Conventional versus highly cross-linked polyethylene in primary total knee replacement : a comparison of revision rates using data from the National Joint Registry for England, Wales, and Northern Ireland

There is evidence to support the use of highly cross-linked polyethylene (HXLPE) in patients undergoing total hip arthroplasty. However, the benefits for those undergoing total knee arthroplasty are uncertain, with conflicting reports based on previous cohort analyses. The purpose of the present study was to compare the revision rates following primary total knee arthroplasty with use of HXLPE as compared with conventional polyethylene (CPE) using data from the National Joint Registry (NJR) for England, Wales and Northern Ireland. We performed a retrospective analysis of primary total knee arthroplasties recorded in the NJR from 2003 to 2014. Cobalt-chromium (CoCr)-CPE and CoCr-HXLPE bearing surfaces were compared using all-cause revision, aseptic revision, and septic revision as end points. Survival analyses were conducted using rates per 100 years observed, Kaplan-Meier survival estimates, and Cox regression hazard ratios (HRs) adjusted for age, sex, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), lead surgeon grade, and implant constraint. Secondary analyses compared the most commonly used HXLPEs (Zimmer Prolong, DePuy XLK, and Stryker X3) against CPE for the 3 most common total knee arthroplasty systems (NexGen, PFC Sigma, and Triathlon). In the present study of 550,658 total knee arthroplasties, the unadjusted aseptic revision rates were significantly lower following procedures performed with CPE (n = 513,744) as compared with those performed with HXLPE total knee replacements (n = 36,914) (0.29 [95% confidence interval (CI), 0.28 to 0.30] compared to 0.38 [95% CI, 0.35 to 0.42], p 35 kg/m, the "second-generation" Stryker X3 HXLPE demonstrated significantly better survival than its respective CPE, with CPE having an HR of 2.6 (95% CI, 1.2 to 5.9) (p = 0.02). Alternative bearings are marketed as having improved wear properties over traditional CoCr-CPE. This registry-based analysis demonstrated no overall survival benefit of HXLPE after a maximum duration of follow-up of 12 years. Because of their increased cost, the routine use of HXLPE bearings may not be justified. However, they may have a role in specific "higher demand" groups such as patients 35 kg/m. Therapeutic Level III. See Instructions for Authors for a complete list of levels of evidence

Financial phantasmagoria: corporate image-work in times of crisis

Our purpose in this article is to relate the real movements in the economy during 2008 to the ?image-work? of financial institutions. Over the period January?December 2008 we collected 241 separate advertisements from 61 financial institutions published in the Financial Times. Reading across the ensemble of advertisements for themes and evocative images provides an impression of the financial imaginaries created by these organizations as the global financial crisis unfolded. In using the term ?phantasmagoria? we move beyond its colloquial sense of a set of strange images designed to dazzle towards the more technical connotation used by Ranci�re (2004) who suggested that words and images can offer a trace of an overall determining set-up if they are torn from their obviousness so they become phantasmagoric figures. The key phantasmagoric figure we identify here is that of the financial institution as timeless, immortal and unchanging; a coherent and autonomous entity amongst other actors. This notion of uniqueness belies the commonality of thinking which precipitated the global financial crisis as well as the limited capacity for control of financial institutions in relation to market events. It also functions as a powerful naturalizing force, making it hard to question certain aspects of the recent period of ?capitalism in crisis?

Putting into Question the Imaginary of Recovery: A Dialectical Reading of the Global Financial Crisis and its Aftermath

In this article we put into question the discourses that emerged during the Global Financial Crisis (GFC) and that coalesced around a particular socio-economic imaginary of ?recovery? over the period 2009-2012. Our reading of these discourses is very much guided by the notion of the dialectic as developed by Fredric Jameson, and as such this paper can be read as attempt to put his theoretical ideas to work. Through our dialectical reading we aim to create a certain estrangement effect that makes the imaginary of recovery seem very odd and unnatural. In order to achieve such an effect we postulate four theses which are deliberately antagonistic: first, that there has been no ?crisis of capitalism?; second, that we must change the valence of the GFC from negative to positive; third, that the relationship between finance capitalism and ?free markets? is deeply contradictory; and fourth, that we must resist the regulation discourse

Distributed leadership, trust and online communities

This paper analyses the role of distributed leadership and trust in online communities. The team-based informal ethos of online collaboration requires a different kind of leadership from that in formal positional hierarchies. Such leadership may be more flexible and sophisticated, capable of encompassing ambiguity and rapid change. Online leaders need to be partially invisible, delegating power and distributing tasks. Yet, simultaneously, online communities are facilitated by the high visibility and subtle control of expert leaders. This paradox: that leaders need to be both highly visible and invisible as appropriate, was derived from prior research and tested in the analysis of online community discussions using a pattern-matching process. It is argued that both leader visibility and invisibility are important for the facilitation of trusting collaboration via distributed leadership. Advanced leadership responses to complex situations in online communities foster positive group interaction and decision-making, facilitated through active distribution of specific tasks

A Coral Damage Index and its Application to Diving Sites in the Egyptian Red Sea

A coral damage index (CDI) is provided, to screen sites to obtain a perspective on the extent and severity of physical damage to coral. Sites are listed as “hot spots” if in any transect the percent of broken coral colonies (BCC) is greater than or equal to 4% or if the percent cover of coral rubble (CR) is greater than or equal to 3%. To demonstrate its utility, the CDI is applied to a real-life management situation off Hurghada and Safaga, Egypt in the Red Sea. The extent of coral damage covered all four diving sites. Forty percent of all the transects were “hot spots” that required management action. Thirty-one percent of the 16 “hot spot” transects were identified by both broken coral and rubble criteria, 25% by only broken coral criterion and 44% by only coral rubble criterion of the CDI, suggesting that past breakage was responsible for most of the observed damage. Sixty-three percent of the “hot spot” transects were at 4 m depth versus 37% at 8 m depth, suggesting that most of the damage was caused by anchors dragging across the reef in shallow water. The severity of coral damage, reflected by CR, was the greatest at Small Giftun in transect 5 at 4 m depth (333% above the CDI). EI Fanous experienced the most severe degree of broken coral damage (325% above the CDI) at 8 m depth along transect 2. Estimates of the number of dives per year show diving carrying capacities for El Fanous, Gotta Abu Ramada, Ras Abu Soma and Small Giftun being exceeded by large amounts. The CDI can be used globally to; gauge the severity and extent of damage, focus managers on areas that need mooring buoys and associated dive site management programs, and provide a starting point from which to focus more detailed coral reef assessments and restoration programs

A Quantitative Ecological Assessment of Diving Sites in the Egyptian Red Sea During a Period of Severe Anchor Damage: A Baseline for Restoration and Sustainable Tourism Management

This paper assesses damage to diving sites off Hurghada and Safaga, Egypt, and examines management responses and options. Data were obtained using the line-intercept-transect method. Using general field observations, a control site comparison and a historical comparison, it was found that the four diving sites studied suffered varying degrees of physical damage and needed management attention. Some transect locations had experienced severe physical damage while others had escaped damage. The most obvious difference between the control site and the four damaged sites (at both 4 and 8 m depths) was the consistently high percentage cover of hard coral (especially Acropora coral) and low percentage cover of soft corals among all transects at the Giftun Canal control site. Total algae percentages were also consistently higher at impacted transect sites versus the control site. From a historical perspective, at the Small Giftun site from 1987 to 1996, percentage hard coral cover decreased by 43% and algal cover increased over fourfold. If the diving tourism industry is to sustain itself in the Egyptian Red Sea, every management effort must be made to minimise controllable sources of stress on the coral reef system. Dive site management programme options, based on peer-reviewed carrying capacity research and stakeholder involvement, are reviewed

Observations of Ultracool White Dwarfs

We present new spectroscopic and photometric measurements of the white dwarfs LHS 3250 and WD 0346+246. Along with F351-50, these white dwarfs are the coolest ones known, all with effective temperatures below 4000 K. Their membership in the Galactic halo population is discussed, and detailed comparisons of all three objects with new atmosphere models are presented. The new models consider the effects of mixed H/He atmospheres and indicate that WD 0346+246 and F351-50 have predominantly helium atmospheres with only traces of hydrogen. LHS 3250 may be a double degenerate whose average radiative temperature is between 2000 and 4000 K, but the new models fail to explain this object

Chemical contaminants, pathogen exposure and general health status of live and beach-cast Washington sea otters (Enhydra lutris kenyoni)

Analyses of blood and liver samples from live captured sea otters and liver samples from beachcast sea otter carcasses off the remote Washington coast indicate relatively low exposure to contaminants, but suggest that even at the low levels measured, exposure may be indicated by biomarker response. Evidence of pathogen exposure is noteworthy - infectious disease presents a potential risk to Washington sea otters, particularly due to their small population size and limited distribution. During 2001 and 2002, 32 sea otters were captured, of which 28 were implanted with transmitters to track their movements and liver and blood samples were collected to evaluate contaminant and pathogen exposure. In addition, liver samples from fifteen beachcast animals that washed ashore between 1991 and 2002 were analyzed to provide historical information and a basis of reference for values obtained from live otters. The results indicate low levels of metals, butyltins, and organochlorine compounds in the blood samples, with many of the organochlorines not detected except polychlorinated biphenyls (PCBs), and a few aromatic hydrocarbons detected in the liver of the live captured animals. Aliphatic hydrocarbons were measurable in the liver from the live captured animals; however, some of these are likely from biogenic sources. A significant reduction of vitamin A storage in the liver was observed in relation to PCB, dibutyltin and octacosane concentration. A significant and strong positive correlation in vitamin A storage in the liver was observed for cadmium and several of the aliphatic hydrocarbons. Peripheral blood mononuclear cell (PBMC) cytochrome P450 induction was elevated in two of 16 animals and may be potentially related to aliphatic and aromatic hydrocarbon exposure. Mean concentration of total butyltin in the liver of the Washington beach-cast otters was more than 15 times lower than the mean concentration reported by Kannan et al. (1998) for Southern sea otters in California. Organochlorine compounds were evident in the liver of beach-cast animals, despite the lack of large human population centers and development along the Washington coast. Concentrations of PCBs and chlordanes (e.g., transchlordane, cis-chlordane, trans-nonachlor, cis-nonachlor and oxychlordane) in liver of Washington beach-cast sea otters were similar to those measured in Aleutian and California sea otters, excluding those from Monterey Bay, which were higher. Mean concentrations of 1,1,1,- trichloro-2,2-bis(p-chlorophyenyl)ethanes (DDTs) were lower, and mean concentrations of cyclohexanes (HCH, e.g., alpha BHC, beta BHC, delta BHC and gamma BHC) were slightly higher in Washington beach-cast otters versus those from California and the Aleutians. Epidemiologically, blood tests revealed that 80 percent of the otters tested positive for morbillivirus and 60 percent for Toxoplasma, the latter of which has been a significant cause of mortality in Southern sea otters in California. This is the first finding of positive morbillivirus titers in sea otters from the Northeast Pacific. Individual deaths may occur from these diseases, perhaps more so when animals are otherwise immuno-compromised or infected with multiple diseases, but a population-threatening die-off from these diseases singly is unlikely while population immunity remains high. The high frequency of detection of morbillivirus and Toxoplasma in the live otters corresponds well with the cause of death of stranded Washington sea otters reported herein, which has generally been attributable to infectious disease. Washington’s sea otter population continues to grow, with over 1100 animals currently inhabiting Washington waters; however, the rate of growth has slowed over recent years. The population has a limited distribution and has not yet reached its carrying capacity and as such, is still considered at high risk to catastrophic events. (PDF contains 189 pages