Participatory scenario development to address potential impacts of land use change: an example from the Italian Alps

Changes to land use such as the removal of natural vegetation and expansion of urban areas can result in degradation of the landscape and an increase in hydro-meteorological risk. This has led to higher interest by decision-makers and scientsts in the future consequences of these drivers. Scenario development can be a useful tool for addressing the high uncertainty regarding modeing future land use changes. Scenarios are not exact forecasts, but images of plausible futures. When studying future land dynamics, emphasis should be given to areas experiencing high rates of socioeconomic change. We have focused on the eastern Italian Alps, which face increasing pressure from tourism development. Identified drivers of local land use change are mostly external and difficult to quantify. This area characterized by a traditional Alpine landscape, is subject to high levels of hydro-meteorological risk, another reason to study potential future land use changes. We tested a scenario generation method based on existing decisions and assumptions about future tourism developmnt. We aimed to develop a framework leading to plausible scenarios that can overcome data inaccessibility and address external drivers. We combined qualitative methods, such as stakeholder interviews and cognitive mapping, with geospatial methods, such as geographic infrmation systems, geostatistics, and environmental modeling. We involved stakeholders from the beginning to support the steps of generating data, understanding the system of land use change, and developing a land use change model for scenario development. In this way, we generate spatio-temporal scenarios that can assist future spatial planning and improve preparedness for possible undesirable development

The influence of computer-assisted surgery on rotational, coronal and sagittal alignment in revision total knee arthroplasty

BACKGROUND: Despite good results of primary total knee arthroplasty (TKA), the number of revision total knee arthroplasties (rTKAs) is rising. Proper implant position is essential, since malposition leads to worse clinical outcome. In rTKA most anatomical landmarks have disappeared because of extensive bone loss, making it more difficult to adequately implant the knee prosthesis. In primary TKA, computer-assisted surgery (CAS) leads to better prosthetic alignment than mechanical navigation guides. Literature about the use of CAS in rTKA is scarce though, and the effect on rotational prosthetic alignment has not been investigated yet. Hence the primary objective of this study is to compare rotational prosthetic alignment when using CAS in rTKA compared to a mechanical navigation guide. Secondary objectives are to compare prosthetic alignment in the coronal and sagittal planes. It is hypothesized that CAS leads to better rotational, coronal and sagittal prosthetic alignment when used during rTKA. METHODS/DESIGN: A prospective clinical intervention study with use of a historical control group will be conducted. Forty-four patients with a minimum age of 18 to be admitted for CAS-rTKA between September 2012 and September 2015 will be included in the intervention group. Forty-four patients with a minimum age of 18 who underwent rTKA with the use of a mechanical navigation guide between January 2002 and April 2012 will form the historical control group. Both groups will be matched according to gender and type of revision prosthesis. Rotational prosthesis alignment will be evaluated using a CT-scan of the knee joint. DISCUSSION: Proper implant position is essential, since malposition leads to worse clinical outcome. Several studies show a significantly positive influence of CAS on prosthetic alignment in primary TKA, but literature about the use of CAS in rTKA is limited. The purpose of this study is thus to investigate the influence of CAS during rTKA on postoperative prosthetic alignment, compared to mechanical navigation guides. TRIAL REGISTRATION: Netherlands National Trial Register NTR351

Testing After Worked Example Study Does Not Enhance Delayed Problem-Solving Performance Compared to Restudy

Four experiments investigated whether the testing effect also applies to the acquisition of problem-solving skills from worked examples. Experiment 1 (n = 120) showed no beneficial effects of testing consisting of isomorphic problem solving or example recall on final test performance, which consisted of isomorphic problem solving, compared to continued study of isomorphic examples. Experiment 2 (n = 124) showed no beneficial effects of testing consisting of identical problem solving compared to restudying an identical example. Interestingly, participants who took both an immediate and a delayed final test outperformed those taking only a delayed test. This finding suggested that testing might become beneficial for retention but only after a certain level of schema acquisition has taken place through restudying several examples. However, experiment 2 had no control condition restudying examples instead of taking the immediate test. Experiment 3 (n = 129) included such a restudy condition, and there was no evidence that testing after studying four examples was more effective for final delayed test performance than restudying, regardless of whether restudied/tested problems were isomorphic or identical. Experiment 4 (n = 75) used a similar design as experiment 3 (i.e., testing/restudy after four examples), but with examples on a different topic and with a different participant population. Again, no evidence of a testing effect was found. Thus, across four experiments, with different types of initial tests, different problem-solving domains, and different participant populations, we found no evidence that testing enhanced delayed test performance compared to restudy. These findings suggest that the testing effect might not apply to acquiring problem-solving skills from worked examples

Should all hip and knee prosthetic joints be aspirated prior to revision surgery?

Aims It is essential to exclude a periprosthetic joint infection (PJI) prior to revision surgery. It is recommended to routinely aspirate the joint before surgery. However, this may not be necessary in a subgroup of patients. The aim of our study was to investigate if specific clinical and implant characteristics could be identified to rule out a PJI prior to revision surgery. Methods We retrospectively evaluated clinical and implant characteristics of patients who underwent a hip or knee revision surgery between October 2015 and October 2018. Patients were diagnosed with a PJI according to the MSIS diagnostic criteria. Results A total of 156 patients were analyzed, including 107 implants that were revised because of prosthetic loosening and 49 because of mechanical failure (i.e. instability, malalignment or malpositioning). No PJI was diagnosed in the group with mechanical failure. In the prosthetic loosening group, 20 of 107 were diagnosed with a PJI (19%). Although there was a significantly lower chance of having a PJI with an implant age of > 5 years combined with a CRP < 5 mg/L, an infection was still present in 3 out of 39 cases (8%). Conclusion Implants with solely mechanical failure without signs of loosening and low inflammatory parameters probably do not require a synovial fluid aspiration. These results need to be confirmed in a larger cohort of patients. In case of prosthetic loosening, all joints need to be aspirated before surgery as no specific characteristic could be identified to rule out an infection

Testing After Worked Example Study Does Not Enhance Delayed Problem-Solving Performance Compared to Restudy

Four experiments investigated whether the testing effect also applies to the acquisition of problem-solving skills from worked examples. Experiment 1 (n = 120) showed no beneficial effects of testing consisting of isomorphic problem solving or example recall on final test performance, which consisted of isomorphic problem solving, compared to continued study of isomorphic examples. Experiment 2 (n = 124) showed no beneficial effects of testing consisting of identical problem solving compared to restudying an identical example. Interestingly, participants who took both an immediate and a delayed final test outperformed those taking only a delayed test. This finding suggested that testing might become beneficial for retention but only after a certain level of schema acquisition has taken place through restudying several examples. However, experiment 2 had no control condition restudying examples instead of taking the immediate test. Experiment 3 (n = 129) included such a restudy condition, and there was no evidence that testing after studying four examples was more effective for

The Validity of a New Low-Dose Stereoradiography System to Perform 2D and 3D Knee Prosthetic Alignment Measurements

INTRODUCTION:The EOS stereoradiography system has shown to provide reliable varus/valgus (VV) measurements of the lower limb in 2D (VV2D) and 3D (VV3D) after total knee arthroplasty (TKA). Validity of these measurements has not been investigated yet, therefore the purpose of this study was to determine validity of EOS VV2D and VV3D. METHODS:EOS images were made of a lower limb phantom containing a knee prosthesis, while varying VV angle from 15° varus to 15° valgus and flexion angle from 0° to 20°, and changing rotation from 20° internal to 20° external rotation. Differences between the actual VV position of the lower limb phantom and its position as measured on EOS 2D and 3D images were investigated. RESULTS:Rotation, flexion or VV angle alone had no major impact on VV2D or VV3D. Combination of VV angle and rotation with full extension did not show major differences in VV2D measurements either. Combination of flexion and rotation with a neutral VV angle showed variation of up to 7.4° for VV2D; maximum variation for VV3D was only 1.5°. A combination of the three variables showed an even greater distortion of VV2D, while VV3D stayed relatively constant. Maximum measurement difference between preset VV angle and VV2D was 9.8°, while the difference with VV3D was only 1.9°. The largest differences between the preset VV angle and VV2D were found when installing the leg in extreme angles, for example 15° valgus, 20° flexion and 20° internal rotation. CONCLUSIONS:After TKA, EOS VV3D were more valid than VV2D, indicating that 3D measurements compensate for malpositioning during acquisition. Caution is warranted when measuring VV angle on a conventional radiograph of a knee with a flexion contracture, varus or valgus angle and/or rotation of the knee joint during acquisition

Triceps Insufficiency After Total Elbow Arthroplasty:A Systematic Review.

Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.BACKGROUND: The incidence of triceps insufficiency after total elbow arthroplasty (TEA) varies in the literature, and a consensus on treatment strategy is lacking. We review the incidence, the risk factors, the clinical presentation, and the diagnosis and treatment of triceps insufficiency after TEA. Based on this information, we have formulated recommendations for clinical practice. METHODS: We performed a systematic review of the literature from January 2003 to April 2020 to identify studies that investigated triceps function following TEA by searching the PubMed, Cochrane, and Embase databases. Eligible studies (1) reported on triceps function following primary or revision TEA for every indication, regardless of technique (e.g., bone grafts), (2) included ≥6 adult patients, (3) had the full-text article available, and (4) had a minimum follow-up of 1 year. RESULTS: Eighty studies with a total of 4,825 TEAs were included. The quality was low in 15 studies, moderate in 64 studies, and high in 1 study. The mean incidence of triceps insufficiency was 4.5%. The rates were highest in patients after revision TEA (22%), in those with posttraumatic arthritis as an indication for surgery (10.2%), and after a triceps-reflecting approach (4.9%). Most studies used the Medical Research Council scale to score triceps function, although cutoff points and the definition of triceps insufficiency differed among studies. Surgical treatment showed favorable results with anconeus tendon transfer and Achilles allograft repair when compared with direct repair. CONCLUSIONS: The incidence of triceps insufficiency varies greatly, probably due to a lack of consensus on the definition of the term. Therefore, we recommend the guidelines for clinical practice that are presented in this article. These guidelines assist clinicians in providing the best possible treatment strategy for their patients and help researchers optimize their future study designs in order to compare outcomes. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

MARIS: Scalable Online Scenario Development Tool for Rangeland Conservancy Managers Using High Spatial-Temporal Resolution Carrying Capacity Maps and Livestock Market Data

Although the management of livestock numbers within the bounds of carrying capacity of African rangelands is a way to manage risks, both scientists and practitioners, caution against a momentary and local use of carrying capacity as a management indicator. Carrying capacity should be seen in wider spatial and temporal/seasonal context as well as in a social and economic context. Given the large numbers of conservancies across Kenya, and its Maasai Mara region in particular, with many more landowner members, it is difficult for conservancies’ managers to contextualize phenomena such as carrying capacity and market price over space and time. We report the results of an investigation in the Maasai Mara rangelands, into functional characteristics a tool for spatial-temporal carrying capacity assessment and livestock markets prices monitoring should have to provide relevant management information to conservancy managers and conservancy members. A scalable web-application called the Mara Rangeland Information System, or MARIS, was developed, which assesses, at 23 meter resolution and 10 day historic or 1-day near-future intervals, both grassland dry matter production, and consumption by 19 wildlife and livestock species, as well as rangeland carrying capacity. MARIS facilitates managers to develop scenarios by varying input variables of either grass production or consumption, or by drawing different management blocks on a carrying capacity map assessing different management practices under scenarios of rainfall. Managers can relate the carrying capacity scenarios to offtake prices at different markets that MARIS monitors over time. After testing MARIS in 6 workshop iterations across the whole development process, Maasai Mara rangeland managers concluded that the prototype is ready for pilot use in management plan development