Variation in Functional Pelvic Tilt in Female Patients Undergoing Total Hip Arthroplasty With Acetabular Dysplasia.

BACKGROUND: As the pelvis is a dynamic structure, the quantification of pelvic tilt (PT) should be done in different hip positions prior to total hip arthroplasty (THA). We sought to investigate functional PT in young female patients undergoing THA and explore the correlation of PT with the extent of acetabular dysplasia. Additionally, we aimed to define the PS-SI (pubic symphysis-sacroiliac joint) index as a PT quantifier on AP pelvis X-ray. METHODS: Pre-THA female patients under the age of 50 years (n = 678) were investigated. Functional PT in 3 positions (supine, standing, and sitting) were measured. Hip parameters including lateral center-edge angle (LCEA), Tönnis angle, head extrusion index (HEI), and femoro-epiphyseal acetabular roof (FEAR) index were correlated to PT values. The PS-SI/SI-SH (sacroiliac joint-sacral height) ratio was also correlated to PT. RESULTS: From the 678 patients, 80% were classified as having acetabular dysplasia. Among these patients, 50.6% were bilaterally dysplastic. The mean functional PT of the entire patient group was 7.4°, 4.1°, and -1.3° in the supine, standing and seated positions. The mean functional PT of the dysplastic group was 7.4°, 4.0°, and -1.2° in the supine, standing and seated positions. The PS-SI/SI-SH ratio was found to be correlated to PT. CONCLUSION: Most of the pre-THA patients had acetabular dysplasia and exhibited anterior PT in the supine and standing positions, most pronounced in the standing position. PT values were comparable between the dysplastic and non-dysplastic group without change with worsening dysplasia. PS-SI/SI-SH ratio can be used to easily characterize PT.

The impact of a smartphone-based cognitive aid on clinical performance during cardiac arrest simulations: A randomized controlled trial.

Objectives: In-hospital cardiac arrests are common and associated with high mortality. Smartphone applications offer quick access to algorithms and timers but often lack real-time guidance. This study assesses the impact of the Code Blue Leader application on the performance of providers leading cardiac arrest simulations. Methods: This open-label randomized controlled trial included Advanced Cardiac Life Support (ACLS)-trained medical doctors (MD) and registered nurses (RN). Participants were randomized to lead the same ACLS simulation with or without the app. The primary outcome, "performance score," was assessed by a trained rater using a validated ACLS scoring system. Secondary outcomes included percentage of critical actions performed, number of incorrect actions, and chest compression fraction (percentage of time spent performing chest compressions). A sample size of 30 participants was calculated to detect a difference of 20% at the 0.05 alpha level with 90% power. Results: Fifteen MDs and 15 RNs underwent stratified randomization. The median (interquartile range) performance score in the app group was 95.3% (93.0%-100.0%) compared to 81.4% (60.5%-88.4%) in the control group, demonstrating an effect size of r = 0.69 (Z = -3.78, r = 0.69, p = 0.0002). The percentage of critical actions performed in the app group was 100% (96.2%-100.0%) compared to 85.0% (74.1%-92.4%) in the control group. The number of incorrect actions performed in the app group was 1 (1) compared to 4 (3-5) in the control group. Chest compression fraction in the app group was 75.5% (73.0%-84.0%) compared to 75.0% (72.0%-85.0%) in the control group. Conclusions: The Code Blue Leader smartphone app significantly improved the performance of ACLS-trained providers in cardiac arrest simulations.

Biomass carbon mining to develop nature-inspired materials for a circular economy.

A transition from a linear to a circular economy is the only alternative to reduce current pressures in natural resources. Our society must redefine our material sources, rethink our supply chains, improve our waste management, and redesign materials and products. Valorizing extensively available biomass wastes, as new carbon mines, and developing biobased materials that mimic nature's efficiency and wasteless procedures are the most promising avenues to achieve technical solutions for the global challenges ahead. Advances in materials processing, and characterization, as well as the rise of artificial intelligence, and machine learning, are supporting this transition to a new materials' mining. Location, cultural, and social aspects are also factors to consider. This perspective discusses new alternatives for carbon mining in biomass wastes, the valorization of biomass using available processing techniques, and the implementation of computational modeling, artificial intelligence, and machine learning to accelerate material's development and process engineering.

Surgeon Estimations of Acetabular Cup Orientation Using Intraoperative Fluoroscopic Imagining Are Unreliable.

Background: Accurate acetabular cup orientation is associated with decreased revision rates and improved outcomes of primary total hip arthroplasty. This study assesses surgeon's ability to estimate both the acetabular component inclination and anteversion angles via intraoperative fluoroscopy (IF) images. Methods: We surveyed orthopedic surgeons to estimate acetabular component inclination and anteversion based on 20 IF images of total hip arthroplasty through a direct anterior approach. Postoperative computed-tomography scans were used to calculate the true inclination and anteversion component angles. The absolute difference between the true and estimated values was calculated to determine the mean and standard deviation of the survey results. Interrater reliability was determined through interclass correlation coefficients. Results: A majority of surgeons preferred the direct anterior approach (83.3%) and utilized IF during surgery (70%). Surgeons surveyed were on average 5.9° away from the true value of inclination (standard deviation = 4.7) and 8.8° away from the true value of anteversion (standard deviation = 6.0). Respondents were within 5° of both inclination and anteversion in 19.7% of cases, and within 10° in 57.3% of cases. All surgeons were determined to have poor reliability in estimating anteversion (interclass correlation coefficient < 0.5). Only 2 surgeons were determined to have moderate reliability when estimating inclination. Conclusions: Surgeons, when solely relying on IF for the estimation of anteversion and inclination, are unreliable. Utilization of other techniques in conjunction with IF would improve observer reliability.

Rotational fishing enables biodiversity recovery and provides a model for oyster (Ostrea edulis) habitat restoration.

Reefs formed by Ostrea edulis, the European native oyster, are among many biogenic habitats that have declined globally. European oyster habitats are now rare, and undisturbed examples have not been described. As more is understood of the ecosystem services provided by the reefs, oyster restoration efforts are on the rise, becoming a more prominent component of Europe's portfolio of marine conservation practices. It is therefore important to establish the relationship between the development of oyster reefs and their associated biotic community if the biodiversity benefits are to be accurately predicted and the progress of restoration projects assessed. The Loch Ryan oyster fishery in Southwest Scotland is the last of its type and uses a rotational harvest system where different areas are fished each year and then left for six years before they are fished again. This provided an opportunity to study the effect of oyster reef development and biodiversity gain at different stages of habitat recovery. In this study three treatments were surveyed for faunal biodiversity, oyster shell density and oyster shell percentage cover. Treatments were plots that had been harvested one year before, two years before, and six years before the study. The treatments were surveyed with SCUBA using a combination of video transects and photo quadrats. Oyster shell density, oyster shell percent cover and macrofaunal biodiversity differed significantly between treatments, with the highest values observed in the six-year treatment. Shell density was 8.5 times higher in the six-year treatment compared to the one-year treatment, whilst Shannon-Wiener's diversity was 60.5% higher, and Margalef's richness 68.8% higher. Shell density and percent cover had a significant positive relationship with macrofaunal biodiversity. This is probably due to the provision of increased structural complexity in the matrix of live and dead oyster shells. Projecting forward the trend of biodiversity increase in relation to time since disturbance indicates that full recovery would take approximately ten years in which time diversity (Shannon-Wiener) would probably have doubled. The findings from the present study indicate the probable biodiversity benefits of oyster habitat restoration and a cost-effective metric (shell density) to judge progress in restoration projects.

High Prevalence of Spinopelvic Risk Factors in Patients With Post-Operative Hip Dislocations.

BACKGROUND: Excessive standing posterior pelvic tilt (PT), lumbar spine stiffness, low pelvic incidence (PI), and severe sagittal spinal deformity (SSD) have been linked to increased dislocation rates. We aimed to determine the prevalence of these 4 parameters in a cohort of unstable total hip arthroplasty (THA) patients and compare these to a large representative control population of primary THA patients. METHODS: Forty-eight patients with instability following primary THA were compared to a control cohort of 9414 THA patients. Lateral X-rays in standing and flexed-seated positions were used to assess PT and lumbar lordosis (LL). Computed tomography scans were used to measure PI and acetabular cup orientation. Thresholds for "at risk" spinopelvic parameters were standing posterior PT ≤ -15°, lumbar flexion (LLstand-LLseated) ≤ 20°, PI ≤ 41°, PI ≥ 70°, and SSD (PI-LLstand mismatch ≥ 20°). RESULTS: There were significant differences in mean spinopelvic parameters between the dislocating and control cohorts (P < .001). There were no differences in mean PI (58° versus 56°, respectively, P = .29) or prevalence of high and low PI between groups. 67% of the dislocating patients had one or more significant risk factors, compared to only 11% of the control. A total of 71% of the dislocating patients had cup orientations within the traditional safe zone. CONCLUSION: Excessive standing posterior PT, low lumbar flexion, and a severe SSD are more prevalent in unstable THAs. Pre-op screening for these parameters combined with appropriate planning and implant selection may help identify at risk patients and reduce the prevalence of dislocation.

Virtual Infection Prevention and Control in Low- and Middle-Income Countries.

COVID-19 brought new challenges and opportunities for infection prevention and control. Virtual infection prevention and control (VIPC), although nascent, is rapidly becoming a viable and necessary strategy for combatting the COVID-19 pandemic. Benefits of VIPC include extending the impact of globally scarce infectious disease providers and public health practitioners, allowing coordination between disparate professionals to more effectively combat infectious disease, and increasing access to and quality of healthcare. Although mainly applied in developed countries, VIPC may play its greatest role in low- and middle-income countries (LMICs) with fewer healthcare resources. We conducted a brief literature search of VIPC in LMICs and found that many studies describe solutions in developed countries or describe planned or theoretical solutions. Few studies describe actual VIPC implementation in LMICs, except for China. Literature from related fields, for example, virtual critical care, and from developed countries is more robust and provides a roadmap for future research on VIPC in LMICs. Further research into strategies and outcomes related to VIPC in LMICs is necessary.

Optimising recruitment in habitat creation for the native European oyster (Ostrea edulis): Implications of temporal and spatial variability in larval abundance.

European oyster (Ostrea edulis) restoration often requires the timely deployment of shell habitat for larval settlement. To inform this increasingly popular process, the present study investigated temporal and spatial abundance patterns of O. edulis larvae in a rare commercial fishery (Loch Ryan, Scotland, UK). Patterns in larval abundance were analysed against variability in temperature, salinity, chlorophyll, oxygen, tidal/moon phase, light, date, and location. 'Temperature sum' (sum total of degrees per day above 7 °C) was the most significant seasonal predictor of larval abundance; with a peak at 617 degree-days. Oyster larval abundance did not significantly vary between oyster bed and non-bed habitats but was significantly higher in the mid and near-surface part of the water column. The findings are discussed in the context of emerging international restoration initiatives and have implications for: where habitat restoration would be successful; the prediction of larval connectivity between sites; and a transferable indicator to optimise shell-habitat deployment timing.

A Naïve Population of European Oyster Ostrea edulis with Reduced Susceptibility to the Pathogen Bonamia ostreae: Are S-Strategy Life Traits Providing Protection?

European populations of the native flat oyster, Ostrea edulis, have been heavily depleted by two protozoan parasites, Marteila refringens and Bonamia ostreae, with mortalities of up to 90% reported in naïve populations. However, in studies carried out over a 10-year period, researching the parasite-host relationship of B. ostreae and O. edulis in several age cohorts within a naïve O. edulis population from Loch Ryan (LR), Scotland, 1364 specimens were challenged and only 64 (5%), across multiple testing protocols, screened positive for B. ostreae. This article presents a case for the development of S-strategy life traits in the LR population that coincide with enhanced immune function and survival. Oysters are considered typical r-strategists (small in size with fast development and high fecundity) while S-strategists, as outlined in Grime's (1977) competitor-stress tolerant-ruderal (C-S-R) triangle theory, are characterized by slow growth and investment in the durability of individuals. This study hypothesizes that slower growth and reduced reproductive output in LR oysters has resulted in the investment of an enhanced immune function and reduced susceptibility to B. ostreae that is, r-strategists with S-strategy life traits equates to protection from significant pathogens. The findings presented here within provide a strong case study for local adaptation of energy allocation and provides empirical support for the C-S-R triangle theory in a marine organism.

Using Transcranial Magnetic Stimulation to Test a Network Model of Perceptual Decision Making in the Human Brain.

Previous research has suggested that the lateral occipital cortex (LOC) is involved with visual decision making, and specifically with the accumulation of information leading to a decision. In humans, this research has been primarily based on imaging and electroencephalography (EEG), and as such only correlational. One line of such research has led to a model of three spatially distributed brain networks that activate in temporal sequence to enable visual decision-making. The model predicted that disturbing neural processing in the LOC at a specific latency would slow object decision-making, increasing reaction time (RT) in a difficult discrimination task. We utilized transcranial magnetic stimulation (TMS) to test this prediction, perturbing LOC beginning at 400 ms post-stimulus onset, a time in the model corresponding to LOC activation at a particular difficulty level, with the expectation of increased RT. Thirteen healthy adults participated in two TMS sessions in which left and right LOC were stimulated separately utilizing neuronavigation and robotic coil guidance. Participants performed a two-alternative forced-choice task selecting whether a car or face was present on each trial amidst visual noise pre-tested to approximate a 75% accuracy level. In an effort to disrupt processing, pairs of TMS pulses separated by 50 ms were presented at one of five stimulus onset asynchronies (SOAs): -200, 200, 400, 450, or 500 ms. Behavioral performance differed systematically across SOAs for RT and accuracy measures. As predicted, TMS at 400 ms resulted in a significant slowing of RT. TMS delivered at -200 ms resulted in faster RT, indicating early stimulation may result in priming and performance enhancement. Use of TMS thus causally demonstrated the involvement of LOC in this task, and more broadly with perceptual decision-making; additionally, it demonstrated the role of TMS in testing well-developed neural models of perceptual processing.

The impact of high-sensitivity troponin implementation on hospital operations and patient outcomes in 3 tertiary care centers.

OBJECTIVE: High-sensitivity troponin T (hs-TnT) assays detect myocardial injury sooner, possibly improving throughput times for emergency department (ED) assessment of suspected acute myocardial infarction (AMI). This study evaluates the influence of hs-TnT implementation on ED length of stay (LOS), consultations and admissions, as well as ED revisits with cardiology admissions for patients undergoing testing for suspected AMI. METHODS: This control pre-post design analysis included patients evaluated using hs-TnT or conventional troponin T. Data were collected from 3 ED databases for patients who had a troponin assay for suspected AMI for the periods February 12, 2011-April 22, 2011 (Ctrl); November 20, 2011-January 28, 2012 (Pre); and February 12, 2012-April 21, 2012 (Post). The primary outcome was ED LOS; secondary outcomes included the proportions of patients who received ED cardiology consultations, patients who were admitted to hospital, and discharged patients who revisited the ED within 30 days. RESULTS: Data were analyzed from 6650 (Ctrl), 6866 (Pre), and 5754 (Post) patients. Median ED LOS decreased following hs-TnT implementation (6.60 hours in Ctrl and Pre vs 6.10 hours in Post, P < .001). There was no change in cardiology consultations or admissions following hs-TnT implementation. Fewer ED revisits occurred within 30 days in Post (16.0% Ctrl, 16.5% Pre vs 14.9% Post; P < .01). These results were preserved after adjusting for age and Canadian Triage Acuity Score. CONCLUSIONS: This hs-TnT implementation strategy, using an equivalent cutoff for the conventional troponin T and hs-TnT assays, decreased ED LOS for patients with suspected AMI and did not increase cardiology resource utilization or ED revisits.

Thirty-year history of Irish (Rossmore) Ostrea edulis selectively bred for disease resistance to Bonamia ostreae.

The protistan pathogen Bonamia ostreae was first detected in Ostrea edulis at Rossmore, Cork Harbour, on the south coast of Ireland in 1987. A selective breeding programme commenced in 1988 by Atlantic Shellfish Ltd. to produce B. ostreae-resistant oysters using 3 to 4 yr old survivors as broodstock for controlled spawning in land-based spatting ponds. On-growing of oyster spat settled on mussel cultch was carried out on designated beds within Cork Harbour. Oyster production subsequently increased successfully, resulting in 3 yr old Rossmore O. edulis being marketed from 1993 onwards and a record tonnage of 4 yr old oysters being produced in 1995 and 1996. O. edulis production, B. ostreae prevalence and oyster mortalities have been monitored and recorded at Rossmore for over 30 yr. The collation and analysis of this data from 52 samples and 3190 oysters demonstrate the introduction and progression of bonamiosis and subsequent interventions to ameliorate disease effects during this period at Rossmore. Results suggest that O. edulis mortalities are now negligible during the first 4 yr of growth, prevalence of B. ostreae infection is low, and no correlation exists between prevalence of infection and oyster mortalities. This study, when compared to other studies of bonamiosis-infected oyster populations, suggests that an intervention in the form of a selective breeding programme is required to reduce the impact of the disease.