Information and entropy theory for the sustainability of coupled human and natural systems

For coupled human and natural systems (CHANS), sustainability can be defined operationally as a feasible, desirable set of flows (material, currency, information, energy, individuals, etc.) that can be maintained despite internal changes and changes in the environment. Sustainable development can be defined as the process by which CHANS can be moved toward sustainability. Specific indicators that give insight into the structure and behavior of feedbacks in CHANS are of particular interest because they would aid in the sustainable management of these systems through an understanding of the structures that govern system behavior. However, the use of specific feedbacks as monitoring tools is rare, possibly because of uncertainties regarding the nature of their dynamics and the diversity of types of feedbacks encountered in these systems. An information theory perspective may help to rectify this situation, as evidenced by recent research in sustainability science that supports the use of unit-free measures such as Shannon entropy and Fisher information to aggregate disparate indicators. These measures have been used for spatial and temporal datasets to monitor progress toward sustainability targets. Here, we provide a review of information theory and a theoretical framework for studying the dynamics of feedbacks in CHANS. We propose a combination of information-based indices that might productively inform our sustainability goals, particularly when related to key feedbacks in CHANS

Is it possible to predict which patients are most likely to benefit from intra-articular corticosteroid injections? A systematic review.

Aim: Intra-articular corticosteroid injections (IACIs) can reduce osteoarthritis-related pain, with differing levels of response across patient groups. This systematic review investigates what is known about the positive and negative predictors of outcomes in patients with osteoarthritis who undergo IACIs.Methods:We systematically searched the Medline, Embase and Cochrane databases to May 2023 for studies that evaluated patients undergoing IACIs for osteoarthritis and reported on predictors of outcomes in these patients.Results: Eight studies were included. Two were placebo-controlled trials, six were observational studies. Due to the heterogeneity of outcomes and variables between the studies, it was not possible to pool the results for formal meta-analysis. Higher baseline pain, older age, higher BMI, lower range of movement, higher Kellgren-Lawrence radiographic score, joint effusion and aspiration were shown to be predictors of a positive response to IACIs in some of the included studies. However, other studies showed no difference in response with these variables, or a negative correlation with response. Sex, smoking, mental health status, hypertension/ischaemic heart disease, diabetes mellitus, duration of symptoms, and socioeconomic status did not demonstrate any correlation with the prediction of positive or negative outcomes after IACIs.Conclusion: Several patient features have been identified as positive predictors of outcomes following IACIs. However, this systematic review has identified inconsistent and variable findings across the existing literature. Further research with standardisation of IACI administration and outcome measures is required to facilitate further analysis of the reliability and significance of predictive factors for response to IACIs

Estimation of blood volume and blood loss in primary total hip and knee replacement:An analysis of formulae for perioperative calculations and their ability to predict length of stay and blood transfusion requirements

INTRODUCTION: Blood loss continues to be a common surgical risk in total hip (THR) and knee replacements (TKR). Accurate prediction of blood loss permits appropriate counselling of risks to patients, target optimisation and forecasting future transfusion requirements. We compared blood volume formulae of Moore and Nadler, and blood loss formulae of Liu, Mercuriali, Bourke, Ward, Gross, Lisander and Meunier, to assess associations between calculated values with length of stay and transfusion requirements and determine which are useful in contemporary practice. METHODS: We retrospectively studied patients undergoing primary THR and TKR. We collected data on patient demographics, surgical interventions, pre- and postoperative haemoglobin and haematocrit values, length of stay and blood transfusion requirements. Spearman correlation tests and least squares multiple linear regression were performed. RESULTS: 149 THRs and 90 TKRs in 239 patients were analysed over four months. There was a very strong correlation between blood volume formulae. There were multiple very strong and strong associations between blood loss formulae. Bourke correlated significantly to length of stay, and Liu, Mercuriali, Lisander and Meunier correlated for incidence of transfusion. CONCLUSION: Accurate estimation of perioperative blood loss is increasingly important as demand for joint replacement surgery increases in an ageing population. If the primary interest is the association of blood loss and length of stay, Bourke's formula should be preferred. If the primary interest is calculating risk of transfusion, the formulae of Liu or Meunier should be preferred. The formulae of Mercuriali and Lisander are becoming redundant in contemporary practice

Cardiorespiratory Responses during 2-Person CPR using Two Assisted CPR Devices Versus Manual CPR

Active Compression-decompression-CPR (ACD-CPR) requires rescuers to perform work during both phases of CPR. ACD-CPR provides active pre-loading of a patient’s heart with venous return as well as enhanced stroke volume during resuscitation. Prolonged, one-person CPR is exhausting and associated with decayed CPR quality over time. Active compression-decompression-CPR (ACD-CPR) requires the rescuer to actively work during both phases of CPR. We evaluated the metabolic cost of manual CPR (M-CPR), ACD-CPR1, and ACD-CPR2 (with adhesive pad) during a 10-min resuscitation period. We hypothesized that the metabolic cost for the devices would be similar to M-CPR. Twenty (10 female) participants (23.5±3.5y, 165.8±25.6cm, 72.5±12.2kg) completed 3 randomized trials with performance feedback by investigators. Expired air was analyzed for estimations of metabolic cost via indirect calorimetry. Participants rested for 10 minutes before the baseline data collection followed by 10 min of CPR to simulate one-person CPR. Treatment effects were observed for VO2, METS, VCO2, RR, RQ, blood lactate, SBP, and RPE. No such effects were observed with HR and DBP as the observed condition differences for HR and DBP were not significantly different from each other. Blood lactate and SBP were significantly higher using ACD-CPR1 compared to MCPR and ACD-CPR2. Although a trend for elevated DBP was observed with ACD-CPR1, this was not significantly different. RQ values for the ACD-CPR1 device (1.0 ± 0.0) were significantly higher than the RQ values for M-CPR (0.9 ± 0.0) and ACD-CPR2 (0.9 ± 0.0). Assisted CPR using the ACD-CPR1 device is more stressful to the cardiorespiratory system as reflected by the higher SBP compared to the ACD-CPR1 or standard MCPR. Metabolically, the ACD-CPR1 required more VO2 and elicited higher RQ, RPE, and lactate values during 10-min simulated one-person resuscitation compared to M-CPR and ACD-CPR1. However, the ACD-CPR2 cardiorespiratory results were similar to that of M-CPR, despite the latter method’s higher rate of compressions (110/min) and passive decompressions

UC-240 Gone Fishin\u27 VR

Gone Fishing is a VR game that allows the player to fish from the comfort of their own home. This take on a fishing simulator has creative and playful designs that are sure to surprise the players. With this game, we intend to invoke different comedic aspects found in other games such as designs, descriptions, and possible voiceovers in order to give the players a good time. This isn’t the average fishing simulator

Common elective orthopaedic procedures and their clinical effectiveness:umbrella review of level 1 evidence

OBJECTIVE: To determine the clinical effectiveness of common elective orthopaedic procedures compared with no treatment, placebo, or non-operative care and assess the impact on clinical guidelines. DESIGN: Umbrella review of meta-analyses of randomised controlled trials or other study designs in the absence of meta-analyses of randomised controlled trials. DATA SOURCES: Ten of the most common elective orthopaedic procedures—arthroscopic anterior cruciate ligament reconstruction, arthroscopic meniscal repair of the knee, arthroscopic partial meniscectomy of the knee, arthroscopic rotator cuff repair, arthroscopic subacromial decompression, carpal tunnel decompression, lumbar spine decompression, lumbar spine fusion, total hip replacement, and total knee replacement—were studied. Medline, Embase, Cochrane Library, and bibliographies were searched until September 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Meta-analyses of randomised controlled trials (or in the absence of meta-analysis other study designs) that compared the clinical effectiveness of any of the 10 orthopaedic procedures with no treatment, placebo, or non-operative care. DATA EXTRACTION AND SYNTHESIS: Summary data were extracted by two independent investigators, and a consensus was reached with the involvement of a third. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews instrument. The Jadad decision algorithm was used to ascertain which meta-analysis represented the best evidence. The National Institute for Health and Care Excellence Evidence search was used to check whether recommendations for each procedure reflected the body of evidence. MAIN OUTCOME MEASURES: Quality and quantity of evidence behind common elective orthopaedic interventions and comparisons with the strength of recommendations in relevant national clinical guidelines. RESULTS: Randomised controlled trial evidence supports the superiority of carpal tunnel decompression and total knee replacement over non-operative care. No randomised controlled trials specifically compared total hip replacement or meniscal repair with non-operative care. Trial evidence for the other six procedures showed no benefit over non-operative care. CONCLUSIONS: Although they may be effective overall or in certain subgroups, no strong, high quality evidence base shows that many commonly performed elective orthopaedic procedures are more effective than non-operative alternatives. Despite the lack of strong evidence, some of these procedures are still recommended by national guidelines in certain situations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018115917

Surgical Versus Non-surgical Treatment of Unstable Lateral Compression Type I (LC1) Injuries of the Pelvis With Complete Sacral Fractures in Non-fragility Fracture Patients:A Systematic Review

Lateral compression type 1 (LC1) injuries comprise two-thirds of pelvic fractures. Approximately one-third of LC1 fractures are unstable and may benefit from surgical fixation to improve stability but it is not clear if this leads to better clinical or cost-effectiveness outcomes. This study explores differences in patient-reported outcomes, complications, time-to-mobilisation, cost-effectiveness, and length of hospital stay between surgically and non-surgically treated unstable LC1 non-fragility fractures. We performed a systematic review to determine whether surgical or non-surgical treatment yielded better clinical and cost-effectiveness outcomes for the treatment of unstable LC1 pelvic injuries with complete sacral fractures, excluding fragility fractures. We searched Medline, Embase and Cochrane databases from inception to June 2022, as well as clinical trial registries. A formal meta-analysis was not possible due to available study designs and heterogeneity. Therefore, a narrative review of the findings has been provided. Five observational studies met the inclusion criteria. A total of 183 patients were treated surgically, and 314 patients were treated non-surgically. Patients treated surgically had lower pain levels (Visual Analogue Scale) and fewer days to mobilisation. Quality of life (EuroQol-5 domains and 36-Item Short Form questionnaires) was better in the surgical group, but not statistically significant. No statistical differences in the length of hospital stay or complication rates were found. This review highlights the low quantity and quality of existing data on patients with unstable LC1 pelvic fractures and the need for a definitive randomised controlled trial to determine whether surgical or non-surgical care should be the preferred treatment concerning clinical and cost-effective care