bluuebunny/crossref_metadata_2025 huggingface dataset:
Making Exercise as Medicine a Clinical Reality
Authors: Wonders Karen Y. , Franklin Barry A. , Brown Sheryl
Published: August 2024

Apply It!

• Emphasize the Prevalence of Chronic Conditions: 52% of U.S. adults suffer from at least one chronic condition, underscoring the widespread need for exercise intervention in managing these diseases.

• Advocate for Structured Exercise Programs: Stress the importance of structured exercise programs in managing chronic diseases, citing well-documented physical and mental health benefits associated with regular physical activity.

• Educate on Exercise Thresholds: Educate clients on the exercise thresholds recommended by the World Health Organization, emphasizing the need for at least 150 to 300 minutes of moderate-intensity physical activity per week, complemented by resistance training and a reduction in sedentary behaviors.

• Tailor Programs to Individual Readiness: Assess clients' readiness to change unhealthy lifestyle habits using models like the Transtheoretical Stages of Change Model, and tailor exercise prescriptions and counseling accordingly to increase the likelihood of successful behavior change.
Prevalence of different types of interproximal contacts in the permanent dentition – a study cast evaluation
Authors: Kailasam Vignesh , Muthu MS , Rao Usha , C Krithika , Kirthiga M , Aarthi J , Warrier Sankara Aravind
Published: August 2024

Background A new classification called OXIS was proposed for categorizing the interproximal contacts of primary molars, modified for the primary canines and its prevalence was established. No such information is available for the permanent dentition. Hence, the aim was to establish the variations in interproximal contacts of the permanent dentition and thereby modify the OXIS classification of primary molars and primary canines to the permanent dentition. Methods We propose a study-cast-based classification of interproximal contacts of the permanent dentition. Three hundred and forty-three pretreatment casts of patients based on an inclusion and exclusion criteria were selected. Contacts of posterior teeth were classified based on OXIS classification of interproximal contacts, and its modification was used for anterior teeth. Results Among the posterior contacts, the ‘O’ type of contact was least prevalent, while most prevalent was the ‘S’ type for second molar-first molar contact, ‘I’ type for the first molar-second premolar contact, and ‘X’ type for the second premolar-first premolar contact. Among the anterior contacts, least prevalent was ‘S1’ type for the first premolar-canine contact, and I type for the canine-lateral incisor and the lateral incisor-central incisor contacts. There was no statistical significance between right- and left-side contacts (P > 0.05) while significance was seen between maxillary and mandibular contacts (P < 0.05). Similarity of contacts ranged from 5.17% to 10.05%. Conclusion The OXIS classification is applicable to posterior permanent teeth, and its modification is representative of anterior permanent teeth.
The impact of acellular pertussis vaccination in pregnancy on the immunogenicity of acellular versus whole-cell pertussis vaccines in infancy: A protocol for a phase IV randomised, controlled mother-infant pertussis vaccine trial (The Gambian Pertussis Study, GaPs)
Authors: Saso Anja , Roetynck Sophie , Okoye Michael , Kanteh Ebrima , Okomo Michelle , Roberts Elishia , Faal Amadou , Jobe Haddijatou , Jeffries David , Kelly Dominic , Huijnen Martijn , Diavatopoulos Dimitri , Kampmann Beate ,   Gambian Pertussis Study (GaPs) trial team,   PERtussIS COrrelates of Protection Europe (PERISCOPE) consortium
Published: August 2024

Background Worldwide we have yet to achieve optimal control of pertussis, an important vaccine-preventable respiratory disease that has a particularly high burden of morbidity and mortality in infants under 1 year. Pertussis immunisation in pregnancy is an effective tool to protect infants in early life. However, there are concerns regarding the impact of maternal antibodies on the infant’s subsequent vaccine responses. The exact nature, duration, and clinical significance of this interaction is poorly understood. Methods We will conduct a phase IV randomised-controlled double-blinded (pregnant women) open-label (infants) trial, GaPs, in a cohort of 600 mother-infant pairs in The Gambia. Healthy pregnant women aged between 18 and 40 years will be recruited from two government antenatal healthcare centres in the Gambian peri-urban western region. They will be randomised to receive either a pertussis booster (TdaP-IPV) or Tetanus-Toxoid (TT, control) at 28-34 weeks’ gestation. Their infants will be further randomised to receive either acellular (aP) or whole-cell pertussis (wP) vaccines as part of the primary immunisation series at 8, 12 and 16 weeks of age and then followed up for 9-months postnatally. Clinical and safety data will be collected from each maternal-infant pair alongside blood samples and mucosal lining fluid, at baseline and multiple time points post-vaccination. Outcomes The trial aims to evaluate the quantity, quality, and persistence of immune responses, at both systemic and mucosal levels, to aP versus wP-containing priming schedules in Gambian infants up to 9-months of age, as well as the impact of pertussis immunisation in pregnancy on these responses. The primary endpoint measured will be the difference in the geometric mean concentration of anti-pertussis-toxin (PT) antibody in aP compared to wP-vaccinated infants at 16-weeks and 9-months postnatally. A further in-depth systems vaccinology approach will be embedded within the trial’s secondary and exploratory endpoints.
Protocol of the Nutritional, Psychosocial, and Environmental Determinants of Neurodevelopment and Child Mental Health (COINCIDE) study
Authors: Lobo Eunice , R. Deepa , Mandal Siddhartha , Menon Jyothi S. , Roy Aditi , Dixit Shweta , Gupta Ruby , Swaminathan Sumathi , Thankachan Prashanth , Bhavnani Supriya , Divan Gauri , Prabhakaran Poornima , van Schayck Onno CP , Babu Giridhara Rathnaiah , Srinivas Prashanth Nuggehalli , Mukherjee Debarati ,   COINCIDE consortium
Published: August 2024

Background Over 250 million children are developing sub-optimally due to their exposure to early life adversities. While previous studies have examined the independent effects of nutritional status, psychosocial adversities, and environmental pollutants on children’s outcomes, little is known about their interaction and cumulative effects. Objectives This study aims to investigate the independent, interaction, and cumulative effects of nutritional, psychosocial, and environmental factors on children’s cognitive development and mental health in urban and rural India. It also seeks to explain pathways leading to inequities in child development outcomes at the individual, household, and neighbourhood levels. Methods A mixed-methods prospective cohort study will be conducted on 1600 caregiver-child dyads (child age 3–9 years) in urban and rural India. Nutritional status, psychosocial adversities, environmental pollutants, and child mental health outcomes will be assessed using parent-report questionnaires. Performance-based measures will be used to assess cognitive outcomes. Venous blood and urine samples will be used to measure nutritional and pesticide biomarkers in 500 children. Indoor air pollution will be monitored in 200 households twice, during two seasons. Multilevel regression, weighted quantile sum regression, and Bayesian kernel machine regression will assess the individual and combined effects of exposures on child outcomes. Thematic analysis of in-depth interviews and focus group discussions will explore pathways to early childhood development inequities. Discussion The data will be used to formulate a Theory of Change (ToC) to explain the biological, psychosocial, and environmental origins of children’s cognitive and mental health outcomes across the first decade of life in diverse Indian settings, which will then inform context-specific intervention targets for promoting children’s outcomes beyond the first 1000 days, potentially generalizable to similar under-resourced global settings. The COINCIDE research infrastructure will comprise a valuable global health resource, including prospective cohort data, validated study tools, and stored biological and environmental samples for future studies.
Meaningful Reading of the Story “Soldier in the Forest”
Authors: Dyagterev M.
Published: August 2024

In the article, the author of the story “Soldier in the Forest” from the book “How Vovka Learned Humanity” reveals the methodology of text activity. The goal of working with the text is to lead children to an understanding of the noble qualities of the heroes of the story, who tidy up the forgotten grave of a soldier who defended the Motherland in the Great Patriotic War. A scenario of a possible lesson on the surrounding world in the fourth grade based on the story “Soldier in the Forest” is given. The methodology of reading the text by younger schoolchildren, its analysis and evaluation of the narrative during the educational dialogue is discussed.
Kuźnia charakterów. Powstanie styczniowe i wojna secesyjna w refleksji charakterologicznej strony przegranej
Authors: Górny Maciej
Published: August 2024

Artykuł omawia związki i analogie pomiędzy interpretacjami powstania styczniowego i wojny secesyjnej w piśmiennictwie polskim i Południa Stanów Zjednoczonych. W obu wypadkach już w czasie działań zbrojnych zaczęły się wytwarzać kultury klęski, w których istotną rolę odgrywała charakterologia narodowa. Najważniejszym punktem odniesienia tych kultur okazała się kultura romantyczna. Wyjątek stanowią głównodowodzący wojsk powstańczych i Konfederacji. Zarówno generał Robert E. Lee, jak i Romuald Traugutt reprezentowali model klasycznego bohatera uzupełniony o wątki chrześcijańskie.
Polityka zagraniczna Austrii wobec państw afrykańskich po II wojnie światowej
Authors: Popławski Dariusz
Published: August 2024

AUSTRIA’S FOREIGN POLICY TOWARDS AFRICAN COUNTRIES AFTER WORLD WAR IIAfter the restoration of sovereignty in 1955, a neutral Austria developed intensive contacts with developing countries. Vienna’s open attitude towards them fostered a positive image of the country, also within African states. The peak of activity in the political dialogue with Africa came during the so-called Kreisky era. The activist foreign policy was not accompanied by effective development aid though. From the mid-1980s there is an apparent shift away from an active policy of neutrality and global engagement in favour of European politics. After the accession to the European Union, the development cooperation takes priority and the African continent becomes one of three key regions. The cooperation focuses on the poorest priority countries south of the Sahara: Ethiopia, Ghana, Mozambique, Burkina Faso. In spite of programmatic and organisational changes, Austria’s financial contribution still significantly lags behind most small countries of the “old Union”.
Niepaństwowi aktorzy dyplomacji opartej na wierze w procesie pokojowym na przykładzie inicjatywy pokojowej liderów religijnych Acholi
Authors: Nadziak Michał J. , Bógdał-Brzezińska Agnieszka
Published: August 2024

FAITH-BASED DIPLOMACY NON-STATE ACTORS IN THE PEACE PROCESS – THE EXAMPLE OF THE ACHOLI RELIGIOUS LEADERS PEACE INITIATIVE
Parallel to the actors of classical diplomacy, non-state actors are engaged in efforts to restore peace. A particular category among them comprises actors of faith-based diplomacy, whose participation in peace processes incorporates their unique tools of mediation and reconciliation. An illustrative example of the specificity of non-state actors practicing faith-based diplomacy is the activity of a group of religious leaders associated with the Acholi community in promoting the peaceful resolution of the rebellion in Northern Uganda that began in 1986. To understand the operational capacity of non-state actors engaged in faith-based diplomacy, this article will analyse the means employed by members of the Acholi Religious Leaders Peace Initiative at both the domestic and international levels, as well as the reception of their actions by the conflict parties and the international community.
LEGADO QUILOMBOLA: Saberes aplicados ao ensino de ciências
Authors: Dias Quintão Maia Emília , Simplício Carvalho Regina
Published: August 2024

Compreende-se a inserção dos saberes populares na escola como uma possibilidade de construção coletiva do conhecimento, a partir da diversidade cultural de diferentes grupos e suas lógicas próprias de leitura do mundo. Em face desses argumentos, o objetivo deste estudo foi relacionar saberes populares às aulas das Ciências (Biologia e Química) da matriz curricular, conforme a Área de Ciências da Natureza e suas Tecnologias do Ensino Médio de uma escola pública localizada em uma comunidade quilombola mineira. Ao vivenciar uma experiência em docência nesta comunidade, identificou-se nos discentes, características que comprometiam o desenvolvimento educacional dos mesmos. A fim de minimizar as dificuldades observadas, refletiu-se sobre a possiblidade de resgatar os saberes locais, visando valorizá-los e aplicá-los no ensino de ciências. Assim foi colocada a questão: É possível a contextualização das aulas ministradas considerando os saberes quilombolas, visando melhoria do ensino-aprendizagem e consequente valorização dos saberes da comunidade? Para o desenvolvimento desse trabalho, foi utilizada uma metodologia de abordagem qualitativa e de natureza aplicada. Quanto aos objetivos da pesquisa, pode ser classificada como descritiva e quanto aos procedimentos é uma pesquisa etnográfica e participante. Após a aplicação da Sequência Didática, verificou-se o desempenho satisfatório em conhecimentos em química e microbiologia adquiridos pelos alunos, quando comparados o teste pré-intervenção e o teste pós-intervenção. Por fim, o momento de culminância revelou a importância da elaboração e aplicação da sequência didática como produto educacional possível de ser replicado ou que sirva de inspiração para a elaboração de outros trabalhos interdisciplinares.
Utilizing the High Maturity Level of Digital Twin for Construction Resource
Authors: Yogi Muhammad Rilly Aka , Saroji Gunawan
Published: August 2024

This article presents an approach to utilize the high maturity level of digital twin for construction resource monitoring. The digital twin is used in construction projects as a systematic representation of physical objects into virtual models of construction. While the resource monitoring system is used as a decision-making tool to optimize resource leveling optimization. A high maturity level is needed to provide an interoperable ecosystem for the construction monitoring process. The state-of-the-art literature review and gap identification are used through various studies related to the research objectives. The result shows that the integration of Building Information Modeling (BIM), geographic information system (GIS), machine learning (ML), and monitoring dashboard is needed for the digital twin resource monitoring model for controlling resource utilization on the project. A platform ecosystem is also required to effectively obtain an efficient decision making process for project construction. The study contributes to the framework of digital twin for aerial construction.
Operational Risk Management of Onshore Processing Facility using Risk Failure Mode and Effect Analysis and Fault Tree Analysis
Authors: Firdaus Itsna Affandi , Irawan Muhammad Isa
Published: August 2024

Onshore Processing Facility (OPF) is one of the natural gas processing fields. The gas is dried and distributed to the consumer. The ideal condition of a process plant is to operate continuously until the planned maintenance time. However, unexpected various operational failure problems exist during operation. The impact of operational failures occurred not only on the OPF itself but also on the Refinery Unit Operation process, which may disrupt fuel distribution in West Java and become a national issue. Research is needed to determine the critical risks of various operational failure modes. Finding the critical risk will hopefully simplify the search for the cause of failure without having to analyze all modes of failure that have occurred. A critical risk is obtained using the Reverse Failure Mode and Effect Analysis (RFMEA) method, which is then analyzed further using Fault Tree Analysis (FTA) to get a basic event. Furthermore, a specific treatment of risk could be proposed. Forty-five failure modes have been identified from operational data. Based on this research, five failure modes have been categorized as critical: Pilot Failure, Air Intake problems, Analog Output / Discrete Output (AO/DO) Modules that often hang, Shut Down caused by Gas Engine Generator (GEG) Hunting, and broken glycol pump. By FTA, the cause of these critical risks can be recognized, and mitigation plans are proposed as a risk response plan for known critical risks. The plan is expected to reduce the occurrence of operational failure or reduce the impact of the failure.
Port’s Land Optimization Using Linear Programming Method
Authors: Wasesa Andarmadi Jati A. , Siswanto Nurhadi
Published: August 2024

Port operational activities, in addition to loading and unloading activities, there are also other business activities, such as land rental business. Land port leased to service users to support loading and unloading activities at the dock. Therefore, the land leasing business is the supporting business that plays a vital role in the operation of the port. Land leased to customers based on zoning designation. There are major zoning to support the needs of dock activities and additional zoning to support other maritime businesses. A suitable zoning area will help operations and increase revenue from land leases. Efficient land use will also reduce the need for reclamation for port development since reclamation is now considered a move that harms the environment's ecosystem. The problem in zoning design for harbor land use is the mismatch of land zoning planning with the needs of land users. A lot of land is empty because it is not suited for the zoning that land users need, thus causing a financial loss for the company. An optimization model is needed to maximize the benefits of land use. This study uses profit as an objective function while regulating and projecting land demand is a constraint. This study has established the optimal land allocation using linear programming to optimize each land zoning to maximize revenue without ignoring existing regulations.
Classification Modeling using Methods Cross Industry Standard Process for Data Mining to Improve Product Quality
Authors: Pratiwi Pravitasari Anjar , Saikhu Ahmad
Published: August 2024

The purpose of this research is to develop a classification model and measure the effect of changes in production inputs on product quality at PT. XZY. This study uses an analytical method adopting the CRISP-DM framework (Cross Industry Standard Process for Data Mining). At the modeling stage, the development of a classification model framework is carried out using the method Random Forest and Logistic Regression. Research results show that  by  applying the  technique  oversampling  k-Mean  SMOTE  produces  a  product classification model with better predictive performance. on models Random Forest with k- Mean SMOTE was able to increase the AUC value from 0.810 to 0.944, while in Logistic Regression there was an increase in the AUC value from 0.690 to 0.724. An increase in the AUC value shows that with k-Mean SMOTE is able to produce a model with very good sensitivity in predicting data classes with low false positive/negative rates. Changes in tow, adhesive, and triacetin materials have a significant effect on the quality of the resulting product. Based on the odds ratio respectively, using adhesive, triacetin, and tow materials with SA/TRIAL status creates a higher chance of producing a product that does not meet the company's quality standards.
Stakeholder Analysis and RFID Implementation Model for Vehicles Using Design Thinking
Authors: Emanuela Gledis , Windharto Agus
Published: August 2024

In Indonesia, the number of motor vehicles in 2022 reached 152,001,696 units. However, the use of technology to monitor the condition of motor vehicles is not very popular yet. Some chips installed on vehicles only serve as monitors. Therefore, researchers  are  interested  in  analyzing  RFID  in  motor vehicles  when  applied  in Indonesia. Through this research, the researchers hope to identify the needs of the Indonesian population regarding the use of RFID chips in motor vehicles. The approach will involve interviewing individuals or parties with interests related to the utilization of RFID in motor vehicles. Additionally, the researchers aim to develop an RFID implementation model that can be used in Indonesia in the future. The methodology for this study is qualitative, employing the design thinking approach. Design thinking was chosen due to its four elements (people-centered, highly creative, hands-on, and iterative) that are user-oriented and promote innovation. It is hoped that  through  this  research,  stakeholders   involved  in  RFID   development   can collaborate and integrate for the development and utilization of RFID in Indonesia.
Evaluation of The Utilization of Bela Procurement System on The Effectiveness and Efficiency of Goods/Services Procurement
Authors: Ratih N. P. Manissar Tri , Suryani Erma
Published: August 2024

This  study  evaluates  the  Bela  Procurement  system's  utilization  and  effectiveness  in  Badung Regency Government. Data collection methods include observation, documentation, and interviews with an inductive qualitative approach. Respondents are personnel from the Badung Regency Goods/Services Procurement Work Unit, Bela Procurement Merchant Admins, and MSMEs in the Bela  Procurement  application.  Data  analysis  uses  the  ITIL  v3  framework.  Results  show  the system's effectiveness and efficiency with a value of 3, despite some external user-side obstacles. Bela Procurement shortened the average order to 5 days, reduced delivery delays to 8%, and increased user satisfaction to 8.3. Prior procurement efficiency ratio increased to 55%. Operational cost savings were 20%. 10 out of 17 features were used, with the rest unused due to not meeting user needs. The system positively contributed to efficiency, completion time, and data accuracy. Obstacles identified include user understanding, technical limitations, and MSME participation. To optimize system utilization, efforts include increasing user training and understanding, MSME participation, and technical updates based on user input
Modeling Prediction of Sulfur Dioxide (SO2), Nitrogen Oxides (NOX) Emissions and Particulate from Coal-Fired Power Plant Using Machine Learning
Authors: Gaol Rina Yani L. , Atok Mohamad
Published: August 2024

Coal-fired power plants remain a crucial source of electricity in meeting national energy demands, despite the environmental challenges posed by the emissions generated during coal combustion. Emission coal-fired power plants include Sulfur Dioxide, Nitrogen Oxides, particulate matter have negative impact to the environment. To mitigate these emissions, regular monitoring, and measurement of gas emissions, as well as the development of emission prediction models, are essential. Machine learning has emerged as a promising approach for predicting gas emissions. In this study, Gradient Boosting (GB), Artificial Neural Network (ANN), and Support Vector Regression (SVR) machine learning models are employed. Factors influencing SO2, NOx, and particulate matter emissions are obtained from Distributed Control System records of the boiler system, along with the gas emission control technologies, comprising a total of 19 independent variables. Optimization of the boiler system can contribute to the reduction of gas emissions. The analysis results, measured by RMSE, R Square, and MAE, indicate that Gradient Boosting yields the most accurate predictions for gas emissions and particulate matter.
Understanding canine atopic dermatitis
Authors: Penny David
Published: August 2024

It is important for veterinary nurses to understand that canine apotic dermatitis is a disease that can resemble many other pruritic skin diseases and to be aware of the many skin issues that can occur when carrying out consultations, conducting telephone triages and booking consultations, as first opinion practices are inundated with itchy dog phone calls. Research has found that pruritic skin disease accounts for just under half of dermatological problems in first opinion practice. Canine apotic dermatitis can very easily be misdiagnosed and mistreated for other skin issues or diseases.
How modern in-house diagnostics compare to external reference laboratories
Authors: Godfrey Hannah
Published: August 2024

Can in-house diagnostics rival external labs? This article examines the latest advances and their comparative performance.
Sustainability in practice: an overview for small animal veterinary professionals
Authors: Shotton Justine
Published: August 2024

This article will focus on what individuals can do in practice and when talking to clients, to help combat the climate crisis. It will discuss actions that individuals can take at home and at work, and look at ways that practices can become more sustainable through their operations, responsible resource use and responsible medicine use. The article will cover how to inspire the team and engage with management on this topic and signposts to further helpful resources. The article also explores some of the main elements of the ‘carbon pawprint’ of pet ownership, and how to have conversations with clients to help them understand these impacts and reduce them – which often has additional benefits of improving animal welfare and saving clients money.
ONE-STAGE VERSUS TWO-STAGE REVISION HIP ARTHROPLASTY: CAN WE CONFIRM THE DATA FROM META-ANALYSIS IN REAL-WORLD REGISTRY DATA?
Authors: Becker L. , Resl M. , Wu Y. , Kirschbaum S. , Perka C.
Published: August 2024

Studies and meta-analyses worldwide show an increased use of one-stage revisions for treating periprosthetic hip infections, often yielding comparable or better outcomes than two-stage revisions. However, it remains unclear if these successful results can be consistently achieved nationwide besides large centers.

This observational cohort study used data from the German Arthroplasty Registry (EPRD) to compare the mortality and re-revision rates between one-stage (n=8183) and two-stage (n=657) first-time revision total hip arthroplasty (RTHA). Kaplan-Meier estimates were applied to evaluate the re-revision rate and cumulative mortality for RTHA.

There was a significant difference in mortality between one-stage and two-stage RTHA (p=0.02). One-year post-surgery, the mortality rate was 9.4% for one-stage revisions and 5.5% for two-stage revisions. At the five-year follow-up, the mortality rate for one-stage revisions was 25.5%, compared to 20.0% for two-stage revisions. No significant differences (p=0.30) were found in re-revision rates between one-stage and two-stage revisions after one year (one-stage 16.5% vs. two-stage 13.5%) or five years (one-stage 21.6% vs. two-stage 20.8%). For multiple revisions, the mortality differences were even larger (p<0.001), with a one-year mortality rate of 12.8% for one-stage RTHA and 5.7% for two-stage RTHA.

Despite the excellent results of one-stage RTHA in the literature from individual large centers, it shows a significantly higher mortality rate with equal re-revision rate compared to two-stage revision in the nationwide care besides large centers. Significant differences can already be seen within the first year, indicating an increased perioperative mortality for one-stage revision, which might be explained by longer surgery duration, blood-loss and patient selection or maybe a lack of experience concerning proper surgical debridement for one-stage revision. This illustrates the need to establish centers for joint-revision surgery that provide interdisciplinary care and high case numbers to improve perioperative outcomes.
MID-TERM RESULTS OF THE NEW ENDO-SPACER TECHNIQUE IN TWO-STAGE SEPTIC EXCHANGE SURGERY FOR PERIPROSTHETIC JOINT INFECTION OF THE HIP
Authors: Lausmann C. , Luck S. , Beil F. T. , Citak M. , Gehrke T.
Published: August 2024

Mechanical failure due to dislocation, fracture and acetabular wear as well as persistence of infection are the main complications associated with the use of hip spacers in the treatment of periprosthetic joint infections (PJI).

We have developed a novel, custom-made spacer as part of two-stage septic hip replacement and present the two- to five-year results after reimplantation.

We prospectively examined a total of 73 patients over our study period in whom our new spacer technique was used. The technique includes a dual mobility inlay and a cemented straight stem in combination with antibiotic-loaded PMMA bone cement which allows full weight bearing meanwhile the interim period. The follow-up ranged between 24 and 60 months after reimplantation as second stage of a two-stage approach. The patients were contacted as part of the follow-up using a questionnaire concerning reoperation, reinfection as well as hip function by using the Harris Hip Score.

72 patients (98,6%) could be reimplanted, one patient is still using the spacer prothesis for 45 months because of excellent functional results with a Harris Hip Score of 95, nevertheless reimplantation is planned. The reinfection rate was less than 7% after reimplantation. The dislocation rate was 5%, and in total there was an overall complication rate of less than 10%. The Harris Hip Score was significantly improved.

The ENDO spacer surgical technique is a promising option in the treatment of periprosthetic joint infections (PJI) for two-stage septic exchange with a low dislocation rate and good infection control after reimplantation. In addition, it enables early mobilization with the possibility of full weight-bearing in the interval between spacer implantation and reimplantation.
EFFECTIVE TREATMENT OF SINGLE-STAGE REVISION USING NON-CONTACT LOW FREQUENCY ULTRASONIC DEBRIDEMENT IN TREATING PERIPROSTHETIC JOINT INFECTIONS: A PROSPECTIVE CLINICAL STUDY
Authors: Cao L.
Published: August 2024

Traditional mechanical debridement can only remove visibly infected tissue and is unable to completely clear all the biofilm that hides within muscle crevices and nerves. This study aims to determine the results of single-stage revision using noncontact low frequency ultrasonic debridement in treating chronic periprosthetic joint infections (PJI).

A prospective study of consecutive patients requiring single-stage revision for chronic PJI was performed since August 2021. After mechanical debridement, an 8‑mm handheld non‑contact low‑frequency ultrasound probe was used for ultrasonic debridement at a frequency of (25±5) kHz and power of 90% for 5 minutes. Each ultrasound lasted 10 seconds with 3‑seconds intervals. The probe was repeatedly sonicated among all soft tissue and bsingle interface. The distal femoral canal and the posterior capsule of the knee were fully sonicated with a special right‑angle probe. Chemical debridement was then performed to irrigation the whole operative area. Recurrence of infection, culture results and number of colonies 24 hours after ultrasonic debridement were recorded.

A total of 45 patients (25 hips and 20 knees) were included and 43 of them (95.6%) were free of infection at a mean follow-up time of 29 months (24 to 33). There were no intraoperative complications related to ultrasonic debridement (neurovascular and muscle injury, poor wound healing and fat liquefaction). The culture‑positive rate of wound liquid before ultrasonic debridement was 40.0% (18/45), which significantly increased to 75.6% (34/45) after ultrasonic debridement (P=0.001). The median number of colonies 24 hours after ultrasonic debridement was 2372 CFU/ml (310 to 4340 CFU/ml), which was significantly higher than that before debridement (307 CFU/ml; 10 to 980 CFU/ml) (P=0.000).

Single-stage revision with non‑contact low‑frequency ultrasonic debridement can fully expose bacteria within biofilm, increase the efficacy of chemical debridement and lead to a favorable short‑term outcome without related complications.
MORE REVISIONS DUE TO INFECTION WITH USE OF REFOBACIN BONE CEMENT R THAN WITH PALACOS R+G: ANALYSIS OF TOTAL HIP ARTHROPLASTIES IN THE SWEDISH ARTHROPLASTY REGISTER 2012 TO 2022
Authors: Kärrholm J. , Itayem R. , Angelomenos V. , Mohaddes M. , Rogmark C. , Rolfson O.
Published: August 2024

In 2022, approximately 60% of inserted cups and stems in Sweden utilized cemented fixation. Two predominant brands, Refobacin Bone Cement R and Palacos R+G, both incorporating gentamicin, were employed in over 90% of primary cemented Total Hip Arthroplasties (THAs) between 2012 and 2022. This study investigates whether the choice between these cement types affects the risk of revision.

The five most frequently used cemented cups and the three most common stems were studied. Inclusion criteria encompassed hips with non-tumour diagnoses, operated through a direct lateral or posterior incision, featuring a 28–36 mm metal or ceramic head. Outcomes were assessed for cup revisions (n=55,457 Refobacin, 37,210 Palacos), stem revisions (n=51,732 Refobacin, 30,018 Palacos), and all-cemented THAs with either brand (n=45,265 Refobacin, 26,347 Palacos). Kaplan-Meier life tables and hazard ratios (HR) utilizing Cox regression were computed, adjusting for age, sex, diagnosis, implant type, femoral head size, and material.

Over a 10-year period, the cumulative percent revision with Refobacin was consistently higher than Palacos in all three analyses (cups: Refobacin 2.4 (2.3–2.5), Palacos 2.1 (2.0–2.2); stems: Refobacin 2.6 (2.5–2.7), Palacos 2.1 (2,0–2,2); all-cemented: Refobacin 3.2 (2.9–3.5), Palacos 2.9 (2.6–3.2)). Both unadjusted and adjusted HR were 13–25% lower with Palacos. In the analysis of all-cemented THAs, the adjusted HR for Palacos was 0.85 (0.76–0.95). Separating revisions into infectious and non-infectious reasons revealed a lower risk of infectious revisions with Palacos in all three analyses (all-cemented: adjusted HR infection 0.66 (0.56–0.78); non-infectious 1.10 (0.94–1.28)).

Hips cemented with Refobacin may face an increased risk of infection, potentially due to a smaller release of antibiotics into surrounding tissues. Unaccounted factors like different mixing systems or unknown biases could also influence outcomes, emphasizing the need for further investigation.
THE ROLE OF ANTIBACTERIAL HYDROGEL COATING ON COMPLICATION RISKS AFTER COMPLEX PRIMARY AND CEMENTLESS HIP REVISION ARTHROPLASTY: A RETROSPECTIVE MATCHED COHORT STUDY
Authors: Zagra L. , Ding B. , Sciamanna L. , D'Apolito R.
Published: August 2024

This study aimed to verify the hypothesis that an antibiotic loaded hydrogel, defensive antimicrobial coating (DAC), reduces overall complication and infection rates when used for high-risk primary and revision total hip arthroplasty (THA).

This was a retrospective study matched cohort study of 238 patients, treated with cementless implants with and without DAC. A sub-group analysis of patients undergoing 2nd stage revision THA for prosthetic joint infection (PJI) was also conducted. Re-infection rates within 2 years, complications necessitating surgical intervention and radiographic analysis for aseptic loosening was assessed.

The mean age was 68.3±11.5 years, with 39 (32.8%) Macpherson class A, 64 (53.8%) class B and 16 (13.4%) class C patients. 4 (3.4%) patients in the DAC group developed complications including 1 PJI and 1 delayed wound healing, while 13 (10.9%) patients in the control group developed complications including 5 PJIs and 3 delayed wound healing (p=0.032). PJI rates (p=0.136) and delayed wound healing rates (p=0.337) were not statistically significant. For 2nd stage revision THA for PJI there were 86 patients in the DAC group and 45 in the control group. 1 (1.2%) patient in the DAC group developed complications with no recurrences of infection or delayed wound healing, while 10 (22.2%) patients in the control group developed complications including 4 recurrent PJI and 1 delayed wound healing (p=0.003). Recurrent PJI rates were statistically significant (p=0.005) while delayed wound healing rates were not (p=0.165). Patients treated with DAC also had lower rates of aseptic loosening (0% vs 6.7%; p=0.015).

Antibiotic impregnated hydrogel coatings on cementless implants showed decreased complication rates after complex primary or revision THA. In 2nd stage revision THA for PJI, it was associated with reduced risk of re-infection and aseptic loosening.
A STANDARD OF CARE IN HIP ARTHROPLASTY: ROUTINE USE OF THE TENDON-SPARING SPAIRE TECHNIQUE WITH MAKO ROBOTIC ASSISTANCE
Authors: Timperley A. J.
Published: August 2024

The SPAIRE technique (Saving Piriformis And Internus, Repair Externus) was first described in 2016 and an approach to the hip in the interval between the inferior gemellus and quadratus femoris can be used for both hemi- and total hip arthroplasty.

The HemiSPAIRE technique in hip hemiarthroplasty for displaced intracapsular fractures has been compared with the standard lateral approach (advocated by NICE) in a pragmatic, superiority, multicentre, randomised controlled trial into postoperative mobility and function. This NIHR funded study was recruited between November 2019 and April 2022 and the results are reported in this presentation.

The author has used the SPAIRE technique in 1026 routine primary total hip replacements since February 2016. The technique is described along with results from NJR data.

SPAIRE is most challenging in patients with small anatomy, reduced offset, with an external rotation deformity. Particularly in these, but in all cases, MAKO robotic assistance facilitates accurate implantation of prostheses and precise recreation of biomechanics. The MAKO robot has been used in all cases since 2018 and SPAIRE/MAKO is now the standard of care in the author's practice.

To evaluate whether robotic-assisted tendon-sparing posterior approaches (piriformis sparing and SPAIRE), improve patient outcomes in total hip arthroplasty compared with a robotic-assisted standard posterior approach, the NIHR Efficacy and Mechanism Evaluation Programme has recently funded the HIPSTER trial (HIP Surgical Techniques to Enhance Rehabilitation). This is a single-centre, double-blinded, parallel three-arm, randomised, controlled, superiority trial; recruitment is in progress.

The greatest value of robotic assistance may be when it is used in combination with tendon-sparing surgery. Data is being gathered to evaluate whether the SPAIRE/MAKO technique confers benefits with regard the speed of post-op mobilisation as well as accelerated return to unrestricted function.
RIM-POINT-COLUMN-ORIENTED ALGORITHM IN CEMENTLESS ACETABULAR RECONSTRUCTION IN REVISION TOTAL HIP ARTHROPLASTY: A MINIMUM FIVE-YEAR FOLLOW-UP STUDY
Authors: Zhou Y.
Published: August 2024

The Paprosky acetabular bone defect classification system and related algorithms for acetabular reconstruction cannot properly guide cementless acetabular reconstruction in the presence of porous metal augments.

We aimed to introduce a rim, points, and column (RPC)-oriented cementless acetabular reconstruction algorithm and its clinical and radiographic outcomes.

A total of 123 patients (128 hips) were enrolled. A minimum 5-year radiographic follow-up was available for 96 (75.8%) hips. The mean clinical and radiographic follow-up durations were 6.8±0.9 (range: 5.2–9.2) and 6.3±1.9 (range: 5.0–9.2) years, respectively.

Harris hip score (HHS) improved significantly from 35.39±9.91 preoperatively to 85.98±12.81 postoperatively (P<0.001). Among the fixation modes, 42 (32.8%) hips were reconstructed with rim fixation, 42 (32.8%) with three-point fixation without point reconstruction, 40 (31.3%) with three-point fixation combined with point reconstruction, and 4 (3.1%) with three-point fixation combined with pelvic distraction. Complementary medial wall reconstruction was performed in 20 (15.6%) patients. All acetabular components were radiographically stable. Nine-year cumulative Kaplan–Meier survival rates for 123 patients with the endpoint defined as periprosthetic joint infection, any reoperation, and dissatisfaction were 96.91% (confidence interval [CI]: 86.26%, 99.34%), 97.66% (CI: 92.91%, 99.24%), and 96.06% (CI: 86.4%, 98.89%), respectively.

Cup stability in cementless acetabular reconstruction depends on rim or three-point fixation. The continuity of the anterior and posterior columns determines whether the points provide adequate stability to the cup. Medial wall reconstruction is an important complementary fixation method for rim or three-point fixation. The patients who underwent cementless acetabular reconstruction guided by the RPC decision-making algorithm demonstrated satisfactory mid-term clinical function, satisfaction levels, radiographic results, and complication rates.
FIVE-YEAR RESULTS OF THE NEW-GENERATION CUSTOM-MADE ACETABULAR TRIFLANGE FOR LARGE ACETABULAR DEFECTS: A PROSPECTIVE CASE SERIES
Authors: Hellemondt van G. G. , Colo E. , Faraj S. S. A. , Hooff van M. , Spruit M.
Published: August 2024

The objective of this study was to assess the clinical and radiological results of patients who were revised using a new generation custom-made triflange acetabular component (CTAC) for component loosening and large acetabular defect (Paprosky 3A and 3B) after previous total hip arthroplasty (THA). New generation CTACs involve the use of patient-specific drill guides and incorporate three-dimensional printed bone models, enhancing precision during surgical implantation.

Data were extracted from a single centre prospective database of patients with large acetabular defects who were treated with a new generation CTAC. Patients were included if they had a minimum follow-up of five years. The modified Oxford Hip Score (mOHS), EurQol EuroQoL five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at two- and five-year follow-up. Reasons for revision, and radiological and clinical complications were registered. Trends over time are described and tested for significance (p<0.05).

A total of 49 (70%) of 70 patients with a mean age of 73.5 years (SD 7.7) had a complete follow-up of 5 years. A significant improvement was found in HOOS, mOHS, EQ-5D-3L utility and NRS, VAS pain rest and activity between baseline and final follow-up. Complications included 8 cases with loosening screws, 4 with bony fractures, 4 periprosthetic infections and 2 cases with dislocation. One patient with bilateral pelvic discontinuity had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage.

New generation CTAC in patients with THA acetabular loosening and massive acetabular bone loss (Paprosky 3A and 3B) can result in stable constructs and significant improvement in functioning and health-related quality of life at five years’ follow-up.
THE ASSOCIATION OF BEARING SURFACE MATERIALS WITH THE RISK OF REVISION FOLLOWING PRIMARY TOTAL HIP ARTHROPLASTY: A COHORT ANALYSIS OF 1,026,481 HIP ARTHROPLASTIES FROM THE NATIONAL JOINT REGISTRY
Authors: Whitehouse M. R. , Patel R. , French J. , Beswick A. , Navvuga P. , Marques E. , Blom A. , Lenguerrand E.
Published: August 2024

We investigated the revision rates of primary total hip replacement (THR) reported in the National Joint Registry (NJR) by types of bearing surfaces used.

We analysed THR procedures across all orthopaedic units in England and Wales. Our analyses estimated all-cause and cause-specific revision rates. We identified primary THRs with heads and monobloc cups or modular acetabular component THRs with head and shell/liner combinations. We used flexible parametric survival models to estimate adjusted hazard ratios (HR).

A total of 1,026,481 primary THRs performed between 2003–2019 are included in the primary analysis (Monobloc: n=378,979 and Modular: n=647,502) with 20,869 (2%) of these primary THRs subsequently undergoing a revision episode (Monobloc: n=7,381 and Modular: n=13,488).

Compared to implants with a cobalt chrome head and highly crosslinked polyethylene (HCLPE) cup, the all-cause risk of revision for monobloc acetabular implant was higher for patients with cobalt chrome or stainless steel head and non-HCLPE cup. The risk of revision was lower for patients with a delta ceramic head and HCLPE cup implant, at any post-operative period.

Compared to patients with a cobalt chrome head and HCLPE liner primary THR, the all-cause risk of revision for modular acetabular implant varied non-constantly. THRs with a delta ceramic or oxidised zirconium head and HCLPE liner had a lower risk of revision throughout the entire post-operative period.

The all-cause and indication-specific risk of prosthesis revision, at different time points following the initial implantation, is lower for implants with a delta ceramic or oxidised zirconium head and a HCLPE liner/cup than commonly used alternatives such as cobalt chrome heads and HCLPE liner/cup.
INFLUENCE OF MANUFACTURING CHARACTERISTICS OF HIGHLY CROSS-LINKED POLYETHYLENE ON FEMORAL HEAD PENETRATION IN TOTAL HIP ARTHROPLASTY: A TEN- TO 20-YEAR FOLLOW-UP STUDY
Authors: Garcia-Rey E.
Published: August 2024

Highly cross-linked polyethylene (HXLPE) has decreased wear and revision rates in total hip replacement (THR) at a long-term. However, the effect of HXLPE manufacturing characteristics on femoral head penetration has not been clearly defined yet. We report this single-institution study to investigate the clinical and radiological results of different HXLPE liners in THR.

In this retrospective cohort analysis of our prospective database, we identified 904 THRs performed between 2000 and 2013. Seven different HXLPE liner types were assessed: remelted (3), annealed (2), sequentially annealed (1) and vitamin E-infused (1). The linear femoral head penetration rate was measured at six weeks, one year, and annually thereafter, using the Roman Software v1.70 package.

Thirty hips were revised for the following reasons: aseptic loosening (11), dislocation (12), periprosthetic femoral fracture (6), and infection (1). No hip was revised for wear or osteolysis. 741 THRs were evaluated for a mean follow-up of 15 years (range, 10 to 20). The mean total penetration 15 years after THR was 0.17 mm in the sequentially annealed, and 0.16 mm in the vitamin E-infused groups, whereas it was 0.26 mm in the melted 95 kGy, 0.27 mm in the melted 5 Mrad and 0.25 mm in the melted 100 kGy groups (p=0.001). From one to 15 years after surgery, the mean wear was 0.206 mm in cups with an acetabular inclination greater than 50º and 0.105 mm in those placed between 35º and 50º (p<0.001).

Although HXLPE characteristics can result in a different wear performance in patients undergoing THR at a mean follow-up of 15 years, the clinical results are excellent. The position of the acetabular component can influence on the femoral head penetration of modern HXLPEs. Nevertheless, these patients should continue to be monitored to detect future problems.