Bulgaria and Macedonia would be hardest hit by a suspension of Russian gas exports through Ukraine

One of the great concerns for EU states over the on-going situation in Crimea is their reliance on Russian gas to meet their energy demands, with around 60 per cent of these imports being delivered through pipelines in Ukraine. Jack Sharples and Andy Judge provide a comprehensive assessment of what the impact would be if the transit routes via Ukraine were suspended. They note that while the situation has generally been portrayed as an ‘EU problem’, the risk to Western Europe would be minimal. Rather, the problem would be a distinctly regional one, with Bulgaria and Macedonia facing a serious loss of gas supplies. Other states in Central and Eastern Europe would not face immediate problems due to existing gas stocks, provided the suspension of transit through Ukraine did not last longer than approximately two months

Strong domain variation and treebank-induced LFG resources

In this paper we present a number of experiments to test the portability of existing treebank induced LFG resources. We test the LFG parsing resources of Cahill et al. (2004) on the ATIS corpus which represents a considerably different domain to the Penn-II Treebank Wall Street Journal sections, from which the resources were induced. This testing shows an under-performance at both c- and f-structure level as a result of the domain variation. We show that in order to adapt the LFG resources of Cahill et al. (2004) to this new domain, all that is necessary is to retrain the c-structure parser on data from the new domain

Equity in access to total joint replacement of the hip and knee in England: cross sectional study

Objective To explore geographical and sociodemographic factors associated with variation in equity in access to total hip and knee replacement surgery

Rates of knee arthroplasty within one-year of undergoing arthroscopic partial meniscectomy in England:temporal trends, regional and age-group variation in conversion rates

Objective The aim of this study was to determine the proportion of patients undergoing arthroscopic partial meniscectomy (APM) then subsequently receiving a knee arthroplasty within one or two years, with focus on patients over the age of 60 years and regional variation. Methods Patients undergoing APM in England over 20-years (01-April-1997 to 31-March 2017) were identified in the national Hospital Episode Statistics (HES). The proportion of patients undergoing arthroplasty in the same knee within one or two years of APM was determined and trends were analysed over time nationally and by NHS Clinical Commissioning Group (CCG) region. Results 806,195 APM patients were eligible for analysis with at least one-year of follow up and 746,630 with two-years. The odds of arthroplasty conversion within one year increased over the study period (odds ratio [OR] 3.10 within 1-year in 2014 vs 2000; 95% confidence interval [CI] 2.75–3.50). For patients undergoing APM aged 60 years or older in 2015–16, 9.9% (1689/17,043; 95% CI 9.5–10.4) underwent arthroplasty within 1-year and, in 2014–15, 16.6% (3100/18,734; 95% CI 16.0–17.1) underwent arthroplasty within 2-years. There was greater than 10-fold variation by CCG. Conclusions Over the study period, the proportion of patients undergoing arthroplasty within one-year of APM increased. In 2015–16, of patients aged 60 years or older who underwent APM, 10% subsequently underwent knee arthroplasty within one year (17% within two years in 2014–15) and there was a high level of regional variation in this outcome. The development and adoption of national treatment guidance is recommended to improve and standardise treatment selection.</p

Risk factors for failure of the 36 mm metal-on-metal Pinnacle total hip arthroplasty system:a retrospective single-centre cohort study

Aims: To determine 10-year failure rates following 36mm metal-on-metal (MoM) Pinnacle total hip replacement (THR), and identify predictors of failure. Methods: We retrospectively assessed a single-centre cohort of 569 primary 36mm MoM Pinnacle THRs (all Corail stems) followed up since 2012 according to MHRA recommendations. Allcause failure rates (all-cause revision, and non-revised cross-sectional imaging failures) were calculated, with predictors for failure identified using multivariable Cox regression. Results: Failure occurred in 97 hips (17.0%). The 10-year cumulative failure rate was 27.1% (95% CI=21.6%-33.7%). Primary implantation from 2006 onwards (Hazard Ratio (HR)=4.30; CI=1.82-10.1; p=0.001) and bilateral MoM hip arthroplasty (HR=1.59; CI=1.03-2.46; p=0.037) predicted failure. The effect of implantation year on failure varied over time. From 4-years onwards following surgery, hips implanted since 2006 had significantly higher failure rates (8-years=28.3%; CI=23.1%-34.5%) compared to hips implanted before 2006 (8- years=6.3%; CI=2.4%-15.8%) (HR=15.2; CI=2.11-110.4; p=0.007). Conclusion: We observed that 36mm MoM Pinnacle THRs have an unacceptably high 10-year failure rate, especially if implanted from 2006 onwards or in bilateral MoM patients. Our findings regarding implantation year and failure support recent concerns about the device manufacturing process. We recommend all patients undergoing implantation since 2006 and those with bilateral MoM hips undergo regular investigation, regardless of symptoms

Can Surgical Trainees Achieve Arthroscopic Competence at the End of Training Programs? A Cross-sectional Study Highlighting the Impact of Working Time Directives.

PURPOSE: To provide training guidance on procedure numbers by assessing how the number of previously performed arthroscopic procedures relate to both competent and expert performance in simulated arthroscopic shoulder tasks. METHODS: A cross-sectional study that assessed simulated shoulder arthroscopic performance was undertaken. A total of 45 participants of varying experience performed 2 validated tasks: a simple diagnostic task and a more complex Bankart labral repair task. All participants provided logbook numbers for previously performed arthroscopies. Performance was assessed with the Global Rating Scale and motion analysis. Receiver operating characteristic curve analyses were conducted to identify optimum cut points for task proficiency at both "competent" and "expert" levels. RESULTS: Increasing surgical experience resulted in significantly better performance for both tasks as assessed by Global Rating Scale or motion analysis (P < .0001). Receiver operating characteristic curve analyses demonstrated 52 previous arthroscopies were needed to perform to a competent level at the diagnostic task and 248 to be competent at the complex task. To perform at an expert level, 290 and 476 previous arthroscopies, respectively, were needed. CONCLUSIONS: This study provides quantified guidance for arthroscopic training and highlights the positive relationship between arthroscopic case load and arthroscopic competency. We have estimated that the number of arthroscopies required to achieve competency in a basic arthroscopic task exceed those recommended in some countries. These estimates provide useful guidance to those responsible for training program. CLINICAL RELEVANCE: The numbers to achieve competent arthroscopic performance in the assessed simulated tasks exceed what is recommended and what is possible during surgical training programs in some countries

A comfort assessment of existing cervical orthoses

Purpose: identify location and intensity of discomfort experienced by healthy participants wearing cervical orthoses. Method: convenience sample of 34 healthy participants wore Stro II, Philadelphia, Headmaster, and AspenVista® cervical orthoses for four-hour periods. Participants reported discomfort level (scale 0-6) and location. Results: participants reported mean discomfort for all orthoses over the four-hour test between ‘a little discomfort’ and ‘very uncomfortable’ (mean discomfort score=1.64, SD=1.50). Seven participants prematurely stopped tests due to pain and six reported maximum discomfort scores. Significant linear increase in discomfort with duration of wear was found for all orthoses. Significantly less discomfort was reported with Stro II than Headmaster and Philadelphia. Age correlated with greater perceived discomfort. Orthoses differed in the location discomfort was experienced. Conclusion: existing cervical orthoses cause discomfort influenced by design and duration of wear with orthoses' design the more significant factor. This work informed the design of a new orthosis and future orthoses developments

Anti-Osteoporosis Medication Prescriptions and Incidence of Subsequent Fracture Among Primary Hip Fracture Patients in England and Wales:An Interrupted Time-Series Analysis

In January 2005 the National Institute for Health and Care Excellence (NICE) in England and Wales provided new guidance on the use of anti-osteoporosis therapies for the secondary prevention of osteoporotic fractures. This was shortly followed in the same year by market authorisation of a generic form of alendronic acid. We here set out to estimate the actual practice impact of these events among hip fracture patients in terms of anti-osteoporosis medicationprescribing and subsequent fracture incidence using primary care data (Clinical Practice Research Datalink) from 1999-2013. Changes in level and trend of prescribing and subsequent fracture following publication of NICE guidance and availability of generic alendronic acid were estimated using an interrupted time series analysis. Both events were considered in combination within a 1-year ‘intervention period’. We identified 10,873 primary hip fracture patients between April 1999 and Sept 2012. Taking into account prior trend, the intervention period was associated with an immediate absolute increase of 14.9% (95% C.I. 10.9 – 18.9) for incident anti-osteoporosis prescriptions and a significant and clinically important reduction in subsequent major and subsequent hip fracture: -0.19% (95% C.I.-0.28 to -0.09) and -0.17% (95% C.I. -0.26 to -0.09) per six months, respectively. This equated to an approximate 14% (major) and 22% (hip) reduction at three years post-intervention relative to expected values based solely on pre-intervention level and trend. We conclude that among hip fracture patients, publication of NICE guidance and availability of generic alendronic acid was temporally associated with increased prescribing and a significant decline in subsequent fractures

Tracking of accelerometry-measured physical activity during childhood: ICAD pooled analysis

Background: Understanding of physical activity (PA) tracking during childhood is important to predict PA behaviors and design appropriate interventions. We compared tracking of PA according to PA level and type of day (weekday/weekend) in a pool of five children's cohort studies.Methods: Data from ALSPAC, CLAN, Iowa Bone Development Study, HEAPS, PEACH were extracted from the International Children's Accelerometry Database (ICAD), resulting in 5,016 participants with age, gender, and accelerometry data at both baseline and follow-up (mean age: 10.3 years at baseline, 12.5 years at follow-up). Daily minutes spent in moderate- and vigorous-intensity PA (MVPA) and vigorous-intensity PA (VPA) was categorized into quintiles. Multinomial logistic regression models were fit to predict follow-up (M)VPA from baseline (M)VPA (reference: 20- < 80%tile), age at follow-up, and follow-up duration.Results: For the weekday, VPA tracking for boys with high baseline VPA was higher than boys with low baseline VPA (ORs: 3.9 [95% CI: 3.1, 5.0] vs. 2.1 [95% CI: 1.6, 2.6]). Among girls, high VPA was less stable when compared low VPA (ORs: 1.8 [95% CI: 1.4, 2.2] vs. 2.6 [95% CI: 2.1, 3.2]). The pattern was similar for MVPA among girls (ORs: 1.6 [95% CI: 1.2, 2.0] vs. 2.8 [95% CI: 2.3, 3.6]). Overall, tracking was lower for the weekend.Conclusions: PA tracking was higher on the weekday than the weekend, and among inactive girls than active girls. The PA " routine" of weekdays should be used to help children establish healthy PA patterns. Supports for PA increase and maintenance of girls are needed. © 2012 Kwon and Janz; licensee BioMed Central Ltd