Sparse interleaved sampling for high resolution focal construct geometry X-ray tomography.

We demonstrate interleaved sampling by multiplexing conical subshells within the tomosynthesis and raster scanning a phantom through a 150 kV shell X-ray beam. Each view comprises pixels sampled on a regular 1 mm grid, which is then upscaled by padding with null pixels before tomosynthesis. We show that upscaled views comprising 1% sample pixels and 99% null pixels increase the contrast transfer function (CTF) computed from constructed optical sections from approximately 0.6 line pairs/mm to 3 line pairs/mm. The driver of our method is to complement work concerning the application of conical shell beams to the measurement of diffracted photons for materials identification. Our approach is relevant to time-critical, and dose-sensitive analytical scanning applications in security screening, process control and medical imaging.

Evaluating the measures in patient-reported outcomes, values and experiences (EMPROVE study): a collaborative audit of PROMs practice in orthopaedic care in the United Kingdom.

INTRODUCTION: All national orthopaedic societies advocate the use of patient reported outcome measures (PROMs), but clear guidance on their use is limited. We utilised a collaborative methodology to perform a national audit aiming to assess the perceived variability in PROMs practice in orthopaedic surgery in the United Kingdom. METHODS: A multicentre collaborative audit of practice was performed extracting PROMs data on 21 commonly performed orthopaedic procedures. For each procedure, data were collected for frequency of PROM collection, type of PROM chosen, administration intervals, method and reason for collection. Compliance with national society recommendations was undertaken. RESULTS: Sixty-three trusts enrolled to participate in the study with a completion rate of 60% (38 trusts). The most frequently reported PROMs were those associated with best practice tariffs (83.3% and 80.6% for hip and knee replacements, respectively). Outside incentivised programmes we observed a higher rate of variation in PROMs practice which failed to meet our audit standard. Across all procedures evaluated, 69% (221/318) of respondents to the study used paper as the primary method of PROM collection. CONCLUSIONS: This is the first national audit of PROMs collection in orthopaedics. The integration of PROMs within best practice tariff platforms positively influences the frequency and standardisation of collection. Outside this initiative, PROMS collection is infrequent and highly varied despite the presence of several registries. Because PROMs collection is a recommendation across all procedures using implantable devices, the success of this will depend on the adequacy of funding, resource delivery and the presence of clearer recommendations.

Suprascapular nerve blockage for painful shoulder pathology - a systematic review and meta-analysis of treatment techniques.

BACKGROUND: Suprascapular nerve blockade (SSNB) through injection (SSNBi) and/or pulsed radiofrequency (PRF) provide options for the management of painful shoulder pathology. Multiple techniques for delivery of SSNB are described but no consensus on optimal symptom control is available. This systematic review and meta-analysis aims to assess patient-focussed outcomes in SSNB and explore the impact of variation in the technical application of this treatment modality. METHODS: MEDLINE, Embase and CINAHL were searched for case series, cohort studies and randomised control trials published from database inception until 28 January 2021. Articles reporting use of SSNBi or PRF for treatment of shoulder pain with a minimum 3 months follow-up were included. Patient-reported outcome measures (PROMs) were extracted and the pooled standardised mean difference (SMD), weighted by study size, was reported. Quality of methodology was assessed using Wylde's nonsummative four-point system. FINDINGS: Of 758 references, 18 studies were included, totalling 704 SSNB. Average pain improvement at 3 months was 52.3%, with meta-analysis demonstrating a SMD of 2.37. Whereas SSNBi combined with PRF shows the greatest SMD of 2.75, this did not differ significantly from SSNBi or PRF when used as monotherapy. Location of treatment and the guidance technique used did not influence outcome. CONCLUSION: SSNBi and PRF provide safe and effective treatment for shoulder pain, as judged by PROMs. This may be of particular value in aging or comorbid patients and with surgical restrictions during the COVID-19 pandemic. Regardless of technique, patients experience a marked improvement in pain that is maintained beyond 3 months.

Investigating pair distribution function use in analysis of nanocrystalline hydroxyapatite and carbonate-substituted hydroxyapatite.

Hydroxyapatite (HA) is a complex material, which is often nanocrystalline when found within a biological setting. This work has directly compared the structural characteristics derived from data collected using a conventional laboratory-based X-ray diffractometer with those collected from a dedicated pair distribution function (PDF) beamline at Diamond Light Source. In particular, the application of PDF analysis methods to carbonated HA is evaluated. 20 synthetic samples were measured using both X-ray diffraction (XRD) and PDFs. Both Rietveld refinement (of laboratory XRD data) and real-space refinement (of PDF data) were used to analyse all samples. The results of Rietveld and real-space refinements were compared to evaluate their application to crystalline and nanocrystalline hydroxyapatite. Significant relationships were observed between real-space refinement parameters and increasing carbonate substitution. Understanding the local order of synthetic hydroxyapatite can benefit several fields, including both biomedical and clinical settings.

The provision of a time-critical elective surgical service during the COVID-19 Crisis: a UK experience.

INTRODUCTION: With the emergence of the COVID-19 pandemic, all elective surgery was temporarily suspended in the UK, allowing for diversion of resource to manage the anticipated surge of critically unwell patients. Continuing to deliver time-critical surgical care is important to avoid excess morbidity and mortality from pathologies unrelated to COVID-19. We describe the implementation and short-term surgical outcomes from a system to deliver time-critical elective surgical care to patients during the COVID-19 pandemic. MATERIALS AND METHODS: A protocol for the prioritisation and safe delivery of time-critical surgery at a COVID-19 'clean' site was implemented at the Nuffield Health Exeter Hospital, an independent sector hospital in the southwest of England. Outcomes to 30 days postoperatively were recorded, including unplanned admissions after daycase surgery, readmissions and complications, as well as the incidence of perioperative COVID-19 infection in patients and staff. RESULTS: A total of 128 surgical procedures were performed during a 31-day period by a range of specialties including breast, plastics, urology, gynaecology, vascular and cardiology. There was one unplanned admission and and two readmissions. Six complications were identified, and all were Clavien-Dindo grade 1 or 2. All 128 patients had preoperative COVID-19 swabs, one of which was positive and the patient had their surgery delayed. Ten patients were tested for COVID-19 postoperatively, with none testing positive. CONCLUSION: This study has demonstrated the implementation of a safe system for delivery of time-critical elective surgical care at a COVID-19 clean site. Other healthcare providers may benefit from implementation of similar methodology as hospitals plan to restart elective surgery.

Anthropogenic climate change has driven over 5 million km2 of drylands towards desertification.

Drylands cover 41% of the earth's land surface and include 45% of the world's agricultural land. These regions are among the most vulnerable ecosystems to anthropogenic climate and land use change and are under threat of desertification. Understanding the roles of anthropogenic climate change, which includes the CO2 fertilization effect, and land use in driving desertification is essential for effective policy responses but remains poorly quantified with methodological differences resulting in large variations in attribution. Here, we perform the first observation-based attribution study of desertification that accounts for climate change, climate variability, CO2 fertilization as well as both the gradual and rapid ecosystem changes caused by land use. We found that, between 1982 and 2015, 6% of the world's drylands underwent desertification driven by unsustainable land use practices compounded by anthropogenic climate change. Despite an average global greening, anthropogenic climate change has degraded 12.6% (5.43 million km2) of drylands, contributing to desertification and affecting 213 million people, 93% of who live in developing economies.

Confocal energy-dispersive X-ray diffraction tomography employing a conical shell beam.

We introduce a new high-energy X-ray diffraction tomography technique for volumetric materials characterization. In this method, a conical shell beam is raster scanned through the samples. A central aperture optically couples the diffracted flux from the samples onto a pixelated energy-resolving detector. Snapshot measurements taken during the scan enable the construction of depth-resolved dark-field section images. The calculation of d-spacing values enables the mapping of material phase in a volumetric image. We demonstrate our technique using five ~15 mm thick, axially separated samples placed within a polymer tray of the type used routinely in airport security stations. Our method has broad analytical utility due to scalability in both scan size and X-ray energy. Additional application areas include medical diagnostics, materials science, and process control.

Combined X-ray diffraction and absorption tomography using a conical shell beam.

We combine diffraction and absorption tomography by raster scanning samples through a hollow cone of pseudo monochromatic X-rays with a mean energy of 58.4 keV. A single image intensifier takes 90x90 (x,y) snapshots during the scan. We demonstrate a proof-of-principle of our technique using a heterogeneous three-dimensional (x,y,z) phantom (90x90x170 mm3) comprised of different material phases, i.e., copper and sodium chlorate. Each snapshot enables the simultaneous measurement of absorption contrast and diffracted flux. The axial resolution was ~1 mm along the (x,y) orthogonal scan directions and ~7 mm along the z-axis. The tomosynthesis of diffracted flux measurements enable the calculation of d-spacing values with ~0.1 Å full width at half maximum (FWHM) at ~2 Å. Thus the identified materials may be color-coded in the absorption optical sections. Characterization of specific material phases is of particular interest in security screening for the identification of narcotics and a wide range of homemade explosives concealed within complex "everyday objects." Other potential application areas include process control and biological imaging.

A novel method to test non-exclusive hypotheses applied to Arctic ice projections from dependent models.

A major conundrum in climate science is how to account for dependence between climate models. This complicates interpretation of probabilistic projections derived from such models. Here we show that this problem can be addressed using a novel method to test multiple non-exclusive hypotheses, and to make predictions under such hypotheses. We apply the method to probabilistically estimate the level of global warming needed for a September ice-free Arctic, using an ensemble of historical and representative concentration pathway 8.5 emissions scenario climate model runs. We show that not accounting for model dependence can lead to biased projections. Incorporating more constraints on models may minimize the impact of neglecting model non-exclusivity. Most likely, September Arctic sea ice will effectively disappear at between approximately 2 and 2.5 K of global warming. Yet, limiting the warming to 1.5 K under the Paris agreement may not be sufficient to prevent the ice-free Arctic.

Comparative learning curves for early complications in anatomical and reverse shoulder arthroplasty.

Introduction There has been a significant increase in the implantation of reverse shoulder replacements over anatomical shoulder replacements in the past five years. Few comparative data exist comparing early complication rates and learning curves. This study aimed to evaluate the early complication rates and learning curves of a single surgeon series of anatomical and reverse shoulder replacements over the first five years of independent practice. Materials and methods The first 100 anatomical and 100 reverse shoulder replacements performed between July 2011 and July 2016 were reviewed to identify early complications. Cumulative sum plots were used to analyse the learning-curve effect. Results Early complications were noted in 4 anatomical and 17 reverse shoulder replacements. One of the anatomical and ten of the reverse shoulder replacements required a return to theatre within three months. The early complication rates were observed to be significantly higher in the reverse shoulder replacement group compared with the anatomical shoulder replacement group (odds ratio 4.9; 95% confidence interval 1.6-15.2, P 1/4 0.057). An inflection point on the anatomical shoulder replacement cumulative sum plot suggestive of a trend to consistent performance was reached at 16 cases. No inflection point was observed on the reverse shoulder replacement cohort. Conclusions We observed a significantly higher early complication rate within the reverse shoulder replacement cohort, with a tenfold increase in early reoperations. In comparison to the trend seen after 16 cases for anatomical shoulder replacement, no trend was seen in the reverse shoulder replacement cohort. This either reflects the higher complication rate seen in reverse shoulder replacement or that the learning curve extends beyond 100 cases, highlighting the need for extended performance monitoring.

Exome sequencing of synchronously resected primary colorectal tumours and colorectal liver metastases to inform oncosurgical management.

BACKGROUND: Next generation sequencing technology has facilitated mapping of the colorectal cancer genotype and furthered our understanding of metastogenesis. The aim of this study was to investigate for conserved and different mutations in the exomes of synchronously resected primary colorectal tumour and liver metastases. This information could potentially be utilised to guide the treatment of advanced disease with the help of biological information from the primary tumour. METHODS: We performed exome sequencing of synchronously resected primary colorectal cancer and colorectal liver metastases as well as normal colonic mucosa and liver parenchyma, from four patients who had received neo-adjuvant chemotherapy, at a depth of 50X using the Ion Proton platform. Raw data was mapped to the reference genome prior to variant calling, annotation and downstream analysis. RESULTS: Exome sequencing identified 585 non-synonymous missense single nucleotide variants (SNVs), of which 215 (36.8%) were unique to the primary tumour, 226 (38.6%) unique to the metastasis and 81 (13.8%) present in patient matched pairs. SNVs identified in the ErbB pathway appear to be concordant between primary and metastatic tumours. CONCLUSION: Only 13.8% of the metastatic exome can be predicted by the genotype of the primary tumour. We have demonstrated concordance of a number of SNVs in the ErbB pathway, which may inform selection of therapeutic agents in advanced colorectal cancer.

Possible glimpses into early speciation: the effect of ovarian fluid on sperm velocity accords with post-copulatory isolation between two guppy populations.

Identifying mechanisms of reproductive isolation is key to understanding speciation. Among the putative mechanisms underlying reproductive isolation, sperm-female interactions (post-mating-prezygotic barriers) are arguably the hardest to identify, not least because these are likely to operate at the cellular or molecular level. Yet sperm-female interactions offer great potential to prevent the transfer of genetic information between different populations at the initial stages of speciation. Here, we provide a preliminary test for the presence of a putative post-mating-prezygotic barrier operating between three populations of Trinidadian guppies (Poecilia reticulata), an internally fertilizing fish that inhabits streams with different levels of connectivity across Trinidad. We experimentally evaluate the effect of female ovarian fluid on sperm velocity (a predictor of competitive fertilization success) according to whether males and females were from the same (native) or different (foreign) populations. Our results reveal the potential for ovarian fluid to act as a post-mating-prezygotic barrier between two populations from different drainages, but also that the strength of this barrier is different among populations. This result may explain the previous finding that, in some populations, sperm from native males have precedence over foreign sperm, which could eventually lead to reproductive isolation between these populations.

Depth resolved snapshot energy-dispersive X-ray diffraction using a conical shell beam.

We demonstrate a novel imaging architecture to collect range encoded diffraction patterns from overlapping samples in a single conical shell projection. The patterns were measured in the dark area encompassed by the beam via a centrally positioned aperture optically coupled to a pixelated energy-resolving detector. We show that a single exposure measurement of 0.3 mAs enables d-spacing values to be calculated. The axial positions of the samples were not required and the resultant measurements were robust in the presence of crystallographic textures. Our results demonstrate rapid volumetric materials characterization and the potential for a direct imaging method, which is of great relevance to applications in medicine, non-destructive testing and security screening.

The colonisation of the glenohumeral joint by Propionibacterium acnes is not associated with frozen shoulder but is more likely to occur after an injection into the joint.

AIMS: Our aim was to investigate the prevalence of Propionibacterium (P.) acnes in the subcutaneous fat and capsule of patients undergoing shoulder surgery for frozen shoulder or instability. PATIENTS AND METHODS: A total of 46 patients undergoing either an arthroscopic capsular release or stabilisation had biopsies taken from the subcutaneous fat and capsule of the shoulder at the time of surgery. These samples were sent for culture in enrichment, and also for Nucleic Acid Amplification testing. The prevalence of P. acnes and other microbes was recorded. Fisher's exact test of binary variables was used to calculate the association with significance set at p < 0.05. Assessment of influence of independent variables including a pre-operative glenohumeral injection, fat colonisation and gender, was undertaken using binary linear regression. RESULTS: A total of 25 patients (53%) had P. acnes in one or more tissue samples and 35 (74%) had other bacterial species. The same microbe was found in the subcutaneous fat and the capsule in 13 patients (28%). There was no statistically significant association between the surgical pathology and capsular colonisation with P. acnes (p = 0.18) or mixed identified bacterial species (p = 0.77). Male gender was significantly associated with an increased capsular colonisation of P. acnes (odds ratio (OR) 12.38, 95% confidence interval (CI) 1.43 to 106.77, p = 0.02). A pre-operative glenohumeral injection was significantly associated with capsular P. acnes colonisation (OR 5.63, 95% CI 1.07 to 29.61, p = 0.04. Positive fat colonisation with P. acnes was significantly associated with capsular P. acnes (OR 363, 95% CI 20.90 to 6304.19, p < 0.01). Regression models pseudo R2 found fat colonisation with P. acnes to explain 70% of the variance of the model. Patients who had a pre-operative glenohumeral injection who were found intra-operatively to have fat colonisation with P. acnes had a statistically significant association with colonisation of their capsule with P. acnes (OR 165, 95% CI 13.51 to 2015.24, p < 0.01). CONCLUSION: These results show a statistically significant association between subcutaneous skin P. acnes culture and P. acnes capsular culture, especially when the patient has undergone a previous injection. The results refute the hypothesis that P. acnes causes frozen shoulder. Cite this article: Bone Joint J 2017;99-B:1067-72.

X-ray absorption tomography employing a conical shell beam.

We demonstrate depth-resolved absorption imaging by scanning an object through a conical shell of X-rays. We measure ring shaped projections and apply tomosynthesis to extract optical sections at different axial focal plane positions. Three-dimensional objects have been imaged to validate our theoretical treatment. The novel principle of our method is scalable with respect to both scan size and X-ray energy. A driver for this work is to complement previously reported methods concerning the measurement of diffracted X-rays for structural analysis. The prospect of employing conical shell beams to combine both absorption and diffraction modalities would provide enhanced analytical utility and has many potential applications in security screening, process control and diagnostic imaging.

Towards new material biomarkers for fracture risk.

Osteoporosis is a prevalent bone condition, characterised by low bone mass and increased fracture risk. Currently, the gold standard for identifying osteoporosis and increased fracture risk is through quantification of bone mineral density (BMD) using dual energy X-ray absorption (DEXA). However, the risk of osteoporotic fracture is determined collectively by bone mass, architecture and physicochemistry of the mineral composite building blocks. Thus DEXA scans alone inevitably fail to fully discriminate individuals who will suffer a fragility fracture. This study examines trabecular bone at both ultrastructure and microarchitectural levels to provide a detailed material view of bone, and therefore provides a more comprehensive explanation of osteoporotic fracture risk. Physicochemical characterisation obtained through X-ray diffraction and infrared analysis indicated significant differences in apatite crystal chemistry and nanostructure between fracture and non-fracture groups. Further, this study, through considering the potential correlations between the chemical biomarkers and microarchitectural properties of trabecular bone, has investigated the relationship between bone mechanical properties (e.g. fragility) and physicochemical material features.

The total opportunity for sexual selection and the integration of pre- and post-mating episodes of sexual selection in a complex world.

It is well known that sexual selection can target reproductive traits during successive pre- and post-mating episodes of selection. A key focus of recent studies has been to understand and quantify how these episodes of sexual selection interact to determine overall variance in reproductive success. In this article, we review empirical developments in this field but also highlight the considerable variability in patterns of pre- and post-mating sexual selection, attributable to variation in patterns of resource acquisition and allocation, ecological and social factors, genotype-by-environment interaction and possible methodological factors that might obscure such patterns. Our aim is to highlight how (co)variances in pre- and post-mating sexually selected traits can be sensitive to changes in a range of ecological and environmental variables. We argue that failure to capture this variation when quantifying the opportunity for sexual selection may lead to erroneous conclusions about the strength, direction or form of sexual selection operating on pre- and post-mating traits. Overall, we advocate for approaches that combine measures of pre- and post-mating selection across contrasting environmental or ecological gradients to better understand the dynamics of sexual selection in polyandrous species. We also discuss some directions for future research in this area.

Observational evidence confirms modelling of the long-term integrity of CO2-reservoir caprocks.

Storage of anthropogenic CO2 in geological formations relies on a caprock as the primary seal preventing buoyant super-critical CO2 escaping. Although natural CO2 reservoirs demonstrate that CO2 may be stored safely for millions of years, uncertainty remains in predicting how caprocks will react with CO2-bearing brines. This uncertainty poses a significant challenge to the risk assessment of geological carbon storage. Here we describe mineral reaction fronts in a CO2 reservoir-caprock system exposed to CO2 over a timescale comparable with that needed for geological carbon storage. The propagation of the reaction front is retarded by redox-sensitive mineral dissolution reactions and carbonate precipitation, which reduces its penetration into the caprock to ∼7 cm in ∼10(5) years. This distance is an order-of-magnitude smaller than previous predictions. The results attest to the significance of transport-limited reactions to the long-term integrity of sealing behaviour in caprocks exposed to CO2.

Classification of fracture and non-fracture groups by analysis of coherent X-ray scatter.

Osteoporotic fractures present a significant social and economic burden, which is set to rise commensurately with the aging population. Greater understanding of the physicochemical differences between osteoporotic and normal conditions will facilitate the development of diagnostic technologies with increased performance and treatments with increased efficacy. Using coherent X-ray scattering we have evaluated a population of 108 ex vivo human bone samples comprised of non-fracture and fracture groups. Principal component fed linear discriminant analysis was used to develop a classification model to discern each condition resulting in a sensitivity and specificity of 93% and 91%, respectively. Evaluating the coherent X-ray scatter differences from each condition supports the hypothesis that a causal physicochemical change has occurred in the fracture group. This work is a critical step along the path towards developing an in vivo diagnostic tool for fracture risk prediction.