The responsiveness of legislative actors to stakeholders’ demands in the European Union

<p>This study examines the extent to which stakeholders’ demands are represented by the Commission, European Parliament, and national governments in the Council when legislative proposals are debated. We formulate and test propositions from resource exchange theory to explain variation in the responsiveness of EU actors to various stakeholders. Our research design integrates the study of the formative and decision-making stages of the legislative process, which are often studied in isolation. We combine new information from detailed qualitative content analysis of consultation documents with an established dataset on subsequent legislative decision-making. The findings indicate that a broad range of stakeholders’ demands are reflected in the positions taken by the national and supranational actors involved in the EU's legislative process, but also that there is considerable variation in the extent to which different EU actors respond to stakeholders of different types and origins.</p

Incentives to comply: the impact of national governments’ and stakeholders’ preferences on compliance with EU laws

Established explanations of differences in compliance outcomes highlight the policy preferences of implementers. The application of these theories to compliance with EU laws focuses on national governments and stakeholders. This study improves on existing conceptualisations of governments’ and stakeholders’ preferences by distinguishing between their incentives to deviate from, conform to and exceed the standards contained in EU laws. We apply these concepts to detailed evidence on national governments’ and stakeholders’ policy preferences and national governments’ transposition records. The study finds that incentives to conform and exceed are generally more frequent than incentives to deviate. Moreover, the policy preferences of national governments and stakeholders are linked, as governments’ preferences often agree with national stakeholders’ demands. Both national governments’ and stakeholders’ incentives to comply positively affect the timeliness of transposition.</p

bmm-2021-0579 supplementary materials

   Abstract  Aims: To identify prognostic biomarker(s) for knee OA in the osteoarthritis initiative (OAI) cohort. Methods: Multilevel regression was used to determine the association of baseline biomarkers and change in biomarker between baseline and 24-months, with clinical and radiographic OA progression over 48 months follow up. Results: Higher values of baseline uCTXII was consistently associated with an increased risk of OA disease progression outcomes:K&L grade (Odds Ratio (OR) 1.15 95% CI (1.03,1.28); medial JSN (OR 1.06 (1.02,1.10)); lateral osteophytes (OR 1.05 (1.01,1.10)); JSW (regression coefficient –0.005 (-0.008,-0.001)); WOMAC pain (OR 1.02 (1.01,1.04)). Changes in sPIIANP and sCOMP over 24 months were associated with clinical disease progression. Conclusion: uCTXII showed stronger associations with radiographic OA and appear to be a reliable prognostic marker while changes in other biomarkers were found in early symptomatic OA supporting the phasic nature of OA.</p

Comparison of the 10-year outcomes of cemented and cementless unicompartmental knee replacements: data from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

Background and purpose — Unicompartmental knee replacement (UKR) offers advantages over total replacement but has higher revision rates, particularly for aseptic loosening. The cementless Oxford UKR was introduced to address this. We undertook a registry-based matched comparison of cementless and cemented UKRs. Patients and methods — From 40,552 Oxford UKRs identified by the National Joint Registry for England, Wales, Northern Ireland and Isle of Man (NJR) we propensity score matched, based on patient, surgical, and implant factors, 7,407 cemented and 7,407 cementless UKRs (total = 14,814). Results — The 10-year cumulative implant survival rates for cementless and cemented UKRs was 93% (95% CI 90–96) and 90% (CI 88–92) respectively, with this difference being significant (HR 0.76; p = 0.002). The risk of revision for aseptic loosening was less than half (p Interpretation — The cementless UKR has improved 10-year implant survival compared with the cemented UKR, independent of patient, implant, and surgical factors. This improved survival in the cementless group was primarily the result of lower revision rate for aseptic loosening, unexplained pain, and lysis, suggesting the fixation of the cementless was superior. However, there was a small increased risk of revision for periprosthetic fracture with the cementless implant.</p

Rates of knee arthroplasty in anterior cruciate ligament reconstructed patients: a longitudinal cohort study of 111,212 procedures over 20 years

Background and purpose — Long-term rates of knee arthroplasty in patients with anterior cruciate ligament (ACL) injury who undergo ligament reconstruction (ACLr) are unclear. We determined this risk of arthroplasty through comparison with the general population. Patients and methods — All patients undergoing an ACLr in England, 1997–2017, were identified from national hospital statistics. Patients subsequently undergoing a knee arthroplasty were identified and survival analysis was performed (survival without undergoing knee arthroplasty). A Cox proportional hazards model was used to identify factors associated with knee arthroplasty. Relative risk of knee arthroplasty (total or partial) in comparison with the general population was determined. Results — 111,212 ACLr patients were eligible for analysis (mean age 29; 77% male). Overall, 0.46% (95% confidence interval [CI] 0.40–0.52) ACLr patients underwent knee arthroplasty within 5 years, 0.97% (CI 0.82–1.2) within 10 years, and 1.8% (CI 1.4–2.3) within 15 years. Knee arthroplasty risk was greater in older age groups and women. In comparison with the general population, the relative risk of undergoing arthroplasty at a younger age (at time of arthroplasty) was elevated: at 30–39 years (risk ratio [RR] 20; CI 11–35), 40–49 years (RR 7.5; CI 5.5–10), and 50–59 years (RR 2.5; CI 1.8–3.5), but not 60–69 years (RR 1.7; CI 0.93–3.2). Interpretation — Patients sustaining an ACL injury who undergo ACLr are at elevated risk of subsequent knee arthroplasty in comparison with the general population. Although the absolute rate of arthroplasty is low, the risk of arthroplasty at a younger age is particularly elevated. When the outcome of shared decision-making is ACLr, this data will help inform patients and clinicians about the long-term risk of requiring knee arthroplasty.</p

Additional file 1: of Total hip arthroplasty versus hemiarthroplasty for independently mobile older adults with intracapsular hip fractures

Codes for defining Charlson co-morbidities* (DOCX 19 kb

Additional file 2 of Access to hip and knee arthroplasty in England: commissioners’ policies for body mass index and smoking status and implications for integrated care systems

Additional file 2

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris

<p><b>Background and purpose</b> — The initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. <a href="#CIT0054" target="_blank">2018a</a>). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision.</p> <p><b>Results and interpretation</b> — The outcomes following ARMD revision surgery appear to have improved with time for several reasons, among them the introduction of regular patient surveillance and lowering of the threshold for performing revision. Furthermore, registry data suggest that outcomes following ARMD revision are influenced by modifiable factors (type of revision procedure and bearing surface implanted), meaning surgeons could potentially reduce failure rates. However, additional large multi-center studies are needed to develop robust thresholds for performing ARMD revision surgery, which will guide surgeons’ treatment of MoMHA patients. The long-term systemic effects of metal ion exposure in patients with these implants must also be investigated, which will help establish whether there are any systemic reasons to recommend revision of MoMHAs</p

Additional file 2: of Total hip arthroplasty versus hemiarthroplasty for independently mobile older adults with intracapsular hip fractures

Figure S1. PRISMA flow diagram showing identification of randomised and quasi-randomised controlled trials from previous systematic reviews. Table S1. Characteristics of excluded studies. Table S2. Characteristics of included studies. Table S3. Risk of bias assessments for included studies. (DOCX 321 kb

Table1_Could sex-specific subtypes of hand osteoarthritis exist? A retrospective study in women presenting to secondary care.pdf

IntroductionHand osteoarthritis is more common in women, and its risk increases around the time of the menopause. We set out to describe the timing between menopause and the onset of symptomatic hand osteoarthritis (OA), and associations with the use of hormone replacement therapy (HRT) or its discontinuation, describing any identifiable subgroups of women.MethodsRetrospective healthcare-records study of sequential women referred to a specialist hand OA clinic, 2007–2015. Confirmation of hand OA diagnosis was by clinican, by accepted criteria. Demographics and clinical variables were from healthcare-records, recorded by standardised proforma. Outcomes of interest were reported age of onset of hand symptoms, reported age at final menstrual period (FMP), time from FMP to reported onset of hand symptoms and time from cessation of HRT to reported onset of hand symptoms. Exposure categories for systemic HRT use were never users, current users, previous users. Analysis of Variance compared groups; linear regression analysed associations of exposure with outcome.Results82/92(89%) of eligible women were post-menopausal, mean age at FMP 49.9 years (SD5.4). In these post-menopausal women, median time from FMP to hand symptom onset was 3 years. 48/82 (59%) developed hand symptoms within the defined peri-menopausal period (FMP ± 4 years), whilst some women developed their symptoms before or after (range −25, 30 years). In women who discontinued HRT prior to symptom onset, the median time from HRT cessation to onset of hand symptoms was 6 months. Past HRT users were older at hand symptom onset than women who had not taken HRT [coeff.4.7 years (0.92, 8.39); P = 0.015].ConclusionsThis study adds to evidence associating the menopause/sex hormone deficiency with hand OA symptom onset in a sizeable subgroup of women (but not all). HRT use/cessation appears to influence the timing of onset of hand OA symptoms. It is not possible to interpret from this type of study whether sex hormone deficiency is causative of disease or modulates its symptoms. It is also not possible to judge whether painful hand osteoarthritis in post-menopausal women is a subtype of disease. Further investigation is indicated of sex-specific subtypes and potential for personalised medicine for post-menopausal women with hand osteoarthritis, as a clearly definable high-risk subgroup.</p