Management of Stiffness following Total Knee Arthroplasty: International Survey on Surgeon Preferences.

INTRODUCTION: Stiffness following total knee arthroplasty (TKA) is a challenging complication and can result in a poor functional outcome. There is considerable debate concerning the definition, work-up, and optimal management of this complication. The aim of this study was to record the definition of stiffness, management practices, and expectations of outcome among surgeons from an international community using a peer-reviewed questionnaire. METHODS: A 23-item peer-reviewed online questionnaire was sent to all members of SICOT to gauge and record the management practices and expectations of outcome in the management of patients with stiffness following TKA. RESULTS: A total of 315 surgeons completed this peer-reviewed questionnaire. Manipulation under anaesthesia (MUA) was the preferred treatment option for stiffness post-TKA, with a majority of the surgeons opting to carry out this procedure between 6 and 12 weeks following the index TKA. Physiotherapy and a continuous passive motion device were also used by the majority of surgeons following MUA, as additional treatment measures. DISCUSSION: MUA is perceived to be a safe and effective primary treatment option for stiffness following TKA. It is best performed between weeks 6 and 12 with expected gains in range of motion from 10 to 20 degrees in 75% of patients

Virtual exams: has COVID-19 provided the impetus to change assessment methods in medicine?

AIMS: The ongoing COVID-19 pandemic has disrupted and delayed medical and surgical examinations where attendance is required in person. Our article aims to outline the validity of online assessment, the range of benefits to both candidate and assessor, and the challenges to its implementation. In addition, we propose pragmatic suggestions for its introduction into medical assessment. METHODS: We reviewed the literature concerning the present status of online medical and surgical assessment to establish the perceived benefits, limitations, and potential problems with this method of assessment. RESULTS: Global experience with online, remote virtual examination has been largely successful with many benefits conferred to the trainee, and both an economic and logistical advantage conferred to the assessor or organization. Advances in online examination software and remote proctoring are overcoming practical caveats including candidate authentication, cheating prevention, cybersecurity, and IT failure. CONCLUSION: Virtual assessment provides benefits to both trainee and assessor in medical and surgical examinations and may also result in cost savings. Virtual assessment is likely to be increasingly used in the post-COVID world and we present recommendations for the continued adoption of virtual examination. It is, however, currently unable to completely replace clinical assessment of trainees. Cite this article: Bone Jt Open 2021;2(2):111-118

Removing the Christian mask: an examination of Scandinavian war cults in Medieval narratives of northwestern Europe from the late Antiquity to the Middle Ages

The aim of this thesis is to de-center Christianity from medieval scholarship in a study of canonized northwestern European war narratives from the late antiquity to the late Middle Ages by unraveling three complex theological frameworks interweaved with Scandinavian polytheistic beliefs. These frameworks are presented in three chapters concerning warrior cults, war rituals, and battle iconography. Beowulf, The History of the Kings of Britain, and additional passages from The Wanderer and The Dream of the Rood are recognized as the primary texts in the study with supporting evidence from An Ecclesiastical History of the English People, eighth-century eddaic poetry, thirteenth-century Icelandic and Nordic sagas, and Le Morte d'Arthur. The study consistently found that it is necessary to alter current pedagogical habits in order to better develop the study of theology in medieval literature by avoiding the conciliatory practice of reading for Christian hegemony

Colouring Australia: a participatory open data platform

Colouring Australia is a digital platform for collecting and visualising building level information across several Australian cities. It provides a valuable resource for bringing together data on building age, material, sustainability ratings, walkability and other key metrics as we plan for net zero cities. Colouring Australia comprises part of the international Colouring Cities Research Programme, which supports the development of open-source platforms that provide open data on national building stocks. In this paper we outline the technical architecture of the platform, and the development and visualisation of a building level walkability metric based on pedestrian access to destinations. This platform provides a useful digital tool for planners to understand which parts of the city are walkable and in turn this can support future active transport programs and policies. Future research will be to validate this novel walkability index through a series of stakeholder and public workshops using the Colouring Australia platform in an interactive tabletop environment where usability testing can be undertaken

Flight Readiness of Mochii S: Portable Spectroscopic Scanning Electron Microscope Facility on the International Space Station (ISS)

The ISS (International Space Station) currently lacks the capability to image and chemically analyze nano-to-micron scale particles from numerous engineering systems. To identify these particles, we must wait for a re-entry vehicle to return them from low earth orbit for ground-based SEM (Scanning Electron Microscope) / EDS (Energy Dispersive X-Ray Spectroscopy) analysis. This may take months, potentially delaying the affected system. Having an EDS-equipped SEM (Mochii S) aboard the ISS will accelerate response time thereby enhancing crew and vehicle safety by rapid and accurate identification of microscopic threats, especially in time-critical situations.The Mochii S payload will be stationed in the Japanese Experiment Module (JEM) powered by 120 VAC (Volts Alternating Current) inverter and connected to station Ethernet and WiFi (Fig. 1). To date the Mochii S payload has undergone testing for command and data handling, power quality, flight vibration, and radiation testing at Johnson Space Center (JSC). Mochii's high-RPM (Revolutions Per Minute) rotating vacuum pumps and high voltage systems have been reviewed to meet safety standards by JSC (Johnson Space Center) Engineering. Topology of the system in the JEM module has been baselined by ISS Safety and JAXA (Japan Space Exploration Agency). Digital controls to and from ISS over Joint Station LAN (Local Area Network) uplink have been simulated and the latencies and data rates have been found to be sufficient for successful operation of the payload from ground.Transporting sensitive electron optical instruments aboard a rocket that sustains 7G acceleration for 8 minutes and then operating it the unique microgravity (micro-g) environment is no trivial matter. To meet strict safety requirements and increase robustness for mission success, over 500 unique verifications must be completed before the payload is certified for spaceflight. Two of which will be discussed in detail are: vibroacoustic testing and magnetic susceptibility shielding and validation

Supporting botanical literacy in the undergraduate science curriculum and beyond with a 71 bespoke campus app

BACKGROUND For almost 100 years it has been acknowledged that the participation in the study of plants at university level has been in decline (Nichols 1919, Hershey 1993, Uno 1994, Drea 2011). It is unlikely that there is a single cause to which this decline can be attributed, however new and emerging biology disciplines (genetics, genomics, proteomics, molecular biology) have impacted on the amount of Botany being taught and when given a choice of using plants or animals to illustrate a concept animal examples dominate (Hershey 1996). This botanical underrepresentation is considered cyclic in that less interest in botany generated at the undergraduate level will lead to fewer educators with sufficient botanical knowledge, in turn leading to again lower levels of botanical representation (Hershey 1993, Uno 1994). At the University of Sydney, we are offering a revised botany curriculum where the number of units of study dedicated to the study of plants has been reduced by half. In the Botany curriculum we now offer, it is crucial to offer maximum engagement with all aspects of Botany and this includes improved engagement with the plants on campus. DESCRIPTION OF INTERVENTION We have developed an app that presents an annotated map of the campus vegetation that can be aligned to the undergraduate biology curriculum. Each plant included in the map is described and phylogenetic information is provided. We have created an illustrated botanical glossary to further support learning ‘in situ’, that is learning not only ‘just in time’ but ‘just in place’. Critically, this intervention included undergraduate student participation and the ‘proof of concept’ – the web-based version of the intervention- was a project undertaken by Lachlan Pettit as his project for Advanced Botany (BIOL2923). We are cognizant that developments such as these that exploit mobile technologies have enormous potential to present the importance of plants in a number of frames beyond the purely scientific. With this in mind, we are ensuring that the app design is aligned with a scientific phylogeny and that the design can be extended to include indigenous phylogenies and links to national initiatives such as Climate Watch. Mobile technologies are improving, especially mapping resolutions. TECHNICAL SPECIFICATIONS OF THE APP iOS app: Development Environment: Xcode 6 & Swift Target devices: iPhone 4 and above Main features: Plant mapping, navigation, plant information, slideshows Frameworks: Foundation, CoreGraphics, UIKit, Mapkit Web app: Architecture: HTML5 + CSS3 Target devices: Mac, PC, Mobile devices Main features: Plant mapping, plant information, slideshows, integrated quiz, glossary of terms CONCLUSIONS Through a blend of good design and innovative mobile technologies we hope to increase botanical awareness and reconnect people with the plants around them. We have high expectations that by using the app to investigate the diverse campus flora we can engage students more effectively. As this project is taken forward it will align with the University of Sydney’s Aboriginal and Torres Strait Islander integrated strategy: Wingara Murra – Bunga Barrabugu. ACKNOWLEDGEMENTS We thank the School of Biological Sciences for the Summer Scholarship awarded to Lachlan Pettit in 2013. We thank the staff of the Grounds Unit, Facilities Management and Services, University of Sydney for access to ArborPlan

Inflammation-driven bone formation in a mouse model of ankylosing spondylitis: sequential not parallel processes

Background\ud \ud Ankylosing spondylitis (AS) is an immune-mediated arthritis particularly targeting the spine and pelvis and is characterised by inflammation, osteoproliferation and frequently ankylosis. Current treatments that predominately target inflammatory pathways have disappointing efficacy in slowing disease progression. Thus, a better understanding of the causal association and pathological progression from inflammation to bone formation, particularly whether inflammation directly initiates osteoproliferation, is required.\ud \ud Methods\ud \ud The proteoglycan-induced spondylitis (PGISp) mouse model of AS was used to histopathologically map the progressive axial disease events, assess molecular changes during disease progression and define disease progression using unbiased clustering of semi-quantitative histology. PGISp mice were followed over a 24-week time course. Spinal disease was assessed using a novel semi-quantitative histological scoring system that independently evaluated the breadth of pathological features associated with PGISp axial disease, including inflammation, joint destruction and excessive tissue formation (osteoproliferation). Matrix components were identified using immunohistochemistry.\ud \ud Results\ud \ud Disease initiated with inflammation at the periphery of the intervertebral disc (IVD) adjacent to the longitudinal ligament, reminiscent of enthesitis, and was associated with upregulated tumor necrosis factor and metalloproteinases. After a lag phase, established inflammation was temporospatially associated with destruction of IVDs, cartilage and bone. At later time points, advanced disease was characterised by substantially reduced inflammation, excessive tissue formation and ectopic chondrocyte expansion. These distinct features differentiated affected mice into early, intermediate and advanced disease stages. Excessive tissue formation was observed in vertebral joints only if the IVD was destroyed as a consequence of the early inflammation. Ectopic excessive tissue was predominantly chondroidal with chondrocyte-like cells embedded within collagen type II- and X-rich matrix. This corresponded with upregulation of mRNA for cartilage markers Col2a1, sox9 and Comp. Osteophytes, though infrequent, were more prevalent in later disease.\ud \ud Conclusions\ud \ud The inflammation-driven IVD destruction was shown to be a prerequisite for axial disease progression to osteoproliferation in the PGISp mouse. Osteoproliferation led to vertebral body deformity and fusion but was never seen concurrent with persistent inflammation, suggesting a sequential process. The findings support that early intervention with anti-inflammatory therapies will be needed to limit destructive processes and consequently prevent progression of AS

Over one third of patients with symptomatic femoroacetabular impingement display femoral or acetabular version abnormalities.

PURPOSE: The aim of this study was investigate the relationship between version and torsional abnormalities of the acetabulum, femur and tibia in patients with symptomatic FAI. METHODS: A systematic review was performed according to PRISMA guidelines using the EMBASE, MEDLINE, PubMed and Cochrane databases. Original research articles evaluating the described version and torsional parameters in FAI were included. The MINORS criteria were used to appraise study quality and risk of bias. Mean version and torsion values were displayed using forest plots and the estimated proportion of hips displaying abnormalities in version/torsion were calculated. RESULTS: A total of 1206 articles were identified from the initial search, with 43 articles, involving 8861 hips, meeting the inclusion criteria. All studies evaluating femoral or acetabular version in FAI reported 'normal' mean version values (10-25 °). However, distribution analysis revealed that an estimated 31% and 51% of patients with FAI displayed abnormal central acetabular and femoral version, respectively. CONCLUSION: Up to 51% of patients presenting with symptomatic FAI show an abnormal femoral version, whilst up to 31% demonstrate abnormal acetabular version. This high percentage of version abnormalities highlights the importance of evaluating these parameters routinely during assessment of patients with FAI, to guide clinical decision-making. LEVEL OF EVIDENCE: IV

Sources of variation in baseline gene expression levels from toxicogenomics study control animals across multiple laboratories

<p>Abstract</p> <p>Background</p> <p>The use of gene expression profiling in both clinical and laboratory settings would be enhanced by better characterization of variance due to individual, environmental, and technical factors. Meta-analysis of microarray data from untreated or vehicle-treated animals within the control arm of toxicogenomics studies could yield useful information on baseline fluctuations in gene expression, although control animal data has not been available on a scale and in a form best served for data-mining.</p> <p>Results</p> <p>A dataset of control animal microarray expression data was assembled by a working group of the Health and Environmental Sciences Institute's Technical Committee on the Application of Genomics in Mechanism Based Risk Assessment in order to provide a public resource for assessments of variability in baseline gene expression. Data from over 500 Affymetrix microarrays from control rat liver and kidney were collected from 16 different institutions. Thirty-five biological and technical factors were obtained for each animal, describing a wide range of study characteristics, and a subset were evaluated in detail for their contribution to total variability using multivariate statistical and graphical techniques.</p> <p>Conclusion</p> <p>The study factors that emerged as key sources of variability included gender, organ section, strain, and fasting state. These and other study factors were identified as key descriptors that should be included in the minimal information about a toxicogenomics study needed for interpretation of results by an independent source. Genes that are the most and least variable, gender-selective, or altered by fasting were also identified and functionally categorized. Better characterization of gene expression variability in control animals will aid in the design of toxicogenomics studies and in the interpretation of their results.</p