bluuebunny/crossref_metadata_2025 huggingface dataset:
Total knee arthroplasty: does ultra-early physical therapy improve functional outcomes and reduce length of stay? A retrospective cohort study
Authors: Thwin Lynn , Chee Brian Rui Kye , Yap Yan Mei , Tan Kelvin Guoping
Published: May 2024

Background

The Enhanced Recovery After Surgery (ERAS) Society recommends that after total knee arthroplasty (TKA), patients should be mobilized early. However, there is no consensus on how early physical therapy should be commenced. We aim to investigate whether ultra-early physical therapy (< 12 h postoperatively) leads to better outcomes.

Methods

This is a retrospective cohort study of 569 patients who underwent primary TKA from August 2017 to December 2019 at our institution. We compared patients who had undergone physical therapy either within 24 h or 24–48 h after TKA. Further subgroup analysis was performed on the < 24 h group, comparing those who had undergone PT within 12 h and within 12–24 h. The outcomes analyzed include the Oxford Knee Scoring System score, Knee Society Scores, range of motion (ROM), length of stay (LOS) and ambulatory distance on discharge. A student’s t test, chi-squared test or Fisher’s exact test was used where appropriate, to determine statistical significance of our findings.

Results

LOS in the < 24 h group was shorter compared to the 24–48 h group (4.87 vs. 5.34 days, p = 0.002). Subgroup analysis showed that LOS was shorter in the ultra-early PT (< 12 h) group compared to the early PT (12–24 h) group (4.75 vs. 4.96 days, p = 0.009). At 3 months postoperatively, there was no significant difference in ROM, ambulatory distance or functional scores between the < 24 h group and 24–48 h group, or on subgroup analysis of the < 24 h group.

Conclusion

Patients who underwent physical therapy within 24 h had a shorter length of stay compared to the 24–48 h group. On subgroup analysis, ultra-early (< 12 h) physical therapy correlated with a shorter length of stay compared to the 12–24 h group (4.75 vs. 4.96 days, p = 0.009) - however, the difference is small and unlikely to be clinically significant. Ultra-early (< 12 h) physical therapy does not confer additional benefit in terms of functional scores, ROM or ambulatory distance. These findings reinforce the importance of early physical therapy after TKA in facilitating earlier patient discharge.
The prevalence of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants is very low: a retrospective cohort register study
Authors: André Lars , Björkelund Anders , Ekelund Ulf , Vedin Tomas , Björk Jonas , Forberg Jakob Lundager
Published: May 2024

Background

Current guidelines from Scandinavian Neuro Committee mandate a 24-hour observation for head trauma patients on anticoagulants, even with normal initial head CT scans, as a means not to miss delayed intracranial hemorrhages. This study aimed to assess the prevalence, and time to diagnosis, of clinically relevant delayed intracranial hemorrhage in head trauma patients treated with oral anticoagulants.

Method

Utilizing comprehensive two-year data from Region Skåne’s emergency departments, which serve a population of 1.3 million inhabitants, this study focused on adult head trauma patients prescribed oral anticoagulants. We identified those with intracranial hemorrhage within 30 days, defining delayed intracranial hemorrhage as a bleeding not apparent on their initial CT head scan. These cases were further defined as clinically relevant if associated with mortality, any intensive care unit admission, or neurosurgery.

Results

Out of the included 2,362 head injury cases (median age 84, 56% on a direct acting oral anticoagulant), five developed delayed intracranial hemorrhages. None of these five cases underwent neurosurgery nor were admitted to an intensive care unit. Only two cases (0.08%, 95% confidence interval [0.01–0.3%]) were classified as clinically relevant, involving subdural hematomas in patients aged 82 and 87 years, who both subsequently died. The diagnosis of these delayed intracranial hemorrhages was made at 4 and 7 days following initial presentation to the emergency department.

Conclusion

In patients with head trauma, on oral anticoagulation, the incidence of clinically relevant delayed intracranial hemorrhage was found to be less than one in a thousand, with detection occurring four days or later after initial presentation. This challenges the effectiveness of the 24-hour observation period recommended by the Scandinavian Neurotrauma Committee guidelines, suggesting a need to reassess these guidelines to optimise care and resource allocation.

Trial registration

This is a retrospective cohort study, does not include any intervention, and has therefore not been registered.
Updated safety results from phase 3 lecanemab study in early Alzheimer’s disease
Authors: Honig Lawrence S. , Sabbagh Marwan N. , van Dyck Christopher H. , Sperling Reisa A. , Hersch Steven , Matta Andre , Giorgi Luigi , Gee Michelle , Kanekiyo Michio , Li David , Purcell Derk , Dhadda Shobha , Irizarry Michael , Kramer Lynn
Published: May 2024

Background

Alzheimer disease (AD) is a major health problem of aging, with tremendous burden on healthcare systems, patients, and families globally. Lecanemab, an FDA-approved amyloid beta (Aβ)-directed antibody indicated for the treatment of early AD, binds with high affinity to soluble Aβ protofibrils, which have been shown to be more toxic to neurons than monomers or insoluble fibrils. Lecanemab has been shown to be well tolerated in multiple clinical trials, although risks include an increased rate of amyloid-related imaging abnormalities (ARIA) and infusion reactions relative to placebo.

Methods

Clarity AD was an 18-month treatment (Core study), multicenter, double-blind, placebo-controlled, parallel-group study with open-label extension (OLE) in participants with early AD. Eligible participants were randomized 1:1 across 2 treatment groups (placebo and lecanemab 10 mg/kg biweekly). Safety evaluations included monitoring of vital signs, physical examinations, adverse events, clinical laboratory parameters, and 12-lead electrocardiograms. ARIA occurrence was monitored throughout the study by magnetic resonance imaging, read both locally and centrally.

Results

Overall, 1795 participants from Core and 1612 participants with at least one dose of lecanemab (Core + OLE) were included. Lecanemab was generally well-tolerated in Clarity AD, with no deaths related to lecanemab in the Core study. There were 9 deaths during the OLE, with 4 deemed possibly related to study treatment. Of the 24 deaths in Core + OLE, 3 were due to intracerebral hemorrhage (ICH): 1 placebo in the Core due to ICH, and 2 lecanemab in OLE with concurrent ICH (1 on tissue plasminogen activator and 1 on anticoagulant therapy). In the Core + OLE, the most common adverse events in the lecanemab group (> 10%) were infusion-related reactions (24.5%), ARIA with hemosiderin deposits (ARIA-H) microhemorrhages (16.0%), COVID-19 (14.7%), ARIA with edema (ARIA-E; 13.6%), and headache (10.3%). ARIA-E and ARIA-H were largely radiographically mild-to-moderate. ARIA-E generally occurred within 3–6 months of treatment, was more common in ApoE e4 carriers (16.8%) and most common in ApoE ε4 homozygous participants (34.5%).

Conclusions

Lecanemab was generally well-tolerated, with the most common adverse events being infusion-related reactions, ARIA-H, ARIA-E. Clinicians, participants, and caregivers should understand the incidence, monitoring, and management of these events for optimal patient care.

Trial registration

ClinicalTrials.gov numbers: Clarity AD NCT03887455)
Retraction Note: Efficient identity security authentication method based on improved R-LWE algorithm in IoT environment
Authors: Yang Lin
Published: May 2024

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s13635-024-00153-8.
Retraction Note: Node fault diagnosis algorithm for wireless sensor networks based on BN and WSN
Authors: Li Ming
Published: May 2024

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s13635-023-00149-w.
On a class of a coupled nonlinear viscoelastic Kirchhoff equations variable-exponents: global existence, blow up, growth and decay of solutions
Authors: Choucha Abdelbaki , Haiour Mohamed , Boulaaras Salah
Published: May 2024

In this work, we consider a quasilinear system of viscoelastic equations with dispersion, source, and variable exponents. Under suitable assumptions on the initial data and the relaxation functions, we obtained that the solution of the system is global and bounded. Next, the blow-up is proved with negative initial energy. After that, the exponential growth of solutions is showed with positive initial energy, and by using an integral inequality due to Komornik, the general decay result is obtained in the case of absence of the source term.
Nonsmooth dynamics of a Filippov predator–prey ecological model with antipredator behavior
Authors: Huang Lidong , Qin Wenjie , Chen Shuai
Published: May 2024

This article proposes a class of nonsmooth Filippov pest–predator ecosystems with intermittent control strategies based on the pest’s antipredator behavior. aiming to investigate the influence of control strategies and switching thresholds on pest control. First, a comprehensive theoretical analysis of various equilibria within the Filippov system is undertaken, emphasizing the presence and stability of sliding mode dynamics and pseudoequilibrium. Secondly, through numerical simulations, the article discusses boundary-focus, boundary-node, and boundary-saddle bifurcation. Finally, the nonexistence of limit cycles in the Filippov system is theoretically studied. The research indicates that the solution trajectories of the model ultimately stabilize either at the real equilibria or at pseudoequilibrium on the model’s switching surface. Moreover, when the model has multiple coexisting real equilibrium and pseudoequilibrium, the pest-control strategy is correlated with the initial density of both the pest and the predator population.
Perceived ageism and psychosocial outcomes during the COVID-19 pandemic
Authors: Hajek André , König Hans-Helmut
Published: May 2024

Background

In light of the existing knowledge gap in this research area (particularly based on representative samples and research conducted during the pandemic), the objective of this study was to explore the association between perceived ageism and psychosocial outcomes (i.e., in terms of life satisfaction, loneliness, social isolation, aging satisfaction and depressive symptoms) among middle-aged and older adults during the COVID-19 pandemic based on nationally representative data.

Methods

We used data from the nationally representative German Ageing Survey, which covers community-dwelling middle-aged and older individuals aged 40 years or over. Specifically, wave 7 of the German Ageing Survey (conducted from November 2020 to March 2021) was analyzed, consisting of a sample of 4,167 individuals with an average age of 68.7 years (SD: 10.1 years; ranging from 46 to 98 years). Established instruments were employed to measure psychosocial outcomes.

Results

Regressions showed that the presence of perceived ageism was significantly associated with unfavorable psychometric outcomes (i.e., higher loneliness: β = 0.29, p < 0.001; higher perceived social isolation: β = 0.32, p < 0.001; more depressive symptoms: β = 2.68, p < 0.001; lower life satisfaction: β=-0.28, p < 0.001; higher negative affect: β = 0.21, p < 0.001; lower aging satisfaction: β=-0.19, p < 0.001), except for positive affect (β=-0.06, p = 0.10). Stratified by age group (i.e., individuals 40 to 64 years; individuals aged 65 years and over, see Tables 3 and 4), comparable results were obtained in terms of significance.

Conclusions

Perceived ageism was associated with unfavorable psychosocial outcomes. This knowledge can help reduce vulnerability to negative psychosocial factors in people in the middle and later years of life.
Curie point depth, thermal gradient and heat flow along the Ethiopia Rift System and adjacent plateaus using spectral evaluation approach: implications for geothermal resources
Authors: Hilemichaeil Samson , Haile Tigistu , Yirgu Gezahegn
Published: May 2024

The Ethiopia Rift System (ERS) is a section of the East African Rift System within Ethiopia extending from the Afar in the northeast to the Kenya border in the southwest. It is apparent that magmatism and magmatic intrusions influence the crustal shape in the ERS resulting in its thinning and the shallowing of magmatic sources at various locations within it. As a consequence, more than 31 volcanoes hosting hydrothermal structures with a conceivable potential to generate massive quantities of geothermal energy have been identified along the ERS. In this study, we map the Curie Point Depth (CDP) over the ERS based on the analysis of aeromagnetic data extracted from the World Digital Magnetic Anomaly Map. Spectral evaluation method was used to estimate the boundaries (top and bottom) of the magnetized crust. Reduced-to-pole (RTP) aeromagnetic records have been divided into 105 (50% overlap) square blocks of 200 × 200 km size. The Curie temperature (580 °C) of magnetite was used to determine the thermal gradient and the heat drift in the area. The depths obtained for the bottom of the magnetized crust are assumed to correspond to the Curie Depths, where the magnetic layer loses all its magnetization. The determined values of Curie Point Depth, geothermal gradient and heat flow for the 50% overlapped 105 blocks, respectively, range from 8.85 to 55.85 km, 10.38 to 65.54 °C/km and 25.96 to 163.84 mW/m2. Lower CPD (< 20 km) in the ERS was obtained between Mille and Gewane (southwest Afar), between Adama (Nazret) and Yerer (NMER) and between Wendo Genet and Koti (SMER) localities. These areas, showing low CPD, exhibit excessive geothermal gradient and high heat flow all of which indicate the presence of significant geothermal potential.
Determinants of postpartum long-acting reversible contraceptives in the extended postpartum period in Shashago district, Central Ethiopia: a cross-sectional study conducted in the community
Authors: Eristu Tesfaye , Mekis Abera , Abdo Ritbano Ahmed
Published: May 2024

Background

Women who fail to initiate contraceptive use within the first year after childbirth face an increased likelihood of experiencing unintended pregnancies in close succession. In regions with limited resources, the use of postpartum contraceptives, particularly long-acting reversible contraceptives, remains notably low. Consequently, this study sought to assess the prevalence and determinants of postpartum long acting reversible contraceptives in the extended postpartum period in the Shashago district, Central Ethiopia.

Methods

This study employed a community-based cross-sectional design, conducted between March 1, 2021, and April 15, 2021, involving a total of 617 women of reproductive age. The selection of study participants was performed using a multistage stratified sampling technique. Data collection was carried out through the use of a structured interviewer-administered questionnaire. Subsequently, the collected data were entered into Epi-data version 3.1 and exported to SPSS version 25 for further analysis. Bivariate and multivariable logistic regression analyses were conducted, and statistical significance was determined using a P value of 0.05, along with adjusted odds ratios (AORs) and their corresponding 95% confidence interval (CI).

Results

A total of 224(36.3%) women used long-acting contraceptives after giving birth. Among these women, 31.1% used Implanon, while 5.2% used an intrauterine device (IUD). Factors significantly associated with the use of long-acting contraceptives after childbirth included age 25–29 years (AOR: 1.8, 95% CI: 1.1-3.0), age ≥ 35 years (AOR = 8.7, 95% CI: 3.6–21.5), primary education (AOR = 3.3, 95% CI: 1.6–6.7), secondary education and above (AOR = 3.5, 95% CI: 1.5–8.3), and history of abortion (AOR = 2.7, 95% CI: 1.3–5.4). Additionally, having good knowledge of long-acting contraceptives after childbirth (AOR: 2.4, 95% CI: 1.5–3.9) was significantly associated with their use.

Conclusion

This study revealed that a small number of women opt for long-acting contraceptives after childbirth, with Implanon being more popular than IUDs. Factors such as age, education level, abortion history, pregnancy counseling, and knowledge about long-acting contraceptives were linked to their usage. Integrating contraceptive counseling into routine antenatal and postnatal care is essential for ensuring access to postpartum contraception. Tailored interventions based on age and education level could also help promote long-acting contraceptive use. More research and targeted interventions are needed to overcome these barriers and improve access to these methods for postpartum women.
Metformin mitigates dementia risk among individuals with type 2 diabetes
Authors: Aderinto Nicholas , Olatunji Gbolahan , Kokori Emmanuel , Fawehinmi Praise , Moradeyo Abdulrahmon , Igwe Stephen , Ojabo Rebecca , Alabi Badrudeen Olalekan , Okafor Emmanuel Chuka , Ologbe Damilola , Olafimihan Ayobami , Olawade David B.
Published: May 2024

This mini-narrative review explores the relationship between diabetes and dementia, focusing on the potential mitigating role of metformin in reducing cognitive decline among individuals with type 2 diabetes. The interplay of factors such as glycemic control, diabetic complications, and lifestyle influences characterises diabetes-related dementia. This review emphasises the significance of comprehensive diabetes management in addressing the heightened risk of dementia in this population. Methodologically, the review synthesises evidence from 23 studies retrieved through searches on PubMed, Embase, Google Scholar, and Scopus. Current evidence suggests a predominantly positive association between metformin use and a reduced risk of dementia in individuals with diabetes. However, the review shows the complex nature of these outcomes, revealing variations in results in some studies. These discrepancies show the importance of exploring dose–response relationships, long-term effects, and demographic diversity to unravel the complexities of metformin's impact on cognitive health. Limitations in the existing body of research, including methodological disparities and confounding variables, necessitate refined approaches in future studies. Large-scale prospective longitudinal studies and randomised controlled trials focusing specifically on cognitive effects are recommended. Propensity score matching and exploration of molecular mechanisms can enhance the validity of findings in clinical practice. From a clinical perspective, metformin can serve as a potential adjunctive therapy for individuals with diabetes at risk of cognitive decline.
Resources recovery-rubidium recovery from desalination brine through hydrometallurgy techniques
Authors: Lee Cheng-Han , Chen Wei-Sheng , Liu Fan-Wei
Published: May 2024

Because of the water scarcity in many regions, different methods have been implemented to address this problem. The desalination technique is known as a practical solution among them. However, brine from the desalination process, which contains high concentrations of salts, minerals, and chemicals, will cause environmental harm to the sea, soil, and groundwater if it is not properly treated. Therefore, recovering critical resources from brine is essential for reducing brine disposal. This study aims to apply two hydrometallurgy systems, namely ion exchange and ionic liquid extraction, to circulate rubidium resources from brine. Dowex G26 resin was employed in the ion exchange system, and the adsorption isotherm model and saturated adsorption capacity were explored initially. The optimal parameters such as pH value, L/S ratio (liquid/solid), adsorption period, and adsorption temperature will then be investigated. In the ionic liquid extraction process, the t-BAMBP/C2mimNTf2system (4-tert-Butyl-2-(α-methylbenzyl) phenol/1-ethyl-3-methylimidazolium bis(trifluoromethyls​ulfonyl)​imide) was used, and the parameters including pH value, concentrations of t-BAMBP, (O + I)/A ratio (organic + ionic liquid/aqueous), extraction time, and extraction temperature will be optimized as well. The results reveal that adsorption capacity and extraction efficiencies were 14.3 mg g− 1and 86%, respectively. Furthermore, suitable reagents, including HCl and HNO3, were applied to desorb and strip rubidium from the Dowex G26 and t-BAMBP/C2mimNTf2systems. To sum up, environmental hazards of desalination brine and rubidium resources can be reduced and recovered through the two different extraction systems.
Ultrasound-Guided Sacral Erector Spinae Plane Block: A Feasible Option for Pain Management During Magnetic Resonance Imaging: A Case Report
Authors: Bilgin Sezgin , Dost Burhan , Turunc Esra , Koksal Ersin , Ustun Yasemin Burcu , Tulgar Serkan
Published: May 2024

Inability to remain motionless owing to pain during magnetic resonance imaging (MRI) may increase the need for sedation and analgesia. Here, we present a case where ultrasound-guided sacral erector spinae plane block (ESPB) was used successfully for pain management during an MRI in a patient suffering from severe sacral pain. Sacral ESPB was performed with a total of 30 mL of 0.25% bupivacaine at the level of the intermediate sacral crest. The patient achieved sensory block in the L5–S4 dermatomes without motor block, resulting in complete pain relief. This case report highlights the feasibility of ultrasound-guided sacral ESPB as a potential pain management technique.
Zasilanie, wydajność i cechy hydrochemiczne wód źródeł Czarnej Wody
Authors: Fac-Beneda Joanna , Lidzbarski Mirosław
Published: May 2024

Czarna Woda zwana również Czarną Wdą płynie w głębokiej dolinie – rynnie Jeziora Dobrego. W jej zlewni występują dwa duże obszary źródliskowe. Jedno ze źródlisk znajduje się w pobliżu dawnej kaszubskiej osady Trzy Młyny. Warunki geomorfologiczne, hydrogeologiczne i hydrograficzne tego terenu sprawiają, że od prawie 200 lat wody tego źródliska są wykorzystywane do hodowli ryb. Jednocześnie jest to teren chroniony prawem, znajduje się bowiem w zasięgu Obszaru Chronionego Krajobrazu Puszczy Darżlubskiej, obszaru Natura 2000 Trzy Młyny PLH220029 oraz rezerwatu leśnego Źródliska Czarnej Wody. Źródliska Czarnej Wody zasilane są wodami infiltracyjnymi poprzez rozbudowany system cyrkulacji wód podziemnych, połączony z czwartorzędowym poziomem wodonośnym. Głównym czynnikiem kształtującym reżim źródeł Czarnej Wody jest infiltracja. Teren rezerwatu jest bardzo zróżnicowany, a na uwagę zasługuje tu silna erozja wsteczna, będąca efektem intensywnego wypływu wód ze źródlisk. Badania wydajności wypływów przeprowadzano patrolowo w roku 2009 (PIG-PIB) i 2015 (Katedra Hydrologii). Próbki do analiz chemicznych (NO2, NO3, NH4, SO4 i Cl) pobrano tylko w 2009 r. Na podstawie przeprowadzonych obliczeń można stwierdzić, że wydajność źródlisk Czarnej Wody (wszystkich wypływów) wynosi około 152 dm3∙s−1, a po uwzględnieniu dodatkowego zasilania na obszarze alimentacji może przekraczać 167 dm3∙s−1. Szacuje się, że prawie wszystkie te wody odprowadzane są przez źródła znajdujące się w rezerwacie. Według pomiarów patrolowych ilość wody źródlanej wynosi około 116 dm3∙s−1. Jak wykazano, wody źródlisk Czarnej Wody pochodzące z międzymorenowego poziomu wodonośnego są odporne na antropopresję. Ich skład chemiczny jest najczęściej zbliżony do naturalnego tła (tab. 4). Jedynie w przypadku dwóch źródeł stwierdzono nieznaczny wzrost zawartości związków azotu oraz chlorków i siarczanów.
A theory and analysis of the impact of gas in the dynamical behavior of the molten salt research reactor leading to the computation of the "gas coefficients of reactivity"
Authors: Price Terry , Clarno Kevin , Chvala Ondrej
Published: May 2024

Background Molten salt reactors, and other types of circulating, liquid fueled, nuclear reactors contain a certain amount of gas entrained in their liquid nuclear fuel. This gas induces an effect on the nuclear and dynamical behavior of the reactor as a whole. Gas voids respond to variation in temperature and pressure differently than liquids. When the gas voids in the reactor working fluid expand, the nuclear fuel is pushed from the core. Likewise, when the gas voids contract, more nuclear fuel enters into the core. Methods This paper examines the interplay of gas void fraction and reactivity in a molten salt reactor, and attempts to elucidate the dynamical response of the void fraction and the reactivity of the system to perturbation in system temperature, pressure, and gas quantity. A theory is presented that aims at describing the relationship between reactivity and gas behavior. This theory is then applied to the Molten Salt Research Reactor (MSRR) design, a facility currently under construction at Abilene Christian University campus. Results A result of this paper is the temperature and void fraction parameterized gas coefficients of reactivity for the Molten Salt Research Reactor. Conclusions The presence of voids accounts for 5-30% of the total temperature coefficient of reactivity, demonstrating their non-trivial contribution. Additionally, the study emphasizes the importance of considering gas content in MSR physics, especially in the context of pressure transients and system reactivity during pump trips. The initial system pressure, particularly in designs like the MSRR operating at sub-atmospheric pressures, is crucial due to its influence on reactivity changes during rapid pressure increases.
Las acciones pedagógicas en el Grupo de Acciones Públicas: estrategia de formación y herramienta para la justicia social
Authors: Zuluaga Hoyos Camila , Sánchez Quintero Anamaría , Pérez Amaya Natalia
Published: May 2024

El Grupo de Acciones Públicas, en el desarrollo de sus objetivos misionales, ha adelantado acciones pedagógicas enfocadas en la formación de estudiantes de derecho con responsabilidad social y de ciudadanos, líderes sociales y comunidades vulnerables, buscando generar la apropiación de los mecanismos de defensa de los derechos humanos en el país. Así, desde las estrategias de litigio se han utilizado herramientas como los talleres, conversatorios o seminarios para garantizar la protección de los derechos de diversas comunidades con las que ha trabajado de la mano. Lo anterior ha fortalecido el rol de liderazgo de las poblaciones con quienes se trabaja para alcanzar soluciones acorde a sus necesidades frente a las problemáticas que les afectan.
Aproximación a la democracia ambiental desde la educación legal clínica y el litigio estratégico
Authors: Muñoz Ávila Lina , Senior Serrano Sebastián
Published: May 2024

Uno de los desafíos sociales más importantes del siglo XXI es lograr la consolidación de los sistemas democráticos. La democratización del Estado y de la sociedad pasa también por la formación y el empoderamiento ciudadano en todos los niveles. En ese sentido, las clínicas jurídicas han servido como una plataforma de lucha por la democracia y han abanderado el fortalecimiento del Estado social de derecho. Lo anterior es particularmente relevante para los temas ambientales, pues a través de la democracia se concibe una nueva forma de relacionamiento con la naturaleza, y se ha buscado la garantía del derecho al ambiente sano y al desarrollo sostenible. Con base en lo anterior, este texto busca ubicar la noción de democracia ambiental, y sus pilares, como una alternativa para la estructuración de casos en el marco de la educación legal clínica y del litigio estratégico los cuales se han convertido en aliados naturales de esta. Muchos de los avances que se han logrado en los derechos de acceso a la información, participación y justicia ambientales se deben hoy a la solidaridad y trabajo de cientos de organizaciones en el mundo, entre las cuales se destacan las clínicas jurídicas al interior de las facultades de derecho, como el Grupo de Acciones Públicas de la Universidad del Rosario.
Estrategias y desafíos de la defensa de las víctimas en la implementación del sistema penal acusatorio La experiencia de la clínica de interés público del ITAM
Authors: Pérez Rivera Héctor Alberto
Published: May 2024

En este texto se describe el desarrollo de la Clínica de Interés Público contra la Trata de Personas del Instituto Tecnológico Autónomo de México (ITAM) en sus ocho años de existencia. Se explican los lineamientos de selección de casos y las estrategias pedagógicas que se utilizan para su abordaje, la formación de alianza con organizaciones no gubernamentales e instituciones públicas y la forma en que se ha combinado el éxito en el litigio de alto impacto y la enseñanza del derecho desarrollando un método particular de enseñanza clínica.
La educación legal clínica en Colombia: un movimiento que llegó para quedarse
Authors: Torres-Villarreal María Lucía
Published: May 2024

El modelo de educación legal clínica en Colombia empieza a evidenciarse curricularmente a finales de los años noventa, cuando se formaliza la primera clínica jurídica que denota los dos objetivos misionales que el modelo estaba planteando en América Latina: el pedagógico, centrado en la enseñanza de habilidades, destrezas y competencias para el ejercicio del derecho, sustentadas en unas premisas de justicia social y valores éticos; y el social, focalizado en la manera de concientizar y sensibilizar a los estudiantes de derecho sobre su rol en un contexto con necesidades sociales y de acceso a la justicia, a partir del ejercicio práctico de su profesión. Este escrito plantea algunas reflexiones que pretenden analizar cómo la educación legal clínica en Colombia ha aportado una serie de elementos para la consolidación de una formación integral, sustentada en valores éticos, sociales y altos estándares académicos, al mismo tiempo que ha planteado grandes retos para las instituciones educativas, el modelo de enseñanza y aprendizaje del derecho y la concientización en torno al rol que los estudiantes tienen en el contexto social de un país como Colombia.
VOZES DE MULHERES: A EXPERIÊNCIA ESTÉTICA DA LEITURA EM CONTEXTO DE PRIVAÇÃO DE LIBERDADE / WOMEN'S VOICES: THE AESTHETIC EXPERIENCE OF READING IN A CONTEXT OF IMPRISONMENT
Authors: Cesar Thays Carvalho , Remenche Maria de Lourdes Rossi
Published: May 2024

O presente estudo faz uma reflexão sobre como as práticas de leitura contribuem para ressignificar as experiências de mulheres em privação de liberdade no espaço-tempo do Centro de Integração Social de Piraquara. A análise, de caráter qualitativo-interpretativista, considera as práticas sociais contextualizadas no âmbito das ciências sociais. A abordagem teórico-metodológica está ancorada na concepção dialógica da linguagem, elaborada pelo Círculo de Bakhtin (Bakhtin 2011, 2014, 2015; Volóchinov 2021, Amorim, 2004), para a leitura como experiência estética, mobilizamos as ideias de Jauss, 1994; Yunes, 1995; Iser, 1999 (a, b,c) e Zilberman, 2001. O corpus de análise constitui-se de 4 (quatro) textos coletados em oficinas de leitura realizadas na unidade prisional e consideram a leitura como experiência estética. Os resultados da análise revelam que a leitura, em ambientes de privação de liberdade, não só promove um ordenamento do caos em que vivem as leitoras, como também se constitui em exercício de liberdade, apesar da restrição espacial. Relações intertextuais, dubiedade de intenções das leitoras e alteridade recuperam a dimensão interativa da ação humana e promovem a produção de sentidos em um processo permanente e descentralizado que proporciona a experiência estética e a expressão pessoal das participantes da pesquisa. Embora a leitura por si só não tenha o poder de transformar a sociedade, ela concede às leitoras privadas de liberdade o direito elementar de se expressarem livremente, registrar suas memórias e (re)significar suas experiências pessoais.
EDUCAÇÃO PARA LIBERDADE: RESSIGNIFICANDO ESPAÇOS SENTENCIADOS POR MEIO DA EXTENSÃO UNIVERSITÁRIA / EDUCATION FOR FREEDOM: REFRAMING SENTENCED SPACES THROUGH UNIVERSITY OUTREACH
Authors: Vellasquez Fabrícia , Rocha Ana Beatriz da Conceição
Published: May 2024

O presente texto, fruto de um trabalho de conclusão de curso em uma universidade pública localizada em um contexto de insistência violência, busca ampliar o entendimento sobre como podemos ressignificar os espaços privados de liberdade, como as prisões, por meio de programas extensionistas que enfatizam a leitura, considerando o potencial transformador da leitura no contexto prisional. Para tanto, buscou problematizar sobre o papel da universidade e o da extensão, como interlocutores de práticas de educação para a liberdade, como sugere o título em uma perspectiva freireana, com vistas a efetivar a saída efetiva e significativa dos egressos do sistema prisional. Além disso, faz uma crítica à extensão como forma de assistencialismo, em que apenas a universidade demanda e dialoga para a sociedade, sem perceber e/ou considerar suas demandas. Com vistas a uma compreensão mais aprofundada dos desafios e das dinâmicas presentes no contexto prisional, a pesquisa, de natureza qualitativa, buscou referenciais bibliográficos e documentais, para o aprofundamento e para a projeção da temática na pauta da educação e da sociedade. Como resultados, o texto pretende se constituir como mais um debate que atualiza e destaca o reconhecimento do potencial da leitura para ressignificação do "mundo prisão" do detento, inclusive nos momentos posteriores ao cumprimento de pena – sendo, portanto, uma demonstração do que se faz possível em situação de efetiva liberdade.
ESTUDO SOBRE A (RE)TEXTUALIZAÇÃO EM GRAMÁTICAS PEDAGÓGICAS BRASILEIRAS CONTEMPORÂNEAS:
Authors: De Pontes CASADO Sheila Fabiana , Rafael Edmilson Luiz
Published: May 2024

Este artigo reflete sobre o processo de gramatização no contexto brasileiro, iniciado no século XIX, que tem produzido instrumentos normativos referenciais para o ensino de língua portuguesa. Nesse contexto, as gramáticas pedagógicas surgem como uma dessas tecnologias por exercer a função de adaptar o conhecimento produzido histórico-socialmente sobre a língua/gramática em saber a ser ensinado, colocando-se, assim, como um importante recurso didático-pedagógico. Com a intenção de ampliar nosso entendimento acerca da arquitetura que dá sustentação à estruturação didática das gramáticas pedagógicas, propomo-nos, no presente estudo, descrever como se caracteriza a propositura discursiva das gramáticas pedagógicas brasileiras contemporâneas, a partir da análise de três obras, ei-las: i) Gramática (Faraco; Moura; Maruxo, 2018); ii) Aprender e praticar gramática (Mauro Ferreira, 2019); e iii) Gramática - texto, reflexão e uso (Cereja; Viana, 2020). Para tanto, recorremos aos referenciais sobre Transposição Didática/(Re)textualização (Chevallard, 1991; Rafael, 2001; Dell’Isola, 2007; Petitjean, 2008), bem como a Libâneo (1990) e a Lino de Araújo (2014) para situar os conteúdos/objetos de ensino no âmbito da didatização. No plano metodológico, esta pesquisa é caracterizada como qualitativa de natureza interpretativa (Paiva, 2019), do tipo bibliográfica/documental (Le Goff, 1990; Marconi; Lakatos, 2003) e está situada no campo da Linguística Aplicada (Moita Lopes, 2009, 2013). Os resultados atestam que cada instrumento normativo analisado está fundamentado em uma abordagem metodológica singular que a caracteriza, a saber: normativo- discursiva; textual-discursiva e prático-discursiva, as quais nomeamos de proposituras discursivas, que correspondem ao enquadramento teórico-metodológico assumido no processo de (re)textualização feito nas gramáticas pedagógicas brasileiras atuais.
Intermittent catheterisation
Authors: Nazarko Linda
Published: May 2024

When an individual has voiding difficulties, the person may require a urinary catheter. Enabling the person to choose an appropriate method of catheterisation and supporting them can have an enormous impact on the individual's health and wellbeing. Indwelling urethral catheters are suitable for some people but for others they can affect a person's lifestyle and lead to depression. Intermittent catheterisation can work well for some people. Intermittent self-catheterisation has been used to manage urinary retention for over 3500 years. It remains the ‘gold standard’ in terms of bladder drainage, but it is under-used and indwelling catheters remain more common. This article examines the history of intermittent catheterisation, indications for self-catheterisation and how to support people to use self-catheterisation.
Transanal irrigation
Authors: Hamilton Conor
Published: May 2024

Conor Hamilton examines the key components healthcare practitioners should consider when using transanal irrigation.
Is the varying management of incontinence-associated dermatitis due to a lack of understanding of etiology?
Authors: Porter Michelle
Published: May 2024

Incontinence-associated dermatitis, previously and sometimes still referred to as moisture lesions or moisture damage, is a commonly seen contact dermatitis that is a reactive response of the skin to chronic contact to urine and faecal matter. Understanding the etiology is fundamental to creating a skin care plan and successfully prevention. Systemic reviews and studies have shown that the continued variability in management results from a combination of knowledge base, observation, diagnosis, and product selection. This article aims to improve clinicians' understanding of incontinence-associated dermatitis and its management.
Peristomal skin care: seeking the solution to maintain skin integrity?
Authors: Ramadan Francesca
Published: May 2024

Francesca Ramadan reviews the mechanisms, benefits and limitations of the most common peristomal skin complication treatments, empowering stoma care practitioners to provide more effective and personalised solutions for their patients.
Developing an integrated nurse and physiotherapist-led bladder, bowel and pelvic health team
Authors: Robson Myra , Brown Victoria
Published: May 2024

A service redesign in 2019 led to the formation of an integrated team of nurses and physiotherapists working together to form a bladder, bowel and pelvic health team across two hospitals and the community in Lewisham and Greenwich NHS Trust. The last few years have had their challenges, but the team is now very successful and has won awards for the integration and achievements, particularly in the redesign of the containment product service. Integrating two professional groups has led to excellent team-work and smoother patient journeys.
Incontinence and homelessness
Authors: Kelly Anne Marie
Published: May 2024

The fundamental principles of why specific people become homeless, can be grounded in a simple rationale or founded within sophisticated reasoning. For instance, people who suffer from substance abuse, addiction, alcohol, gambling, have mental health concerns or financial difficulties may be susceptible to homelessness. It is also identified that persons who experienced violence in their childhood or abuse by a partner are at a higher risk of becoming homeless. Homelessness knows no ethnic, cultural, religious or gender boundaries, and can impact all individuals' health and well-being. A health problem and worldwide phenomenon that affects all cohorts of the population, including the homeless, is urinary incontinence. The aim of this article is to increase the awareness of incontinence and highlight the impact it has on the lives of people that experience homelessness.
TOTAL KNEE ARTHROPLASTY REVISION RATES IN MOBILE- VERSUS FIXED-BEARING IMPLANTS: A NEW ZEALAND JOINT REGISTRY STUDY
Authors: Scherf Erynne , Willis Jinny , Frampton Chris , Hooper Gary
Published: May 2024

Introduction

The mobile-bearing (MB) total knee arthroplasty (TKA) design was introduced with the aim of reducing polyethylene wear and component loosening seen in the fixed-bearing (FB) design. A recent joint registry study has revealed increased risk for all-cause revision, but not revision for infection, in MB-TKA. We used the New Zealand Joint Registry (NZJR) to compare all-cause revision rates, and revision rates for aseptic loosening of MB-TKA compared with fixed bearing (FB) TKA.

Methods

All patients who underwent a primary TKA registered in the NZJR between the 1st January 1999 to 31st December 2021 were identified. Analysis compared MB to FB designs, with sub analysis of implants from a single company. We identified 135,707 primary TKAs, with 104,074 (76.7%) FB-TKAs and 31,633 (23.3%) MB-TKAs recorded. We examined all-cause revision rates, reasons for revision and performed survival analyses.

Results

For all-comers, MB-TKA had an all-cause revision rate of 0.43/100-component-years (OCY) compared with 0.42/OCY for FB-TKA (p=0.09). The all-cause revision rate was higher for those age < 65 years (MB TKA 0.60/OCY vs. FB-TKA 0.59/OCY) compared to those > 65 years at time of primary TKA (MB-TKA 0.29/OCY vs. FB-TKA 0.32/OCY), however there was no statistically significant difference between implant design in either age group (p=0.16 and p=0.64; respectively). Similarly, there was no difference in revision rates for aseptic loosening between implant designs. Kaplan-Meier survival analysis demonstrates no statistically significant difference in revision-free survival of implants, with both MB-TKA and FB-TKA demonstrating ∼93% revision free survival at 23 years.

Conclusions

Both FB- and MB-TKA demonstrated excellent survivorship, with no significant difference in all-cause revision rates or revision for aseptic loosening between implant designs.
ACCURACY OF REGISTRY-REPORTED REASONS FOR UNICOMPARTMENTAL KNEE ARTHROPLASTY REVISION
Authors: Chen William , Tay Mei Lin , Bolam Scott , Rosser Kenrick , Monk A. Paul , Young Simon W.
Published: May 2024

Introduction

A key outcome measured by national joint registries are revision events. This informs best practice and identifies poor-performing surgical devices. Although registry data often record reasons for revision arthroplasty, interpretation is limited by lack of standardised definitions of revision reasons and objective assessment of radiologic and laboratory parameters. Our study aim was to compare reasons for unicompartmental knee arthroplasty (UKA) revision reported to the New Zealand Joint Registry (NZJR) with reasons identified by independent clinical review.

Methods

A total of 2,272 patients undergoing primary medial and lateral UKA at four large tertiary hospitals between 2000 and 2017 were included. A total of 158 patients underwent subsequent revision with mean follow-up of 8 years. A systematic review of clinical findings, radiographs and operative data was performed to identify revision cases and to determine the reasons for revision using a standardised protocol. These were compared to reasons reported to the NZJR using Chi-squared and Fisher exact tests.

Results

Osteoarthritis progression was the most common reason for revision on systematic clinical review (30%), however this was underreported to the registry (4%, p<0.001). A larger proportion of revisions reported to the registry were for ‘unexplained pain’ (30% of cases vs. 4% on clinical review, p<0.001). A reason for revision was not reported to the registry for 24 (15%) of cases.

Discussion and Conclusion

We found significant inaccuracies in registry-reported reasons for revision following UKA. These included over-reporting of ‘unexplained pain’, under-reporting of osteoarthritis progression, and failure to identify a reason for revision. Efforts to improve registry capture of revision reasons for UKA should focus on increasing accuracy in these three areas. This could be addressed through standardised recording methods and tailored revision reason options for UKA for surgeons to select when recording the reasons.
OUTCOMES OF TRABECULAR METAL IN REVISION ACETABULAR RECONSTRUCTION IN AUCKLAND
Authors: Sim Katarina , Schluter Dean , Sharp Rob
Published: May 2024

Introduction

Acetabular component loosening with associated bone loss is a challenge in revision hip arthroplasty. Trabecular Metal (TM) by Zimmer Biomet has been shown to have greater implant survivorship for all-cause acetabular revision in small cohort retrospective studies. Our study aims to review outcomes of acetabular TM implants locally.

Method

This is a retrospective observational study using data from Auckland City and North Shore Hospitals from 1st of January 2010 to 31st of December 2020. Primary outcome is implant survivorship (re-revision acetabular surgery for any cause) demonstrated using Kaplan-Meier analysis. Secondary outcome is indication for index revision and re-revision surgery. Multivariate analysis used to identify statistically significant factors for re-revision surgery.

Results

225 cases used acetabular TM implants (shells and/or augments) over 10 years. Indications include aseptic loosening (63%), instability (15%) and infection (13%). Of these, 12% (n=28) had further re-revision for infection (54%) and instability (21%). Median time to re-revision was 156 days (range 11 – 2022). No cases of re-revision were due to failure of bony ingrowth or acetabular component loosening. Ethnicity, smoking status, and age were not risk factors for re-revision procedures. Additionally, previous prosthetic joint infection, ethnicity, sex and age were not significant risk factors for re-revision due to infection. Implant survivorship was 80% at 1 year, 71% at 5 years and 64% at 10 years.

Discussion

Main indications for re-revision were infection and instability. Demographic factors and co-morbidities did not correlate with increased re-revision risk. Survivorship is poorer compared to cumulative survivorship reported by the New Zealand Joint Registry (NZJR). Explanations are multifactorial and possibly contributed by underestimation of true revision rates by registry data.

Conclusions

We need to identify alternate causes for poorer survivorship and review the role of TM implants in acetabular revision within our specified population.
INFLUENCE OF OBESITY ON FUNCTIONAL OUTCOMES AND REVISION RATES FOLLOWING REVISION TOTAL KNEE ARTHROPLASTY
Authors: Penumarthy Rushi , Jennings Angus
Published: May 2024

Background

Obesity has been linked with increased rates of knee osteoarthritis. Limited information is available on the survival and functional outcome results of rTKR in the obese patients. This registry-based study aimed to identify whether BMI is an independent risk factor for poorer functional outcomes and /or implant survival in rTKA.

Methods

New Zealand Joint Registry (NZJR) data of patients who underwent rTKA from 1st January 2010 to January 2023 was performed. Demographics, American Society of Anesthesiologists (ASA), BMI, Operative time, indications for revision and components revised of the patients undergoing rTKA was collected. Oxford knee score (OKS) at 6 months and rates of second revision (re- revision) were stratified based on standardised BMI categories.

Results

Of the 2687 revisions, functional outcome scores were available for 1261 patients. Oxford knee scores following rTKA are significantly inferior in higher BMI patients (36.5 vs 31.5 p<0.001). This held true when adjusted for age (35.7 vs 30.9 p<0.001).

Tibial component loosening was a more common indication for revision in patients with BMI >40 (31.1% vs 21% for BMI <25), whereas periprosthetic femoral fracture was significantly more commonly seen in patients with BMI <25.

Re-revision rates displayed no significant differences between any pairs of BMI groups (2.18/100 component years) and adjusting for age and sex did not alter this (p= 0.462). Indications for re-revision were also not different between BMI categories.

Over 50% of the rTKA patients were obese. Significantly more obese patients were ASA grade 3,4 and more were <75 years. Operative time was longer in the obese patients (p<0.001).

Conclusions

Although overall re-revision rates are similar between all BMI categories, the functional outcomes favour those with lower BMI. Patients with higher BMI are younger, more comorbid and carry potentially higher perioperative risks. The registry data provides valuable information when providing counsel to patients undergoing rTKA and lends further support to optimising patients prior to pTKA.