The long-term impacts of opioid use before and after joint arthroplasty: matched cohort analysis of New Zealand linked register data.

BACKGROUND: Opioids are commonly used both before and after total joint arthroplasty (TJA). OBJECTIVE: The objective of this study was to estimate the long-term effects of pre- and perioperative opioid use in patients undergoing TJA. METHODS: We used linked population datasets to identify all (n =18,666) patients who had a publicly funded TJA in New Zealand between 2011 and 2013. We used propensity score matching to match individuals who used opioids either before surgery, during hospital stay, or immediately post-discharge with individuals who did not based on a comprehensive set of covariates. Regression analysis was used to estimate the effect of opioid use on health and socio-economic outcomes over 5 years. RESULTS: Opioid use in the 3 months prior to surgery was associated with significant increases in healthcare utilization and costs (number of hospitalizations 6%, days spent in hospital 14.4%, opioid scripts dispensed 181%, and total healthcare costs 11%). Also increased were the rate of receiving social benefits (2 percentage points) and the rates of opioid overdose (0.5 percentage points) and mortality (3 percentage points). Opioid use during hospital stay or post-discharge was associated with increased long-term opioid use, but there was little evidence of other adverse effects. CONCLUSIONS: Opioid use before TJA is associated with significant negative health and economic consequences and should be limited. This has implications for opioid prescribing in primary care. There is little evidence that peri- or post-operative opioid use is associated with significant long-term detriments.

Opioids are commonly used both before and after total joint replacement surgery to manage pain in patients with osteoarthritis. This study investigates the long-term consequences of opioid use around total joint replacement surgery in New Zealand during 2011­2013 using administrative data. We compare the outcomes of surgery patients who used opioids (treatment group) to those who did not (control group) but who had very similar pre-surgery characteristics as the treatment cohort. We find that opioid use in the months prior to surgery was associated with significant increases in healthcare utilization and costs, higher likelihood of receiving social benefits, and higher risk of opioid overdose and mortality 5 years post-surgery. Opioid use during hospital stay or post-discharge was associated with increased long-term opioid use, but there was little evidence of other adverse effects. These results highlight the importance of ongoing efforts to reduce opioid use before surgery.

Phylogeny and classification of Odonata using targeted genomics.

Dragonflies and damselflies are a charismatic, medium-sized insect order (~6300 species) with a unique potential to approach comparative research questions. Their taxonomy and many ecological traits for a large fraction of extant species are relatively well understood. However, until now, the lack of a large-scale phylogeny based on high throughput data with the potential to connect both perspectives has precluded comparative evolutionary questions for these insects. Here, we provide an ordinal hypothesis of classification based on anchored hybrid enrichment using a total of 136 species representing 46 of the 48 families or incertae sedis, and a total of 478 target loci. Our analyses recovered the monophyly for all three suborders: Anisoptera, Anisozygoptera and Zygoptera. Although the backbone of the topology was reinforced and showed the highest support values to date, our genomic data was unable to stronglyresolve portions of the topology. In addition, a quartet sampling approach highlights the potential evolutionary scenarios that may have shaped evolutionary phylogeny (e.g., incomplete lineage sorting and introgression) of this taxon. Finally, in light of our phylogenomic reconstruction and previous morphological and molecular information we proposed an updated odonate classification and define five new families (Amanipodagrionidae fam. nov., Mesagrionidae fam. nov., Mesopodagrionidae fam. nov., Priscagrionidae fam. nov., Protolestidae fam. nov.) and reinstate another two (Rhipidolestidae stat. res., Tatocnemididae stat. res.). Additionally, we feature the problematic taxonomic groupings for examination in future studies to improve our current phylogenetic hypothesis.

Why do bugs perish? Range size and local vulnerability traits as surrogates of Odonata extinction risk.

Despite claims of an insect decline worldwide, our understanding of extinction risk in insects is incomplete. Using bionomic data of all odonate (603 dragonflies and damselflies) North American species, we assessed (i) regional extinction risk and whether this is related to local extirpation; (ii) whether these two patterns are similar altitudinally and latitudinally; and (iii) the areas of conservation concern. We used geographic range size as a predictor of regional extinction risk and body size, thermal limits and habitat association as predictors of local extirpation. We found that (i) greater regional extinction risk is related to narrow thermal limits, lotic habitat use and large body size (this in damselflies but not dragonflies); (ii) southern species are more climate tolerant but with more limited geographic range size than northern species; and (iii) two priority areas for odonate conservation are the cold temperate to sub-boreal northeastern USA and the transversal neo-volcanic system. Our approach can be used to estimate insect extinction risk as it compensates for the lack of abundance data.

Influence of non-orthodontic intervention on digit sucking and consequent anterior open bite: a preliminary study.

OBJECTIVES: This study aimed to assess behavioural and occlusal outcomes of non-orthodontic intervention (NOI) in a sample of children, 4-12 years of age, in Australia, in order to establish clinical relevance. MATERIALS AND METHODS: Data from 91 patient records of 4- to 12-year-old children reporting a habit of digit sucking, from two clinics in north-eastern Australia, were de-identified and used. Each patient had been examined at two visits, separated by an interval of 4 months, using standard clinical procedures. RESULTS: Of the 77 children who received a 4-month NOI, 69 (89.6%) had ceased their digit sucking habit by the end of the NOI period [χ2=67.0, degrees of freedom (d.f.)=1, P<0.001]. Of the 72 subjects who had front teeth, the number with anterior open bite decreased from 37 (51.4%) to 12 (16.7%) upon completion of NOI (χ2=21.3, d.f.=1, P<0.001). Among the 32 patients with a measurable overjet, the mean overjet was found to decrease from 4.2±2.4 mm to 3.1±1.9 mm after implementation of NOI (t=5.8, d.f.=31, P<0.001). Children who received NOI were more likely to quit the digit sucking habit in the 4-month period (P<0.001, OR=51.8, 95% CI: 9.8-273.9) and were more likely to appear without anterior open bite at a 4-month recall (P<0.001, OR=30.0, 95% CI: 5.9-151.6). CONCLUSIONS: This study demonstrated clinical relevance of NOI on the cessation of a digit sucking habit, closure of anterior open bite and reduction of overjet. Further investigations are indicated.

Human cadaveric histomorphological and metallurgical analysis of dental implants following 12.5 years of service.

OBJECTIVES: To provide a metallurgical and histomorphological analysis of hybrid bridgework and associated dental implants which have been in a clinical load bearing situation for a period of 12.5 years. MATERIAL AND METHODS: The physical integrity of the hybrid framework was examined with stereoimaging microscopy and scanning electron microscopy for signs of wear, fatigue cracks, corrosion. Elemental spectra and maps of the surface were analysed with an EDAX Detecting Unit (AMETEK, Inc, Mahwah, NJ, USA). Similarly, the supporting titanium abutments screwed into the implants were examined for fatigue and corrosion. Bone density scans and bone trabecular patterns were obtained from radiographs. Microcomputer tomography was used to assess the bone-implant interface and bone architecture around the implants. Histological sections were stained with 1% basic fuchsin to assess osseous microdamage. RESULTS: The study demonstrated that the gold alloy framework to be in satisfactory condition with little indication of corrosion or cracking. The interface between the gold alloy and the titanium abutments likewise demonstrated no obvious corrosion cells. No radiographic evidence of any adverse loss of bone around the implants was noted. Bone mineral density was related to implant position, being higher between the implants. Scanning electron micrograph images confirmed the good bone integration with the implant threads with a high level of organisation, maturation and adaptation for the entire length of the implant. There was no evidence of any microdamage. CONCLUSIONS: The implants, abutments and hybrid framework were in remarkably good condition considering their length of service.

Developing prototypes of a modernized approach to assess crop protection chemical safety.

In 2019, the US EPA Administrator issued a directive directing the agency away from reliance on vertebrate tests by 2035, whilst maintaining high-quality human health and environmental risk assessments. There is no accepted approach to achieve this. The decade-long duration of the crop protection (CP) chemical R&D process therefore requires both the invention and application of a modernized approach to those CP chemical projects entering corporate research portfolios by the mid-2020s. We conducted problem formulation discussions with regulatory agency scientists which created the problem statement: "Develop, demonstrate, and implement a modern scientifically sound and robust strategy that applies appropriate and flexible exposure and effects characterization without chemical specific vertebrate tests to reliably address risk, uncertainties, and deficiencies in data and its interpretation with equivalent confidence as do the currently accepted test guidelines and meet the regulatory needs of the agencies". The solution must provide the knowledge needed to confidently conclude human health and environmental protective risk assessments. Exploring this led to a conceptual model involving the creation and parallel submission of a new approach without reliance on chemical-specific vertebrate tests. Assessment in parallel to a traditional package will determine whether it supports some, or all, of the necessary risk management actions. Analysis of any deficiencies will provide valuable feedback to focus development of tools or approaches for subsequent iterations. When found to provide sufficient information, it will form the technical foun­dation of stakeholder engagement to explore acceptance of a new approach to CP chemical risk assessment.

The US EPA, and other regulatory agencies, aim to reduce the use of vertebrate animal tests for assessing risks of crop protection chemicals. There is currently no accepted way to do this. We outline a proposal to perform both the assessment using traditional vertebrate testing and a set of new non-animal methods. These data sets must each be combined with a calculated estimate of user exposure to the pesticide based on its intended use. Comparing the outcome of these two assess­ments will show whether the set of non-animal methods needs to be improved further. When the new approach appears to reliably predict the risks, the different stakeholders must be brought together to assess whether the non-animal methods package is acceptable and can replace the tests on vertebrate animals while maintaining the same level of protection of human health and the environment.

Arctos: Community-driven innovations for managing natural and cultural history collections.

More than tools for managing physical and digital objects, museum collection management systems (CMS) serve as platforms for structuring, integrating, and making accessible the rich data embodied by natural history collections. Here we describe Arctos, a scalable community solution for managing and publishing global biological, geological, and cultural collections data for research and education. Specific goals are to: (1) Describe the core features and implementation of Arctos for a broad audience with respect to the biodiversity informatics principles that enable high quality research; (2) Highlight the unique aspects of Arctos; (3) Illustrate Arctos as a model for supporting and enhancing the Digital Extended Specimen concept; and (4) Emphasize the role of the Arctos community for improving data discovery and enabling cross-disciplinary, integrative studies within a sustainable governance model. In addition to detailing Arctos as both a community of museum professionals and a collection database platform, we discuss how Arctos achieves its richly annotated data by creating a web of knowledge with deep connections between catalog records and derived or associated data. We also highlight the value of Arctos as an educational resource. Finally, we present the financial model of fiscal sponsorship by a nonprofit organization, implemented in 2022, to ensure the long-term success and sustainability of Arctos.

Increasing accountability to drive improvement.

Governments need to be more strategic in their approach to healthcare and ensure greater accountability for the performance of their health systems. They can start by agreeing on a pan-Canadian vision for the health of Canadians and the services to be provided, accompanied by explicit policy goals, evidence-based performance targets, and more transparent public reporting.

The thermal index: its strengths, weaknesses, and proposed improvements.

The thermal index (TI) has been used as a relative indicator of thermal risk during diagnostic ultrasound examinations for many years. It is useful in providing feedback to the clinician or sonographer, allowing assessment of relative, potential risks to the patient of an adverse effect due to a thermal mechanism. Recently, several shortcomings of the TI formulations in quantifying the risk to the patient have been identified by members of the basic scientific community, and possible improvements to address these shortcomings have been proposed. For this reason, the Output Standards Subcommittee of the American Institute of Ultrasound in Medicine convened a subcommittee to review the strengths of the TI formulations as well as their weaknesses and proposed improvements. This article summarizes the findings of this subcommittee. After a careful review of the literature and an assessment of the cost of updating the TI formulations while maximizing the quality of patient care, the Output Standards Subcommittee makes the following recommendations: (1) some inconsistencies in the current TI formulations should be resolved, and the break point distance should be redefined to take focusing into consideration; (2) an entirely new indicator of thermal risk that incorporates the time dependence not be implemented at this time but be included in continuing efforts toward standards or consensus documents; (3) the exponential dependence of risk on temperature not be incorporated into a new definition of the TI formulations at this time but be included in continuing efforts toward standards or consensus documents; (4) the TI formulations not be altered to include nonlinear propagation at this time but be included in continuing efforts toward standards or consensus documents; and (5) a new indicator for risk from thermal mechanisms should be developed, distinct from the traditional TI formulations, for new imaging modalities such as acoustic radiation force impulse imaging, which have more complicated pulsing sequences than traditional imaging.

Validation of Inertial Sensor to Measure Barbell Kinematics across a Spectrum of Loading Conditions.

The aim of this study was to evaluate the level of agreement in measuring back squat kinematics between an inertial measurement unit (IMU) and a 3D motion capture system (3DMOCAP). Kinematic variables included concentric peak velocity (CPV), concentric mean velocity (CMV), eccentric peak velocity (EPV), eccentric mean velocity (EMV), mean propulsive velocity (MPV), and POP-100: a proprietary variable. Sixteen resistance-trained males performed an incrementally loaded one repetition maximum (1RM) squat protocol. A series of Pearson correlations, 2 × 4 RM ANOVA, Cohen's d effect size differences, coefficient of variation (CV), and standard error of the estimate (SEE) were calculated. A large relationship existed for all variables between devices (r = 0.78-0.95). Between-device agreement for CPV worsened beyond 60% 1RM. The remaining variables were in agreement between devices with trivial effect size differences and similar CV magnitudes. These results support the use of the IMU, regardless of relative intensity, when measuring EMV, EPV, MPV, and POP-100. However, practitioners should carefully select kinematic variables of interest when using the present IMU device for velocity-based training (VBT), as certain measurements (e.g., CMV, CPV) do not possess practically acceptable reliability or accuracy. Finally, the IMU device exhibited considerable practical data collection concerns, as one participant was completely excluded and 13% of the remaining attempts displayed obvious internal error.

The utilization of Gleason grade as the primary criterion for ordering nuclear bone scan in newly diagnosed prostate cancer patients.

Utilization of nuclear bone scans for staging newly diagnosed prostate cancer has decreased dramatically due to PSA-driven stage migration. The current criteria for performing bone scans are based on limited historical data. This study evaluates serum PSA and Gleason grade in predicting positive scans in a contemporary large series of newly diagnosed prostate cancer patients. Eight hundred consecutive cases of newly diagnosed prostate cancer over a 64-month period underwent a staging nuclear scan. All subjects had histologically confirmed cancer. The relationship between PSA, Gleason grade, and bone scan was examined by calculating series of crude, stratified, and adjusted odds ratios with corresponding 95% confidence intervals. Four percent (32/800) of all bone scans were positive. This proportion was significantly lower in patients with Gleason score or=8 (18.8%, p < 0.001). Among patients with Gleason score 30 ng/ml compared to or=8, the rate was significantly higher (27.9 vs. 0%) when PSA was >10 ng/ml compared to 30 ng/ml. However, for patients with a high Gleason score (8-10), we recommend a bone scan if the PSA is >10 ng/ml.

Workshop on Pesticide Exposure Assessment Paradigm for Non-Apis Bees: Foundation and Summaries.

Current pesticide risk assessment practices use the honey bee, Apis mellifera L., as a surrogate to characterize the likelihood of chemical exposure of a candidate pesticide for all bee species. Bees make up a diverse insect group that provides critical pollination services to both managed and wild ecosystems. Accordingly, they display a diversity of behaviors and vary greatly in their lifestyles and phenologies, such as their timing of emergence, degree of sociality, and foraging and nesting behaviors. Some of these factors may lead to disparate or variable routes of exposure when compared to honey bees. For those that possess life histories that are distinct from A. mellifera, further risk assessments may be warranted. In January 2017, 40 bee researchers, representative of regulatory agencies, academia, and agrochemical industries, gathered to discuss the current state of science on pesticide exposure to non-Apis bees and to determine how well honey bee exposure estimates, implemented by different regulatory agencies, may be protective for non-Apis bees. Workshop participants determined that although current risk assessment procedures for honey bees are largely conservative, several routes of exposure are unique to non-Apis bees and warranted further investigation. In this forum article, we discuss these key routes of exposure relevant to non-Apis bees and identify important research gaps that can help inform future bee risk assessment decisions.

Laparoscopic ureteral reimplant for distal ureteral strictures.

BACKGROUND AND OBJECTIVES: The incidence of ureteral injuries is on the rise. Endoscopic treatment of long distal ureteral strictures is associated with poor success rates, and open ureteral reimplantation is a potentially morbid surgical procedure. The objective of this study was to review our early results with laparoscopic ureteral reimplantation. METHODS: Between May 2004 and February 2007, 6 patients with ureteral strictures secondary to either gynecological surgery (4) or urolithiasis (2) presented for treatment. These patients failed traditional conservative treatment and underwent laparoscopic ureteral reimplantation. RESULTS: Five of the 6 cases were performed completely laparoscopically, while one patient had an elective open conversion to complete the vesicoureteral anastomosis. No major intraoperative or postoperative complications were encountered. The mean operating room time was 277 minutes (range, 180 to 360). The average hospital stay was 2.7 days (range, 2 to 5). All patients had a successful outcome defined as no evidence of radiographic obstruction and no clinical complaints of persistent renal colic. Mean follow-up was 13.2 months (range, 2 to 33). CONCLUSION: Our early results demonstrate that laparoscopic ureteral reimplantation is an effective minimally invasive treatment option for distal ureteral strictures.

Quantifying the degree of bias from using county-scale data in species distribution modeling: Can increasing sample size or using county-averaged environmental data reduce distributional overprediction?

Citizen-science databases have been used to develop species distribution models (SDMs), although many taxa may be only georeferenced to county. It is tacitly assumed that SDMs built from county-scale data should be less precise than those built with more accurate localities, but the extent of the bias is currently unknown. Our aims in this study were to illustrate the effects of using county-scale data on the spatial extent and accuracy of SDMs relative to true locality data and to compare potential compensatory methods (including increased sample size and using overall county environmental averages rather than point locality environmental data). To do so, we developed SDMs in maxent with PRISM-derived BIOCLIM parameters for 283 and 230 species of odonates (dragonflies and damselflies) and butterflies, respectively, for five subsets from the OdonataCentral and Butterflies and Moths of North America citizen-science databases: (1) a true locality dataset, (2) a corresponding sister dataset of county-centroid coordinates, (3) a dataset where the average environmental conditions within each county were assigned to each record, (4) a 50/50% mix of true localities and county-centroid coordinates, and (5) a 50/50% mix of true localities and records assigned the average environmental conditions within each county. These mixtures allowed us to quantify the degree of bias from county-scale data. Models developed with county centroids overpredicted the extent of suitable habitat by 15% on average compared to true locality models, although larger sample sizes (>100 locality records) reduced this disparity. Assigning county-averaged environmental conditions did not offer consistent improvement, however. Because county-level data are of limited value for developing SDMs except for species that are widespread and well collected or that inhabit regions where small, climatically uniform counties predominate, three means of encouraging more accurate georeferencing in citizen-science databases are provided.

Fracture, roughness and phase transformation in CAD/CAM milling and subsequent surface treatments of lithium metasilicate/disilicate glass-ceramics.

This paper studied surface fracture, roughness and morphology, phase transformations, and material removal mechanisms of lithium metasilicate/disilicate glass ceramics (LMGC/LDGC) in CAD/CAM-milling and subsequent surface treatments. LMGC (IPS e.max CAD) blocks were milled using a chairside dental CAD/CAM milling unit and then treated in sintering, polishing and glazing processes. X-ray diffraction was performed on all processed surfaces. Scanning electron microscopy (SEM) was applied to analyse surface fracture and morphology. Surface roughness was quantitatively characterized by the arithmetic average surface roughness Ra and the maximum roughness Rz using desktop SEM-assisted morphology analytical software. The CAD/CAM milling induced extensive brittle cracks and crystal pulverization on LMGC surfaces, which indicate that the dominant removal mechanism was the fracture mode. Polishing and sintering of the milled LMGC lowered the surface roughness (ANOVA, p < 0.05), respectively, while sintering also fully transformed the weak LMGC to the strong LDGC. However, polishing and glazing of LDGC did not significantly improve the roughness (ANOVA, p > 0.05). In comparison of all applied fabrication process routes, it is found that CAD/CAM milling followed by polishing and sintering produced the smoothest surface with Ra = 0.12 ± 0.08µm and Rz = 0.89 ± 0.26µm. Thus, it is proposed as the optimized process route for LMGC/LDGC in dental restorations. This route enables to manufacture LMGC/LDGC restorations with cost effectiveness, time efficiency, and improved surface quality for better occlusal functions and reduced bacterial plaque accumulation.

Does type of team matter? An investigation of the relationships between job characteristics and outcomes within a team-based environment.

The authors examined the relationship between team type (consultative or substantive); job characteristics; and the outcome variables of job satisfaction, satisfaction with team processes and activities, and team commitment. The present results supported the hypothesis that job characteristics mediate the relationship between team type and team commitment and partially mediate the relationship between team type and job satisfaction and satisfaction with team processes and activities. However, contrary to the hypothesis, consultative team members perceived the content of their jobs to be more enriched and reported higher levels of satisfaction and commitment than did substantive team members.

A real time biofeedback using Kinect and Wii to improve gait for post-total knee replacement rehabilitation: a case study report.

PURPOSE: This study aimed to develop a low-cost real-time biofeedback system to assist with rehabilitation for patients following total knee replacement (TKR) and to assess its feasibility of use in a post-TKR patient case study design with a comparison group. METHOD: The biofeedback system consisted of Microsoft Kinect(TM) and Nintendo Wii balance board with a dedicated software. A six-week inpatient rehabilitation program was augmented by biofeedback and tested in a single patient following TKR. Three patients underwent a six weeks standard rehabilitation with no biofeedback and served as a control group. Gait, function and pain were assessed and compared before and after the rehabilitation. RESULTS: The biofeedback software incorporated real time visual feedback to correct limb alignment, movement pattern and weight distribution. Improvements in pain, function and quality of life were observed in both groups. The strong improvement in the knee moment pattern demonstrated in the case study indicates feasibility of the biofeedback-augmented intervention. CONCLUSION: This novel biofeedback software has used simple commercially accessible equipment that can be feasibly incorporated to augment a post-TKR rehabilitation program. Our preliminary results indicate the potential of this biofeedback-assisted rehabilitation to improve knee function during gait. Research is required to test this hypothesis. Implications for Rehabilitation The real-time biofeedback system developed integrated custom-made software and simple low-cost commercially accessible equipment such as Kinect and Wii board to provide augmented information during rehabilitation following TKR. The software incorporated key rehabilitation principles and visual feedback to correct alignment of the lower legs, pelvic and trunk as well as providing feedback on limbs weight distribution. The case study patient demonstrated greater improvement in their knee function where a more normal biphasic knee moment was achieved following the six-week biofeedback intervention.

Consistent ozone-induced decreases in pasture forage quality across several grassland types and consequences for UK lamb production.

In this study we have demonstrated that rising background ozone has the potential to reduce grassland forage quality and explored the implications for livestock production. We analysed pasture samples from seven ozone exposure experiments comprising mesotrophic, calcareous, haymeadow and sanddune unimproved grasslands conducted in open-top chambers, solardomes and a field release system. Across all grassland types, there were significant increases in acid detergent fibre, crude fibre and lignin content with increasing ozone concentration, resulting in decreased pasture quality in terms of the metabolisable energy content of the vegetation. We derived a dose-response function for metabolisable energy of the grassland with ozone concentration, applicable to a range of grassland types, and used this to predict effects on pasture quality of UK vegetation at 1 km resolution using modelled ozone data for 2007 and for predicted higher average ozone concentrations in 2020. This showed a potential total reduction in lamb production in the UK of approximately 4% in 2020 compared to 2007. The largest impacts were in geographical areas of modest ozone increases between the two years, but where large numbers of lambs were present. For an individual farmer working to a very small cost margin this could represent a large reduction in profit, both in regions where the impacts per lamb and those where the impacts per km(2) of grazing land are largest. In the short term farmers could adapt their lamb management in response to changed forage quality by additional supplementary feed of high metabolisable energy content. Nationally this increase in annual additional feed in 2020 compared to 2007 would be 2,166 tonnes (an increase of 0.7%). Of added concern are the longer-term consequences of continual deterioration of pasture quality and the implications for changes in farming practices to compensate for potential reductions in livestock production capacity.