What Can We Learn From COVID-19 Protocols With Regard to Management of Nonoperative Pediatric Orthopaedic Injuries?

INTRODUCTION: The COVID-19 pandemic has resulted in significant changes to normal practice in pediatric outpatient orthopaedics, with the instigation of telephone fracture clinic appointments, and the use of self-removable casting. We aim to determine any beneficial or detrimental short-term effects of these changes. METHODS: All patients referred to fracture clinic from the emergency department during the period March 24, 2020 to May 10, 2020 (national lockdown) were assessed for number of face to face and telephone appointments, number of radiographs performed, time to discharge, use of a removable cast, any cast complications, other complications, reattendance or re-referral after discharge. They were compared with patients referred in the same period in 2019. Follow-up was to 6 months for every patient. RESULTS: In 2019, 240 patients were reviewed and 110 in 2020. Changes in practice resulted in significant differences in the number of face to face appointments per patient [2 (1 to 6) 2019 vs. 1 (0 to 5) 2020 (P<0.00001)] and increase in telephone appointments [0 (0 to 1) 2019 vs. 1 (0 to 2) 2020]. Number of radiographs per patient [1 (1 to 7) 2019 vs. 1 (1 to ) 2020 (P=0.0178)] and time to discharge [29 d (0 to 483) 2019 vs. 16 d (0 to 216) 2020 (P<0.00001)] also reduced significantly. Use of a self-removable casting technique increased significantly (2.4% of casts in 2019 vs. 91.8% in 2020 (P<0.00001). There were no significant differences in complications related to cast or otherwise, unplanned attendance or reattendance after discharge. Use of self-removable casts for supracondylar fractures and for simple injuries (including distal radius, forearm, Toddler's, and ankle fractures) also demonstrated no change in complication rate. Significant potential cost savings of >£185 000 per annum could be demonstrated through clinic appointment and cast removal reductions. DISCUSSION: Changes to the normal management of pediatric orthopaedic trauma brought about by the COVID-19 pandemic have been demonstrated to be safe in the short term with no increase in complications demonstrated. Potential cost savings are possible both to the health care provider and also to the patient because of reduced hospital attendance. It is feasible to continue these practices for the potential benefits as they appear safe in the short term. LEVEL OF EVIDENCE: Level III-therapeutic study-retrospective comparative study.

Microscopic analysis of the microbiota of three commercial Phytoseiidae species (Acari: Mesostigmata).

Microbes associated with the external and internal anatomy of three commercially available predatory mite species-Phytoseiulus persimilis, Typhlodromips (= Amblyseius) swirskii, and Neoseiulus (= Amblyseius) cucumeris-were examined using light microscopy, confocal laser scanning microscopy and fluorescence in-situ hybridization (FISH). Four microbe morphotypes were observed on external body regions. These included three microfungi-like organisms (named T1, T2 and T3) and rod-shaped bacteria (T4). Morphotypes showed unique distributions on the external body regions and certain microbes were found only on one host species. Microfungi-like T1 were present in all three species whereas T2 and T3 were present in only P. persimilis and T. swirskii, respectively. T1 and T2 microbes were most abundant on the ventral structures of the idiosoma and legs, most frequently associated with coxae, coxal folds, ventrianal shields and epigynal shields. T3 microbes were most abundant on legs and dorsal idiosoma. T4 microbes were less abundant and were attached to epigynal shields of N. cucumeris and T. swirskii. Significant differences in distribution between batches suggest temporal fluctuations in the microbiota of phytoseiids in mass-reared systems. FISH showed bacteria within the alimentary tract, in Malpighian tubules and anal atria. These may aid absorption of excretory products or maintaining gut physiology. We suggest a mechanism by which microbes may be transmitted to offspring and throughout populations. This study aims to improve our knowledge of this poorly understood area and highlights the necessity of understanding the microbiota of Acari.

Cementless total knee arthroplasty in young patients using tantalum trabecular implants results in significantly lower rates of aseptic loosening.

Aims: The mean age of patients undergoing total knee arthroplasty (TKA) has reduced with time. Younger patients have increased expectations following TKA. Aseptic loosening of the tibial component is the most common cause of failure of TKA in the UK. Interest in cementless TKA has re-emerged due to its encouraging results in the younger patient population. We review a large series of tantalum trabecular metal cementless implants in patients who are at the highest risk of revision surgery. Methods: A total of 454 consecutive patients who underwent cementless TKA between August 2004 and December 2021 were reviewed. The mean follow-up was ten years. Plain radiographs were analyzed for radiolucent lines. Patients who underwent revision TKA were recorded, and the cause for revision was determined. Data from the National Joint Registry for England, Wales, Northern Island, the Isle of Man and the States of Guernsey (NJR) were compared with our series. Results: No patients in our series had evidence of radiolucent lines on their latest radiological assessment. Only eight patients out of 454 required revision arthroplasty, and none of these revisions were indicated for aseptic loosening of the tibial baseplate. When compared to data from the NJR annual report, Kaplan-Meier estimates from our series (2.94 (95% confidence interval (CI) 1.24 to 5.87)) show a significant reduction in cumulative estimates of revision compared to all cemented (4.82 (95% CI 4.69 to 4.96)) or cementless TKA (5.65 (95% CI 5.23 to 6.10)). Our data (2.94 (95% CI 1.24 to 5.87)) also show lower cumulative revision rates compared to the most popular implant (PFC Sigma Cemented Knee implant fixation, 4.03 (95% CI 3.75 to 4.33)). The prosthesis time revision rate (PTIR) estimates for our series (2.07 (95% CI 0.95 to 3.83)) were lower than those of cemented cases (4.53 (95% CI 4.49 to 4.57)) from NJR. Conclusion: The NexGen trabecular (tantalum) cementless implant has lower revision rates in our series compared to all cemented implants and other types of cementless implants, and its use in younger patients should be encouraged.

Role of atmospheric rivers in shaping long term Arctic moisture variability.

Atmospheric rivers (ARs) reaching high-latitudes in summer contribute to the majority of climatological poleward water vapor transport into the Arctic. This transport has exhibited long term changes over the past decades, which cannot be entirely explained by anthropogenic forcing according to ensemble model responses. Here, through observational analyses and model experiments in which winds are adjusted to match observations, we demonstrate that low-frequency, large-scale circulation changes in the Arctic play a decisive role in regulating AR activity and thus inducing the recent upsurge of this activity in the region. It is estimated that the trend in summertime AR activity may contribute to 36% of the increasing trend of atmospheric summer moisture over the entire Arctic since 1979 and account for over half of the humidity trends in certain areas experiencing significant recent warming, such as western Greenland, northern Europe, and eastern Siberia. This indicates that AR activity, mostly driven by strong synoptic weather systems often regarded as stochastic, may serve as a vital mechanism in regulating long term moisture variability in the Arctic.

Life table parameters and capture success ratio studies of Typhlodromips swirskii (Acari: Phytoseiidae) to the factitious prey Suidasia medanensis (Acari: Suidasidae).

The predatory mite Typhlodromips swirskii (Athias-Henriot) is commonly used to suppress pest populations of thrips and whitefly in commercial greenhouses. Many generalist phytoseiid mites can be reared on astigmatid factitious prey. This study investigated the life table parameters of T. swirskii to the astigmatid mite Suidasia medanensis (Oudemans) and the capture success ratio of T. swirskii to different life stages of the prey. Juvenile development time and survival was 5.01 ± 0.10 days and 93 %, respectively. The intrinsic (r m ) and finite (λ) rates of increase were 0.222 and 1.249, respectively, with average oviposition rate of 1.71 ± 0.07 eggs/female/day. The capture success ratio of T. swirskii to S. medanensis was: eggs > freeze killed adults > nymphs > live adults. Typhlodromips swirskii was concluded to exhibit good population growth rates with S. medanensis as prey and, a prey population with predominance of eggs and nymphs to be advantageous to the predator due to an unidentified defence mechanism of adult prey.

High tibial osteotomy: A review of the readability and quality of patient information on the internet.

Background: High tibial osteotomy (HTO) is a common procedure performed for unicompartmental knee osteoarthritis (OA). Patients are increasingly using the internet to research surgical procedures to help aid decision making. Our aim was to assess the readability and quality of information available to patients online relating to HTO. Methods: A systematic review of three search engines Google®, Bing®, and Yahoo® using the search terms "high tibial osteotomy" and "tibial osteotomy" separately was performed. The first three pages of results for each search engine were analyzed. Readability was assessed using the Flesch Reading Ease Scale (FRES), Flesch-Kincaid Grade level (FKGL) and the Simple Measure of Gobbledygook formula (SMOG). Quality was assessed with the DISCERN questionnaire, JAMAbenchmarks and the presence of Health on the Net Foundation Code of Conduct (HONCode). Results: Twenty-four webpages were included after duplicates (n=42) and exclusions (n=24).The overall readability was low, with a mean FRES of 53.2 (SD: 9.1), FKGL 10.7 (SD: 1.8),SMOG 10.4 (SD: 1.5). Quality was also low with a mean DISCERN score of 42 (SD: 12.3).None of the webpages fulfilled all of the JAMA benchmarking criteria and only 2/24 (8.3%)webpages possessed HONCode certification. Conclusion: The overall online information available to patient's considering HTO is of lowreadability and quality. Improving the quality and readability of patient information online willbenefit informed patient decision making before HTO surgery.

From head to hind: Elucidating function through contrasting morphometrics of ancient and modern pedigree dogs.

Used together, caliper- and geometric-based morphometric analyses provide complimentary approaches to classifying form and function of archaeozoological remains. Here we apply these analytical tools to the skeletal remains of an ancient male dog unearthed from a rural farm settlement of Roman date near present day Warmington, United Kingdom. Our comparisons of the Warmington Roman dog against the morphological characteristics of modern dog breeds enabled us to establish the former's size and shape. It was of medium stature. Analysis of viscerocrania and neurocrania indicate it falls within the meso- to dolichocephalic rankings of modern dogs. The neurocranium shape and the dimensions of its long bones strongly suggest that the Warmington dog shares similarities to modern sight hounds. Historically sight hounds were bred for speed, as necessitated of a hunter that runs down small prey. Our analysis suggests that the Warmington dog was likely bred for, or derived from, Roman hunting stock. By revealing the Warmington Roman dog's form from cranial and postcranial analyses, we shed light on Roman life in one of the furthest outposts of the Roman Empire.

Volatiles of the entomopathogenic fungus, Metarhizium brunneum, attract and kill plant parasitic nematodes.

Root knot nematodes (RKNs) cause significant crop losses. Although RKNs and entomopathogenic fungi, such as Metarhizium brunneum, are associated with plant roots, very little is known about the interactions between these two organisms. This study showed that conidia and VOCs of Me. brunneum influenced the behaviour of M. hapla. The response was dependent on the fungal strain, VOC, concentration of both VOC and conidia, and time. Tomatoes planted in soil treated with the highest doses of conidia usually had a higher number of nematodes than untreated control plants. This was particularly obvious for Me. brunneum strain ARSEF 4556, 7 and 14-days post-treatment. The VOCs, 1-octen-3-ol and 3-octanone, lured M. hapla to plants when used at low doses and repelled them at high doses. In Petri dish assays. the VOCs 1-octen-3-ol and 3-octanone, caused 100% mortality of M. hapla at the highest dose tested (20 µl). Very few live M. hapla were recovered from soil treated with the VOC 1-octen-3-ol, especially at the highest doses tested.

Neighbourhood greenspace influences on childhood obesity in Sheffield, UK.

BACKGROUND: One cause of childhood obesity is a reduction in the amount of unstructured time spent outdoors, resulting in less physical activity. Greenspaces have the potential to increase children's physical activity levels, so it is desirable to understand how to create spaces that promote visitation and activity. OBJECTIVES: We investigate the relationship between rates of obesity at ages 4 to 5 and 10 to 11 in small-area census geographies, and indicators of the neighbourhood greenspace environment, in the northern English city of Sheffield. METHODS: To capture the environment at scales relevant to children, we test the importance of overall green cover; garden size; tree density around residential addresses; and accessibility within 300 m of any greenspace, greenspaces that meet quality criteria, and greenspaces with play facilities. We use a multimodel inference approach to improve robustness. RESULTS: The density of trees around addresses is significant at both ages, indicating the importance of the greenspace environment in the immediate vicinity of houses. For 10 to 11 year olds, accessibility of greenspaces meeting quality criteria is also significant, highlighting that the wider environment becomes important with age and independence. CONCLUSIONS: More attention should be given to children's requirements of greenspace when considering interventions to increase physical activity or planning new residential areas.

The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases: A multicentre comparative study.

AIMS: The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service. METHODS: Data was collected from an adult major trauma centre, paediatric major trauma centre, district general hospital, and a regional hand trauma unit. Data collection included patient demographics, injury mechanism, injury type and treatment required. Time periods studied corresponded with the two weeks leading up to lockdown in the UK, two weeks during lockdown, and the same two-week period in 2019. RESULTS: There was a 55.7% (12,935 vs 5,733) reduction in total accident and emergency (A&E) attendances with a 53.7% (354 vs 164) reduction in trauma admissions during lockdown compared to 2019. The number of patients with fragility fractures requiring admission remained constant (32 patients in 2019 vs 31 patients during lockdown; p > 0.05). Road traffic collisions (57.1%, n = 8) were the commonest cause of major trauma admissions during lockdown. There was a significant increase in DIY related-hand injuries (26% (n = 13)) lockdown vs 8% (n = 11 in 2019, p = 0.006) during lockdown, which resulted in an increase in nerve injuries (12% (n = 6 in lockdown) vs 2.5% (n = 3 in 2019, p = 0.015) and hand infections (24% (n = 12) in lockdown vs 6.2% (n = 8) in 2019, p = 0.002). CONCLUSION: The national lockdown has dramatically reduced orthopaedic trauma admissions. The incidence of fragility fractures requiring surgery has not changed. Appropriate provision in theatres should remain in place to ensure these patients can be managed as a surgical priority. DIY-related hand injuries have increased which has led to an increased in nerve injuries requiring intervention.

Paediatric orthopaedics in lockdown: A study on the effect of the SARS-Cov-2 pandemic on acute paediatric orthopaedics and trauma.

AIMS: To determine the impact of COVID-19 on orthopaediatric admissions and fracture clinics within a regional integrated care system (ICS). METHODS: A retrospective review was performed for all paediatric orthopaedic patients admitted across the region during the recent lockdown period (24 March 2020 to 10 May 2020) and the same period in 2019. Age, sex, mechanism, anatomical region, and treatment modality were compared, as were fracture clinic attendances within the receiving regional major trauma centre (MTC) between the two periods. RESULTS: Paediatric trauma admissions across the region fell by 33% (197 vs 132) with a proportional increase to 59% (n = 78) of admissions to the MTC during lockdown compared with 28.4% in 2019 (N = 56). There was a reduction in manipulation under anaesthetic (p = 0.015) and the use of Kirschner wires (K-wires) (p = 0.040) between the two time periods. The median time to surgery remained one day in both (2019 IQR 0 to 2; 2020 IQR 1 to 1). Supracondylar fractures were the most common reason for fracture clinic attendance (17.3%, n = 19) with a proportional increase of 108.4% vs 2019 (2019 n = 20; 2020 n = 19) (p = 0.007). While upper limb injuries and falls from play apparatus, equipment, or height remained the most common indications for admission, there was a reduction in sports injuries (p < 0.001) but an increase in lacerations (p = 0.031). Fracture clinic management changed with 67% (n = 40) of follow-up appointments via telephone and 69% (n = 65) of patients requiring cast immobilization treated with a 3M Soft Cast, enabling self-removal. The safeguarding team saw a 22% reduction in referrals (2019: n = 41, 2020: n = 32). CONCLUSION: During this viral pandemic, the number of trauma cases decreased with a change in the mechanism of injury, median age of presentation, and an increase in referrals to the regional MTC. Adaptions in standard practice led to fewer MUA, and K-wire procedures being performed, more supracondylar fractures managed through clinic and an increase in the use of removable cast.Cite this article: Bone Joint Open 2020;1-7:424-430.

Using image analysis to design a prototype autodissemination device intended for the biorational control of Plodia interpunctella.

The extent to which a carrier powder was taken up and horizontally transferred by contaminated Indianmeal moth, Plodia interpunctella (Hübner) individuals to conspecifics was evaluated. Using a marker dye, which was shown to be colocalized with the carrier powder, the amount of powder on the Indianmeal moth, as determined by spectrophotometry, was correlated with quantification based on a novel image analysis approach that enabled differentiation of powder uptake by body region. Over a 48-h period, more powder was retained on the ventral surface than the dorsal side, with the head region showing the greatest amount of powder uptake and retention. During courtship, powder was horizontally transferred by treated males to 1.6% of the head and 0.06% of the untreated females' body. To inoculate moths, a pit-fall style autodissemination station was determined as being more effective than a powder tray, as significantly more material was taken up to the key areas of the moth's body where powder is more effectively retained and more likely to be horizontally transferred. Additionally, a pit-fall station prevented moths from exhibiting avoidance behavior from the powder, which was frequently encountered if they had to walk into a powder tray. This study shows that different regions of the Indianmeal moth body vary in capacity to carry powder and that future research efforts should target these specific regions. Although the proposed autodissemination system was optimized for management strategies of Indianmeal moth, we believe the results presented here can be used to develop novel management strategies for other insect pests.

Fungal volatile organic compounds show promise as potent molluscicides.

BACKGROUND: Slugs and snails constitute major crop pests. Withdrawal of metaldehyde has prompted a search for more environmentally friendly yet fast acting molluscicides. This study investigated the response of representative molluscs to conidia and volatile organic compounds (VOCs) of the insect pathogenic fungus Metarhizium brunneum Petch. RESULTS: Conidia of M. brunneum had antifeedant/repellent properties with repellency being dependent upon the fungal strain and conidia concentration. Three commonly produced fungal VOCs, 1-octene, 3-octanone and 1-octen-3-ol, were repellent at low doses (1-5 µL) but could kill slugs and snails on contact or fumigation. At the highest dose tested (10 µL), 100% mortality was achieved for Cornu aspersum Muller (garden snail) and Derocerus reticulatum Muller (grey field slug) within 1 h post-treatment with the first deaths being recorded in <11 min. Aqueous formulations (20% v/v) of the most potent VOCs, 3-octanone and 1-octen-3-ol, could be sprayed onto plants to kill or drive the pest of the crop with no phytotoxic effects. CONCLUSION: The sensitivity of terrestrial molluscs to 3-octanone and 1-octen-3-ol and the ephemeral nature of these compounds makes these excellent candidates for development as mollusc repellents or molluscicides. © 2019 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Effects of adhesive powders on the mating and flight behavior of Mediterranean fruit fly (Diptera: Tephritidae).

Powders that adhere to insect cuticle can be used as carrier particles for synthetic insecticides, entomopathogens, or pheromones in insect control systems, and insects can be lured into contact with such powder mixtures by using attractants. Secondary transfer of adhesive powders to conspecifics during social interactions has been reported; however, this transfer relies on insects leaving the source of powder and continuing normal behavior when contaminated. We examined the ability of the Mediterranean fruit fly, Ceratitis capitata Wiedemann (Diptera: Tephritidae), to fly and mate after being contaminated with one of two adhesive powders: an electrostatic wax powder, Entostat, and a proprietary metallic powder, Entomag. During continuous observations for 1 h in a flight tunnel, male C. capitata made significantly more flights than females. Treating C. capitata with either powder significantly suppressed the flight activity of male C. capitata compared with untreated controls, whereas powder treatment had a negligible effect on female flight activity. Within 1 h, male C. capitata treated with Entomag recovered normal flight activity, but Entostat-treated males were not fully recovered. Virgin male C. capitata treated with either Entostat or Entomag were able to mate with virgin female C. capitata, but the onset of mating was delayed compared with control C. capitata by approximately 1 h. Even though the effect of powder uptake on behavior seemed to be temporary, scanning electron micrograph images of treated C. capitata showed that both powders were retained for > 24 h on most body parts. The adhesive powders showed potential for use as carrier particles for pesticides, entomopathogens, or pheromones in novel C. capitata control systems.

Finite element analysis to model complex mitral valve repair.

Although finite element analysis has been used to model simple mitral repair, it has not been used to model complex repair. A virtual mitral valve model was successful in simulating normal and abnormal valve function. Models were then developed to simulate an edge-to-edge repair and repair employing quadrangular resection. Stress contour plots demonstrated increased stresses along the mitral annulus, corresponding to the annuloplasty. The role of finite element analysis in guiding clinical practice remains undetermined.

Supramolecular Daisy Chains.

Our childhoods may be recalled when a self-complementary cation, endowed with both a dibenzo[24]crown-8 macroring and a secondary dialkylammonium sidearm, self-assembles to form a two-component supramolecular architecture that is reminiscent of a daisy chain (depicted schematically on the right). This daisy-chain-like superarchitecture is stabilized by a combination of [N+ -H⋅⋅⋅O] hydrogen bonds and aryl-aryl stacking interactions.