK OF IMPINGEMENT AFTER THA SURGERY ARE NOT CAPTURED WITH NEUTRAL BONY ALIGNMENT
Authors: Hardwick-Morris M. , Twiggs J. , Miles B. , Jones E. , Bruce W. J. M. , Walter W. L.
Published: February 2023

Dislocation is one of the most common complications in total hip arthroplasty (THA) and is primarily driven by bony or prosthetic impingement. The aim of this study was two-fold. First, to develop a simulation that incorporates the functional position of the femur and pelvis and instantaneously determines range of motion (ROM) limits. Second, to assess the number of patients for whom their functional bony alignment escalates impingement risk.

468 patients underwent a preoperative THA planning protocol that included functional x-rays and a lower limb CT scan. The CT scan was segmented and landmarked, and the x-rays were measured for pelvic tilt, femoral rotation, and preoperative leg length discrepancy (LLD). All patients received 3D templating with the same implant combination (Depuy; Corail/Pinnacle). Implants were positioned according to standardised criteria.

Each patient was simulated in a novel ROM simulation that instantaneously calculates bony and prosthetic impingement limits in functional movements. Simulated motions included flexion and standing-external rotation (ER). Each patient's ROM was simulated with their bones oriented in both functional and neutral positions.

13% patients suffered a ROM impingement for functional but not neutral extension-ER. As a result, 48% patients who failed the functional-ER simulation would not be detected without consideration of the functional bony alignment. 16% patients suffered a ROM impingement for functional but not neutral flexion. As a result, 65% patients who failed the flexion simulation would not be detected without consideration of the functional bony alignment.

We have developed a ROM simulation for use with preoperative planning for THA surgery that can solve bony and prosthetic impingement limits instantaneously. The advantage of our ROM simulation over previous simulations is instantaneous impingement detection, not requiring implant geometries to be analysed prior to use, and addressing the functional position of both the femur and pelvis.
DETERMINATION OF PREOPERATIVE RISK FACTORS FOR ILIOPSOAS TENDONITIS
Authors: Hardwick-Morris M. , Twiggs J. , Miles B. , Balakumar J. , Walter W. L.
Published: February 2023

Iliopsoas impingement occurs in between 5-30% of patients after hip arthroplasty and has been thought to only be caused by an oversized cup, cup malpositioning, or the depth of the psoas valley. However, no study has associated the relationship between preoperative measurements with the risk of impingement. This study sought to assess impingement between the iliopsoas and acetabular cup using a novel validated model to determine the risk factors for iliopsoas impingement.

413 patients received lower limb CT scans and lateral x-rays that were segmented, landmarked, and measured using a validated preoperative planning protocol. Implants were positioned according to the preference of ten experienced surgeons. The segmented bones were transformed to the standing reference frame and simulated with a novel computational model that detects impingement between the iliopsoas and acetabular cup. Definitions of patients at-risk and not at-risk of impingement were defined from a previous validation study of the simulation. At-risk patients were propensity score matched to not at-risk patients.

21% of patients were assessed as being at-risk of iliopsoas impingement. Significant differences between at-risk patients and not at-risk patients were observed in standing pelvic tilt (p << 0.01), standing femoral internal rotation (p << 0.01), medio-lateral centre-of-rotation (COR) change (p << 0.01), supine cup anteversion (p << 0.01), pre- to postoperative cup offset change (p << 0.001), postoperative gross offset (p = 0.009), and supero-inferior COR change (p = 0.02).

Impingement between the iliopsoas and acetabular cup is under-studied and may be more common than is published in the literature. Previously it has been thought to only be related to cup size or positioning. However, we have observed significant differences between at-risk and not at-risk patients in additional measurements. This indicates that its occurrence is more complex than simply being related to cup position.
‘OVERALL PAIN’, ‘LIMPING WHEN WALKING’, AND ‘KNEE GIVING WAY’ ARE THE STRONGEST OXFORD KNEE SCORE PREDICTORS OF SUBSEQUENT REVISION WITHIN TWO YEARS
Authors: Tay M.L. , Monk A.P. , Frampton C.M. , Hooper G.J. , Young S.W.
Published: February 2023

Source of the study: University of Auckland, Auckland, New Zealand and University of Otago, Christchurch, New Zealand

The Oxford Knee Score (OKS) is a 12-item questionnaire used to track knee arthroplasty outcomes. Validation of such patient reported outcome measures is typically anchored to a single question based on patient ‘satisfaction’, however risk of subsequent revision surgery is also an important outcome measure. The OKS can predict subsequent revision risk within two years, however it is not known which item(s) are the strongest predictors. Our aim was to identify which questions were most relevant in the prediction of subsequent knee arthroplasty revision risk.

All primary TKAs (n=27,708) and UKAs (n=8,415) captured by the New Zealand Joint Registry between 1999 and 2019 with at least one OKS response at six months, five years or ten years post-surgery were included. Logistic regression and receiver operating characteristics (ROC) curves were used to assess prediction models at six months, five years and ten years.

Q1 ‘overall pain’ was the strongest predictor of revision within two years (TKA: 6 months, odds ratio (OR) 1.37; 5 years, OR 1.80; 10 years, OR 1.43; UKA: 6 months, OR 1.32; 5 years, OR 2.88; 10 years, OR 1.85; all p<0.05). A reduced model with just three questions (Q1, Q6 ‘limping when walking’, Q10 ‘knee giving way’) showed comparable or better diagnostic ability with the full OKS (area under the curve (AUC): TKA: 6 months, 0.77 vs. 0.76; 5 years, 0.78 vs. 0.75; 10 years, 0.76 vs. 0.73; UKA: 6 months, 0.80 vs. 0.78; 5 years: 0.81 vs. 0.77; 10 years, 0.80 vs. 0.77).

The three questions on overall knee pain, limping when walking, and knee ‘giving way’ were the strongest predictors of subsequent revision within two years. Attention to the responses for these three key questions during follow-up may allow for prompt identification of patients most at risk of revision.
COMPARISON OF REVISION ‘THRESHOLDS’ USING PATIENT-REPORTED OUTCOMES FOLLOWING TOTAL AND UNICOMPARTMENTAL KNEE ARTHROPLASTY
Authors: Tay M.L. , Monk A.P. , Frampton C.M. , Hooper G.J. , Young S.W.
Published: February 2023

Source of the study: University of Auckland, Auckland, New Zealand and University of Otago, Christchurch, New Zealand

Patient reported outcome measures (PROMs) are predictors of knee arthroplasty revision. Unicompartmental knee arthroplasty (UKA) is effective for patients with the correct indications, however has higher revision rates than total knee arthroplasty (TKA). Different revision thresholds for the procedures have been postulated. Our aims were to investigate: 1) if PROMs could predict knee arthroplasty revision within two years of the score at six months, five years and ten years follow-up, and 2) if revision ‘thresholds’ differed between TKA and UKA.

All TKAs and UKAs captured by the New Zealand Joint Registry between 1999 and 2019 with at least one OKS response at six months (TKA n=27,708, UKA n=8,415), five years (TKA n=11,519, UKA n=3,365) or ten years (TKA n=6,311, UKA n=1,744) were included. were propensity-score matched 2:1 with UKAs for comparison of revision thresholds.

Logistic regression indicated that for every one-unit decrease in OKS, the odds of TKA and UKA revision decreased by 10% and 11% at six months, 10% and 12% at five years and 9% and 5% at ten years. Fewer TKA patients with ‘poor’ outcomes (≤25) subsequently underwent revision compared with UKA at six months (5.1% vs. 19.6%, p<0.001), five years (4.3% vs. 12.5%, p<0.001) and ten years (6.4%vs. 15.0%, p=0.02). Compared with TKA, UKA patients were 2.5 times more likely to undergo revision for ‘unknown’ reasons, bearing dislocations and disease progression.

The OKS is a strong predictor of subsequent knee arthroplasty revision within two years of the score from early to late term. A lower revision threshold was found with UKA when compared with a matched TKA cohort. Higher revision rates of UKA are associated with both lower clinical thresholds for revision and additional modes of UKA failure.
SIMILAR SURVIVORSHIP FOR UNCEMENTED MOBILE-BEARING AND CEMENTED FIXED-BEARING MEDIAL UNICOMPARTMENTAL KNEE ARTHROPLASTY BUT DIFFERENT REASONS FOR REVISION
Authors: Tay M.L. , Bolam S.M. , Coleman B , Munro J.T. , Monk A.P. , Hooper G.J. , Young S.W.
Published: February 2023

Source of the study: University of Auckland, Auckland, New Zealand

Unicompartmental knee arthroplasty (UKA) is effective for patients with isolated compartment osteoarthritis, however the procedure has higher revision rates. Long-term survivorship and accurate characterisation of revision reasons are limited by a lack of long-term data and standardised revision definitions. We aimed to identify survivorship, risk factors and revision reasons in a large UKA cohort with up to 20 years follow-up.

Patient, implant and revision details were recorded through clinical and radiological review for 2,137 consecutive patients undergoing primary medial UKA across Auckland, Canterbury, Counties Manukau and Waitematā DHB between 2000 and 2017. Revision reasons were determined from review of clinical, laboratory, and radiological records for each patient using a standardised protocol. To ensure complete follow-up data was cross-referenced with the New Zealand Joint Registry to identify patients undergoing subsequent revision outside the hospitals. Implant survival, revision risk and revision reasons were analysed using Cox proportional-hazards and competing risk analyses.

Implant survivorship at 15 years was comparable for cemented fixed-bearing (cemFB; 91%) and uncemented mobile-bearing (uncemMB; 91%), but lower for cemented mobile-bearing (cemMB; 80%) implants. There was higher incidence of aseptic loosening with cemented implants (3-4% vs. 0.4% uncemented, p<0.01), osteoarthritis (OA) progression with cemMB implants (9% vs. 3% cemFB/uncemMB; p<0.05) and bearing dislocations with uncemMB implants (3% vs. 2% cemMB, p=0.02). Compared with the oldest patients (≥75 years), there was a nearly two-fold increase in risk for those aged 55-64 (hazard ratio 1.9; confidence interval 1.1–3.3, p=0.03). No association was found with gender, BMI or ASA.

Cemented mobile-bearing implants and younger age were linked to lower implant survivorship. These were associated with disease progression and bearing dislocations. The use of cemented fixed-bearing and uncemented mobile-bearing designs have superior comparable long-term survivorship.
THE LIFETIME REVISION RISK OF KNEE ARTHROPLASTY
Authors: Tay M.L. , Stone B. , Nugent M. , Frampton C.M. , Hooper G.J. , Young S.W.
Published: February 2023

Source of the study: University of Auckland, Auckland, New Zealand and University of Otago, Christchurch, New Zealand

Outcomes following knee arthroplasty are typically defined as implant survivorship at defined timepoints, or revision incidence over time. These estimates are difficult to conceptualise, and lack context for younger patients with more remaining years of life. We therefore aimed to determine a ‘lifetime’ risk of revision as a more useful metric for total (TKA) and unicompartmental knee arthroplasty (UKA).

The New Zealand Joint Registry was used to identify 96,497 primary TKAs and 13,481 primary UKAs performed between 1999 and 2019. Patient mortality and revision incidence were also extracted. Estimates of lifetime risk were calculated using an actuarial lifetable method. The estimates were stratified by age and gender. Reasons for revision were categorised using previously published standardised definitions.

The lifetime risk of UKA revision was two-fold higher than TKA across all age groups (range 3.7-40.4% UKA, 1.6-22.4% TKA). Revision risk was higher for males with TKA (range 3.4%-25.2% males, 1.1%-20% females), but higher for females with UKA (range 4.3%-43.4% vs. 2.9%-37.4% for males). Revision due to infections were higher for TKA (1.5% males, 0.7% females) compared with UKA (0.4% males, 0.1% females). The increased risk in younger UKA patients was associated with higher incidence of aseptic loosening (UKA 2%, TKA 1%) and ‘unexplained pain’ (UKA 2%, TKA 0.2%).

The risk for UKA was two-fold higher than TKA, and this was partially explained by a higher proportion of revisions due to ‘unexplained pain’. For TKA, males had higher risk of revision, in contrast to UKA where females had higher risk; this gender difference was associated with higher incidence of infections with TKA. Younger age, gender and higher ASA status were also associated with increased lifetime risk of UKA revision. Lifetime risk of revision can provide a meaningful measure of arthroplasty outcomes to aid patient counselling.