bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased prevalence of idiopathic scoliosis in patients treated for childhood haematopoietic malignancy
Authors: Sim Francis C. J. , Birley Emma , Khan Almas L. , Loughenbury Peter R. , Millner Peter
Published: August 2021

Aims

The aim of this study was to determine whether there is an increased prevalence of scoliosis in patients who have suffered from a haematopoietic malignancy in childhood.

Methods

Patients with a history of lymphoma or leukaemia with a current age between 12 and 25 years were identified from the regional paediatric oncology database. The medical records and radiological findings were reviewed, and any spinal deformity identified. The treatment of the malignancy and the spinal deformity, if any, was noted.

Results

From a cohort of 346 patients, 19 (5.5%) had radiological evidence of scoliosis, defined as a Cobb angle of > 10°. A total of five patients (1.4% of the total cohort) had a Cobb angle of > 40°, all of whom had corrective surgery. No patient with scoliosis had other pathology as a possible cause of the scoliosis and all had been treated with high doses of steroids for leukaemia, either acute or chronic myeloid, or acute lymphoblastic.

Conclusion

There is an increased prevalence of idiopathic-like scoliosis and larger curves (Cobb angle of > 40°) associated with childhood leukaemia, which has not been previously reported in the literature. Causative factors may relate to the underlying disease process and/or its treatment. Cite this article: Bone Joint J 2021;103-B(8):1400–1404.
Comparison of free vascularized fibular flaps and allograft fibular strut grafts to supplement spinopelvic reconstruction for sacral malignancies
Authors: Wellings Elizabeth P. , Houdek Matthew T. , Owen Aaron R. , Bakri Karim , Yaszemski Michael J. , Sim Franklin H. , Moran Steven L. , Rose Peter S.
Published: August 2021

Aims

Orthopaedic and reconstructive surgeons are faced with large defects after the resection of malignant tumours of the sacrum. Spinopelvic reconstruction is advocated for resections above the level of the S1 neural foramina or involving the sacroiliac joint. Fixation may be augmented with either free vascularized fibular flaps (FVFs) or allograft fibular struts (AFSs) in a cathedral style. However, there are no studies comparing these reconstructive techniques.

Methods

We reviewed 44 patients (23 female, 21 male) with a mean age of 40 years (SD 17), who underwent en bloc sacrectomy for a malignant tumour of the sacrum with a reconstruction using a total (n = 20), subtotal (n = 2), or hemicathedral (n = 25) technique. The reconstructions were supplemented with a FVF in 25 patients (57%) and an AFS in 19 patients (43%). The mean length of the strut graft was 13 cm (SD 4). The mean follow-up was seven years (SD 5).

Results

There was no difference in the mean age, sex, length of graft, size of the tumour, or the proportion of patients with a history of treatment with radiotherapy in the two groups. Reconstruction using an AFS was associated with nonunion (odds ratio 7.464 (95% confidence interval (CI) 1.77 to 31.36); p = 0.007) and a significantly longer mean time to union (12 months (SD 3) vs eight (SD 3); p = 0.001) compared with a reconstruction using a FVF. Revision for a pseudoarthrosis was more likely to occur in the AFS group compared with the FVF group (hazard ratio 3.84 (95% CI 0.74 to 19.80); p = 0.109); however, this was not significant. Following the procedure, 32 patients (78%) were mobile with a mean Musculoskeletal Tumor Society Score 93 of 52% (SD 24%). There was a significantly higher mean score in patients reconstructed with a FVF compared with an AFS (62% vs 42%; p = 0.003).

Conclusion

Supplementation of spinopelvic reconstruction with a FVF was associated with a shorter time to union and a trend towards a reduced risk of hardware failure secondary to nonunion compared with reconstruction using an AFS. Spinopelvic fixation supplemented with a FVF is our preferred technique for reconstruction following resection of a sacral tumour. Cite this article: Bone Joint J 2021;103-B(8):1414–1420.
Predictors for poor outcome for conservatively treated traumatic triangular fibrocartilage complex tears
Authors: Xiao Ji-Yang , Liu Bo , Li Lily , Shi Hai-Fei , Wu Feiran
Published: August 2021

Aims

The primary aim of this study was to assess if traumatic triangular fibrocartilage complex (TFCC) tears can be treated successfully with immobilization alone. Our secondary aims were to identify clinical factors that may predict a poor prognosis.

Methods

This was a retrospective analysis of 89 wrists in 88 patients between January 2015 and January 2019. All patients were managed conservatively initially with either a short-arm or above-elbow custom-moulded thermoplastic splint for six weeks. Outcome measures recorded included a visual analogue scale for pain, Patient-Rated Wrist Evaluation, Disabilities of the Arm, Shoulder and Hand score, and the modified Mayo Wrist Score (MMWS). Patients were considered to have had a poor outcome if their final MMWS was less than 80 points, or if they required eventual surgical intervention. Univariate and logistic regression analyses were used to identify independent predictors for a poor outcome.

Results

In total, 76% of wrists (42/55) treated with an above-elbow splint had a good outcome, compared to only 29% (10/34) with a short-arm splint (p < 0.001). The presence of a complete foveal TFCC tear (p = 0.009) and a dorsally subluxated distal radioulnar joint (DRUJ) (p = 0.032) were significantly associated with a poor outcome on univariate analysis. Sex, age, energy of injury, hand dominance, manual occupation, ulnar variance, and a delay in initial treatment demonstrated no significant association. Multiple logistic regression revealed that short-arm immobilization (p < 0.001) and DRUJ subluxation (p = 0.020) were significant independent predictive factors of an eventual poor outcome.

Conclusion

Nonoperative management of traumatic TFCC injuries with above-elbow immobilization is a viable treatment method, particularly in patients without DRUJ subluxation. Early surgery should be considered for patients with dorsal ulnar subluxation treated with short-arm splints to prevent prolonged morbidity. Cite this article: Bone Joint J 2021;103-B(8):1386–1391.
Long-term competing risks for overall and cause-specific failure of rotating-hinge distal femoral arthroplasty for tumour reconstruction
Authors: Ogura Koichi , Fujiwara Tomohiro , Morris Carol D. , Boland Patrick J. , Healey John H.
Published: August 2021

Aims

Rotating-hinge knee prostheses are commonly used to reconstruct the distal femur after resection of a tumour, despite the projected long-term burden of reoperation due to complications. Few studies have examined the factors that influence their failure and none, to our knowledge, have used competing risk models to do so. The purpose of this study was to determine the risk factors for failure of a rotating-hinge knee distal femoral arthroplasty using the Fine-Gray competing risk model.

Methods

We retrospectively reviewed 209 consecutive patients who, between 1991 and 2016, had undergone resection of the distal femur for tumour and reconstruction using a rotating-hinge knee prosthesis. The study endpoint was failure of the prosthesis, defined as removal of the femoral component, the tibial component, or the bone-implant fixation; major revision (exchange of the femoral component, tibial component, or the bone-implant fixation); or amputation.

Results

Multivariate Fine-Gray regression analyses revealed different hazards for each Henderson failure mode: percentage of femoral resection (p = 0.001) and extent of quadriceps muscle resection (p = 0.005) for overall prosthetic failure; extent of quadriceps muscle resection (p = 0.002) and fixation of femoral component (p = 0.011) for type 2 failure (aseptic loosening); age (p = 0.009) and percentage of femoral resection (p = 0.019) for type 3 failure (mechanical failure); and type of joint resection (p = 0.037) for type 4 (infection) were independent predictors. A bone stem ratio of > 2.5 reliably predicted aseptic loosening.

Conclusion

We identified independent risk factors for overall and cause-specific prosthetic failure after rotating-hinge knee distal femoral arthroplasty using a competing risk Fine-Gray model. A bone stem ratio > 2.5 reliably predicts aseptic loosening. An accurate knowledge of the risks of distal femoral arthroplasty after resection for tumour assists surgical planning and managing patient expectations. Cite this article: Bone Joint J 2021;103-B(8):1405–1413.
Minimum five-year outcomes of reverse total shoulder arthroplasty using a trabecular metal glenoid base plate
Authors: Kankanalu Pradeep , Borton Zakk M. , Morgan Marie L. , Cresswell Tim , Espag Marius P. , Tambe Amol A. , Clark David I.
Published: August 2021

Aims

Reverse total shoulder arthroplasty (RTSA) using trabecular metal (TM)-backed glenoid implants has been introduced with the aim to increase implant survival. Only short-term reports on the outcomes of TM-RTSA have been published to date. We aim to present the seven-year survival of TM-backed glenoid implants along with minimum five-year clinical and radiological outcomes.

Methods

All consecutive elective RTSAs performed at a single centre between November 2008 and October 2014 were reviewed. Patients who had primary TM-RTSA for rotator cuff arthropathy and osteoarthritis with deficient cuff were included. A total of 190 shoulders in 168 patients (41 male, 127 female) were identified for inclusion at a mean of 7.27 years (SD 1.4) from surgery. The primary outcome was survival of the implant with all-cause revision and aseptic glenoid loosening as endpoints. Secondary outcomes were clinical, radiological, and patient-related outcomes with a five-year minimum follow-up.

Results

The implant was revised in ten shoulders (5.2%) with a median time to revision of 21.2 months (interquartile range (IQR) 9.9 to 41.8). The Kaplan-Meier survivorship estimate at seven years was 95.9% (95% confidence interval (CI) 91.7 to 98; 35 RTSAs at risk) for aseptic mechanical failure of the glenoid and 94.8% (95% CI 77.5 to 96.3; 35 RTSAs at risk) for all-cause revision. Minimum five-year clinical and radiological outcomes were available for 103 and 98 RTSAs respectively with a median follow-up time of six years (IQR 5.2 to 7.0). Median postoperative Oxford Shoulder Score was 38 (IQR 31 to 45); median Constant and Murley score was 60 (IQR 47.5 to 70); median forward flexion 115° (IQR 100° to 125°); median abduction 95° (IQR 80° to 120°); and external rotation 25° (IQR 15° to 40°) Scapular notching was seen in 62 RTSAs (63.2%).

Conclusion

We present the largest and longest-term series of TM-backed glenoid implants demonstrating 94.8% all-cause survivorship at seven years. Specifically pertaining to glenoid loosening, survival of the implant increased to 95.9%. In addition, we report satisfactory minimum five-year clinical and radiological outcomes. Cite this article: Bone Joint J 2021;103-B(8):1333–1338.
The association of lumbosacral transitional vertebral anomalies with acetabular dysplasia in adult patients with hip-spine syndrome
Authors: Sun Joshua , Chhabra Avneesh , Thakur Uma , Vazquez Louis , Xi Yin , Wells Joel
Published: August 2021

Aims

Some patients presenting with hip pain and instability and underlying acetabular dysplasia (AD) do not experience resolution of symptoms after surgical management. Hip-spine syndrome is a possible underlying cause. We hypothesized that there is a higher frequency of radiological spine anomalies in patients with AD. We also assessed the relationship between radiological severity of AD and frequency of spine anomalies.

Methods

In a retrospective analysis of registry data, 122 hips in 122 patients who presented with hip pain and and a final diagnosis of AD were studied. Two observers analyzed hip and spine variables using standard radiographs to assess AD. The frequency of lumbosacral transitional vertebra (LSTV), along with associated Castellvi grade, pars interarticularis defect, and spinal morphological measurements were recorded and correlated with radiological severity of AD.

Results

Out of 122 patients, 110 (90.2%) were female and 12 (9.8%) were male. We analyzed the radiographs of 122 hips (59 (48.4%) symptomatic left hips, and 63 (51.6%) symptomatic right hips). Average age at time of presentation was 34.2 years (SD 11.2). Frequency of LSTV was high (39% to 43%), compared to historic records from the general population, with Castellvi type 3b being the most common (60% to 63%). Patients with AD have increased L4 and L5 interpedicular distance compared to published values. Frequency of pars interarticularis defect was 4%. Intraclass correlation coefficient for hip and spine variables assessed ranged from good (0.60 to 0.75) to excellent (0.75 to 1.00). Severity of AD did not demonstrate significant correlation with frequency of radiological spine anomalies.

Conclusion

Patients with AD have increased frequency of spinal anomalies seen on standard hip radiographs. However, there exists no correlation between radiological severity of AD and frequency of spine anomalies. In managing AD patients, clinicians should also assess spinal anomalies that are easily found on standard hip radiographs. Cite this article: Bone Joint J 2021;103-B(8):1351–1357.
Cryoablation-aided joint retention surgery for epiphysis involvement in osteosarcoma compared with endoprosthetic replacement
Authors: Li Jing , Lu Yajie , Chen Guojing , Li Minghui , Xiao Xin , Ji Chuanlei , Wang Zhen , Guo Zheng
Published: August 2021

Aims

We have previously reported cryoablation-assisted joint-sparing surgery for osteosarcoma with epiphyseal involvement. However, it is not clear whether this is a comparable alternative to conventional joint arthroplasty in terms of oncological and functional outcomes.

Methods

A total of 22 patients who had localized osteosarcoma with epiphyseal involvement around the knee and underwent limb salvage surgery were allocated to joint preservation (JP) group and joint arthroplasty (JA) group. Subjects were followed with radiographs, Musculoskeletal Tumor Society (MSTS) score, and clinical evaluations at one, three, and five years postoperatively.

Results

Patients in both groups (ten in JP and 12 in JA) did not differ in local recurrence (p ≥ 0.999) and occurrence of metastases (p ≥ 0.999). Overall survival was similar in both groups (p = 0.858). Patients in the JP group had less range of motion (ROM) of the knee (p < 0.001) and lower MSTS scores (p = 0.010) compared with those of the JA group only at one year postoperatively. There was no difference between groups either at three years for ROM (p = 0.185) and MSTS score (p = 0.678) or at five years for ROM (p = 0.687) and MSTS score (p = 0.536), postoperatively. Patients in the JA group tended to have more complications (p = 0.074). Survival of primary reconstruction in the JP group was better than that of the JA group (p = 0.030).

Conclusion

Cryoablation-aided joint-sparing surgery offers native joint preservation with comparable functional recovery and more durable reconstruction without jeopardizing oncological outcomes compared with conventional limb salvage surgery. Cite this article: Bone Joint J 2021;103-B(8):1421–1427.
Reliability and validity of the Unified Classification System for postoperative periprosthetic femoral fractures around cemented polished taper-slip stems
Authors: Jain Sameer , Mohrir Ganesh , Townsend Oliver , Lamb Jonathan N. , Palan Jeya , Aderinto Joseph , Pandit Hemant
Published: August 2021

Aims

This aim of this study was to assess the reliability and validity of the Unified Classification System (UCS) for postoperative periprosthetic femoral fractures (PFFs) around cemented polished taper-slip (PTS) stems.

Methods

Radiographs of 71 patients with a PFF admitted consecutively at two centres between 25 February 2012 and 19 May 2020 were collated by an independent investigator. Six observers (three hip consultants and three trainees) were familiarized with the UCS. Each PFF was classified on two separate occasions, with a mean time between assessments of 22.7 days (16 to 29). Interobserver reliability for more than two observers was assessed using percentage agreement and Fleiss’ kappa statistic. Intraobserver reliability between two observers was calculated with Cohen kappa statistic. Validity was tested on surgically managed UCS type B PFFs where stem stability was documented in operation notes (n = 50). Validity was assessed using percentage agreement and Cohen kappa statistic between radiological assessment and intraoperative findings. Kappa statistics were interpreted using Landis and Koch criteria. All six observers were blinded to operation notes and postoperative radiographs.

Results

Interobserver reliability percentage agreement was 58.5% and the overall kappa value was 0.442 (moderate agreement). Lowest kappa values were seen for type B fractures (0.095 to 0.360). The mean intraobserver reliability kappa value was 0.672 (0.447 to 0.867), indicating substantial agreement. Validity percentage agreement was 65.7% and the mean kappa value was 0.300 (0.160 to 0.4400) indicating only fair agreement.

Conclusion

This study demonstrates that the UCS is unsatisfactory for the classification of PFFs around PTS stems, and that it has considerably lower reliability and validity than previously described for other stem types. Radiological PTS stem loosening in the presence of PFF is poorly defined and formal intraoperative testing of stem stability is recommended. Cite this article: Bone Joint J 2021;103-B(8):1339–1344.
Patient-acceptable symptom state for reporting outcomes following unicompartmental knee arthroplasty
Authors: Plancher Kevin D. , Brite Jasmine E. , Briggs Karen K. , Petterson Stephanie C.
Published: August 2021

Aims

The patient-acceptable symptom state (PASS) is a level of wellbeing, which is measured by the patient. The aim of this study was to determine if the proportion of patients who achieved an acceptable level of function (PASS) after medial unicompartmental knee arthroplasty (UKA) was different based on the status of the anterior cruciate ligament (ACL) at the time of surgery.

Methods

A total of 114 patients who underwent UKA for isolated medial osteoarthritis (OA) of the knee were included in the study. Their mean age was 65 years (SD 10). No patient underwent a bilateral procedure. Those who had undergone ACL reconstruction during the previous five years were excluded. The Knee injury Osteoarthritis Outcome Score Activities of Daily Living (KOOS ADL) function score was used as the primary outcome measure with a PASS of 87.5, as described for total knee arthroplasty (TKA). Patients completed all other KOOS subscales, Lysholm score, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Veterans Rand 12-item health survey score. Failure was defined as conversion to TKA.

Results

Survivorship at ten years was 97% in both the ACL-deficient and ACL-intact groups. The mean survival was 16.1 years (95% confidence interval (CI) 15.3 to 16.8) for the ACL-deficient group and 15.6 years (95% CI 14.8 to 16.361) for the ACL-intact group (p = 0.878). At a mean of nine years (SD 3.5) in the ACL-deficient group, 32 patients (87%) reached the PASS for the KOOS ADL. In the ACL-intact group, at a mean of 8.6 years (SD 3) follow-up, 63 patients (85%) reached PASS for the KOOS ADL. There was no significant difference in the percentage of patients who reached PASS for all KOOS subscales and Lysholm between the two groups.

Conclusion

PASS was achieved in 85% of all UKAs for KOOS ADL, similar to reports for TKA. Fixed-bearing, medial, non-robotically-assisted UKA resulted in 97% survival at ten years in both the ACL-deficient and ACL-intact groups. There was no significant difference in all outcomes between the two groups. Understanding PASS will allow better communication between surgeons and patients to improve the surgical management of patients with single compartment OA of the knee. This study provides mid- to long-term data supporting the use of PASS to document outcomes following UKA. PASS was met in more than 85% of patients with no differences between ACL-deficient and ACL-intact knees at a mean follow-up of nine years. Cite this article: Bone Joint J 2021;103-B(8):1367–1372.
Outcomes of single- and two-stage revision total knee arthroplasty for chronic periprosthetic joint infection
Authors: Matar Hosam E. , Bloch Benjamin V. , Snape Susan E. , James Peter J.
Published: August 2021

Aims

Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint infections (PJIs). We have introduced this approach to our clinical practice and sought to evaluate rates of reinfection and re-revision, along with predictors of failure of both single- and two-stage rTKA for chronic PJI.

Methods

A retrospective comparative cohort study of all rTKAs for chronic PJI between 1 April 2003 and 31 December 2018 was undertaken using prospective databases. Patients with acute infections were excluded; rTKAs were classified as single-stage, stage 1, or stage 2 of two-stage revision. The primary outcome measure was failure to eradicate or recurrent infection. Variables evaluated for failure by regression analysis included age, BMI, American Society of Anesthesiologists grade, infecting organisms, and the presence of a sinus. Patient survivorship was also compared between the groups.

Results

A total of 292 consecutive first-time rTKAs for chronic PJI were included: 82 single-stage (28.1%); and 210 two-stage (71.9%) revisions. The mean age was 71 years (27 to 90), with 165 females (57.4%), and a mean BMI of 30.9 kg/m2 (20 to 53). Significantly more patients with a known infecting organism were in the single-stage group (93.9% vs 80.47%; p = 0.004). The infecting organism was identified preoperatively in 246 cases (84.2%). At a mean follow-up of 6.3 years (2.0 to 17.6), the failure rate was 6.1% in the single-stage, and 12% in the two-stage groups. All failures occurred within four years of treatment. The presence of a sinus was an independent risk factor for failure (odds ratio (OR) 4.97; 95% confidence interval (CI) 1.593 to 15.505; p = 0.006), as well as age > 80 years (OR 5.962; 95% CI 1.156 to 30.73; p = 0.033). The ten-year patient survivorship rate was 72% in the single-stage group compared with 70.5% in the two-stage group. This difference was not significant (p = 0.517).

Conclusion

Single-stage rTKA is an effective strategy with a high success rate comparable to two-stage approach in appropriately selected patients. Cite this article: Bone Joint J 2021;103-B(8):1373–1379.
Association between body composite indices and vertebral fractures in pre and postmenopausal women in Korea
Authors: Kim HyunJin , Lee Chung-woo , Nam Myung Ji , Choi Yeon Joo , Han Kyungdo , Jung Jin-Hyung , Kim Do-Hoon , Park Joo-Hyun
Published: August 2021

The association between obesity and vertebral fracture remains controversial. This study aimed to investigate the association between obesity/abdominal obesity and vertebral fracture according to menopausal status. This nationwide population-based epidemiologic study collected data from the Korean National Health Insurance Services to investigate the association between obesity/abdominal obesity and vertebral fracture in pre and postmenopausal women who underwent national cancer screening in 2009. We used three body composite indices of obesity, body mass index, waist circumference and waist-to-height ratio, to classify participants into obesity and abdominal obesity groups. In both pre and postmenopausal groups, participants with obesity showed a higher risk of vertebral fracture and the association was stronger in those with abdominal obesity (p< 0.001). Participants with obesity showed a high risk of vertebral fracture, and the association was stronger in participants with abdominal obesity (p< 0.001). In both pre and postmenopausal groups, participants with obesity showed a higher risk of vertebral fracture (adjusted HR, 1.24; 95% CI, 1.19–1.30), (adjusted HR, 1.04; 95% CI, 1.03–1.05, and those with abdominal obesity showed even higher risk of vertebral fractures (adjusted HR, 1.35; 95% CI, 1.27–1.43), (adjusted HR, 1.13; 95% CI, 1.11–1.14). Vertebral fracture risk is higher in pre and postmenopausal women with obesity and even higher in those with abdominal obesity. Therefore, weight management can prevent vertebral fractures.
Political judgement competency among upper secondary-school pupils
Authors: Weisseno Simon , Weisseno Georg
Published: August 2021

Within the discipline of political didactics, differing views exist on political judgement as the goal or content of classroom teaching. In this study, political judgement is understood as a competency. It requires situational deliberation and decision-making, but must also take into account political values. For this study, 401 upper secondary pupils in years 11–12 were presented with a 45-minute judgement test. The pupils were asked to adopt a personal position on a specific matter in an essay, using argumentative deliberation. As in the lens model of judgement, they were required to adduce and evaluate different aspects under conditions of uncertainty, since no definitive information was available. In the test, five levels were used to assess the ‘complexity’ of a judgement. All previous tasks had to be solved before a higher level of complexity could be reached. On the basis of the assumed interdependencies of levels (tasks) in a testlet, the test was scaled using a testlet model from item response theory. All the testlets show significantly higher variances than the test as a whole. The test was able to produce a good total variance. The analyses of construct validity by means of fluid intelligence and subject knowledge conform to expectations. The test evaluated with the testlet model indicates that this can be assumed to be a multilevel process.
THE EUROPEAN UNION GERIATRIC MEDICINE SOCIETY (EUGMS) WORKING GROUP ON FRAILTY IN OLDER PERSONS
Authors: CESARI M. , ABELLAN VAN KAN G. , ARIOGUL S. , BAEYENS J.P. , BAUER J. , CANKURTARAN M. , CEDERHOLM T. , CHERUBINI A. , CRUZ-JENTOFT A.J. , CURGUNLU A. , LANDI F. , SAYER A.A. , STRANDBERG T. , TOPINKOVA E. , VAN ASSELT D. , VELLAS B. , ZEKRY D. , MICHEL J.P.
Published: August 2021

The concept of frailty was introduced in literature to help atclinically depicting the transition of a robust older individualinto a different clinical phenotype of risk (1-5). Frailty isgenerally described as a multisystemic impairment responsiblefor a state of increased vulnerability to endogenous andexogenous stressors (6, 7). This syndrome may represent thefirst step towards the evident and clinically relevant functionaldisability (a cornerstone outcome for geriatric medicine)8, andhas shown to be predictive of major negative health-relatedevents, including
INCORPORATING FRAILTY INTO CLINICAL PRACTICE AND CLINICAL RESEARCH
Authors: ROWE J.W. , FRIED L.P.
Published: August 2021

While frailty is a common syndrome in older persons that isassociated with very significant morbidity and mortality, theoften subtle and varied clinical manifestations have fostereddisagreement regarding its definition, causes, and naturalhistory. Recently consensus has begun to emerge on theacceptance of the following definition for physical frailty “amedical syndrome with multiple causes and contributors that ischaracterized by diminished strength, endurance, and reducedphysiologic function that increases an individual’s vulnerabilityfor developing increased dependency and/or death” (1). Basedon this emerging consensus and the development of severalrapid, validated screening tests, our understanding of theepidemiology of this syndrome is rapidly advancing.
HOW TO EMPOWER THE PRIMARY CARE PHYSICIAN IN THE IDENTIFICATION OF THE VULNERABLE OLDER PERSON WITH A VIEW TO PREVENTING FRAILTY AND ALL ITS CONSEQUENCES
Authors: PHILP I.
Published: August 2021

Primary care physicians are well aware of the human andfinancial consequences of frailty; loss of independence in dailyliving activities, reduced participation in family and communitylife, increased use of acute hospital and long-term care services,and a negative impact on the lives of spouses and family carers.
PHYSICAL ACTIVITY AS HEALTHY INTERVENTION AGAINST SEVERE OXIDATIVE STRESS IN ELDERLY POPULATION
Authors: TOMAS-ZAPICO C. , IGLESIAS-GUTIERREZ E. , FERNANDEZ-GARCIA B. , DE GONZALO-CALVO D.
Published: August 2021

Severe oxidative stress is a relevant risk factor for major deleterious health-related events in olderpeople and is thought to be an important contributor to age-related disease. Literature has suggested oxidativestress as a therapeutic target for mitigating the biological decline and attenuating the occurrence of adverseclinical events in aged individuals. However, definitive treatments are not known. Regular and moderate physicalactivity has been proposed as possible intervention for slowing age-related decline. This healthy strategy presentsa wide range of beneficial aspects for elderly, from the reduction of morbidity, disability, frailty and mortalityrates to treatment of many age-related disorders. Importantly, the global benefits on health are not shared by anyother strategies. Nevertheless, the physiological basis by which exercise produces its benefits to the organism isnot fully understood. This review summarizes the evidence for the role of physical activity as potential healthyintervention for mitigating the negative aspects of aging through the modulation of the oxidative mechanisms.
IMPACT OF NUTRITIONAL RISK ON SELF-CARE CAPACITY: SOCIAL SUPPORT AS A SOURCE OF PROTECTION FOR COMMUNITY-DWELLING OLDER ADULTS LIVING IN A RURAL AREA
Authors: JUNG S.E. , HERMANN J.R. , BISHOP A.
Published: August 2021

Background:Loss of independence is a major concern for rural older adults. Older adults living inrural areas are at an increased nutritional risk, which can lead to functional impairments in self-care capacity.Identifying factors, which have a role in sustaining rural older adults’ self-care capacity, could help withmaintaining independence as long as possible. Objective:The objective of this study was to examine the effect ofsocial support as a moderator between nutritional risk and self-care capacity. Design:Cross sectional designusing convenient sampling. Setting:Rural Oklahoma counties designated as “non-metro” and having populationsunder 5,000. Participants:Participants included 171 community-dwelling older adults, 65 years of age and older.Measurements:Data were collected using self-report surveys on self-care capacity (using the Duke OlderAmericans Resources and Services Procedures), social support (using the Social Provisions Scale), andnutritional risk (using the Mini-Nutritional Assessment short form). Using hierarchical linear regressiontechniques, data were analyzed to explore the moderating influence of social support in the association betweennutritional risk and self-care capacity. Results:A significant interaction emerged between nutritional risk, socialsupport, and self-care capacity (β = 0.20 p < 0.05). Thus, the deleterious impact of nutritional risk on self-carecapacity was reduced by social support. Conclusions:Results provide further support of the “buffering-hypothesis” and have implications relative to the importance of accessible social provisions to enhance self-carecapacity and quality of life among older adults residing in rural settings.
FRAILTY DETECTION WITH THE GERONTOPOLE FRAILTY SCREENING TOOL (GFST)
Authors: DEMOUGEOT L. , ABELLAN VAN KAN G. , VELLAS B. , DE SOUTO BARRETO P.
Published: August 2021

Frailty is commonly regarded as a pre-disability condition of older persons. Its importance in theelderly should be more carefully taken into account in the clinical practice. To implement interventions aimed atpreventing disability in frail older adults, screening tools for the early detection of this syndrome are needed. Inthis context, the Gérontopôle Frailty Screening Tool (GFST) has been recently proposed as an instrument forassisting general practitioners in the detection of non-disabled frail older adults. In the present paper, we brieflydiscuss about the difficulties of translating knowledge from the frailty research field to the clinical practice. Suchdifficulties are illustrated by presenting the evolution of the GFST over time. The use of frailty screening tools,such as the GFST, in the clinical practice is necessary to support the identification of older persons at risk ofadverse events and promote the implementation of individualized strategies against disability.
IMPACT OF POST-ACUTE TRANSITION CARE FOR FRAIL OLDER PEOPLE: A PROSPECTIVE STUDY
Authors: PEEL N.M. , HUBBARD R.E. , GRAY L.C.
Published: August 2021

Objectives:To describe the characteristics and outcomes of frail older people in a post-acutetransitional care program and to compare the recovery trajectories of patients with high and low care needs todetermine who benefits from transition care. Design:Prospective observational cohort. Participants and Setting:351 patients admitted to community-based transition care in two Australian states during an 11 monthrecruitment period. Intervention:Transition care provides a package of services including personal care,physiotherapy and occupational therapy, nursing care and case management post discharge from hospital. It istargeted at frail older people who, in the absence of an alternative, would otherwise be eligible for admission toresidential aged care. Measurements: A comprehensive geriatric assessment using the interRAI Home Careinstrument was conducted at transition care admission and discharge. Primary outcomes included changes infunctional ability during transition care, living status at discharge and six months follow-up, and hospital re-admissions over the follow-up period. For comparison of outcomes, the cohort was divided into two groups basedon risk factors for admission to high or low-level residential aged care. Results:There were no significantdifferences between groups on outcomes, with over 85% of the cohort living in the community at follow-up.More than 80% of the cohort showed functional improvement or maintenance of independence during transitioncare, with no significant differences between the groups. Conclusions:Post-acute programs should not betargeted solely at fitter older people: those who are frail also have the potential to gain from community-basedrehabilitation.
History of Hepatic Encephalopathy Is Not a Contraindication to Transjugular Intrahepatic Portosystemic Shunt Placement for Refractory Ascites
Authors: Saab Sammy , Zhao Matthew , Asokan Ishan , Yum Jung Jun , Lee Edward Wolfgang
Published: August 2021

INTRODUCTION:

The outcomes of transjugular intrahepatic portosystemic shunt (TIPS) placement in patients with hepatic encephalopathy (HE) are controversial. We studied the relationship of pre-TIPS HE in patients undergoing TIPS for refractory ascites on all-cause mortality and development of post-TIPS HE.

METHODS:

A single-center retrospective comparison study was performed for patients undergoing TIPS for refractory ascites. Survival by history of pre-TIPS HE was demonstrated with Kaplan-Meier curves. Univariate and multivariate logistic regression analyses were performed to identify the predictors of post-TIPS clinical outcomes for patients with and without pre-TIPS HE.

RESULTS:

We identified 202 TIPS recipients (61% male, mean ± SD; age 59.1 ± 10.2 years; mean model for end-stage liver disease score 17.3 ± 6.9). Pre-TIPS HE did not predispose patients for increased all-cause mortality, increased risk of experiencing HE within 60 days, or increased risk of hospital admission for HE within 6 months. A multivariate analysis demonstrated that total bilirubin (odds ratio [OR] 1.03; P = 0.016) and blood urea nitrogen (OR 1.15; P = 0.002) were predictors for all-cause mortality within 6 months post-TIPS. Age ≥65 years (OR 3.92; P = 0.004), creatinine (OR 2.22; P = 0.014), and Child-Pugh score (OR 1.53; P = 0.006) were predictors for HE within 60 days post-TIPS. Predictors of intensive care admission for HE within 6 months post-TIPS included age ≥65 years (OR 8.84; P = 0.018), history of any admission for HE within 6 months pre-TIPS (OR 8.42; P = 0.017), and creatinine (OR 2.22; P = 0.015).

DISCUSSION:

If controlled, pre-TIPS HE does not adversely impact patient survival or clinical outcomes, such as development of HE within 60 days of TIPS or hospital admission for HE within 6 months. Patients may be able to undergo TIPS for refractory ascites despite a history of HE.
Adult-Onset Autoimmune Enteropathy in an European Tertiary Referral Center
Authors: van Wanrooij Roy L.J. , Neefjes-Borst E. Andra , Bontkes Hetty J. , Schreurs Marco W.J. , Langerak Anton W. , Mulder Chris J.J. , Bouma Gerd
Published: August 2021

INTRODUCTION:

Adult-onset autoimmune enteropathy (AIE) is a rare cause of severe chronic diarrhea because of small intestinal villous atrophy. We report on patients with adult-onset AIE in an European referral center.

METHODS:

Retrospective study including patients diagnosed with AIE in the Amsterdam UMC, location VUmc, between January 2003 and December 2019. Clinical, serological, and histological features and response to treatment were reported. The specificity of antienterocyte antibodies (AEA) was evaluated by examining the prevalence of AEA in (i) controls (n = 30) and in patients with (ii) AIE (n = 13), (iii) celiac disease (CD, n = 52), (iv) refractory celiac disease type 2 (n = 18), and (v) enteropathy-associated T-cell lymphoma (EATL, n = 10).

RESULTS:

Thirteen AIE patients were included, 8 women (62%), median age of 52 years (range 23–73), and 6 (46%) with an autoimmune disease. AEA were observed in 11 cases (85%), but were also found in CD (7.7%), refractory celiac disease type 2 (16.7%), and EATL (20%). Ten patients (77%) were human leukocyte antigen DQ2.5 heterozygous. Total parenteral nutrition was required in 8 cases (62%). Steroids induced clinical remission in 8 cases (62%). Step-up therapy with rituximab, cyclosporine, infliximab, and cladribine in steroid-refractory patients was only moderately effective. Four patients died (31%), but 4 (31%) others are in long-term drug-free remission after receiving immunosuppressive treatment, including 1 patient who underwent autologous stem cell transplantation.

DISCUSSION:

Adult-onset AIE is a rare but severe enteropathy that occurs in patients susceptible for autoimmune disease. Four patients (31%) died secondary to therapy-refractory malabsorption, while immunosuppressive therapy leads to a long-lasting drug-free remission in one-third of patients.
An´alisis de desempe˜no de capas de CNN para arquitecturas heterog´eneas basadas en FPGAs usando HLS
Authors: Guerra Londono Mateo , Castano Londono Luis Fernando , Alzate Anzola Cristian Camilo , Marquez Viloria David Andres , Velasquez Velez Ricardo Andres
Published: August 2021

Contexto: Las redes neuronales convolucionales (CNNs) son actualmente utilizadas en una amplia gama de aplicaciones de inteligencia artificial. En muchos casos, dichas aplicaciones requieren la ejecución de las redes en tiempo real en dispositivos integrados. Por esto, el interés en que estas aplicaciones puedan alcanzar un buen desempeño con bajo consumo de potencia. Las CNNs realizan operaciones entre los datos de entrada y los pesos de la red, con la particularidad de que no existe dependencia entre la mayoría de las operaciones. Por tal motivo, el paralelismo inherente de los FPGAs puede ser usado para realizar múltiples operaciones en paralelo, manteniendo el buen desempeño por vatio que caracteriza a estos dispositivos. Este artículo se enfoca en la evaluación del algoritmo de convolución para una capa convolucional de redes neuronales explorando directivas de paralelización usando VIVADO HLS, y su objetivo es evaluar el desempeño del algoritmo utilizando directivas de optimización.
Método: La metodología consiste en una exploración del espacio de diseño de la implementación de una capa de una red neuronal convolucional usando VIVADO HLS. La verificación del funcionamiento del FPGA fue realizada comparando los datos de salida con el mismo algoritmo de convolución implementado en MATLAB. Una capa de la versión comercial Xilinx DNNK fue usada como referencia para las medidas de desempeño de las diferentes implementaciones obtenidas en la exploración del espacio de diseño. En este trabajo se utilizan múltiples variaciones de directivas de optimización, tales como pipeline, array partition, y unroll.
Resultados: Este trabajo presenta los resultados de una implementación de referencia (sin directivas de optimización) del algoritmo de convolución con respecto a la latencia del algoritmo y los recursos de hardware utilizados por la FPGA. Los resultados se comparan con implementaciones del algoritmo, incluyendo diferentes combinaciones de dos directivas de optimización (pipeline y partition array).
Conclusiones: Este trabajo explora el espacio de diseño de un algoritmo de convolución para una capa de red neuronal convolucional sobre FPGAs. La exploración incluye el efecto causado por la transferencia de los datos entre la memoria DDR y la memoria on-chip del FPGA. Además, dicho efecto es causado por las directivas de optimización en Vivado HLS sobre los diferentes ciclos del algoritmo.
Impact of a public health environmental contingency (COVID-19) on Stress and a General Health of workers from different industrial sector.
Authors: Ibarra Victor
Published: August 2021

Abstract.

The problems that arise in society, in relation to health affect workers to some extent, this is the case of the COVID -19 pandemic, which has somehow affected organizations in general, such as: in their profits, in the reduction of personnel, in adapting new forms of work if required, and in activating health protocols to avoid the spread of it in its workers, this health situation that is present worldwide has had a great impact on people from the psychological aspect, it is for this the interest to carry out this research, with the purpose of knowing the perception of the workers of different organizations in this pandemic situation, that is to say, how it has affected them in relation to stress and therefore their general health, the instruments applied were: Perceived Stress Scale (10 items) and the Goldberg General Health Questionnaire.

The results of this work gave us a Cronbach alpha of α = .85 of reliability which indicates that this study is reliable, likewise 60% of the population report that they have felt stress due to COVID-19, as well as 42% of the population state that they have perceived factors or symptoms that affect their mental health to some degree.
Actor-network theory as a method for evaluating the energy sectors
Authors: Masuda Heloísa Lumy , Castañeda-Ayarza Juan Arturo
Published: August 2021

The objective of this article was to evaluate the current utilization of the Actor-Network Theory (ANT) as a research method in the energy sector. High impact scientific articles gathered from the ScienceDirect database were analyzed, taking into account the methodological research particularities (in terms of its nature, objective, issue approach, and technical procedures) and the means of data collection and analysis in the light of the ANT method. Few pieces of research in the energy sector were found utilizing ANT as an analysis method. A pattern for the methodological characterization was identified, in which most of the articles approached ANT as a diagnostic, exploratory, qualitative, and analytical method for case studies. Since most of the papers aimed mainly at the reconstruction of past events, data collection was characterized mainly by searching for documents and, whenever possible, by contacting the players who participated in the reconstructed history. The analysis, though, aimed at identifying the participants and the dynamics of their interactions. The ANT method presents immense potential for research in the energy sector since energy systems evolve throughout complex networks, inseverable from environmental, technological, and social, including those of political and economic nature. Still, as yet, in a continually growing development scenario, ANT's utilization may contribute to understanding how these networks evolve and who plays the most crucial role in it.
Study on satisfaction level of exporters as a subset of export promotion- the multi-method study on CONCOR
Authors: Pandey Prashant Kumar , Pandey Praveen Kumar
Published: August 2021

The purpose of the paper is to understand the effect of the services offered by the CONCOR on the satisfaction level of the exporters and the importers, which at first, requires the comprehensive understanding of the services and the best initiatives that are been taken the CONCOR to influence the satisfaction level of the exporters and importers. This paper is based on the deductive approach which includes building up a hypothesis (or hypotheses) in view of existing literature, and afterward outlining an exploration strategy to test the hypothesis (or, hypotheses). After analysis, it has been found by the authors that the level of satisfaction of the exporters and importers is been influenced by the services offered by CONCOR and the years of engagement that the traders have with CONCOR. Also, the satisfaction level that the traders have with the add-on benefits such as discount schemes or e-filling, is very high which shows the happiness among the traders from the services of CONCOR. Through this study, CONCOR can get the ideal services that are been provided with the objective of export promotion and also the possible flaws in services can be redesigned and can also be enhanced through aggressiveness. The study is limited to the data collected from the CONCOR, Tughlakabad. Through this study, export promotion agencies including CONCOR can get the ideal services that is been provided with the objective of export promotion, and also the possible flaws in services can be redesigned and can also be enhanced through aggressiveness.
Does teachers' self-efficacy influence their organizational commitment?
Authors: Waweru Nancy Minjire , Kihoro Prof. John Mwaniki , Gachunga Prof. Hazel Gachoka
Published: August 2021

Self-efficacy has become the focus of attention in the field of teaching. Teachers with higher teaching efficacy portray more enthusiasm for teaching and have greater commitment to teaching. The purpose of this study was to investigate whether self-efficacy has an influence on teachers’ organizational commitment (OC). This study hypothesized that teachers’ self-efficacy would have no significant relationship on teachers’ organizational commitment. The study employed survey research design to establish the relationship between self-efficacy and teachers’ OC. Simple random sampling was employed to draw a study population of 480 teachers in secondary schools in Nairobi, Machakos, Kajiado, and Kiambu counties in Kenya. The method of data collection was through the use of questionnaires which were distributed randomly to respondents. The data was analyzed through descriptive, correlation and regression analysis. The study established that teachers’ self-efficacy had positive influence on their OC which indicates that teachers with high self-efficacy were more committed to their institutions. The study recommends that teachers’ employer should provide new teachers with guided mastery experiences and come up with ways of building their self-efficacy in order to improve their OC. The study suggests further research on the effect of teachers’ self-efficacy on students’ achievements.