Effects of neuromuscular training (NEMEX-TJR) on patient-reported outcomes and physical function in severe primary hip or knee osteoarthritis: a controlled before-and-after study

Background: The benefits of exercise in mild and moderate knee or hip osteoarthritis (OA) are apparent, but the evidence in severe OA is less clear. We recently reported that neuromuscular training was well tolerated and feasible in patients with severe primary hip or knee OA. The aims of this controlled before-and-after study were to compare baseline status to an age-matched population-based reference group and to examine the effects of neuromuscular training on patient-reported outcomes and physical function in patients with severe primary OA of the hip or knee. Methods: 87 patients (60-77 years) with severe primary OA of the hip (n = 38, 55% women) or knee (n = 49, 59% women) awaiting total joint replacement (TJR) had supervised, neuromuscular training (NEMEX-TJR) in groups with individualized level and progression of training. A reference group (n = 43, 53% women) was included for comparison with patients' data. Assessments included self-reported outcomes (HOOS/KOOS) and measures of physical function (chair stands, number of knee bends/30 sec, knee extensor strength, 20-meter walk test) at baseline and at follow-up before TJR. Analysis of covariance (ANCOVA) was used for comparing patients and references and elucidating influence of demographic factors on change. The paired t-test was used for comparisons within groups. Results: At baseline, patients reported worse scores than the references in all HOOS/KOOS subscales (hip 27-47%, knee 14-52%, of reference scores, respectively) and had functional limitations (hip 72-85%, knee 42-85%, of references scores, respectively). NEMEX-TJR (mean 12 weeks (SD 5.6) of training) improved self-reported outcomes (hip 9-29%, knee 7-20%) and physical function (hip 3-18%, knee 5-19%) (p = 15%) in HOOS/KOOS subscales by training. The improvement in HOOS/KOOS subscale ADL was greater for patients with knee OA than hip OA, while the improvement in subscale Sport/Rec was greater for patients with hip OA than knee OA. Conclusions: Both self-reported outcomes and physical function were clearly worse compared with the reference group. Neuromuscular training with an individualized approach and gradual progression showed promise for improving patient-reported outcomes and physical function even in older patients with severe primary OA of the hip or knee

Probiotics for preventing acute otitis media in children

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: to assess the effects of probiotics to prevent the occurrence and reduce the severity of acute otitis media in children.</p

The lectotype for the Asian elephant, Elephas maximus Linnaeus, 1758 (Mammalia, Proboscidea) and comments on ‘primary, secondary and tertiary syntypes’ and ‘virtual lectotype designation’

Last November a group of colleagues and ourselves designated a lectotype for the Asian elephant, Elephas maximus Linnaeus, 1758, having used morphology and genetic and proteomic sequencing to confirm that Linnaeus’s syntypes included both Asian and African elephants. The article was published (Cappellini et al., 2013) online in the Zoological Journal of the Linnean Society, together with eight items of Supplementary Information, and appeared on paper in the ZJLS in January 2014. The paper and SI items are available online at DOI:10.1111/zoj.12084. The lectotype is a very nearly complete mounted skeleton on display in the Natural History Museum of the University of Florence. John Ray described the specimen in 1673 and 1693 and Linnaeus cited Ray’s 1693 publication. The lectotype designation is available and valid. Dubois, Nemésio & Bour, however, have criticised our choice of selected specimen (published in Bionomina, June 2014; a preview is available online at http://mapress.com/bionomina/content.htm). We are concerned because they have demonstrated misunderstanding or ignorance of a number of aspects of the International Code of Zoological Nomenclatur

Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery

Background: The Medical Outcomes General Health Survey (SF-36) is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36 subscales following orthopedic surgery.Methods: Longitudinal data on outcomes of total hip replacement (THR, n = 255), total knee replacement (TKR, n = 103), arthroscopic partial meniscectomy (APM, n = 74) and anterior cruciate ligament reconstruction (ACL, n = 62) were used to estimate the effect sizes (ES, magnitude of change) and minimal detectable change (sensitivity) at the group and individual level. To provide context for interpreting the magnitude of changes in SF-36 scores, we also compared patients\u27 scores with age and sex-matched population norms. The studies were conducted in Sweden. Follow-up was five years in THR and TKR studies, two years in ACL, and three months in APM.Results: On average, large effect sizes (ES&ge;0.80) were found after orthopedic surgery in SF-36 subscales measuring physical aspects (physical functioning, role physical, and bodily pain). Small (0.20&ndash;0.49) to moderate (0.50&ndash;0.79) effect sizes were found in subscales measuring mental and social aspects (role emotional, vitality, social functioning, and mental health). General health scores remained relatively unchanged during the follow-up. Despite improvements, post-surgery mean scores of patients were still below the age and sex matched population norms on physical subscales. Patients\u27 scores on mental and social subscales approached population norms following the surgery. At the individual level, scores of a large proportion of patients were affected by floor or ceiling effects on several subscales and the sensitivity to individual change was very low.Conclusion: Large to moderate meaningful changes in group scores were observed in all SF-36 subscales except General Health across the intervention groups. Therefore, in orthopedic settings, the SF-36 can be used to show changes for groups in physical, mental, and social dimensions and in comparison with population norms. However, SF-36 subscales have low sensitivity to individual change and so we caution against using SF-36 to monitor the health status of individual patients undergoing orthopedic surgery.<br /

Towards a framework for corporate disclosure of circular economy : Company perspectives and recommendations

Circular economy (CE) is becoming an increasingly mandatory material issue within corporate sustainability reporting, however, what remains unaddressed within literature are the perspectives and capacities of the companies which must soon adapt to meet the evolving reporting requirements. This research aims to capture insights from companies engaged with CE in order to develop recommendations that support the integration of CE within corporate sustainability reports. To do this, a series of semi-structured interviews and focus groups were conducted with companies operating in Italy or the Netherlands, not limited by sector. The results provide a list of challenges experienced-and benefits gained-by companies from externally communicating CE. Companies are urged to consider not only risks associated with staying in the linear economy but also those associated with the implementation of new circular practices, to communicate potential sustainability trade-offs and reduce potential claims of CE-related greenwashing. Practical recommendations are offered for developing targets and indicators for CE as well as identifying and reporting CE-specific risks and opportunities

Company perspectives and recommendations

The authors would like to thank all of the companies involved for their time, valuable insights and ongoing support of this research. This project has received funding from the European Union's Horizon 2020 research and innovation programme under Marie Sklodowska‐Curie grant agreement No 765198. The authors acknowledge and thank the support given to CENSE by the Portuguese Foundation for Science and Technology (FCT) through the strategic project Publisher Copyright: © 2023 The Authors. Corporate Social Responsibility and Environmental Management published by ERP Environment and John Wiley & Sons Ltd.Circular economy (CE) is becoming an increasingly mandatory material issue within corporate sustainability reporting, however, what remains unaddressed within literature are the perspectives and capacities of the companies which must soon adapt to meet the evolving reporting requirements. This research aims to capture insights from companies engaged with CE in order to develop recommendations that support the integration of CE within corporate sustainability reports. To do this, a series of semi-structured interviews and focus groups were conducted with companies operating in Italy or the Netherlands, not limited by sector. The results provide a list of challenges experienced- and benefits gained- by companies from externally communicating CE. Companies are urged to consider not only risks associated with staying in the linear economy but also those associated with the implementation of new circular practices, to communicate potential sustainability trade-offs and reduce potential claims of CE-related greenwashing. Practical recommendations are offered for developing targets and indicators for CE as well as identifying and reporting CE-specific risks and opportunities.publishersversionpublishe

Prediction of final infarct volume from native CT perfusion and treatment parameters using deep learning

CT Perfusion (CTP) imaging has gained importance in the diagnosis of acute stroke. Conventional perfusion analysis performs a deconvolution of the measurements and thresholds the perfusion parameters to determine the tissue status. We pursue a data-driven and deconvolution-free approach, where a deep neural network learns to predict the final infarct volume directly from the native CTP images and metadata such as the time parameters and treatment. This would allow clinicians to simulate various treatments and gain insight into predicted tissue status over time. We demonstrate on a multicenter dataset that our approach is able to predict the final infarct and effectively uses the metadata. An ablation study shows that using the native CTP measurements instead of the deconvolved measurements improves the prediction.Comment: Accepted for publication in Medical Image Analysi

Comparing estimates of physical activity in children across different cut-points and the associations with weight status

This study aimed to compare sedentary time (SED) and intensity-specific physical activity (PA) estimates and the associations of SED and PA with body mass index (BMI) and waist circumference (WC) using three different sets of cut-points in preschool-aged children. A total of 751 children (4.7 +/- 0.9 years, boys 52.7%) wore an ActiGraph GT3X+BT accelerometer on their hip for 7 days (24 h). Euclidean norm -1 G with negative values rounded to zero (ENMO) and activity counts from vertical axis (VACounts) and vector magnitude (VMCounts) were derived. Estimates of SED and light, moderate, vigorous, and moderate-to-vigorous PA (MVPA) were calculated for commonly used cut-points by Hildebrand et al., Butte et al., and Evenson et al. Furthermore, the prevalence of meeting the PA recommendation, 180 min/day of which at least 60 min/day being MVPA, were assessed for the cut-points. Multilevel mixed analysis was used to examine associations of SED and PA with BMI and WC. In accordance with the results, SED and PA intensity estimates differed largely across cut-points (i.e., SED = 22-341 min/day; light PA = 52-257 min/day; moderate PA = 5-18 min/day; vigorous PA = 7-17 min/day; MVPA = 13-35 min/day), and the prevalence of children meeting the PA recommendation varied from 4% to 70%. Associations of SED and PA with BMI or WC varied between the cut-points. Our results indicate that SED and PA estimates in preschool-aged children between studies using these cut-points are poorly comparable. Methods facilitating accelerometer-derived PA estimate comparison between studies are highly warranted.Peer reviewe

Hip disability and osteoarthritis outcome score (HOOS) – validity and responsiveness in total hip replacement

BACKGROUND: The aim of the study was to evaluate if physical functions usually associated with a younger population were of importance for an older population, and to construct an outcome measure for hip osteoarthritis with improved responsiveness compared to the Western Ontario McMaster osteoarthritis score (WOMAC LK 3.0). METHODS: A 40 item questionnaire (hip disability and osteoarthritis outcome score, HOOS) was constructed to assess patient-relevant outcomes in five separate subscales (pain, symptoms, activity of daily living, sport and recreation function and hip related quality of life). The HOOS contains all WOMAC LK 3.0 questions in unchanged form. The HOOS was distributed to 90 patients with primary hip osteoarthritis (mean age 71.5, range 49–85, 41 females) assigned for total hip replacement for osteoarthritis preoperatively and at six months follow-up. RESULTS: The HOOS met set criteria of validity and responsiveness. It was more responsive than WOMAC regarding the subscales pain (SRM 2.11 vs. 1.83) and other symptoms (SRM 1.83 vs. 1.28). The responsiveness (SRM) for the two added subscales sport and recreation and quality of life were 1.29 and 1.65, respectively. Patients ≤ 66 years of age (range 49–66) reported higher responsiveness in all five subscales than patients >66 years of age (range 67–85) (Pain SRM 2.60 vs. 1.97, other symptoms SRM 3.0 vs. 1.60, activity of daily living SRM 2.51 vs. 1.52, sport and recreation function SRM 1.53 vs. 1.21 and hip related quality of life SRM 1.95 vs. 1.57). CONCLUSION: The HOOS 2.0 appears to be useful for the evaluation of patient-relevant outcome after THR and is more responsive than the WOMAC LK 3.0. The added subscales sport and recreation function and hip related quality of life were highly responsive for this group of patients, with the responsiveness being highest for those younger than 66

Knee arthroplasty: are patients' expectations fulfilled?: A prospective study of pain and function in 102 patients with 5-year follow-up

Background and purpose With an aging population expecting an active life after retirement, patients’ expectations of improvement after surgery are also increasing. We analyzed the relationship between preoperative expectations and postoperative satisfaction and self-reported outcomes with regard to pain and physical function after knee arthroplasty