bluuebunny/crossref_metadata_2025 huggingface dataset:
Similar skills, different frames: a thematic analysis exploring conceptualizations held by community-based organization practitioners and academics regarding skills to use evidence-based interventions to address cancer inequities
Authors: Ramanadhan Shoba , Cruz Jennifer L. , Weese Maggie , Naveed Natasha , Kirk Shinelle , Rivard Madison K. , Kirk Judi , Whitaker Albert , Peterson Karen , Eisenkraft Arthur
Published: July 2023

Background

Community-based organizations (CBOs) are critical partners in delivering evidence-based interventions (EBIs) to address cancer inequities. However, CBO practitioners do not typically have access to opportunities to build the necessary capacity (skills, knowledge, motivation, and resources) for using EBIs. Although capacity-building interventions can offer a solution, inconsistent definitions and measurements of capacity limit the ability to develop and evaluate such efforts. We explored how and why conceptualizations of core skills for EBI use differ between practitioners and academics addressing cancer and other health inequities. We anchored the inquiry with a commonly used set of target skills for EBI capacity-building efforts.

Methods

The study was conducted by an interdisciplinary team of academic researchers and CBO practitioners. We gathered data through semi-structured, hour-long interviews with practitioners and academics working to address cancer and other health inequities (n = 19). After hearing a brief vignette about a CBO addressing cervical cancer inequities, participants considered a widely accepted list of skills for EBI use that included assessing needs, engaging stakeholders, and selecting, adapting, implementing, evaluating, and sustaining the EBI. We used a team-based, reflexive thematic analysis approach grounded in critical and constructivist perspectives.

Results

Overall, the original list resonated with practitioners and academics and they added new skills to the list (cultural humility and systems change). Practitioners’ responses described skills from the reference point of addressing broader community needs and context and achieving change over the long term, emphasizing aspects of health promotion in their descriptions. Academics offered a mix of perspectives, with some focused on addressing community needs (and related flexibility regarding EBIs) but more emphasized skills needed to deliver a specific EBI to achieve a focused set of health and equity outcomes.

Conclusions

There is a significant opportunity to leverage complementary expertise and perspectives held by practitioners and academics addressing cancer inequities. However, the different frames utilized suggest proactive efforts will be required to find alignment across groups, particularly in valuing diverse contributions and identifying relevant outcomes of interest for each group. Such alignment is critical to designing effective capacity-building interventions and supporting the routine utilization of EBIs to address cancer inequities.
Cognitive impact on patients with COVID-19 infection
Authors: Shaddad Ahmad Mohammad Abdo Kheder , Hussein Aliaë Abd Rabou Mohamed , Tohamy Amal Mohamed Aly , Khaleel Waleed Gamal Elddin
Published: July 2023

Background

SARS‐COV‐2 infection reframed medical knowledge in many aspects, yet there is still a lot to be discovered. Coronavirus disease 19 (COVID-19) can cause neuropsychiatric, psychological, and psychosocial impairments. Literature regarding the cognitive impact of COVID-19 is still limited.

This study aims to evaluate cognitive function, anxiety, and depression among patients with coronavirus disease 19.

Methods

Sixty COVID-19 patients were recruited and sub-grouped according to the site of care into three groups, home isolation, ward, and RICU, and compared with 60 matched control participants. Entire clinical history, O2 saturation, mini-mental state examination (MMSE), Hamilton’s anxiety (HAM-A), and depression rating scales (HAM-D) were assessed.

Results

MMSE showed significantly lowest results for the ICU group, with a value of 21.65 ± 3.52. Anxiety levels were the highest for the ICU group, with a highly significant difference vs. the home isolation group (42.45 ± 4.85 vs. 27.05 ± 9.52; p< 0.001). Depression values assessed showed a highly significant difference in intergroup comparison (44.8 ± 6.64 vs. 28.7 ± 7.54 vs. 31.25 ± 8.89; p<0.001, for ICU vs. ward vs. home group, respectively).

MMSE revealed a significant negative correlation with age and education level, anxiety level had significant negative correlations with severity of illness and male gender, and depression level had highly significant negative correlations with severity of illness and male gender.

Conclusion

Both cognitive and neuropsychiatric symptoms were affected in COVID-19 cases, especially in ICU-admitted patients. The impact of these disorders was significant in older age, lower oxygen saturation, and severe disease.

Trial registration

ClinicalTrials.gov. NCT05293561. Registered on March 24, 2022.
Kinematics and behaviour in fish escape responses: guidelines for conducting, analysing and reporting experiments
Authors: Roche Dominique G. , Tytell Eric D. , Domenici Paolo
Published: July 2023

Work carried out since the late 1970s has provided key insights into the comparative biomechanics, kinematics, behaviour and neurobiology of fish escape responses. An escape response is an ecologically important behaviour used by fishes to evade predation and aggression via rapid swimming movements. With environmental change expected to affect the physiology and biomechanics of aquatic ectotherms, there is a growing interest in understanding how environmental stressors affect the swimming performance and behaviour of fishes during escape responses, particularly in the context of predator–prey interactions. As the study of fish swimming continues to expand, there have been repeated calls to standardise experiments and reporting practices to facilitate integrative and comparative studies. Here, we provide a set of practical guidelines for conducting, analysing and reporting experiments on escape responses in fish, including a reporting checklist to assist authors undertaking these experiments. These resources will facilitate executing and reporting escape response experiments in a rigorous and transparent fashion, helping to advance the study of fish swimming in an era of rapid environmental change.
The allometric scaling of oxygen supply and demand in the California horn shark, Heterodontus francisci
Authors: Prinzing Tanya S. , Bigman Jennifer S. , Skelton Zachary R. , Dulvy Nicholas K. , Wegner Nicholas C.
Published: July 2023

The gill surface area of aquatic ectotherms is thought to be closely linked to the ontogenetic scaling of metabolic rate, a relationship that is often used to explain and predict ecological patterns across species. However, there are surprisingly few within-species tests of whether metabolic rate and gill area scale similarly. We examined the relationship between oxygen supply (gill area) and demand (metabolic rate) by making paired estimates of gill area with resting and maximum metabolic rates across ontogeny in the relatively inactive California horn shark, Heterodontus francisci. We found that the allometric slope of resting metabolic rate was 0.966±0.058 (±95% CI), whereas that of maximum metabolic rate was somewhat steeper (1.073±0.040). We also discovered that the scaling of gill area shifted with ontogeny: the allometric slope of gill area was shallower in individuals <0.203 kg in body mass (0.564±0.261), but increased to 1.012±0.113 later in life. This appears to reflect changes in demand for gill-oxygen uptake during egg case development and immediately post hatch, whereas for most of ontogeny, gill area scales in between that of resting and maximum metabolic rate. These relationships differ from predictions of the gill oxygen limitation theory, which argues that the allometric scaling of gill area constrains metabolic processes. Thus, for the California horn shark, metabolic rate does not appear limited by theoretical surface-area-to-volume ratio constraints of gill area. These results highlight the importance of data from paired and size-matched individuals when comparing physiological scaling relationships.
Influence Campaigns
Authors: Sadler Evan
Published: July 2023

Firms and politicians, among others, invest heavily to influence people’s opinions. Because peers influence one another, these efforts must account for social networks. Using a model of opinion dynamics with a non-degenerate steady state, I develop a new measure of influence, and I highlight how opinion fluctuations impact influence campaigns. If agents interact less frequently with those holding different opinions, the variance of public opinion decreases. Consequently, a risk-averse planner focuses on persuading a large majority of agents in a small set of tightly knit groups, while a risk-loving planner makes much broader appeals. (JEL D11, D72, D83, D85, Z13)
Equilibrium Screening and Categorical Inequality
Authors: Fosgerau Mogens , Sethi Rajiv , Weibull Jörgen
Published: July 2023

We analyze equilibrium outcomes under costly screening of candidates from distinct categories. Candidates choose how much effort to invest in skill acquisition, and the screener decides how carefully to screen each candidate. Typically, there are multiple equilibria, and ex ante identical individuals in different categories can receive different equilibrium treatment. The imposition of a quota for an initially disadvantaged group can result in increased screening intensity and skill investment by destabilizing the least active equilibrium. The endogeneity of screening enables powerful comparative statics, which we use to unify different strands in the literature on discrimination. (JEL D63, D82, D83, J24, J31, J71, M51)
Keeping Up with “The Joneses”: Reference-Dependent Choice with Social Comparisons
Authors: Langtry Alastair
Published: July 2023

Keeping up with “The Joneses” matters. This paper examines a model of reference-dependent choice where reference points are determined by social comparisons. An increase in the strength of social comparisons, even by only a few agents, increases consumption and decreases welfare for everyone. Strikingly, a higher marginal cost of consumption can increase welfare. In a labor market, social comparisons with coworkers create a big fish in a small pond effect, inducing incomplete labor market sorting. Further, it is the skilled workers with the weakest social networks who are induced to give up income to become the big fish. (JEL D85, J22, J24, J61)
The identification of high-performing antibodies for Coiled-coil-helix-coiled-coil-helix domain containing protein 10 (CHCHD10) for use in Western Blot, immunoprecipitation and immunofluorescence
Authors: Ayoubi Riham , Alshafie Walaa , Southern Kathleen , McPherson Peter S. , Laflamme Carl ,   NeuroSGC/YCharOS/EDDU collaborative group
Published: July 2023

CHCHD10 is a mitochondrial protein, implicated in the regulation of mitochondrial morphology and cristae structure, as well as the maintenance of mitochondrial DNA integrity. Recently discovered to be associated with amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) in its mutant form, the scientific community would benefit from the availability of validated anti-CHCHD10 antibodies. In this study, we characterized four CHCHD10 commercial antibodies for Western Blot, immunoprecipitation, and immunofluorescence using a standardized experimental protocol based on comparing read-outs in knockout cell lines and isogenic parental controls. As this study highlights high-performing antibodies for CHCHD10, we encourage readers to use it as a guide to select the most appropriate antibody for their specific needs.
Designing a behaviour change intervention to address the behavioural risk factors for stillbirth: A study protocol
Authors: Escañuela Sánchez Tamara , Matvienko-Sikar Karen , Greene Richard A. , Byrne Molly , O'Donoghue Keelin
Published: July 2023

Introduction

Stillbirth is a devastating outcome that, in some cases, has the potential to be prevented by addressing some of its modifiable risk factors such as smoking, alcohol consumption, illicit drug use, high maternal weight, lack of attendance to antenatal care, and sleep position. The aim of this study will be to design a behaviour change intervention focusing on the behavioural risk factors for stillbirth and based on the COM-B model and the Behaviour Change Wheel (BCW) systematic framework.

Methods

The first stage of the BCW framework involves understanding the target behaviour and defining the problem in behavioural terms. The second stage involves identifying intervention options, including intervention functions and policy categories. Finally, the third stage involves identifying content and implementation options, including behaviour change techniques (BCTs) and the mode of delivery. We will use multiple studies already conducted in our research team to inform the different stages of the BCW framework, these include a series of systematic reviews of the literature, qualitative interviews with pregnant women, and a survey study with healthcare professionals. Further, we will utilise a stakeholder group to obtain input through the process of the design of the intervention.

Discussion

This protocol provides a systematic and evidence-based approach to intervention design. The systematic review of the literature, qualitative interviews, and expert consensus workshops will ensure that the intervention design is based on the needs and preferences of pregnant women, healthcare professionals, and stakeholders involved in stillbirth prevention. The proposed intervention could be adapted and implemented in other settings to prevent stillbirth in high-risk populations.
Classification of dental implant systems using cloud-based deep learning algorithm: an experimental study
Authors: Kong Hyun Jun
Published: July 2023

Background: This study aimed to evaluate the accuracy and clinical usability of implant system classification using automated machine learning on a Google Cloud platform.Methods: Four dental implant systems were selected: Osstem TSIII, Osstem USII, Biomet 3i Os-seotite External, and Dentsply Sirona Xive. A total of 4,800 periapical radiographs (1,200 for each implant system) were collected and labeled based on electronic medical records. Regions of interest were manually cropped to 400×800 pixels, and all images were uploaded to Google Cloud storage. Approximately 80% of the images were used for training, 10% for validation, and 10% for testing. Google automated machine learning (AutoML) Vision automatically executed a neural architecture search technology to apply an appropriate algorithm to the uploaded data. A single-label image classification model was trained using AutoML. The performance of the mod-el was evaluated in terms of accuracy, precision, recall, specificity, and F1 score.Results: The accuracy, precision, recall, specificity, and F1 score of the AutoML Vision model were 0.981, 0.963, 0.961, 0.985, and 0.962, respectively. Osstem TSIII had an accuracy of 100%. Osstem USII and 3i Osseotite External were most often confused in the confusion matrix.Conclusion: Deep learning-based AutoML on a cloud platform showed high accuracy in the classification of dental implant systems as a fine-tuned convolutional neural network. Higher-quality images from various implant systems will be required to improve the performance and clinical usability of the model.
On Some Aspects of Financing Large-Scale Investment Projects in Modern Conditions
Authors: Mazhara E.
Published: July 2023

The overdue changes in the world geopolitical alignments, along with the change in the role of Russia in the world economy, are confirmed by the course of a special military operation. For the current stage of economic development, systemic solutions are needed to ensure the solution of the tasks set by the President of the Russian Federation in the shortest possible time. For the economic sphere, this concerns its restructuring as soon as possible for subsequent functioning in the conditions of mobilization of all available resources. The implementation of large-scale (priority) investment projects is the tool that makes the maximum contribution to the formation of the country’s GDP, provides the conditions for its preservation and development in the long term. Therefore, the study is aimed at identifying some aspects of financing large-scale investment projects in modern conditions.
Features of Operational Coordination in the Procurement of Strategic Types of Products
Authors: Abramova E.
Published: July 2023

This article discusses modern aspects of operational coordination in the procurement of strategic products.

The peculiarities of relations between suppliers and consumers at the interfunctional and interorganizational levels of interaction within the framework of mutual agreement on the procedures for selecting suppliers, concluding contracts, placing orders, organizing supplies and paying for goods/services are studied.

The main emphasis is placed on the harmonization of operational procurement procedures within the framework of partnerships based on reaching compromises between the participants of the CP. It is shown that in the context of the formation of long-term relationships with key partners, interaction should be based on the principles of trust and mutual benefit.

In conclusion, the cycle of coordination of operational procurement procedures in terms of partnerships between suppliers and consumers is presented.
Development of the Risk Management System for Innovative Projects in the Framework of the Integrated Management System of the Retailers
Authors: Zorin A. , Pokamyestov I.
Published: July 2023

The article examines the investment attractiveness of the Special Economic Zone «Alabuga». The mechanism of attracting Russian and foreign investments in the development of this special economic zone is considered. The volume, dynamics and structure of investments are analyzed. A comparison of the volume of investments in 2020 and in the conditions of tightened sanctions was carried out. The result of the scientific work were recommendations for the further development of «Alabuga».
SONHAR COM A SORBONNE? VOCÊ VEIO DO VALE DO IPÊ! A cor da Baixada Fluminense
Authors: Teixeira - Ndandá Kialunda Ana Sarah Cardoso , Ferreira Geisa
Published: July 2023

Este artigo discute a relação entre o recorte racial que abarca o processo de formação da Baixada Fluminense do Rio de Janeiro e a construção do pensamento comum de que pessoas oriundas das periferias estão sentenciadas geograficamente a espaços destinados à lonjura e pobreza. Trata-se de uma pesquisa de abordagem qualitativa, tendo como procedimento técnico o levantamento bibliográfico e está delineada na metodologia afetiva e na escrevivência, uma vez que parte da experiência vivida no seio da comunidade familiar e territorial de uma das autoras. De acordo com as análises realizadas é possível considerar a existência de um projeto de sociedade articulado pelas elites e agentes públicos (litoral - formado por pessoas brancas), com base na distribuição socioespacial, que inviabiliza a população periférica (“sertão distante” - formado por uma população de cor), sobretudo jovem, desde muito cedo de ousar sonhar. Em razão disto, pretende-se contribuir com o amplo debate acerca do direito à cidade enquanto instrumento de transformação da realidade social e empoderamento da juventude negra e periférica.
MUSEU DA MARÉ – QUANDO A MEMÓRIA SE TORNA FERRAMENTA DE LUTA E RESISTÊNCIA
Authors: Silva Lourenço Cezar da , Do Nascimento Diogo Silva
Published: July 2023

O presente artigo é baseado na dissertação de mestrado intitulada “Do Ceasm ao Museu - o lugar de memória ou a memória do lugar”, defendida em 2018, no Programa de Pós-Graduação em Educação da UFRJ. Nesse processo, foi identificado que o Museu da Maré não apresenta uma história oficial sobre o bairro Maré. Na verdade, de forma interativa, o espaço relaciona as memórias dos mediadores às memórias dos visitantes. Outra característica do Museu é que ele foi criado e é mantido pelos próprios moradores e faz parte de uma estratégia de seus fundadores para fortalecer uma identidade coletiva e sentimento de pertencimento para que ampliasse o número de moradores consciente de seus direitos e capazes de reivindicar políticas públicas que melhorem a situação do Bairro Maré, no Rio de Janeiro. Depois de 15 anos de existência, essa estrutura, estruturada e estruturante, impressiona-nos por sua vitalidade na disputa de sentidos, de sentimentos e do ser favelado, que segue a sua luta pelo direito à Favela, à cidade e à memória.
Hyperosmolar, hyperglycaemic state: a case study
Authors: Rowberry Rowena , Mortimore Gerri
Published: July 2023

Hyperosmolar, hyperglycaemic state (HHS) is diagnosed from a triad of symptoms: severe hyperglycaemia, profound dehydration and a high serum osmolality. Often, patients are admitted confused, which emphasises the importance of obtaining good collateral histories where possible. This article will explore a case study and examine the clinical symptoms, pathophysiology and evidence-based management of HSS to highlight how the assessment, timely diagnosis and treatment of HHS is a complex and challenging task.
Making Extra-Long Bridges A Reality
Authors: Knight Helen
Published: July 2023

UK researchers model how to safely span long distances in the future
USING A DIGITAL INCLINOMETER SIGNIFICANTLY IMPROVES THE ACCURACY OF DEROTATION OSTEOTOMY: A SIMULATION STUDY
Authors: Watts Daniel , Bye Daniel , Nelson Divya , Chase Helen , Nunney Ian , Marshall Tom , Sanghrajka Anish
Published: July 2023

Introduction

Derotation osteotomies are commonly performed in paediatric orthopaedic and limb reconstruction practice. The purpose of this study was to determine whether the use of a digital inclinometer significantly improves the accuracy in attaining the desired correction.

Materials & Methods

We designed an electronic survey regarding derotation femoral osteotomy (DFO) including methods of intra-operative angular correction assessment and acceptable margins of error for correction. This was distributed to 28 paediatric orthopaedic surgeons in our region. A DFO model was created, using an anatomic sawbone with foam covering. 8 orthopaedic surgeons each performed two 30-degree DFOs, one using K-wires and visual estimation (VE), and the other using a Digital Inclinometer (DI). Two radiologists reported pre and post procedure rotational profile CT scans to assess the achieved rotational correction.

Results

There was a 68% response rate to the survey. The most popular methods of estimating intra-operative correction were reported to be K-wires and rotation marks on bone. The majority of respondents reported that a 6–10 degree margin of error was acceptable for a 30-degree derotation. This was therefore set as the upper limit for acceptable error margin in the simulation study. The mean error in rotation in the VE group of simulated DFO was 19.7 degrees, with error>5 degrees and error>10 degrees in 7 (88%) and 6 (75%) cases respectively. Mean error in DI group was 3.1 degrees, with error>5 degrees in 1 case (13%).

Conclusions

Our results show that the compared to conventional techniques, the use of an inclinometer significantly improves the accuracy of femoral de-rotation and significantly reduces the incidence of unacceptable errors in correction. We would suggest that digital inclinometers be used to assess intra-operative correction during derotation osteotomies.
POSTOPERATIVE PROTOCOLS FOR LOWER EXTREMITY FREE FLAP RECONSTRUCTIONS: A NATIONAL SURVEY OF UK MAJOR TRAUMA CENTRES
Authors: Georgiannakis Ariadni , Glynou Sevasti Panagiota , Ackling Edward , Bystrzonowski Nicola , Pafitanis Georgios , Diver Andrew
Published: July 2023

Introduction

Despite the established guidelines on lower extremity free flap reconstruction by the British Orthopaedic Association Standard for Trauma (BOAST-4) the post-operative care has yet to be standardised. There is currently no coherent evidence in the literature regarding clinical monitoring, warming, dangling and compression; the optimal regimes and their respective physiological benefits. The aim of this study is to survey all UK Major Trauma Centres (MTCs) with regards to the post-operative care of lower extremity free flaps and elucidate the current protocols for clinical monitoring, warming, dangling and compression.

Materials & Methods

All UK-based adult MTCs were surveyed. We formulated a detailed questionnaire to enquire about the post-operative care of lower extremity free flap reconstructions; the number of free flap reconstructions per month and take backs per month and for which post-operative methods a protocol is used in each MTC. We asked specific questions concerning: clinical monitoring, warming, dangling and compression. This questionnaire was distributed to consultant leads in the form of multiple choice questions, with an option of free-text box for further comments, using JISC online surveys. Results were analysed in Excel and presented in percentages.

Results

The 28 adult MTCs were contacted. The results showed a lack of formal regional protocols with great variability, suggesting there is no general consensus on post-operative care of lower extremity free flap reconstructions with regards to clinical monitoring, warming, dangling and compression.

Conclusions

This survey of UK MTCs on the post-operative protocols for lower extremity free flap reconstruction demonstrated lack of evidence, consensus and large variability in common practice which requires standardisation.
A RETROSPECTIVE REVIEW OF THE THERAPEUTIC CHALLENGES OF 16 FITBONE INTRAMEDULLARY FEMORAL LENGTHENINGS COMPLETED AT SHEFFIELD CHILDREN'S HOSPITAL BETWEEN 2021 AND 2022
Authors: Tunbridge Rebecca , Mackarel Christina
Published: July 2023

Introduction

At Sheffield Children's Hospital, treatment of leg length discrepancy is a common procedure. Historically, this has been done with external fixators. With the development in intramedullary technology, internal nails have become the preferred modality for long bone lengthening in the adolescent population. However, it is important to review whether this technology practically reduces the known challenges seen and if it brings any new issues. Therefore, the aim of this review is to retrospectively evaluate the therapeutic challenges of 16 fit-bone intramedullary femoral lengthening's at Sheffield Children's Hospital between 2021–2022.

Materials & Methods

The international classification of function (ICF) framework was used to differentiate outcomes. The patient's therapy notes were retrospectively reviewed for themes around structural, activity and participation limitation. The findings were grouped for analysis and the main themes presented.

Results

There were 8 males, mean age 17.4 years (range 17–18) and 8 females, mean age 15.9 years (range 14–18). 5 right and 11 left femurs were lengthened. Underlying pathology varied amongst the 16 patients. All patients went into a hinged knee brace post operatively. Structural limitations included: pain, fixed flexion deformity of the knee, loss of knee flexion, quadriceps muscle lag, muscle spasms and gluteal weakness. The primary activity limitation was reduced weight bearing with altered gait pattern. Participation limitations included reduced school attendance and involvement in activities with peers. Access to Physiotherapy from local services varied dramatically. Five of the cohort have completed treatment.

Conclusions

Anecdotally, intramedullary femoral lengthening nails have perceived benefits for families compared to external fixators in the adolescent population. However, there remain musculoskeletal and psychosocial outcomes requiring therapeutic management throughout the lengthening process and beyond. Therefore, quantifying these outcomes is essential for measuring the impact on each patient for comparison. To interpret these themes, we need to evaluate the outcomes objectively, this was not done consistently in this review. Future research should look at outcome measures that are sensitive to all aspects of the ICF. With an aim of improving the therapeutic treatment provided and the overall outcome for the children treated.
EARLY EXPERIENCE OF THE FITBONE NAIL IN ADOLESCENCE: A LEARNING CURVE
Authors: Musielak Bartosz , Green Nick , Giles Stephen , Madan Sanjeev , Fernandes James
Published: July 2023

Introduction

Intramedullary lengthening devices have been in use in older children with closed /open growth plates with good success. This study aims to present the early experience of the FITBONE nail since withdrawal of the PRECICE nail.

Materials & Methods

Retrospective analysis of both antegrade and retrograde techniques were utilized. Only patients where union was achieved and full weight bearing commenced were included. The complication rate, length gained, distraction index, weight bearing index (WBI) as well as mechanical axes were analysed.

Results

14 (7 males, 7 females) of a total of 16 (7 males, 7 females) patients with a mean age of 16.9 years with varied diagnosis of LLD were analysed. The mean length gained was 38 mm with an average distraction index of 0,74 mm/day. WBI in these patients on average was 59,6 days/cm lengthened. 6 complications were observed, including two nonunions (successfully treated) and a knee subluxation. Mechanical axis deviation improved from 13,3 mm to 6 mm on average. Overall there has been a nonsignificant tendency for WBI to decrease (Spearman's rank correlation coefficient −0.47, p=0.08) with increasing number of cases done, while no correlation between length gained and WBI (−0.01, p=0.96, respectively) was observed. Some nuances will be discussed.

Conclusions

Limb lengthening with the FITBONE nail is relatively safe and efficient, however no significant change was seen in the outcome with previous motorized nails.
“THE FRAMES CHAT”: DOES THE PREOPERATIVE FRAMES COUNSELLING SESSION ADEQUATELY PREPARE PATIENTS FOR LIFE WITH A CIRCULAR FRAME?
Authors: Bridgeman Philippa , Carter Lucy , Heeley Emily
Published: July 2023

Introduction

Introduction: Pre-operative counselling to prepare patients for frame surgery is important to ensure expectations of recovery and rehabilitation are realistic and anxiety is reduced. The aim of the study was to ascertain whether the current clinical nurse specialist frames counselling session (CNS FCS) prepared patients adequately for life with a frame as well as to explore information patients felt was missing.

Materials & Methods

Materials and Method: Patient reported questions were used to assess frames patient views on the CNS FCS. Thirty frames patients were asked about the CNS FCS information, involvement in decision making, factors influencing frames surgery decision and patient experience.

Results

Results: There were 27 patients who received CNS frames counselling and 82% of those (N=22) said they definitely received enough information to make a decision when faced with a choice of surgical plans. 85% (N=23) reported definitely feeling involved in the decision making process with factors contributing to choosing frame treatment being lower risk of deep infection, quicker / safer recovery and advice from the limb reconstruction team. 48% (N=13) definitely felt the CNS FCS gave them a realistic idea of what it's like to live with a frame and 52% (N=14) answered yes to some extent. Feedback on providing more information around sleeping with a frame was provided which has been added to future CNS FCS.

Conclusions

Conclusion: The current CNS FCS does prepare patients for frames surgery and life with a circular frame and important points raised by patients in this study have been added to future patient information sessions. Regular patient satisfaction audits should be carried out to ensure information remains useful and current patient needs and concerns are met.
THE USE OF CALCIUM SULPHATE SYNTHETIC BONE GRAFT IN A PAEDIATRIC POPULATION
Authors: Wilson Graeme , Prior Christopher
Published: July 2023

Introduction

The purpose of this study was to analyse the efficacy and complications associated with the use of Calcium Sulphate synthetic bone graft in a paediatric population. There are no published articles on the use in children.

Materials & Methods

A retrospective review was undertaken of the notes, microbiology, and X-Rays of 17 cases (in 15 patients) of calcium sulphate use in paediatric patients. As well as patient demographic data, data collected included indication, use of additional agents (antibiotics), return to theatre, and wound complications. Major complications were also assessed for.

Results

There were 17 cases, in 15 patients, in our case series where calcium sulphate synthetic bone graft was used. The average patient age was 12.0 years (range 5 years – 17 years). Indications for use included likely infection (12), possible infection (3), and 2 elective finger cases (enchondroma and osteotomy). The humerus was the most common target site (5), followed by the femur (4), tibia (3), calcaneum (2), finger (2) and metatarsal (1) also included. There were positive intra-operative microbiology samples for eleven cases (Staphylococcus aureus and Staphylococcus epidermidis). Antibiotics were used in all cases except the elective finger surgery, and choice ranged between vancomycin, gentamicin, or a combination of both. Two patients required return to theatre for management of ongoing deep infection, although one case was later deemed to be non-infective osteomyelitis. Seven patients had undergone debridements prior to the definitive one with calcium sulphate (5 without Calcium Sulphate, 2 with Calcium Sulphate). Three patients experienced wound issues in the form of discharge/leakage, all were managed with dressings and did not require return to theatre.

Conclusions

Calcium Sulphate synthetic bone graft, with addition of antibiotics, is an efficacious treatment in the paediatric population and is not associated with any major complications. Wound discharge should be observed for, and patients/parents warned about this, but only as per the adult population.
COVID-19-ENFORCED CHANGE OF PRACTICE. USING INTERNAL FIXATION IN PREFERENCE TO CIRCULAR EXTERNAL FIXATION: LESSONS LEARNED
Authors: Thompson Emmet , Shamoon Sameer , Qureshi Amir
Published: July 2023

Introduction

Circular external fixators are fundamental to lower limb reconstruction, primarily in situations with a high risk of infection such as open fractures. During the Covid-19 pandemic, use of circular frames in our unit decreased, following departmental approval, due to resource management and in keeping with BOA guidelines as we opted to “consider alternative techniques for patients who require soft tissue reconstruction to avoid multiple operations”. These alternatives included the use of internal fixation (plate osteosynthesis and intramedullary nailing) as a measure to reduce the number of hospital attendances for patients and to conserve resources. This change in practice has continued in part following the pandemic with the increased use of internal fixation in cases previously deemed unsuitable for such techniques. We present our experience of this treatment strategy in the management of complex lower limb injuries, focusing on outcomes and consider the lessons learnt.

Materials & Methods

Data of patients with complex lower limb injuries treated before, during and after the pandemic were collected from our in-house trauma database, theatre records and follow up clinics. The rationale for choosing other techniques over a circular frame, the type of alternative technique used, the cost of such alternatives, the need for soft tissue reconstruction, time to recovery, complications and amputation rates were compared among groups.

Results

These data suggest comparable outcomes between circular frames and alternative techniques can be achieved. A notable reduction in the number of circular frames applied during the review period was observed. Furthermore, frame fixation was associated with more frequent outpatient review and the associated implications for resource management.

Conclusions

Conclusion: The Covid-19 pandemic has posed great challenges to the Trauma and Orthopaedic community, forcing us to be flexible by adopting alternative treatment methods to traditional circular external fixation. These alternatives have proven feasible and potentially more cost effective, prompting their adoption in the post pandemic era. However, this change of practice is not without potential consequences and continued investigation is warranted.
SAFETY AND EFFICACY OF DULOXETINE IN PATIENTS UNDERGOING TOTAL HIP OR KNEE ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS.
Authors: Qayum Kaif , Ng Zhan , Sudarshan Veena , Kudhail Kavina , Sapra Huzaefah , Guerero Daniel , Daoub Ahmed
Published: July 2023

Patients undergoing total hip or knee arthroplasty (THA/TKA) are commonly associated with high pain scores and narcotic use. Duloxetine is effective in relieving chronic pain. The aim of this study was to evaluate the safety and efficacy of duloxetine for pain management following THA/TKA.

Five major databases (PubMed, Embase, Scopus, Cochrane, and Web of Science) were searched for randomised controlled trials (RCTs) that compared duloxetine to placebo in patients that underwent THA/TKA. The primary outcome was pain reduction with rest and movement at short-term and long-term time intervals. Secondary outcomes were the use of analgesics, length of stay, and safety profile. The risk of bias was assessed using the Cochrane tool. Data were pooled using RevMan 5.4. The results were reported as mean difference (MD) or standardised MD (SMD) and 95% confidence intervals (CI).

Eight RCTs with 767 patients were included. 50.2% (n=385/767) of patients received duloxetine. After one day, duloxetine was superior to the control regarding pain reduction with rest (SMD= −0.22 [−0.41, −0.03], p=0.02) after sensitivity analysis and pain reduction at movement (SMD= −0.39 [−0.55, −0.24], p<0.001). Similarly, after 12 weeks, duloxetine significantly reduced pain with rest (SMD= −0.3 [−0.52, −0.09], p=0.006) and pain with movement (SMD= −0.52 [−0.87, −0.17], p=0.003). In addition, after sensitivity analysis, duloxetine was associated with less analgesic use after one day (MD= −4.65 [−7.3, −2.01], p<0.001) and two days (MD= −5.65 [−10.62, −0.67], p=0.03). Patients who received duloxetine also required fewer analgesics after three days. However, there was no significant difference between the duloxetine and control groups in analgesic use after one week, length of stay, and adverse events.

Duloxetine was superior to the placebo regarding short-term and long-term pain reduction with rest and movement following THA/TKA. Duloxetine reduced postoperative analgesic use. There was no significant difference between duloxetine and placebo regarding adverse events and length of stay.
RETRIEVAL ANALYSIS OF DUAL MOBILITY POLYETHYLENE LINERS FOR TOTAL HIP ARTHROPLASTY
Authors: Smeeton Mackenzie , Wilcox Ruth , Isaac Graham , Anderson James , Board Tim , Van Citters Douglas W. , Williams Sophie
Published: July 2023

Dual Mobility (DM) Total Hip Replacements (THRs) were introduced to reduce dislocation risk, which is the most common cause of early revision. The in-vivo mechanics of these implants is not well understood, despite their increased use in both elective and trauma settings. Therefore, the aim of this study was to comprehensively assess retrieved DM polyethylene liners for signs of damage using visual inspection and semi-quantitative geometric assessment techniques.

Retrieved DM liners (n=20) were visually inspected for the presence of seven established modes of polyethylene damage. If embedded debris was identified on the external surface, its material composition was characterised using energy-dispersive x-ray analysis (EDX). Additionally, each liner was geometrically assessed for signs of wear/deformation using a validated methodology.

Visual inspection of the liners revealed that scratching and pitting were the most common damage modes on either surface. Burnishing was observed on 50% and 15% of the internal and external surfaces, respectively. In addition, embedded debris was identified on 25% of the internal and 65% of the external surfaces. EDX analysis of the debris identified several materials including iron, titanium, cobalt-chrome, and tantalum. Geometric analysis demonstrated highly variable damage patterns across the liners.

The results of this study provide insight into the in-vivo mechanics of DM bearings. For example, the results suggest that the internal bearing (i.e., between the head and liner) acts as the primary articulation site for DM-THRs as evidenced by a higher incidence of burnishing and larger, more concentrated regions of penetration across the liners’ internal surfaces. Furthermore, circumferential, and crescent-shaped damage patterns were identified on the articulating surfaces of the liners thus providing evidence that these components can rotate within the acetabular shell with varying degrees of mobility. The mechanics of DM bearings are complex and may be influenced by several factors (e.g., soft tissue fibrosis, patient activities) and thus further investigation is warranted.

Finally, the results of this study suggest that DM liners may be susceptible to ex-vivo surface damage and thus caution is advised when handling and/or assessing these types of components.
POSITIONING THE LIPPED LINER IN TOTAL HIP ARTHROPLASTY: A KINEMATIC MODEL ANALYSIS OF LIP ORIENTATION, CUP POSITION, AND STEM ANTEVERSION
Authors: Navacchia Alessandro , Pagkalos Joseph , Davis Edward
Published: July 2023

We have previously reported on the improved all-cause revision and improved revision for instability risk in lipped liner THAs using the NJR dataset. These findings corroborate studies from the Australian (AOANJRR) and New Zealand (NZOA) joint registries. The optimal orientation of the lip in THAs utilising a lipped liner remains unclear to many surgeons. The aim of this study was to identify impingement-free optimal liner orientations whilst considering femoral stem version, cup inclination and cup version.

A cementless THA kinematic model was developed using a 20 degree XLPE liner. Physiological ROM and provocative dislocation manoeuvre analyses were performed. A total of 9 cup positions were analysed (inclination 30–40–50 degrees, anteversion 5-15-25 degrees) and combined with 3 stem positions (anteversion 0-15-30 degrees) and 5 lip orientations (right hip 11 to 7 o'clock).

Some lip orientation/component position combinations lead to impingement within the physiological ROM range. Using a lipped liner increases the femoral head travel distance prior to dislocation when impingement occurs in the plane of the lip. In THAs with a cup inclination of 30 and 40 degrees, inferior lip orientations (7–8 o'clock for a right hip) performed best. Superior lip orientation performed best with a cup inclination of 50 degrees. Femoral stem version has a significant effect on the range of movement prior to impingement and hence the preferred lip orientation.

The optimal orientation of the lip in lipped liner THA is dependent on the position of both the acetabular and femoral components. In the common component orientation combination of stem anteversion 15, cup inclination 40 and cup anteversion 15, the optimal lip orientation was postero-inferiorly (8 o'clock for a right hip). Preventing impingement during physiological ROM is possible with appropriate lip liner orientation.
THE HISTORIC AND PROJECTED HIP FRACTURE BURDEN AND INCIDENCE IN SCOTLAND: 2017 – 2029
Authors: Harris Euan , Farrow Luke , Martin Caroline , Adam Karen
Published: July 2023

Hip fracture represents a significant challenge, placing increasing pressure on health and social care services in Scotland. This study establishes the ‘historic’ hip fracture burden, namely, the annual number of hip fractures in Scotland, and respective incidence, between 2017 – 2021. Furthermore, the ‘projected’ hip fracture burden and incidence from 2022 – 2029 was estimated, to inform future capacity and funding of health and social care services.

The number of individuals with a hip fracture in Scotland between 2017 and 2021 was identified through the Scottish Hip Fracture Audit, enabling the annual number of hip fractures and respective incidence between 2017 – 2021 to be calculated. Projection modelling was performed using Exponential Smoothing and Auto Regressive Integrated Moving Average to estimate the number of hip fractures occurring annually from 2022 – 2029. A combined average projection was employed to provide a more accurate forecast. Accounting for predicted changes within the population demographics of Scotland, the projected hip fracture incidence up to 2029 was calculated.

Between 2017 and 2021 the annual number of hip fractures in Scotland increased from 6675 to 7797 (15%), with an increase in incidence from 313 to 350 per 100,000 (11%) of the at-risk population. Hip fracture was observed to increase across all groups, notably males, and the 70–79 and 80–89 age cohorts. By 2029, the combined average projection estimated the annual number of hip fractures at 10311, with an incidence rate of 463 per 100,000, representing a 32% increase from 2021. The largest percentage increase in hip fracture by 2029 occurs in the 70–79 and 80–89 age cohorts (57% and 53% respectively). Based upon these projections, overall length of hospital stay following hip fracture will increase by 60699 days per annum by 2029, incurring an additional cost of at least £25 million.

Projection modelling demonstrates the annual number of hip fractures in Scotland will increase substantially by 2029, with significant implications for health and social care services. This increase in hip fracture burden and incidence is influenced strongly by changing population demographics, primarily an ageing population.
REVISION BEARING SELECTION FOLLOWING CERAMIC BEARING FRACTURE: A PATIENT SAFETY DECISION
Authors: Howard Daniel , Manktelow Brad , DeSteiger Richard , Skinner John , Ashford Robert
Published: July 2023

Ceramic bearing fractures are rare events, but mandate revision and implantation of new bearings. Revisions using metal heads have been reported to lead to gross volumetric head wear (due to abrasive retained ceramic micro-debris), cobalt toxicity, multi-organ failure and death. Such complications are widely published (50+ reports), yet we know that patients continue to be put at risk. Using data from the NJR and AOANJRR, this study seeks to compare the risk of re-revision and death by revision bearing combination following a ceramic bearing fracture.

Data were extracted from the NJR and AOANJRR, identifying revisions for ceramic bearing fracture. Subsequent outcomes of survival, re-revision and death were compared between revision bearing combinations (ceramic-on-ceramic, ceramic-on-polyethylene, and metal-on-polyethylene).

366 cases were available for analysis from the NJR dataset (MoP=34, CoP=112, CoC=221) and 174 from the AOANJRR dataset (MoP=17, CoP=44, CoC=113). The overall incidence rate of adverse outcome (revision or death) was 0.65 for metal heads and 0.23 for ceramic head articulations (p=0.0012) across the whole time period (NJR). Kaplan-Meir survival estimates demonstrate an increased risk of both re-revision and death where a metal head has been used vs a ceramic head following revision for ceramic fracture.

There are few decisions in arthroplasty surgery that can lead to serious harm or death for our patients, but revision using a metal head following ceramic bearing fracture is one of them. This study enhances the signal of what is already known but previously only reported as inherently low-level evidence (case reports and small series) due to event rarity. Use of a metal head in revision for ceramic fracture represents an avoidable patient safety issue, which revision guidelines should seek to address.