bluuebunny/crossref_metadata_2025 huggingface dataset:
EDUCAÇÃO EM TEMPOS DE PANDEMIA: UM ESTUDO SOBRE VALORES HUMANOS DE PROFESSORES DO ENSINO FUNDAMENTAL EM PICOS - PIAUÍ
Authors: Mourão Ada Raquel Teixeira , Luz Mirlene de Araújo , Lapa Luiz Gonzaga Lapa Junior
Published: August 2024

Este trabalho buscou investigar os valores humanos demonstrados por professores do ensino fundamental da cidade de Picos/PI, e como eles vivenciaram o trabalho remoto no momento de pandemia de Covid-19. Foram analisados os valores humanos manifestados pelos docentes, além de identificar as condições materiais de acesso para o bom desempenho de suas atividades. Como guia dessa investigação recorreu-se à Teoria de Valores Humanos do psicólogo social Shalom Schwartz. A teoria, inicialmente, evidencia dez valores motivacionais e que foram analisados nesta pesquisa. Posteriormente, no ano de 2012, foram propostos 19 valores para a Teoria Refinada de Valores Humanos. A pesquisa apresenta cunho qualitativo, realizada por meio de entrevista pela plataforma Google meet, seguindo roteiro semiestruturado, com sete professores de escolas públicas e privadas da cidade de Picos, Piauí. Os resultados demonstraram que os valores presentes nas falas dos professores foram: autodeterminação, realização, universalismo, benevolência, segurança e cooperação, pertencentes à Teoria de Valores Humanos. Maioria dos professores possuía boas condições materiais de trabalho como equipamentos eletrônicos, Internet e espaço adequado. Conclui-se que, com a transformação do contexto educacional para o ensino virtual, os professores foram afetados de forma direta, tanto em relação ao emocional quanto nas relações sociais, devido a preocupações e problemas recorrentes do ensino e da pandemia.
Development of Lean 4.0 Readiness Assessment Tool
Authors: Rahmatindar Princesia Olivia P , Singgih Moses Laksono , Karningsih Putu Dana
Published: August 2024

The concept of sustainable development focuses on efficient resource utilization and waste minimization, aligning with lean principles, forming the basis for implementing Industry 4.0. When Industry 4.0 technology is applied to inefficient processes, it can exacerbate waste. The integration of these principles, known as Lean 4.0, addresses future challenges by enhancing efficiency, flexibility, and production quality. The initial step toward Industry 4.0 involves evaluating the maturity of lean implementation and readiness for Industry 4.0. However, there is a lack of a unified assessment tool for Lean 4.0, prompting this study to adapt existing tools. Utilizing INDI 4.0 as a reference model for Industry 4.0 readiness in Indonesian companies, the research proposes modifications to create the Lean 4.0 Readiness Assessment Tool, incorporating indicators for both lean and Industry 4.0 readiness. The study employs the Delphi Method for indicator validation. Delphi 1 aims to achieve consensus on suitable indicators to serve as guidelines in the assessment tool, while Delphi 2 seeks expert opinions regarding the importance levels of each indicator. This study suggests 5 dimensions and 69 indicators.
Clinical Effect of Personalized Adjustable Mandibular Advancement Device on Obstructive Sleep Apnea
Authors: Wang Wei , Pang Jian , Zhang Yi-Xue , Mo Yi-Meng , Zhang Jiao , Wei Zhen-Hui
Published: August 2024

Aims/Background: Mandibular advancement devices are effective in treating mild or moderate obstructive sleep apnea (OSA), but such devices that are commonly used in clinical settings require further improvement. In this study, we evaluated the clinical effects of personalized adjustable mandibular advancement devices on mild or moderate OSA.

Methods: Forty patients with mild or moderate OSA were randomly divided into experimental (personalized adjustable device) and control (traditional device) groups. Side effects, including increased salivation, dry mouth, muscle aches, and temporomandibular joint discomfort, were assessed. Respiratory markers during sleep, including the apnea-hypopnea index, mean blood oxygen saturation, lowest blood oxygen saturation and maximum apnea time, were evaluated using polysomnography. The upper airway cross-sectional area and temporomandibular joint morphology and motion trajectory were evaluated using cone beam computed tomography.

Results: Side effects were significantly lower in the experimental group than in the control group. Respiratory marker levels were significantly restored post-treatment. Soft palate- and tongue-pharyngeal cross-sectional areas were significantly increased in both groups, but temporomandibular joint morphology or motion trajectory remained unchanged.

Conclusion: The personalized adjustable mandibular advancement devices may reduce side effects and are effective in treating patients with OSA.

Clinical Trial Registration: The study was registered and approved by the Chinese Clinical Trial Registry (ChiCTR2400080306). https://www.chictr.org.cn/showproj.html?proj=206538 .
CattleReview
Authors: Barrett David C
Published: August 2024

Introduction:

In this Cattle Review we consider two papers recently published in the same journal investigating cow-calf contact in dairy production and a paper looking at omphalitis in beef suckler (cow-calf) operations.
Third eyelid laceration in a cat
Authors: Huitson Kelly
Published: August 2024

This case report discusses the management of a significant laceration on the third eyelid of a cat at an isolated island clinic location. The patient required immediate surgery to correct the laceration as well as medical management to prevent significant or prolonged periods with a superficial corneal ulceration. The patient healed quickly without further complications.
GELENEKSEL EKOLOJİK BİLGİ BAĞLAMINDA IĞDIR’DA BİR HALK METEOROLOJİSİ UYGULAMASI
Authors: Doğan Oğuz
Published: August 2024

İnsanlığın ortak bir yaşam düzleminde çevresiyle uyum içinde yaşama çabasının ürünü olan geleneksel ekolojik bilgi, sürdürülebilirliği temel alan hayat anlayışıyla kültürel yapının temelini oluşturmaktadır. Tarımsal faaliyetlere dayalı yaşam alışkanlıklarının egemen olduğu Iğdır ve yöresinde yapılan hava tahminleri ve hava koşullarına müdahale edilmeye çalışılması sırasında gerçekleştirilen uygulamalar, sözü edilen geleneksel bilginin önemli örneklerindendir. Bu çalışmayla, sözlü kültür geleneği içerisinde varlığını sürdüren ekolojik bilginin kapsam alanına giren halk meteorolojisi uygulamaları, yörede bulunan kaynak kişilerle yapılan mülakatlar neticesinde derlenmeye çalışılmıştır. Veriler, nitel araştırma tekniği kullanılarak elde edilen bilgilerden oluşmaktadır. Yörede yapılan araştırma, bir yönüyle geleneksel ekolojik bilginin belgelenmesi ve korunmasına katkıda bulunmayı amaç edinmektedir. Bu çalışmayla, bölgede bulunan geleneksel ekolojik bilgi yalnızca doğa ve doğa olaylarının sınıflandırılmasıyla sınırlı tutulmamış, geleneksel ekolojik bilginin halk kültürüyle olan derin ilişkisine de dikkat çekilmeye gayret edilmiştir. Böylelikle GEB’in bütünüyle ortaya çıkarılması ve olası kültürel çözülmenin önüne geçilmesi sağlanmaya çalışılmıştır. Bahse konu uygulamalar, geleneksel ekolojik bilginin yerel olma özelliğinden ötürü kendi bağlamı içerisinde toplumsal yapı göz önüne alınarak değerlendirilmeye alınmıştır. Yöre insanının böylesi bir geleneksel ekolojik bilgiye başvurmasındaki temel düşünce, dolunun zararlı etkilerini azaltmayı, tarımsal bitkilerde oluşabilecek tahribatı önlemeyi ve doğal kaynakların korunmasına katkı sağlamayı kapsamaktadır. Sonuç olarak, yöre insanının atalarından miras alarak devam ettirdiği geleneksel ekolojik bilgi temelli uygulamalar, teknolojik gelişmeler ve yanlış tarımsal faaliyetler sonucu bölgede ortaya çıkan çevresel problemlerin çözümü için ilham alınabilecek bir alternatif olma konumundadır. Bu doğrultuda bölgede yürütülen tarımsal faaliyetlerde GEB’e dayalı çözümlerin öncelenmesi ve desteklenmesi aynı zamanda sürdürülebilirlik hedeflerine ulaşılması için de odak bir nokta olarak kabul edilmelidir.
MORTALITY AND RE-REVISION FOLLOWING SINGLE-STAGE COMPARED WITH TWO-STAGE REVISION FOR INFECTED HIP ARTHROPLASTY
Authors: Lenguerrand E. , Whitehouse M. R. , Beswick A. D. , Kunutsor S. K. , Webb J. C. J. , Mehendale S. , Porter M. , Blom A. W.
Published: August 2024

We compared the risks of re-revision and mortality between two-stage and single-stage revision surgeries among patients with infected primary hip arthroplasty. Patients with a periprosthetic joint infection (PJI) of their primary arthroplasty revised with single-stage or two-stage procedure in England and Wales between 2003 and 2014 were identified from the National Joint Registry. We used Poisson regression with restricted cubic splines to compute hazard ratios (HRs) at different postoperative periods. The total number of revisions and re-revisions undergone by patients was compared between the two strategies. In total, 535 primary hip arthroplasties were revised with single-stage procedure (1,525 person-years) and 1,605 with two-stage procedure (5,885 person-years). All-cause re-revision was higher following single-stage revision, especially in the first three months (HR at 3 months = 1.98 (95% confidence interval (CI) 1.14 to 3.43), p = 0.009). The risks were comparable thereafter. Re-revision for PJI was higher in the first three postoperative months for single-stage revision and waned with time (HR at 3 months = 1.81 (95% CI 1.22 to 2.68), p = 0.003; HR at 6 months = 1.25 (95% CI 0.71 to 2.21), p = 0.441; HR at 12 months = 0.94 (95% CI 0.54 to 1.63), p = 0.819). Patients initially managed with a single-stage revision received fewer revision operations (mean 1.3 (SD 0.7) vs 2.2 (SD 0.6), p < 0.001). Mortality rates were comparable between these two procedures (29/10,000 person-years vs 33/10,000). The risk of unplanned re-revision was lower following two-stage revision, but only in the early postoperative period. The lower overall number of revision procedures associated with a single-stage revision strategy and the equivalent mortality rates to two-stage revision are reassuring. With appropriate counselling, single-stage revision is a viable option for the treatment of hip PJI.
FUNCTIONAL OUTCOME OF DUAL MOBILITY ARTICULATIONS: IS THERE A COMPROMISE?
Authors: Shimmin A.
Published: August 2024

Dislocation is still one of the more common reasons for revision of THR.Registry and large institutional data has demonstrated the effectiveness of Dual Mobility articulations in reducing revision for dislocation after THR. There is little data about whether the use of dual mobility is associated with a comprised clinical functional outcome.

This study aimed to ascertain whether the use of Dual Mobility articulations (DM cups) comes within a compromise to the functional of the THR procedure as measured by the Hip disability and Osteoarthritis Outcome Score (HOOS).

Utilising a retrospective design, patients were grouped into those with DM cups with 12 PROMs (Cohort 1) or a large data base of all THR procedures also with a complete set of 12 month PROMs (Cohort 2). The 2 groups were matched for age and gender through propensity score matching. The comparison focused on five domains of the HOOS: Pain, Symptoms, Activities of Daily Living (ADL), Sports and Recreation, and Quality of Life (QOL) at 6- and 12-months post-operation.

12 month PROM data suggested a convergence in scores for several domains, no uniform superiority of one articulation type over the other was found across all domains. These results suggest that both DM cup and standard articulations can effectively improve patient-reported outcomes in THR surgeries, but there are variations in recovery within each cohort that are potentially influenced by factors beyond the articulation type.

This study contributes to the ongoing dialogue on optimising prosthetic selection to enhance recovery trajectories and quality of life for THR patients, emphasising the critical role of evidence-based decision-making in orthopaedic surgery.
THE USE OF POROUS TITANIUM ACETABULAR AUGMENTS IN PRIMARY TOTAL HIP ARTHROPLASTY FOR HIP DYSPLASIA OR RAPIDLY DESTRUCTIVE COXOPATHY
Authors: Sugano N. , Ando W. , Maeda Y , Tamura K , Uemura K , Takashima K , Hamada H.
Published: August 2024

In primary total hip arthroplasty (THA) for patients with Crowe II or higher classes developmental dysplasia of the hip (DDH) or rapidly destructive coxopathy (RDC), the placement of the cup can be challenging due to superior and lateral acetabular bone defects. Traditionally, bone grafts from resected femoral heads were used to fill these defects, but bulk graft poses a risk of collapse, especially in DDH with hypoplastic femoral heads or in RDC where good quality bone is scarce. Recently, porous metal augments have shown promising outcomes in revision surgeries, yet reports on their efficacy in primary THA are limited.

This study retrospectively evaluated 27 patients (30 hips) who underwent primary THA using cementless cups and porous titanium acetabular augments for DDH or RDC, with follow-up periods ranging from 2 to 10 years (average 4.1 years). The cohort included 22 females (24 hips) and 5 males (6 hips), with an average age of 67 years at the time of surgery.

The findings at the final follow-up showed no radiographic evidence of loosening or radiolucency around the cups and augments, indicating successful biological fixation in all cases. Clinically, there was a significant improvement in the WOMAC score from an average of 39.1±14.7 preoperatively to 5.1±6.4 postoperatively. These results suggest that the use of cementless cups and porous titanium acetabular augments in primary THA for DDH and RDC can lead to high levels of clinical improvement and reliable biological fixation, indicating their potential as a viable solution for managing challenging acetabular defects in these conditions.
VISUALIZED NAVIGATION-ASSISTED ACETABULAR MIRROR RECONSTRUCTION EXHIBITS BETTER FUNCTIONAL PERFORMANCE IN TOTAL HIP ARTHROPLASTY FOR CROWE II/III DEVELOPMENTAL DYSPLASIA OF THE HIP: A RETROSPECTIVE COHORT STUDY
Authors: Zhang B. , Kong X. , Zhou Y. , Zhang H. , Jiang Q. , Chai W.
Published: August 2024

There is still no clear consensus regarding which cup position might provide better functional performance for developmental dysplasia of the hip (DDH). This study aimed to evaluated the feasibility and efficacy of acetabular mirroring reconstruction for DDH in total hip arthroplasty (THA).

The study reviewed 96 patients (96 hips) with unilateral Crowe type-II/III DDH undergoing either visualized navigation-assisted mirroring reconstruction with augment according to the rotation center and biomechanical structure of the contralateral normal hips (Mirroring group, 51 hips) or high hip center reconstruction (HHC group, 45 hips) in THA from 2020 to 2023. The functional and radiographic results were analyzed between the groups during a mean follow-up period of 27.5 and 28.9 months (a minimum follow-up of 12 months).

The Harris hip score at the last follow-up significantly improved in both groups, while it was significantly higher in the mirroring group (P<0.001). In the HHC group, the rotation center height and greater trochanter height were significantly increased in the affected hip (P<0.001; P<0.001) and the abductor lever arm was significantly decreased in the affected hip compared to that in the contralateral normal hip (P<0.001), whereas in the mirroring group no significant statistical differences were observed between two sides. The limping occurred in 7 patients (13.7%) in the mirroring group and 14 patients (31.1%) in the HHC group (P=0.040). A multiple logistic regression demonstrated mirroring reconstruction could reduce the incidence of postoperative limping (P=0.020).

Both mirroring and HHC reconstruction could improve the functional performance of THA, whereas mirroring reconstruction could offer superior biomechanical results and gait improvement as compared with HHC reconstruction, meeting the higher requirements of functional recovery.
NO DIFFERENCE IN IN-HOSPITAL OPIOID USE AND 90-DAY OPIOID PRESCRIPTIONS IN PATIENTS UNDERGOING ANTERIOR AND POSTEROLATERAL APPROACH TOTAL HIP ARTHROPLASTY
Authors: Borsinger T. M. , Chandi S. K. , Neitzke C. C. , Cororaton A. D. , Valle A. Gonzalez Della , Chalmers B. P.
Published: August 2024

Proponents of the direct anterior approach (DAA) for hip arthroplasty (THA) claim lower postoperative pain compared to the posterolateral approach (PA); however, whether that theoretical advantage results in lower opioid consumption is unclear. We sought to investigate the relationship between the DAA and PA on total 90-day predicted opioid consumption in a large cohort.

Retrospective analysis identified 2,304 DAA and 6,288 PA primary THAs in patients >18 years old from February 2019 to April 2022. Ninety-day postoperative total morphine milligram equivalent (MME); in-hospital administration, discharge prescriptions, and refills within 90 days were compared between DAA and PA cohorts. Nearest-neighbor matching was performed controlling for age, sex, BMI, ASA, and periarticular injection to evaluate opioid consumption patterns for DAA and PA. Quantile regression was employed to predict the median (50th percentile) MME prescribed by surgical approach.

After matching, DAA and PA demonstrated similar median total 90-day prescribed MME (p = 0.008). After adjusting for patient and surgical factors, quantile regression predicted a similar median total 90-day prescribed MME for DAA and PA (243.5 versus 242.7; p = 0.78). While approach did not demonstrate a significant relationship for predicted 90-day MME, other factors including age, sex, BMI, length of stay, peripheral anesthesia, periarticular injection, and white or Caucasian race demonstrated a significant relationship with predicted 90-day MME (p <0.0001).

While we identified several risk factors for increased in-hospital and 90-day post-operative opioid consumption, a comparison between DAA and PA did not demonstrate significantly different opioid prescribing patterns.
STEMS IMPLANTED THROUGH A DIRECT ANTERIOR APPROACH HAVE HIGHER ANTEVERSION THAN THOSE IMPLANTED THROUGH A POSTERIOR APPROACH
Authors: Solomon M. , Plaskos C. , Pierrepont J.
Published: August 2024

The purpose of this study was to investigate the influence of surgical approach on femoral stem version in THA.

This was a retrospective database review of 830 THAs in 830 patients that had both preoperative and postoperative CT scans. All patients underwent staged bilateral THAs and received CT-based 3D planning on both sides. Stem version was measured in the second CT-scan and compared to the native neck axis measured in the first CT-scan, using the posterior condyles as the reference for both. Cases were performed by 104 surgeons using either a direct anterior (DAA, n=303) or posterior (PA, n=527) approach and one of four stem designs: quadrangular taper, calcar-guided short stem, flat taper and fit-and-fill. Sub-analyses investigated changes in version for low (≤5°), neutral (5–25°) and high (≥25°) native version subgroups and for the different implant types.

Native version was not different between approaches (DAA = 12.6°, PA = 13.6°, p = 0.16). Overall, DAA stems were more anteverted relative to the native neck axis vs PA stems (5.9° vs 1.4°, p<0.001). This trend persisted in hips with high native version (3.2° vs -5.3°, p<0.01) and neutral native version (5.3° vs 1.3°, p<0.001), but did not reach significance in the low native version subgroup (8.9° vs 5.9°, p=0.13). Quadrangular taper, calcar-guided, and flat taper stem types had significantly more anteversion than native for DAA, while no differences were found for PA.

Stems implanted with a direct anterior approach had more anteversion than those implanted with a posterior approach. The smaller surgical field, soft tissue tension and lack of a “tibial” vertical reference frame may contribute to this finding.
PRESERVATION OF THE LATERAL CIRCUMFLEX ARTERY IN DIRECT ANTERIOR APPROACH TOTAL HIP ARTHROPLASTY: EFFECT ON MUSCLE STATUS AND CLINICAL OUTCOMES
Authors: Bell L. , Stephan A. , Pfirrmann C. W. A. , Stadelmann V. , Schwitter L. , Rüdiger H. A. , Leunig M.
Published: August 2024

The direct anterior approach (DAA) is a popular minimally invasive approach for total hip arthroplasty (THA). It usually involves ligation of the lateral femoral circumflex artery's ascending branch (a-LFCA), which contributes to the perfusion of the tensor fasciae latae (TFL) muscle. Periarticular muscle status and clinical outcome were assessed after DAA-THA after a-LFCA preservation versus ligation.

We evaluated surgical records of 161 patients undergoing DAA-THA with tentative preservation of the a-LFCA by the senior author between May and November 2021. Among 92 eligible patients, 33 (35 hips) featured successful preservation, of which 20 (22 hips, 13 female) participated in the study. From 59 patients with ligated a-LFCA, 26 (27 hips, 15 female) were enrolled, constituting the control group. MRI and clinical examinations were performed at 17–26 months to analyze volume and fatty infiltration of the TFL, gluteus medius and gluteus minimus muscles relative to the contralateral non-THA hip (15 preserved, 18 ligated). Clinical and radiographic data was retrospectively extracted from patient files. Patient-reported outcomes (PROMs) were added from the THA registry.

There was a relative difference in TFL muscle volume of -6.27 cm3 (−9.89%, p=0.018) after a-LFCA preservation versus -8.6 cm3 (=11.62%, p=0.002) after ligation, without group differences (p>0.340). a-LFCA preservation showed lower relative TFL fatty infiltration (p=0.10). Gluteal muscle status was similar between sides and groups. Coxa valga morphology was more frequent in a-LFCA preservation (83%) than ligation (17%). Clinical outcomes showed high patient satisfaction in both groups, without difference in PROMs, but less anterolateral soft-tissue swelling after a-LFCA preservation (p<0.001).

Despite excellent clinical results in both groups, preservation of the a-LFCA was associated with less TFL fatty infiltration and soft tissue swelling. Provided there is no compromise of intraoperative access we recommend a-LFCA preservation for DAA-THA.
ARTHROSCOPIC TREATMENT OF ANTERIOR INFERIOR ILIAC SPINE IMPINGEMENT: FIVE-YEAR CLINICAL OUTCOMES
Authors: Peña O. Marín , Lozoya J. M. , Martin M. Cañones , Reig J. Sanz , Sadiq M.
Published: August 2024

There is a limited literature available describing the various diagnostic modalities and treatment options for the management of subspine impingement (SSI). We developed a study to evaluate the clinical improvement at 1 year and 5 years, with iHOT 33 and HOS hip scores.

(1) Do patients with subspine compression improve with arthroscopic treatment clinically at short term follow-up (1 year)? (2) Is the improvement maintained in the mid-term (5 years)?

43 young patients with subspine compression (prominent anterior inferior iliac spine) treated arthroscopically between January 2010 and December 2021 were included. Patients completed the iHOT33, HOS-SPORT and HOS-ADL questionnaires before surgery, 1 year and 5 years follow up. We evaluated pre and postoperative differences at one year and at 5 years. Minimum Clinically Significant Difference (MCID) and the Substantial Clinical Benefit (SCB) were used to stablish clinical improvement.

Mean age was 37.38 years and 66% were males. Almost 75% and 70% of our patients exceed the MCID and the SCB respectively in all the questionnaires after 1 year-follow up. However, at 5 years-follow up, nearly 70% and 65% of the patients exceeded MCID and SCB respectively.

We demonstrate that arthroscopic treatment of subspine impingement as an effective treatment for Subspine impingement. However, it is necessary larger sample size and longer follow up period to analyze the long-term results to demonstrate this treatment as the “gold standard”.
COMPARISON OF SURVIVAL RATES AND ANALYSIS OF FIRST-TIME STEM REVISION OF SHORT-STEMMED AND NORMAL-STEMMED TOTAL HIP ARTHROPLASTIES BASED ON 16,258 SHORT STEMS FROM THE AUSTRALIAN, DUTCH, AND SWEDISH REGISTRIES
Authors: Rilby K. , van Veghel M. H. W. , van Steenbergen L. N. , Lewis P. , Mohaddes M. , Kärrholm J. , Schreurs W. , Hannink G.
Published: August 2024

Short-stem total hip arthroplasty (THA) may have bone sparing properties, which could be advantageous in a younger population with high risk of future revision surgery. We used data from the AOANJRR, LROI and SAR to compare survival rates of primary THA, stems used in the first-time revision procedures as well as the overall survival of first-time revisions between a cohort of short-stem and standard-stem THA.

Short-stem THAs (designed as a short stem with mainly metaphyseal fixation) between 2007 and 2021 were identified (n=16,258). A propensity score matched cohort (1:2) with standard THAs in each register was identified (n=32,515). The cohorts were merged into a research dataset. Overall survival at 12 years follow-up was calculated using Kaplan-Meier survival analyses. Stem revisions (short-stem THA n=239, standard-stem THA n=352) were identified. The type of revision stem was classified as standard (<160 mm) or long (>160 mm). The survival rate of all first-time revisions in the two groups was calculated using any type of revision as outcome.

The 12 year- overall survival rate (all revisions, all causes) for primary short-stem THAs was 95.3% (CI 94.5–95.9%), which was comparable to 95.2% (CI 94.7–95.7%) for standard-stem THAs. In the short-stem THA group, a standard stem (<160 mm) was more often (59%) used in the first-time revision than in the standard-stem group (47%, p=0.004). The overall survival of the first-time revisions did not differ between cases primarily operated with a short or a standard stem.

In our multi-national register study, the overall survival rate of short stems was similar to that of standard stems. In short stem revisions there was a higher likelihood of using a standard-length stem for the revision compared with first-time revisions of standard stems. This finding might indicate bone-sparing properties with short-stemmed THAs.
THE USE OF LARGE METAL HEADS IN THIN VITAMIN E-DOPED CROSS-LINKED POLYETHYLENE INSERTS DOES NOT INCREASE POLYETHYLENE WEAR IN TOTAL HIP ARTHROPLASTY: FIVE-YEAR RESULTS FROM A RANDOMIZED CONTROLLED TRIAL
Authors: Tsikandylakis G. , Mortensen K. R. L. , Gromov K. , Mohaddes M. , Malchau H. , Troelsen A.
Published: August 2024

Vitamin E-doped cross-linked polyethylene (VEPE) has encouraged the use of larger heads in thinner liners in total hip arthroplasty (THA). However, there are concerns about wear and mechanical failure of the thin liner, especially when metal heads are used. The aim of this randomized controlled trial was to investigate if the use of a large metal head in a thin VEPE liner would increase polyethylene wear compared with a standard 32-mm metal head and to compare periacetabular radiolucencies and patient-reported outcomes in THA.

96 candidates for uncemented THA were randomly allocated to either the largest possible metal head (36–44 mm) that could be fitted in the thinnest available VEPE liner (intervention group) or a standard 32-mm metal head (control group). The primary outcome was proximal head penetration (PHP) measured with model-based radiostereometric analysis (RSA). Secondary outcomes were periacetabular radiolucencies and patient-reported outcomes. The mid-term results of the trial at 5 years are presented.

Median total PHP (interquartile range) was -0.04 mm (−0.12 to 0.02) in the intervention group and -0.03 mm (=0.14 to 0.05) in the control group (p=0.691). The rates of periacetabular radiolucencies were 1/44 and 4/42 (p=0.197), respectively. Patient-reported hip function and health-related quality of life did not differ between the groups, but participants in the intervention group reported a higher level of activity (median UCLA rank 7 vs 6, p=0.020). There were 5 revisions caused by dislocations (2), periprosthetic fracture (1), stem subsidence (1), or iliopsoas impingement (1).

Large metal heads in thin VEPE liners did not increase liner wear and were not associated with liner failure 5 years after THA.
COBALT TOXICITY FROM THIRD BODY WEAR OF A METAL HEAD FOLLOWING TOTAL HIP ARTHROPLASTY REVISION FOR CERAMIC-ON-CERAMIC BEARING FRACTURE: A SERIES OF FIVE CASES
Authors: Terhune E. B. , Sutter E. G. , Balkissoon R. , Pallante G. D. , Specht L. , Leikin J. B. , Kwon Y. M. , Lewallen D. G. , Gerlinger T. L. , Jacobs J. J.
Published: August 2024

Ceramic-on-ceramic (CoC) articulations in total hip arthroplasty (THA) have low wear, but the unique risk of fracture. After revision for CoC fracture, ceramic third bodies can lead to runaway wear of cobalt chrome (CoCr) causing extremely elevated blood cobalt. We present five cases of ceramic liner fractures revised to a CoCr head associated with the rapid development of severe cobalt toxicity.

We identified 5 cases of fractured CoC THA treated with revision to CoCr on highly cross-linked polyethylene (HXLPE) – three to conventional bearings and two to modular dual mobility bearings (CoCr acetabular liner, CoCr femoral head, and HXLPE). Mean follow up was 2.5 years after CoCr/HXLPE re-revision.

Symptoms of cobalt toxicity occurred at average 9.5 months after revision for ceramic fracture (range 6–12). All patients developed vision and hearing loss, balance difficulties, and peripheral neuropathy. Several had cardiomyopathy, endocrinopathy, and local skin discoloration. Two reported hip pain. Re-revision for cobalt toxicity occurred at an average of 22 months (range 10–36) after revision for ceramic fracture. Average serum cobalt level at re-revision was 991 μg/L (range 734–1302, normal <1 μg/L). All CoCr heads exhibited massive wear with asphericity; deep tissues exhibited prominent metallosis. Treatment consisted of debridement and revision to a ceramic head with HXLPE. Serum cobalt improved to an average of 25 μg/L at final follow up. All patients reported partial improvement in vision and hearing; peripheral neuropathy and balance did not recover.

Systemic cobalt toxicity is a rare but devastating complication of ceramic fracture in THA treated with cobalt-alloy bearings. Cobalt alloy bearings should be avoided in this setting. The diagnosis of systemic cobalt toxicity requires a high index of suspicion and was typically delayed following systemic symptoms. Debridement and revision to a ceramic-on-HXLPE leads to improvement but not resolution of cobalt toxicity complications.
IDENTIFYING RISK FACTORS FOR DISEASE PROGRESSION IN DEVELOPMENTAL DYSPLASIA OF THE HIP USING A CONTRALATERAL HIP MODEL
Authors: Harris M. D. , Thapa S. , Lieberman E. G. , Pascual-Garrido C. , Abu-Amer W. , Nepple J. J. , Clohisy J. C.
Published: August 2024

Developmental dysplasia of the hip can cause pain and premature osteoarthritis. However, the risk factors and timing for disease progression in young adults are not fully defined. This study identified the incidence and risk factors for contralateral hip pain and surgery after periacetabular osteotomy (PAO) on an index dysplastic hip.

Patients followed for 2+ years after unilateral PAO were grouped by eventual contralateral pain or no-pain, based on modified Harris Hip Score, and surgery or no-surgery. Univariate analysis tested group differences in demographics, radiographic measures, and range-of-motion. Kaplan-Meier survival analysis assessed pain development and contralateral hip surgery over time. Multivariate regression identified pain and surgery risk factors. Pain and surgery predictors were further analyzed in Dysplastic, Borderline, and Non-dysplastic subcategories, and in five-degree increments of lateral center edge angle (LCEA) and acetabular inclination (AI).

184 patients were followed for 4.6±1.6 years, during which 51% (93/184) reported hip pain and 33% (60/184) underwent contralateral surgery. Kaplan-Meier analysis predicted 5-year survivorship of 49% for pain development and 66% for contralateral surgery. Painful hips exhibited more severe dysplasia than no-pain hips (LCEA 16.5º vs 20.3º, p<0.001; AI 13.2º vs 10.0º p<0.001). AI was the sole predictor of pain, with every 1° AI increase raising the risk by 11%. Surgical hips also had more severe dysplasia (LCEA 14.9º vs 20.0º, p<0.001; AI 14.7º vs 10.2º p<0.001) and were younger (21.6 vs 24.1 years, p=0.022). AI and a maximum alpha angle ≥55° predicted contralateral surgery.

5 years after index hip PAO, 51% of contralateral hips experience pain and 34% percent are expected to need surgery. More severe dysplasia, based on LCEA and AI, increases the risk of contralateral hip pain and surgery, with AI being a predictor of both outcomes. Knowing these risks can inform patient counseling and treatment planning.
A NOVEL MAGNETIC SYSTEM TO TREAT TOTAL HIP ARTHROPLASTY INSTABILITY
Authors: Cook S. D. , Patron L. P. , Salkeld S. L. , Nolan L. P. , Lavernia C. J.
Published: August 2024

Dislocation after total hip replacement (THR) is a devastating complication. Risk factors include patient and surgical factors. Mitigation of this complication has proven partially effective. This study investigated a new innovating technique to decrease this problem using rare earth magnets.

Computer simulations with design and magnetic finite element analysis software were used to analyze and quantitate the forces around hip implants with embedded magnets into the components during hip range of motion. N52 Neodymium-Iron-Boron rare earth magnets were sized to fit within the existing acetabular shells and the taper of a hip system. Additionally, magnets placed within the existing screw holes were studied. A 50mm titanium acetabular shell and a 36mm ceramic liner utilizing a taper sleeve adapter were modeled which allowed for the use of a 12mm × 5mm magnet placed in the center hole, an 18mm × 15mm magnet within the femoral head, and 10mm × 5mm magnets in the screw holes.

Biomechanical testing was also performed using in-vitro bone and implant models to determine retention forces through a range of hip motion.

The novel system incorporating magnets generated retentive forces between the acetabular cup and femoral head of between 10 to 20 N through a range of hip motion. Retentive forces were stronger at the extreme position hip range of motion when additional magnets were placed in the acetabular screw holes. Greater retentive forces can be obtained with specially designed femoral head bores and acetabular shells specifically designed to incorporate larger magnets. Mechanical testing validated the loads obtained and demonstrated the feasibility of the magnet system to provide joint stability and prevent dislocations.

Rare earth magnets provide exceptional attractive strength and can be used to impart stability and prevent dislocation in THR without the complications and limitations of conventional methods.
DOES TOTAL HIP ARTHROPLASTY BENEFIT PATIENTS WITH MINIMAL RADIOLOGICAL OSTEOARTHRITIS?
Authors: Logishetty K. , Verhaegen J. , Hutt J. , Witt J.
Published: August 2024

There is some evidence to suggest that outcomes of THA in patients with minimal radiographic osteoarthritis may not be associated with predictable outcomes. The aim of this study was to:

Assess the outcome of patients with hip pain who underwent THA with no or minimal radiographic signs of osteoarthritis,

Identify patient comorbidities and multiplanar imaging findings which are predictive of outcome,

Compare the outcome in these patients to the expected outcome of THA in hip OA.

A retrospective review of 107 hips (102 patients, 90F:12M, median age 40.6, IQR 35.1–45.8 years, range 18–73) were included for analysis. Plain radiographs were evaluated using the Tonnis grading scale of hip OA. Outcome measures were all-cause revision; iHOT12; EQ-5D; Oxford Hip Score; UCLA Activity Scale; and whether THA had resulted in the patient's hip pain and function being Better/Same/Worse.

The median Oxford Hip Score was 33.3 (IQR 13.9, range 13–48), and 36/107 (33.6%) hips achieved an OHS≥42. There was no association between primary hip diagnosis and post-operative PROMs. A total of 91 of the 102 patients (89.2%, 93 hips) reported that their hip pain and function was Better than prior to THA and would have the surgery again, 7 patients (6.8%, 10 hips) felt the Same, and 4 patients (3.9%, 4 hips) felt Worse and would not have the surgery again.

Younger patients undergoing total hip arthroplasty with no or minimal radiographic osteoarthritis had lower postoperative Oxford Hip Scores than the general population; though most felt symptomatically better and knowing what they know now, would have surgery again. Those with chronic pain syndrome or hypermobility were likely to benefit less. Those with subchondral cysts or joint space narrowing on CT imaging were more likely to achieve higher functional scores and satisfaction.
Compact laser spectroscopy-based sensor using a transformer-based model for analysis of multiple molecules
Authors: Bayrakli Ismail , Eken Enes
Published: August 2024

Interest in the development of compact sensors that consume low energy is increasing day by day. This study reports, to our knowledge, such a novel sensor system that can analyze multiple molecules simultaneously with high sensitivity under ambient conditions (900 mbar and 300 K). To quantify molecules, a distributed feedback quantum cascade laser (DFB QCL) was combined with a compact multi-pass absorption (mpass) cell without the need for vacuum components, lock-in amplifier, or any electric filters. By using a transformer-encoder-based model, the noise level was reduced and the pressure-broadened absorption lines of the molecules were separated, narrowed (resolved), and displayed one by one. In this way, molecules can be quantified using pressure-broadened overlapping absorption lines under ambient conditions. To test our sensor system, CO2 and N2O molecules were used. Depending on the concentration values, SNR can be improved by up to 50 times. Better results are obtained at higher concentration values. Detection limits for N2O and CO2 molecules were determined to be 30 ppb and 180 ppm, respectively. The analysis time of molecules is around 80 ms.
Microfluidic point-of-care testing device for multiplexed detection of liver function blood markers
Authors: Li Yingchun , Cheng Haobo
Published: August 2024

In this work, we developed a novel microfluidic paper-based analytical device to quantify the blood markers of liver function from human fingertips and whole blood samples. The device can quickly acquire information for screening liver injury and supporting clinical decision-making by simultaneously performing quantitative tests for alanine aminotransferase, aspartate aminotransferase, and albumin. We evaluated the detection accuracy and the storage stability of the device using fingertip samples. The yielded results of our device correlated well with those from Mindray BS350s, even under the conditions of 35 °C and 90%RH. Thus, it offers an effective platform for clinical assessment of liver injury particularly in resource-limited areas.
Magnetically induced perfect absorption and slow light trapping in a double-cavity structure with strontium atoms
Authors: Zhou Shuang , Li Xiyun , Li Ying , Pu Yong
Published: August 2024

Photon manipulation using quantum interference is crucial for understanding the physical meaning of optical phenomena and promoting photonic quantum technologies. Here, two fundamentally optical phenomena, including coherent perfect absorption (CPA) and slow light trapping, are proposed simultaneously in a double-cavity structure with strontium atoms. When two counterpropagating probe fields are injected into the coupled atom-cavity system, we demonstrate that double-cavity-mediated interference assisted by the atomic Zeeman effect can be utilized to control multiple mode splitting in the transmission light. According to the analytical CPA criterion, we report that these splitting modes in the output spectra can be completely absorbed, forming multiple perfect or nearly perfect absorption. More importantly, we illustrate that sizable intracavity field localization can be found at the multiple CPA points, as an amount of system energy stores in the intracavity fields and the atomic excited states. In this case, the dispersion property of the system enables the localized intracavity fields to operate in the long-lived slow-light regime, whose group delay is tuned to be in the order of microseconds.
Ultra-smooth processing of lithium niobate for outstanding mid-infrared transmittance
Authors: Tian Ke-Shuai , Li Hong-Yu , Wang Zhen , Zheng Jia-Xin , Zhang Xin , Wang Lei , Liu Xue-Qing
Published: August 2024

The fabrication of anti-reflection (AR) subwavelength structures (SWSs) of lithium niobate (LN) is a challenging but rewarding task in mid-infrared LN laser systems. However, there are still some issues with the high-quality processing and fabrication of bifacial AR SWSs. Herein, a novel, to the best of our knowledge, approach to the fabrication of SWSs was proposed, which includes femtosecond laser ablation followed by wet etching and thermal annealing. The fabricated structures exhibit high surface quality (Ra = 0.08 nm) and uniformity. According to the experimental and simulated results, the transmittance of the mid-infrared AR SWSs with a period of 1.8 µm could be improved from 78% to 87% in the 3.6–5 µm band. Furthermore, the double-sided construction enabled a transmittance of up to 90%. The results have great potential in the promotion of the development of mid-infrared laser systems and LN-based photonics.
The conformational plasticity of structurally unrelated lipid transport proteins correlates with their mode of action
Authors: Srinivasan Sriraksha , Di Luca Andrea , Álvarez Daniel , John Peter Arun T. , Gehin Charlotte , Lone Museer A. , Hornemann Thorsten , D’Angelo Giovanni , Vanni Stefano
Published: August 2024

Lipid transfer proteins (LTPs) are key players in cellular homeostasis and regulation, as they coordinate the exchange of lipids between different cellular organelles. Despite their importance, our mechanistic understanding of how LTPs function at the molecular level is still in its infancy, mostly due to the large number of existing LTPs and to the low degree of conservation at the sequence and structural level. In this work, we use molecular simulations to characterize a representative dataset of lipid transport domains (LTDs) of 12 LTPs that belong to 8 distinct families. We find that despite no sequence homology nor structural conservation, the conformational landscape of LTDs displays common features, characterized by the presence of at least 2 main conformations whose populations are modulated by the presence of the bound lipid. These conformational properties correlate with their mechanistic mode of action, allowing for the interpretation and design of experimental strategies to further dissect their mechanism. Our findings indicate the existence of a conserved, fold-independent mechanism of lipid transfer across LTPs of various families and offer a general framework for understanding their functional mechanism.
A noninvasive BCG skin challenge model for assessing tuberculosis vaccine efficacy
Authors: Krishnan Nitya , Priestman Miles , Uhía Iria , Charitakis Natalie , Glegola-Madejska Izabella T. , Baer Thomas M. , Tranberg Albin , Faraj Alan , Simonsson Ulrika SH , Robertson Brian D.
Published: August 2024

We report here on the characterisation in mice of a noninvasive bacille Calmette-Guérin (BCG) skin challenge model for assessing tuberculosis (TB) vaccine efficacy. Controlled human infection models (CHIMs) are valuable tools for assessing the relevant biological activity of vaccine candidates, with the potential to accelerate TB vaccine development into the clinic. TB infection poses significant constraints on the design of a CHIM using the causative agent Mycobacterium tuberculosis (Mtb). A safer alternative is a challenge model using the attenuated vaccine agent Mycobacterium bovis BCG as a surrogate for Mtb, and intradermal (skin) challenge as an alternative to pulmonary infection. We have developed a unique noninvasive imaging system based on fluorescent reporters (FluorBCG) to quantitatively measure bacterial load over time, thereby determining a relevant biological vaccine effect. We assessed the utility of this model to measure the effectiveness of 2 TB vaccines: the currently licenced BCG and a novel subunit vaccine candidate. To assess the efficacy of the skin challenge model, a nonlinear mixed-effects models was built describing the decline of fluorescence over time. The model-based analysis identified that BCG vaccination reduced the fluorescence readout of both fluorophores compared to unvaccinated mice (p < 0.001). However, vaccination with the novel subunit candidate did not alter the fluorescence decline compared to unvaccinated mice (p > 0.05). BCG-vaccinated mice that showed the reduced fluorescent readout also had a reduced bacterial burden in the lungs when challenged with Mtb. This supports the fluorescence activity in the skin as a reflection of vaccine induced functional pulmonary immune responses. This novel noninvasive approach allows for repeated measurements from the challenge site, providing a dynamic readout of vaccine induced responses over time. This BCG skin challenge model represents an important contribution to the ongoing development of controlled challenge models for TB.
Burnout and quality of life among healthcare workers in central Uganda
Authors: Kabunga Amir , Kigongo Eustes , Okalo Ponsiano , Udho Samson , Grace Anna Auma , Tumwesigye Raymond , Akello Anne Ruth , Musinguzi Marvin , Acup Walter , Nabaziwa Jannat , Shikanga Enos Mwirotsi , Namata Haliama
Published: August 2024

Background

The widespread problem of burnout among healthcare workers is not only common but also a significant concern that impacts the entire healthcare system in Uganda. It is essential to understand the connection between burnout and quality of life among healthcare workers in the specific context of central Uganda, where healthcare professionals face high patient volumes, limited resources, exposure to infectious diseases, and socioeconomic challenges. This study examined the relationship between burnout and quality of life among healthcare workers in central Uganda.

Methods

This research utilized a cross-sectional study conducted across various healthcare settings in central Uganda. The data were analyzed at descriptive, bivariate, and multivariate levels. The relationship between dependent and independent variables was evaluated using an independent t-test for binary variables and a one-way analysis of variance (ANOVA) for categorical variables. Significance was determined with a reported p-value, with relationships deemed significant at p < 0.2. For multivariable analysis, multiple linear regression was employed using a forward selection method, with significance set at 5% (p < 0.05).

Results

Our findings indicate that nearly 40% of healthcare workers reported experiencing high levels of burnout. The average score for overall quality of life was 10.71 (±4.89), with variations observed across different domains. The study reveals a significant connection between socio-demographic factors, burnout, and overall quality of life, emphasizing the impact of job category, supervisory support, sleep quality, and burnout on the well-being of healthcare workers. Predictive analysis illustrates how these factors influence both overall quality of life scores and scores in specific domains. Particularly noteworthy is that nurses and technicians tend to have a lower quality of life compared to physicians.

Conclusion

The results underscore the relationship between socio-demographic factors, burnout, and particular aspects of quality of life. Notably, job category, supervisory support, sleep quality, and burnout stand out as significant factors shaping the well-being of healthcare workers. Nurses and technicians encounter distinct challenges, suggesting the need for interventions tailored to their needs. Addressing issues such as inadequate supervisory support, burnout, and sleep-related problems is recognized as a potential approach to improving the overall quality of life among healthcare workers.