How Has COVID-19 Affected Our Orthopedic Implant Industry Partners? Implications for the Surgeon-Industry Relationship in 2020 and Beyond

This article is made available for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.Background The COVID-19 pandemic has had far-reaching societal and financial consequences. The purpose of this study was to evaluate how COVID-19 has affected AAHKS industry partners and the surgeon-industry relationship, emphasizing education, resource allocation, and strategic direction for the 2nd half of 2020. Methods AAHKS industry partners were contacted to participate in a blinded survey and optional interview with the AAHKS Industry Relations Committee. Based on the results, a group of AAHKS member surgeons with disparate practice types were asked to postulate on how the COVID-19 pandemic has and will affect their practice and relationship with Industry. Results AAHKS industry partner responses indicated decreased resource allocation for regional, “other national,” and AAHKS annual meetings (67%, 55%, and 30%, respectively). Web-based educational content was expected to increase in 2020 and will likely remain a point of emphasis in 2021 (100% and 70% of responders). For Q3/Q4 2020, a significant emphasis was placed on site of service/outpatient TJA and COVID-19-related safety measures (70% and 90% of responders), as well as increased availability of instrumentation and implants (40% and 60%, respectively). Conclusion The COVID-19 pandemic has altered the orthopedic landscape for the foreseeable future. Survey responses by AAHKS industry partners demonstrate a continued commitment to surgeon education with and increasing shift to a web-based platform. Increased resource allocation for outpatient TJA and COVID-19-related safety measures were significant. Articulating optimal mechanisms to aid industry in supporting surgeons with different practice models to meet demand during the second half of fiscal year 2020 will be critical

Estimating forest canopy parameters from satellite waveform LiDAR by inversion of the FLIGHT three-dimensional radiative transfer model

The Geoscience Laser Altimeter System (GLAS) has the potential to accurately map global vegetation heights and fractional cover metrics using active laser pulse emission/reception. However, large uncertainties in the derivation of data products exist, since multiple physically plausible interpretations of the data are possible. In this study a method is described and evaluated to derive vegetation height and fractional cover from GLAS waveforms by inversion of the FLIGHT radiative transfer model. A lookup-table is constructed giving expected waveforms for a comprehensive set of canopy realisations, and is used to determine the most likely set of biophysical parameters describing the forest structure, consistent with any given GLAS waveform. The parameters retrieved are canopy height, leaf area index (LAI), fractional cover and ground slope. The range of possible parameters consistent with the waveform is used to give a per-retrieval uncertainty estimate for each retrieved parameter. The retrieved estimates were evaluated first using a simulated data set and then validated against airborne laser scanning (ALS) products for three forest sites coincident with GLAS overpasses. Results for height retrieval show mean absolute error (MAE) of 3.71 m for a mixed temperate forest site within Forest of Dean (UK), 3.35 m for the Southern Old Aspen Site, Saskatchewan, Canada, and 5.13 m for a boreal coniferous site in Norunda, Sweden. Fractional cover showed MAE of 0.10 for Forest of Dean and 0.23 for Norunda. Coefficient of determination between ALS and GLAS estimates over the combined dataset gave R2 values of 0.71 for height and 0.48 for fractional cover, with biases of −3.4 m and 0.02 respectively. Smallest errors were found where overpass dates for ALS data collection closely matched GLAS overpasses. Explicit instrument parameterisation means the method is readily adapted to future planned spaceborne LiDAR instruments such as GEDI

Mapping Arctic Bottomfast Sea Ice Using SAR Interferometry

Bottomfast sea ice is an integral part of many near-coastal Arctic ecosystems with implications for subsea permafrost, coastal stability and morphology. Bottomfast sea ice is also of great relevance to over-ice travel by coastal communities, industrial ice roads, and marine habitats. There are currently large uncertainties around where and how much bottomfast ice is present in the Arctic due to the lack of effective approaches for detecting bottomfast sea ice on large spatial scales. Here, we suggest a robust method capable of detecting bottomfast sea ice using spaceborne synthetic aperture radar interferometry. This approach is used to discriminate between slowly deforming floating ice and completely stationary bottomfast ice based on the interferometric phase. We validate the approach over freshwater ice in the Mackenzie Delta, Canada, and over sea ice in the Colville Delta and Elson Lagoon, Alaska. For these areas, bottomfast ice, as interpreted from the interferometric phase, shows high correlation with local bathymetry and in-situ ice auger and ground penetrating radar measurements. The technique is further used to track the seasonal evolution of bottomfast ice in the Kasegaluk Lagoon, Alaska, by identifying freeze-up progression and areas of liquid water throughout winter

Progressive realism and the EU’s international actorness: towards a grand strategy?

The EU lacks a coherent strategy to guide its international actions.This is a problem that has been amply discussed in both academic and policy-making circles, but that remains to be fully addressed. The December 2013 European Council recognised the issue, and the EU High Representative Federica Mogherini is in charge of a strategic review that will lead to a global strategy by June 2016. Most arguments in favour of a grand strategy rely on utilitarian arguments that highlight the EU’s potential for a more efficient foreign policy. By linking a progressive realist approach to the importance of an EU grand strategy, this article intends to demonstrate the normative need for such a guiding document. As it will be argued, a grand strategy is a necessary step in the consolidation of the EU as a pluralist postnational polity that has in the fulfilment of its citizens’ interests its raison d’être

Assessing the feasibility, acceptability and potential effectiveness of Dignity Therapy for people with advanced cancer referred to a hospital-based palliative care team: Study protocol

<p>Abstract</p> <p>Background</p> <p>Loss of dignity for people with advanced cancer is associated with high levels of psychological and spiritual distress and the loss of the will to live. Dignity Therapy is a brief psychotherapy, which has been developed to help promote dignity and reduce distress. It comprises a recorded interview, which is transcribed, edited then returned to the patient, who can bequeath it to people of their choosing. Piloting in Canada, Australia and the USA, has suggested that Dignity Therapy is beneficial to people with advanced cancer and their families. The aims of this study are to assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to reduce psychological and spiritual distress in people with advanced cancer who have been referred to hospital-based palliative care teams in the UK, and to pilot the methods for a Phase III RCT.</p> <p>Design</p> <p>A randomised controlled open-label trial. Forty patients with advanced cancer are randomly allocated to one of two groups: (i) Intervention (Dignity Therapy offered in addition to any standard care), and (ii) Control group (standard care). Recipients of the 'generativity' documents are asked their views on taking part in the study and the therapy. Both quantitative and qualitative outcomes are assessed in face-to-face interviews at baseline and at approximately one and four weeks after the intervention (equivalent in the control group). The primary outcome is patients' sense of dignity (potential effectiveness) assessed by the Patient Dignity Inventory. Secondary outcomes for patients include distress, hopefulness and quality of life. In view of the relatively small sample size, quantitative analyses are mainly descriptive. The qualitative analysis uses the Framework method.</p> <p>Discussion</p> <p>Dignity Therapy is brief, can be delivered at the bedside and may help both patients and their families. This detailed exploratory research shows if it is feasible to offer Dignity Therapy to patients with advanced cancer, many of whom are likely to be in the terminal stage of their illness, whether it is acceptable to them and their families, if it is likely to be effective, and determine whether a Phase III RCT is desirable.</p> <p>Trial registration</p> <p>Current Controlled Clinical Trials: ISRCTN29868352</p

Moving beyond fan typologies: The impact of social integration on team loyalty in football

The purpose of this paper is to develop detailed insight into loyalty among football fans of Hibernian FC, moving beyond typologies to a more socially grounded approach. Issues explored include patterns of consumption, distinctions between fan groups, and antecedents of loyalty. The origins and development of the club are evaluated, and consumer fanaticism, football fan loyalty, consumption behaviour, and the sociological impact of fan communities are discussed. Data were collected using a variety of methods, including participant observation, in-depth interviews, and analysis of websites and fan forums. Key findings relate to the impact of family and community influences on loyalty, initial experiences of developing associations with the club, through to the impact of socialisation, and the lived experience of being a supporter. A supporter matrix is constructed as a portrayal of the loyalty found at the club. A range of theoretical implications is considered, and the matrix promoted as a tool for understanding loyalty in clubs with similar social structures and community connections

Identification and Characterization of the Lamprey High-Mobility Group Box 1 Gene

High-mobility group box 1 (HMGB1), a highly conserved DNA-binding protein, plays an important role in maintaining nucleosome structures, transcription, and inflammation. We identified a homolog of HMGB1 in the Japanese lamprey (Lampetra japonica). The Lampetra japonica HMGB1 gene (Lj-HMGB1) has over 70% sequence identity with its homologs in jawed vertebrates. Despite the reasonably high sequence identity with other HMGB1 proteins, Lj-HMGB1 did not group together with these proteins in a phylogenetic analysis. We examined Lj-HMGB1 expression in lymphocyte-like cells, and the kidneys, heart, gills, and intestines of lampreys before and after the animals were challenged with lipopolysaccharide (LPS) and concanavalin A (ConA). Lj-HMGB1 was initially expressed at a higher level in the heart, but after treatment with LPS and ConA only the gills demonstrated a significant up-regulation of expression. The recombinant Lj-HMGB1 (rLj-HMGB1) protein bound double-stranded DNA and induced the proliferation of human adenocarcinoma cells to a similar extent as human HMGB1. We further revealed that Lj-HMGB1 was able to induce the production of tumor necrosis factor-α (TNF-α), a pro-inflammatory mediator, in activated human acute monocytic leukemia cells. These results suggest that lampreys use HMGB1 to activate their innate immunity for the purpose of pathogen defense

A Phosphatidylinositol 3-Kinase/Protein Kinase B-independent Activation of Mammalian Target of Rapamycin Signaling Is Sufficient to Induce Skeletal Muscle Hypertrophy

Overexpression of Rheb activates mTOR signaling via a PI3K/PKB-independent mechanism and is sufficient to induce skeletal muscle hypertrophy. The hypertrophic effects of Rheb are driven through a rapamycin-sensitive (RS) mechanism, mTOR is the RS element that confers the hypertrophy and the kinase activity of mTOR is necessary for this event

Structure-Function Study of Mammalian Munc18-1 and C. elegans UNC-18 Implicates Domain 3b in the Regulation of Exocytosis

Munc18-1 is an essential synaptic protein functioning during multiple stages of the exocytotic process including vesicle recruitment, docking and fusion. These functions require a number of distinct syntaxin-dependent interactions; however, Munc18-1 also regulates vesicle fusion via syntaxin-independent interactions with other exocytotic proteins. Although the structural regions of the Munc18-1 protein involved in closed-conformation syntaxin binding have been thoroughly examined, regions of the protein involved in other interactions are poorly characterised. To investigate this we performed a random transposon mutagenesis, identifying domain 3b of Munc18-1 as a functionally important region of the protein. Transposon insertion in an exposed loop within this domain specifically disrupted Mint1 binding despite leaving affinity for closed conformation syntaxin and binding to the SNARE complex unaffected. The insertion mutation significantly reduced total amounts of exocytosis as measured by carbon fiber amperometry in chromaffin cells. Introduction of the equivalent mutation in UNC-18 in Caenorhabditis elegans also reduced neurotransmitter release as assessed by aldicarb sensitivity. Correlation between the two experimental methods for recording changes in the number of exocytotic events was verified using a previously identified gain of function Munc18-1 mutation E466K (increased exocytosis in chromaffin cells and aldicarb hypersensitivity of C. elegans). These data implicate a novel role for an exposed loop in domain 3b of Munc18-1 in transducing regulation of vesicle fusion independent of closed-conformation syntaxin binding

Muscle Fiber Type-Dependent Differences in the Regulation of Protein Synthesis

This study examined fiber type-dependent differences in the regulation of protein synthesis in individual muscle fibers found within the same whole muscle. Specifically, the in vivo SUrface SEnsing of Translation (SUnSET) methodology was used to measure protein synthesis in type 1, 2A, 2X and 2B fibers of the mouse plantaris muscle, in response to food deprivation (FD), and mechanical overload induced by synergist ablation (SA). The results show that 48 h of FD induced a greater decrease in protein synthesis in type 2X and 2B fibers compared to type 1 and 2A fibers. Type 2X and 2B fibers also had the largest FD-induced decrease in total S6 protein and Ser240/244 S6 phosphorylation, respectively. Moreover, only type 2X and 2B fibers displayed a FD-induced decrease in cross-sectional area (CSA). Ten days of SA also induced fiber type-dependent responses, with type 2B fibers having the smallest SA-induced increases in protein synthesis, CSA and Ser240/244 S6 phosphorylation, but the largest increase in total S6 protein. Embryonic myosin heavy chain (MHCEmb) positive fibers were also found in SA muscles and the protein synthesis rates, levels of S6 Ser240/244 phosphorylation, and total S6 protein content, were 3.6-, 6.1- and 2.9-fold greater than that found in fibers from control muscles, respectively. Overall, these results reveal differential responses in the regulation of protein synthesis and fiber size between fiber types found within the same whole muscle. Moreover, these findings demonstrate that changes found at the whole muscle level do not necessarily reflect changes in individual fiber types