bluuebunny/crossref_metadata_2025 huggingface dataset:
Οι γνώσεις των εκπαιδευτικών προσχολικής αγωγής ως προς τον αυτισμό και οι απόψεις τους απέναντι στη συμπερίληψη παιδιών με αυτισμό
Authors: Γρηγορόπουλος Ηρακλής Νικόλαος , Προβατά Αδαμαντίνη
Published: June 2021

Σκοπός της παρούσας έρευνας ήταν να διερευνήσει τις γνώσεις εκπαιδευτικών προσχολικής αγωγής ως προς τον αυτισμό και τις απόψεις τους απέναντι στη συμπερίληψη παιδιών με αυτισμό στη γενική τάξη. Στην έρευνα συμμετείχαν 91 εκπαιδευτικοί προσχολικής αγωγής, από την ευρύτερη περιοχή της Δυτικής Μακεδονίας. Για τη διερεύνηση των παραπάνω ερωτημάτων χρησιμοποιήθηκε ένα ερωτηματολόγιο δημογραφικών στοιχείων και το ερωτηματολόγιο Autism Inclusion Questionnaire (AIQ) των Segall & Campbell (2007). Σύμφωνα με τα αποτελέσματα της συγκεκριμένης έρευνας, οι περισσότεροι από τους συμμετέχοντες εκπαιδευτικούς προσχολικής ηλικίας διέθεταν επαρκές επίπεδο γνώσεων, ωστόσο εμφανίζονταν ουδέτεροι απέναντι στη συμπερίληψη των παιδιών με αυτισμό στη γενική τάξη. Επιπλέον, η προηγούμενη εμπειρία τους με παιδιά στο φάσμα του αυτισμού και η επιπλέον επιμόρφωση τους στην ειδική αγωγή  δε συσχετίστηκαν με θετικότερες απόψεις απέναντι στη συμπερίληψη των συγκεκριμένων παιδιών. Η διερεύνηση των απόψεων των εκπαιδευτικών μπορεί να συμβάλει ουσιαστικά στον καταλληλότερο σχεδιασμό πρακτικών συμπεριληπτικής εκπαίδευσης
Stage 2 Registered Report: Variation in neurodevelopmental outcomes in children with sex chromosome trisomies: testing the double hit hypothesis
Authors: Newbury Dianne F. , Simpson Nuala H. , Thompson Paul A. , Bishop Dorothy V. M.
Published: June 2021

Background: The presence of an extra sex chromosome is associated with an increased rate of neurodevelopmental difficulties involving language. The 'double hit' hypothesis proposes that the adverse impact of the extra sex chromosome is amplified when genes that are expressed from the sex chromosomes interact with autosomal variants that usually have only mild effects. We predicted that the impact of an additional sex chromosome on neurodevelopment would depend on common autosomal variants involved in synaptic functions.

 Methods: We analysed data from 130 children with sex chromosome trisomies (SCTs: 42 girls with trisomy X, 43 boys with Klinefelter syndrome, and 45 boys with XYY). Two comparison groups were formed from 370 children from a twin study. Three indicators of phenotype were: (i) Standard score on a test of nonword repetition; (ii). A language factor score derived from a test battery; (iii) A general scale of neurodevelopmental challenges based on all available information. Preselected regions of two genes, CNTNAP2 and NRXN1, were tested for association with neurodevelopmental outcomes using Generalised Structural Component Analysis.

Results: There was wide phenotypic variation in the SCT group, as well as overall impairment on all three phenotypic measures. There was no association of phenotype with CNTNAP2 or NRXN1 variants in either the SCT group or the comparison groups. Supplementary analyses found no indication of any impact of trisomy type on the results, and exploratory analyses of individual SNPs confirmed the lack of association.

Conclusions: We cannot rule out that a double hit may be implicated in the phenotypic variability in children with SCTs, but our analysis does not find any support for the idea that common variants in CNTNAP2 or NRXN1 are associated with the severity of language and neurodevelopmental impairments that often accompany an extra X or Y chromosome.

Stage 1 report: http://dx.doi.org/10.12688/wellcomeopenres.13828.2
Study protocol for a phase 2A trial of the safety and tolerability of increased dose rifampicin and adjunctive linezolid, with or without aspirin, for HIV-associated tuberculous meningitis [LASER-TBM]
Authors: Davis Angharad G. , Wasserman Sean , Maxebengula Mpumi , Stek Cari , Bremer Marise , Daroowala Remy , Aziz Saalikha , Goliath Rene , Stegmann Stephani , Koekemoer Sonya , Jackson Amanda , Lai Sai Louise , Kadernani Yakub , Sihoyiya Thandi , Liang C.Jason , Dodd Lori , Denti Paolo , Crede Thomas , Naude Jonathan , Szymanski Patryk , Vallie Yakoob , Banderker Ismail , Moosa Shiraz , Raubenheimer Peter , Lai Rachel P.J. , Joska John , Nightingale Sam , Dreyer Anna , Wahl Gerda , Offiah Curtis , Vorster Isak , Candy Sally , Robertson Frances , Meintjes Ernesta , Maartens Gary , Black John , Meintjes Graeme , Wilkinson Robert J.
Published: June 2021

Background: Tuberculous meningitis (TBM) is the most lethal form of tuberculosis with a mortality of ~50% in those co-infected with HIV-1. Current antibiotic regimens are based on those known to be effective in pulmonary TB and do not account for the differing ability of the drugs to penetrate the central nervous system (CNS). The host immune response drives pathology in TBM, yet effective host-directed therapies are scarce. There is sufficient data to suggest that higher doses of rifampicin (RIF), additional linezolid (LZD) and adjunctive aspirin (ASA) will be beneficial in TBM yet rigorous investigation of the safety of these interventions in the context of HIV associated TBM is required. We hypothesise that increased dose RIF, LZD and ASA used in combination and in addition to standard of care for the first 56 days of treatment with be safe and tolerated in HIV-1 infected people with TBM.

Methods: In an open-label randomised parallel study, up to 100 participants will receive either; i) standard of care (n=40, control arm), ii) standard of care plus increased dose RIF (35mg/kg) and LZD (1200mg OD for 28 days, 600mg OD for 28 days) (n=30, experimental arm 1), or iii) as per experimental arm 1 plus additional ASA 1000mg OD (n=30, experimental arm 2). After 56 days participants will continue standard treatment as per national guidelines. The primary endpoint is death and the occurrence of solicited treatment-related adverse events at 56 days. In a planned pharmacokinetic (PK) sub-study we aim to assess PK/pharmacodynamic (PD) of oral vs IV rifampicin, describe LZD and RIF PK and cerebrospinal fluid concentrations, explore PK/PD relationships, and investigate drug-drug interactions between LZD and RIF. Safety and pharmacokinetic data from this study will inform a planned phase III study of intensified therapy in TBM.

Clinicaltrials.gov registration: NCT03927313 (25/04/2019)
Primary accounting documentation
Authors: Sigidov Yuriy , Kalashnikova Elena , Horol'skaya Tat'yana
Published: May 2021

The textbook sets out the theoretical foundations of the document flow of an economic entity, considers the stages of the movement of accounting documents from the moment of their creation to their transfer to storage, presents the procedure for registration of primary accounting documents on the facts of economic life in various parts of the accounting process in accordance with the requirements of Russian accounting and tax legislation.
Meets the requirements of the federal state educational standards of higher education of the latest generation.
It is intended for students in the field of training 38.03.01 "Economics", practicing accountants, economists, students of the advanced training system.
Electroactivation of media in agricultural technologies as a way to intensify production processes
Authors: Ksenz Nikolay , Cheba Boris , Yudaev Igor'
Published: May 2021

The monograph examines the scientific foundations, methodological approaches and applied aspects of the electroactivation of air and water solutions for their direct use in various technological processes of agricultural production. The results of numerous experimental studies of the authors and other researchers conducted over several years to substantiate the parameters and operating modes of electrotechnological installations for the electrical activation of various media are presented.
It is intended for undergraduates, postgraduates, engineers and researchers who study and deal with issues of electrical technology, in particular, the development of electroactivators and the use of electroactivation processes in various areas of agricultural production and processing of agricultural products.
Russia and the world in the First World War: diplomacy, war on the Western front, culture and modernization of military equipment
Authors: Agureev Stanislav , Boltaevskiy Andrey , Pryadko Igor'
Published: May 2021

In the monograph, the authors answer a number of questions related to the history of the First World War: from its diplomatic preparation to the planning and implementation of major military operations and foreign policy outcomes. Various aspects of world diplomacy on the eve of the war, public opinion of the belligerent countries, aspects of conducting and planning military operations, as well as the reflection of this war in the works of domestic and foreign historians are subjected to a detailed rethinking.
It is intended for professional historians and for a wider readership, teachers and students.
Globalism and ecophilosophy of the future
Authors: Ismailov Nariman
Published: May 2021

From the point of view of the new science of globalism, the problems of the ecological, socio-economic state of the world and countries are considered through the prism of the interaction of the human psyche and society and the inhabited world. The criteria of ecological civilization of countries and peoples are justified. Optimizing the consumption of natural bio-and energy resources is becoming a fundamental environmental factor for sustainable development. The "Law of the maximum for humanity" as the law of the biosphere can be the arbitration court, the neutral force that will explain the historical need for mutual understanding, taking into account the interests of ecology and economy for the survival of man as a biovid on Earth; a new reality will begin to form — the phenomenon of co-residence of the world society with the biosphere. The world's population, its energy and bio-consumption, as well as all living matter on the planet, must correspond to the biological capacity of the Earth and not go beyond its boundaries. The task of the society is to implement a worldview breakthrough at the current stage of development, its own cultural mutation, which in the future will create the basis for adaptive technological and socio-cultural development. The task is to classify the entire Earth as a "Green Book" and to solve systemic environmental problems of a global nature. An integral part of sustainable development should be the principle of "vital consumption" at both the personal and social level, instead of the dominant principle of"expanded production and consumption". The indicator of the" culture of consumption "of natural resources, both at the individual level and at the level of society, should be included as an integral part of the integral indicator in the "True Indicator of Progress" and the "Human Development Index".
The book is interdisciplinary in nature; it is a kind of scientific and philosophical poetic essay intended for teachers and students of universities in the field of sociology, ecology, biology and related fields, as well as for everyone who cares about the future of society.
ADyC. Arte, Diseño y Comunicación (2020)
Authors: Mancera Martínez Manuel Fernando
Published: May 2021

Este año 2020, extraño y peculiar, nos embarcamos como los protagonistas de nuestro concepto creativo en un viaje complejo y desconocido. Desde Arte, Diseño y Comunicación, hemos querido homenajear la efeméride de la Circunnavegación que rememora, desde la gráfica, la expedición marítima que iniciara Magallanes en 1519 buscando esa nueva ruta comercial en busca de las islas de las especias. Este curso 19-20 los estudiantes/investigadores del área de la gráfica han desarrollado la propuesta teniendo como referencia la documentación que Antonio de Pigafetta dejara como constancia del primer viaje alrededor del mundo.
Court interpreting in the United Kingdom: analysis of the Ministry of Justice’s Language Service New Contract
Authors: Ruiz Mezcua Aurora , Fernández Gallego Casilda Alicia
Published: May 2021

Court interpreting is a challenging context where languages are fundamental to ensure justice and respect for human rights. The phenomenon of public service interpreting is a relatively recent one and the UK is considered to be one of the pioneer countries in providing Community Interpretation. The main objective of this research is to analyse the diverse aspects of the contract signed by the MoJ in 2012 with a private company for the outsourcing of language services. The MoJ previously obtained such services from freelance interpreters through a different system. We study the reasons for changing the old Ministry of Justice language service contract, the transition and also the new system, from an interpreting quality perspective. Consequently, this paper concentrates on one hypothesis: that there are elements in this outsourcing contract that pose a risk to the quality of the services provided under it.
Błędy gramatyczne w polszczyźnie studentów ukraińskojęzycznych
Authors: Izdebska-Długosz Dominika
Published: June 2021

LINGUISTIC ERROS IN POLISH FOR UKRAINIAN-SPEAKING STUDENTS The question of linguistic errors made in Polish by Ukrainians, discussed in the dissertation at hand, places it in the field of Polish lapsology – a branch of comparative glottodidactics. The inspiration for writing this dissertation derives from my teaching experience – five years of teaching Polish as a Foreign Language (PFL) to Ukrainian- -speaking groups, thus groups homogeneous in terms of their first language. It was observed that linguistic errors of a certain kind and type are made in Polish by students from Ukraine regularly and irrespective of their language level. It seemed obvious that the phenomenon of linguistic interference – negative transfer the students’ mother tongue – is responsible for the majority of repeated errors. In no way do teaching methods applied in teaching Polish as a Foreign Language (TPFL) allow for conquering interlingual errors; moreover, they promote skills and competences which due to the phenomenon of intercomprehension do not require particular didactic measures. Experimenting with different teaching methods and types of activities in class allowed for certainty that Ukrainian-speaking students should be taught Polish using different methods than the groups heterogeneous in terms of their first language. On the other hand, delving into voluminous literature on this subject matter allowed for establishing that similar conclusions have been drawn by linguists and practising language teachers for almost 30 years (in TPFL, much longer in other languages). Hence arises the question of dissonance between the awareness of the sources of problems East Slavic groups must face while acquiring Polish and the lack of practical solutions in TPFL to these groups.
La responsabilidad civil por productos medico- sanitarios defectuosos, de la prevención a la reparación
Authors: Villalba Cuéllar Juan Carlos , Pérez Forero Andrea Carolina
Published: June 2021

El régimen de la responsabilidad civil por productos defectuosos en el ámbito médico sanitario puede tener una serie de matices especiales que ameritan su estudio. Este artículo pretende abordar el tema desde una perspectiva propia del derecho del consumo, lo que implica el análisis del sistema preventivo o de control previo de la puesta en el mercado del producto, para luego estudiar lo propio al régimen resarcitorio encaminado a controlar la responsabilidad civil derivada de productos medico sanitarios defectuosos las características de este tipo de responsabilidad civil.
(How) Will I Socialize You? The Impact of Supervisor Initial Evaluations and Subsequent Support on the Socialization of Temporary Newcomers
Authors: Dufour Lucas , Escribano Pablo I. , Maoret Massimo
Published: June 2021

This study proposes and tests a new theoretical model explaining whether, and how, supervisors socialize “temporary newcomers,” defined as new organizational members who join an organization on a temporary basis, with a potential, but uncertain, opportunity of receiving a long-term job offer in the future. We suggest that under specific conditions, supervisors first evaluate temporary newcomers’ proactivity based on whether they positively stand out by proposing new feasible ideas and by promoting their achievements. On the basis of these initial evaluations, supervisors then decide whether to increase their support of newcomers’ creativity (using an investiture approach) or to intensify newcomers’ socialization by attempting to change their behavior (using a divestiture approach). When supervisors adopt an investiture approach, it positively influences temporary newcomers’ socialization adjustment outcomes, as indicated by increased newcomer job satisfaction, social integration, task performance, organizational and task socialization, challenge stress, and reduced hindrance stress. When supervisors instead adopt a divestiture approach, it has an opposite (thus negative) effect on the same socialization outcomes. We tested our theoretical model using a mix-method design, based on a three-wave longitudinal sample of 325 newcomer–supervisor dyads spanning a wide range of companies and industries, complemented with interviews of 41 supervisors.
Burnout and attrition in surgical trainees: what can be done to prevent it?
Authors: Gibby Mary , McKimm Judy
Published: May 2021

Burnout, mental health disorders and suicide are more common among doctors than the general population. Burnt-out doctors self-report increased rates of medical errors and the provision of suboptimal patient care. Surgeons in training are particularly at risk of burnout and are also less likely to seek professional support. Female surgical trainees have especially high rates of attrition, potentially because of issues surrounding childcare and motherhood. Several strategies to reduce burnout and promote resilience have been trialled among doctors. Schwartz rounds and mindfulness training have been shown to be effective, but only in those motivated to participate. A reduction in working hours has conflicting results, particularly among surgical trainees, which may be linked to the subsequent reduction in training opportunities, such as operative time and the ability to complete assessments. Early identification and targeted support of at-risk individuals is a potentially effective strategy that requires further research.
Robotic arm-assisted versus conventional medial unicompartmental knee arthroplasty: five-year clinical outcomes of a randomized controlled trial
Authors: Banger Matthew , Doonan James , Rowe Philip , Jones Bryn , MacLean Angus , Blyth Mark J. B.
Published: June 2021

Aims

Unicompartmental knee arthroplasty (UKA) is a bone-preserving treatment option for osteoarthritis localized to a single compartment in the knee. The success of the procedure is sensitive to patient selection and alignment errors. Robotic arm-assisted UKA provides technological assistance to intraoperative bony resection accuracy, which is thought to improve ligament balancing. This paper presents the five-year outcomes of a comparison between manual and robotically assisted UKAs.

Methods

The trial design was a prospective, randomized, parallel, single-centre study comparing surgical alignment in patients undergoing UKA for the treatment of medial compartment osteoarthritis (ISRCTN77119437). Participants underwent surgery using either robotic arm-assisted surgery or conventional manual instrumentation. The primary outcome measure (surgical accuracy) has previously been reported, and, along with secondary outcomes, were collected at one-, two-, and five-year timepoints. Analysis of five-year results and longitudinal analysis for all timepoints was performed to compare the two groups.

Results

Overall, 104 (80%) patients of the original 130 who received surgery were available at five years (55 robotic, 49 manual). Both procedures reported successful results over all outcomes. At five years, there were no statistical differences between the groups in any of the patient reported or clinical outcomes. There was a lower reintervention rate in the robotic arm-assisted group with 0% requiring further surgery compared with six (9%) of the manual group requiring additional surgical intervention (p < 0.001).

Conclusion

This study has shown excellent clinical outcomes in both groups with no statistical or clinical differences in the patient-reported outcome measures. The notable difference was the lower reintervention rate at five years for roboticarm-assisted UKA when compared with a manual approach. Cite this article: Bone Joint J 2021;103-B(6):1088–1095.
Ten-year follow-up of stemmed hemiarthroplasty for acute proximal humeral fractures
Authors: Amundsen Alexander , Brorson Stig , Olsen Bo S. , Rasmussen Jeppe V.
Published: June 2021

Aims

There is no consensus on the treatment of proximal humeral fractures. Hemiarthroplasty has been widely used in patients when non-surgical treatment is not possible. There is, despite extensive use, limited information about the long-term outcome. Our primary aim was to report ten-year patient-reported outcome after hemiarthroplasty for acute proximal humeral fractures. The secondary aims were to report the cumulative revision rate and risk factors for an inferior patient-reported outcome.

Methods

We obtained data on 1,371 hemiarthroplasties for acute proximal humeral fractures from the Danish Shoulder Arthroplasty Registry between 2006 and 2010. Of these, 549 patients (40%) were alive and available for follow-up. The Western Ontario Osteoarthritis of the Shoulder (WOOS) questionnaire was sent to all patients at nine to 14 years after primary surgery. Revision rates were calculated using the Kaplan-Meier method. Risk factors for an inferior WOOS score were analyzed using the linear regression model.

Results

Mean age at surgery was 67 years (24 to 90) and 445 (81%) patients were female. A complete questionnaire was returned by 364 (66%) patients at a mean follow-up of 10.6 years (8.8 to 13.8). Mean WOOS score was 64 (4.3 to 100.0). There was no correlation between WOOS scores and age, sex, arthroplasty brand, or year of surgery. The 14-year cumulative revision rate was 5.7% (confidence interval 4.1 to 7.2). Patients aged younger than 55 years and patients aged between 55 to 74 years had 5.6-times (2.0 to 9.3) and 4.3-times (1.9 to 16.7) higher risk of revision than patients aged older than 75 years, respectively.

Conclusion

This is the largest long-term follow-up study of acute proximal humeral fractures treated with hemiarthroplasty. We found a low revision rate and an acceptable ten-year patient-reported outcome. The patient-reported outcome should be interpreted with caution as we have no information about the patients who died or did not return a complete WOOS score. The long-term outcome and revision rate suggest that hemiarthroplasty offers a valid alternative when non-surgical treatment is not possible. Cite this article: Bone Joint J 2021;103-B(6):1063–1069.
Is 2 mm a wide margin in high-grade conventional chondrosarcomas of the pelvis?
Authors: Kurisunkal Vineet , Laitinen Minna K. , Kaneuchi Yoichi , Kapanci Bilal , Stevenson Jonathan , Parry Michael C. , Reito Aleksi , Fujiwara Tomohiro , Jeys Lee M.
Published: June 2021

Aims

Controversy exists as to what should be considered a safe resection margin to minimize local recurrence in high-grade pelvic chondrosarcomas (CS). The aim of this study is to quantify what is a safe margin of resection for high-grade CS of the pelvis.

Methods

We retrospectively identified 105 non-metastatic patients with high-grade pelvic CS of bone who underwent surgery (limb salvage/amputations) between 2000 and 2018. There were 82 (78%) male and 23 (22%) female patients with a mean age of 55 years (26 to 84). The majority of the patients underwent limb salvage surgery (n = 82; 78%) compared to 23 (22%) who had amputation. In total, 66 (64%) patients were grade 2 CS compared to 38 (36%) grade 3 CS. All patients were assessed for stage, pelvic anatomical classification, type of resection and reconstruction, margin status, local recurrence, distant recurrence, and overall survival. Surgical margins were stratified into millimetres: < 1 mm; > 1 mm but < 2 mm; and > 2 mm.

Results

The disease-­specific survival (DSS) at five years was 69% (95% confidence interval (CI) 56% to 81%) and 51% (95% CI 31% to 70%) for grade 2 and 3 CS, respectively (p = 0.092). The local recurrence-free survival (LRFS) at five years was 59% (95% CI 45% to 72%) for grade 2 CS and 42% (95% CI 21% to 63%) for grade 3 CS (p = 0.318). A margin of more than 2 mm was a significant predictor of increased LRFS (p = 0.001). There was a tendency, but without statistical significance, for a > 2 mm margin to be a predictor of improved DSS. Local recurrence (LR) was a highly significant predictor of DSS, analyzed in a competing risk model (p = 0.001).

Conclusion

Obtaining wide margins in the pelvis remains challenging for high-grade pelvic CS. On the basis of our study, we conclude that it is necessary to achieve at least a 2 mm margin for optimal oncological outcomes in patients with high-grade CS of the pelvis. Cite this article: Bone Joint J 2021;103-B(6):1150–1154.
Early functional rehabilitation compared with traditional immobilization for acute Achilles tendon ruptures
Authors: Liu Xuan , Dai Tian-Jiao , Li Bao-Lin , Li Chen , Zheng Zhou-Yuan , Liu Ye
Published: June 2021

Aims

The aim of this meta-analysis was to assess the prognosis after early functional rehabilitation or traditional immobilization in patients who underwent operative or nonoperative treatment for rupture of the Achilles tendon.

Methods

PubMed, Embase, Web of Science, and Cochrane Library were searched for randomized controlled trials (RCTs) from their inception to 3 June 2020, using keywords related to rupture of the Achilles tendon and rehabilitation. Data extraction was undertaken by independent reviewers and subgroup analyses were performed based on the form of treatment. Risk ratios (RRs) and weighted mean differences (WMDs) (with 95% confidence intervals (CIs)) were used as summary association measures.

Results

We included 19 trials with a total of 1,758 patients. There was no difference between the re-rupture rate (RR 0.84 (95% CI 0.56 to 1.28); p = 0.423), time to return to work (WMD -1.29 (95% CI -2.63 to 0.05); p = 0.060), and sporting activity (WMD -1.50 (95% CI -4.36 to 1.37); p = 0.306) between the early functional rehabilitation and the traditional immobilization treatment strategies. Early rehabilitation up to 12 weeks yielded significantly better Achilles tendon Total Rupture Scores ((ATRS) WMD 5.11 (95% CI 2.10 to 8.12); p < 0.001). Patients who underwent functional rehabilitation had significantly lower limb symmetry index of heel-rise work ((HRW) WMD -4.19 (95% CI -8.20 to 0.17); p = 0.041) at one year.

Conclusion

Early functional rehabilitation is safe and provides better early function and the same functional outcome in the longer term. Cite this article: Bone Joint J 2021;103-B(6):1021–1030.
Patients with an increased time to treatment initiation have a poorer overall survival after definitive surgery for localized high-grade soft-tissue sarcoma in the extremity or trunk
Authors: Ogura Koichi , Fujiwara Tomohiro , Healey John H.
Published: June 2021

Aims

Time to treatment initiation (TTI) is generally defined as the time from the histological diagnosis of malignancy to the initiation of first definitive treatment. There is no consensus on the impact of TTI on the overall survival in patients with a soft-tissue sarcoma. The purpose of this study was to determine if an increased TTI is associated with overall survival in patients with a soft-tissue sarcoma, and to identify the factors associated with a prolonged TTI.

Methods

We identified 23,786 patients from the National Cancer Database who had undergone definitive surgery between 2004 and 2015 for a localized high-grade soft-tissue sarcoma of the limbs or trunk. A Cox proportional hazards model was used to examine the relationship between a number of factors and overall survival. We calculated the incidence rate ratio (IRR) using negative binomial regression models to identify the factors that affected TTI.

Results

Patients in whom the time to treatment initiation was prolonged had poorer overall survival than those with a TTI of 0 to 30 days. These were: 31 to 60 days (hazard ratio (HR) 1.08, p = 0.011); 61 to 90 days (HR 1.11, p = 0.044); and 91 days (HR 1.22; p = 0.003). The restricted cubic spline showed that the hazard ratio increased substantially with a TTI longer than 50 days. Non-academic centres (vs academic centres; IRR ranging from 0.64 to 0.86; p < 0.001) had a shorter TTI. Those insured by Medicaid (vs private insurance; IRR 1.34), were uninsured (vs private insurance; IRR 1.17), or underwent a transition in care (IRR 1.62) had a longer TTI.

Conclusion

A time to treatment initiation of more than 30 days after diagnosis was independently associated with poorer survival. The hazard ratio showed linear increase, especially if the TTI was more than 50 days. We recommend starting treatment within 30 days of diagnosis to achieve the highest likelihood of cure for localized high-grade soft-tissue sarcomas in the limbs and trunk, even when a patient needs to be referred to a specialist centre. Cite this article: Bone Joint J 2021;103-B(6):1142–1149.
The effect of time to irrigation and debridement on the rate of reoperation in open fractures
Authors: Johal Herman , Axelrod Daniel , Sprague Sheila , Petrisor Brad , Jeray Kyle J. , Heels-Ansdell Diane , Bzovsky Sofia , Bhandari Mohit
Published: June 2021

Aims

Despite long-standing dogma, a clear relationship between the timing of surgical irrigation and debridement (I&D) and the development of subsequent deep infection has not been established in the literature. Traditionally, I&D of an open fracture has been recommended within six hours of injury based on animal studies from the 1970s, however the clinical basis for this remains unclear. Using data from a multicentre randomized controlled trial of 2,447 open fracture patients, the primary objective of this secondary analysis is to determine if a relationship exists between timing of wound I&D (within six hours of injury vs beyond six hours) and subsequent reoperation rate for infection or healing complications within one year for patients with open limb fractures requiring surgical treatment.

Methods

To adjust for the influence of patient and injury characteristics on the timing of I&D, a propensity score was developed from the dataset. Propensity-adjusted regression allowed for a matched cohort analysis within the study population to determine if early irrigation put patients independently at risk for reoperation, while controlling for confounding factors. Results were reported as odds ratios (ORs), 95% confidence intervals (CIs), and p-values. All analyses were conducted using STATA 14.

Results

In total, 2,286 of 2,447 patients randomized to the trial from 41 orthopaedic trauma centres across five countries had complete data regarding time to I&D. Prior to matching, the patients managed with early I&D had a higher proportion requiring reoperation for infection or healing complications (17% vs 13%; p = 0.019), however this does not account for selection bias of more severe injuries preferentially being treated earlier. When accounting for propensity matching, early irrigation was not associated with reoperation (OR 0.71 (95% CI 0.47 to 1.07); p = 0.73).

Conclusion

When accounting for other variables, late irrigation does not independently increase risk of reoperation. Cite this article: Bone Joint J 2021;103-B(6):1055–1062.
2021 Mark Coventry Award: Use of a smartphone-based care platform after primary partial and total knee arthroplasty: a prospective randomized controlled trial
Authors: Crawford David A. , Duwelius Paul J. , Sneller Michael A. , Morris Michael J. , Hurst Jason M. , Berend Keith R. , Lombardi Adolph V.
Published: May 2021

Aims

The purpose is to determine the non-inferiority of a smartphone-based exercise educational care management system after primary knee arthroplasty compared with a traditional in-person physiotherapy rehabilitation model.

Methods

A multicentre prospective randomized controlled trial was conducted evaluating the use of a smartphone-based care management system for primary total knee arthroplasty (TKA) and partial knee arthroplasty (PKA). Patients in the control group (n = 244) received the respective institution’s standard of care with formal physiotherapy. The treatment group (n = 208) were provided a smartwatch and smartphone application. Early outcomes assessed included 90-day knee range of movement, EuroQoL five-dimension five-level score, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) score, 30-day single leg stance (SLS) time, Time up and Go (TUG) time, and need for manipulation under anaesthesia (MUA).

Results

Overall, 90-day mean flexion was not significantly different between the control (121° (SD 11.7°)) and treatment groups (121o; p = 0.559); 90-day mean SLS was 22.7 seconds (SD 9.8) in controls and 24.3 seconds (SD 20.8) in treatment (p = 0.519); 90-day mean TUG times were 10.1 seconds (SD 4.8) in control and 9.3 seconds (SD 3.3) in treatment (p = 0.139). Mean KOOS JR scores were significantly different between control group (73.6 (SD 13.4)) and treatment group (70.4 (SD 12.6); p = 0.026). MUAs were performed in nine (3.7%) patients in the control group and four (1.9%) in the treatment group (p = 0.398). Physiotherapy was performed by 230 (94.4%) of control group and 123 (59.3%) of treatment group (p < 0.001). There were no significant differences between groups in postoperative urgent care visits, or readmissions within 90 days, with significantly fewer emergency department visits in the treatment group (16 (8.2%) vs five (2.5%), p = 0.014).

Conclusion

The use of the smartwatch/smartphone care platform demonstrated non-inferiority of clinically significant outcomes to traditional care models, while requiring significantly less postoperative physiotherapy and fewer emergency department visits. This platform could aid in decreasing postoperative costs, while improving patient engagement and communication with the healthcare team. Cite this article: Bone Joint J 2021;103-B(6 Supple A):3–12.
Hernia rationing: an assessment of commissioning guidelines
Authors: Gewanter W , Hubbard T , Ferguson D
Published: May 2021

Introduction

Hernias are a common surgical condition. Most guidelines recommend repair in almost all cases. NHS Devon clinical commissioning group (CCG) guidelines restrict the commissioning of hernia repair. The aim of this study was to follow up a cohort of patients referred for hernia repair to assess the impact of commissioning guidelines on clinical outcomes.

Methods

All patients referred to a single UK surgeon with an abdominal wall hernia over a 12-month period were followed up to determine whether CCG criteria were initially met. If they were not, time to any subsequent surgical intervention was recorded.

Results

After exclusions, 106 patients referred for abdominal wall hernia repair were followed up. Of these, 53 (49%) fulfilled commissioning guidelines for surgical repair. Thirty-one patients (23%) who had an indication for surgical repair did not fulfil commissioning criteria. This group was followed up for a median of 1,112 days (range: 962–1,287 days). Twelve patients (39%) required an operation within 900 days with one of these (3%) requiring emergency repair. These 12 patients waited a mean of 232 days before being accepted for surgery.

Conclusions

A large number of patients who did not initially meet NHS Devon CCG’s criteria ultimately required surgery. Three per cent of this ‘watch and wait’ group required emergency repair. NHS Devon CCG guidelines do not effectively identify patients who can be managed safely without surgical hernia repair. The incidence of emergency repair in this group should inform the prioritisation of hernia repairs when restarting elective services that have been halted because of the COVID-19 pandemic.
A Simple Technique for Removal of Interlocking Screw from an Intramedullary Nail: A Case Report
Authors: Prabhakar Sumanth Madhusudan , Decruz Joshua , James Wee Liang Hao , Kunnasegaran Remesh
Published: May 2021

Introduction: Difficulties encountered during removal of implants present a common technical challenge in orthopedic surgery, for which a number of factors have been implicated. A variety of techniques and instruments have been used to overcome this. However, some of these may prove to be time consuming, expensive, and inaccessible to many surgical setups. We describe a technique used for the removal of a jammed interlocking screw from an intramedullary nail that allows for minimal damage to the hardware, bone, and surrounding soft tissue, with the added advantage of being relatively quick and technically uncomplicated with the use of simple instruments.
Case Report: We describe the case of an 81-year-old female with a history of surgical fixation for a left femur intertrochanteric fracture, who presented with groin pain 13 months post-fixation. Radiographs were suggestive of avascular necrosis of the femoral head with resultant cut-in of the blade, and the patient was eventually taken up for the removal of implants and total hip replacement. Intraoperatively, difficulties were encountered in the removal of the distal interlocking screw, with failure of conventional techniques initially. A high-speed burr was then employed to shape the screw head so as to achieve better grip with extraction devices, which facilitated smooth removal.
Conclusion: We describe a simple method for difficult screw removal involving the use of a high-speed burr and vise grip pliers. This technique provides a quick and inexpensive option with commonly available surgical tools and may be considered when encountering difficulties with screw extraction.
Keywords: Trauma, revision surgery, interlocking screw, screw removal.
Synovial Chondromatosis of Hip in a Young Patient Salvaged With Mini Arthrotomy Without Hip Dislocation – A Case Report
Authors: Mahajan Neetin P. , Kumar G S Prasanna , Marfatia Ankit , Mane Akash V. , Gop Akhil , Patil Tushar C
Published: May 2021

Introduction: Synovial chondromatosis is a rare, benign disorder of the synovium, which leads to loose body formation due to metaplastic transformation. It presents as multiple cartilaginous bodies in the synovial joints, bursae and in tendon sheaths. The diagnosis often delayed in hip involvement due to insidious onset of symptoms. Surgical management is essential to manage synovial chondromatosis, which includes hip dislocation and debridement, arthroscopic removal or using arthrotomy.
Case Report: A 20-year-old male patient presented with complaints of pain in the left hip since 1 year and difficulty in walking for 6 months. On examination, the patient had mild tenderness over the left hip with the restriction of joint movements. He had flexion deformity of 30°, adduction and external rotation deformity of 10 and 15°, respectively. X-ray of the pelvis with both hips anteroposterior and left hip lateral view revealed calcified nodular mass over superior, inferior part of the femoral head, and anterior part of the neck with decreased joint space. As the patient was disabled with pain, stiffness especially restricted flexion and abduction and difficulty in daily routine activities, we planned for surgical excision of the loose bodies. Using lateral approach to the hip, intra-articular loose bodies were removed through arthrotomy without hip dislocation. At present 2-year follow-up, the patient is having full hip range of motion with no difficulty in squatting, sitting cross-legged, and radiological examination showed no evidence of recurrence. The patient is fully satisfied with the chosen treatment and participating in running and other sports.
Conclusion: Although hip synovial chondromatosis are rare, early surgical intervention with complete removal of loose bodies, joint distraction for 6 weeks to allow healing, and early initiation of hip physiotherapy helps in getting better outcome even in patients with early stages of hip arthritis. The early surgical interv
Neglected Isolated Sleeve Fracture of the Superior Pole of the Patella in a Healthy Adult – A Case Report and Review of Literature
Authors: Kushwaha Sudhir Shyam , Kumar Nitish , Bharti Ajay , Maurya Garima
Published: May 2021

Introduction: Sleeve fracture (SF) represents an unusual type of patellar fracture and has been reported mainly in children or adolescents. Superior pole fracture in adults is a very rare occurrence because the enthesis of the adult patella is more resilient to avulsion injury as compared to an immature pediatric skeleton. Due to the rarity of these fractures in adults and vague radiographic findings, the chances of missing the fracture are very high.
Case Report: An 18-year-old boy presented to our outpatient department with a history of fall while trying to jump across a wall 6 months ago. At the time of presentation, the patient mainly complained of loss of active extension of the knee in the sitting position and a palpable gap over the upper part of the patella. After radiographic evaluation, a diagnosis of SF was made. The patient was managed surgically, and thereafter, early rehabilitation was done. After 10 weeks post-surgery, the patient was free from any pain, had a full range of motion, and was able to walk without support.
Conclusion: Adults presenting with acute injury to knee with limitation of extension and palpable gap over the superior pole of the patella, a differential diagnosis of SF must be suspected and should be ruled out by clinical examination and relevant investigations.
Keywords: Sleeve fracture, patella, superior pole, adult.
Operative Intervention for a Chronic Fifth Carpometacarpal Dislocation: A Case Report and Review of Literature
Authors: Boltuch Andrew D , Harker John N
Published: May 2021

Introduction: Carpometacarpal (CMC) dislocations are infrequent hand injuries that are often missed in the acute care setting, resulting in inappropriate treatment and significant morbidity. CMC dislocations occur in a volar or dorsal direction, and volar dislocations are traditionally subclassified as either volar-ulnar or volar-radial. While various treatment methods and injury identification techniques have been reported in the literature, there remains a lack of standardization in the treatment of these injuries. This case report reviews the current literature on the subject in an attempt to further our knowledge on the subject.
Case Report: A 73-year-old right hand dominant male presented to the clinic complaining of persistent pain on the ulnar aspect of his left hand for the past 3 months. The injury had been missed in the urgent care and emergency settings before his arrival to the office. Radiographs demonstrated a volar-ulnar dislocation of the fifth CMC joint. The patient subsequently underwent open reduction with internal fixation to correct his deformity. Post-operative QuickDASH and grip strength measurements were gathered at post-operative visits.
Conclusion: This paper provides a literature review on the diagnostic techniques and management options of the fifth CMC dislocations. It further provides a treatment algorithm for a chronic volar-ulnar fifth CMC dislocation being amenable to open reduction and Kirschner wire fixation with an excellent outcome.
Keywords: Carpometacarpal, hand, dislocation.
Experimental demonstration and investigation of vortex circular Pearcey beams in a dynamically shaped fashion
Authors: Zhu Li-Yan , Chen Yue , Fang Zhao-Xiang , Ding Wei-Ping , Lu Rong-De
Published: June 2021

Optical vortex, typically characterized by a helical phase front, results in a possession of orbital angular momentum. In recent years, teleportation of the vortex mode using novel beams with peculiar features has gained great interest. Here, we experimentally demonstrate the propagation dynamics for a new class of the auto-focusing vortex circular Pearcey beam (VCPB), which is theoretically described by delivering the coaxial or off-axial spiral phases into the circular Pearcey beam (CPB), forming the crescent or bottle-like focal structure with self-rotation. Notably, such a hybrid beam with various types is experimentally obtained through a digital micromirror device (DMD) with the binary amplitude holography, and this DMD-based modulation scheme combined with controllable vortex modes enables dynamic switching among the VCPBs. We also measure the topological phase by interferometry and we explain the beam property on the basis of Poynting vector, showing a good agreement with the simulations. Further, the number, location and mode of embedded vortices could offer multiple dimensions of flexibility for target beam modulation, thus the experimentally controllable VCPBs will bring potential to high-speed optical communications and particle manipulations that require dynamic shaping.
Differentiable model-based adaptive optics for two-photon microscopy
Authors: Vishniakou Ivan , Seelig Johannes D.
Published: June 2021

Aberrations limit scanning fluorescence microscopy when imaging in scattering materials such as biological tissue. Model-based approaches for adaptive optics take advantage of a computational model of the optical setup. Such models can be combined with the optimization techniques of machine learning frameworks to find aberration corrections, as was demonstrated for focusing a laser beam through aberrations onto a camera [Opt. Express 28 26436 (26436)10.1364/OE.403487]. Here, we extend this approach to two-photon scanning microscopy. The developed sensorless technique finds corrections for aberrations in scattering samples and will be useful for a range of imaging application, for example in brain tissue.
Lasing from MEH-PPV with a refractive index tunable by electron irradiation
Authors: Lim Hyung San , Lee Ju Hyuk , Jeong Heon Yong , Cho Sung Oh
Published: June 2021

A simple one-step approach to producing a distributed feedback (DFB) laser through selective irradiation of the gain medium, MEH-PPV, is presented. Electron irradiation alters the refractive index of MEH-PPV, thus, direct patterning by electron irradiation can be applied to create a periodic diffraction grating. The non-irradiated regions of MEH-PPV serve as the primary gain medium, while the irradiated regions of MEH-PPV provide the refractive index difference required to fabricate a DFB laser. This method was successfully applied to achieve lasing with a relatively low lasing threshold of 3 kW/cm2or 1.8 µJ/cm2 (pulse width: 600 ps). Furthermore, the lasing wavelength can be finely tuned by simply adjusting the grating period. In stark contrast to the simple one-step process described in this work, conventional procedures for the fabrication of DFB lasers involve multiple steps of varying complexity, including mold creation and careful coating of the substrate with the gain medium.
Over 400 W graded-index fiber Raman laser with brightness enhancement
Authors: Fan Chenchen , Chen Yizhu , Yao Tianfu , Xiao Hu , Xu Jiangming , Leng Jinyong , Zhou Pu , Wolf Alexey A. , Nemov Ilya N. , Kuznetsov Alexey G. , Kablukov Sergey I. , Babin Sergey A.
Published: June 2021

The power scaling on all-fiberized Raman fiber oscillator with brightness enhancement (BE) based on multimode graded-index (GRIN) fiber is demonstrated. Thanks to beam cleanup of GRIN fiber itself and single-mode selection properties of the fiber Bragg gratings inscribed in the center of GRIN fiber, the efficient BE is realized. For the laser cavity with single OC FBG, continuous-wave power of 334 W with an M2 value of 2.8 and BE value of 5.6 were obtained at a wavelength of 1120 nm with an optical-to-optical efficiency of 49.6%. Furthermore, the cavity reflectivity is increased by employing two OC FBGs to scale the output power up to 443 W, while the corresponding M2 is 3.5 with BE of 4.2. To our best knowledge, it is the highest power in Raman oscillator based on GRIN fiber.