Golfers are physically more active and have greater health associated quality of life than non-golfers following lower limb arthroplasty.

Background: The health benefits of physical activity are well recognised. This study assessed whether golfers were more physically active after lower limb arthroplasty when compared to those that did not play golf (primary outcome). In addition pre and postoperative changes in health-associated quality of life (HAQoL) and joint specific outcomes between golfers and none golfers were assessed (secondary outcomes). Methods: There were 304 patients [THA (n = 155) or TKA (n = 149)] prospectively registered during a 4-month period undergoing lower limb arthroplasty. The mean age was 70.0 (range 37-92, standard deviation 10.2) years and included 188 (61%) females and 120 (39%) males. They completed pre and postoperative questionnaires assessing recreational activity, physical activity, HAQoL (EuroQol [EQ]), joint specific health (Oxford scores), and satisfaction. Results: Golfers (n = 33, 10.9%) were more likely to achieve longer than 3 hours of moderate activity during a week (48.5% vs 38.0%, odds ratio (OR) 3.4, p = 0.045) and achieved their recommended activity level (96.8% vs 77.7%, OR 8.6, p = 0.015) compared to non-golfers following arthroplasty. Postoperative EQ5D (p = 0.034) and EQVAS (p = 0.019) were significantly greater in golfers. The joint specific Oxford hip score was greater in golfers compared to non-golfers (mean difference 5.6, p = 0.022), however no difference was observed in the Oxford knee score following TKA (p = 0.495). Conclusion: Golfers were more likely to achieve their weekly recommended level of physical activity and had a greater HAQoL relative to those that did not play golf following lower limb arthroplasty. More specifically after THA golfers also had a greater postoperative joint specific outcome, but no such advantage was observed in those following TKA. Evidence Level: Level II, diagnostic study.

Cost-utility analysis of total knee arthroplasty using 10-year data from a randomised controlled trial: Implant design influences quality-adjusted life year gain.

BACKGROUND: The aim of this study was to perform a cost-utility analysis for total knee arthroplasty (TKA) over a 10-year follow up period. METHODS: Two-hundred and twelve patients were randomised to receive either a Kinemax or a Triathlon TKA. Patients were assessed pre-operatively, and at 6 months, and 1, 3, 7 and 10 years postoperatively. The costs of the primary and revision surgery were accounted for. One-year quality-adjusted life year (QALY) gain was used to estimate 10-year gains using the established annual health gain discounts. RESULTS: Forty-eight patients died and eight were revised during the follow up period. Overall QALY gain per patient over the 10-year period was 2.594 and the cost per patient was £6559, which resulted in a cost per QALY of £2761 at 10 years. The Triathlon group had a significantly greater QALY gain compared with the Kinemax (mean difference (MD) 0.53, 95% CI 0.03-1.03, P = 0.02), which resulted in a cost per QALY for the Triathlon group of £2521 compared with £3107 for the Kinemax group at 10 years. The 5% annual discount resulted in a significantly lower QALY gain (MD 0.135, 95% CI 0.201-0.354, P = 0.002), whereas the 3.5% annual discount resulted in non-significant difference in QALY gain compared with the actual gain (MD 0.021, 95% CI -0.084 to 0.077, P = 0.292). CONCLUSIONS: TKA was a cost-effective intervention, and the Triathlon was associated with a greater cost effectiveness at 10 years. The 3.5% annual discounts for QALY gain would seem to be the most accurate, with an underestimation being observed with the 5% discount.

Effects of weather and social factors on hormone levels in the European badger (Meles meles).

Animals in the wild continually experience changes in environmental and social conditions, which they respond to with behavioural, physiological and morphological adaptations related to individual phenotypic quality. During unfavourable environmental conditions, reproduction can be traded-off against self-maintenance, mediated through changes in reproductive hormone levels. Using the European badger (Meles meles) as a model species, we examine how testosterone in males and oestrogens in females respond to marked deviations in weather from the long-term mean (rainfall and temperature, where badger earthworm food supply is weather dependent), and to social factors (number of adult males and females per social group and total adults in the population), in relation to age, weight and head-body length. Across seasons, testosterone levels correlated postively with body weight and rainfall variability, whereas oestrone correlated positively with population density, but negatively with temperature variability. Restricting analyses to the mating season (spring), heavier males had higher testosterone levels and longer females had higher oestradiol levels. Spring oestrone levels were lower when temperatures were above normal. That we see these effects for this generally adaptive species with a broad bioclimatic niche serves to highlight that climatic effects (especially with the threat of anthropogenic climate change) on reproductive physiology warrant careful attention in a conservation context.

Golfers have greater preoperative and equal postoperative function when undergoing total knee arthroplasty compared to non-golfers.

BACKGROUND: Approximately 10% to 20% of patients with joint arthroplasties are golfers. The aim of this study was to assess if being a golfer is associated with functional outcomes, satisfaction or improvement in quality of life (QoL) compared to non-golfers following total knee arthroplasty. METHODS: All patients undergoing primary total knee arthroplasty (TKA) over a one-year period at a single institution were included with one-year postoperative outcomes. Patients were retrospectively followed up to assess if they had been golfers at the time of their surgery. Multivariate linear regression analysis was performed to assess the independent association of preoperative golfing status on postoperative function and health-related outcomes. RESULTS: The study cohort consisted of a total of 514 patients undergoing TKA. This included 223 (43.3%) male patients and 291 (56.7%) female patients, with an overall mean age of 70 (SD 9.5) years. The preoperative Oxford Knee Score (OKS) was significantly higher in golfers when adjusting for confounders (Diff 3.4 [95% CI 1 to 5.8], p = 0.006). There was no difference in postoperative outcomes between golfers and non-golfers. There was however a trend towards a higher Forgotten Joint Score (FJS) in the golfers (difference 9.3, 95% CI - 0.2 to 18.8, p = 0.056). Of the 48 patients who reported being golfers at the time of their surgery, 43 (89.6%) returned to golf and 88.4% of those were satisfied with their involvement in golf following surgery. CONCLUSIONS: Golfers had better preoperative and equal postoperative knee specific function compared to non-golfers. The majority of golfers returned to golf by one year and were satisfied with their involvement in the game. LEVEL OF EVIDENCE: III.

Diabesity: a superadded effect contributing to worse total primary hip replacement operative outcomes for patients with diabetes and obesity.

INTRODUCTION: Although the independent effects of diabetes mellitus and obesity on total hip replacement (THR) outcomes have been widely studied, their combined effect remains uncharacterised. This study aimed to assess the influence of diabesity on primary THR operative outcomes. MATERIALS AND METHODS: A retrospective study was performed comparing the outcomes of patients with diabesity (diabetes mellitus and obesity [BMI ≥ 30]) with a control cohort after primary THR using an established arthroplasty database. Data were collected pre-operatively and 12 months post-operatively, including Oxford Hip Score (OHS), EuroQol 5-dimensions (EQ5D), post-operative satisfaction and complication rates. RESULTS: 2323 THRs were analysed, of which 94 (4%) had diabesity. Diabesity was independently associated with significantly worse OHS improvement post-operatively (- 1.85 points, 95% CI - 2.93 to - 0.76, p = 0.001). This reduction in addition to the independent effect of obesity (- 0.69 points, 95% CI - 1.18 to - 0.21, p = 0.005) resulted in an overall 2.54 point OHS reduction for patients with diabesity. Diabesity was not associated with EQ5D score change or post-operative satisfaction. Diabesity was independently associated with a worse pre-operative EQ5D score (-0.08 points, 95% CI -0.12 to -0.03, p = 0.002). When combining the associated risk of obesity (Odds Ratio (OR) 1.71, 95% CI 1.15-2.54, p = 0.008) with the superadded effect of diabesity (OR 2.37, 95% CI 1.19-4.71, p = 0.014) the rate of superficial wound infection post-operatively was significantly increased (OR 4.05, 95% CI 1.38-11.95). Obesity was associated with a significantly increased risk of deep infection (OR 3.67, 95% CI 1.55-8.68, p = 0.003), but no additive effect of diabetes was found. CONCLUSIONS: Diabesity confers a superadded effect over established associations between THR outcomes and obesity and diabetes individually. Patients with diabesity experience worse improvement in hip-specific functional outcome, worse post-operative quality of life, and an increased risk of superficial and deep wound infection following THR.

Spectrum of opportunistic fungal lung co-infections in COVID-19: What the radiologist needs to know.

Fungal lung co-infections associated with COVID-19 may occur in severely ill patients or those with underlying co-morbidities, and immunosuppression. The most common invasive fungal infections are caused by aspergillosis, mucormycosis, pneumocystis, cryptococcus, and candida. Radiologists integrate the clinical disease features with the CT pattern-based approach and play a crucial role in identifying these co-infections in COVID-19 to assist clinicians to make a confident diagnosis, initiate treatment and prevent complications.

Espectro de coinfecciones pulmonares fúngicas oportunistas en COVID-19: lo que el radiólogo debe saber / Spectrum of opportunistic fungal lung co-infections in COVID-19: What the radiologist needs to know

Las coinfecciones pulmonares fúngicas asociadas a la COVID-19 pueden ocurrir en pacientes gravemente enfermos o con comorbilidades subyacentes e inmunosupresión. Las infecciones fúngicas invasivas más comunes son causadas por aspergilosis, mucormicosis, y las debidas a Pneumocystis, criptococo y cándida. Los radiólogos integran las características clínicas de la enfermedad con el enfoque basado en patrones de TAC y desempeñan un papel crucial en la identificación de estas coinfecciones en la COVID-19 para ayudar a los médicos a realizar un diagnóstico seguro, iniciar el tratamiento y prevenir complicaciones.(AU)

Fungal lung co-infections associated with COVID-19 may occur in severely ill patients or those with underlying co-morbidities, and immunosuppression. The most common invasive fungal infections are caused by aspergillosis, mucormycosis, pneumocystis, cryptococcus, and candida. Radiologists integrate the clinical disease features with the CT pattern-based approach and play a crucial role in identifying these co-infections in COVID-19 to assist clinicians to make a confident diagnosis, initiate treatment and prevent complications.(AU)

Barriers to artificial intelligence implementation in radiology practice: What the radiologist needs to know.

Artificial Intelligence has the potential to disrupt the way clinical radiology is practiced globally. However, there are barriers that radiologists should be aware of prior to implementing Artificial Intelligence in daily practice. Barriers include regulatory compliance, ethical issues, data privacy, cybersecurity, AI training bias, and safe integration of AI into routine practice. In this article, we summarize the issues and the impact on clinical radiology.

[Spectrum of opportunistic fungal lung co-infections in COVID-19: What the radiologist needs to know]. / Espectro de coinfecciones pulmonares fúngicas oportunistas en COVID-19: lo que el radiólogo debe saber.

Fungal lung co-infections associated with COVID-19 may occur in severely ill patients or those with underlying co-morbidities, and immunosuppression. The most common invasive fungal infections are caused by aspergillosis, mucormycosis, pneumocystis, cryptococcus, and candida. Radiologists integrate the clinical disease features with the CT pattern-based approach and play a crucial role in identifying these co-infections in COVID-19 to assist clinicians to make a confident diagnosis, initiate treatment and prevent complications.

Towards equitable conservation: Social capital, fear and livestock loss shape perceived benefit from a protected area.

Providing sufficient benefits to local people can be an important component of effective and equitable conservation, especially where local communities face substantial opportunity costs or disbenefits from conservation. However, the distribution of benefits to local people is often inadequate or inequitable. In this study we investigated the heterogeneity in the extent to which people living near Hwange National Park (HNP), Zimbabwe, perceive benefit from the presence of the park. Specifically, we examined the relationships between a diverse set of candidate predictor variables and perceived benefit from HNP. Our candidate predictor variables broadly relate to personal assets, social capital, value orientation, fear of lions, and belief and participation in human-wildlife conflict mitigation schemes. One third of respondents reported that their household experienced at least some benefits from HNP. Of all respondents, 6% perceived their household to benefit strongly from HNP and 2% very strongly. Livestock loss to wildlife was the most important factor for predicting perceived benefit, with those suffering more loss less likely to perceive benefit. Multiple demographic factors predicted perceived benefit with, for instance, older people and those with less education perceiving less benefit. Employment in conservation-related work positively affected perceived benefit, whereas fear of lions had a negative impact. Social capital appeared to have a positive influence on perceived benefit from HNP. The relationship between social capital and perceived benefit was positive and plateauing, which suggests that social capital is especially impactful on the benefit perceived by individuals reporting the least social capital. We also found a positive association between belief in compensation schemes and perceived benefit from HNP. We posit hypotheses for this association but are unable to determine the underlying drivers of this relationship. Finally, participation in the community guardians programme, a human-lion conflict mitigation programme, was positively related to perceived benefit from HNP. Thus, our findings emphasise the value of considering a diverse array of factors when investigating park-people relationships and yield insights for improving the equitability of conservation in and around HNP and similar systems.

Dificultades en la implantación de la inteligencia artificial en la práctica radiológica: lo que el radiólogo necesita saber / Barriers to Artificial Intelligence implementation in radiology practice: What the Radiologist needs to know

La inteligencia artificial (IA) ofrece la posibilidad de cambiar la práctica de la radiología clínica en todo el mundo. Sin embargo, existen dificultades que los radiólogos deben conocer antes de aplicar la inteligencia artificial en la práctica diaria. Estas dificultades incluyen cuestiones de cumplimiento de la legislación, cuestiones éticas, aspectos relacionados con la privacidad de los datos y la ciberseguridad, el sesgo de aprendizaje automático y la integración segura de la IA en la práctica habitual. En este artículo, resumimos estas cuestiones y su repercusión en la radiología clínica.(AU)

Artificial Intelligence has the potential to disrupt the way clinical radiology is practiced globally. However, there are barriers that radiologists should be aware of prior to implementing Artificial Intelligence in daily practice. Barriers include regulatory compliance, ethical issues, data privacy, cybersecurity, AI training bias, and safe integration of AI into routine practice. In this article, we summarize the issues and the impact on clinical radiology.(AU)

Canadian Association of Radiologists Guidance on Contrast-Associated Acute Kidney Injury.

Purpose: Iodinated contrast media is one of the most frequently administered pharmaceuticals. In Canada, over 5.4 million computed tomography (CT) examinations were performed in 2019, of which 50% were contrast enhanced. Acute kidney injury (AKI) occurring after iodinated contrast administration was historically considered a common iatrogenic complication which was managed by screening patients, prophylactic strategies, and follow-up evaluation of renal function. The Canadian Association of Radiologists (CAR) initially published guidelines on the prevention of contrast induced nephropathy in 2007, with an update in 2012. However, new developments in the field have led to the availability of safer contrast agents and changes in clinical practice, prompting a complete revision of the earlier recommendations. Information sources: Published literature, including clinical trials, retrospective cohort series, review articles, and case reports, along with expert opinions from radiologists and nephrologists across Canada. Methods: The leadership of the CAR formed a working group of radiologists and nephrologists with expertise in contrast administration and patient management related to contrast-associated AKI. We conducted a comprehensive review of the published literature to evaluate the evidence about contrast as a cause of AKI, and to inform evidence-based recommendations. Based on the available literature, the working group developed consensus recommendations. Key Findings: The working group developed 21 recommendations, on screening, choice of iodinated contrast media, prophylaxis, medication considerations, and post contrast administration management. The key changes from the 2012 guidelines were (1) Simplification of screening to a simple questionnaire, and not delaying emergent examinations due to a need for creatinine measurements (2) Prophylaxis considerations only for patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min/1.73 m2 (3) Not recommending the routine discontinuation of any drugs to decrease risk of AKI, except metformin when eGFR is less than 30 mL/min/1.73 m2 and (4) Not requiring routine follow up serum creatinine measurements post iodinated contrast administration. Limitations: We did not conduct a formal systematic review or meta-analysis. We did not evaluate our specific suggestions in the clinical environment. Implications: Given the importance of iodinated contrast media use in diagnosis and management, and the low risk of AKI after contrast use, these guidelines aim to streamline the processes around iodinated contrast use in most clinical settings. As newer evidence arises that may change or add to the recommendations provided, the working group will revise these guidelines.

Justification: Les agents de contraste iodés (ACI) sont parmi les produits pharmaceutiques les plus fréquemment administrés. Au Canada, plus de 5,4 millions d'examens de tomodensitométrie (TDM) ont été réalisés en 2019, dont 50 % ont été faits avec un ACI. L'insuffisance rénale aiguë (IRA) survenant après l'administration d'un ACI était historiquement considérée comme une complication iatrogénique fréquente qui était prise en charge par le dépistage des patients, des stratégies prophylactiques et une évaluation de suivi de la fonction rénale. L'Association canadienne des radiologistes (CAR) a publié des lignes directrices pour la prévention de la néphropathie induite par les agents de contraste en 2007 et une mise à jour en 2012. De nouveaux développements sur le terrain ont toutefois mené à la disponibilité d'agents de contraste plus sécuritaires et à des changements dans la pratique clinique, ce qui a entraîné une révision complète des recommandations antérieures. Sources: La littérature publiée, y compris les essais cliniques, les séries de cohortes rétrospectives, les articles-synthèse et les rapports de cas, de même que les opinions d'experts de radiologistes et de néphrologues de partout au Canada. Méthodologie: La direction de la CAR a formé un groupe de travail composé de radiologues et de néphrologues ayant une expertise dans l'administration d'ACI et la gestion de patients atteints d'IRA survenant après l'administration d'un ACI. Le groupe a procédé à une revue complète de la littérature publiée afin d'évaluer les données probantes sur les ACI comme cause de l'IRA et de formuler des recommandations en fonction de celles-ci. Le groupe de travail a élaboré des recommandations consensuelles en se fondant sur la documentation disponible. Principaux résultats: Le groupe de travail a élaboré 21 recommandations sur le dépistage, le choix des agents de contraste iodés, la prophylaxie, les considérations relatives aux médicaments et la gestion post-administration de l'ACI. Les principaux changements par rapport aux lignes directrices de 2012 étaient : (1) de simplifier le dépistage à un simple questionnaire et de ne pas retarder les examens émergents en raison du besoin de mesurer la créatinine; (2) d'avoir des considérations prophylactiques uniquement pour les patients dont le débit de filtration glomérulaire estimé (DFGe) est inférieur à 30 mL/min/1,73 m2; (3) de ne pas recommander l'arrêt des médicaments visant à réduire le risque d'IRA, comme c'est normalement le cas, sauf la metformine lorsque le DFGe est inférieur à 30 mL/min/1,73 m2 et; (4) ne pas demander de mesures de suivi de routine de la créatinine sérique après administration d'un agent de contraste iodé. Limites: Le groupe n'a pas procédé à une revue formelle et systématique de la littérature sur le sujet ni à une méta-analyse. Les suggestions n'ont pas été évaluées dans un environnement clinique. Conclusion: Compte tenu de l'importance des agents de contraste iodés dans le diagnostic et la prise en charge des patients, et du faible risque d'IRA encouru après leur administration, ces recommandations ne visent qu'à simplifier les processus relatifs à l'utilisation des ACI dans la plupart des milieux cliniques. Le groupe de travail révisera ces lignes directrices au fur et à mesure que des éléments de preuve plus récents seront ajoutés aux recommandations fournies.

Canadian Association of Radiologists Guidance on Contrast Associated Acute Kidney Injury.

Iodinated contrast media (ICM) is one of the most frequently administered pharmaceuticals. In Canada, over 5.4 million computed tomography (CT) examinations were performed in 2019, of which 50% were contrast enhanced. Acute kidney injury (AKI) occurring after ICM administration was historically considered a common iatrogenic complication which was managed by screening patients, prophylactic strategies, and follow up evaluation of renal function. The Canadian Association of Radiologists (CAR) initially published guidelines on the prevention of contrast induced nephropathy in 2007, with an update in 2012. However, new developments in the field have led to the availability of safer contrast agents and changes in clinical practice, prompting a complete revision of the earlier recommendations. This revised guidance document was developed by a multidisciplinary CAR Working Group of radiologists and nephrologists, and summarizes changes in practice related to contrast administration, screening, and risk stratification since the last guideline. It reviews the scientific evidence for contrast associated AKI and provides consensus-based recommendations for its prevention and management in the Canadian healthcare context. This article is a joint publication in the Canadian Association of Radiologists Journal and Canadian Journal of Kidney Health and Disease, intended to inform both communities of practice.

Cold Spray: Over 30 Years of Development Toward a Hot Future.

Cold Spray (CS) is a deposition process, part of the thermal spray family. In this method, powder particles are accelerated at supersonic speed within a nozzle; impacts against a substrate material triggers a complex process, ultimately leading to consolidation and bonding. CS, in its modern form, has been around for approximately 30 years and has undergone through exciting and unprecedented developmental steps. In this article, we have summarized the key inventions and sub-inventions which pioneered the innovation aspect to the process that is known today, and the key breakthroughs related to the processing of materials CS is currently mastering. CS has not followed a liner path since its invention, but an evolution more similar to a hype cycle: high initial growth of expectations, followed by a decrease in interest and a renewed thrust pushed by a number of demonstrated industrial applications. The process interest is expected to continue (gently) to grow, alongside with further development of equipment and feedstock materials specific for CS processing. A number of current applications have been identified the areas that the process is likely to be the most disruptive in the medium-long term future have been laid down.

Utility of MRCP in surveillance of primary sclerosing cholangitis associated hepatobiliary malignancy: 15 year experience at a single institution in Ontario, Canada.

OBJECTIVE: Magnetic resonance cholangiopancreatography (MRCP) is used for the surveillance of primary sclerosing cholangitis (PSC) and its associated complications. The time interval gap for subsequent follow-up MRCP is variable depending on clinical practice patterns, therefore this study was done to assess the MRCP follow-up strategy used in our institution for screening PSC-associated hepatobiliary malignancies. MATERIALS AND METHODS: This retrospective observational cohort included MRCP studies in adult patients, with clinical and radiological diagnosis of PSC over the past 15-year period between January 1, 2003 to December 31, 2018. The study population was grouped based on the presence and absence of PSC-associated malignancy. The frequency of MRCP follow-up was compared between the groups to look for MRI ordering trends in surveillance for PSC-associated complications. RESULTS: The overall median interval follow-up with MRCP was 14 months. The median follow-up interval in cases with PSC-associated malignancy was 6.0 months, compared to 13.1 months in the PSC group without malignancy (p 0.013). During the study period, the PSC-associated malignancy group had a median number of 7.5 scans, while the no malignancy group had a median number of 4 scans. Three patients (3/10, 30%) developed hepatobiliary malignancies within the first year of clinical diagnosis of PSC. The most common malignancy associated with PSC was cholangiocarcinoma (4.6%,7/10). Other PSC-associated malignancies included carcinoma gallbladder (1.3%,2/10), and hepatocellular carcinoma (0.6%,1/10). The median age of PSC associated malignancies was 56 (IQR 15) and higher compared to median age of PSC group without malignancies 46 (IQR 25.5), p 0.035. CONCLUSION: The median interval for subsequent follow-up MRCP in our study cohort was 14 months. One-third of PSC-associated hepato-biliary malignancies developed within the first year of clinical diagnosis of PSC, and the risk of PSC-associated hepato-biliary malignancy is constant after the first year.

Preoperative morbidity and joint awareness while awaiting hip arthroscopy for femoroacetabular impingement.

PURPOSE: The Forgotten Joint Score (FJS-12) is a valid tool in the evaluation of patients undergoing hip arthroscopy, assessing the unique concept of joint awareness in the setting of a patient's hip pathology. The preoperative burden on patients' mental wellbeing of impaired joint function or symptoms is well established. The purpose of this study was to determine patients' awareness of their hip joint whilst awaiting hip arthroscopy for femoroacetabular impingement, to explore any association between joint awareness and mental health status, and to determine whether this relates to time spent waiting for arthroscopy preoperatively. METHODS: A prospective database of patients undergoing hip arthroscopy between January 2018 and November 2020 was analysed. All patients with a diagnosis of femoroacetabular impingement (FAI) undergoing arthroscopic treatment were included. Questionnaires included the FJS-12, twelve item international hip outcome tool (iHOT-12), EuroQol 5D-5L (EQ-5D-5L) and the Tegner activity score. Pearson's correlation coefficient was used to assess relationships between continuous variables. RESULTS: Preoperative functional outcomes were completed by 81 patients (97.5%) prior to undergoing hip arthroscopy. Median preoperative FJS-12 score was 16.67 (IQR 8.33 - 29.68). Forty-four patients reported any level of anxiety/depression preoperatively (54.3%). Preoperative FJS-12 showed a significant negative correlation with worsening mental health status (r = - 0.359, p <  0.001), and a significant positive correlation with EQ-5D-5L (r = 0.445, p <  0.001). The duration of symptoms or time on the waiting list did not correlate with increased joint awareness or worsened mental health. CONCLUSION: Joint awareness is high when awaiting hip arthroscopy for FAI. Increasing levels of joint awareness correlate with poorer mental health status and poorer quality of life measures, however these parameters do not seem to be associated with increased duration of symptoms prior to surgery or time on the waiting list for surgery.

On the prevalence of flow instabilities from high-fidelity computational fluid dynamics of intracranial bifurcation aneurysms.

High-fidelity computational fluid dynamics (HF-CFD) has revealed the potential for high-frequency flow instabilities (aka "turbulent-like" flow) in intracranial aneurysms, consistent with classic in vivo and in vitro reports of bruits and/or wall vibrations. However, HF-CFD has typically been performed on limited numbers of cases, often with unphysiological inflow conditions or focused on sidewall-type aneurysms where flow instabilities may be inherently less prevalent. Here we report HF-CFD of 50 bifurcation aneurysm cases from the open-source Aneurisk model repository. These were meshed using quadratic finite elements having an average effective spatial resolution of 0.065 mm, and solved under physiologically-pulsatile flow conditions using a well-validated, minimally-dissipative solver with 20,000 time-steps per cardiac cycle Flow instability was quantified using the recently introduced spectral power index (SPI), which quantifies, from 0 to 1, the power associated with velocity fluctuations above those of the driving inflow waveform. Of the 50 cases, nearly half showed regions within the sac having SPI up to 0.5, often with non-negligible power into the 100's of Hz, and roughly 1/3 had sac-averaged SPI > 0.1. High SPI did not significantly predict rupture status in this cohort. Proper orthogonal decomposition of cases with highest SPIavg revealed time-varying energetics consistent with transient turbulence. Our reported prevalence of high-frequency flow instabilities in HF-CFD modelling of aneurysms suggests that care must be taken to avoid routinely overlooking them if we are to understand the highly dynamic mechanical forces to which some aneurysm walls may be exposed, and their prevalence in vivo.

Dynamic interactions between apex predators reveal contrasting seasonal attraction patterns.

Apex predators play important roles in ecosystem functioning and, where they coexist, intraguild interactions can have profound effects on trophic relationships. Interactions between predators range from intraguild predation and competition to facilitation through scavenging opportunities. Despite the increased availability of fine-scale GPS data, the determinants and outcomes of encounters between apex predators remain understudied. We used simultaneous GPS data from collared spotted hyaenas (Crocuta crocuta) and African lions (Panthera leo) in Hwange National Park, Zimbabwe, to determine the environmental conditions of the encounters between the two species, which species provoked the encounter, and which species dominated the encounter. Our results show that encounters between hyaenas and lions are mostly resource-related (over a carcass or around waterholes). In the wet season, encounters mainly occur at a carcass, with lions being dominant over its access. In the dry season, encounters mainly occur in the absence of a carcass and near waterholes. Movements of hyaenas and lions before, during, and after these dry-season encounters suggest two interference scenarios: a passive interference scenario whereby both predators would be attracted to waterholes but lions would leave a waterhole used by hyaenas because of prey disturbance, and an active interference scenario whereby hyaenas would actively chase lions from waterhole areas, which are prime hunting grounds. This study highlights the seasonal dynamics of predator interactions and illustrates how the relative importance of negative interactions (interference competition during the dry season) and positive interactions (scavenging opportunities during the wet season) shifts over the course of the year.

Clinical decision-making and importance of the AAE/AAOMR position statement for CBCT examination in endodontic cases.

AIM: To compare conventional radiographic and cone beam computed tomography (CBCT) findings with reference to the American Association of Endodontics and American Academy of Oral and Maxillofacial Radiology (AAE/AAOMR) joint position statement and to determine the effect of the CBCT on the initial diagnoses and treatment plans in a single-centre Postgraduate Endodontic Programme. METHODOLOGY: The clinical CBCT scans of patients, treated at the Endodontic Department of the University of British Columbia, were reviewed for CBCT referrals by comparing them with corresponding radiographs. The features considered were periapical lesions, missed/extra canals, root fractures, complex anatomy, calcified canals and root resorption of tooth/teeth in question. Reasons for the CBCT prescriptions were assigned to 3 groups: to formulate the primary diagnosis, to confirm the diagnosis achieved by clinical examination and conventional radiographs, and to assist in treatment planning. Variables were compared statistically using chi-square and McNemar tests. RESULTS: A total of 128 CBCT examinations were performed on 110 patients. No CBCT examination was performed more than once on the same tooth. Overall, 76% of CBCT examinations were performed on previously root filled teeth. CBCT images revealed a significantly higher incidence of periapical lesions (P = 0.002), missed canals (P < 0.001), vertical root fractures (P = 0.004) and complex anatomy (P = 0.008) than periapical radiographs. CBCT was prescribed most frequently to assist surgical treatment planning (62%) rather than for generating a diagnosis (9%) or confirming diagnoses (29%). Both the diagnosis (P = 0.001) and the treatment plan (P = 0.005) initially made by examining periapical radiographs were altered significantly by the subsequent CBCT examination by revealing information such as new periapical lesions, missed canals or involvement of buccal or lingual cortical bone. CONCLUSION: CBCT examinations were prescribed mainly to assist treatment planning rather than for diagnosis. The majority of CBCT examinations were performed on previously root filled teeth. The additional information obtained from CBCT scans resulted in the alteration of the initial diagnoses as well as subsequent treatment plans in 59 out of 128 cases.

Quality of life, function and disability in individuals with chronic ankle symptoms: a cross-sectional online survey.

BACKGROUND: Chronic ankle conditions affect approximately 20% of Australian adults. Although there is a plethora of research on chronic hip and knee conditions, there is limited understanding of the impact of ankle problems. Thus, the significance of chronic ankle conditions is not clear. The aim of this study was to compare self-reported function, disability, instability, physical activity and quality of life (QoL) between adults with and without ankle symptoms. A secondary aim was to explore factors associated with QoL. METHOD: Individuals with symptoms of ankle pain and stiffness (symptomatic individuals) and controls with no ankle pain or stiffness (asymptomatic individuals) completed a cross-sectional online survey. The survey included the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure (FAAM), Cumberland Ankle Instability Tool (CAIT), International Physical Activity Questionnaire (IPAQ), Assessment of QoL (AQoL-6D), and questions about ankle injury history. RESULTS: A total of 394 individuals (270 symptomatic and 124 asymptomatic) with mean age of 48.8 (standard deviation (SD): 12.1) years and body mass index of 28.7 (7.7) kgm- 2 completed the survey. Standardized mean differences (SMD) were large to very large (1.45 to 3.20) for greater disability (AOS) and instability (CAIT), and poorer function (FAAM) in symptomatic compared to asymptomatic individuals. Individuals with ankle symptoms had higher body mass index and lower QoL (medium effect: SMD > 1). There were no differences in self-report physical activity between groups. Lower activities of daily living (ADL) function (FAAM-ADL) best explained QoL in a multiple regression model (R2 = 0.66, p = 0.001). CONCLUSION: Individuals with ankle symptoms reported ankle instability, greater disability, compromised function and worse QoL compared to asymptomatic individuals. There was a strong relationship between ankle function and QoL. Ankle-specific ability during ADL best explained the reduced QoL in individuals with ankle symptoms. Clinicians and researchers should consider ankle function as an antecedent to poorer QoL in patients who have ankle symptoms.