A novel classifier of radiographic knee osteoarthritis for use on knee DXA images is predictive of joint replacement in UK Biobank

ObjectivesDXA scans may offer a novel means of evaluating radiographic knee OA (rKOA) in large population studies and through opportunistic screening. We aimed to develop and apply a semi-automated method for assessing rKOA using ≈20 000 knee DXA images from UK Biobank (UKB) and assess its face validity by checking for expected relationships with clinical outcomes.MethodsRight knee DXA scans were manually annotated for osteophytes to derive corresponding grades. Joint space narrowing (JSN) grades in the medial joint compartment were determined from automatically measured minimum joint space width. Overall rKOA grade (0–4) was determined by combining osteophyte and JSN grades. Logistic regression was employed to investigate the associations of osteophyte, JSN and rKOA grades with knee pain and hospital-diagnosed KOA. Cox proportional hazards modelling was used to examine the associations of these variables with risk of subsequent total knee replacement (TKR).ResultsOf the 19 595 participants included (mean age 63.7 years), 19.5% had rKOA grade ≥1 (26.1% female, 12.5% male). Grade ≥1 osteophytes and grade ≥1 JSN were associated with knee pain, hospital-diagnosed KOA and TKR. Higher rKOA grades were linked to stronger associations with these clinical outcomes, with the most pronounced effects observed for TKR. Hazard ratios for the association of rKOA grades with TKR were 3.28, 8.75 and 28.63 for grades 1, 2 and 3–4, respectively.ConclusionsOur DXA-derived measure of rKOA demonstrated a progressive relationship with clinical outcomes. These findings support the use of DXA for classifying rKOA in large epidemiological studies and in future population-based screening

¹⁰Be evidence for extensive, low-elevation Late Pleistocene glaciation in far eastern (Arunachal) Himalayas - timing and palaeoclimate reconstruction

The glacial history of the eastern Himalayas has remained undocumented compared to its western and central regions. In this study, we present 63 Be-10 exposure ages from glacial deposits in the Dri Valley, situated at the eastern extremity of the Himalayas, to reconstruct the first Pleistocene glaciation history of the ~900 km long Arunachal Himalayas. The most extensive glaciation occurred before ~48 ka (and possibly earlier than ~58 ka), when the (inferred) trunk glacier reached 100 km in length and descended to around 1500 to 1300 m above sea level (a.s.l) – among the lowest elevations recorded for glaciers in the Himalayan-Tibetan Orogen. The main valley glacier remained substantial during the Last (Global) Glacial Maximum (LGM) and had a length of ~76 km and terminated around 1680 m a.s.l. Despite dense forest cover, paraglacial and postglacial erosion obscuring (prominent) glacial landforms in the Dri Valley, an integrated approach combining geomorphological evidence and high-resolution satellite imagery with cosmogenic-based geochronological data has enabled a detailed reconstruction of its Pleistocene glaciation. Glacial deposits covering elevations from 3700 to 1600 m a.s.l were subdivided based on morphostratigraphy, revealing four periods of postglacial exposure dating to ≥58 ka, ~48 ka, ~19 ka and ~13 ka. The results indicate that the Dri Valley cirques (elevations ~3700 to ~3800 m a.s.l) became ice free between ~14 – 13 ka. Reconstruction of the cirque glacier yields an equilibrium line altitude (ELA) of approximately 3750 m, corresponding to a ∆ELA of ~900 m compared to today which is among the largest ELA depressions in the Himalayas for this period (~14 ka to present). Our findings reveal that Late Quaternary glaciation in the Dri Valley was primarily temperature-driven, influenced by long-term orbital forcing. With approximately 90% of the region’s abundant annual precipitation today occurring in summer, a positive mass balance for the Dri glacier is maintained up to a temperature-sensitive threshold. Beyond this threshold, even minimal warming would have caused glacier retreat (or collapse) due to a larger percentage of the summer precipitation falling as rain rather than snow, reducing the glacier’s accumulation. This is reflected in the termination of Dri Valley glacial phases correlating with known regional warm periods. This study offers critical insights into the climate-glacier interactions in the understudied eastern Himalayas and enhances our understanding of broader Himalayan-Tibetan palaeoclimate

Exploring the impact of work-related stress and professional wellbeing with practitioners in homes for children

This study examines experiences of staff wellbeing in homes for cared-for children and theoretically considers how staff wellbeing influences the care children receive. Staff in these settings often experience high levels of stress and burnout, due to the demanding nature of their roles and the lack of professional support. Personal accounts and approaches to coping were collected through an anonymous online platform, then explored through descriptive statistics, a correlation matrix, three separate multiple regression analyses, a multiple linear regression, and thematic analysis. Staff wellbeing is significantly influenced by coping strategies, self-compassion, and support systems. Participants who reported higher levels of compassion satisfaction exhibited lower levels of burnout. Conversely, avoidant coping strategies and unprocessed secondary traumatic stress were associated with increased burnout. The study also underscores the importance of a supportive work environment, including regular supervision, professional development, and access to mental health resources, in enhancing staff resilience and reducing turnover. Recommendations for the homes for children sector include implementing comprehensive support systems to enhance staff wellbeing, and integrating trauma-informed care training and principles. By addressing these areas, the sector can improve care quality and better support the developmental needs of vulnerable children through enhanced placement stability and therapeutic value

A national survey of current discharge planning and aftercare arrangement practices for those returned to prison from secure psychiatric services in England and Wales

BackgroundLittle is known about the transition process for those returned to prison following treatment in secure psychiatric services. This study is the first internationally to explore the process of discharge/aftercare planning for this population.AimTo identify the current national discharge and aftercare planning procedures for people returned to prison in England and Wales.MethodsA national survey of current service discharge planning and aftercare arrangement practices in low- and medium-secure psychiatric services and prison mental health teams in England and Wales.ResultsWe had a 72% response rate across prison-based and secure mental health services. A summative contents analysis highlighted that outstanding priority areas for improvement, include (a) relationship building to improve communication and understanding between secure psychiatric services, prison mental health services, and the prison estate and (b) significant reform and additional resources to achieve the expected standard of care and to provide people returned to prison with a care package tailored to meet their specific needs.ConclusionEffective care planning and management of return to prison from secure psychiatric services has the potential to improve patient health and well-being in prison and up to and beyond their subsequent prison release, with far-reaching effects on prevention of relapse, hospital readmission, reoffending and other adverse events

A unified framework for asset ranking based on their criticality through case studies

Purpose – Effective asset management is grounded in a strategic framework prioritising assets according to their criticality to minimise downtime, reduce maintenance costs and maintain operational efficiency. This paper introduces a unified framework for asset ranking that integrates expert insights, criteria weighting and risk assessment techniques. Unlike standalone approaches, this framework addresses biases and inaccuracies by harnessing the strengths of each method while mitigating their limitations.Design/methodology/approach – The framework starts with an asset audit that examines field and historical performance data, followed by data cleaning and expert validation through questionnaires to ensure the criteria’s relevance. A pairwise comparison matrix is used to weight the criteria, while risk elements are assessed using failure mode, effects and criticality analysis. This process leads to calculating the risk priority index, which ranks the critical assets.Findings – The framework is demonstrated through a case study of two 500 kW wind turbine models: geared and direct-drive. The findings reveal that direct-drive turbines are generally more critical, informing their maintenance priorities.Research limitations/implications – This paper illustrates the framework’s potential for effective resource allocation and risk mitigation, offering flexibility for application across diverse industries. Nevertheless, its reliance on historical data and expert input may need enhancement.Originality/value – This comprehensive approach ensures a structured method for asset prioritisation that addresses the real-world challenges inherent in asset management by leveraging the strengths of multiple methodologies and mitigating their limitations

The Impact of Living With Inducible Laryngeal Obstruction

Inducible Laryngeal Obstruction (ILO) is an inappropriate, transient, reversible narrowing of the larynx in response to external triggers. The aim of this qualitative study was to develop an in-depth understanding of the experiences of individuals living with ILO and the impact this has on their lives. We describe the impact the disease has on patients, and this should promote clinician awareness of the experience of ILO from the patient's perspective and support a personalised approach to care.</p

Interdisciplinary Systematic Review: A Novel Approach to Evidence Synthesis

Reporting on the newly started project "Interdisciplinary Systematic Review: A Novel Approach to Evidence Synthesis