bluuebunny/crossref_metadata_2025 huggingface dataset:
Το κόστος της άνοιας στην Αρκαδία
Authors: Τσαμπαλάς Ευάγγελος
Published: February 2023

Συχνά αναφέρεται ότι οι δυτικές ανεπτυγμένες κοινωνίες είναι γηράσκουσες κοινωνίες. Καθώς ο αριθμός των ηλικιωμένων αυξάνεται, ένας μεγάλος αριθμός νοσημάτων που σχετίζονται με την τρίτη ηλικία εμφανίζεται στο προσκήνιο απαιτώντας ολοένα και μεγαλύτερο μερίδιο από τις κρατικές υποδομές και τους οικονομικούς προϋπολογισμούς, για να αντιμετωπιστεί. Η άνοια αποτελεί μείζον και χαρακτηριστικό παράδειγμα αυτού του τύπου των μελλοντικών ιατρικών και κοινωνικοοικονομικών προβλημάτων. Στη μελέτη μας διαπραγματευόμαστε το θέμα της άνοιας και των κοινωνικών και οικονομικών της παραμέτρων. Στο πρώτο μέρος αναλύουμε την άνοια από ιατρική σκοπιά. Παρουσιάζουμε μία σύντομη ιστορική αναδρομή της νόσου, επιδημιολογικά στοιχεία, την κλινική εικόνα, τη διάγνωση και τη διαφορική διάγνωση, την παθολογική ανατομία, την παθογένεια και τέλος τη θεραπευτική αντιμετώπιση. Στο δεύτερο μέρος γίνεται μία αναλυτική παρουσίαση τόσο των κοινωνικών παραμέτρων της νόσου, οι οποίες είναι πολύπλευρες και κωδικοποιούνται με την ονομασία «φορτίο των φροντιστών», όσο και των οικονομικών επιπτώσεών της. Χρησιμοποιούμε τα εργαλεία των ‘Οικονομικών της Υγείας’, για να αναδείξουμε όχι μόνο το άμεσο κόστος με το οποίο η νόσος επιβαρύνει τους εμπλεκόμενους, αλλά και το έμμεσο κόστος, δηλαδή την άτυπη φροντίδα, που η κοινωνία «πληρώνει» χωρίς να συνειδητοποιεί απόλυτα το μέγεθός της. Το τρίτο μέρος περιλαμβάνει την ερευνητική εργασία που έλαβε χώρα στην γεωγραφική περιοχή της Αρκαδίας, σε δείγμα 110 ασθενών με άνοια και των φροντιστών τους. Προσδιορίσαμε λοιπόν το κόστος της άνοιας, την κατανομή του σε ιδιωτικό και δημόσιο, τις κατηγορίες που το καθορίζουν και βέβαια τις σχέσεις αυτών με τη βαρύτητα της νόσου. Τέλος συσχετίσαμε το κόστος της άνοιας και της επιβάρυνσης των φροντιστών με δημογραφικά και κλινικά χαρακτηριστικά των ασθενών, αλλά και των φροντιστών. Για το σκοπό αυτό χρησιμοποιήσαμε δύο μοντέλα πολλαπλής γραμμικής παλινδρόμησης.
Διερεύνηση του μοντέλου νευροσπλαχνικής απαρτίωσης στη σχιζοφρένεια και την ιδεοψυχαναγκαστική διαταραχή
Authors: Λαζαρίδη Μαρίνα
Published: February 2023

Στο πλαίσιο του Μοντέλου Νευροσπλαχνικής Απαρτίωσης (MNA) διερευνήθηκε αρχικά η σύνδεση μεταξύ δύο ελλειμμάτων που εμφανίζονται σταθερά στη σχιζοφρένεια: το έλλειμμα στην παρασυμπαθητική ρύθμιση και το έλλειμμα στο νοητικό ανασταλτικό έλεγχο. Στη συνέχεια εξετάστηκε η σχέση αυτών των λειτουργιών και στην ιδεοψυχαναγκαστική διαταραχή (ΙΔΨ) όπου τα ευρήματα ως προς το αν εμφανίζεται έλλειμμα στους ασθενείς είναι αντικρουόμενα.Τριάντα υγιείς μάρτυρες, 30 ασθενείς με σχιζοφρένεια και 28 ασθενείς με ΙΔΨ πραγματοποίησαν το διεθνώς τυποποιημένο αντισακκαδικό πρωτόκολλο ενώ παράλληλα καταγράφηκαν τα ηλεκτροκαρδιογραφικά τους δεδομένα. Ελέγχθηκε η αλληλεπίδραση μεταξύ της ομάδας, της νοητικής αναστολής δράσης όπως μετρήθηκε με το ποσοστό σφάλματος (ER) στην αντισακκαδική εργασία και η παρασυμπαθητική δραστηριότητα όπως μετρήθηκε με την υψηλή συχνότητα της Μεταβλητότητας Καρδιακού Ρυθμού (HF-HRV). Τα ευρήματα επιβεβαίωσαν ότι η μειωμένη HF-HRV σχετίζεται ειδικά με το αυξημένο ER μόνο στους ασθενείς με σχιζοφρένεια. Οι ασθενείς με ΙΔΨ εμφάνισαν μεν έλλειμμα στη παρασυμπαθητική δραστηριότητα αλλά όχι στην αναστολή δράσης. Η επίδοση των δύο ομάδων ασθενών σε άλλα μέτρα οφθαλμοκινητικής λειτουργίας, όπως ο χρόνος αντίδρασης και η μεταβλητότητα του χρόνου αντίδρασης που σχετίζονται με τον έλεγχο της βουλητικής κίνησης και τη νοητική σταθερότητα αντίστοιχα, δεν συνδέθηκαν με το έλλειμμα στην παρατηρείται έλλειμμα στη νοητική αναστολή δράσης αναμένεται και έλλειμμα στη παρασυμπαθητική ενεργοποίηση, αλλά όχι το αντίστροφο. Τα ευρήματα αναδεικνύουν τον κυρίαρχο ρόλο των περιοχών του προμετωπιαίου φλοιού στο κύκλωμα που προτείνει το ΜΝΑ.
Practical considerations for a TB controlled human infection model (TB-CHIM); the case for TB-CHIM in Africa, a systematic review of the literature and report of 2 workshop discussions in UK and Malawi
Authors: Gordon Stephen B. , Sichone Simon , Chirwa Anthony E. , Hazenberg Phoebe , Kafuko Zacharia , Ferreira Daniela M. , Flynn JoAnne , Fortune Sarah , Balasingam Shobana , Biagini Giancarlo A. , McShane Helen , Mwandumba Henry C , Jambo Kondwani , Dedha Keertan , Raj Sharma Nimisha , Robertson Brian D. , Walker Naomi F , Morton Ben ,   TB Controlled Human Infection Model Development Group
Published: February 2023

Background: Tuberculosis (TB) remains a major challenge in many domains including diagnosis, pathogenesis, prevention, treatment, drug resistance and long-term protection of the public health by vaccination. A controlled human infection model (CHIM) could potentially facilitate breakthroughs in each of these domains but has so far been considered impossible owing to technical and safety concerns.

Methods: A systematic review of mycobacterial human challenge studies was carried out to evaluate progress to date, best possible ways forward and challenges to be overcome. We searched MEDLINE (1946 to current) and CINAHL (1984 to current) databases; and Google Scholar to search citations in selected manuscripts. The final search was conducted 3rd February 2022. Inclusion criteria: adults ≥18 years old; administration of live mycobacteria; and interventional trials or cohort studies with immune and/or microbiological endpoints. Exclusion criteria: animal studies; studies with no primary data; no administration of live mycobacteria; retrospective cohort studies; case-series; and case-reports. Relevant tools (Cochrane Collaboration for RCTs and Newcastle-Ottawa Scale for non-randomised studies) were used to assess risk of bias and present a narrative synthesis of our findings.

Results: The search identified 1,388 titles for review; of these 90 were reviewed for inclusion; and 27 were included. Of these, 15 were randomised controlled trials and 12 were prospective cohort studies. We focussed on administration route, challenge agent and dose administered for data extraction. Overall, BCG studies including fluorescent BCG show the most immediate utility, and genetically modified Mycobacteria tuberculosis is the most tantalising prospect of discovery breakthrough.

Conclusions: The TB-CHIM development group met in 2019 and 2022 to consider the results of the systematic review, to hear presentations from many of the senior authors whose work had been reviewed and to consider best ways forward. This paper reports both the systematic review and the deliberations.

Registration: PROSPERO (CRD42022302785; 21 January 2022).
The genome sequence of the Lesser Hornet Hoverfly, Volucella inanis (Linnaeus, 1758)
Authors: Crowley Liam M. , Mitchell Ryan ,   University of Oxford and Wytham Woods Genome Acquisition Lab,   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, Weston Scarlett T. , Wotton Karl R. ,   Darwin Tree of Life Consortium
Published: February 2023

We present a genome assembly from an individual female Volucella inanis (the Lesser Hornet Hoverfly; Arthropoda; Insecta; Diptera; Syrphidae). The genome sequence is 961 megabases in span. Most of the assembly is scaffolded into six chromosomal pseudomolecules, including the assembled X sex chromosome. The mitochondrial genome has also been assembled and is 16.0 kilobases in length. Gene annotation of this assembly on Ensembl has identified 11,616 protein coding genes.
Keeping it real
Authors: Weinstein Nicole
Published: February 2023

The late Helen Bromley's focus on authentic resources that prompt children to ‘talk’ is one of her key legacies, finds Nicole Weinstein in the final feature of this series
Let's go to…: the Fitzwilliam Museum
Authors: Wallis Nicola
Published: February 2023

Nicola Wallis, museum educator at the Fitzwilliam Museum in Cambridge, discusses a programme devised especially to engage hard-to-reach families
Wellbeing
Authors: O'Sullivan June
Published: February 2023

June O'Sullivan, CEO of London Early Years Foundation, considers why physical activity is important for children's wellbeing
Physical development on a budget: Table the motion
Authors: Manners Lala
Published: February 2023

These table-based activities explored by Dr Lala Manners will help children develop overall strength and co-ordination, with additional language and maths possibilities
Market view: The First M&As OF 2023
Authors: Kanwar Arun
Published: February 2023

Arun Kanwar, managing partner at Cairneagle, on market activity at the start of the year
Is your primary care network ready for the future?
Authors: Cumberlege Justin
Published: February 2023

Justin Cumberlege, Partner at Hempsons, the healthcare specialists lawyers, says PCNs should ensure that they are ready for the future when the current Network DES Contract comes to an end in March 2024
The from on
Authors: Hughes David
Published: February 2023

NASA’s X-59 and its flight test campaign will define the shape and capabilities of a new generation of supersonic aircraft
New & Novel
Authors: Eden Paul
Published: February 2023

Nova Systems offers worldwide civil and military trials capability, from simple aircraft modifications to full program certification campaigns
AI in the Sky
Authors: Hughes David
Published: February 2023

How one of the largest avionics companies in the world is testing the technology that enables unmanned flight
The Aircraft that Made Airbus
Authors: Sampson Ben
Published: February 2023

The A320 is one of aviation’s most successful aircraft, but the short haul workhorse had an inauspicious start to life
The Graham-Hoffman-Hosoya-type theorems for the exponential distance matrix
Authors: Du Zhibin , Xing Rundan
Published: February 2023

Let $G$ be a strongly connected digraph with vertex set $\{v_1, v_2, \dots, v_n\}$. Denote by $D_{ij}$ the distance between vertices $v_i$ and $v_j$ in $G$. Two variant versions of the distance matrix were proposed by Yan and Yeh (Adv. Appl. Math.), and Bapat et al.  (Linear Algebra Appl.) independently, one is the $q$-distance matrix, and the other is the exponential distance matrix. Given a nonzero indeterminate $q$, the $q$-distance matrix $\mathscr{D}_G=(\mathscr{D}_{ij})_{n\times n}$ of $G$ is defined as\[\mathscr{D}_{ij}=\left\{\begin{array}{cl}1+q+\dots+q^{D_{ij}-1}&\text{if $i\ne j$},\\0&\text{otherwise}.\end{array}\right.\]In particular, when $q = 1$, it would be reduced to the distance matrix of $G$. The exponential distance matrix $\mathscr{F}_G=(\mathscr{F}_{ij})_{n\times n}$ of $G$ is defined as\[\mathscr{F}_{ij}= q^{D_{ij}}.\] In $1977$, Graham et al.  (J. Graph Theory) established a classical formula connecting the determinants and cofactor sums of the distance matrices of strongly connected digraphs in terms of their blocks, which plays a powerful role in the subsequent researches on the determinants of distance matrices. Sivasubramanian (Electron. J. Combin.) and Li  et al. (Discuss. Math. Graph Theory) independently extended it from the distance matrix to the $q$-distance matrix. In this note, three formulae of such types for the exponential distance matrices of strongly connected digraphs will be presented.
Hypocoercivity and hypocontractivity concepts for linear dynamical systems
Authors: Achleitner Franz , Arnold Anton , Mehrmann Volker
Published: February 2023

For linear dynamical systems (in continuous-time and discrete-time), we revisit and extend the concepts of hypocoercivity and hypocontractivity and give a detailed analysis of the relations of these concepts to (asymptotic) stability, as well as (semi-)dissipativity and (semi-)contractivity, respectively. On the basis of these results, the short-time behavior of the propagator norm for linear continuous-time and discrete-time systems is characterized by the (shifted) hypocoercivity index and the (scaled) hypocontractivity index, respectively.
ORTHOPAEDIC INJURIES AFTER ELECTRONIC SCOOTER TRAUMA IN A LEVEL 1 TRAUMA CENTRE BEFORE AND AFTER INTRODUCTION OF AN ESCOOTER RIDE-SHARING SCHEME
Authors: Talia A.J. , Clare S. , Liew S.M. , Edwards E.R.
Published: February 2023

The Victorian state government introduced a trial electronic scooter sharing scheme on 1st February 2022 in inner city Melbourne. Despite epidemiological data from other jurisdictions that show these devices are associated with significant trauma. This is a descriptive study from the largest trauma centre in Victoria demonstrating the “scope of the problem” after introduction of this government-approved, ride sharing scheme.

Retrospective case series. Our hospital orthopaedic department database was searched from 1/1/2021 to 30/6/22 to identify all presentations associated with electronic scooter trauma, the mechanism of injury and admission information was confirmed via chart review. Data collected included: mode of arrival, alcohol/drug involvement, hospital LOS, injury severity score, ICU admission, list of injuries, operations undertaken, surgical procedures, discharge destination, death.

In the 12 months prior to and 5 months since introduction of the ride share scheme, 43 patients were identified. 18 patients (42% of our cohort) presented in the 5 months since ride sharing was introduced, and 25 patients in the preceding 12 months.

58% were found to be alcohol or drug affected. All patients were admitted to hospital, 14% of which included ICU admission. 44% were polytrauma admissions. Median hospital length of stay was 2 days. The longest individual hospital stay was 69 days. No patients in this series died. There were 49 surgical procedures in 35 patients including neurosurgical, plastics and maxillofacial operations. Mean Injury Severity Score was 10.

Despite data demonstrating their danger in other jurisdictions, the Victorian state government approved a trial of an electronic scooter ride share scheme in inner Melbourne in February 2022. These devices are associated with a significant trauma burden and the rate has increased since the introduction of the ride-sharing scheme. This data may be combined with other hospital data and could be used to inform policy makers.
DO PERSONALITY TRAITS INFLUENCE PATIENT SATISFACTION AFTER TOTAL KNEE ARTHROPLASTY?
Authors: Giurea A. , Fraberger G. , Kolbitsch P. , Lass R. , Kubista B. , Windhager R.
Published: February 2023

Ten to twenty percent of patients are dissatisfied with the clinical result after total knee arthroplasty (TKA). Aim of this study was to investigate the impact of personality traits on patient satisfaction and subjective outcome of TKA.

We investigated 80 patients with 86 computer navigated TKAs (Emotion®, B Braun Aesculap) and asked for patient satisfaction. We divided patients into two groups (satisfied or dissatisfied). 12 personality traits were tested by an independent psychologist, using the Freiburg Personality Inventory (FPI-R). Postoperative examination included Knee Society Score (KSS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and the Visual Analogue Scale (VAS). Radiologic investigation was done in all patients.

84% of our patients were satisfied, while 16% were not satisfied with clinical outcome. The FPI-R showed statistically significant influence of four personality traits on patient satisfaction: life satisfaction (ρ = 0.006), performance orientation (ρ =0.015), somatic distress (ρ = 0.001), and emotional stability (ρ = 0.002). All clinical scores (VAS, WOMAC, and KSS) showed significant better results in the satisfied patient group. Radiological examination showed optimal alignment of all TKAs. There were no complications requiring revision surgery in both groups.

The results of our study show that personality traits may influence patient satisfaction and clinical outcome after TKA. Thus, patients personality traits may be a useful predictive factor for postoperative satisfaction after TKA.
PAEDIATRIC MULTIFOCAL MUSCULOSKELETAL SEPSIS: A 15-YEAR REVIEW OF OUTCOMES
Authors: McDonald A. , Byrnes C. , Boyle M. , Crawford H.
Published: February 2023

Survival of sepsis has been documented worldwide, but little is documented about the long-term health outcomes of multifocal sepsis from acute musculoskeletal infection - the first study of its kind in New Zealand.

Children admitted to the Paediatric Intensive Care Unit (PICU) from 1st January 2002 to 31st December 2017 with a musculoskeletal focus of infection were identified from hospital coding data. Notes review from discharge to present day determined survival and morbidity. Present-day clinical assessment of the musculoskeletal and respiratory systems along with questionnaires on health-related quality of life, mental health and sleep were performed.

Seventy patients were studied. Seven children died acutely (five Pasifika and two Māori children) indicating 10% mortality. Long-term survival was favourable with no recorded deaths after discharge. Recurrence/chronic infection occurred in 23%, a mean of 1.1 year after discharge. Growth disturbance occurred in 18%, a mean of 3 years after discharge. The hip joint and proximal femur have the worst complications. Children under 2 years are most at risk of long-term disability. No patients had chronic respiratory illness beyond 90 days. Fifteen children had symptoms of acute neurological impairment, three of whom had permanent brain injury. Twenty-six survivors (41%) were assessed a mean of 8.2 years after discharge. Health-related quality of life scores were on par with normative data. Six patients and eight parents screened positive for moderate to severe post-traumatic stress disorder.

Paediatric multifocal musculoskeletal sepsis can result in complex illness with long hospital stay and multi-organ complications. Māori and Pasifika children, those under two and those involving the proximal femur/or hip are most at risk. Other outcomes are favourable with no evidence of chronic lung disease or poor quality of life. A period of rehabilitation for children with identified acquired brain injury should be part of discharge planning.
MOBILE DATA SECURITY: INSTANT MESSAGING IN ORTHOPAEDICS
Authors: McDonald A. , Maling A. , Puttick M.
Published: February 2023

Instant messaging via WhatsApp is used within hospital teams. Group messaging can lead to efficient and non-hierarchical communication. Despite being end-to-end encrypted, WhatsApp is owned by Facebook, raising concerns regarding data security. The aims of this study were: 1) to record the prevalence of WhatsApp group instant messaging amongst clinical teams; 2) to ascertain clinician attitudes towards use of instant messaging, 3) to gauge clinicians’ awareness of best practice regarding mobile data protection and 4) to create a practical guideline based off available literature that can be used to by clinicians to improve data security practice.

Over a two-week period, clinical nurse specialists in the Auckland District Health Board Department of Orthopaedics retrospectively completed a blind audit of all messaging activity across the five teams WhatsApp group message threads, recording quantity of messages sent and the nature of the messages. Concurrently individuals in these WhatsApp groups completed an anonymous survey of their use of WhatsApp and their awareness of local data security policies and practice. A guideline adapted from available literature was created to compare current practice to recommended standards and subsequently adopted into local policy.

1360 messages were sent via WhatsApp in a two-week period. 384 (28%) of the messages contained patient identifiable data. Thirty-six photos were shared. Participants rated use of WhatsApp at 9.1/10 – extremely beneficial. Sixty-five per cent of clinicians reported they had not read or were unaware of the ADHB policies regarding mobile devices and information privacy and security.

WhatsApp use is widespread within the Orthopaedic department and is the preferred platform of communication with many perceived benefits. Data security is a risk and implementation of an appropriate guideline to assist clinicians in achieving best practice is crucial to ensure patient data remains protected.
A SYSTEMATIC REVIEW AND META-ANALYSIS OF PATIENT-RECORDED OUTCOME MEASURES IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: HOW GOOD IS GOOD ENOUGH?
Authors: Reason S. , Wainwright C.
Published: February 2023

Little guidance exists in the current literature regarding which patient recorded outcome measures (PROMs) are most clinically appropriate following anterior cruciate ligament reconstruction (ACL) surgery, and what results surgeons should expect or accept. Many PROMs have been validated, but their “ideal” results have not been published, limiting a surgeon's ability to compare their patients’ outcomes with those of their colleagues.

We undertook a systematic review of PROMs for ACL to look at common usage and outcomes. After appropriate paper selection, we then undertook a pragmatic meta-analysis (i.e., including all papers that fulfilled the selection criteria, regardless of CONSORT status) and calculated weighted mean outcome scores and standard deviations for the most commonly used PROMs.

A comprehensive literature search of all English articles of PubMed and other sources including search terms (‘Patient related outcome measure’ or ‘PROM’) AND ‘anterior cruciate ligament’ (limited to abstract/title) yielded 722 articles. Title review narrowed this to 268, and abstracts review to 151, of which 88 were included in our meta-analysis. Weighted mean and standard deviations were calculated for IKDC, KOOS, Lysholm, Teneger and “VAS Pain” PROMs as the most commonly reported. We identified significant, novel findings relating to selected PROMs and (i) demographics including age, gender and body mass index, (ii) surgical factors including bundle count, strand count, and graft type, and (iii) post operative complications.

We clarified the most commonly used PROMs for ACL, and their weighted means and standard deviations. This will allow surgeons to compare results with colleagues, ensuring they meet international levels of quality in PROMs. We have also updated which patient and operative factors have an impact on PROMs scoring to allow for population variance.
PERCEPTION OF PERIOPERATIVE RISK FOR ARTHROPLASTY PATIENTS: A POLL OF AUSTRALIAN ORTHOPAEDIC SURGEONS
Authors: Wall C.J. , de Steiger R.N. , Mulford J.S. , Lewis P.L. , Campbell D.G.
Published: February 2023

There is growing interest in the peri-operative management of patients with indications for hip and knee arthroplasty in the setting of modifiable risk factors such as morbid obesity, type 2 diabetes mellitus, and smoking. A recent survey of the American Association of Hip and Knee Surgeons (AAHKS) found that 95% of respondents address modifiable risk factors prior to surgery. The aim of this study was to poll Australian arthroplasty surgeons regarding their approach to patients with modifiable risk factors.

The survey tool used in the AAHKS study was adapted for use in the Australian context and distributed to the membership of the Arthroplasty Society of Australia via Survey Monkey.

Seventy-seven survey responses were received, representing a response rate of 64%. The majority of respondents were experienced, high volume arthroplasty surgeons. Overall, 91% of respondents restricted access to arthroplasty for patients with modifiable risk factors. Seventy-two percent of surgeons restricted access for excessive body mass index, 85% for poor diabetic control, and 46% for smoking. Most respondents made decisions based on personal experience or literature review rather than hospital or departmental pressures.

Despite differences in healthcare systems, our findings were similar to those of the AAHKS survey, although their responses were more restrictive in all domains. Differences were noted in responses concerning financial considerations for potentially underprivileged populations. The survey is currently being administered by arthroplasty societies in six other countries, allowing comparison of orthopaedic practice across different healthcare systems around the world.

In conclusion, over 90% of Australian arthroplasty surgeons who responded to the survey address modifiable risk factors prior to surgery.
ARTICULAR WEAR PATTERNS OBSERVED IN HIP ARTHROSCOPIC PATIENTS ACROSS EARLY DISEASE STATES: A RETROSPECTIVE COHORT STUDY
Authors: Eagles A. , Erian C. , Kermeci S. , Lovell D. , Weinrauch P.C.L.
Published: February 2023

Arthroscopic hip surgery is increasingly common in Australia. Hip arthroscopy is indicated for a range of diagnostic and therapeutic purposes, including labral tears, capsular laxity and femoral-acetabular impingement (FAI). Despite this, previous cohort studies aiming to characterise hip pathology seen on arthroscopic examination are mostly limited to patients with known diagnoses of FAI. Therefore, little is known of the native articular wear patterns encountered in other disease states. Therefore, we aimed to define common osteochondral wear patterns for a cohort of patients managed via hip arthroscopy.

We retrospectively analysed intraoperative data for 1127 patients managed via hip arthroscopy between 2008 and 2013, for either therapeutic or diagnostic purposes. Intraoperative data was categorized by location (A-E as defined by Fontana et al. 2016) and chondral damage (0-4 scale as defined by Beck et al. 2005) with respect to both acetabulum and femoral head.

Data for 1127 patients were included. Location of acetabular chondral pathology was variable with locations C1 and D1 representing the most common regions of damage. Labral tears predominated in locations C and D. Femoral chondral pathology was evenly distributed. The degree of femoral chondral injury was predominantly grade 1, whilst acetabular wear was evenly distributed.

Large proportions of wear were observed at the peripheral superior and anterior regions of the lunate surface of the acetabulum in keeping with prior works. However, we observed higher rates of central wear and lower rates of grade 4 acetabular damage extending into superior/posterior zones, in our cohort.

Our work characterises common articular wear patterns encountered at the time of hip arthroscopy. Further inquiry into the natural history of osteochondral lesions is needed to better understand and manage these conditions.
ETHNIC DIFFERENCES IN THE UTILIZATION AND OUTCOME OF PATIENTS UNDERGOING TOTAL HIP AND KNEE ARTHROPLASTY IN NEW ZEALAND
Authors: Gleeson Chynna , Zhu M. , Frampton C. , Young S.W. , Poutawera V. , Mutu-Grigg J.
Published: February 2023

The New Zealand Joint Registry (NZJR) was established in 1999. However, ethnicity data was not recorded by prioritisation in line with Ministry of Health (MoH) recommendations. Recently, cross-referencing with MoH updated ethnicity data for all 326,150 entries in the NZJR database. The objective of this national level, population study was to identify any ethnic disparities in access and outcome for Māori for primary total hip (THA) and knee arthroplasty (TKA) for Osteoarthritis.

The utilisation rate for THA and TKAs were calculated for the Māori and NZ European population from all data in the NZJR and Census data in 2001, 2006, 2013 and 2018. Utilisation rate was reported separately for four age groups (<55, 55-64, 65-74, >75) over four time periods (1999-2004, 2005-2009, 2010-2014, 2015-2020). Revision rate, 6 months and 5-year Oxford scores were adjusted for age, sex and BMI, then compared between groups.

In every age group and at all but one time point, significant under-utilisation of TKA was observed in Māori. For THAs, Māori had similar utilisation rates in the <55 and 55-64 age groups, but significantly lower utilisation rates in all other age groups.

When adjusted for age, sex and BMI, no significant differences in revision rates were observed between Māori and NZ Europeans for THAs (HR 0.939, P 0.417) or TKAs (HR 1.129, P 0.149). Adjusted 6 months and 5-year Oxford scores were significantly higher in NZ Europeans, however, the maximum difference was less than 3 points and is unlikely to be clinically significant.

Despite the same risk of being diagnosed with osteoarthritis, Māori are less likely to undergo THA and TKA. There are no clinically significant differences in outcomes post arthroplasty between Māori and NZ Europeans. Further research is required to investigate causes for lower utilisation in Māori.
CERVICAL SPINE CANAL MORPHOLOGY: A RADIOLOGICAL ANALYSIS IN A NEW ZEALAND COHORT
Authors: Goddard-Hodge D. , Baker J.
Published: February 2023

Reduced cervical spine canal AP diameter is linked to the development of spinal cord injury and myelopathy. This is of particular interest to clinicians in New Zealand, given a unique socio-ethnic make-up and prevalent participation in collision sport. Our study builds upon previous unpublished evidence, by analysing normal cervical spine CT scans to explore morphological differences in the sub-axial cervical spine canal, between New Zealand European, Māori and Paciāca individuals.

670 sub-axial cervical vertebrae (C3-C7) were analysed radiographically using high resolution CT trauma scans, showing no acute pathology with respect to the cervical spine. All measurements were made uPlising mulP-planar reconstruction software to obtain slices parallel to the superior endplate at each vertebral level. Maximal canal diameter was measured in the AP and transverse planes. Statistical analysis was performed using analysis of variance (ANOVA).

We included 250 Maori, 250 NZ European and 170 Paciāca vertebrae (455 male, 215 female). Statistically and clinically signiācant differences were found in sagittal canal diameter between all ethnicities, at all spinal levels. NZ European vertebrae demonstrated the largest AP diameter and Paciāca the smallest, at all levels. Transverse canal diameter showed no signiācant difference between ethnicities, however the raatio of AP:transverse diameter was signiācantly different at all spinal levels except C3. Subjective morphological differences in the shape of the vertebral canal were noted, with Māori and Paciāca patients tending towards a flatter, curved canal shape.

A previous study of 166 patients (Coldham, G. et al. 2006) found cervical canal AP diameter to be narrower in Māori and Paciāca patients than in NZ Europeans. Our study, evaluating the normal population, conārms these differences are likely reﬂecPve of genuine variation between these ethniciPes. Future research is required to critically evaluate the morphologic differences noted during this study.
THE EFFECT OF SURGEON VOLUME ON REVISION FOR DEEP PERIPROSTHETIC JOINT INFECTION: AN ANALYSIS OF 602,919 PRIMARY TOTAL KNEE ARTHROPLASTIES
Authors: Vaotuua D. , O'Connor P. , Belford M. , Lewis P. , Hatton A. , McAuliffe M.
Published: February 2023

Deep infection is a devastating complication of total knee arthroplasty (TKA). This study aimed to determine if there was a relationship between surgeon volume and the incidence of revision for infection after primary TKA.

Data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 1 September 1999 to 31 December 2020 for primary TKA for osteoarthritis that were revised for infection. Surgeon volume was defined by the number of primary TKA procedures performed by the surgeon in the year the primary TKA was performed and grouped as <25, 25-49, 50-74, 75-99, >100 primary TKA procedures per year. Kaplan Meir estimates for cumulative percent revision (CPR) and Cox Proportional Hazard Ratios were performed to compare rates of revision for infection by surgeon volume, with sub-analyses for patella and polyethylene use, age <65 years and male gender.

5295 of 602,919 primary TKA for osteoarthritis were revised for infection. High volume surgeons (>100 TKA/year) had a significantly lower rate of revision for infection with a CPR at 1 and 17 years of 0.4% (95% CI 0.3, 0.4) and 1.5% (95% CI 1.2, 2.0), respectively, compared with 0.6% (95% CI 0.5, 0.7) and 2.1% (95% CI 1.8, 2.3), respectively, for low volume surgeons (<25 TKR/year). Differences between the high-volume group and the remaining groups remained when sub-analysis for age, gender, ASA, BMI, patella resurfacing and the use of cross-linked polyethylene (XLPE).

High volume surgeons have lower rates of revision for infection in primary TKA.
NEUTRAL HYPOCHLOROUS ACID SOLUTION AS AN ORTHOPAEDIC STERILIZATION AGENT
Authors: Parker J. , Lim K. , Woodfield T. , Calhaem I. , Hooper. G.
Published: February 2023

Hypochlorous acid (HOCl) is a potent anti-bacterial agent which could reduce periprosthetic joint infection. Early infection complications in joint replacements are often considered to be due to local contamination at the time of surgery and result in a significant socioeconomic cost. Current theatre cleaning procedures produce “clean” operating theatres which still contain bacteria (colony forming units, CFU). Reducing this bacterial load may reduce local contamination at the time of surgery. HOCl is produced naturally in the human neutrophil and has been implicated as the primary agent involved in bacterial killing during this process. In vitro research confirms its efficacy against essentially all clinically relevant bacteria. The recent advent of commercial production of HOCl, delivered as a fog, has resulted in extensive use in the food industry. Reported lack of corrosion and high anti-bacterial potency are seen as two key factors for the use of HOCl in the orthopaedic environment. Prior work by the authors comparing human cell toxicity of HOCl, chlorhexidine and iodine solutions shows favourable results.

This study evaluates use of neutral HOCl applied as a dry room fog to decrease bacteria in the operating theatre environment. Using an animal operating theatre as the test site, bacterial swabs were taken from ten 100cm2 sample areas before standard cleaning with detergent, after standard cleaning, and again after 60 minutes exposure to HOCl fog.

After standard cleaning, 6 of 10 sample sites recorded significant bacterial growth (>10 CFU/100cm2). After exposure to HOCl fog, growth in all 10 sites was below detection limits (<10 CFU/100cm2). This was repeated with specific exposure to Staphylococcus aureus and Escherichia coli.

We can conclude that HOCl is effective when used as a fogging agent to reduce bacterial loading within an operating theatre environment and as such has significant potential to reduce intraoperative contamination and periprosthetic infection.
THE LIGAMENTOUS CONTRIBUTION TO STABILITY AT THE DISTAL RADIOULNAR JOINT
Authors: Schwer E. , Grant J. , Taylor D. , Hewitt J. , Blyth P.
Published: February 2023

The triangular fibrocartilage complex (TFCC) is a known stabiliser of the distal radioulnar joint (DRUJ). An injury to these structures can result in significant disability including pain, weakness and joint stiffness. The contribution each of its components makes to the stability of the TFCC is not well understood. This study was undertaken to investigate the role of the individual ligaments of the TFCC and their contribution to joint stability.

The study was undertaken in two parts. 30 cadaveric forearms were studied in each group. The ligaments of the TFCC were progressively sectioned and the resulting effect on the stability of the DRUJ was measured. A custom jig was created to apply a 20N force through the distal radius, with the ulna fixed.

Experiment one measured the effect on DRUJ translation after TFCC sectioning. Experiment two added the measurement of rotational instability.

Part one of the study showed that complete sectioning of the TFCC caused a mean increase in translation of 6.09(±3) mm. Sectioning the palmar radioulnar ligament of the TFCC caused the most translation.

Part two demonstrated a change in rotation with a mean of 18 (± 6) degrees following sectioning of the TFCC. There was a progressive increase in rotational instability until the palmar radioulnar ligament was also sectioned.

Linear translation consistently increased after sectioning all of the TFCC ligaments, confirming its importance for DRUJ stability. Sectioning of the palmar radioulnar ligament most commonly caused the greatest degree of translation. This suggests injury to this ligament would more likely result in a greater degree of translational instability. The increase in rotation also suggests that this type of instability would be symptomatic in a TFCC injury.
CO-OPERATION: DUAL-CONSULTANT OPERATING IN ORTHOPAEDICS AND EFFECT ON STRESS
Authors: Lynch-Larkin J. , D'Arcy M. , Chuang T.
Published: February 2023

The role of dual consultant operating (DCO) in general orthopaedics has not been researched; where it has shown benefit in other specialties, there is a lack of information on how DCO affects the surgeons themselves. We wanted to explore the potential effects of DCO on stress, as a foundation for further research to guide support for our surgeons.

We conducted a survey among orthopaedic consultants around New Zealand, containing questions pertaining to the demographics of respondents, their experience with DCO, what the expected risks and benefits of DCO would be, and provided two high-stress exemplar clinical scenarios where respondents were asked to rate their expected stress level at baseline, with a more junior consultant present, and with a more senior consultant present.

We found 99% of respondents had been involved in DCO at some point in their careers, yet only 38% were involved in DCO on at least a monthly basis. Perceived benefits greatly outweighed potential risks: 95% felt DCO would decrease their stress, 91% felt it improved intraoperative decision making, and 89% felt it provided more enjoyment at work and enhanced collegiality. A decrease in perceived stress was seen from baseline with a more junior consultant available and a greater decrease in stress seen with a more senior consultant, particularly in a complex elective setting.

All respondents felt there is benefit in DCO and the vast majority feel it has positive effects on stress levels. In a time where burnout is more prevalent, using tools such as DCO could be an effective way to decrease stress, enhance enjoyment and collegiality — challenging some key contributors to burnout — and support mentorship with further skill acquisition. This research provides a good base to pursue further qualitative and quantitative research into the area, with a view to addressing barriers to provision of regular DCO.
SIXTEEN-YEAR SURVIVAL AND FUNCTIONAL RESULTS OF THE CEMENTLESS OXFORD UNICOMPARTMENTAL KNEE REPLACEMENT
Authors: Mowbray J. , Frampton C. , Maxwell R. , Hooper G.
Published: February 2023

Cementless fixation is an alternative to cemented unicompartmental knee replacement (UKR), with several advantages over cementation. This study reports on the 15-year survival and 10-year clinical outcomes of the cementless Oxford unicompartmental knee replacement (OUKR).

This prospective study describes the clinical outcomes and survival of first 693 consecutive cementless medial OUKRs implanted in New Zealand.

The sixteen-year survival was 89.2%, with forty-six knees being revised. The commonest reason for revision was progression of arthritis, which occurred in twenty-three knees, followed by primary dislocation of the bearing, which occurred in nine knees. There were two bearing dislocations secondary to trauma and a ruptured ACL, and two tibial plateau fractures. There were four revisions for polyethylene wear. There were four revisions for aseptic tibial loosening, and one revision for impingement secondary to overhang of the tibial component. There was only one revision for deep infection and one revision where the indication was not stated. The mean OKS improved from 23.3 (7.4 SD) to 40.59 (SD 6.8) at a mean follow-up of sixteen years.

In conclusion, the cementless OUKR is a safe and reproducible procedure with excellent sixteen-year survival and clinical outcomes.
ACCURACY OF ACETABULAR ALIGNMENT USING INERTIAL AND OPTICAL NAVIGATION SYSTEMS DURING HIP ARTHROPLASTY
Authors: Xu J. , Veltman W. , Chai Y. , Walter W.
Published: February 2023

Navigation in total hip arthroplasty has been shown to improve acetabular positioning and can decrease the incidence of mal-positioned acetabular components. The aim of this study was to assess two surgical guidance systems by comparing intra-operative measurements of acetabular component inclination and anteversion with a post-operative CT scan.

We prospectively collected intra-operative navigation data from 102 hips receiving conventional THA or hip resurfacing arthroplasty through either a direct anterior or posterior approach. Two guidance systems were used simultaneously: an inertial navigation system (INS) and optical navigation system (ONS). Acetabular component anteversion and inclination was measured on a post-operative CT.

The average age of the patients was 64 years (range: 24-92) and average BMI was 27 kg/m2 (range 19-38). 52% had hip surgery through an anterior approach. 98% of the INS measurements and 88% of the ONS measurements were within 10° of the CT measurements. The mean (and standard deviation) of the absolute difference between the post-operative CT and the intra-operative measurements for inclination and anteversion were 3.0° (2.8) and 4.5° (3.2) respectively for the ONS, along with 2.1° (2.3) and 2.4° (2.1) respectively for the INS. There was significantly lower mean absolute difference to CT for the INS when compared to ONS in both anteversion (p<0.001) and inclination (p=0.02).

Both types of navigation produced reliable and reproducible acetabular cup positioning. It is important that patient-specific planning and navigation are used together to ensure that surgeons are targeting the optimal acetabular cup position. This assistance with cup positioning can provide benefits over free-hand techniques, especially in patients with an altered acetabular structure or extensive acetabular bone loss.

In conclusion, both ONS and INS allowed for adequate acetabular positioning as measured on postoperative CT, and thus provide reliable intraoperative feedback for optimal acetabular component placement.
PROTOCOL FOR EXAMINING TRANSFER VALIDITY OF A SUPRACONDYLAR HUMERAL FRACTURE PINNING AUGMENTED REALITY SIMULATOR
Authors: Guo J. , Blyth P. , Clifford K. , Hooper N. , Crawford H.A.
Published: February 2023

Augmented reality simulators offer opportunities for practice of orthopaedic procedures outside of theatre environments. We developed an augmented reality simulator that allows trainees to practice pinning of paediatric supracondylar humeral fractures (SCHF) in a radiation-free environment at no extra risk to patients. The simulator is composed of a tangible child's elbow model, and simulated fluoroscopy on a tablet device. The treatment of these fractures is likely one of the first procedures involving X-ray guided wire insertion that trainee orthopaedic surgeons will encounter. This study aims to examine the extent of improvement simulator training provides to real-world operating theatre performance.

This multi-centre study will involve four cohorts of New Zealand orthopaedic trainees in their SET1 year. Trainees with no simulator exposure in 2019 - 2021 will form the comparator cohort. Trainees in 2022 will receive additional, regular simulator training as the intervention cohort. The comparator cohort's performance in paediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a six-month period. The performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to examine whether additional training with an augmented reality simulator shows improved real-world surgical outcomes compared to traditional surgical training. This protocol has been approved by the University of Otago Health Ethics committee, and the study is due for completion in 2024.

This study is the first nation-wide transfer validity study of a surgical simulator in New Zealand. As of September 2022, all trainees in the intervention cohort have been recruited along with eight retrospective trainees via email. We present this protocol to maintain transparency of the prespecified research plans and ensure robust scientific methods. This protocol may also assist other researchers conducting similar studies within small populations.
CAN THE RESULTS OF A RANDOMIZED CONTROLLED TRIAL CHANGE THE TREATMENT PREFERENCES OF ORTHOPAEDIC SURGEONS?
Authors: Sonntag J. , Landale K. , Brorson S. , A. Harris I.
Published: February 2023

The aim of this study was to investigate surgeons’ reported change of treatment preference in response to the results and conclusion from a randomized controlled trial (RCT) and to study patterns of change between subspecialties and nationalities.

Two questionnaires were developed through the Delphi process for this cross-sectional survey of surgical preference. The first questionnaire was sent out before the publication of a RCT and the second questionnaire was sent out after publication. The RCT investigated repair or non-repair of the pronator quadratus (PQ) muscle during volar locked plating of distal radial fractures (DRFs). Overall, 380 orthopaedic surgeons were invited to participate in the first questionnaire, of whom 115 replied. One hundred surgeons were invited to participate in the second questionnaire. The primary outcome was the proportion of surgeons for whom a treatment change was warranted, who then reported a change of treatment preference following the RCT. Secondary outcomes included the reasons for repair or non-repair, reasons for and against following the RCT results, and difference of preferred treatment of the PQ muscle between surgeons of different nationalities, qualifications, years of training, and number of procedures performed per year.

Of the 100 surgeons invited for the second questionnaire, 74 replied. For the primary outcome, 6 of 32 surgeons (19%), who usually repaired the PQ muscle and therefore a change of treatment preference was warranted, reported a change of treatment preference based on the RCT publication. Of the secondary outcomes, restoring anatomy was the most common response for repairing the PQ muscle.

The majority of the orthopaedic surgeons, where a change of treatment preference was warranted based on the results and conclusion of a RCT, did not report willingness to change their treatment preference.
Bionic Mechanical Analysis of Dragonfly Wings: The Feasibility of Mesh Combination to Improve Structural Stiffness
Authors: Wei Yangyang , Guo Huidi , Zhang Siyi , Li Jingyuan , Wang Yihan , Liu Chajuan
Published: February 2023

The nodes of the object will show different degrees of deformation and displacement or even damage over time. The mesh structure is flexible and different mesh shapes and arrangements will affect the structural stiffness of the object. The unique structure of dragonfly wing veins allows the dragonfly to withstand pressures several times higher than itself and to fly freely. This study is based on dragonfly wing bionics to disassemble the structure of dragonfly wing vein geometry. And it aims to investigate the deflection under different geometries and three-dimensional spatial structures by using the drawing software Auto CAD to draw dragonfly sample graphics, the finite element software Hyper mesh to build the model and the solver OptiStruct to analyze the structure of wrinkling, arching deflection, z-direction maximum displacement, y-direction maximum rotation angle, combined displacement test under the different loads. The results show that: (1) The dragonfly wing vein mesh structure can enhance the stiffness under load. (2) In contrast, the displacement deformation of quadrilateral and combined hexagonal is smaller. (3) The structural stiffness of quadrilateral hexagon is enhanced as the height of wrinkling and arching increases. (4) The improvement of grid deflection with membrane structure is better than that without membrane structure. According to the above experimental results, the quadrilateral wrinkling and hexagonal arching structure has a significant improvement on the load bearing and deflection of the mesh, and has the potential to make structural optimization of the mesh series products, which is suitable for practical application and promotion.