Contemporary outcomes of debridement, antibiotics and implant retention in knee arthroplasty

Periprosthetic joint infection (PJI) is a major complication after knee arthroplasty, with approximately a quarter of knee arthroplasty revisions citing PJI as an indication. With the demand for knee arthroplasty predicted to increase, coupled with a lack of evidence for decreasing PJI risk, an appreciation of the burdens of PJI on both patients and health care systems is vital. Patients with PJI can experience a reduced quality of life as well as increased morbidity, whilst the management of PJI has significant economic implications. Surgical options include debridement, antibiotics and implant retention (DAIR), single-stage revision, two-stage revision and salvage procedures. DAIR involves the systematic debridement of all infected and unhealthy tissues coupled with directed antibiotic therapy, with definitive infection clearance the objective. In contrast to single- and two-stage revision procedures for PJI, DAIR does not involve the removal of fixed implants, with only modular components exchanged. Potential benefits of DAIR include reduced tissue destruction, reduced morbidity and reduced healthcare burdens, but with a higher reinfection risk compared to staged revision techniques, and utility largely restricted to acute bacterial PJI. A review of contemporary DAIR outcomes is of value given advances in the understanding of PJI biology; the development of consensus-based definitions for PJI diagnosis and treatment outcomes; and evolution of DAIR indications and technique. This review discusses outcomes of DAIR for knee PJI, published over the last two decades

A multi-centre study of adults with learning disabilities referred to services for antisocial or offending behaviour: demographic, individual, offending and service characteristics

This study was carried out as part of a larger study commissioned by the UK Department of Health to investigate the service pathways for offenders with learning disabilities (LD). The study covered three health regions in the UK and included 477 people with LD referred to services because of antisocial or offending behaviour during a 12-month period. Data were collected concerning demographic, individual, offending behaviour and service characteristics. The findings of the study are broadly consistent with contemporary research concerning this population, particularly in relation to the nature and frequency of offending, history of offending, psychopathology, age and gender distribution. However, very few of those referred had any form of structured care plan, despite having significant offending histories, and this may have compromised early identification of their needs and communication between the health, social and other services involved

Referrals into services for offenders with intellectual disabilities: variables predicting community or secure provision

Background There is a need for research to promote an understanding among service developers on why people with intellectual disabilities (ID) are referred to offender services in order for them to receive appropriate assessment and treatment. Previous studies investigating referrals into forensic ID services have concentrated on referral sources and administrative variables such as legal status. Aims To construct a predictive model for choice of service referral based on a comprehensive range of information about the clientele. Method We conducted a case record study of 336 people referred to community services and 141 to secure provision. We gathered information on referral source, demographics, diagnosis, index behaviour, prior problem behaviours and history of abuse. Results Comparisons revealed 19 candidate variables which were then entered into multivariate logistic regression. The resulting model retained six variables: community living at time of referral, physical aggression, being charged, referral from tertiary health care, diverse problem behaviour and IQ < 50, which correctly predicted the referral pathway for 85.7% of cases. Conclusions An index act of physical aggression and a history of diversity of problem behaviours as predictors against the likelihood of community service referral suggest that professionals have similar concerns about people with ID as they do about their more average offending peers; however, the more severe levels of ID mitigated in favour of community referral, regardless. Offenders with ID tend to be referred within levels of service rather than between them, for example, form tertiary services into generic community services

Enhanced recovery programmes in knee arthroplasty: current concepts

The concept of a multimodal approach to improve the care of surgical patients was first proposed by Kehlet in the 1990s. Measures to optimise the surgical patient, and minimise perioperative stresses, aimed to improve postoperative outcomes. Although originally introduced in colorectal surgery, these ‘enhanced recovery programmes’ have now seen widespread uptake in multiple surgical specialities, including orthopaedics. Patients undergoing knee arthroplasty are well suited to an enhanced recovery approach. These programmes optimise the patient at each stage of the surgical journey, including preoperative optimisation of fitness, perioperative anaesthetic and surgical techniques and finally postoperative rehabilitation and discharge plans. The available evidence supports a number of improvements after programme introduction, including shorter length of stay, morbidity and economics. However, the impact on other outcomes is less clear. One of the issues in the field is a lack of consensus on what interventions an enhanced recovery programme should contain and the specifics of these interventions. As a result, individual units develop their own programmes, making the interpretation and comparison of their impact difficult. This article discusses interventions that could be considered for inclusion in an enhanced recovery programme for knee arthroplasty

Parameter estimation on gravitational waves from neutron-star binaries with spinning components

Inspiraling binary neutron stars are expected to be one of the most significant sources of gravitational-wave signals for the new generation of advanced ground-based detectors. We investigate how well we could hope to measure properties of these binaries using the Advanced LIGO detectors, which began operation in September 2015. We study an astrophysically motivated population of sources (binary components with masses $1.2~\mathrm{M}_\odot$--$1.6~\mathrm{M}_\odot$ and spins of less than $0.05$) using the full LIGO analysis pipeline. While this simulated population covers the observed range of potential binary neutron-star sources, we do not exclude the possibility of sources with parameters outside these ranges; given the existing uncertainty in distributions of mass and spin, it is critical that analyses account for the full range of possible mass and spin configurations. We find that conservative prior assumptions on neutron-star mass and spin lead to average fractional uncertainties in component masses of $\sim 16\%$, with little constraint on spins (the median $90\%$ upper limit on the spin of the more massive component is $\sim 0.7$). Stronger prior constraints on neutron-star spins can further constrain mass estimates, but only marginally. However, we find that the sky position and luminosity distance for these sources are not influenced by the inclusion of spin; therefore, if LIGO detects a low-spin population of BNS sources, less computationally expensive results calculated neglecting spin will be sufficient for guiding electromagnetic follow-up.Comment: 10 pages, 9 figure

Association of Blood MicroRNA Expression and Polymorphisms with Cognitive and Biomarker Changes in Older Adults

BackgroundIdentifying individuals before the onset of overt symptoms is key in the prevention of Alzheimer's disease (AD).ObjkectivesInvestigate the use of miRNA as early blood-biomarker of cognitive decline in older adults.DesignCross-sectional.SettingTwo observational cohorts (CHARIOT-PRO, Alzheimer's Disease Neuroimaging Initiative (ADNI)).Participants830 individuals without overt clinical symptoms from CHARIOT-PRO and 812 individuals from ADNI.MeasurementsqPCR analysis of a prioritised set of 38 miRNAs in the blood of individuals from CHARIOT-PRO, followed by a brain-specific functional enrichment analysis for the significant miRNAs. In ADNI, genetic association analysis for polymorphisms within the significant miRNAs' genes and CSF levels of phosphorylated-tau, total-tau, amyloid-& beta;42, soluble-TREM2 and BACE1 activity using whole genome sequencing data. Post-hoc analysis using multi-omics datasets.ResultsSix miRNAs (hsa-miR-128-3p, hsa-miR-144-5p, hsa-miR-146a-5p, hsa-miR-26a-5p, hsa-miR-29c-3p and hsa-miR-363-3p) were downregulated in the blood of individuals with low cognitive performance on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The pathway enrichment analysis indicated involvement of apoptosis and inflammation, relevant in early AD stages. Polymorphisms within genes encoding for hsa-miR-29c-3p and hsa-miR-146a-5p were associated with CSF levels of amyloid-& beta;42, soluble-TREM2 and BACE1 activity, and 21 variants were eQTL for hippocampal MIR29C expression.Conclusionssix miRNAs may serve as potential blood biomarker of subclinical cognitive deficits in AD. Polymorphisms within these miRNAs suggest a possible interplay between the amyloid cascade and microglial activation at preclinical stages of AD

Early Advanced LIGO binary neutron-star sky localization and parameter estimation

2015 will see the first observations of Advanced LIGO and the start of the gravitational-wave (GW) advanced-detector era. One of the most promising sources for ground-based GW detectors are binary neutron-star (BNS) coalescences. In order to use any detections for astrophysics, we must understand the capabilities of our parameter-estimation analysis. By simulating the GWs from an astrophysically motivated population of BNSs, we examine the accuracy of parameter inferences in the early advanced-detector era. We find that sky location, which is important for electromagnetic follow-up, can be determined rapidly (~5 s), but that sky areas may be hundreds of square degrees. The degeneracy between component mass and spin means there is significant uncertainty for measurements of the individual masses and spins; however, the chirp mass is well measured (typically better than 0.1%).Comment: 4 pages, 2 figures. Published in the proceedings of Amaldi 1

Pathways into services for offenders with intellectual disabilities : childhood experience, diagnostic information and offence variables

The patterns and pathways into intellectual disability (ID) offender services were studied through case file review for 477 participants referred in one calendar year to community generic, community forensic, and low, medium, and maximum secure services. Data were gathered on referral source, demographic information, index behavior, prior problem behaviors, diagnostic information, and abuse or deprivation. Community referrers tended to refer to community services and secure service referrers to secure services. Physical and verbal violence were the most frequent index behaviors, whereas contact sexual offenses were more prominent in maximum security. Age at first incident varied with security, with the youngest in maximum secure services. Attention-deficit/hyperactivity disorder or conduct disorder was the most frequently recorded diagnosis, and severe deprivation was the most frequent adverse developmental experience. Fire starting, theft, and road traffic offenses did not feature prominently. Generic community services accepted a number of referrals with forensic-type behavior and had higher proportions of both women and people with moderate or severe ID

Pitzhanger Manor, Soane, Gandy and an interpretation

[EN] This article is the analysis of a drawing that Joseph Gandy made for John Soane. Its aim is to reveal its mysteries, the way in how it point to Soane without “naming him” directly and to think about the argument and the scenography that drawing contains, beyond Gandy’s the technical skill[ES] Este artículo es el análisis de un dibujo que Joseph Gandy hizo para John Soane, Su objetivo es desvelar los misterios que plantea y que acaban señalando a Soane sin "nombrarlo" directamente, y a partir de aquí, reflexionar sobre el contenido argumental y escenográfico que el dibujo contiene, más allá de la habilidad técnica de Gandy.Martínez Mindeguia, F. (2015). Pitzhanger Manor, Soane, Gandy y una interpretación. EGA. Revista de Expresión Gráfica Arquitectónica. 20(25):120-127. doi:10.4995/ega.2015.3342.SWORD1201272025Divitiis, B., 2003. A Newly Discovered Volume from the Office of Sir John Soane. The Burlington Magazine, 145(1200), pp.180-198.Divitiis, B., 2005. New Drawings for the interiors of the Breakfast Room and Library at Pitzhanger Manor. Architectural History, 48, pp.163-172.Furján, H., & Furjan, H. (1997). The Specular Spectacle of the House of the Collector. Assemblage, (34), 56. doi:10.2307/3171253Furján, H., 1983. Sir John Soanne's Spectacular Thetre. AA Files, 47, pp. 12-22.Hénin, E. (2011). Parrhasius and the Stage Curtain: Theatre, Metapainting and the Idea of Representation in the Seventeenth Century. Theatricality in Early Modern Art and Architecture, 48-61. doi:10.1002/9781444396744.ch4Lukacher, B., 1983. Phantasmagoria and Emanations: Lighting Effects in the Architectural Fantasies of Joseph Michael Gandy. AA Files, 4, pp.40-48.Lukacher, B., 1987. John Soane and his Draughtsman Josep Michael Gandy. Daidalos, 25, pp.51-64.Lukacher, B., 2006. Joseph Gandy: An Architectural Visionary in Georgian England. Londres: Thames & Hudson.Middleton, R., 1992. Introduction. Le Camus de Mézières, N., 1780. The Genius of architecture, or, The analogy of that art with our sensations. Santa Monica: Getty Center for the History of Art and Humanities, pp.17-64.Moleón, P., 2001. John Soane (1753-1837) y la razón poética. Madrid: Mairea.Pelletier, L., 2006. Architecture in Words: Theatre, language and the sensuous space of architecture. Londres: Routledge.Price, U., 1810. Essays on the Picturesque. Londres: Maxman, vol.1.Richardson, M. y Stevens, M.A., eds., 1999. John Soane Architect: Master of Space and Light. Londres: Royal Academy of Arts.Van Eck, C., 2007. Classical Rhetorical and the Visual Arts in Early Modern Europe. Nueva York: Cambridge University Press.Zeitlin, J., ed., 1913. Hazlitt On English Literature: An Introduction to the Appreciation of Literature. Nueva York: Oxford University Press

Evaluation of CyberKnife ® fiducial tracking limitations to assist targeting accuracy: A phantom study with fiducial displacement

Introduction The underlying assumptions of the CyberKnife® (Accuray, Sunnyvale, CA, US) fiducial tracking system are: i) fiducial positions are accurately detected; ii) inter-fiducial geometry remains consistent (rigid); iii) inter-fiducial geometric array changes are detected and either accommodated with corrections or treatment is interrupted. However: i) soft-tissue targets are deformable & fiducial migration is possible; ii) the accuracy of the tracking system has not previously been examined with fiducial displacement; iii) treatment interruptions may occur due to inter-fiducial geometric changes, but there is little information available to assist subsequent troubleshooting. The purpose of this study was to emulate a clinical target defined with a two, three, or four-fiducial array where one fiducial is displaced to mimic a target deformation or fiducial migration scenario. The objectives: evaluate the fiducial positioning accuracy, array interpretation, & corresponding corrections of the CyberKnife system, with the aim of assisting troubleshooting following fiducial displacement. Methods A novel solid-water phantom was constructed with three fixed fiducials (F1,F2,F3) & one moveable fiducial (F4), arranged as if placed to track an imaginary clinical target. Using either two fiducials (F1,F4), different combinations of three fiducials (F1,F2,F4; F1,F3,F4; F2,F3,F4) or four fiducials (F1,F2,F3,F4), repeat experiments were conducted where F4 was displaced inferiorly at 2-mm intervals from 0-16 mm. Data were acquired at each position of F4, including rigid body errors (RBE), fiducial x, y, & z coordinate displacements, six degrees of freedom (DOF) corrections, & robot center-of-mass (COM) translation corrections. Results Maximum positioning difference (mean±SD) between the reference and live x, y, & z coordinates for the three fixed fiducials was 0.08±0.30 mm, confirming good accuracy for fixed fiducial registration. For two fiducials (F1,F4), F4 registration was accurate to 14-mm displacement and the F4 x-axis coordinate change was 2.0±0.12 mm with each 2 mm inferior displacement validating the phantom for tracking evaluation. RBE was >5 mm (system threshold) at 6-14 mm F4 displacement: however, F1 was misidentified as the RBE main contributor. Further, F1/F4 false-lock occurred at 16 mm F4 displacement with corresponding RBE 13 mm. For combinations of three fiducials, F4 registration was accurate to 10-mm displacement. RBE was >5 mm at 6-16 mm F4 displacement: however, F4 false-lock occurred at 12-16 mm with RBE 5-6 mm. For four fiducials, F4 registration was accurate to 4 mm displacement: however, F4 false-lock occurred at 6-16 mm displacement with concerning RBE <2 & <5 at 6 & 8-mm F4 displacement, respectively. False-locks were easily identified in the phantom but frequently uncorrectable. Conclusions Results indicate fiducial positioning accuracy and system output following fiducial displacement depends on the number of fiducials correlated, displacement distance, and clinical thresholds applied. Displacements ≤4 mm were accurately located, but some displacements 6-16 mm were misrepresented, either by erroneous main contributor (two-fiducial array only) or by false-locks and misleading RBE, which underestimated displacement. Operator vigilance and implementation of our practical guidelines based on the study findings may help reduce targeting error and assist troubleshooting in clinical situations