Are people following hip and knee arthroplasty at greater risk of experiencing a fall and fracture? Data from the Osteoarthritis Initiative

Introduction: Falls are a major challenge for older people and are a significant source of mortality and morbidity. There has been uncertainty as to whether people with total hip (THA) or knee (TKA) arthroplasty have a greater risk of falls and associated fractures. This analysis was to explore this question with a large community dataset. Materials and Methods: Data from all people enrolled onto the US Osteoarthritis Initiative programme who had undergone a THA (n=104) or TKA (n=165), within a 12 month period, were compared to those who had not undergone an arthroplasty (n=4631). Data was collected on: the number of participants who reported a fall within a 12 month period; the frequency of falls in this period; and whether a fracture was sustained during this period. Odd ratios were calculated for the probability of experiencing a fall or fracture between the groups. Results: There was no statistical difference in falls between people following THA (OR 0.90; 95% CI: 0.58 to 1.41) or TKA (OR: 0.95; 0.67 to 1.35) compared to a non-arthroplasty cohort. Whilst there was no statistical difference in fracture risk between people following TKA compared to non-arthroplasty individuals (OR: 1.25; 95% CI: 0.57 to 2.70), those who underwent THA had a 65% lower chance of experiencing a fracture in the initial 12 post-operative months compared to the non-THA cohort (OR 0.35; 95% CI: 0.19 to 0.65; p<0.01). Conclusions: There appears a lower chance of experiencing a fracture for people following THA compared to those who have not

Quantum Fluctuation Theorems

Recent advances in experimental techniques allow one to measure and control systems at the level of single molecules and atoms. Here gaining information about fluctuating thermodynamic quantities is crucial for understanding nonequilibrium thermodynamic behavior of small systems. To achieve this aim, stochastic thermodynamics offers a theoretical framework, and nonequilibrium equalities such as Jarzynski equality and fluctuation theorems provide key information about the fluctuating thermodynamic quantities. We review the recent progress in quantum fluctuation theorems, including the studies of Maxwell's demon which plays a crucial role in connecting thermodynamics with information.Comment: As a chapter of: F. Binder, L. A. Correa, C. Gogolin, J. Anders, and G. Adesso (eds.), "Thermodynamics in the quantum regime - Fundamental Aspects and New Directions", (Springer International Publishing, 2018

CPRD GOLD and linked ONS mortality records: Reconciling guidelines

Background The Clinical Practice Research Datalink (CPRD) GOLD is an extremely influential U.K. primary care dataset for epidemiological research having a number of published papers based on its data much bigger than any other U.K. primary care dataset. The Office for National Statistics (ONS) death data for England can be linked to GOLD at the patient level and are considered the gold standard on mortality. GOLD, which also holds death data, has been recently assessed against ONS linked dataset and the accuracy of its dates of death has been deemed sufficient for the majority of observational studies. However, there is a lack of guidance on how to manage the challenges existing when ONS mortality and GOLD datasets are linked, including linkage coverage period, linkage correctness likelihood, linkage regional limitations and data discrepancy. Objectives Provide reconciling guidelines on how to make maximum and at the same time trustworthy use of mortality information coming from both GOLD and ONS linked datasets with the aim of improving the quality, reproducibility, transparency and comparison of clinical research. Method and results We have developed recommendations on how to manage mortality data coming from both GOLD and linked ONS, taking into account linkage coverage period, linkage correctness likelihood, linkage regional limitations and data discrepancies between these two datasets. We have also implemented these guidelines in an SQL algorithm for researchers to use. Conclusion We have provided detailed guidelines on the reconciliation of mortality data between GOLD and ONS linked death datasets, taking into account both their strengths and limitations. The consistent application of these guidelines made practical by an SQL algorithm, has the potential to improve clinical research quality, reproducibility, transparency and comparison

Second law, entropy production, and reversibility in thermodynamics of information

We present a pedagogical review of the fundamental concepts in thermodynamics of information, by focusing on the second law of thermodynamics and the entropy production. Especially, we discuss the relationship among thermodynamic reversibility, logical reversibility, and heat emission in the context of the Landauer principle and clarify that these three concepts are fundamentally distinct to each other. We also discuss thermodynamics of measurement and feedback control by Maxwell's demon. We clarify that the demon and the second law are indeed consistent in the measurement and the feedback processes individually, by including the mutual information to the entropy production.Comment: 43 pages, 10 figures. As a chapter of: G. Snider et al. (eds.), "Energy Limits in Computation: A Review of Landauer's Principle, Theory and Experiments

Processes and coastal dynamics in the Ensenada de Marbella: recent morphosedimentary evolution

La Ensenada de Marbella ha experimentado en las últimas décadas cambios físicos y socio-económicos sustanciales debidos fundamentalmente a una transformación en el modelo económico y un desarrollo acusado del turismo residencial y todos los impactos en los usos del suelo relacionado con ello. Sin embargo, las causas de la alteración de la dinámica litoral también hay que buscarlas en cambios en la morfología del nearshore y en la dinámica sedimentaria. Para analizar la morfodinámica de la ensenada en varios escenarios temporales, simulaciones de oleaje sobre batimetrías del 1888 y actuales revelan cambios importantes en los patrones dispersión de la energía y el funcionamiento de la bahía a través de complejas células litorales de transporte. El análisis de los procesos dinámicos en la zona del nearshore y el estudio volumétrico a través de modelos de batimetrías secuenciales muestran como dichos cambios morfológicos de los fondos costeros pueden o no estar relacionados con cambios a largo plazo en la línea de costa, y por tanto ser co-responsables de los procesos de erosión y acreción acelerados evidentes a lo largo de la Ensenada

Opioid use in knee or hip osteoarthritis: a region-wide population-based cohort study

Objective To quantify opioid use in knee and hip osteoarthritis (OA) patients, and to estimate the proportion of opioids in the population attributable to OA patients. Design Population-based cohort study. Methods We included 751579 residents in southern Sweden, aged ≥35 years in 2015. Doctor-diagnosed knee or hip OA between 1998 and 2015 was the exposure. Dispensed weak and strong opioids were identified between November 2013 and October 2015 from the Swedish Prescribed Drug Register (SPDR). We determined age- and sex-standardized 12-month period prevalence of opioid use from November 2014 until October 2015 and calculated prevalence ratios and incidence rate ratios adjusted for age, sex, and other socio-demographic variables. We estimated the population attributable fraction (PAF) of incident opioid use attributable to OA patients. Results The 12-month prevalence of opioid use among OA patients was 23.7% [95% confidence intervals (CI) 23.3–24.2], which was two-fold higher compared to individuals without knee or hip OA: prevalence ratio: 2.1 [95% CI 2.1–2.1]. Similarly, OA patients were more likely to have an incident opioid dispensation, especially for strong opioids (incidence rate ratio: 2.6 [95% CI 2.5–2.7]). population attributable fractions (PAF) of incident opioid use attributable to OA patients was 12%, 9% for weak and 17% for strong opioids. Conclusions Every fourth patient with knee or hip OA has opioids dispensed over a 1-year period, and 12% of incident opioid dispensations are attributable to OA and/or its related comorbidities. These results highlight that patients with knee and hip OA constitute a group of patients with an alarmingly high use of opioids

Mapping existing hip and knee replacement registries in Europe

The general shortage of evidence regarding benefits and harms of medical devices has been highlighted following the serious safety concerns with metal-on-metal hip replacements and silicone breast implants and was again pointed out in a recent survey of European Health Technology Assessment institutions. In this context the new European medical device regulation will enforce post-marketing surveillance of existing and new implants. The usefulness of registry data as a source of information for medical device real-world clinical performance and safety has been demonstrated. However, these data might be under-used by researchers and policy makers. One reason for this is the insufficient awareness of their existence. The aim of this review is to provide information to relevant stakeholders on the extent and breadth of the data currently collected in European joint replacement registries. We identified 24 registries, most of them of national coverage. Total numbers of primary total hip and knee replacements included were over 3.1 and 2.5 million records, respectively. The current focus of these registries is on whole-lifespan implant surveillance via revision rate monitoring, quality assessment of surgical and perioperative care, and hospital performance assessment. More recently, national and international comparison and benchmarking have increasingly become part of their endeavors

Smooth Entropy in Axiomatic Thermodynamics

Thermodynamics can be formulated in either of two approaches, the phenomenological approach, which refers to the macroscopic properties of systems, and the statistical approach, which describes systems in terms of their microscopic constituents. We establish a connection between these two approaches by means of a new axiomatic framework that can take errors and imprecisions into account. This link extends to systems of arbitrary sizes including very small systems, for which the treatment of imprecisions is pertinent to any realistic situation. Based on this, we identify the quantities that characterise whether certain thermodynamic processes are possible with entropy measures from information theory. In the error-tolerant case, these entropies are so-called smooth min and max entropies. Our considerations further show that in an appropriate macroscopic limit there is a single entropy measure that characterises which state transformations are possible. In the case of many independent copies of a system (the so-called i.i.d. regime), the relevant quantity is the von Neumann entropy. Transformations among microcanonical states are characterised by the Boltzmann entropy